{ "ACETYLCYSTEINE - ANALGESICS (NON-OPIOID)": { "side-effects": "Side-effects\u00a0hypersensitivity-like reactions managed by reducing\r\ninfusion rate or suspending until reaction settled (rash also managed\r\nby giving antihistamine; acute asthma managed by giving nebulised\r\nshort-acting beta2agonist)\u2014contact the National Poisons\r\nInformation Service if reaction severe; slight increase in INR and\r\nprothrombin time", "indications": "Indications\u00a0paracetamol overdosage, \n(From Analgesics (non-opioid): British National Formulary)\nParacetamolIn cases of intravenous paracetamol poisoning contact the National Poisons Information Service for advice on risk assessment and management.\u00a0Single or repeated doses totalling as little as 10\u201315\u00a0g (20\u201330 tablets) or 150\u00a0mg/kg of paracetamol ingested within 24\u00a0hours may cause severe hepatocellular necrosis and, much less frequently, renal tubular necrosis. To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110\u00a0kg, use a body-weight of 110\u00a0kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg). Patients at high-risk of liver damage, including those taking enzyme-inducing drugs or who are malnourished (see below), may develop liver toxicity with as little as 75\u00a0mg/kg of paracetamol (equivalent to approx. 5\u00a0g (10 tablets) in a 70-kg patient) taken within 24 hours. Nausea and vomiting, the only early features of poisoning, usually settle within 24 hours. Persistence beyond this time, often associated with the onset of right subcostal pain and tenderness, usually indicates development of hepatic necrosis. Liver damage is maximal 3\u20134 days after ingestion and may lead to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Therefore, despite a lack of significant early symptoms, patients who have taken an overdose of paracetamol should be transferred to hospital urgently.Administration of activated charcoal should be considered if paracetamol in excess of 150\u00a0mg/kg or 12\u00a0g, whichever is the smaller (or in excess of 75\u00a0mg/kg for those considered to be at high risk, see below), is thought to have been ingested within the previous hour.Acetylcysteine protects the liver if infused up to, and possibly beyond, 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of ingestion, after which effectiveness declines. In patients who present 8\u201336 hours after a potentially toxic ingestion, acetylcysteine treatment should commence immediately even if plasma-paracetamol concentrations are not yet available; if more than 24 hours have elapsed since ingestion advice should be sought from the National Poisons Information Service. Giving acetylcysteine by mouth [unlicensed route] is an alternative if intravenous access is not possible\u2014contact the National Poisons Information Service for advice. In remote areas, methionine by mouth is an alternative only if acetylcysteine cannot be given promptly. Once the patient reaches hospital the need to continue treatment with the antidote will be assessed from the plasma-paracetamol concentration (related to the time from ingestion).Patients at risk of liver damage and therefore requiring treatment can be identified from a single measurement of the plasma-paracetamol concentration, related to the time from ingestion, provided this time interval is not less than 4 hours; earlier samples may be misleading. The concentration is plotted on a paracetamol treatment graph, with a reference line (\u2018normal treatment line\u2019) joining plots of 200\u00a0mg/litre (1.32\u00a0mmol/litre) at 4 hours and 6.25\u00a0mg/litre (0.04\u00a0mmol/litre) at 24 hours (see Paracetamol poisoning treatment graph). Those whose plasma-paracetamol concentration is on or above the normal treatment line are treated with acetylcysteine by intravenous infusion (or, if acetylcysteine is not available, with methionine by mouth, provided the overdose has been taken within 10\u201312 hours and the patient is not vomiting). Patients at high-risk of liver damage include those: taking liver enzyme-inducing drugs (e.g. carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, rifabutin, efavirenz, nevirapine, alcohol and St John\u2019s wort);who are malnourished (e.g. in anorexia or bulimia, cystic fibrosis, hepatitis C, in alcoholism, or those who are HIV-positive);who have not eaten for a few days.These patients can develop toxicity at lower plasma-paracetamol concentration and should be treated if the concentration is on or above the high-risk treatment line (which joins plots that are at 50% of the plasma-paracetamol concentrations of the normal treatment line). The prognostic accuracy of plasma-paracetamol concentration taken after 15 hours is uncertain, but a concentration on or above the relevant treatment line should be regarded as carrying a serious risk of liver damage.The plasma-paracetamol concentration may be difficult to interpret when paracetamol has been ingested over several hours. If there is doubt about timing or the need for treatment then the patient should be treated with an antidote.", "name": "ACETYLCYSTEINE - ANALGESICS (NON-OPIOID)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29528.htm", "doses": [ "By intravenous infusion, adult and child, initially\r\n150\u00a0mg/kg (max. 16.5\u00a0g) over 15 minutes, then 50\u00a0mg/kg (max. 5.5\u00a0g)\r\nover 4 hours then 100\u00a0mg/kg (max. 11\u00a0g) over 16 hours", "Dilute requisite dose in glucose\r\n5% as follows: adult and child over 12 years, initially 200\u00a0mL given over\r\n15 minutes, then 500\u00a0mL over 4 hours, then 1\u00a0litre over 16 hours; child under 12 years, body-weight over 20\u00a0kg, initially\r\n100\u00a0mL given over 15 minutes, then 250\u00a0mL over 4 hours, then 500\u00a0mL\r\nover 16 hours; child body-weight under\r\n20\u00a0kg, initially 3\u00a0mL/kg given over 15 minutes, then 7\u00a0mL/kg over\r\n4 hours, then 14\u00a0mL/kg over 16 hours", "Glucose 5% is preferred infusion fluid; sodium\r\nchloride 0.9% is an alternative if glucose 5% unsuitable" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Analgesics (non-opioid)", "ACETYLCYSTEINE" ], "cautions": "Cautions\u00a0asthma (see Side-effects\r\nbelow but do not delay acetylcysteine treatment); acetylcysteine\r\nmay slightly increase INR and prothrombin time" }, "ANIDULAFUNGIN": { "indications": "Indications\u00a0invasive candidiasis (see notes above)", "name": "ANIDULAFUNGIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.4 Echinocandin antifungals" ], "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, flushing, convulsion,\r\nheadache, coagulopathy, hypokalaemia, raised serum creatinine, rash,\r\npruritus; less commonly abdominal pain, cholestasis,\r\nhypertension, hyperglycaemia, urticaria, injection-site pain; also\r\nreported, hypotension, dyspnoea, bronchospasm, hepatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200270.htm", "doses": [ "By intravenous infusion, adult over 18 years, 200\u00a0mg on first day then 100\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "ACETYLCYSTEINE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "ACETYLCYSTEINE" ], "indications": "Indications\u00a0tear deficiency, impaired or abnormal mucus production", "name": "ACETYLCYSTEINE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5540.htm", "doses": [ "Apply 3\u20134 times daily" ] }, "GUANETHIDINE MONOSULPHATE ": { "indications": "Indications\u00a0hypertensive crisis (but no longer recommended\u2014see section 2.5)", "name": "GUANETHIDINE MONOSULPHATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.3 Adrenergic neurone blocking drugs", "GUANETHIDINE MONOSULPHATE" ], "cautions": "Cautions\u00a0 coronary or cerebral arteriosclerosis, asthma, history of peptic ulceration; interactions: Appendix 1 (adrenergic neurone blockers)", "side-effects": "Side-effects\u00a0postural hypotension, failure of ejaculation,\r\nfluid retention, nasal congestion, headache, diarrhoea, drowsiness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2558.htm", "doses": [ "By intramuscular injection, 10\u201320\u00a0mg, repeated\r\nafter 3 hours if required" ], "pregnancy": "Pregnancy\u00a0postural hypotension and reduced uteroplacental perfusion;\r\nshould not be used to treat hypertension in pregnancy" }, "FLUDROCORTISONE ACETATE": { "indications": "Indications\u00a0mineralocorticoid replacement in adrenocortical insufficiency", "name": "FLUDROCORTISONE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.1 Replacement therapy", "FLUDROCORTISONE ACETATE" ], "cautions": "Cautions\u00a0section 6.3.2; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0section 6.3.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4253.htm", "doses": [ "50\u2013300\u00a0micrograms daily; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "BETAMETHASONE - GLUCOCORTICOID THERAPY": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; congenital adrenal hyperplasia; see also notes above; ear\r\n(section\r\n12.1.1); eye (section 11.4.1); nose (section 12.2.1); oral ulceration (section 12.3.1)", "name": "BETAMETHASONE - GLUCOCORTICOID THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "BETAMETHASONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4267.htm", "doses": [ "By mouth, usual range 0.5\u20135\u00a0mg daily; see\r\nalso Administration (above)", "By intramuscular injection or slow intravenous injection or infusion, 4\u201320\u00a0mg, repeated up to 4 times in 24 hours; child, by slow intravenous injection, up to 1 year 1\u00a0mg, 1\u20135 years 2\u00a0mg, 6\u201312 years 4\u00a0mg, repeated up\r\nto 4 times in 24 hours according to response" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding; transient\r\neffect on fetal movements and heart rate" }, "EFLORNITHINE": { "indications": "Indications\u00a0\n(From Hirsutism: British National Formulary)\nHirsutism", "name": "EFLORNITHINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.9 Shampoos and other preparations for scalp and hair conditions", "Hirsutism", "EFLORNITHINE" ], "side-effects": "Side-effects\u00a0acne, application site reactions including burning\r\nand stinging sensation, rash; less commonly abnormal\r\nhair texture and growth", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129050.htm", "doses": [ "Apply thinly twice daily; child under 12 years not recommended", "Preparation must be rubbed in thoroughly;\r\ncosmetics may be applied over treated area 5 minutes after eflornithine;\r\ndo not wash treated area for 4 hours after application" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises avoid" }, "ACEMETACIN": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other musculoskeletal\r\ndisorders; postoperative analgesia", "name": "ACEMETACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0see under Indometacin and notes aboveDriving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see under Indometacin and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5202.htm", "doses": [ "120\u00a0mg daily in divided doses with food, increased if\r\nnecessary to 180\u00a0mg daily; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "CLOTRIMAZOLE": { "indications": "Indications\u00a0fungal skin infections; vaginal candidiasis (section 7.2.2); otitis\r\nexterna (section 12.1.1)", "name": "CLOTRIMAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6155.htm", "doses": [ "Apply 2\u20133 times daily" ], "pregnancy": "Pregnancy\u00a0minimal absorption from skin; not known to be harmful" }, "OXPRENOLOL HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0see under Dose", "name": "OXPRENOLOL HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "OXPRENOLOL HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2511.htm", "doses": [ "Hypertension, 80\u2013160\u00a0mg daily in 2\u20133 divided doses, increased\r\nas required; max. 320\u00a0mg daily", "Angina, 80\u2013160\u00a0mg daily in 2\u20133 divided doses; max. 320\u00a0mg daily", "Arrhythmias, 40\u2013240\u00a0mg daily in 2\u20133 divided doses; max. 240\u00a0mg\r\ndaily", "Anxiety symptoms (short-term use), 40\u201380\u00a0mg daily in 1\u20132 divided\r\ndoses", "Name[Slow-Trasicor\u00ae (Amdipharm) ] Tablets, m/r, f/c, oxprenolol\r\nhydrochloride 160\u00a0mg, net price 28-tab pack = \u00a37.50. \r\n Label:\r\n 8, 25Dose\u00a0hypertension, angina, initially 160\u00a0mg once daily; if\r\nnecessary may be increased to max. 320\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "PARACETAMOL With antiemetics": { "indications": "Indications\u00a0mild to moderate pain, pyrexia", "name": "PARACETAMOL With antiemetics", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "PARACETAMOL", "With antiemetics" ], "cautions": "Cautions\u00a0alcohol dependence; max. daily infusion dose 3\u00a0g in patients with hepatocellular\r\ninsufficiency, chronic alcoholism, chronic malnutrition,\r\nor dehydration; before administering, check when paracetamol last administered and\r\ncumulative paracetamol dose over previous 24 hours; interactions: Appendix 1 (paracetamol)", "side-effects": "Side-effects\u00a0side-effects rare, but rashes, blood disorders\r\n(including thrombocytopenia, leucopenia, neutropenia) reported; hypotension,\r\nflushing, and tachycardia also reported on infusion; important: liver damage (and less frequently renal damage) following overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3555.htm", "doses": [ "By mouth, 0.5\u20131\u00a0g every 4\u20136 hours to a\r\nmax. of 4\u00a0g daily; child 2 months\r\n60\u00a0mg for post-immunisation pyrexia, repeated once after 4\u20136 hours\r\nif necessary; otherwise under 3 months see BNF for Children; 3\u20136 months\r\n60\u00a0mg, 6 months\u20132 years 120\u00a0mg, 2\u20134 years 180\u00a0mg, 4\u20136 years 240\u00a0mg,\r\n6\u20138 years 240\u2013250\u00a0mg, 8\u201310 years 360\u2013375\u00a0mg, 10\u201312 years 480\u2013500\u00a0mg,\r\n12\u201316 years 480\u2013750\u00a0mg; these doses may be repeated every 4\u20136 hours\r\nwhen necessary (max. of 4 doses in 24 hours)", "By intravenous infusion over 15 minutes, adult and child over\r\n50\u00a0kg, 1\u00a0g every 4\u20136 hours, max. 4\u00a0g daily; adult and child 10\u201350\u00a0kg, 15\u00a0mg/kg every\r\n4\u20136 hours, max. 60\u00a0mg/kg daily; neonate and child less than 10\u00a0kg see BNF for Children", "By rectum, adult and child over 12 years 0.5\u20131\u00a0g every\r\n4\u20136 hours to a max. of 4\u00a0g daily; child under 3 months see BNF for Children, 3 months\u20131 year 60\u2013125\u00a0mg, 1\u20135 years 125\u2013250\u00a0mg, 5\u201312 years\r\n250\u2013500\u00a0mg; these doses may be repeated every 4\u20136 hours as necessary\r\n(max. 4 doses in 24 hours)", "For full Joint Committee on Vaccination and\r\nImmunisation recommendation on post-immunisation pyrexia, see section 14.1", "Name[Paramax\u00ae (Sanofi-Aventis) ] Tablets, scored, paracetamol 500\u00a0mg, metoclopramide hydrochloride 5\u00a0mg, net\r\nprice 42-tab pack = \u00a39.64. \r\n Label:\r\n 17, 30\nSachets, effervescent powder, sugar-free,\r\nthe contents of 1 sachet = 1 tablet; to be dissolved in \u00bc tumblerful\r\nof liquid before administration, net price 42-sachet pack = \u00a312.52. \r\n Label:\r\n 13, 17, 30Dose\u00a0acute migraine, (tablets or sachets): 2 at onset of attack\r\nthen every 4 hours when necessary to max. of 6 in 24 hours; adult 12\u201319 years, 1 at onset of attack then 1 every\r\n4 hours when necessary to max. of 3 in 24 hours (max. dose of metoclopramide\r\n500\u00a0micrograms/kg daily)Important\u00a0Metoclopramide can cause severe extrapyramidal effects, particularly in children\r\nand young adults (for further details, see Metoclopramide)Note\u00a0Treatment should not exceed 3 months due\r\nto risk of tardive dyskinesia" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "BETAMETHASONE With neomycin": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "BETAMETHASONE With neomycin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "BETAMETHASONE", "With neomycin" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5420.htm", "doses": [ "Apply eye drops every 1\u20132 hours until controlled then\r\nreduce frequency; apply eye ointment 2\u20134 times daily or at night when used with eye drops", "Name[Betnesol-N\u00ae (UCB Pharma) ] Drops (for ear, eye, or nose), see section\r\n12.1.1Dose\u00a0apply up to 6 times daily" ] }, "VALPROIC ACID": { "indications": "Indications\u00a0treatment of manic\r\nepisodes associated with bipolar disorder; migraine prophylaxis (section 4.7.4.2)", "name": "VALPROIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.3 Antimanic drugs", "Valproate", "VALPROIC ACID" ], "cautions": "Cautions\u00a0see Sodium Valproate, section 4.8.1; monitor closely if dose greater\r\nthan 45\u00a0mg/kg daily", "side-effects": "Side-effects\u00a0see Sodium Valproate, section 4.8.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106064.htm", "doses": [ "Mania, initially 750\u00a0mg daily in 2\u20133 divided doses, increased\r\naccording to response, usual dose 1\u20132\u00a0g daily; doses greater than\r\n45\u00a0mg/kg daily require careful monitoring; child under 18 years not recommended", "Migraine prophylaxis [unlicensed], initially 250\u00a0mg twice daily,\r\nincreased if necessary to 1\u00a0g daily in divided doses" ], "pregnancy": "Pregnancy\u00a0see Sodium Valproate, section 4.8.1" }, "ZONISAMIDE": { "indications": "Indications\u00a0\n(From Zonisamide: British National Formulary)\nZonisamide", "name": "ZONISAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Zonisamide", "ZONISAMIDE" ], "cautions": "Cautions\u00a0elderly; ensure\r\nadequate hydration (especially if predisposition to\r\nnephrolithiasis or in strenuous activity or warm environment); concomitant use of drugs that increase risk of hyperthermia or nephrolithiasis; metabolic acidosis (consider dose reduction\r\nor discontinuation); avoid abrupt withdrawal; interactions: see Interactions in section 4.8.1 and Appendix 1 (zonisamide)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, abdominal pain, constipation,\r\ndyspepsia, anorexia, weight loss; drowsiness, dizziness, confusion,\r\nagitation, irritability, depression, psychosis, ataxia, speech disorder,\r\nimpaired memory and attention, fatigue, nystagmus, paraesthesia, tremor,\r\npyrexia, insomnia; diplopia; ecchymosis; rash (consider withdrawal); less commonly vomiting, cholelithiasis, cholecystitis, aggression,\r\nsuicidal ideation, seizures, pneumonia, urinary tract infection, urinary\r\ncalculus, and hypokalaemia; very rarely hepatitis,\r\npancreatitis, aspiration, dyspnoea, hallucinations, amnesia, coma,\r\nmyasthenic syndrome, neuroleptic malignant syndrome, heat stroke,\r\nhydronephrosis, renal failure, metabolic acidosis, renal tubular acidosis,\r\nblood disorders, rhabdomyolysis, impaired sweating, pruritus, Stevens-Johnson\r\nsyndrome, and toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129259.htm", "doses": [ "adult over 18 years, initially\r\n50\u00a0mg daily in 2 divided doses, increased after 7 days to 100\u00a0mg daily\r\nin 2 divided doses; then increase if necessary by 100\u00a0mg every 7 days;\r\nusual maintenance 300\u2013500\u00a0mg daily in 1\u20132 divided doses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "AZATHIOPRINE - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0severe refractory eczema [unlicensed\r\nindication]; inflammatory bowel disease (section 1.5.3); autoimmune conditions and prophylaxis\r\nof transplant rejection (section 8.2.1); rheumatoid arthritis (section 10.1.3)", "name": "AZATHIOPRINE - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "AZATHIOPRINE" ], "cautions": "Cautions\u00a0section 8.2.1", "side-effects": "Side-effects\u00a0section 8.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204281.htm", "doses": [ "Severe refractory eczema [unlicensed indication], by mouth, normal or high TPMT activity, 1\u20133\u00a0mg/kg daily;\r\nintermediate TPMT activity, 0.5\u20131.5\u00a0mg/kg daily" ], "pregnancy": "Pregnancy\u00a0section 8.2.1" }, "GLUCOSAMINE ": { "indications": "Indications\u00a0symptomatic relief of mild to moderate osteoarthritis of the knee", "name": "GLUCOSAMINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.5 Other drugs for rheumatic diseases", "Glucosamine", "GLUCOSAMINE" ], "cautions": "Cautions\u00a0impaired glucose tolerance (monitor blood-glucose\r\nconcentration before treatment and periodically thereafter); predisposition to cardiovascular disease (monitor\r\ncholesterol); asthma; interactions: Appendix 1 (glucosamine)", "side-effects": "Side-effects\u00a0nausea, abdominal pain, dyspepsia, flatulence,\r\ndiarrhoea, constipation, drowsiness, headache, fatigue; less\r\ncommonly flushing, rash, pruritus; also reported visual disturbances, hair loss", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200003.htm", "doses": [ "See under preparations", "adult over 18 years, 2\r\ntablets once daily; review treatment if no benefit after 2\u20133 months" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014no information available" }, "RISPERIDONE - SECOND-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0acute and chronic psychoses, mania; short-term treatment (up to 6\r\nweeks) of persistent aggression in patients with moderate to severe\r\nAlzheimer\u2019s dementia unresponsive to non-pharmacological interventions\r\nand when there is a risk of harm to self or others; short-term treatment\r\n(up to 6 weeks) of persistent aggression in conduct disorder (under\r\nspecialist supervision)", "name": "RISPERIDONE - SECOND-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "RISPERIDONE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; dementia with\r\nLewy bodies; dehydration;\r\navoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\ngastro-intestinal disturbances (including diarrhoea, constipation,\r\nnausea and vomiting, dyspepsia, abdominal pain), dry mouth; dyspnoea;\r\ndrowsiness, asthenia, tremor, sleep disturbances, agitation, anxiety,\r\nheadache; urinary incontinence; arthralgia, myalgia; abnormal vision;\r\nepistaxis; rash; less commonly anorexia, ECG changes,\r\nhypoaesthesia, impaired concentration, hyperprolactinaemia (with galactorrhoea,\r\nmenstrual disturbances, gynaecomastia), sexual dysfunction, blood\r\ndisorders, tinnitus, angioedema; rarely intestinal\r\nobstruction, pancreatitis, jaundice, seizures, hyponatraemia, abnormal\r\ntemperature regulation; oedema and priapism also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202660.htm", "doses": [ "Psychosis, 2\u00a0mg in 1\u20132 divided doses on first day then 4\u00a0mg in 1\u20132 divided doses on second day (slower titration\r\nappropriate in some patients); usual dose range 4\u20136\u00a0mg daily; doses\r\nabove 10\u00a0mg daily only if benefit considered to outweigh risk (max.\r\n16\u00a0mg daily); elderly initially 500\u00a0micrograms\r\ntwice daily increased in steps of 500\u00a0micrograms twice daily to 1\u20132\u00a0mg\r\ntwice daily; child 12\u201318 years see BNF for Children", "Mania, initially 2\u00a0mg once daily, increased if necessary in\r\nsteps of 1\u00a0mg daily; usual dose range 1\u20136\u00a0mg daily; elderly initially 500\u00a0micrograms twice daily increased\r\nin steps of 500\u00a0micrograms twice daily to 1\u20132\u00a0mg twice daily; child 12\u201318 years see BNF for Children", "Persistent aggression in Alzheimer\u2019s dementia, initially 250\u00a0micrograms\r\ntwice daily, increased according to response in steps of 250\u00a0micrograms\r\ntwice daily on alternate days; usual dose 500\u00a0micrograms twice daily\r\n(up to 1\u00a0mg twice daily has been required)", "Persistent aggression in conduct disorder, child over 5 years, body-weight under 50\u00a0kg, initially 250\u00a0micrograms\r\nonce daily, increased according to response in steps of 250\u00a0micrograms\r\non alternate days; usual dose 500\u00a0micrograms daily (up to 750\u00a0micrograms\r\nonce daily has been required); child over 5 years, body-weight over 50\u00a0kg, initially 500\u00a0micrograms once\r\ndaily, increased according to response in steps of 500\u00a0micrograms\r\non alternate days; usual dose 1\u00a0mg daily (up to 1.5\u00a0mg once daily\r\nhas been required)" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes;\r\nalso use only if potential benefit outweighs risk" }, "IRON SUCROSE": { "indications": "Indications\u00a0iron-deficiency anaemia, \n(From 9.1.1.2 Parenteral iron: British National Formulary)\n9.1.1.2 Parenteral iron", "name": "IRON SUCROSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.2 Parenteral iron", "IRON SUCROSE" ], "cautions": "Cautions\u00a0oral iron should not be given until 5\r\ndays after last injection; infection (discontinue\r\nif ongoing bacteraemia)Anaphylaxis\u00a0Anaphylactic reactions\r\ncan occur with parenteral iron and a test dose is recommended before\r\nthe first dose; the patient should be carefully observed for 15 minutes. Facilities for cardiopulmonary resuscitation must\r\nbe available", "side-effects": "Side-effects\u00a0taste disturbances; less commonly nausea, vomiting, abdominal pain, diarrhoea, hypotension, tachycardia,\r\nflushing, palpitation, chest pain, bronchospasm, dyspnoea, headache,\r\ndizziness, fever, myalgia, pruritus, rash, and injection-site reactions; rarely peripheral oedema, hypertension, anaphylactic reactions\r\n(see Anaphylaxis above), fatigue, asthenia, and paraesthesia; bradycardia,\r\nconfusion, arthralgia, and increased sweating also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129558.htm", "doses": [ "By slow intravenous injection or by intravenous infusion, calculated according to\r\nbody-weight and iron deficit, consult product literature; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid in first trimester" }, "BIMATOPROST": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle glaucoma; ocular hypertension", "name": "BIMATOPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.; also\r\nnausea, asthenia, hypertension", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112790.htm", "doses": [ "Apply once daily, preferably in the evening; child under 18 years, not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "INSULIN GLARGINE": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN GLARGINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106539.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n6 years, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "RISEDRONATE SODIUM With calcium carbonate and colecalciferol": { "indications": "Indications\u00a0see under Dose", "name": "RISEDRONATE SODIUM With calcium carbonate and colecalciferol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "RISEDRONATE SODIUM", "With calcium carbonate and colecalciferol" ], "cautions": "Cautions\u00a0oesophageal abnormalities and other factors\r\nwhich delay transit or emptying (e.g. stricture or achalasia\u2014see also under Side-effects); correct hypocalcaemia before starting, correct other disturbances of bone and mineral metabolism (e.g.\r\nvitamin-D deficiency) at onset of treatment; consider dental check-up before initiating bisphosphonate (risk of osteonecrosis of the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0abdominal pain, dyspepsia, nausea, diarrhoea,\r\nconstipation, headache, musculoskeletal pain; less commonly oesophagitis, oesophageal ulcer, dysphagia, gastritis, duodenitis,\r\nuveitis; rarely glossitis, oesophageal stricture,\r\natypical femoral fractures (see MHRA/CHM advice); also reported gastroduodenal ulceration, hepatic disorders,\r\nStevens-Johnson syndrome, toxic epidermal necrolysis, hair loss, cutaneous\r\nvasculitis, osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)Oesophageal reactions\u00a0Patients should\r\nbe advised to stop taking the tablets and seek medical attention if\r\nthey develop symptoms of oesophageal irritation such as dysphagia,\r\npain on swallowing, retrosternal pain, or heartburn", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200960.htm", "doses": [ "Paget\u2019s disease of bone, 30\u00a0mg daily for 2 months; may\r\nbe repeated if necessary after at least 2 months", "Treatment of postmenopausal osteoporosis to reduce risk of vertebral\r\nor hip fractures, 5\u00a0mg daily or 35\u00a0mg once weekly", "Prevention of osteoporosis (including corticosteroid-induced\r\nosteoporosis) in postmenopausal women, 5\u00a0mg daily", "Treatment of osteoporosis in men at high risk of fractures,\r\n35\u00a0mg once weekly", "child see BNF for Children", "Swallow tablets whole with full glass\r\nof water; on rising, take on an empty stomach at least 30 minutes\r\nbefore first food or drink of the day or, if taking\r\nat any other time of the day, avoid food and drink for at least 2\r\nhours before or after risedronate (particularly avoid calcium-containing\r\nproducts e.g. milk; also avoid iron and mineral supplements and antacids);\r\nstand or sit upright for at least 30 minutes; do not take tablets\r\nat bedtime or before rising", "Name[Actonel\u00ae Combi (Warner Chilcott) ] Tablets, f/c, orange, risedronate\r\nsodium 35\u00a0mg (Actonel Once a Week\u00ae);\nGranules, effervescent, lemon flavour,\r\ncalcium carbonate 2.5\u00a0g (calcium 1\u00a0g or Ca2+ 25\u00a0mmol) and\r\ncolecalciferol 22\u00a0micrograms (880\u00a0units)/sachet, net price 24-sachet\r\nplus 4-tab pack = \u00a319.12. Counselling, administration, food and calcium\r\n(see above)Dose\u00a0treatment of postmenopausal osteoporosis to reduce risk\r\nof vertebral or hip fractures, given in weekly cycles, 1 Actonel Once a Week\u00ae tablet on the first day followed by\r\n1 calcium and colecalciferol sachet daily for 6 daysCounselling\u00a0 Tablets should be swallowed whole\r\nwith plenty of water while sitting or standing; to be taken on an\r\nempty stomach at least 30 minutes before breakfast (or another oral\r\nmedicine); patient should stand or sit upright for at least 30 minutes\r\nafter taking tablet. Granules should be stirred into a glass of water\r\nand after dissolution complete taken immediately" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DENOSUMAB": { "indications": "Indications\u00a0see under preparations", "name": "DENOSUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Denosumab" ], "cautions": "Cautions\u00a0correct hypocalcaemia and vitamin D deficiency before\r\nstarting (monitor plasma-calcium concentration during therapy); consider dental check-up and carry out invasive procedures\r\nbefore initiating treatment (risk of osteoneocrosis of the jaw)", "side-effects": "Side-effects\u00a0diarrhoea, constipation, dyspnoea, urinary tract\r\ninfection, upper respiratory tract infection, pain in extremity, sciatica,\r\nhypocalcaemia, hypophosphataemia, cataracts, rash, sweating; less commonly diverticulitis, cellulitis (seek prompt medical\r\nattention), ear infection; rarely osteonecrosis of\r\nthe jaw", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207296.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid" }, "CEFRADINE": { "indications": "Indications\u00a0see under Cefaclor; surgical prophylaxis", "name": "CEFRADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFRADINE" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76947.htm", "doses": [ "250\u2013500\u00a0mg every 6 hours or 0.5\u20131\u00a0g every\r\n12 hours; up to 1\u00a0g every 6 hours in severe infections; child 7\u201312 years, 25\u201350\u00a0mg/kg daily in 2\u20134 divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "DOCUSATE SODIUM": { "indications": "Indications\u00a0constipation, adjunct in abdominal radiological procedures", "name": "DOCUSATE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "DOCUSATE SODIUM" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; do not give with liquid paraffin; rectal preparations\r\nnot indicated if haemorrhoids or anal fissure", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; also rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2214.htm", "doses": [ "By mouth, chronic constipation, up\r\nto 500\u00a0mg daily in divided doses; child (but see section\r\n1.6) 6 months\u20132 years 12.5\u00a0mg 3 times daily, adjusted according\r\nto response (use paediatric solution); 2\u201312 years 12.5\u201325\u00a0mg 3 times\r\ndaily, adjusted according to response (use paediatric oral solution)", "Oral preparations act within 1\u20132 days", "With barium meal, adult and child over 12 years, 400\u00a0mg" ], "pregnancy": "Pregnancy\u00a0not known to be harmful\u2014manufacturer advises caution" }, "FLUOCINOLONE ACETONIDE": { "indications": "Indications\u00a0inflammatory skin disorders such as eczemas;\r\npsoriasis, \n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "FLUOCINOLONE ACETONIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUOCINOLONE ACETONIDE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5909.htm", "doses": [ "Apply thinly 1\u20132 times daily, reducing strength as condition\r\nresponds" ] }, "POLYMYXINS": { "indications": "Indications\u00a0bacterial skin infections", "name": "POLYMYXINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.1 Antibacterial preparations only used topically", "POLYMYXINS" ], "cautions": "Cautions\u00a0large areas, see belowLarge areas\u00a0If large areas of skin\r\nare being treated nephrotoxicity and neurotoxicity may be a hazard, particularly in children, in the elderly, and in those with renal\r\nimpairment", "side-effects": "Side-effects\u00a0sensitisation (see also notes above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6129.htm", "doses": [ "apply twice daily or more frequently if required" ] }, "DIFLUCORTOLONE VALERATE": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; high\r\nstrength (0.3%), short-term treatment of severe exacerbations; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "DIFLUCORTOLONE VALERATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5900.htm", "doses": [ "Apply thinly 1\u20132 times daily for up to 4 weeks (0.1% preparations)\r\nor 2 weeks (0.3% preparations), reducing strength as condition responds;\r\nmax. 60\u00a0g of 0.3% per week" ] }, "NARATRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine", "name": "NARATRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; sensitivity to sulfonamides; interactions: Appendix 1 (5HT1 agonists)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; also less commonly bradycardia,\r\ntachycardia, palpitation, and visual disturbance; rarely ischaemic colitis, rash, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61020.htm", "doses": [ "2.5\u00a0mg, repeated after at least 4 hours if migraine recurs\r\n(patient not responding should not take second dose for same attack);\r\nmax. 5\u00a0mg in 24 hours; child and adolescent under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "Topical NSAIDs Proprietary preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices", "Topical NSAIDs", "Proprietary preparations" ], "name": "Topical NSAIDs Proprietary preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5366.htm", "doses": [ "Name[(1)Oruvail\u00ae (Sanofi-Aventis) ] Gel, ketoprofen 2.5%, net price 100\u00a0g = \u00a36.84. Counselling, photosensitivity, see aboveExcipients include fragranceDose\u00a0apply 2\u20134 times daily for up to 7 days (usual recommended\r\ndose 15\u00a0g daily)" ] }, "MYCOPHENOLATE MOFETIL": { "indications": "Indications\u00a0prophylaxis of acute renal, cardiac, or hepatic\r\ntransplant rejection (in combination with ciclosporin and corticosteroids) under specialist supervision", "name": "MYCOPHENOLATE MOFETIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.1 Antiproliferative immunosuppressants", "MYCOPHENOLATE MOFETIL" ], "cautions": "Cautions\u00a0see Bioavailability; full blood counts every week for 4 weeks then twice a month for 2\r\nmonths then every month in the first year (consider interrupting treatment if neutropenia develops); exclude pregnancy before starting treatment; elderly (increased risk of infection,\r\ngastro-intestinal haemorrhage and pulmonary oedema); children (higher incidence of side-effects may call\r\nfor temporary reduction of dose or interruption); active\r\nserious gastro-intestinal disease (risk of haemorrhage,\r\nulceration and perforation); delayed graft function; increased susceptibility to skin cancer (avoid exposure to strong sunlight); interactions: Appendix 1 (mycophenolate)Bone marrow suppression\u00a0Patients\r\nshould be warned to report immediately any signs or symptoms of bone\r\nmarrow suppression e.g. infection or inexplicable bruising or bleeding", "side-effects": "Side-effects\u00a0taste disturbance, gingival hyperplasia, nausea,\r\nconstipation, flatulence, anorexia, weight loss, vomiting, abdominal\r\npain, gastro-intestinal inflammation, ulceration, and bleeding, hepatitis,\r\njaundice, pancreatitis, stomatitis, oedema, tachycardia, hypertension,\r\nhypotension, vasodilatation, cough, dyspnoea, insomnia, agitation,\r\nconfusion, depression, anxiety, convulsions, paraesthesia, myasthenic\r\nsyndrome, tremor, dizziness, headache, influenza-like syndrome, infections,\r\nhyperglycaemia, renal impairment, malignancy (particularly of the\r\nskin), blood disorders (including leucopenia, anaemia, thrombocytopenia,\r\npancytopenia, and red cell aplasia\u2014\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nMycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine. It is licensed for the prophylaxis of acute rejection in renal, hepatic or cardiac transplantation when used in combination with ciclosporin and corticosteroids. There is evidence that compared with similar regimens incorporating azathioprine, mycophenolate mofetil reduces the risk of acute rejection episodes; the risk of opportunistic infections (particularly due to tissue-invasive cytomegalovirus) and the occurrence of blood disorders such as leucopenia may be higher.Cases of pure red cell aplasia have been reported with azathioprine and with mycophenolate mofetil; dose reduction or discontinuation should be considered under specialist supervision.), disturbances of electrolytes\r\nand blood lipids, arthralgia, alopecia, acne, skin hypertrophy, and\r\nrash; also reported intestinal villous atrophy, progressive\r\nmultifocal leucoencephalopathy, interstitial lung disease, pulmonary\r\nfibrosis ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38697.htm", "doses": [ "Renal transplantation, by mouth, 1\u00a0g twice\r\ndaily starting within 72 hours of transplantation or by intravenous infusion, 1\u00a0g twice daily starting\r\nwithin 24 hours of transplantation for max. 14 days (then transfer\r\nto oral therapy); child and adolescent 2\u201318 years, by mouth 600\u00a0mg/m2 twice daily (max. 2\u00a0g daily)", "Tablets and capsules not appropriate for\r\ndose titration in children with body surface area less than 1.25\u00a0m2", "Cardiac transplantation, by mouth, adult over 18 years, 1.5\u00a0g twice daily starting within\r\n5 days of transplantation", "Hepatic transplantation, by intravenous infusion, adult over 18 years, 1\u00a0g twice daily\r\nstarting within 24 hours of transplantation for 4 days (up to max.\r\n14 days), then by mouth, 1.5\u00a0g twice daily as soon\r\nas is tolerated" ], "pregnancy": "Pregnancy\u00a0avoid\u2014congenital malformations reported; effective\r\ncontraception required before treatment, during treatment, and for\r\n6 weeks after discontinuation of treatment" }, "FLUDARABINE PHOSPHATE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nFludarabine is licensed for the initial treatment of advanced B-cell chronic lymphocytic leukaemia (CLL) or after first-line treatment in patients with sufficient bone-marrow reserves; it is usually given by mouth, but can be given by intravenous injection or infusion. Fludarabine is well tolerated but it does cause myelosuppression, which may be cumulative. Immunosuppression is also common (see panel on cladribine and fludarabine below), and co-trimoxazole is used to prevent pneumocystis infection. Immune-mediated haemolytic anaemia, thrombocytopenia, and neutropenia are less common side-effects.", "name": "FLUDARABINE PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "FLUDARABINE PHOSPHATE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; monitor for signs of haemolysis; monitor for neurological toxicity; worsening\r\nof existing and increased susceptibility to skin cancer; interactions: Appendix 1 (fludarabine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also diarrhoea, anorexia; oedema; pneumonia, cough; peripheral\r\nneuropathy, visual disturbances; chills, fever, malaise, weakness;\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202654.htm", "doses": [ "By mouth, adult 40\u00a0mg/m2 for 5 days every 28 days usually for 6 cycles", "By intravenous injection or infusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (embryotoxic and teratogenic in animal studies); manufacturer advises effective contraception during and\r\nfor at least 6 months after treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "SALMETEROL": { "indications": "Indications\u00a0reversible airways obstruction (including nocturnal asthma and prevention\r\nof exercise-induced bronchospasm) in patients requiring long-term\r\nregular bronchodilator therapy, see also %s\n(From Management of chronic asthma: British National Formulary)\nManagement of chronic asthma;\r\nchronic obstructive pulmonary diseaseNote\u00a0Not for immediate relief of acute asthma\r\nattacks; for use in asthma only in patients who regularly use an inhaled\r\ncorticosteroid, \n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nLong-acting beta2 agonists\u00a0Formoterol (eformoterol) and salmeterol are longer-acting beta2 agonists which are administered by inhalation. They should be used for asthma only in patients who regularly use an inhaled corticosteroid (see CHM advice below). They have a role in the long-term control of chronic asthma (see Management of Chronic Asthma table) and they can be useful in nocturnal asthma. Salmeterol should not be used for the relief of an asthma attack; it has a slower onset of action than salbutamol or terbutaline. Formoterol is licensed for short-term symptom relief and for the prevention of exercise-induced bronchospasm; its speed of onset of action is similar to that of salbutamol. Combination inhalers that contain a long-acting beta2 agonist and a corticosteroid (section 3.2) ensure that long-acting beta2 agonists are not used without concomitant corticosteroids, but reduce the flexibility to adjust the dose of each component.", "name": "SALMETEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; nausea, dizziness, arthralgia,\r\nand rash also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2910.htm", "doses": [ "By inhalation, asthma, 50\u00a0micrograms\r\n(2 puffs or 1 blister) twice daily; up to 100\u00a0micrograms (4 puffs\r\nor 2 blisters) twice daily in more severe airways obstruction; child 5\u201312 years, 50\u00a0micrograms (2 puffs or 1 blister)\r\ntwice daily", "Chronic obstructive pulmonary disease 50\u00a0micrograms (2 puffs\r\nor 1 blister) twice daily", "Advise patients that salmeterol should not be used for relief of acute attacks,\r\nnot to exceed prescribed dose, and to follow manufacturer\u2019s directions;\r\nif a previously effective dose of inhaled salmeterol fails to provide adequate relief, a doctor\u2019s advice should be obtained\r\nas soon as possible" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "PRIMAQUINE": { "indications": "Indications\u00a0adjunct in the treatment of Plasmodium vivax and P. ovale malaria (eradication of liver stages)", "name": "PRIMAQUINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Primaquine" ], "cautions": "Cautions\u00a0G6PD deficiency (test blood, see under Benign Malarias (treatment)); systemic diseases associated with granulocytopenia (e.g. rheumatoid arthritis, lupus erythematosus); interactions: Appendix 1 (primaquine)", "side-effects": "Side-effects\u00a0nausea, vomiting, anorexia, abdominal pain; less\r\ncommonly methaemoglobinaemia, haemolytic anaemia especially in G6PD\r\ndeficiency, leucopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4021.htm", "doses": [ "Treatment of benign malarias, see notes above" ], "pregnancy": "Pregnancy\u00a0risk of neonatal haemolysis and methaemoglobinaemia\r\nin third trimester; see also Benign Malarias (treatment)" }, "CHLORAMPHENICOL - ANTIBACTERIALS": { "side-effects": "Side-effects\u00a0transient stinging; see also notes above", "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "CHLORAMPHENICOL - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5376.htm", "doses": [ "See Administration in\r\nnotes above" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "CHLORAMPHENICOL" ] }, "APIXABAN": { "indications": "Indications\u00a0\n(From Apixaban: British National Formulary)\nApixaban", "name": "APIXABAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Apixaban" ], "cautions": "Cautions\u00a0see notes above; also bleeding disorders; active gastro-intestinal\r\nulceration; history of haemorrhagic stroke; severe hypertension; bacterial\r\nendocarditis; recent brain, spinal, or ophthalmic surgery; concomitant\r\nuse of drugs that increase risk of bleeding; anaesthesia with postoperative\r\nindwelling epidural catheter (risk of paralysis\u2014monitor neurological\r\nsigns and wait 20\u201330 hours after apixaban dose before removing catheter\r\nand do not give next dose until at least 5 hours after catheter removal); interactions: Appendix 1 (apixaban)", "side-effects": "Side-effects\u00a0nausea, haemorrhage (\n(From Apixaban: British National Formulary)\nApixaban), bruising, anaemia; less\r\ncommonly hypotension, thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217724.htm", "doses": [ "Prophylaxis of venous thromboembolism following knee replacement\r\nsurgery, adult over 18 years, 2.5\u00a0mg\r\ntwice daily for 10\u201314 days, starting 12\u201324 hours after surgery", "Prophylaxis of venous thromboembolism following hip replacement\r\nsurgery, adult over 18 years, 2.5\u00a0mg\r\ntwice daily for 32\u201338 days, starting 12\u201324 hours after surgery" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "DOXAZOSIN - ALPHA-BLOCKERS": { "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported. and %s\n(From DOXAZOSIN: British National Formulary)\nDOXAZOSIN", "indications": "Indications\u00a0benign prostatic hyperplasia; hypertension\r\n(section 2.5.4)", "name": "DOXAZOSIN - ALPHA-BLOCKERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106150.htm", "doses": [ "Initially 1\u00a0mg daily; dose may be doubled at intervals\r\nof 1\u20132 weeks according to response, up to max. 8\u00a0mg daily; usual maintenance\r\n2\u20134\u00a0mg daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "DOXAZOSIN" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers). and %s\n(From DOXAZOSIN: British National Formulary)\nDOXAZOSIN" }, "LIDOCAINE HYDROCHLORIDE": { "indications": "Indications\u00a0ventricular arrhythmias, especially\r\nafter myocardial infarction; eye (section 11.7); local anaesthesia (section 15.2)", "name": "LIDOCAINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Ventricular arrhythmias" ], "cautions": "Cautions\u00a0lower doses in congestive cardiac\r\nfailure and following cardiac surgery; monitor ECG and have resuscitation facilities\r\navailable; elderly; interactions: Appendix 1 (lidocaine)", "side-effects": "Side-effects\u00a0dizziness, paraesthesia, or drowsiness (particularly\r\nif injection too rapid); other CNS effects include confusion, respiratory\r\ndepression and convulsions; hypotension and bradycardia (may lead\r\nto cardiac arrest); rarely hypersensitivity reactions\r\nincluding anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2441.htm", "doses": [ "By intravenous injection, in patients without\r\ngross circulatory impairment, 100\u00a0mg as a bolus over a few minutes\r\n(50\u00a0mg in lighter patients or those whose circulation is severely\r\nimpaired), followed immediately by infusion of 4\u00a0mg/minute\r\nfor 30 minutes, 2\u00a0mg/minute for 2 hours, then 1\u00a0mg/minute; reduce\r\nconcentration further if infusion continued beyond 24 hours (ECG monitoring\r\nand specialist advice for infusion)", "Following intravenous injection lidocaine has a short duration of action (lasting for 15\u201320 minutes).\r\nIf an intravenous infusion is not immediately available\r\nthe initial intravenous injection of 50\u2013100\u00a0mg can\r\nbe repeated if necessary once or twice at intervals of not less than\r\n10 minutes" ], "pregnancy": "Pregnancy\u00a0crosses the placenta but not known to be harmful\r\nin animal studies\u2014use if benefit outweighs risk" }, "TOREMIFENE": { "indications": "Indications\u00a0hormone-dependent metastatic breast cancer in postmenopausal women", "name": "TOREMIFENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer", "TOREMIFENE" ], "cautions": "Cautions\u00a0hypercalcaemia may occur (especially if bone metastases and usually\r\nat beginning of treatment); avoid in acute porphyria (but see section 9.8.2); history of severe thromboembolic\r\ndisease; interactions: Appendix 1 (toremifene)Endometrial changes\u00a0Increased endometrial\r\nchanges, including hyperplasia, polyps and cancer reported.\r\nAbnormal vaginal bleeding including menstrual irregularities, vaginal\r\ndischarge and symptoms such as pelvic pain or pressure should be promptly\r\ninvestigated", "side-effects": "Side-effects\u00a0nausea, vomiting; oedema; depression, dizziness,\r\nfatigue; sweating, hot flushes, vaginal bleeding or discharge (important: see Cautions); rash; less commonly anorexia, constipation, increased weight, thromboembolic events,\r\ndyspnoea, insomnia, headache, endometrial hypertrophy; very\r\nrarely jaundice, transient corneal opacity, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/40599.htm", "doses": [ "60\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "SALBUTAMOL - SELECTIVE BETA2 AGONISTS": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction; premature labour (section 7.1.3)", "name": "SALBUTAMOL - SELECTIVE BETA2 AGONISTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "SALBUTAMOL" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also lactic acidosis with high\r\ndoses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31938.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\n4\u00a0mg (elderly and sensitive patients initially 2\u00a0mg) 3\u20134 times daily;\r\nmax. single dose 8\u00a0mg (but unlikely to provide much extra benefit\r\nor to be tolerated); child under 2\r\nyears see BNF for Children; 2\u20136 years 1\u20132\u00a0mg 3\u20134 times daily, 6\u201312 years 2\u00a0mg 3\u20134 times\r\ndaily", "By subcutaneous or intramuscular injection, 500\u00a0micrograms, repeated\r\nevery 4 hours if necessary", "By slow intravenous injection (but\r\nsee also Management of Acute Asthma table), (dilute to a concentration\r\nof 50\u00a0micrograms/mL), 250\u00a0micrograms, repeated if necessary; child under 18 years see BNF for Children", "By intravenous infusion (but see\r\nalso Management of Acute Asthma table), initially 5\u00a0micrograms/minute,\r\nadjusted according to response and heart-rate usually in range 3\u201320\u00a0micrograms/minute,\r\nor more if necessary; child under 18\r\nyears see BNF for Children", "By aerosol inhalation (but see also Management of Acute Asthma table, or Management of Chronic Asthma\r\ntable),\r\n100\u2013200\u00a0micrograms (1\u20132 puffs); for persistent symptoms up to 4 times\r\ndaily; child 100\u00a0micrograms (1 puff),\r\nincreased to 200\u00a0micrograms (2 puffs) if necessary; for persistent\r\nsymptoms up to 4 times daily ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 200\u00a0micrograms\r\n(2 puffs); child 100\u00a0micrograms (1\r\npuff), increased to 200\u00a0micrograms (2 puffs) if necessary", "By inhalation of powder (but see\r\nalso Management of Chronic Asthma\r\ntable),\r\n200\u2013400\u00a0micrograms; for persistent symptoms up to 4 times daily; child over 5 years 200\u00a0micrograms; for persistent\r\nsymptoms up to 4 times daily (for Asmasal Clickhaler\u00ae, Salbulin Novolizer\u00ae, and Ventolin\r\nAccuhaler\u00ae doses, see under preparations) ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 400\u00a0micrograms; child 200\u00a0micrograms", "By inhalation of nebulised solution, adult and child over\r\n5 years 2.5\u20135\u00a0mg, repeated up to 4 times daily or more frequently\r\nin severe cases; child under 5 years\r\n2.5\u00a0mg, repeated up to 4 times daily or more frequently in severe\r\ncases; see also Management of Acute Asthma table and Management of Chronic Asthma\r\ntable" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "CALCITRIOL": { "indications": "Indications\u00a0mild to moderate plaque psoriasis", "name": "CALCITRIOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Vitamin D and analogues" ], "cautions": "Cautions\u00a0\n(From Vitamin D and analogues: British National Formulary)\nVitamin D and analogues", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106484.htm", "doses": [ "adult and child over 12 years, apply twice daily; not more\r\nthan 35% of body surface to be treated daily, max. 30\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use in restricted amounts only\r\nif clearly necessary and to monitor urine- and serum-calcium concentration" }, "MINOCYCLINE - MODIFIED RELEASE": { "indications": "Indications\u00a0see notes above; meningococcal carrier state; acne vulgaris (%s\n(From 13.6.2 Oral preparations for acne: British National Formulary)\n13.6.2 Oral preparations for acne)", "name": "MINOCYCLINE - MODIFIED RELEASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "MINOCYCLINE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; if treatment continued for longer\r\nthan 6 months, monitor every 3 months for hepatotoxicity, pigmentation\r\nand for systemic lupus erythematosus\u2014discontinue if these develop\r\nor if pre-existing systemic lupus erythematosus worsens", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\ndizziness and vertigo (more common in women); rarely anorexia, tinnitus, impaired hearing, hyperaesthesia, paraesthesia,\r\nacute renal failure, pigmentation (sometimes irreversible), and alopecia; very rarely systemic lupus erythematosus, discoloration\r\nof conjunctiva, tears, and sweat", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213709.htm", "doses": [ "100\u00a0mg twice daily", "Acne, see section 13.6.2 and under preparations, below", "Prophylaxis of asymptomatic meningococcal carrier state (but\r\nno longer recommended, see notes above), 100\u00a0mg twice daily for 5\r\ndays usually followed by rifampicin", "Tablets or capsules should be swallowed\r\nwhole with plenty of fluid while sitting or standing", "Name[Minocycline m/r preparations ] Capsules, m/r, minocycline (as hydrochloride)\r\n100\u00a0mg, net price 56-cap pack = \u00a320.08. \r\n Label:\r\n 6, 25Brands include Acnamino\u00ae MR, Minocin\r\nMR\u00ae, Sebomin MR\u00aeDose\u00a0acne, 100\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "ANASTROZOLE": { "indications": "Indications\u00a0adjuvant treatment of oestrogen-receptor-positive early invasive\r\nbreast cancer in postmenopausal women; adjuvant treatment of oestrogen-receptor-positive\r\nearly breast cancer in postmenopausal women following 2\u20133 years of\r\ntamoxifen therapy; advanced breast cancer in postmenopausal women\r\nwhich is oestrogen-receptor-positive or responsive to tamoxifen", "name": "ANASTROZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer" ], "cautions": "Cautions\u00a0laboratory test for menopause if doubt; susceptibility to osteoporosis (assess bone mineral density before treatment and at regular intervals)", "side-effects": "Side-effects\u00a0hot flushes, vaginal dryness, vaginal bleeding,\r\nhair thinning, anorexia, nausea, vomiting, diarrhoea, headache, arthralgia,\r\narthritis, bone fractures, bone pain, rash (including Stevens-Johnson\r\nsyndrome), cutaneous vasculitis; asthenia and drowsiness\u2014may initially\r\naffect ability to drive or operate machinery; slight increases in\r\ntotal cholesterol levels reported; very rarely allergic reactions\r\nincluding angioedema and anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/36794.htm", "doses": [ "1\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "WARFARIN SODIUM": { "indications": "Indications\u00a0prophylaxis of embolisation in rheumatic heart disease and atrial\r\nfibrillation; prophylaxis after insertion of prosthetic heart valve;\r\nprophylaxis and treatment of venous thrombosis and pulmonary embolism;\r\ntransient ischaemic attacks", "name": "WARFARIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Coumarins and phenindione", "WARFARIN SODIUM" ], "cautions": "Cautions\u00a0\n(From 2.8.2 Oral anticoagulants: British National Formulary)\n2.8.2 Oral anticoagulants; also conditions in\r\nwhich risk of bleeding is increased, e.g. history of gastro-intestinal bleeding, peptic ulcer, recent surgery, recent ischaemic stroke, postpartum\r\n(delay warfarin until risk of haemorrhage is low\u2014usually 5\u20137 days\r\nafter delivery), bacterial endocarditis (use only if warfarin otherwise\r\nindicated); uncontrolled hypertension; concomitant use of drugs that increase risk of bleeding; avoid cranberry juice; interactions: Appendix 1 (coumarins)", "side-effects": "Side-effects\u00a0haemorrhage\u2014see notes above; also nausea, vomiting,\r\ndiarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia,\r\npurpura, rash, \u2018purple toes\u2019, skin necrosis (increased risk in patients\r\nwith protein C or protein S deficiency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202912.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0\n(From Coumarins and phenindione: British National Formulary)\nPregnancy\u00a0 Warfarin, acenocoumarol, and phenindione are teratogenic and should not be given in the first trimester of pregnancy. Women of child-bearing age should be warned of this danger since stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality. These oral anticoagulants cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters. Difficult decisions may have to be made, particularly in women with prosthetic heart valves, atrial fibrillation, or with a history of recurrent venous thrombosis or pulmonary embolism." }, "DOCUSATE SODIUM Rectal preparations": { "indications": "Indications\u00a0constipation, adjunct in abdominal radiological procedures", "name": "DOCUSATE SODIUM Rectal preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "DOCUSATE SODIUM", "Rectal preparations" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; do not give with liquid paraffin; rectal preparations\r\nnot indicated if haemorrhoids or anal fissure", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; also rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2217.htm", "doses": [ "By mouth, chronic constipation, up\r\nto 500\u00a0mg daily in divided doses; child (but see section\r\n1.6) 6 months\u20132 years 12.5\u00a0mg 3 times daily, adjusted according\r\nto response (use paediatric solution); 2\u201312 years 12.5\u201325\u00a0mg 3 times\r\ndaily, adjusted according to response (use paediatric oral solution)", "Oral preparations act within 1\u20132 days", "With barium meal, adult and child over 12 years, 400\u00a0mg", "Name[Norgalax Micro-enema\u00ae (Norgine)] Enema, docusate sodium 120\u00a0mg in 10-g single-dose disposable packs. Net price 10-g unit\r\n= 57pDose\u00a0adult and child (but see section\r\n1.6) over 12 years, 10-g unit" ], "pregnancy": "Pregnancy\u00a0not known to be harmful\u2014manufacturer advises caution" }, "IRINOTECAN HYDROCHLORIDE": { "indications": "Indications\u00a0 \n(From Topoisomerase I inhibitors: British National Formulary)\nTopoisomerase I inhibitors", "name": "IRINOTECAN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Topoisomerase I inhibitors" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; raised plasma-bilirubin concentration (see under Hepatic\r\nimpairment); risk factors for cardiac disease; monitor respiratory function; interactions: Appendix 1 (irinotecan) ", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also acute\r\ncholinergic syndrome (with early diarrhoea) and delayed diarrhoea\r\n(consult product literature); less commonly interstitial\r\npulmonary disease", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60755.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); manufacturer advises effective contraception during and\r\nfor up to 1 month after treatment in women and up to 3 months after\r\ntreatment in men; see also Pregnancy and Reproductive\r\nFunction" }, "CABAZITAXEL": { "indications": "Indications\u00a0\n(From Taxanes: British National Formulary)\nCabazitaxel, in combination with prednisone or prednisolone, is licensed for the treatment of hormone refractory metastatic prostate cancer in patients who have previously been treated with a docetaxel-containing regimen. Routine premedication with a corticosteroid, an antihistamine, and a histamine H2-receptor antagonist is recommended to prevent severe hypersensitivity reactions. Hypersensitivity reactions are common.Other side-effects of cabazitaxel include weight changes, diarrhoea, constipation, abdominal pain, dyspepsia, gastroesophageal reflux, haemorrhoids, rectal haemorrhage, taste disturbance, dry mouth, chest pain, atrial fibrillation, tachycardia, hypertension, hypotension, flushing, oedema, dyspnoea, cough, peripheral neuropathy, paraesthesia, hypoesthesia, anxiety, confusion, dizziness, headache, malaise, vertigo, chills, hyperglycaemia, urinary retention, urinary incontinence, renal disorders (fatal cases of renal failure reported), dehydration, electrolyte disturbances, sciatica, arthralgia, muscle spasm, myalgia, increased lacrimation, tinnitus, dry skin, erythema.", "name": "CABAZITAXEL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Taxanes", "CABAZITAXEL" ], "cautions": "Cautions\u00a0see section 8.1; monitor electrolytes\u2014correct\r\ndehydration; avoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1 (cabazitaxel)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215606.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0ensure effective contraception during treatment (women)\r\nand for up to 6 months after treatment (men); see also Pregnancy and Reproductive\r\nFunction" }, "METRONIDAZOLE - ANTIBACTERIAL PREPARATIONS ALSO USED SYSTEMICALLY": { "side-effects": "Side-effects\u00a0skin irritation", "indications": "Indications\u00a0see preparations; rosacea (see also section 13.6); Helicobacter pylori eradication\r\n(section 1.3); anaerobic infections (section 5.1.11 and section 7.2.2); protozoal infections (section 5.4.2)", "name": "METRONIDAZOLE - ANTIBACTERIAL PREPARATIONS ALSO USED SYSTEMICALLY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201640.htm", "doses": [ "See preparations", "inflammatory papules and pustules of rosacea, apply twice\r\ndaily for 6 weeks (longer if necessary)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.2 Antibacterial preparations also used systemically", "METRONIDAZOLE" ], "cautions": "Cautions\u00a0avoid exposure to strong sunlight or UV light" }, "SAXAGLIPTIN": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "SAXAGLIPTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "SAXAGLIPTIN" ], "cautions": "Cautions\u00a0elderly; determine\r\nrenal function before treatment and periodically thereafter; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0vomiting, dyspepsia, gastritis; peripheral oedema;\r\nheadache, dizziness, fatigue; upper respiratory tract infection, urinary\r\ntract infection, gastroenteritis, sinusitis, nasopharyngitis; hypoglycaemia,\r\nmyalgia; less commonly dyslipidaemia, hypertriglyceridaemia,\r\nerectile dysfunction, arthralgia; also reported rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204113.htm", "doses": [ "adult over 18 years, 5\u00a0mg\r\nonce daily", "Dose of concomitant sulfonylurea may need\r\nto be reduced" ], "pregnancy": "Pregnancy\u00a0avoid unless essential\u2014toxicity in animal studies" }, "PROCYCLIDINE HYDROCHLORIDE": { "indications": "Indications\u00a0parkinsonism; drug-induced extrapyramidal\r\nsymptoms (but not tardive dyskinesia, \n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinic drugs exert their antiparkinsonian action by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency. Antimuscarinic drugs can be useful in drug-induced parkinsonism, but they are generally not used in idiopathic Parkinson\u2019s disease because they are less effective than dopaminergic drugs and they are associated with cognitive impairment.The antimuscarinic drugs orphenadrine, procyclidine, and trihexyphenidyl reduce the symptoms of parkinsonism induced by antipsychotic drugs, but there is no justification for giving them routinely in the absence of parkinsonian side-effects. Tardive dyskinesia is not improved by antimuscarinic drugs and may be made worse.In idiopathic Parkinson\u2019s disease, antimuscarinic drugs reduce tremor and rigidity but they have little effect on bradykinesia. They may be useful in reducing sialorrhoea.There are no important differences between the antimuscarinic drugs, but some patients tolerate one better than another.Procyclidine can be given parenterally and is effective emergency treatment for acute drug-induced dystonic reactions.)", "name": "PROCYCLIDINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.2 Antimuscarinic drugs used in parkinsonism", "PROCYCLIDINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinics should be used with caution in cardiovascular disease, hypertension, psychotic disorders, prostatic hypertrophy, pyrexia, in those susceptible to angle-closure glaucoma, and in the elderly. Antimuscarinics should not be withdrawn abruptly in patients taking long-term treatment. Antimuscarinics are liable to abuse. Interactions: Appendix 1 (Antimuscarinics)", "side-effects": "Side-effects\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nSide-effects of antimuscarinics include constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria, hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision, and rash. Angle-closure glaucoma occurs very rarely.; also\r\ngingivitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3668.htm", "doses": [ "By mouth, 2.5\u00a0mg 3 times daily, increased\r\ngradually in steps of 2.5\u20135\u00a0mg daily every 2\u20133 days if necessary;\r\nusual max. 30\u00a0mg daily in 2\u20134 divided doses (60\u00a0mg daily in exceptional\r\ncircumstances); elderly preferably\r\nlower end of range", "By intramuscular or intravenous\r\ninjection, acute dystonia, 5\u201310\u00a0mg (occasionally more than\r\n10\u00a0mg), usually effective in 5\u201310 minutes but may need 30 minutes\r\nfor relief; elderly preferably lower\r\nend of range" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "QUETIAPINE Modified release": { "indications": "Indications\u00a0schizophrenia; mania, either alone or with mood stabilisers; depression\r\nin bipolar disorder; adjunctive treatment in major depressive disorder", "name": "QUETIAPINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "QUETIAPINE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also cerebrovascular disease; patients at risk\r\nof aspiration pneumonia; treatment of depression\r\nin patients under 25 years (increased risk of suicide)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\ndry mouth, constipation, dyspepsia; tachycardia, hypertension, elevated\r\nplasma-triglyceride and -cholesterol concentrations, peripheral oedema;\r\ndrowsiness, headache, irritability, dysarthria, asthenia; leucopenia,\r\nneutropenia; blurred vision; rhinitis; less commonly dysphagia, seizures, restless legs syndrome, hyponatraemia, and\r\neosinophilia; rarely jaundice and priapism; very rarely hepatitis, angioedema, Stevens-Johnson syndrome,\r\nand rhabdomyolysis; suicidal behaviour (particularly on initiation)\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201325.htm", "doses": [ "Schizophrenia, adult over\r\n18 years, 25\u00a0mg twice daily on day 1, 50\u00a0mg twice daily on day 2,\r\n100\u00a0mg twice daily on day 3, 150\u00a0mg twice daily on day 4, then adjusted\r\naccording to response, usual range 300\u2013450\u00a0mg daily in 2 divided doses;\r\nmax. 750\u00a0mg daily; elderly initially\r\n25\u00a0mg daily as a single dose, increased in steps of 25\u201350\u00a0mg daily\r\nin 2 divided doses; child 12\u201318 years\r\nsee BNF for Children", "Treatment of mania in bipolar disorder, adult over 18 years, 50\u00a0mg twice daily on day 1, 100\u00a0mg twice daily on\r\nday 2, 150\u00a0mg twice daily on day 3, 200\u00a0mg twice daily on day 4, then\r\nadjusted according to response in steps of up to 200\u00a0mg daily to max.\r\n800\u00a0mg daily; usual range 400\u2013800\u00a0mg daily in 2 divided doses; elderly initially 25\u00a0mg daily as a single dose, increased\r\nin steps of 25\u201350\u00a0mg daily in 2 divided doses; child 12\u201318 years see BNF for Children", "Prevention of mania and depression in bipolar disorder, adult over 18 years, continue at the dose effective\r\nfor treatment of bipolar disorder and adjust to lowest effective dose;\r\nusual range 300\u2013800\u00a0mg in 2 divided doses", "Treatment of mania in bipolar disorder, adult over 18 years, 300\u00a0mg once daily on day 1, then 600\u00a0mg once daily\r\non day 2, then adjusted according to response; dose range 400\u2013800\u00a0mg\r\nonce daily; elderly initially 50\u00a0mg\r\nonce daily adjusted according to response in steps of 50\u00a0mg daily", "Prevention of mania and depression in bipolar disorder, adult over 18 years, continue at the dose effective\r\nfor treatment of bipolar disorder and adjust to lowest effective dose;\r\nusual range 300\u2013800\u00a0mg once daily", "Name[Seroquel\u00ae XL (AstraZeneca) ] Tablets, m/r, quetiapine (as fumarate) 50\u00a0mg (peach), net price 60-tab pack = \u00a367.66; 150\u00a0mg\r\n(white) 60-tab pack = \u00a3113.10; 200\u00a0mg (yellow), 60-tab pack = \u00a3113.10;\r\n300\u00a0mg (pale yellow), 60-tab pack = \u00a3170.00; 400\u00a0mg (white), 60-tab\r\npack = \u00a3226.20. \r\n Label:\r\n 2, 23, 25Dose\u00a0schizophrenia, adult over\r\n18 years, 300\u00a0mg once daily on day 1, then 600\u00a0mg once daily on day\r\n2; adjust according to response, usual dose 600\u00a0mg once daily; max.\r\n800\u00a0mg under specialist supervision; elderly initially 50\u00a0mg once daily adjusted according to response in steps\r\nof 50\u00a0mg dailyTreatment of mania in bipolar disorder, adult over 18 years, 300\u00a0mg once daily on day 1, then 600\u00a0mg once daily\r\non day 2, then adjusted according to response; dose range 400\u2013800\u00a0mg\r\nonce daily; elderly initially 50\u00a0mg\r\nonce daily adjusted according to response in steps of 50\u00a0mg dailyTreatment of depression in bipolar disorder, adult over 18 years, 50\u00a0mg once daily (at bedtime)\r\non day 1, 100\u00a0mg once daily on day 2, 200\u00a0mg once daily on day 3,\r\n300\u00a0mg once daily on day 4; adjust according to response, usual dose\r\n300\u00a0mg once daily, max. 600\u00a0mg dailyPrevention of mania and depression in bipolar disorder, adult over 18 years, continue at the dose effective\r\nfor treatment of bipolar disorder and adjust to lowest effective dose;\r\nusual range 300\u2013800\u00a0mg once dailyAdjunctive treatment of major depression, adult over 18 years, 50\u00a0mg once daily at bedtime for 2 days, then 150\u00a0mg\r\nonce daily for 2 days, then adjusted according to response, usual\r\nrange 150\u2013300\u00a0mg once daily; elderly, initially 50\u00a0mg once daily for 3 days, then increase if necessary\r\nto 100\u00a0mg once daily for 4 days; thereafter adjusted in steps of 50\u00a0mg\r\naccording to response, usual range 50\u2013300\u00a0mg once daily (dose of 300\u00a0mg\r\nshould not be reached before day 22 of treatment)" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk" }, "TESTOSTERONE AND ESTERS Oral": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS Oral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS", "Oral" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4363.htm", "doses": [ "See under preparations", "Name[Restandol\u00ae Testocaps (Organon) ] Capsules, orange, testosterone undecanoate\r\n40\u00a0mg in oily solution, net price 30-cap pack = \u00a38.55; 60-cap pack\r\n= \u00a317.10. \r\n Label:\r\n 21, 25Dose\u00a0androgen deficiency, 120\u2013160\u00a0mg daily for 2\u20133 weeks; maintenance\r\n40\u2013120\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "PACLITAXEL": { "indications": "Indications\u00a0ovarian cancer (advanced or residual disease following laparotomy)\r\nin combination with cisplatin; metastatic ovarian\r\ncancer where platinum-containing therapy has failed; locally advanced\r\nor metastatic breast cancer (in combination with other cytotoxics\r\nor alone if other cytotoxics have failed or are inappropriate); adjuvant\r\ntreatment of node-positive breast cancer following treatment with\r\nanthracycline and cyclophosphamide; non-small cell lung cancer (in\r\ncombination with cisplatin) when surgery or radiotherapy\r\nnot appropriate; advanced AIDS-related Kaposi\u2019s sarcoma where liposomal\r\nanthracycline therapy has failed", "name": "PACLITAXEL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Taxanes", "PACLITAXEL" ], "cautions": "Cautions\u00a0see section 8.1 and notes\r\nabove; avoid in acute porphyria (but\r\nsee section 9.8.2); interactions: Appendix 1\r\n(paclitaxel)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129352.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nensure effective contraception during and for at least 6 months after\r\ntreatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "HUMAN MENOPAUSAL GONADOTROPHINS Menotrophin": { "indications": "Indications\u00a0see notes above", "name": "HUMAN MENOPAUSAL GONADOTROPHINS Menotrophin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "HUMAN MENOPAUSAL GONADOTROPHINS", "Menotrophin" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0ovarian hyperstimulation, increased risk of multiple\r\npregnancy and miscarriage, hypersensitivity reactions, gastro-intestinal\r\ndisturbances, headache, joint pain, fever, injection site reactions, very rarely thromboembolism; gynaecomastia, acne, and weight\r\ngain reported in men", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88361.htm", "doses": [ "By deep intramuscular or subcutaneous injection, according to patient\u2019s response", "Name[Menopur\u00ae (Ferring) ] Injection, powder for reconstitution,\r\nmenotrophin as follicle-stimulating hormone 75\u00a0units and luteinising\r\nhormone 75\u00a0units, net price per vial (with solvent) = \u00a316.38. For\r\nintramuscular or subcutaneous injection" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TRETINOIN - TOPICAL RETINOIDS AND RELATED PREPARATIONS FOR ACNE": { "indications": "Indications\u00a0see preparations; malignant disease (section 8.1.5)", "name": "TRETINOIN - TOPICAL RETINOIDS AND RELATED PREPARATIONS FOR ACNE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "TRETINOIN" ], "cautions": "Cautions\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106179.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "PERINDOPRIL ERBUMINE": { "indications": "Indications\u00a0hypertension (but \n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nHypertension\u00a0An ACE inhibitor may be the most appropriate initial drug for hypertension in younger Caucasian patients; Afro-Caribbean patients, those aged over 55 years, and those with primary aldosteronism respond less well (see section 2.5). ACE inhibitors are particularly indicated for hypertension in patients with type 1 diabetes with nephropathy (see also section 6.1.5). They may reduce blood pressure very rapidly in some patients particularly in those receiving diuretic therapy (see Cautions, below); the first dose should preferably be given at bedtime.); symptomatic\r\nheart failure (adjunct\u2014\n(From 2.5.5 Drugs affecting the renin-angiotensin system: British National Formulary)\n2.5.5 Drugs affecting the renin-angiotensin system); prophylaxis\r\nof cardiac events following myocardial infarction or revascularisation\r\nin stable coronary artery disease", "name": "PERINDOPRIL ERBUMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nSide-effects\u00a0ACE inhibitors can cause profound hypotension (see Cautions) and renal impairment (see Renal effects above), and a persistent dry cough. They can also cause angioedema (onset may be delayed; higher incidence reported in Afro-Caribbean patients), rash (which may be associated with pruritus and urticaria), pancreatitis, and upper respiratory-tract symptoms such as sinusitis, rhinitis, and sore throat. Gastro-intestinal effects reported with ACE inhibitors include nausea, vomiting, dyspepsia, diarrhoea, constipation, and abdominal pain. Altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure have been reported\u2014discontinue if marked elevation of hepatic enzymes or jaundice. Hyperkalaemia, hypoglycaemia, and blood disorders including thrombocytopenia, leucopenia, neutropenia, and haemolytic anaemia have also been reported. Other reported side-effects include headache, dizziness, fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia, arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.; also\r\nasthenia, mood and sleep disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2597.htm", "doses": [ "Hypertension, initially 4\u00a0mg once daily in the morning\r\nfor 1 month, subsequently adjusted according to response; if used\r\nin addition to diuretic (see notes above),\r\nin elderly, in renal impairment, in cardiac decompensation, or in\r\nvolume depletion, initially 2\u00a0mg once daily; max. 8\u00a0mg daily", "Heart failure (adjunct), initially 2\u00a0mg once daily in the morning\r\nunder close medical supervision (see notes above),\r\nincreased after at least 2 weeks to max. 4\u00a0mg once daily if tolerated", "Following myocardial infarction or revascularisation, initially\r\n4\u00a0mg once daily in the morning increased after 2 weeks to 8\u00a0mg once\r\ndaily if tolerated; elderly 2\u00a0mg once\r\ndaily for 1 week, then 4\u00a0mg once daily for 1 week, thereafter increased\r\nto 8\u00a0mg once daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "DOXAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS": { "indications": "Indications\u00a0hypertension (see notes above); benign prostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "DOXAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0care with initial dose (postural hypotension); pulmonary oedema due to aortic or mitral stenosis; cataract surgery (risk of intra-operative\r\nfloppy iris syndrome); heart failure; interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance\r\nof skilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\ndyspnoea, coughing; fatigue, vertigo, paraesthesia, sleep disturbance,\r\nanxiety; influenza-like symptoms; back pain, myalgia; less\r\ncommonly weight changes, angina, myocardial infarction, hypoaesthesia,\r\ntremor, agitation, micturition disturbance, epistaxis, arthralgia,\r\ntinnitus, and gout; very rarely cholestasis, hepatitis,\r\njaundice, bradycardia, arrhythmias, bronchospasm, hot flushes, gynaecomastia,\r\nabnormal ejaculation, leucopenia, thrombocytopenia, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2564.htm", "doses": [ "Hypertension, 1\u00a0mg daily, increased after 1\u20132 weeks to\r\n2\u00a0mg once daily, and thereafter to 4\u00a0mg once daily, if necessary;\r\nmax. 16\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "HYDROCORTISONE Proprietary hydrocortisone preparations": { "indications": "Indications\u00a0mild inflammatory skin disorders such as eczemas\r\n(but for over-the-counter preparations, see below); nappy rash (see\r\nalso section 13.2.2)", "name": "HYDROCORTISONE Proprietary hydrocortisone preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "HYDROCORTISONE", "Proprietary hydrocortisone preparations" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5847.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Mildison\u00ae (Astellas) ] Lipocream, hydrocortisone 1%, net price 30\u00a0g = \u00a31.71. \r\n Label:\r\n 28, counselling, application. Potency: mildExcipients include cetostearyl\r\nalcohol, hydroxybenzoates (parabens)" ] }, "TAZAROTENE": { "indications": "Indications\u00a0mild to moderate plaque psoriasis affecting\r\nup to 10% of skin area", "name": "TAZAROTENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tazarotene" ], "cautions": "Cautions\u00a0wash hands immediately after use, avoid contact with eyes, face, intertriginous areas, hair-covered\r\nscalp, eczematous or inflamed skin; avoid excessive exposure to UV light (including sunlight,\r\nsolariums, PUVA or UVB treatment); do not\r\napply emollients or cosmetics within 1 hour of application", "side-effects": "Side-effects\u00a0local irritation (more common with higher concentration\r\nand may require discontinuation), pruritus, burning, erythema, desquamation,\r\nnon-specific rash, contact dermatitis, and worsening of psoriasis;\r\nrarely stinging and inflamed, dry or painful skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/66074.htm", "doses": [ "Apply once daily in the evening usually for up to 12 weeks; child under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0avoid; effective contraception required (oral progestogen-only\r\ncontraceptives not considered effective)" }, "BOSENTAN": { "indications": "Indications\u00a0pulmonary arterial hypertension; systemic sclerosis with ongoing\r\ndigital ulcer disease (to reduce number of new digital ulcers)", "name": "BOSENTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "BOSENTAN" ], "cautions": "Cautions\u00a0not to be initiated if systemic systolic\r\nblood pressure is below 85\u00a0mmHg; monitor\r\nhaemoglobin before and during treatment (monthly for first 4 months,\r\nthen 3-monthly); avoid abrupt withdrawal; monitor liver function before treatment, at monthly\r\nintervals during treatment, and 2 weeks after dose increase (reduce\r\ndose or suspend treatment if liver enzymes raised significantly)\u2014discontinue\r\nif symptoms of liver impairment; interactions: Appendix 1 (bosentan)", "side-effects": "Side-effects\u00a0diarrhoea, gastro-oesophageal reflux, flushing,\r\nhypotension, palpitation, oedema, syncope, headache, anaemia; less commonly thrombocytopenia, neutropenia; leucopenia; rarely liver cirrhosis, liver failure (see cautions above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119711.htm", "doses": [ "Pulmonary arterial hypertension, initially 62.5\u00a0mg twice\r\ndaily increased after 4 weeks to 125\u00a0mg twice daily; max. 250\u00a0mg twice\r\ndaily; child under 18 years see BNF for Children", "Systemic sclerosis with ongoing digital ulcer disease, initially\r\n62.5\u00a0mg twice daily increased after 4 weeks to 125\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\neffective contraception required during administration (hormonal contraception\r\nnot considered effective); monthly pregnancy tests advised" }, "RABIES VACCINE": { "indications": "Indications\u00a0immunisation against rabies", "name": "RABIES VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Rabies vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nreported paresis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201184.htm", "doses": [ "Pre-exposure prophylaxis, by intramuscular injection in deltoid region or anterolateral thigh in infants, 1\u00a0mL on days\r\n0, 7, and 21 or 28; for those at continued risk give a single reinforcing\r\ndose 1 year after the primary course is completed and booster doses\r\nevery 3\u20135 years; for those at intermittent risk give booster doses\r\nevery 2\u20135 years", "Post-exposure prophylaxis, by intramuscular injection in deltoid region or anterolateral thigh in infants, 1\u00a0mL (see notes above)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "SODIUM FUSIDATE": { "indications": "Indications\u00a0penicillin-resistant staphylococcal infection including osteomyelitis;\r\nstaphylococcal endocarditis in combination with other antibacterials\r\n(Table 1, section 5.1)", "name": "SODIUM FUSIDATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Fusidic acid" ], "cautions": "Cautions\u00a0monitor liver function with high doses\r\nor on prolonged therapy; elimination may be reduced\r\nin biliary disease or biliary obstruction; interactions: Appendix 1 (fusidic acid)", "side-effects": "Side-effects\u00a0nausea, vomiting, reversible jaundice, especially\r\nafter high dosage or rapid infusion (withdraw therapy if persistent);\r\nrarely hypersensitivity reactions, acute renal failure (usually with\r\njaundice), blood disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3870.htm", "doses": [ "See under Preparations, below" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturer advises use\r\nonly if potential benefit outweighs risk" }, "LORATADINE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, chronic\r\nidiopathic urticaria", "name": "LORATADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3026.htm", "doses": [ "adult and child over 12 years 10\u00a0mg once daily; child 2\u201312 years, body-weight under 30\u00a0kg, 5\u00a0mg once\r\ndaily; body-weight over 30\u00a0kg, 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "HEPATITIS A VACCINE ": { "indications": "Indications\u00a0immunisation against hepatitis A infection", "name": "HEPATITIS A VACCINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis A vaccine", "HEPATITIS A VACCINE", "Single component" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; for\r\ncombination vaccines, see also Typhoid vaccine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/40231.htm", "doses": [ "See under preparations", "Name[Avaxim\u00ae (Sanofi Pasteur) ] Injection, suspension of formaldehyde-inactivated hepatitis A virus (GBM grown in\r\nhuman diploid cells) 320 antigen units/mL adsorbed onto aluminium\r\nhydroxide, net price 0.5-mL prefilled syringe = \u00a318.10Excipients include neomycinDose\u00a0by intramuscular injection (see note below), adult and child over\r\n16 years, 0.5\u00a0mL as a single dose; booster dose 0.5\u00a0mL 6\u201312 months\r\nafter initial doseNote\u00a0Booster dose may be delayed by up to 3 years\r\nif not given after recommended interval following primary dose with Avaxim\u00ae. The deltoid region is the preferred site of injection.\r\nThe subcutaneous route may be used for patients with bleeding disorders;\r\nnot to be injected into the buttock (vaccine efficacy reduced)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "DRONEDARONE": { "indications": "Indications\u00a0\n(From Supraventricular arrhythmias: British National Formulary)\nDronedarone is a multi-channel blocking anti-arrhythmic drug; it is licensed for the maintenance of sinus rhythm after cardioversion in clinically stable patients with paroxysmal or persistent atrial fibrillation, when altenative treatments are unsuitable; dronedarone should be initiated and monitored under specialist supervision.", "name": "DRONEDARONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular arrhythmias" ], "cautions": "Cautions\u00a0monitor liver function (see\r\nHepatic Disorders below); monitor for heart failure (see Heart Failure\r\nbelow); perform ECG at least every 6 months\u2014consider discontinuation\r\nif atrial fibrillation reoccurs; coronary artery disease; correct hypokalaemia and hypomagnesaemia before starting and during\r\ntreatment; measure serum creatinine before\r\ntreatment and 7 days after initiation\u2014if raised, measure\r\nagain after a further 7 days and consider discontinuation if creatinine\r\ncontinues to rise; interactions: Appendix 1 (dronedarone)Hepatic disorders\u00a0Liver injury, including life-threatening\r\nacute liver failure reported rarely; monitor liver function\r\nbefore treatment, 1 week and 1 month after initiation of treatment,\r\nthen monthly for 6 months, then every 3 months for 6 months and periodically\r\nthereafter\u2014discontinue treatment if 2 consecutive alanine aminotransferase\r\nconcentrations exceed 3 times upper limit of normal. Patients or their carers should be told how to recognise signs of\r\nliver disorder and advised to seek prompt medical attention if symptoms\r\nsuch as abdominal pain, anorexia, nausea, vomiting, fever, malaise,\r\nitching, dark urine, or jaundice developHeart failure\u00a0New-onset or worsening heart failure\r\nreported; patients or their carers should be told how\r\nto recognise signs of heart failure and advised to seek prompt medical\r\nattention if symptoms such as weight gain, dependent oedema, or dyspnoea\r\ndevelop or worsen; if heart failure or left ventricular\r\nsystolic dysfunction develops, discontinue treatment", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, QT-interval prolongation,\r\nbradycardia, heart failure (see also Heart Failure above), malaise,\r\nrash, pruritus, raised serum creatinine; less commonly taste disturbance, interstitial lung disease including pneumonitis\r\nand pulmonary fibrosis (investigate if symptoms such as dyspnoea or\r\ndry cough develop and discontinue treatment if confirmed), erythema,\r\neczema, dermatitis, photosensitivity; rarely liver\r\ninjury (including life-threatening acute liver failure\u2014see also Hepatic\r\nDisorders above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/206568.htm", "doses": [ "adult over 18 years, 400\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "FOSPHENYTOIN SODIUM": { "indications": "Indications\u00a0status epilepticus; seizures associated\r\nwith neurosurgery or head injury; when phenytoin by mouth not possible", "name": "FOSPHENYTOIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus" ], "cautions": "Cautions\u00a0see Phenytoin Sodium; resuscitation facilities must be available; interactions: see Interactions in section 4.8.1 and Appendix 1 (phenytoin)", "side-effects": "Side-effects\u00a0see Phenytoin Sodium; also dry mouth, taste disturbance, vasodilatation, asthenia,\r\ndysarthria, euphoria, incoordination, chills, visual disturbances,\r\ntinnitus, pruritus, ecchymosis; less commonly hypoaesthesia,\r\nincreased or decreased reflexes, stupor, muscle weakness, muscle spasm,\r\npain, hypoacusis; also reported extrapyramidal disorder,\r\ntwitching, confusion, hyperglycaemiaImportant\u00a0Intravenous infusion of fosphenytoin has been associated with severe cardiovascular reactions including\r\nasystole, ventricular fibrillation, and cardiac arrest. Hypotension,\r\nbradycardia, and heart block have also been reported. The following are recommended:monitor heart rate, blood pressure, and respiratory function\r\nfor duration of infusion;observe patient for at least 30 minutes after infusion;if hypotension occurs, reduce infusion rate or discontinue;reduce dose or infusion rate in elderly, and in renal or hepatic impairment.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77533.htm", "doses": [ "Prescriptions for fosphenytoin\r\nsodium should state the dose in terms of phenytoin sodium equivalent (PE); fosphenytoin sodium 1.5\u00a0mg\r\n\u2261 phenytoin sodium 1\u00a0mg", "Status epilepticus, by intravenous infusion (at a rate of 100\u2013150\u00a0mg(PE)/minute), initially 20\u00a0mg(PE)/kg then by intravenous infusion (at a rate of 50\u2013100\u00a0mg(PE)/minute),\r\n4\u20135\u00a0mg(PE)/kg daily in 1\u20132 divided doses, dose adjusted according\r\nto response and trough plasma-phenytoin concentration", "child 5 years and over, by intravenous infusion (at a rate of 2\u20133\u00a0mg(PE)/kg/minute),\r\ninitially 20\u00a0mg(PE)/kg then by intravenous infusion (at a rate of 1\u20132\u00a0mg(PE)/kg/minute), 4\u20135\u00a0mg(PE)/kg daily in 1\u20134\r\ndivided doses, dose adjusted according to response and trough plasma-phenytoin concentration", "Prophylaxis or treatment of seizures associated\r\nwith neurosurgery or head injury, by intramuscular injection or by intravenous infusion (at a\r\nrate of 50\u2013100\u00a0mg(PE)/minute), initially 10\u201315\u00a0mg(PE)/kg then by intramuscular injection or by\r\nintravenous infusion (at a rate of 50\u2013100\u00a0mg(PE)/minute),\r\n4\u20135\u00a0mg(PE)/kg daily (in 1\u20132 divided doses), dose adjusted according\r\nto response and trough plasma-phenytoin concentration", "child 5 years and over, by intravenous infusion (at a rate of 1\u20132\u00a0mg(PE)/kg/minute),\r\ninitially 10\u201315\u00a0mg(PE)/kg then 4\u20135\u00a0mg(PE)/kg daily in 1\u20134 divided\r\ndoses, dose adjusted according to response and trough plasma-phenytoin concentration", "Temporary substitution for oral phenytoin, by intramuscular injection or by intravenous infusion (at a rate of 50\u2013100\u00a0mg(PE)/minute),\r\nsame dose and dosing frequency as oral phenytoin therapy; child 5 years and over, by intravenous infusion (at a rate of 1\u20132\u00a0mg(PE)/kg/minute,\r\nmax. 100\u00a0mg(PE)/minute), same dose and dosing frequency as oral phenytoin therapy", "elderly consider\r\n10\u201325% reduction in dose or infusion rate", "Fosphenytoin sodium doses in BNF may differ\r\nfrom those in product literature" ], "pregnancy": "Pregnancy\u00a0see Phenytoin, section 4.8.1, and Pregnancy" }, "METOCLOPRAMIDE HYDROCHLORIDE High-dose (with cytotoxic chemotherapy only)": { "indications": "Indications\u00a0adults, nausea and vomiting, particularly\r\nin gastro-intestinal disorders (section 1.2) and treatment\r\nwith cytotoxics or radiotherapy; migraine (section 4.7.4.1)Patients under 20 years\u00a0Use restricted to severe\r\nintractable vomiting of known cause, vomiting of radiotherapy and\r\ncytotoxics, aid to gastro-intestinal intubation, premedication; dose\r\nshould be determined on the basis of body-weight", "name": "METOCLOPRAMIDE HYDROCHLORIDE High-dose (with cytotoxic chemotherapy only)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Domperidone and metoclopramide", "METOCLOPRAMIDE HYDROCHLORIDE", "High-dose (with cytotoxic chemotherapy only)" ], "cautions": "Cautions\u00a0elderly, young\r\nadults (15\u201319 years old), and children; atopic allergy (including asthma); cardiac conduction disturbances (and concomitant\r\nuse of other drugs affecting cardiac conduction); may mask underlying disorders such as cerebral irritation; acute porphyria (section 9.8.2); epilepsy; interactions: Appendix 1 (metoclopramide)", "side-effects": "Side-effects\u00a0extrapyramidal effects (especially in children\r\nand young adults (15\u201319 years old)\u2014see above),\r\nhyperprolactinaemia, occasionally tardive dyskinesia on prolonged\r\nadministration; also reported, dyspnoea, anxiety, confusion, drowsiness,\r\ndizziness, tremor, restlessness, diarrhoea, depression, neuroleptic\r\nmalignant syndrome, visual disturbances, rashes, pruritus, oedema;\r\ncardiac conduction abnormalities reported following intravenous administration; rarely methaemoglobinaemia (more severe in G6PD deficiency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3435.htm", "doses": [ "By mouth or by intramuscular injection or by\r\nintravenous injection over 1\u20132 minutes, nausea and vomiting,\r\n10\u00a0mg (5\u00a0mg in young adults 15\u201319 years, body-weight under 60\u00a0kg)\r\n3 times daily; child up to 1 year (body-weight\r\nup to 10\u00a0kg) 100\u00a0micrograms/kg (max. 1\u00a0mg) twice daily, 1\u20133 years\r\n(body-weight 10\u201314\u00a0kg) 1\u00a0mg 2\u20133 times daily, 3\u20135 years (body-weight\r\n15\u201319\u00a0kg) 2\u00a0mg 2\u20133 times daily, 5\u20139 years (body-weight 20\u201329\u00a0kg) 2.5\u00a0mg\r\n3 times daily, 9\u201315 years (body-weight 30\u00a0kg and over) 5\u00a0mg 3 times\r\ndaily", "Daily dose of metoclopramide should not normally\r\nexceed 500\u00a0micrograms/kg, particularly for children and young adults\r\n(restricted use, see above)", "For diagnostic procedures, as a single dose 5\u201310 minutes before\r\nexamination, 10\u201320\u00a0mg (10\u00a0mg in young adults 15\u201319 years); child under 3 years 1\u00a0mg, 3\u20135 years 2\u00a0mg, 5\u20139 years\r\n2.5\u00a0mg, 9\u201314 years 5\u00a0mg", "Name[Maxolon High Dose\u00ae (Amdipharm) ] Injection, metoclopramide\r\nhydrochloride 5\u00a0mg/mL, net price 20-mL amp = \u00a32.67.For dilution and use as an intravenous infusion\r\nin nausea and vomiting associated with cytotoxic chemotherapy onlyDose\u00a0by continuous intravenous infusion (preferred\r\nmethod), initially (before starting chemotherapy), 2\u20134\u00a0mg/kg over\r\n15\u201320 minutes, then 3\u20135\u00a0mg/kg over 8\u201312 hours; max. in 24 hours, 10\u00a0mg/kgBy intermittent intravenous infusion, initially\r\n(before starting chemotherapy), up to 2\u00a0mg/kg over at least 15 minutes\r\nthen up to 2\u00a0mg/kg over at least 15 minutes every 2 hours; max. in\r\n24 hours, 10\u00a0mg/kg" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "BELIMUMAB": { "indications": "Indications\u00a0see under Cytokine Modulators above", "name": "BELIMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; do not initiate until\r\nactive infections controlled; history or development of malignancy; interactions: Appendix 1 (belimumab)", "side-effects": "Side-effects\u00a0\n(From Cytokine modulators: British National Formulary)\nBelimumab inhibits the activity of B-lymphocyte stimulator. Belimumab is licensed as adjunctive therapy in patients with active, autoantibody-positive systemic lupus erythematosus with a high degree of disease activity despite standard therapy. Infusion-related side-effects are reported commonly with belimumab and occur predominantly during the first 2 infusions. Premedication with an antihistamine, with or without an antipyretic, may be considered.; also\r\ndiarrhoea, nausea, hypersensitivity reactions, vomiting, depression,\r\ninsomnia, migraine, infections, pyrexia, leucopenia, pain in extremities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217729.htm", "doses": [ "By intravenous infusion, adult over 18 years, 10\u00a0mg/kg, repeated 2 weeks and\r\n4 weeks after initial infusion, then every 4 weeks; review treatment\r\nif no response within 6 months" ], "pregnancy": "Pregnancy\u00a0avoid unless essential; manufacturer advises adequate\r\ncontraception during treatment and for at least 4 months after last\r\ndose " }, "ISONIAZID": { "indications": "Indications\u00a0tuberculosis, in combination with other drugs; prophylaxis\u2014Table\r\n2, section 5.1", "name": "ISONIAZID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs" ], "cautions": "Cautions\u00a0see Monitoring in notes above; also slow acetylator status (increased risk of side-effects); epilepsy; history of psychosis; alcohol dependence, malnutrition, diabetes\r\nmellitus, HIV infection (risk of peripheral\r\nneuritis); acute porphyria (section 9.8.2); interactions: Appendix 1 (isoniazid)Hepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of liver disorder, and\r\nadvised to discontinue treatment and seek immediate medical attention\r\nif symptoms such as persistent nausea, vomiting, malaise or jaundice\r\ndevelop", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, dry mouth; peripheral\r\nneuritis with high doses (pyridoxine prophylaxis, see notes above),\r\noptic neuritis, convulsions, psychotic episodes, vertigo; hypersensitivity\r\nreactions including fever, Stevens-Johnson syndrome, purpura; blood\r\ndisorders including agranulocytosis, haemolytic anaemia, aplastic\r\nanaemia; hepatitis (especially over age of 35 years); pancreatitis;\r\ninterstitial pneumonitis; systemic lupus erythematosus-like syndrome,\r\npellagra, hyperreflexia, difficulty with micturition, hyperglycaemia,\r\nand gynaecomastia reported; hearing loss and tinnitus (in patients\r\nwith end-stage renal impairment); when used with tyramine or histamine\r\nrich foods, tachycardia, palpitation, hypotension, flushing, headache,\r\ndizziness, and sweating also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3907.htm", "doses": [ "By mouth or by\r\nintramuscular or intravenous injection, see notes above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; prophylactic pyridoxine\r\nrecommended; see also Pregnancy" }, "VANCOMYCIN": { "indications": "Indications\u00a0see notes above", "name": "VANCOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Vancomycin and teicoplanin", "VANCOMYCIN" ], "cautions": "Cautions\u00a0avoid rapid infusion (risk of anaphylactoid reactions,\r\nsee Side-effects); rotate infusion sites; elderly; avoid if history\r\nof deafness; all patients require plasma-vancomycin measurement (after 3 or 4 doses if renal function\r\nnormal, earlier if renal impairment), blood counts, urinalysis, and renal function tests; monitor auditory function in elderly or if renal impairment; teicoplanin\r\nsensitivity; systemic absorption may follow\r\noral administration especially in inflammatory bowel disorders or following multiple doses; interactions: Appendix 1 (vancomycin)", "side-effects": "Side-effects\u00a0after parenteral administration: nephrotoxicity\r\nincluding renal failure and interstitial nephritis; ototoxicity (discontinue\r\nif tinnitus occurs); blood disorders including neutropenia (usually\r\nafter 1 week or cumulative dose of 25\u00a0g), rarely agranulocytosis and\r\nthrombocytopenia; nausea; chills, fever; eosinophilia, anaphylaxis,\r\nrashes (including exfoliative dermatitis, Stevens-Johnson syndrome,\r\ntoxic epidermal necrolysis, and vasculitis); phlebitis (irritant to\r\ntissue); on rapid infusion, severe hypotension (including shock and\r\ncardiac arrest), wheezing, dyspnoea, urticaria, pruritus, flushing\r\nof the upper body (\u2018red man\u2019 syndrome), pain and muscle spasm of back\r\nand chest", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37245.htm", "doses": [ "By mouth, Clostridium difficile infection, (see also notes above), 125\u00a0mg\r\nevery 6 hours for 10\u201314 days (increased up to 500\u00a0mg every 6 hours\r\nif infection fails to respond or is life-threatening)", "By intravenous infusion, 1\u20131.5\u00a0g\r\nevery 12 hours; elderly over 65 years,\r\n500\u00a0mg every 12 hours or 1\u00a0g once daily", "Plasma concentration monitoring required\r\n(see Cautions above); pre-dose (\u2018trough\u2019) concentration should be\r\n10\u201315\u00a0mg/litre (15\u201320\u00a0mg/litre for less sensitive strains of meticillin-resistant Staphylococcus aureus)", "Surgical prophylaxis, by intravenous infusion, 1\u00a0g", "child under 18 years\r\nsee BNF for Children", "Vancomycin doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014plasma-vancomycin concentration monitoring essential\r\nto reduce risk of fetal toxicity" }, "TOLTERODINE TARTRATE": { "indications": "Indications\u00a0see under Dose", "name": "TOLTERODINE TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "TOLTERODINE TARTRATE" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; history of QT-interval prolongation; concomitant\r\nuse with other drugs known to prolong QT interval", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\nchest pain, peripheral oedema; sinusitis, bronchitis; paraesthesia,\r\nfatigue, vertigo, weight gain; flushing also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70146.htm", "doses": [ "Urinary frequency, urgency, and incontinence, adult over 18 years, 2\u00a0mg twice daily; reduce to\r\n1\u00a0mg twice daily if necessary to minimise side-effects; child 2\u201318 years see BNF for Children", "Nocturnal enuresis associated with overactive bladder, child 5\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "METFORMIN HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0diabetes\r\nmellitus (see notes above); polycystic ovary syndrome [unlicensed\r\nindication]", "name": "METFORMIN HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.2 Biguanides", "METFORMIN HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 6.1.2.2 Biguanides: British National Formulary)\nVery rarely, metformin can provoke lactic acidosis. It is most likely to occur in patients with renal impairment, see Lactic Acidosis below.Metformin is used for the symptomatic management of polycystic ovary syndrome [unlicensed indication]; however, treatment should be initiated by a specialist. Metformin improves insulin sensitivity, may aid weight reduction, helps to normalise menstrual cycle (increasing the rate of spontaneous ovulation), and may improve hirsutism.; determine renal function before treatment and at least annually (at\r\nleast twice a year in patients with additional risk factors for renal\r\nimpairment, or if deterioration suspected); interactions: Appendix 1 (antidiabetics)Lactic acidosis\u00a0Use with caution\r\nin renal impairment\u2014increased risk of lactic acidosis; avoid in significant renal impairment. NICE%s\n(From Metformin: British National Formulary)\n(1)NICE clinical guideline 87 (May 2009): Type 2 diabetes: The management of type 2 diabetes recommends that the dose\r\nshould be reviewed if eGFR less than 45\u00a0mL/minute/1.73\u00a0m2 and to avoid if eGFR less than 30\u00a0mL/minute/1.73\u00a0m2. Withdraw or interrupt treatment\r\nin those at risk of tissue hypoxia or sudden deterioration in renal\r\nfunction, such as those with dehydration, severe infection, shock,\r\nsepsis, acute heart failure, respiratory failure or hepatic impairment,\r\nor those who have recently had a myocardial infarction", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, diarrhoea (usually\r\ntransient), abdominal pain, taste disturbance, rarely lactic acidosis (withdraw treatment), decreased vitamin-B12 absorption, erythema, pruritus and urticaria; hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201498.htm", "doses": [ "Diabetes mellitus, adult and child over 10 years initially\r\n500\u00a0mg with breakfast for at least 1 week then 500\u00a0mg with breakfast\r\nand evening meal for at least 1 week then 500\u00a0mg with breakfast, lunch\r\nand evening meal; usual max. 2\u00a0g daily in divided doses", "Polycystic ovary syndrome [unlicensed], initially 500\u00a0mg with\r\nbreakfast for 1 week, then 500\u00a0mg with breakfast and evening meal\r\nfor 1 week, then 1.5\u20131.7\u00a0g daily in 2\u20133 divided doses", "Metformin doses in the BNF may differ from\r\nthose in the product literature", "Name[Metformin (Non-Proprietary)] Tablets, m/r, metformin hydrochloride 500\u00a0mg, net price 28 tab-pack = \u00a33.07, 56 tab-pack\r\n= \u00a36.14. \r\n Label:\r\n 21, 25Dose\u00a0initially 500\u00a0mg once daily, increased every 10\u201315 days,\r\nmax. 2\u00a0g once daily with evening meal; if control not achieved, use\r\n1\u00a0g twice daily with meals, and if control still not achieved change\r\nto standard-release tabletsNote\u00a0Patients taking up to 2\u00a0g daily of the standard-release metformin may start with the same daily dose of metformin\r\nmodified release; not suitable if dose of standard-release tablets\r\nmore than 2\u00a0g dailyBrands include Bolamyn\u00ae SR, Glucient\u00ae SR, Metabet\u00ae SR" ], "pregnancy": "Pregnancy\u00a0used in pregnancy for both pre-existing and gestational\r\ndiabetes\u2014see also section 6.1.2" }, "DACTINOMYCIN": { "indications": "Indications\u00a0 \n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nDactinomycin is principally used to treat paediatric cancers; it is given intravenously. Its side-effects are similar to those of doxorubicin, except that cardiac toxicity is not a problem.", "name": "DACTINOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "DACTINOMYCIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215551.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "SALBUTAMOL": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction; premature labour (section 7.1.3)", "name": "SALBUTAMOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "SALBUTAMOL" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also lactic acidosis with high\r\ndoses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31938.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\n4\u00a0mg (elderly and sensitive patients initially 2\u00a0mg) 3\u20134 times daily;\r\nmax. single dose 8\u00a0mg (but unlikely to provide much extra benefit\r\nor to be tolerated); child under 2\r\nyears see BNF for Children; 2\u20136 years 1\u20132\u00a0mg 3\u20134 times daily, 6\u201312 years 2\u00a0mg 3\u20134 times\r\ndaily", "By subcutaneous or intramuscular injection, 500\u00a0micrograms, repeated\r\nevery 4 hours if necessary", "By slow intravenous injection (but\r\nsee also Management of Acute Asthma table), (dilute to a concentration\r\nof 50\u00a0micrograms/mL), 250\u00a0micrograms, repeated if necessary; child under 18 years see BNF for Children", "By intravenous infusion (but see\r\nalso Management of Acute Asthma table), initially 5\u00a0micrograms/minute,\r\nadjusted according to response and heart-rate usually in range 3\u201320\u00a0micrograms/minute,\r\nor more if necessary; child under 18\r\nyears see BNF for Children", "By aerosol inhalation (but see also Management of Acute Asthma table, or Management of Chronic Asthma\r\ntable),\r\n100\u2013200\u00a0micrograms (1\u20132 puffs); for persistent symptoms up to 4 times\r\ndaily; child 100\u00a0micrograms (1 puff),\r\nincreased to 200\u00a0micrograms (2 puffs) if necessary; for persistent\r\nsymptoms up to 4 times daily ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 200\u00a0micrograms\r\n(2 puffs); child 100\u00a0micrograms (1\r\npuff), increased to 200\u00a0micrograms (2 puffs) if necessary", "By inhalation of powder (but see\r\nalso Management of Chronic Asthma\r\ntable),\r\n200\u2013400\u00a0micrograms; for persistent symptoms up to 4 times daily; child over 5 years 200\u00a0micrograms; for persistent\r\nsymptoms up to 4 times daily (for Asmasal Clickhaler\u00ae, Salbulin Novolizer\u00ae, and Ventolin\r\nAccuhaler\u00ae doses, see under preparations) ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 400\u00a0micrograms; child 200\u00a0micrograms", "By inhalation of nebulised solution, adult and child over\r\n5 years 2.5\u20135\u00a0mg, repeated up to 4 times daily or more frequently\r\nin severe cases; child under 5 years\r\n2.5\u00a0mg, repeated up to 4 times daily or more frequently in severe\r\ncases; see also Management of Acute Asthma table and Management of Chronic Asthma\r\ntable" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "TINIDAZOLE - AMOEBICIDES": { "indications": "Indications\u00a0see under Dose below; anaerobic infections, section 5.1.11", "name": "TINIDAZOLE - AMOEBICIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.2 Amoebicides", "TINIDAZOLE" ], "cautions": "Cautions\u00a0section 5.1.11", "side-effects": "Side-effects\u00a0section 5.1.11", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/102433.htm", "doses": [ "Intestinal amoebiasis, 2\u00a0g daily for 2\u20133 days; child 50\u201360\u00a0mg/kg daily for 3 days", "Amoebic involvement of liver, 1.5\u20132\u00a0g daily for 3\u20136 days; child 50\u201360\u00a0mg/kg daily for 5 days", "Urogenital trichomoniasis and giardiasis, single 2\u00a0g dose; child single dose of 50\u201375\u00a0mg/kg (repeated once if\r\nnecessary)" ], "pregnancy": "Pregnancy\u00a0section 5.1.11" }, "RIFAXIMIN": { "indications": "Indications\u00a0travellers\u2019 diarrhoea that is\r\nnot associated with fever, bloody diarrhoea, blood or leucocytes in\r\nthe stool, or 8 or more unformed stools in the previous 24 hours", "name": "RIFAXIMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Rifaximin" ], "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, flatulence,\r\nheadache, dizziness; less commonly taste disturbances,\r\nperipheral oedema, sleep disturbances, nervousness, hypoaesthesia,\r\nparaesthesia, influenza-like symptoms, polyuria, glycosuria, polymenorrhoea,\r\nblood disorders, rash; also reported antibiotic-associated\r\ncolitis, pruritis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203701.htm", "doses": [ "adult over 18 years, 200\u00a0mg\r\nevery 8 hours for 3 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "CO-BENELDOPA": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-BENELDOPA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-BENELDOPA" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215615.htm", "doses": [ "Expressed as levodopa, initially 50\u00a0mg\r\n3\u20134 times daily (100\u00a0mg 3 times daily in advanced disease), increased\r\nby 100\u00a0mg daily once or twice weekly according to response; usual\r\nmaintenance dose 400\u2013800\u00a0mg daily in divided doses; elderly initially 50\u00a0mg once or twice daily, increased\r\nby 50\u00a0mg daily every 3\u20134 days according to response", "When transferring patients from another levodopa/dopa-decarboxylase\r\ninhibitor preparation, the previous preparation should be discontinued\r\n12 hours before (although interval can be shorter)", "When administered as an adjunct to other\r\nantiparkinsonian drugs, once therapeutic effect apparent, the other\r\ndrugs may be reduced or withdrawn", "When switching from modified-release levodopa\r\nto dispersible co-beneldopa, reduce dose by approx. 30%" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "LEVONORGESTREL": { "indications": "Indications\u00a0emergency contraception", "name": "LEVONORGESTREL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.5 Emergency contraception", "Hormonal methods", "LEVONORGESTREL" ], "cautions": "Cautions\u00a0\n(From Hormonal methods: British National Formulary)\nHormonal emergency contraceptives include levonorgestrel and ulipristal; either drug should be taken as soon as possible after unprotected intercourse to increase efficacy.Levonorgestrel is effective if taken within 72 hours (3 days) of unprotected intercourse and may also be used between 72 and 96 hours after unprotected intercourse [unlicensed use], but efficacy decreases with time. Ulipristal, a progesterone receptor modulator, is effective if taken within 120 hours (5 days) of unprotected intercourse.Levonorgestrel is less effective than insertion of an intra-uterine device (see below). Ulipristal is as effective as levonorgestrel, but its efficacy compared to an intra-uterine device is not yet known.If vomiting occurs within 2 hours of taking levonorgestrel or within 3 hours of taking ulipristal, a replacement dose should be given. If an antiemetic is required domperidone is preferred.; past ectopic pregnancy; severe malabsorption syndromes; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: \n(From Hormonal methods: British National Formulary)\nInteractions\u00a0The effectiveness of levonorgestrel, and possibly ulipristal, is reduced in women taking enzyme-inducing drugs (and possibly for 4 weeks after stopping); a copper intra-uterine device can be offered instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3\u00a0mg taken as a single dose [unlicensed dose\u2014advise women accordingly]. There is no need to increase the dose for emergency contraception if the patient is taking antibacterials that are not enzyme inducers. and\r\nAppendix 1 (progestogens)", "side-effects": "Side-effects\u00a0menstrual irregularities (see also notes above), nausea,\r\nlow abdominal pain, fatigue, headache, dizziness, breast tenderness,\r\nvomiting", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/83608.htm", "doses": [ "1.5\u00a0mg as a single dose as soon as possible after coitus,\r\npreferably within 12 hours but no later than after 72 hours (but see\r\nalso notes above)" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "AZELASTINE HYDROCHLORIDE - OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0 mild transient irritation; bitter taste reported", "indications": "Indications\u00a0allergic conjunctivitis", "name": "AZELASTINE HYDROCHLORIDE - OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68963.htm", "doses": [ "Seasonal allergic conjunctivitis, adult and child over 4 years, apply twice\r\ndaily, increased if necessary to 4 times daily", "Perennial conjunctivitis, adult and child over 12 years, apply twice\r\ndaily, increased if necessary to 4 times daily; max. duration of treatment\r\n6 weeks" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "AZELASTINE HYDROCHLORIDE" ] }, "CLOPIDOGREL": { "indications": "Indications\u00a0prevention of atherothrombotic events in peripheral arterial disease,\r\nor within 35 days of myocardial infarction, or within 6 months of\r\nischaemic stroke; prevention of artherothrombotic events in acute\r\ncoronary syndrome without ST-segment elevation (given with aspirin\u2014see\r\nnotes above) and in acute myocardial infarction with ST-segment elevation\r\n(given with aspirin\u2014see notes above); prevention of atherothrombotic\r\nand thromboembolic events in patients with atrial fibrillation (given\r\nwith aspirin\u2014\n(From 2.9 Antiplatelet drugs: British National Formulary)\n2.9 Antiplatelet drugs) and for whom warfarin is unsuitable", "name": "CLOPIDOGREL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "CLOPIDOGREL" ], "cautions": "Cautions\u00a0patients at risk of increased bleeding from trauma, surgery, or other pathological conditions; concomitant use of drugs that increase risk of bleeding; discontinue 7 days before elective surgery if antiplatelet\r\neffect not desirable; interactions: Appendix 1 (clopidogrel)", "side-effects": "Side-effects\u00a0dyspepsia, abdominal pain, diarrhoea; bleeding\r\ndisorders (including gastro-intestinal and intracranial); less commonly nausea, vomiting, gastritis, flatulence, constipation,\r\ngastric and duodenal ulcers, headache, dizziness, paraesthesia, leucopenia,\r\ndecreased platelets (very rarely severe thrombocytopenia), eosinophilia,\r\nrash, and pruritus; rarely vertigo; very\r\nrarely colitis, pancreatitis, hepatitis, acute liver failure,\r\nvasculitis, confusion, hallucinations, taste disturbance, stomatitis,\r\nbronchospasm, interstitial pneumonitis, blood disorders (including\r\nthrombocytopenic purpura, agranulocytosis and pancytopenia), and hypersensitivity-like\r\nreactions (including fever, glomerulonephritis, arthralgia, Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis, lichen planus)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/74105.htm", "doses": [ "Prevention of atherothrombotic events in peripheral arterial\r\ndisease or after myocardial infarction or ischaemic stroke, 75\u00a0mg\r\nonce daily", "Acute coronary syndrome (without ST-segment elevation), initially\r\n300\u00a0mg then 75\u00a0mg daily (with aspirin\u2014see notes above)", "Acute myocardial infarction (with ST-segment elevation), initially\r\n300\u00a0mg then 75\u00a0mg daily (with aspirin\u2014see notes above); initial dose omitted if patient\r\nover 75 years", "Prevention of atherothrombotic and thromboembolic events in\r\npatients with atrial fibrillation (with aspirin\u2014see notes above), 75\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "PALIPERIDONE - ANTIPSYCHOTIC DEPOT INJECTIONS": { "indications": "Indications\u00a0maintenance in schizophrenia in patients\r\npreviously responsive to paliperidone or risperidone", "name": "PALIPERIDONE - ANTIPSYCHOTIC DEPOT INJECTIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "PALIPERIDONE" ], "cautions": "Cautions\u00a0see Paliperidone (section 4.2.1) and notes above", "side-effects": "Side-effects\u00a0see Paliperidone (section 4.2.1) and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215621.htm", "doses": [ "By deep intramuscular injection into the\r\ndeltoid muscle, 150\u00a0mg on day 1, then 100\u00a0mg on day 8, then adjusted\r\nat monthly intervals according to response; recommended maintenance\r\ndose 75\u00a0mg (range 25\u2013150\u00a0mg) monthly", "Following the second dose, monthly maintenance\r\ndoses can be administered into either the deltoid or gluteal muscle;\r\nfor missed doses see product literature" ], "pregnancy": "Pregnancy\u00a0see Paliperidone (section 4.2.1)" }, "HYDROCORTISONE With antimicrobials": { "indications": "Indications\u00a0mild inflammatory skin disorders such as eczemas\r\n(but for over-the-counter preparations, see below); nappy rash (see\r\nalso section 13.2.2)", "name": "HYDROCORTISONE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "HYDROCORTISONE", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5856.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Daktacort\u00ae (Janssen) ] Cream, hydrocortisone 1%, miconazole nitrate 2%, net price 30\u00a0g = \u00a32.49. \r\n Label:\r\n 28, counselling, application. Potency: mildExcipients include butylated\r\nhydroxyanisole, disodium edetateInteractions: Appendix 1 (miconazole)\u2014see miconazole nitrateDental prescribing on NHS\u00a0May be prescribed as\r\nMiconazole and Hydrocortisone Cream for max. 7 daysNote\u00a0A 15-g tube is on sale to the public for\r\nthe treatment of athlete\u2019s foot and candidal intertrigo\nOintment, hydrocortisone 1%, miconazole nitrate 2%, net price 30\u00a0g = \u00a32.50. \r\n Label:\r\n 28, counselling, application. Potency: mildExcipients none as listed in section 13.1.3Interactions: Appendix 1 (miconazole)\u2014see miconazole nitrateDental prescribing on NHS\u00a0May be prescribed as\r\nMiconazole and Hydrocortisone Ointment for max. 7 days" ] }, "ABIRATERONE ACETATE": { "indications": "Indications\u00a0see notes above", "name": "ABIRATERONE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Anti-androgens", "ABIRATERONE ACETATE" ], "cautions": "Cautions\u00a0history of cardiovascular disease\u2014correct hypertension\r\nand hypokalaemia before treatment; monitor blood pressure, serum potassium\r\nconcentration, and fluid balance before treatment, and at least monthly\r\nduring treatment; monitor liver function before treatment, then every\r\n2 weeks for the first 3 months of treatment, then monthly thereafter\u2014interrupt\r\ntreatment if serum alanine aminotransferase greater than 5 times the\r\nupper limit (consult product literature for details of restarting\r\ntreatment at a lower dose) and discontinue if 20 times the upper limit\r\n(and do not readminister)", "side-effects": "Side-effects\u00a0hepatotoxicity (see under Cautions, above), hypertension,\r\nhypertriglyceridaemia, heart failure, angina, arrhythmia, tachycardia,\r\nperipheral oedema, urinary tract infection, hypokalaemia; less commonly adrenal insufficiency", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218798.htm", "doses": [ "1\u00a0g once daily", "Consult product literature for dose of concurrent\r\nprednisone or prednisolone" ] }, "ENOXAPARIN SODIUM": { "indications": "Indications\u00a0see notes above and under preparations", "name": "ENOXAPARIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Low molecular weight heparins" ], "cautions": "Cautions\u00a0see under Heparin and notes above; low body-weight (increased risk of bleeding)", "side-effects": "Side-effects\u00a0see under Heparin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2775.htm", "doses": [ "See under preparation below" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; see also Pregnancy" }, "Other preparations used in peripheral vascular disease": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs" ], "name": "Other preparations used in peripheral vascular disease", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2721.htm", "doses": [ "relief of symptoms of oedema associated with chronic venous\r\ninsufficiency, 500\u00a0mg twice daily" ] }, "LERCANIDIPINE HYDROCHLORIDE": { "indications": "Indications\u00a0mild to moderate hypertension", "name": "LERCANIDIPINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers" ], "cautions": "Cautions\u00a0left ventricular dysfunction; sick sinus syndrome (if pacemaker not fitted); interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0less commonly flushing, peripheral\r\noedema, palpitation, tachycardia, headache, dizziness; rarely gastro-intestinal disturbances, angina, asthenia, drowsiness, polyuria,\r\nmyalgia, rash; very rarely gingival hyperplasia,\r\nmyocardial infarction, hypotension; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69311.htm", "doses": [ "Initially 10\u00a0mg once daily; increased, if necessary, after\r\nat least 2 weeks to 20\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "CARBOMERS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "CARBOMERS" ], "indications": "Indications\u00a0dry eyes including keratoconjunctivitis sicca, unstable tear film", "name": "CARBOMERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128434.htm", "doses": [ "Apply 3\u20134 times daily or as required" ] }, "PAROXETINE": { "indications": "Indications\u00a0major depression, obsessive-compulsive disorder, panic disorder;\r\nsocial anxiety disorder; post-traumatic stress disorder; generalised\r\nanxiety disorder", "name": "PAROXETINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors", "PAROXETINE" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.; also achlorhydria or high gastric pH (reduced absorption\r\nof oral suspension)", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; also yawning; abnormal dreams;\r\nraised cholesterol; less commonly arrhythmias, confusion,\r\nurinary incontinence; rarely panic attacks and paradoxical\r\nincreased anxiety during initial treatment of panic disorder (reduce\r\ndose), depersonalisation, and neuroleptic malignant syndrome-like\r\nevent; rarely restless legs syndrome; very\r\nrarely peripheral oedema, acute glaucoma, hepatic disorders\r\n(e.g. hepatitis), and priapism; also reported tinnitus,\r\nextrapyramidal reactions (including orofacial dystonias) and withdrawal\r\nreactions (\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nThe risk of withdrawal reactions is higher with paroxetine (see also Withdrawal, section 4.3). Gastro-intestinal disturbances, headache, anxiety, dizziness, paraesthesia, electric shock sensation in the head, neck, and spine, tinnitus, sleep disturbances, fatigue, influenza-like symptoms, and sweating are the most common features of abrupt withdrawal of an SSRI or marked reduction of the dose; palpitation and visual disturbances can occur less commonly. The dose should be tapered over at least a few weeks to avoid these effects. For some patients, it may be necessary to withdraw treatment over a longer period; consider obtaining specialist advice if symptoms persist.)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3370.htm", "doses": [ "Major depression, social anxiety disorder, post-traumatic\r\nstress disorder, generalised anxiety disorder, adult over 18 years, recommended dose 20\u00a0mg each morning (no evidence\r\nof greater efficacy at higher doses); max. 50\u00a0mg daily (elderly 40\u00a0mg daily); child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)", "Obsessive-compulsive disorder, adult over 18 years, initially 20\u00a0mg each morning, increased gradually\r\nin steps of 10\u00a0mg to recommended dose of 40\u00a0mg daily (no evidence\r\nof greater efficacy at higher doses); max. 60\u00a0mg daily (elderly 40\u00a0mg daily)", "Panic disorder, adult over 18\r\nyears, initially 10\u00a0mg each morning, increased gradually in steps\r\nof 10\u00a0mg to recommended dose of 40\u00a0mg daily (no evidence of greater\r\nefficacy at higher doses); max. 60\u00a0mg daily (elderly 40\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0increased risk of congenital malformations, especially\r\nif used in the first trimester; see also notes above" }, "OXYBUTYNIN HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence, neurogenic bladder instability,\r\nand nocturnal enuresis associated with overactive bladder", "name": "OXYBUTYNIN HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "OXYBUTYNIN HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also less commonly anorexia, facial flushing; rarely night terrors; application site reactions with patches; also reported cognitive impairment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88024.htm", "doses": [ "adult and child over 12 years, initially 5\u00a0mg 2\u20133 times daily,\r\nincreased if necessary to max. 5\u00a0mg 4 times daily; elderly initially 2.5\u20133\u00a0mg twice daily, increased\r\nto 5\u00a0mg twice daily according to response and tolerance; child 5\u201312 years, neurogenic bladder instability,\r\n2.5\u20133\u00a0mg twice daily, increased to 5\u00a0mg 2\u20133 times daily; child under 5 years see BNF for Children; child 5\u201318 years, nocturnal enuresis associated with\r\noveractive bladder, 2.5\u20133\u00a0mg twice daily increased to 5\u00a0mg 2\u20133 times\r\ndaily (last dose before bedtime)", "Name[Lyrinel\u00ae XL (Janssen) ] Tablets, m/r, oxybutynin\r\nhydrochloride 5\u00a0mg (yellow), net price 30-tab pack = \u00a313.77;\r\n10\u00a0mg (pink), 30-tab pack = \u00a327.54. \r\n Label:\r\n 3, 25Dose\u00a0initially 5\u00a0mg once daily, adjusted according to response\r\nin steps of 5\u00a0mg at weekly intervals; max. 20\u00a0mg once daily; child over 6 years, neurogenic bladder instability,\r\ninitially 5\u00a0mg once daily, adjusted according to response in steps\r\nof 5\u00a0mg at weekly intervals; max. 15\u00a0mg once dailyNote\u00a0Patients taking immediate-release oxybutynin\r\nmay be transferred to the nearest equivalent daily dose of Lyrinel\u00ae XL" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless essential\u2014toxicity\r\nin animal studies" }, "DOXYCYCLINE - ANTIMALARIALS": { "indications": "Indications\u00a0prophylaxis of malaria; adjunct to\r\nquinine in treatment of Plasmodium falciparum malaria; see also section 5.1.3", "name": "DOXYCYCLINE - ANTIMALARIALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Tetracyclines", "DOXYCYCLINE" ], "cautions": "Cautions\u00a0section 5.1.3", "side-effects": "Side-effects\u00a0section 5.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127945.htm", "doses": [ "Prophylaxis of malaria, started 1\u20132 days before entering\r\nendemic area and continued for 4 weeks after leaving (see notes above), adult and child over\r\n12 years, 100\u00a0mg once daily", "Treatment of falciparum malaria, see notes above" ], "pregnancy": "Pregnancy\u00a0section 5.1.3" }, "LEVOFOLINIC ACID Disodium levofolinate": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nThe calcium salt of levofolinic acid, a single isomer of folinic acid, is also used for rescue therapy following methotrexate administration, for cases of methotrexate overdose, and for use with fluorouracil for colorectal cancer. The dose of calcium levofolinate is generally half that of calcium folinate.", "name": "LEVOFOLINIC ACID Disodium levofolinate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression", "LEVOFOLINIC ACID", "Disodium levofolinate" ], "cautions": "Cautions\u00a0see Folinic acid", "side-effects": "Side-effects\u00a0see Folinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202613.htm", "doses": [ "See under preparations", "Adjunct to fluorouracil in colorectal cancer,\r\nconsult product literature", "Name[Levofolinic Acid (Non-proprietary) ] Injection, levofolinic acid (as\r\ndisodium salt) 50\u00a0mg/mL, net price 1-mL vial = \u00a324.70, 4-mL vial =\r\n\u00a380.40Dose\u00a0as an antidote to methotrexate, by intravenous injection or infusion, consult product literatureAdjunct to fluorouracil in colorectal cancer,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0see Folinic acid" }, "AZATHIOPRINE - ANTIPROLIFERATIVE IMMUNOSUPPRESSANTS": { "indications": "Indications\u00a0\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nThiopurine methyltransferaseThe enzyme thiopurine methyltransferase (TPMT) metabolises thiopurine drugs (azathioprine, mercaptopurine, tioguanine); the risk of myelosuppression is increased in patients with reduced activity of the enzyme, particularly for the few individuals in whom TPMT activity is undetectable. Consider measuring TPMT activity before starting azathioprine, mercaptopurine, or tioguanine therapy. Patients with absent TPMT activity should not receive thiopurine drugs; those with reduced TPMT activity may be treated under specialist supervision.; inflammatory bowel disease [unlicensed\r\nindication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE); rheumatoid arthritis (%s\n(From Drugs affecting the immune response: British National Formulary)\nDrugs affecting the immune response); severe\r\nrefractory eczema [unlicensed indication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE)", "name": "AZATHIOPRINE - ANTIPROLIFERATIVE IMMUNOSUPPRESSANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.1 Antiproliferative immunosuppressants", "AZATHIOPRINE" ], "cautions": "Cautions\u00a0\n(From Immunosuppressant therapy: British National Formulary)\nBioavailabilityDifferent formulations of the same immunosuppressant may vary in bioavailability and to avoid reduced effect or excessive side-effects, it is important not to change formulation except on the advice of a transplant specialist.;\r\nthiopurine methyltransferase status (see notes above); monitor\r\nfor toxicity throughout treatment; monitor full blood\r\ncount weekly (more frequently with higher doses or if severe hepatic\r\nor renal impairment) for first 4 weeks (manufacturer advises weekly\r\nmonitoring for 8 weeks but evidence of practical value unsatisfactory),\r\nthereafter reduce frequency of monitoring to at least every 3 months; reduce dose in elderly; interactions: Appendix 1 (azathioprine)Bone marrow suppression\u00a0Patients\r\nshould be warned to report immediately any signs or symptoms of bone\r\nmarrow suppression e.g. inexplicable bruising or bleeding, infection", "side-effects": "Side-effects\u00a0hypersensitivity reactions (including malaise,\r\ndizziness, vomiting, diarrhoea, fever, rigors, myalgia, arthralgia,\r\nrash, hypotension and interstitial nephritis\u2014calling for immediate\r\nwithdrawal); dose-related bone marrow suppression (see also Cautions);\r\nliver impairment, cholestatic jaundice, hair loss and increased susceptibility\r\nto infections and colitis in patients also receiving corticosteroids;\r\nnausea; rarely pancreatitis, pneumonitis, hepatic\r\nveno-occlusive disease, lymphoma, red cell aplasia\u2014\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nMycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine. It is licensed for the prophylaxis of acute rejection in renal, hepatic or cardiac transplantation when used in combination with ciclosporin and corticosteroids. There is evidence that compared with similar regimens incorporating azathioprine, mycophenolate mofetil reduces the risk of acute rejection episodes; the risk of opportunistic infections (particularly due to tissue-invasive cytomegalovirus) and the occurrence of blood disorders such as leucopenia may be higher.Cases of pure red cell aplasia have been reported with azathioprine and with mycophenolate mofetil; dose reduction or discontinuation should be considered under specialist supervision.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4780.htm", "doses": [ "By mouth, or (if\r\noral administration not possible\u2014intravenous solution very irritant,\r\nsee below) by intravenous injection over at least 1\r\nminute (followed by 50\u00a0mL sodium chloride intravenous\r\ninfusion), or by intravenous infusion", "Autoimmune conditions, 1\u20133\u00a0mg/kg daily, adjusted according to\r\nresponse (consider withdrawal if no improvement within 3 months)", "Suppression of transplant rejection, 1\u20132.5\u00a0mg/kg daily adjusted according\r\nto response", "Azathioprine doses in BNF may differ from\r\nthose in product literature", "Intravenous injection is alkaline and very irritant, intravenous route should therefore\r\nbe used only if oral route not feasible, see also\r\nAppendix 4" ], "pregnancy": "Pregnancy\u00a0treatment should not generally be initiated during\r\npregnancy; see also Immunosuppressant therapy" }, "MEDROXYPROGESTERONE ACETATE - FEMALE SEX HORMONES": { "indications": "Indications\u00a0see under Dose; contraception (section 7.3.2.2); malignant\r\ndisease (section\r\n8.3.2)", "name": "MEDROXYPROGESTERONE ACETATE - FEMALE SEX HORMONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens", "MEDROXYPROGESTERONE ACETATE" ], "cautions": "Cautions\u00a0\n(From 6.4.1.2 Progestogens: British National Formulary)\nCautions\u00a0Progestogens should be used with caution in conditions that may worsen with fluid retention e.g. epilepsy, hypertension, migraine, asthma, or cardiac dysfunction, and in those susceptible to thromboembolism (particular caution with high dose). Care is also required in those with a history of depression. Progestogens can decrease glucose tolerance and patients with diabetes should be monitored closely. For interactions see Appendix 1 (progestogens).", "side-effects": "Side-effects\u00a0see notes above; indigestion", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4349.htm", "doses": [ "By mouth, 2.5\u201310\u00a0mg daily for 5\u201310 days\r\nbeginning on day 16 to 21 of cycle, repeated for 2 cycles in dysfunctional\r\nuterine bleeding and 3 cycles in secondary amenorrhoea", "Mild to moderate endometriosis, 10\u00a0mg 3 times daily for 90 consecutive\r\ndays, beginning on day 1 of cycle", "Progestogenic opposition of oestrogen HRT, 10\u00a0mg daily for the\r\nlast 14 days of each 28-day oestrogen HRT cycle" ], "pregnancy": "Pregnancy\u00a0section 8.3.2" }, "ALTEPLASE": { "indications": "Indications\u00a0acute myocardial infarction (see\r\nnotes above and section 2.10.1); pulmonary embolism; acute\r\nischaemic stroke (treatment under specialist neurology physician only); thrombolytic treatment of occluded central venous\r\naccess devices (including those used for haemodialysis)", "name": "ALTEPLASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.10 Stable angina, acute coronary syndromes, and fibrinolysis", "2.10.2 Fibrinolytic drugs", "ALTEPLASE" ], "cautions": "Cautions\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nCautions\u00a0Thrombolytic drugs should be used with caution if there is a risk of bleeding including that from venepuncture or invasive procedures. They should also be used with caution in external chest compression, elderly, hypertension, conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation), and recent or concurrent use of drugs that increase the risk of bleeding.; in acute stroke, monitor for intracranial haemorrhage, monitor blood pressure (antihypertensive recommended if systolic\r\nabove 180\u00a0mmHg or diastolic above 105\u00a0mmHg)", "side-effects": "Side-effects\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nSide-effects\u00a0Side-effects of thrombolytics are mainly nausea and vomiting and bleeding. When thrombolytics are used in myocardial infarction, reperfusion arrhythmias and recurrent ischaemia and angina may occur. Reperfusion may also cause cerebral and pulmonary oedema. Hypotension can also occur and can usually be controlled by elevating the patient\u2019s legs, or by reducing the rate of infusion or stopping it temporarily. Back pain, fever, and convulsions have been reported. Bleeding is usually limited to the site of injection, but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs (e.g. tranexamic acid). Rarely further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). Thrombolytics can cause allergic reactions (including rash, flushing and uveitis) and anaphylaxis has been reported (for details of management see Allergic Emergencies, section 3.4.3). Guillain-Barr\u00e9 syndrome has been reported rarely after streptokinase treatment.; also\r\nrisk of cerebral bleeding increased in acute stroke", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2815.htm", "doses": [ "See under preparations below", "myocardial infarction, accelerated regimen (initiated\r\nwithin 6 hours of symptom onset), 15\u00a0mg by intravenous injection, followed by intravenous infusion of 50\u00a0mg over 30\r\nminutes, then 35\u00a0mg over 60 minutes (total dose 100\u00a0mg over 90 minutes);\r\nin patients less than 65\u00a0kg, 15\u00a0mg by intravenous injection, followed by intravenous infusion of 0.75\u00a0mg/kg over\r\n30 minutes, then 0.5\u00a0mg/kg over 60 minutes (max. total dose 100\u00a0mg\r\nover 90 minutes)", "Myocardial infarction, initiated within 6\u201312 hours\r\nof symptom onset, 10\u00a0mg by intravenous injection, followed by intravenous infusion of 50\u00a0mg over 60 minutes, then 4 infusions each of 10\u00a0mg over 30 minutes (total dose 100\u00a0mg\r\nover 3 hours; max. 1.5\u00a0mg/kg in patients less than 65\u00a0kg)", "Pulmonary embolism, 10\u00a0mg by intravenous injection over 1\u20132 minutes, followed by intravenous infusion of 90\u00a0mg over 2 hours; max. 1.5\u00a0mg/kg in patients less than 65\u00a0kg", "Acute stroke (treatment must begin within 3\r\nhours of symptom onset), by intravenous administration over 60 minutes, 900\u00a0micrograms/kg (max. 90\u00a0mg); initial 10% of\r\ndose by intravenous injection, remainder by intravenous infusion; elderly over 80 years not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nPregnancy\u00a0Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy." }, "FINASTERIDE - ANDROGENETIC ALOPECIA": { "side-effects": "Side-effects\u00a0section 6.4.2", "indications": "Indications\u00a0androgenetic alopecia in men; benign\r\nprostatic hyperplasia (section 6.4.2)", "name": "FINASTERIDE - ANDROGENETIC ALOPECIA", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106493.htm", "doses": [ "By mouth 1\u00a0mg daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.9 Shampoos and other preparations for scalp and hair conditions", "Androgenetic alopecia", "FINASTERIDE" ], "cautions": "Cautions\u00a0section 6.4.2" }, "FEBUXOSTAT": { "indications": "Indications\u00a0treatment of chronic hyperuricaemia\r\nin gout (but see also NICE guidance)", "name": "FEBUXOSTAT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Long-term control of gout" ], "cautions": "Cautions\u00a0administer prophylactic NSAID (not aspirin or salicylates) or colchicine for at least 6\r\nmonths after starting febuxostat to avoid precipitating an acute attack; transplant recipients; monitor liver function tests before and periodically during treatment\r\nas indicated; thyroid disorders; interactions: Appendix 1 (febuxostat)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, abnormal liver\r\nfunction tests; headache; rash; less commonly taste\r\ndisturbances, increased appetite; hypertension, oedema, flushing;\r\ndizziness, paraesthesia, drowsiness; influenza-like symptoms; haematuria,\r\nnephrolithiasis, increased urinary frequency, decreased libido; myalgia;\r\ndermatitis, pruritus, urticaria; rarely thirst, palpitation, asthenia, nervousness, insomnia, and renal impairment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204954.htm", "doses": [ "adult over 18 years, 80\u00a0mg\r\nonce daily, if after 2\u20134 weeks serum uric acid greater than 6\u00a0mg/100\u00a0mL,\r\nincrease to 120\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014limited information available" }, "ADALIMUMAB - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0\n(From 13.5.3 Drugs affecting the immune response: British National Formulary)\nEtanercept, adalimumab, and infliximab inhibit the activity of tumour necrosis factor (TNF\u03b1). They are used for severe plaque psoriasis either refractory to at least 2 standard systemic treatments and photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications; while either etanercept or adalimumab is considered to be the first choice in stable disease, infliximab or adalimumab may be useful when rapid disease control is required. Ustekinumab (a monoclonal antibody that inhibits interleukins 12 and 23) can be used for severe plaque psoriasis that has not responded to at least 2 standard systemic treatments and photochemotherapy, or when these treatments cannot be used because of intolerance or contra-indications (see also NICE guidance below). Adalimumab, etanercept, and infliximab are also licensed for psoriatic arthritis (section 10.1.3).NICE guidance(1)Adalimumab for plaque psoriasis in adults (June 2008)Adalimumab is recommended for the treatment of severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Adalimumab should be withdrawn if the response is not adequate after 16 weeks.NICE guidance(2)Etanercept and efalizumab for plaque psoriasis in adults (July 2006)Etanercept is recommended for severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Etanercept should be withdrawn if the response is not adequate after 12 weeks.Following suspension of the marketing authorisation for efalizumab, NICE has temporarily withdrawn its guidance on the use of efalizumab for plaque psoriasis.NICE guidanceInfliximab for plaque psoriasis in adults (January 2008)Infliximab is recommended for the treatment of very severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) or to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Infliximab should be withdrawn if the response is not adequate after 10 weeks.NICE GuidanceUstekinumab for plaque psoriasis in adults (September 2009)Ustekinumab is recommended for the treatment of severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Ustekinumab should be withdrawn if the response is not adequate after 16 weeks.For patients weighing over 100\u00a0kg, the manufacturer should provide the 90-mg dose of ustekinumab at the same price as the 45-mg dose; Crohn\u2019s\r\ndisease (%s\n(From ADALIMUMAB: British National Formulary)\nADALIMUMAB); ankylosing spondylitis, polyarticular\r\njuvenile idiopathic arthritis, psoriatic arthritis, rheumatoid arthritis\r\n(%s\n(From ADALIMUMAB: British National Formulary)\nADALIMUMAB)", "name": "ADALIMUMAB - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators", "ADALIMUMAB" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201659.htm", "doses": [ "By subcutaneous injection, plaque psoriasis, adult over 18 years, initially 80\u00a0mg, then 40\u00a0mg\r\non alternate weeks starting 1 week after initial dose; discontinue\r\ntreatment if no response within 16 weeks" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "OCTREOTIDE Depot preparation": { "indications": "Indications\u00a0see under Dose", "name": "OCTREOTIDE Depot preparation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.3 Somatostatin analogues", "OCTREOTIDE", "Depot preparation" ], "cautions": "Cautions\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\nCautions\u00a0Growth hormone-secreting pituitary tumours can expand causing serious complications; during treatment with somatostatin analogues patients should be monitored for signs of tumour expansion (e.g. visual field defects). Ultrasound examination of the gallbladder is recommended before treatment and at intervals of 6\u201312 months during treatment (avoid abrupt withdrawal of short-acting octreotide\u2014see Side-effects below). In insulinoma an increase in the depth and duration of hypoglycaemia may occur (observe patients when initiating treatment and changing doses); in diabetes mellitus, insulin or oral antidiabetic requirements may be reduced. Patients with carcinoid tumours must only receive lanreotide after excluding the presence of an obstructive intestinal tumour.; monitor thyroid function on long-term therapy; interactions: Appendix 1 (octreotide)", "side-effects": "Side-effects\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\n8.3.4.3 Somatostatin analogues; also arrhythmias, bradycardia,\r\ndyspnoea, headache, dizziness, dehydration, alopecia,\r\nrash; hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/67833.htm", "doses": [ "Symptoms associated with carcinoid tumours with features of carcinoid syndrome,\r\nVIPomas, glucagonomas, by subcutaneous injection, initially 50\u00a0micrograms once or twice daily, gradually increased\r\naccording to response to 200\u00a0micrograms 3 times daily (higher doses\r\nrequired exceptionally); maintenance doses variable; in carcinoid\r\ntumours discontinue after 1 week if no effect; if rapid response required,\r\ninitial dose by intravenous injection (with ECG monitoring\r\nand after dilution to a concentration of 10\u201350% with sodium\r\nchloride 0.9% injection)", "Acromegaly, short-term treatment before pituitary surgery or long-term treatment in those inadequately controlled\r\nby other treatment or until radiotherapy becomes\r\nfully effective by subcutaneous injection, 100\u2013200\u00a0micrograms\r\n3 times daily; discontinue if no improvement within 3 months", "Prevention of complications following pancreatic surgery, consult\r\nproduct literature", "Name[Sandostatin Lar\u00ae (Novartis) ] Injection (microsphere powder for\r\naqueous suspension), octreotide (as acetate) 10-mg\r\nvial = \u00a3427.13; 20-mg vial = \u00a3705.50; 30-mg vial = \u00a3903.13 (all supplied\r\nwith 2.5-mL diluent-filled syringe)Dose\u00a0acromegaly (test dose by subcutaneous injection 50\u2013100\u00a0micrograms if subcutaneous octreotide not previously given),\r\nneuroendocrine (particularly carcinoid) tumour adequately controlled\r\nby subcutaneous octreotide, by deep intramuscular injection into gluteal muscle, initially 20\u00a0mg every 4 weeks for 3 months\r\nthen adjusted according to response; max. 30\u00a0mg every 4 weeksFor acromegaly, start depot octreotide 1 day after the last dose of subcutaneous octreotide (for pituitary surgery give last dose of depot octreotide at least\r\n3 weeks before surgery); for neuroendocrine tumours, continue subcutaneous octreotide for 2 weeks after first dose of depot octreotide Advanced neuroendocrine tumours of the midgut,\r\nor tumours of unknown primary origin where non-midgut sites of origin\r\nhave been excluded, 30\u00a0mg every 4 weeks" ], "pregnancy": "Pregnancy\u00a0possible effect on fetal growth; manufacturer advises\r\nuse only if potential benefit outweighs risk and effective contraception\r\nrequired during treatment" }, "CARBOPLATIN": { "indications": "Indications\u00a0\n(From Platinum compounds: British National Formulary)\nCarboplatin is widely used in the treatment of advanced ovarian cancer and lung cancer (particularly the small cell type). It is given intravenously. The dose of carboplatin is determined according to renal function rather than body surface area. Carboplatin can be given on an outpatient basis and is better tolerated than cisplatin; nausea and vomiting are reduced in severity and nephrotoxicity, neurotoxicity, and ototoxicity are much less of a problem than with cisplatin. It is, however, more myelosuppressive than cisplatin.", "name": "CARBOPLATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Platinum compounds" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (platinum compounds)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11760.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and embryotoxic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "GENTAMICIN - ANTIBACTERIALS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials" ], "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "GENTAMICIN - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5386.htm", "doses": [ "See Administration in\r\nnotes above" ] }, "PROPYLTHIOURACIL": { "indications": "Indications\u00a0hyperthyroidism", "name": "PROPYLTHIOURACIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.2 Thyroid and antithyroid drugs", "6.2.2 Antithyroid drugs", "PROPYLTHIOURACIL" ], "cautions": "Cautions\u00a0monitor for hepatotoxicityHepatotoxicity\u00a0Severe hepatic reactions\r\nhave been reported, including fatal cases and cases requiring liver\r\ntransplant\u2014discontinue if significant liver-enzyme abnormalities developCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek prompt\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain, jaundice, dark urine, or pruritus develop", "side-effects": "Side-effects\u00a0see under Carbimazole; leucopenia;\r\nrarely cutaneous vasculitis, thrombocytopenia, aplastic anaemia, hypoprothrombinaemia,\r\nhepatic disorders (including hepatitis, hepatic failure, encephalopathy,\r\nhepatic necrosis; see also Hepatotoxicity above), nephritis, lupus\r\nerythematous-like syndromes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202832.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0neonatal goitre and hypothyroidism; see also notes above" }, "ETAMSYLATE ": { "indications": "Indications\u00a0short-term blood loss in menorrhagia", "name": "ETAMSYLATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.11 Antifibrinolytic drugs and haemostatics" ], "cautions": "Cautions\u00a0exclude structural or histological causes of menorrhagia,\r\nor fibroids causing distortion of the uterine cavity, before initiating\r\ntreatment", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, fever (discontinue\r\ntreatment), headache, rashes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128139.htm", "doses": [ "500\u00a0mg 4 times daily during menstruation" ] }, "CATUMAXOMAB": { "indications": "Indications\u00a0\n(From Catumaxomab: British National Formulary)\nCatumaxomab", "name": "CATUMAXOMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Catumaxomab", "CATUMAXOMAB" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; haemodynamic insufficiency, oedema,\r\nhypoproteinaemia", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also abdominal pain,\r\ndiarrhoea, constipation, dyspepsia, flatulence, ileus, anorexia, dehydration,\r\ncholangitis, tachycardia, hypotension, hypertension, flushing, dyspnoea,\r\npleural effusion, cough, hypoxia, insomnia, anxiety, headache, dizziness,\r\ninfection, hyperglycaemia, electrolyte disturbances, proteinuria,\r\nhaematuria, leukocyturea, myalgia, arthralgia, vertigo, rash, sweating,\r\nskin reactions, less commonly gastro-intestinal haemorrhage,\r\nintestinal obstruction, seizures, acute renal failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218119.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid\u2014limited information available" }, "IRBESARTAN With diuretic": { "indications": "Indications\u00a0hypertension; renal disease in hypertensive type 2 diabetes mellitus\r\n(see also notes above)", "name": "IRBESARTAN With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "IRBESARTAN", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also nausea, vomiting; fatigue;\r\nmusculoskeletal pain; less commonly diarrhoea, dyspepsia,\r\nflushing, tachycardia, chest pain, cough, and sexual dysfunction; rarely rash, urticaria; very rarely headache,\r\nmyalgia, arthralgia, tinnitus, taste disturbance, hepatitis, renal\r\ndysfunction, and cutaneous vasculitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89563.htm", "doses": [ "Hypertension, initially 150\u00a0mg once daily, increased if\r\nnecessary to 300\u00a0mg once daily (in haemodialysis or in elderly over 75 years, initial dose of 75\u00a0mg once\r\ndaily may be used); child not recommended", "Renal disease in hypertensive type 2 diabetes mellitus, initially\r\n150\u00a0mg once daily, increased to 300\u00a0mg once daily if tolerated (in\r\nhaemodialysis or in elderly over 75\r\nyears, consider initial dose of 75\u00a0mg once daily); child not recommended", "Name[CoAprovel\u00ae (Bristol-Myers Squibb) (Sanofi-Aventis) ] Tablets, f/c, irbesartan 150\u00a0mg, hydrochlorothiazide 12.5\u00a0mg (peach),\r\nnet price 28-tab pack = \u00a311.84; irbesartan 300\u00a0mg, hydrochlorothiazide 12.5\u00a0mg (peach), 28-tab pack = \u00a315.93;\r\nirbesartan 300\u00a0mg, hydrochlorothiazide 25\u00a0mg (pink), 28-tab pack =\r\n\u00a315.93" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "SODIUM CHLORIDE - MOUTHWASHES, GARGLES, AND DENTIFRICES": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "SODIUM CHLORIDE" ], "indications": "Indications\u00a0oral hygiene,\r\n\n(From 12.3.4 Mouthwashes, gargles, and dentifrices: British National Formulary)\n12.3.4 Mouthwashes, gargles, and dentifrices", "name": "SODIUM CHLORIDE - MOUTHWASHES, GARGLES, AND DENTIFRICES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5748.htm", "doses": [ "extemporaneous preparations should be prepared according\r\nto the following formula: sodium chloride 1.5\u00a0g, sodium bicarbonate 1\u00a0g, concentrated peppermint emulsion 2.5\u00a0mL, double-strength chloroform\r\nwater 50\u00a0mL, water to 100\u00a0mL" ] }, "AMLODIPINE With valsartan": { "indications": "Indications\u00a0hypertension, prophylaxis of angina", "name": "AMLODIPINE With valsartan", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "AMLODIPINE", "With valsartan" ], "cautions": "Cautions\u00a0acute porphyria (but see section 9.8.2); interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0abdominal pain, nausea; palpitation, flushing,\r\noedema; headache, dizziness, sleep disturbances, fatigue; less commonly gastro-intestinal disturbances, dry mouth,\r\ntaste disturbances, hypotension, syncope, chest pain, dyspnoea, rhinitis,\r\nmood changes, asthenia, tremor, paraesthesia, urinary disturbances,\r\nimpotence, gynaecomastia, weight changes, myalgia, muscle cramps,\r\nback pain, arthralgia, visual disturbances, tinnitus, pruritus, rashes\r\n(including isolated reports of erythema multiforme), sweating, alopecia,\r\npurpura, and skin discolouration; very rarely gastritis,\r\npancreatitis, hepatitis, jaundice, cholestasis, gingival hyperplasia,\r\nmyocardial infarction, arrhythmias, tachycardia, vasculitis, coughing,\r\nperipheral neuropathy, hyperglycaemia, thrombocytopenia, angioedema,\r\nand urticaria; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130153.htm", "doses": [ "Hypertension or angina, initially 5\u00a0mg once daily; max.\r\n10\u00a0mg once daily", "Tablets from various suppliers may contain\r\ndifferent salts (e.g. amlodipine besilate, amlodipine maleate, and\r\namlodipine mesilate) but the strength is expressed in terms of amlodipine\r\n(base); tablets containing different salts are considered interchangeable", "Name[Exforge\u00ae (Novartis) ] Tablets 5/80, f/c, dark yellow,\r\namlodipine 5\u00a0mg, valsartan 80\u00a0mg, net price 28-tab pack = \u00a313.97\nTablets 5/160, f/c, dark yellow,\r\namlodipine 5\u00a0mg, valsartan 160\u00a0mg, net price 28-tab pack = \u00a318.41\nTablets 10/160, f/c, light yellow,\r\namlodipine 10\u00a0mg, valsartan 160\u00a0mg, net price 28-tab pack = \u00a318.41" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid,\r\nbut risk to fetus should be balanced against risk of uncontrolled\r\nmaternal hypertension" }, "BEVACIZUMAB": { "indications": "Indications\u00a0\n(From Bevacizumab: British National Formulary)\nBevacizumab", "name": "BEVACIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Bevacizumab", "BEVACIZUMAB" ], "cautions": "Cautions\u00a0see section 8.1; intra-abdominal inflammation (risk of gastro-intestinal perforation); increased\r\nrisk of fistulas (discontinue permanently if tracheo-oesophageal or\r\ngrade 4 fistula develops); withhold treatment\r\nfor elective surgery and avoid for at least\r\n28 days after major surgery or until wound fully healed; history of hypertension (increased risk\r\nof proteinuria\u2014discontinue if nephrotic syndrome); uncontrolled hypertension; monitor blood pressure; history of arterial\r\nthromboembolism; history of cardiovascular\r\ndisease (increased risk of cardiovascular events especially in the\r\nelderly); monitor for congestive heart\r\nfailure; increased risk of haemorrhage\r\n(especially tumour-associated haemorrhage); monitor for reversible posterior leucoencephalopathy syndrome (presenting\r\nas seizures, headache, altered mental status, visual disturbance or\r\ncortical blindness, with or without hypertension); untreated CNS metastases; consider dental check-up\r\nbefore initiating treatment (risk of osteonecrosis of the jaw, see MHRA/CHM advice)", "side-effects": "Side-effects\u00a0see section 8.1; gastro-intestinal perforation, intestinal obstruction,\r\nabdominal pain, diarrhoea, constipation, taste disturbances; mucocutaneous\r\nbleeding, haemorrhage, hypoxia, arterial thromboembolism, congestive\r\nheart failure, syncope, supraventricular tachycardia, hypertension\r\n(see also Cautions); dyspnoea, rhinitis; anorexia, drowsiness, headache,\r\nperipheral neuropathy, asthenia, lethargy; pyrexia; proteinuria; dehydration;\r\neye disorders; fistulas, pulmonary hypertension, impaired wound healing,\r\nosteonecrosis of the jaw (see MHRA/CHM advice), hand-foot syndrome, exfoliative\r\ndermatitis, dry skin, skin discoloration, and hypersensitivity reactions\r\n(including flushing, rash, hypotension, chest pain, and rigors) also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129344.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies;\r\neffective contraception required during and for at least 6 months\r\nafter treatment in women; see also Pregnancy and Reproductive\r\nFunction" }, "ENOXIMONE": { "indications": "Indications\u00a0congestive heart failure where cardiac output reduced and filling\r\npressures increased", "name": "ENOXIMONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.1 Positive inotropic drugs", "2.1.2 Phosphodiesterase type-3 inhibitors", "ENOXIMONE" ], "cautions": "Cautions\u00a0heart failure associated with hypertrophic cardiomyopathy, stenotic or obstructive\r\nvalvular disease or other outlet obstruction; monitor blood pressure, heart rate, ECG, central venous pressure, fluid and electrolyte status, renal function, platelet count, hepatic enzymes; avoid extravasation; interactions: Appendix 1 (phosphodiesterase\r\ntype-3 inhibitors)", "side-effects": "Side-effects\u00a0ectopic beats; less frequently ventricular tachycardia\r\nor supraventricular arrhythmias (more likely in patients with pre-existing\r\narrhythmias); hypotension; also headache, insomnia, nausea and vomiting,\r\ndiarrhoea; occasionally, chills, oliguria, fever, urinary retention;\r\nupper and lower limb pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2319.htm", "doses": [ "By slow intravenous injection (rate not\r\nexceeding 12.5\u00a0mg/minute), diluted before use, initially 0.5\u20131\u00a0mg/kg,\r\nthen 500\u00a0micrograms/kg every 30\u00a0minutes until satisfactory response\r\nor total of 3\u00a0mg/kg given; maintenance, initial dose of up to 3\u00a0mg/kg\r\nmay be repeated every 3\u20136\u00a0hours as required", "By intravenous infusion, initially\r\n90\u00a0micrograms/kg/minute over 10\u201330\u00a0minutes, followed by continuous\r\nor intermittent infusion of 5\u201320\u00a0micrograms/kg/minute", "Total dose over 24\u00a0hours should not usually exceed 24\u00a0mg/kg" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "TOPOTECAN": { "indications": "Indications\u00a0\n(From Topoisomerase I inhibitors: British National Formulary)\nTopoisomerase I inhibitors", "name": "TOPOTECAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Topoisomerase I inhibitors" ], "cautions": "Cautions\u00a0see section 8.1 and notes above", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60767.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenicity and fetal loss in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "BENPERIDOL": { "indications": "Indications\u00a0control of deviant antisocial sexual behaviour (but see notes above)", "name": "BENPERIDOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "BENPERIDOL" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also manufacturer advises regular blood counts and liver function tests\r\nduring long-term treatment; risk factors\r\nfor stroke", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106500.htm", "doses": [ "0.25\u20131.5\u00a0mg daily in divided doses, adjusted according\r\nto response; elderly (or debilitated)\r\ninitially half adult dose; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "AMIODARONE HYDROCHLORIDE": { "indications": "Indications\u00a0see notes above (should be initiated in hospital or under specialist\r\nsupervision)", "name": "AMIODARONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias", "AMIODARONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0liver-function and thyroid-function tests\r\nrequired before treatment and then every 6 months (\n(From Supraventricular and ventricular arrhythmias: British National Formulary)\nAmiodarone contains iodine and can cause disorders of thyroid function; both hypothyroidism and hyperthyroidism may occur. Clinical assessment alone is unreliable, and laboratory tests should be performed before treatment and every 6 months. Thyroxine (T4) may be raised in the absence of hyperthyroidism; therefore tri-iodothyronine (T3), T4, and thyroid-stimulating hormone (thyrotrophin, TSH) should all be measured. A raised T3 and T4 with a very low or undetectable TSH concentration suggests the development of thyrotoxicosis. The thyrotoxicosis may be very refractory, and amiodarone should usually be withdrawn at least temporarily to help achieve control; treatment with carbimazole may be required. Hypothyroidism can be treated with replacement therapy without withdrawing amiodarone if it is essential; careful supervision is required. for tests of thyroid function); hypokalaemia (measure serum-potassium concentration before treatment); chest x-ray required before treatment; heart failure; elderly; severe bradycardia and conduction disturbances in\r\nexcessive dosage; intravenous use may cause\r\nmoderate and transient fall in blood pressure (circulatory collapse\r\nprecipitated by rapid administration or overdosage) or\r\nsevere hepatocellular toxicity (monitor transaminases closely); administration by central venous catheter recommended if repeated\r\nor continuous infusion required\u2014infusion via peripheral veins may\r\ncause pain and inflammation; ECG monitoring\r\nand resuscitation facilities must be available during intravenous\r\nuse; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(amiodarone)", "side-effects": "Side-effects\u00a0nausea, vomiting, taste disturbances, raised serum\r\ntransaminases (may require dose reduction or withdrawal if accompanied\r\nby acute liver disorders), jaundice; bradycardia (see Cautions); pulmonary\r\ntoxicity (including pneumonitis and fibrosis); tremor, sleep disorders;\r\nhypothyroidism, hyperthyroidism; reversible corneal microdeposits\r\n(sometimes with night glare); phototoxicity, persistent slate-grey\r\nskin discoloration (see also notes above), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction\r\ndisturbances (see Cautions), peripheral neuropathy and myopathy (usually\r\nreversible on withdrawal); very rarely chronic liver\r\ndisease including cirrhosis, sinus arrest, bronchospasm (in patients\r\nwith severe respiratory failure), ataxia, benign intracranial hypertension,\r\nheadache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic\r\nanaemia, thrombocytopenia, rash (including exfoliative dermatitis),\r\nhypersensitivity including vasculitis, alopecia, impaired vision due\r\nto optic neuritis or optic neuropathy (including blindness), anaphylaxis\r\non rapid injection, also hypotension, respiratory distress syndrome,\r\nsweating, and hot flushes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2419.htm", "doses": [ "By mouth, 200\u00a0mg 3 times daily for 1 week\r\nreduced to 200\u00a0mg twice daily for a further week; maintenance, usually\r\n200\u00a0mg daily or the minimum required to control the arrhythmia", "By intravenous infusion (see Cautions above),\r\ninitially 5\u00a0mg/kg over 20\u2013120 minutes with ECG monitoring; subsequent\r\ninfusion given if necessary according to response up to max. 1.2\u00a0g\r\nin 24 hours", "Ventricular fibrillation or pulseless ventricular tachycardia\r\nrefractory to defibrillation, section 2.7.3" ], "pregnancy": "Pregnancy\u00a0possible risk of neonatal goitre; use only if no\r\nalternative" }, "METHOTREXATE - DRUGS AFFECTING THE IMMUNE RESPONSE": { "indications": "Indications\u00a0see under dose; Crohn\u2019s disease [unlicensed\r\nindication] (section 1.5.3); malignant disease (section 8.1.3); psoriasis (section 13.5.3)", "name": "METHOTREXATE - DRUGS AFFECTING THE IMMUNE RESPONSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "METHOTREXATE" ], "cautions": "Cautions\u00a0section 8.1; see Monitoring, Blood Count, Liver\r\nToxicity, and Pulmonary Toxicity below; extreme caution\r\nin blood disorders (avoid if severe); peptic\r\nulceration, ulcerative colitis, diarrhoea and ulcerative\r\nstomatitis (withdraw if stomatitis develops\u2014may be first sign of gastro-intestinal toxicity); risk of accumulation\r\nin pleural effusion or ascites\u2014drain before treatment; acute porphyria (section 9.8.2); interactions: see below and Appendix 1 (methotrexate)MonitoringIn view of reports of blood dyscrasias (including fatalities)\r\nand liver cirrhosis with low-dose methotrexate patients\r\nshould:have full blood count and renal and liver\r\nfunction tests before starting treatment and repeated every 1\u20132 weeks\r\nuntil therapy stabilised, thereafter patients should be monitored\r\nevery 2\u20133 months(1)be advised to report all symptoms and signs\r\nsuggestive of infection, especially sore throatTreatment with folinic acid (as calcium folinate, section 8.1) may be\r\nrequired in acute toxicityBlood count\u00a0Bone marrow suppression can occur\r\nabruptly; factors likely to increase toxicity include advanced age, renal impairment, and concomitant use with another anti-folate drug (e.g. trimethoprim). A clinically significant drop in white cell\r\ncount or platelet count calls for immediate withdrawal of methotrexate and introduction of supportive therapyLiver toxicity\u00a0Liver cirrhosis reported. Treatment\r\nshould not be started or should be discontinued if any abnormality\r\nof liver function tests or liver biopsy is present or develops during\r\ntherapy. Abnormalities can return to normal within 2\r\nweeks after which treatment may be recommenced if judged appropriatePulmonary toxicity\u00a0Pulmonary toxicity\r\nmay be a special problem in rheumatoid arthritis (patient to seek\r\nmedical attention if dyspnoea, cough or fever); monitor\r\nfor symptoms at each visit\u2014discontinue if pneumonitis suspected.Aspirin and other NSAIDs\u00a0If aspirin or other NSAIDs are given concurrently the dose\r\nof methotrexate should be carefully monitored. Patients should be advised to avoid self-medication with over-the-counter aspirin or ibuprofen", "side-effects": "Side-effects\u00a0section 8.1; also anorexia, abdominal discomfort,\r\ndyspepsia, gastro-intestinal ulceration and bleeding, diarrhoea, toxic\r\nmegacolon, hepatotoxicity (see Cautions above); hypotension, pericarditis,\r\npericardial tamponade; pulmonary oedema, pleuritic pain, pulmonary\r\nfibrosis, interstitial pneumonitis (see also Pulmonary Toxicity above);\r\nanaphylactic reactions, urticaria; dizziness, chills, fever, drowsiness,\r\ninsomnia, malaise, headache, mood changes, neurotoxicity, confusion,\r\nparaesthesia; precipitation of diabetes; menstrual disturbances, vaginitis,\r\ncystitis, reduced libido, impotence; blood disorders; haematuria,\r\ndysuria, renal failure; osteoporosis, arthralgia, myalgia, vasculitis;\r\nconjunctivitis, visual disturbance; rash, pruritus, Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis, photosensitivity, changes in\r\nnail and skin pigmentation, telangiectasia, acne, furuncolosis, ecchymosis;\r\ninjection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130052.htm", "doses": [ "Moderate to severe active rheumatoid arthritis, by mouth, adult over 18 years,\r\n7.5\u00a0mg once weekly, adjusted according to response; max. weekly dose\r\n20\u00a0mg", "Severe active rheumatoid arthritis, by subcutaneous or by intramuscular or by intravenous injection, adult over 18 years, 7.5\u00a0mg once weekly, increased according to response\r\nby 2.5\u00a0mg weekly; max. weekly dose 25\u00a0mg", "child under 18 years see BNF for Children", "Note that the above dose is a weekly dose.\r\nTo avoid error with low-dose methotrexate, it is recommended that:", "the patient is carefully advised of the dose and frequency and the reason for taking methotrexate\r\nand any other prescribed medicine (e.g. folic acid);", "only one strength of methotrexate tablet (usually 2.5\r\nmg) is prescribed and dispensed;", "the prescription and the dispensing label clearly show\r\nthe dose and frequency of methotrexate administration;", "the patient is warned to report immediately the onset\r\nof any feature of blood disorders (e.g. sore throat, bruising, and\r\nmouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort,\r\nand dark urine), and respiratory effects (e.g. shortness of breath).", "Methotrexate treatment\r\nbooklets should be issued where appropriate, and are available for\r\npurchase from:", "GP practices can obtain supplies through their\r\nPrimary Care Trust (PCT) or Agency stores.", "NHS Hospitals can order supplies from www.nhsforms.co.uk or by emailing nhsforms@mmm.com.", "These booklets include advice for adults taking oral methotrexate\r\nfor inflammatory conditions, and a section for recording results of\r\nblood tests and dosage information." ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic; fertility may be reduced during\r\ntherapy but this may be reversible); effective contraception required\r\nduring and for at least 3 months after treatment in men or women;\r\nsee also section 8.1" }, "FLUOROURACIL - PHOTODAMAGE": { "indications": "Indications\u00a0superficial malignant and pre-malignant\r\nskin lesions; other malignant disease (section 8.1.3) ", "name": "FLUOROURACIL - PHOTODAMAGE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.8 Sunscreens and camouflagers", "13.8.1 Sunscreen preparations", "Photodamage" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes; caution in handling\u2014irritant to tissues", "side-effects": "Side-effects\u00a0local irritation (use a topical corticosteroid\r\nfor severe discomfort associated with inflammatory reactions), photosensitivity,\r\nerythema multiforme", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200023.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid (teratogenic)" }, "COLESTIPOL HYDROCHLORIDE": { "indications": "Indications\u00a0hyperlipidaemias, particularly type IIa, in patients who have not\r\nresponded adequately to diet and other appropriate measures", "name": "COLESTIPOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Bile acid sequestrants" ], "cautions": "Cautions\u00a0\n(From Bile acid sequestrants: British National Formulary)\nCautions\u00a0Bile acid sequestrants interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged. Interactions: Appendix 1 (bile acid sequestrants); interactions: Appendix 1 (colestipol)", "side-effects": "Side-effects\u00a0\n(From Bile acid sequestrants: British National Formulary)\nSide-effects\u00a0As bile acid sequestrants are not absorbed, gastro-intestinal side-effects predominate. Constipation is common, but diarrhoea has occurred, as have nausea, vomiting, and gastro-intestinal discomfort. Hypertriglyceridaemia may be aggravated. An increased bleeding tendency has been reported due to hypoprothrombinaemia associated with vitamin K deficiency.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2841.htm", "doses": [ "Initially 5\u00a0g 1\u20132 times daily in liquid increased if necessary\r\nin 5-g increments at intervals of 1 month to max. 30\u00a0g daily (in 1\u20132\r\ndivided doses)", "the contents of each sachet should be mixed\r\nwith at least 100\u00a0mL of water or other suitable liquid such as fruit\r\njuice or skimmed milk; alternatively it can be mixed with thin soups,\r\ncereals, yoghurt, or pulpy fruits ensuring at least 100\u00a0mL of liquid\r\nis provided" ], "pregnancy": "Pregnancy\u00a0\n(From Bile acid sequestrants: British National Formulary)\nPregnancy and breast-feeding\u00a0Bile acid sequestrants should be used with caution as although the drugs are not absorbed, they may cause fat-soluble vitamin deficiency on prolonged use." }, "CLONIDINE HYDROCHLORIDE - PROPHYLAXIS OF MIGRAINE": { "indications": "Indications\u00a0prevention of recurrent migraine\r\n(but see notes above), vascular headache, menopausal flushing; hypertension\r\n(%s\n(From 2.5.2 Centrally acting antihypertensive drugs: British National Formulary)\n2.5.2 Centrally acting antihypertensive drugs)", "name": "CLONIDINE HYDROCHLORIDE - PROPHYLAXIS OF MIGRAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.2 Prophylaxis of migraine", "CLONIDINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0depressive illness; heart failure; Raynaud\u2019s syndrome; concurrent antihypertensive therapy; cerebrovascular disease; polyneuropathy; constipation; interactions: Appendix 1 (clonidine)", "side-effects": "Side-effects\u00a0constipation, dry mouth, nausea, vomiting; postural\r\nhypotension; depression, sleep disorder, dizziness, headache, drowsiness;\r\nerectile dysfunction; less commonly Raynaud\u2019s syndrome,\r\nparaesthesia, hallucination, rash, and pruritus; rarely AV block, gynaecomastia, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3568.htm", "doses": [ "adult over 18 years, 50\u00a0micrograms\r\ntwice daily, increased after 2 weeks to 75\u00a0micrograms twice daily\r\nif necessary" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk" }, "3.9.2 Demulcent and expectorant cough preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations" ], "name": "3.9.2 Demulcent and expectorant cough preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3130.htm", "doses": [ "adult and child over 12 years 5\u00a0mL 3\u20134 times daily" ] }, "ADALIMUMAB - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0see under Cytokine Modulators above; Crohn\u2019s disease\r\n(section 1.5.3); psoriasis (section 13.5.3)", "name": "ADALIMUMAB - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; monitor for infection before, during, and for 5 months after treatment (see also Tuberculosis below); do not initiate until\r\nactive infections are controlled; discontinue\r\nif new serious infection develops; hepatitis\r\nB virus\u2014monitor for active infection; children should\r\nbe brought up to date with current immunisation schedule (section 14.1) before initiating therapy; mild\r\nheart failure (discontinue if symptoms develop or worsen\u2014avoid in\r\nmoderate or severe heart failure); demyelinating CNS disorders (risk of exacerbation); history or development of malignancy; monitor for non-melanoma skin cancer before and during treatment,\r\nespecially in patients with a history of PUVA treatment for psoriasis\r\nor extensive immunosuppressant therapy; interactions: Appendix 1 (adalimumab)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting adalimumab. Patients who have previously received\r\nadequate treatment for tuberculosis can start adalimumab but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting adalimumab. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with adalimumab. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) develop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators and Cautions above; also vomiting, dyspepsia, gastro-intestinal\r\nhaemorrhage; dizziness, hyperlipidaemia, hypertension, oedema, flushing,\r\nchest pain, tachycardia; cough, dyspnoea; mood changes, sleep disturbances,\r\nanxiety, paraesthesia; haematuria, renal impairment; benign tumours,\r\nskin cancer; electrolyte disturbances, hyperuricaemia; musculoskeletal\r\npain; eye disorders; rash, dermatitis, onycholysis, impaired healing; less commonly dysphagia, pancreatitis, cholelithiasis, hepatic\r\nsteatosis, cholecystitis, arrhythmias, interstitial lung disease,\r\npneumonitis, tremor, erectile dysfunction, nocturia, malignancy (including\r\nsolid tumours, lymphoma, and leukaemia), rhabdomyolysis, hearing loss,\r\ntinnitus; rarely vascular occlusion, myocardial infarction,\r\ndemyelinating disorders; also reported pulmonary\r\nembolism, pleural effusion, sarcoidosis, Stevens-Johnson syndrome,\r\ncutaneous vasculitis, new onset or worsening psoriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128230.htm", "doses": [ "By subcutaneous injection, rheumatoid\r\narthritis, adult over 18 years, 40\u00a0mg\r\non alternate weeks; if necessary increased to 40\u00a0mg weekly in patients\r\nreceiving adalimumab alone; review treatment if no response within\r\n12 weeks", "Polyarticular juvenile idiopathic arthritis, child 4\u201312 years, 24\u00a0mg/m2 (max. 40\u00a0mg)\r\non alternate weeks; child 13\u201317 years,\r\n40\u00a0mg on alternate weeks; review treatment if no response within 12\r\nweeks", "Psoriatic arthritis, ankylosing spondylitis, adult over 18 years, 40\u00a0mg on alternate weeks; discontinue\r\ntreatment if no response within 12 weeks" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nrequired during treatment and for at least 5 months after last dose" }, "VILDAGLIPTIN WITH METFORMIN": { "indications": "Indications\u00a0type 2 diabetes mellitus not controlled\r\nby metformin alone", "name": "VILDAGLIPTIN WITH METFORMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "VILDAGLIPTIN WITH METFORMIN" ], "cautions": "Cautions\u00a0determine renal function before treatment\r\nand at least annually (at least twice a year in patients with additional\r\nrisk factors for renal impairment, or if deterioration suspected); monitor liver function (see below); interactions: Appendix 1 (antidiabetics)Liver toxicity\u00a0Rare reports of liver dysfunction; monitor liver function before treatment and every 3 months for the\r\nfirst year and periodically thereafter; advise patients to seek prompt medical attention if symptoms such\r\nas nausea, vomiting, abdominal pain, fatigue, and dark urine develop; discontinue if jaundice or other signs of liver dysfunction\r\noccurLactic acidosis\u00a0Use with caution\r\nin renal impairment\u2014increased risk of lactic acidosis; avoid if eGFR less than 50\u00a0mL/minute/1.73\u00a0m2. Withdraw or interrupt treatment in those\r\nat risk of tissue hypoxia or sudden deterioration in renal function,\r\nsuch as those with dehydration, severe infection, shock, sepsis, acute\r\nheart failure, respiratory failure or hepatic impairment, or those\r\nwho have recently had a myocardial infarction", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea (usually transient),\r\nabdominal pain, taste disturbance, peripheral oedema, headache, tremor,\r\nanorexia, asthenia, dizziness; less commonly constipation,\r\nhypoglycaemia, arthralgia; rarely hepatic dysfunction\r\n(see also Liver Toxicity above), lactic acidosis (withdraw treatment),\r\ndecreased vitamin-B12 absorption, erythema, pruritus, and\r\nurticaria; very rarely nasopharyngitis, upper respiratory\r\ntract infection; pancreatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201550.htm", "doses": [ "See under preparations", "adult over 18 years, 1\r\ntablet twice daily (based on patient\u2019s current metformin dose)", "adult over 18 years, 1\r\ntablet twice daily (based on patient\u2019s current metformin dose)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "METHYLPHENIDATE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0attention deficit hyperactivity disorder (under specialist supervision);\r\nnarcolepsy [unlicensed indication]", "name": "METHYLPHENIDATE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.4 CNS\r\nstimulants and drugs used for attention deficit hyperactivity disorder", "METHYLPHENIDATE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder: British National Formulary)\nDrug treatment of ADHD should be part of a comprehensive treatment programme. The choice of medication should take into consideration co-morbid conditions (such as tic disorders, Tourette syndrome, and epilepsy), the adverse effect profile, potential for drug misuse, and preferences of the patient and carers. Methylphenidate and atomoxetine are used for the management of ADHD; dexamfetamine is an alternative in children who do not respond to these drugs. Before initiation of drug therapy, and every 6 months thereafter, pulse, blood pressure, weight, and height should be measured.The need to continue drug treatment for ADHD should be reviewed at least annually. This may involve suspending treatment.; also monitor for psychiatric disorders; anxiety or agitation; tics or a family history of Tourette syndrome; drug or alcohol dependence; epilepsy (discontinue if increased seizure frequency); susceptibility to angle-closure glaucoma; avoid abrupt withdrawal; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0abdominal pain, nausea, vomiting, diarrhoea, dyspepsia,\r\ndry mouth, anorexia, reduced weight gain; tachycardia, palpitation,\r\narrhythmias, changes in blood pressure; cough, nasopharyngitis; tics\r\n(very rarely Tourette syndrome), insomnia, nervousness,\r\nasthenia, depression, irritability, aggression, headache, drowsiness,\r\ndizziness, movement disorders; fever; arthralgia; rash, pruritus,\r\nalopecia; growth restriction; less commonly constipation,\r\ndyspnoea, abnormal dreams, confusion, suicidal ideation, urinary frequency,\r\nhaematuria, muscle cramps, epistaxis; rarely angina,\r\nsweating, and visual disturbances; very rarely hepatic\r\ndysfunction, myocardial infarction, cerebral arteritis, psychosis,\r\nneuroleptic malignant syndrome, tolerance and dependence, blood disorders\r\nincluding leucopenia and thrombocytopenia, angle-closure glaucoma,\r\nexfoliative dermatitis, and erythema multiforme; supraventricular\r\ntachycardia, bradycardia, and convulsions also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129249.htm", "doses": [ "Attention deficit hyperactivity disorder, adult over 18 years [unlicensed use], 5\u00a0mg 2\u20133 times\r\ndaily increased if necessary at weekly intervals according to response,\r\nmax. 100\u00a0mg daily in 2\u20133 divided doses; child 6\u201318 years, initially 5\u00a0mg 1\u20132 times daily, increased if necessary\r\nat weekly intervals by 5\u201310\u00a0mg daily; usual max. 60\u00a0mg daily in 2\u20133\r\ndivided doses but may be increased to 2.1\u00a0mg/kg daily in 2\u20133 divided\r\ndoses (max. 90\u00a0mg daily) under the direction of a specialist; discontinue\r\nif no response after 1 month; child 4\u20136 years see BNF for Children", "If effect wears off in evening (with\r\nrebound hyperactivity) a dose at bedtime may be appropriate (establish\r\nneed with trial bedtime dose)", "Treatment may be started using a modified-release\r\npreparation", "Narcolepsy [unlicensed indication], 10\u201360\u00a0mg (usually 20\u201330\u00a0mg)\r\ndaily in divided doses before meals", "Name[Equasym XL\u00ae (Shire) ] Capsules, m/r, methylphenidate hydrochloride\r\n10\u00a0mg (white/green), net price 30-cap pack = \u00a325.00; 20\u00a0mg (white/blue),\r\n30-cap pack = \u00a330.00; 30\u00a0mg (white/brown), 30-cap pack = \u00a335.00. \r\n Label:\r\n 25Note\u00a0Equasym XL\u00ae capsules consist\r\nof an immediate-release component (30% of the dose) and a modified-release\r\ncomponent (70% of the dose)Dose\u00a0attention deficit hyperactivity disorder, adult over 18 years [unlicensed use], initially 10\u00a0mg\r\nonce daily in the morning before breakfast, increased gradually at\r\nweekly intervals if necessary, max. 100\u00a0mg daily; child 6\u201318 years, initially 10\u00a0mg once daily in the morning before breakfast,\r\nincreased gradually at weekly intervals if necessary, usual max. 60\u00a0mg\r\ndaily but may be increased to 2.1\u00a0mg/kg daily (max. 90\u00a0mg daily) [unlicensed]\r\nunder the direction of a specialist; discontinue if no response after\r\n1 monthNote\u00a0Contents of capsule can be sprinkled on a\r\ntablespoon of apple sauce (then swallowed immediately without chewing)" ], "pregnancy": "Pregnancy\u00a0limited experience\u2014avoid unless potential benefit\r\noutweighs risk" }, "MAGNESIUM CARBONATE": { "indications": "Indications\u00a0dyspepsia", "name": "MAGNESIUM CARBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone", "Aluminium- and magnesium-containing antacids", "MAGNESIUM CARBONATE" ], "cautions": "Cautions\u00a0\n(From 1.1.1 Antacids and simeticone: British National Formulary)\nAluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and trisilicate), being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects. Aluminium accumulation does not appear to be a risk if renal function is normal.; interactions: Appendix\u00a01 (antacids)", "side-effects": "Side-effects\u00a0diarrhoea; belching due to liberated carbon dioxide", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2027.htm", "doses": [ "10\u00a0mL 3 times daily in water" ] }, "PIOGLITAZONE": { "indications": "Indications\u00a0type 2 diabetes mellitus (alone or combined with metformin or a sulfonylurea,\r\nor with both, or with insulin\u2014see also notes above)", "name": "PIOGLITAZONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "PIOGLITAZONE" ], "cautions": "Cautions\u00a0monitor liver function (see below); cardiovascular\r\ndisease or in combination with insulin (risk of heart failure\u2014see MHRA/CHM advice); substitute insulin during peri-operative period (omit pioglitazone\r\non morning of surgery and recommence when eating and drinking normally); increased risk of bone fractures, particularly\r\nin women; avoid in acute porphyria (but see section 9.8.2); risk factors for bladder cancer\r\n(see Risk of Bladder Cancer); elderly (increased risk of heart failure, fractures,\r\nand bladder cancer); interactions: Appendix 1 (antidiabetics)Liver toxicity\u00a0Rare reports of liver dysfunction; monitor liver function before treatment, and periodically thereafter; advise patients to seek immediate medical attention if symptoms\r\nsuch as nausea, vomiting, abdominal pain, fatigue and dark urine develop; discontinue if jaundice occurs", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, weight gain, oedema,\r\nanaemia, headache, visual disturbances, dizziness, arthralgia, hypoaesthesia,\r\nhaematuria, impotence; less commonly hypoglycaemia,\r\nfatigue, insomnia, vertigo, sweating, altered blood lipids, proteinuria,\r\nbladder cancer; see also Liver Toxicity above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129900.htm", "doses": [ "adult over 18 years, initially\r\n15\u201330\u00a0mg once daily increased to 45\u00a0mg once daily according to response,\r\n(elderly, initiate with lowest possible\r\ndose and increase gradually); review treatment after 3\u20136 months and\r\nregularly thereafter", "Dose of concomitant sulfonylurea or insulin\r\nmay need to be reduced" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "BUSERELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS": { "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nSide-effects\u00a0The gonadorelin analogues cause side-effects similar to the menopause in women and orchidectomy in men and include hot flushes and sweating, sexual dysfunction, vaginal dryness or bleeding, and gynaecomastia or changes in breast size. Signs and symptoms of prostate or breast cancer may worsen initially (managed in prostate cancer with anti-androgens, see above). Other side-effects include hypersensitivity reactions (rashes, pruritus, asthma, and rarely anaphylaxis), injection site reactions (see Cautions), headache (rarely migraine), visual disturbances, dizziness, arthralgia and possibly myalgia, hair loss, peripheral oedema, gastro-intestinal disturbances, weight changes, sleep disorders, and mood changes.; worsening\r\nhypertension, palpitation, glucose intolerance,\r\naltered blood lipids, thrombocytopenia, leucopenia, nervousness, fatigue,\r\nmemory and concentration disturbances, anxiety, increased thirst,\r\nhearing disorders, musculoskeletal pain; nasal irritation, nose bleeds\r\nand altered sense of taste and smell (spray formulation only)", "indications": "Indications\u00a0advanced prostate cancer; other indications\r\n(section 6.7.2)", "name": "BUSERELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4824.htm", "doses": [ "By subcutaneous injection, 500\u00a0micrograms\r\nevery 8 hours for 7 days, then intranasally, 1 spray\r\ninto each nostril 6 times daily (see also notes above)", "Avoid use of nasal decongestants\r\nbefore and for at least 30 minutes after treatment." ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0diabetes, hypertension, depression; see\r\nalso notes above" }, "LOCAL CORTICOSTEROID INJECTIONS Triamcinolone acetonide": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Triamcinolone acetonide", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Triamcinolone acetonide" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5285.htm", "doses": [ "See under preparations", "Name[Kenalog\u00ae Intra-articular/Intramuscular (Squibb) ] Injection (aqueous suspension), triamcinolone acetonide 40\u00a0mg/mL, net price 1-mL vial =\r\n\u00a31.49Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 5\u201340\u00a0mg according to size; total max.\r\n80\u00a0mg (for doses below 5\u00a0mg use Adcortyl\u00ae Intra-articular/Intradermal); where appropriate may be repeated when relapse occurs; child under 18 years see BNF for ChildrenFor intramuscular injection, see section 6.3.2 " ] }, "LARONIDASE": { "indications": "Indications\u00a0(specialist use only) non-neurological\r\nmanifestations of mucopolysaccharidosis I", "name": "LARONIDASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Mucopolysaccharidosis", "LARONIDASE" ], "cautions": "Cautions\u00a0monitor immunoglobulin G (IgG) antibody\r\nconcentration; interactions: Appendix\r\n1 (laronidase)Infusion-related reactions\u00a0%s\n(From Mucopolysaccharidosis: British National Formulary)\nInfusion-related reactions\u00a0Infusion-related reactions often occur with administration of laronidase, idursulfase, and galsulfase; they can be managed by slowing the infusion rate or interrupting the infusion, and can be minimised by pre-treatment with an antihistamine and an antipyretic. Recurrent infusion-related reactions may require pre-treatment with a corticosteroid\u2014consult product literature for details.", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain; cold\r\nextremities, pallor, flushing, tachycardia, blood pressure changes;\r\ndyspnoea, cough, angioedema, anaphylaxis; headache, paraesthesia,\r\ndizziness, fatigue, restlessness; influenza-like symptoms; musculoskeletal\r\npain, pain in extremities; rash, pruritus, urticaria, alopecia, infusion-site\r\nreactions; bronchospasm and respiratory arrest also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128508.htm", "doses": [ "By intravenous infusion, 100\u00a0units/kg once\r\nweekly; child see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014no information\r\navailable" }, "ADENOSINE": { "indications": "Indications\u00a0rapid reversion to sinus rhythm of paroxysmal supraventricular tachycardias,\r\nincluding those associated with accessory conducting pathways (e.g.\r\nWolff-Parkinson-White syndrome); aid to diagnosis of broad or narrow\r\ncomplex supraventricular tachycardias; in conjunction with radionuclide\r\nmyocardial perfusion imaging in patients who cannot exercise adequately\r\nor for whom exercise is inappropriate", "name": "ADENOSINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular arrhythmias", "ADENOSINE" ], "cautions": "Cautions\u00a0monitor ECG and have resuscitation facilities available; atrial fibrillation or flutter with accessory pathway (conduction\r\ndown anomalous pathway may increase); first-degree AV\r\nblock; bundle branch block; left main coronary artery stenosis; uncorrected hypovolaemia; stenotic valvular\r\nheart disease; left to right shunt; pericarditis; pericardial\r\neffusion; autonomic dysfunction; stenotic carotid artery disease with cerebrovascular\r\ninsufficiency; recent myocardial infarction; heart failure; heart transplant (see below); interactions: Appendix 1 (adenosine)", "side-effects": "Side-effects\u00a0nausea; arrhythmia (discontinue if asystole or\r\nsevere bradycardia occur), sinus pause, AV block, flushing, angina\r\n(discontinue), dizziness; dyspnoea; headache; less commonly metallic taste; palpitation, hyperventilation, weakness, blurred\r\nvision, sweating; very rarely transient worsening\r\nof intracranial hypertension, bronchospasm, injection-site reactions; also reported vomiting, syncope, hypotension (discontinue\r\nif severe), cardiac arrest, respiratory failure (discontinue), and\r\nconvulsions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2413.htm", "doses": [ "By rapid intravenous injection into central\r\nor large peripheral vein, 6\u00a0mg over 2 seconds with cardiac monitoring;\r\nif necessary followed by 12\u00a0mg after 1\u20132 minutes, and then by 12\u00a0mg\r\nafter a further 1\u20132 minutes; increments should not be given if high\r\nlevel AV block develops at any particular dose", "Patients with a heart transplant are very sensitive to effects of adenosine and should receive initial\r\ndose of 3\u00a0mg over 2 seconds, followed if necessary by 6\u00a0mg after 1\u20132\r\nminutes, and then by 12\u00a0mg after a further 1\u20132 minutes. ", "Also, if essential to give with dipyridamole reduce adenosine dose to a quarter of the usual dose", "Adenosine doses in the BNF may differ from\r\nthose in product literature", "By intravenous infusion in conjunction with radionuclide\r\nmyocardial perfusion imaging\u2014consult product literature" ], "pregnancy": "Pregnancy\u00a0large doses may produce foetal toxicity; manufacturer\r\nadvises use only if potential benefit outweighs risk" }, "DIAMORPHINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "DIAMORPHINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "DIAMORPHINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also severe diarrhoea; toxic psychosis, CNS depression; severe\r\ncor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nanorexia, taste disturbance; syncope; asthenia, raised intracranial\r\npressure; myocardial infarction also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3522.htm", "doses": [ "Acute pain, by subcutaneous or intramuscular injection, 5\u00a0mg repeated every 4 hours\r\nif necessary (up to 10\u00a0mg for heavier well-muscled patients); by slow intravenous injection, quarter to half corresponding\r\nintramuscular dose", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u00a0mg followed by a further 2.5\u20135\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (1\u00a0mg/minute) 2.5\u20135\u00a0mg", "Chronic pain, by subcutaneous or intramuscular injection, adult not currently treated with a strong opioid analgesic,\r\ninitially 2.5\u20135\u00a0mg every 4 hours, adjusted according to response; adult currently treated with a strong\r\nopioid analgesic\u2014see Prescribing in Palliative\r\nCare; by subcutaneous infusion, adult not currently treated with a strong opioid analgesic,\r\ninitially 5\u201310\u00a0mg over 24 hours, adjusted according to response; adult currently treated with a strong\r\nopioid analgesic\u2014see Prescribing in Palliative\r\nCare" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "PHOLCODINE": { "indications": "Indications\u00a0dry cough", "name": "PHOLCODINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations", "3.9.1 Cough suppressants", "PHOLCODINE" ], "cautions": "Cautions\u00a0asthma; chronic, persistent,\r\nor productive cough; interactions: Appendix 1 (pholcodine)", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, sputum retention,\r\ndrowsiness, dizziness, excitation, confusion, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3079.htm", "doses": [ "Name[Galenphol\u00ae (Thornton & Ross)] child (but not generally\r\nrecommended, see notes above) 6\u201312\r\nyears 10\u00a0mL 3 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "MORPHINE": { "indications": "Indications\u00a0see notes above; cough in terminal disease\r\n(%s\n(From Palliative care: British National Formulary)\nPalliative care); pain (%s\n(From MORPHINE SALTS: British National Formulary)\nMORPHINE SALTS)", "name": "MORPHINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.2 Antimotility drugs" ], "cautions": "Cautions\u00a0\n(From 1.4 Acute diarrhoea: British National Formulary)\nHowever, antimotility drugs are not recommended for acute diarrhoea in young children. and under Morphine Salts (%s\n(From MORPHINE SALTS: British National Formulary)\nsee notes above; also pancreatitis, cardiac arrhythmias, severe cor pulmonale)", "side-effects": "Side-effects\u00a0see notes above and under Morphine Salts (%s\n(From MORPHINE SALTS: British National Formulary)\nsee notes above; also paralytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation of pancreatitis, taste disturbance; hypertension, hypothermia, syncope; bronchospasm, inhibition of cough reflex; restlessness, seizures, paraesthesia, asthenia, malaise, disorientation, excitation, agitation, delirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle fasciculation, rhabdomyolysis, and nystagmus); sedation\r\nand the risk of dependence are greater", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2162.htm", "doses": [ "See preparation" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "DITHRANOL Non-proprietary preparations": { "indications": "Indications\u00a0subacute and chronic psoriasis, see notes above", "name": "DITHRANOL Non-proprietary preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Dithranol", "DITHRANOL", "Non-proprietary preparations" ], "cautions": "Cautions\u00a0avoid use near eyes and\r\nsensitive areas of skin; see\r\nalso notes above", "side-effects": "Side-effects\u00a0local burning sensation and irritation; stains\r\nskin, hair, and fabrics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5980.htm", "doses": [ "See notes above and under preparations", "Some of these dithranol preparations also contain coal tar or salicylic acid\u2014for cautions, contra-indications, and side-effects\r\nsee under Tars (above) or under Salicylic Acid", "Name[(1)Dithranol Ointment, BP ] Ointment, dithranol, in yellow soft paraffin; usual strengths 0.1\u20132%. Part of basis\r\nmay be replaced by hard paraffin if a stiffer preparation is required. \r\n Label:\r\n 28" ] }, "AZELAIC ACID": { "indications": "Indications\u00a0see preparations", "name": "AZELAIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Benzoyl peroxide and azelaic acid", "AZELAIC ACID" ], "cautions": "Cautions\u00a0avoid contact with eyes, mouth, and mucous membranes", "side-effects": "Side-effects\u00a0local irritation (reduce frequency or discontinue\r\ntemporarily); less commonly skin discoloration; very rarely photosensitisation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19891.htm", "doses": [ "acne vulgaris, apply twice daily (sensitive skin, once\r\ndaily for first week). Extended treatment may be required but manufacturer\r\nadvises period of treatment should not exceed 6 months" ] }, "METOPROLOL TARTRATE": { "indications": "Indications\u00a0see under Dose", "name": "METOPROLOL TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "METOPROLOL TARTRATE" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202849.htm", "doses": [ "By mouth, hypertension, initially\r\n100\u00a0mg daily, increased if necessary to 200\u00a0mg daily in 1\u20132 divided\r\ndoses; max. 400\u00a0mg daily (but high doses rarely necessary)", "Angina, 50\u2013100\u00a0mg 2\u20133 times daily", "Arrhythmias, usually 50\u00a0mg 2\u20133\u00a0times daily; up to 300\u00a0mg daily\r\nin divided doses if necessary", "Migraine prophylaxis, 100\u2013200\u00a0mg daily in divided doses", "Hyperthyroidism (adjunct), 50\u00a0mg 4 times daily", "By intravenous injection, arrhythmias,\r\nup to 5\u00a0mg at rate 1\u20132\u00a0mg/minute, repeated after 5\u00a0minutes if necessary,\r\ntotal dose 10\u201315\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "In surgery, by slow intravenous injection 2\u20134\u00a0mg\r\nat induction or to control arrhythmias developing during anaesthesia;\r\n2-mg doses may be repeated to a max. of 10\u00a0mg", "Early intervention within 12 hours of infarction, by\r\nintravenous injection 5\u00a0mg every 2\u00a0minutes to a max. of 15\u00a0mg,\r\nfollowed after 15 minutes by 50\u00a0mg by mouth every 6\r\nhours for 48 hours; maintenance 200\u00a0mg daily in divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "YELLOW FEVER VACCINE, LIVE": { "indications": "Indications\u00a0immunisation against yellow fever", "name": "YELLOW FEVER VACCINE, LIVE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Yellow fever vaccine" ], "cautions": "Cautions\u00a0\n(From 14.1 Active immunity: British National Formulary)\nCautions\u00a0Most individuals can safely receive the majority of vaccines. Vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. See also Predisposition to Neurological Problems, below. For individuals with bleeding disorders, see Route of administration, below. If alcohol or disinfectant is used for cleansing the skin it should be allowed to evaporate before vaccination to prevent possible inactivation of live vaccines.When 2 or more vaccines are required (and are not available as a combined preparation), they should be given simultaneously at different sites, preferably in a different limb; if more than one injection is to be given in the same limb, they should be administered at least 2.5\u00a0cm apart (but see also BCG Vaccines). When 2 live vaccines cannot be given at the same time, they should be separated by an interval of at least 4 weeks. For interactions see Appendix 1 (vaccines).See also Cautions under individual vaccines ; also individuals over 60 years\u2014greater risk of vaccine-associated adverse\r\neffects, \n(From Yellow fever vaccine: British National Formulary)\nVery rare, vaccine-associated adverse effects have been reported, such as viscerotropic disease (yellow fever vaccine-associated viscerotropic disease, YEL-AVD), a syndrome which may include metabolic acidosis, muscle and liver cytolysis, and multi-organ failure. Neurological disorders (yellow fever vaccine-associated neurotropic disease, YEL-AND) such as encephalitis have also been reported. These very rare adverse effects usually have occurred after the first dose of yellow fever vaccine in those with no previous immunity.; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0\n(From 14.1 Active immunity: British National Formulary)\nSide-effects\u00a0Injection of a vaccine may be followed by local reactions such as pain, inflammation, redness, and lymphangitis. An induration or sterile abscess may develop at the injection site. Gastro-intestinal disturbances, fever, headache, irritability, loss of appetite, fatigue, myalgia, and malaise are among the most commonly reported side-effects. Other side-effects include influenza-like symptoms, dizziness, paraesthesia, asthenia, drowsiness, arthralgia, rash, and lymphadenopathy. Hypersensitivity reactions, such as bronchospasm, angioedema, urticaria, and anaphylaxis, are very rare but can be fatal (see section 3.4.3 for management of allergic emergencies).Oral vaccines such as cholera, live poliomyelitis, rotavirus, and live typhoid can also cause gastro-intestinal disturbances such as nausea, vomiting, abdominal pain and cramps, and diarrhoea.See also Predisposition to neurological problems, below.Some vaccines (e.g. poliomyelitis) produce very few reactions, while others (e.g. measles, mumps and rubella) may cause a very mild form of the disease. Occasionally more serious adverse reactions can occur\u2014these should always be reported to the CHM (see Adverse Reactions to Drugs).See also Preterm Birth.Post-immunisation pyrexia in infantsThe parent should be advised that if pyrexia develops after childhood immunisation, and the infant seems distressed, a dose of paracetamol can be given and, if necessary, a second dose can be given 6 hours later; ibuprofen may be used if paracetamol is unsuitable. The parent should be warned to seek medical advice if the pyrexia persists.For post-immunisation pyrexia in an infant aged 2\u20133 months, the dose of paracetamol is 60\u00a0mg; the dose of ibuprofen is 50\u00a0mg (on a doctor\u2019s advice). An oral syringe can be obtained from any pharmacy to give the small volume required.Predisposition to neurological problems When there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended; advice on the management of fever (see Post-immunisation pyrexia in infants, above) should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended.Children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and perinatal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule.When there is a still evolving neurological problem, including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable.Further information on adverse effects associated with specific vaccines can be found under individual vaccines.; also\r\nreported neurotropic disease and viscerotropic disease (\n(From Yellow fever vaccine: British National Formulary)\nVery rare, vaccine-associated adverse effects have been reported, such as viscerotropic disease (yellow fever vaccine-associated viscerotropic disease, YEL-AVD), a syndrome which may include metabolic acidosis, muscle and liver cytolysis, and multi-organ failure. Neurological disorders (yellow fever vaccine-associated neurotropic disease, YEL-AND) such as encephalitis have also been reported. These very rare adverse effects usually have occurred after the first dose of yellow fever vaccine in those with no previous immunity.)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201179.htm", "doses": [ "By deep subcutaneous injection, adult and child over\r\n9 months, 0.5\u00a0mL (see also notes above)" ], "pregnancy": "Pregnancy\u00a0\n(From Yellow fever vaccine: British National Formulary)\nPregnancy\u00a0Live yellow fever vaccine should not be given during pregnancy, but if a significant risk of exposure cannot be avoided then vaccination should be delayed to the third trimester if possible (but the need for immunisation usually outweighs risk to the fetus)." }, "KETOCONAZOLE ": { "indications": "Indications\u00a0dermatophytoses and Malassezia folliculitis either resistant to fluconazole, terbinafine, or itraconazole or in patients intolerant of these antifungals; chronic\r\nmucocutaneous, cutaneous, and oropharyngeal candidiasis either resistant to fluconazole or itraconazole or in\r\npatients intolerant of these antifungals", "name": "KETOCONAZOLE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.2 Imidazole antifungals", "KETOCONAZOLE" ], "cautions": "Cautions\u00a0predisposition to adrenocortical insufficiency; interactions: Appendix 1 (antifungals, imidazole)Hepatotoxicity\u00a0Potentially life-threatening hepatotoxicity\r\nreported very rarely; risk of hepatotoxicity greater\r\nif given for longer than 10 days. Monitor\r\nliver function before treatment, then on weeks 2 and 4 of treatment,\r\nthen every month. Avoid or use with caution\r\nif abnormal liver function tests (avoid in active liver disease) or if history of hepatotoxicity\r\nwith other drugsCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek prompt\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain, jaundice, or dark urine develop", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain; pruritus; less commonly diarrhoea, headache, dizziness, drowsiness,\r\nand rash; also reported fatal liver damage (see Hepatotoxicity above),\r\ndyspepsia, raised intracranial pressure, paraesthesia, adrenocortical\r\ninsufficiency, erectile dysfunction, menstrual disorders, azoospermia\r\n(with high doses), gynaecomastia, thrombocytopenia, photophobia, photosensitivity,\r\nand alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3984.htm", "doses": [ "200\u00a0mg once daily, increased if response inadequate to\r\n400\u00a0mg once daily; continued until symptoms have cleared and cultures\r\nnegative, but see Cautions (max. duration of treatment 4 weeks for Malassezia infection); child body-weight 15\u201330\u00a0kg, 100\u00a0mg once daily; body-weight over 30\u00a0kg,\r\nadult dose" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk (teratogenicity in animal studies)" }, "TENOFOVIR DISOPROXIL With efavirenz and emtricitabine": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral\r\ndrugs; chronic hepatitis B infection with either compensated\r\nliver disease (with evidence of viral replication, and histologically\r\ndocumented active liver inflammation or fibrosis) or decompensated liver disease", "name": "TENOFOVIR DISOPROXIL With efavirenz and emtricitabine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "TENOFOVIR DISOPROXIL", "With efavirenz and emtricitabine" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test renal function and serum phosphate before\r\ntreatment, then every 4 weeks (more frequently if at increased risk\r\nof renal impairment) for 1 year and then every 3 months, interrupt treatment if renal function deteriorates or serum phosphate\r\ndecreases; concomitant or recent use of nephrotoxic\r\ndrugs; interactions: Appendix 1 (tenofovir) Chronic hepatits B\u00a0 When treating\r\nchronic hepatitis B with tenofovir, monitor liver function tests every\r\n3 months and viral markers for hepatitis B every 3\u20136 months during\r\ntreatment (continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation)", "side-effects": "Side-effects\u00a0see notes above; also hypophosphataemia; rarely renal failure, proximal renal tubulopathy, nephrogenic\r\ndiabetes insipidus; also reported reduced bone density", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200890.htm", "doses": [ "adult over 18 years, 245\u00a0mg\r\nonce daily", "HIV infection stabilised on antiretroviral therapy for\r\nmore than 3 months, adult over 18 years,\r\n1 tablet once daily", "Name[Atripla\u00ae (Gilead) ] Tablets, pink, f/c, efavirenz 600\u00a0mg,\r\nemtricitabine 200\u00a0mg, tenofovir disoproxil (as fumarate) 245\u00a0mg, net\r\nprice 30-tab pack = \u00a3626.90. \r\n Label:\r\n 23, 25Dose\u00a0HIV infection stabilised on antiretroviral therapy for\r\nmore than 3 months, adult over 18 years,\r\n1 tablet once dailyMissed dose\u00a0If a dose is more than 12 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "Oral vitamin B complex preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.2 Vitamin B group" ], "name": "Oral vitamin B complex preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5119.htm", "doses": [ "treatment of vitamin-B deficiency, 1\u20132 tablets 3 times\r\ndaily" ] }, "NORETHISTERONE": { "indications": "Indications\u00a0see under Dose; HRT (section 6.4.1.1); contraception (section 7.3.1 and section 7.3.2); malignant disease (section\r\n8.3.2)", "name": "NORETHISTERONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens" ], "cautions": "Cautions\u00a0\n(From 6.4.1.2 Progestogens: British National Formulary)\nCautions\u00a0Progestogens should be used with caution in conditions that may worsen with fluid retention e.g. epilepsy, hypertension, migraine, asthma, or cardiac dysfunction, and in those susceptible to thromboembolism (particular caution with high dose). Care is also required in those with a history of depression. Progestogens can decrease glucose tolerance and patients with diabetes should be monitored closely. For interactions see Appendix 1 (progestogens).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4350.htm", "doses": [ "Endometriosis, by mouth, 10\u201315\u00a0mg daily\r\nfor 4\u20136 months or longer, starting on day 5 of cycle (if spotting\r\noccurs increase dose to 20\u201325\u00a0mg daily, reduced once bleeding has\r\nstopped)", "Dysfunctional uterine bleeding, menorrhagia (but see notes above), by mouth, 5\u00a0mg 3 times daily for 10 days to arrest bleeding;\r\nto prevent bleeding 5\u00a0mg twice daily from day 19 to 26", "Dysmenorrhoea (but see notes above), by mouth, 5\u00a0mg 3 times daily from day 5 to 24 for 3\u20134 cycles", "Premenstrual syndrome (but not recommended, see notes above), by mouth, 5\u00a0mg 2\u20133 times daily from day 19 to 26 for several\r\ncycles", "Postponement of menstruation, by mouth, 5\u00a0mg\r\n3 times daily starting 3 days before expected onset (menstruation\r\noccurs 2\u20133 days after stopping)" ], "pregnancy": "Pregnancy\u00a0section 8.3.2" }, "FINASTERIDE": { "indications": "Indications\u00a0benign prostatic hyperplasia;\r\nmale-pattern baldness in men (section 13.9)", "name": "FINASTERIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "Anti-androgens", "Dutasteride and finasteride" ], "cautions": "Cautions\u00a0\n(From Dutasteride and finasteride: British National Formulary)\nCautions\u00a0Dutasteride and finasteride decrease serum concentration of prostate cancer markers such as prostate-specific antigen; reference values may need adjustment. Both dutasteride and finasteride are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. Women of childbearing potential should avoid handling crushed or broken tablets of finasteride and leaking capsules of dutasteride.; also obstructive\r\nuropathyMale breast cancer\u00a0Cases of male breast cancer\r\nhave been reported. Patients or their carers should be\r\ntold to promptly report to their doctor any changes in breast tissue\r\nsuch as lumps, pain, or nipple discharge", "side-effects": "Side-effects\u00a0see notes above; also testicular pain, hypersensitivity\r\nreactions (including lip and face swelling, pruritus and rash); male\r\nbreast cancer also reported (see Cautions above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4376.htm", "doses": [ "5\u00a0mg daily, review treatment at 3\u20136 months and then every\r\n6\u201312 months (may require several months\u2019 treatment before benefit\r\nis obtained)" ] }, "DANTRON With docusate sodium (as co-danthrusate)": { "indications": "Indications\u00a0only for constipation in terminally ill patients of all ages", "name": "DANTRON With docusate sodium (as co-danthrusate)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "DANTRON", "With docusate sodium (as co-danthrusate)" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; rodent studies indicate potential carcinogenic risk; avoid prolonged contact with skin (as in incontinent patients or\r\ninfants wearing nappies)\u2014risk of irritation and excoriation", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; urine may be coloured red", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2212.htm", "doses": [ "See under preparations", "5\u201315\u00a0mL at night; child 6\u201312 years 5\u00a0mL at night (restricted indications, see notes above)", "Name[Co-danthrusate (Non-proprietary) ] Capsules, co-danthrusate 50/60 (dantron 50\u00a0mg, docusate sodium 60\u00a0mg).\r\nNet price 63-cap pack = \u00a318.04. \r\n Label:\r\n 14, (urine red)Dose\u00a01\u20133 capsules at night; child 6\u201312 years 1 capsule at night (restricted indications, see notes\r\nabove)Brands include Normax\u00ae\nSuspension, yellow, co-danthrusate\r\n50/60 (dantron 50\u00a0mg, docusate sodium 60\u00a0mg/5\u00a0mL). Net price 200\u00a0mL = \u00a317.95. \r\n Label:\r\n 14, (urine red)Dose\u00a05\u201315\u00a0mL at night; child 6\u201312 years 5\u00a0mL at night (restricted indications, see notes above)Brands include Normax\u00ae" ], "pregnancy": "Pregnancy\u00a0manufacturers of co-danthramer and co-danthrusate\r\nadvise avoid\u2014no information available" }, "INSULIN": { "indications": "Indications\u00a0diabetes mellitus; diabetic ketoacidosis\r\n(section 6.1.3)", "name": "INSULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins", "INSULIN" ], "cautions": "Cautions\u00a0section 6.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above; transient\r\noedema; local reactions and fat hypertrophy at injection site; rarely hypersensitivity reactions including urticaria, rash;\r\noverdose causes hypoglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4084.htm", "doses": [ "By subcutaneous, intramuscular or intravenous injection or intravenous infusion, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "SODIUM VALPROATE Modified release": { "indications": "Indications\u00a0all forms of epilepsy; migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2); mania\r\n(section 4.2.3)", "name": "SODIUM VALPROATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Valproate", "SODIUM VALPROATE", "Modified release" ], "cautions": "Cautions\u00a0monitor liver function\r\nbefore therapy and during first 6 months especially in patients most\r\nat risk (see also below); measure full\r\nblood count and ensure no undue potential\r\nfor bleeding before starting and before surgery; systemic lupus erythematosus; false-positive\r\nurine tests for ketones; avoid abrupt withdrawal; consider vitamin D supplementation in patients that\r\nare immobilised for long periods or who have inadequate sun exposure\r\nor dietary intake of calcium; interactions: see Interactions in section 4.8.1 and Appendix 1 (valproate)Liver toxicity\u00a0Liver dysfunction (including fatal\r\nhepatic failure) has occurred in association with valproate (especially\r\nin children under 3 years and in those\r\nwith metabolic or degenerative\r\ndisorders, organic brain disease or severe seizure disorders associated with mental\r\nretardation) usually in first 6 months and usually involving\r\nmultiple antiepileptic therapy. Raised liver enzymes\r\nduring valproate treatment are usually transient but patients should\r\nbe reassessed clinically and liver function (including prothrombin\r\ntime) monitored until return to normal\u2014discontinue if abnormally prolonged prothrombin time (particularly\r\nin association with other relevant abnormalities).Blood or hepatic disorders\u00a0Patients or their carers should be told how to recognise signs and\r\nsymptoms of blood or liver disorders and advised to seek immediate\r\nmedical attention if symptoms developPancreatitis\u00a0Patients or their carers\r\nshould be told how to recognise signs and symptoms of pancreatitis\r\nand advised to seek immediate medical attention if symptoms such as\r\nabdominal pain, nausea, or vomiting develop; discontinue if pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0nausea, gastric irritation, diarrhoea; weight\r\ngain; hyperammonaemia, thrombocytopenia; transient hair loss (regrowth\r\nmay be curly); less frequently increased alertness,\r\naggression, hyperactivity, behavioural disturbances, ataxia, tremor,\r\nand vasculitis; rarely hepatic dysfunction (see under\r\nCautions; withdraw treatment immediately if persistent vomiting and\r\nabdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or\r\nloss of seizure control), lethargy, drowsiness, confusion, stupor,\r\nhallucinations, blood disorders (including anaemia, leucopenia, pancytopenia),\r\nhearing loss, and rash; very rarely pancreatitis\r\n(see under Cautions), peripheral oedema, increase in bleeding time,\r\nextrapyramidal symptoms, dementia, encephalopathy, coma, gynaecomastia,\r\nFanconi\u2019s syndrome, hirsutism, acne, enuresis, hyponatraemia, toxic\r\nepidermal necrolysis, and Stevens-Johnson syndrome; suicidal ideation;\r\nreduced bone mineral density (see Cautions); also reported menstrual disturbances, male infertility, syndrome of inappropriate\r\nsecretion of antidiuretic hormone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201160.htm", "doses": [ "Epilepsy, by mouth, initially 600\u00a0mg\r\ndaily in 1\u20132 divided doses, increased gradually (in steps of 150\u2013300\u00a0mg)\r\nevery 3 days; usual maintenance dose 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily),\r\nmax. 2.5\u00a0g daily; child 1 month\u201312\r\nyears, initially 10\u201315\u00a0mg/kg (max. 600\u00a0mg) daily in 1\u20132 divided doses;\r\nusual maintenance dose 25\u201330\u00a0mg/kg daily in 2 divided doses", "Initiation of valproate treatment by intravenous administration, adult and child over 12 years, initially 10\u00a0mg/kg (usually 400\u2013800\u00a0mg) by intravenous injection (over 3\u20135 minutes) followed by intravenous infusion or intravenous\r\ninjection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up\r\nto max. 2.5\u00a0g daily; usual range 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily); child 1 month\u201312 years, 10\u00a0mg/kg by intravenous\r\ninjection (over 3\u20135 minutes) followed by intravenous\r\ninfusion or intravenous injection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up to usual range 20\u201340\u00a0mg/kg\r\ndaily (doses above 40\u00a0mg/kg daily monitor clinical chemistry and haematological\r\nparameters)", "Continuation of valproate treatment by intravenous injection (over 3\u20135 minutes) or intravenous infusion in 2\u20134 divided doses, or by continuous intravenous infusion, same as established oral daily dose", "Migraine prophylaxis [unlicensed], by mouth, initially 200\u00a0mg twice daily, increased if necessary to 1.2\u20131.5\u00a0g\r\ndaily in divided doses", "Mania, see under Episenta\u00ae", "Granules may be mixed with soft food\r\nor drink that is cold or at room temperature, and swallowed immediately\r\nwithout chewing", "Name[Epilim Chronosphere\u00ae (Sanofi-Aventis) ] Granules, m/r, sodium valproate\r\n50\u00a0mg (as sodium valproate and valproic acid), net price 30-sachet\r\npack = \u00a330.00; 100\u00a0mg, 30-sachet pack = \u00a330.00; 250\u00a0mg, 30-sachet\r\npack = \u00a330.00; 500\u00a0mg, 30-sachet pack = \u00a330.00; 750\u00a0mg, 30-sachet\r\npack = \u00a330.00; 1\u00a0g, 30-sachet pack = \u00a330.00. \r\n Label:\r\n 8, 21, 25, counselling, administration, pancreatitis, blood, or hepatic disorder symptoms (see above), driving\r\n(see notes above)Dose\u00a0epilepsy, adult and child, as above to the nearest whole 50-mg sachet;\r\ntotal daily dose given in 1\u20132 divided dosesCounselling\u00a0Granules may be mixed with soft food\r\nor drink that is cold or at room temperature, and swallowed immediately\r\nwithout chewing" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nneonatal bleeding (related to hypofibrinaemia) and neonatal hepatotoxicity\r\nalso reported" }, "ALDESLEUKIN": { "indications": "Indications\u00a0\n(From Aldesleukin: British National Formulary)\nAldesleukin", "name": "ALDESLEUKIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Aldesleukin" ], "cautions": "Cautions\u00a0consult product literature; interactions: Appendix 1 (aldesleukin)", "side-effects": "Side-effects\u00a0see section 8.1, notes above, and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203210.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk (toxicity\r\nin animal studies); ensure effective contraception\r\nduring treatment in men and women; see also Pregnancy and Reproductive\r\nFunction" }, "TYPHOID VACCINE": { "indications": "Indications\u00a0immunisation against typhoid fever", "name": "TYPHOID VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Typhoid vaccines" ], "cautions": "Cautions\u00a0section 14.1; interactions: see above and Appendix\r\n1 (typhoid vaccine (oral) )", "side-effects": "Side-effects\u00a0section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201185.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "RIFABUTIN": { "indications": "Indications\u00a0see under Dose", "name": "RIFABUTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "RIFABUTIN" ], "cautions": "Cautions\u00a0see under Rifampicin; acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0nausea, vomiting; leucopenia, thrombocytopenia,\r\nanaemia, rarely haemolysis; raised liver enzymes, jaundice, rarely\r\nhepatitis; uveitis following high doses or administration with drugs\r\nwhich raise plasma concentration\u2014see also interactions: Appendix 1 (rifamycins); arthralgia, myalgia, influenza-like syndrome,\r\ndyspnoea; also hypersensitivity reactions including fever, rash, eosinophilia,\r\nbronchospasm, shock; skin, urine, saliva and other body secretions\r\ncoloured orange-red; asymptomatic corneal opacities reported with\r\nlong-term use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/14339.htm", "doses": [ "Prophylaxis of Mycobacterium\r\navium complex infections in immunosuppressed patients with\r\nlow CD4 count (see product literature), 300\u00a0mg daily as a single dose", "Treatment of non-tuberculous mycobacterial disease, in combination\r\nwith other drugs, 450\u2013600\u00a0mg daily as a single dose for up to 6 months\r\nafter cultures negative", "Treatment of pulmonary tuberculosis, in combination with other\r\ndrugs, 150\u2013450\u00a0mg daily as a single dose for at least 6 months", "child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "DOXYCYCLINE": { "indications": "Indications\u00a0see notes above; chronic prostatitis; sinusitis, syphilis, pelvic\r\ninflammatory disease (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy); treatment\r\nand prophylaxis of anthrax [unlicensed indication]; malaria treatment\r\nand prophylaxis (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials); recurrent aphthous ulceration, adjunct to gingival\r\nscaling and root planing for periodontitis (%s\n(From 12.3.1 Drugs for oral ulceration and inflammation: British National Formulary)\n12.3.1 Drugs for oral ulceration and inflammation); oral\r\nherpes simplex (%s\n(From Oropharyngeal viral infections: British National Formulary)\nOropharyngeal viral infections); rosacea, acne vulgaris (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "DOXYCYCLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "DOXYCYCLINE" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; alcohol dependence; photosensitivity reported\r\n(avoid exposure to sunlight or sun lamps)", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nanorexia, dry mouth, flushing, anxiety, and tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204180.htm", "doses": [ "200\u00a0mg on first day, then 100\u00a0mg daily; severe infections\r\n(including refractory urinary-tract infections), 200\u00a0mg daily", "Early syphilis, 100\u00a0mg twice daily for 14 days; late latent\r\nsyphilis, 100\u00a0mg twice daily for 28 days; neurosyphilis, 200\u00a0mg twice\r\ndaily for 28 days", "Uncomplicated genital chlamydia, non-gonococcal urethritis,\r\n100\u00a0mg twice daily for 7 days (14 days in pelvic inflammatory disease,\r\nsee also Table 1, section 5.1)", "Lyme disease (see also section 5.1.1.3), 100\u00a0mg twice daily for 10\u201314\r\ndays (28 days in Lyme arthritis)", "Anthrax (treatment or post-exposure prophylaxis; see also section 5.1.12), 100\u00a0mg twice daily; child (only if alternative antibacterial cannot be given) [unlicensed\r\ndose] 5\u00a0mg/kg daily in 2 divided doses (max. 200\u00a0mg daily)", "Capsules should be swallowed whole\r\nwith plenty of fluid during meals while sitting or standing", "Doxycycline doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "CO-CODAMOL ": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-CODAMOL ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-CODAMOL" ], "cautions": "Cautions\u00a0hypotension, asthma (avoid during attack) and impaired respiratory function (avoid in chronic obstructive pulmonary disease), prostatic hypertrophy; shock; myasthenia gravis; obstructive or inflammatory bowel disorders; diseases\r\nof the biliary tract; reduced dose recommended in elderly and debilitated patients, in hypothyroidism, and in adrenocortical\r\ninsufficiency; convulsive disorders; cardiac arrhythmias; acute abdomen; gallstones; alcohol dependence; interactions: Appendix 1 (opioid analgesics, paracetamol)Variation in metabolism\u00a0The capacity\r\nto metabolise codeine can vary considerably and lead to either reduced\r\ntherapeutic effect or marked increase in side-effectsDependence and withdrawal\u00a0Repeated use of opioid\r\nanalgesics, such as codeine, is associated with the development of\r\npsychological and physical dependence; although this is rarely a problem\r\nwith therapeutic use, caution in advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment", "side-effects": "Side-effects\u00a0nausea and vomiting (particularly in initial stages),\r\nconstipation, dry mouth, and biliary spasm; larger doses produce respiratory\r\ndepression, hypotension, and muscle rigidity; other side-effects include\r\nabdominal pain, anorexia, bradycardia, tachycardia, palpitation, oedema,\r\npostural hypotension, seizures, malaise, hypothermia; hallucinations,\r\nvertigo, euphoria, dysphoria, mood changes, dependence, dizziness,\r\nconfusion, drowsiness, sleep disturbances, headache; sexual dysfunction,\r\ndifficulty with micturition, urinary retention, ureteric spasm, muscle\r\nfasciculation; blood disorders (including thrombocytopenia, leucopenia,\r\nneutropenia), miosis, visual disturbances, flushing, sweating, rashes,\r\nurticaria and pruritus; pancreatitis also reported; important: liver damage (and less frequently renal damage) following overdosage with paracetamol; see Emergency Treatment of\r\nPoisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced\r\nrespiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201060.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0codeine may depress neonatal respiration; withdrawal\r\neffects in neonates of dependent mothers; gastric stasis and risk\r\nof inhalation pneumonia in mother during labour" }, "LIOTHYRONINE SODIUM": { "indications": "Indications\u00a0see notes above", "name": "LIOTHYRONINE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.2 Thyroid and antithyroid drugs", "6.2.1 Thyroid hormones", "LIOTHYRONINE SODIUM" ], "cautions": "Cautions\u00a0see under Levothyroxine Sodium; interactions: Appendix 1 (thyroid hormones)", "side-effects": "Side-effects\u00a0see under Levothyroxine Sodium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4241.htm", "doses": [ "By mouth, initially 10\u201320\u00a0micrograms daily\r\ngradually increased to 60\u00a0micrograms daily in 2\u20133 divided doses; elderly smaller initial doses; child, adult dose reduced in proportion to body-weight", "By slow intravenous injection, hypothyroid coma,\r\n5\u201320\u00a0micrograms repeated every 12 hours or as often as every 4 hours\r\nif necessary; alternatively initially 50\u00a0micrograms\r\nthen 25\u00a0micrograms every 8 hours reducing to 25\u00a0micrograms twice daily" ], "pregnancy": "Pregnancy\u00a0does not cross the placenta in significant amounts;\r\nmonitor maternal thyroid function tests\u2014dosage adjustment may be necessary" }, "MEPTAZINOL": { "indications": "Indications\u00a0moderate to severe pain, including postoperative and obstetric pain\r\nand renal colic; peri-operative analgesia, section 15.1.4.3", "name": "MEPTAZINOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; effects only partially reversed by naloxone", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; can induce\r\nwithdrawal symptoms in patients dependent on opioids; also diarrhoea,\r\nabdominal pain, dyspepsia, and hypothermia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3531.htm", "doses": [ "By mouth, 200\u00a0mg every 3\u20136 hours as required; child not recommended", "By intramuscular injection, 75\u2013100\u00a0mg every 2\u20134\r\nhours if necessary; obstetric analgesia, 100\u2013150\u00a0mg according to patient\u2019s\r\nweight (2\u00a0mg/kg); child not recommended", "By slow intravenous injection, 50\u2013100\u00a0mg every\r\n2\u20134 hours if necessary; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "ETORICOXIB": { "indications": "Indications\u00a0pain and inflammation in osteoarthritis, rheumatoid arthritis, and\r\nankylosing spondylitis; acute gout", "name": "ETORICOXIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "ETORICOXIB" ], "cautions": "Cautions\u00a0 \n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; also dehydration; monitor blood pressure before\r\ntreatment, 2 weeks after initiation and periodically during treatment", "side-effects": "Side-effects\u00a0 \n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also palpitation, fatigue, influenza-like\r\nsymptoms, ecchymosis; less commonly dry mouth, taste\r\ndisturbance, mouth ulcer, appetite and weight change, atrial fibrillation,\r\ntransient ischaemic attack, chest pain, flushing, cough, dyspnoea,\r\nepistaxis, anxiety, mental acuity impaired, paraesthesia, electrolyte\r\ndisturbance, myalgia and arthralgia; very rarely confusion\r\nand hallucinations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106544.htm", "doses": [ "Osteoarthritis, adult and child over 16 years, 30\u00a0mg once daily, increased\r\nif necessary to 60\u00a0mg once daily", "Rheumatoid arthritis and ankylosing spondylitis, adult and child over\r\n16 years, 90\u00a0mg once daily", "Acute gout, adult and child over 16 years, 120\u00a0mg once daily for max. 8\r\ndays" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (teratogenic in animal studies); see also notes above" }, "RABEPRAZOLE SODIUM": { "indications": "Indications\u00a0see under Dose", "name": "RABEPRAZOLE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.5 Proton pump inhibitors", "RABEPRAZOLE SODIUM" ], "cautions": "Cautions\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nCautions\u00a0Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.; interactions: Appendix 1 (proton pump inhibitors)", "side-effects": "Side-effects\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nSide-effects\u00a0Side-effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.; also cough, influenza-like syndrome,\r\nand rhinitis; less commonly chest pain and nervousness; rarely anorexia and weight gain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73249.htm", "doses": [ "Benign gastric ulcer, 20\u00a0mg daily in the morning for 8\r\nweeks", "Duodenal ulcer, 20\u00a0mg daily in the morning for 4 weeks", "Duodenal and benign gastric ulcer associated with Helicobacter pylori, see Recommended Regimens for Helicobacter pylori Eradication", "Gastro-oesophageal reflux disease, 20\u00a0mg once daily for 4\u20138\r\nweeks; maintenance 10\u201320\u00a0mg daily; symptomatic treatment in the absence\r\nof oesophagitis, 10\u00a0mg daily for up to 4 weeks, then 10\u00a0mg daily when\r\nrequired", "Zollinger\u2013Ellison syndrome, initially 60\u00a0mg once daily adjusted\r\naccording to response (max. 120\u00a0mg daily); doses above 100\u00a0mg daily\r\ngiven in 2 divided doses", "child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "TRETINOIN - TRETINOIN": { "indications": "Indications\u00a0\n(From Tretinoin: British National Formulary)\nTretinoin; acne (%s\n(From 13.6.1 Topical preparations for acne: British National Formulary)\n13.6.1 Topical preparations for acne); photodamage (%s\n(From 13.8.1 Sunscreen preparations: British National Formulary)\n13.8.1 Sunscreen preparations)", "name": "TRETINOIN - TRETINOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Tretinoin" ], "cautions": "Cautions\u00a0exclude pregnancy before starting treatment; monitor haematological and coagulation profile, liver\r\nfunction, serum calcium and plasma lipids before and during treatment; increased risk of thromboembolism during first month\r\nof treatment; interactions: Appendix\r\n1 (retinoids)", "side-effects": "Side-effects\u00a0retinoic acid syndrome (fever, dyspnoea, acute\r\nrespiratory distress, pulmonary infiltrates, pleural effusion, hyperleucocytosis,\r\nhypotension, oedema, weight gain, hepatic, renal and multi-organ failure)\r\nrequires immediate treatment\u2014consult product literature; gastro-intestinal\r\ndisturbances, pancreatitis; arrhythmias, flushing, oedema; headache,\r\nbenign intracranial hypertension (mainly in children\u2014consider dose\r\nreduction if intractable headache in children), shivering, dizziness,\r\nconfusion, anxiety, depression, insomnia, paraesthesia, visual and\r\nhearing disturbances; raised liver enzymes, serum creatinine and lipids;\r\nbone and chest pain, alopecia, erythema, rash, pruritus, sweating,\r\ndry skin and mucous membranes, cheilitis; thromboembolism,\r\nhypercalcaemia, and genital ulceration reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65167.htm", "doses": [ "adult and child 45\u00a0mg/m2 daily in 2 divided doses,\r\nmax. duration of treatment 90 days (consult product literature for\r\ndetails of concomitant chemotherapy)" ], "pregnancy": "Pregnancy\u00a0teratogenic; effective contraception must be used\r\nfor at least 1 month before oral treatment, during treatment and for\r\nat least 1 month after stopping (oral progestogen-only contraceptives\r\nnot considered effective)" }, "CLOTRIMAZOLE - ANTIFUNGAL PREPARATIONS": { "indications": "Indications\u00a0fungal skin infections; vaginal candidiasis (section 7.2.2); otitis\r\nexterna (section 12.1.1)", "name": "CLOTRIMAZOLE - ANTIFUNGAL PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6155.htm", "doses": [ "Apply 2\u20133 times daily" ], "pregnancy": "Pregnancy\u00a0minimal absorption from skin; not known to be harmful" }, "ISOPHANE INSULIN": { "indications": "Indications\u00a0diabetes mellitus", "name": "ISOPHANE INSULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "ISOPHANE INSULIN" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4108.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "CO-PHENOTROPE": { "indications": "Indications\u00a0adjunct to rehydration in acute diarrhoea\r\n(but see notes above); control of faecal consistency after colostomy\r\nor ileostomy (%s\n(From 1.8 Stoma care: British National Formulary)\n1.8 Stoma care)", "name": "CO-PHENOTROPE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.2 Antimotility drugs", "CO-PHENOTROPE" ], "cautions": "Cautions\u00a0section 4.7.2; also young children are particularly susceptible to overdosage and symptoms may be delayed and observation is needed for at least\r\n48 hours after ingestion; presence of subclinical\r\ndoses of atropine may give rise to atropine side-effects in susceptible\r\nindividuals or in overdosage (section 1.2); interactions: Appendix 1 (antimuscarinics, opioid analgesics)", "side-effects": "Side-effects\u00a0section 4.7.2 and\r\nalso see under Antimuscarinics (section 1.2); also\r\nabdominal pain, anorexia, and fever", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201693.htm", "doses": [ "See preparations", "initially 4 tablets, followed by 2 tablets every 6 hours\r\nuntil diarrhoea controlled; child under\r\n4 years see BNF for Children, 4\u20139 years 1 tablet 3 times daily, 9\u201312 years 1 tablet 4\r\ntimes daily, 12\u201316 years 2 tablets 3 times daily, but see also notes\r\nabove" ], "pregnancy": "Pregnancy\u00a0section 4.7.2 and\r\nalso see under Atropine Sulphate (section 1.2)" }, "ALUMINIUM SALTS": { "indications": "Indications\u00a0see under Dose below", "name": "ALUMINIUM SALTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.12 Antiperspirants", "ALUMINIUM SALTS" ], "cautions": "Cautions\u00a0avoid contact with eyes or mucous membranes; avoid use on broken or irritated skin; do not\r\nshave axillae or use depilatories within 12 hours of application; avoid contact with clothing", "side-effects": "Side-effects\u00a0skin irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5819.htm", "doses": [ "Hyperhidrosis affecting axillae, hands or feet, apply\r\nliquid formulation at night to dry skin, wash off the following morning,\r\ninitially daily then reduce frequency as condition improves\u2014do not\r\nbathe immediately before use", "Hyperhidrosis, bromidrosis, intertrigo, and prevention of tinea\r\npedis and related conditions, apply powder to dry skin" ] }, "PRAZOSIN - ALPHA-BLOCKERS": { "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported. and %s\n(From PRAZOSIN: British National Formulary)\nPRAZOSIN", "indications": "Indications\u00a0benign prostatic hyperplasia; hypertension, congestive\r\nheart failure and Raynaud\u2019s syndrome (section 2.5.4)", "name": "PRAZOSIN - ALPHA-BLOCKERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4618.htm", "doses": [ "Initially 500\u00a0micrograms twice daily for 3\u20137 days, subsequently\r\nadjusted according to response; usual maintenance (and max.) 2\u00a0mg\r\ntwice daily; elderly initiate with\r\nlowest possible dose", "First dose may\r\ncause collapse due to hypotensive effect (therefore should be taken\r\non retiring to bed). Patient should be\r\nwarned to lie down if symptoms such as dizziness, fatigue or sweating\r\ndevelop, and to remain lying down until they abate completely" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers). and %s\n(From PRAZOSIN: British National Formulary)\nPRAZOSIN" }, "REBOXETINE": { "indications": "Indications\u00a0major depression", "name": "REBOXETINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs" ], "cautions": "Cautions\u00a0history of cardiovascular disease and epilepsy; bipolar disorder; urinary retention; prostatic\r\nhypertrophy; susceptibility to angle-closure\r\nglaucoma; avoid abrupt withdrawal; interactions: Appendix 1 (reboxetine)", "side-effects": "Side-effects\u00a0nausea, dry mouth, constipation, anorexia; tachycardia,\r\npalpitation, vasodilation, postural hypotension; headache, insomnia,\r\ndizziness; chills; impotence; urinary retention; impaired visual accommodation;\r\nsweating; lowering of plasma-potassium concentration on prolonged\r\nadministration in the elderly; very rarely angle-closure\r\nglaucoma; also reported vomiting, hypertension, paraesthesia,\r\nagitation, anxiety, irritability, hallucinations, aggression, Raynaud\u2019s\r\nsyndrome, hyponatraemia, testicular pain, cold extremities,\r\nand rash; suicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60899.htm", "doses": [ "4\u00a0mg twice daily increased if necessary after 3\u20134 weeks\r\nto 10\u00a0mg daily in divided doses, max. 12\u00a0mg daily; child under 18 years and elderly not recommended" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014limited\r\ninformation available" }, "NAPROXEN": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\ndysmenorrhoea; acute gout", "name": "NAPROXEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "NAPROXEN" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213719.htm", "doses": [ "Rheumatic disease, 0.5\u20131\u00a0g daily in 1\u20132 divided doses; child 2\u201318 years, juvenile idiopathic arthritis,\r\nsee BNF for Children", "Acute musculoskeletal disorders and dysmenorrhoea, 500\u00a0mg initially,\r\nthen 250\u00a0mg every 6\u20138 hours as required; max. dose after first day\r\n1.25\u00a0g daily; child under 18 years,\r\nsee BNF for Children", "Acute gout, 750\u00a0mg initially, then 250\u00a0mg every 8 hours until\r\nattack has passed; child under 16 years\r\nnot recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "STERCULIA": { "indications": "Indications\u00a0see notes above", "name": "STERCULIA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.1 Bulk-forming laxatives" ], "cautions": "Cautions\u00a0see under Ispaghula Husk", "side-effects": "Side-effects\u00a0see under Ispaghula Husk", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2202.htm", "doses": [ "See under preparations below", "Preparations that swell in contact\r\nwith liquid should always be carefully swallowed with water and should\r\nnot be taken immediately before going to bed" ] }, "VENLAFAXINE": { "indications": "Indications\u00a0major depression, generalised anxiety disorder", "name": "VENLAFAXINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs" ], "cautions": "Cautions\u00a0heart disease (monitor\r\nblood pressure); diabetes; history of epilepsy; history or family history\r\nof mania; susceptibility to angle-closure glaucoma; concomitant use of drugs that increase risk of bleeding, history of bleeding disorders; interactions: Appendix 1 (venlafaxine)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)Withdrawal\u00a0Gastro-intestinal disturbances, headache,\r\nanxiety, dizziness, paraesthesia, tremor, sleep disturbances, and\r\nsweating are most common features of withdrawal if treatment stopped\r\nabruptly or if dose reduced markedly; dose should be reduced over\r\nseveral weeks", "side-effects": "Side-effects\u00a0constipation, nausea, anorexia, weight changes,\r\nvomiting; hypertension, palpitation, vasodilatation, changes in serum\r\ncholesterol; chills, yawning; dizziness, dry mouth, insomnia, nervousness,\r\ndrowsiness, asthenia, headache, abnormal dreams, anxiety, confusion,\r\nhypertonia, sensory disturbances, tremor; difficulty with micturition,\r\nsexual dysfunction, menstrual disturbances; visual disturbances, mydriasis\r\n(very rarely angle-closure glaucoma); sweating; less commonly bruxism, diarrhoea, taste disturbance, postural\r\nhypotension, arrhythmias, agitation, apathy, incoordination, hallucinations,\r\nmyoclonus, angioedema, urinary retention, bleeding disorders (including\r\necchymosis and gastro-intestinal haemorrhage), tinnitus, alopecia,\r\nphotosensitivity, and rash; rarely mania, hypomania,\r\nseizures, extrapyramidal symptoms including akathisia, urinary incontinence; also reported hepatitis, pancreatitis, hypotension, QT-interval\r\nprolongation, aggression, neuroleptic malignant syndrome, delirium,\r\nvertigo, syndrome of inappropriate anti-diuretic hormone secretion\r\n(see Hyponatraemia and Antidepressant\r\nTherapy),\r\nhyperprolactinaemia, blood dyscrasias, rhabdomyolysis, pruritus, urticaria,\r\nStevens-Johnson syndrome; suicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27102.htm", "doses": [ "Depression, adult over\r\n18 years, initially 75\u00a0mg daily in 2 divided doses increased if necessary\r\nat intervals of at least 2 weeks; max. 375\u00a0mg daily; child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)", "Faster dose titration may be necessary in\r\nsome patients", "Generalised anxiety disorder and social anxiety disorder, see\r\nunder preparations below" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity\r\nin animal studies; risk of withdrawal effects in\r\nneonate" }, "FLUOXETINE": { "indications": "Indications\u00a0see under Dose", "name": "FLUOXETINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; also diarrhoea, dysphagia, vasodilatation,\r\nhypotension, flushing, palpitation, pharyngitis, dyspnoea, chills,\r\ntaste disturbance, sleep disturbances, malaise, euphoria, confusion,\r\nyawning, impaired concentration, changes in blood sugar, alopecia,\r\nurinary frequency; haemorrhage, pulmonary inflammation and fibrosis,\r\nhepatitis, toxic epidermal necrolysis, priapism, and neuroleptic malignant\r\nsyndrome-like event also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3365.htm", "doses": [ "Major depression, 20\u00a0mg daily increased after 3\u20134 weeks\r\nif necessary, and at appropriate intervals thereafter; max. 60\u00a0mg\r\ndaily (elderly usual max. 40\u00a0mg daily\r\nbut 60\u00a0mg can be used); child 8\u201318\r\nyears, 10\u00a0mg daily increased after 1\u20132 weeks if necessary, max. 20\u00a0mg\r\ndaily (but see also Depressive Illness in Children\r\nand Adolescents)", "Daily dose may be administered as a single\r\nor divided dose", "Bulimia nervosa, adult over 18\r\nyears, 60\u00a0mg daily as a single or divided dose", "Obsessive-compulsive disorder, adult over 18 years, 20\u00a0mg daily; increased gradually if necessary to\r\nmax. 60\u00a0mg daily (elderly usual max.\r\n40\u00a0mg daily but 60\u00a0mg can be used); review treatment if inadequate\r\nresponse after 10 weeks", "Daily dose may be administered as a single\r\nor divided dose", "Consider\r\nthe long half-life of fluoxetine when adjusting\r\ndosage (or in overdosage)" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nPregnancy\u00a0Manufacturers advise that SSRIs should not be used during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when SSRIs are taken during early pregnancy. If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported; see also individual monographs." }, "DILOXANIDE FUROATE": { "indications": "Indications\u00a0see notes above; chronic amoebiasis and as adjunct\r\nto metronidazole or tinidazole in acute amoebiasis", "name": "DILOXANIDE FUROATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.2 Amoebicides", "DILOXANIDE FUROATE" ], "side-effects": "Side-effects\u00a0flatulence, vomiting, urticaria, pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4038.htm", "doses": [ "500\u00a0mg every 8 hours for 10 days; child body-weight over 25\u00a0kg, 20\u00a0mg/kg daily in 3\r\ndivided doses for 10 days; body-weight under 25\u00a0kg, see BNF for Children", "See also notes above" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "MEGESTROL ACETATE": { "indications": "Indications\u00a0\n(From 8.3.2 Progestogens: British National Formulary)\n8.3.2 Progestogens", "name": "MEGESTROL ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.2 Progestogens" ], "cautions": "Cautions\u00a0see under Medroxyprogesterone acetate (section\r\n6.4.1.2) and notes above; interactions: Appendix 1 (progestogens)", "side-effects": "Side-effects\u00a0see under Medroxyprogesterone acetate (section\r\n6.4.1.2) and notes above; also reported vomiting, carpal tunnel syndrome, Cushing\u2019s syndrome, and tumour\r\nflare (with or without hypercalcaemia)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4812.htm", "doses": [ "Breast cancer, 160\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0avoid; reversible feminisation of male fetuses reported\r\nin animal studies; risk of hypospadias in male fetuses\r\nand masculinisation of female fetuses" }, "QUININE - NOCTURNAL LEG CRAMPS": { "indications": "Indications\u00a0see notes above; malaria (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials)", "name": "QUININE - NOCTURNAL LEG CRAMPS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "Nocturnal leg cramps" ], "cautions": "Cautions\u00a0see section\r\n5.4.1 and\r\nnotes above", "side-effects": "Side-effects\u00a0section\r\n5.4.1; important: very toxic in overdosage\u2014immediate advice from poison centres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31769.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0section 5.4.1" }, "ALPHA TOCOPHEROL": { "indications": "Indications\u00a0vitamin E deficiency because of malabsorption\r\nin congenital or hereditary chronic cholestasis", "name": "ALPHA TOCOPHEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.5 Vitamin E", "ALPHA TOCOPHEROL" ], "cautions": "Cautions\u00a0predisposition to thrombosis; interactions: Appendix 1 (Vitamin E)", "side-effects": "Side-effects\u00a0diarrhoea; less commonly asthenia,\r\nheadache, disturbances in serum-potassium and serum-sodium concentrations,\r\nalopecia, pruritus, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207466.htm", "doses": [ "child under 18 years, 17\u00a0mg/kg\r\ndaily, adjusted as necessary" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution, no evidence of harm\r\nin animal studies" }, "METYRAPONE": { "indications": "Indications\u00a0see notes above and under Dose (specialist supervision in hospital)", "name": "METYRAPONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.3 Metyrapone" ], "cautions": "Cautions\u00a0gross hypopituitarism (risk of precipitating\r\nacute adrenal failure); hypertension on\r\nlong-term administration; hypothyroidism\r\n(delayed response); many drugs\r\ninterfere with diagnostic estimation of steroids; avoid in acute porphyria (section 9.8.2)Driving\u00a0Drowsiness may affect the\r\nperformance of skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0occasional nausea, vomiting, dizziness, headache,\r\nhypotension, sedation; rarely abdominal pain, allergic skin reactions,\r\nhypoadrenalism, hirsutism", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4479.htm", "doses": [ "Differential diagnosis of ACTH-dependent Cushing\u2019s syndrome,\r\n750\u00a0mg every 4 hours for 6 doses; child 15\u00a0mg/kg (minimum 250\u00a0mg) every 4 hours for 6 doses", "Management of Cushing\u2019s syndrome, range 0.25\u20136\u00a0g daily, tailored\r\nto cortisol production; see notes above", "Resistant oedema due to increased aldosterone secretion in cirrhosis,\r\nnephrotic syndrome, and congestive heart failure (with glucocorticoid\r\nreplacement therapy) 3\u00a0g daily in divided doses" ], "pregnancy": "Pregnancy\u00a0avoid (may impair biosynthesis of fetal-placental\r\nsteroids)" }, "CLOBETASOL PROPIONATE With antimicrobials": { "indications": "Indications\u00a0short-term treatment only of severe\r\nresistant inflammatory skin disorders such as recalcitrant eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "CLOBETASOL PROPIONATE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "CLOBETASOL PROPIONATE", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215462.htm", "doses": [ "Apply thinly 1\u20132 times daily for up to 4 weeks; max. 50\u00a0g\r\nof 0.05% preparation per week", "Name[Clobetasol with neomycin and nystatin (Non-proprietary) ] Cream, clobetasol propionate 0.05%,\r\nneomycin sulphate 0.5%, nystatin 100\u00a0000\u00a0units/g, net price 30\u00a0g =\r\n\u00a364.00. \r\n Label:\r\n 28, counselling, application. Potency: very potent\nOintment, clobetasol propionate\r\n0.05%, neomycin sulphate 0.5%, nystatin 100\u00a0000\u00a0units/g, in a paraffin\r\nbasis, net price 30\u00a0g = \u00a364.00. \r\n Label:\r\n 28, counselling, application. Potency: very potent" ] }, "LEFLUNOMIDE": { "indications": "Indications\u00a0(specialist use only) moderate to severe\r\nactive rheumatoid arthritis; active psoriatic arthritis", "name": "LEFLUNOMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "LEFLUNOMIDE" ], "cautions": "Cautions\u00a0 impaired bone-marrow function including anaemia,\r\nleucopenia or thrombocytopenia (avoid if significant and due to causes\r\nother than rheumatoid arthritis); recent treatment with other hepatotoxic\r\nor myelotoxic disease-modifying antirheumatic drugs; washout procedures\r\nrecommended for serious adverse effects or before switching to other\r\ndisease-modifying antirheumatic drugs (consult product literature\r\nand see Washout Procedure, below); history of tuberculosis; exclude pregnancy before treatment; effective contraception essential during treatment and for at least 2 years after\r\ntreatment in women and at least 3 months after treatment in men (plasma\r\nconcentration monitoring required; waiting time before conception\r\nmay be reduced with washout procedure\u2014consult product literature and\r\nsee Washout Procedure, below); monitor full blood count (including differential white\r\ncell count and platelet count) before treatment and every 2 weeks\r\nfor 6 months then every 8 weeks; monitor\r\nliver function\u2014see Hepatotoxicity, below; monitor blood pressure; interactions: Appendix 1 (leflunomide)Hepatotoxicity\u00a0Potentially life-threatening hepatotoxicity\r\nreported usually in the first 6 months; monitor liver function before\r\ntreatment and every 2 weeks for first 6 months then every 8 weeks.\r\nDiscontinue treatment (and institute washout procedure\u2014consult product\r\nliterature and see Washout Procedure below) or reduce dose according\r\nto liver-function abnormality; if liver-function\r\nabnormality persists after dose reduction, discontinue treatment and\r\ninstitute washout procedureWashout procedure\u00a0To aid drug elimination in case\r\nof serious adverse effect, or before starting another disease-modifying\r\nantirheumatic drug, or before conception (see also Pregnancy below),\r\nstop treatment and give either colestyramine 8\u00a0g 3 times daily for 11 days or activated charcoal\r\n50\u00a0g 4 times daily for 11 days; the concentration of the active metabolite\r\nafter washout should be less than 20\u00a0micrograms/litre (measured on\r\n2 occasions 14 days apart) in men or women before conception\u2014consult\r\nproduct literature. Procedure may be repeated as necessary", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, anorexia, oral mucosal\r\ndisorders, abdominal pain; increased blood pressure; headache, dizziness,\r\nasthenia, paraesthesia; leucopenia; tenosynovitis; alopecia, rash,\r\ndry skin, pruritus; less commonly taste disturbance,\r\nanxiety, hyperlipidaemia, hypokalaemia, hypophosphataemia, anaemia,\r\nthrombocytopenia, and tendon rupture; rarely hepatitis,\r\njaundice (see Hepatotoxicity, above), interstitial lung disease, severe\r\ninfection, eosinophilia, and pancytopenia; very rarely pancreatitis, hepatic failure (see Hepatotoxicity, above), peripheral\r\nneuropathy, vasculitis, progressive multifocal leucoencephalopathy,\r\nStevens-Johnson syndrome, and toxic epidermal necrolysis; hypouricaemia,\r\nreduced sperm count, and renal failure also reported; important: discontinue treatment and institute washout procedure (see Washout\r\nProcedure under Cautions) in case of serious side-effect", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213632.htm", "doses": [ "Rheumatoid arthritis, adult over 18 years, initially 100\u00a0mg once daily for 3 days, then 10\u201320\u00a0mg\r\nonce daily", "Psoriatic arthritis, adult over\r\n18 years, initially 100\u00a0mg once daily for 3 days, then 20\u00a0mg once\r\ndaily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014active metabolite teratogenic in animal studies; effective contraception essential during treatment and\r\nfor at least 2 years after treatment in women and at least 3 months\r\nafter treatment in men (see also Cautions above)" }, "PIPOTIAZINE PALMITATE": { "indications": "Indications\u00a0maintenance in schizophrenia and other psychoses", "name": "PIPOTIAZINE PALMITATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "PIPOTIAZINE PALMITATE" ], "cautions": "Cautions\u00a0see section 4.2.1 and notes above; also thyrotoxicosis; hypothyroidism", "side-effects": "Side-effects\u00a0see section 4.2.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3276.htm", "doses": [ "By deep intramuscular injection into the\r\ngluteal muscle, test dose 25\u00a0mg, then a further 25\u201350\u00a0mg after 4\u20137\r\ndays, then adjusted according to response at intervals of 4 weeks;\r\nusual maintenance range 50\u2013100\u00a0mg (max. 200\u00a0mg) every 4 weeks; elderly initially 5\u201310\u00a0mg; child not recommended" ], "pregnancy": "Pregnancy\u00a0see section 4.2.1" }, "BUDESONIDE WITH FORMOTEROL FUMARATE": { "indications": "Indications\u00a0see under preparations (see also Management of Chronic Asthma\r\ntable)", "name": "BUDESONIDE WITH FORMOTEROL FUMARATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0see section 3.1.1.1 and\r\nCautions of Inhaled Corticosteroids (section 3.2)", "side-effects": "Side-effects\u00a0see Formoterol (section 3.1.1.1) and Side-effects of Inhaled\r\nCorticosteroids (section 3.2)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201431.htm", "doses": [ "See under preparations", "Advise patients not to exceed prescribed\r\ndose, and to follow manufacturer\u2019s directions; if a previously effective\r\ndose of inhaled formoterol fails to provide adequate relief, a doctor\u2019s\r\nadvice should be obtained as soon as possible" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "POLYMYXIN B SULPHATE": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "POLYMYXIN B SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "POLYMYXIN B SULPHATE" ], "side-effects": "Side-effects\u00a0local irritation and dermatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86217.htm", "doses": [ "See Administration in\r\nnotes above" ] }, "CALCIUM SALTS - CALCIUM SUPPLEMENTS": { "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances; with injection, bradycardia, arrhythmias, peripheral vasodilatation,\r\nfall in blood pressure, sweating, injection-site reactions, severe\r\ntissue damage with extravasation", "indications": "Indications\u00a0see notes above; calcium deficiency", "name": "CALCIUM SALTS - CALCIUM SUPPLEMENTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5045.htm", "doses": [ "By mouth, daily in divided doses, see notes above", "By slow intravenous injection, acute hypocalcaemia,\r\ncalcium gluconate 1\u20132\u00a0g (Ca2+ 2.25\u20134.5\u00a0mmol); child see BNF for Children" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.1 Calcium supplements", "CALCIUM SALTS" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; avoid calcium chloride in respiratory acidosis or\r\nrespiratory failure; interactions: Appendix 1 (antacids, calcium\r\nsalts)" }, "COLESTYRAMINE - DRUGS AFFECTING INTESTINAL SECRETIONS": { "indications": "Indications\u00a0pruritus associated with partial biliary obstruction\r\nand primary biliary cirrhosis; diarrhoea associated with Crohn\u2019s disease,\r\nileal resection, vagotomy, diabetic vagal neuropathy, and radiation;\r\nhypercholesterolaemia (section 2.12)", "name": "COLESTYRAMINE - DRUGS AFFECTING INTESTINAL SECRETIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.9 Drugs affecting intestinal secretions", "1.9.2 Bile acid sequestrants", "COLESTYRAMINE" ], "cautions": "Cautions\u00a0section 2.12", "side-effects": "Side-effects\u00a0section 2.12", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106279.htm", "doses": [ "Pruritus, 4\u20138\u00a0g daily in a suitable liquid; child 1\u201318 years see BNF for Children", "Diarrhoea, initially 4\u00a0g daily increased by 4\u00a0g at weekly intervals\r\nto 12\u201324\u00a0g daily in a suitable liquid in 1\u20134 divided doses, then adjusted\r\nas required; max. 36\u00a0g daily; child 1\u201318 years see BNF for Children", "Other drugs should be taken at least\r\n1 hour before or 4\u20136 hours after colestyramine to\r\nreduce possible interference with absorption", "The contents of each sachet should be mixed\r\nwith at least 150\u00a0mL of water or other suitable liquid such as fruit\r\njuice, skimmed milk, thin soups, and pulpy fruits with a high moisture\r\ncontent" ], "pregnancy": "Pregnancy\u00a0section 2.12" }, "EXENATIDE": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "EXENATIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "EXENATIDE" ], "cautions": "Cautions\u00a0elderly; pancreatitis (see below); may cause weight loss greater than 1.5\u00a0kg weekly; interactions: Appendix 1 (antidiabetics)Pancreatitis\u00a0Severe pancreatitis (sometimes fatal),\r\nincluding haemorrhagic or necrotising pancreatitis, has been reported\r\nrarely. Patients or their carers should be told how to\r\nrecognise signs and symptoms of pancreatitis and advised to seek prompt\r\nmedical attention if symptoms such as abdominal pain, nausea, and\r\nvomiting develop; discontinue permanently\r\nif pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances including nausea,\r\nvomiting, diarrhoea, dyspepsia, abdominal pain and distension, gastro-oesophageal\r\nreflux disease, decreased appetite, weight loss, headache, dizziness,\r\nagitation, asthenia, hypoglycaemia, increased sweating, injection-site\r\nreactions, antibody formation; less commonly pancreatitis\r\n(see Cautions above); rarely alopecia; very\r\nrarely anaphylactic reactions; also reported constipation,\r\nflatulence, eructation, dehydration, taste disturbance, renal impairment,\r\ndrowsiness, rash, pruritus, urticaria, and angioedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218696.htm", "doses": [ "By subcutaneous injection, adult over 18 years, initially 5\u00a0micrograms twice\r\ndaily within 1 hour before 2 main meals (at least 6 hours apart),\r\nincreased if necessary after at least 1 month to max. 10\u00a0micrograms\r\ntwice daily", "If a dose is missed, continue with\r\nthe next scheduled dose\u2014do not administer after a\r\nmeal. Some oral medications should be taken at least 1 hour before\r\nor 4 hours after exenatide injection\u2014consult product literature for\r\ndetails", "Dose of concomitant sulfonylurea may need\r\nto be reduced" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies.\r\nWomen of child-bearing age should use effective contraception during\r\ntreatment with modified-release exenatide and for 12 weeks after discontinuation" }, "BIMATOPROST With timolol": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle glaucoma; ocular hypertension", "name": "BIMATOPROST With timolol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides", "BIMATOPROST", "With timolol" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.; also\r\nnausea, asthenia, hypertension", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129670.htm", "doses": [ "Apply once daily, preferably in the evening; child under 18 years, not recommended", "Name[Ganfort\u00ae (Allergan) ] Eye drops, bimatoprost 300\u00a0micrograms/mL,\r\ntimolol (as maleate) 5\u00a0mg/mL, net price 3-mL = \u00a313.95, triple pack\r\n(3 x 3\u00a0mL) = \u00a337.59Excipients include benzalkonium chlorideDose\u00a0for raised intra-ocular pressure in patients with open-angle\r\nglaucoma or ocular hypertension when beta-blocker or prostaglandin\r\nanalogue alone not adequate, adult over\r\n18 years, apply once daily in the morning" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "CLONIDINE HYDROCHLORIDE ": { "indications": "Indications\u00a0hypertension; migraine (section 4.7.4.2); menopausal flushing (section 6.4.1.1)", "name": "CLONIDINE HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.2 Centrally acting antihypertensive drugs" ], "cautions": "Cautions\u00a0must be withdrawn gradually to avoid\r\nsevere rebound hypertension; mild to moderate\r\nbradyarrhythmia; constipation; polyneuropathy; Raynaud\u2019s\r\nsyndrome or other occlusive peripheral\r\nvascular disease; history of depression; interactions: Appendix 1 (clonidine)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol may be enhanced", "side-effects": "Side-effects\u00a0constipation, nausea, dry mouth, vomiting, salivary\r\ngland pain, postural hypotension, dizziness, sleep disturbances, headache,\r\nmalaise, drowsiness, depression, sexual dysfunction, less\r\ncommonly bradycardia, Raynaud\u2019s syndrome, delusion, hallucination,\r\nparaesthesia, pruritus, rash, urticaria; rarely colonic\r\npseudo-obstruction, AV block, gynaecomastia, decreased lacrimation,\r\nnasal dryness, alopecia; also reported hepatitis,\r\nfluid retention, bradyarrhythmia, confusion, impaired visual accommodation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2546.htm", "doses": [ "By mouth, 50\u2013100\u00a0micrograms 3 times\r\ndaily, increased every second or third day; usual max. dose 1.2\u00a0mg\r\ndaily" ], "pregnancy": "Pregnancy\u00a0may lower fetal heart rate, but risk should be balanced\r\nagainst risk of uncontrolled maternal hypertension; avoid intravenous\r\ninjection" }, "TROSPIUM CHLORIDE": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence", "name": "TROSPIUM CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; rarely chest pain, dyspnoea, and asthenia; very\r\nrarely myalgia and arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88020.htm", "doses": [ "adult and child over 12 years, 20\u00a0mg twice daily before food" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution" }, "CO-AMOXICLAV Other oral preparations": { "indications": "Indications\u00a0infections due to beta-lactamase-producing\r\nstrains (where amoxicillin alone not appropriate)\r\nincluding respiratory-tract infections, bone and joint infections,\r\ngenito-urinary and abdominal infections, cellulitis, animal bites,\r\nsevere dental infection with spreading cellulitis or dental infection\r\nnot responding to first-line antibacterial", "name": "CO-AMOXICLAV Other oral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.3 Broad-spectrum penicillins", "CO-AMOXICLAV", "Other oral preparations" ], "cautions": "Cautions\u00a0see under Ampicillin and notes above; maintain adequate hydration with high doses (particularly during\r\nparenteral therapy); interactions: Appendix\r\n1 (penicillins)Cholestatic jaundice\u00a0Cholestatic\r\njaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has\r\nshown that the risk of acute liver toxicity was about 6 times greater\r\nwith co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above\r\nthe age of 65 years and in men; these reactions have only\r\nrarely been reported in children. Jaundice is usually self-limiting\r\nand very rarely fatal. The duration of treatment should\r\nbe appropriate to the indication and should not usually exceed 14\r\ndays", "side-effects": "Side-effects\u00a0see under Ampicillin; hepatitis,\r\ncholestatic jaundice (see above); Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, exfoliative dermatitis, vasculitis reported;\r\nrarely prolongation of bleeding time, dizziness, headache, convulsions\r\n(particularly with high doses or in renal impairment); superficial\r\nstaining of teeth with suspension, phlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204235.htm", "doses": [ "By mouth, expressed as co-amoxiclav, one 250/125 strength tablet every 8 hours; increased\r\nin severe infection to one 500/125 strength tablet\r\nevery 8 hours; neonate 0.25\u00a0mL/kg of 125/31 suspension every 8 hours; child 1 month\u20131 year, 0.25\u00a0mL/kg of 125/31 suspension\r\nevery 8 hours, dose doubled in severe infection; 1\u20136 years, 5\u00a0mL of 125/31 suspension every 8 hours or 0.25\u00a0mL/kg\r\nof 125/31 suspension every 8 hours, dose doubled\r\nin severe infection; 6\u201312 years, 5\u00a0mL of 250/62 suspension\r\nevery 8 hours or 0.15\u00a0mL/kg of 250/62 suspension every 8 hours, dose doubled in severe infection", "Severe dental infections (but not generally first-line, see notes above), expressed\r\nas co-amoxiclav, adult and child over 12 years, one 250/125 strength tablet every 8 hours for 5 days", "By intravenous injection over 3\u20134\r\nminutes or by intravenous infusion, expressed as co-amoxiclav, 1.2\u00a0g every 8 hours; neonate 30\u00a0mg/kg every 12 hours; child 1\u20133 months 30\u00a0mg/kg every 12 hours; child 3 months\u201318 years, 30\u00a0mg/kg (max. 1.2\u00a0g) every 8 hours", "Surgical prophylaxis, expressed as co-amoxiclav, 1.2\u00a0g up to 30 minutes before the procedure; for high risk procedures\r\nup to 2\u20133 further doses of 1.2\u00a0g may be given every 8 hours", "Name[Co-amoxiclav (Non-proprietary) ] Suspension \u2018400/57\u2019, co-amoxiclav 400/57 (amoxicillin 400\u00a0mg as trihydrate, clavulanic\r\nacid 57\u00a0mg as potassium salt)/5\u00a0mL when reconstituted with water,\r\nnet price 35\u00a0mL = \u00a34.13, 70\u00a0mL = \u00a35.79. \r\n Label:\r\n 9 Excipients may include aspartame (section 9.4.1)Note\u00a0Sugar-free versions are available and can\r\nbe ordered by specifying \u2018sugar-free\u2019 on the prescriptionBrands include Augmentin-Duo\u00aeDose\u00a0adult and child over 40\u00a0kg 10\u00a0mL twice daily, increased to\r\n10\u00a0mL three times daily in severe infection; child 2 months\u20132 years 0.15\u00a0mL/kg twice daily, 2\u20136 years (13\u201321\u00a0kg) 2.5\u00a0mL\r\ntwice daily, 7\u201312 years (22\u201340\u00a0kg) 5\u00a0mL twice daily, doubled in severe\r\ninfection" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TOBRAMYCIN": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "TOBRAMYCIN" ], "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "TOBRAMYCIN", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213676.htm", "doses": [ "adult and child over 1 year, apply twice daily for 6\u20138 days;\r\nin severe infection, apply 4 times daily on the first day, then twice\r\ndaily for 5\u20137 days" ] }, "ICATIBANT": { "indications": "Indications\u00a0acute attacks of hereditary angioedema\r\nin patients with C1-esterase inhibitor deficiency", "name": "ICATIBANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Angioedema", "ICATIBANT" ], "cautions": "Cautions\u00a0ischaemic heart disease, stroke", "side-effects": "Side-effects\u00a0dizziness, headache, injection-site reactions,\r\nrash, pruritus, erythema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201204.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 30\u00a0mg as a single dose, repeated\r\nafter 6 hours if necessary; a third dose may be given after a further\r\n6 hours (max. 3 doses in 24 hours)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "THYMOL": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "THYMOL" ], "indications": "Indications\u00a0oral hygiene, \n(From 12.3.4 Mouthwashes, gargles, and dentifrices: British National Formulary)\n12.3.4 Mouthwashes, gargles, and dentifrices", "name": "THYMOL", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5751.htm", "doses": [ "dissolve 1 tablet in a tumblerful of warm water" ] }, "THIAMINE": { "indications": "Indications\u00a0see notes above", "name": "THIAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.2 Vitamin B group", "THIAMINE" ], "cautions": "Cautions\u00a0anaphylaxis may occasionally follow injection (see MHRA/CHM advice below)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/12851.htm", "doses": [ "Mild deficiency, by mouth, 25\u2013100\u00a0mg daily;\r\nsevere deficiency, 200\u2013300\u00a0mg daily in divided doses" ] }, "ENFUVIRTIDE": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs for resistant infection or for patients intolerant\r\nto other antiretroviral regimens", "name": "ENFUVIRTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Other antiretrovirals", "ENFUVIRTIDE" ], "cautions": "Cautions\u00a0Hypersensitivity reactions\u00a0Hypersensitivity\r\nreactions including rash, fever, nausea, vomiting, chills, rigors,\r\nlow blood pressure, respiratory distress, glomerulonephritis, and\r\nraised liver enzymes reported; discontinue\r\nimmediately if any signs or symptoms of systemic hypersensitivity\r\ndevelop and do not rechallengeCounselling\u00a0Patients should be told\r\nhow to recognise signs of hypersensitivity, and advised to discontinue\r\ntreatment and seek immediate medical attention if symptoms develop", "side-effects": "Side-effects\u00a0injection-site reactions; pancreatitis, gastro-oesophageal\r\nreflux disease, anorexia, weight loss; hypertriglyceridaemia; peripheral\r\nneuropathy, asthenia, tremor, anxiety, nightmares, irritability, impaired\r\nconcentration, vertigo; pneumonia, sinusitis, influenza-like illness;\r\ndiabetes mellitus; haematuria; renal calculi, lymphadenopathy; myalgia;\r\nconjunctivitis; dry skin, acne, erythema, skin papilloma; less commonly hypersensitivity reactions (see Cautions);\r\nsee also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128191.htm", "doses": [ "By subcutaneous injection, 90\u00a0mg twice\r\ndaily; child 6\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "PROPRANOLOL HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0see under Dose", "name": "PROPRANOLOL HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "PROPRANOLOL HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nBeta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA, see above), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers, see above). Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.; also avoid abrupt\r\nwithdrawal especially in ischaemic heart disease; first-degree AV block; portal hypertension\r\n(risk of deterioration in liver function); diabetes; history of\r\nobstructive airways disease (introduce cautiously and monitor lung\r\nfunction\u2014\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nBeta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA, see above), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers, see above). Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.); myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked (also see notes above); psoriasis; history of hypersensitivity\u2014may increase sensitivity\r\nto allergens and result in more serious hypersensitivity response, also may reduce response to adrenaline (epinephrine) (see also %s\n(From 3.4.3 Allergic emergencies: British National Formulary)\n3.4.3 Allergic emergencies); interactions: Appendix 1\r\n(beta-blockers), important: verapamil\r\ninteraction, see also VERAPAMIL %s\n(From 2.6.2 Calcium-channel blockers: British National Formulary)\n2.6.2 Calcium-channel blockers ", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nbradycardia, heart failure, hypotension, conduction disorders, peripheral\r\nvasoconstriction (including exacerbation of intermittent claudication\r\nand Raynaud\u2019s phenomenon); bronchospasm (see above), dyspnoea; headache,\r\nfatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses;\r\nsexual dysfunction; purpura, thrombocytopenia; visual disturbances;\r\nexacerbation of psoriasis, alopecia; rarely rashes\r\nand dry eyes (reversible on withdrawal); overdosage: \n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2461.htm", "doses": [ "By mouth, hypertension, initially\r\n80\u00a0mg twice daily, increased at weekly intervals as required; maintenance\r\n160\u2013320\u00a0mg daily", "Prophylaxis of variceal bleeding in portal hypertension, initially\r\n40\u00a0mg twice daily, increased to 80\u00a0mg twice daily according to heart\r\nrate; max. 160\u00a0mg twice daily", "Phaeochromocytoma (only with an alpha-blocker), 60\u00a0mg daily\r\nfor 3\u00a0days before surgery or 30\u00a0mg daily in patients\r\nunsuitable for surgery", "Angina, initially 40\u00a0mg 2\u20133\u00a0times daily; maintenance 120\u2013240\u00a0mg\r\ndaily", "Arrhythmias, hypertrophic cardiomyopathy, anxiety tachycardia,\r\nand thyrotoxicosis (adjunct), 10\u201340\u00a0mg 3\u20134\u00a0times daily", "Anxiety with symptoms such as palpitation, sweating, tremor,\r\n40\u00a0mg once daily, increased to 40\u00a0mg 3 times daily if necessary", "Prophylaxis after myocardial infarction, 40\u00a0mg 4 times daily\r\nfor 2\u20133 days, then 80\u00a0mg twice daily, beginning 5 to 21 days after\r\ninfarction", "Essential tremor, initially 40\u00a0mg 2\u20133\u00a0times daily; maintenance\r\n80\u2013160\u00a0mg daily", "Migraine prophylaxis, 80\u2013240\u00a0mg daily in divided doses", "By intravenous injection, arrhythmias\r\nand thyrotoxic crisis, 1\u00a0mg over 1 minute; if necessary repeat at\r\n2-minute intervals; max. total dose 10\u00a0mg (5\u00a0mg in anaesthesia)", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning ", "Name[Inderal-LA\u00ae (AstraZeneca) ] Capsules, m/r, lavender/pink, propranolol hydrochloride 160\u00a0mg, net price 28-cap pack\r\n= \u00a32.95. \r\n Label:\r\n 8, 25Note\u00a0Modified-release capsules containing propranolol hydrochloride 160\u00a0mg also available; brands\r\ninclude Bedranol SR\u00ae, Beta Prograne\u00ae, Slo-Pro\u00ae" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "BELATACEPT": { "indications": "Indications\u00a0see notes above", "name": "BELATACEPT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "BELATACEPT" ], "cautions": "Cautions\u00a0increased risk of infection; risk factors for post-transplant\r\nlymphoproliferative disorder; avoid excessive exposure to UV light\r\nincluding sunlightTuberculosis\u00a0Patients should be evaluated for\r\nlatent and active tuberculosis before starting treatment, and monitored\r\nfor signs and symptoms of tuberculosis during and after treatment", "side-effects": "Side-effects\u00a0(reported when used in combination with basiliximab,\r\nmycophenolate mofetil and corticosteroids) diarrhoea, constipation,\r\nnausea, vomiting, hypertension, peripheral oedema, cough, headache,\r\npyrexia, infection, malignancy, anaemia, leucopenia, dehydration,\r\nhypophosphataemia; less commonly infusion related\r\nreactions, progressive multifocal leukoencephalopathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218781.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0use only if essential; adequate contraception must\r\nbe used during treatment and for up to 8 weeks after last dose" }, "TERAZOSIN - ALPHA-BLOCKERS": { "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported. and %s\n(From TERAZOSIN: British National Formulary)\nTERAZOSIN", "indications": "Indications\u00a0 benign prostatic hyperplasia; hypertension\r\n(section 2.5.4)", "name": "TERAZOSIN - ALPHA-BLOCKERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/13998.htm", "doses": [ "Initially 1\u00a0mg at bedtime; if necessary dose may be doubled\r\nat intervals of 1\u20132 weeks according to response, up to max. 10\u00a0mg\r\nonce daily; usual maintenance 5\u201310\u00a0mg daily", "First dose may\r\ncause collapse due to hypotensive effect (therefore should be taken\r\non retiring to bed). Patient should be\r\nwarned to lie down if symptoms such as dizziness, fatigue or sweating\r\ndevelop, and to remain lying down until they abate completely" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "TERAZOSIN" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers). and %s\n(From TERAZOSIN: British National Formulary)\nTERAZOSINDriving\u00a0May affect performance of skilled tasks\r\ne.g. driving" }, "BILASTINE": { "indications": "Indications\u00a0symptomatic relief of allergic rhinoconjunctivitis and urticaria", "name": "BILASTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines", "BILASTINE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0headache, malaise; less commonly abdominal pain, diarrhoea, increased appetite, weight gain, thirst,\r\ngastritis, prolongation of the QT interval, dyspnoea, anxiety, insomnia,\r\nvertigo, dizziness, pyrexia, oral herpes, tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215660.htm", "doses": [ "adult and child over 12 years, 20\u00a0mg once daily", "Advise patient to take tablet 1 hour\r\nbefore or 2 hours after food or fruit juice" ], "pregnancy": "Pregnancy\u00a0avoid\u2014limited information available; see also notes above" }, "CO-DYDRAMOL - WITH DIHYDROCODEINE TARTRATE 10\u00a0MG": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-DYDRAMOL - WITH DIHYDROCODEINE TARTRATE 10\u00a0MG", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-DYDRAMOL", "With dihydrocodeine tartrate 10\u00a0mg" ], "cautions": "Cautions\u00a0section 4.7.2; also alcohol dependence; severe cor pulmonale; interactions: Appendix 1 (opioid analgesics, paracetamol)", "side-effects": "Side-effects\u00a0section 4.7.2; also\r\nabdominal pain, paralytic ileus, pancreatitis, paraesthesia, blood\r\ndisorders (including thrombocytopenia, leucopenia, neutropenia); important: liver damage (and less frequently renal damage)\r\nfollowing overdosage with paracetamol; see Emergency\r\nTreatment of Poisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced respiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208663.htm", "doses": [ "See under preparations", "Name[Co-dydramol (Non-proprietary) ] Tablets, scored, co-dydramol 10/500\r\n(dihydrocodeine tartrate 10\u00a0mg, paracetamol 500\u00a0mg), net price 30-tab pack = \u00a31.06. \r\n Label:\r\n 29, 30Dose\u00a01\u20132 tablets every 4\u20136 hours; max. 8 tablets daily; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0withdrawal effects in neonates of dependant mothers" }, "INDORAMIN": { "indications": "Indications\u00a0hypertension (see notes above); benign\r\nprostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "INDORAMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "INDORAMIN" ], "cautions": "Cautions\u00a0avoid alcohol (enhances rate and\r\nextent of absorption); control incipient\r\nheart failure before initiating indoramin; elderly; Parkinson\u2019s disease (extrapyramidal\r\ndisorders reported); epilepsy (convulsions in animal studies); history\r\nof depression; cataract surgery (risk of\r\nintra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol may be enhanced", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\nsedation; less commonly fatigue, weight gain, failure\r\nof ejaculation; also reported extrapyramidal disorders, urinary frequency, and incontinence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9939.htm", "doses": [ "Hypertension, initially 25\u00a0mg twice daily, increased by\r\n25\u201350\u00a0mg daily at intervals of 2 weeks; max. daily dose 200\u00a0mg in\r\n2\u20133 divided doses" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "LOCAL CORTICOSTEROID INJECTIONS Prednisolone acetate": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Prednisolone acetate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Prednisolone acetate" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5282.htm", "doses": [ "See under preparations", "Name[Deltastab\u00ae (Sovereign) ] Injection (aqueous suspension), prednisolone acetate 25\u00a0mg/mL, net price 1-mL amp = \u00a35.73Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 5\u201325\u00a0mg according to size; not more than\r\n3 joints should be treated on any one day; where appropriate may be\r\nrepeated when relapse occursFor intramuscular injection, see section 6.3.2 " ] }, "HYDROCORTISONE - CHRONIC BOWEL DISORDERS": { "side-effects": "Side-effects\u00a0section 6.3.2; also local irritation", "indications": "Indications\u00a0ulcerative colitis, proctitis, proctosigmoiditis", "name": "HYDROCORTISONE - CHRONIC BOWEL DISORDERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2180.htm", "doses": [ "By rectum see preparations", "initially 1 metered application (125\u00a0mg hydrocortisone acetate) inserted into the rectum once or twice\r\ndaily for 2\u20133 weeks, then once on alternate days; child 2\u201318 years see BNF for Children" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids", "HYDROCORTISONE" ], "cautions": "Cautions\u00a0section 6.3.2; systemic absorption may occur; prolonged\r\nuse should be avoided" }, "COMBINED HORMONAL CONTRACEPTIVES": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4553.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "PERGOLIDE": { "indications": "Indications\u00a0alone or as adjunct to co-beneldopa or co-careldopa in Parkinson\u2019s\r\ndisease where dopamine-receptor agonists other than ergot derivative\r\nnot appropriate", "name": "PERGOLIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "PERGOLIDE" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; arrhythmias or underlying cardiac disease; history of confusion, psychosis, or hallucinations, dyskinesia (may exacerbate); acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(pergolide)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, vomiting, dyspepsia, abdominal pain; dyspnoea, rhinitis; hallucinations,\r\ndyskinesia, drowsiness (including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.);\r\ndiplopia; also reported constipation, diarrhoea, hiccups, tachycardia,\r\natrial premature contractions, palpitation, hypotension, syncope,\r\nRaynaud\u2019s phenomenon, compulsive behaviour (\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.), insomnia,\r\nconfusion, dizziness, fever, erythromelalgia, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128421.htm", "doses": [ "Monotherapy, 50\u00a0micrograms at night on day 1, then\r\n50\u00a0micrograms twice daily on days 2\u20134, then increased by 100\u2013250\u00a0micrograms\r\ndaily every 3\u20134 days to 1.5\u00a0mg daily in 3 divided doses at day 28;\r\nafter day 30, further increases every 3\u20134 days of up to 250\u00a0micrograms\r\ndaily; usual maintenance dose 2.1\u20132.5\u00a0mg daily; max. 3\u00a0mg daily", "Adjunctive therapy with levodopa, 50\u00a0micrograms daily for 2 days, increased gradually by 100\u2013150\u00a0micrograms\r\nevery 3 days over next 12 days, usually given in 3 divided doses;\r\nfurther increases of 250\u00a0micrograms every 3 days; max. 3\u00a0mg daily", "During pergolide titration levodopa dose\r\nmay be reduced cautiously" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "DEXRAZOXANE": { "indications": "Indications\u00a0\n(From Anthracycline side-effects: British National Formulary)\nAnthracycline side-effects and under\r\npreparations", "name": "DEXRAZOXANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Anthracycline side-effects", "DEXRAZOXANE" ], "cautions": "Cautions\u00a0\n(From Anthracycline side-effects: British National Formulary)\nAnthracycline side-effects; monitor full blood count", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, abdominal pain, diarrhoea,\r\nstomatitis, dry mouth, anorexia; dyspnoea; dizziness, syncope, asthenia,\r\nparaesthesia, tremor, fatigue, drowsiness; pyrexia; vaginal haemorrhage;\r\nmyalgia; blood disorders (including anaemia, leucopenia, neutropenia,\r\nthrombocytopenia, and increased myelosuppression); alopecia, pruritus;\r\nperipheral oedema, injection-site reactions including phlebitis; also reported secondary malignancies", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200214.htm", "doses": [ "See under preparations", "prevention of anthracycline-induced cardiotoxicity, adult over 18 years, by intravenous infusion (30 minutes before anthracycline administration), 10 times the doxorubicin-equivalent\r\ndose or 10 times the epirubicin-equivalent dose" ], "pregnancy": "Pregnancy\u00a0avoid unless essential (toxicity in animal studies); ensure effective contraception during and for at least\r\n3 months after treatment in men and women" }, "GLICLAZIDE Modified release": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "GLICLAZIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas", "GLICLAZIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106128.htm", "doses": [ "Initially, 40\u201380\u00a0mg daily, adjusted according to response;\r\nup to 160\u00a0mg as a single dose, with breakfast; higher doses divided;\r\nmax. 320\u00a0mg daily", "Name[Diamicron\u00ae MR (Servier) ] Tablets, m/r, gliclazide 30\u00a0mg,\r\nnet price 28-tab pack = \u00a32.81, 56-tab pack = \u00a35.62. \r\n Label:\r\n 25Dose\u00a0adult initially\r\n30\u00a0mg daily with breakfast, adjusted according to response every 4\r\nweeks (after 2 weeks if no decrease in blood glucose); max. 120\u00a0mg\r\ndailyNote\u00a0Diamicron\u00ae MR 30\u00a0mg may\r\nbe considered to be approximately equivalent in therapeutic effect\r\nto standard formulation Diamicron\u00ae 80\u00a0mg " ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "TETRACOSACTIDE": { "indications": "Indications\u00a0see notes above", "name": "TETRACOSACTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Corticotrophins" ], "cautions": "Cautions\u00a0as for corticosteroids, section 6.3.2; important: risk\r\nof anaphylaxis (medical supervision; consult product literature); history of atopic allergy (e.g. asthma, eczema, hayfever); history of hypersensitivity; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0as for corticosteroids, section 6.3.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4397.htm", "doses": [ "See under preparations below" ], "pregnancy": "Pregnancy\u00a0avoid (but may be used diagnostically if essential)" }, "TRAVOPROST": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle glaucoma; ocular hypertension", "name": "TRAVOPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides", "TRAVOPROST" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.; also\r\nreported hypotension, bradycardia, browache", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106169.htm", "doses": [ "Apply once daily, preferably in the evening; child under 18 years, not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "AMPHOTERICIN": { "indications": "Indications\u00a0See under Dose", "name": "AMPHOTERICIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.3 Polyene antifungals", "AMPHOTERICIN" ], "cautions": "Cautions\u00a0when given parenterally, toxicity common\r\n(close supervision necessary and test dose required;\r\nsee Anaphylaxis below); hepatic and renal function tests,\r\nblood counts, and plasma electrolyte (including plasma-potassium and\r\nmagnesium concentration) monitoring required; corticosteroids (avoid except to control reactions); avoid rapid infusion (risk of arrhythmias); interactions: Appendix 1 (amphotericin)Anaphylaxis\u00a0Anaphylaxis occurs rarely\r\nwith any intravenous amphotericin product and a\r\ntest dose is advisable before the first infusion; the\r\npatient should be carefully observed for at least 30 minutes after\r\nthe test dose. Prophylactic antipyretics or hydrocortisone should only be used in patients who have\r\npreviously experienced acute adverse reactions (in whom continued\r\ntreatment with amphotericin is essential)", "side-effects": "Side-effects\u00a0when given parenterally, anorexia, nausea and\r\nvomiting, diarrhoea, epigastric pain; febrile reactions, headache,\r\nmuscle and joint pain; anaemia; disturbances in renal function (including\r\nhypokalaemia and hypomagnesaemia) and renal toxicity; also cardiovascular\r\ntoxicity (including arrhythmias, blood pressure changes), blood disorders,\r\nneurological disorders (including hearing loss, diplopia, convulsions,\r\nperipheral neuropathy, encephalopathy), abnormal liver function (discontinue\r\ntreatment), rash, anaphylactoid reactions (see Anaphylaxis, above);\r\npain and thrombophlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3971.htm", "doses": [ "By intravenous infusion, see preparations", "Different preparations of intravenous amphotericin\r\nvary in their pharmacodynamics, pharmacokinetics, dosage, and administration;\r\nthese preparations should not be considered interchangeable.\r\nTo avoid confusion, prescribers should specify the brand to be dispensed.", "by intravenous infusion, systemic fungal\r\ninfections, initial test dose of 1\u00a0mg over 20\u201330 minutes then 250\u00a0micrograms/kg\r\ndaily, gradually increased over 2\u20134 days, if tolerated, to 1\u00a0mg/kg\r\ndaily; max. (severe infection) 1.5\u00a0mg/kg daily or on alternate days; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0not known to be harmful but manufacturers advise\r\navoid unless potential benefit outweighs risk" }, "DEXMEDETOMIDINE": { "indications": "Indications\u00a0maintenance of sedation during intensive\r\ncare", "name": "DEXMEDETOMIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.4 Other drugs for sedation" ], "cautions": "Cautions\u00a0monitor cardiac function; monitor respiratory function\r\nin non-intubated patients; severe neurological disorders; bradycardia;\r\nischaemic heart disease or severe cerebrovascular disease (especially\r\nat higher doses); spinal cord injury; abrupt withdrawal after prolonged\r\nuse; malignant hyperthermia", "side-effects": "Side-effects\u00a0nausea, vomiting, dry mouth, bradycardia, myocardial\r\nischaemia, myocardial infarction, tachycardia, blood pressure changes,\r\nagitation, changes in blood sugar, hyperthermia; less commonly abdominal distension, AV block, decreased cardiac output, dyspnoea,\r\nhallucination, metabolic acidosis, hypoalbuminaemia, thirst", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217732.htm", "doses": [ "By intravenous infusion, adult over 18 years, 0.7\u00a0micrograms/kg/hour adjusted\r\naccording to response (usual range 0.2\u20131.4\u00a0micrograms/kg/hour)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "CHLORPHENAMINE MALEATE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, urticaria; emergency\r\ntreatment of anaphylactic reactions (section 3.4.3)", "name": "CHLORPHENAMINE MALEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines", "CHLORPHENAMINE MALEATE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; also\r\nexfoliative dermatitis and tinnitus reported; injections may cause\r\ntransient hypotension or CNS stimulation and may be irritant", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3037.htm", "doses": [ "By mouth, 4\u00a0mg every 4\u20136 hours, max. 24\u00a0mg\r\ndaily (elderly max. 12\u00a0mg daily); child under 1 year see BNF for Children; 1\u20132 years\r\n1\u00a0mg twice daily; 2\u20136 years 1\u00a0mg every 4\u20136 hours, max. 6\u00a0mg daily;\r\n6\u201312 years 2\u00a0mg every 4\u20136 hours, max. 12\u00a0mg daily", "By intramuscular injection or by intravenous injection over 1 minute, 10\u00a0mg, repeated\r\nif required up to max. 4 doses in 24 hours; child under 6 months 250\u00a0micrograms/kg (max. 2.5\u00a0mg); 6 months\u20136 years\r\n2.5\u00a0mg; 6\u201312 years 5\u00a0mg; these doses may be repeated if required up\r\nto max. 4 doses in 24 hours" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "RASBURICASE": { "indications": "Indications\u00a0prophylaxis and treatment of acute hyperuricaemia with initial chemotherapy\r\nfor haematological malignancy", "name": "RASBURICASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Hyperuricaemia associated with cytotoxic drugs" ], "cautions": "Cautions\u00a0monitor closely for hypersensitivity; atopic allergies; may interfere\r\nwith test for uric acid\u2014consult product literature", "side-effects": "Side-effects\u00a0fever; less commonly nausea,\r\nvomiting, diarrhoea, headache, hypersensitivity reactions (including\r\nrash, bronchospasm and anaphylaxis); haemolytic anaemia, methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106160.htm", "doses": [ "By intravenous infusion, 200\u00a0micrograms/kg\r\nonce daily for up to 7 days according to plasma-uric acid concentration" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "QUINAPRIL": { "indications": "Indications\u00a0essential hypertension; congestive heart failure\r\n(adjunct\u2014see section 2.5.5)", "name": "QUINAPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "QUINAPRIL" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; asthenia, chest pain, oedema,\r\nflatulence, nervousness, depression, insomnia, blurred vision, impotence,\r\nand back pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2601.htm", "doses": [ "Hypertension, initially 10\u00a0mg once daily; with a diuretic\r\n(see notes above),\r\nin elderly, or in renal impairment initially 2.5\u00a0mg daily; usual maintenance\r\ndose 20\u201340\u00a0mg daily in single or 2 divided doses; up to 80\u00a0mg daily\r\nhas been given", "Heart failure (adjunct), initial dose 2.5\u00a0mg daily under close\r\nmedical supervision (see notes above),\r\nincreased gradually to 10\u201320\u00a0mg daily in 1\u20132 divided doses if tolerated;\r\nmax. 40\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "MIRTAZAPINE": { "indications": "Indications\u00a0major depression", "name": "MIRTAZAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs", "MIRTAZAPINE" ], "cautions": "Cautions\u00a0elderly, cardiac\r\ndisorders, hypotension, history of urinary retention, susceptibility\r\nto angle-closure glaucoma, diabetes mellitus, psychoses (may aggravate psychotic symptoms), history of seizures or bipolar depression; interactions: Appendix 1\r\n(mirtazapine)Blood disorders\u00a0Patients should be\r\nadvised to report any fever, sore throat, stomatitis or other signs\r\nof infection during treatment. Blood count\r\nshould be performed and the drug stopped immediately if blood dyscrasia\r\nsuspectedWithdrawal\u00a0Nausea, vomiting, dizziness, agitation,\r\nanxiety, and headache are most common features of withdrawal if treatment\r\nstopped abruptly or if dose reduced markedly; dose should be reduced\r\nover several weeks", "side-effects": "Side-effects\u00a0increased appetite, weight gain, dry mouth; postural\r\nhypotension, peripheral oedema; drowsiness, fatigue, tremor, dizziness,\r\nabnormal dreams, confusion, anxiety, insomnia; arthralgia, myalgia; less commonly syncope, hypotension, mania, hallucinations,\r\nmovement disorders; rarely myoclonus; very\r\nrarely blood disorders (see Cautions), convulsions, hyponatraemia\r\n(see Hyponatraemia and Antidepressant\r\nTherapy),\r\nsuicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy),\r\nand angle-closure glaucoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127984.htm", "doses": [ "Initially 15\u201330\u00a0mg daily at bedtime increased within 2\u20134\r\nweeks according to response; max. 45\u00a0mg daily as a single dose at\r\nbedtime or in 2 divided doses; child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)" ], "pregnancy": "Pregnancy\u00a0use with caution\u2014limited experience; monitor neonate\r\nfor withdrawal effects" }, "ROCURONIUM BROMIDE": { "indications": "Indications\u00a0neuromuscular blockade (intermediate duration) for surgery or during\r\nintensive care", "name": "ROCURONIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs", "ROCURONIUM BROMIDE" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207422.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "Intubation, adult and child over 1 month, by intravenous injection, initially 600\u00a0micrograms/kg; maintenance by intravenous\r\ninjection, 150\u00a0micrograms/kg (elderly 75\u2013100\u00a0micrograms/kg) or maintenance by\r\nintravenous infusion, 300\u2013600\u00a0micrograms/kg/hour (elderly up to 400\u00a0micrograms/kg/hour) adjusted according\r\nto response", "Intensive care, by intravenous injection, adult initially 600\u00a0micrograms/kg (optional); maintenance by intravenous infusion, 300\u2013600\u00a0micrograms/kg/hour for first\r\nhour, then adjusted according to response; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "EPROSARTAN": { "indications": "Indications\u00a0hypertension (see also notes above)", "name": "EPROSARTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists" ], "cautions": "Cautions\u00a0see notes above", "side-effects": "Side-effects\u00a0see notes above; also flatulence, hypertriglyceridaemia,\r\narthralgia, rhinitis; rarely headache, asthenia,\r\nanaemia, hypersensitivity reactions (including rash, pruritus, urticaria); very rarely nausea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85176.htm", "doses": [ "600\u00a0mg once daily (elderly over 75 years, initially 300\u00a0mg\r\nonce daily); if necessary increased after 2\u20133 weeks to 800\u00a0mg once\r\ndaily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "CLOBETASOL PROPIONATE": { "indications": "Indications\u00a0short-term treatment only of severe\r\nresistant inflammatory skin disorders such as recalcitrant eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "CLOBETASOL PROPIONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "CLOBETASOL PROPIONATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5891.htm", "doses": [ "Apply thinly 1\u20132 times daily for up to 4 weeks; max. 50\u00a0g\r\nof 0.05% preparation per week" ] }, "DICLOFENAC SODIUM Modified release": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\nacute gout; postoperative pain", "name": "DICLOFENAC SODIUM Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DICLOFENAC SODIUM", "Modified release" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation; injection site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5210.htm", "doses": [ "By mouth, 75\u2013150\u00a0mg daily in 2\u20133\r\ndivided doses", "By rectum in suppositories, 75\u2013150\u00a0mg\r\ndaily in divided doses", "Juvenile idiopathic arthritis, child 6 months\u201318 years, by mouth, see BNF for Children", "Postoperative pain, child 6\u201312 years, by rectum, 1\u20132\u00a0mg/kg (max. 150\u00a0mg) daily\r\nin divided doses (12.5\u00a0mg and 25\u00a0mg suppositories only) for max. 4\r\ndays", "Name[Voltarol\u00ae Retard (Novartis) ] Tablets, m/r, f/c, red, diclofenac sodium 100\u00a0mg. Net price 28-tab pack = \u00a39.47. \r\n Label:\r\n 21, 25Dose\u00a0adult over 18 years, 1\r\ntablet once daily; child 12\u201318 years\r\nsee BNF for ChildrenNote\u00a0Other brands of modified-release tablets\r\ncontaining diclofenac sodium 100\u00a0mg include Defenac\u00ae Retard, Dexomon\u00ae Retard 100, Dicloflex\u00ae Retard, Fenactol\u00ae Retard 100\u00a0mg, Flamatak\u00ae 100 MR, Slofenac\u00ae SR, Volsaid\u00ae Retard 100" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "GLYCERYL TRINITRATE": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2633.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TRIPTORELIN": { "indications": "Indications\u00a0prostate cancer; endometriosis, precocious\r\npuberty, reduction in size of uterine fibroids; male hypersexuality\r\nwith severe sexual deviation (section 6.7.2)", "name": "TRIPTORELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues", "TRIPTORELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Men at risk of tumour \u2018flare\u2019 (see above) should be monitored closely during the first month of therapy. Caution is required in patients with metabolic bone disease because reduced bone mineral density can occur. The injection site should be rotated.; risk of ureteric obstruction and spinal cord compression in men", "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues; also\r\ndry mouth, transient hypertension, paraesthesia, and increased dysuria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128318.htm", "doses": [ "Name[Gonapeptyl Depot\u00ae (Ferring) ] advanced prostate cancer, by subcutaneous or deep intramuscular injection,\r\n3.75\u00a0mg every 4 weeks (see also notes above)" ] }, "MEDROXYPROGESTERONE ACETATE": { "indications": "Indications\u00a0see under Dose; contraception (section 7.3.2.2); malignant\r\ndisease (section\r\n8.3.2)", "name": "MEDROXYPROGESTERONE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens", "MEDROXYPROGESTERONE ACETATE" ], "cautions": "Cautions\u00a0\n(From 6.4.1.2 Progestogens: British National Formulary)\nCautions\u00a0Progestogens should be used with caution in conditions that may worsen with fluid retention e.g. epilepsy, hypertension, migraine, asthma, or cardiac dysfunction, and in those susceptible to thromboembolism (particular caution with high dose). Care is also required in those with a history of depression. Progestogens can decrease glucose tolerance and patients with diabetes should be monitored closely. For interactions see Appendix 1 (progestogens).", "side-effects": "Side-effects\u00a0see notes above; indigestion", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4349.htm", "doses": [ "By mouth, 2.5\u201310\u00a0mg daily for 5\u201310 days\r\nbeginning on day 16 to 21 of cycle, repeated for 2 cycles in dysfunctional\r\nuterine bleeding and 3 cycles in secondary amenorrhoea", "Mild to moderate endometriosis, 10\u00a0mg 3 times daily for 90 consecutive\r\ndays, beginning on day 1 of cycle", "Progestogenic opposition of oestrogen HRT, 10\u00a0mg daily for the\r\nlast 14 days of each 28-day oestrogen HRT cycle" ], "pregnancy": "Pregnancy\u00a0section 8.3.2" }, "TAPENTADOL": { "indications": "Indications\u00a0moderate to severe pain which can be managed only with opioid analgesics", "name": "TAPENTADOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndecreased appetite, diarrhoea, dyspepsia, abdominal discomfort, weight\r\nloss, anxiety, tremor, ataxia, dysarthria, hypoaesthesia, paraesthesia,\r\nseizures, malaise, muscle spasms", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/214542.htm", "doses": [ "adult over 18 years, by mouth, initially 50\u00a0mg every 4\u20136 hours (max. 700\u00a0mg in\r\nthe first 24 hours), adjusted according to response; max. 600\u00a0mg daily", "During the first 24 hours of treatment, an\r\nadditional dose of 50\u00a0mg may be taken 1 hour after the initial dose,\r\nif pain control not achieved" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "OESTROGENS, TOPICAL": { "indications": "Indications\u00a0see notes above", "name": "OESTROGENS, TOPICAL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.2 Treatment of vaginal and vulval conditions", "7.2.1 Preparations for vaginal and vulval changes", "Topical HRT for vaginal atrophy", "OESTROGENS, TOPICAL" ], "cautions": "Cautions\u00a0\n(From Topical HRT for vaginal atrophy: British National Formulary)\nA cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium in menopausal atrophic vaginitis. It is important to bear in mind that topical oestrogens should be used in the smallest effective amount to minimise systemic effects. Modified-release vaginal tablets and an impregnated vaginal ring are now also available.The risk of endometrial hyperplasia and carcinoma is increased when systemic oestrogens are administered alone for prolonged periods (section 6.4.1.1). The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.; see also Oestrogens for\r\nHRT (%s\n(From 6.4.1.1 Oestrogens and HRT: British National Formulary)\n6.4.1.1 Oestrogens and HRT); interrupt treatment periodically\r\nto assess need for continued treatment", "side-effects": "Side-effects\u00a0see notes above; see also Oestrogens\r\nfor HRT (%s\n(From 6.4.1.1 Oestrogens and HRT: British National Formulary)\n6.4.1.1 Oestrogens and HRT); local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4525.htm", "doses": [ "insert 1 applicator-dose daily for 2\u20133 weeks, then reduce\r\nto twice a week (discontinue every 2\u20133 months for 4 weeks to assess\r\nneed for further treatment); vaginal surgery, 1 applicator-dose daily\r\nfor 2 weeks before surgery, resuming 2 weeks after surgery" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "CLOMIPRAMINE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0depressive illness, phobic and obsessional states; adjunctive treatment\r\nof cataplexy associated with narcolepsy", "name": "CLOMIPRAMINE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "CLOMIPRAMINE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, diarrhoea, hypertension, flushing, restlessness, fatigue,\r\naggression, impaired memory, muscle weakness, muscle hypertonia, myoclonus,\r\nmydriasis, and yawning; very rarely allergic alveolitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3308.htm", "doses": [ "Depressive illness, adult over 18 years, initially 10\u00a0mg daily, increased gradually as necessary\r\nto 30\u2013150\u00a0mg daily in divided doses or as a single\r\ndose at bedtime; max. 250\u00a0mg daily; elderly initially 10\u00a0mg daily increased carefully over approx. 10 days to\r\n30\u201375\u00a0mg daily", "Phobic and obsessional states, adult over 18 years, initially 25\u00a0mg daily (elderly 10\u00a0mg daily) increased over 2 weeks to 100\u2013150\u00a0mg daily; max. 250\u00a0mg\r\ndaily", "Adjunctive treatment of cataplexy associated with narcolepsy, adult over 18 years, initially 10\u00a0mg daily, gradually\r\nincreased until satisfactory response (range 10\u201375\u00a0mg daily)", "Name[Anafranil SR\u00ae (Novartis) ] Tablets, m/r, grey-red, f/c, clomipramine hydrochloride 75\u00a0mg, net price 28-tab pack\r\n= \u00a38.83. \r\n Label:\r\n 2, 25Dose\u00a0see above; to be taken once\r\ndaily " ], "pregnancy": "Pregnancy\u00a0neonatal withdrawal symptoms reported if used during\r\nthird trimester" }, "VINORELBINE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\nThe vinca alkaloids, vinblastine, vincristine, and vindesine, are used to treat a variety of cancers including leukaemias, lymphomas, and some solid tumours (e.g. breast and lung cancer). Vinorelbine is a semi-synthetic vinca alkaloid; it is given intravenously or orally for the treatment of advanced breast cancer and for advanced non-small cell lung cancer. For the role of vinorelbine in the treatment of breast cancer, see section 8.3.4.1. Vinflunine is licensed as monotherapy for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a platinum-containing regimen.Neurotoxicity, usually as peripheral or autonomic neuropathy, occurs with all vinca alkaloids and is a limiting side-effect of vincristine; it occurs less often with vindesine, vinblastine, vinorelbine, and vinflunine. Patients with neurotoxicity commonly have peripheral paraesthesia, loss of deep tendon reflexes, abdominal pain, and constipation; ototoxicity has been reported. If symptoms of neurotoxicity are severe, doses should be reduced. Motor weakness can also occur, and increasing motor weakness calls for dose reduction or discontinuation of these drugs. Recovery from neurotoxic effects is usually slow but complete.Myelosuppression is a dose-limiting side-effect of vinblastine, vindesine, vinorelbine, and vinflunine; vincristine causes negligible myelosuppression. The vinca alkaloids cause severe local irritation and care must be taken to avoid extravasation. Severe bronchospasm has been reported following administration of the vinca alkaloids (more commonly when used in combination with mitomycin-C).", "name": "VINORELBINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide", "VINORELBINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; ischaemic heart disease; caution in handling; interactions: Appendix 1 (vinorelbine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also rarely pancreatitis; hyponatraemia and inappropriate\r\nsecretion of antidiuretic hormone also reported; irritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129824.htm", "doses": [ "By mouth, 60\u00a0mg/m2 once weekly\r\nfor 3 weeks, increased if tolerated to 80\u00a0mg/m2 once weekly;\r\nmax. 160\u00a0mg once weekly", "By intravenous injection or infusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid unless essential (teratogenicity, and fetal\r\nloss in animal studies); manufacturer advises effective\r\ncontraception during and for 3 months after treatment; men must avoid\r\nfathering a child during and for at least 3 months after treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "DIPYRIDAMOLE With aspirin": { "indications": "Indications\u00a0see notes above and under Dose", "name": "DIPYRIDAMOLE With aspirin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "DIPYRIDAMOLE", "With aspirin" ], "cautions": "Cautions\u00a0rapidly worsening angina, aortic stenosis, recent\r\nmyocardial infarction, left ventricular\r\noutflow obstruction, heart failure; may exacerbate migraine; hypotension; myasthenia gravis (risk of\r\nexacerbation); coagulation disorders; concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (dipyridamole)", "side-effects": "Side-effects\u00a0gastro-intestinal effects, dizziness, myalgia,\r\nthrobbing headache, hypotension, hot flushes and tachycardia; worsening\r\nsymptoms of coronary heart disease; hypersensitivity reactions such\r\nas rash, urticaria, severe bronchospasm and angioedema; increased\r\nbleeding during or after surgery; thrombocytopenia reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69388.htm", "doses": [ "By mouth, 300\u2013600\u00a0mg daily in 3\u20134\r\ndivided doses", "Modified-release preparations, see under preparation below", "By intravenous injection, diagnostic\r\nonly, consult product literature", "Name[Asasantin\u00ae Retard (Boehringer Ingelheim) ] Capsules, red/ivory, aspirin 25\u00a0mg, dipyridamole 200\u00a0mg (m/r), net price 60-cap\r\npack = \u00a37.79. \r\n Label:\r\n 21, 25Dose\u00a0secondary prevention of ischaemic stroke and transient\r\nischaemic attacks, 1 capsule twice dailyNote\u00a0Dispense in original container (pack contains\r\na desiccant) and discard any capsules remaining 6 weeks after opening" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "CYPROTERONE ACETATE - CYPROTERONE ACETATE": { "side-effects": "Side-effects\u00a0fatigue and lassitude, breathlessness, weight\r\nchanges, reduced sebum production (may clear acne), changes in hair\r\npattern, gynaecomastia (rarely leading to galactorrhoea and benign\r\nbreast nodules); rarely hypersensitivity reactions, rash and osteoporosis;\r\ninhibition of spermatogenesis (see notes above); hepatotoxicity reported\r\n(including jaundice, hepatitis and hepatic failure (fatalities reported\r\nat dosages of 100\u00a0mg and above, usually in men treated for advanced\r\nprostate cancer), \n(From CYPROTERONE ACETATE: British National Formulary)\nSide-effects\u00a0see section 6.4.2Hepatotoxicity\u00a0Direct hepatic toxicity including jaundice, hepatitis and hepatic failure have been reported (fatalities reported at dosages of 100\u00a0mg and above, usually in men treated for advanced prostate cancer). Liver function tests should be performed before and regularly during treatment and whenever symptoms suggestive of hepatotoxicity occur\u2014if confirmed cyproterone should normally be withdrawn unless the hepatotoxicity can be explained by another cause such as metastatic disease (in which case cyproterone should be continued only if the perceived benefit exceeds the risk) for details and warnings)", "indications": "Indications\u00a0see notes above; prostate\r\ncancer (%s\n(From 8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists: British National Formulary)\n8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists)", "name": "CYPROTERONE ACETATE - CYPROTERONE ACETATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86559.htm", "doses": [ "adult over 18 years, male\r\nhypersexuality, 50\u00a0mg twice daily after food" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "Anti-androgens", "Cyproterone acetate", "CYPROTERONE ACETATE" ], "cautions": "Cautions\u00a0ineffective for male hypersexuality in\r\nchronic alcoholism (relevance to prostate cancer\r\nnot known); blood counts initially and\r\nthroughout treatment; monitor hepatic function\r\nregularly (liver function tests should\r\nbe performed before treatment, see also under Side-effects\r\nbelow); monitor adrenocortical function regularly; diabetes mellitus (see also Contra-indications)Driving\u00a0Fatigue and lassitude may\r\nimpair performance of skilled tasks (e.g. driving)" }, "VALSARTAN With diuretic": { "indications": "Indications\u00a0hypertension; heart failure when ACE inhibitors cannot be used, or\r\nin conjunction with an ACE inhibitor when a beta-blocker cannot be\r\nused (see also section 2.5.5); myocardial infarction with\r\nleft ventricular failure or left ventricular systolic dysfunction\r\n(adjunct\u2014see section 2.5.5 and section 2.10.1)", "name": "VALSARTAN With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "VALSARTAN", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; renal impairment; less\r\ncommonly gastro-intestinal disturbance, syncope, fatigue,\r\ncough, headache, acute renal failure; neutropenia, thrombocytopenia,\r\nmyalgia, and hypersensitivity reactions (including rash, pruritus,\r\nvasculitis, and serum sickness) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129035.htm", "doses": [ "Hypertension, usually 80\u00a0mg once daily (initially 40\u00a0mg\r\nonce daily in intravascular volume depletion); if necessary increased\r\nat intervals of 4 weeks up to max. 320\u00a0mg daily", "Heart failure, initially 40\u00a0mg twice daily increased at intervals\r\nof at least 2 weeks up to max. 160\u00a0mg twice daily", "Myocardial infarction, initially 20\u00a0mg twice daily increased\r\nover several weeks to 160\u00a0mg twice daily if tolerated", "Name[Co-Diovan\u00ae (Novartis) ] Tablets 80/12.5, orange, f/c, valsartan\r\n80\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a313.97\nTablets 160/12.5, red, f/c, valsartan\r\n160\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a318.41\nTablets 160/25, brown-orange, f/c,\r\nvalsartan 160\u00a0mg, hydrochlorothiazide 25\u00a0mg, net price 28-tab pack\r\n= \u00a318.41" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "DANAPAROID SODIUM": { "indications": "Indications\u00a0prevention of deep-vein thrombosis\r\nin general or orthopaedic surgery; thromboembolic disease in patients\r\nwith history of heparin-induced thrombocytopenia", "name": "DANAPAROID SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Heparinoids" ], "cautions": "Cautions\u00a0recent bleeding or risk of bleeding; concomitant use of drugs\r\nthat increase risk of bleeding; antibodies\r\nto heparins (risk of antibody-induced thrombocytopenia); body-weight over 90\u00a0kg (monitor anti factor Xa activity)", "side-effects": "Side-effects\u00a0bleeding; hypersensitivity reactions (including\r\nrash)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129019.htm", "doses": [ "Prevention of deep-vein thrombosis, by subcutaneous\r\ninjection, 750\u00a0units twice daily for 7\u201310 days; initiate treatment\r\nbefore operation (with last pre-operative dose 1\u20134 hours before surgery)", "Thromboembolic disease in patients with history of heparin-induced\r\nthrombocytopenia, by intravenous injection, 2500\u00a0units\r\n(1250\u00a0units if body-weight under 55\u00a0kg, 3750\u00a0units if over 90\u00a0kg),\r\nfollowed by intravenous infusion of 400\u00a0units/hour\r\nfor 2 hours, then 300\u00a0units/hour for 2 hours, then 200\u00a0units/hour for 5 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014limited information available\r\nbut not known to be harmful" }, "IPRATROPIUM BROMIDE - ANTIMUSCARINIC": { "side-effects": "Side-effects\u00a0epistaxis, nasal dryness, and irritation; less\r\nfrequently nausea, headache, and pharyngitis; very rarely antimuscarinic effects such as gastro-intestinal motility disturbances,\r\npalpitations, and urinary retention", "indications": "Indications\u00a0rhinorrhoea associated with allergic and non-allergic\r\nrhinitis", "name": "IPRATROPIUM BROMIDE - ANTIMUSCARINIC", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5668.htm", "doses": [ "adult and child over 12 years, 42\u00a0micrograms (2 sprays) into\r\neach nostril 2\u20133 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.2 Topical nasal decongestants", "Antimuscarinic" ], "cautions": "Cautions\u00a0see section 3.1.2; avoid\r\nspraying near eyes" }, "FERROUS GLUCONATE": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS GLUCONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4859.htm", "doses": [ "See under preparation below and notes above" ] }, "NAPROXEN With misoprostol": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\ndysmenorrhoea; acute gout", "name": "NAPROXEN With misoprostol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "NAPROXEN", "With misoprostol" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5252.htm", "doses": [ "Rheumatic disease, 0.5\u20131\u00a0g daily in 1\u20132 divided doses; child 2\u201318 years, juvenile idiopathic arthritis,\r\nsee BNF for Children", "Acute musculoskeletal disorders and dysmenorrhoea, 500\u00a0mg initially,\r\nthen 250\u00a0mg every 6\u20138 hours as required; max. dose after first day\r\n1.25\u00a0g daily; child under 18 years,\r\nsee BNF for Children", "Acute gout, 750\u00a0mg initially, then 250\u00a0mg every 8 hours until\r\nattack has passed; child under 16 years\r\nnot recommended", "Name[Napratec\u00ae (Pharmacia) ] Combination pack, 56 yellow scored\r\ntablets, naproxen 500\u00a0mg; 56 white scored tablets, misoprostol 200 micrograms. Net price = \u00a323.76. \r\n Label:\r\n 21Dose\u00a0patients requiring naproxen for rheumatoid\r\narthritis, osteoarthritis, or ankylosing spondylitis, with prophylaxis\r\nagainst NSAID-induced gastroduodenal ulceration, 1 naproxen 500-mg tablet and 1 misoprostol 200-microgram\r\ntablet taken together twice daily with food; child not recommended Note\u00a0The BNF recommends a higher starting dose\r\nof misoprostol for prophylaxis against NSAID-induced gastroduodenal\r\nulceration than that provided by Napratec\u00ae (see section 1.3.4)" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "EVEROLIMUS": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nEverolimus, a protein kinase inhibitor, is licensed for the treatment of advanced renal cell carcinoma when the disease has progressed despite treatment with vascular endothelial growth factor-targeted therapy (see NICE guidance below), and for the treatment of unresectable or metastatic, well- or moderately-differentiated neuroendocrine tumours of pancreatic origin. It is also licensed for the treatment of subependymal giant cell astrocytoma associated with tuberous sclerosis complex in patients who require therapeutic intervention but are not amenable to surgery.NICE guidanceEverolimus for the second-line treatment of advanced renal cell carcinoma (April 2011)Everolimus is not recommended for the second-line treatment of advanced renal cell carcinoma.", "name": "EVEROLIMUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "EVEROLIMUS" ], "cautions": "Cautions\u00a0see section 8.1; monitor blood-glucose\r\nconcentration before treatment and periodically thereafter; monitor renal function before treatment and periodically thereafter; reduce dose or discontinue if severe side-effects occur\u2014consult product\r\nliterature; interactions: Appendix\r\n1 (everolimus)Pneumonitis\u00a0Non-infectious pneumonitis reported. Patients should be advised to seek urgent medical advice if new or\r\nworsening respiratory symptoms occur", "side-effects": "Side-effects\u00a0see section 8.1; also\r\ndiarrhoea, dry mouth, abdominal pain, dysphagia, anorexia, taste disturbance;\r\nchest pain, hypertension, hyperlipidaemia, hypercholesterolaemia,\r\nperipheral oedema; pneumonitis (including interstitial lung disease);\r\nasthenia, anxiety, fatigue, headache, insomnia; increased susceptibility\r\nto infections (including pneumonia, aspergillosis, and candidiasis);\r\nhyperglycaemia, hypoglycaemia, dehydration; eyelid oedema; renal failure,\r\nelectrolyte disturbance; arthralgia; epistaxis; skin and nail disorders\r\n(including hand-foot syndrome); less commonly congestive\r\nheart failure, flushing, and impaired wound healing; hepatitis B reactivation\r\nand haemorrhage also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204152.htm", "doses": [ "See under preparations", "renal cell carcinoma, neuroendocrine tumours of pancreatic\r\norigin, adult over 18 years, 10\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); effective contraception must be used during and for up\r\nto 8 weeks after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "ETHOSUXIMIDE": { "indications": "Indications\u00a0\n(From Ethosuximide: British National Formulary)\nEthosuximide", "name": "ETHOSUXIMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Ethosuximide", "ETHOSUXIMIDE" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; avoid in acute porphyria (section 9.8.2); interactions: see Interactions in section\r\n4.8.1 and Appendix 1 (ethosuximide)Blood disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of blood disorders, and\r\nadvised to seek immediate medical attention if symptoms such as fever,\r\nmouth ulcers, bruising, or bleeding develop", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including nausea,\r\nvomiting, diarrhoea, abdominal pain, anorexia, weight loss); less frequently headache, fatigue, drowsiness, dizziness,\r\nhiccup, ataxia, euphoria, irritability, aggression, impaired concentration; rarely tongue swelling, sleep disturbances, depression,\r\npsychosis, photophobia, dyskinesia, increased libido, vaginal bleeding,\r\nmyopia, gingival hypertrophy, rash; also reported hyperactivity, increase in seizure frequency, blood disorders (including\r\nleucopenia, agranulocytosis, pancytopenia, and aplastic anaemia\u2014blood\r\ncounts required if features of infection), systemic lupus erythematosus,\r\nStevens-Johnson syndrome; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3583.htm", "doses": [ "adult and child over 6 years, initially 500\u00a0mg daily in 2 divided\r\ndoses, increased by 250\u00a0mg every 5\u20137 days to usual dose of 1\u20131.5\u00a0g\r\ndaily in 2 divided doses; occasionally up to 2\u00a0g daily may be needed; child 1 month\u20136 years, initially 10\u00a0mg/kg (max. 250\u00a0mg)\r\ndaily in 2 divided doses, increased every 5\u20137 days to usual dose of\r\n20\u201340\u00a0mg/kg (max. 1\u00a0g) daily in 2 divided doses; total daily dose\r\nmay be given in 3 divided doses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "MAGNESIUM CITRATE": { "indications": "Indications\u00a0see preparations", "name": "MAGNESIUM CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.5 Bowel cleansing preparations", "MAGNESIUM CITRATE" ], "cautions": "Cautions\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations", "side-effects": "Side-effects\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2244.htm", "doses": [ "See preparations", "bowel evacuation for surgery, colonoscopy or radiological\r\nexamination, on day before procedure, 1 sachet at 8 a.m. and 1 sachet\r\nbetween 2 and 4 p.m.; child 5\u201310 years\r\none-third adult dose; over 10 years and frail elderly one-half adult dose" ], "pregnancy": "Pregnancy\u00a0caution" }, "OLMESARTAN MEDOXOMIL With diuretic": { "indications": "Indications\u00a0hypertension (see also notes above)", "name": "OLMESARTAN MEDOXOMIL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "OLMESARTAN MEDOXOMIL", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain, peripheral oedema, hypertriglyceridaemia; fatigue; influenza-like\r\nsymptoms, cough, pharyngitis, rhinitis; urinary-tract infection; haematuria,\r\nhyperuricaemia; arthritis, musculoskeletal pain; less commonly angina, vertigo, rash; very rarely headache, thrombocytopenia,\r\nmyalgia, pruritus, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129688.htm", "doses": [ "Initially 10\u00a0mg once daily; if necessary increased to\r\n20\u00a0mg once daily; max. 40\u00a0mg daily", "Name[Olmetec Plus\u00ae (Daiichi Sankyo) ] Tablets, f/c, olmesartan medoxomil\r\n20\u00a0mg, hydrochlorothiazide 12.5\u00a0mg (red-yellow), net price 28-tab\r\npack = \u00a312.95; olmesartan medoxomil 20\u00a0mg, hydrochlorothiazide 25\u00a0mg\r\n(pink), 28-tab pack = \u00a312.95; olmesartan medoxomil 40\u00a0mg, hydrochlorothiazide 12.5\u00a0mg (red-yellow), 28-tab pack = \u00a317.50" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "TRANEXAMIC ACID": { "indications": "Indications\u00a0see notes above", "name": "TRANEXAMIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.11 Antifibrinolytic drugs and haemostatics", "TRANEXAMIC ACID" ], "cautions": "Cautions\u00a0massive haematuria (avoid if risk of ureteric\r\nobstruction); irregular menstrual bleeding (exclude structural\r\nor histological causes of menorrhagia, or fibroids causing distortion\r\nof the uterine cavity, before initiating treatment);\r\npatients receiving oral contraceptives (increased risk of thrombosis); regular liver function tests in long-term treatment of hereditary\r\nangioedema", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea (reduce dose); rarely disturbances in colour vision (discontinue), thromboembolic\r\nevents, convulsions, allergic skin reactions; dizziness and hypotension\r\non rapid intravenous injection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2830.htm", "doses": [ "By mouth, local fibrinolysis, 1\u20131.5\u00a0g\r\n(or 15\u201325\u00a0mg/kg) 2\u20133 times daily", "Menorrhagia (initiated when menstruation has started), 1\u00a0g 3\r\ntimes daily for up to 4 days; max. 4\u00a0g daily", "Hereditary angioedema, 1\u20131.5\u00a0g 2\u20133 times daily", "Epistaxis, 1\u00a0g 3 times daily for 7 days", "By slow intravenous injection, local fibrinolysis,\r\n0.5\u20131\u00a0g 3 times daily", "By continuous intravenous infusion, local fibrinolysis, following initial treatment by intravenous\r\ninjection, 25\u201350\u00a0mg/kg over 24 hours" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity in animal studies; manufacturer advises use only if potential benefit outweighs\r\nrisk\u2014crosses the placenta" }, "INFLIXIMAB - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0see under Cytokine Modulators above; inflammatory bowel\r\ndisease (section 1.5.3); psoriasis (section 13.5.3)", "name": "INFLIXIMAB - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators", "INFLIXIMAB" ], "cautions": "Cautions\u00a0predisposition to infection; monitor for infection before, during, and for 6 months after treatment (see also Tuberculosis below); discontinue if new serious\r\ninfection develops; hepatitis B virus\u2014monitor\r\nfor active infection; mild heart failure\r\n(discontinue if symptoms develop or worsen); demyelinating disorders (risk of exacerbation); history or development of malignancy; history of prolonged immunosuppressant or PUVA treatment in patients\r\nwith psoriasis; interactions: Appendix\r\n1 (infliximab) Tuberculosis\u00a0Patients should be evaluated for\r\ntuberculosis before treatment. Active tuberculosis should\r\nbe treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting infliximab. Patients who have previously received\r\nadequate treatment for tuberculosis can start infliximab but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting infliximab. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with infliximab. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) developHypersensitivity reactions\u00a0Hypersensitivity reactions\r\n(including fever, chest pain, hypotension, hypertension, dyspnoea,\r\ntransient visual loss, pruritus, urticaria, serum sickness-like reactions,\r\nangioedema, anaphylaxis) reported during or within 1\u20132 hours after\r\ninfusion (risk greatest during first or second infusion or in patients\r\nwho discontinue other immunosuppressants). All patients should be observed carefully for 1\u20132 hours after infusion\r\nand resuscitation equipment should be available for immediate use.\r\nProphylactic antipyretics, antihistamines, or hydrocortisone may be administered. Monitor for symptoms of delayed hypersensitivity\r\nif readministered after a prolonged period. Patients\r\nshould be advised to keep Alert card with them at all times and seek medical advice if symptoms of delayed hypersensitivity\r\ndevelop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators and under Cautions above; also constipation, diarrhoea, dyspepsia,\r\ngastro-intestinal haemorrhage, gastro-oesophageal reflux, flushing,\r\nhypotension, hypertension, palpitation, tachycardia, sleep disturbances,\r\ndizziness, paraesthesia, hypoaesthesia, arthralgia, myalgia, epistaxis,\r\nalopecia, rash, ecchymosis, hyperhydrosis, new onset or worsening\r\npsoriasis, dry skin; less commonly hepatitis, cholecystitis,\r\nintestinal perforation, pancreatitis, heart failure, arrhythmia, bradycardia,\r\nsyncope, peripheral ischaemia, pleurisy, pulmonary oedema, amnesia,\r\nagitation, confusion, nervousness, neuropathy, seizures, vaginitis,\r\neye disorders, bullous eruption, cheilitis, seborrhoea, impaired healing,\r\nrosacea, hyperkeratosis, abnormal skin pigmentation; rarely pericardial effusion, vasospasm, interstitial lung disease, leukaemia,\r\nlymphoma, demyelinating disorders, Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis; also reported hepatic failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128235.htm", "doses": [ "By intravenous infusion, rheumatoid\r\narthritis (in combination with methotrexate), adult over 18 years, 3\u00a0mg/kg, repeated 2 weeks and 6 weeks after initial\r\ninfusion, then every 8 weeks; if response inadequate after 12 weeks,\r\ndose may be increased in steps of 1.5\u00a0mg/kg every 8 weeks, up to max.\r\n7.5\u00a0mg/kg every 8 weeks; alternatively, 3\u00a0mg/kg may be given every\r\n4 weeks; discontinue if no response by 12 weeks of initial infusion\r\nor after dose adjustment", "Ankylosing spondylitis, adult over 18 years, 5\u00a0mg/kg, repeated 2 weeks and 6 weeks after initial\r\ninfusion, then every 6\u20138 weeks; discontinue if no response by 6 weeks\r\nof initial infusion", "Psoriatic arthritis (in combination with methotrexate), adult over 18 years, 5\u00a0mg/kg, repeated\r\n2 weeks and 6 weeks after initial infusion, then every 8 weeks" ], "pregnancy": "Pregnancy\u00a0use only if essential; manufacturer advises adequate\r\ncontraception during and for at least 6 months after last dose" }, "UROKINASE": { "indications": "Indications\u00a0thromboembolic occlusive vascular disease\r\nincluding deep-vein thrombosis, pulmonary embolism, and occlusive\r\nperipheral arterial disease; occluded arteriovenous haemodialysis\r\nshunts, and intravenous catheters and cannulas blocked by fibrin clots", "name": "UROKINASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.10 Stable angina, acute coronary syndromes, and fibrinolysis", "2.10.2 Fibrinolytic drugs", "UROKINASE" ], "cautions": "Cautions\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nCautions\u00a0Thrombolytic drugs should be used with caution if there is a risk of bleeding including that from venepuncture or invasive procedures. They should also be used with caution in external chest compression, elderly, hypertension, conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation), and recent or concurrent use of drugs that increase the risk of bleeding.", "side-effects": "Side-effects\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nSide-effects\u00a0Side-effects of thrombolytics are mainly nausea and vomiting and bleeding. When thrombolytics are used in myocardial infarction, reperfusion arrhythmias and recurrent ischaemia and angina may occur. Reperfusion may also cause cerebral and pulmonary oedema. Hypotension can also occur and can usually be controlled by elevating the patient\u2019s legs, or by reducing the rate of infusion or stopping it temporarily. Back pain, fever, and convulsions have been reported. Bleeding is usually limited to the site of injection, but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs (e.g. tranexamic acid). Rarely further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). Thrombolytics can cause allergic reactions (including rash, flushing and uveitis) and anaphylaxis has been reported (for details of management see Allergic Emergencies, section 3.4.3). Guillain-Barr\u00e9 syndrome has been reported rarely after streptokinase treatment.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130135.htm", "doses": [ "See under preparations below", "deep-vein thrombosis, by intravenous infusion, initially 4400\u00a0units/kg in 15\u00a0mL sodium chloride 0.9% over 10 minutes,\r\nfollowed by 4400\u00a0units/kg/hour for 12\u201324 hours", "Pulmonary embolism, by intravenous infusion,\r\ninitially 4400\u00a0units/kg in 15\u00a0mL sodium chloride 0.9% over 10 minutes,\r\nfollowed by 4400\u00a0units/kg/hour for 12 hours or by injection into pulmonary artery, initially 15\u00a0000\u00a0units/kg,\r\nsubsequent doses adjusted according to response; max. 3 doses in 24\r\nhours", "Occlusive peripheral arterial disease, consult product literature", "Occluded catheters and cannulas, by injection directly\r\ninto catheter or cannula, 5000\u201325\u00a0000\u00a0units dissolved in suitable\r\nvolume of sodium chloride 0.9% to fill the catheter or cannula lumen;\r\nleave for 20\u201360 minutes then aspirate the lysate; repeat if necessary" ], "pregnancy": "Pregnancy\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nPregnancy\u00a0Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy." }, "NITRAZEPAM": { "indications": "Indications\u00a0insomnia (short-term use; \n(From 4.1 Hypnotics and anxiolytics: British National Formulary)\nImportant: benzodiazepine indications Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. The use of benzodiazepines to treat short-term \u2018mild\u2019 anxiety is inappropriate. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.)", "name": "NITRAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Benzodiazepines" ], "cautions": "Cautions\u00a0respiratory disease; muscle\r\nweakness and myasthenia gravis; history of drug or alcohol abuse; hypoalbuminaemia; marked\r\npersonality disorder; reduce dose in elderly and debilitated; avoid prolonged\r\nuse (and abrupt withdrawal thereafter); acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(anxiolytics and hypnotics)Driving\u00a0Drowsiness may persist the\r\nnext day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness and lightheadedness the next day; confusion\r\nand ataxia (especially in the elderly); amnesia may occur; dependence;\r\nsee also under Diazepam (section\r\n4.1.2); overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3142.htm", "doses": [ "5\u201310\u00a0mg at bedtime; elderly (or debilitated) 2.5\u20135\u00a0mg; child 1\r\nmonth\u20132 years (infantile spasms) see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "PROPAFENONE HYDROCHLORIDE": { "indications": "Indications\u00a0ventricular arrhythmias; paroxysmal supraventricular tachyarrhythmias\r\nwhich include paroxysmal atrial flutter or fibrillation and paroxysmal\r\nre-entrant tachycardias involving the AV node or accessory pathway,\r\nwhere standard therapy ineffective or contra-indicated", "name": "PROPAFENONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias" ], "cautions": "Cautions\u00a0heart failure; elderly; pacemaker patients; potential for conversion of paroxysmal atrial fibrillation\r\nto atrial flutter with 2:1 or 1:1 conduction block;\r\ngreat caution in obstructive airways disease owing to beta-blocking activity (contra-indicated if severe); interactions: Appendix 1 (propafenone)Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth, bitter\r\ntaste, anorexia, jaundice, cholestasis, hepatitis; chest pain, bradycardia,\r\nsino-atrial, atrioventricular, or intraventricular blocks, hypotension\r\n(including postural hypotension), dizziness, syncope, pro-arhythmic\r\neffects; anxiety, confusion, ataxia, restlessness, headache, sleep\r\ndisorders, paraesthesia, fatigue, seizures, extrapyramidal symptoms;\r\nimpotence, reduced sperm count; blood disorders; lupus syndrome; blurred\r\nvision; hypersensitivity (including skin reactions)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2451.htm", "doses": [ "Body-weight 70\u00a0kg and over, initially 150\u00a0mg 3 times\r\ndaily after food under direct hospital supervision with ECG monitoring\r\nand blood pressure control (if QRS interval prolonged by more than\r\n20%, reduce dose or discontinue until ECG returns to normal limits);\r\nmay be increased at intervals of at least 3 days to 300\u00a0mg twice daily\r\nand, if necessary, to max. 300\u00a0mg 3 times daily; body-weight under\r\n70\u00a0kg, reduce dose; elderly may respond\r\nto lower doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "AMIKACIN": { "indications": "Indications\u00a0serious Gram-negative infections resistant to gentamicin", "name": "AMIKACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "AMIKACIN" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64687.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate dose and monitor serum-amikacin concentration\r\nclosely", "Multiple daily dose regimen, by intramuscular or by slow intravenous injection or by infusion, 15\u00a0mg/kg daily in\r\n2 divided doses, increased to 22.5\u00a0mg/kg daily in 3 divided doses\r\nin severe infections; max. 1.5\u00a0g daily for up to 10 days (max. cumulative\r\ndose 15\u00a0g); child under 18 years see BNF for Children", "Once daily dose regimen (not for endocarditis, febrile neutropenia,\r\nor meningitis; see notes above and also consult local guidelines), by intravenous infusion, initially 15\u00a0mg/kg (max. 1.5\u00a0g),\r\nthen adjust according to serum-amikacin concentration; max. cumulative\r\ndose 15\u00a0g; child under 18 years see BNF for Children", "For multiple daily dose regimen, one-hour\r\n(\u2018peak\u2019) serum concentration should not exceed 30\u00a0mg/litre; pre-dose\r\n(\u2018trough\u2019) concentration should be less than 10\u00a0mg/litre. For once\r\ndaily dose regimen, pre-dose (\u2018trough\u2019) concentration should be less\r\nthan 5\u00a0mg/litre" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "PROBENECID": { "indications": "Indications\u00a0prevention of nephrotoxicity associated with cidofovir (section 5.3.2.2)", "name": "PROBENECID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Long-term control of gout", "PROBENECID" ], "cautions": "Cautions\u00a0ensure adequate fluid intake (about 2\u20133 litres\r\ndaily) and render urine alkaline if uric\r\nacid overload is high; peptic ulceration; transient false-positive Benedict\u2019s test; G6PD-deficiency (section 9.1.5); interactions: Appendix 1\r\n(probenecid)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; less commonly sore gums, flushing, headache, dizziness, urinary frequency, anaemia,\r\nalopecia; hepatic necrosis, hypersensitivity reactions (including\r\nanaphylaxis, pruritus, urticaria, fever, and Stevens-Johnson syndrome),\r\nnephrotic syndrome, haemolytic anaemia, leucopenia, and aplastic anaemia\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5319.htm", "doses": [ "Used with cidofovir, see section 5.3.2.2" ] }, "EMEDASTINE": { "indications": "Indications\u00a0seasonal allergic conjunctivitis", "name": "EMEDASTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations" ], "side-effects": "Side-effects\u00a0transient burning or stinging; blurred vision,\r\nlocal oedema, keratitis, irritation, dry eye, lacrimation, corneal\r\ninfiltrates (discontinue) and staining; photophobia; headache, and\r\nrhinitis occasionally reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76476.htm", "doses": [ "adult and child over 3 years, apply twice daily" ] }, "EPOPROSTENOL": { "indications": "Indications\u00a0see notes above", "name": "EPOPROSTENOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Epoprostenol" ], "cautions": "Cautions\u00a0anticoagulant monitoring required when\r\ngiven with anticoagulants; haemorrhagic\r\ndiathesis; concomitant use of drugs that\r\nincrease risk of bleeding; dose titration\r\nfor pulmonary hypertension should be in hospital (risk of pulmonary\r\noedema); avoid abrupt withdrawal when used for primary\r\npulmonary hypertension (risk of rebound pulmonary hypertension)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain, bleeding,\r\nbradycardia, tachycardia, hypotension, flushing, chest pain, anxiety,\r\nheadache, sepsis, jaw pain, arthralgia; less commonly dry mouth, pulmonary oedema, sweating; rarely agitation,\r\npallor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2789.htm", "doses": [ "See product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014no information available" }, "COMBINED HORMONAL CONTRACEPTIVES Transdermal (standard strength)": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Transdermal (standard strength)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Transdermal (standard strength)" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127951.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days", "Name[Ethinylestradiol with Norelgestromin] " ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "CALCIUM SALTS": { "indications": "Indications\u00a0see notes above; calcium deficiency", "name": "CALCIUM SALTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.1 Calcium supplements", "CALCIUM SALTS" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; avoid calcium chloride in respiratory acidosis or\r\nrespiratory failure; interactions: Appendix 1 (antacids, calcium\r\nsalts)", "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances; with injection, bradycardia, arrhythmias, peripheral vasodilatation,\r\nfall in blood pressure, sweating, injection-site reactions, severe\r\ntissue damage with extravasation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5045.htm", "doses": [ "By mouth, daily in divided doses, see notes above", "By slow intravenous injection, acute hypocalcaemia,\r\ncalcium gluconate 1\u20132\u00a0g (Ca2+ 2.25\u20134.5\u00a0mmol); child see BNF for Children" ] }, "RIFAMPICIN Combined preparations": { "indications": "Indications\u00a0see under Dose", "name": "RIFAMPICIN Combined preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "RIFAMPICIN", "Combined preparations" ], "cautions": "Cautions\u00a0see Monitoring in notes above; also liver function tests and blood counts in hepatic disorders, alcohol dependence, and on prolonged\r\ntherapy, see also below); acute porphyria (section 9.8.2); important: effectiveness of hormonal contraceptives is reduced and alternative\r\nfamily planning advice should be offered (see also section 7.3.1); discolours soft\r\ncontact lenses; see also notes above; interactions: Appendix 1 (rifamycins)Note\u00a0If treatment interrupted re-introduce\r\nwith low dosage and increase gradually; discontinue permanently if serious side-effects developHepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of liver disorder, and\r\nadvised to discontinue treatment and seek immediate medical attention\r\nif symptoms such as persistent nausea, vomiting, malaise or jaundice\r\ndevelop", "side-effects": "Side-effects\u00a0gastro-intestinal symptoms including anorexia,\r\nnausea, vomiting, diarrhoea (antibiotic-associated colitis reported);\r\nheadache, drowsiness; those occurring mainly on intermittent therapy\r\ninclude influenza-like symptoms (with chills, fever, dizziness, bone\r\npain), respiratory symptoms (including shortness of breath), collapse\r\nand shock, haemolytic anaemia, thrombocytopenic purpura, disseminated\r\nintravascular coagulation, and acute renal failure; alterations of\r\nliver function, jaundice; flushing, urticaria, and rashes; other side-effects\r\nreported include oedema, psychoses, adrenal insufficiency, muscular\r\nweakness and myopathy, exfoliative dermatitis, toxic epidermal necrolysis,\r\nStevens-Johnson syndrome, pemphigoid reactions, leucopenia, eosinophilia,\r\nmenstrual disturbances; urine, saliva, and other body secretions coloured\r\norange-red; thrombophlebitis reported if infusion used for prolonged\r\nperiod", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3918.htm", "doses": [ "Brucellosis, legionnaires\u2019 disease, endocarditis and serious\r\nstaphylococcal infections, in combination with other drugs, by mouth or by intravenous infusion, 0.6\u20131.2\u00a0g daily (in 2\u20134 divided doses)", "Tuberculosis, in combination with other drugs, see notes above", "Leprosy, section 5.1.10", "Prophylaxis of meningococcal meningitis and Haemophilus\r\ninfluenzae (type b) infection, Table 2, section 5.1", "Name[Rifater\u00ae (Sanofi-Aventis) ] Tablets, pink, s/c, rifampicin 120\u00a0mg, isoniazid 50\u00a0mg, pyrazinamide 300\u00a0mg, net price 100-tab pack= \u00a321.95. \r\n Label:\r\n 8, 14, 22, counselling, see lenses aboveDose\u00a0initial treatment of pulmonary tuberculosis, patients\r\nup to 40\u00a0kg 3 tablets daily preferably before breakfast, 40\u201349\u00a0kg\r\n4 tablets daily, 50\u201364\u00a0kg 5 tablets daily, 65\u00a0kg or more, 6 tablets\r\ndaily; not suitable for use in children" ], "pregnancy": "Pregnancy\u00a0manufacturers advise very high doses teratogenic\r\nin animal studies in first trimester; risk of neonatal\r\nbleeding may be increased in third trimester; see also Pregnancy" }, "CHLOROQUINE": { "indications": "Indications\u00a0chemoprophylaxis and treatment of malaria;\r\nrheumatoid arthritis and lupus erythematosus (section 10.1.3)", "name": "CHLOROQUINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Chloroquine", "CHLOROQUINE" ], "cautions": "Cautions\u00a0may exacerbate psoriasis; neurological disorders (avoid for prophylaxis if history of epilepsy, \n(From Prophylaxis against malaria: British National Formulary)\nBoth chloroquine and mefloquine are unsuitable for malaria prophylaxis in individuals with a history of epilepsy. In areas without chloroquine resistance proguanil 200\u00a0mg daily alone is recommended; in areas with chloroquine resistance, doxycycline or Malarone\u00ae may be considered); may aggravate myasthenia gravis; severe\r\ngastro-intestinal disorders; G6PD deficiency (\n(From 9.1.5 G6PD deficiency: British National Formulary)\n9.1.5 G6PD deficiency); ophthalmic examination and long-term therapy,\r\nsee under Chloroquine, %s\n(From Antimalarials: British National Formulary)\nA review group convened by the Royal College of Ophthalmologists has updated guidelines for screening to prevent ocular toxicity on long-term treatment with chloroquine and hydroxychloroquine (Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening 2009). Chloroquine should be considered (for treating chronic inflammatory conditions) only if other drugs have failed. All patients taking chloroquine should receive ocular examination according to a protocol arranged locally between the prescriber and the ophthalmologist. The following recommendations relate to hydroxychloroquine, which is only rarely associated with toxicity.Before treatment:Assess renal and liver function (adjust dose if impaired)Ask patient about visual impairment (not corrected by glasses). If impairment or eye disease present, assessment by an optometrist is advised and any abnormality should be referred to an ophthalmologistRecord near visual acuity of each eye (with glasses where appropriate) using a standard reading chartInitiate hydroxychloroquine treatment if no abnormality detected (at a dose not exceeding hydroxychloroquine sulphate 6.5\u00a0mg/kg daily)During treatment:Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chartRefer to ophthalmologist if visual acuity changes or if vision blurred and warn patient to seek prescribing doctor\u2019s advice about stopping treatmentA child treated for juvenile idiopathic arthritis should receive slit-lamp examination routinely to check for uveitisIf long-term treatment is required (more than 5 years), individual arrangement should be agreed with the local ophthalmologist; avoid concurrent therapy with hepatotoxic drugs\u2014other interactions: Appendix 1 (chloroquine and hydroxychloroquine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, headache; also\r\nhypotension, convulsions, visual disturbances, depigmentation or loss\r\nof hair, skin reactions (rashes, pruritus); rarely, bone-marrow suppression,\r\nhypersensitivity reactions such as urticaria and angioedema; other\r\nside-effects (not usually associated with malaria prophylaxis or treatment),\r\nsee under Chloroquine, section 10.1.3; very\r\ntoxic in overdosage\u2014immediate advice from poisons\r\ncentres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69510.htm", "doses": [ "Doses expressed as chloroquine base", "Prophylaxis of malaria, preferably started 1 week before entering\r\nendemic area and continued for 4 weeks after leaving (see notes above),\r\n310\u00a0mg once weekly; infant up to 12\r\nweeks body-weight under 6\u00a0kg, 37.5\u00a0mg once weekly; 12 weeks\u20131 year\r\nbody-weight 6\u201310\u00a0kg, 75\u00a0mg once weekly; child 1\u20134 years body-weight 10\u201316\u00a0kg, 112.5\u00a0mg once weekly; 4\u20138 years\r\nbody-weight 16\u201325\u00a0kg, 150\u00a0mg once weekly (or 155\u00a0mg once weekly if\r\ntablets used); 8\u201313 years body-weight 25\u201345\u00a0kg, 225\u00a0mg once weekly\r\n(or 232.5\u00a0mg once weekly if tablets used); over 13 years body-weight\r\nover 45\u00a0kg, adult dose", "Treatment of benign malarias, see notes above", "Warn travellers about importance of avoiding mosquito bites, importance of taking\r\nprophylaxis regularly, and importance of immediate\r\nvisit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "Chloroquine doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0benefit of prophylaxis and treatment in malaria outweighs\r\nrisk; see also Benign Malarias (treatment) and Prophylaxis Against Malaria" }, "PEGAPTANIB SODIUM": { "indications": "Indications\u00a0\n(From Subfoveal choroidal neovascularisation: British National Formulary)\nPegaptanib and ranibizumab are vascular endothelial growth factor inhibitors licensed for the treatment of neovascular (wet) age-related macular degeneration. Ranibizumab is also licensed for the treatment of visual impairment due to diabetic macular oedema or macular oedema secondary to branch or central retinal vein occlusion. Ranibizumab can be administered concomitantly with laser photocoagulation for the treatment of diabetic macular oedema and for macular oedema secondary to branch retinal vein occlusion. They are given by intravitreal injection by specialists experienced in the management of this condition.The Scottish Medicines Consortium has advised (May 2007) that ranibizumab (Lucentis\u00ae) is accepted for use within NHS Scotland for the treatment of neovascular (wet) age-related macular degeneration. The Scottish Medicines Consortium has advised (October 2011) that ranibizumab (Lucentis\u00ae) is accepted for restricted use within NHS Scotland for the treatment of macular oedema secondary to central retinal vein occlusion.\u2014specialist use only", "name": "PEGAPTANIB SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment", "Subfoveal choroidal neovascularisation", "PEGAPTANIB SODIUM" ], "cautions": "Cautions\u00a0monitor intra-ocular pressure following\r\ninjection", "side-effects": "Side-effects\u00a0rhinorrhoea; headache; eye pain, anterior chamber\r\ninflammation, raised intra-ocular pressure, punctate keratitis, vitreous\r\nfloaters, cataract, conjunctival and retinal haemorrhage, local oedema,\r\nconjunctivitis, corneal dystrophy, dry eye, endophthalmitis, eye discharge,\r\neye irritation, macular degeneration, mydriasis, periorbital haematoma,\r\nphotophobia, flashing lights, vitreous disorders; less commonly vomiting, dyspepsia, palpitation, chest pain, hypertension, aortic\r\naneurysm, influenza-like symptoms, nightmares, depression, back pain,\r\nasthenopia, blepharitis, corneal deposits, vitreous haemorrhage, chalazion,\r\nretinal exudates, eyelid ptosis, decreased intra-ocular pressure,\r\ninjection-site reactions, retinal detachment, occlusion of retinal\r\nblood vessels, ectropion, eye movement disorder, pupillary disorder,\r\niritis, optic nerve cupping, nasopharyngitis, deafness, vertigo, eczema,\r\nchanges in hair colour, rash, pruritus, night sweats", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129681.htm", "doses": [ "By intravitreal injection, 300\u00a0micrograms\r\nonce every 6 weeks into the affected eye", "For further information on administration,\r\nconsult product literature. Review treatment if no benefit after 2\r\nconsecutive injections" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "DIAZEPAM - BENZODIAZEPINES": { "indications": "Indications\u00a0premedication; conscious sedation for procedures, and in conjunction\r\nwith local anaesthesia; short-term use in anxiety or insomnia, adjunct\r\nin acute alcohol withdrawal (section 4.1.2); status epilepticus (section 4.8.2); muscle spasms (section 10.2.2)", "name": "DIAZEPAM - BENZODIAZEPINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nDiazepam is used to produce mild sedation with amnesia. It is a long-acting drug with active metabolites and a second period of drowsiness can occur several hours after its administration, %s\n(From DIAZEPAM: British National Formulary)\nrespiratory disease, muscle weakness and myasthenia gravis, history of drug or alcohol abuse, marked personality disorder; reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal thereafter); special precautions for intravenous injection (section 4.8.2); acute porphyria (section 9.8.2); when given parenterally, close observation required until full recovery from sedation; interactions: Appendix 1 (anxiolytics and hypnotics), and %s\n(From DIAZEPAM: British National Formulary)\nsee Diazepam, section 4.1.2; when given intravenously facilities for reversing respiratory depression with mechanical ventilation must be immediately available (but see also notes above); interactions: Appendix 1 (anxiolytics and hypnotics)", "side-effects": "Side-effects\u00a0see notes above and %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6597.htm", "doses": [ "By mouth, adult over 18 years, 5\u201310\u00a0mg 1\u20132 hours before procedure (up to max. 20\u00a0mg\r\nfor dental procedures carried out in hospital); elderly (or debilitated), half adult dose", "By intravenous injection into a large vein (emulsion\r\npreparation preferred), sedative cover for minor surgical and medical\r\nprocedures, adult over 18 years, 10\u201320\u00a0mg\r\nover 2\u20134 minutes, immediately before procedure; premedication 100\u2013200\u00a0micrograms/kg" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "SODIUM HYALURONATE Single use": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "SODIUM HYALURONATE", "Single use" ], "indications": "Indications\u00a0dry eye conditions", "name": "SODIUM HYALURONATE Single use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201467.htm", "doses": [ "Apply as required", "Name[Ocusan\u00ae (Agepha)] Eye drops, sodium hyaluronate 0.2%,\r\n net price 20 \u00d7 0.5\u00a0mL = \u00a35.25" ] }, "EZETIMIBE": { "indications": "Indications\u00a0adjunct to dietary measures and statin treatment in primary hypercholesterolaemia\r\nand homozygous familial hypercholesterolaemia (ezetimibe alone in\r\nprimary hypercholesterolaemia if statin inappropriate or not tolerated);\r\nadjunct to dietary measures in homozygous sitosterolaemia", "name": "EZETIMIBE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Ezetimibe" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (ezetimibe)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; headache, fatigue;\r\nmyalgia; rarely arthralgia, hypersensitivity reactions\r\n(including rash, angioedema, and anaphylaxis), hepatitis; very\r\nrarely pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia,\r\nraised creatine kinase, myopathy, and rhabdomyolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128035.htm", "doses": [ "adult and child over 10 years, 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "BRIMONIDINE TARTRATE": { "indications": "Indications\u00a0raised intra-ocular pressure, see notes above", "name": "BRIMONIDINE TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Sympathomimetics" ], "cautions": "Cautions\u00a0severe cardiovascular disease; cerebral or coronary\r\ninsufficiency, Raynaud\u2019s syndrome, thromboangiitis obliterans, postural hypotension, depression; children 2\u201312 years (increased risk of drowsiness); interactions: Appendix 1 (brimonidine)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0dry mouth, gastro-intestinal disturbances, taste\r\ndisturbances, upper respiratory symptoms, headache, drowsiness, dizziness,\r\nmalaise, ocular disturbances (including hyperaemia, burning, stinging,\r\npruritus, pain and dryness), visual disturbances, eyelid inflammation,\r\nphotophobia, corneal erosion and staining, conjunctival disturbances\r\n(including blanching, follicles, and infection); less commonly palpitation, arrhythmia, bradycardia, tachycardia, depression, nasal\r\ndryness; rarely dyspnoea; very rarely hypertension, hypotension, syncope, insomnia, iritis, miosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/59167.htm", "doses": [ "Apply twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if benefit outweighs\r\nrisk" }, "DISODIUM PAMIDRONATE": { "indications": "Indications\u00a0see under Dose", "name": "DISODIUM PAMIDRONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "DISODIUM PAMIDRONATE" ], "cautions": "Cautions\u00a0assess renal function before each dose; ensure adequate hydration; cardiac disease (especially in elderly); previous thyroid surgery (risk of hypocalcaemia); monitor\r\nserum electrolytes, calcium and phosphate\u2014possibility of convulsions\r\ndue to electrolyte changes; avoid concurrent use with other bisphosphonates; consider dental check-up before initiating bisphosphonate (risk of osteonecrosis of the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)Driving\u00a0Patients should be warned\r\nagainst driving or operating machinery immediately after treatment\r\n(somnolence or dizziness can occur)", "side-effects": "Side-effects\u00a0hypophosphataemia, fever and influenza-like symptoms\r\n(sometimes accompanied by malaise, rigors, fatigue and flushes); nausea,\r\nvomiting, anorexia, abdominal pain, diarrhoea, constipation; symptomatic\r\nhypocalcaemia (paraesthesia, tetany), hypomagnesaemia, headache, insomnia,\r\ndrowsiness; hypertension; anaemia, thrombocytopenia, lymphocytopenia;\r\nrash; arthralgia, myalgia, bone pain; rarely muscle\r\ncramps, atypical femoral fractures (see MHRA/CHM advice),\r\ndyspepsia, agitation, confusion, dizziness, lethargy; leucopenia,\r\nhypotension, pruritus, hyperkalaemia or hypokalaemia, and hypernatraemia;\r\nosteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw),\r\nisolated cases of seizures, hallucinations, haematuria, acute renal\r\nfailure, deterioration of renal disease, conjunctivitis and other\r\nocular symptoms; atrial fibrillation, and reactivation of herpes simplex\r\nand zoster also reported; also injection-site reactions ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106515.htm", "doses": [ "By slow intravenous infusion (via\r\ncannula in a relatively large vein), see also Appendix 4", "Hypercalcaemia of malignancy, according to serum calcium concentration\r\n15\u201360\u00a0mg in single infusion or in divided doses over 2\u20134 days; max.\r\n90\u00a0mg per treatment course", "Osteolytic lesions and bone pain in bone metastases associated\r\nwith breast cancer or multiple myeloma, 90\u00a0mg every 4 weeks (or every\r\n3 weeks to coincide with chemotherapy in breast cancer)", "Paget\u2019s disease of bone, 30\u00a0mg once a week for 6 weeks (total\r\ndose 180\u00a0mg) or 30\u00a0mg in first week then 60\u00a0mg every\r\nother week (total dose 210\u00a0mg); max. total 360\u00a0mg (in divided doses\r\nof 60\u00a0mg) per treatment course; may be repeated every 6 months", "child not recommended", "Oral supplements\r\nare advised to minimise potential risk of hypocalcaemia for those\r\nwith mainly lytic bone metastases or multiple myeloma at risk of calcium\r\nor vitamin D deficiency (e.g. through malabsorption or lack of exposure\r\nto sunlight) and in those with Paget\u2019s disease" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TIROFIBAN": { "indications": "Indications\u00a0prevention of early myocardial infarction (in combination with unfractionated\r\nheparin and aspirin) in patients with unstable angina or non-ST-segment-elevation\r\nmyocardial infarction and with last episode of chest pain within 12\r\nhours (use under specialist supervision)", "name": "TIROFIBAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "TIROFIBAN" ], "cautions": "Cautions\u00a0major surgery or severe trauma within\r\n3 months (avoid if within 6 weeks); traumatic or protracted cardiopulmonary\r\nresuscitation, organ biopsy or lithotripsy within last 2 weeks; risk of bleeding including active peptic ulcer within 3 months, uncontrolled\r\nsevere hypertension, acute pericarditis, aortic dissection, haemorrhagic\r\nretinopathy, vasculitis, haematuria, faecal occult blood, elderly, low body-weight; severe heart failure, cardiogenic\r\nshock, anaemia; puncture of non-compressible vessel within 24 hours; concomitant drugs that increase risk of bleeding (including\r\nwithin 48 hours of thrombolytic administration); monitor platelet count, haemoglobin and haematocrit before treatment,\r\n2\u20136 hours after start of treatment and then at least once daily; discontinue if thrombolytic therapy, intra-aortic\r\nballoon pump or emergency cardiac surgery necessary; discontinue immediately if serious or uncontrollable bleeding occurs; interactions: Appendix 1 (tirofiban)", "side-effects": "Side-effects\u00a0nausea, headache, fever, bleeding manifestations,\r\nreversible thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81474.htm", "doses": [ "Angiography planned for 4\u201348 hours after diagnosis, by intravenous infusion, initially 400\u00a0nanograms/kg/minute\r\nfor 30 minutes, then 100\u00a0nanograms/kg/minute for at least 48 hours\r\n(continue during and for 12\u201324 hours after percutaneous coronary intervention);\r\nmax. duration of treatment 108 hours", "Angiography within 4 hours of diagnosis, by intravenous injection, 25\u00a0micrograms/kg given over 3 minutes\r\nat start of percutaneous coronary intervention, then by intravenous infusion, 150\u00a0nanograms/kg/minute for 18\u201324\r\nhours; max. duration of treatment 48 hours" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "TARS": { "indications": "Indications\u00a0psoriasis and occasionally\r\nchronic atopic eczema", "name": "TARS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tars", "TARS" ], "cautions": "Cautions\u00a0application to face and skin flexures; use suitable chemical protection gloves for extemporaneous\r\npreparation", "side-effects": "Side-effects\u00a0skin irritation and acne-like eruptions, photosensitivity;\r\nstains skin, hair, and fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/32569.htm", "doses": [ "Apply 1\u20133 times daily starting with low-strength preparations", "For shampoo preparations see section 13.9; for\r\nuse with dressings see Appendix 5 (section A5.8.9)" ] }, "NAFARELIN": { "indications": "Indications\u00a0see under Dose", "name": "NAFARELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.", "side-effects": "Side-effects\u00a0see notes above; acne", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4475.htm", "doses": [ "Endometriosis, women over 18 years, 200\u00a0micrograms twice\r\ndaily as one spray in one nostril in the morning and one spray in\r\nthe other nostril in the evening (starting on days 2\u20134 of menstruation),\r\nmax. duration of treatment 6 months (do not repeat)", "Pituitary desensitisation before induction of ovulation by gonadotrophins\r\nfor in vitro fertilisation (under specialist supervision),\r\n400\u00a0micrograms (one spray in each nostril) twice daily starting in\r\nearly follicular phase (day 2) or, after exclusion of pregnancy, in\r\nmidluteal phase (day 21) and continued until down-regulation achieved\r\n(usually within 4 weeks) then maintained (usually for 8\u201312 days) during\r\ngonadotrophin administration (stopping gonadotrophin and nafarelin on administration of chorionic gonadotrophin at follicular maturity); discontinue if down-regulation not achieved\r\nwithin 12 weeks", "Avoid use of nasal decongestants before\r\nand for at least 30\u00a0minutes after treatment; repeat dose if sneezing\r\noccurs during or immediately after administration" ], "pregnancy": "Pregnancy\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues" }, "OFLOXACIN": { "indications": "Indications\u00a0see under Dose", "name": "OFLOXACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones", "OFLOXACIN" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; history of psychiatric\r\nillness; interactions: Appendix 1 (quinolones)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving); effects enhanced\r\nby alcohol", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.; also cough, nasopharyngitis, eye irritation; rarely arrhythmias, bronchospasm, abnormal dreams, hot flushes, hyperhidrosis; very rarely neuropathy, extrapyramidal symptoms, tinnitus;\r\nalso reported pneumonitis, changes in blood sugar, myopathy, rhabdomyolysis;\r\non intravenous infusion, hypotension and local reactions (including\r\nthrombophlebitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3959.htm", "doses": [ "By mouth, urinary-tract infections,\r\n200\u2013400\u00a0mg daily preferably in the morning, increased if necessary\r\nin upper urinary-tract infections to 400\u00a0mg twice daily", "Acute or chronic prostatitis, 200\u00a0mg twice daily for 28 days", "Lower respiratory-tract infections, 400\u00a0mg daily preferably\r\nin the morning, increased if necessary to 400\u00a0mg twice daily", "Skin and soft-tissue infections, 400\u00a0mg twice daily", "Uncomplicated gonorrhoea, 400\u00a0mg as a single dose", "Uncomplicated genital chlamydial infection, non-gonococcal urethritis,\r\n400\u00a0mg daily in single or divided doses for 7 days", "Pelvic inflammatory disease (see also section 5.1, table 1), 400\u00a0mg twice daily for\r\n14 days", "By intravenous infusion (over at\r\nleast 30 minutes for each 200\u00a0mg), complicated urinary-tract infection,\r\n200\u00a0mg daily", "Lower respiratory-tract infection, 200\u00a0mg twice daily", "Septicaemia, 200\u00a0mg twice daily", "Skin and soft-tissue infections, 400\u00a0mg twice daily", "Severe or complicated infections, dose may be increased to 400\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "CIMETIDINE": { "indications": "Indications\u00a0benign gastric and duodenal ulceration, stomal ulcer, reflux oesophagitis,\r\nother conditions where gastric acid reduction is beneficial (see notes\r\nabove and section\r\n1.9.4)", "name": "CIMETIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.1 H2-receptor antagonists", "CIMETIDINE" ], "cautions": "Cautions\u00a0\n(From 1.3.1 H2-receptor antagonists: British National Formulary)\nCautions\u00a0H2-receptor antagonists might mask symptoms of gastric cancer; particular care is required in patients presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment.; interactions: Appendix 1 (histamine H2-antagonists)\r\nand notes above", "side-effects": "Side-effects\u00a0see notes above; also malaise; less commonly tachycardia; rarely interstitial nephritis; very rarely pancreatitis, galactorrhoea, vasculitis, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2116.htm", "doses": [ "400\u00a0mg twice daily (with breakfast and at night) or 800\u00a0mg at night (benign gastric and duodenal ulceration)\r\nfor at least 4 weeks (6 weeks in gastric ulceration, 8 weeks in NSAID-associated\r\nulceration); when necessary the dose may be increased to 400\u00a0mg 4\r\ntimes daily; infant under 1 year 20\u00a0mg/kg\r\ndaily in divided doses has been used; child 1\u201312 years, 25\u201330\u00a0mg/kg daily in divided doses; max. 400\u00a0mg 4 times\r\ndaily", "Maintenance, 400\u00a0mg at night or 400\u00a0mg morning\r\nand night", "Reflux oesophagitis, 400\u00a0mg 4 times daily for 4\u20138 weeks", "Prophylaxis of stress ulceration, 200\u2013400\u00a0mg every 4\u20136 hours", "Gastric acid reduction (prophylaxis of acid aspiration; do not\r\nuse syrup), obstetrics 400\u00a0mg at start of labour, then up to 400\u00a0mg\r\nevery 4 hours if required (max. 2.4\u00a0g daily); surgical procedures\r\n400\u00a0mg 90\u2013120 minutes before induction of general anaesthesia", "Short-bowel syndrome, 400\u00a0mg twice daily (with breakfast and\r\nat bedtime) adjusted according to response", "To reduce degradation of pancreatic enzyme supplements, 0.8\u20131.6\u00a0g\r\ndaily in 4 divided doses 1\u20131\u00bd hours before meals" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "AMLODIPINE": { "indications": "Indications\u00a0hypertension, prophylaxis of angina", "name": "AMLODIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "AMLODIPINE" ], "cautions": "Cautions\u00a0acute porphyria (but see section 9.8.2); interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0abdominal pain, nausea; palpitation, flushing,\r\noedema; headache, dizziness, sleep disturbances, fatigue; less commonly gastro-intestinal disturbances, dry mouth,\r\ntaste disturbances, hypotension, syncope, chest pain, dyspnoea, rhinitis,\r\nmood changes, asthenia, tremor, paraesthesia, urinary disturbances,\r\nimpotence, gynaecomastia, weight changes, myalgia, muscle cramps,\r\nback pain, arthralgia, visual disturbances, tinnitus, pruritus, rashes\r\n(including isolated reports of erythema multiforme), sweating, alopecia,\r\npurpura, and skin discolouration; very rarely gastritis,\r\npancreatitis, hepatitis, jaundice, cholestasis, gingival hyperplasia,\r\nmyocardial infarction, arrhythmias, tachycardia, vasculitis, coughing,\r\nperipheral neuropathy, hyperglycaemia, thrombocytopenia, angioedema,\r\nand urticaria; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130152.htm", "doses": [ "Hypertension or angina, initially 5\u00a0mg once daily; max.\r\n10\u00a0mg once daily", "Tablets from various suppliers may contain\r\ndifferent salts (e.g. amlodipine besilate, amlodipine maleate, and\r\namlodipine mesilate) but the strength is expressed in terms of amlodipine\r\n(base); tablets containing different salts are considered interchangeable" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid,\r\nbut risk to fetus should be balanced against risk of uncontrolled\r\nmaternal hypertension" }, "LANREOTIDE": { "indications": "Indications\u00a0%s\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\n8.3.4.3 Somatostatin analogues", "name": "LANREOTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.3 Somatostatin analogues", "LANREOTIDE" ], "cautions": "Cautions\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\n8.3.4.3 Somatostatin analogues; cardiac disorders (including bradycardia); interactions: Appendix 1 (lanreotide)", "side-effects": "Side-effects\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\n8.3.4.3 Somatostatin analogues; also reported\r\nconstipation, dyspepsia, bradycardia, asthenia, dizziness, fatigue,\r\nraised bilirubin, biliary dilatation, alopecia; less commonly skin nodule, hot flushes, leg pain, malaise, headache, insomnia,\r\ntenesmus, decreased libido, drowsiness, pruritus, increased\r\nsweating; rarely hypothyroidism (monitor as necessary)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106502.htm", "doses": [ "See under preparations", "by deep subcutaneous injection into the\r\ngluteal region, acromegaly (if somatostatin analogue not given previously),\r\ninitially 60\u00a0mg every 28 days, adjusted according to response; for\r\npatients treated previously with somatostatin analogue, consult product\r\nliterature for initial dose" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "NANDROLONE": { "indications": "Indications\u00a0osteoporosis in postmenopausal women (but not recommended, see notes\r\nabove); aplastic anaemia (section 9.1.3)", "name": "NANDROLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.3 Anabolic steroids", "NANDROLONE" ], "cautions": "Cautions\u00a0cardiac impairment, hypertension, diabetes mellitus, epilepsy, migraine; monitor skeletal maturation in young patients; skeletal metastases (risk of hypercalcaemia); interactions: Appendix 1 (anabolic steroids)", "side-effects": "Side-effects\u00a0acne, sodium retention with oedema, virilisation\r\nwith high doses including voice changes (sometimes irreversible),\r\namenorrhoea, inhibition of spermatogenesis, premature epiphyseal closure;\r\nabnormal liver-function tests reported with high doses; liver tumours\r\nreported occasionally on prolonged treatment with anabolic steroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4380.htm", "doses": [ "See below", "by deep intramuscular injection, 50\u00a0mg\r\nevery 3 weeks" ] }, "HEPATITIS A VACCINE - WITH TYPHOID VACCINE": { "indications": "Indications\u00a0immunisation against hepatitis A infection", "name": "HEPATITIS A VACCINE - WITH TYPHOID VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis A vaccine", "HEPATITIS A VACCINE", "With typhoid vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; for\r\ncombination vaccines, see also Typhoid vaccine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81606.htm", "doses": [ "See under preparations", "Name[Hepatyrix\u00ae (GSK) ] Injection, suspension of inactivated\r\nhepatitis A virus (grown in human diploid cells) 1440 ELISA units/mL\r\nadsorbed onto aluminium hydroxide, combined with\r\ntyphoid vaccine containing 25\u00a0micrograms/mL virulence polysaccharide\r\nantigen of Salmonella typhi, net price 1-mL prefilled\r\nsyringe = \u00a332.08Excipients include neomycinDose\u00a0by intramuscular injection (see note below), adult and child over\r\n15 years, 1\u00a0mL as a single dose; booster doses, see under single component hepatitis A vaccine (above) and under polysaccharide typhoid vaccineNote\u00a0The deltoid region is the preferred site\r\nof injection. The subcutaneous route may be used for patients with\r\n bleeding disorders; not to be injected into the buttock (vaccine\r\nefficacy reduced)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "GLYCERYL TRINITRATE Short-acting tablets and sprays": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE Short-acting tablets and sprays", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE", "Short-acting tablets and sprays" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2622.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations", "Name[GTN 300 mcg (Martindale)] Sublingual tablets, glyceryl\r\ntrinitrate 300\u00a0micrograms, net price 100 =\r\n\u00a32.71. \r\n Label:\r\n 16" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "METHOTREXATE - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0see under Inflammatory Bowel Disease; malignant disease (section 8.1.3); rheumatoid arthritis (section 10.1.3); psoriasis (section 13.5.3)", "name": "METHOTREXATE - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "METHOTREXATE" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201305.htm", "doses": [ "By intramuscular injection, severe Crohn\u2019s\r\ndisease [unlicensed indication], adult over 18 years, induction of remission, 25\u00a0mg once weekly; maintenance,\r\n15\u00a0mg once weekly", "By mouth, maintenance of remission of severe\r\nCrohn\u2019s disease [unlicensed indication], adult over 18 years, 10\u201325\u00a0mg once weekly", "Note that the above dose is a weekly dose.\r\nTo avoid error with low-dose methotrexate, it is recommended that:", "the patient is carefully advised of the dose and frequency and the reason for taking methotrexate\r\nand any other prescribed medicine (e.g. folic acid);", "only one strength of methotrexate tablet (usually 2.5\u00a0mg)\r\nis prescribed and dispensed;", "the prescription and the dispensing label clearly show\r\nthe dose and frequency of methotrexate administration;", "the patient is warned to report immediately the onset\r\nof any feature of blood disorders (e.g. sore throat, bruising, and\r\nmouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort,\r\nand dark urine), and respiratory effects (e.g. shortness of breath)." ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "GEMEPROST": { "indications": "Indications\u00a0see\r\nunder Dose", "name": "GEMEPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics" ], "cautions": "Cautions\u00a0obstructive airways disease, cardiovascular insufficiency, raised intra-ocular pressure, cervicitis or vaginitis; interactions: Appendix 1 (prostaglandins)Important\u00a0For warnings relating to use of gemeprost in a patient undergoing induction\r\nof abortion with mifepristone, see\r\nunder Mifepristone and Note below", "side-effects": "Side-effects\u00a0vaginal bleeding and uterine pain; nausea, vomiting,\r\nor diarrhoea; headache, muscle weakness, dizziness, flushing, chills,\r\nbackache, dyspnoea, chest pain, palpitation and mild pyrexia; uterine\r\nrupture reported (most commonly in multiparas or if history of uterine\r\nsurgery or if given with intravenous oxytocics); also reported severe\r\nhypotension, coronary artery spasm and myocardial infarction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4497.htm", "doses": [ "By vagina, cervical ripening prior to first\r\ntrimester surgical abortion, 1\u00a0mg inserted into posterior fornix 3\r\nhours before surgery", "Second trimester abortion, 1\u00a0mg inserted into posterior fornix\r\nevery 3 hours for max. of 5 administrations; second course may begin\r\n24 hours after start of treatment (if treatment fails pregnancy should\r\nbe terminated by another method)", "Second trimester intra-uterine death, 1\u00a0mg inserted into posterior\r\nfornix every 3 hours for max. of 5 administrations only; monitor for\r\ncoagulopathy", "If used in combination with mifepristone,\r\ncarefully monitor blood pressure and pulse for 3 hours" ] }, "POSACONAZOLE": { "indications": "Indications\u00a0invasive aspergillosis (see notes above); fusariosis either unresponsive to, or in patients intolerant\r\nof, amphotericin; chromoblastomycosis and mycetoma either unresponsive\r\nto, or in patients intolerant of, itraconazole; coccidioidomycosis\r\neither unresponsive to, or in patients intolerant of, amphotericin,\r\nitraconazole, or fluconazole; see also under Dose", "name": "POSACONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.1 Triazole antifungals" ], "cautions": "Cautions\u00a0cardiomyopathy, bradycardia, symptomatic arrhythmias, history of QT interval prolongation, concomitant use with other drugs known to cause QT-interval prolongation; monitor electrolytes (including potassium, magnesium,\r\nand calcium) before and during therapy, monitor liver function; interactions: Appendix 1 (antifungals, triazole)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including nausea,\r\nvomiting, abdominal pain, diarrhoea, dyspepsia, and flatulence); dizziness,\r\nheadache, paraesthesia, drowsiness, fatigue, fever, anorexia; blood\r\ndisorders (including anaemia, neutropenia, and thrombocytopenia),\r\nelectrolyte disturbances; dry mouth; rash; less commonly pancreatitis, hepatic disorders, arrhythmias, palpitation, changes\r\nin blood pressure, oedema, convulsions, neuropathy, tremor, hyperglycaemia,\r\nmenstrual disorders, renal failure, musculoskeletal pain, visual disturbances,\r\nmouth ulcers, and alopecia; rarely ileus, cardiac\r\nfailure, myocardial infarction, stroke, thrombosis, syncope, pneumonitis,\r\npsychosis, depression, encephalopathy, adrenal insufficiency, breast\r\npain, hearing impairment, and Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129707.htm", "doses": [ "400\u00a0mg twice daily with food or if food\r\nnot tolerated, 200\u00a0mg 4 times daily", "Oropharyngeal candidiasis (severe infection or in immunocompromised\r\npatients only), 200\u00a0mg with food on first day, then 100\u00a0mg once daily\r\nwith food for 13 days", "Prophylaxis of invasive fungal infections in patients undergoing\r\nbone-marrow transplantation or receiving chemotherapy for acute myeloid\r\nleukaemia and myelodysplastic syndrome who are expected to become\r\nneutropenic, and who are intolerant of fluconazole or itraconazole,\r\n200\u00a0mg 3 times daily with food, starting before transplantation or\r\nbefore chemotherapy and continued until neutrophil count recovers", "child under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk and recommends effective contraception during treatment;\r\ntoxicity in animal studies" }, "PROPANTHELINE BROMIDE - ANTIMUSCARINICS": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal\r\ndisorders characterised by smooth muscle spasm; urinary frequency\r\n(section 7.4.2); gustatory\r\nsweating (section 6.1.5)", "name": "PROPANTHELINE BROMIDE - ANTIMUSCARINICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "PROPANTHELINE BROMIDE" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2094.htm", "doses": [ "adult and child over 12 years, 15\u00a0mg 3 times daily at least\r\n1 hour before meals and 30\u00a0mg at night, max. 120\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "VELAGLUCERASE ALFA": { "indications": "Indications\u00a0(specialist use only) type I Gaucher\u2019s\r\ndisease", "name": "VELAGLUCERASE ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Gaucher\u2019s disease", "VELAGLUCERASE ALFA" ], "cautions": "Cautions\u00a0monitor immunoglobulin G (IgG) antibody\r\nconcentration in severe infusion-related reactions or if there is a lack or loss of effect with velaglucerase alfaInfusion-related reactions\u00a0Infusion-related\r\nreactions very common; manage by slowing the infusion rate, or interrupting\r\nthe infusion, or minimise by pre-treatment with an antihistamine,\r\nantipyretic, or corticosteroid\u2014consult product literature", "side-effects": "Side-effects\u00a0nausea, abdominal pain, tachycardia, hypertension,\r\nhypotension, flushing, headache, dizziness, malaise, pyrexia, arthralgia,\r\nbone pain, back pain, hypersensitivity reactions, rash, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213594.htm", "doses": [ "By intravenous infusion, 60\u00a0units/kg once\r\nevery 2 weeks; adjusted according to response to 15\u201360\u00a0units/kg once\r\nevery 2 weeks; child under 18 years\r\nsee BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use with caution\u2014limited information\r\navailable" }, "MEMANTINE HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe dementia in Alzheimer\u2019s disease", "name": "MEMANTINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.11 Drugs for dementia", "MEMANTINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0history of convulsions; interactions: Appendix 1 (memantine)", "side-effects": "Side-effects\u00a0constipation; hypertension; dyspnoea; headache,\r\ndizziness, drowsiness; less commonly vomiting, thrombosis,\r\nheart failure, confusion, fatigue, hallucinations, and abnormal gait; very rarely seizures; pancreatitis, psychosis, depression,\r\nand suicidal ideation also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119739.htm", "doses": [ "Initially 5\u00a0mg once daily, increased in steps of 5\u00a0mg\r\nat weekly intervals to max. 20\u00a0mg daily" ] }, "TRETINOIN With antibacterial": { "indications": "Indications\u00a0see preparations; malignant disease (section 8.1.5)", "name": "TRETINOIN With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "TRETINOIN", "With antibacterial" ], "cautions": "Cautions\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106180.htm", "doses": [ "See preparations", "Name[Aknemycin\u00ae Plus (Almirall) ] Solution, tretinoin 0.025%, erythromycin 4% in an alcoholic basis,\r\nnet price 25\u00a0mL = \u00a37.05. \r\n Label:\r\n 11Excipients none as listed in section 13.1.3Dose\u00a0acne, apply thinly 1\u20132 times daily" ], "pregnancy": "Pregnancy\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "IODINE AND IODIDE": { "indications": "Indications\u00a0thyrotoxicosis (pre-operative)", "name": "IODINE AND IODIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.2 Thyroid and antithyroid drugs", "6.2.2 Antithyroid drugs" ], "cautions": "Cautions\u00a0children; not for long-term treatment", "side-effects": "Side-effects\u00a0hypersensitivity reactions including coryza-like\r\nsymptoms, headache, lacrimation, conjunctivitis, pain in salivary\r\nglands, laryngitis, bronchitis, rashes; on prolonged treatment depression,\r\ninsomnia, impotence; goitre in infants of mothers taking iodides", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4245.htm", "doses": [ "See under preparation" ], "pregnancy": "Pregnancy\u00a0neonatal goitre and hypothyroidism; see also notes above" }, "ERGOCALCIFEROL Pharmacological strengths": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "ERGOCALCIFEROL Pharmacological strengths", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "ERGOCALCIFEROL", "Pharmacological strengths" ], "cautions": "Cautions\u00a0take care to ensure correct dose in infants; monitor plasma-calcium concentration in patients receiving\r\nhigh doses and in renal impairment (\n(From 9.6.4 Vitamin D: British National Formulary)\nImportant. All patients receiving pharmacological doses of vitamin D should have their plasma-calcium concentration checked at intervals (initially once or twice weekly) and whenever nausea or vomiting occur.); interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0symptoms of overdosage include\r\nanorexia, lassitude, nausea and vomiting, diarrhoea, constipation,\r\nweight loss, polyuria, sweating, headache, thirst, vertigo, and raised\r\nconcentrations of calcium and phosphate in plasma and urine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5136.htm", "doses": [ "See notes above", "Name[Ergocalciferol (Non-proprietary)] Tablets, ergocalciferol 250\u00a0micrograms\r\n(10\u00a0000\u00a0units), net price 100 = \u00a321.99; 1.25\u00a0mg (50\u00a0000\u00a0units), 100\r\n= \u00a330.34Note\u00a0May be difficult to obtainImportant\u00a0When the strength of the tablets ordered\r\nor prescribed is not clear, the intention of the prescriber with respect\r\nto the strength (expressed in micrograms or milligrams per tablet)\r\nshould be ascertained.\nInjection , for intramuscular use\r\nonly, ergocalciferol, 7.5\u00a0mg (300\u00a0000\u00a0units)/mL in oil, net price\r\n1-mL amp = \u00a39.35, 2-mL amp = \u00a310.84Note\u00a0Other formulations of ergocalciferol are\r\navailable from \u2018special-order\u2019 manufacturers\r\nor specialist importing companies" ], "pregnancy": "Pregnancy\u00a0high doses teratogenic in animals but therapeutic doses unlikely to be harmful" }, "CALCITONIN (SALMON)/SALCATONIN": { "indications": "Indications\u00a0see under Dose", "name": "CALCITONIN (SALMON)/SALCATONIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.1 Calcitonin and parathyroid hormone" ], "cautions": "Cautions\u00a0history of allergy (skin test advised); heart failure", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain; flushing;\r\ndizziness, headache, taste disturbances; musculoskeletal pain; with\r\nnasal spray nose and throat irritation, rhinitis, sinusitis and epistaxis; less commonly diuresis, oedema, cough, visual disturbances,\r\ninjection-site reactions, rash, hypersensitivity reactions including\r\npruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4443.htm", "doses": [ "Hypercalcaemia of malignancy (see also section 9.5.1.2), adult over 18 years, by subcutaneous or intramuscular injection, 100\u00a0units\r\nevery 6\u20138 hours adjusted according to response; max. 400\u00a0units every\r\n6\u20138 hours; in severe or emergency cases, by intravenous infusion, up to 10\u00a0units/kg over at least 6 hours", "Paget\u2019s disease of bone, adult over 18 years, by subcutaneous or intramuscular injection, 50\u00a0units 3 times weekly to\r\n100\u00a0units daily adjusted according to response", "Postmenopausal osteoporosis to reduce risk of vertebral fractures, intranasally, 200\u00a0units (1 spray) into one nostril daily,\r\nwith dietary calcium and vitamin D supplements (section 9.5.1.1 and section\r\n9.6.4)", "Prevention of acute bone loss due to sudden immobility, adult over 18 years, by subcutaneous or intramuscular injection, 100\u00a0units\r\ndaily in 1\u20132 divided doses for 2\u20134 weeks, reduced to 50\u00a0units daily\r\nat start of mobilisation and continued until fully mobile" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk (toxicity\r\nin animal studies)" }, "PARATHYROID HORMONE": { "indications": "Indications\u00a0treatment of osteoporosis in postmenopausal women\r\nat high risk of fractures (to reduce the risk of vertebral fractures)\r\n(see also notes above)", "name": "PARATHYROID HORMONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.1 Calcitonin and parathyroid hormone", "PARATHYROID HORMONE" ], "cautions": "Cautions\u00a0monitor serum or urinary calcium concentration\r\nat 1, 3 and 6 months after initiation of treatment (consult product literature for guidance if serum-calcium concentration\r\nraised); active or previous urolithiasis; concomitant cardiac glycosides", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, constipation, diarrhoea;\r\npalpitation; headache, dizziness, fatigue, asthenia; transient hypercalcaemia,\r\nhypercalciuria; muscle cramp, pain in extremities, back pain; injection-site\r\nreactions; less commonly abdominal pain, altered\r\nsense of smell, taste disturbance, anorexia, influenza, hyperuricaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129906.htm", "doses": [ "By subcutaneous injection, 100\u00a0micrograms\r\ndaily, max. duration of treatment 24 months" ], "pregnancy": "Pregnancy\u00a0avoid" }, "SODIUM VALPROATE": { "indications": "Indications\u00a0all forms of epilepsy; migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2); mania\r\n(section 4.2.3)", "name": "SODIUM VALPROATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Valproate", "SODIUM VALPROATE" ], "cautions": "Cautions\u00a0monitor liver function\r\nbefore therapy and during first 6 months especially in patients most\r\nat risk (see also below); measure full\r\nblood count and ensure no undue potential\r\nfor bleeding before starting and before surgery; systemic lupus erythematosus; false-positive\r\nurine tests for ketones; avoid abrupt withdrawal; consider vitamin D supplementation in patients that\r\nare immobilised for long periods or who have inadequate sun exposure\r\nor dietary intake of calcium; interactions: see Interactions in section 4.8.1 and Appendix 1 (valproate)Liver toxicity\u00a0Liver dysfunction (including fatal\r\nhepatic failure) has occurred in association with valproate (especially\r\nin children under 3 years and in those\r\nwith metabolic or degenerative\r\ndisorders, organic brain disease or severe seizure disorders associated with mental\r\nretardation) usually in first 6 months and usually involving\r\nmultiple antiepileptic therapy. Raised liver enzymes\r\nduring valproate treatment are usually transient but patients should\r\nbe reassessed clinically and liver function (including prothrombin\r\ntime) monitored until return to normal\u2014discontinue if abnormally prolonged prothrombin time (particularly\r\nin association with other relevant abnormalities).Blood or hepatic disorders\u00a0Patients or their carers should be told how to recognise signs and\r\nsymptoms of blood or liver disorders and advised to seek immediate\r\nmedical attention if symptoms developPancreatitis\u00a0Patients or their carers\r\nshould be told how to recognise signs and symptoms of pancreatitis\r\nand advised to seek immediate medical attention if symptoms such as\r\nabdominal pain, nausea, or vomiting develop; discontinue if pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0nausea, gastric irritation, diarrhoea; weight\r\ngain; hyperammonaemia, thrombocytopenia; transient hair loss (regrowth\r\nmay be curly); less frequently increased alertness,\r\naggression, hyperactivity, behavioural disturbances, ataxia, tremor,\r\nand vasculitis; rarely hepatic dysfunction (see under\r\nCautions; withdraw treatment immediately if persistent vomiting and\r\nabdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or\r\nloss of seizure control), lethargy, drowsiness, confusion, stupor,\r\nhallucinations, blood disorders (including anaemia, leucopenia, pancytopenia),\r\nhearing loss, and rash; very rarely pancreatitis\r\n(see under Cautions), peripheral oedema, increase in bleeding time,\r\nextrapyramidal symptoms, dementia, encephalopathy, coma, gynaecomastia,\r\nFanconi\u2019s syndrome, hirsutism, acne, enuresis, hyponatraemia, toxic\r\nepidermal necrolysis, and Stevens-Johnson syndrome; suicidal ideation;\r\nreduced bone mineral density (see Cautions); also reported menstrual disturbances, male infertility, syndrome of inappropriate\r\nsecretion of antidiuretic hormone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130021.htm", "doses": [ "Epilepsy, by mouth, initially 600\u00a0mg\r\ndaily in 1\u20132 divided doses, increased gradually (in steps of 150\u2013300\u00a0mg)\r\nevery 3 days; usual maintenance dose 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily),\r\nmax. 2.5\u00a0g daily; child 1 month\u201312\r\nyears, initially 10\u201315\u00a0mg/kg (max. 600\u00a0mg) daily in 1\u20132 divided doses;\r\nusual maintenance dose 25\u201330\u00a0mg/kg daily in 2 divided doses", "Initiation of valproate treatment by intravenous administration, adult and child over 12 years, initially 10\u00a0mg/kg (usually 400\u2013800\u00a0mg) by intravenous injection (over 3\u20135 minutes) followed by intravenous infusion or intravenous\r\ninjection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up\r\nto max. 2.5\u00a0g daily; usual range 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily); child 1 month\u201312 years, 10\u00a0mg/kg by intravenous\r\ninjection (over 3\u20135 minutes) followed by intravenous\r\ninfusion or intravenous injection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up to usual range 20\u201340\u00a0mg/kg\r\ndaily (doses above 40\u00a0mg/kg daily monitor clinical chemistry and haematological\r\nparameters)", "Continuation of valproate treatment by intravenous injection (over 3\u20135 minutes) or intravenous infusion in 2\u20134 divided doses, or by continuous intravenous infusion, same as established oral daily dose", "Migraine prophylaxis [unlicensed], by mouth, initially 200\u00a0mg twice daily, increased if necessary to 1.2\u20131.5\u00a0g\r\ndaily in divided doses", "Mania, see under Episenta\u00ae" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nneonatal bleeding (related to hypofibrinaemia) and neonatal hepatotoxicity\r\nalso reported" }, "PEPPERMINT OIL": { "indications": "Indications\u00a0relief of abdominal colic and distension, particularly\r\nin irritable bowel syndrome", "name": "PEPPERMINT OIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Other antispasmodics", "PEPPERMINT OIL" ], "cautions": "Cautions\u00a0sensitivity to menthol", "side-effects": "Side-effects\u00a0heartburn, perianal irritation; rarely, allergic\r\nreactions (including rash, headache, bradycardia, muscle tremor, ataxia)Local irritation\u00a0Capsules should not be broken\r\nor chewed because peppermint oil may irritate mouth\r\nor oesophagus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2105.htm", "doses": [ "See preparations", "adult and child over 15 years, 1\u20132 capsules, swallowed whole\r\nwith water, 3 times daily for up to 3 months if necessary" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "SODIUM CROMOGLICATE - FOOD ALLERGY": { "side-effects": "Side-effects\u00a0occasional nausea, rashes, and joint pain", "indications": "Indications\u00a0food allergy (in conjunction\r\nwith dietary restriction); asthma (section 3.3.1); allergic conjunctivitis (section 11.4.2); allergic rhinitis (section 12.2.1)", "name": "SODIUM CROMOGLICATE - FOOD ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2189.htm", "doses": [ "200\u00a0mg 4 times daily before meals; may be increased if\r\nnecessary after 2\u20133 weeks to a max. of 40\u00a0mg/kg daily and then reduced\r\naccording to response; child 2\u201314 years\r\n100\u00a0mg 4 times daily before meals; may be increased if necessary after\r\n2\u20133 weeks to a max. of 40\u00a0mg/kg daily and then reduced according to\r\nresponse", "Capsules may be swallowed whole or\r\nthe contents dissolved in hot water and diluted with cold water before\r\ntaking" ], "pregnancy": "Pregnancy\u00a0not known to be harmful", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.4 Food allergy", "SODIUM CROMOGLICATE" ] }, "DEXKETOPROFEN": { "indications": "Indications\u00a0short-term treatment of mild to moderate pain including dysmenorrhoea", "name": "DEXKETOPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DEXKETOPROFEN" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76935.htm", "doses": [ "12.5\u00a0mg every 4\u20136 hours or 25\u00a0mg every\r\n8 hours; max. 75\u00a0mg daily; elderly initially\r\nmax. 50\u00a0mg daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ETANERCEPT - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0 see under Cytokine Modulators above", "name": "ETANERCEPT - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection (avoid if predisposition to septicaemia); significant\r\nexposure to herpes zoster virus\u2014interrupt treatment\r\nand consider varicella\u2013zoster immunoglobulin; hepatitis\r\nB virus\u2014monitor for active infection; monitor\r\nfor worsening hepatitis C infection; children should\r\nbe brought up to date with current immunisation schedule (section 14.1) before initiating therapy; heart failure (risk of exacerbation); history or increased\r\nrisk of demyelinating disorders; history or development of malignancy; monitor for skin cancer before and during treatment, particularly\r\nin those at risk (including patients with psoriasis or a history of\r\nPUVA treatment); history of blood disorders; diabetes mellitus; interactions: Appendix 1 (etanercept)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting etanercept. Patients who have previously received\r\nadequate treatment for tuberculosis can start etanercept but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting etanercept. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with etanercept. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) develop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators; also less commonly interstitial lung disease,\r\nskin cancer, uveitis, rash, new onset or worsening psoriasis; rarely demyelinating disorders, seizures, lymphoma, Stevens-Johnson\r\nsyndrome, vasculitis; very rarely toxic epidermal\r\nnecrolysis; also reported appendicitis, gastritis,\r\noesophagitis, inflammatory bowel disease, vomiting, diabetes mellitus,\r\nmalignancy (including solid tumours and leukaemia), macrophage activation\r\nsyndrome, and cutaneous ulcer", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128236.htm", "doses": [ "By subcutaneous injection, rheumatoid\r\narthritis, psoriatic arthritis, ankylosing spondylitis, adult over 18 years, 25\u00a0mg twice weekly or 50\u00a0mg once weekly", "Active polyarticular juvenile idiopathic arthritis, child 2\u201317 years, 400\u00a0micrograms/kg (max. 25\u00a0mg)\r\ntwice weekly, with an interval of 3\u20134 days between doses; consider\r\ndiscontinuation if no response after 4 months" ], "pregnancy": "Pregnancy\u00a0avoid\u2014limited information available; manufacturer\r\nadvises effective contraception required during treatment and for\r\n3 weeks after last dose" }, "LENALIDOMIDE": { "indications": "Indications\u00a0\n(From Lenalidomide and thalidomide: British National Formulary)\nLenalidomide is an immunomodulating drug with antineoplastic, anti-angiogenic, and pro-erythropoietic properties. It is licensed, in combination with dexamethasone, for the treatment of multiple myeloma in patients who have received at least one previous therapy.The most serious side-effects of lenalidomide are venous thromboembolism and severe neutropenia. Lenalidomide is structurally related to thalidomide and there is a risk of teratogenesis.The Scottish Medicines Consortium has advised (April 2010) that lenalidomide, in combination with dexamethasone, is accepted for restricted use within NHS Scotland for patients with multiple myeloma who have received at least two prior therapies.NICE guidanceLenalidomide for the treatment of multiple myeloma (June 2009)Lenalidomide in combination with dexamethasone is an option for the treatment of multiple myeloma in patients who have received two or more prior therapies. The drug cost of lenalidomide will be met by the manufacturer for patients who remain on treatment for more than 26 cycles.", "name": "LENALIDOMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Lenalidomide and thalidomide" ], "cautions": "Cautions\u00a0\n(From Lenalidomide and thalidomide: British National Formulary)\nLenalidomide is an immunomodulating drug with antineoplastic, anti-angiogenic, and pro-erythropoietic properties. It is licensed, in combination with dexamethasone, for the treatment of multiple myeloma in patients who have received at least one previous therapy.The most serious side-effects of lenalidomide are venous thromboembolism and severe neutropenia. Lenalidomide is structurally related to thalidomide and there is a risk of teratogenesis.The Scottish Medicines Consortium has advised (April 2010) that lenalidomide, in combination with dexamethasone, is accepted for restricted use within NHS Scotland for patients with multiple myeloma who have received at least two prior therapies.NICE guidanceLenalidomide for the treatment of multiple myeloma (June 2009)Lenalidomide in combination with dexamethasone is an option for the treatment of multiple myeloma in patients who have received two or more prior therapies. The drug cost of lenalidomide will be met by the manufacturer for patients who remain on treatment for more than 26 cycles.; monitor full blood\r\ncount (including differential white cell count and platelet count)\r\nbefore treatment and every week for the first 8 weeks then every 4\r\nweeks (reduce dose or interrupt treatment\r\nif neutropenia or thrombocytopenia develop\u2014consult product literature); monitor for arterial or venous thromboembolism (consider\r\npermanent discontinuation if thromboembolic event occurs) and use caution with concomitant drugs that increase\r\nthe risk of thromboembolism\u2014see also Thromboembolism\r\nbelow; high tumour burden\u2014risk of %s\n(From Side-effects of cytotoxic drugs: British National Formulary)\nTumour lysis syndrome\u00a0Tumour lysis syndrome occurs secondary to spontaneous or treatment-related rapid destruction of malignant cells. Patients at risk of tumour lysis syndrome include those with non-Hodgkin\u2019s lymphoma (especially if high grade and bulky disease), Burkitt\u2019s lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia (particularly if high white blood cell counts or bulky disease), and occasionally those with solid tumours. Pre-existing hyperuricaemia, dehydration, and renal impairment are also predisposing factors. Features include hyperkalaemia, hyperuricaemia (see below), and hyperphosphataemia with hypocalcaemia; renal damage and arrhythmias can follow. Early identification of patients at risk, and initiation of prophylaxis or therapy for tumour lysis syndrome, is essential.; monitor thyroid\r\nfunction; risk factors for myocardial infarction; interactions: Appendix 1 (lenalidomide)Thromboembolism\u00a0Risk factors for thromboembolism\r\n(such as smoking, hypertension, hyperlipidaemia) should be minimised\r\nand thromboprophylaxis should be considered in patients with multiple\r\nrisk factors.Patients and their carers should be made aware\r\nof the symptoms of thromboembolism and advised to report sudden breathlessness,\r\nchest pain, or swelling of a limbNeutropenia and thrombocytopenia\u00a0Patients and their carers should be made aware of the symptoms of\r\nneutropenia and advised to seek medical advice if symptoms suggestive\r\nof neutropenia (such as fever, sore throat) or of thrombocytopenia\r\n(such as bleeding) developSecond primary malignancy \u00a0Patients should be\r\ncarefully evaluated before and during treatment with lenalidomide\r\nusing routine cancer screening for occurrence of second primary malignancy\r\nand treatment should be instituted as indicated", "side-effects": "Side-effects\u00a0myocardial infarction, hypotension, deep vein\r\nthrombosis; pneumonia, dyspnoea; tremor, hypoaesthesia, fatigue, asthenia;\r\nneutropenia, thrombocytopenia, anaemia, lymphopenia, leucopenia; muscle\r\ncramp; pruritus, rash; rarely Stevens-Johnson syndrome\r\nand toxic epidermal necrolysis; also reported interstitial\r\npneumonitis, pancreatitis, pulmonary embolism, cerebrovascular events,\r\nsecondary malignancies", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200218.htm", "doses": [ "adult over 18 years, 25\u00a0mg\r\nonce daily for 21 consecutive days of a 28-day cycle; for doses of\r\ndexamethasone, consult product literature" ], "pregnancy": "Pregnancy\u00a0important: teratogenic risk; see\r\nalso notes above" }, "FENTANYL Patches": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL Patches", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL", "Patches" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27054.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare", "Name[Durogesic DTrans\u00ae (Janssen) ] Patches, self-adhesive, transparent, fentanyl, \u201812\u2019 patch (releasing approx. 12\u00a0micrograms/hour\r\nfor 72 hours), net price 5 = \u00a313.69; \u201825\u2019 patch (releasing approx.\r\n25\u00a0micrograms/hour for 72 hours), 5 = \u00a319.59; \u201850\u2019 patch (releasing\r\napprox. 50\u00a0micrograms/hour for 72 hours), 5 = \u00a336.59; \u201875\u2019 patch (releasing\r\napprox. 75\u00a0micrograms/hour for 72 hours), 5 = \u00a350.99; \u2018100\u2019 patch\r\n(releasing approx. 100\u00a0micrograms/hour for 72 hours), 5 = \u00a362.89. \r\n Label:\r\n 2, counselling, administration" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "SALICYLATES Choline salicylate": { "indications": "Indications\u00a0mild oral and perioral lesions", "name": "SALICYLATES Choline salicylate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "SALICYLATES", "Choline salicylate" ], "cautions": "Cautions\u00a0not to be applied to dentures\u2014leave at\r\nleast 30 minutes before re-insertion of dentures; frequent\r\napplication, especially in children, may give rise to salicylate poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5695.htm", "doses": [ "Name[Choline Salicylate Dental Gel, BP] Oral gel, choline salicylate 8.7%\r\nin a flavoured gel basis, net price 15\u00a0g = \u00a31.89Brands include Bonjela\u00ae (sugar-free)Dose\u00a0adult and child over 16 years, apply \u00bd-inch of gel with gentle\r\nmassage not more often than every 3 hoursDental prescribing on NHS\u00a0Choline Salicylate Dental\r\nGel may be prescribed" ] }, "PRAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS": { "indications": "Indications\u00a0hypertension (\n(From 2.5.4 Alpha-adrenoceptor blocking drugs: British National Formulary)\n2.5.4 Alpha-adrenoceptor blocking drugs); congestive\r\nheart failure (but \n(From Heart failure: British National Formulary)\nHeart failure); Raynaud\u2019s syndrome (see also %s\n(From 2.6.4 Peripheral vasodilators and related drugs: British National Formulary)\nManagement of Raynaud\u2019s syndrome includes avoidance of exposure to cold and stopping smoking. More severe symptoms may require vasodilator treatment, which is most often successful in primary Raynaud\u2019s syndrome. Nifedipine (section 2.6.2) is useful for reducing the frequency and severity of vasospastic attacks. Alternatively, naftidrofuryl may produce symptomatic improvement; inositol nicotinate (a nicotinic acid derivative) may also be considered. Pentoxifylline, prazosin, and moxisylyte are not established as being effective for the treatment of Raynaud\u2019s syndrome.); benign prostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "PRAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "PRAZOSIN" ], "cautions": "Cautions\u00a0first dose may cause collapse due to\r\nhypotension (therefore should be taken on retiring to bed); elderly; cataract surgery\r\n(risk of intra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\ndyspnoea; nervousness; urinary frequency; less commonly insomnia, paraesthesia, sweating, arthralgia, eye disorders, tinnitus,\r\nand epistaxis; rarely pancreatitis, flushing, vasculitis,\r\nbradycardia, hallucinations, worsening of narcolepsy, gynaecomastia,\r\nurinary incontinence, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2575.htm", "doses": [ "Hypertension (see notes above), 500\u00a0micrograms 2\u20133 times\r\ndaily for 3\u20137 days, the initial dose on retiring to bed at night (to\r\navoid collapse, see Cautions); increased to 1\u00a0mg 2\u20133 times daily for\r\na further 3\u20137 days; further increased if necessary to max. 20\u00a0mg daily\r\nin divided doses", "Congestive heart failure (but see section 2.5.5), 500\u00a0micrograms 2\u20134 times daily (initial dose\r\nat bedtime, see above), increasing to 4\u00a0mg daily in divided doses;\r\nmaintenance 4\u201320\u00a0mg daily in divided doses (but rarely used)", "Raynaud\u2019s syndrome (but efficacy not established, see section 2.6.4), initially\r\n500\u00a0micrograms twice daily (initial dose at bedtime, see above) increased,\r\nif necessary, after 3\u20137 days to usual maintenance 1\u20132\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "PERINDOPRIL ARGININE": { "indications": "Indications\u00a0see under Perindopril Erbumine and notes above", "name": "PERINDOPRIL ARGININE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "PERINDOPRIL ARGININE" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see under Perindopril Erbumine and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106554.htm", "doses": [ "Hypertension, initially 5\u00a0mg once daily in the morning\r\nfor 1 month, subsequently adjusted according to response; if used\r\nin addition to diuretic (see notes above),\r\nin elderly, in renal impairment, in cardiac decompensation, or in\r\nvolume depletion, initially 2.5\u00a0mg once daily; max. 10\u00a0mg daily", "Heart failure (adjunct), initially 2.5\u00a0mg once daily in the\r\nmorning under close medical supervision (see notes above),\r\nincreased after 2 weeks to max. 5\u00a0mg once daily if tolerated", "Following myocardial infarction or revascularisation, initially\r\n5\u00a0mg once daily in the morning increased after 2 weeks to 10\u00a0mg once\r\ndaily if tolerated; elderly 2.5\u00a0mg\r\nonce daily for 1 week, then 5\u00a0mg once daily for 1 week, thereafter\r\nincreased to 10\u00a0mg once daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "ZALEPLON": { "indications": "Indications\u00a0insomnia (short-term use\u2014up to 2 weeks)", "name": "ZALEPLON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Zaleplon, zolpidem, and zopiclone", "ZALEPLON" ], "cautions": "Cautions\u00a0respiratory insufficiency (avoid if severe); muscle weakness and myasthenia gravis, history of drug or alcohol abuse; depression (risk of suicidal ideation); avoid prolonged\r\nuse (risk of tolerance and withdrawal symptoms); interactions: Appendix 1 (anxiolytics\r\nand hypnotics)", "side-effects": "Side-effects\u00a0amnesia, paraesthesia, drowsiness; dysmenorrhea; less commonly nausea, anorexia, asthenia, incoordination,\r\nconfusion, impaired concentration, depression, depersonalisation,\r\ndizziness, hallucinations, disturbances of smell, hearing, speech,\r\nand vision; photosensitivity; paradoxical effects (see Paradoxical Effects) and sleep-walking also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85914.htm", "doses": [ "adult over 18 years, 10\u00a0mg\r\nat bedtime or after going to bed if difficulty falling asleep; elderly 5\u00a0mg", "Patients should be advised not to take a\r\nsecond dose during a single night" ], "pregnancy": "Pregnancy\u00a0use only if necessary and restrict to occasional\r\nshort-term use; risk of withdrawal symptoms in neonate if used in\r\nlate pregnancy" }, "INTERFERON GAMMA-1b": { "indications": "Indications\u00a0\n(From Interferon gamma: British National Formulary)\nInterferon gamma", "name": "INTERFERON GAMMA-1b", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon gamma", "INTERFERON GAMMA-1b" ], "cautions": "Cautions\u00a0seizure disorders (including seizures associated with fever); cardiac\r\ndisease (including ischaemia, congestive heart failure, and arrhythmias); monitor before and during\r\ntreatment: haematological tests (including full blood count, differential\r\nwhite cell count, and platelet count), blood chemistry tests (including\r\nrenal and liver function tests) and urinalysis; avoid simultaneous administration of foreign proteins including immunological products (risk of exaggerated immune response); interactions: Appendix 1 (interferons)Driving\u00a0May impair ability to drive\r\nor operate machinery; effects may be enhanced\r\nby alcohol", "side-effects": "Side-effects\u00a0nausea, vomiting; headache, fatigue, fever; myalgia,\r\narthralgia; rash, injection-site reactions; rarely confusion and systemic lupus erythematosus; also reported, neutropenia,\r\nthrombocytopenia, and raised liver enzymes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202811.htm", "doses": [ "See under preparation", "By subcutaneous injection, 50\u00a0micrograms/m2 3 times a week; patients with body surface area of 0.5\u00a0m2 or less, 1.5\u00a0micrograms/kg 3 times a week; not yet recommended\r\nfor children under 6 months with chronic granulomatous disease" ], "pregnancy": "Pregnancy\u00a0manufacturers recommend avoid unless potential benefit\r\noutweighs risk (toxicity in animal studies); effective\r\ncontraception required during treatment\u2014consult product literature" }, "FERROUS SULPHATE": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4846.htm", "doses": [ "See under preparations below and notes above" ] }, "METOCLOPRAMIDE HYDROCHLORIDE": { "indications": "Indications\u00a0adults, nausea and vomiting, particularly\r\nin gastro-intestinal disorders (section 1.2) and treatment\r\nwith cytotoxics or radiotherapy; migraine (section 4.7.4.1)Patients under 20 years\u00a0Use restricted to severe\r\nintractable vomiting of known cause, vomiting of radiotherapy and\r\ncytotoxics, aid to gastro-intestinal intubation, premedication; dose\r\nshould be determined on the basis of body-weight", "name": "METOCLOPRAMIDE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Domperidone and metoclopramide", "METOCLOPRAMIDE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0elderly, young\r\nadults (15\u201319 years old), and children; atopic allergy (including asthma); cardiac conduction disturbances (and concomitant\r\nuse of other drugs affecting cardiac conduction); may mask underlying disorders such as cerebral irritation; acute porphyria (section 9.8.2); epilepsy; interactions: Appendix 1 (metoclopramide)", "side-effects": "Side-effects\u00a0extrapyramidal effects (especially in children\r\nand young adults (15\u201319 years old)\u2014see above),\r\nhyperprolactinaemia, occasionally tardive dyskinesia on prolonged\r\nadministration; also reported, dyspnoea, anxiety, confusion, drowsiness,\r\ndizziness, tremor, restlessness, diarrhoea, depression, neuroleptic\r\nmalignant syndrome, visual disturbances, rashes, pruritus, oedema;\r\ncardiac conduction abnormalities reported following intravenous administration; rarely methaemoglobinaemia (more severe in G6PD deficiency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3432.htm", "doses": [ "By mouth or by intramuscular injection or by\r\nintravenous injection over 1\u20132 minutes, nausea and vomiting,\r\n10\u00a0mg (5\u00a0mg in young adults 15\u201319 years, body-weight under 60\u00a0kg)\r\n3 times daily; child up to 1 year (body-weight\r\nup to 10\u00a0kg) 100\u00a0micrograms/kg (max. 1\u00a0mg) twice daily, 1\u20133 years\r\n(body-weight 10\u201314\u00a0kg) 1\u00a0mg 2\u20133 times daily, 3\u20135 years (body-weight\r\n15\u201319\u00a0kg) 2\u00a0mg 2\u20133 times daily, 5\u20139 years (body-weight 20\u201329\u00a0kg) 2.5\u00a0mg\r\n3 times daily, 9\u201315 years (body-weight 30\u00a0kg and over) 5\u00a0mg 3 times\r\ndaily", "Daily dose of metoclopramide should not normally\r\nexceed 500\u00a0micrograms/kg, particularly for children and young adults\r\n(restricted use, see above)", "For diagnostic procedures, as a single dose 5\u201310 minutes before\r\nexamination, 10\u201320\u00a0mg (10\u00a0mg in young adults 15\u201319 years); child under 3 years 1\u00a0mg, 3\u20135 years 2\u00a0mg, 5\u20139 years\r\n2.5\u00a0mg, 9\u201314 years 5\u00a0mg" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "DITHRANOL Proprietary preparations": { "indications": "Indications\u00a0subacute and chronic psoriasis, see notes above", "name": "DITHRANOL Proprietary preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Dithranol", "DITHRANOL", "Proprietary preparations" ], "cautions": "Cautions\u00a0avoid use near eyes and\r\nsensitive areas of skin; see\r\nalso notes above", "side-effects": "Side-effects\u00a0local burning sensation and irritation; stains\r\nskin, hair, and fabrics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5987.htm", "doses": [ "See notes above and under preparations", "Some of these dithranol preparations also contain coal tar or salicylic acid\u2014for cautions, contra-indications, and side-effects\r\nsee under Tars (above) or under Salicylic Acid", "for application to scalp, initially apply on alternate\r\ndays for 10\u201320 minutes; may be increased to daily application for\r\nmax. 1 hour and then wash off", "Name[Psorin\u00ae (LPC)] Ointment, dithranol 0.11%, coal tar 1%, salicylic acid 1.6%, net price 50\u00a0g = \u00a39.22, 100\u00a0g = \u00a318.44. \r\n Label:\r\n 28Excipients include beeswax, wool\r\nfatDose\u00a0for application to skin up to twice daily\nScalp gel, dithranol 0.25%, salicylic acid 1.6% in gel basis containing\r\nmethyl salicylate, net price 50\u00a0g = \u00a37.03. \r\n Label:\r\n 28Excipients none as listed in section 13.1.3Dose\u00a0for application to scalp, initially apply on alternate\r\ndays for 10\u201320 minutes; may be increased to daily application for\r\nmax. 1 hour and then wash off" ] }, "DESFERRIOXAMINE MESILATE - IRON SALTS": { "indications": "Indications\u00a0iron poisoning; chronic\r\niron overload (section 9.1.3)", "name": "DESFERRIOXAMINE MESILATE - IRON SALTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Iron salts" ], "cautions": "Cautions\u00a0section 9.1.3", "side-effects": "Side-effects\u00a0section\r\n9.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29544.htm", "doses": [ "By continuous intravenous infusion, adult and child up\r\nto 15\u00a0mg/kg/hour, reduced after 4\u20136 hours; max. 80\u00a0mg/kg in 24 hours\r\n(in severe cases, higher doses on advice from the National Poisons\r\nInformation Service)" ], "pregnancy": "Pregnancy\u00a0section 9.1.3" }, "TRIFLUOPERAZINE - PHENOTHIAZINES AND RELATED DRUGS": { "indications": "Indications\u00a0severe nausea and vomiting (see notes\r\nabove); other indications (section 4.2.1)", "name": "TRIFLUOPERAZINE - PHENOTHIAZINES AND RELATED DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0see notes in section 4.2.1", "side-effects": "Side-effects\u00a0see Trifluoperazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3426.htm", "doses": [ "2\u20134\u00a0mg daily in divided doses; max. 6\u00a0mg\r\ndaily; child 3\u20135 years up to 1\u00a0mg daily,\r\n6\u201312 years up to 4\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "LODOXAMIDE": { "indications": "Indications\u00a0allergic conjunctivitis", "name": "LODOXAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "LODOXAMIDE" ], "side-effects": "Side-effects\u00a0burning, stinging, itching, blurred vision, tear\r\nproduction disturbance, and ocular discomfort; less commonly flushing, nasal dryness, dizziness, drowsiness, headache, blepharitis\r\nand keratitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5448.htm", "doses": [ "adult and child over 4 years, apply 4 times daily; improvement\r\nof symptoms may sometimes require treatment for up to 4 weeks" ] }, "LEVOFLOXACIN": { "indications": "Indications\u00a0see under Dose", "name": "LEVOFLOXACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones", "LEVOFLOXACIN" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; history of psychiatric\r\nillness; interactions: Appendix 1 (quinolones)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.;\r\nalso flatulence, constipation; rarely tachycardia; very rarely pneumonitis, peripheral neuropathy, and hypoglycaemia;\r\nalso reported, rhabdomyolysis, potentially life-threatening hepatic\r\nfailure; local reactions and transient hypotension reported with infusion", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215577.htm", "doses": [ "By mouth, acute sinusitis, 500\u00a0mg\r\ndaily for 10\u201314 days", "Exacerbation of chronic bronchitis, 250\u2013500\u00a0mg daily for 7\u201310\r\ndays", "Community-acquired pneumonia, 500\u00a0mg once or twice daily for\r\n7\u201314 days", "Urinary-tract infections, 250\u00a0mg daily for 7\u201310 days (for 3\r\ndays in uncomplicated infection)", "Chronic prostatitis, 500\u00a0mg once daily for 28 days", "Skin and soft tissue infections, 250\u00a0mg daily or 500\u00a0mg once or twice daily for 7\u201314 days", "By intravenous infusion (over at\r\nleast 60 minutes for 500\u00a0mg), community-acquired pneumonia, 500\u00a0mg\r\nonce or twice daily", "Complicated urinary-tract infections, 250\u00a0mg daily, increased\r\nin severe infections", "Skin and soft tissue infections, 500\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "VORICONAZOLE": { "indications": "Indications\u00a0invasive aspergillosis; serious infections caused by Scedosporium spp., Fusarium spp., or invasive fluconazole-resistant Candida spp. (including C. krusei)", "name": "VORICONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.1 Triazole antifungals", "VORICONAZOLE" ], "cautions": "Cautions\u00a0electrolyte disturbances, cardiomyopathy, bradycardia, symptomatic arrhythmias, history of QT interval prolongation, concomitant\r\nuse with other drugs that prolong QT interval; avoid exposure to sunlight; patients at\r\nrisk of pancreatitis; monitor renal function; interactions: Appendix 1 (antifungals, triazole)Hepatotoxicity\u00a0Hepatitis, cholestasis, and fulminant\r\nhepatic failure reported uncommonly usually in first 10 days; risk\r\nincreased in patients with haematological malignancy. Monitor liver function before treatment and during treatment", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, jaundice\r\n(see Hepatotoxicity above), oedema, hypotension, chest pain, respiratory\r\ndistress syndrome, sinusitis, headache, dizziness, asthenia, anxiety,\r\ndepression, confusion, agitation, hallucinations, paraesthesia, tremor,\r\ninfluenza-like symptoms, hypoglycaemia, haematuria, blood disorders\r\n(including anaemia, thrombocytopenia, leucopenia, pancytopenia), acute\r\nrenal failure, hypokalaemia, visual disturbances (including altered\r\nperception, blurred vision, and photophobia), rash, pruritus, photosensitivity,\r\nalopecia, cheilitis, injection-site reactions; less commonly dyspepsia, duodenitis, cholecystitis, pancreatitis, hepatitis (see\r\nHepatotoxicity above), constipation, arrhythmias (including QT interval\r\nprolongation), syncope, raised serum cholesterol, hypersensitivity\r\nreactions (including flushing), ataxia, nystagmus, hypoaesthesia,\r\nadrenocortical insufficiency, arthritis, blepharitis, optic neuritis,\r\nscleritis, glossitis, gingivitis, psoriasis, Stevens-Johnson syndrome; rarely pseudomembranous colitis, taste disturbances (more\r\ncommon with oral suspension), convulsions, insomnia, tinnitus, hearing\r\ndisturbances, extrapyramidal effects, hypertonia, hypothyroidism,\r\nhyperthyroidism, discoid lupus erythematosus, toxic epidermal necrolysis,\r\npseudoporphyria, retinal haemorrhage, optic atrophy; also reported\r\nsquamous cell carcinoma of skin (particularly in presence of phototoxicity\r\nor in the immunosuppressed)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119741.htm", "doses": [ "By mouth, adult and child over 12 years, body-weight\r\nover 40\u00a0kg, 400\u00a0mg every 12 hours for 2 doses then 200\u00a0mg every 12\r\nhours, increased if necessary to 300\u00a0mg every 12 hours; body-weight\r\nunder 40\u00a0kg, 200\u00a0mg every 12 hours for 2 doses then 100\u00a0mg every 12\r\nhours, increased if necessary to 150\u00a0mg every 12 hours; child 2\u201312 years, (oral suspension recommended) 200\u00a0mg\r\nevery 12 hours", "By intravenous infusion, 6\u00a0mg/kg every 12 hours\r\nfor 2 doses, then 4\u00a0mg/kg every 12 hours (reduced to 3\u00a0mg/kg every\r\n12 hours if not tolerated) for max. 6 months; child 2\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises avoid unless potential benefit outweighs risk; effective contraception\r\nrequired during treatment" }, "DILTIAZEM HYDROCHLORIDE": { "indications": "Indications\u00a0prophylaxis and treatment of angina; hypertension", "name": "DILTIAZEM HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers" ], "cautions": "Cautions\u00a0heart failure or significantly impaired left ventricular function, bradycardia (avoid if severe), first degree\r\nAV block, or prolonged PR interval; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0bradycardia, sino-atrial block, AV block, palpitation,\r\ndizziness, hypotension, malaise, asthenia, headache, hot flushes,\r\ngastro-intestinal disturbances, oedema (notably of ankles); rarely\r\nrashes (including erythema multiforme and exfoliative dermatitis),\r\nphotosensitivity; hepatitis, gynaecomastia, gum hyperplasia, extrapyramidal\r\nsymptoms, depression reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2673.htm", "doses": [ "Angina, 60\u00a0mg 3 times daily (elderly initially twice daily);\r\nincreased if necessary to 360\u00a0mg daily", "Longer-acting formulations, see under preparations below" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ATENOLOL": { "indications": "Indications\u00a0see under Dose", "name": "ATENOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2468.htm", "doses": [ "By mouth, hypertension, 25\u201350\u00a0mg\r\ndaily (higher doses rarely necessary)", "Angina, 100\u00a0mg daily in 1 or 2 doses", "Arrhythmias, 50\u2013100\u00a0mg daily", "Migraine prophylaxis [unlicensed], 50\u2013200\u00a0mg daily in divided\r\ndoses", "By intravenous injection, arrhythmias,\r\n2.5\u00a0mg at a rate of 1\u00a0mg/minute, repeated at 5-minute intervals to\r\na max. of 10\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "By intravenous infusion, arrhythmias,\r\n150\u00a0micrograms/kg over 20\u00a0minutes, repeated every 12 hours if required", "Early intervention within 12 hours of myocardial infarction\r\n(section 2.10.1), by intravenous injection over 5 minutes, 5\u00a0mg, then by mouth, 50\u00a0mg after\r\n15 minutes, 50\u00a0mg after 12 hours, then 100\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "OXYCODONE WITH NALOXONE": { "indications": "Indications\u00a0severe pain requiring opioid\r\nanalgesia", "name": "OXYCODONE WITH NALOXONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "OXYCODONE WITH NALOXONE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nOpioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs). and under %s\n(From OXYCODONE HYDROCHLORIDE: British National Formulary)\nOXYCODONE HYDROCHLORIDE; also hypertension", "side-effects": "Side-effects\u00a0see under Oxycodone Hydrochloride; withdrawal symptoms\r\nmay be provoked in patients switching from other chronic high-dose\r\nopioid treatment; also weight changes, angina, hypertension, rhinorrhoea,\r\nmalaise; rarely yawning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202521.htm", "doses": [ "See under preparations", "adult over 18 years not\r\ncurrently treated with opioid analgesics, initially 10\u00a0mg/5\u00a0mg every\r\n12 hours, increased according to response; patients already receiving\r\nopioid analgesics can start with a higher dose of Targinact\u00ae; max. Targinact\u00ae 40\u00a0mg/20\u00a0mg every 12 hours", "Supplemental modified-release oxycodone (without\r\nnaloxone) can be prescribed for patients who need higher doses\u2014consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. " }, "STREPTOMYCIN": { "indications": "Indications\u00a0tuberculosis, in combination with other drugs; adjunct to doxycycline in brucellosis; enterococcal endocarditis (Table\r\n1, section 5.1)", "name": "STREPTOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs" ], "cautions": "Cautions\u00a0see under Aminoglycosides, section 5.1.4; interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0see under Aminoglycosides, section 5.1.4; also\r\nhypersensitivity reactions, paraesthesia of mouth", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3923.htm", "doses": [ "By deep intramuscular injection,\r\ntuberculosis [unlicensed], 15\u00a0mg/kg (max. 1\u00a0g) daily (reduced in\r\nthose under 50\u00a0kg, those over 40 years, or those with renal impairment)", "Brucellosis, expert advice essential", "Side-effects increase after\r\na cumulative dose of 100\u00a0g, which should only be exceeded in exceptional\r\ncircumstances", "One-hour (\u2018peak\u2019) concentration should be\r\n15\u201340\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should be less than\r\n5\u00a0mg/litre (less than 1\u00a0mg/litre in renal impairment or in those over\r\n50 years)" ], "pregnancy": "Pregnancy\u00a0see under Aminoglycosides, section 5.1.4" }, "BRINZOLAMIDE": { "indications": "Indications\u00a0reduction of intra-ocular pressure in ocular hypertension and open-angle\r\nglaucoma either as adjunct to beta-blockers or prostaglandin\r\nanalogues or used alone in patients unresponsive\r\nto beta-blockers or if beta-blockers contra-indicated", "name": "BRINZOLAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "BRINZOLAMIDE" ], "cautions": "Cautions\u00a0systemic absorption follows topical application; renal tubular immaturity or abnormality; interactions: Appendix 1 (brinzolamide)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also taste\r\ndisturbances, dry mouth, headache, ocular disturbances (including\r\ncorneal erosion, corneal oedema, photophobia, and reduced visual acuity); less commonly nausea, vomiting, diarrhoea, dyspepsia, oesophagitis,\r\nflatulence, oral hypoaesthesia and paraesthesia, chest pain, bradycardia,\r\npalpitation, dyspnoea, cough, upper respiratory tract congestion,\r\npharyngitis, depression, sleep disturbances, nervousness, malaise,\r\ndrowsiness, amnesia, dizziness, paraesthesia, sinusitis, decreased\r\nlibido, erectile dysfunction, renal pain, epistaxis, nasal dryness,\r\nthroat irritation, tinnitus, alopecia; also reported arrhythmia, tachycardia, hypertension, peripheral oedema, asthma,\r\ntremor, vertigo, rhinitis, dermatitis, erythema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202585.htm", "doses": [ "Apply twice daily increased to max. 3 times daily if necessary" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "Other preparations for urinary disorders": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.3 Drugs used in urological pain" ], "name": "Other preparations for urinary disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4656.htm", "doses": [ "1\u20132 capsules 3\u20134 times daily before food; child not recommended" ] }, "CO-CARELDOPA For use with enteral tube": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-CARELDOPA For use with enteral tube", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-CARELDOPA", "For use with enteral tube" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129431.htm", "doses": [ "Expressed as levodopa, initially 100\u00a0mg (with carbidopa\r\n25\u00a0mg) 3 times daily, increased by 50\u2013100\u00a0mg (with carbidopa 12.5\u201325\u00a0mg)\r\ndaily or on alternate days according to response, up to 800\u00a0mg (with\r\ncarbidopa 200\u00a0mg) daily in divided doses", "Alternatively, initially 50\u2013100\u00a0mg (with carbidopa 10\u201312.5\u00a0mg)\r\n3\u20134 times daily, increased by 50\u2013100\u00a0mg daily or on alternate days\r\naccording to response, up to 800\u00a0mg (with carbidopa 80\u2013100\u00a0mg) daily\r\nin divided doses ", "Alternatively, initially 125\u00a0mg (with carbidopa 12.5\u00a0mg, as\r\n\u00bd tablet of co-careldopa 25/250) 1\u20132 times daily, increased by 125\u00a0mg\r\n(with carbidopa 12.5\u00a0mg) daily or on alternate days according to response", "When co-careldopa is used, the total daily dose of carbidopa\r\nshould be at least 70\u00a0mg. A lower dose may not achieve full inhibition\r\nof extracerebral dopa-decarboxylase, with a resultant\r\nincrease in side-effects.", "When transferring patients\r\nfrom another levodopa/dopa-decarboxylase inhibitor preparation, the\r\nprevious preparation should be discontinued at least 12 hours before", "Name[Duodopa\u00ae (Abbott Healthcare) ] Intestinal gel, co-careldopa 5/20 (carbidopa 5\u00a0mg as monohydrate, levodopa 20\u00a0mg)/mL, net price\r\n100\u00a0mL cassette (for use with Duodopa\u00ae portable\r\npump) = \u00a377.00. \r\n Label:\r\n 10, 14, counselling, driving, see notes aboveDose\u00a0severe Parkinson\u2019s disease inadequately controlled by\r\nother preparations, consult product literature" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "THEOPHYLLINE": { "indications": "Indications\u00a0reversible airways obstruction, severe acute asthma; see also Management of Chronic Asthma\r\ntable and Management of Acute Asthma\r\ntable", "name": "THEOPHYLLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.3 Theophylline" ], "cautions": "Cautions\u00a0\n(From 3.1.3 Theophylline: British National Formulary)\nTheophylline is metabolised in the liver. The plasma-theophylline concentration is increased in heart failure, hepatic impairment, viral infections, in the elderly, and by drugs that inhibit its metabolism. The plasma-theophylline concentration is decreased in smokers, by alcohol consumption, and by drugs that induce its metabolism. For interactions: see Appendix 1 (theophylline). Differences in the half-life of theophylline are important because the toxic dose is close to the therapeutic dose. In most individuals, satisfactory bronchodilation is associated with a plasma-theophylline concentration of 10\u201320\u00a0mg/litre (see Note below), although a lower plasma-theophylline concentration may be effective. Adverse effects can occur within the range 10\u201320\u00a0mg/litre and both the frequency and severity increase at concentrations above 20\u00a0mg/litre., also cardiac arrhythmias or other cardiac disease; hypertension; hyperthyroidism; peptic ulcer; epilepsy; elderly; fever; hypokalaemia risk, \n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nPotentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.; avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); monitor plasma-theophylline concentration (\n(From 3.1.3 Theophylline: British National Formulary)\n3.1.3 Theophylline); dose adjustment\r\nmay be necessary if smoking started or stopped during treatment", "side-effects": "Side-effects\u00a0nausea, vomiting, gastric irritation, diarrhoea,\r\npalpitation, tachycardia, arrhythmias, headache, CNS stimulation,\r\ninsomnia, convulsions; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2930.htm", "doses": [ "See under preparations below", "Plasma-theophylline concentration\r\nfor optimum response 10\u201320\u00a0mg/litre (55\u2013110 micromol/litre); 4\u20136 hours\r\nafter a dose and at least 5 days after starting treatment; narrow\r\nmargin between therapeutic and toxic dose, see also notes above" ], "pregnancy": "Pregnancy\u00a0neonatal irritability and apnoea have been reported;\r\nsee also section 3.1" }, "BETAHISTINE DIHYDROCHLORIDE": { "indications": "Indications\u00a0vertigo, tinnitus and hearing loss associated with M\u00e9ni\u00e8re\u2019s\r\ndisease", "name": "BETAHISTINE DIHYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Other drugs for M\u00e9ni\u00e8re\u2019s disease" ], "cautions": "Cautions\u00a0asthma, history\r\nof peptic ulcer; interactions: Appendix\r\n1 (betahistine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; headache, rashes\r\nand pruritus reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3454.htm", "doses": [ "Initially 16\u00a0mg 3 times daily, preferably with food; maintenance\r\n24\u201348\u00a0mg daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid unless clearly necessary\u2014no information available" }, "ADRENALINE/EPINEPHRINE Intravenous": { "indications": "Indications\u00a0emergency treatment of acute\r\nanaphylaxis; angioedema; cardiopulmonary resuscitation (section 2.7.3); priapism [unlicensed] (section 7.4.5)", "name": "ADRENALINE/EPINEPHRINE Intravenous", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Anaphylaxis", "ADRENALINE/EPINEPHRINE", "Intravenous" ], "cautions": "Cautions\u00a0for cautions in non-life-threatening situations, see section 2.7.3Interactions\u00a0Severe anaphylaxis in\r\npatients taking beta-blockers may not respond to adrenaline, calling\r\nfor bronchodilator therapy, see intravenous salbutamol; adrenaline can cause\r\nsevere hypertension and bradycardia in those taking non-cardioselective\r\nbeta-blockers. Other interactions,\r\nsee Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0section 2.7.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129849.htm", "doses": [ "Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1\u00a0mg/mL)\r\nsolution for administration by healthcare professionals, see notes and table above", "Acute anaphylaxis, by intramuscular injection for self-administration, see under preparations", "Acute anaphylaxis when there is doubt as to the adequacy of\r\nthe circulation, by slow intravenous injection of 1\r\nin 10\u00a0000 (100\u00a0micrograms/mL) solution (extreme caution\u2014specialist\r\nuse only), see notes above", "Intravenous route should be used with extreme care by specialists only, see notes above", "Name[Minijet\u00ae Adrenaline 1 in 10\u00a0000 (UCB Pharma) ] Injection, adrenaline (as hydrochloride)\r\n1 in 10\u00a0000 (100\u00a0micrograms/mL), net price 3-mL prefilled syringe\r\n= \u00a36.27; 10-mL prefilled syringe = \u00a36.15 Excipients include sulphites" ], "pregnancy": "Pregnancy\u00a0section 2.7.3" }, "FOLLITROPIN ALFA and BETA Follitropin alfa": { "indications": "Indications\u00a0see notes above", "name": "FOLLITROPIN ALFA and BETA Follitropin alfa", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "FOLLITROPIN ALFA and BETA", "Follitropin alfa" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0see under Human Menopausal Gonadotrophins", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38658.htm", "doses": [ "By subcutaneous or intramuscular injection, according to patient\u2019s response", "Name[Gonal-F\u00ae (Merck Serono) ] Injection, powder for reconstitution,\r\nfollitropin alfa. Net price 75-unit amp = \u00a321.02; 450\u00a0units/0.75\u00a0mL,\r\nmultidose vial = \u00a3126.10; 1050\u00a0units/1.75\u00a0mL, multidose vial = \u00a3294.22\r\n(all with solvent). For subcutaneous injection\nInjection, prefilled pen, follitropin\r\nalfa 600\u00a0units/mL, net price 0.5\u00a0mL (300\u00a0units) = \u00a394.00, 0.75\u00a0mL\r\n(450\u00a0units) = \u00a3141.00, 1.5\u00a0mL (900\u00a0units) = \u00a3282.00. For subcutaneous\r\ninjection" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DEGARELIX": { "indications": "Indications\u00a0\n(From Gonadotrophin-releasing hormone antagonists: British National Formulary)\nGonadotrophin-releasing hormone antagonists", "name": "DEGARELIX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadotrophin-releasing hormone antagonists", "DEGARELIX" ], "cautions": "Cautions\u00a0susceptibility to QT-interval prolongation\r\n(avoid concomitant use of drugs that prolong QT interval); monitor bone density; diabetes", "side-effects": "Side-effects\u00a0nausea; dizziness, headache, drowsiness, insomnia,\r\nasthenia; influenza-like symptoms; hot flushes, sweating (including\r\nnight sweats), weight gain; injection-site reactions; less\r\ncommonly diarrhoea, vomiting, abdominal discomfort, dry mouth,\r\nconstipation, anorexia, atrio-ventricular block, QT-interval prolongation,\r\nfainting, hypertension, hypersensitivity reactions, depression, anxiety,\r\noedema, gynaecomastia, micturition urgency, renal impairment, sexual\r\ndysfunction, pelvic pain, prostatitis, testicular pain, anaemia, musculoskeletal\r\npain, tinnitus, urticaria, alopecia, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202691.htm", "doses": [ "By subcutaneous injection into the abdominal\r\nregion, adult over 18 years, initially\r\n240\u00a0mg (administered as 2 injections of 120\u00a0mg), then 80\u00a0mg every\r\n28 days" ] }, "FENTANYL - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS": { "indications": "Indications\u00a0analgesia during operation, enhancement\r\nof anaesthesia; respiratory depressant in assisted respiration; analgesia\r\nin other situations (section 4.7.2)", "name": "FENTANYL - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.3 Opioid analgesics", "FENTANYL" ], "cautions": "Cautions\u00a0see Fentanyl, section 4.7.2 and notes above", "side-effects": "Side-effects\u00a0see Fentanyl, section 4.7.2 and notes above; also myoclonic movements; less commonly laryngospasm; rarely asystole\r\nand insomnia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6628.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "By slow intravenous injection, with\r\nspontaneous respiration, adult and child over 12 years, initially 50\u2013100\u00a0micrograms\r\n(max. 200\u00a0micrograms on specialist advice), then 25\u201350\u00a0micrograms\r\nas required; child 1 month\u201312 years\r\nsee BNF for Children", "With assisted ventilation, adult and child over 12 years, initially\r\n0.3\u20133.5\u00a0mg, then 100\u2013200\u00a0micrograms as required; child 1 month\u201312 years see BNF for Children", "By intravenous infusion, with spontaneous\r\nrespiration, adult, 3\u20134.8\u00a0micrograms/kg/hour\r\nadjusted according to response", "With assisted ventilation, adult, initially 10\u00a0micrograms/kg over 10 minutes then 6\u00a0micrograms/kg/hour\r\nadjusted according to response; may require up to 180\u00a0micrograms/kg/hour\r\nduring cardiac surgery; child 1 month\u201318\r\nyears see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.7.2" }, "DOSULEPIN HYDROCHLORIDE ": { "indications": "Indications\u00a0depressive illness, particularly where sedation is required", "name": "DOSULEPIN HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "DOSULEPIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nincreased intra-ocular pressure; high rate of fatality in overdose\u2014\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nOverdosage\u00a0Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage. In particular, overdosage with dosulepin and amitriptyline is associated with a relatively high rate of fatality. Lofepramine is associated with the lowest risk of fatality in overdosage, in comparison with other tricyclic antidepressant drugs. For advice on overdosage see Emergency Treatment of Poisoning.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3313.htm", "doses": [ "Initially 75\u00a0mg (elderly 50\u201375\u00a0mg) daily in divided doses or as a single\r\ndose at bedtime, increased gradually as necessary to 150\u00a0mg daily\r\n(elderly 75\u00a0mg may be sufficient);\r\nup to 225\u00a0mg daily in some circumstances (e.g. hospital use); child not recommended", "A maximum prescription equivalent to 2 weeks\u2019\r\nsupply of 75\u00a0mg daily should be considered in patients with increased\r\nrisk factors for suicide at initiation of treatment, during any dose\r\nadjustment, and until improvement occurs" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "IBANDRONIC ACID": { "indications": "Indications\u00a0see under Dose", "name": "IBANDRONIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "IBANDRONIC ACID" ], "cautions": "Cautions\u00a0consider dental check-up before initiating\r\nbisphosphonate (risk of osteonecrosis of\r\nthe jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; monitor renal function and serum calcium, phosphate\r\nand magnesium; cardiac disease (avoid fluid overload); interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0hypocalcaemia, hypophosphataemia, influenza-like\r\nsymptoms (including fever, chills, and muscle pain), bone pain; oesophageal\r\nreactions (see below), diarrhoea, nausea, vomiting, gastritis, abdominal\r\npain, dyspepsia, pharyngitis; headache, asthenia, rash; rarely anaemia, atypical femoral fractures (see MHRA/CHM advice),\r\nhypersensitivity reactions (pruritus, bronchospasm and angioedema\r\nreported); urticaria; injection-site reactions; very rarely osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)Oesophageal reactions\u00a0Severe oesophageal reactions\r\nreported with all oral bisphosphonates; patients should be advised to stop tablets and seek medical attention\r\nfor symptoms of oesophageal irritation such as dysphagia, pain on\r\nswallowing, retrosternal pain, or heartburn", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129542.htm", "doses": [ "Reduction of bone damage in bone metastases in breast\r\ncancer, by mouth, 50\u00a0mg daily, or by intravenous infusion, 6\u00a0mg every 3\u20134 weeks", "Hypercalcaemia of malignancy by intravenous infusion, according to serum calcium concentration, 2\u20134\u00a0mg in single infusion ", "Treatment of postmenopausal osteoporosis, by mouth, 150\u00a0mg once a month or by intravenous injection over 15\u201330\u00a0seconds, 3\u00a0mg every 3 months", "child not recommended", "Tablets should be swallowed whole\r\nwith plenty of water while sitting or standing; to be taken on an\r\nempty stomach at least 30 minutes (ibandronic acid tablets, 50\u00a0mg)\r\nor 1 hour (Bonviva\u00ae tablets, 150\u00a0mg) before first\r\nfood or drink (other than water) of the day, or another oral medicine;\r\npatient should stand or sit upright for at least 1 hour after taking\r\ntablet" ], "pregnancy": "Pregnancy\u00a0avoid" }, "CO-AMILOFRUSE": { "indications": "Indications\u00a0oedema", "name": "CO-AMILOFRUSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "CO-AMILOFRUSE" ], "cautions": "Cautions\u00a0monitor electrolytes; hepatorenal syndrome; hypotension; correct hypovolaemia before using in oliguria; hypoproteinaemia; diabetes\r\nmellitus; gout; impaired micturition; prostatic enlargement; elderly; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0include gastro-intestinal disturbances, dry mouth,\r\npancreatitis, intrahepatic cholestasis, hepatic encephalopathy; hypotension,\r\ntemporary increase in serum cholesterol and triglyceride concentrations;\r\nconfusion, paraesthesia; hyperglycaemia; metabolic alkalosis or acidosis;\r\nhyponatraemia, hypokalaemia (due to furosemide\u2014may be followed by\r\nhyperkalaemia due to amiloride; see also section 2.2), hypomagnesaemia,\r\nhypocalcaemia, bone marrow depression (withdraw treatment), blood\r\ndisorders (including thrombocytopenia, leucopenia, agranulocytosis,\r\naplastic anaemia, and haemolytic anaemia); hyperuricaemia, gout; tinnitus\r\nand deafness (usually in renal impairment or in hypoproteinaemia);\r\nhypersensitivity reactions (including rashes, photosensitivity, eosinophilia,\r\nexfoliative dermatitis, purpura, anaphylaxis, Stevens-Johnson syndrome,\r\ntoxic epidermal necrolysis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200391.htm", "doses": [ "See under preparations", "child under 18 years, see BNF for children", "1\u20132 tablets in the morning", "1\u20132\u00a0tablets in the morning", "1 tablet in the morning" ], "pregnancy": "Pregnancy\u00a0not used to treat hypertension in pregnancy" }, "DANAZOL": { "indications": "Indications\u00a0see notes above and under Dose", "name": "DANAZOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins" ], "cautions": "Cautions\u00a0cardiac impairment (avoid\r\nif severe), elderly, polycythaemia, epilepsy, diabetes mellitus, hypertension, migraine, lipoprotein disorder, history of thrombosis or thromboembolic\r\ndisease; withdraw if\r\nvirilisation (may be irreversible on continued use); non-hormonal contraceptive methods should be used, if appropriate; interactions: Appendix 1 (danazol)", "side-effects": "Side-effects\u00a0nausea, dizziness, skin reactions including rashes,\r\nphotosensitivity and exfoliative dermatitis, fever, backache, nervousness,\r\nmood changes, anxiety, changes in libido, vertigo, fatigue, epigastric\r\nand pleuritic pain, headache, weight gain; menstrual disturbances,\r\nvaginal dryness and irritation, flushing and reduction in breast size;\r\nmusculo-skeletal spasm, joint pain and swelling, hair loss; androgenic\r\neffects including acne, oily skin, oedema, hirsutism, voice changes\r\nand rarely clitoral hypertrophy (see also Cautions); temporary alteration\r\nin lipoproteins and other metabolic changes, insulin resistance; thrombotic\r\nevents; leucopenia, thrombocytopenia, eosinophilia, reversible erythrocytosis\r\nor polycythaemia reported; headache and visual disturbances may indicate\r\nbenign intracranial hypertension; rarely cholestatic jaundice, pancreatitis,\r\npeliosis hepatis and benign hepatic adenomata", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4463.htm", "doses": [ "In women of child-bearing potential, treatment\r\nshould start during menstruation, preferably on day 1", "Endometriosis, 200\u2013800\u00a0mg daily in up to 4 divided doses, adjusted\r\nto achieve amenorrhoea, usually for 3\u20136 months ", "Severe pain and tenderness in benign fibrocystic breast disease\r\nnot responding to other treatment, 300\u00a0mg daily in divided doses usually\r\nfor 3\u20136 months", "Hereditary angioedema [unlicensed indication], initially 200\u00a0mg\r\n2\u20133 times daily, then reduced according to response" ], "pregnancy": "Pregnancy\u00a0avoid; has weak androgenic effects and virilisation\r\nof female fetus reported" }, "QUININE": { "indications": "Indications\u00a0see notes above; malaria (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials)", "name": "QUININE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "Nocturnal leg cramps" ], "cautions": "Cautions\u00a0see section\r\n5.4.1 and\r\nnotes above", "side-effects": "Side-effects\u00a0section\r\n5.4.1; important: very toxic in overdosage\u2014immediate advice from poison centres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31769.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0section 5.4.1" }, "PINDOLOL With diuretic": { "indications": "Indications\u00a0see under Dose", "name": "PINDOLOL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "PINDOLOL", "With diuretic" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2520.htm", "doses": [ "Hypertension, initially 5\u00a0mg 2\u20133 times daily or 15\u00a0mg once daily, increased as required at weekly intervals; usual\r\nmaintenance 15\u201330\u00a0mg daily; max. 45\u00a0mg daily", "Angina, 2.5\u20135\u00a0mg up to 3 times daily", "Name[Viskaldix\u00ae (Amdipharm) ] Tablets, scored, pindolol 10\u00a0mg, clopamide 5\u00a0mg, net price 28-tab pack = \u00a36.70. \r\n Label:\r\n 8Dose\u00a0hypertension, 1 tablet daily in the morning, increased\r\nif necessary after 2\u20133 weeks to 2 tablets once daily; max. 3 tablets\r\ndaily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "INSULIN GLULISINE": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN GLULISINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins" ], "cautions": "Cautions\u00a0section 6.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129524.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n6 years, immediately before meals or when necessary shortly after\r\nmeals, according to requirements", "By subcutaneous infusion or intravenous infusion adult and child over 6 years, according\r\nto requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "DIHYDROCODEINE TARTRATE": { "indications": "Indications\u00a0moderate to severe pain", "name": "DIHYDROCODEINE TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "DIHYDROCODEINE TARTRATE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis; severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, diarrhoea, seizures, and\r\nparaesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/18219.htm", "doses": [ "By mouth, 30\u00a0mg every 4\u20136 hours when necessary\r\n(see also notes above); child over\r\n4 years 0.5\u20131\u00a0mg/kg every 4\u20136 hours", "By deep subcutaneous or intramuscular injection, up to 50\u00a0mg repeated every 4\u20136 hours\r\nif necessary; child over 4 years 0.5\u20131\u00a0mg/kg\r\nevery 4\u20136 hours" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "MERCAPTOPURINE": { "indications": "Indications\u00a0see under Inflammatory Bowel disease; acute leukaemias and chronic\r\nmyeloid leukaemia (section 8.1.3)", "name": "MERCAPTOPURINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "MERCAPTOPURINE" ], "cautions": "Cautions\u00a0section 8.1.3", "side-effects": "Side-effects\u00a0section 8.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201299.htm", "doses": [ "Severe acute Crohn\u2019s disease, maintenance of remission\r\nof Crohn\u2019s disease or ulcerative colitis [unlicensed indications], adult over 18 years, by mouth, 1\u20131.5\u00a0mg/kg\r\ndaily; some patients may respond to lower doses" ], "pregnancy": "Pregnancy\u00a0section 8.1.3" }, "DOMPERIDONE": { "indications": "Indications\u00a0nausea and vomiting, dyspepsia, gastro-oesophageal\r\nreflux", "name": "DOMPERIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Domperidone and metoclopramide", "DOMPERIDONE" ], "cautions": "Cautions\u00a0children; interactions: Appendix 1 (domperidone)", "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances\r\n(including cramps) and hyperprolactinaemia; very rarely ventricular arrhythmias, agitation, drowsiness, nervousness, seizures,\r\nextrapyramidal effects, headache, and rashes; also reported QT-interval\r\nprolongation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3430.htm", "doses": [ "By mouth, adult and child body-weight over 35\u00a0kg,\r\n10\u201320\u00a0mg 3\u20134 times daily; max. 80\u00a0mg daily; child body-weight up to 35\u00a0kg (nausea and vomiting only), 250\u2013500\u00a0micrograms/kg\r\n3\u20134 times daily; max. 2.4\u00a0mg/kg daily", "By rectum, adult and child body-weight over 35\u00a0kg,\r\n60\u00a0mg twice daily; child 15\u201335\u00a0kg (nausea\r\nand vomiting only), 30\u00a0mg twice daily; child body-weight under 15\u00a0kg, not recommended" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "ATOSIBAN": { "indications": "Indications\u00a0uncomplicated premature labour (see notes above)", "name": "ATOSIBAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.3 Myometrial relaxants", "Atosiban" ], "cautions": "Cautions\u00a0monitor blood loss after delivery; intra-uterine growth restriction; abnormal placental site", "side-effects": "Side-effects\u00a0nausea, vomiting, tachycardia, hypotension, headache,\r\ndizziness, hot flushes, hyperglycaemia, injection-site reaction; less commonly pruritus, rash, fever, insomnia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85639.htm", "doses": [ "By intravenous injection, initially 6.75\u00a0mg\r\nover 1 minute, then by intravenous infusion 18\u00a0mg/hour\r\nfor 3 hours, then 6\u00a0mg/hour for up to 45 hours; max. duration of treatment\r\n48 hours" ] }, "PALIVIZUMAB": { "indications": "Indications\u00a0\n(From 5.3.5 Respiratory syncytial virus: British National Formulary)\n5.3.5 Respiratory syncytial virus", "name": "PALIVIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.5 Respiratory syncytial virus", "PALIVIZUMAB" ], "cautions": "Cautions\u00a0moderate to severe acute infection or febrile illness; thrombocytopenia; serum-palivizumab concentration\r\nmay be reduced after cardiac surgery; hypersensitivity\r\nto humanised monoclonal antibodies", "side-effects": "Side-effects\u00a0fever, injection-site reactions, nervousness; less commonly diarrhoea, vomiting, constipation, haemorrhage,\r\nrhinitis, cough, wheeze, pain, drowsiness, asthenia, hyperkinesia,\r\nleucopenia, and rash; also reported, apnoea, hypersensitivity reactions\r\n(including anaphylaxis), convulsions and thombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82142.htm", "doses": [ "By intramuscular injection (preferably\r\nin anterolateral thigh), 15\u00a0mg/kg once a month during season of RSV\r\nrisk (child undergoing cardiac bypass surgery, 15\u00a0mg/kg as soon as\r\nstable after surgery, then once a month during season of risk); injection\r\nvolume over 1\u00a0mL should be divided between more than one site" ] }, "FLUCONAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "FLUCONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.1 Triazole antifungals", "FLUCONAZOLE" ], "cautions": "Cautions\u00a0concomitant use with hepatotoxic drugs, monitor liver function with high doses or extended courses\u2014discontinue if signs or symptoms of hepatic disease\r\n(risk of hepatic necrosis); susceptibility\r\nto QT interval prolongation; interactions: Appendix 1 (antifungals, triazole)", "side-effects": "Side-effects\u00a0nausea, abdominal discomfort, diarrhoea, flatulence,\r\nheadache, rash (discontinue treatment or monitor closely if infection\r\ninvasive or systemic); less frequently dyspepsia, vomiting, taste\r\ndisturbance, hepatic disorders, hypersensitivity reactions, anaphylaxis,\r\ndizziness, seizures, alopecia, pruritus, toxic epidermal necrolysis,\r\nStevens-Johnson syndrome (severe cutaneous reactions more likely in\r\nHIV-positive patients), hyperlipidaemia, leucopenia,\r\nthrombocytopenia, and hypokalaemia reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127970.htm", "doses": [ "Vaginal candidiasis (see also Recurrent Vulvovaginal Candidiasis, section 7.2.2) and\r\ncandidal balanitis, adult and child over 16 years, by mouth, a single\r\ndose of 150\u00a0mg", "Mucosal candidiasis (except genital), by mouth, 50\u00a0mg daily (100\u00a0mg daily in unusually difficult infections) given\r\nfor 7\u201314 days in oropharyngeal candidiasis (max. 14 days except in\r\nseverely immunocompromised patients); for 14 days in atrophic oral\r\ncandidiasis associated with dentures; for 14\u201330 days in other mucosal\r\ninfections (e.g. oesophagitis, candiduria, non-invasive bronchopulmonary\r\ninfections); child by mouth or by intravenous infusion, 3\u20136\u00a0mg/kg\r\non first day then 3\u00a0mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate\r\n2\u20134 weeks old)", "Tinea pedis, corporis, cruris, pityriasis versicolor, and dermal\r\ncandidiasis, by mouth, 50\u00a0mg daily for 2\u20134 weeks (for\r\nup to 6 weeks in tinea pedis); max. duration of treatment 6 weeks", "Invasive candidal infections (including candidaemia and disseminated\r\ncandidiasis) and cryptococcal infections (including meningitis), by mouth or intravenous infusion, 400\u00a0mg on first day then 200\u2013400\u00a0mg daily; max. 800\u00a0mg daily in\r\nsevere infections [unlicensed dose]; treatment continued according\r\nto response (at least 8 weeks for cryptococcal meningitis); child 6\u201312\u00a0mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2\u20134 weeks old); max. 800\u00a0mg daily [unlicensed\r\ndose]", "Prevention of relapse of cryptococcal meningitis in HIV-infected\r\npatients after completion of primary therapy, by mouth or by intravenous infusion, 200\u00a0mg\r\ndaily", "Prevention of fungal infections in immunocompromised patients, by mouth or by intravenous infusion, 50\u2013400\u00a0mg daily adjusted according to risk; 400\u00a0mg daily if high\r\nrisk of systemic infections e.g. following bone-marrow transplantation;\r\ncommence treatment before anticipated onset of neutropenia and continue\r\nfor 7 days after neutrophil count in desirable range; child according to extent and duration of neutropenia,\r\n3\u201312\u00a0mg/kg daily (every 72 hours in neonate up to 2 weeks old, every 48 hours in neonate 2\u20134 weeks old); max. 400\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014multiple congenital abnormalities\r\nreported with long-term high doses" }, "TERBUTALINE SULPHATE": { "indications": "Indications\u00a0uncomplicated premature labour (\n(From 7.1.3 Myometrial relaxants: British National Formulary)\nA beta2 agonist (salbutamol or terbutaline) is used for inhibiting uncomplicated premature labour between 24 and 33 weeks of gestation and it may permit a delay in delivery of at least 48 hours. Prolonged therapy should be avoided since risk to the mother increases after 48 hours and there is a lack of evidence of benefit from further treatment; maintenance treatment is therefore not recommended.); asthma\r\n(%s\n(From 3.1.1 Adrenoceptor agonists: British National Formulary)\n3.1.1 Adrenoceptor agonists)", "name": "TERBUTALINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.3 Myometrial relaxants", "Beta2 agonists", "TERBUTALINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From Beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in patients with suspected cardiovascular disease (such patients should be assessed by a cardiologist before initiating therapy\u2014see also Contra-indications, below), hypertension, mild to moderate pre-eclampsia, hyperthyroidism, and hypokalaemia (particular risk with potassium-depleting diuretics\u2014see also Hypokalaemia). It is important to monitor pulse rate (should not exceed 140 beats per minute), ECG (discontinue treatment if signs of myocardial ischaemia develop), and the patient\u2019s fluid and electrolyte status (avoid over-hydration\u2014discontinue drug immediately and initiate diuretic therapy if pulmonary oedema occurs). Beta2 agonists should also be used with caution in diabetes\u2014monitor blood glucose (risk of hyperglycaemia and ketoacidosis, especially with intravenous beta2 agonists).; interactions: Appendix 1 (sympathomimetics, beta2)", "side-effects": "Side-effects\u00a0\n(From Beta2 agonists: British National Formulary)\nSide-effects\u00a0 Side-effects of the beta2 agonists include nausea, vomiting, pulmonary oedema (see Cautions above), palpitation, tachycardia, arrhythmias, myocardial ischaemia, peripheral vasodilation, headache, tremor, hyperglycaemia, hypokalaemia (see Cautions), muscle cramps and tension, and hypersensitivity reactions (including angioedema, urticaria, rash, bronchospasm, hypotension, and collapse).; also\r\nreported sleep disturbances and behavioural disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104941.htm", "doses": [ "By intravenous infusion, 5\u00a0micrograms/minute\r\nfor 20 minutes, increased every 20 minutes in steps of 2.5\u00a0micrograms/minute\r\nuntil contractions have ceased (more than 10\u00a0micrograms/minute should seldom be given\u201420\u00a0micrograms/minute should not be exceeded), continue for 1 hour then decrease every 20 minutes\r\nin steps of 2.5\u00a0micrograms/minute to lowest dose that maintains suppression,\r\ncontinue at this level for 12 hours then by mouth (but\r\nsee notes above), 5\u00a0mg every 8 hours for as long as is desirable to\r\nprolong pregnancy (or alternatively follow the intravenous infusion by subcutaneous injection 250\u00a0micrograms every 6 hours for\r\na few days then by mouth as above)" ] }, "RIVASTIGMINE": { "indications": "Indications\u00a0mild to moderate dementia in Alzheimer\u2019s disease or in Parkinson\u2019s\r\ndisease", "name": "RIVASTIGMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.11 Drugs for dementia", "RIVASTIGMINE" ], "cautions": "Cautions\u00a0gastric or duodenal ulcers (or susceptibility to ulcers); monitor body-weight; sick sinus syndrome, conduction\r\nabnormalities; history of asthma or chronic obstructive pulmonary\r\ndisease; history of seizures; bladder outflow obstruction; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, dyspepsia, anorexia,\r\nweight loss, increased salivation, abdominal pain, bradycardia, dizziness,\r\nheadache, drowsiness, malaise, agitation, anxiety, tremor, confusion,\r\ninsomnia, extrapyramidal symptoms (and worsening of Parkinson\u2019s disease),\r\nsweating; less commonly atrial fibrillation, AV block,\r\ndepression, syncope; rarely gastric and duodenal\r\nulceration, angina, seizures, rash; very rarely gastro-intestinal\r\nhaemorrhage, pancreatitis, tachycardia, hypertension, hallucinations; also reported dehydration, hepatitis, restlessness, aggression,\r\nsick sinus syndromeNote\u00a0Transdermal administration less likely to\r\ncause gastro-intestinal disturbanceNote\u00a0Treatment should be interrupted if gastro-intestinal\r\nside-effects occur and withheld until their resolution\u2014retitrate dose\r\nif necessary", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68984.htm", "doses": [ "By mouth, initially 1.5\u00a0mg twice daily,\r\nincreased in steps of 1.5\u00a0mg twice daily at intervals of at least\r\n2 weeks according to response and tolerance; usual range 3\u20136\u00a0mg twice\r\ndaily; max. 6\u00a0mg twice daily; if treatment interrupted for more than\r\nseveral days, treatment should be retitrated from 1.5\u00a0mg twice daily", "By transdermal application, initially apply 4.6\u00a0mg/24\r\nhours patch to clean, dry, non-hairy, non-irritated skin on back,\r\nupper arm, or chest, removing after 24 hours and siting a replacement\r\npatch on a different area (avoid using the same area for 14 days);\r\nif well tolerated increase to 9.5\u00a0mg/24 hours patch daily after at\r\nleast 4 weeks; if treatment interrupted for more than several days,\r\ntreatment should be retitrated from 4.6\u00a0mg/24 hours patch", "When switching from oral to transdermal therapy,\r\npatients taking 3\u20136\u00a0mg by mouth daily should initially switch to 4.6\u00a0mg/24\r\nhours patch (then titrate as above); patients taking 9\u201312\u00a0mg by mouth\r\ndaily should switch to 9.5\u00a0mg/24 hours patch. The first patch should\r\nbe applied on the day following the last oral dose" ] }, "INTERFERON BETA Interferon beta-1a": { "indications": "Indications\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and under preparations", "name": "INTERFERON BETA Interferon beta-1a", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon beta", "INTERFERON BETA", "Interferon beta-1a" ], "cautions": "Cautions\u00a0\n(From Interferon beta: British National Formulary)\nCautions\u00a0Caution is advised in those with severe hepatic or renal impairment or a history of cardiac disorders, depressive disorders (avoid in severe depression or in those with suicidal ideation), seizures, or severe myelosupression. Patients should be monitored for signs of hepatic injury. and consult product literature", "side-effects": "Side-effects\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70429.htm", "doses": [ "See under preparations", "Name[Rebif\u00ae (Merck Serono) ] Injection, interferon beta-1a, net price 22-microgram (6\u00a0million-unit) prefilled syringe =\r\n\u00a352.07; 44-microgram (12\u00a0million-unit) prefilled syringe = \u00a367.77;\r\nstarter pack of 6 \u00d7 8.8-microgram (2.4\u00a0million-unit) prefilled syringes\r\nwith 6 \u00d7 22-microgram (6\u00a0million-unit) prefilled syringes = \u00a3552.19Note\u00a0For subcutaneous injection\nExcipients include benzyl alcohol (avoid in neonates, see Excipients)\nInjection, interferon beta-1a, 44\u00a0micrograms (12 million-units/mL), net price 1.5\u00a0mL (66-microgram,\r\n18\u00a0million-unit) cartridge = \u00a3203.31; 88-micrograms (24\u00a0million-units/mL),\r\n1.5\u00a0mL (132-microgram, 36 million-unit) cartridge = \u00a3171.97; starter\r\npack of 2 \u00d7 1.5\u00a0mL (132-microgram, 36 million-unit) cartridge = \u00a3406.61Note\u00a0Cartridges for use with RebiSmart\u00ae auto-injector\r\ndevice. For subcutaneous injection\nExcipients include benzyl alcohol (avoid in neonates, see Excipients)\nInjection (RebiDose\u00ae), interferon\r\nbeta-1a, net price 22-microgram (6 million-unit) prefilled pen = \u00a352.06;\r\n44-microgram (12 million-unit) prefilled pen = \u00a367.77; starter pack\r\nof 6 \u00d7 8.8-microgram (2.4 million-unit) prefilled pens with 6 \u00d7 22-microgram\r\n(6 million-unit) prefilled pens = \u00a3552.19Note\u00a0For subcutaneous injection\nExcipients include benzyl alcohol (avoid in neonates, see Excipients)Dose\u00a0for relapsing, remitting multiple sclerosis, consult product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk (toxicity\r\nin animal studies); effective contraception required\r\nduring treatment\u2014consult product literature" }, "INTERFERON BETA Interferon beta-1b": { "indications": "Indications\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and under preparations", "name": "INTERFERON BETA Interferon beta-1b", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon beta", "INTERFERON BETA", "Interferon beta-1b" ], "cautions": "Cautions\u00a0\n(From Interferon beta: British National Formulary)\nCautions\u00a0Caution is advised in those with severe hepatic or renal impairment or a history of cardiac disorders, depressive disorders (avoid in severe depression or in those with suicidal ideation), seizures, or severe myelosupression. Patients should be monitored for signs of hepatic injury. and consult product literature", "side-effects": "Side-effects\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202485.htm", "doses": [ "See under preparations", "Name[Extavia\u00ae (Novartis) ] Injection, powder for reconstitution,\r\ninterferon beta-1b. Net price 300-microgram (9.6 million-unit) vial\r\nwith diluent = \u00a339.78Note\u00a0for subcutaneous injectionDose\u00a0for relapsing, remitting multiple sclerosis, for secondary\r\nprogressive multiple sclerosis with active disease, or for a single\r\ndemyelinating event with an active inflammatory process (if severe\r\nenough to require intravenous corticosteroid and patient at high risk\r\nof developing multiple sclerosis), consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk (toxicity\r\nin animal studies); effective contraception required\r\nduring treatment\u2014consult product literature" }, "DEFLAZACORT": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders", "name": "DEFLAZACORT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "DEFLAZACORT" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56530.htm", "doses": [ "Usual maintenance 3\u201318\u00a0mg daily (acute disorders,\r\ninitially up to 120\u00a0mg daily); see also Administration (above)", "child 0.25\u20131.5\u00a0mg/kg daily (or\r\non alternate days); see also Administration (above)" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "ISOTRETINOIN With antibacterial": { "indications": "Indications\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne; oral treatment\r\n(\n(From 13.6.2 Oral preparations for acne: British National Formulary)\n13.6.2 Oral preparations for acne)", "name": "ISOTRETINOIN With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "ISOTRETINOIN", "With antibacterial" ], "cautions": "Cautions\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne;\r\nalso personal or familial history of non-melanoma skin\r\ncancer", "side-effects": "Side-effects\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nSide-effects\u00a0Local reactions include burning, erythema, stinging, pruritus, dry or peeling skin (discontinue if severe). Increased sensitivity to UVB light or sunlight occurs. Temporary changes of skin pigmentation with tretinoin have been reported. Eye irritation and oedema, and blistering or crusting of skin have been reported rarely.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61338.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Isotrexin\u00ae (Stiefel) ] Gel, isotretinoin 0.05%, erythromycin 2% in ethanolic\r\nbasis, net price 30\u00a0g = \u00a37.47. \r\n Label:\r\n 11Excipients include butylated hydroxytoluene" ], "pregnancy": "Pregnancy\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "ESCITALOPRAM": { "indications": "Indications\u00a0see under Dose", "name": "ESCITALOPRAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.; susceptibility\r\nto QT-interval prolongation", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; also sinusitis, yawning; fatigue,\r\nrestlessness, abnormal dreams, paraesthesia; pyrexia; less\r\ncommonly taste disturbance, bruxism, syncope, tachycardia,\r\noedema, confusion, menstrual disturbances, epistaxis, mydriasis, tinnitus,\r\npruritus, and alopecia; rarely bradycardia, aggression,\r\nand depersonalisation; hepatitis, postural hypotension, QT interval\r\nprolongation, and thrombocytopenia also reported; paradoxical increased\r\nanxiety during initial treatment of panic disorder (reduce dose)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106511.htm", "doses": [ "adult over 18 years, depressive\r\nillness, generalised anxiety disorder, and obsessive-compulsive disorder,\r\n10\u00a0mg once daily increased if necessary to max. 20\u00a0mg daily; elderly over 65 years, initially half adult dose,\r\nlower maintenance dose may be sufficient; max. 10\u00a0mg daily; child not recommended (see Depressive Illness in Children\r\nand Adolescents)", "adult over 18 years, panic disorder,\r\ninitially 5\u00a0mg once daily increased to 10\u00a0mg daily after 7 days; max.\r\n20\u00a0mg daily; elderly over 65 years, initially half adult dose, lower maintenance dose may be sufficient;\r\nmax. 10\u00a0mg daily", "adult over 18 years, social anxiety\r\ndisorder, initially 10\u00a0mg once daily adjusted after 2\u20134 weeks; usual\r\ndose 5\u201320\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nPregnancy\u00a0Manufacturers advise that SSRIs should not be used during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when SSRIs are taken during early pregnancy. If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported; see also individual monographs." }, "CRISANTASPASE": { "indications": "Indications\u00a0\n(From Crisantaspase: British National Formulary)\nCrisantaspase", "name": "CRISANTASPASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Crisantaspase", "CRISANTASPASE" ], "cautions": "Cautions\u00a0\n(From Crisantaspase: British National Formulary)\nFacilities for the management of anaphylaxis should be available.", "side-effects": "Side-effects\u00a0see section 8.1; also\r\nliver dysfunction, pancreatitis, diarrhoea; coagulation disorders;\r\nlethargy, drowsiness, confusion, dizziness, neurotoxicity, convulsions,\r\nheadache; less commonly changes in blood lipids,\r\nanaphylaxis, hyperglycaemia; rarely CNS depression; very rarely myalgia; abdominal pain and hypertension also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11771.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid; see also Pregnancy and Reproductive\r\nFunction" }, "SALBUTAMOL Parenteral": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction; premature labour (section 7.1.3)", "name": "SALBUTAMOL Parenteral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "SALBUTAMOL", "Parenteral" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also lactic acidosis with high\r\ndoses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2885.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\n4\u00a0mg (elderly and sensitive patients initially 2\u00a0mg) 3\u20134 times daily;\r\nmax. single dose 8\u00a0mg (but unlikely to provide much extra benefit\r\nor to be tolerated); child under 2\r\nyears see BNF for Children; 2\u20136 years 1\u20132\u00a0mg 3\u20134 times daily, 6\u201312 years 2\u00a0mg 3\u20134 times\r\ndaily", "By subcutaneous or intramuscular injection, 500\u00a0micrograms, repeated\r\nevery 4 hours if necessary", "By slow intravenous injection (but\r\nsee also Management of Acute Asthma table), (dilute to a concentration\r\nof 50\u00a0micrograms/mL), 250\u00a0micrograms, repeated if necessary; child under 18 years see BNF for Children", "By intravenous infusion (but see\r\nalso Management of Acute Asthma table), initially 5\u00a0micrograms/minute,\r\nadjusted according to response and heart-rate usually in range 3\u201320\u00a0micrograms/minute,\r\nor more if necessary; child under 18\r\nyears see BNF for Children", "By aerosol inhalation (but see also Management of Acute Asthma table, or Management of Chronic Asthma\r\ntable),\r\n100\u2013200\u00a0micrograms (1\u20132 puffs); for persistent symptoms up to 4 times\r\ndaily; child 100\u00a0micrograms (1 puff),\r\nincreased to 200\u00a0micrograms (2 puffs) if necessary; for persistent\r\nsymptoms up to 4 times daily ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 200\u00a0micrograms\r\n(2 puffs); child 100\u00a0micrograms (1\r\npuff), increased to 200\u00a0micrograms (2 puffs) if necessary", "By inhalation of powder (but see\r\nalso Management of Chronic Asthma\r\ntable),\r\n200\u2013400\u00a0micrograms; for persistent symptoms up to 4 times daily; child over 5 years 200\u00a0micrograms; for persistent\r\nsymptoms up to 4 times daily (for Asmasal Clickhaler\u00ae, Salbulin Novolizer\u00ae, and Ventolin\r\nAccuhaler\u00ae doses, see under preparations) ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 400\u00a0micrograms; child 200\u00a0micrograms", "By inhalation of nebulised solution, adult and child over\r\n5 years 2.5\u20135\u00a0mg, repeated up to 4 times daily or more frequently\r\nin severe cases; child under 5 years\r\n2.5\u00a0mg, repeated up to 4 times daily or more frequently in severe\r\ncases; see also Management of Acute Asthma table and Management of Chronic Asthma\r\ntable", "Name[Ventolin\u00ae (A&H) ] Injection, salbutamol (as sulphate) 500\u00a0micrograms/mL, net price 1-mL amp = 38p\nSolution for intravenous infusion, salbutamol (as sulphate) 1\u00a0mg/mL. Dilute before\r\nuse. Net price 5-mL amp = \u00a32.48" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "QUININE - QUININE": { "indications": "Indications\u00a0falciparum malaria; nocturnal leg cramps, see section 10.2.2", "name": "QUININE - QUININE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Quinine", "QUININE" ], "cautions": "Cautions\u00a0cardiac disease (including atrial fibrillation, conduction defects, heart block), elderly\u2014monitor\r\nECG during parenteral treatment; monitor blood glucose\r\nand electrolyte concentration during parenteral treatment; G6PD deficiency (see section 9.1.5); interactions: Appendix 1\r\n(quinine)", "side-effects": "Side-effects\u00a0cinchonism, including tinnitus, hearing impairment,\r\nvertigo, headache, nausea, vomiting, abdominal pain, diarrhoea, visual\r\ndisturbances (including temporary blindness), confusion; cardiovascular\r\neffects (see Cautions); dyspnoea; hypersensitivity reactions including\r\nangioedema, rashes, hot and flushed skin; hypoglycaemia (especially\r\nafter parenteral administration); blood disorders (including thrombocytopenia\r\nand intravascular coagulation); acute renal failure; muscle weakness;\r\nphotosensitivity; very toxic in overdosage\u2014immediate\r\nadvice from poisons centres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4034.htm", "doses": [ "Treatment of malaria, see notes above", "Quinine (anhydrous base)\r\n100\u00a0mg\u00a0\u2261\u00a0quinine bisulphate 169\u00a0mg\u00a0\u2261\u00a0quinine dihydrochloride 122\u00a0mg\u00a0\u2261\u00a0quinine hydrochloride\r\n122\u00a0mg\u00a0\u2261\u00a0quinine sulphate 121\u00a0mg. Quinine bisulphate 300-mg tablets are available but provide less quinine than 300\u00a0mg of the dihydrochloride, hydrochloride,\r\nor sulphate" ], "pregnancy": "Pregnancy\u00a0high doses are teratogenic in first trimester; but in malaria benefit of treatment outweighs risk; see also Falciparum Malaria (treatment)" }, "TRIHEXYPHENIDYL HYDROCHLORIDE": { "indications": "Indications\u00a0parkinsonism; drug-induced\r\nextrapyramidal symptoms (but not tardive dyskinesia, \n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinic drugs exert their antiparkinsonian action by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency. Antimuscarinic drugs can be useful in drug-induced parkinsonism, but they are generally not used in idiopathic Parkinson\u2019s disease because they are less effective than dopaminergic drugs and they are associated with cognitive impairment.The antimuscarinic drugs orphenadrine, procyclidine, and trihexyphenidyl reduce the symptoms of parkinsonism induced by antipsychotic drugs, but there is no justification for giving them routinely in the absence of parkinsonian side-effects. Tardive dyskinesia is not improved by antimuscarinic drugs and may be made worse.In idiopathic Parkinson\u2019s disease, antimuscarinic drugs reduce tremor and rigidity but they have little effect on bradykinesia. They may be useful in reducing sialorrhoea.There are no important differences between the antimuscarinic drugs, but some patients tolerate one better than another.Procyclidine can be given parenterally and is effective emergency treatment for acute drug-induced dystonic reactions.)", "name": "TRIHEXYPHENIDYL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.2 Antimuscarinic drugs used in parkinsonism" ], "cautions": "Cautions\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinics should be used with caution in cardiovascular disease, hypertension, psychotic disorders, prostatic hypertrophy, pyrexia, in those susceptible to angle-closure glaucoma, and in the elderly. Antimuscarinics should not be withdrawn abruptly in patients taking long-term treatment. Antimuscarinics are liable to abuse. Interactions: Appendix 1 (Antimuscarinics)", "side-effects": "Side-effects\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nSide-effects of antimuscarinics include constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria, hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision, and rash. Angle-closure glaucoma occurs very rarely.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3655.htm", "doses": [ "1\u00a0mg daily, increased by 2\u00a0mg every 3\u20135 days according\r\nto response; usual maintenance dose 5\u201315\u00a0mg daily in 3\u20134 divided doses\r\n(max. 20\u00a0mg daily); elderly preferably\r\nlower end of range; child under 18\r\nyears see BNF for Children", "Not recommended for use in\r\nParkinson\u2019s disease because of toxicity in the elderly and the risk\r\nof aggravating dementia. However, if using in combination with co-careldopa\r\nor co-beneldopa the usual maintenance dose is 2\u20136\u00a0mg daily in divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "INDOMETACIN": { "indications": "Indications\u00a0pain and moderate\r\nto severe inflammation in rheumatic disease and other acute musculoskeletal\r\ndisorders; acute gout; dysmenorrhoea; premature labour (section 7.1.3)", "name": "INDOMETACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; also epilepsy, parkinsonism, psychiatric disturbances; during prolonged therapy\r\nophthalmic and blood examinations particularly advisable; avoid rectal administration in proctitis and haemorrhoidsDriving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; rarely confusion,\r\nconvulsions, psychiatric disturbances, syncope, blood disorders (particularly\r\nthrombocytopenia), hyperglycaemia, peripheral neuropathy, intestinal\r\nstrictures; also reported hyperkalaemia; suppositories\r\nmay cause rectal irritation and occasional bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5228.htm", "doses": [ "By mouth, rheumatic disease, 50\u2013200\u00a0mg\r\ndaily in divided doses; child see BNF for Children", "Acute gout, 150\u2013200\u00a0mg daily in divided doses", "Dysmenorrhoea, up to 75\u00a0mg daily", "By rectum in suppositories, 100\u00a0mg\r\nat night and in the morning if required; child not recommended", "Combined oral and rectal treatment, max. total daily dose 150\u2013200\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "CHLORAMPHENICOL ": { "indications": "Indications\u00a0bacterial infection in otitis externa (but \n(From 12.1.1 Otitis externa: British National Formulary)\nIf infection is present, a topical anti-infective which is not used systemically (such as neomycin or clioquinol) may be used, but for only about a week as excessive use may result in fungal infections; these may be difficult to treat and require expert advice)", "name": "CHLORAMPHENICOL ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-infective preparations", "CHLORAMPHENICOL" ], "cautions": "Cautions\u00a0avoid prolonged use (\n(From 12.1.1 Otitis externa: British National Formulary)\nIf infection is present, a topical anti-infective which is not used systemically (such as neomycin or clioquinol) may be used, but for only about a week as excessive use may result in fungal infections; these may be difficult to treat and require expert advice)", "side-effects": "Side-effects\u00a0high incidence of sensitivity reactions to vehicle", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5599.htm", "doses": [ "ear, apply 2\u20133 drops 2\u20133 times daily" ] }, "MILRINONE": { "indications": "Indications\u00a0short-term treatment of severe congestive heart failure unresponsive\r\nto conventional maintenance therapy (not immediately after myocardial\r\ninfarction); acute heart failure, including low output states following\r\nheart surgery", "name": "MILRINONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.1 Positive inotropic drugs", "2.1.2 Phosphodiesterase type-3 inhibitors" ], "cautions": "Cautions\u00a0see under Enoximone; also correct hypokalaemia; interactions: Appendix 1 (phosphodiesterase type-3 inhibitors)", "side-effects": "Side-effects\u00a0ectopic beats, ventricular tachycardia, supraventricular\r\narrhythmias (more likely in patients with pre-existing arrhythmias),\r\nhypotension; headache; less commonly ventricular\r\nfibrillation, chest pain, tremor, hypokalaemia, thrombocytopenia; very rarely bronchospasm, anaphylaxis, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2320.htm", "doses": [ "By intravenous injection over 10 minutes,\r\neither undiluted or diluted before use, 50\u00a0micrograms/kg followed\r\nby intravenous infusion at a rate of 375\u2013750\u00a0nanograms/kg/minute,\r\nusually for up to 12\u00a0hours following surgery or for 48\u201372 hours in\r\ncongestive heart failure; max. daily dose 1.13\u00a0mg/kg" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "TELBIVUDINE": { "indications": "Indications\u00a0chronic hepatitis B infection with\r\ncompensated liver disease, evidence of viral replication, and histologically\r\ndocumented active liver inflammation or fibrosis", "name": "TELBIVUDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.3 Viral hepatitis", "5.3.3.1 Chronic hepatitis B" ], "cautions": "Cautions\u00a0monitor liver function tests every 3\r\nmonths and viral markers of hepatitis B every 3\u20136 months during treatment\r\n(continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation); lamivudine-resistant chronic hepatitis B\u2014risk of telbivudine resistance; discontinue if deterioration in liver function, hepatic\r\nsteatosis, progressive hepatomegaly or unexplained lactic acidosis; interactions: Appendix 1 (telbivudine)Counselling\u00a0Patients should be advised\r\nto promptly report unexplained muscle pain, tenderness, or weakness,\r\nor numbness, tingling or burning sensations", "side-effects": "Side-effects\u00a0nausea, diarrhoea, abdominal pain, raised serum\r\namylase and lipase; cough; dizziness, headache, fatigue; rash; less commonly taste disturbance, arthralgia, myalgia, myopathy\r\n(discontinue treatment), and peripheral neuropathy; also reported,\r\nlactic acidosis and rhabdomyolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200281.htm", "doses": [ "adult and child over 16 years, 600\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "SENNA": { "indications": "Indications\u00a0constipation", "name": "SENNA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2222.htm", "doses": [ "See under preparations", "Acts in 8\u201312 hours" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "FLUOROURACIL - ANTIMETABOLITES": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nFluorouracil is used to treat a number of solid tumours, including gastro-intestinal tract cancers and breast cancer. It is commonly used with folinic acid in advanced colorectal cancer. It may also be used topically for certain malignant and pre-malignant skin lesions. Toxicity is unusual, but may include myelosuppression, mucositis, and rarely a cerebellar syndrome. On prolonged infusion, a desquamative hand\u2013foot syndrome may occur.; pre-malignant and malignant skin lesions (%s\n(From FLUOROURACIL: British National Formulary)\nFLUOROURACIL)", "name": "FLUOROURACIL - ANTIMETABOLITES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "FLUOROURACIL" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues; interactions: Appendix 1 (fluorouracil)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also local irritation with topical preparation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4732.htm", "doses": [ "By intravenous injection or infusion or by intra-arterial\r\ninfusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic); see also Pregnancy and Reproductive\r\nFunction" }, "AMINOPHYLLINE Modified release": { "indications": "Indications\u00a0reversible airways obstruction, severe\r\nacute asthma", "name": "AMINOPHYLLINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.3 Theophylline", "AMINOPHYLLINE", "Modified release" ], "cautions": "Cautions\u00a0see under Theophylline", "side-effects": "Side-effects\u00a0see under Theophylline; also allergy to ethylenediamine can cause urticaria, erythema,\r\nand exfoliative dermatitis; hypotension, arrhythmias, and convulsions\r\nespecially if given rapidly by intravenous injection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2943.htm", "doses": [ "See under preparations, below", "Plasma-theophylline concentration\r\nfor optimum response 10\u201320\u00a0mg/litre (55\u2013110\u00a0micromol/litre); measure\r\nplasma-theophylline concentration 4\u20136 hours after dose by mouth and\r\nat least 5 days after starting oral treatment; measure plasma-theophylline\r\nconcentration 4\u20136 hours after the start of intravenous infusion; narrow\r\nmargin between therapeutic and toxic dose, see also notes above", "To avoid excessive dosage\r\nin obese patients, dose should be calculated on the basis of ideal\r\nweight for height", "initially 1 tablet twice daily, increased after 1 week\r\nto 2 tablets twice daily if necessary", "Name[Phyllocontin Continus\u00ae (Napp)] Tablets, m/r, yellow, f/c, aminophylline hydrate 225\u00a0mg, net price 56-tab pack = \u00a32.39. \r\n Label:\r\n 25Dose\u00a0adult and child body-weight over 40\u00a0kg initially 1 tablet twice\r\ndaily, increased after 1 week to 2 tablets twice daily according to\r\nplasma-theophylline concentration\nForte tablets, m/r, yellow, f/c, aminophylline hydrate 350\u00a0mg, net price 56-tab pack = \u00a34.22. \r\n Label:\r\n 25Dose\u00a0initially 1 tablet twice daily, increased after 1 week\r\nto 2 tablets twice daily if necessaryNote\u00a0Phyllocontin Continus\u00ae Forte tablets are for smokers and other patients with shorter theophylline half-life (see notes above)" ], "pregnancy": "Pregnancy\u00a0see under Theophylline" }, "METARAMINOL": { "indications": "Indications\u00a0acute hypotension (see notes above); priapism (%s\n(From 7.4.5 Drugs for erectile dysfunction: British National Formulary)\n7.4.5 Drugs for erectile dysfunction) [unlicensed\r\nindication]", "name": "METARAMINOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.2 Vasoconstrictor sympathomimetics" ], "cautions": "Cautions\u00a0see under Noradrenaline; longer duration of action than noradrenaline (norepinephrine), see below; cirrhosisHypertensive response\u00a0Metaraminol has a longer duration of action than noradrenaline,\r\nand an excessive vasopressor response may cause a prolonged rise in\r\nblood pressure", "side-effects": "Side-effects\u00a0see under Noradrenaline; also tachycardia; fatal\r\nventricular arrhythmia reported in Laennec\u2019s cirrhosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2752.htm", "doses": [ "By intravenous infusion, 15\u2013100\u00a0mg, adjusted\r\naccording to response", "In emergency, by intravenous injection, 0.5\u20135\u00a0mg\r\nthen by intravenous infusion, 15\u2013100\u00a0mg, adjusted according\r\nto response" ], "pregnancy": "Pregnancy\u00a0may reduce placental perfusion\u2014manufacturer advises\r\nuse only if potential benefit outweighs risk" }, "USTEKINUMAB": { "indications": "Indications\u00a0\n(From 13.5.3 Drugs affecting the immune response: British National Formulary)\nEtanercept, adalimumab, and infliximab inhibit the activity of tumour necrosis factor (TNF\u03b1). They are used for severe plaque psoriasis either refractory to at least 2 standard systemic treatments and photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications; while either etanercept or adalimumab is considered to be the first choice in stable disease, infliximab or adalimumab may be useful when rapid disease control is required. Ustekinumab (a monoclonal antibody that inhibits interleukins 12 and 23) can be used for severe plaque psoriasis that has not responded to at least 2 standard systemic treatments and photochemotherapy, or when these treatments cannot be used because of intolerance or contra-indications (see also NICE guidance below). Adalimumab, etanercept, and infliximab are also licensed for psoriatic arthritis (section 10.1.3).NICE guidance(1)Adalimumab for plaque psoriasis in adults (June 2008)Adalimumab is recommended for the treatment of severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Adalimumab should be withdrawn if the response is not adequate after 16 weeks.NICE guidance(2)Etanercept and efalizumab for plaque psoriasis in adults (July 2006)Etanercept is recommended for severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Etanercept should be withdrawn if the response is not adequate after 12 weeks.Following suspension of the marketing authorisation for efalizumab, NICE has temporarily withdrawn its guidance on the use of efalizumab for plaque psoriasis.NICE guidanceInfliximab for plaque psoriasis in adults (January 2008)Infliximab is recommended for the treatment of very severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) or to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Infliximab should be withdrawn if the response is not adequate after 10 weeks.NICE GuidanceUstekinumab for plaque psoriasis in adults (September 2009)Ustekinumab is recommended for the treatment of severe plaque psoriasis which has failed to respond to standard systemic treatments (including ciclosporin and methotrexate) and to photochemotherapy, or when standard treatments cannot be used because of intolerance or contra-indications. Ustekinumab should be withdrawn if the response is not adequate after 16 weeks.For patients weighing over 100\u00a0kg, the manufacturer should provide the 90-mg dose of ustekinumab at the same price as the 45-mg dose", "name": "USTEKINUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; history or development\r\nof malignancy; elderly; interactions: Appendix 1 (ustekinumab)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting ustekinumab. Patients who have previously received\r\nadequate treatment for tuberculosis can start ustekinumab but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting ustekinumab. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with ustekinumab. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) develop", "side-effects": "Side-effects\u00a0infections (sometimes severe); diarrhoea; hypersensitivity\r\nreactions (possibly delayed onset), pain in pharynx and\r\nlarynx; headache, fatigue, dizziness, depression; arthralgia; myalgia;\r\nnasal congestion; pruritus, injection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202793.htm", "doses": [ "By subcutaneous injection, plaque psoriasis, adult over 18 years, body-weight under 100\u00a0kg, initially\r\n45\u00a0mg, then 45\u00a0mg 4 weeks after initial dose, then 45\u00a0mg every 12\r\nweeks; body-weight over 100\u00a0kg, initially 45\u201390\u00a0mg, then 45\u201390\u00a0mg\r\n4 weeks after initial dose, then 45\u201390\u00a0mg every 12 weeks ", "Discontinue if no response within 16 weeks" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nduring treatment and for 15 weeks after stopping treatment" }, "LOMUSTINE": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nLomustine is a lipid-soluble nitrosourea and is given by mouth. It is used mainly to treat Hodgkin\u2019s disease resistant to conventional therapy, malignant melanoma and certain solid tumours. Bone-marrow toxicity is delayed, and the drug is therefore given at intervals of 4 to 6 weeks. Permanent bone-marrow damage can occur with prolonged use. Nausea and vomiting are common and moderately severe.Bendamustine given intravenously is licensed for the treatment of chronic lymphocytic leukaemia, non-Hodgkin\u2019s lymphoma, and for the treatment of multiple myeloma. The Scottish Medicines Consortium has advised (March 2011) that bendamustine (Levact\u00ae) is accepted for restricted use within NHS Scotland for the treatment of chronic lymphocytic leukaemia in patients for whom fludarabine combination chemotherapy is not appropriate.NICE guidanceBendamustine for the first-line treatment of chronic lymphocytic leukaemia (February 2011)Bendamustine is recommended as an option for the treatment of chronic lymphocytic leukaemia in patients for whom fludarabine combination chemotherapy is not appropriate.", "name": "LOMUSTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "LOMUSTINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above;\r\navoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(lomustine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4692.htm", "doses": [ "Used alone, 120\u2013130\u00a0mg/m2 body-surface every\r\n6\u20138 weeks" ], "pregnancy": "Pregnancy\u00a0avoid (manufacturer advises effective contraception\r\nduring and for at least 6 months after treatment in men or women);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "INSULIN ZINC SUSPENSION Highly purified animal": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN ZINC SUSPENSION Highly purified animal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "INSULIN ZINC SUSPENSION", "Highly purified animal" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4096.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements", "Name[Hypurin\u00ae Bovine Lente (Wockhardt) ] Injection, insulin zinc\r\nsuspension (bovine, highly purified) 100\u00a0units/mL. Net price\r\n10-mL vial = \u00a327.72Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "AZATHIOPRINE": { "indications": "Indications\u00a0\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nThiopurine methyltransferaseThe enzyme thiopurine methyltransferase (TPMT) metabolises thiopurine drugs (azathioprine, mercaptopurine, tioguanine); the risk of myelosuppression is increased in patients with reduced activity of the enzyme, particularly for the few individuals in whom TPMT activity is undetectable. Consider measuring TPMT activity before starting azathioprine, mercaptopurine, or tioguanine therapy. Patients with absent TPMT activity should not receive thiopurine drugs; those with reduced TPMT activity may be treated under specialist supervision.; inflammatory bowel disease [unlicensed\r\nindication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE); rheumatoid arthritis (%s\n(From Drugs affecting the immune response: British National Formulary)\nDrugs affecting the immune response); severe\r\nrefractory eczema [unlicensed indication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE)", "name": "AZATHIOPRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.1 Antiproliferative immunosuppressants", "AZATHIOPRINE" ], "cautions": "Cautions\u00a0\n(From Immunosuppressant therapy: British National Formulary)\nBioavailabilityDifferent formulations of the same immunosuppressant may vary in bioavailability and to avoid reduced effect or excessive side-effects, it is important not to change formulation except on the advice of a transplant specialist.;\r\nthiopurine methyltransferase status (see notes above); monitor\r\nfor toxicity throughout treatment; monitor full blood\r\ncount weekly (more frequently with higher doses or if severe hepatic\r\nor renal impairment) for first 4 weeks (manufacturer advises weekly\r\nmonitoring for 8 weeks but evidence of practical value unsatisfactory),\r\nthereafter reduce frequency of monitoring to at least every 3 months; reduce dose in elderly; interactions: Appendix 1 (azathioprine)Bone marrow suppression\u00a0Patients\r\nshould be warned to report immediately any signs or symptoms of bone\r\nmarrow suppression e.g. inexplicable bruising or bleeding, infection", "side-effects": "Side-effects\u00a0hypersensitivity reactions (including malaise,\r\ndizziness, vomiting, diarrhoea, fever, rigors, myalgia, arthralgia,\r\nrash, hypotension and interstitial nephritis\u2014calling for immediate\r\nwithdrawal); dose-related bone marrow suppression (see also Cautions);\r\nliver impairment, cholestatic jaundice, hair loss and increased susceptibility\r\nto infections and colitis in patients also receiving corticosteroids;\r\nnausea; rarely pancreatitis, pneumonitis, hepatic\r\nveno-occlusive disease, lymphoma, red cell aplasia\u2014\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nMycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine. It is licensed for the prophylaxis of acute rejection in renal, hepatic or cardiac transplantation when used in combination with ciclosporin and corticosteroids. There is evidence that compared with similar regimens incorporating azathioprine, mycophenolate mofetil reduces the risk of acute rejection episodes; the risk of opportunistic infections (particularly due to tissue-invasive cytomegalovirus) and the occurrence of blood disorders such as leucopenia may be higher.Cases of pure red cell aplasia have been reported with azathioprine and with mycophenolate mofetil; dose reduction or discontinuation should be considered under specialist supervision.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4780.htm", "doses": [ "By mouth, or (if\r\noral administration not possible\u2014intravenous solution very irritant,\r\nsee below) by intravenous injection over at least 1\r\nminute (followed by 50\u00a0mL sodium chloride intravenous\r\ninfusion), or by intravenous infusion", "Autoimmune conditions, 1\u20133\u00a0mg/kg daily, adjusted according to\r\nresponse (consider withdrawal if no improvement within 3 months)", "Suppression of transplant rejection, 1\u20132.5\u00a0mg/kg daily adjusted according\r\nto response", "Azathioprine doses in BNF may differ from\r\nthose in product literature", "Intravenous injection is alkaline and very irritant, intravenous route should therefore\r\nbe used only if oral route not feasible, see also\r\nAppendix 4" ], "pregnancy": "Pregnancy\u00a0treatment should not generally be initiated during\r\npregnancy; see also Immunosuppressant therapy" }, "CLEMASTINE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, urticaria", "name": "CLEMASTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines", "CLEMASTINE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3040.htm", "doses": [ "1\u00a0mg twice daily, increased up to 6\u00a0mg daily if required; child 1\u20133 years 250\u2013500\u00a0micrograms twice daily; 3\u20136\r\nyears 500\u00a0micrograms twice daily; 6\u201312 years 0.5\u20131\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "FAMPRIDINE": { "indications": "Indications\u00a0(specialist use only) improvement of\r\nwalking disability in multiple sclerosis", "name": "FAMPRIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.1 Drugs that enhance neuromuscular transmission", "Acetylcholine-release enhancers", "FAMPRIDINE" ], "cautions": "Cautions\u00a0predisposition to seizures including concomitant use\r\nof drugs that lower seizure threshold; symptomatic cardiac rhythm\r\ndisorders, sinoatrial or atrioventricular conduction\r\ndisorders;interactions: Appendix 1 (fampridine)", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, dyspepsia, dyspnoea,\r\npharyngolaryngeal pain, dizziness, headache, paraesthesia, tremor,\r\nmalaise, insomnia, anxiety, urinary tract infection, back pain; less commonly seizures", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218785.htm", "doses": [ "adult over 18 years, 10\u00a0mg\r\nevery 12 hours; discontinue treatment if no improvement within 2 weeks" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "VERTEPORFIN": { "indications": "Indications\u00a0see notes above\u2014specialist use only", "name": "VERTEPORFIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment", "Subfoveal choroidal neovascularisation" ], "cautions": "Cautions\u00a0photosensitivity\u2014avoid exposure of unprotected\r\nskin and eyes to bright light during infusion and for 48 hours afterwards; concomitant use with other photosensitising drugs; biliary obstruction; avoid\r\nextravasation", "side-effects": "Side-effects\u00a0nausea, hypercholesterolaemia, malaise, back pain,\r\nphotosensitivity, visual disturbances (including reduced visual acuity,\r\nflashing lights, visual-field defects), less commonly hypertension, hyperaesthesia, pyrexia, retinal detachment, haemorrhage, rarely retinal or choroidal vessel non-perfusion; also reported chest pain, myocardial infarction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/90014.htm", "doses": [ "By intravenous infusion over 10 minutes,\r\n6\u00a0mg/m2", "For information on administration and light\r\nactivation, consult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk (teratogenic in animal studies)" }, "PREPARATIONS FOR OTHER VAGINAL INFECTIONS": { "cautions": "Cautions\u00a0not recommended during menstruation; some absorption may occur, see section 5.1.11 for systemic effects", "name": "PREPARATIONS FOR OTHER VAGINAL INFECTIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.2 Treatment of vaginal and vulval conditions", "7.2.2 Vaginal and vulval infections", "Other infections", "PREPARATIONS FOR OTHER VAGINAL INFECTIONS" ], "side-effects": "Side-effects\u00a0local effects including irritation, candidiasis,\r\nabnormal discharge, pelvic discomfort", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64487.htm", "doses": [ "bacterial vaginosis, insert 5-g applicatorful at night\r\nfor 5 nights" ] }, "13.2.1 Emollients Preparations containing urea": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.2 Emollient and barrier preparations", "13.2.1 Emollients", "Preparations containing urea" ], "name": "13.2.1 Emollients Preparations containing urea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208097.htm", "doses": [ "Name[Hydromol\u00ae Intensive (Alliance)] Cream, urea 10%, net price 30\u00a0g\r\n= \u00a31.64, 100\u00a0g = \u00a34.37Excipients none as listed in section 13.1.3Dose\u00a0for dry, scaling and itching skin, apply thinly twice\r\ndaily" ] }, "IPRATROPIUM BROMIDE": { "indications": "Indications\u00a0reversible airways obstruction, particularly\r\nin chronic obstructive pulmonary disease; rhinitis (section 12.2.2)", "name": "IPRATROPIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.2 Antimuscarinic bronchodilators" ], "cautions": "Cautions\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nCautions\u00a0Antimuscarinic bronchodilators should be used with caution in patients with prostatic hyperplasia, bladder outflow obstruction, and those susceptible to angle-closure glaucoma (see below); interactions: Appendix 1 (antimuscarinics).Glaucoma\u00a0Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists); care needed to protect patient\u2019s eyes from nebulised drug or from drug powder.", "side-effects": "Side-effects\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nSide-effects\u00a0Dry mouth is the most common side-effect of antimuscarinic bronchodilators; also constipation, cough, paradoxical bronchospasm, headache, dizziness; less commonly nausea, tachycardia, palpitation, atrial fibrillation, urinary retention, eye pain, corneal oedema, angle-closure glaucoma, blurred vision, stomatitis, rash, and pruritus can occur. Raised intra-ocular pressure and urticaria have occurred rarely.; also\r\nthroat irritation; less commonly vomiting, diarrhoea,\r\nlaryngospasm, pharyngeal oedema, conjunctival hyperaemia, mydriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2925.htm", "doses": [ "By aerosol inhalation, 20\u201340\u00a0micrograms\r\n3\u20134 times daily; child up to 6 years\r\n20\u00a0micrograms 3 times daily, 6\u201312 years 20\u201340\u00a0micrograms 3 times daily", "By inhalation of powder, adult and child over\r\n12 years, 40\u00a0micrograms 3\u20134 times daily (may be doubled in less responsive\r\npatients)", "By inhalation of nebulised solution, reversible airways obstruction in chronic obstructive pulmonary\r\ndisease, 250\u2013500\u00a0micrograms 3\u20134 times daily", "Acute bronchospasm (but see also Management of Acute Asthma\r\ntable),\r\n500\u00a0micrograms repeated as necessary; child under 5 years 125\u2013250\u00a0micrograms, max. 1\u00a0mg daily; 6\u201312 years 250\u00a0micrograms,\r\nmax. 1\u00a0mg daily", "Advise patient not\r\nto exceed prescribed dose and to follow manufacturer\u2019s directions" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "GLYCERYL TRINITRATE Transdermal preparations": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE Transdermal preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE", "Transdermal preparations" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2637.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations", "Name[Percutol\u00ae (Aspire)] Ointment, glyceryl trinitrate 2%, net price 60\u00a0g = \u00a359.65. \r\n Label:\r\n Counselling, see administration below Excipients include wool fatDose\u00a0prophylaxis of angina, usual dose 1\u20132\u00a0inches of ointment\r\nmeasured on to Applirule\u00ae, and applied (usually\r\nto chest, arm, or thigh) without rubbing in and secured with surgical\r\ntape, every 3\u20134 hours as required; to determine dose, \u00bd\u00a0inch on first\r\nday then increased by \u00bd\u00a0inch/day until headache occurs, then reduced\r\nby \u00bd\u00a0inchNote\u00a0Approx. 800\u00a0micrograms/hour absorbed from\r\n1 inch of ointment" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TIGECYCLINE": { "indications": "Indications\u00a0\n(From Tigecycline: British National Formulary)\nTigecycline", "name": "TIGECYCLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "Tigecycline" ], "cautions": "Cautions\u00a0cholestasis; interactions: Appendix 1 (tigecycline)", "side-effects": "Side-effects\u00a0\n(From Tigecycline: British National Formulary)\nTigecycline; also nausea, vomiting, abdominal\r\npain, dyspepsia, diarrhoea, anorexia, bilirubinaemia, dizziness, headache,\r\nhypoglycaemia, prolonged prothrombin time, prolonged activated partial\r\nthromboplastin time, rash, pruritus, and injection-site reactions; less commonly pancreatitis, cholestatic jaundice, and hypoproteinaemia;\r\nalso reported, antibiotic-associated colitis, hepatic failure, thrombocytopenia,\r\nStevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129711.htm", "doses": [ "By intravenous infusion, adult over 18 years, initially 100\u00a0mg, then 50\u00a0mg\r\nevery 12 hours for 5\u201314 days" ], "pregnancy": "Pregnancy\u00a0see under Tetracyclines" }, "PROCARBAZINE": { "indications": "Indications\u00a0\n(From Procarbazine: British National Formulary)\nProcarbazine", "name": "PROCARBAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Procarbazine", "PROCARBAZINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; cardiovascular or cerebrovascular disease; phaeochromocytoma; epilepsy; interactions: Appendix 1 (procarbazine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also loss of appetite; jaundice\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11788.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies\r\nand isolated reports in humans); see also Pregnancy and Reproductive\r\nFunction" }, "LANTHANUM": { "indications": "Indications\u00a0\n(From 9.5.2.2 Phosphate-binding agents: British National Formulary)\nLanthanum is licensed for the control of hyperphosphataemia in patients with chronic renal failure on haemodialysis or continuous ambulatory peritoneal dialysis (CAPD), and in patients with chronic kidney disease not on dialysis who have a serum-phosphate concentration of 1.78\u00a0mmol/litre or more that cannot be controlled by a low-phosphate diet.", "name": "LANTHANUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "LANTHANUM" ], "cautions": "Cautions\u00a0acute peptic ulcer; ulcerative colitis; Crohn\u2019s disease; bowel obstruction; interactions: Appendix 1 (lanthanum)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; hypocalcaemia; less commonly anorexia, increased appetite, taste disturbances,\r\ndry mouth, thirst, stomatitis, chest pain, peripheral oedema, headache,\r\ndizziness, vertigo, asthenia, fatigue, malaise, hyperglycaemia, hyperparathyroidism,\r\nhypercalcaemia, hypophosphataemia, eosinophilia, arthralgia, myalgia,\r\nosteoporosis, sweating, alopecia, pruritus, and erythematous rash;\r\naccumulation of lanthanum in bone, and transient changes in QT interval\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130068.htm", "doses": [ "adult over 18 years, usual\r\ndose range 1.5\u20133\u00a0g daily in divided doses chewed with or immediately\r\nafter meals, adjusted according to serum-phosphate concentration every\r\n2\u20133 weeks " ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "FENTANYL Nasal spray": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL Nasal spray", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL", "Nasal spray" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204140.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare", "Name[Instanyl\u00ae (Nycomed) ] Nasal spray, fentanyl (as citrate)\r\n50\u00a0micrograms/metered spray, net price single-dose pack = \u00a35.95, 10-dose\r\npack = \u00a359.50, 20-dose pack = \u00a3119.00; 100\u00a0micrograms/metered spray,\r\nsingle-dose pack = \u00a35.95, 10-dose pack = \u00a359.50, 20-dose pack = \u00a3119.00;\r\n200\u00a0micrograms/metered spray, single-dose pack = \u00a35.95, 10-dose pack\r\n= \u00a359.50, 20-dose pack = \u00a3119.00. \r\n Label:\r\n 2, counselling, administrationDose\u00a0breakthrough pain in patients receiving opioid therapy\r\nfor chronic cancer pain, adult over\r\n18 years, initially 50\u00a0micrograms into one nostril, repeated once\r\nif necessary after 10 minutes; adjust dose according to response;\r\nmax. 2 sprays for each pain episode and minimum 4 hours between treatment\r\nof each pain episodeNote\u00a0If more than 4 breakthrough pain episodes\r\ndaily, adjust background analgesiaCounselling\u00a0Patient should sit or stand during\r\nadministration. Avoid concomitant use of other nasal preparationsThe Scottish Medicines\r\nConsortium has advised that Instanyl\u00ae nasal spray should\r\nbe restricted for use within NHS Scotland for the management of breakthrough\r\npain in adult patients using opioid therapy for chronic cancer pain,\r\nwhen other short-acting opioids are unsuitable" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "MENINGOCOCCAL VACCINES Meningococcal A, C, W135, and Y conjugate vaccine": { "indications": "Indications\u00a0immunisation against Neisseria\r\nmeningitidis", "name": "MENINGOCOCCAL VACCINES Meningococcal A, C, W135, and Y conjugate vaccine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Meningococcal vaccines", "MENINGOCOCCAL VACCINES", "Meningococcal A, C, W135, and Y conjugate vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also rarely symptoms of meningitis reported (but no evidence\r\nthat the vaccine causes meningococcal C meningitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207506.htm", "doses": [ "See under preparations", "Name[Menveo\u00ae (Novartis Vaccines) ] Injection, powder for reconstitution,\r\ncapsular oligosaccharide antigens of Neisseria meningitidis groups A, C, W135, and Y (conjugated to Corynebacterium\r\ndiphtheriae protein), net price single-dose vial (with\r\nsyringe containing diluent) = \u00a340.01Dose\u00a0by intramuscular injection preferably into\r\ndeltoid region, adult and child over 1 year 0.5\u00a0mL as a single dose; child 3 months\u20131 year 2 doses of 0.5\u00a0mL separated\r\nby an interval of 1 monthNote\u00a0Advice in BNF may differ from that in product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "LEUPRORELIN ACETATE - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS": { "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues and %s\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues; also fatigue, muscle weakness,\r\nparaesthesia, hypertension, palpitation, alteration of glucose tolerance and of blood lipids; hypotension, jaundice, thrombocytopenia\r\nand leucopenia reported", "indications": "Indications\u00a0locally advanced prostate cancer as an\r\nalternative to surgical castration; adjuvant treatment to radiotherapy\r\nor radical prostatectomy in patients with high-risk localised or locally\r\nadvanced prostate cancer; metastatic prostate cancer; endometriosis,\r\nendometrial thinning, uterine fibroids (section 6.7.2)", "name": "LEUPRORELIN ACETATE - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4835.htm", "doses": [ "Name[Prostap\u00ae SR DCS (Takeda) ] prostate cancer (see indications), by subcutaneous or by intramuscular injection, 3.75\u00a0mg\r\nevery month" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues", "LEUPRORELIN ACETATE" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Men at risk of tumour \u2018flare\u2019 (see above) should be monitored closely during the first month of therapy. Caution is required in patients with metabolic bone disease because reduced bone mineral density can occur. The injection site should be rotated. and %s\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues; risk of ureteric\r\nobstruction and spinal cord compression in men" }, "FELODIPINE": { "indications": "Indications\u00a0hypertension, prophylaxis of angina", "name": "FELODIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "FELODIPINE" ], "cautions": "Cautions\u00a0withdraw if ischaemic pain\r\noccurs or existing pain worsens shortly after initiating treatment\r\nor if cardiogenic shock develops; severe left ventricular\r\ndysfunction; acute porphyria (but see section 9.8.2); interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0flushing, headache, palpitation, dizziness, fatigue,\r\ngravitational oedema; rarely rash, pruritus, cutaneous vasculitis,\r\ngum hyperplasia, urinary frequency, impotence, fever; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128200.htm", "doses": [ "Hypertension, initially 5\u00a0mg (elderly 2.5\u00a0mg) daily in\r\nthe morning; usual maintenance 5\u201310\u00a0mg once daily; doses above 20\u00a0mg\r\ndaily rarely needed", "Angina, initially 5\u00a0mg daily in the morning, increased if necessary\r\nto 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0avoid; toxicity in animal studies;\r\nmay inhibit labour" }, "TREOSULFAN": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nTreosulfan is given by mouth or by intravenous or intraperitoneal administration and is used to treat ovarian cancer. Skin pigmentation is a common side-effect and allergic alveolitis, pulmonary fibrosis and haemorrhagic cystitis occur rarely.", "name": "TREOSULFAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs" ], "cautions": "Cautions\u00a0see section 8.1;\r\navoid in acute porphyria (but see section 9.8.2)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4699.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid; see also Pregnancy and Reproductive\r\nFunction" }, "PROGUANIL HYDROCHLORIDE WITH ATOVAQUONE": { "indications": "Indications\u00a0treatment of acute uncomplicated falciparum malaria and prophylaxis\r\nof falciparum malaria, particularly where resistance to other antimalarial\r\ndrugs suspected; treatment of benign malaria [unlicensed indication]", "name": "PROGUANIL HYDROCHLORIDE WITH ATOVAQUONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Proguanil", "PROGUANIL HYDROCHLORIDE WITH ATOVAQUONE" ], "cautions": "Cautions\u00a0diarrhoea or vomiting (reduced absorption of atovaquone); efficacy not evaluated in cerebral or complicated malaria (including\r\nhyperparasitaemia, pulmonary oedema or renal failure); interactions: see Appendix 1 (proguanil, atovaquone)", "side-effects": "Side-effects\u00a0abdominal pain, nausea, vomiting, diarrhoea; cough;\r\nheadache, dizziness, insomnia, abnormal dreams, depression, anorexia,\r\nfever; rash, pruritus; less frequently stomatitis,\r\npalpitation, anxiety, blood disorders, hyponatraemia, and hair loss;\r\nalso reported, hepatitis, cholestasis, tachycardia, hallucinations,\r\nseizures, vasculitis, mouth ulcers, photosensitivity, and Stevens-Johnson\r\nsyndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64365.htm", "doses": [ "See preparations", "Warn travellers about importance of avoiding mosquito bites, importance of taking\r\nprophylaxis regularly, and importance of immediate visit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "prophylaxis of malaria, started 1\u20132 days before entering\r\nendemic area and continued for 1 week after leaving, adult and child over\r\n40\u00a0kg, 1 tablet daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "Heparin flushes": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants" ], "name": "Heparin flushes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106044.htm", "doses": [ "to maintain patency of catheters, cannulas, etc. 10\u2013200\u00a0units\r\nflushed through every 4\u20138 hours. Not for therapeutic\r\nuse" ] }, "DEXAMETHASONE": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; diagnosis of Cushing\u2019s disease, congenital adrenal hyperplasia;\r\ncerebral oedema associated with malignancy; croup (section\r\n3.1); nausea and vomiting with chemotherapy (section 8.1); rheumatic disease (section 10.1.2); eye (section 11.4.1); see also notes above", "name": "DEXAMETHASONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "DEXAMETHASONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids; also perineal irritation may follow\r\nintravenous administration of the phosphate ester", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4272.htm", "doses": [ "By mouth, usual range 0.5\u201310\u00a0mg daily; child 10\u2013100\u00a0micrograms/kg daily; see also Administration\r\n(above)", "By intramuscular injection or slow intravenous injection or infusion, see under preparations", "By intramuscular injection or slow intravenous injection or infusion, 0.4\u201320\u00a0mg; child 200\u2013400\u00a0micrograms/kg daily", "Cerebral oedema, by intravenous injection 8\u201316\u00a0mg\r\ninitially, then 5\u00a0mg by intramuscular injection or intravenous injection every 6 hours as\r\nrequired for 2\u20134 days then gradually reduced and stopped over 5\u20137\r\ndays", "Adjunctive treatment of bacterial meningitis, (starting before\r\nor with first dose of antibacterial treatment), [unlicensed indication], by intravenous injection 8.3\u00a0mg every 6 hours for 4 days; child 3 months\u201318 years see BNF for Children", "by intramuscular injection or slow intravenous injection or infusion, 0.4\u201320\u00a0mg; child 167\u2013333\u00a0micrograms/kg daily", "Cerebral oedema associated with malignancy, by intravenous\r\ninjection 8.3\u00a0mg initially, then 3.3\u00a0mg by intramuscular\r\ninjection every 6 hours as required for 2\u20134 days then gradually\r\nreduced and stopped over 5\u20137 days", "Adjunctive treatment of bacterial meningitis, (starting before\r\nor with first dose of antibacterial treatment), [unlicensed indication], by intravenous injection 8.3\u00a0mg every 6 hours for 4 days; child 3 months\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "CLINDAMYCIN": { "indications": "Indications\u00a0see notes above; staphylococcal bone and joint infections, peritonitis;\r\nfalciparum malaria (%s\n(From Falciparum malaria (treatment): British National Formulary)\nFalciparum malaria (treatment))", "name": "CLINDAMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.6 Clindamycin" ], "cautions": "Cautions\u00a0discontinue\r\nimmediately if diarrhoea or colitis develops; monitor liver\r\nand renal function if treatment exceeds 10 days, and in neonates and\r\ninfants; avoid rapid intravenous administration; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (clindamycin)", "side-effects": "Side-effects\u00a0diarrhoea (discontinue treatment), abdominal discomfort,\r\noesophagitis, oesophageal ulcers, taste disturbances, nausea, vomiting,\r\nantibiotic-associated colitis; jaundice; leucopenia, eosinophilia,\r\nand thrombocytopenia reported; polyarthritis reported; rash, pruritus,\r\nurticaria, anaphylactoid reactions, Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, exfoliative and vesiculobullous dermatitis reported;\r\npain, induration, and abscess after intramuscular injection; thrombophlebitis\r\nafter intravenous injection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3864.htm", "doses": [ "By mouth, 150\u2013300\u00a0mg every 6 hours; up\r\nto 450\u00a0mg every 6 hours in severe infections; child, 3\u20136\u00a0mg/kg every 6 hours", "Patients should discontinue immediately\r\nand contact doctor if diarrhoea develops; capsules should be swallowed\r\nwith a glass of water.", "By deep intramuscular injection or by intravenous infusion, 0.6\u20132.7\u00a0g daily\r\n(in 2\u20134 divided doses); life-threatening infection, up to 4.8\u00a0g daily;\r\nsingle doses above 600\u00a0mg by intravenous infusion only; single doses\r\nby intravenous infusion not to exceed 1.2\u00a0g; child over 1 month, 15\u201340\u00a0mg/kg daily in 3\u20134 divided doses; severe infections,\r\nat least 300\u00a0mg daily regardless of weight" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ALPROSTADIL Urethral application": { "indications": "Indications\u00a0erectile dysfunction (including aid to diagnosis)", "name": "ALPROSTADIL Urethral application", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Alprostadil", "ALPROSTADIL", "Urethral application" ], "cautions": "Cautions\u00a0priapism\u2014patients\r\nshould be instructed to report any erection lasting 4\u00a0hours or longer\u2014for management, see section 7.4.5; anatomical deformations of\r\npenis (painful erection more likely)\u2014follow up regularly to detect\r\nsigns of penile fibrosis (consider discontinuation if\r\nangulation, cavernosal fibrosis or Peyronie\u2019s disease develop); interactions: Appendix 1 (prostaglandins)", "side-effects": "Side-effects\u00a0hypotension, hypertension; dizziness, headache;\r\npenile pain, other localised pain (buttocks, leg, testicular, abdominal);\r\ninfluenza-like syndrome; urethral burning, urethral bleeding; injection\r\nsite reactions including penile fibrosis, penile oedema, penile rash,\r\nhaematoma, haemosiderin deposits; less commonly nausea,\r\ndry mouth, vasodilatation, syncope, supraventricular extrasystole,\r\nrapid pulse, asthenia, leg cramps, pelvic pain, scrotal or testicular\r\noedema, scrotal erythema, testicular thickening, micturation difficulties,\r\nhaematuria, mydriasis, and sweating; local reactions including penile\r\nwarmth, pruritus, irritation, penile numbness or sensitivity, balantitis,\r\nphimosis, priapism (see section 7.4.5 and under Cautions), abnormal ejaculation; rarely vertigo, urinary-tract infection, and hypersensitivity\r\nreactions (including rash, erythema, urticaria, and anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64940.htm", "doses": [ "See under preparations below", "During initiation of treatment MUSE\u00ae should be used under medical supervision; self-administration may only be undertaken after proper training", "Name[(1)MUSE\u00ae (Meda) ] Urethral application, alprostadil, net price 250-microgram single-use applicator = \u00a311.30, 500-microgram\r\nsingle-use applicator = \u00a311.30, 1-mg single-use applicator = \u00a311.56\r\n(all strengths also available in packs of 6 applicators)Condoms no evidence of harm to latex condoms and diaphragmsDose\u00a0by direct urethral application, adult over 18 years, erectile dysfunction, initially\r\n250\u00a0micrograms adjusted according to response (usual range 0.125\u20131\u00a0mg);\r\nmax. 2 doses in 24 hours and 7 doses in 7 days)Note\u00a0During initiation of treatment MUSE\u00ae should be used under medical supervision; self-administration may only be undertaken after proper trainingAid to diagnosis, 500\u00a0micrograms as a single dose" ] }, "SULINDAC": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other musculoskeletal\r\ndisorders; acute gout", "name": "SULINDAC", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "SULINDAC" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; also history of renal stones and ensure adequate\r\nhydration", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; jaundice with fever, cholestasis,\r\nhepatitis, hepatic failure; also urine discoloration occasionally\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89154.htm", "doses": [ "200\u00a0mg twice daily (may be reduced according to response);\r\nmax. 400\u00a0mg daily; acute gout should respond within 7 days; limit\r\ntreatment of peri-articular disorders to 7\u201310 days; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "GRISEOFULVIN - ANTIFUNGAL PREPARATIONS": { "indications": "Indications\u00a0tinea pedis; resistant fungal infections\r\n(section 5.2.5)", "name": "GRISEOFULVIN - ANTIFUNGAL PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129234.htm", "doses": [ "Apply 400\u00a0micrograms (1 spray) to an area approx. 13\u00a0cm2 once daily, increased to 1.2\u00a0mg (3 sprays, allowing each\r\nspray to dry between applications) once daily if necessary; max. treatment\r\nduration 4 weeks" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "ATOMOXETINE": { "indications": "Indications\u00a0attention deficit hyperactivity disorder (initiated by a specialist\r\nphysician experienced in managing the condition)", "name": "ATOMOXETINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.4 CNS\r\nstimulants and drugs used for attention deficit hyperactivity disorder" ], "cautions": "Cautions\u00a0\n(From 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder: British National Formulary)\nDrug treatment of ADHD should be part of a comprehensive treatment programme. The choice of medication should take into consideration co-morbid conditions (such as tic disorders, Tourette syndrome, and epilepsy), the adverse effect profile, potential for drug misuse, and preferences of the patient and carers. Methylphenidate and atomoxetine are used for the management of ADHD; dexamfetamine is an alternative in children who do not respond to these drugs. Before initiation of drug therapy, and every 6 months thereafter, pulse, blood pressure, weight, and height should be measured.The need to continue drug treatment for ADHD should be reviewed at least annually. This may involve suspending treatment.; also cardiovascular disease including hypertension and tachycardia; structural\r\ncardiac abnormalities; QT-interval prolongation (avoid concomitant use of drugs that prolong QT interval); psychosis or mania; monitor for appearance of depression or tics; history\r\nof seizures; aggressive behaviour, hostility, or emotional\r\nlability; susceptibility to angle-closure\r\nglaucoma; interactions: Appendix 1\r\n(atomoxetine)Hepatic disorders\u00a0Following rare\r\nreports of hepatic disorders, patients and carers should be advised\r\nof the risk and be told how to recognise symptoms; prompt medical attention should be sought in case of abdominal pain,\r\nunexplained nausea, malaise, darkening of the urine, or jaundiceSuicidal ideation\u00a0Following reports\r\nof suicidal thoughts and behaviour, patients and their carers should\r\nbe informed about the risk and told to report clinical worsening,\r\nsuicidal thoughts or behaviour, irritability, agitation, or depression", "side-effects": "Side-effects\u00a0anorexia, dry mouth, nausea, vomiting, abdominal\r\npain, constipation, dyspepsia, flatulence; palpitation, tachycardia,\r\nincreased blood pressure, postural hypotension, hot flushes; sleep\r\ndisturbance, dizziness, headache, fatigue, lethargy, drowsiness, irritability,\r\ntremor, rigors; urinary retention, enuresis, prostatitis, sexual dysfunction,\r\nmenstrual disturbances, conjunctivitis; dermatitis, pruritus, rash,\r\nsweating, weight changes; less commonly suicidal\r\nideation (see Suicidal Ideation, above), aggression, hostility, emotional\r\nlability, cold extremities, mydriasis; very rarely angle-closure glaucoma; also reported hepatic disorders (see Hepatic\r\nDisorders, above), psychosis, hypoaesthesia, anxiety, depression,\r\nseizures, and Raynaud\u2019s phenomenon", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128405.htm", "doses": [ "adult over 18 years, body-weight\r\nover 70\u00a0kg, initially 40\u00a0mg daily for 7 days, increased according\r\nto response; usual maintenance 80\u2013100\u00a0mg daily, but may be increased\r\nto max. 120\u00a0mg daily [unlicensed] under the direction of a specialist; child 6\u201318 years, body-weight over 70\u00a0kg, initially\r\n40\u00a0mg daily for 7 days, increased according to response; usual maintenance\r\n80\u00a0mg daily, but may be increased to max. 120\u00a0mg daily [unlicensed]\r\nunder the direction of a specialist; adult and child over 6 years, body-weight\r\nunder 70\u00a0kg, initially 500\u00a0micrograms/kg daily for 7 days, increased\r\naccording to response; usual maintenance 1.2\u00a0mg/kg daily, but may\r\nbe increased to 1.8\u00a0mg/kg daily (max. 120\u00a0mg daily) [unlicensed] under\r\nthe direction of a specialist", "Total daily dose may be given either as a single dose in the morning or in 2 divided\r\ndoses with last dose no later than early evening" ], "pregnancy": "Pregnancy\u00a0no information available; avoid unless potential\r\nbenefit outweighs risk" }, "ERGOTAMINE TARTRATE - ERGOTAMINE TARTRATE": { "indications": "Indications\u00a0treatment of acute migraine and migraine variants unresponsive to analgesics", "name": "ERGOTAMINE TARTRATE - ERGOTAMINE TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "Ergot alkaloids", "ERGOTAMINE TARTRATE" ], "cautions": "Cautions\u00a0risk of peripheral vasospasm (see below); elderly; dependence (see Ergot Alkaloids above); cardiac\r\ndisease; anaemia; interactions: Appendix 1 (ergot alkaloids)Peripheral vasospasm\u00a0Warn patient\r\nto stop treatment immediately if numbness or tingling of extremities\r\ndevelops and to contact doctor.", "side-effects": "Side-effects\u00a0abdominal pain, nausea, vomiting; dizziness; less commonly diarrhoea, pain and weakness in extremities,\r\ncyanosis, peripheral vasoconstriction, paraesthesia, and hypoaesthesia; rarely intestinal ischaemia, arrhythmias, increased blood\r\npressure, bradycardia, tachycardia, dyspnoea, ergotism (including\r\nabsence of pulse and numbness in extremities), myalgia, rash, and\r\nurticaria; very rarely myocardial ischaemia, myocardial\r\ninfarction, heart-valve fibrosis, and gangrene; constipation, dry\r\nmouth, cerebral ischaemia, thrombosis, drowsiness, sleep disturbances,\r\ntremor, seizures, extrapyramidal effects, anxiety, depression, confusion,\r\nhallucinations, renal artery spasm, urinary retention, blood disorders,\r\nblurred vision, and arthralgia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3557.htm", "doses": [ "Name[Cafergot\u00ae (Alliance) ] adult and child over 12 years, 1\u20132 tablets at onset; max. 4\r\ntablets in 24 hours; not to be repeated at intervals of less than\r\n4 days; max. 8 tablets in one week (but see also notes above)" ], "pregnancy": "Pregnancy\u00a0avoid; oxytocic effect on the uterus" }, "SUCRALFATE": { "indications": "Indications\u00a0see under Dose", "name": "SUCRALFATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.3 Chelates and complexes" ], "cautions": "Cautions\u00a0administration of sucralfate and enteral feeds should be separated by 1 hour; interactions: Appendix 1 (sucralfate)Bezoar formation\u00a0Following reports\r\nof bezoar formation associated with sucralfate, caution is advised in seriously ill patients, especially those\r\nreceiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric\r\nemptying", "side-effects": "Side-effects\u00a0constipation; less frequently diarrhoea, nausea, indigestion, flatulence, gastric discomfort,\r\nback pain, dizziness, headache, drowsiness, bezoar formation (see\r\nabove), dry mouth and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2131.htm", "doses": [ "Benign gastric and duodenal ulceration and chronic gastritis, adult and child over\r\n15 years, 2\u00a0g twice daily (on rising and at bedtime) or 1\u00a0g 4 times daily 1 hour before meals and at bedtime, taken for\r\n4\u20136 weeks or in resistant cases up to 12 weeks; max. 8\u00a0g daily", "Prophylaxis of stress ulceration, adult and child over 15 years, 1\u00a0g 6 times\r\ndaily; max. 8\u00a0g daily", "child under 15 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; absorption from gastro-intestinal\r\ntract negligible" }, "MELPHALAN": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nMelphalan is licensed for the treatment of multiple myeloma, polycythaemia vera, childhood neuroblastoma, advanced ovarian adenocarcinoma, and advanced breast cancer. However, in practice, melphalan is rarely used for ovarian adenocarcinoma; it is no longer used for advanced breast cancer. Melphalan is also licensed for regional arterial perfusion in localised malignant melanoma of the extremities and localised soft-tissue sarcoma of the extremities. Interstitial pneumonitis and life-threatening pulmonary fibrosis are rarely associated with melphalan.", "name": "MELPHALAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "MELPHALAN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; avoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(melphalan)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4694.htm", "doses": [ "By mouth, multiple myeloma, dose\r\nmay vary according to regimen; typical dose 150\u00a0micrograms/kg daily\r\nfor 4 days, repeated every 6 weeks", "Polycythaemia vera, initially, 6\u201310\u00a0mg daily reduced after 5\u20137\r\ndays to 2\u20134\u00a0mg daily until satisfactory response then further reduce\r\nto 2\u20136\u00a0mg per week", "By intravenous injection or infusion or by regional arterial\r\nperfusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (manufacturer advises adequate contraception\r\nduring treatment in men or women); see also Pregnancy and Reproductive\r\nFunction" }, "PROMAZINE HYDROCHLORIDE ": { "indications": "Indications\u00a0see under Dose", "name": "PROMAZINE HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "PROMAZINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also cerebral arteriosclerosis", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nhaemolytic anaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3244.htm", "doses": [ "Short-term adjunctive management of psychomotor agitation,\r\n100\u2013200\u00a0mg 4 times daily; child not\r\nrecommended", "Agitation and restlessness in elderly, 25\u201350\u00a0mg 4 times daily" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "CARBOCISTEINE": { "indications": "Indications\u00a0reduction of sputum viscosity, \n(From 3.7 Mucolytics: British National Formulary)\n3.7 Mucolytics", "name": "CARBOCISTEINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.7 Mucolytics", "CARBOCISTEINE" ], "cautions": "Cautions\u00a0\n(From 3.7 Mucolytics: British National Formulary)\nMucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.", "side-effects": "Side-effects\u00a0rarely gastro-intestinal bleeding;\r\nhypersensitivity reactions (including rash and anaphylaxis) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3063.htm", "doses": [ "Initially 2.25\u00a0g daily in divided doses, then 1.5\u00a0g daily\r\nin divided doses as condition improves; child 2\u20135 years 62.5\u2013125\u00a0mg 4 times daily, 5\u201312 years 250\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid in first trimester" }, "MORPHINE SALTS Modified-release 24-hourly oral preparations": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Modified-release 24-hourly oral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Modified-release 24-hourly oral preparations" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38995.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[MXL\u00ae (Napp) ] Capsules, m/r, morphine sulphate 30\u00a0mg (light blue), net price 28-cap pack = \u00a310.91; 60\u00a0mg\r\n(brown), 28-cap pack = \u00a314.95; 90\u00a0mg (pink), 28-cap pack = \u00a322.04;\r\n120\u00a0mg (green), 28-cap pack = \u00a329.15; 150\u00a0mg (blue), 28-cap pack =\r\n\u00a336.43; 200\u00a0mg (red-brown), 28-cap pack = \u00a346.15. \r\n Label:\r\n 2, counselling, see belowDose\u00a0every 24 hours, dose adjusted according to daily morphine requirements; for further advice on determining\r\ndose, see Prescribing in Palliative\r\nCare;\r\ndosage requirements should be reviewed if the brand is alteredCounselling\u00a0Swallow whole or open capsule and\r\nsprinkle contents on soft foodNote\u00a0Prescriptions must also specify \u2018capsules\u2019\r\n(i.e. \u2018MXL capsules\u2019)" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "DIPHTHERIA-CONTAINING VACCINES Diphtheria-containing vaccines for children over 10 years and adults": { "indications": "Indications\u00a0\n(From Diphtheria vaccines: British National Formulary)\nDiphtheria vaccines", "name": "DIPHTHERIA-CONTAINING VACCINES Diphtheria-containing vaccines for children over 10 years and adults", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Diphtheria vaccines", "DIPHTHERIA-CONTAINING VACCINES", "Diphtheria-containing vaccines for children over 10 years and adults" ], "cautions": "Cautions\u00a0see section 14.1 and see also individual components\r\nof vaccines", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nrestlessness, sleep disturbances, and unusual crying in infants", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129024.htm", "doses": [ "See under preparations", "Name[Adsorbed Diphtheria [low dose], Tetanus and Poliomyelitis\r\n(Inactivated) Vaccine ] Injection, suspension of diphtheria\r\ntoxoid [low dose], tetanus toxoid and inactivated poliomyelitis vaccine\r\ncomponents adsorbed on a mineral carrier, net price 0.5-mL prefilled\r\nsyringe = \u00a36.35Excipients may include neomycin, polymyxin\r\nB and streptomycin Dose\u00a0by intramuscular injection, adult and child over\r\n10 years, primary immunisation, 3 doses each of 0.5\u00a0mL separated by\r\nintervals of 1 month; second booster dose, 0.5\u00a0mL given 10 years after\r\nfirst booster dose (may also be used as first booster dose in those\r\nover 10 years who have received only 3 previous doses of a diphtheria-containing\r\nvaccine); see also notes on booster doses and contactsBrands include Revaxis\u00ae; available as part of immunisation schedule,\r\nfrom health organisations or ImmForm" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "IRON DEXTRAN": { "indications": "Indications\u00a0iron-deficiency\r\nanaemia, \n(From 9.1.1.2 Parenteral iron: British National Formulary)\n9.1.1.2 Parenteral iron", "name": "IRON DEXTRAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.2 Parenteral iron", "IRON DEXTRAN" ], "cautions": "Cautions\u00a0oral iron should not be given until 5\r\ndays after last injectionAnaphylaxis\u00a0Anaphylactic reactions\r\ncan occur with parenteral iron and a test dose is recommended before each dose; the patient should be carefully observed for\r\n60 minutes after the first test dose and for 15 minutes after subsequent\r\ntest doses (subsequent test doses not necessary for intramuscular\r\nadministration). Facilities for cardiopulmonary\r\nresuscitation must be available; risk of allergic reactions\r\nincreased in immune or inflammatory conditions", "side-effects": "Side-effects\u00a0less commonly nausea, vomiting,\r\nabdominal pain, flushing, dyspnoea, anaphylactic reactions (see Anaphylaxis\r\nabove), numbness, cramps, blurred vision, pruritus, and rash; rarely diarrhoea, chest pain, hypotension, angioedema,\r\narrhythmias, tachycardia, dizziness, restlessness, fatigue, seizures,\r\ntremor, impaired consciousness, myalgia, arthralgia, sweating, and\r\ninjection-site reactions; very rarely hypertension,\r\npalpitation, headache, paraesthesia, haemolysis, and transient deafness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/75068.htm", "doses": [ "By deep intramuscular injection into\r\nthe gluteal muscle or by slow intravenous\r\ninjection or by intravenous infusion, calculated according to body-weight and iron deficit, consult product\r\nliterature", "child under 14 years, not recommended" ], "pregnancy": "Pregnancy\u00a0avoid in first trimester" }, "INDAPAMIDE Modified release": { "indications": "Indications\u00a0essential hypertension", "name": "INDAPAMIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "INDAPAMIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics); also acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ; also\r\npalpitation, diuresis with doses above 2.5\u00a0mg daily", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201655.htm", "doses": [ "2.5\u00a0mg daily in the morning", "Name[Ethibide XL\u00ae (Genus) ] Tablets, m/r, indapamide\r\n1.5\u00a0mg, net price 30-tab pack = \u00a34.05. \r\n Label:\r\n 25Dose\u00a0hypertension, 1 tablet daily, preferably in the morning" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "CALCIUM SALTS Parenteral preparations": { "indications": "Indications\u00a0see notes above; calcium deficiency", "name": "CALCIUM SALTS Parenteral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.1 Calcium supplements", "CALCIUM SALTS", "Parenteral preparations" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; avoid calcium chloride in respiratory acidosis or\r\nrespiratory failure; interactions: Appendix 1 (antacids, calcium\r\nsalts)", "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances; with injection, bradycardia, arrhythmias, peripheral vasodilatation,\r\nfall in blood pressure, sweating, injection-site reactions, severe\r\ntissue damage with extravasation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5048.htm", "doses": [ "By mouth, daily in divided doses, see notes above", "By slow intravenous injection, acute hypocalcaemia,\r\ncalcium gluconate 1\u20132\u00a0g (Ca2+ 2.25\u20134.5\u00a0mmol); child see BNF for Children", "Name[Calcium Chloride (Non-proprietary) ] Injection, calcium chloride dihydrate\r\n10% (calcium 27.3\u00a0mg or Ca2+ 680\u00a0micromol/mL), net price\r\n10-mL disposable syringe = \u00a35.10Brands include Minijet\u00ae Calcium Chloride 10%\nInjection, calcium chloride dihydrate\r\n13.4% (calcium 36\u00a0mg or Ca2+ 910\u00a0micromol/mL), net price\r\n10-mL amp = \u00a314.94" ] }, "GOSERELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS": { "indications": "Indications\u00a0locally advanced prostate cancer as\r\nan alternative to surgical castration; adjuvant treatment to radiotherapy\r\nor radical prostatectomy in patients with high-risk localised or locally\r\nadvanced prostate cancer; neoadjuvant treatment prior to radiotherapy\r\nin patients with high-risk localised or locally advanced prostate\r\ncancer; metastatic prostate cancer; advanced breast cancer; oestrogen-receptor-positive\r\nearly breast cancer (section 8.3.4.1); endometriosis, endometrial\r\nthinning, uterine fibroids, assisted reproduction (section 6.7.2)", "name": "GOSERELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues", "GOSERELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues are as effective as orchidectomy or diethylstilbestrol (section 8.3.1) but are expensive and require parenteral administration, at least initially. They cause initial stimulation then depression of luteinising hormone release by the pituitary. During the initial stage (1\u20132 weeks) increased production of testosterone may be associated with progression of prostate cancer. In susceptible patients this tumour \u2018flare\u2019 may cause spinal cord compression, ureteric obstruction or increased bone pain. When such problems are anticipated, alternative treatments (e.g. orchidectomy) or concomitant use of an anti-androgen such as cyproterone acetate or flutamide (see below) are recommended; anti-androgen treatment should be started before the gonadorelin analogue; diabetes; risk of ureteric obstruction\r\nand spinal cord compression in men", "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nSide-effects\u00a0The gonadorelin analogues cause side-effects similar to the menopause in women and orchidectomy in men and include hot flushes and sweating, sexual dysfunction, vaginal dryness or bleeding, and gynaecomastia or changes in breast size. Signs and symptoms of prostate or breast cancer may worsen initially (managed in prostate cancer with anti-androgens, see above). Other side-effects include hypersensitivity reactions (rashes, pruritus, asthma, and rarely anaphylaxis), injection site reactions (see Cautions), headache (rarely migraine), visual disturbances, dizziness, arthralgia and possibly myalgia, hair loss, peripheral oedema, gastro-intestinal disturbances, weight changes, sleep disorders, and mood changes.; also\r\ntransient changes in blood pressure; paraesthesia; rarely hypercalcaemia (in patients with metastatic breast cancer)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/36799.htm", "doses": [ "Name[Zoladex\u00ae LA (AstraZeneca) ] prostate cancer (see indications above), by subcutaneous\r\ninjection into anterior abdominal wall, 10.8\u00a0mg every 12 weeks" ], "pregnancy": "Pregnancy\u00a0see Goserelin, section 6.7.2" }, "DIAZEPAM - DRUGS USED IN STATUS EPILEPTICUS": { "indications": "Indications\u00a0status epilepticus; febrile convulsions (section 4.8.3); convulsions due to poisoning\r\n(see Emergency Treatment of Poisoning); other indications (section 4.1.2, section 10.2.2, and section 15.1.4.1)", "name": "DIAZEPAM - DRUGS USED IN STATUS EPILEPTICUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus", "DIAZEPAM" ], "cautions": "Cautions\u00a0see Diazepam, section 4.1.2; when given intravenously\r\nfacilities for reversing respiratory depression with mechanical ventilation\r\nmust be immediately available (but see also notes above)", "side-effects": "Side-effects\u00a0see Diazepam, section 4.1.2; hypotension\r\nand apnoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3619.htm", "doses": [ "Status epilepticus (but see notes above), febrile\r\nconvulsions, and convulsions due to poisoning, by intravenous\r\ninjection, 10\u00a0mg at a rate of 1\u00a0mL (5\u00a0mg) per minute, repeated\r\nonce after 10 minutes if necessary; child under 12 years, 300\u2013400\u00a0micrograms/kg (max. 10\u00a0mg) [unlicensed dose],\r\nrepeated once after 10 minutes if necessary", "By rectum as rectal solution, adult and child over\r\n12 years, 10\u201320\u00a0mg, repeated once after 10\u201315 minutes if necessary; elderly 10\u00a0mg; neonate [unlicensed] 1.25\u20132.5\u00a0mg; child 1\r\nmonth\u20131 year [unlicensed] 5\u00a0mg; 1\u20132 years 5\u00a0mg; 2\u201312 years 5\u201310\u00a0mg" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2, and Pregnancy" }, "PROPANTHELINE BROMIDE - URINARY INCONTINENCE": { "indications": "Indications\u00a0adult enuresis", "name": "PROPANTHELINE BROMIDE - URINARY INCONTINENCE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; ulcerative colitis", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\nfacial flushing", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4636.htm", "doses": [ "Initially 15\u00a0mg 3 times daily at least one hour before\r\nfood and 30\u00a0mg at bedtime, subsequently adjusted according to response\r\n(max. 120\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "RIMEXOLONE": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "RIMEXOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "RIMEXOLONE" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82621.htm", "doses": [ "Postoperative inflammation, apply 4 times daily\r\nfor 2 weeks, beginning 24 hours after surgery", "Steroid-responsive inflammation, apply at least\r\n4 times daily for up to 4 weeks", "Uveitis, apply every hour during daytime in week\r\n1, then every 2 hours in week 2, then 4 times daily in week 3, then\r\ntwice daily for first 4 days of week 4, then once daily for remaining\r\n3 days of week 4" ] }, "MOMETASONE FUROATE - DRUGS USED IN NASAL ALLERGY": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0see preparations", "name": "MOMETASONE FUROATE - DRUGS USED IN NASAL ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60799.htm", "doses": [ "prophylaxis and treatment of allergic rhinitis, adult and child over\r\n12 years, 100\u00a0micrograms (2 sprays) into each nostril once daily,\r\nincreased if necessary to max. 200\u00a0micrograms (4 sprays) into each\r\nnostril once daily; when control achieved reduce to 50\u00a0micrograms\r\n(1 spray) into each nostril once daily; child 6\u201312 years, 50\u00a0micrograms (1 spray) into each nostril\r\nonce daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "MOMETASONE FUROATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered." }, "ACICLOVIR - ANTIVIRALS": { "side-effects": "Side-effects\u00a0local irritation and inflammation, superficial\r\npunctate keratopathy; rarely blepharitis; very rarely hypersensitivity reactions including angioedema", "indications": "Indications\u00a0local treatment of herpes simplex\r\ninfections", "name": "ACICLOVIR - ANTIVIRALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5413.htm", "doses": [ "Apply 5 times daily (continue for at least 3 days after\r\ncomplete healing)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.3 Antivirals", "ACICLOVIR" ] }, "GLYCEROL": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "GLYCEROL" ], "indications": "Indications\u00a0constipation", "name": "GLYCEROL", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2219.htm", "doses": [ "See below", "1 suppository moistened with water before use, when required.\r\nThe usual sizes are for infant under\r\n1 year, small (1-g mould), child 1\u201312\r\nyears medium (2-g mould), adult and child over 12 years, large (4-g mould)" ] }, "ACEBUTOLOL": { "indications": "Indications\u00a0see under Dose", "name": "ACEBUTOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "ACEBUTOLOL" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2465.htm", "doses": [ "Hypertension, initially 400\u00a0mg once daily or 200\u00a0mg twice daily, increased after 2 weeks to 400\u00a0mg twice daily\r\nif necessary; up to 1.2\u00a0g daily has been used", "Angina, initially 400\u00a0mg once daily or 200\u00a0mg\r\ntwice daily; 300\u00a0mg 3\u00a0times daily in severe angina; up to 1.2\u00a0g daily\r\nhas been used", "Arrhythmias, 0.4\u20131.2\u00a0g daily in 2\u20133 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "RASAGILINE": { "indications": "Indications\u00a0Parkinson\u2019s disease, used alone or\r\nas adjunct to co-beneldopa or co-careldopa", "name": "RASAGILINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Monoamine-oxidase-B inhibitors" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; interactions: Appendix 1 (rasagiline)", "side-effects": "Side-effects\u00a0dry mouth, dyspepsia, constipation, flatulence;\r\nangina; headache, depression, anorexia, weight loss, abnormal dreams,\r\nvertigo, hallucinations; influenza-like symptoms; urinary urgency;\r\nleucopenia; arthralgia; conjunctivitis; rhinitis; rash, skin carcinoma; less commonly myocardial infarction, and cerebrovascular\r\naccident", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129434.htm", "doses": [ "1\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "Poultices": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices" ], "name": "Poultices", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5359.htm", "doses": [ "warm and apply directly or between layers of muslin; avoid\r\napplication of overheated poultice" ] }, "OESTROGENS FOR HRT Estradiol only": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT Estradiol only", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT", "Estradiol only" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4309.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch", "Name[Estraderm TTS\u00ae (Novartis) ] Patches, self-adhesive, estradiol, TTS\u00a025 patch (releasing approx. 25\u00a0micrograms/24 hours),\r\nnet price, 8-patch pack = \u00a35.96, 24-patch pack = \u00a317.88; TTS\u00a0100\r\npatch (releasing approx. 100\u00a0micrograms/24 hours), 8-patch\r\npack = \u00a37.22, 24-patch pack = \u00a321.72, 20-patch pack (hosp. only) =\r\n\u00a316.76. \r\n Label:\r\n Counselling, administrationDose\u00a0menopausal symptoms, 1 patch to be applied twice weekly\r\ncontinuously starting within 5 days of onset of menstruation (or at\r\nany time if cycles have ceased or are infrequent), with cyclical progestogen\r\nfor at least 12 days of each cycle in women with a uterus; initiate\r\ntherapy with TTS\u00a025 for first 3 months, subsequently\r\nadjust according to response" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "COLISTIMETHATE SODIUM": { "indications": "Indications\u00a0see notes above", "name": "COLISTIMETHATE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Polymyxins", "COLISTIMETHATE SODIUM" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2); risk of bronchospasm on inhalation\u2014may\r\nbe prevented or treated with a selective beta2 agonist; interactions: Appendix 1 (polymyxins)", "side-effects": "Side-effects\u00a0Specific side-effects for parenteral treatment\u00a0Neurotoxicity reported especially with excessive doses (including\r\napnoea, perioral and peripheral paraesthesia, vertigo, headache, muscle\r\nweakness; rarely vasomotor instability, slurred speech, confusion,\r\npsychosis, visual disturbances), nephrotoxicity, rashSpecific side-effects for inhaled treatment\u00a0Sore\r\nthroat, sore mouth, cough, bronchospasm", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127956.htm", "doses": [ "By slow intravenous injection into a totally\r\nimplantable venous access device, or by intravenous\r\ninfusion (but see notes above), adult and child body-weight under 60\u00a0kg,\r\n50\u00a0000\u201375\u00a0000\u00a0units/kg daily in 3 divided doses; body-weight over\r\n60\u00a0kg, 1\u20132\u00a0million units every 8 hours", " Plasma concentration monitoring required\r\nin renal impairment; recommended \u2018peak\u2019 plasma-colistimethate sodium\r\nconcentration (approx. 30 minutes after intravenous injection or infusion)\r\n10\u201315\u00a0mg/litre (125\u2013200\u00a0units/mL)", "By inhalation of nebulised solution, adult and child over\r\n2 years, 1\u20132\u00a0million\u00a0units twice daily; increased to 2 million\u00a0units\r\n3 times daily for subsequent respiratory isolates of Ps.\r\naeruginosa; child 1 month\u20132\r\nyears, 0.5\u20131\u00a0million\u00a0units twice daily; increased to 1 million\u00a0units\r\n3 times daily for subsequent respiratory isolates of Ps.\r\naeruginosa" ], "pregnancy": "Pregnancy\u00a0avoid\u2014possible risk of fetal toxicity especially\r\nin second and third trimesters" }, "POTASSIUM PERMANGANATE": { "indications": "Indications\u00a0cleansing and deodorising suppurating eczematous reactions and wounds", "name": "POTASSIUM PERMANGANATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.11 Skin cleansers, antiseptics, and desloughing agents", "13.11.6 Oxidisers and dyes", "POTASSIUM PERMANGANATE" ], "cautions": "Cautions\u00a0irritant to mucous membranes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6290.htm", "doses": [ "Wet dressings or baths, approx. 0.01% solution", "Stains skin and clothing", "to be diluted 1 in 10 to provide a 0.01% (1 in 10\u00a0000)\r\nsolution" ] }, "ERYTHROMYCIN": { "indications": "Indications\u00a0susceptible infections in patients with penicillin hypersensitivity;\r\noral infections (see notes above); campylobacter enteritis, syphilis,\r\nnon-gonococcal urethritis, respiratory-tract infections (including\r\nLegionella infection), skin infections (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy); chronic\r\nprostatitis; prophylaxis of diphtheria, group A streptococcal infection,\r\nand pneumococcal infection (Table 2, %s\n(From Table 2. Summary of antibacterial prophylaxis: British National Formulary)\nTable 2. Summary of antibacterial prophylaxis), and\r\npertussis; acne vulgaris and rosacea (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "ERYTHROMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides" ], "cautions": "Cautions\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nOral infections\u00a0The macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved. However, many organisms are now resistant to macrolides or rapidly develop resistance; their use should therefore be limited to short courses. Metronidazole (section 5.1.11) may be preferred as an alternative to a penicillin.Cautions\u00a0Macrolides should be used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. ; neonate under\r\n2 weeks (risk of hypertrophic pyloric stenosis); avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(macrolides)", "side-effects": "Side-effects\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nSide-effects\u00a0Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-effects of the macrolides, but they are mild and less frequent with azithromycin and clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice) and rash occur less frequently. Other side-effects reported rarely or very rarely include pancreatitis, antibiotic-associated colitis, QT interval prolongation, arrhythmias, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Generally reversible hearing loss (sometimes with tinnitus) has been reported after large doses of a macrolide; it occurs commonly after long-term therapy with azithromycin. Intravenous infusion may cause local tenderness and phlebitis.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3850.htm", "doses": [ "By mouth, adult and child over 8 years, 250\u2013500\u00a0mg\r\nevery 6 hours or 0.5\u20131\u00a0g every 12 hours (see notes\r\nabove); up to 4\u00a0g daily in divided doses in severe infections; neonate 12.5\u00a0mg/kg every 6 hours; child 1 month\u20132 years 125\u00a0mg every 6 hours or 250\u00a0mg every 12 hours, 2\u20138 years 250\u00a0mg every 6\u00a0hours or 500\u00a0mg every 12 hours, doses doubled for severe infections", "Early syphilis, 500\u00a0mg 4 times daily for 14 days; child 12\u201318 years see BNF for Children", "Uncomplicated genital chlamydia, non-gonococcal urethritis,\r\n500\u00a0mg twice daily for 14 days; child under 18 years see BNF for Children", "Lyme disease (see also section 5.1.1.3), 500\u00a0mg 4 times daily for\r\n14\u201321\u00a0days; child under 18 years see BNF for Children", "By intravenous infusion, adult and child severe\r\ninfections, 12.5\u00a0mg/kg every 6 hours; mild infections (when oral treatment\r\nnot possible), 6.25\u00a0mg/kg every 6 hours; neonate see BNF for Children" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "NORADRENALINE/NOREPINEPHRINE": { "indications": "Indications\u00a0see under dose", "name": "NORADRENALINE/NOREPINEPHRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.2 Vasoconstrictor sympathomimetics" ], "cautions": "Cautions\u00a0coronary, mesenteric,\r\nor peripheral vascular thrombosis; following myocardial infarction, Prinzmetal\u2019s\r\nvariant angina, hyperthyroidism, diabetes mellitus; hypoxia or hypercapnia; uncorrected\r\nhypovolaemia; elderly; extravasation at injection site may cause necrosis; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, hypoxia, arrhythmias,\r\nperipheral ischaemia, palpitation, hypertension, bradycardia, tachycardia,\r\ndyspnoea, headache, insomnia, confusion, anxiety, psychosis, weakness,\r\ntremor, urinary retention, angle-closure glaucoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2756.htm", "doses": [ "Acute hypotension, by intravenous infusion, via central venous catheter, of a solution containing noradrenaline\r\n40\u00a0micrograms (base)/mL at an initial rate of 0.16\u20130.33\u00a0mL/minute,\r\nadjusted according to response", "1\u00a0mg of noradrenaline base is equivalent\r\nto 2\u00a0mg of noradrenaline acid tartrate. Dose expressed as the base" ], "pregnancy": "Pregnancy\u00a0avoid\u2014may reduce placental perfusion" }, "ETHINYLESTRADIOL - ETHINYLESTRADIOL": { "indications": "Indications\u00a0see\r\nnotes above", "name": "ETHINYLESTRADIOL - ETHINYLESTRADIOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "Ethinylestradiol", "ETHINYLESTRADIOL" ], "cautions": "Cautions\u00a0cardiovascular disease (sodium retention with oedema, thromboembolism); see also under Combined Hormonal Contraceptives (section 7.3.1) and under Oestrogens for HRT ", "side-effects": "Side-effects\u00a0feminising effects in men; see also under Combined Hormonal Contraceptives (section 7.3.1) and under Oestrogens for HRT", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4334.htm", "doses": [ "Menopausal symptoms and osteoporosis prophylaxis, (with\r\nprogestogen for 12\u201314 days per cycle in women with intact uterus),\r\n10\u201350\u00a0micrograms daily for 21 days, repeated after 7-day tablet-free\r\nperiod", "Female hypogonadism, 10\u201350\u00a0micrograms daily, usually on cyclical\r\nbasis; initial oestrogen therapy should be followed by combined oestrogen\r\nand progestogen therapy", "Menstrual disorders, 20\u201350\u00a0micrograms daily from day 5 to 25\r\nof each cycle, with progestogen added either throughout the cycle\r\nor from day 15 to 25" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "VALACICLOVIR": { "indications": "Indications\u00a0treatment of herpes zoster; treatment\r\nof initial and suppression of recurrent herpes simplex infections\r\nof skin and mucous membranes including initial and recurrent genital\r\nherpes; reduction of transmission of genital herpes; prevention of\r\ncytomegalovirus disease following solid organ transplantation when\r\nvalganciclovir or ganciclovir cannot be used", "name": "VALACICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.1 Herpes simplex and varicella\u2013zoster infection", "VALACICLOVIR" ], "cautions": "Cautions\u00a0see under Aciclovir", "side-effects": "Side-effects\u00a0see under Aciclovir but neurological reactions\r\nmore frequent with high doses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/33567.htm", "doses": [ "Herpes zoster, 1\u00a0g 3 times daily for 7 days (in immunocompromised\r\ncontinue for 2 days after crusting of lesions); child 12\u201318 years see BNF for Children", "Herpes simplex, treatment of first episode,\r\n500\u00a0mg twice daily for 5 days, longer if new lesions appear during\r\ntreatment or if healing incomplete (1\u00a0g twice daily for 10 days in\r\nimmunocompromised or HIV-positive patients); treatment of recurrent infection, 500\u00a0mg twice daily for 3\u20135 days (1\u00a0g\r\ntwice daily for 5\u201310 days in immunocompromised or HIV-positive patients); child 12\u201318 years see BNF for Children", "Herpes labialis, treatment, adult and child over 12 years, initially\r\n2\u00a0g, then 2\u00a0g 12 hours after initial dose", "Herpes simplex, suppression, 500\u00a0mg daily in 1\u20132 divided doses\r\n(in immunocompromised or HIV positive patients, 500\u00a0mg twice daily);\r\ntherapy interrupted every 6\u201312 months to reassess recurrence frequency\u2014consider\r\nrestarting after two or more recurrences; child 12\u201318 years see BNF for Children", "Reduction of transmission of genital herpes, seek specialist\r\nadvice, 500\u00a0mg once daily to be taken by the infected partner", "Prevention of cytomegalovirus disease following solid organ\r\ntransplantation (preferably starting within 72 hours of transplantation),\r\n2\u00a0g 4 times daily usually for 90 days; child 12\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see under Aciclovir" }, "ABATACEPT": { "indications": "Indications\u00a0see under Cytokine Modulators, above", "name": "ABATACEPT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection (screen for\r\nlatent tuberculosis and viral hepatitis); do not initiate until active infections are controlled; children should be brought up to date with current immunisation\r\nschedule (section 14.1) before\r\ninitiating therapy; progressive multifocal leucoencephalopathy\u2014discontinue treatment\r\nif neurological symptoms present; elderly\r\n(increased risk of side-effects); interactions: Appendix 1 (abatacept)", "side-effects": "Side-effects\u00a0abdominal pain, diarrhoea, dyspepsia, nausea;\r\nflushing, hypertension; cough; dizziness, fatigue, headache; infection,\r\nrhinitis; rash; less commonly gastritis, stomatitis,\r\ntachycardia, bradycardia, palpitation, hypotension, dyspnoea, paraesthesia,\r\nweight gain, depression, anxiety, amenorrhoea, basal cell carcinoma,\r\nthrombocytopenia, leucopenia, arthralgia, pain in extremities, conjunctivitis,\r\nvisual disturbance, vertigo, bruising, alopecia, and dry skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130136.htm", "doses": [ "By intravenous infusion, rheumatoid\r\narthritis (see notes above), adult over 18 years, body-weight less than 60\u00a0kg,\r\n500\u00a0mg, repeated 2 weeks and 4 weeks after initial infusion, then\r\nevery 4 weeks; body-weight 60\u2013100\u00a0kg, 750\u00a0mg repeated 2 weeks and\r\n4 weeks after initial infusion, then every 4 weeks; body-weight over\r\n100\u00a0kg, 1\u00a0g repeated 2 weeks and 4 weeks after initial infusion, then\r\nevery 4 weeks", "Polyarticular juvenile idiopathic arthritis (see notes above), child 6\u201317 years, body-weight less than 75\u00a0kg, 10\u00a0mg/kg,\r\nrepeated 2 weeks and 4 weeks after initial infusion, then every 4\r\nweeks; body-weight 75\u2013100\u00a0kg, 750\u00a0mg, repeated 2 weeks and 4 weeks\r\nafter initial infusion, then every 4 weeks; body-weight over 100\u00a0kg,\r\n1\u00a0g, repeated 2 weeks and 4 weeks after initial infusion, then every\r\n4 weeks", "Review treatment if no response within 6\r\nmonths" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014effective\r\ncontraception required during treatment and for 14 weeks after last\r\ndose" }, "SITAGLIPTIN": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "SITAGLIPTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs" ], "cautions": "Cautions\u00a0discontinue if symptoms of acute pancreatitis\r\n(persistent, severe abdominal pain); interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; peripheral oedema;\r\nupper respiratory tract infection, nasopharyngitis; pain; less commonly dry mouth, anorexia, headache, drowsiness,\r\ndizziness, hypoglycaemia, osteoarthritis; also reported pancreatitis, rash, cutaneous vasculitis, and Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130071.htm", "doses": [ "adult over 18 years, 100\u00a0mg\r\nonce daily", "Dose of concomitant sulfonylurea\r\nor insulin may need to be reduced" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "ETODOLAC Modified release": { "indications": "Indications\u00a0pain and inflammation in rheumatoid arthritis and osteoarthritis", "name": "ETODOLAC Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "ETODOLAC", "Modified release" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also stomatitis, vasculitis, palpitation,\r\ndyspnoea, confusion, fatigue, paraesthesia, tremor, urinary frequency,\r\ndysuria, pyrexia, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200012.htm", "doses": [ "adult over 18 years, 300\u2013600\u00a0mg\r\ndaily in 1\u20132 divided doses", "Name[Etopan XL\u00ae (Taro) ] Tablets, m/r, f/c, grey, etodolac\r\n600\u00a0mg, net price 30-tab pack = \u00a314.60. \r\n Label:\r\n 25Dose\u00a01 tablet daily; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "SEVELAMER HYDROCHLORIDE": { "indications": "Indications\u00a0hyperphosphataemia in patients on haemodialysis or peritoneal dialysis", "name": "SEVELAMER HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "SEVELAMER HYDROCHLORIDE" ], "cautions": "Cautions\u00a0gastro-intestinal disorders; interactions: Appendix 1 (sevelamer)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, constipation,\r\ndiarrhoea, dyspepsia, flatulence; very rarely intestinal\r\nobstruction; also reported intestinal perforation,\r\nileus, diverticulitis, pruritus, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85902.htm", "doses": [ "adult over 18 years, initially\r\n2.4\u20134.8\u00a0g daily in 3 divided doses with meals, adjusted according\r\nto serum-phosphate concentration (usual dose range 2.4\u201312\u00a0g daily\r\nin 3 divided doses); child see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "HUMAN MENOPAUSAL GONADOTROPHINS Urofollitropin": { "indications": "Indications\u00a0see notes above", "name": "HUMAN MENOPAUSAL GONADOTROPHINS Urofollitropin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "HUMAN MENOPAUSAL GONADOTROPHINS", "Urofollitropin" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0ovarian hyperstimulation, increased risk of multiple\r\npregnancy and miscarriage, hypersensitivity reactions, gastro-intestinal\r\ndisturbances, headache, joint pain, fever, injection site reactions, very rarely thromboembolism; gynaecomastia, acne, and weight\r\ngain reported in men", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200068.htm", "doses": [ "By deep intramuscular or subcutaneous injection, according to patient\u2019s response", "Name[Fostimon\u00ae (Pharmasure) ] Injection, powder for reconstitution,\r\nurofollitropin as follicle-stimulating hormone 75\u00a0units, net price\r\nper vial (with solvent) = \u00a327.90; follicle-stimulating hormone 150\r\nunits, net price per vial (with solvent) = \u00a355.80. For intramuscular\r\nor subcutaneous injection" ], "pregnancy": "Pregnancy\u00a0avoid" }, "RAMIPRIL WITH FELODIPINE": { "indications": "Indications\u00a0hypertension in patients stabilised\r\non the individual components in the same proportions", "name": "RAMIPRIL WITH FELODIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\n2.5.5.1 Angiotensin-converting enzyme inhibitors; withdraw if ischaemic pain occurs or existing pain worsens shortly\r\nafter initiating treatment or if cardiogenic shock develops; severe left ventricular dysfunction; avoid grapefruit juice (may affect metabolism); interactions: Appendix 1 (ACE inhibitors, calcium\r\nchannel blockers)", "side-effects": "Side-effects\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nSide-effects\u00a0ACE inhibitors can cause profound hypotension (see Cautions) and renal impairment (see Renal effects above), and a persistent dry cough. They can also cause angioedema (onset may be delayed; higher incidence reported in Afro-Caribbean patients), rash (which may be associated with pruritus and urticaria), pancreatitis, and upper respiratory-tract symptoms such as sinusitis, rhinitis, and sore throat. Gastro-intestinal effects reported with ACE inhibitors include nausea, vomiting, dyspepsia, diarrhoea, constipation, and abdominal pain. Altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis, and hepatic failure have been reported\u2014discontinue if marked elevation of hepatic enzymes or jaundice. Hyperkalaemia, hypoglycaemia, and blood disorders including thrombocytopenia, leucopenia, neutropenia, and haemolytic anaemia have also been reported. Other reported side-effects include headache, dizziness, fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia, arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.; also\r\narrhythmias, gravitational oedema, flushing, headache, palpitation;\r\ndizziness, fatigue; conjunctivitis; skin reactions such as pruritus\r\nand rash; rarely loss of appetite, stomatitis, dry\r\nmouth; angina, syncope; bronchitis; confusion, anxiety, nervousness,\r\ndepression, fever; urinary frequency, impotence, decreased libido;\r\nmuscle cramps; gingival hyperplasia, cutaneous vasculitis; very rarely cerebrovascular accident, myocardial infarction;\r\nprecipitation or intensification of Raynaud\u2019s phenomenon; Stevens-Johnson\r\nsyndrome, pemphigoid exanthema, alopecia, onycholysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200392.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported.; toxicity\r\nin animal studies with felodipine; may inhibit labour;\r\navoid" }, "HYDROCORTISONE ACETATE": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "HYDROCORTISONE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5433.htm", "doses": [ "Apply eye drops every 30\u201360 minutes until controlled then\r\nreduce frequency to every 4 hours" ] }, "SIROLIMUS": { "indications": "Indications\u00a0prophylaxis of organ rejection in kidney allograft recipients (initially\r\nin combination with ciclosporin and corticosteroid, then with corticosteroid\r\nonly); see also under Dose", "name": "SIROLIMUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "SIROLIMUS" ], "cautions": "Cautions\u00a0monitor kidney function when given with\r\nciclosporin; monitor whole blood-sirolimus\r\ntrough concentration (Afro-Caribbean patients may require higher doses); hyperlipidaemia (monitor lipids); monitor urine proteins; increased susceptibility\r\nto infection (especially urinary-tract infection); increased susceptibility to lymphoma and other malignancies, particularly\r\nof the skin (limit exposure to UV light); interactions: Appendix 1 (sirolimus)", "side-effects": "Side-effects\u00a0abdominal pain, constipation, nausea, diarrhoea,\r\nascites, stomatitis; oedema, tachycardia, hypertension, hypercholesterolaemia,\r\nhypertriglyceridaemia, venous thromboembolism; pleural effusion, pneumonitis;\r\nheadache; pyrexia; proteinuria, haemolytic uraemic syndrome; anaemia,\r\nthrombocytopenia, thrombotic thrombocytopenic purpura, leucopenia,\r\nneutropenia, hypokalaemia, hypophosphataemia, hyperglycaemia, lymphocele;\r\narthralgia, osteonecrosis; epistaxis; acne, rash, impaired healing; less commonly pancreatitis, pulmonary embolism, pulmonary\r\nhaemorrhage, pericardial effusion, nephrotic syndrome, pancytopenia; rarely interstitial lung disease, alveolar proteinosis,\r\nhepatic necrosis, lymphoedema, and hypersensitivity reactions including\r\nanaphylactic reactions, angioedema, exfoliative dermatitis, and hypersensitivity\r\nvasculitis; focal segmental glomerulosclerosis and reversible impairment\r\nof male fertility also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106035.htm", "doses": [ "Initially 6\u00a0mg, after surgery (once wound has healed),\r\nthen 2\u00a0mg once daily (dose adjusted according to whole blood-sirolimus\r\ntrough concentration) in combination with ciclosporin and corticosteroid\r\nfor 2\u20133 months (sirolimus given 4 hours after ciclosporin); ciclosporin\r\nshould then be withdrawn over 4\u20138 weeks (if not possible, sirolimus\r\nshould be discontinued and an alternate immunosuppressive regimen\r\nused)", "Manufacturer advises pre-dose (\u2018trough\u2019)\r\nwhole blood-sirolimus concentration (using chromatographic assay) when used with ciclosporin should be 4\u201312\u00a0micrograms/litre\r\n(local treatment protocols may differ); after withdrawal of ciclosporin\r\npre-dose whole blood-sirolimus concentration should be 12\u201320\u00a0micrograms/litre\r\n(local treatment protocols may differ); close monitoring\r\nof whole blood-sirolimus concentration required if concomitant treatment\r\nwith potent inducers or inhibitors of metabolism and after discontinuing\r\nthem, or if ciclosporin dose reduced significantly or stopped; see\r\nalso Hepatic Impairment above", "When changing between oral solution and tablets, measurement\r\nof whole blood \u2018trough\u2019 sirolimus concentration after 1\u20132 weeks is\r\nrecommended", "Sirolimus whole-blood\r\nconcentration is measured using either high performance liquid chromatography\r\n(HPLC) or immunoassay. Switching between different immunoassays or\r\nbetween an immunoassay and HPLC can lead to clinically significant\r\ndifferences in results and therefore incorrect dose adjustments. Adjustment\r\nto the target therapeutic dose range should be made with knowledge\r\nof the assay used and corresponding reference range" ], "pregnancy": "Pregnancy\u00a0avoid unless essential\u2014(toxicity in animal studies); effective contraception must be used during treatment\r\nand for 12 weeks after stopping" }, "FLUOCORTOLONE": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas unresponsive to\r\nless potent corticosteroids; psoriasis, \n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "FLUOCORTOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUOCORTOLONE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5916.htm", "doses": [ "Apply thinly 1\u20132 times daily, reducing strength as condition\r\nresponds" ] }, "DOXAZOSIN Modified-release": { "indications": "Indications\u00a0hypertension (see notes above); benign prostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "DOXAZOSIN Modified-release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "DOXAZOSIN", "Modified-release" ], "cautions": "Cautions\u00a0care with initial dose (postural hypotension); pulmonary oedema due to aortic or mitral stenosis; cataract surgery (risk of intra-operative\r\nfloppy iris syndrome); heart failure; interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance\r\nof skilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\ndyspnoea, coughing; fatigue, vertigo, paraesthesia, sleep disturbance,\r\nanxiety; influenza-like symptoms; back pain, myalgia; less\r\ncommonly weight changes, angina, myocardial infarction, hypoaesthesia,\r\ntremor, agitation, micturition disturbance, epistaxis, arthralgia,\r\ntinnitus, and gout; very rarely cholestasis, hepatitis,\r\njaundice, bradycardia, arrhythmias, bronchospasm, hot flushes, gynaecomastia,\r\nabnormal ejaculation, leucopenia, thrombocytopenia, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106041.htm", "doses": [ "Hypertension, 1\u00a0mg daily, increased after 1\u20132 weeks to\r\n2\u00a0mg once daily, and thereafter to 4\u00a0mg once daily, if necessary;\r\nmax. 16\u00a0mg daily", "Name[Cardura\u00ae XL (Pfizer) ] Tablets, m/r, doxazosin (as mesilate)\r\n4\u00a0mg, net price 28-tab pack = \u00a35.00; 8\u00a0mg, 28-tab pack = \u00a39.98. \r\n Label:\r\n 25, counselling, driving, initial doseDose\u00a0hypertension, benign prostatic hyperplasia, 4\u00a0mg once\r\ndaily, increased to 8\u00a0mg once daily after 4 weeks if necessary" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "CHLORDIAZEPOXIDE HYDROCHLORIDE": { "indications": "Indications\u00a0short-term use in anxiety (see section 4.1);\r\nadjunct in acute alcohol withdrawal (section 4.10.1)", "name": "CHLORDIAZEPOXIDE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Benzodiazepines", "CHLORDIAZEPOXIDE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see under Diazepam", "side-effects": "Side-effects\u00a0see under Diazepam", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3179.htm", "doses": [ "Anxiety, 10\u00a0mg 3 times daily increased if necessary to\r\n60\u2013100\u00a0mg daily in divided doses; elderly (or debilitated) half adult dose; child not recommended", "Treatment of alcohol withdrawal in moderate dependence, 10\u201330\u00a0mg\r\n4 times daily (according to local protocol), gradually reduced over\r\n5\u20137 days", "Treatment of alcohol withdrawal in severe dependence, 10\u201350\u00a0mg\r\n4 times daily (with 10\u201340\u00a0mg as required, if necessary, for the first\r\n2 days; max. total daily dose 250\u00a0mg) (according to local protocol),\r\ngradually reduced over 7\u201310 days" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "BECLOMETASONE DIPROPIONATE Compound preparations": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "BECLOMETASONE DIPROPIONATE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids", "BECLOMETASONE DIPROPIONATE", "Compound preparations" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200011.htm", "doses": [ "By aerosol inhalation, see Management of Chronic Asthma\r\ntable (important: for Clenil Modulite\u00ae and Qvar\u00ae, see under preparations)", "By inhalation of dry powder (important: for Asmabec\u00ae and Becodisks\u00ae, see\r\nunder preparations), 200\u2013400\u00a0micrograms twice daily; adjusted as necessary\r\nup to 800\u00a0micrograms twice daily; child over 5 years 100\u2013200\u00a0micrograms twice daily, adjusted as necessary", "Name[Fostair\u00ae (Chiesi) ] Aerosol inhalation, beclometasone\r\ndipropionate 100\u00a0micrograms, formoterol fumarate 6\u00a0micrograms/metered\r\ninhalation, net price 120-dose unit = \u00a329.32. \r\n Label:\r\n 8, counselling, administration, 10, steroid card with high dosesDose\u00a0by aerosol inhalation, asthma, adult over 18 years, 1\u20132 puffs twice daily; max.\r\n4 puffs dailyWhen switching patients from other beclometasone\r\ndipropionate and formoterol fumarate inhalers, Fostair\u00ae 100/6 can be prescribed for patients already using\r\nbeclometasone dipropionate 250\u00a0micrograms in another CFC-free inhaler;\r\nthe dose of Fostair\u00ae should be adjusted according\r\nto responseNote\u00a0The MHRA has advised (July 2008) that beclometasone\r\ndipropionate CFC-free inhalers should be prescribed by brand name" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "TRANDOLAPRIL": { "indications": "Indications\u00a0mild to moderate hypertension; following myocardial\r\ninfarction in patients with left ventricular dysfunction", "name": "TRANDOLAPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also ileus, dry mouth; tachycardia,\r\npalpitation, arrhythmias, angina, transient ischaemic attacks, cerebral\r\nhaemorrhage, myocardial infarction, syncope; dyspnoea, bronchitis;\r\nasthenia, nervousness, sleep disturbances; hot flushes; alopecia,\r\nsweating, skin reactions including Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, and psoriasis-like efflorescence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2605.htm", "doses": [ "Hypertension, initially 500\u00a0micrograms once daily, increased\r\nat intervals of 2\u20134 weeks; usual range 1\u20132\u00a0mg once daily; max. 4\u00a0mg\r\ndaily; if used in addition to diuretic see notes above", "Prophylaxis after myocardial infarction (starting as early as\r\n3 days after infarction), initially 500\u00a0micrograms once daily, gradually\r\nincreased to max. 4\u00a0mg once daily", "If symptomatic hypotension develops during\r\ntitration, do not increase dose further; if possible, reduce dose\r\nof any adjunctive treatment and if this is not effective or feasible,\r\nreduce dose of trandolapril" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "GANCICLOVIR": { "indications": "Indications\u00a0life-threatening or sight-threatening\r\ncytomegalovirus infections in immunocompromised patients only; prevention\r\nof cytomegalovirus disease during immunosuppressive therapy following\r\norgan transplantation; local treatment of CMV retinitis (section\r\n11.3.3)", "name": "GANCICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.2 Cytomegalovirus infection" ], "cautions": "Cautions\u00a0close monitoring of full blood count (severe deterioration\r\nmay require correction and possibly treatment interruption); history of cytopenia; potential\r\ncarcinogen and teratogen; radiotherapy; ensure adequate hydration during intravenous\r\nadministration; vesicant\u2014infuse into vein\r\nwith adequate flow preferably using plastic cannula; children\r\n(possible risk of long-term carcinogenic or reproductive toxicity); interactions: Appendix 1 (ganciclovir)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, dyspepsia, abdominal\r\npain, constipation, flatulence, dysphagia, taste disturbance, hepatic\r\ndysfunction; dyspnoea, chest pain, cough; headache, insomnia, convulsions,\r\ndizziness, peripheral neuropathy, depression, anxiety, confusion,\r\nabnormal thinking, fatigue, weight loss, anorexia; infection, pyrexia,\r\nnight sweats; anaemia, leucopenia, thrombocytopenia, pancytopenia,\r\nrenal impairment; myalgia, arthralgia; macular oedema, retinal detachment,\r\nvitreous floaters, eye pain; ear pain; dermatitis, pruritus; injection-site\r\nreactions; less commonly mouth ulcers, pancreatitis,\r\narrhythmias, hypotension, anaphylactic reactions, psychosis, tremor,\r\nmale infertility, haematuria, disturbances in hearing and vision,\r\nand alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4005.htm", "doses": [ "By intravenous infusion, initially\r\n(induction) 5\u00a0mg/kg every 12 hours for 14\u201321 days for treatment or\r\nfor 7\u201314 days for prevention; maintenance (for patients at risk of\r\nrelapse of retinitis) 6\u00a0mg/kg daily on 5 days per week or 5\u00a0mg/kg daily until adequate recovery of immunity; if retinitis\r\nprogresses initial induction treatment may be repeated; child under 18 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic risk; ensure effective contraception\r\nduring treatment and barrier contraception for men during\r\nand for at least 90 days after treatment" }, "OMEGA-3-MARINE TRIGLYCERIDES": { "indications": "Indications\u00a0adjunct in the reduction of plasma triglycerides\r\nin severe hypertriglyceridaemia", "name": "OMEGA-3-MARINE TRIGLYCERIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Omega-3 fatty acid compounds", "OMEGA-3-MARINE TRIGLYCERIDES" ], "cautions": "Cautions\u00a0haemorrhagic disorders, anticoagulant treatment; aspirin-sensitive asthma; type 2 diabetes", "side-effects": "Side-effects\u00a0occasional nausea and belching", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2864.htm", "doses": [ "See under preparations below", "5 capsules twice daily with food", "5\u00a0mL twice daily with food" ] }, "MENINGOCOCCAL VACCINES Meningococcal polysaccharide A, C, W135 and Y vaccine": { "indications": "Indications\u00a0immunisation against Neisseria\r\nmeningitidis", "name": "MENINGOCOCCAL VACCINES Meningococcal polysaccharide A, C, W135 and Y vaccine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Meningococcal vaccines", "MENINGOCOCCAL VACCINES", "Meningococcal polysaccharide A, C, W135 and Y vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also rarely symptoms of meningitis reported (but no evidence\r\nthat the vaccine causes meningococcal C meningitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106193.htm", "doses": [ "See under preparations", "Name[ACWY Vax\u00ae (GSK) ] Injection, powder for reconstitution,\r\ncapsular polysaccharide antigens of Neisseria meningitidis groups A, C, W135, and Y, net price single-dose vial (with syringe\r\ncontaining diluent) = \u00a316.73Dose\u00a0by deep subcutaneous injection, adult and child over\r\n5 years 0.5\u00a0mL as a single dose; booster dose for those at continued\r\nrisk, 0.5\u00a0mL every 5 years" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "PIVMECILLINAM HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose below", "name": "PIVMECILLINAM HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.5 Mecillinams" ], "cautions": "Cautions\u00a0see under Benzylpenicillin (section 5.1.1.1); also liver\r\nand renal function tests required in long-term use; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Benzylpenicillin (section 5.1.1.1); nausea,\r\nvomiting, abdominal pain, headache, dizziness; also reported mouth\r\nulcers, oesophagitis, reduced serum and total body carnitine (especially with long-term or repeated use)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81581.htm", "doses": [ "Acute uncomplicated cystitis, adult and child over 40\u00a0kg, initially 400\u00a0mg\r\nthen 200\u00a0mg every 8 hours for 3 days ", "Chronic or recurrent bacteriuria, adult and child over 40\u00a0kg, 400\u00a0mg every\r\n6\u20138 hours ", "Urinary-tract infections, child under 40\u00a0kg, 20\u201340\u00a0mg/kg daily in 3\u20134 divided doses ", "Salmonellosis, not recommended therefore no dose stated", "Tablets should be swallowed whole\r\nwith plenty of fluid during meals while sitting or standing" ], "pregnancy": "Pregnancy\u00a0not known to be harmful, but manufacturer advises\r\navoid" }, "FLUPENTIXOL DECANOATE": { "indications": "Indications\u00a0maintenance in schizophrenia and other psychoses", "name": "FLUPENTIXOL DECANOATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "FLUPENTIXOL DECANOATE" ], "cautions": "Cautions\u00a0see Flupentixol (section 4.2.1) and notes above; an alternative antipsychotic may be necessary if symptoms such as\r\naggression or agitation appear", "side-effects": "Side-effects\u00a0see Flupentixol (section 4.2.1) and notes above,\r\nbut may have a mood elevating effect", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3266.htm", "doses": [ "By deep intramuscular injection into the\r\nupper outer buttock or lateral thigh, test dose 20\u00a0mg, then after\r\nat least 7 days 20\u201340\u00a0mg repeated at intervals of 2\u20134 weeks, adjusted\r\naccording to response; max. 400\u00a0mg weekly; usual maintenance dose\r\n50\u00a0mg every 4 weeks to 300\u00a0mg every 2 weeks; elderly initially quarter to half adult dose; child not recommended" ], "pregnancy": "Pregnancy\u00a0see section 4.2.1" }, "PARICALCITOL": { "indications": "Indications\u00a0see under preparations below", "name": "PARICALCITOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D" ], "cautions": "Cautions\u00a0monitor plasma calcium and phosphate\r\nduring dose titration and at least monthly when stabilised; monitor parathyroid hormone concentration; interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0see under Ergocalciferol; also\r\ndyspepsia, taste disturbance, breast tenderness, acne, pruritus, and\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129354.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises avoid unless potential benefit outweighs risk; see also under Ergocalciferol" }, "CABERGOLINE - BROMOCRIPTINE AND OTHER DOPAMINERGIC DRUGS": { "indications": "Indications\u00a0see notes above and under Dose", "name": "CABERGOLINE - BROMOCRIPTINE AND OTHER DOPAMINERGIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.1 Bromocriptine and other dopaminergic drugs", "CABERGOLINE" ], "cautions": "Cautions\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nCautions\u00a0see notes below; also bromocriptine and cabergoline should be used with caution in patients with a history of peptic ulcer, particularly in acromegalic patients. Treatment should be withdrawn if gastro-intestinal bleeding occurs. In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment). Bromocriptine and cabergoline should be used with caution in patients with Raynaud\u2019s syndrome and cardiovascular disease (see also Contra-indications under Bromocriptine, below). Monitor for fibrotic disease (see Fibrotic Reactions, below). Caution is also advised in patients with a history of serious mental disorders (especially psychotic disorders) and in those with acute porpyhria (see section 9.8.2). Tolerance may be reduced by alcohol.; also monthly pregnancy tests during the amenorrhoeic period; advise non-hormonal contraception if pregnancy not\r\ndesired (see also Pregnancy, below); interactions: Appendix 1 (cabergoline)", "side-effects": "Side-effects\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nSide-effects\u00a0Nausea, constipation, and headache are common side-effects of bromocriptine and cabergoline. Paraesthesia has been reported rarely. Other reported side-effects include hypotension (see also Hypotensive Reactions, below), drowsiness (see also Driving, below), dyskinesia, pathological gambling, increased libido, hypersexuality, leg cramps, allergic skin reactions, alopecia, and peripheral oedema. Bromocriptine and cabergoline have been associated with pleuritis, pleural effusion, cardiac valvulopathy, pericardial effusion, constrictive pericarditis, and retroperitoneal, pleural, and pulmonary fibrosis (see Fibrotic Reactions). ; also\r\ncardiac valvulopathy, dyspepsia, gastritis, epigastric and abdominal\r\npain, angina, syncope, depression, confusion, hallucinations, breast\r\npain; rarely vomiting, palpitation, epistaxis, digital\r\nvasospasm, hot flushes, transient hemianopia, muscle weakness; also reported erythromelalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/21316.htm", "doses": [ "Prevention of lactation (but see notes above and under\r\nContra-indications), during first day postpartum, 1\u00a0mg as a single\r\ndose; suppression of established lactation (but see notes above) 250\u00a0micrograms\r\nevery 12\u00a0hours for 2 days; child under\r\n16 years, not recommended", "Hyperprolactinaemic disorders, 500\u00a0micrograms weekly (as a single\r\ndose or as 2 divided doses on separate days) increased\r\nat monthly intervals in steps of 500\u00a0micrograms until optimal therapeutic\r\nresponse (usually 1\u00a0mg weekly, range 0.25\u20132\u00a0mg weekly) with monthly\r\nmonitoring of serum prolactin levels; reduce initial dose and increase\r\nmore gradually if patient intolerant; over 1\u00a0mg weekly give as divided\r\ndoses; up to 4.5\u00a0mg weekly has been used in hyperprolactinaemic patients; child under 16 years, not recommended", "Parkinson\u2019s disease, section 4.9.1" ], "pregnancy": "Pregnancy\u00a0exclude pregnancy before starting and discontinue\r\n1 month before intended conception (ovulatory cycles persist for 6\r\nmonths)\u2014discontinue if pregnancy occurs during treatment (specialist\r\nadvice needed)" }, "FERROUS FUMARATE With folic acid": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS FUMARATE With folic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "FERROUS FUMARATE", "With folic acid" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4879.htm", "doses": [ "See under preparations below and notes above", "Name[Galfer FA\u00ae (Thornton & Ross)] Capsules, red/yellow, ferrous\r\nfumarate 305\u00a0mg (100\u00a0mg iron), folic acid 350\u00a0micrograms, net price 100 = \u00a32.17Dose\u00a01 capsule daily before food" ] }, "LANSOPRAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "LANSOPRAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.5 Proton pump inhibitors", "LANSOPRAZOLE" ], "cautions": "Cautions\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nCautions\u00a0Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.; interactions: Appendix 1 (proton pump inhibitors)", "side-effects": "Side-effects\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nSide-effects\u00a0Side-effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.; also glossitis, pancreatitis,\r\nanorexia, restlessness, tremor, impotence, petechiae, and purpura; very rarely colitis, raised serum cholesterol or triglycerides", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/17818.htm", "doses": [ "Benign gastric ulcer, 30\u00a0mg daily in the morning for 8\r\nweeks", "Duodenal ulcer, 30\u00a0mg daily in the morning for 4 weeks; maintenance\r\n15\u00a0mg daily", "NSAID-associated duodenal or gastric ulcer, 30\u00a0mg once daily\r\nfor 4 weeks, continued for further 4 weeks if not fully healed; prophylaxis,\r\n15\u201330\u00a0mg once daily", "Eradication of Helicobacter pylori associated\r\nwith duodenal ulcer or ulcer-like dyspepsia, see Recommended Regimens for Helicobacter pylori Eradication", "Zollinger-Ellison syndrome (and other hypersecretory conditions),\r\ninitially 60\u00a0mg once daily adjusted according to response; daily doses\r\nof 120\u00a0mg or more given in two divided doses", "Gastro-oesophageal reflux disease, 30\u00a0mg daily in the morning\r\nfor 4 weeks, continued for further 4 weeks if not fully healed; maintenance\r\n15\u201330\u00a0mg daily", "Acid-related dyspepsia, 15\u201330\u00a0mg daily in the morning for 2\u20134\r\nweeks", "child under 18 years see BNF for Children", "Lansoprazole doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "TROSPIUM CHLORIDE Modified release": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence", "name": "TROSPIUM CHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "TROSPIUM CHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; rarely chest pain, dyspnoea, and asthenia; very\r\nrarely myalgia and arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204086.htm", "doses": [ "adult and child over 12 years, 20\u00a0mg twice daily before food", "Name[Regurin\u00ae XL (Speciality European) ] Capsules, orange/white, m/r, trospium chloride 60\u00a0mg, net price 28-cap pack = \u00a323.05. \r\n Label:\r\n 23, 25Dose\u00a0adult over 18 years, 60\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution" }, "SALICYLIC ACID - PREPARATIONS FOR WARTS AND CALLUSES": { "side-effects": "Side-effects\u00a0skin irritation, skin ulceration (with high concentrations)", "indications": "Indications\u00a0see under preparations; psoriasis (section 13.5.2); fungal nail infections (section 13.10.2)", "name": "SALICYLIC ACID - PREPARATIONS FOR WARTS AND CALLUSES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6057.htm", "doses": [ "See under preparations; advise patient to apply carefully\r\nto wart and to protect surrounding skin (e.g. with soft paraffin or\r\nspecially designed plaster); rub wart surface gently with file or\r\npumice stone once weekly; treatment may need to be continued for up\r\nto 3 months", "for plantar warts, apply daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses", "SALICYLIC ACID" ], "cautions": "Cautions\u00a0significant peripheral neuropathy, patients with diabetes at risk of neuropathic ulcers; impaired peripheral circulation; protect surrounding skin and avoid broken\r\nskin; not suitable for application to face, anogenital region, or large areas" }, "FLAVOXATE HYDROCHLORIDE": { "indications": "Indications\u00a0urinary frequency and incontinence, dysuria, urgency; bladder spasms\r\ndue to catheterisation, cytoscopy, or surgery", "name": "FLAVOXATE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\nvertigo, eosinophilia, leucopenia, urticaria, erythema, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4631.htm", "doses": [ "adult and child over 12 years, 200\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless no safer alternative" }, "LOFEPRAMINE": { "indications": "Indications\u00a0depressive illness", "name": "LOFEPRAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "LOFEPRAMINE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\noedema and hepatic disorders reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38848.htm", "doses": [ "140\u2013210\u00a0mg daily in divided doses; elderly may respond to lower doses; child under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0neonatal withdrawal symptoms and respiratory depression\r\nreported if used during third trimester" }, "COLECALCIFEROL With calcium": { "indications": "Indications\u00a0see notes above", "name": "COLECALCIFEROL With calcium", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "COLECALCIFEROL", "With calcium" ], "cautions": "Cautions\u00a0see under Ergocalciferol", "side-effects": "Side-effects\u00a0see under Ergocalciferol", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56424.htm", "doses": [ "See notes above", "Name[Cacit\u00ae D3 (Warner Chilcott)] Granules, effervescent, lemon flavour,\r\ncalcium carbonate 1.25\u00a0g (calcium 500\u00a0mg or Ca2+ 12.5\u00a0mmol), colecalciferol 11\u00a0micrograms (440\u00a0units)/sachet, net price\r\n30-sachet pack = \u00a34.06. \r\n Label:\r\n 13" ], "pregnancy": "Pregnancy\u00a0see under Ergocalciferol" }, "PNEUMOCOCCAL VACCINE Pneumococcal polysaccharide conjugate vaccine (adsorbed)": { "indications": "Indications\u00a0immunisation against pneumococcal infection", "name": "PNEUMOCOCCAL VACCINE Pneumococcal polysaccharide conjugate vaccine (adsorbed)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Pneumococcal vaccines", "PNEUMOCOCCAL VACCINE", "Pneumococcal polysaccharide conjugate vaccine (adsorbed)" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also Revaccination, above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207827.htm", "doses": [ "See under preparations", "Name[Prevenar 13\u00ae (Wyeth) ] Injection, polysaccharide from each\r\nof 13 capsular types of pneumococcus (conjugated to carrier protein)\r\nadsorbed onto aluminium phosphate, net price 0.5-mL prefilled syringe\r\n= \u00a349.10Dose\u00a0by intramuscular injection, child 2 months\u20135 years, 0.5\u00a0mL (see notes above and Immunisation\r\nschedule, section 14.1)Note\u00a0Deltoid muscle is preferred site of injection\r\nin young children; anterolateral thigh is preferred site in infants.The dose in the BNF may differ from that in product literature.Available as part of childhood immunisation schedule from ImmForm" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "RABIES IMMUNOGLOBULIN": { "indications": "Indications\u00a0post-exposure prophylaxis against rabies\r\ninfection", "name": "RABIES IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Rabies" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines\u2014see under Normal Immunoglobulin", "side-effects": "Side-effects\u00a0injection site swelling and pain; very\r\nrarely anaphylaxis; buccal ulceration, glossitis, chest tightness,\r\ndyspnoea, tremor, dizziness, arthralgia, and facial oedema also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202720.htm", "doses": [ "See under preparation" ] }, "CHLORHEXIDINE GLUCONATE": { "indications": "Indications\u00a0see under preparations below", "name": "CHLORHEXIDINE GLUCONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "CHLORHEXIDINE GLUCONATE" ], "side-effects": "Side-effects\u00a0mucosal irritation (if desquamation occurs, discontinue\r\ntreatment or dilute mouthwash with an equal volume of water); taste\r\ndisturbance; reversible brown staining of teeth, and of silicate or\r\ncomposite restorations; tongue discoloration; parotid gland swelling\r\nreportedNote\u00a0Chlorhexidine gluconate\r\nmay be incompatible with some ingredients in toothpaste; leave an\r\ninterval of at least 30 minutes between using mouthwash and toothpaste", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5735.htm", "doses": [ "oral hygiene and plaque inhibition and gingivitis, brush\r\non the teeth once or twice daily", "oral hygiene and plaque inhibition, oral candidiasis,\r\ngingivitis, and management of aphthous ulcers, rinse mouth with 10\u00a0mL\r\nfor about 1 minute twice daily ", "oral hygiene and plaque inhibition, oral candidiasis,\r\ngingivitis, and management of aphthous ulcers, apply as required to\r\ntooth, gingival, or ulcer surfaces using up to 12 actuations (approx.\r\n0.14\u00a0mL/actuation) twice daily" ] }, "ALPROSTADIL Intracavernosal injection": { "indications": "Indications\u00a0erectile dysfunction (including aid to diagnosis)", "name": "ALPROSTADIL Intracavernosal injection", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Alprostadil", "ALPROSTADIL", "Intracavernosal injection" ], "cautions": "Cautions\u00a0priapism\u2014patients\r\nshould be instructed to report any erection lasting 4\u00a0hours or longer\u2014for management, see section 7.4.5; anatomical deformations of\r\npenis (painful erection more likely)\u2014follow up regularly to detect\r\nsigns of penile fibrosis (consider discontinuation if\r\nangulation, cavernosal fibrosis or Peyronie\u2019s disease develop); interactions: Appendix 1 (prostaglandins)", "side-effects": "Side-effects\u00a0hypotension, hypertension; dizziness, headache;\r\npenile pain, other localised pain (buttocks, leg, testicular, abdominal);\r\ninfluenza-like syndrome; urethral burning, urethral bleeding; injection\r\nsite reactions including penile fibrosis, penile oedema, penile rash,\r\nhaematoma, haemosiderin deposits; less commonly nausea,\r\ndry mouth, vasodilatation, syncope, supraventricular extrasystole,\r\nrapid pulse, asthenia, leg cramps, pelvic pain, scrotal or testicular\r\noedema, scrotal erythema, testicular thickening, micturation difficulties,\r\nhaematuria, mydriasis, and sweating; local reactions including penile\r\nwarmth, pruritus, irritation, penile numbness or sensitivity, balantitis,\r\nphimosis, priapism (see section 7.4.5 and under Cautions), abnormal ejaculation; rarely vertigo, urinary-tract infection, and hypersensitivity\r\nreactions (including rash, erythema, urticaria, and anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/18536.htm", "doses": [ "See under preparations below", "The first dose must be given\r\nby medically trained personnel; self-administration\r\nmay only be undertaken after proper training ", "Name[(1)Caverject\u00ae (Pharmacia) ] Injection, powder for reconstitution, alprostadil, net price 5-microgram vial = \u00a37.73; 10-microgram\r\nvial = \u00a39.24; 20-microgram vial = \u00a311.94; 40-microgram vial = \u00a321.58\r\n(all with diluent-filled syringe, needles and swabs)\nCaverject\u00ae Dual Chamber, double-chamber\r\ncartridges (containing alprostadil and diluent),\r\nnet price 10-microgram cartridge (for doses 2.5\u201310\u00a0micrograms) = \u00a37.35;\r\n20-microgram cartridge (for doses 5\u201320\u00a0micrograms) = \u00a39.50 (both with\r\nneedles)Dose\u00a0by direct intracavernosal injection, adult over 18 years, erectile dysfunction, first\r\ndose 2.5\u00a0micrograms, second dose 5\u00a0micrograms (if some response to\r\nfirst dose) or 7.5\u00a0micrograms (if no response to\r\nfirst dose), increasing in steps of 5\u201310\u00a0micrograms to obtain dose\r\nsuitable for producing erection lasting not more than 1 hour (neurological\r\ndysfunction, first dose 1.25\u00a0micrograms, second dose 2.5\u00a0micrograms,\r\nthird dose 5\u00a0micrograms, increasing in steps of 5\u201310\u00a0micrograms to\r\nobtain suitable dose); if no response to dose then next higher dose\r\ncan be given within 1 hour, if there is a response the next dose should\r\nnot be given for at least 24\u00a0hours; usual dose 5\u201320\u00a0micrograms; max.\r\n60\u00a0micrograms; max. frequency of injection not more than 3 times per\r\nweek with at least 24 hour interval between injectionsNote\u00a0The first dose must be given\r\nby medically trained personnel; self-administration\r\nmay only be undertaken after proper training Aid to diagnosis, 10\u201320\u00a0micrograms as a single dose (where\r\nevidence of neurological dysfunction, initially 5\u00a0micrograms and max.\r\n10\u00a0micrograms)\u2014consult product literature for details" ] }, "MORPHINE SALTS Injections": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Injections", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Injections" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3502.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[Morphine Sulphate (Non-proprietary) ] Injection, morphine sulphate 10, 15, 20, and 30\u00a0mg/mL, net price 1- and 2-mL amp (all)\r\n= 72p\u2013\u00a31.40\nIntravenous infusion, morphine sulphate 1\u00a0mg/mL, net price 50-mL vial = \u00a35.00; 2\u00a0mg/mL, 50-mL vial\r\n= \u00a35.89" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "NATALIZUMAB": { "indications": "Indications\u00a0\n(From Natalizumab: British National Formulary)\nNatalizumab", "name": "NATALIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Natalizumab", "NATALIZUMAB" ], "cautions": "Cautions\u00a0\n(From Natalizumab: British National Formulary)\nNatalizumab and consult product\r\nliterature; prior treatment with immunosuppressants\r\n(increased risk of progressive multifocal leukoencephalopathy); monitor liver function (see below)Liver toxicity\u00a0Liver dysfunction reported; advise patients to seek immediate medical attention if symptoms such\r\nas jaundice or dark urine develop; discontinue\r\ntreatment if significant liver injury occursProgressive multifocal leucoencephalopathy (PML)\u00a0Patients should be informed about the risks of PML before\r\nstarting treatment with natalizumab and again after 2 years; they\r\nshould be given an alert card which includes information about the\r\nsymptoms of PML (see also %s\n(From Natalizumab: British National Formulary)\nNatalizumab)Hypersensitivity reactions\u00a0Patients\r\nshould be told the importance of uninterrupted dosing, particularly\r\nin the early months of treatment (intermittent therapy may increase\r\nrisk of sensitisation)", "side-effects": "Side-effects\u00a0\n(From Natalizumab: British National Formulary)\nNatalizumab; also urinary-tract infection,\r\nnasopharyngitis, autoantibodies, and arthralgia; less commonly hypersensitivity reactions (see above); liver toxicity also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129975.htm", "doses": [ "By intravenous infusion, adult over 18 years, 300\u00a0mg once every 4 weeks; discontinue\r\nif no response after 6 months" ], "pregnancy": "Pregnancy\u00a0avoid unless essential\u2014toxicity in animal studies" }, "GLUCOSE": { "indications": "Indications\u00a0fluid replacement (see notes above),\r\nprovision of energy (%s\n(From 9.3 Intravenous nutrition: British National Formulary)\n9.3 Intravenous nutrition); hypoglycaemia (%s\n(From 6.1.4 Treatment of hypoglycaemia: British National Formulary)\n6.1.4 Treatment of hypoglycaemia) ", "name": "GLUCOSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Intravenous glucose" ], "side-effects": "Side-effects\u00a0glucose injections especially\r\nif hypertonic may have a low pH and may cause venous irritation and\r\nthrombophlebitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4979.htm", "doses": [ "Water replacement, see notes above; energy source, 1\u20133\u00a0litres\r\ndaily of 20\u201350% solution" ] }, "HYDROXYZINE HYDROCHLORIDE": { "indications": "Indications\u00a0pruritus", "name": "HYDROXYZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).; also susceptibility to QT-interval prolongation", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3092.htm", "doses": [ "Pruritus, initially 25\u00a0mg at night increased if necessary\r\nto 25\u00a0mg 3\u20134 times daily; child 1\u20136\r\nyears initially 5\u201315\u00a0mg at night increased if necessary to 50\u00a0mg daily\r\nin 3\u20134 divided doses; 6\u201312 years initially 15\u201325\u00a0mg at night increased\r\nif necessary to 50\u2013100\u00a0mg daily in 3\u20134 divided doses; child under 1 year see BNF for Children" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies with\r\nhigh doses; see also notes above" }, "PREDNISOLONE - GLUCOCORTICOID THERAPY": { "indications": "Indications\u00a0suppression of inflammatory and allergic disorders; see also notes\r\nabove; inflammatory bowel disease (section 1.5); asthma (section 3.1 and section 3.2); croup (section 3.1); immunosuppression (section 8.2.2); rheumatic\r\ndisease (section 10.1.2); eye (section 11.4.1); ear (section 12.1.1)", "name": "PREDNISOLONE - GLUCOCORTICOID THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids; also Duchenne\u2019s muscular dystrophy (possible transient rhabdomyolysis\r\nand myoglobinuria following strenuous physical activity)", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4258.htm", "doses": [ "By mouth, initially, up to 10\u201320\u00a0mg\r\ndaily (severe disease, up to 60\u00a0mg daily), preferably taken in the\r\nmorning after breakfast; can often be reduced within a few days but\r\nmay need to be continued for several weeks or months", "Maintenance, usual range, 2.5\u201315\u00a0mg daily, but higher doses\r\nmay be needed; cushingoid side-effects increasingly likely with doses\r\nabove 7.5\u00a0mg daily", "By intramuscular injection, prednisolone acetate (section 10.1.2.2), 25\u2013100\u00a0mg once or twice\r\nweekly" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "FROVATRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine", "name": "FROVATRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists", "FROVATRIPTAN" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; interactions: Appendix 1 (5HT1 agonists)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; also dry mouth, dyspepsia, abdominal pain,\r\nparaesthesia, drowsiness, headache, visual disturbances, sweating; less commonly diarrhoea, dysphagia, flatulence, tachycardia,\r\npalpitation, hypertension, rhinitis, pharyngitis, sinusitis, laryngitis,\r\ntremor, anxiety, asthenia, insomnia, confusion, nervousness, impaired\r\nconcentration, agitation, depression, depersonalisation, taste disturbances,\r\nmicturition disorders, thirst, dehydration, arthralgia, muscle stiffness,\r\ntinnitus, vertigo, pruritus; rarely constipation,\r\ngastro-oesophageal reflux, irritable bowel syndrome, hiccup, peptic\r\nulcer, stomatitis, bradycardia, hyperventilation, amnesia, abnormal\r\ndreams, hypertonia, hypotonia, breast tenderness, hypocalcaemia, hypoglycaemia,\r\nbilirubinaemia, epistaxis, urticaria, pyrexia, and purpura", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128095.htm", "doses": [ "2.5\u00a0mg as soon as possible after onset repeated after\r\n2 hours if migraine recurs (patient not responding should not take\r\nsecond dose for same attack); max. 5\u00a0mg in 24 hours; child and adolescent under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "TENECTEPLASE": { "indications": "Indications\u00a0acute myocardial infarction (see notes above and %s\n(From 2.10.1 Management of stable angina and acute coronary syndromes: British National Formulary)\n2.10.1 Management of stable angina and acute coronary syndromes)", "name": "TENECTEPLASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.10 Stable angina, acute coronary syndromes, and fibrinolysis", "2.10.2 Fibrinolytic drugs" ], "cautions": "Cautions\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nCautions\u00a0Thrombolytic drugs should be used with caution if there is a risk of bleeding including that from venepuncture or invasive procedures. They should also be used with caution in external chest compression, elderly, hypertension, conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation), and recent or concurrent use of drugs that increase the risk of bleeding.", "side-effects": "Side-effects\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nSide-effects\u00a0Side-effects of thrombolytics are mainly nausea and vomiting and bleeding. When thrombolytics are used in myocardial infarction, reperfusion arrhythmias and recurrent ischaemia and angina may occur. Reperfusion may also cause cerebral and pulmonary oedema. Hypotension can also occur and can usually be controlled by elevating the patient\u2019s legs, or by reducing the rate of infusion or stopping it temporarily. Back pain, fever, and convulsions have been reported. Bleeding is usually limited to the site of injection, but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs (e.g. tranexamic acid). Rarely further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). Thrombolytics can cause allergic reactions (including rash, flushing and uveitis) and anaphylaxis has been reported (for details of management see Allergic Emergencies, section 3.4.3). Guillain-Barr\u00e9 syndrome has been reported rarely after streptokinase treatment.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106045.htm", "doses": [ "By intravenous injection over 10 seconds\r\n(initiated within 6 hours of symptom onset), 30\u201350\u00a0mg according to\r\nbody-weight\u2014consult product literature; max. 50\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From Heparin: British National Formulary)\nPregnancy\u00a0Heparins are used for the management of venous thromboembolism in pregnancy because they do not cross the placenta. Low molecular weight heparins are preferred because they have a lower risk of osteoporosis and of heparin-induced thrombocytopenia. Low molecular weight heparins are eliminated more rapidly in pregnancy, requiring alteration of the dosage regimen for drugs such as dalteparin, enoxaparin, and tinzaparin; see also under individual drugs. Treatment should be stopped at the onset of labour and advice sought from a specialist on continuing therapy after birth." }, "HALOPERIDOL - ANTIPSYCHOTIC DEPOT INJECTIONS": { "indications": "Indications\u00a0maintenance in schizophrenia\r\nand other psychoses", "name": "HALOPERIDOL - ANTIPSYCHOTIC DEPOT INJECTIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "HALOPERIDOL" ], "cautions": "Cautions\u00a0see Haloperidol (section 4.2.1) and notes above", "side-effects": "Side-effects\u00a0see Haloperidol (section 4.2.1) and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3274.htm", "doses": [ "By deep intramuscular injection into the\r\ngluteal muscle, initially 50\u00a0mg every 4 weeks, if necessary increasing\r\nby 50-mg increments to 300\u00a0mg every 4 weeks; higher doses may be needed\r\nin some patients; elderly, initially\r\n12.5\u201325\u00a0mg every 4 weeks; child not\r\nrecommended", "If 2-weekly administration preferred, doses\r\nshould be halved" ], "pregnancy": "Pregnancy\u00a0see section 4.2.1" }, "MECYSTEINE HYDROCHLORIDE": { "indications": "Indications\u00a0reduction of sputum viscosity", "name": "MECYSTEINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.7 Mucolytics", "MECYSTEINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 3.7 Mucolytics: British National Formulary)\nMucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3066.htm", "doses": [ "200\u00a0mg 4 times daily for 2 days, then 200\u00a0mg 3 times daily\r\nfor 6 weeks, then 200\u00a0mg twice daily; child 5\u201312 years 100\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "ELTROMBOPAG": { "indications": "Indications\u00a0\n(From Idiopathic thrombocytopenic purpura: British National Formulary)\nEltrombopag and romiplostim are thrombopoietin receptor agonists licensed for the treatment of chronic idiopathic thrombocytopenic purpura in splenectomised patients refractory to other treatments, such as corticosteroids or immunoglobulins, or as a second-line treatment in non-splenectomised patients when surgery is contra-indicated (see also NICE guidance below). Eltrombopag is an oral preparation and romiplostim is an injection which is made biosynthetically by recombinant DNA technology; they should both be used under the supervision of a specialist.", "name": "ELTROMBOPAG", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.4 Drugs used in platelet disorders", "Idiopathic thrombocytopenic purpura", "ELTROMBOPAG" ], "cautions": "Cautions\u00a0patients of East Asian origin (see under Dose); risk factors for thromboembolism; monitor full blood count including platelet count and peripheral\r\nblood smears every week during treatment until a stable platelet count\r\nis reached (50 \u00d7 109/litre or more for at least 4 weeks),\r\nthen monthly thereafter; monitor liver function before\r\ntreatment, every two weeks when adjusting the dose, and monthly thereafter; regular ophthalmological examinations for cataract\r\nformation recommended; interactions: Appendix 1 (eltrombopag)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances including nausea,\r\ndiarrhoea, abdominal pain, and constipation; peripheral oedema; headache,\r\ninsomnia, paraesthesia, fatigue; arthralgia, bone pain, myalgia; cataract,\r\ndry eye; pruritus, rash, alopecia; less commonly dry\r\nmouth, gingival bleeding, haemorrhoids, taste disturbances, cholestasis,\r\nhepatitis, anorexia, changes in appetite, weight gain, flushing, palpitation,\r\nQT-interval prolongation, hypertension, tachycardia, thromboembolic\r\nevents (including deep vein thrombosis, pulmonary embolism, and acute\r\nmyocardial infarction), cough, sleep disorders, mood changes, depression,\r\nanxiety, dizziness, migraine, hemiparesis, tremor, peripheral neuropathy,\r\nrespiratory and urinary tract infections, renal failure, nocturia,\r\nrectosigmoid cancer, blood disorders (including anaemia, and thrombocytopenia),\r\ngout, eye disorders, vertigo, epistaxis, skin reactions including\r\necchymosis, and sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208264.htm", "doses": [ "adult over 18 years, initially\r\n50\u00a0mg once daily (patients of east asian origin such as Chinese, Japanese, Taiwanese, or Korean, initially\r\n25\u00a0mg once daily), adjusted to achieve a platelet count of 50 \u00d7 109/litre or more (consult product literature for dose adjustments);\r\nmax. 75\u00a0mg once daily; discontinue if inadequate response after 4\r\nweeks at maximum dose ", "Each dose should be taken at least\r\n4 hours before or after any dairy products (or foods containing calcium),\r\nindigestion remedies, or medicines containing aluminium, calcium,\r\niron, magnesium, zinc, or selenium to reduce possible interference\r\nwith absorption" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies;\r\nensure effective contraception during treatment" }, "CLONAZEPAM - DRUGS USED IN STATUS EPILEPTICUS": { "indications": "Indications\u00a0status epilepticus; other\r\nforms of epilepsy, and myoclonus (section 4.8.1)", "name": "CLONAZEPAM - DRUGS USED IN STATUS EPILEPTICUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus", "CLONAZEPAM" ], "cautions": "Cautions\u00a0see Clonazepam, section 4.8.1; facilities for\r\nreversing respiratory depression with mechanical ventilation must\r\nbe at hand (but see also notes above) ", "side-effects": "Side-effects\u00a0see Clonazepam, section 4.8.1; hypotension\r\nand apnoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9934.htm", "doses": [ "By intravenous injection into a large vein\r\n(over at least 2 minutes), 1\u00a0mg, repeated if necessary; child all ages, 500\u00a0micrograms" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2, and Pregnancy" }, "BORTEZOMIB": { "indications": "Indications\u00a0\n(From Bortezomib: British National Formulary)\nBortezomib", "name": "BORTEZOMIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Bortezomib" ], "cautions": "Cautions\u00a0see section 8.1; cardiovascular disease; pulmonary disease (chest x-ray recommended before\r\ntreatment\u2014discontinue if interstitial lung disease develops); consider antiviral prophylaxis for herpes zoster infection; history of seizures; amyloidosis; risk of neuropathy\u2014consult product literature; monitor blood-glucose concentration in patients on\r\noral antidiabetics; interactions: Appendix\r\n1 (bortezomib)", "side-effects": "Side-effects\u00a0see section 8.1; also gastro-intestinal disturbances\r\nincluding constipation (cases of ileus reported), taste disturbance,\r\ndry mouth, decreased appetite; postural hypotension, hypertension,\r\nhaematoma, phlebitis, chest pain, oedema; dyspnoea, cough; confusion,\r\ndepression, insomnia, anxiety, peripheral neuropathy, paraesthesia,\r\nheadache, dizziness, tremor, asthenia, fatigue; reactivation of herpes\r\nzoster infection, influenza-like symptoms; renal impairment, dysuria;\r\ndehydration, hypokalaemia, hyperglycaemia; muscle cramps, arthralgia,\r\nbone pain; blurred vision, eye pain; epistaxis; urticaria, pruritus,\r\nerythema, dry skin, eczema, rash, increased sweating; less\r\ncommonly syncope, seizures; reversible posterior leucoencephalopathy\r\nsyndrome (discontinue treatment), toxic epidermal necrolysis, Sweet\u2019s\r\nsyndrome, and vasculitic rash also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128313.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises effective contraception during\r\nand for 3 months after treatment in men or women\u2014toxicity in animal studies; see also Pregnancy and Reproductive\r\nFunction" }, "ATENOLOL With diuretic": { "indications": "Indications\u00a0see under Dose", "name": "ATENOLOL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "ATENOLOL", "With diuretic" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2473.htm", "doses": [ "By mouth, hypertension, 25\u201350\u00a0mg\r\ndaily (higher doses rarely necessary)", "Angina, 100\u00a0mg daily in 1 or 2 doses", "Arrhythmias, 50\u2013100\u00a0mg daily", "Migraine prophylaxis [unlicensed], 50\u2013200\u00a0mg daily in divided\r\ndoses", "By intravenous injection, arrhythmias,\r\n2.5\u00a0mg at a rate of 1\u00a0mg/minute, repeated at 5-minute intervals to\r\na max. of 10\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "By intravenous infusion, arrhythmias,\r\n150\u00a0micrograms/kg over 20\u00a0minutes, repeated every 12 hours if required", "Early intervention within 12 hours of myocardial infarction\r\n(section 2.10.1), by intravenous injection over 5 minutes, 5\u00a0mg, then by mouth, 50\u00a0mg after\r\n15 minutes, 50\u00a0mg after 12 hours, then 100\u00a0mg daily", "Name[Kalten\u00ae (BPC 100) ] Capsules, red/ivory, atenolol 50\u00a0mg, amiloride hydrochloride 2.5\u00a0mg, hydrochlorothiazide 25\u00a0mg, net price 28-cap pack = \u00a312.17. \r\n Label:\r\n 8Dose\u00a0hypertension, 1 capsule daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "CLOZAPINE": { "indications": "Indications\u00a0schizophrenia (including psychosis in Parkinson\u2019s disease) in patients\r\nunresponsive to, or intolerant of, conventional antipsychotic drugs", "name": "CLOZAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "CLOZAPINE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; elderly; monitor leucocyte and differential blood counts (see\r\nAgranulocytosis, below); prostatic hypertrophy, susceptibility to angle-closure glaucoma; taper off other antipsychotics before starting; close medical supervision during initiation (risk of collapse because of hypotension); dose adjustment\r\nmay be necessary if smoking started or stopped during treatmentWithdrawal\u00a0On planned withdrawal\r\nreduce dose over 1\u20132 weeks to avoid risk of rebound psychosis. If abrupt withdrawal necessary observe patient carefullyAgranulocytosis\u00a0Neutropenia and potentially fatal\r\nagranulocytosis reported. Leucocyte and differential\r\nblood counts must be normal before starting; monitor counts every week for 18 weeks then at least every 2 weeks\r\nand if clozapine continued and blood count stable after 1 year at\r\nleast every 4 weeks (and 4 weeks after discontinuation); if leucocyte count below 3000/mm3 or\r\nif absolute neutrophil count below 1500/mm3 discontinue\r\npermanently and refer to haematologist. Patients who have a low white\r\nblood cell count because of benign ethnic neutropenia may be started\r\non clozapine with the agreement of a haematologist. Avoid\r\ndrugs which depress leucopoiesis; patients\r\nshould report immediately symptoms of infection, especially influenza-like\r\nillnessMyocarditis and cardiomyopathy\u00a0Fatal myocarditis\r\n(most commonly in first 2 months) and cardiomyopathy reported.Perform physical examination and take full\r\nmedical history before startingSpecialist examination required if cardiac abnormalities\r\nor history of heart disease found\u2014clozapine initiated only in absence\r\nof severe heart disease and if benefit outweighs riskPersistent tachycardia especially in first\r\n2 months should prompt observation for other indicators for myocarditis\r\nor cardiomyopathyIf myocarditis or cardiomyopathy suspected clozapine should\r\nbe stopped and patient evaluated urgently by cardiologistDiscontinue permanently in clozapine-induced\r\nmyocarditis or cardiomyopathyGastro-intestinal obstruction\u00a0Reactions resembling\r\ngastro-intestinal obstruction reported. Clozapine should be used cautiously with drugs which cause constipation (e.g. antimuscarinic drugs) or in history of colonic disease or bowel surgery. Monitor for constipation and prescribe laxative if required", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nconstipation (see Cautions), hypersalivation, dry mouth, nausea, vomiting,\r\nanorexia; tachycardia, ECG changes, hypertension; drowsiness, dizziness,\r\nheadache, dysarthria, tremor, seizures, fatigue, impaired temperature\r\nregulation; urinary incontinence and retention; leucopenia, eosinophilia,\r\nleucocytosis; blurred vision; sweating; less commonly speech disorder, agranulocytosis (important: see\r\nCautions); rarely dysphagia, hepatitis, cholestatic\r\njaundice, pancreatitis, circulatory collapse, arrhythmia, myocarditis\r\n(important: see Cautions), pericarditis, agitation,\r\nconfusion, delirium, pneumonia, anaemia; very rarely parotid gland enlargement, intestinal obstruction (see Cautions),\r\ncardiomyopathy, myocardial infarction, respiratory depression, obsessive\r\ncompulsive disorder, priapism, interstitial nephritis, thrombocytopenia,\r\nthrombocythaemia, hypertriglyceridaemia, hypercholesterolaemia, hyperlipidaemia,\r\nangle-closure glaucoma, fulminant hepatic necrosis, and skin reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129164.htm", "doses": [ "Schizophrenia, adult over\r\n16 years, 12.5\u00a0mg once or twice (elderly 12.5\u00a0mg once) on first day then 25\u201350\u00a0mg (elderly 25\u201337.5\u00a0mg) on second day then increased gradually (if well tolerated)\r\nin steps of 25\u201350\u00a0mg daily (elderly max. increment 25\u00a0mg daily) over 14\u201321 days up to 300\u00a0mg daily in\r\ndivided doses (larger dose at night, up to 200\u00a0mg daily may be taken\r\nas a single dose at bedtime); if necessary may be further increased\r\nin steps of 50\u2013100\u00a0mg once (preferably) or twice weekly; usual dose\r\n200\u2013450\u00a0mg daily (max. 900\u00a0mg daily)", "Restarting after interval of more than 2 days, 12.5\u00a0mg once or twice on first\r\nday (but may be feasible to increase more quickly than on initiation)\u2014extreme\r\ncaution if previous respiratory or cardiac arrest with initial dosing", "Psychosis in Parkinson\u2019s disease, adult over 16 years, 12.5\u00a0mg at bedtime then increased according to response\r\nin steps of 12.5\u00a0mg up to twice weekly; usual dose range 25\u201337.5\u00a0mg\r\nat bedtime, usual max. 50\u00a0mg daily; exceptionally, dose may be increased\r\nfurther in steps of 12.5\u00a0mg weekly to max. 100\u00a0mg daily in 1\u20132 divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use with caution" }, "BETAMETHASONE ESTERS With antimicrobials": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "BETAMETHASONE ESTERS With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "BETAMETHASONE ESTERS", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.; use of more than 100\u00a0g per week\r\nof 0.1% preparation likely to cause adrenal suppression", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5886.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Fucibet\u00ae (LEO) ] Cream, betamethasone (as valerate) 0.1%, fusidic acid 2%, net price\r\n30\u00a0g = \u00a35.29, 60\u00a0g = \u00a310.58. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include cetostearyl\r\nalcohol, chlorocresol\nLipid cream, betamethasone (as valerate)\r\n0.1%, fusidic acid 2%, net price 30\u00a0g = \u00a35.62. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include cetostearyl alcohol, hydroxybenzoates\r\n(parabens)" ] }, "PRAMIPEXOLE Modified release": { "indications": "Indications\u00a0Parkinson\u2019s disease, used alone or\r\nas an adjunct to co-beneldopa\r\nor co-careldopa; moderate to severe restless legs syndrome", "name": "PRAMIPEXOLE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "PRAMIPEXOLE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; psychotic disorders; ophthalmological\r\ntesting recommended (risk of visual disorders); severe cardiovascular disease; risk of\r\npostural hypotension (especially on initiation)\u2014monitor blood pressure; interactions: Appendix 1 (pramipexole)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, constipation, vomiting, weight changes, decreased appetite,\r\nhypotension (including postural hypotension), peripheral oedema, dizziness,\r\ndyskinesia, hyperkinesia, drowsiness (including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.),\r\nheadache, sleep disturbances, confusion, hallucinations, restlessness,\r\nvisual disturbances; less commonly hiccups, cardiac\r\nfailure, syncope, pneumonia, dyspnoea, binge eating, compulsive behaviour\r\n(\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.), amnesia,\r\ndelusion, paranoia, pruritus, rash; also reported paradoxical worsening of restless legs syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204132.htm", "doses": [ "Doses and strengths are stated in terms\r\nof pramipexole (base); equivalent strengths in\r\nterms of pramipexole dihydrochloride monohydrate\r\n(salt) are as follows: 88\u00a0micrograms base \u2261 125\u00a0micrograms\r\nsalt; 180\u00a0micrograms base \u2261 250\u00a0micrograms salt; 350\u00a0micrograms base \u2261 500\u00a0micrograms salt;700\u00a0micrograms\r\nbase \u2261 1\u00a0mg salt", "Parkinson\u2019s disease, adult over\r\n18 years, initially 88\u00a0micrograms 3 times daily, dose doubled every\r\n5\u20137 days if tolerated to 350\u00a0micrograms 3 times daily; further increased\r\nif necessary by 180\u00a0micrograms 3 times daily at weekly intervals;\r\nmax. 3.3\u00a0mg daily in 3 divided doses", "During dose titration and maintenance, levodopa dose may be reduced", "Restless legs syndrome, adult over 18 years, initially 88\u00a0micrograms once daily 2\u20133 hours before\r\nbedtime, dose doubled every 4\u20137 days if necessary; max. 540\u00a0micrograms\r\ndaily", "During dose titration and maintenance, levodopa\r\ndose may be reduced according to response", "Name[Mirapexin\u00ae Prolonged Release (Boehringer Ingelheim) ] Tablets, m/r, pramipexole 260\u00a0micrograms,\r\nnet price 30-tab pack = \u00a328.65; 520\u00a0micrograms, 30-tab pack = \u00a357.30;\r\n1.05\u00a0mg, 30-tab pack = \u00a3114.60; 1.57\u00a0mg, 30-tab pack = \u00a3171.90; 2.1\u00a0mg,\r\n30-tab pack = \u00a3229.20; 2.62\u00a0mg, 30-tab pack = \u00a3286.50; 3.15\u00a0mg, 30-tab\r\npack = \u00a3343.80. \r\n Label:\r\n 10, 25, counselling, driving, see notes aboveImportant\u00a0Doses and strengths are stated in terms\r\nof pramipexole (base); equivalent strengths in terms of pramipexole\r\ndihydrochloride monohydrate (salt) are as follows: 260\u00a0micrograms\r\nbase \u2261 375\u00a0micrograms salt;520\u00a0micrograms base \u2261 750\u00a0micrograms\r\nsalt;1.05\u00a0mg base \u2261 1.5\u00a0mg salt;1.57\u00a0mg base \u2261\r\n2.25\u00a0mg salt;2.1\u00a0mg base \u2261 3\u00a0mg salt;2.62\u00a0mg base\r\n\u2261 3.75\u00a0mg salt;3.15\u00a0mg base \u2261 4.5\u00a0mg saltDose\u00a0Parkinson\u2019s disease (with or without co-beneldopa or co-careldopa), adult over 18 years, initially 260\u00a0micrograms once\r\ndaily, dose doubled every 5\u20137 days to 1.05\u00a0mg once daily; further\r\nincreased if necessary by 520\u00a0micrograms daily at weekly intervals;\r\nmax. 3.15\u00a0mg once dailyNote\u00a0During dose titration and maintenance, levodopa\r\ndose may be reduced according to response" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014no information\r\navailable" }, "NITROFURANTOIN Modified release": { "indications": "Indications\u00a0urinary-tract infections", "name": "NITROFURANTOIN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.13 Urinary-tract infections", "NITROFURANTOIN", "Modified release" ], "cautions": "Cautions\u00a0anaemia; diabetes\r\nmellitus; electrolyte imbalance; vitamin B and folate deficiency; pulmonary disease; on long-term therapy, monitor liver function and monitor for pulmonary symptoms, especially\r\nin the elderly (discontinue if deterioration\r\nin lung function); susceptibility to peripheral\r\nneuropathy; false positive urinary glucose (if tested for reducing substances); urine may be coloured yellow or brown; interactions: Appendix 1 (nitrofurantoin)", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, and diarrhoea; acute\r\nand chronic pulmonary reactions (pulmonary fibrosis reported; possible\r\nassociation with lupus erythematosus-like syndrome); peripheral neuropathy;\r\nalso reported, hypersensitivity reactions (including angioedema, anaphylaxis,\r\nsialadenitis, urticaria, rash and pruritus); rarely, cholestatic jaundice,\r\nhepatitis, exfoliative dermatitis, erythema multiforme, pancreatitis,\r\narthralgia, blood disorders (including agranulocytosis, thrombocytopenia,\r\nand aplastic anaemia), benign intracranial hypertension, and transient\r\nalopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3964.htm", "doses": [ "Acute uncomplicated infection, 50\u00a0mg every 6 hours with\r\nfood for 7 days (3 days usually adequate in women); child over 3 months, 750\u00a0micrograms/kg every 6 hours", "Severe chronic recurrent infection, 100\u00a0mg every 6 hours with\r\nfood for 7 days (dose reduced or discontinued if severe nausea)", "Prophylaxis (but see Cautions), 50\u2013100\u00a0mg at night; child over 3 months, 1\u00a0mg/kg at night", "Name[Macrobid\u00ae (Goldshield) ] Capsules, m/r, blue/yellow, nitrofurantoin 100\u00a0mg (as nitrofurantoin macrocrystals and nitrofurantoin monohydrate),\r\nnet price 14-cap pack = \u00a34.89. \r\n Label:\r\n 9, 14, 21, 25Dose\u00a0uncomplicated urinary-tract infection, 1 capsule twice\r\ndaily with foodGenito-urinary surgical prophylaxis, 1 capsule twice daily\r\non day of procedure and for 3 days after" ], "pregnancy": "Pregnancy\u00a0avoid at term\u2014may produce neonatal haemolysis" }, "INFLUENZA VACCINES": { "indications": "Indications\u00a0annual immunisation against seasonal\r\ninfluenza", "name": "INFLUENZA VACCINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Influenza vaccines", "INFLUENZA VACCINES" ], "cautions": "Cautions\u00a0see section 14.1; increased\r\nrisk of fever in child under 5 years with Viroflu\u00ae, and in child 5\u20139 years with Enzira\u00ae or preparations\r\nmarketed by Pfizer or CSL Biotherapies; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nreported febrile convulsions and transient thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202380.htm", "doses": [ "By intramuscular injection, adult and child over\r\n13 years, 0.5\u00a0mL as a single dose; child 6 months\u20133 years, 0.25\u20130.5\u00a0mL; 3\u201313 years 0.5\u00a0mL; for children 6\r\nmonths to 13 years who have not received seasonal influenza vaccine\r\npreviously, repeat after 4\u20136 weeks", "By intradermal injection, see under Intanza\u00ae below" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "Alginate raft-forming oral suspensions": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.2 Compound alginates and proprietary indigestion preparations" ], "name": "Alginate raft-forming oral suspensions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129416.htm", "doses": [ "10\u201320\u00a0mL after meals and at bedtime; child 6\u201312 years 5\u201310\u00a0mL after meals and at bedtime" ] }, "TEMOCILLIN": { "indications": "Indications\u00a0septicaemia, urinary-tract infections, lower respiratory-tract infections\r\ncaused by susceptible Gram-negative bacteria", "name": "TEMOCILLIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.2 Penicillinase-resistant penicillins", "TEMOCILLIN" ], "cautions": "Cautions\u00a0see under Benzylpenicillin (section 5.1.1.1); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Benzylpenicillin (section 5.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129717.htm", "doses": [ "adult over 18 years, by intramuscular injection or by\r\nintravenous injection over 3\u20134 minutes, or by intravenous infusion, 1\u20132\u00a0g every 12 hours " ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "POTASSIUM CITRATE": { "indications": "Indications\u00a0relief of discomfort in mild urinary-tract\r\ninfections; alkalinisation of urine", "name": "POTASSIUM CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.3 Drugs used in urological pain", "Alkalinisation of urine", "POTASSIUM CITRATE" ], "cautions": "Cautions\u00a0cardiac disease; elderly; interactions: Appendix 1\r\n(potassium salts)", "side-effects": "Side-effects\u00a0hyperkalaemia on prolonged high dosage, mild diuresis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4648.htm", "doses": [ "See under preparation", "10\u00a0mL 3 times daily well diluted with water" ] }, "ILOPROST": { "indications": "Indications\u00a0idiopathic or familial pulmonary arterial hypertension", "name": "ILOPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs" ], "cautions": "Cautions\u00a0unstable pulmonary hypertension with\r\nadvanced right heart failure; hypotension (do not initiate if systolic blood pressure below 85\u00a0mmHg); acute pulmonary infection; chronic obstructive pulmonary disease; severe asthma; interactions: Appendix\r\n1 (iloprost)", "side-effects": "Side-effects\u00a0vasodilatation, hypotension, syncope, cough, headache,\r\nthroat or jaw pain; nausea, vomiting, diarrhoea, chest pain, dyspnoea,\r\nbronchospasm, and wheezing also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128452.htm", "doses": [ "By inhalation of nebulised solution, initial\r\ndose 2.5\u00a0micrograms increased to 5\u00a0micrograms for second dose, if\r\ntolerated maintain at 5\u00a0micrograms 6\u20139 times daily according to response;\r\nreduce to 2.5\u00a0micrograms 6\u20139 times daily if higher dose not tolerated; child 8\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); effective contraception must be used during treatment" }, "ORAL REHYDRATION SALTS (ORS)": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.2 Oral sodium and water", "Oral rehydration therapy (ORT)" ], "indications": "Indications\u00a0fluid and electrolyte loss in\r\ndiarrhoea, see notes above", "name": "ORAL REHYDRATION SALTS (ORS)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4954.htm", "doses": [ "According to fluid loss, usually 200\u2013400\u00a0mL solution after\r\nevery loose motion; infant 1\u20131\u00bd times\r\nusual feed volume; child 200\u00a0mL after\r\nevery loose motion" ] }, "INFLIXIMAB - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0see notes above; inflammatory bowel\r\ndisease (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB); ankylosing spondylitis, psoriatic\r\narthritis, rheumatoid arthritis (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB)", "name": "INFLIXIMAB - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators", "INFLIXIMAB" ], "cautions": "Cautions\u00a0section 10.1.3; monitor for non-melanoma skin cancer before and during treatment", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201661.htm", "doses": [ "By intravenous infusion, plaque psoriasis, adult over 18 years, 5\u00a0mg/kg, repeated 2 weeks and\r\n6 weeks after initial infusion, then every 8 weeks; discontinue if\r\nno response within 14 weeks of initial infusion" ], "pregnancy": "Pregnancy\u00a0section\r\n10.1.3" }, "ASPIRIN": { "indications": "Indications\u00a0mild to moderate pain, pyrexia; antiplatelet (section 2.9)", "name": "ASPIRIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "ASPIRIN" ], "cautions": "Cautions\u00a0asthma, allergic\r\ndisease, dehydration; preferably avoid during fever or viral infection\r\nin children (risk of Reye\u2019s syndrome, see below); elderly; G6PD-deficiency (section 9.1.5); concomitant use of drugs that\r\nincrease risk of bleeding; anaemia; thyrotoxicosis; interactions: Appendix 1 (aspirin)", "side-effects": "Side-effects\u00a0generally mild and infrequent but high incidence\r\nof gastro-intestinal irritation with slight asymptomatic blood loss,\r\nblood disorders have occurred (including increased bleeding time),\r\nconfusion, tinnitus, bronchospasm and skin reactions in hypersensitive\r\npatients. Prolonged administration, see section 10.1.1. Overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3462.htm", "doses": [ "By mouth, 300\u2013900\u00a0mg every 4\u20136 hours when\r\nnecessary; max. 4\u00a0g daily; child under\r\n16 years not recommended (see Reye\u2019s Syndrome, above)", "By rectum, 450\u2013900\u00a0mg every 4 hours (max. 3.6\u00a0g\r\ndaily); child under 16 years not recommended\r\n(see Reye\u2019s Syndrome, above)" ], "pregnancy": "Pregnancy\u00a0high doses may be related to intrauterine growth\r\nrestriction and teratogenic effects; impaired platelet function with\r\nrisk of haemorrhage, and delayed onset and increased duration of labour\r\nwith increased blood loss, can occur if used during delivery; avoid\r\nanalgesic doses if possible in last few weeks (low doses probably\r\nnot harmful); with high doses, closure of fetal ductus arteriosus\r\nin utero and possibly persistent pulmonary hypertension of newborn;\r\nkernicterus in jaundiced neonates" }, "PYRIMETHAMINE WITH SULFADOXINE": { "indications": "Indications\u00a0adjunct to quinine in treatment of Plasmodium falciparum malaria; not recommended for prophylaxis", "name": "PYRIMETHAMINE WITH SULFADOXINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Pyrimethamine" ], "cautions": "Cautions\u00a0see under Pyrimethamine and under Co-trimoxazole (section 5.1.8); not recommended\r\nfor prophylaxis (severe side-effects on long-term use); interactions: Appendix 1 (pyrimethamine, sulfonamides)", "side-effects": "Side-effects\u00a0see under Pyrimethamine and\r\nunder Co-trimoxazole (section 5.1.8); pulmonary infiltrates (e.g.\r\neosinophilic or allergic alveolitis) reported\u2014discontinue if cough\r\nor shortness of breath", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/33618.htm", "doses": [ "Treatment of falciparum malaria, see notes above", "Prophylaxis, not recommended by UK malaria experts" ], "pregnancy": "Pregnancy\u00a0possible teratogenic risk in first trimester (pyrimethamine a folate antagonist); in third trimester\u2014risk of neonatal haemolysis and methaemoglobinaemia;\r\nfear of increased risk of kernicterus in neonates appears to be unfounded;\r\nsee also Falciparum Malaria (treatment)" }, "MOXIFLOXACIN": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "MOXIFLOXACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "MOXIFLOXACIN" ], "cautions": "Cautions\u00a0not recommended for neonates", "side-effects": "Side-effects\u00a0taste disturbances, ocular discomfort (including\r\npain, irritation and dryness), hyperaemia; less commonly vomiting, headache, paraesthesia, corneal disorders (including keratitis,\r\nerosion, and staining), conjunctival haemorrhage, eyelid erythema,\r\nvisual disturbances, nasal discomfort, pharyngolaryngeal pain; also reported nausea, palpitation, dyspnoea, dizziness,\r\nraised intra-ocular pressure, photophobia, rash, pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213680.htm", "doses": [ "adult and child over 1 month, apply 3 times daily (continue\r\ntreatment for 2\u20133 days after infection improves; review if no improvement\r\nwithin 5 days)" ] }, "HYDROXOCOBALAMIN - DRUGS USED IN MEGALOBLASTIC ANAEMIAS": { "side-effects": "Side-effects\u00a0nausea, headache, dizziness; fever, hypersensitivity\r\nreactions (including rash and pruritus); injection-site reactions;\r\nhypokalaemia and thrombocytosis during initial treatment; chromaturia", "indications": "Indications\u00a0see under dose below; cyanide poisoning (see Emergency Treatment of Poisoning)", "name": "HYDROXOCOBALAMIN - DRUGS USED IN MEGALOBLASTIC ANAEMIAS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4902.htm", "doses": [ "By intramuscular injection, pernicious\r\nanaemia and other macrocytic anaemias without neurological involvement,\r\ninitially 1\u00a0mg 3 times a week for 2 weeks then 1\u00a0mg every 3 months", "Pernicious anaemia and other macrocytic anaemias with neurological\r\ninvolvement, initially 1\u00a0mg on alternate days until no further improvement,\r\nthen 1\u00a0mg every 2 months", "Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency, 1\u00a0mg every 2\u20133 months", "Tobacco amblyopia and Leber\u2019s optic atrophy, initially 1\u00a0mg\r\ndaily for 2 weeks, then 1\u00a0mg twice weekly until no further improvement,\r\nthereafter 1\u00a0mg every 1\u20133 months", "child see BNF for Children" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.2 Drugs used in megaloblastic anaemias" ], "cautions": "Cautions\u00a0should not be given before diagnosis\r\nfully established but see also notes above; interactions: Appendix 1 (hydroxocobalamin)" }, "EPIRUBICIN HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nEpirubicin is structurally related to doxorubicin and clinical trials suggest that it is as effective in the treatment of breast cancer. A maximum cumulative dose of 0.9\u20131\u00a0g/m2 is recommended to help avoid cardiotoxicity. Like doxorubicin it is given intravenously and by bladder instillation. Hyperpigmentation of skin, nails, and oral mucosa, and red coloration of the urine, may occur. and %s\n(From 7.4.4 Bladder instillations and urological surgery: British National Formulary)\n7.4.4 Bladder instillations and urological surgery", "name": "EPIRUBICIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "EPIRUBICIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant\r\nto tissues; interactions: Appendix\r\n1 (epirubicin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4716.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (carcinogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "GLYCERYL TRINITRATE Longer-acting tablets": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE Longer-acting tablets", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE", "Longer-acting tablets" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2626.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations", "Name[Suscard\u00ae (Forest)] Buccal tablets, m/r, glyceryl\r\ntrinitrate 2\u00a0mg, net price 100-tab pack = \u00a312.70; 3\u00a0mg,\r\n100-tab pack = \u00a318.33; 5\u00a0mg, 100-tab pack = \u00a324.96. Counselling, see\r\nbelowDose\u00a0treatment of angina, 2\u00a0mg as required, increased to 3\u00a0mg\r\nif necessary; prophylaxis 2\u20133\u00a0mg 3 times daily; 5\u00a0mg in severe anginaUnstable angina (adjunct), up to 5\u00a0mg with ECG monitoringCongestive heart failure, 5\u00a0mg 3 times daily, increased\r\nto 10\u00a0mg 3 times daily in severe casesAcute heart failure, 5\u00a0mg repeated until symptoms abateCounselling\u00a0Tablets have rapid onset of effect;\r\nthey are placed between upper lip and gum, and left to dissolve; vary\r\nsite to reduce risk of dental caries" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ONDANSETRON": { "indications": "Indications\u00a0see under Dose", "name": "ONDANSETRON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "5HT3-receptor antagonists", "ONDANSETRON" ], "cautions": "Cautions\u00a0QT-interval prolongation (avoid concomitant use of drugs that prolong QT interval); subacute intestinal obstruction; adenotonsillar surgery; interactions: Appendix 1 (ondansetron)", "side-effects": "Side-effects\u00a0constipation; headache; flushing; injection site-reactions; less commonly hiccups, hypotension, bradycardia, chest pain,\r\narrhythmias, movement disorders, seizures; on intravenous\r\nadministration, rarely dizziness, transient\r\nvisual disturbances (very rarely transient blindness);\r\nsuppositories may cause rectal irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129637.htm", "doses": [ "Moderately emetogenic chemotherapy or radiotherapy, adult over 18 years, by mouth, 8\u00a0mg\r\n1\u20132 hours before treatment or by rectum, 16\u00a0mg 1\u20132 hours before treatment or by\r\nintramuscular injection or slow intravenous\r\ninjection, 8\u00a0mg immediately before treatment", "then by mouth, 8\u00a0mg every 12\r\nhours for up to 5 days or by rectum, 16\u00a0mg daily for up to 5 days", "Severely emetogenic chemotherapy (consult product\r\nliterature for dose of concomitant corticosteroid), adult over 18 years, by intramuscular injection or slow intravenous injection, 8\u00a0mg\r\nimmediately before treatment, where necessary followed by 2 further\r\ndoses of 8\u00a0mg at intervals of 2\u20134 hours (or followed\r\nby 1\u00a0mg/hour by continuous intravenous infusion for\r\nup to 24 hours)", "then by mouth, 8\u00a0mg every 12\r\nhours for up to 5 days or by rectum, 16\u00a0mg daily for up to 5 days;", "alternatively, by intravenous infusion over at least 15 minutes, 32\u00a0mg immediately before treatment or by mouth, 24\u00a0mg 1\u20132 hours before treatment or by rectum, 16\u00a0mg 1\u20132 hours before treatment", "then by mouth, 8\u00a0mg every 12\r\nhours for up to 5 days or by rectum, 16\u00a0mg daily for up to 5 days", "Chemotherapy-induced nausea and vomiting, child 6 months\u201318 years, by intravenous infusion over at least 15 minutes, 5\u00a0mg/m2 (max. 8\u00a0mg) immediately\r\nbefore chemotherapy, then for body-surface area less\r\nthan 0.6\u00a0m2 2\u00a0mg by mouth every 12 hours\r\nfor up to 5 days; for body-surface area 0.6\u00a0m2 or greater\r\n4\u00a0mg by mouth every 12 hours for up to 5 days; max.\r\ntotal daily dose 32\u00a0mg", "alternatively, by intravenous infusion over at least 15 minutes, 150\u00a0micrograms/kg (max. 8\u00a0mg) immediately\r\nbefore chemotherapy repeated at intervals of 4 hours for 2 further\r\ndoses, then for body-weight 10\u00a0kg or less 2\u00a0mg by mouth every 12 hours for up to 5 days; for body-weight\r\nover 10\u00a0kg 4\u00a0mg by mouth every 12 hours for up to 5\r\ndays; max. total daily dose 32\u00a0mg", "For chemotherapy-induced nausea and vomiting,\r\noral dosing can start 12 hours after intravenous administration", "Prevention of postoperative nausea and vomiting, by mouth, 16\u00a0mg 1 hour before anaesthesia or 8\u00a0mg 1 hour before anaesthesia followed by 8\u00a0mg at intervals of\r\n8 hours for 2 further doses", "alternatively, by intramuscular or slow intravenous injection, 4\u00a0mg\r\nat induction of anaesthesia; child 1\r\nmonth\u201318 years, by slow intravenous injection over\r\nat least 30 seconds, 100\u00a0micrograms/kg (max. 4\u00a0mg) before, during,\r\nor after induction of anaesthesia", "Treatment of postoperative nausea and vomiting, by intramuscular or slow intravenous injection, 4\u00a0mg; child 1 month\u201318 years, by slow intravenous\r\ninjection over at least 30 seconds, 100\u00a0micrograms/kg (max.\r\n4\u00a0mg)" ], "pregnancy": "Pregnancy\u00a0no information available; avoid unless potential\r\nbenefit outweighs risk" }, "MOXISYLYTE ": { "indications": "Indications\u00a0primary Raynaud\u2019s syndrome (short-term treatment)", "name": "MOXISYLYTE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs" ], "cautions": "Cautions\u00a0diabetes mellitus", "side-effects": "Side-effects\u00a0nausea, diarrhoea, flushing, headache, dizziness;\r\nhepatic reactions including cholestatic jaundice and hepatitis reported\r\nto CSM", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2718.htm", "doses": [ "Initially 40\u00a0mg 4 times daily, increased to 80\u00a0mg 4 times\r\ndaily if poor initial response; discontinue after 2 weeks if no response" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "PROTAMINE ZINC INSULIN": { "indications": "Indications\u00a0diabetes mellitus", "name": "PROTAMINE ZINC INSULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins" ], "cautions": "Cautions\u00a0section 6.1.1.1; see\r\nalso notes above; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4117.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "DISODIUM ETIDRONATE With calcium carbonate": { "indications": "Indications\u00a0see under Dose", "name": "DISODIUM ETIDRONATE With calcium carbonate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "DISODIUM ETIDRONATE", "With calcium carbonate" ], "cautions": "Cautions\u00a0consider dental check-up before initiating\r\nbisphosphonate (risk of osteonecrosis of\r\nthe jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0nausea, diarrhoea or constipation, abdominal pain,\r\nincreased bone pain in Paget\u2019s disease, also increased risk of fractures\r\nwith high doses in Paget\u2019s disease (discontinue if fractures occur); rarely exacerbation of asthma, skin reactions (including\r\nangioedema, rash, urticaria and pruritus), transient hyperphosphataemia,\r\nheadache, paraesthesia, peripheral neuropathy, atypical femoral fractures\r\n(see MHRA/CHM advice); very rarely osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw);\r\nblood disorders (including leucopenia, agranulocytosis and pancytopenia)\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4451.htm", "doses": [ "Paget\u2019s disease of bone, by mouth, 5\u00a0mg/kg\r\nas a single daily dose for up to 6 months; doses above 10\u00a0mg/kg daily\r\nfor up to 3 months may be used with caution but doses above 20\u00a0mg/kg\r\ndaily are not recommended; after interval of not less than 3 months\r\nmay be repeated where evidence of reactivation\u2014including biochemical\r\nindices (avoid premature retreatment)", "Serum phosphate, serum alkaline phosphatase\r\nand (if possible) urinary hydroxyproline should be measured before\r\nstarting and at intervals of 3 months\u2014consult product literature for\r\nfurther details", "Osteoporosis, see under Didronel PMO\u00ae", "Avoid food for at least 2 hours before\r\nand after oral treatment, particularly calcium-containing products\r\ne.g. milk; also avoid iron and mineral supplements and antacids", "Name[Didronel PMO\u00ae (Warner Chilcott) ] Tablets, 14 white, disodium\r\netidronate 400\u00a0mg; 76 pink, effervescent, calcium carbonate\r\n1.25\u00a0g (Cacit\u00ae). Net price per pack = \u00a319.89. \r\n Label:\r\n 10, patient information leaflet, counselling, food and calcium (see above)Dose\u00a0treatment of osteoporosis, prevention of bone loss in\r\npostmenopausal women (particularly if hormone replacement therapy\r\ninappropriate), and prevention and treatment of corticosteroid-induced\r\nosteoporosis, given in 90-day cycles, 1 Didronel\u00ae tablet daily for 14 days, then 1 Cacit\u00ae tablet\r\ndaily for 76 days" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ALGLUCOSIDASE ALFA": { "indications": "Indications\u00a0(specialist use only) Pompe disease ", "name": "ALGLUCOSIDASE ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Pompe disease", "ALGLUCOSIDASE ALFA" ], "cautions": "Cautions\u00a0cardiac and respiratory dysfunction\u2014monitor\r\nclosely; monitor immunoglobulin G (IgG)\r\nantibody concentrationInfusion-related reactions\u00a0Infusion-related\r\nreactions very common, calling for use of antihistamine, antipyretic,\r\nor corticosteroid; consult product literature for details", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea; flushing, tachycardia,\r\nblood pressure changes, cold extremities, cyanosis, facial oedema,\r\nchest discomfort; cough, tachypnoea, bronchospasm; headache, agitation,\r\ntremor, irritability, restlessness, paraesthesia, dizziness, fatigue;\r\npyrexia; antibody formation; myalgia, muscle spasm; sweating, rash,\r\npruritus, urticaria, injection-site reactions; hypersensitivity reactions\r\n(including anaphylaxis); severe skin reactions (including ulcerative\r\nand necrotising skin lesions) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129922.htm", "doses": [ "By intravenous infusion, adult and child 20\u00a0mg/kg\r\nevery 2 weeks" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies, but\r\ntreatment should not be withheld" }, "DOXYCYCLINE - ANTIBACTERIAL DRUGS": { "indications": "Indications\u00a0see notes above; chronic prostatitis; sinusitis, syphilis, pelvic\r\ninflammatory disease (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy); treatment\r\nand prophylaxis of anthrax [unlicensed indication]; malaria treatment\r\nand prophylaxis (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials); recurrent aphthous ulceration, adjunct to gingival\r\nscaling and root planing for periodontitis (%s\n(From 12.3.1 Drugs for oral ulceration and inflammation: British National Formulary)\n12.3.1 Drugs for oral ulceration and inflammation); oral\r\nherpes simplex (%s\n(From Oropharyngeal viral infections: British National Formulary)\nOropharyngeal viral infections); rosacea, acne vulgaris (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "DOXYCYCLINE - ANTIBACTERIAL DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "DOXYCYCLINE" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; alcohol dependence; photosensitivity reported\r\n(avoid exposure to sunlight or sun lamps)", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nanorexia, dry mouth, flushing, anxiety, and tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3817.htm", "doses": [ "200\u00a0mg on first day, then 100\u00a0mg daily; severe infections\r\n(including refractory urinary-tract infections), 200\u00a0mg daily", "Early syphilis, 100\u00a0mg twice daily for 14 days; late latent\r\nsyphilis, 100\u00a0mg twice daily for 28 days; neurosyphilis, 200\u00a0mg twice\r\ndaily for 28 days", "Uncomplicated genital chlamydia, non-gonococcal urethritis,\r\n100\u00a0mg twice daily for 7 days (14 days in pelvic inflammatory disease,\r\nsee also Table 1, section 5.1)", "Lyme disease (see also section 5.1.1.3), 100\u00a0mg twice daily for 10\u201314\r\ndays (28 days in Lyme arthritis)", "Anthrax (treatment or post-exposure prophylaxis; see also section 5.1.12), 100\u00a0mg twice daily; child (only if alternative antibacterial cannot be given) [unlicensed\r\ndose] 5\u00a0mg/kg daily in 2 divided doses (max. 200\u00a0mg daily)", "Capsules should be swallowed whole\r\nwith plenty of fluid during meals while sitting or standing", "Doxycycline doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "NORETHISTERONE - SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE": { "indications": "Indications\u00a0\n(From 8.3.2 Progestogens: British National Formulary)\n8.3.2 Progestogens; other indications (%s\n(From 6.4.1.2 Progestogens: British National Formulary)\n6.4.1.2 Progestogens)", "name": "NORETHISTERONE - SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.2 Progestogens", "NORETHISTERONE" ], "cautions": "Cautions\u00a0see section\r\n6.4.1.2 and notes above; interactions: Appendix 1 (progestogens)", "side-effects": "Side-effects\u00a0see section\r\n6.4.1.2 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100123.htm", "doses": [ "Breast cancer, 40\u00a0mg daily, increased to 60\u00a0mg daily if\r\nrequired" ], "pregnancy": "Pregnancy\u00a0masculinisation of female fetuses and other defects\r\nreported; see also oral Progestogen-only Contraceptives (section 7.3.2.1)" }, "VITAMIN A": { "indications": "Indications\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "name": "VITAMIN A", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.1 Vitamin A", "VITAMIN A" ], "cautions": "Cautions\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\nPregnancy\u00a0In view of evidence suggesting that high levels of vitamin A may cause birth defects, women who are (or may become) pregnant are advised not to take vitamin A supplements (including tablets and fish-liver oil drops), except on the advice of a doctor or an antenatal clinic; nor should they eat liver or products such as liver pat\u00e9 or liver sausage.; interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5091.htm", "doses": [ "See notes above and under preparations" ], "pregnancy": "Pregnancy\u00a0excessive doses may be teratogenic; see also notes above" }, "12.2.3 Nasal preparations for infection": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose" ], "name": "12.2.3 Nasal preparations for infection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5672.htm", "doses": [ "nose, 2\u20133 drops into each nostril 2\u20133 times\r\ndaily; eye, section 11.4.1; ear, section\r\n12.1.1" ] }, "HYDROCORTISONE - GLUCOCORTICOID THERAPY": { "indications": "Indications\u00a0adrenocortical insufficiency (section 6.3.1); shock; see also notes above; hypersensitivity\r\nreactions e.g. anaphylaxis and angioedema (section 3.4.3); asthma (section 3.1); severe inflammatory bowel disease\r\n(section 1.5); haemorrhoids (section 1.7.2); rheumatic\r\ndisease (section 10.1.2); eye (section 11.4.1); skin (section 13.4)", "name": "HYDROCORTISONE - GLUCOCORTICOID THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "HYDROCORTISONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids; also phosphate ester associated\r\nwith paraesthesia and pain (particularly in the perineal region)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200895.htm", "doses": [ "By mouth, replacement therapy, 20\u201330\u00a0mg\r\ndaily in divided doses\u2014see section 6.3.1; child 1 month\u201318\r\nyears see BNF for Children", "By intramuscular injection or slow intravenous injection or infusion, 100\u2013500\u00a0mg, 3\u20134 times in 24 hours or as required; child by slow intravenous injection up to 1 year 25\u00a0mg, 1\u20135 years 50\u00a0mg, 6\u201312 years 100\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "TRIAMCINOLONE ACETONIDE - CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and treatment of allergic\r\nrhinitis", "name": "TRIAMCINOLONE ACETONIDE - CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60801.htm", "doses": [ "adult and child over 12 years, 110\u00a0micrograms (2 sprays) into\r\neach nostril once daily; when control achieved, reduce to 55\u00a0micrograms\r\n(1 spray) into each nostril once daily; child 6\u201312 years, 55\u00a0micrograms (1 spray) into each nostril once daily,\r\nincreased if necessary to 110\u00a0micrograms (2 sprays) into each nostril\r\nonce daily; when control achieved, reduce to 55\u00a0micrograms (1 spray)\r\ninto each nostril once daily; max. duration of treatment 3 months; child 2\u20136 years see BNF for Children", "Preparations of triamcinolone acetonide can\r\nbe sold to the public for nasal administration as a non-pressurised\r\nnasal spray if supplied for the symptomatic treatment of seasonal\r\nallergic rhinitis in adults over 18 years, subject to max. daily dose\r\nof 110\u00a0micrograms per nostril for max. 3 months, and a pack size of\r\n3.575\u00a0mg" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "TRIAMCINOLONE ACETONIDE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered." }, "TESTOSTERONE AND ESTERS Transdermal preparations": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS Transdermal preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS", "Transdermal preparations" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200060.htm", "doses": [ "See under preparations", "Apply gel on clean, dry, intact skin\r\nof abdomen or both inner thighs, preferably in the morning. Gently\r\nrub in with a finger until dry before dressing. Wash hands with soap\r\nand water after applying gel; avoid washing application site for at\r\nleast 2 hours. Not to be applied on genital area.", "Name[Tostran\u00ae (ProStrakan) ] Gel, testosterone 2% (10\u00a0mg/metered\r\napplication), net price 60-g multidose dispenser = \u00a326.67. Counselling,\r\nadministration Excipients include butylhydroxytoluene, propylene glycol (see section 13.1.3)Dose\u00a0hypogonadism due to testosterone deficiency in men (over\r\n18 years), initially 60\u00a0mg testosterone (3\u00a0g gel) applied once daily;\r\nsubsequent applications adjusted according to response; max. 80\u00a0mg\r\n(4\u00a0g gel) dailyCounselling\u00a0Apply gel on clean, dry, intact skin\r\nof abdomen or both inner thighs, preferably in the morning. Gently\r\nrub in with a finger until dry before dressing. Wash hands with soap\r\nand water after applying gel; avoid washing application site for at\r\nleast 2 hours. Not to be applied on genital area.Avoid skin contact with gel application sites to prevent testosterone\r\ntransfer to other people, especially pregnant women and children\u2014consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "RANIBIZUMAB": { "indications": "Indications\u00a0see notes above\u2014specialist use only", "name": "RANIBIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment", "Subfoveal choroidal neovascularisation", "RANIBIZUMAB" ], "cautions": "Cautions\u00a0history of stroke or transient\r\nischaemic attack; patients at risk of retinal pigment epithelial tear; monitor intra-ocular pressure and for signs of ocular\r\ninfection following injection", "side-effects": "Side-effects\u00a0nausea, headache, nasopharyngitis, cough, anxiety,\r\nanaemia, urinary tract infections, arthralgia, raised intra-ocular\r\npressure, visual disturbance, conjuctival retinal and vitreous disorders,\r\neye inflammation and irritation, eye haemorrhage, allergic skin reactions; less commonly atrial fibrillation, blindness, corneal disorders,\r\niris adhesion, injection site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130048.htm", "doses": [ "Neovascular (wet) age-related macular degeneration, by intravitreal injection, adult, 500\u00a0micrograms once a month into the affected eye; monitor visual\r\nacuity monthly; continue treatment until visual acuity is stable for\r\n3 consecutive months; thereafter monitor visual acuity monthly; if\r\nnecessary subsequent doses may be given at least 1 month apart", "Diabetic macular oedema, macular oedema secondary to retinal\r\nvein occlusion, by intravitreal injection, adult, 500\u00a0micrograms once a month into the affected\r\neye; monitor visual acuity monthly; continue treatment until visual\r\nacuity is stable for 3 consecutive months (discontinue treatment if\r\nno improvement in visual acuity after initial 3 injections); thereafter\r\nmonitor visual acuity monthly; if necessary subsequent doses may be\r\ngiven at least 1 month apart", "Concomitant treatment of diabetic macular oedema, or macular\r\noedema secondary to branch retinal vein occlusion, with laser photocoagulation, by intravitreal injection, adult, 500\u00a0micrograms at least 30 minutes after laser photocoagulation", "For further information on administration,\r\nconsult product literature", "Antimicrobial eye drops should be administered into the affected\r\neye 4 times daily for 3 days before and 3 days after each injection" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk and recommends effective contraception during, and\r\nfor at least 3 months after, treatment" }, "PILOCARPINE Long acting": { "indications": "Indications\u00a0see notes above; dry mouth (%s\n(From 12.3.5 Treatment of dry mouth: British National Formulary)\n12.3.5 Treatment of dry mouth)", "name": "PILOCARPINE Long acting", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Miotics", "PILOCARPINE", "Long acting" ], "cautions": "Cautions\u00a0\n(From Miotics: British National Formulary)\nCautions\u00a0A darkly pigmented iris may require a higher concentration of the miotic or more frequent administration and care should be taken to avoid overdosage. Retinal detachment has occurred in susceptible individuals and those with retinal disease; therefore fundus examination is advised before starting treatment with a miotic. Care is also required in conjunctival or corneal damage. Intra-ocular pressure and visual fields should be monitored in those with chronic simple glaucoma and those receiving long-term treatment with a miotic. Miotics should be used with caution in patients with peptic ulceration, gastro-intestinal spasm, cardiac disease, hypertension, hypotension, marked vasomotor instability, asthma, epilepsy, Parkinson\u2019s disease, hyperthyroidism, and urinary-tract obstruction.Counselling\u00a0Blurred vision may affect performance of skilled tasks (e.g. driving) particularly at night or in reduced lighting", "side-effects": "Side-effects\u00a0\n(From Miotics: British National Formulary)\nMiotics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/55588.htm", "doses": [ "Apply up to 4 times daily; long-acting preparations, see\r\nunder preparations below", "Name[Pilogel\u00ae (Alcon) ] Ophthalmic gel, pilocarpine hydrochloride 4%, net price 5\u00a0g = \u00a36.52Excipients include benzalkonium chloride, disodium edetateDose\u00a0apply 1\u20131.5\u00a0cm gel once daily at bedtime" ] }, "PORFIMER SODIUM": { "indications": "Indications\u00a0non-small cell lung cancer; oesophageal cancer; \n(From Porfimer sodium and temoporfin: British National Formulary)\nPorfimer sodium and temoporfin", "name": "PORFIMER SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Porfimer sodium and temoporfin" ], "cautions": "Cautions\u00a0see section 8.1; avoid exposure of skin and eyes\r\nto direct sunlight or bright indoor light for at least 30 days", "side-effects": "Side-effects\u00a0see section 8.1; photosensitivity (see Cautions\r\nabove\u2014sunscreens offer no protection), constipation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106032.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "FUROSEMIDE": { "indications": "Indications\u00a0oedema (\n(From 2.2.2 Loop diuretics: British National Formulary)\n2.2.2 Loop diuretics); resistant hypertension (\n(From 2.2.2 Loop diuretics: British National Formulary)\n2.2.2 Loop diuretics)", "name": "FUROSEMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.2 Loop diuretics", "FUROSEMIDE" ], "cautions": "Cautions\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nCautions\u00a0Hypovolaemia and hypotension should be corrected before initiation of treatment with loop diuretics; electrolytes should be monitored during treatment (see also Potassium Loss, section 2.2). Loop diuretics can exacerbate diabetes (but hyperglycaemia is less likely than with thiazides) and gout. If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; an adequate urinary output should be established before initiating treatment; interactions: Appendix 1 (diuretics).; also hypoproteinaemia may reduce diuretic effect and increase risk of\r\nside-effects; hepatorenal syndrome; intravenous administration rate should not usually\r\nexceed 4\u00a0mg/minute, however single doses of up to 80\u00a0mg may be administered\r\nmore rapidly", "side-effects": "Side-effects\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of loop diuretics include mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia (less common than with thiazides), acute urinary retention, electrolyte disturbances (including hyponatraemia, hypokalaemia (see section 2.2), hypocalcaemia, hypochloraemia, and hypomagnesaemia), metabolic alkalosis, blood disorders (including bone-marrow depression, thrombocytopenia, and leucopenia), hyperuricaemia, visual disturbances, tinnitus and deafness (usually with high parenteral doses and rapid administration, and in renal impairment), and hypersensitivity reactions (including rash, photosensitivity, and pruritus).; also\r\nintrahepatic cholestasis and gout", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2355.htm", "doses": [ "By mouth, oedema, initially 40\u00a0mg\r\nin the morning; maintenance 20\u201340\u00a0mg daily; child under 18 years see BNF for Children", "Resistant oedema, 80\u2013120\u00a0mg daily", "Resistant hypertension, 40\u201380\u00a0mg daily", "By intramuscular injection or slow intravenous injection (rate of administration,\r\nsee Cautions above), initially 20\u201350\u00a0mg, increased if necessary in\r\nsteps of 20\u00a0mg not less than every 2 hours; doses greater than 50\u00a0mg by intravenous infusion only; max. 1.5\u00a0g daily; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nPregnancy\u00a0Furosemide and bumetanide should not be used to treat gestational hypertension because of the maternal hypovolaemia associated with this condition." }, "FENOFIBRATE": { "indications": "Indications\u00a0hyperlipidaemias of types IIa, IIb, III, IV, and V in patients who\r\nhave not responded adequately to diet and other appropriate measures;\r\nalso see notes above", "name": "FENOFIBRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Fibrates", "FENOFIBRATE" ], "cautions": "Cautions\u00a0see under Bezafibrate; liver function tests recommended every 3 months for first year (discontinue\r\ntreatment if significantly raised)", "side-effects": "Side-effects\u00a0see under Bezafibrate; also very rarely hepatitis, pancreatitis, and interstitial pneumopathies", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2852.htm", "doses": [ "See preparations below", "initially 3 capsules daily in divided doses; usual range\r\n2\u20134 capsules daily; child 4\u201315 years\r\n1 capsule/20\u00a0kg daily", "initially 1 capsule daily (dose form not appropriate for\r\nchildren or in renal impairment)", "severe hyperlipidaemia, 1 capsule daily (dose form not\r\nappropriate for children or in renal impairment)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014embryotoxicity in animal studies" }, "MOMETASONE FUROATE - RESPIRATORY SYSTEM": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "MOMETASONE FUROATE - RESPIRATORY SYSTEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.; also pharyngitis, headache; less commonly dyspepsia, weight increase, palpitation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127924.htm", "doses": [ "By inhalation of powder, adult and child over\r\n12 years, 400\u00a0micrograms as a single dose in the evening or in 2 divided\r\ndoses, reduced to 200\u00a0micrograms once daily if control maintained;\r\ndose may be increased to max. 400\u00a0micrograms twice daily in severe\r\nasthma" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "METRONIDAZOLE": { "indications": "Indications\u00a0see preparations; rosacea (see also section 13.6); Helicobacter pylori eradication\r\n(section 1.3); anaerobic infections (section 5.1.11 and section 7.2.2); protozoal infections (section 5.4.2)", "name": "METRONIDAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.2 Antibacterial preparations also used systemically" ], "cautions": "Cautions\u00a0avoid exposure to strong sunlight or UV light", "side-effects": "Side-effects\u00a0skin irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6143.htm", "doses": [ "See preparations" ] }, "GANCICLOVIR - ANTIVIRALS": { "side-effects": "Side-effects\u00a0burning sensation, tingling, superficial punctate\r\nkeratitis", "indications": "Indications\u00a0local treatment of herpes simplex infections", "name": "GANCICLOVIR - ANTIVIRALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202590.htm", "doses": [ "Apply 5 times daily until healing complete, then apply\r\n3 times daily for a further 7 days" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.3 Antivirals" ] }, "PRASUGREL": { "indications": "Indications\u00a0in combination with aspirin for the\r\nprevention of atherothrombotic events in patients with acute coronary\r\nsyndrome undergoing percutaneous coronary intervention", "name": "PRASUGREL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs" ], "cautions": "Cautions\u00a0patients at increased risk of bleeding\r\n(e.g. from recent trauma, surgery, gastro-intestinal bleeding, or\r\nactive peptic ulcer disease); concomitant\r\nuse of drugs that increase risk of bleeding; discontinue at least 7 days before elective surgery if antiplatelet\r\neffect not desirable; elderly; body-weight less than 60\u00a0kg; history of hypersensitivity reactions to thienopyridines (e.g. clopidogrel); interactions: Appendix 1 (prasugrel)", "side-effects": "Side-effects\u00a0haemorrhage (including gastro-intestinal and intracranial),\r\nhaematoma, haematuria, anaemia, rash; less commonly hypersensitivity reactions including angioedema; rarely thrombocytopenia; also reported thrombotic thrombocytopenic\r\npurpura ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202499.htm", "doses": [ "adult over 18 years, (with\r\naspirin\u2014see notes above) initially 60\u00a0mg as a single dose\r\nthen body-weight over 60\u00a0kg, 10\u00a0mg once daily or body-weight\r\nunder 60\u00a0kg or elderly over 75 years,\r\n5\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "NORMAL IMMUNOGLOBULIN For intramuscular use": { "indications": "Indications\u00a0 \n(From 14.5.1 Normal immunoglobulin: British National Formulary)\n14.5.1 Normal immunoglobulin", "name": "NORMAL IMMUNOGLOBULIN For intramuscular use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.1 Normal immunoglobulin", "NORMAL IMMUNOGLOBULIN", "For intramuscular use" ], "cautions": "Cautions\u00a0hypo- or agammaglobulinaemia with or\r\nwithout IgA deficiency; interference with live virus vaccines\u2014\n(From 14.5.1 Normal immunoglobulin: British National Formulary)\nNormal immunoglobulin may interfere with the immune response to live virus vaccines which should therefore only be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin (this does not apply to yellow fever vaccine since normal immunoglobulin does not contain antibody to this virus).Intravenous use\u00a0thrombophilic disorders, or risk factors for arterial or venous thromboembolic\r\nevents; obesity; ensure adequate hydration, renal insufficiency", "side-effects": "Side-effects\u00a0nausea, diarrhoea, chills, fever, headache, dizziness,\r\narthralgia, myalgia, muscle spasms, low back pain; rarely hypotension, anaphylaxis, cutaneous skin reactions, aseptic meningitis,\r\nacute renal failure; also reported with intravenous use, injection site reactions, abdominal pain and distension, blood\r\npressure fluctuations, haemolytic anaemia, thromboembolic events including\r\nmyocardial infarction, stroke, pulmonary embolism, and deep vein thrombosisNote\u00a0Adverse reactions are more likely to occur\r\nin patients receiving normal immunoglobulin for the first time, or\r\nfollowing a prolonged period between treatments, or when a different\r\nbrand of normal immunoglobulin is administered.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6541.htm", "doses": [ "See under preparations", "Antibody titres can vary widely between normal\r\nimmunoglobulin preparations from different manufacturers\u2014formulations\r\nare not interchangeable; patients should be maintained\r\non the same formulation throughout long-term treatment to avoid adverse\r\neffects", "Name[Normal Immunoglobulin ] Normal immunoglobulin injection. 250-mg vial; 750-mg vialDose\u00a0by deep intramuscular injection, to control\r\noutbreaks of hepatitis A (see notes above), 500\u00a0mg; child under 10 years 250\u00a0mg Rubella in pregnancy, prevention of clinical attack, 750\u00a0mgAvailable from the Centre for Infections and other regional\r\nHealth Protection Agency offices (for contacts and control of outbreaks\r\nonly, see section 14.5 under Availability)" ] }, "METOLAZONE": { "indications": "Indications\u00a0oedema, hypertension (see also notes above)", "name": "METOLAZONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "METOLAZONE" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics); also acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ; also\r\nchills, chest pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202839.htm", "doses": [ "Oedema, 5\u201310\u00a0mg daily in the morning, increased if necessary\r\nto 20\u00a0mg daily in resistant oedema, max. 80\u00a0mg daily", "Hypertension, initially 5\u00a0mg daily in the morning; maintenance\r\n5\u00a0mg on alternate days" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "PERICYAZINE": { "indications": "Indications\u00a0see under Dose", "name": "PERICYAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; more\r\nsedating; hypotension common when treatment initiated; respiratory\r\ndepression", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3235.htm", "doses": [ "Schizophrenia and other psychoses, initially 75\u00a0mg daily\r\nin divided doses increased at weekly intervals by steps of 25\u00a0mg according\r\nto response; usual max. 300\u00a0mg daily (elderly initially 15\u201330\u00a0mg daily); child and infant over\r\n1 year (schizophrenia or behavioural disorders only), initially, 500\u00a0micrograms\r\ndaily for 10-kg child, increased by 1\u00a0mg for each additional 5\u00a0kg\r\nbody-weight to max. total daily dose of 10\u00a0mg; dose may be gradually\r\nincreased according to response but maintenance should not exceed\r\ntwice initial dose", "Short-term adjunctive management of severe anxiety, psychomotor\r\nagitation, and violent or dangerously impulsive behaviour, initially\r\n15\u201330\u00a0mg (elderly 5\u201310\u00a0mg) daily divided into 2 doses, taking the\r\nlarger dose at bedtime, adjusted according to response; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "CYPROHEPTADINE HYDROCHLORIDE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, urticaria", "name": "CYPROHEPTADINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines", "CYPROHEPTADINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3043.htm", "doses": [ "Allergy, usual dose 4\u00a0mg 3\u20134 times daily; usual range\r\n4\u201320\u00a0mg daily, max. 32\u00a0mg daily; child 2\u20136 years 2\u00a0mg 2\u20133 times daily, max. 12\u00a0mg daily; 7\u201314 years 4\u00a0mg\r\n2\u20133 times daily, max. 16\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "FLUPHENAZINE DECANOATE": { "indications": "Indications\u00a0maintenance in schizophrenia and other\r\npsychoses", "name": "FLUPHENAZINE DECANOATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "FLUPHENAZINE DECANOATE" ], "cautions": "Cautions\u00a0see section 4.2.1 and notes above; dose adjustment may be necessary if smoking started or stopped during\r\ntreatment; QT-interval prolongation (avoid concomitant drugs that prolong QT interval)", "side-effects": "Side-effects\u00a0see section 4.2.1 and notes above;\r\nless sedating and fewer antimuscarinic or hypotensive symptoms, but\r\nextrapyramidal symptoms, particularly dystonic reactions and akathisia,\r\nmore frequent; systemic lupus erythematosus, inappropriate antidiuretic\r\nhormone secretion, and oedema also reported; extrapyramidal symptoms\r\nusually appear a few hours after injection and continue for about\r\n2 days but may be delayed", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129235.htm", "doses": [ "By deep intramuscular injection into the\r\ngluteal muscle, test dose 12.5\u00a0mg (6.25\u00a0mg in elderly), then after\r\n4\u20137 days 12.5\u2013100\u00a0mg repeated at intervals of 14\u201335 days, adjusted\r\naccording to response; child not recommended" ], "pregnancy": "Pregnancy\u00a0see section 4.2.1" }, "RISPERIDONE - ANTIPSYCHOTIC DEPOT INJECTIONS": { "indications": "Indications\u00a0schizophrenia and other psychoses\r\nin patients tolerant to risperidone by mouth", "name": "RISPERIDONE - ANTIPSYCHOTIC DEPOT INJECTIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections" ], "cautions": "Cautions\u00a0see Risperidone (section 4.2.1) and notes above", "side-effects": "Side-effects\u00a0see Risperidone (section 4.2.1) and notes above; also\r\nhypertension; depression, paraesthesia; less commonly apathy, weight loss, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119707.htm", "doses": [ "By deep intramuscular injection into the\r\ndeltoid or gluteal muscle, patients taking oral risperidone up to\r\n4\u00a0mg daily, initially 25\u00a0mg every 2 weeks; patients taking oral risperidone\r\nover 4\u00a0mg daily, initially 37.5\u00a0mg every 2 weeks; dose adjusted at\r\nintervals of at least 4 weeks in steps of 12.5\u00a0mg to max. 50\u00a0mg every\r\n2 weeks; child under 18 years not recommended", "During initiation risperidone by mouth may\r\nneed to be continued for 4\u20136 weeks; risperidone by mouth may also\r\nbe used during dose adjustment of depot injection" ], "pregnancy": "Pregnancy\u00a0see Risperidone (section 4.2.1)" }, "PERMETHRIN": { "indications": "Indications\u00a0see notes above and under Dose", "name": "PERMETHRIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.4 Parasiticidal preparations", "Permethrin", "PERMETHRIN" ], "cautions": "Cautions\u00a0avoid contact with eyes; do not use on broken or secondarily infected skin; children under 6 months, medical\r\nsupervision required for cream rinse (head lice); children aged 2 months\u20132 years, medical supervision required for\r\ndermal cream (scabies)", "side-effects": "Side-effects\u00a0pruritus, erythema, and stinging; rarely rashes\r\nand oedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/74623.htm", "doses": [ "Scabies, apply 5% preparation over whole body and wash\r\noff after 8\u201312 hours; child (see also\r\nCautions, above) apply over whole body including face, neck, scalp\r\nand ears; if hands washed with soap within 8 hours of application,\r\nthey should be treated again with cream (see notes above); repeat\r\napplication after 7 days", "Manufacturer recommends application to the\r\nbody but to exclude head and neck. However, application should be\r\nextended to the scalp, neck, face, and ears", "Larger patients may require up to two 30-g packs for adequate\r\ntreatment", "Crab lice, adult over 18 years,\r\napply 5% cream over whole body, allow to dry naturally and wash off\r\nafter 12 hours or after leaving on overnight; repeat application after\r\n7 days" ] }, "LINEZOLID": { "indications": "Indications\u00a0pneumonia, complicated skin and soft-tissue infections caused by\r\nGram-positive bacteria (initiated under expert supervision)", "name": "LINEZOLID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Linezolid", "LINEZOLID" ], "cautions": "Cautions\u00a0monitor full blood count (including platelet\r\ncount) weekly (see also Blood disorders below); history of seizures; unless close observation and blood-pressure\r\nmonitoring possible, avoid in uncontrolled hypertension, phaeochromocytoma, carcinoid tumour, thyrotoxicosis, bipolar depression,\r\nschizophrenia, or acute confusional states; interactions: Appendix 1 (MAOIs)Blood disordersHaematopoietic disorders (including thrombocytopenia, anaemia,\r\nleucopenia, and pancytopenia) have been reported in patients receiving\r\nlinezolid, particularly the elderly. It is recommended that full blood\r\ncounts are monitored weekly. Close monitoring is recommended in patients\r\nwho:receive treatment for more than 10\u201314 days; have pre-existing myelosuppression;are receiving drugs that may have adverse effects on haemoglobin,\r\nblood counts, or platelet function; have severe renal impairment.If significant myelosuppression occurs, treatment\r\nshould be stopped unless it is considered essential, in which case\r\nintensive monitoring of blood counts and appropriate management should\r\nbe implemented.CHM advice (optic neuropathy)Severe optic neuropathy may occur rarely, particularly if linezolid is used for longer than 28 days. The CHM recommends\r\nthat:patients should be warned to report symptoms\r\nof visual impairment (including blurred vision, visual field defect,\r\nchanges in visual acuity and colour vision) immediately;patients experiencing new visual symptoms\r\n(regardless of treatment duration) should be evaluated promptly, and\r\nreferred to an ophthalmologist if necessary;visual function should be monitored regularly\r\nif treatment is required for longer than 28 days.Monoamine oxidase inhibition\u00a0Linezolid is a reversible,\r\nnon-selective monoamine oxidase inhibitor (MAOI). Patients should avoid consuming large amounts of tyramine-rich foods (such\r\nas mature cheese, yeast extracts, undistilled alcoholic beverages,\r\nand fermented soya bean products). In addition, linezolid\r\nshould not be given with another MAOI or within 2 weeks of stopping\r\nanother MAOI. Unless close observation and\r\nblood-pressure monitoring is possible, avoid in those receiving SSRIs, 5HT1 agonists (\u2018triptans\u2019), tricyclic antidepressants, sympathomimetics,\r\ndopaminergics, buspirone, pethidine and possibly other opioid analgesics.\r\nFor other interactions see Appendix 1 (MAOIs) ", "side-effects": "Side-effects\u00a0diarrhoea (antibiotic-associated colitis reported),\r\nnausea, vomiting, taste disturbances, headache; less commonly thirst, dry mouth, glossitis, stomatitis, tongue discoloration,\r\nabdominal pain, dyspepsia, gastritis, constipation, pancreatitis,\r\nhypertension, fever, fatigue, dizziness, insomnia, hypoaesthesia,\r\nparaesthesia, tinnitus, polyuria, leucopenia, thrombocytopenia, eosinophilia,\r\nelectrolyte disturbances, blurred vision, rash, pruritus, diaphoresis,\r\ninjection-site reactions; rarely tachycardia, transient\r\nischaemic attacks, renal failure; also reported tooth discoloration,\r\nconvulsions, lactic acidosis, hyponatraemia, pancytopenia,\r\nanaemia, Stevens-Johnson syndrome, toxic epidermal necrolysis; peripheral\r\nand optic neuropathy reported on prolonged therapy (see also CHM advice\r\nabove)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106110.htm", "doses": [ "By mouth, 600\u00a0mg every 12 hours usually\r\nfor 10\u201314 days (max. duration of treatment 28 days); child [unlicensed] 1 week\u201312 years, 10\u00a0mg/kg every\r\n8 hours; 12\u201318 years, adult dose", "By intravenous infusion over 30\u2013120\r\nminutes, 600\u00a0mg every 12 hours; child [unlicensed] 1 week\u201312 years, 10\u00a0mg/kg every 8 hours; 12\u201318 years,\r\nadult dose" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "GLICLAZIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "GLICLAZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas", "GLICLAZIDE" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106127.htm", "doses": [ "Initially, 40\u201380\u00a0mg daily, adjusted according to response;\r\nup to 160\u00a0mg as a single dose, with breakfast; higher doses divided;\r\nmax. 320\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "CHLORAMPHENICOL - CHLORAMPHENICOL": { "indications": "Indications\u00a0see notes above", "name": "CHLORAMPHENICOL - CHLORAMPHENICOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Chloramphenicol" ], "cautions": "Cautions\u00a0avoid repeated courses and prolonged treatment; blood counts\r\nrequired before and periodically during treatment; monitor plasma-chloramphenicol concentration in\r\nneonates (see below); interactions: Appendix 1 (chloramphenicol)", "side-effects": "Side-effects\u00a0blood disorders including reversible and irreversible\r\naplastic anaemia (with reports of resulting leukaemia), peripheral\r\nneuritis, optic neuritis, headache, depression, urticaria, erythema\r\nmultiforme, nausea, vomiting, diarrhoea, stomatitis, glossitis, dry\r\nmouth; nocturnal haemoglobinuria reported; grey syndrome (abdominal\r\ndistension, pallid cyanosis, circulatory collapse) may follow excessive\r\ndoses in neonates with immature hepatic metabolism", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3867.htm", "doses": [ "By mouth or by\r\nintravenous injection or infusion, 12.5\u00a0mg/kg every 6 hours (exceptionally, can be doubled for severe\r\ninfections such as septicaemia and meningitis, providing high doses\r\nreduced as soon as clinically indicated); child over 1 month, haemophilus epiglottitis and pyogenic meningitis,\r\n12.5\u201325\u00a0mg/kg every 6 hours (high dosages decreased as soon as clinically\r\nindicated); neonate under 2 weeks,\r\n12.5\u00a0mg/kg twice daily; 2 weeks\u20131 month, 12.5\u00a0mg/kg 2\u20134 times daily", "Plasma concentration monitoring required\r\nin neonates and preferred in those under 4 years of age, in the elderly,\r\nand in hepatic impairment; recommended peak plasma concentration (approx.\r\n2 hours after administration by mouth, intravenous injection or infusion)\r\n10\u201325\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should not exceed\r\n15\u00a0mg/litre" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; neonatal \u2018grey syndrome\u2019\r\nif used in third trimester" }, "AMOXICILLIN": { "indications": "Indications\u00a0see under Ampicillin; also oral infections, Lyme\r\ndisease (see notes above); endocarditis treatment (Table 1, %s\n(From Cardiovascular system: British National Formulary)\nCardiovascular system); anthrax (%s\n(From 5.1.12 Quinolones: British National Formulary)\nAnthrax\u00a0Inhalation or gastro-intestinal anthrax should be treated initially with either ciprofloxacin [not licensed for gastro-intestinal anthrax] or doxycycline [unlicensed indication] (section 5.1.3) combined with one or two other antibacterials (such as amoxicillin, benzylpenicillin, chloramphenicol, clarithromycin, clindamycin, imipenem with cilastatin, rifampicin [unlicensed indication], and vancomycin). When the condition improves and the sensitivity of the Bacillus anthracis strain is known, treatment may be switched to a single antibacterial. Treatment should continue for 60 days because germination may be delayed.Cutaneous anthrax should be treated with either ciprofloxacin [unlicensed indication] or doxycycline [unlicensed indication] (section 5.1.3) for 7 days. Treatment may be switched to amoxicillin (section 5.1.1.3) if the infecting strain is susceptible. Treatment may need to be extended to 60 days if exposure is due to aerosol. A combination of antibacterials for 14 days is recommended for cutaneous anthrax with systemic features, extensive oedema, or lesions of the head or neck.Ciprofloxacin or doxycycline may be given for post-exposure prophylaxis. If exposure is confirmed, antibacterial prophylaxis should continue for 60 days. Antibacterial prophylaxis may be switched to amoxicillin after 10\u201314 days if the strain of B. anthracis is susceptible. Vaccination against anthrax (section 14.4) may allow the duration of antibacterial prophylaxis to be shortened.); adjunct in listerial meningitis\r\n(Table 1, %s\n(From Central nervous system: British National Formulary)\nCentral nervous system); pneumococcal infection prophylaxis\r\n(Table 2, %s\n(From Prevention of pneumococcal infection in asplenia or in patients with sickle-cell disease: British National Formulary)\nPrevention of pneumococcal infection in asplenia or in patients with sickle-cell disease); Helicobacter pylori eradication (%s\n(From 1.3 Antisecretory drugs and mucosal protectants: British National Formulary)\n1.3 Antisecretory drugs and mucosal protectants)", "name": "AMOXICILLIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.3 Broad-spectrum penicillins", "AMOXICILLIN" ], "cautions": "Cautions\u00a0see under Ampicillin; maintain adequate\r\nhydration with high doses (particularly during parenteral therapy); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Ampicillin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3725.htm", "doses": [ "By mouth, adult and child over 5 years, 250\u00a0mg every\r\n8 hours, dose doubled in severe infection; child, 1 month\u20131 year, 62.5\u00a0mg every 8 hours, dose doubled in severe infection;\r\n1\u20135 years, 125\u00a0mg every 8 hours, dose doubled in severe infection", "Otitis media, 500\u00a0mg every 8 hours; child 40\u00a0mg/kg daily in 3 divided doses (max. 1.5\u00a0g daily)", "Pneumonia, adult over 18 years,\r\n0.5\u20131\u00a0g every 8 hours", "Lyme disease (see also notes above), adult and child over 5 years, 500\u00a0mg every\r\n8 hours for 14\u201321 days (for 28 days in Lyme arthritis) [unlicensed\r\nindication]; child 1 month\u20135 years\r\nsee BNF for Children", "Anthrax (treatment and post-exposure prophylaxis\u2014see also section 5.1.12), 500\u00a0mg every 8 hours; child body-weight under 20\u00a0kg, 80\u00a0mg/kg daily in 3 divided doses, body-weight\r\nover 20\u00a0kg, adult dose", "Short-course oral therapy", "Dental abscess, adult over 18\r\nyears, 3\u00a0g repeated after 8 hours", "Urinary-tract infections, adult over 18 years, 3\u00a0g repeated after 10\u201312 hours", "By intramuscular injection, adult over 18 years, 500\u00a0mg every 8 hours", "By intravenous injection or infusion, 500\u00a0mg every 8 hours increased to 1\u00a0g every\r\n6 hours in severe infection; child 1\r\nmonth\u201318 years, 20\u201330\u00a0mg/kg (max. 500\u00a0mg) every 8 hours; dose doubled\r\nin severe infection (max. 4\u00a0g daily)", "Listerial meningitis (in combination with another\r\nantibiotic, see Table 1, section 5.1), by intravenous infusion, adult over 18 years, 2\u00a0g every 4\r\nhours; child under 18\r\nyears see BNF for Children", "Endocarditis (in combination with another antibiotic\r\nif necessary, see Table 1, section 5.1), by intravenous infusion, adult over 18 years, 2\u00a0g every 6\r\nhours, increased to 2\u00a0g every 4 hours e.g. in enterococcal endocarditis\r\nor if amoxicillin used alone; child under 18 years see BNF for Children", "Amoxicillin doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ETHAMBUTOL HYDROCHLORIDE": { "indications": "Indications\u00a0tuberculosis, in combination with other drugs", "name": "ETHAMBUTOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "ETHAMBUTOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0elderly; test\r\nvisual acuity before treatment and warn\r\npatients to report visual changes\u2014see Monitoring in %s\n(From 5.1.9 Antituberculosis drugs: British National Formulary)\nMonitoring\u00a0Since isoniazid, rifampicin and pyrazinamide are associated with liver toxicity, hepatic function should be checked before treatment with these drugs. Those with pre-existing liver disease or alcohol dependence should have frequent checks particularly in the first 2 months. If there is no evidence of liver disease (and pre-treatment liver function is normal), further checks are only necessary if the patient develops fever, malaise, vomiting, jaundice or unexplained deterioration during treatment. In view of the need to comply fully with antituberculous treatment on the one hand and to guard against serious liver damage on the other, patients and their carers should be informed carefully how to recognise signs of liver disorders and advised to discontinue treatment and seek immediate medical attention should symptoms of liver disease occur.Renal function should be checked before treatment with antituberculous drugs and appropriate dosage adjustments made. Streptomycin or ethambutol should preferably be avoided in patients with renal impairment, but if used, the dose should be reduced and the plasma-drug concentration monitored.Visual acuity should be tested before ethambutol is used (see below).; young\r\nchildren (see notes above)\u2014routine ophthalmological monitoring recommended", "side-effects": "Side-effects\u00a0optic neuritis, red/green colour blindness, peripheral\r\nneuritis, rarely rash, pruritus, urticaria, thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202885.htm", "doses": [ "See notes above", "\u2018Peak\u2019 concentration (2\u20132.5 hours after dose)\r\nshould be 2\u20136\u00a0mg/litre (7\u201322\u00a0micromol/litre); \u2018trough\u2019 (pre-dose)\r\nconcentration should be less than 1\u00a0mg/litre (4\u00a0micromol/litre); see\r\nRenal Impairment above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; see also Pregnancy" }, "CHLORTALIDONE": { "indications": "Indications\u00a0ascites due to cirrhosis in stable patients (under close supervision),\r\noedema due to nephrotic syndrome, hypertension (see also notes above),\r\nmild to moderate chronic heart failure; diabetes insipidus (see section 6.5.2)", "name": "CHLORTALIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "CHLORTALIDONE" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ; also rarely jaundice and allergic interstitial nephritis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2330.htm", "doses": [ "Oedema, up to 50\u00a0mg daily", "Hypertension, 25\u00a0mg daily in the morning, increased to 50\u00a0mg\r\ndaily if necessary (but see notes above)", "Heart failure, 25\u201350\u00a0mg daily in the morning, increased if necessary\r\nto 100\u2013200\u00a0mg daily (reduce to lowest effective dose for maintenance)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "IDOXURIDINE IN DIMETHYL SULFOXIDE ": { "indications": "Indications\u00a0herpes simplex and herpes\r\nzoster infection but of little value", "name": "IDOXURIDINE IN DIMETHYL SULFOXIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.3 Antiviral preparations", "IDOXURIDINE IN DIMETHYL SULFOXIDE" ], "cautions": "Cautions\u00a0avoid contact with the eyes, mucous membranes, and textiles; interactions: Appendix 1 (dimethyl sulfoxide)", "side-effects": "Side-effects\u00a0stinging on application, changes in taste; overuse\r\nmay cause maceration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6186.htm", "doses": [ "apply to lesions 4 times daily for 4 days, starting at\r\nfirst sign of attack; child under 12\r\nyears, not recommended" ], "pregnancy": "Pregnancy\u00a0teratogenic in animal studies\u2014manufacturer\r\nadvises avoid" }, "NEVIRAPINE": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "NEVIRAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Non-nucleoside reverse transcriptase inhibitors", "NEVIRAPINE" ], "cautions": "Cautions\u00a0chronic hepatitis B or C, high CD4 cell count, and\r\nwomen (all at greater risk of hepatic side-effects\u2014if plasma HIV-1\r\nRNA detectable, manufacturer advises avoid in women with CD4 cell\r\ncount greater than 250 cells/mm3 or in men with CD4 cell\r\ncount greater than 400 cells/mm3 unless potential benefit\r\noutweighs risk); interactions: Appendix 1 (nevirapine)Hepatic disease\u00a0Potentially life-threatening\r\nhepatotoxicity including fatal fulminant hepatitis reported usually\r\nin first 6 weeks; close monitoring required\r\nduring first 18 weeks; monitor liver function\r\nbefore treatment then every 2 weeks for 2 months then after 1 month\r\nand then regularly; discontinue permanently\r\nif abnormalities in liver function tests accompanied by hypersensitivity\r\nreaction (rash, fever, arthralgia, myalgia, lymphadenopathy, hepatitis,\r\nrenal impairment, eosinophilia, granulocytopenia); suspend if severe abnormalities in liver function tests but no hypersensitivity\r\nreaction\u2014discontinue permanently if significant\r\nliver function abnormalities recur; monitor\r\npatient closely if mild to moderate abnormalities in liver function\r\ntests with no hypersensitivity reactionRash\u00a0Rash, usually in first 6 weeks,\r\nis most common side-effect; incidence reduced if introduced at low\r\ndose and dose increased after 14 days; monitor closely for skin reactions during first 18 weeks; discontinue permanently if severe rash or if rash\r\naccompanied by blistering, oral lesions, conjunctivitis, facial oedema,\r\ngeneral malaise or hypersensitivity reactions; if rash mild or moderate may continue without interruption but dose\r\nshould not be increased until rash resolvesCounselling\u00a0Patients should be told\r\nhow to recognise hypersensitivity reactions and advised to discontinue\r\ntreatment and seek immediate medical attention if severe skin reaction,\r\nhypersensitivity reactions, or symptoms of hepatitis develop", "side-effects": "Side-effects\u00a0rash including Stevens-Johnson syndrome and rarely,\r\ntoxic epidermal necrolysis (see also Cautions above); nausea, hepatitis\r\n(see also Hepatic Disease above), headache; less commonly vomiting, abdominal pain, fatigue, fever, and myalgia; rarely diarrhoea, angioedema, anaphylaxis, hypersensitivity reactions (may\r\ninvolve hepatic reactions and rash, see Hepatic Disease above), arthralgia,\r\nanaemia, and granulocytopenia (more frequent in children); see also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69475.htm", "doses": [ " 200\u00a0mg once daily of \u2018immediate-release\u2019 preparation\r\nfor first 14 days then (if no rash present) 200\u00a0mg twice daily of\r\n\u2018immediate-release\u2019 preparation or 400\u00a0mg once daily of modified-release\r\npreparation; child under 18 years see BNF for children", "Duration of once daily dose regimen of \u2018immediate-release\u2019\r\npreparation should not exceed 28 days; if rash not resolved within\r\n28 days, alternative treatment should be sought. If treatment interrupted\r\nfor more than 7 days, restart using the once daily dose regimen of\r\nthe \u2018immediate-release\u2019 preparation for the first 14 days as for new\r\ntreatment", "If a dose is more than 8 hours late\r\nwith the \u2018immediate-release\u2019 preparation (or more than 12 hours late\r\nwith the modified-release preparation), the missed dose should not\r\nbe taken and the next dose should be taken at the usual time" ], "pregnancy": "Pregnancy\u00a0although manufacturer advises caution, may be appropriate\r\nto use if clearly indicated; see also Pregnancy" }, "IRBESARTAN": { "indications": "Indications\u00a0hypertension; renal disease in hypertensive type 2 diabetes mellitus\r\n(see also notes above)", "name": "IRBESARTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "IRBESARTAN" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also nausea, vomiting; fatigue;\r\nmusculoskeletal pain; less commonly diarrhoea, dyspepsia,\r\nflushing, tachycardia, chest pain, cough, and sexual dysfunction; rarely rash, urticaria; very rarely headache,\r\nmyalgia, arthralgia, tinnitus, taste disturbance, hepatitis, renal\r\ndysfunction, and cutaneous vasculitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64890.htm", "doses": [ "Hypertension, initially 150\u00a0mg once daily, increased if\r\nnecessary to 300\u00a0mg once daily (in haemodialysis or in elderly over 75 years, initial dose of 75\u00a0mg once\r\ndaily may be used); child not recommended", "Renal disease in hypertensive type 2 diabetes mellitus, initially\r\n150\u00a0mg once daily, increased to 300\u00a0mg once daily if tolerated (in\r\nhaemodialysis or in elderly over 75\r\nyears, consider initial dose of 75\u00a0mg once daily); child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "PIOGLITAZONE With metformin": { "indications": "Indications\u00a0type 2 diabetes mellitus (alone or combined with metformin or a sulfonylurea,\r\nor with both, or with insulin\u2014see also notes above)", "name": "PIOGLITAZONE With metformin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "PIOGLITAZONE", "With metformin" ], "cautions": "Cautions\u00a0monitor liver function (see below); cardiovascular\r\ndisease or in combination with insulin (risk of heart failure\u2014see MHRA/CHM advice); substitute insulin during peri-operative period (omit pioglitazone\r\non morning of surgery and recommence when eating and drinking normally); increased risk of bone fractures, particularly\r\nin women; avoid in acute porphyria (but see section 9.8.2); risk factors for bladder cancer\r\n(see Risk of Bladder Cancer); elderly (increased risk of heart failure, fractures,\r\nand bladder cancer); interactions: Appendix 1 (antidiabetics)Liver toxicity\u00a0Rare reports of liver dysfunction; monitor liver function before treatment, and periodically thereafter; advise patients to seek immediate medical attention if symptoms\r\nsuch as nausea, vomiting, abdominal pain, fatigue and dark urine develop; discontinue if jaundice occurs", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, weight gain, oedema,\r\nanaemia, headache, visual disturbances, dizziness, arthralgia, hypoaesthesia,\r\nhaematuria, impotence; less commonly hypoglycaemia,\r\nfatigue, insomnia, vertigo, sweating, altered blood lipids, proteinuria,\r\nbladder cancer; see also Liver Toxicity above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129901.htm", "doses": [ "adult over 18 years, initially\r\n15\u201330\u00a0mg once daily increased to 45\u00a0mg once daily according to response,\r\n(elderly, initiate with lowest possible\r\ndose and increase gradually); review treatment after 3\u20136 months and\r\nregularly thereafter", "Dose of concomitant sulfonylurea or insulin\r\nmay need to be reduced", "Titration with the individual components\r\n(pioglitazone and metformin) desirable before initiating Competact\u00ae", "Name[Competact\u00ae (Takeda) ] Tablets, f/c, pioglitazone (as hydrochloride)\r\n15\u00a0mg, metformin hydrochloride 850\u00a0mg, net price 56-tab pack = \u00a335.89. \r\n Label:\r\n 21Dose\u00a0adult over 18 years, type\r\n2 diabetes not controlled by metformin alone, 1 tablet twice dailyNote\u00a0Titration with the individual components\r\n(pioglitazone and metformin) desirable before initiating Competact\u00ae" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "ORAL REHYDRATION SALTS (ORS) UK formulations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.2 Oral sodium and water", "Oral rehydration therapy (ORT)", "ORAL REHYDRATION SALTS (ORS)", "UK formulations" ], "indications": "Indications\u00a0fluid and electrolyte loss in\r\ndiarrhoea, see notes above", "name": "ORAL REHYDRATION SALTS (ORS) UK formulations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65424.htm", "doses": [ "According to fluid loss, usually 200\u2013400\u00a0mL solution after\r\nevery loose motion; infant 1\u20131\u00bd times\r\nusual feed volume; child 200\u00a0mL after\r\nevery loose motion", "Name[Dioralyte\u00ae Relief (Sanofi-Aventis)] Oral powder, sodium chloride 350\u00a0mg, potassium chloride 300\u00a0mg, sodium\r\ncitrate 580\u00a0mg, cooked rice powder 6\u00a0g/sachet, net price\r\n6-sachet pack (apricot-, black currant- or raspberry-flavoured) =\r\n\u00a32.50, 20-sachet pack (apricot-flavoured) = \u00a37.13Note\u00a0Reconstitute 1 sachet with 200\u00a0mL of water\r\n(freshly boiled and cooled for infants); 5 sachets when reconstituted\r\nwith 1 litre of water provide Na+ 60\u00a0mmol, K+ 20\u00a0mmol, Cl- 50\u00a0mmol and citrate 10\u00a0mmol; contains aspartame\r\n(section 9.4.1)" ] }, "OLOPATADINE": { "indications": "Indications\u00a0seasonal allergic conjunctivitis", "name": "OLOPATADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations" ], "side-effects": "Side-effects\u00a0local irritation; less commonly keratitis, dry\r\neye, local oedema, photophobia; headache, asthenia, dizziness; dry\r\nnose also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128047.htm", "doses": [ "adult and child over 3 years, apply twice daily; max. duration\r\nof treatment 4 months" ] }, "AZACITIDINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nAzacitidine is a pyrimidine analogue that is given by subcutaneous injection. It is used in the treatment of intermediate-2 and high-risk myelodysplastic syndromes, chronic myelomonocytic leukaemia, and acute myeloid leukaemia, in adults who are not eligible for haemotopoietic stem cell transplantation.NICE guidanceAzacitidine for the treatment of myelodysplastic syndromes, chronic myelomonocytic leukaemia and acute myeloid leukaemia (March 2011)Azacitidine is recommended in adults who are not eligible for haemotopoietic stem cell transplantation as an option for the treatment of intermediate-2 and high-risk myelodysplastic syndromes, chronic myelomonocytic leukaemia, or acute myeloid leukaemia.", "name": "AZACITIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1; history of severe\r\ncongestive heart failure, unstable cardiac or pulmonary\r\ndisease; monitor for\r\nbleeding; monitor serum bicarbonate", "side-effects": "Side-effects\u00a0see section 8.1; also\r\ngastro-intestinal disturbances (including diarrhoea, constipation,\r\nabdominal pain, and dyspepsia), anorexia; hypertension, hypotension;\r\ndyspnoea, pneumonia; anxiety, insomnia, dizziness, headache, drowsiness;\r\nhaematuria; hypokalaemia; arthralgia, myalgia; injection-site reactions,\r\nrash, haematoma; haemorrhage (including cerebral haemorrhage); less commonly hypersensitivity reactions (including anaphylactic\r\nreactions); hepatic coma, hepatic failure and renal failure also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202601.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nmanufacturer advises effective contraception during and for 3 months\r\nafter treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "TRANYLCYPROMINE ": { "indications": "Indications\u00a0depressive illness", "name": "TRANYLCYPROMINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.2 Monoamine-oxidase inhibitors" ], "cautions": "Cautions\u00a0see under Phenelzine", "side-effects": "Side-effects\u00a0see under Phenelzine; insomnia; hypertensive\r\ncrises with throbbing headache requiring discontinuation of treatment\r\nmore frequent than with other MAOIs; liver damage less frequent than\r\nwith phenelzine; blood dyscrasias also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3346.htm", "doses": [ "Initially 10\u00a0mg twice daily not later than 3\u00a0p.m., increasing\r\nthe second daily dose to 20\u00a0mg after 1 week if necessary; doses above\r\n30\u00a0mg daily under close supervision only; usual maintenance dose 10\u00a0mg\r\ndaily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nPregnancy\u00a0There is an increased risk of neonatal malformations when phenelzine, isocarboxazid, or tranylcypromine is used during pregnancy. The safety of moclobemide in pregnancy has not been established. Manufacturers advise avoid use unless there are compelling reasons." }, "ESLICARBAZEPINE ACETATE": { "indications": "Indications\u00a0\n(From Carbamazepine and related antiepileptics: British National Formulary)\nCarbamazepine and related antiepileptics", "name": "ESLICARBAZEPINE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Carbamazepine and related antiepileptics" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; hyponatraemia (monitor plasma-sodium\r\nconcentration in patients at risk and discontinue treatment if hyponatraemia occurs); PR-interval prolongation (avoid concomitant\r\nadministration of drugs that prolong PR interval); elderly; interactions: see Interactions in section\r\n4.8.1 and Appendix 1 (eslicarbazepine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; dizziness, drowsiness,\r\nheadache, impaired coordination, tremor, visual disturbances, fatigue;\r\nrash; less commonly dry mouth, dehydration, gingival\r\nhyperplasia, stomatitis; palpitation, bradycardia, hypertension, hypotension,\r\nepistaxis, appetite changes, weight changes, agitation, hyperactivity,\r\nconfusion, mood changes, psychosis, impaired memory, insomnia, dysaesthesia,\r\ndystonia, parosmia, movement disorders, convulsions, peripheral neuropathy,\r\nnystagmus, dysarthria, taste disturbance, liver disorders, hypothyroidism,\r\nanaemia, hyponatraemia (see Cautions), electrolyte imbalance, tinnitus,\r\nalopecia, sweating, nail disorder, myalgia, nocturia, menstruation\r\nchanges, malaise, chills, peripheral oedema; very rarely pancreatitis, thrombocytopenia, and leucopenia; PR-interval prolongation\r\nalso reported; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203911.htm", "doses": [ "adult over 18 years, initially\r\n400\u00a0mg once daily, increased after 1\u20132 weeks to 800\u00a0mg once daily;\r\nmax. 1.2\u00a0g" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "MODAFINIL": { "indications": "Indications\u00a0excessive sleepiness\r\nassociated with narcolepsy with or without cataplexy", "name": "MODAFINIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.4 CNS\r\nstimulants and drugs used for attention deficit hyperactivity disorder" ], "cautions": "Cautions\u00a0monitor blood pressure and heart rate\r\nin hypertensive patients (but see Contra-indications); ECG required before initiation; history\r\nof psychosis, depression, mania, alcohol or drug abuse; discontinue treatment if psychiatric symptoms develop; possibility of dependence; discontinue treatment if rash develops; interactions: Appendix 1 (modafinil)", "side-effects": "Side-effects\u00a0dry mouth, appetite changes, gastro-intestinal\r\ndisturbances (including nausea, diarrhoea, constipation, and dyspepsia),\r\nabdominal pain; tachycardia, vasodilatation, chest pain, palpitation;\r\nheadache (uncommonly migraine), anxiety, sleep disturbances, dizziness,\r\ndrowsiness, depression, confusion, paraesthesia, asthenia; visual\r\ndisturbances; less commonly flatulence, reflux, vomiting,\r\nmouth ulcers, glossitis, dysphagia, taste disturbance, weight changes,\r\nhypertension, hypotension, bradycardia, arrhythmia, peripheral oedema,\r\nhypercholesterolaemia, rhinitis, dyspnoea, epistaxis, dyskinesia,\r\namnesia, emotional lability, abnormal dreams, suicidal ideation, tremor,\r\ndecreased libido, agitation, aggression, hyperglycaemia, thirst, urinary\r\nfrequency, menstrual disturbances, eosinophilia, leucopenia, myasthenia,\r\nmuscle cramps, hypertonia, myalgia, arthralgia, dry eye, sinusitis,\r\nacne, sweating, rash, and pruritus; rarely hallucinations,\r\nmania, psychosis; multi-organ hypersensitivity reaction, Stevens-Johnson\r\nsyndrome, and toxic epidermal necrolysis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68990.htm", "doses": [ "Narcolepsy adult over 18\r\nyears, initially 200\u00a0mg daily, either in 2 divided\r\ndoses morning and at noon or as a single dose in\r\nthe morning, dose adjusted according to response to 200\u2013400\u00a0mg daily\r\nin 2 divided doses or as a single dose; elderly initiate at 100\u00a0mg daily; child 5\u201318\r\nyears see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid" }, "AMIFAMPRIDINE": { "indications": "Indications\u00a0(specialist use only) symptomatic treatment\r\nof Lambert-Eaton myasthenic syndrome", "name": "AMIFAMPRIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.1 Drugs that enhance neuromuscular transmission", "Acetylcholine-release enhancers", "AMIFAMPRIDINE" ], "cautions": "Cautions\u00a0concomitant use of drugs that lower convulsive\r\nthreshold; non-paraneoplastic form of Lambert-Eaton\r\nmyasthenic syndrome; clinical and ECG monitoring\r\nrequired at treatment initiation and yearly thereafter", "side-effects": "Side-effects\u00a0gastro-intestinal disorders; paraesthesia; palpitations,\r\narrhythmias, Raynaud\u2019s syndrome, cough, bronchial hypersecretion,\r\nexacerbation or precipitation of asthma, sleep disturbances, convulsions,\r\nanxiety, drowsiness, dizziness, weakness, headache, chorea, myoclonia,\r\nand blurred vision also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207438.htm", "doses": [ "adult over 18 years, initially\r\n15\u00a0mg daily in 3 divided doses, increased in steps of 5\u00a0mg every 4\u20135\r\ndays, to max. 60\u00a0mg daily in 3\u20134 divided doses; max. single dose 20\u00a0mg" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014ensure effective contraception\r\nduring treatment in men and women" }, "EPHEDRINE HYDROCHLORIDE - TOPICAL NASAL DECONGESTANTS": { "indications": "Indications\u00a0nasal congestion", "name": "EPHEDRINE HYDROCHLORIDE - TOPICAL NASAL DECONGESTANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.2 Topical nasal decongestants", "Sympathomimetics", "EPHEDRINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see section 3.1.1.2 and notes above; also avoid\r\nexcessive or prolonged use; interactions: Appendix\r\n1 (sympathomimetics)", "side-effects": "Side-effects\u00a0local irritation, nausea, headache; after excessive\r\nuse tolerance with diminished effect, rebound congestion; cardiovascular\r\neffects also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5659.htm", "doses": [ "See below", "adult and child over 12 years, 1\u20132 drops into each nostril\r\nup to 4 times daily when required, max. duration 7 days" ], "pregnancy": "Pregnancy\u00a0see section 3.1.1.2" }, "DOXYCYCLINE Modified-release": { "indications": "Indications\u00a0see notes above; chronic prostatitis; sinusitis, syphilis, pelvic\r\ninflammatory disease (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy); treatment\r\nand prophylaxis of anthrax [unlicensed indication]; malaria treatment\r\nand prophylaxis (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials); recurrent aphthous ulceration, adjunct to gingival\r\nscaling and root planing for periodontitis (%s\n(From 12.3.1 Drugs for oral ulceration and inflammation: British National Formulary)\n12.3.1 Drugs for oral ulceration and inflammation); oral\r\nherpes simplex (%s\n(From Oropharyngeal viral infections: British National Formulary)\nOropharyngeal viral infections); rosacea, acne vulgaris (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "DOXYCYCLINE Modified-release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "DOXYCYCLINE", "Modified-release" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; alcohol dependence; photosensitivity reported\r\n(avoid exposure to sunlight or sun lamps)", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nanorexia, dry mouth, flushing, anxiety, and tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204181.htm", "doses": [ "200\u00a0mg on first day, then 100\u00a0mg daily; severe infections\r\n(including refractory urinary-tract infections), 200\u00a0mg daily", "Early syphilis, 100\u00a0mg twice daily for 14 days; late latent\r\nsyphilis, 100\u00a0mg twice daily for 28 days; neurosyphilis, 200\u00a0mg twice\r\ndaily for 28 days", "Uncomplicated genital chlamydia, non-gonococcal urethritis,\r\n100\u00a0mg twice daily for 7 days (14 days in pelvic inflammatory disease,\r\nsee also Table 1, section 5.1)", "Lyme disease (see also section 5.1.1.3), 100\u00a0mg twice daily for 10\u201314\r\ndays (28 days in Lyme arthritis)", "Anthrax (treatment or post-exposure prophylaxis; see also section 5.1.12), 100\u00a0mg twice daily; child (only if alternative antibacterial cannot be given) [unlicensed\r\ndose] 5\u00a0mg/kg daily in 2 divided doses (max. 200\u00a0mg daily)", "Capsules should be swallowed whole\r\nwith plenty of fluid during meals while sitting or standing", "Doxycycline doses in BNF\r\nmay differ from those in product literature", "Name[Efracea\u00ae (Galderma) ] Capsules, m/r, beige, doxycycline\r\n(as monohydrate) 40\u00a0mg, net price 56-cap pack = \u00a329.78. \r\n Label:\r\n 6, 11, 27, counselling, postureDose\u00a0papulopustular, facial rosacea (without ocular involvement),\r\n40\u00a0mg daily in the morning for 16 weeks; consider discontinuing treatment\r\nif no response after 6 weeks" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "ORAL REHYDRATION SALTS (ORS) WHO formulation": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.2 Oral sodium and water", "Oral rehydration therapy (ORT)", "ORAL REHYDRATION SALTS (ORS)", "WHO formulation" ], "indications": "Indications\u00a0fluid and electrolyte loss in\r\ndiarrhoea, see notes above", "name": "ORAL REHYDRATION SALTS (ORS) WHO formulation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4963.htm", "doses": [ "According to fluid loss, usually 200\u2013400\u00a0mL solution after\r\nevery loose motion; infant 1\u20131\u00bd times\r\nusual feed volume; child 200\u00a0mL after\r\nevery loose motion", "Name[Oral Rehydration Salts (Non-proprietary)] Oral powder, sodium chloride 2.6\u00a0g, potassium chloride 1.5\u00a0g, sodium\r\ncitrate 2.9\u00a0g, anhydrous glucose 13.5\u00a0g.\r\nTo be dissolved in sufficient water to produce 1\u00a0litre (providing\r\nNa+ 75\u00a0mmol, K+ 20\u00a0mmol, Cl\u2013 65\u00a0mmol,\r\ncitrate 10\u00a0mmol, glucose 75\u00a0mmol/litre)Note\u00a0Recommended by the WHO and the United Nations\r\nChildren\u2019s Fund but not commonly used in the UK." ] }, "TRIAMTERENE WITH FUROSEMIDE": { "indications": "Indications\u00a0oedema", "name": "TRIAMTERENE WITH FUROSEMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "TRIAMTERENE WITH FUROSEMIDE" ], "cautions": "Cautions\u00a0hypotension; diabetes mellitus; prostatic enlargement; impaired micturition; gout; monitor electrolytes; elderly; hepatorenal syndrome; may\r\ncause blue fluorescence of urine; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth; hypotension;\r\nhyperglycaemia (less common than with thiazides); electrolyte disturbances\r\nincluding hypokalaemia (section 2.2), hyperkalaemia,\r\nhyponatraemia, hypocalcaemia, hypomagnesaemia, hyperuricaemia and\r\ngout, metabolic alkalosis; rarely pancreatitis, intrahepatic\r\ncholestasis, paraesthesia, blood disorders (including thrombocytopenia,\r\nleucopenia, agranulocytosis, aplastic anaemia, haemolytic anaemia),\r\nbone marrow depression (withdraw treatment), tinnitus and deafness\r\n(usually in renal impairment or in hypoproteinaemia), hypersensitivity\r\nreactions (including rashes, photosensitivity, eosinophilia, exfoliative\r\ndermatitis, purpura, and anaphylaxis); temporary increase in plasma\r\ncholesterol and triglyceride concentration also reported; triamterene\r\nfound in kidney stones", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200412.htm", "doses": [ "See preparations", "\u00bd\u20132\u00a0tablets daily in the morning" ] }, "SILDENAFIL - PHOSPHODIESTERASE TYPE-5 INHIBITORS": { "side-effects": "Side-effects\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nThe side-effects of sildenafil, tadalafil, and vardenafil include dyspepsia, nausea, vomiting, headache (including migraine), flushing, dizziness, myalgia, back pain, visual disturbances (non-arteritic anterior ischaemic optic neuropathy has been reported\u2014stop drug if sudden visual impairment occurs), and nasal congestion. Less common side-effects include painful red eyes, palpitation, tachycardia, hypotension, hypertension, epistaxis. Other side-effects reported rarely include syncope, hypersensitivity reactions (including rash, facial oedema, and Stevens-Johnson syndrome), and priapism. Serious cardiovascular events (including arrhythmia, unstable angina, and myocardial infarction), seizures, sudden hearing loss (discontinue drug and seek medical advice), and retinal vascular occlusion have also been reported. ; also less commonly chest pain, drowsiness, hypoaesthesia, vertigo,\r\ntinnitus, dry mouth, fatigue; rarely cerebrovascular\r\naccident and atrial fibrillation", "indications": "Indications\u00a0erectile dysfunction; pulmonary hypertension\r\n(section 2.5.1)", "name": "SILDENAFIL - PHOSPHODIESTERASE TYPE-5 INHIBITORS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129684.htm", "doses": [ "adult over 18 years initially\r\n50\u00a0mg approx. 1 hour before sexual activity, subsequent doses adjusted\r\naccording to response to 25\u2013100\u00a0mg as a single dose as needed; max.\r\n1 dose in 24 hours (max. single dose 100\u00a0mg)", "Onset of effect may be delayed if taken with\r\nfood" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Phosphodiesterase type-5 inhibitors", "SILDENAFIL" ], "cautions": "Cautions\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nCautions\u00a0Sildenafil, tadalafil, and vardenafil should be used with caution in cardiovascular disease, left ventricular outflow obstruction, anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie\u2019s disease), and in those with a predisposition to priapism (e.g. in sickle-cell disease, multiple myeloma, or leukaemia). Concomitant treatment with a phosphodiesterase type-5 inhibitor and an alpha-blocker (section 2.5.4 and section 7.4.1) can increase the risk of postural hypotension\u2014initiate treatment with a phosphodiesterase type-5 inhibitor (at a low dose) only once the patient is stable on the alpha-blocker; see also interactions: Appendix 1 (sildenafil, tadalafil, vardenafil).; also bleeding\r\ndisorders or active peptic ulceration; interactions: Appendix 1 (sildenafil)" }, "GENTAMICIN - AMINOGLYCOSIDES": { "indications": "Indications\u00a0septicaemia and neonatal sepsis; meningitis and other CNS infections;\r\nbiliary-tract infection, acute pyelonephritis or prostatitis, endocarditis\r\n(\n(From 5.1.4 Aminoglycosides: British National Formulary)\nEndocarditis\u00a0Gentamicin is used in combination with other antibiotics for the treatment of bacterial endocarditis (Table 1, section 5.1). Serum-gentamicin concentration should be determined twice each week (more often in renal impairment). Streptomycin may be used as an alternative in gentamicin-resistant enterococcal endocarditis.); pneumonia\r\nin hospital patients, adjunct in listerial meningitis (Table 1, %s\n(From Central nervous system: British National Formulary)\nCentral nervous system); eye (%s\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials); ear (%s\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "GENTAMICIN - AMINOGLYCOSIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "GENTAMICIN" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3833.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate dose and monitor serum-gentamicin concentration\r\nclosely", "Multiple daily dose regimen, by intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous\r\ninfusion, 3\u20135\u00a0mg/kg daily (in divided doses every 8 hours),\r\nsee also notes above; child under 18\r\nyears see BNF for Children", "Endocarditis (in combination with other antibacterials, see\r\nTable 1, section 5.1), adult 1\u00a0mg/kg every 8 hours; child under\r\n18 years see BNF for Children", "Once daily dose regimen (see notes above and also consult local\r\nguidelines), by intravenous infusion, initially 5\u20137\u00a0mg/kg,\r\nthen adjust according to serum-gentamicin concentration; child under 18 years see BNF for Children", "Surgical prophylaxis, adult over\r\n18 years, by slow intravenous injection over at least\r\n3 minutes, 1.5\u00a0mg/kg up to 30 minutes before the procedure (up to\r\n3 further doses of 1.5\u00a0mg/kg may be given every 8 hours for high-risk\r\nprocedures) or (for joint replacement surgery) by intravenous infusion, 5\u00a0mg/kg as a single dose up to 30\r\nminutes before the procedure", "By intrathecal injection, seek specialist advice,\r\n1\u00a0mg daily (increased if necessary to 5\u00a0mg daily); only preservative-free,\r\nintrathecal preparation should be used; child under 18 years see BNF for Children", "For multiple daily dose regimen, one-hour\r\n(\u2018peak\u2019) serum concentration should be 5\u201310\u00a0mg/litre (3\u20135\u00a0mg/litre\r\nfor endocarditis); pre-dose (\u2018trough\u2019) concentration should be less\r\nthan 2\u00a0mg/litre (less than 1\u00a0mg/litre for endocarditis). For once-daily\r\ndose regimen, consult local guidelines on monitoring serum-gentamicin\r\nconcentration" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "BECLOMETASONE DIPROPIONATE - TOPICAL CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "indications": "Indications\u00a0severe inflammatory skin disorders\r\nsuch as eczemas unresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "BECLOMETASONE DIPROPIONATE - TOPICAL CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203251.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity." }, "GRASS AND TREE POLLEN EXTRACTS Grass pollen extract": { "indications": "Indications\u00a0treatment of seasonal allergic hay\r\nfever due to grass or tree pollen in patients who have failed to respond\r\nto anti-allergy drugs (\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\nImmunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or extracts of grass and tree pollen can reduce symptoms of asthma and allergic rhinoconjunctivitis. A vaccine containing extracts of wasp and bee venom is used to reduce the risk of severe anaphylaxis and systemic reactions in individuals with hypersensitivity to wasp and bee stings. An oral preparation of grass pollen extract (Grazax\u00ae) is also licensed for grass pollen-induced rhinitis and conjuctivitis. Those requiring immunotherapy must be referred to a hospital specialist for accurate diagnosis, assessment, and treatment.In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for the following indications:seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs;hypersensitivity to wasp and bee venoms.Desensitising vaccines should generally be avoided or used with particular care in patients with asthma.)", "name": "GRASS AND TREE POLLEN EXTRACTS Grass pollen extract", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.2 Allergen immunotherapy", "GRASS AND TREE POLLEN EXTRACTS", "Grass pollen extract" ], "cautions": "Cautions\u00a0\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\nImmunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or extracts of grass and tree pollen can reduce symptoms of asthma and allergic rhinoconjunctivitis. A vaccine containing extracts of wasp and bee venom is used to reduce the risk of severe anaphylaxis and systemic reactions in individuals with hypersensitivity to wasp and bee stings. An oral preparation of grass pollen extract (Grazax\u00ae) is also licensed for grass pollen-induced rhinitis and conjuctivitis. Those requiring immunotherapy must be referred to a hospital specialist for accurate diagnosis, assessment, and treatment.In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for the following indications:seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs;hypersensitivity to wasp and bee venoms.Desensitising vaccines should generally be avoided or used with particular care in patients with asthma. and consult product literature", "side-effects": "Side-effects\u00a0\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\n3.4.2 Allergen immunotherapy and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130041.htm", "doses": [ "See under preparations below", "Name[Grazax\u00ae (ALK-Abell\u00f3) ] Oral lyophilisates (= freeze-dried tablets), grass pollen extract 75\u00a0000\u00a0units, net price 30-tab pack\r\n= \u00a366.77. \r\n Label:\r\n Counselling, administrationDose\u00a0adult and child over 5 years, 1 tablet daily; start treatment\r\nat least 4 months before start of pollen season and continue for up\r\nto 3 yearsCounselling\u00a0Tablets should be placed under the\r\ntongue and allowed to disperse. Advise patient not to swallow for\r\n1 minute, or eat or drink for 5 minutes after taking the tablet" ], "pregnancy": "Pregnancy\u00a0avoid" }, "BUSPIRONE HYDROCHLORIDE": { "indications": "Indications\u00a0anxiety (short-term use)", "name": "BUSPIRONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Buspirone" ], "cautions": "Cautions\u00a0does not alleviate benzodiazepine withdrawal (\n(From Buspirone: British National Formulary)\nBuspirone); interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving); effects of alcohol may be enhanced", "side-effects": "Side-effects\u00a0nausea; dizziness, headache, nervousness, excitement; rarely dry mouth, tachycardia, palpitation, chest pain,\r\ndrowsiness, confusion, seizures, fatigue, and sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3192.htm", "doses": [ "adult over 18 years, 5\u00a0mg\r\n2\u20133 times daily, increased as necessary every 2\u20133 days; usual range\r\n15\u201330\u00a0mg daily in divided doses; max. 45\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ECONAZOLE NITRATE": { "indications": "Indications\u00a0fungal skin infections; vaginal candidiasis (section 7.2.2)", "name": "ECONAZOLE NITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "ECONAZOLE NITRATE" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6160.htm", "doses": [ "Skin infections apply twice daily; nail infections, apply\r\nonce daily under occlusive dressing" ], "pregnancy": "Pregnancy\u00a0minimal absorption from skin; not known to be harmful" }, "PREGABALIN": { "indications": "Indications\u00a0peripheral and central neuropathic\r\npain (section 4.7.3); adjunctive therapy for focal\r\nseizures with or without secondary generalisation; generalised anxiety\r\ndisorder (section 4.3)", "name": "PREGABALIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Gabapentin and pregabalin" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal (taper over at least 1 week); severe congestive heart\r\nfailure; conditions that may precipitate\r\nencephalopathy", "side-effects": "Side-effects\u00a0dry mouth, constipation, vomiting, flatulence,\r\noedema, dizziness, drowsiness, irritability, impaired attention, disturbances\r\nin muscle control and movement, speech disorder, impaired memory,\r\nparaesthesia, euphoria, confusion, malaise, appetite changes, insomnia,\r\nweight gain, sexual dysfunction, visual disturbances (including blurred\r\nvision, diplopia, visual field defects); less commonly abdominal distension, hypersalivation, gastro-oesophageal reflux\r\ndisease, thirst, taste disturbance, flushing, hypotension, hypertension,\r\ntachycardia, syncope, first-degree AV block, dyspnoea, nasal dryness,\r\nstupor, depersonalisation, depression, abnormal dreams, hallucinations,\r\nagitation, cognitive impairment, panic attacks, chills, hypoglycaemia,\r\nthrombocytopenia, urinary incontinence, dysuria, myalgia, arthralgia,\r\ndry eye, lacrimation, hyperacusis, nasopharyngitis, sweating, rash; rarely ascites, dysphagia, pancreatitis, weight loss, cold\r\nextremities, arrhythmia, bradycardia, cough, epistaxis, rhinitis,\r\nparosmia, hyperglycaemia, renal failure, oliguria, menstrual disturbances,\r\nbreast pain, breast discharge, breast hypertrophy, neutropenia, hypokalaemia,\r\nleucopenia, rhabdomyolysis, urticaria; also reported diarrhoea, nausea, congestive heart failure, QT-interval prolongation,\r\naggression, headache, convulsions, encephalopathy, urinary retention,\r\nkeratitis, Stevens-Johnson syndrome, pruritus; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129077.htm", "doses": [ "Neuropathic pain, adult over 18 years, initially 150\u00a0mg daily in 2\u20133 divided doses, increased\r\nif necessary after 3\u20137 days to 300\u00a0mg daily in 2\u20133 divided doses,\r\nincreased further if necessary after 7 days to max. 600\u00a0mg daily in\r\n2\u20133 divided doses", "Epilepsy, adult over 18 years,\r\ninitially 25\u00a0mg twice daily, increased at 7-day intervals in steps\r\nof 50\u00a0mg daily to 300\u00a0mg daily in 2\u20133 divided doses, increased further\r\nif necessary after 7 days to max. 600\u00a0mg daily in 2\u20133 divided doses", "Generalised anxiety disorder, adult over 18 years, initially 150\u00a0mg daily in 2\u20133 divided doses, increased\r\nif necessary at 7-day intervals in steps of 150\u00a0mg daily; max. 600\u00a0mg\r\ndaily in 2\u20133 divided doses", "Pregabalin doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "ACAMPROSATE CALCIUM": { "indications": "Indications\u00a0\n(From Acamprosate: British National Formulary)\nAcamprosate", "name": "ACAMPROSATE CALCIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.1 Alcohol dependence", "Acamprosate", "ACAMPROSATE CALCIUM" ], "cautions": "Cautions\u00a0continued alcohol abuse (risk of treatment failure)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, abdominal pain; fluctuation\r\nin libido; pruritus, maculopapular rash; rarely bullous\r\nskin reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/39076.htm", "doses": [ "adult 18\u201365 years, body-weight\r\n60\u00a0kg and over, 666\u00a0mg 3 times daily; body-weight less than 60\u00a0kg,\r\n666\u00a0mg at breakfast, 333\u00a0mg at midday, and 333\u00a0mg at night", "child 16\u201318 years (under specialist\r\nsupervision) [unlicensed], body-weight 60\u00a0kg and over, 666\u00a0mg 3 times\r\ndaily; body-weight less than 60\u00a0kg, 666\u00a0mg at breakfast, 333\u00a0mg at\r\nmidday, and 333\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0avoid" }, "GLIPIZIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "GLIPIZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above; also dizziness, drowsiness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4175.htm", "doses": [ "Initially 2.5\u20135\u00a0mg daily shortly before breakfast or lunch,\r\nadjusted according to response; max. 20\u00a0mg daily; up to 15\u00a0mg may\r\nbe given as a single dose; higher doses divided" ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "RAMIPRIL": { "indications": "Indications\u00a0hypertension; symptomatic heart failure (adjunct\u2014see section 2.5.5); following\r\nmyocardial infarction in patients with clinical evidence of heart\r\nfailure; prevention of cardiovascular events in patients with atherosclerotic\r\ncardiovascular disease or with diabetes mellitus and at least one\r\nadditional risk factor for cardiovascular disease; nephropathy (consult\r\nproduct literature)", "name": "RAMIPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; arrhythmias, angina, chest pain,\r\nsyncope, cerebrovascular accident, myocardial infarction, loss of\r\nappetite, stomatitis, dry mouth, skin reactions including erythema\r\nmultiforme and pemphigoid exanthema; precipitation or exacerbation\r\nof Raynaud\u2019s syndrome; conjunctivitis, onycholysis, confusion, nervousness,\r\ndepression, anxiety, impotence, decreased libido, alopecia, bronchitis\r\nand muscle cramps", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2603.htm", "doses": [ "Hypertension, initially 1.25\u20132.5\u00a0mg once daily, increased\r\nat intervals of 2\u20134 weeks to max. 10\u00a0mg once daily; if used in addition\r\nto diuretic see notes above", "Heart failure (adjunct), initially 1.25\u00a0mg once daily under\r\nclose medical supervision (see notes above),\r\nincreased gradually at intervals of 1\u20132 weeks to max. 10\u00a0mg daily\r\nif tolerated (preferably taken in 2 divided doses)", "Prophylaxis after myocardial infarction (started at least 48\r\nhours after infarction), initially 2.5\u00a0mg twice daily, increased after\r\n3 days to 5\u00a0mg twice daily", "If initial 2.5-mg dose not tolerated, give\r\n1.25\u00a0mg twice daily for 2 days before increasing to 2.5\u00a0mg twice daily,\r\nthen 5\u00a0mg twice daily; withdraw if dose cannot be increased to 2.5\u00a0mg\r\ntwice daily", "Prophylaxis of cardiovascular events, initially 2.5\u00a0mg once\r\ndaily, increased after 1\u20132 weeks to 5\u00a0mg once daily, then increased\r\nafter a further 2\u20133 weeks to 10\u00a0mg once daily", "Nephropathy, initially 1.25\u00a0mg once daily, increased after 2\r\nweeks to 2.5\u00a0mg once daily, then increased after a further 2 weeks\r\nto 5\u00a0mg once daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "POVIDONE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents" ], "indications": "Indications\u00a0dry eye conditions", "name": "POVIDONE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76456.htm", "doses": [ "Apply 4 times daily or as required" ] }, "FORMALDEHYDE": { "indications": "Indications\u00a0see under preparations", "name": "FORMALDEHYDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses", "FORMALDEHYDE" ], "cautions": "Cautions\u00a0see under Salicylic Acid", "side-effects": "Side-effects\u00a0see under Salicylic Acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6064.htm", "doses": [ "for warts, particularly plantar warts, apply twice daily" ] }, "CLARITHROMYCIN": { "indications": "Indications\u00a0respiratory-tract infections, mild to moderate skin and soft-tissue\r\ninfections, otitis media; Lyme disease (see also section 5.1.1.3); prevention of pertussis (Table\r\n2, section 5.1); Helicobacter pylori eradication (section 1.3)", "name": "CLARITHROMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides" ], "cautions": "Cautions\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nOral infections\u00a0The macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved. However, many organisms are now resistant to macrolides or rapidly develop resistance; their use should therefore be limited to short courses. Metronidazole (section 5.1.11) may be preferred as an alternative to a penicillin.Cautions\u00a0Macrolides should be used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. ; interactions: Appendix 1 (macrolides)", "side-effects": "Side-effects\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nSide-effects\u00a0Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-effects of the macrolides, but they are mild and less frequent with azithromycin and clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice) and rash occur less frequently. Other side-effects reported rarely or very rarely include pancreatitis, antibiotic-associated colitis, QT interval prolongation, arrhythmias, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Generally reversible hearing loss (sometimes with tinnitus) has been reported after large doses of a macrolide; it occurs commonly after long-term therapy with azithromycin. Intravenous infusion may cause local tenderness and phlebitis.; also\r\ndyspepsia, tooth and tongue discoloration, smell and taste disturbances,\r\nstomatitis, glossitis, and headache; less commonly arthralgia and myalgia; rarely tinnitus; very rarely dizziness, insomnia, nightmares, anxiety, confusion,\r\npsychosis, paraesthesia, convulsions, hypoglycaemia, renal failure,\r\ninterstitial nephritis, leucopenia, and thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3861.htm", "doses": [ "By mouth, adult and child over 12 years, 250\u00a0mg every\r\n12 hours for 7 days, increased in pneumonia or severe infections to\r\n500\u00a0mg every 12 hours for up to 14 days (see also Table 1, section 5.1); child body-weight under 8\u00a0kg, 7.5\u00a0mg/kg twice daily; 8\u201311\u00a0kg, 62.5\u00a0mg\r\ntwice daily; 12\u201319\u00a0kg, 125\u00a0mg twice daily; 20\u201329\u00a0kg, 187.5\u00a0mg twice\r\ndaily; 30\u201340\u00a0kg, 250\u00a0mg twice daily", "Lyme disease (see also section 5.1.1.3), adult and child over 12 years, 500\u00a0mg every\r\n12 hours for 14\u201321 days [unlicensed duration]; child 1 month\u201312 years see BNF for Children", "By intravenous infusion into larger\r\nproximal vein, adult and child over 12 years, 500\u00a0mg twice daily; child 1 month\u201312 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "FLUMETASONE PIVALATE With antibacterial": { "indications": "Indications\u00a0eczematous inflammation in otitis externa (\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "FLUMETASONE PIVALATE With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "FLUMETASONE PIVALATE", "With antibacterial" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31405.htm", "doses": [ "Name[Locorten-Vioform\u00ae (Amdipharm) ] Ear drops, flumetasone\r\npivalate 0.02%, clioquinol 1%. Net price\r\n7.5\u00a0mL = \u00a31.76Contra-indications\u00a0iodine sensitivityDose\u00a0adult and child over 2 years apply 2\u20133 drops into the ear twice\r\ndaily for 7\u201310 daysNote\u00a0Clioquinol stains skin and clothing" ] }, "AZATHIOPRINE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0\n(From Drugs affecting the immune response: British National Formulary)\nDrugs affecting the immune response; inflammatory\r\nbowel disease [unlicensed indication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE); autoimmune conditions and prophylaxis\r\nof transplantation rejection (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE); severe refractory eczema [unlicensed\r\nindication] (%s\n(From AZATHIOPRINE: British National Formulary)\nAZATHIOPRINE)", "name": "AZATHIOPRINE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "AZATHIOPRINE" ], "cautions": "Cautions\u00a0section 8.2.1", "side-effects": "Side-effects\u00a0section 8.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106293.htm", "doses": [ "By mouth, initially, rarely more than 3\u00a0mg/kg\r\ndaily, reduced according to response; maintenance 1\u20133\u00a0mg/kg daily;\r\nconsider withdrawal if no improvement within 3 months" ], "pregnancy": "Pregnancy\u00a0section 8.2.1" }, "ALENDRONIC ACID With colecalciferol": { "indications": "Indications\u00a0see under Dose", "name": "ALENDRONIC ACID With colecalciferol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "ALENDRONIC ACID", "With colecalciferol" ], "cautions": "Cautions\u00a0upper gastro-intestinal disorders (dysphagia, symptomatic\r\noesophageal disease, gastritis, duodenitis, or ulcers\u2014see also under\r\nContra-indications and Side-effects); history (within 1 year) of ulcers,\r\nactive gastro-intestinal bleeding, or surgery of the upper gastro-intestinal\r\ntract; correct disturbances of calcium\r\nand mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia)\r\nbefore starting and monitor serum-calcium concentration\r\nduring treatment; consider dental check-up before\r\ninitiating bisphosphonate (risk of osteonecrosis\r\nof the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); exclude other causes of osteoporosis; atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0oesophageal reactions (see below), abdominal pain\r\nand distension, dyspepsia, regurgitation, melaena, diarrhoea or constipation,\r\nflatulence, musculoskeletal pain, headache; rarely rash, pruritus, erythema, photosensitivity, uveitis, scleritis,\r\ntransient decrease in serum calcium and phosphate; nausea, vomiting,\r\ngastritis, peptic ulceration, hypersensitivity reactions (including\r\nurticaria and angioedema), atypical femoral fractures with long-term\r\nuse (see MHRA/CHM advice);\r\nmyalgia, malaise, and fever at initiation of treatment; very\r\nrarely severe skin reactions (including Stevens-Johnson syndrome),\r\nosteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)Oesophageal reactions\u00a0Severe oesophageal reactions\r\n(oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal\r\nerosions) have been reported; patients should be advised\r\nto stop taking the tablets and to seek medical attention if they develop\r\nsymptoms of oesophageal irritation such as dysphagia, new or worsening\r\nheartburn, pain on swallowing or retrosternal pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129541.htm", "doses": [ "Treatment of postmenopausal osteoporosis, 10\u00a0mg daily or 70\u00a0mg once weekly", "Treatment of osteoporosis in men, 10\u00a0mg daily", "Prevention and treatment of corticosteroid-induced osteoporosis\r\nin postmenopausal women not receiving hormone replacement therapy,\r\n10\u00a0mg daily", "treatment of postmenopausal osteoporosis in women at risk\r\nof vitamin D deficiency, 1 tablet once weekly", "Name[Fosavance\u00ae (MSD) ] Tablets, alendronic acid (as sodium\r\nalendronate) 70\u00a0mg, colecalciferol 70\u00a0micrograms (2 800\u00a0units), net\r\nprice 4-tab pack = \u00a322.80. Counselling, administrationDose\u00a0treatment of postmenopausal osteoporosis in women at risk\r\nof vitamin D deficiency, 1 tablet once weeklyCounselling\u00a0Tablets should be swallowed whole\r\nwith plenty of water while sitting or standing; to be taken on an\r\nempty stomach at least 30 minutes before breakfast (or another oral\r\nmedicine); patient should stand or sit upright for at least 30 minutes\r\nafter taking tablet" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ALVERINE CITRATE": { "indications": "Indications\u00a0adjunct in gastro-intestinal disorders characterised by smooth muscle\r\nspasm; dysmenorrhoea", "name": "ALVERINE CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Other antispasmodics" ], "side-effects": "Side-effects\u00a0nausea; dyspnoea; headache, dizziness; pruritus,\r\nrash; hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2096.htm", "doses": [ "adult and child over 12 years, 60\u2013120\u00a0mg 1\u20133 times daily" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "LOPERAMIDE HYDROCHLORIDE Compound preparations": { "indications": "Indications\u00a0symptomatic treatment of acute diarrhoea; adjunct to rehydration\r\nin acute diarrhoea in adults and children over 4 years (but see notes\r\nabove); chronic diarrhoea in adults only", "name": "LOPERAMIDE HYDROCHLORIDE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.2 Antimotility drugs", "LOPERAMIDE HYDROCHLORIDE", "Compound preparations" ], "cautions": "Cautions\u00a0\n(From 1.4 Acute diarrhoea: British National Formulary)\nHowever, antimotility drugs are not recommended for acute diarrhoea in young children.; interactions: Appendix 1 (loperamide)", "side-effects": "Side-effects\u00a0abdominal cramps, dizziness, drowsiness, and skin\r\nreactions including urticaria; paralytic ileus and abdominal bloating\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106499.htm", "doses": [ "Acute diarrhoea, 4\u00a0mg initially followed by 2\u00a0mg after\r\neach loose stool for up to 5 days; usual dose 6\u20138\u00a0mg daily; max. 16\u00a0mg\r\ndaily; child under 4 years not recommended;\r\n4\u20138 years, 1\u00a0mg 3\u20134 times daily for up to 3 days only; 8\u201312 years, 2\u00a0mg 4 times daily for up to 5 days", "Chronic diarrhoea in adults, initially, 4\u20138\u00a0mg daily in divided\r\ndoses, subsequently adjusted according to response and given in 2\r\ndivided doses for maintenance; max. 16\u00a0mg daily; child under 18 years see BNF for Children", "Faecal incontinence [unlicensed indication], initially 500\u00a0micrograms\r\ndaily, adjusted according to response; max. 16\u00a0mg daily in divided\r\ndoses", "Name[Imodium\u00ae Plus (McNeil)] Caplets (= tablets), loperamide\r\nhydrochloride 2\u00a0mg, simeticone 125\u00a0mg, net price 6-tab pack = \u00a32.27,\r\n12-tab pack = \u00a33.58Dose\u00a0acute diarrhoea with abdominal colic, initially 2 caplets\r\n(child 12\u201318 years 1 caplet) then 1\r\ncaplet after each loose stool; max. 4 caplets daily for up to 2 days; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014no information available" }, "SODIUM THIOSULPHATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Other poisons", "Cyanides" ], "indications": "Indications\u00a0in conjunction with sodium nitrite for cyanide poisoning", "name": "SODIUM THIOSULPHATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29556.htm", "doses": [ "By intravenous injection over 10 minutes\r\n(as sodium thiosulphate injection 500\u00a0mg/mL), 12.5\u00a0g; dose may be\r\nrepeated in severe cyanide poisoning if dicobalt edetate not available; child 400\u00a0mg/kg (max. 12.5\u00a0g); dose may be repeated\r\nin severe cyanide poisoning if dicobalt edetate not available" ] }, "FLURAZEPAM": { "indications": "Indications\u00a0insomnia (short-term use; \n(From 4.1 Hypnotics and anxiolytics: British National Formulary)\nImportant: benzodiazepine indications Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. The use of benzodiazepines to treat short-term \u2018mild\u2019 anxiety is inappropriate. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.)", "name": "FLURAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Benzodiazepines" ], "cautions": "Cautions\u00a0see under Nitrazepam", "side-effects": "Side-effects\u00a0see under Nitrazepam", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3146.htm", "doses": [ "15\u201330\u00a0mg at bedtime; elderly (or debilitated) 15\u00a0mg; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "ACICLOVIR": { "indications": "Indications\u00a0\n(From 13.10.3 Antiviral preparations: British National Formulary)\n13.10.3 Antiviral preparations; herpes simplex and varicella\u2013zoster\r\ninfections (%s\n(From ACICLOVIR: British National Formulary)\nACICLOVIR); eye infections (%s\n(From ACICLOVIR: British National Formulary)\nACICLOVIR)", "name": "ACICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.3 Antiviral preparations" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes", "side-effects": "Side-effects\u00a0transient stinging or burning; occasionally erythema,\r\nitching or drying of the skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6183.htm", "doses": [ "Apply to lesions every 4 hours (5 times daily) for 5\u201310\r\ndays, starting at first sign of attack" ], "pregnancy": "Pregnancy\u00a0not known to be harmful\u2014manufacturers advise use\r\nonly when potential benefit outweighs risk; limited absorption from\r\ntopical aciclovir preparations" }, "TOLBUTAMIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "TOLBUTAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas", "TOLBUTAMIDE" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above; also headache, tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202892.htm", "doses": [ "0.5\u20131.5\u00a0g (max. 2\u00a0g) daily in divided doses with or immediately\r\nafter meals or as a single dose with or immediately\r\nafter breakfast" ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "TRIPTORELIN - DRUGS AFFECTING GONADOTROPHINS": { "indications": "Indications\u00a0 endometriosis; precocious puberty; reduction in\r\nsize of uterine fibroids; male hypersexuality with severe sexual\r\ndeviation; advanced prostate cancer (section 8.3.4.2)", "name": "TRIPTORELIN - DRUGS AFFECTING GONADOTROPHINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues", "TRIPTORELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.", "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues; also gastro-intestinal\r\ndisturbances; in precocious puberty, withdrawal bleeding in females\r\nmay occur in the first month of treatment; asthenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129912.htm", "doses": [ "See under preparations below", "by subcutaneous or deep intramuscular injection, endometriosis and reduction\r\nin size of uterine fibroids, 3.75\u00a0mg every 4 weeks starting during\r\nfirst 5 days of menstrual cycle; max. duration of treatment 6 months\r\n(not to be repeated)", "Precocious puberty, body-weight over 30\u00a0kg, initially 3.75\u00a0mg\r\nevery 2 weeks for 3 doses, then every 3\u20134 weeks; body-weight 20\u201330\u00a0kg,\r\ninitially 2.5\u00a0mg every 2 weeks for 3 doses, then every 3\u20134 weeks;\r\nbody-weight under 20\u00a0kg, initially 1.875\u00a0mg every 2 weeks for 3 doses,\r\nthen every 3\u20134 weeks; discontinue when bone maturation consistent\r\nwith age over 12 years in girls or over 13 years in boys" ], "pregnancy": "Pregnancy\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues" }, "TRIAMCINOLONE ACETONIDE": { "indications": "Indications\u00a0prophylaxis and treatment of allergic\r\nrhinitis", "name": "TRIAMCINOLONE ACETONIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "TRIAMCINOLONE ACETONIDE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60801.htm", "doses": [ "adult and child over 12 years, 110\u00a0micrograms (2 sprays) into\r\neach nostril once daily; when control achieved, reduce to 55\u00a0micrograms\r\n(1 spray) into each nostril once daily; child 6\u201312 years, 55\u00a0micrograms (1 spray) into each nostril once daily,\r\nincreased if necessary to 110\u00a0micrograms (2 sprays) into each nostril\r\nonce daily; when control achieved, reduce to 55\u00a0micrograms (1 spray)\r\ninto each nostril once daily; max. duration of treatment 3 months; child 2\u20136 years see BNF for Children", "Preparations of triamcinolone acetonide can\r\nbe sold to the public for nasal administration as a non-pressurised\r\nnasal spray if supplied for the symptomatic treatment of seasonal\r\nallergic rhinitis in adults over 18 years, subject to max. daily dose\r\nof 110\u00a0micrograms per nostril for max. 3 months, and a pack size of\r\n3.575\u00a0mg" ] }, "13.2.1 Emollients With antimicrobials": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.2 Emollient and barrier preparations", "13.2.1 Emollients", "With antimicrobials" ], "name": "13.2.1 Emollients With antimicrobials", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208031.htm", "doses": [ "Name[Eczmol\u00ae (Genus)] Cream, chlorhexidine gluconate 1\u00a0%\r\nin emollient basis, net price 250\u00a0mL = \u00a33.70Excipients include cetostearyl\r\nalcoholDose\u00a0for dry and pruritic skin conditions including eczema\r\nand dermatitis, apply to skin or use as soap substitute" ] }, "BUPRENORPHINE - OPIOID ANALGESICS": { "indications": "Indications\u00a0see under Dose and under Patches; opioid dependence (section 4.10.3)", "name": "BUPRENORPHINE - OPIOID ANALGESICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "BUPRENORPHINE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also impaired consciousness; effects only partially\r\nreversed by naloxone; monitor liver functionFever or external heat\u00a0Monitor patients\r\nusing patches for increased side-effects if fever present (increased\r\nabsorption possible); avoid exposing application\r\nsite to external heat (may also increase absorption)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; can induce\r\nmild withdrawal symptoms in patients dependent on opioids; also diarrhoea,\r\nabdominal pain, anorexia, dyspepsia; vasodilatation; dyspnoea; paraesthesia,\r\nasthenia, fatigue, agitation, anxiety; less commonly flatulence, taste disturbance, angina, hypertension, syncope, hypoxia,\r\nwheezing, cough, restlessness, depersonalisation, dysarthria, impaired\r\nmemory, hypoaesthesia, tremor, influenza-like symptoms, pyrexia, rhinitis,\r\nrigors, muscle cramp, myalgia, tinnitus, dry eye, and dry skin; rarely paralytic ileus, dysphagia, impaired concentration,\r\nand psychosis; very rarely retching, hyperventilation,\r\nhiccups, and muscle fasciculation; hepatic necrosis and hepatitis\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3513.htm", "doses": [ "Moderate to severe pain, by sublingual administration, 200\u2013400\u00a0micrograms every 6\u20138 hours; child over 6 years, 16\u201325\u00a0kg, 100\u00a0micrograms every 6\u20138 hours; 25\u201337.5\u00a0kg,\r\n100\u2013200\u00a0micrograms every 6\u20138 hours; 37.5\u201350\u00a0kg, 200\u2013300\u00a0micrograms\r\nevery 6\u20138 hours", "By intramuscular or slow\r\nintravenous injection, 300\u2013600\u00a0micrograms every 6\u20138 hours; child over 6 months 3\u20136\u00a0micrograms/kg every 6\u20138 hours\r\n(max. 9\u00a0micrograms/kg)", "Premedication, by sublingual administration, 400\u00a0micrograms", "By intramuscular injection, 300\u00a0micrograms", "Intra-operative analgesia, by slow intravenous injection, 300\u2013450\u00a0micrograms" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. and %s\n(From Opioid substitution therapy: British National Formulary)\nPregnancy\u00a0Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death. Opioid substitution therapy is recommended during pregnancy because it carries a lower risk to the fetus than continued use of illicit drugs. If a woman who is stabilised on methadone or buprenorphine for treatment of opioid dependence becomes pregnant, therapy should be continued [buprenorphine is not licensed for use in pregnancy]. Many pregnant patients choose a withdrawal regimen, but withdrawal during the first trimester should be avoided because it is associated with an increased risk of spontaneous miscarriage. Withdrawal of methadone or buprenorphine should be undertaken gradually during the second trimester; for example, the dose of methadone may be reduced by 2\u20133\u00a0mg every 3\u20135 days. If illicit drug use occurs, the patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen.Further withdrawal of methadone or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and the risk of neonatal mortality. Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.The neonate should be monitored for respiratory depression and signs of withdrawal if the mother is prescribed high doses of opioid substitute.Signs of neonatal withdrawal from opioids usually develop 24\u201372 hours after delivery but symptoms may be delayed for up to 14 days, so monitoring may be required for several weeks. Symptoms include a high-pitched cry, rapid breathing, hungry but ineffective suckling, and excessive wakefulness; severe, but rare symptoms include hypertonicity and convulsions." }, "PROMETHAZINE HYDROCHLORIDE - DRUGS USED IN NAUSEA AND VERTIGO": { "indications": "Indications\u00a0nausea, vomiting, vertigo, labyrinthine\r\ndisorders, motion sickness; allergy and urticaria (section\r\n3.4.1); sedation (section\r\n4.1.1)", "name": "PROMETHAZINE HYDROCHLORIDE - DRUGS USED IN NAUSEA AND VERTIGO", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines" ], "cautions": "Cautions\u00a0see Promethazine Hydrochloride, section 3.4.1", "side-effects": "Side-effects\u00a0see Promethazine Hydrochloride, section 3.4.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3408.htm", "doses": [ "By mouth, 20\u201325\u00a0mg at bedtime on night\r\nbefore travel, repeat following morning if necessary; child 2\u20135 years 5\u00a0mg at night, and following morning\r\nif necessary, 5\u201310 years 10\u00a0mg at night, and following morning if\r\nnecessary" ], "pregnancy": "Pregnancy\u00a0see notes in section 3.4.1" }, "MORPHINE SALTS Tablets": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Tablets", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Tablets" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3497.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[Sevredol\u00ae (Napp) ] Tablets, f/c, scored, morphine sulphate 10\u00a0mg (blue), net price 56-tab pack = \u00a35.29; 20\u00a0mg (pink),\r\n56-tab pack = \u00a310.57; 50\u00a0mg (pale green), 56-tab pack = \u00a328.02. \r\n Label:\r\n 2" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "STRONTIUM RANELATE": { "indications": "Indications\u00a0\n(From Strontium ranelate: British National Formulary)\nStrontium ranelate", "name": "STRONTIUM RANELATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Strontium ranelate" ], "cautions": "Cautions\u00a0predisposition to thromboembolism; interferes with colorimetric measurements of calcium\r\nin blood and urine; interactions: Appendix\r\n1 (strontium ranelate)", "side-effects": "Side-effects\u00a0nausea, diarrhoea; venous thromboembolism; headache;\r\ndermatitis, eczema; very rarely vomiting, abdominal\r\npain, stomatitis, and hypersensitivity reactions, including rash,\r\npruritus, urticaria and angioedema\u2014see Severe Allergic Reactions,\r\nbelowSevere allergic reactionsSevere allergic reactions, including drug rash with eosinophilia\r\nand systemic symptoms (DRESS), have been reported in patients taking\r\nstrontium ranelate. DRESS starts with rash, fever, swollen glands,\r\nand increased white cell count, and it can affect the liver, kidneys\r\nand lungs; DRESS can also be fatal.Patients should be advised to stop taking strontium\r\nranelate and consult their doctor immediately if skin rash develops.\r\nTreatment with strontium ranelate should not be restarted.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129052.htm", "doses": [ "2\u00a0g once daily in water, preferably at bedtime", " Avoid food for 2 hours before and\r\nafter taking granules, particularly calcium-containing products e.g.\r\nmilk; also preferably avoid concomitant antacids containing aluminium\r\nand magnesium hydroxides for 2 hours after taking granules" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "SODIUM NITRITE": { "indications": "Indications\u00a0poisoning with cyanides (used in conjunction with sodium\r\nthiosulphate)", "name": "SODIUM NITRITE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Other poisons", "Cyanides", "SODIUM NITRITE" ], "side-effects": "Side-effects\u00a0flushing and headache due to vasodilatation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29555.htm", "doses": [ "By intravenous injection over 5\u201320 minutes\r\n(as sodium nitrite injection 30\u00a0mg/mL), 300\u00a0mg; child 4\u201310\u00a0mg/kg (max. 300\u00a0mg)" ] }, "SODIUM BICARBONATE - ALKALINISATION OF URINE": { "indications": "Indications\u00a0relief of\r\ndiscomfort in mild urinary-tract infections; alkalinisation of urine", "name": "SODIUM BICARBONATE - ALKALINISATION OF URINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.3 Drugs used in urological pain", "Alkalinisation of urine", "SODIUM BICARBONATE" ], "cautions": "Cautions\u00a0cardiac disease; patients on sodium-restricted diet; elderly; avoid prolonged use; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0eructation, alkalosis on prolonged use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104944.htm", "doses": [ "3\u00a0g in water every 2 hours until urinary pH exceeds 7;\r\nmaintenance of alkaline urine 5\u201310\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "HYDROCORTISONE - TOPICAL CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0see notes above", "indications": "Indications\u00a0mild inflammatory skin disorders such as eczemas\r\n(but for over-the-counter preparations, see below); nappy rash (see\r\nalso section 13.2.2)", "name": "HYDROCORTISONE - TOPICAL CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/15416.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "HYDROCORTISONE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity." }, "BECLOMETASONE DIPROPIONATE - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0adjunct to aminosalicylates in acute\r\nmild to moderate ulcerative colitis; asthma (section 3.2); allergic and vasomotor rhinitis (section 12.2.1); oral ulceration [unlicensed\r\nindication] (section 12.3.1)", "name": "BECLOMETASONE DIPROPIONATE - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids" ], "cautions": "Cautions\u00a0section 6.3.2; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0section 6.3.2; also nausea, constipation, headache,\r\nand drowsiness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200263.htm", "doses": [ "5\u00a0mg in the morning; max. duration of treatment 4 weeks; child safety and efficacy not established" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "FLUDROXYCORTIDE": { "indications": "Indications\u00a0inflammatory skin disorders such as eczemas", "name": "FLUDROXYCORTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5917.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "PETHIDINE HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe pain, obstetric analgesia; peri-operative analgesia", "name": "PETHIDINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; not suitable for severe continuing pain; accumulation of metabolites may result in neurotoxicity; cardiac arrhythmias, severe\r\ncor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nrestlessness, tremor, and hypothermia; convulsions reported in overdosage", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3542.htm", "doses": [ "Acute pain, by mouth, 50\u2013150\u00a0mg every\r\n4 hours; child 0.5\u20132\u00a0mg/kg", "By subcutaneous or intramuscular\r\ninjection, 25\u2013100\u00a0mg (elderly or debilitated, initially 25\u00a0mg), repeated after 4 hours; child, by intramuscular injection,\r\n0.5\u20132\u00a0mg/kg", "By slow intravenous injection, 25\u201350\u00a0mg (elderly or debilitated, initially 25\u00a0mg), repeated\r\nafter 4 hours", "Obstetric analgesia, by subcutaneous or intramuscular injection, 50\u2013100\u00a0mg, repeated 1\u20133 hours\r\nlater if necessary; max. 400\u00a0mg in 24 hours", "Premedication, by intramuscular injection, 25\u2013100\u00a0mg\r\n1 hour before operation (elderly or\r\ndebilitated, 25\u00a0mg); child 0.5\u20132\u00a0mg/kg", "Postoperative pain, by subcutaneous or intramuscular injection, 25\u2013100\u00a0mg (elderly or debilitated, initially 25\u00a0mg), every 2\u20133\r\nhours if necessary; child, by\r\nintramuscular injection, 0.5\u20132\u00a0mg/kg", "In the postoperative period,\r\nthe patient should be closely monitored for pain relief as well as\r\nfor side-effects especially respiratory depression" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "STREPTOKINASE": { "indications": "Indications\u00a0acute myocardial infarction (see notes above and %s\n(From 2.10.1 Management of stable angina and acute coronary syndromes: British National Formulary)\n2.10.1 Management of stable angina and acute coronary syndromes); deep-vein thrombosis, pulmonary\r\nembolism, acute arterial thromboembolism, and central retinal venous\r\nor arterial thrombosis", "name": "STREPTOKINASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.10 Stable angina, acute coronary syndromes, and fibrinolysis", "2.10.2 Fibrinolytic drugs", "STREPTOKINASE" ], "cautions": "Cautions\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nCautions\u00a0Thrombolytic drugs should be used with caution if there is a risk of bleeding including that from venepuncture or invasive procedures. They should also be used with caution in external chest compression, elderly, hypertension, conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation), and recent or concurrent use of drugs that increase the risk of bleeding.", "side-effects": "Side-effects\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nSide-effects\u00a0Side-effects of thrombolytics are mainly nausea and vomiting and bleeding. When thrombolytics are used in myocardial infarction, reperfusion arrhythmias and recurrent ischaemia and angina may occur. Reperfusion may also cause cerebral and pulmonary oedema. Hypotension can also occur and can usually be controlled by elevating the patient\u2019s legs, or by reducing the rate of infusion or stopping it temporarily. Back pain, fever, and convulsions have been reported. Bleeding is usually limited to the site of injection, but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs (e.g. tranexamic acid). Rarely further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). Thrombolytics can cause allergic reactions (including rash, flushing and uveitis) and anaphylaxis has been reported (for details of management see Allergic Emergencies, section 3.4.3). Guillain-Barr\u00e9 syndrome has been reported rarely after streptokinase treatment.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2820.htm", "doses": [ "Myocardial infarction (initiated within 12 hours of symptom\r\nonset), by intravenous infusion, 1.5 million units\r\nover 60 minutes", "Deep-vein thrombosis, pulmonary embolism, acute arterial thromboembolism,\r\ncentral retinal venous or arterial thrombosis, by intravenous\r\ninfusion, 250\u00a0000\u00a0units over 30 minutes, then 100\u00a0000\u00a0units\r\nevery hour for up to 12\u201372 hours according to condition with monitoring\r\nof clotting parameters (consult product literature)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nPregnancy\u00a0Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy." }, "GOSERELIN": { "indications": "Indications\u00a0see under Dose; prostate cancer (section 8.3.4.2); early\r\nand advanced breast cancer (section\r\n8.3.4.1)", "name": "GOSERELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues", "GOSERELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.; polycystic ovarian disease; diabetes", "side-effects": "Side-effects\u00a0see notes above; withdrawal bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104938.htm", "doses": [ "By subcutaneous injection into anterior\r\nabdominal wall (as Zoladex\u00ae)", "Endometriosis, 3.6\u00a0mg every 28 days; max. duration of treatment\r\n6 months (do not repeat)", "Endometrial thinning before intra-uterine surgery, 3.6\u00a0mg (may\r\nbe repeated after 28 days if uterus is large or to allow flexible\r\nsurgical timing)", "Before surgery in women who have anaemia due to uterine fibroids,\r\n3.6\u00a0mg every 28 days (with supplementary iron); max. duration of treatment\r\n3 months", "Pituitary desensitisation before induction of ovulation by gonadotrophins\r\nfor in vitro fertilisation (under specialist supervision),\r\nafter exclusion of pregnancy, 3.6\u00a0mg to achieve pituitary down-regulation\r\n(usually 1\u20133 weeks) then gonadotrophin is administered (stopping gonadotrophin\r\non administration of chorionic gonadotrophin at\r\nappropriate stage of follicular development)" ], "pregnancy": "Pregnancy\u00a0use non-hormonal contraceptives during treatment;\r\nsee also notes above" }, "ORLISTAT": { "indications": "Indications\u00a0adjunct in obesity (see notes above)", "name": "ORLISTAT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.5 Drugs used in the treatment of obesity", "4.5.1 Anti-obesity drugs acting on the gastro-intestinal tract", "ORLISTAT" ], "cautions": "Cautions\u00a0may impair absorption of fat-soluble\r\nvitamins; chronic kidney disease or volume depletion; interactions: Appendix 1 (orlistat)Multivitamins\u00a0If a multivitamin supplement\r\nis required, it should be taken at least 2 hours after orlistat dose or at bedtime", "side-effects": "Side-effects\u00a0oily leakage from rectum, flatulence, faecal urgency,\r\nliquid or oily stools, faecal incontinence, abdominal distension and\r\npain (gastro-intestinal effects minimised by reduced fat intake),\r\ntooth and gingival disorders, respiratory infections, malaise, anxiety,\r\nheadache, menstrual disturbances, urinary-tract infection, hypoglycaemia; also reported rectal bleeding, diverticulitis, cholelithiasis,\r\nhepatitis, hypothyroidism, oxalate nephropathy, bullous eruptions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73513.htm", "doses": [ "adult over 18 years, 120\u00a0mg\r\ntaken immediately before, during, or up to 1 hour after each main\r\nmeal (max. 120\u00a0mg 3 times daily); continue treatment beyond 12 weeks\r\nonly if weight loss since start of treatment exceeds 5% (target for\r\ninitial weight loss may be lower in patients with type 2 diabetes); child over 12 years see BNF for Children", "If a meal is missed or contains no fat, the\r\ndose of orlistat should be omitted" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "THALIDOMIDE": { "indications": "Indications\u00a0\n(From Lenalidomide and thalidomide: British National Formulary)\nLenalidomide and thalidomide", "name": "THALIDOMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Lenalidomide and thalidomide", "THALIDOMIDE" ], "cautions": "Cautions\u00a0\n(From Lenalidomide and thalidomide: British National Formulary)\nLenalidomide and thalidomide; high\r\ntumour burden\u2014risk of %s\n(From Side-effects of cytotoxic drugs: British National Formulary)\nTumour lysis syndrome\u00a0Tumour lysis syndrome occurs secondary to spontaneous or treatment-related rapid destruction of malignant cells. Patients at risk of tumour lysis syndrome include those with non-Hodgkin\u2019s lymphoma (especially if high grade and bulky disease), Burkitt\u2019s lymphoma, acute lymphoblastic leukaemia and acute myeloid leukaemia (particularly if high white blood cell counts or bulky disease), and occasionally those with solid tumours. Pre-existing hyperuricaemia, dehydration, and renal impairment are also predisposing factors. Features include hyperkalaemia, hyperuricaemia (see below), and hyperphosphataemia with hypocalcaemia; renal damage and arrhythmias can follow. Early identification of patients at risk, and initiation of prophylaxis or therapy for tumour lysis syndrome, is essential.; monitor for\r\narterial or venous thromboembolism and\r\nuse caution with concomitant drugs that increase the risk of peripheral\r\nneuropathy or thromboembolism\u2014see also Thromboembolism,\r\nbelowThromboembolism\u00a0Risk factors for thromboembolism\r\n(such as smoking, hypertension, hyperlipidaemia) should be minimised.Thromboprophylaxis is recommended for at least the first 5 months\r\nof treatment, especially in patients with additional thrombotic risk\r\nfactors. Patients and their carers should be made aware\r\nof the symptoms of thromboembolism and advised to report sudden breathlessness,\r\nchest pain, or swelling of a limbPeripheral neuropathy\u00a0Monitor patients\r\nfor signs and symptoms of peripheral neuropathy; patients and their carers should be advised to seek medical advice\r\nif symptoms such as paraesthesia, abnormal coordination, or weakness\r\ndevelop. Dose reduction, dose interruption, or treatment\r\ndiscontinuation may be necessary\u2014consult product literature. Patients with pre-existing peripheral neuropathy should not be treated\r\nwith thalidomide unless the potential clinical benefits outweigh the\r\nrisk", "side-effects": "Side-effects\u00a0vomiting, dry mouth, dyspepsia, constipation;\r\nbradycardia, cardiac failure, deep vein thrombosis; dyspnoea, interstitial\r\nlung disease, pulmonary embolism, peripheral oedema; asthenia, confusion,\r\ndepression, dizziness, drowsiness, peripheral neuropathy, dysaesthesia,\r\nparaesthesia, syncope, tremor; pyrexia; pneumonia; anaemia, leucopenia,\r\nneutropenia, lymphopenia, thrombocytopenia; skin reactions including\r\nStevens-Johnson syndrome; also reported toxic epidermal\r\nnecrolysis, intestinal obstruction, gastro-intestinal perforation,\r\nhypothyroidism, sexual dysfunction, myocardial infarction, cerebrovascular\r\nevents", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201480.htm", "doses": [ "adult over 18 years, 200\u00a0mg\r\nonce daily at bedtime for 6-week cycle; max. 12 cycles" ], "pregnancy": "Pregnancy\u00a0important teratogenic risk; see\r\nalso notes above" }, "Topical NSAIDs Non-proprietary preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices", "Topical NSAIDs", "Non-proprietary preparations" ], "name": "Topical NSAIDs Non-proprietary preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202682.htm", "doses": [ "Name[Ibuprofen (Non-proprietary)] Gel, ibuprofen 5\u00a0%, net price 30\u00a0g\r\n= \u00a32.10, 50\u00a0g = \u00a32.93, 100\u00a0g = \u00a35.39. Counselling, photosensitivity, see aboveDose\u00a0apply up to 3 times daily" ] }, "PENTAZOCINE ": { "indications": "Indications\u00a0moderate to severe pain, but see notes above", "name": "PENTAZOCINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "PENTAZOCINE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, arterial or pulmonary hypertension, cardiac arrhythmias, myocardial\r\ninfarction, phaeochromocytoma; effects only partially reversed by naloxone", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, hypertension, syncope, seizures, paraesthesia, tremor,\r\nraised intracranial pressure, disorientation, hypothermia, chills,\r\nblood disorders, myalgia, and toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3541.htm", "doses": [ "By mouth, pentazocine hydrochloride 50\u00a0mg every 3\u20134 hours preferably after food (range\r\n25\u2013100\u00a0mg); max. 600\u00a0mg daily; child 6\u201312 years 25\u00a0mg", "By subcutaneous, intramuscular, or intravenous injection, moderate pain, pentazocine 30\u00a0mg, severe pain 45\u201360\u00a0mg every 3\u20134 hours\r\nwhen necessary; max. 360\u00a0mg daily; child over 1 year, by subcutaneous or intramuscular injection, up to 1\u00a0mg/kg, by\r\nintravenous injection up to 500\u00a0micrograms/kg" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "LEVOBUNOLOL HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "name": "LEVOBUNOLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Beta-blockers", "LEVOBUNOLOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From Beta-blockers: British National Formulary)\nSystemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block, or uncontrolled heart failure. Important: for a warning to avoid in asthma see below", "side-effects": "Side-effects\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers; anterior uveitis occasionally\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5513.htm", "doses": [ "Apply once or twice daily" ] }, "TETANUS IMMUNOGLOBULIN": { "indications": "Indications\u00a0post-exposure prophylaxis and treatment\r\nof tetanus infection", "name": "TETANUS IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Tetanus", "TETANUS IMMUNOGLOBULIN" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines\u2014see Normal Immunoglobulins", "side-effects": "Side-effects\u00a0injection site swelling and pain; rarely anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6549.htm", "doses": [ "Post-exposure prophylaxis, by intramuscular injection 250\u00a0units, increased to 500\u00a0units if more than 24 hours have elapsed\r\nor there is risk of heavy contamination or following burns" ] }, "OSELTAMIVIR": { "indications": "Indications\u00a0see notes above", "name": "OSELTAMIVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.4 Influenza", "OSELTAMIVIR" ], "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea; headache;\r\nconjunctivitis; less commonly eczema; also reported\r\nhepatitis, gastro-intestinal bleeding, arrhythmias, neuropsychiatric\r\ndisorders (more frequent in children and adolescents), thrombocytopenia,\r\nvisual disturbances, Stevens-Johnson syndrome, and toxic epidermal\r\nnecrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119744.htm", "doses": [ "Prevention of influenza, adult and child over 13 years, 75\u00a0mg once\r\ndaily for 10 days for post-exposure prophylaxis; for up to 6 weeks\r\nduring an epidemic; child under 1 month\r\n(see notes above), 2\u00a0mg/kg\r\nonce daily for 10 days for post-exposure prophylaxis; 1\u20133 months (see notes above), 2.5\u00a0mg/kg\r\nonce daily for 10 days for post\u2013exposure prophylaxis; 3 months\u20131 year\r\n(see notes above), 3\u00a0mg/kg\r\nonce daily for 10 days for post-exposure prophylaxis; 1\u201313 years,\r\nbody-weight under 15\u00a0kg, 30\u00a0mg once daily for 10 days for post-exposure\r\nprophylaxis (for up to 6 weeks during an epidemic); body-weight 15\u201323\u00a0kg,\r\n45\u00a0mg once daily for 10 days for post-exposure prophylaxis (for up\r\nto 6 weeks during an epidemic); body-weight 23\u201340\u00a0kg, 60\u00a0mg once daily\r\nfor 10 days for post-exposure prophylaxis (for up to 6 weeks during\r\nan epidemic); body-weight over 40\u00a0kg, adult dose", "Treatment of influenza, adult and child over 13 years, 75\u00a0mg every\r\n12 hours for 5 days; child under 1\r\nmonth (see notes above), 2\u00a0mg/kg\r\nevery 12 hours for 5 days; 1\u20133 months (see notes above), 2.5\u00a0mg/kg\r\nevery 12 hours for 5 days; 3 months\u20131 year (see notes above), 3\u00a0mg/kg\r\nevery 12 hours for 5 days; 1\u201313 years, body-weight under 15\u00a0kg, 30\u00a0mg\r\nevery 12 hours for 5 days, body-weight 15\u201323\u00a0kg, 45\u00a0mg every 12 hours\r\nfor 5 days, body-weight 23\u201340\u00a0kg, 60\u00a0mg every 12 hours for 5 days,\r\nbody-weight over 40\u00a0kg, adult dose", "Not licensed for use in children under 1\r\nyear of age unless there is a pandemic" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk (e.g.\r\nduring a pandemic); see also Pregnancy and Breast-feeding" }, "TYPHOID VACCINE Typhoid polysaccharide vaccine for injection": { "indications": "Indications\u00a0immunisation against typhoid fever", "name": "TYPHOID VACCINE Typhoid polysaccharide vaccine for injection", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Typhoid vaccines", "TYPHOID VACCINE", "Typhoid polysaccharide vaccine for injection" ], "cautions": "Cautions\u00a0section 14.1; interactions: see above and Appendix\r\n1 (typhoid vaccine (oral) )", "side-effects": "Side-effects\u00a0section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6532.htm", "doses": [ "See under preparations", "Name[Typhim Vi\u00ae (Sanofi Pasteur) ] Injection, Vi capsular polysaccharide\r\ntyphoid vaccine, 50\u00a0micrograms/mL virulence polysaccharide antigen\r\nof formaldehyde-inactivated Salmonella typhi,\r\nnet price 0.5-mL prefilled syringe = \u00a39.30Dose\u00a0by intramuscular injection, 0.5\u00a0mL, at\r\nleast 2 weeks before potential exposure to typhoid infection child under 2 years (see notes above)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "COLESTYRAMINE - LIPID-REGULATING DRUGS": { "indications": "Indications\u00a0hyperlipidaemias, particularly type IIa,\r\nin patients who have not responded adequately to diet and other appropriate\r\nmeasures; primary prevention of coronary heart disease in men aged\r\n35\u201359 years with primary hypercholesterolaemia who have not responded\r\nto diet and other appropriate measures; pruritus associated with partial\r\nbiliary obstruction and primary biliary cirrhosis (section 1.9.2); diarrhoeal disorders (section 1.9.2)", "name": "COLESTYRAMINE - LIPID-REGULATING DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Bile acid sequestrants", "COLESTYRAMINE" ], "cautions": "Cautions\u00a0\n(From Bile acid sequestrants: British National Formulary)\nCautions\u00a0Bile acid sequestrants interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged. Interactions: Appendix 1 (bile acid sequestrants); interactions: Appendix 1 (colestyramine)", "side-effects": "Side-effects\u00a0\n(From Bile acid sequestrants: British National Formulary)\nSide-effects\u00a0As bile acid sequestrants are not absorbed, gastro-intestinal side-effects predominate. Constipation is common, but diarrhoea has occurred, as have nausea, vomiting, and gastro-intestinal discomfort. Hypertriglyceridaemia may be aggravated. An increased bleeding tendency has been reported due to hypoprothrombinaemia associated with vitamin K deficiency.;\r\nintestinal obstruction reported rarely and hyperchloraemic acidosis\r\nreported on prolonged use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2839.htm", "doses": [ "Lipid reduction, initially 4\u00a0g daily increased by 4\u00a0g\r\nat weekly intervals to 12\u201324\u00a0g daily in 1\u20134 divided doses, then adjusted\r\nas required; max. 36\u00a0g daily", "Pruritus, see section 1.9.2", "Diarrhoeal disorders, see section 1.9.2", "child 6\u201312 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Bile acid sequestrants: British National Formulary)\nPregnancy and breast-feeding\u00a0Bile acid sequestrants should be used with caution as although the drugs are not absorbed, they may cause fat-soluble vitamin deficiency on prolonged use." }, "BECLOMETASONE DIPROPIONATE - RESPIRATORY SYSTEM": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "BECLOMETASONE DIPROPIONATE - RESPIRATORY SYSTEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids", "BECLOMETASONE DIPROPIONATE" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65569.htm", "doses": [ "By aerosol inhalation, see Management of Chronic Asthma\r\ntable (important: for Clenil Modulite\u00ae and Qvar\u00ae, see under preparations)", "By inhalation of dry powder (important: for Asmabec\u00ae and Becodisks\u00ae, see\r\nunder preparations), 200\u2013400\u00a0micrograms twice daily; adjusted as necessary\r\nup to 800\u00a0micrograms twice daily; child over 5 years 100\u2013200\u00a0micrograms twice daily, adjusted as necessary" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "SODIUM CROMOGLICATE Single use": { "indications": "Indications\u00a0allergic conjunctivitis; seasonal\r\nkeratoconjunctivitis", "name": "SODIUM CROMOGLICATE Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "SODIUM CROMOGLICATE", "Single use" ], "side-effects": "Side-effects\u00a0burning and stinging", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213745.htm", "doses": [ "adult and child apply eye drops 4 times daily", "Name[Catacrom\u00ae (Moorfields)] Eye drops, sodium cromoglicate 2%,\r\nnet price 30 \u00d7 0.3\u00a0mL = \u00a38.99" ] }, "2.2.4 Potassium-sparing diuretics with other diuretics Spironolactone with loop diuretics": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "Spironolactone with loop diuretics" ], "name": "2.2.4 Potassium-sparing diuretics with other diuretics Spironolactone with loop diuretics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2392.htm", "doses": [ "Name[Lasilactone\u00ae (Sanofi-Aventis) ] Capsules, blue/white, spironolactone 50\u00a0mg, furosemide 20\u00a0mg, net price 28-cap pack = \u00a37.97Dose\u00a0resistant oedema, 1\u20134\u00a0capsules daily" ] }, "ARTICAINE HYDROCHLORIDE WITH ADRENALINE": { "indications": "Indications\u00a0infiltration anaesthesia in dentistry", "name": "ARTICAINE HYDROCHLORIDE WITH ADRENALINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Articaine" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics and\r\nAdrenaline, section 2.7.3", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and\r\nAdrenaline, section 2.7.3; also methaemoglobinaemia (see Prilocaine for treatment)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213801.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "adult and child over 4 years, consult expert dental sources; important: see also Administration" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014no information\r\navailable" }, "CICLOSPORIN - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0see under Dose; severe acute ulcerative\r\ncolitis (section 1.5.3); transplantation and graft-versus-host\r\ndisease (section 8.2.2)", "name": "CICLOSPORIN - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response" ], "cautions": "Cautions\u00a0section 8.2.2Additional cautions in atopic dermatitis and psoriasis\u00a0Contra-indicated in abnormal\r\nrenal function, uncontrolled hypertension (see also below), infections\r\nnot under control, and malignancy (see also below). Dermatological\r\nand physical examination, including blood pressure and renal function\r\nmeasurements required at least twice before starting. During treatment,\r\nmonitor serum creatinine every 2 weeks for first 3 months then every\r\nmonth; reduce dose by 25\u201350% if serum creatinine increases more than\r\n30% above baseline (even if within normal range) and discontinue if\r\nreduction not successful within 1 month. Discontinue if hypertension\r\ndevelops that cannot be controlled by dose reduction or antihypertensive\r\ntherapy. Avoid excessive exposure to sunlight and avoid use of UVB\r\nor PUVA. In atopic dermatitis, also allow herpes\r\nsimplex infections to clear before starting (if they occur during\r\ntreatment withdraw if severe); Staphylococcus aureus skin infections not absolute contra-indication providing controlled\r\n(but avoid erythromycin unless no other alternative\u2014see\r\nalso interactions: Appendix 1 (ciclosporin)); investigate lymphadenopathy that persists despite improvement\r\nin atopic dermatitis. In psoriasis, also exclude\r\nmalignancies (including those of skin and cervix) before starting\r\n(biopsy any lesions not typical of psoriasis) and treat patients with\r\nmalignant or pre-malignant conditions of skin only after appropriate\r\ntreatment (and if no other option); discontinue if lymphoproliferative\r\ndisorder develops", "side-effects": "Side-effects\u00a0section 8.2.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6000.htm", "doses": [ "Short-term treatment (usually for max. 8 weeks but\r\ncan be longer under specialist supervision) of severe atopic dermatitis\r\nwhere conventional therapy ineffective or inappropriate, administered\r\nin accordance with expert advice, by mouth, adult and child over\r\n16 years, initially 2.5\u00a0mg/kg daily in 2 divided doses, if good initial\r\nresponse not achieved within 2 weeks, increase rapidly to max. 5\u00a0mg/kg\r\ndaily; initial dose of 5\u00a0mg/kg daily in 2 divided doses if very severe; child under 16 years see BNF for Children", "Severe psoriasis where conventional therapy ineffective\r\nor inappropriate, administered in accordance with expert advice, by mouth, adult and child over 16 years, initially 2.5\u00a0mg/kg daily in\r\n2 divided doses, increased gradually to max. 5\u00a0mg/kg daily if no improvement\r\nwithin 1 month (discontinue if response still insufficient after 6\r\nweeks); initial dose of 5\u00a0mg/kg daily justified if rapid control required; child under 16 years see BNF for Children", "For preparations and counselling and\r\nfor advice on conversion between the preparations, see section 8.2.2" ], "pregnancy": "Pregnancy\u00a0see Immunosuppressant Therapy" }, "ROPINIROLE": { "indications": "Indications\u00a0Parkinson\u2019s disease, either used alone or as adjunct to co-beneldopa\r\nor co-careldopa; moderate to severe restless legs syndrome", "name": "ROPINIROLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "ROPINIROLE" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; severe cardiovascular disease (risk of hypotension\u2014monitor\r\nblood pressure), major psychotic disorders; elderly; avoid abrupt withdrawal; dose adjustment\r\nmay be necessary if smoking started or stopped during treatment; interactions: Appendix 1 (ropinirole)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, vomiting, abdominal pain, dyspepsia, gastro-oesophageal reflux\r\ndisease, constipation; hypotension; syncope, peripheral oedema; drowsiness\r\n(including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.),\r\ndizziness, nervousness, fatigue, dyskinesia, hallucinations, confusion; less commonly psychosis, compulsive behaviour (\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.); very rarely hepatic disorders; also reported paradoxical worsening of restless legs syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57175.htm", "doses": [ "Parkinson\u2019s disease, initially 750\u00a0micrograms daily\r\nin 3 divided doses, increased by increments of 750\u00a0micrograms daily\r\nat weekly intervals to 3\u00a0mg daily in 3 divided doses; further increased\r\nby increments of 1.5\u20133\u00a0mg daily at weekly intervals according to response;\r\nusual range 9\u201316\u00a0mg daily in 3 divided doses (but higher doses may\r\nbe required if used with levodopa); max. 24\u00a0mg daily in 3 divided\r\ndoses", "When administered as adjunct to levodopa, concurrent dose of levodopa may be reduced by\r\napprox. 20%; ropinirole doses in the BNF may differ\r\nfrom those in product literature", "Restless legs syndrome, adult over 18 years initially 250\u00a0micrograms at night for 2 days, increased\r\nif tolerated to 500\u00a0micrograms at night for 5 days and then to 1\u00a0mg\r\nat night for 7 days; further increased at weekly intervals in steps\r\nof 500\u00a0micrograms daily according to response; usual dose 2\u00a0mg at\r\nnight; max. 4\u00a0mg daily", "Repeat dose titration if restarting after\r\ninterval of more than a few days" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity\r\nin animal studies" }, "OLMESARTAN MEDOXOMIL With calcium-channel blocker": { "indications": "Indications\u00a0hypertension (see also notes above)", "name": "OLMESARTAN MEDOXOMIL With calcium-channel blocker", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "OLMESARTAN MEDOXOMIL", "With calcium-channel blocker" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain, peripheral oedema, hypertriglyceridaemia; fatigue; influenza-like\r\nsymptoms, cough, pharyngitis, rhinitis; urinary-tract infection; haematuria,\r\nhyperuricaemia; arthritis, musculoskeletal pain; less commonly angina, vertigo, rash; very rarely headache, thrombocytopenia,\r\nmyalgia, pruritus, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202473.htm", "doses": [ "Initially 10\u00a0mg once daily; if necessary increased to\r\n20\u00a0mg once daily; max. 40\u00a0mg daily", "Name[Sevikar\u00ae (Daiichi Sankyo) ] Tablets 20/5, white, f/c, olmesartan\r\nmedoxomil 20\u00a0mg, amlodipine (as besilate) 5\u00a0mg, net price 28-tab pack\r\n= \u00a316.95\nTablets 40/5, ivory, f/c, olmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 5\u00a0mg, net\r\nprice 28-tab pack = \u00a316.95\nTablets 40/10, brownish-red, f/c,\r\nolmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 10\u00a0mg, net price\r\n28-tab pack = \u00a316.95" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "MANNITOL": { "indications": "Indications\u00a0see notes above; glaucoma (%s\n(From 11.6 Treatment of glaucoma: British National Formulary)\n11.6 Treatment of glaucoma)", "name": "MANNITOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.5 Osmotic diuretics", "MANNITOL" ], "cautions": "Cautions\u00a0extravasation causes inflammation and\r\nthrombophlebitis; monitor fluid and electrolyte\r\nbalance, serum osmolality, and pulmonary and renal function; assess cardiac function before and during treatment; interactions: Appendix 1 (mannitol)", "side-effects": "Side-effects\u00a0less commonly hypotension, thrombophlebitis,\r\nfluid and electrolyte imbalance; rarely dry mouth,\r\nthirst, nausea, vomiting, oedema, raised intracranial pressure, arrhythmia,\r\nhypertension, pulmonary oedema, chest pain, headache, convulsions,\r\ndizziness, chills, fever, urinary retention, focal osmotic nephrosis,\r\ndehydration, cramp, blurred vision, rhinitis, skin necrosis, and hypersensitivity\r\nreactions (including urticaria and anaphylaxis); very rarely congestive heart failure and acute renal failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2395.htm", "doses": [ "Cerebral oedema and raised intra-ocular pressure, by intravenous infusion over 30\u201360 minutes, 0.25\u20132\u00a0g/kg repeated\r\nif necessary 1\u20132 times after 4\u20138 hours", "For mannitol 20%, an in-line filter is recommended\r\n(15-micron filters have been used)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014no information\r\navailable" }, "CICLESONIDE": { "indications": "Indications\u00a0prophylaxis of asthma", "name": "CICLESONIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.; also less commonly nausea, taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129218.htm", "doses": [ "By aerosol inhalation, 160\u00a0micrograms daily\r\nas a single dose reduced to 80\u00a0micrograms daily if control maintained;\r\ndose may be increased to max. 320\u00a0micrograms twice daily if necessary\r\nin severe asthma [unlicensed]; child 12\u201318 years, 160\u00a0micrograms daily as a single dose reduced to 80\u00a0micrograms\r\ndaily if control maintained" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "PEGVISOMANT": { "indications": "Indications\u00a0see notes above", "name": "PEGVISOMANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Growth hormone receptor antagonists" ], "cautions": "Cautions\u00a0liver disease (monitor liver enzymes\r\nevery 4\u20136 weeks for 6 months or if symptoms of hepatitis develop); diabetes mellitus (adjustment of antidiabetic therapy\r\nmay be necessary); possible increase in\r\nfemale fertility", "side-effects": "Side-effects\u00a0diarrhoea, constipation, nausea, vomiting, abdominal\r\ndistension, dyspepsia, flatulence, elevated liver enzymes; hypertension;\r\nheadache, asthenia, dizziness, drowsiness, tremor, sleep disturbances;\r\ninfluenza-like syndrome, weight gain, hyperglycaemia, hypoglycaemia;\r\narthralgia, myalgia; injection-site reactions (rotate injection sites\r\nto avoid lipohypertrophy), sweating, pruritus, rash; fatigue; hypercholesterolaemia;\r\nless commonly thrombocytopenia, leucopenia, leucocytosis, bleeding\r\ntendency", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128350.htm", "doses": [ "By subcutaneous injection, initially 80\u00a0mg,\r\nthen 10\u00a0mg daily, increased in steps of 5\u00a0mg daily according to response;\r\nmax. 30\u00a0mg daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid" }, "MICONAZOLE Buccal preparation": { "indications": "Indications\u00a0see preparations", "name": "MICONAZOLE Buccal preparation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.2 Oropharyngeal anti-infective drugs", "Oropharyngeal fungal infections", "MICONAZOLE", "Buccal preparation" ], "cautions": "Cautions\u00a0avoid in acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(antifungals, imidazole)", "side-effects": "Side-effects\u00a0nausea, vomiting; rash; with buccal tablets, abdominal pain, taste disturbance, burning sensation at application\r\nsite, pruritus, and oedema; with oral gel, very rarely diarrhoea (usually on long-term treatment),\r\nhepatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200949.htm", "doses": [ "See preparations", "Name[Loramyc\u00ae (Therabel) ] Mucoadhesive buccal tablets, white-yellow,\r\nmiconazole 50\u00a0mg, net price 14-tab pack = \u00a352.12. \r\n Label:\r\n 10, counselling, administrationDose\u00a0oropharyngeal candidiasis in immunocompromised adult, 50\u00a0mg daily preferably taken in the morning\r\nfor 7 days; if no improvement, continue treatment for a further 7\r\ndaysCounselling\u00a0Place rounded side of tablet on upper\r\ngum above an incisor tooth and hold upper lip firmly over the gum\r\nfor 30 seconds using a finger. If tablet detaches within 6 hours,\r\nreplace with a new tablet. With each dose, use alternate sides of\r\nthe gumNote\u00a0 The Scottish Medicines Consortium has advised (January 2011) that miconazole mucoadhesive buccal tablets\r\n(Loramyc\u00ae) are not recommended for use within NHS\r\nScotland." ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid if possible\u2014toxicity at\r\nhigh doses in animal studies" }, "FINGOLIMOD": { "indications": "Indications\u00a0\n(From Fingolimod: British National Formulary)\nFingolimod", "name": "FINGOLIMOD", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Fingolimod", "FINGOLIMOD" ], "cautions": "Cautions\u00a0monitor blood pressure; monitor for bradycardia for 6 hours after first dose; susceptibility to QT-interval prolongation (including\r\nelectrolyte disturbances, concomitant use of drugs that prolong QT\r\ninterval); severe respiratory disease; pulmonary fibrosis; chronic\r\nobstructive pulmonary disease; risk of\r\nmacular oedema\u2014eye examination recommended 3\u20134 months after initiation\r\nof treatment (and before initiation of treatment in patients with\r\ndiabetes or history of uveitis); interactions: Appendix 1 (fingolimod)", "side-effects": "Side-effects\u00a0diarrhoea, weight loss, AV block, bradycardia,\r\nhypertension, cough, dyspnoea, depression, malaise, headache, migraine,\r\ndizziness, paraesthesia, influenza, herpes, bronchitis, sinusitis,\r\ngastroenteritis, tinea, lymphopenia, leucopenia, back pain, blurred\r\nvision, eye pain, eczema, alopecia, pruritus; less commonly pneumonia, neutropenia, macular oedema; also reported lymphoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215607.htm", "doses": [ "adult over 18 years, 500\u00a0micrograms\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nexclude pregnancy before treatment and ensure effective contraception\r\nduring and for at least 2 months after treatment" }, "TESTOSTERONE AND ESTERS Implant": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS Implant", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS", "Implant" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4370.htm", "doses": [ "See under preparations", "Name[Testosterone (Organon) ] Implant, testosterone 100\u00a0mg, net\r\nprice = \u00a37.40; 200\u00a0mg = \u00a313.79Dose\u00a0by implantation, male hypogonadism, 100\u2013600\u00a0mg;\r\n600\u00a0mg usually maintains plasma-testosterone concentration within\r\nthe normal range for 4\u20135 months" ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "2.2.4 Potassium-sparing diuretics with other diuretics Spironolactone with thiazides": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "Spironolactone with thiazides" ], "name": "2.2.4 Potassium-sparing diuretics with other diuretics Spironolactone with thiazides", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2389.htm", "doses": [ "congestive heart failure, initially 2 tablets daily; range\r\n1\u20134 tablets daily (but not recommended because spironolactone generally\r\ngiven in lower dose)", "Name[Co-flumactone (Non-proprietary) ] Tablets, co-flumactone 25/25 (hydroflumethiazide\r\n25\u00a0mg, spironolactone 25\u00a0mg), net price 100-tab\r\npack = \u00a320.23Brands include Aldactide\u00a025\u00aeDose\u00a0congestive heart failure, initially 4 tablets daily; range\r\n1\u20138 tablets daily (but not recommended because spironolactone generally\r\ngiven in lower dose)\nTablets, co-flumactone 50/50 (hydroflumethiazide\r\n50\u00a0mg, spironolactone 50\u00a0mg), net\r\nprice 28-tab pack = \u00a310.70Brands include Aldactide\u00a050\u00aeDose\u00a0congestive heart failure, initially 2 tablets daily; range\r\n1\u20134 tablets daily (but not recommended because spironolactone generally\r\ngiven in lower dose)" ] }, "CO-CODAMOL - CO-CODAMOL 15/500": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-CODAMOL - CO-CODAMOL 15/500", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-CODAMOL", "Co-codamol 15/500" ], "cautions": "Cautions\u00a0hypotension, asthma (avoid during attack) and impaired respiratory function (avoid in chronic obstructive pulmonary disease), prostatic hypertrophy; shock; myasthenia gravis; obstructive or inflammatory bowel disorders; diseases\r\nof the biliary tract; reduced dose recommended in elderly and debilitated patients, in hypothyroidism, and in adrenocortical\r\ninsufficiency; convulsive disorders; cardiac arrhythmias; acute abdomen; gallstones; alcohol dependence; interactions: Appendix 1 (opioid analgesics, paracetamol)Variation in metabolism\u00a0The capacity\r\nto metabolise codeine can vary considerably and lead to either reduced\r\ntherapeutic effect or marked increase in side-effectsDependence and withdrawal\u00a0Repeated use of opioid\r\nanalgesics, such as codeine, is associated with the development of\r\npsychological and physical dependence; although this is rarely a problem\r\nwith therapeutic use, caution in advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment", "side-effects": "Side-effects\u00a0nausea and vomiting (particularly in initial stages),\r\nconstipation, dry mouth, and biliary spasm; larger doses produce respiratory\r\ndepression, hypotension, and muscle rigidity; other side-effects include\r\nabdominal pain, anorexia, bradycardia, tachycardia, palpitation, oedema,\r\npostural hypotension, seizures, malaise, hypothermia; hallucinations,\r\nvertigo, euphoria, dysphoria, mood changes, dependence, dizziness,\r\nconfusion, drowsiness, sleep disturbances, headache; sexual dysfunction,\r\ndifficulty with micturition, urinary retention, ureteric spasm, muscle\r\nfasciculation; blood disorders (including thrombocytopenia, leucopenia,\r\nneutropenia), miosis, visual disturbances, flushing, sweating, rashes,\r\nurticaria and pruritus; pancreatitis also reported; important: liver damage (and less frequently renal damage) following overdosage with paracetamol; see Emergency Treatment of\r\nPoisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced\r\nrespiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201063.htm", "doses": [ "See under preparations", "adult over 18 years 2 tablets\r\nevery 4 hours; max. 8 tablets daily; child not recommended", "Name[Codipar\u00ae (Goldshield) ] Caplets (= tablets), co-codamol\r\n15/500 (codeine phosphate 15\u00a0mg, paracetamol 500\u00a0mg), net price 100-tab pack = \u00a38.25. \r\n Label:\r\n 2, 29, 30Dose\u00a01\u20132 tablets every 4 hours; max. 8 tablets daily; child under 12 years not recommended\nEffervescent tablets, co-codamol\r\n15/500 (codeine phosphate 15\u00a0mg, paracetamol 500\u00a0mg), net price 100-tab pack = \u00a38.25. \r\n Label:\r\n 2, 13, 29, 30Electrolytes: Na+ 16.5\u00a0mmol/tabletDose\u00a0adult over 18 years 2 tablets\r\nevery 4 hours; max. 8 tablets daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0codeine may depress neonatal respiration; withdrawal\r\neffects in neonates of dependent mothers; gastric stasis and risk\r\nof inhalation pneumonia in mother during labour" }, "NICARDIPINE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0prophylaxis of angina; mild to moderate hypertension", "name": "NICARDIPINE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "NICARDIPINE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0withdraw if ischaemic pain occurs\r\nor existing pain worsens within 30 minutes of initiating treatment\r\nor increasing dose; congestive heart failure or significantly impaired left ventricular function; elderly; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0dizziness, headache, peripheral oedema, flushing,\r\npalpitation, nausea; also gastro-intestinal disturbances, drowsiness,\r\ninsomnia, tinnitus, hypotension, rashes, dyspnoea, paraesthesia, frequency\r\nof micturition; thrombocytopenia, depression and impotence reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2690.htm", "doses": [ "Initially 20\u00a0mg 3 times daily, increased, after at least\r\nthree days, to 30\u00a0mg 3 times daily (usual range 60\u2013120\u00a0mg daily)", "Name[Cardene SR\u00ae (Astellas) ] Capsules, m/r, nicardipine\r\nhydrochloride 30\u00a0mg, net price 56-cap pack = \u00a37.15; 45\u00a0mg\r\n(blue), 56-cap pack = \u00a310.40. \r\n Label:\r\n 25Dose\u00a0mild to moderate hypertension, initially 30\u00a0mg twice daily;\r\nusual effective dose 45\u00a0mg twice daily (range 30\u201360\u00a0mg twice daily)" ], "pregnancy": "Pregnancy\u00a0may inhibit labour; toxicity in animal studies; manufacturer advises avoid, but risk to fetus should be\r\nbalanced against risk of uncontrolled maternal hypertension" }, "FERRIC CARBOXYMALTOSE": { "indications": "Indications\u00a0iron-deficiency anaemia, \n(From 9.1.1.2 Parenteral iron: British National Formulary)\n9.1.1.2 Parenteral iron", "name": "FERRIC CARBOXYMALTOSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.2 Parenteral iron", "FERRIC CARBOXYMALTOSE" ], "cautions": "Cautions\u00a0hypersensitivity can occur with parenteral\r\niron and facilities for cardiopulmonary resuscitation must be available; oral iron should not be given until 5 days after last\r\ninjection; allergic disorders including\r\nasthma and eczema; infection (discontinue\r\nif ongoing bacteraemia)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; headache, dizziness;\r\nrash, injection-site reactions; less commonly hypertension,\r\nhypotension, flushing, chest pain, peripheral oedema, hypersensitivity\r\nreactions (including anaphylaxis), fatigue, paraesthesia, malaise,\r\npyrexia, rigors, myalgia, arthralgia, back pain, pruritus, and urticaria; rarely dyspnoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201168.htm", "doses": [ "By slow intravenous injection or by intravenous infusion, adult and child over 14 years, calculated\r\naccording to body-weight and iron deficit, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid in first trimester; crosses the placenta in animal studies; may influence skeletal development" }, "MEPIVACAINE HYDROCHLORIDE": { "indications": "Indications\u00a0infiltration anaesthesia and nerve\r\nblock in dentistry", "name": "MEPIVACAINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Mepivacaine" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/209331.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "adult and child over 3 years, consult expert dental sources; important: see also Administration" ], "pregnancy": "Pregnancy\u00a0use with caution in early pregnancy" }, "TACALCITOL": { "indications": "Indications\u00a0plaque psoriasis", "name": "TACALCITOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Vitamin D and analogues", "TACALCITOL" ], "cautions": "Cautions\u00a0\n(From Vitamin D and analogues: British National Formulary)\nVitamin D and analogues; avoid eyes; monitor serum calcium if risk\r\nof hypercalcaemia; if used in conjunction\r\nwith UV treatment, UV radiation should be given in the morning and tacalcitol applied at bedtime", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38415.htm", "doses": [ "adult and child over 12 years, apply once daily preferably\r\nat bedtime; max. 10\u00a0g ointment or 10\u00a0mL lotion daily", "When lotion and ointment used together, max.\r\ntotal tacalcitol 280\u00a0micrograms in any one week (e.g. lotion 30\u00a0mL\r\nwith ointment 40\u00a0g)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless no safer alternative\u2014no\r\ninformation available" }, "CARBAMAZEPINE": { "indications": "Indications\u00a0focal and secondary generalised tonic-clonic\r\nseizures, primary generalised tonic-clonic seizures; trigeminal neuralgia;\r\nprophylaxis of bipolar disorder unresponsive to lithium; adjunct in\r\nacute alcohol withdrawal [unlicensed] (section 4.10.1); diabetic neuropathy [unlicensed]\r\n(section 6.1.5)", "name": "CARBAMAZEPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Carbamazepine and related antiepileptics", "CARBAMAZEPINE" ], "cautions": "Cautions\u00a0cardiac disease (see also\r\nContra-indications); skin reactions (see\r\nalso Blood, Hepatic, or Skin Disorders, below and under Side-effects); test for\r\nHLA-B*1502 allele in individuals of Han Chinese or Thai origin (avoid\r\nunless no alternative\u2014risk of Stevens-Johnson syndrome in presence\r\nof HLA-B*1502 allele); history of haematological reactions\r\nto other drugs; manufacturer recommends\r\nblood counts and hepatic and renal function tests (but evidence of\r\npractical value uncertain); may exacerbate\r\nabsence and myoclonic seizures; consider\r\nvitamin D supplementation in patients who are immobilised for long\r\nperiods or who have inadequate sun exposure or dietary intake of calcium; susceptibility to angle-closure glaucoma; cross-sensitivity reported with oxcarbazepine and with phenytoin\r\n(see also Antiepileptic Hypersensitivity\r\nSyndrome); avoid abrupt withdrawal; interactions: see Interactions in section 4.8.1 and Appendix 1 (carbamazepine)Blood, hepatic, or skin disorders\u00a0Patients or their carers should be told how to recognise signs of\r\nblood, liver, or skin disorders, and advised to seek immediate medical\r\nattention if symptoms such as fever, rash, mouth ulcers, bruising,\r\nor bleeding develop. Carbamazepine should be withdrawn\r\nimmediately in cases of aggravated liver dysfunction or acute liver\r\ndisease. Leucopenia that is severe, progressive, or associated\r\nwith clinical symptoms requires withdrawal (if necessary under cover\r\nof a suitable alternative).", "side-effects": "Side-effects\u00a0\n(From Carbamazepine and related antiepileptics: British National Formulary)\nCarbamazepine and related antiepileptics; also dry\r\nmouth, nausea, vomiting, oedema, ataxia, dizziness, drowsiness, fatigue,\r\nheadache, hyponatraemia (leading in rare cases to water intoxication),\r\nblood disorders (including eosinophilia, leucopenia, thrombocytopenia,\r\nhaemolytic anaemia, and aplastic anaemia), dermatitis, urticaria; less commonly diarrhoea, constipation, involuntary movements\r\n(including nystagmus), visual disturbances; rarely abdominal pain, anorexia, hepatitis, jaundice, vanishing bile duct\r\nsyndrome, cardiac conduction disorders, hypertension, hypotension,\r\nperipheral neuropathy, dysarthria, aggression, agitation, confusion,\r\ndepression, hallucinations, restlessness, paraesthesia, lymph node\r\nenlargement, muscle weakness, systemic lupus erythematosus, delayed\r\nmulti-organ hypersensitivity disorder (see also %s\n(From 4.8.1 Control of the epilepsies: British National Formulary)\nAntiepileptic hypersensitivity syndrome\u00a0Antiepileptic hypersensitivity syndrome is a rare but potentially fatal syndrome associated with some antiepileptic drugs (carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide); rarely cross-sensitivity occurs between some of these antiepileptic drugs. Some other antiepileptics (eslicarbazepine, stiripentol, and zonisamide) have a theoretical risk. The symptoms usually start between 1 and 8 weeks of exposure; fever, rash, and lymphadenopathy are most commonly seen. Other systemic signs include liver dysfunction, haematological, renal, and pulmonary abnormalities, vasculitis, and multi-organ failure. If signs or symptoms of hypersensitivity syndrome occur, the drug should be withdrawn immediately, the patient must not be re-exposed, and expert advice should be sought.); very rarely pancreatitis, stomatitis, hepatic failure, taste\r\ndisturbance, exacerbation of coronary artery disease, AV block with\r\nsyncope, circulatory collapse, hypercholesterolaemia, thrombophlebitis,\r\nthromboembolism, pulmonary hypersensitivity (with dyspnoea, pneumonitis,\r\nor pneumonia), psychosis, neuroleptic malignant syndrome, osteomalacia\r\n(see Cautions), osteoporosis, galactorrhoea, gynaecomastia, impaired\r\nmale fertility, interstitial nephritis, renal failure, sexual dysfunction,\r\nurinary frequency, urinary retention, arthralgia, muscle pain, muscle\r\nspasm, conjunctivitis, angle-closure glaucoma, hearing disorders,\r\nacne, alterations in skin pigmentation, alopecia, hirsutism, sweating,\r\nphotosensitivity, purpura, Stevens-Johnson syndrome, toxic epidermal\r\nnecrolysis, aseptic meningitis; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68853.htm", "doses": [ "Different preparations may vary in bioavailability;\r\nto avoid reduced effect or excessive side-effects, it may be prudent\r\nto avoid changing the formulation", "Epilepsy, by mouth, initially 100\u2013200\u00a0mg\r\n1\u20132 times daily, increased slowly (see notes above) to usual\r\ndose of 0.8\u20131.2\u00a0g daily in divided doses; in some cases 1.6\u20132\u00a0g daily\r\nin divided doses may be needed; elderly reduce initial dose; child daily\r\nin divided doses, up to 1 year 100\u2013200\u00a0mg, 1\u20135 years 200\u2013400\u00a0mg, 5\u201310\r\nyears 400\u2013600\u00a0mg, 10\u201315 years 0.6\u20131\u00a0g", "By rectum, for short-term use (max. 7 days) when\r\noral therapy temporarily not possible; 125-mg suppository approx.\r\nequivalent to 100-mg tablet, but final adjustment should always depend\r\non clinical response (plasma concentration monitoring recommended);\r\nmax. 1\u00a0g daily in 4 divided doses", "Trigeminal neuralgia, by mouth, initially\r\n100\u00a0mg 1\u20132 times daily (but some patients may require higher initial\r\ndose), increased gradually according to response; usual dose 200\u00a0mg\r\n3\u20134 times daily, up to 1.6\u00a0g daily in some patients", "Prophylaxis of bipolar disorder unresponsive to\r\nlithium (see also section 4.2.3), by mouth, initially 400\u00a0mg\r\ndaily in divided doses increased until symptoms controlled; usual\r\nrange 400\u2013600\u00a0mg daily; max. 1.6\u00a0g daily", "Treatment of alcohol withdrawal [unlicensed indication], by mouth, initially 800\u00a0mg daily in divided doses, reduced\r\ngradually over 5 days to 200\u00a0mg daily; usual treatment duration 7\u201310\r\ndays", "Diabetic neuropathy [unlicensed indication], by mouth, initially 100\u00a0mg 1\u20132 times daily, increased gradually\r\naccording to response; usual dose 200\u00a0mg 3\u20134 times daily, up to 1.6\u00a0g\r\ndaily in some patients", "Plasma concentration for optimum response\r\n4\u201312\u00a0mg/litre (20\u201350\u00a0micromol/litre)" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nmonitor plasma-carbamazepine concentration" }, "SUNITINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nSunitinib, a tyrosine kinase inhibitor, is licensed for the treatment of advanced or metastatic renal cell carcinoma (but see NICE Guidance, below). It is also licensed for the treatment of unresectable or metastatic malignant gastro-intestinal stromal tumours, after failure of imatinib, and for the treatment of unresectable or metastatic pancreatic neuroendocrine tumors.The Scottish Medicines Consortium has advised (October 2009 and April 2011) that sunitinib (Sutent\u00ae) is accepted for restricted use within NHS Scotland for the treatment of unresectable or metastatic malignant gastro-intestinal stromal tumours after failure of imatinib and for unresectable or metastatic pancreatic neuroendocrine tumours.", "name": "SUNITINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "SUNITINIB" ], "cautions": "Cautions\u00a0see section 8.1; cardiovascular disease\u2014discontinue\r\nif congestive heart failure develops; susceptibility\r\nto QT-interval prolongation; hypertension; increased risk of bleeding; monitor for thyroid dysfunction; consider dental check-up\r\nbefore initiating treatment (risk of osteonecrosis of the jaw, see MHRA/CHM advice); interactions: Appendix 1 (sunitinib) ", "side-effects": "Side-effects\u00a0see section 8.1; also\r\nabdominal pain, diarrhoea, constipation, anorexia, taste disturbance,\r\ndehydration; hypertension, oedema; dyspnoea, cough; fatigue, dizziness,\r\nheadache, insomnia, peripheral neuropathy, paraesthesia; hypothyroidism;\r\narthralgia, myalgia; increased lacrimation; epistaxis; skin, hair,\r\nand urine discoloration, hand-foot syndrome, dry skin, and rash; gastro-intestinal\r\nperforation, fistula formation (interrupt treatment if occurs) pancreatitis,\r\nosteonecrosis of the jaw (see MHRA/CHM advice), hepatic failure, proteinuria\r\n(rarely nephrotic syndrome) and seizures reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129972.htm", "doses": [ "Gastro-intestinal stromal tumours and metastatic renal\r\ncell carcinoma, 50\u00a0mg once daily for 4 weeks, followed by a 2-week\r\ntreatment-free period to complete 6-week cycle; adjust dose in steps\r\nof 12.5\u00a0mg according to tolerability; dose range 25\u201375\u00a0mg daily", "Pancreatic neuroendocrine tumours, 37.5\u00a0mg once daily,\r\nwithout a treatment-free period; adjust dose in steps of 12.5\u00a0mg according\r\nto tolerability; max. dose 50\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies; effective\r\ncontraception required during treatment; see also Pregnancy and Reproductive\r\nFunction" }, "HALOTHANE": { "indications": "Indications\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "name": "HALOTHANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.2 Inhalational anaesthetics", "Volatile liquid anaesthetics" ], "cautions": "Cautions\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics (important: \n(From Volatile liquid anaesthetics: British National Formulary)\nHalothane hepatotoxicitySevere hepatotoxicity can follow halothane anaesthesia. It occurs more frequently after repeated exposure to halothane and has a high mortality. The risk of severe hepatotoxicity appears to be increased by repeated exposures within a short time interval, but even after a long interval (sometimes of several years), susceptible patients have been reported to develop jaundice. Since there is no reliable way of identifying patients at risk, the following precautions are recommended before the use of halothane:a careful anaesthetic history should be taken to determine previous exposure and previous reactions to halothane;repeated exposure to halothane within a period of at least 3 months should be avoided unless there are overriding clinical circumstances;a history of unexplained jaundice or pyrexia in a patient following exposure to halothane is an absolute contra-indication to its future use in that patient. above); avoid for dental procedures in those under 18 years unless treated\r\nin hospital (high risk of arrhythmia); avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200103.htm", "doses": [ "Induction of anaesthesia, by inhalation using specifically calibrated vaporiser, in oxygen or nitrous oxide\u2013oxygen, adult and child over\r\n1 month, initially 0.5% then increased gradually according to response\r\nto 2\u20134%", "Maintenance of anaesthesia, by inhalation using\r\nspecifically calibrated vaporiser, in oxygen, oxygen-air, or nitrous\r\noxide\u2013oxygen, adult and child over 1 month, 0.5\u20132%" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "TERBINAFINE": { "indications": "Indications\u00a0dermatophyte infections of the nails, ringworm infections (including\r\ntinea pedis, cruris, and corporis) where oral therapy appropriate\r\n(due to site, severity or extent)", "name": "TERBINAFINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.5 Other antifungals", "TERBINAFINE" ], "cautions": "Cautions\u00a0psoriasis (risk of exacerbation); autoimmune disease (risk of lupus-erythematosus-like\r\neffect); interactions: Appendix 1 (terbinafine)", "side-effects": "Side-effects\u00a0abdominal discomfort, anorexia, nausea, diarrhoea;\r\nheadache; rash and urticaria occasionally with arthralgia or myalgia; less commonly taste disturbance; rarely liver toxicity (including jaundice, cholestasis and hepatitis)\u2014discontinue\r\ntreatment, angioedema, dizziness, malaise, paraesthesia, hypoaesthesia,\r\nphotosensitivity; very rarely psychiatric disturbances,\r\nblood disorders (including leucopenia and thrombocytopenia), lupus\r\nerythematosus-like effect, exacerbation of psoriasis,\r\nserious skin reactions (including Stevens-Johnson syndrome and toxic\r\nepidermal necrolysis)\u2014discontinue treatment if progressive skin rash;\r\nalso reported, pancreatitis, vasculitis, influenza-like symptoms,\r\nrhabdomyolysis, disturbances in smell", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129516.htm", "doses": [ "By mouth, 250\u00a0mg daily usually for 2\u20136\r\nweeks in tinea pedis, 2\u20134 weeks in tinea cruris, 4 weeks in tinea\r\ncorporis, 6 weeks\u20133 months in nail infections (occasionally longer\r\nin toenail infections); child [unlicensed]\r\nusually for 4 weeks, tinea capitis, over 1 year, body-weight 10\u201320\u00a0kg,\r\n62.5\u00a0mg once daily; body-weight 20\u201340\u00a0kg, 125\u00a0mg once daily; body-weight\r\nover 40\u00a0kg, 250\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "HUMAN PAPILLOMA VIRUS VACCINES": { "indications": "Indications\u00a0\n(From Human papilloma virus vaccines: British National Formulary)\nHuman papilloma virus vaccines and under\r\npreparations", "name": "HUMAN PAPILLOMA VIRUS VACCINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Human papilloma virus vaccines", "HUMAN PAPILLOMA VIRUS VACCINES" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129915.htm", "doses": [ "See notes above and under\r\npreparations", "To avoid confusion, prescribers should specify\r\nthe brand to be dispensed", "prevention of premalignant genital lesions, cervical cancer\r\nand genital warts, by intramuscular injection preferably\r\ninto deltoid region or higher anterolateral thigh, adult and child 9\u201326\r\nyears, 3 doses of 0.5\u00a0mL, the second 2 months and the third 6 months\r\nafter the first dose", "Alternative schedule for adult and child 9\u201326 years, 3 doses of\r\n0.5\u00a0mL, the second at least 1 month, and the third at least 4 months\r\nafter the first dose; schedule should be completed within 12 months" ], "pregnancy": "Pregnancy\u00a0not known to be harmful, but vaccination should be\r\npostponed until completion of pregnancy" }, "ISOPHANE INSULIN Human sequence": { "indications": "Indications\u00a0diabetes mellitus", "name": "ISOPHANE INSULIN Human sequence", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "ISOPHANE INSULIN", "Human sequence" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86346.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements", "Name[Insuman\u00ae Basal (Sanofi-Aventis) ] Injection, isophane insulin (human, crb) 100\u00a0units/mL, net price 5-mL vial = \u00a35.61; 5 \u00d7 3-mL\r\ncartridge (for ClikSTAR\u00ae and Autopen\u00ae\r\n24) = \u00a317.50; 5 \u00d7 3-mL Insuman\u00ae Basal Solostar\u00ae prefilled disposable injection devices (range 1\u201380\u00a0units, allowing\r\n1-unit dosage adjustment) = \u00a319.80Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "APOMORPHINE HYDROCHLORIDE": { "indications": "Indications\u00a0refractory motor fluctuations in Parkinson\u2019s disease (\u2018off\u2019 episodes)\r\ninadequately controlled by co-beneldopa or co-careldopa or other dopaminergics\r\n(for capable and motivated patients under specialist supervision)", "name": "APOMORPHINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; pulmonary disease, cardiovascular disease, history of postural hypotension (special care on initiation); susceptibility to QT-interval prolongation; neuropsychiatric conditions; monitor hepatic, haemopoietic, renal, and cardiovascular function; with concomitant levodopa test initially and every 6 months for haemolytic anaemia\r\nand thrombocytopenia (development\r\ncalls for specialist haematological care with dose reduction and possible\r\ndiscontinuation); interactions: Appendix 1 (apomorphine)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, vomiting (\n(From Dopamine-receptor agonists: British National Formulary)\nApomorphine is a potent dopamine-receptor agonist that is sometimes helpful in advanced disease for patients experiencing unpredictable \u2018off\u2019 periods with levodopa treatment. Apomorphine should be initiated in a specialist clinic with at least two days pretreatment with domperidone for nausea and vomiting. After an overnight withdrawal of oral antiparkinsonian medication to induce an \u2018off\u2019 episode, the threshold dose of apomorphine is determined. Oral antiparkinsonian medication is then restarted. The patient must be taught to self-administer apomorphine by subcutaneous injection into the lower abdomen or outer thigh at the first sign of an \u2018off\u2019 episode. Once treatment has been established it may be possible to gradually reduce other antiparkinsonian medications and reduce or withdraw domperidone therapy. Treatment with apomorphine should remain under specialist supervision.); yawning; drowsiness (including\r\nsudden onset of sleep), confusion, hallucinations; less commonly postural hypotension, dyspnoea, dyskinesia during \u2018on\u2019 periods (may\r\nrequire discontinuation), haemolytic anaemia and thrombocytopenia\r\nwith levodopa (see Cautions), and rash; rarely eosinophilia;\r\nperipheral oedema, compulsive behaviour (\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.), and\r\ndizziness also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/10071.htm", "doses": [ "By subcutaneous injection, adult over 18 years, to determine threshold dose\r\n(see also notes above), initially 1\u00a0mg at the first sign\r\nof \u2018off\u2019 episode; if inadequate or no response after 30 minutes, then\r\na further 2\u00a0mg should be given; thereafter increase dose at minimum\r\n40-minute intervals until satisfactory response obtained; usual range\r\n3\u201330\u00a0mg daily in divided doses; subcutaneous infusion may be preferable\r\nin those requiring division of injections into more than 10 doses\r\ndaily; max. single dose 10\u00a0mg", "By continuous subcutaneous infusion, adult over 18 years, (those requiring division into\r\nmore than 10 injections daily) initially 1\u00a0mg/hour increased according\r\nto response (not more often than every 4 hours) in max. steps of 500\u00a0micrograms/hour,\r\nto usual rate of 1\u20134\u00a0mg/hour (15\u201360\u00a0micrograms/kg/hour); change infusion\r\nsite every 12 hours and give during waking hours only (tolerance may\r\noccur unless there is a 4-hour treatment-free period at night\u201424-hour\r\ninfusions not recommended unless severe night-time symptoms); intermittent\r\nbolus doses may be needed", "Total daily dose by either route (or combined\r\nroutes) max. 100\u00a0mg" ], "pregnancy": "Pregnancy\u00a0avoid unless clearly necessary" }, "AMANTADINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose; parkinsonism (section 4.9.1)", "name": "AMANTADINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.4 Influenza" ], "cautions": "Cautions\u00a0section 4.9.1", "side-effects": "Side-effects\u00a0section 4.9.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3996.htm", "doses": [ "Influenza A (see also notes above), adult and child over\r\n10 years, treatment, 100\u00a0mg daily for 4\u20135 days; prophylaxis, 100\u00a0mg\r\ndaily usually for 6 weeks or with influenza vaccination\r\nfor 2\u20133 weeks after vaccination" ], "pregnancy": "Pregnancy\u00a0section 4.9.1" }, "FULVESTRANT": { "indications": "Indications\u00a0treatment of oestrogen-receptor-positive metastatic or locally advanced\r\nbreast cancer in postmenopausal women in whom disease progresses or\r\nrelapses while on, or after, other anti-oestrogen therapy", "name": "FULVESTRANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer", "FULVESTRANT" ], "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea; venous thromboembolism;\r\nanorexia, headache, asthenia; urinary-tract infections; hot flushes;\r\nback pain; rash, injection-site reactions, hypersensitivity reactions; less commonly vaginal haemorrhage, vaginal candidiasis,\r\nand leucorrhoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128317.htm", "doses": [ "By deep intramuscular injection into buttock,\r\n500\u00a0mg every 2 weeks for the first 3 doses, then 500\u00a0mg every month", "500\u00a0mg dose should be administered as one\r\n250-mg injection (slowly over 1\u20132 minutes) into each buttock" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014increased incidence of\r\nfetal abnormalities and death in animal studies " }, "Botulism antitoxin": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera" ], "name": "Botulism antitoxin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6464.htm", "doses": [ "prophylaxis, consult product literature" ] }, "ISOPHANE INSULIN Highly purified animal": { "indications": "Indications\u00a0diabetes mellitus", "name": "ISOPHANE INSULIN Highly purified animal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "ISOPHANE INSULIN", "Highly purified animal" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61216.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements", "Name[Hypurin\u00ae Porcine Isophane (Wockhardt) ] Injection, isophane insulin (porcine, highly purified) 100\u00a0units/mL. Net price 10-mL vial =\r\n\u00a325.20; cartridges (for Autopen\u00ae Classic) 5 \u00d7 3\u00a0mL = \u00a337.80Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "MIDAZOLAM": { "indications": "Indications\u00a0conscious sedation for procedures; sedation in intensive care; sedation\r\nin anaesthesia; premedication; induction of anaesthesia; status epilepticus\r\n(section 4.8.2)", "name": "MIDAZOLAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\n15.1.4.1 Benzodiazepines; cardiac disease; respiratory disease; myasthenia\r\ngravis; neonates; children (particularly if cardiovascular impairment); risk of airways obstruction and hypoventilation in\r\nchildren under 6 months (monitor respiratory rate and oxygen saturation); history of drug or alcohol abuse; reduce\r\ndose in elderly and debilitated; risk of severe hypotension in hypovolaemia, vasoconstriction, hypothermia; avoid prolonged use (and abrupt withdrawal thereafter); concentration of midazolam in children under 15\u00a0kg not to exceed 1\u00a0mg/mL; interactions: Appendix 1 (anxiolytics and hypnotics)", "side-effects": "Side-effects\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\n15.1.4.1 Benzodiazepines; gastro-intestinal disturbances,\r\nincreased appetite, jaundice; hypotension, cardiac arrest, heart rate\r\nchanges, anaphylaxis, thrombosis; laryngospasm, bronchospasm, respiratory\r\ndepression and respiratory arrest (particularly with high doses or\r\non rapid injection); drowsiness, confusion, ataxia, amnesia, headache,\r\neuphoria, hallucinations, convulsions (more common in neonates), dizziness,\r\nvertigo, involuntary movements, paradoxical excitement and aggression\r\n(especially in children and elderly), dysarthria; urinary retention,\r\nincontinence, changes in libido; blood disorders; muscle weakness;\r\nvisual disturbances; salivation changes; skin reactions; injection-site\r\nreactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6601.htm", "doses": [ "Conscious sedation for procedures, by slow\r\nintravenous injection (approx. 2\u00a0mg/minute) 5\u201310 minutes before\r\nprocedure, initially 2\u20132.5\u00a0mg (elderly 0.5\u20131\u00a0mg), increased if necessary in steps of 1\u00a0mg (elderly 0.5\u20131\u00a0mg); usual total dose 3.5\u20135\u00a0mg (max.\r\n7.5\u00a0mg), elderly max. 3.5\u00a0mg; child 1 month\u201318 years see BNF for Children", "By rectum, child 6 months\u201318 years see BNF for Children", "By mouth, child 1 month\u201318 years see BNF for Children", "By buccal administration, child 6 months\u201318 years see BNF for Children", "Sedative in combined anaesthesia, by intravenous injection, 30\u2013100\u00a0micrograms/kg repeated as required or by continuous\r\nintravenous infusion, 30\u2013100\u00a0micrograms/kg/hour (elderly lower doses needed); child not recommended", "Premedication, by deep intramuscular injection, adult over 18 years, 70\u2013100\u00a0micrograms/kg\r\n(elderly or debilitated 25\u201350\u00a0micrograms/kg)\r\n20\u201360 minutes before induction", "By intravenous injection, adult over 18 years, 1\u20132\u00a0mg 5\u201330 minutes before procedure, repeated as\r\nrequired (elderly or debilitated 0.5\u00a0mg,\r\nrepeat dose slowly as required)", "By rectum, child 6 months\u201312 years see BNF for Children", "By mouth, child 1 month\u201318 years see BNF for Children", "Induction (but rarely used), by slow intravenous injection, 150\u2013200\u00a0micrograms/kg (elderly or\r\ndebilitated 50\u2013150\u00a0micrograms/kg) given in divided doses (max. 5\u00a0mg)\r\nat intervals of 2 minutes; max. total dose 600\u00a0micrograms/kg; child 7\u201318 years initially 150\u00a0micrograms/kg (max.\r\n7.5\u00a0mg) given in steps of 50\u00a0micrograms/kg (max. 2.5\u00a0mg) over 2\u20135\r\nminutes; wait for 2\u20135 minutes then give additional doses of 50\u00a0micrograms/kg\r\n(max. 2.5\u00a0mg) every 2 minutes if necessary; max. total dose 500\u00a0micrograms/kg\r\n(not exceeding 25\u00a0mg)", "Sedation of patients receiving intensive care, by slow\r\nintravenous injection, initially 30\u2013300\u00a0micrograms/kg given\r\nin steps of 1\u20132.5\u00a0mg every 2 minutes, then by slow intravenous\r\ninjection or by continuous intravenous\r\ninfusion, 30\u2013200\u00a0micrograms/kg/hour; reduce dose (or reduce\r\nor omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia;\r\nlower doses may be adequate if opioid analgesic also used; child under 12 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid regular use (risk of neonatal withdrawal symptoms);\r\nuse only if clear indication such as seizure control (high doses during\r\nlate pregnancy or labour may cause neonatal hypothermia, hypotonia,\r\nand respiratory depression)" }, "OFLOXACIN - ANTIBACTERIALS": { "side-effects": "Side-effects\u00a0local irritation including photophobia; dizziness,\r\nnumbness, nausea and headache reported", "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "OFLOXACIN - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5400.htm", "doses": [ "Apply every 2\u20134 hours for the first 2 days then reduce\r\nfrequency to 4 times daily (max. 10 days treatment)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if benefit outweighs\r\nrisk; systemic quinolones have caused arthropathy in animal studies", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "OFLOXACIN" ] }, "SODIUM STIBOGLUCONATE": { "indications": "Indications\u00a0leishmaniasis", "name": "SODIUM STIBOGLUCONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.5 Leishmaniacides", "SODIUM STIBOGLUCONATE" ], "cautions": "Cautions\u00a0intravenous injections must be given\r\nslowly over 5 minutes (to reduce risk of local thrombosis) and stopped\r\nif coughing or substernal pain; mucocutaneous\r\ndisease (see below); monitor ECG before\r\nand during treatment; heart disease (withdraw if conduction disturbances occur); treat intercurrent infection (e.g. pneumonia)Mucocutaneous disease\u00a0Successful treatment of mucocutaneous leishmaniasis may induce severe\r\ninflammation around the lesions (may be life-threatening if pharyngeal\r\nor tracheal involvement)\u2014may require corticosteroid", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, abdominal pain, diarrhoea;\r\nECG changes; coughing (see Cautions); headache, lethargy; arthralgia,\r\nmyalgia; rarely jaundice, flushing, bleeding from\r\nnose or gum, substernal pain (see Cautions), vertigo, fever, sweating,\r\nand rash; also reported pancreatitis and anaphylaxis; pain and thrombosis\r\non intravenous administration, intramuscular injection also painful", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4050.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "CELIPROLOL HYDROCHLORIDE": { "indications": "Indications\u00a0mild to moderate hypertension", "name": "CELIPROLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "CELIPROLOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride; also hot\r\nflushes; rarely depression, pneumonitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2485.htm", "doses": [ "200\u00a0mg once daily in the morning, increased to 400\u00a0mg\r\nonce daily if necessary" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "PHENYLEPHRINE HYDROCHLORIDE": { "indications": "Indications\u00a0acute hypotension (see notes above); priapism\r\n(%s\n(From 7.4.5 Drugs for erectile dysfunction: British National Formulary)\n7.4.5 Drugs for erectile dysfunction) [unlicensed\r\nindication]", "name": "PHENYLEPHRINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.2 Vasoconstrictor sympathomimetics", "PHENYLEPHRINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see under Noradrenaline; longer duration of action than noradrenaline (norepinephrine), see below; coronary diseaseHypertensive response\u00a0Phenylephrine\r\nhas a longer duration of action than noradrenaline, and an excessive\r\nvasopressor response may cause a prolonged rise in blood pressure", "side-effects": "Side-effects\u00a0see under Noradrenaline; also tachycardia or reflex\r\nbradycardia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2759.htm", "doses": [ "By subcutaneous or intramuscular injection, 2\u20135\u00a0mg, followed if necessary\r\nafter at least 15 minutes by further doses of 1\u201310\u00a0mg", "By slow intravenous injection of\r\na 1\u00a0mg/mL solution, 100\u2013500\u00a0micrograms repeated as necessary after\r\nat least 15 minutes", "By intravenous infusion, initial\r\nrate up to 180\u00a0micrograms/minute reduced to 30\u201360\u00a0micrograms/minute\r\naccording to response" ], "pregnancy": "Pregnancy\u00a0avoid if possible; malformations reported following\r\nuse in first trimester; fetal hypoxia and bradycardia reported in\r\nlate pregnancy and labour" }, "FLUTICASONE PROPIONATE": { "indications": "Indications\u00a0inflammatory skin disorders such as dermatitis\r\nand eczemas unresponsive to less potent corticosteroids", "name": "FLUTICASONE PROPIONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUTICASONE PROPIONATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19234.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "CETUXIMAB": { "indications": "Indications\u00a0\n(From Cetuximab: British National Formulary)\nCetuximab and product literature", "name": "CETUXIMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Cetuximab", "CETUXIMAB" ], "cautions": "Cautions\u00a0cardiovascular disease, cardiopulmonary disease, pulmonary disease\u2014discontinue\r\nif interstitial lung disease; history of, or risk factors\r\nfor keratitis, ulcerative keratitis (including contact lens use),\r\nor severe dry eye", "side-effects": "Side-effects\u00a0infusion-related reactions including dyspnoea,\r\ndizziness, chills, fever, and hypersensitivity reactions (possibly\r\ndelayed onset) such as rash, urticaria, bronchospasm, hypotension,\r\nhypertension, and shock; nausea, vomiting, diarrhoea, headache, aseptic\r\nmeningitis, hypomagnesaemia, hypocalcaemia, conjunctivitis, blepharitis,\r\nkeratitis, skin reactions including acne, pruritus, dry skin, desquamation,\r\nhypertrichosis, and nail disorders; Stevens-Johnson syndrome and toxic\r\nepidermal necrolysis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129184.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014no information\r\navailable; see also Pregnancy and Reproductive\r\nFunction" }, "BUSULFAN": { "indications": "Indications\u00a0%s\n(From 8.1.1 Alkylating drugs: British National Formulary)\nBusulfan is given by mouth to treat chronic myeloid leukaemia. Busulfan given by mouth or intravenously, followed by cyclophosphamide, is also licensed as conditioning treatment before haematopoietic stem-cell transplantation in adults and children. Frequent blood tests are necessary because excessive myelosuppression may result in irreversible bone-marrow aplasia. Rarely, progressive pulmonary fibrosis is associated with busulfan. Skin hyperpigmentation is a common side-effect of oral therapy.", "name": "BUSULFAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "BUSULFAN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; monitor cardiac function; previous radiation therapy; avoid in acute\r\nporphyria (but see section 9.8.2); interactions: Appendix 1\r\n(busulfan)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also hepatotoxicity (including\r\nhepatic veno-occlusive disease, hyperbilirubinaemia, jaundice and\r\nfibrosis); cardiac tamponade in thalassaemia; pneumonia; skin hyperpigmentation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4679.htm", "doses": [ "Chronic myeloid leukaemia, induction of remission, by mouth, 60\u00a0micrograms/kg daily (max. 4\u00a0mg); maintenance,\r\nusually 0.5\u20132\u00a0mg daily", "Conditioning treatment before haematopoietic stem-cell\r\ntransplantation, by mouth or by intravenous infusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animals);\r\nmanufacturers advise effective contraception during and for 6 months\r\nafter treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "BUSERELIN - DRUGS AFFECTING GONADOTROPHINS": { "indications": "Indications\u00a0see under Dose; prostate\r\ncancer (section 8.3.4.2)", "name": "BUSERELIN - DRUGS AFFECTING GONADOTROPHINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues", "BUSERELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.; polycystic ovarian disease, depression, hypertension, diabetes", "side-effects": "Side-effects\u00a0see notes above; initially withdrawal bleeding\r\nand subsequently breakthrough bleeding, leucorrhoea; nausea, vomiting,\r\nconstipation, diarrhoea; anxiety, memory and concentration disturbances,\r\nsleep disturbances, nervousness, dizziness, drowsiness; breast tenderness,\r\nlactation; abdominal pain; fatigue; increased thirst, changes in appetite;\r\nacne, dry skin, splitting nails, dry eyes; altered blood lipids, leucopenia,\r\nthrombocytopenia; hearing disturbances; reduced glucose tolerance", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4470.htm", "doses": [ "Endometriosis, intranasally, 300\u00a0micrograms\r\n(one 150-microgram spray in each nostril) 3 times daily (starting\r\non days 1 or 2 of menstruation); max. duration of treatment 6 months\r\n(do not repeat)", "Pituitary desensitisation before induction of ovulation\r\nby gonadotrophins for in vitro fertilisation (under\r\nspecialist supervision), by subcutaneous injection,\r\n200\u2013500\u00a0micrograms daily given as a single injection (occasionally\r\nup to 500\u00a0micrograms twice daily may be needed) starting in early\r\nfollicular phase (day 1) or, after exclusion of pregnancy,\r\nin midluteal phase (day 21) and continued until down-regulation achieved\r\n(usually about 1\u20133 weeks) then maintained during gonadotrophin administration\r\n(stopping gonadotrophin and buserelin on administration\r\nof chorionic gonadotrophin at appropriate stage\r\nof follicular development)", "Intranasally, 150\u00a0micrograms (one spray in one\r\nnostril) 4 times daily during waking hours (occasionally up to 300\u00a0micrograms\r\n4 times daily may be needed) starting in early follicular phase (day\r\n1) or, after exclusion of pregnancy, in midluteal\r\nphase (day 21) and continued until down-regulation achieved (usually\r\nabout 2\u20133 weeks) then maintained during gonadotrophin administration\r\n(stopping gonadotrophin and buserelin on administration\r\nof chorionic gonadotrophin at appropriate stage\r\nof follicular development)", "Avoid use of nasal decongestants before\r\nand for at least 30 minutes after treatment" ], "pregnancy": "Pregnancy\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues" }, "FLUTICASONE PROPIONATE - DRUGS USED IN NASAL ALLERGY": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and treatment of\r\nallergic rhinitis and perennial rhinitis; nasal polyps", "name": "FLUTICASONE PROPIONATE - DRUGS USED IN NASAL ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5651.htm", "doses": [ "Rhinitis, 100\u00a0micrograms (2 sprays) into each nostril\r\nonce daily, preferably in the morning, increased to max. twice daily\r\nif required; when control achieved reduce to 50\u00a0micrograms (1 spray)\r\ninto each nostril once daily; child 4\u201311 years, 50\u00a0micrograms (1 spray) into each nostril once daily,\r\npreferably in the morning, increased to max. twice daily if required", "Nasal polyps, see Flixonase Nasule\u00ae below" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.; interactions: Appendix 1 (corticosteroids)" }, "DEFERASIROX": { "indications": "Indications\u00a0\n(From Iron overload: British National Formulary)\nIron overload", "name": "DEFERASIROX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Iron overload", "DEFERASIROX" ], "cautions": "Cautions\u00a0eye and ear examinations required before\r\ntreatment and annually during treatment; monitor body-weight, height, and sexual development in children annually; monitor serum-ferritin concentration monthly; elderly (increased risk of side-effects); risk of gastro-intestinal ulceration and haemorrhage; platelet count less than 50 \u00d7 109/litre; consider treatment interruption if unexplained cytopenia occurs; not recommended in conditions which may reduce life\r\nexpectancy (e.g. high-risk myelodysplastic syndromes); history of liver cirrhosis; test liver function before treatment, then every 2 weeks during the\r\nfirst month, and then monthly; measure\r\nbaseline serum creatinine and monitor renal function weekly during\r\nthe first month of treatment and monthly thereafter; test for proteinuria monthly; interactions: Appendix 1 (deferasirox)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including ulceration\r\nand fatal haemorrhage); headache; proteinuria; pruritus, rash; less commonly hepatitis, cholelithiasis, oedema, fatigue,\r\nanxiety, sleep disorder, dizziness, pyrexia, pharyngitis, glucosuria,\r\nrenal tubulopathy, disturbances of hearing and vision (including lens\r\nopacity and maculopathy), and skin pigmentation; hepatic failure,\r\nacute renal failure, blood disorders (including agranulocytosis, neutropenia,\r\npancytopenia, and thrombocytopenia), hypersensitivity reactions (including\r\nanaphylaxis and angioedema), alopecia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129929.htm", "doses": [ "adult and child over 2 years initially 10\u201330\u00a0mg/kg once daily\r\naccording to serum-ferritin concentration and amount of transfused\r\nblood (consult product literature); maintenance, adjust dose every\r\n3\u20136 months in steps of 5\u201310\u00a0mg/kg according to serum-ferritin concentration;\r\nusual max. 30\u00a0mg/kg daily, but may be increased to max. 40\u00a0mg/kg daily\r\nand reduced in steps of 5\u201310\u00a0mg/kg once control achieved" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies" }, "OESTROGENS FOR HRT Estradiol, estriol and estrone": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT Estradiol, estriol and estrone", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT", "Estradiol, estriol and estrone" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4311.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch", "Name[Hormonin\u00ae (Amdipharm) ] Tablets, pink, estradiol 600\u00a0micrograms,\r\nestriol 270\u00a0micrograms, estrone 1.4\u00a0mg, net price 84-tab pack = \u00a36.94Dose\u00a0menopausal symptoms and osteoporosis prophylaxis (see section 6.6),\r\n1\u20132 tablets daily starting within 5 days of onset of menstruation\r\n(or at any time if cycles have ceased or are infrequent), with cyclical\r\nprogestogen for 12\u201314 days of each cycle in women with a uterusNote\u00a0Hormonin tablets can be\r\ngiven continuously or cyclically (21 days out of 28)" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "CO-CODAMOL - CO-CODAMOL 30/500": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-CODAMOL - CO-CODAMOL 30/500", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-CODAMOL", "Co-codamol 30/500" ], "cautions": "Cautions\u00a0hypotension, asthma (avoid during attack) and impaired respiratory function (avoid in chronic obstructive pulmonary disease), prostatic hypertrophy; shock; myasthenia gravis; obstructive or inflammatory bowel disorders; diseases\r\nof the biliary tract; reduced dose recommended in elderly and debilitated patients, in hypothyroidism, and in adrenocortical\r\ninsufficiency; convulsive disorders; cardiac arrhythmias; acute abdomen; gallstones; alcohol dependence; interactions: Appendix 1 (opioid analgesics, paracetamol)Variation in metabolism\u00a0The capacity\r\nto metabolise codeine can vary considerably and lead to either reduced\r\ntherapeutic effect or marked increase in side-effectsDependence and withdrawal\u00a0Repeated use of opioid\r\nanalgesics, such as codeine, is associated with the development of\r\npsychological and physical dependence; although this is rarely a problem\r\nwith therapeutic use, caution in advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment", "side-effects": "Side-effects\u00a0nausea and vomiting (particularly in initial stages),\r\nconstipation, dry mouth, and biliary spasm; larger doses produce respiratory\r\ndepression, hypotension, and muscle rigidity; other side-effects include\r\nabdominal pain, anorexia, bradycardia, tachycardia, palpitation, oedema,\r\npostural hypotension, seizures, malaise, hypothermia; hallucinations,\r\nvertigo, euphoria, dysphoria, mood changes, dependence, dizziness,\r\nconfusion, drowsiness, sleep disturbances, headache; sexual dysfunction,\r\ndifficulty with micturition, urinary retention, ureteric spasm, muscle\r\nfasciculation; blood disorders (including thrombocytopenia, leucopenia,\r\nneutropenia), miosis, visual disturbances, flushing, sweating, rashes,\r\nurticaria and pruritus; pancreatitis also reported; important: liver damage (and less frequently renal damage) following overdosage with paracetamol; see Emergency Treatment of\r\nPoisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced\r\nrespiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201065.htm", "doses": [ "See under preparations", "1\u20132 capsules every 4 hours; max. 8 capsules daily; child under 12 years not recommended", "Name[Kapake\u00ae (Galen) ] Tablets, scored, co-codamol 30/500\r\n(codeine phosphate 30\u00a0mg, paracetamol 500\u00a0mg), net price 30-tab pack = \u00a32.26 (hosp. only), 100-tab pack\r\n= \u00a37.10. \r\n Label:\r\n 2, 29, 30Dose\u00a01\u20132 tablets every 4 hours; max. 8 tablets daily; child under 12 years not recommended\nCapsules, co-codamol 30/500 (codeine phosphate 30\u00a0mg, paracetamol 500\u00a0mg), net price 100-cap pack = \u00a37.10. \r\n Label:\r\n 2, 29, 30Dose\u00a01\u20132 capsules every 4 hours; max. 8 capsules daily; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0codeine may depress neonatal respiration; withdrawal\r\neffects in neonates of dependent mothers; gastric stasis and risk\r\nof inhalation pneumonia in mother during labour" }, "ACETAZOLAMIDE Modified release": { "indications": "Indications\u00a0reduction of intra-ocular pressure in open-angle glaucoma, secondary\r\nglaucoma, and peri-operatively in angle-closure glaucoma; diuresis\r\n(section 2.2.7); epilepsy", "name": "ACETAZOLAMIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "ACETAZOLAMIDE", "Modified release" ], "cautions": "Cautions\u00a0not generally recommended for prolonged\r\nuse but if given monitor blood count and plasma-electrolyte\r\nconcentration; pulmonary obstruction and impaired alveolar ventilation (risk of acidosis); elderly; diabetes mellitus; renal calculi; avoid extravasation\r\nat injection site (risk of necrosis); interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also nausea,\r\nvomiting, diarrhoea, taste disturbance, loss of appetite, paraesthesia,\r\nflushing, headache, dizziness, fatigue, irritability, excitement,\r\nataxia, depression, thirst, polyuria, reduced libido; less\r\ncommonly melaena, drowsiness, confusion, hearing disturbances,\r\nfever, glycosuria, metabolic acidosis and electrolyte disturbances\r\non long-term therapy, haematuria, crystalluria, renal and ureteric\r\ncolic, renal lesions or calculi, renal failure, blood disorders, bone\r\nmarrow suppression, rash (including Stevens-Johnson syndrome and toxic\r\nepidermal necrosis); rarely fulminant hepatic necrosis,\r\nhepatitis, cholestatic jaundice, flaccid paralysis, convulsions, photosensitivity; also reported transient myopia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5521.htm", "doses": [ "Glaucoma, by mouth or by intravenous injection, 0.25\u20131\u00a0g daily in divided\r\ndoses", "Epilepsy, by mouth or by intravenous injection, 0.25\u20131\u00a0g daily in divided doses; child 8\u201330\u00a0mg/kg daily, max. 750\u00a0mg daily", "Dose by intramuscular injection, as for intravenous injection but preferably avoided because of\r\nalkalinity", "Name[Diamox\u00ae SR (Goldshield) ] Capsules, m/r, orange, enclosing\r\norange f/c pellets, acetazolamide 250\u00a0mg. Net price\r\n30-cap pack = \u00a316.66 \r\n Label:\r\n 3, 25Dose\u00a0glaucoma, 1\u20132 capsules daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid, especially in first trimester\r\n(toxicity in animal studies)" }, "ERLOTINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nErlotinib, a tyrosine kinase inhibitor, is licensed in combination with gemcitabine for the treatment of metastatic pancreatic cancer. It is also licensed for the treatment of locally advanced or metastatic non-small cell lung cancer after failure of previous chemotherapy and as monotherapy for maintenance treatment of locally advanced or metastatic non-small cell lung cancer with stable disease after four cycles of platinum-based chemotherapy.", "name": "ERLOTINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "ERLOTINIB" ], "cautions": "Cautions\u00a0see section 8.1; pre-existing liver disease or concomitant\r\nuse with hepatotoxic drugs\u2014monitor liver function; dose adjustment\r\nmay be necessary if smoking started or stopped during treatment; interactions: Appendix 1 (erlotinib)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also diarrhoea, abdominal pain, dyspepsia, flatulence; anorexia,\r\ndepression, neuropathy, headache; fatigue, rigor; conjunctivitis;\r\npruritus, dry skin; less commonly gastro-intestinal\r\nperforation, interstitial lung disease\u2014discontinue if unexplained\r\nsymptoms such as dyspnoea, cough or fever occur; eyelash changes; rarely hepatic failure; very rarely corneal\r\nperforation or ulceration, Stevens-Johnson syndrome, and toxic epidermal\r\nnecrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129404.htm", "doses": [ "Non-small cell lung cancer, 150\u00a0mg once daily", "Pancreatic cancer, 100\u00a0mg once daily in combination\r\nwith gemcitabine" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies; effective contraception required during and for at least\r\n2 weeks after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "AMITRIPTYLINE HYDROCHLORIDE": { "indications": "Indications\u00a0depressive illness (but not recommended, see\r\nnotes above); neuropathic pain [unlicensed] (section 4.7.3); migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2)", "name": "AMITRIPTYLINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "AMITRIPTYLINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, stomatitis, palpitation, oedema, hypertension, restlessness,\r\nfatigue, mydriasis, and increased intra-ocular pressure; high rate\r\nof fatality in overdose\u2014\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nOverdosage\u00a0Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage. In particular, overdosage with dosulepin and amitriptyline is associated with a relatively high rate of fatality. Lofepramine is associated with the lowest risk of fatality in overdosage, in comparison with other tricyclic antidepressant drugs. For advice on overdosage see Emergency Treatment of Poisoning.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27089.htm", "doses": [ "Depression (but not recommended, see notes above), adult and child over\r\n16 years, initially 75\u00a0mg (elderly and adolescents 30\u201375\u00a0mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary\r\nto 150\u2013200\u00a0mg", "Neuropathic pain [unlicensed indication], initially 10\u00a0mg daily\r\nat night, gradually increased if necessary to 75\u00a0mg daily; higher\r\ndoses under specialist supervision", "Migraine prophylaxis [unlicensed indication], initially 10\u00a0mg\r\nat night, increased if necessary to maintenance of 50\u201375\u00a0mg at night;\r\nmax. 150\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "DEXTRAN 70": { "indications": "Indications\u00a0short-term blood volume expansion", "name": "DEXTRAN 70", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "DEXTRAN 70" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; can interfere with some laboratory tests (\n(From Plasma substitutes: British National Formulary)\nDextran 70 by intravenous infusion is used for volume expansion. Dextran may interfere with blood group cross-matching or biochemical measurements, and these should be carried out before infusion is begun. ); where possible, monitor central venous pressure", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106200.htm", "doses": [ "See under preparation below" ], "pregnancy": "Pregnancy\u00a0avoid\u2014reports of anaphylaxis in mother causing fetal\r\nanoxia, neurological damage and death" }, "OXYBUTYNIN HYDROCHLORIDE": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence, neurogenic bladder instability,\r\nand nocturnal enuresis associated with overactive bladder", "name": "OXYBUTYNIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "OXYBUTYNIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also less commonly anorexia, facial flushing; rarely night terrors; application site reactions with patches; also reported cognitive impairment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61077.htm", "doses": [ "adult and child over 12 years, initially 5\u00a0mg 2\u20133 times daily,\r\nincreased if necessary to max. 5\u00a0mg 4 times daily; elderly initially 2.5\u20133\u00a0mg twice daily, increased\r\nto 5\u00a0mg twice daily according to response and tolerance; child 5\u201312 years, neurogenic bladder instability,\r\n2.5\u20133\u00a0mg twice daily, increased to 5\u00a0mg 2\u20133 times daily; child under 5 years see BNF for Children; child 5\u201318 years, nocturnal enuresis associated with\r\noveractive bladder, 2.5\u20133\u00a0mg twice daily increased to 5\u00a0mg 2\u20133 times\r\ndaily (last dose before bedtime)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless essential\u2014toxicity\r\nin animal studies" }, "LEVOCETIRIZINE HYDROCHLORIDE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, urticaria", "name": "LEVOCETIRIZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; very rarely weight gain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106056.htm", "doses": [ "adult and child over 6 years, 5\u00a0mg once daily; child under 6 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "TARS With corticosteroids": { "indications": "Indications\u00a0psoriasis and occasionally\r\nchronic atopic eczema", "name": "TARS With corticosteroids", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tars", "TARS", "With corticosteroids" ], "cautions": "Cautions\u00a0application to face and skin flexures; use suitable chemical protection gloves for extemporaneous\r\npreparation", "side-effects": "Side-effects\u00a0skin irritation and acne-like eruptions, photosensitivity;\r\nstains skin, hair, and fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5961.htm", "doses": [ "Apply 1\u20133 times daily starting with low-strength preparations", "For shampoo preparations see section 13.9; for\r\nuse with dressings see Appendix 5 (section A5.8.9)", "Name[Alphosyl HC\u00ae (GSK Consumer Healthcare) ] Cream, alcoholic coal tar extract 5%, hydrocortisone 0.5%, allantoin 2%,\r\nnet price 100\u00a0g = \u00a33.10. \r\n Label:\r\n 28. Potency: mildExcipients include beeswax, cetyl alcohol,\r\nhydroxybenzoates (parabens), isopropyl palmitateDose\u00a0adult and child over 5 years, psoriasis, apply thinly twice\r\ndaily" ] }, "TRAMADOL HYDROCHLORIDE Modified-release 12-hourly preparations": { "indications": "Indications\u00a0moderate to severe pain", "name": "TRAMADOL HYDROCHLORIDE Modified-release 12-hourly preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "TRAMADOL HYDROCHLORIDE", "Modified-release 12-hourly preparations" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; impaired consciousness; excessive bronchial\r\nsecretions; not suitable as a substitute\r\nin opioid-dependent patientsGeneral anaesthesia\u00a0Not recommended\r\nfor analgesia during potentially light planes of general anaesthesia (possibly increased intra-operative recall reported)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndiarrhoea, retching, fatigue, paraesthesia; less commonly gastritis, and flatulence; rarely anorexia, syncope,\r\nhypertension, bronchospasm, dyspnoea, wheezing, seizures, and muscle\r\nweakness; blood disorders also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201334.htm", "doses": [ "adult and child over 12 years, by mouth, 50\u2013100\u00a0mg\r\nnot more often than every 4 hours; total of more than 400\u00a0mg daily\r\nnot usually required", "adult and child over 12 years, by intramuscular injection or by intravenous injection (over\r\n2\u20133 minutes) or by intravenous infusion, 50\u2013100\u00a0mg every 4\u20136 hours", "Postoperative pain, 100\u00a0mg initially then 50\u00a0mg every 10\u201320\r\nminutes if necessary during first hour to total max. 250\u00a0mg (including\r\ninitial dose) in first hour, then 50\u2013100\u00a0mg every\r\n4\u20136 hours; max. 600\u00a0mg daily", "Name[Tramquel\u00ae SR (Meda) ] Capsules, m/r, tramadol hydrochloride\r\n50\u00a0mg (dark green), net price 60-cap pack = \u00a37.20; 100\u00a0mg (white),\r\n60-cap pack = \u00a314.39; 150\u00a0mg (dark green), 60-cap pack = \u00a321.59; 200\u00a0mg\r\n(yellow), 60-cap pack = \u00a328.78. \r\n Label:\r\n 2, counselling, administrationDose\u00a0adult and child over 12 years, 50\u2013100\u00a0mg twice daily increased\r\nif necessary to 150\u2013200\u00a0mg twice daily; total of more than 400\u00a0mg\r\ndaily not usually requiredCounselling\u00a0Swallow whole or open capsule and\r\nswallow contents immediately without chewing" ], "pregnancy": "Pregnancy\u00a0embryotoxic in animal studies\u2014manufacturers advise\r\navoid; see also notes above" }, "INFLUENZA VACCINES Seasonal influenza vaccine for intradermal use": { "indications": "Indications\u00a0annual immunisation against seasonal\r\ninfluenza", "name": "INFLUENZA VACCINES Seasonal influenza vaccine for intradermal use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Influenza vaccines", "INFLUENZA VACCINES", "Seasonal influenza vaccine for intradermal use" ], "cautions": "Cautions\u00a0see section 14.1; increased\r\nrisk of fever in child under 5 years with Viroflu\u00ae, and in child 5\u20139 years with Enzira\u00ae or preparations\r\nmarketed by Pfizer or CSL Biotherapies; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nreported febrile convulsions and transient thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202381.htm", "doses": [ "By intramuscular injection, adult and child over\r\n13 years, 0.5\u00a0mL as a single dose; child 6 months\u20133 years, 0.25\u20130.5\u00a0mL; 3\u201313 years 0.5\u00a0mL; for children 6\r\nmonths to 13 years who have not received seasonal influenza vaccine\r\npreviously, repeat after 4\u20136 weeks", "By intradermal injection, see under Intanza\u00ae below", "Name[Intanza\u00ae (Sanofi Pasteur) ] Injection, suspension of formaldehyde-inactivated\r\ninfluenza virus (split virion, grown in fertilised hens\u2019 eggs), net\r\nprice, prefilled syringe, 9\u00a0micrograms (0.1\u00a0mL) = \u00a39.05; prefilled\r\nsyringe, 15\u00a0micrograms (0.1\u00a0mL) = \u00a39.05Excipients include neomycinDose\u00a0by intradermal injection into deltoid region, adult 18\u201360 years, 9\u00a0micrograms as a single dose; adult over 60 years, 15\u00a0micrograms as a single dose" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "FLUVASTATIN": { "indications": "Indications\u00a0adjunct to diet in primary hypercholesterolaemia or combined (mixed)\r\nhyperlipidaemia (types IIa and IIb); prevention of coronary events\r\nafter percutaneous coronary intervention", "name": "FLUVASTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins", "FLUVASTATIN" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ", "side-effects": "Side-effects\u00a0see notes above; also very rarely vasculitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88743.htm", "doses": [ "Hypercholesterolaemia or combined hyperlipidaemia, initially\r\n20\u201340\u00a0mg daily in the evening, adjusted at intervals of at least 4\r\nweeks; up to 80\u00a0mg daily (given in 2 divided doses) may be required; child under 18 years see BNF for Children", "Following percutaneous coronary intervention, 80\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "ALPROSTADIL": { "indications": "Indications\u00a0erectile dysfunction (including aid to diagnosis)", "name": "ALPROSTADIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Alprostadil" ], "cautions": "Cautions\u00a0priapism\u2014patients\r\nshould be instructed to report any erection lasting 4\u00a0hours or longer\u2014for management, see section 7.4.5; anatomical deformations of\r\npenis (painful erection more likely)\u2014follow up regularly to detect\r\nsigns of penile fibrosis (consider discontinuation if\r\nangulation, cavernosal fibrosis or Peyronie\u2019s disease develop); interactions: Appendix 1 (prostaglandins)", "side-effects": "Side-effects\u00a0hypotension, hypertension; dizziness, headache;\r\npenile pain, other localised pain (buttocks, leg, testicular, abdominal);\r\ninfluenza-like syndrome; urethral burning, urethral bleeding; injection\r\nsite reactions including penile fibrosis, penile oedema, penile rash,\r\nhaematoma, haemosiderin deposits; less commonly nausea,\r\ndry mouth, vasodilatation, syncope, supraventricular extrasystole,\r\nrapid pulse, asthenia, leg cramps, pelvic pain, scrotal or testicular\r\noedema, scrotal erythema, testicular thickening, micturation difficulties,\r\nhaematuria, mydriasis, and sweating; local reactions including penile\r\nwarmth, pruritus, irritation, penile numbness or sensitivity, balantitis,\r\nphimosis, priapism (see section 7.4.5 and under Cautions), abnormal ejaculation; rarely vertigo, urinary-tract infection, and hypersensitivity\r\nreactions (including rash, erythema, urticaria, and anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/18535.htm", "doses": [ "See under preparations below" ] }, "CAPECITABINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nCapecitabine, which is metabolised to fluorouracil, is given by mouth. It is licensed as monotherapy or combination therapy for adjuvant treatment of advanced colon cancer following surgery, for monotherapy or combination therapy of metastatic colorectal cancer, and for first-line treatment of advanced gastric cancer in combination with a platinum-based regimen. Capecitabine is also licensed for second-line treatment of locally advanced or metastatic breast cancer either in combination with docetaxel (where previous therapy included an anthracycline) or alone (after failure of a taxane and anthracycline regimen or where further anthracycline treatment is not indicated). For the role of capecitabine in the treatment of breast cancer, see section 8.3.4.1. ", "name": "CAPECITABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "CAPECITABINE" ], "cautions": "Cautions\u00a0see section 8.1; history of significant cardiovascular\r\ndisease, arrhythmias; monitor plasma-calcium concentration; diabetes mellitus; interactions: Appendix\r\n1 (fluorouracil) ", "side-effects": "Side-effects\u00a0see section 8.1; hand\u2013foot (desquamative) syndrome;\r\ndiarrhoea; also reported QT-prolongation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106109.htm", "doses": [ "Stage III colon cancer, adjuvant following surgery,\r\nmonotherapy, adult over 18 years 1.25\u00a0g/m2 twice daily for 14 days, subsequent courses repeated after\r\na 7-day interval; recommended duration of treatment 6 months", "Stage III colon cancer, adjuvant following surgery,\r\nin combination therapy, adult over\r\n18 years 0.8\u20131\u00a0g/m2 twice daily for 14 days, subsequent\r\ncourses repeated after a 7\u2013day interval; recommended duration of treatment\r\n6 months", "Metastatic colorectal cancer, monotherapy, adult over 18 years 1.25\u00a0g/m2 twice daily\r\nfor 14 days, subsequent courses repeated after a 7-day interval", "Metastatic colorectal cancer, in combination therapy, adult over 18 years 0.8\u20131\u00a0g/m2 twice daily\r\nfor 14 days, subsequent courses repeated after a 7-day interval", "Advanced gastric cancer, in combination with a platinum-based\r\nregimen, adult over 18 years 0.8\u20131\u00a0g/m2 twice daily for 14 days, subsequent courses repeated after\r\na 7-day interval or 625\u00a0mg/m2 twice daily given continuously", "Locally advanced or metastatic breast cancer, monotherapy\r\nor in combination with docetaxel, adult over 18 years 1.25\u00a0g/m2 twice daily for 14 days, subsequent\r\ncourses repeated after a 7-day interval", "Adjust dose according to tolerability\u2014consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "NORMAL IMMUNOGLOBULIN For subcutaneous use": { "indications": "Indications\u00a0 \n(From 14.5.1 Normal immunoglobulin: British National Formulary)\n14.5.1 Normal immunoglobulin", "name": "NORMAL IMMUNOGLOBULIN For subcutaneous use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.1 Normal immunoglobulin", "NORMAL IMMUNOGLOBULIN", "For subcutaneous use" ], "cautions": "Cautions\u00a0hypo- or agammaglobulinaemia with or\r\nwithout IgA deficiency; interference with live virus vaccines\u2014\n(From 14.5.1 Normal immunoglobulin: British National Formulary)\nNormal immunoglobulin may interfere with the immune response to live virus vaccines which should therefore only be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin (this does not apply to yellow fever vaccine since normal immunoglobulin does not contain antibody to this virus).Intravenous use\u00a0thrombophilic disorders, or risk factors for arterial or venous thromboembolic\r\nevents; obesity; ensure adequate hydration, renal insufficiency", "side-effects": "Side-effects\u00a0nausea, diarrhoea, chills, fever, headache, dizziness,\r\narthralgia, myalgia, muscle spasms, low back pain; rarely hypotension, anaphylaxis, cutaneous skin reactions, aseptic meningitis,\r\nacute renal failure; also reported with intravenous use, injection site reactions, abdominal pain and distension, blood\r\npressure fluctuations, haemolytic anaemia, thromboembolic events including\r\nmyocardial infarction, stroke, pulmonary embolism, and deep vein thrombosisNote\u00a0Adverse reactions are more likely to occur\r\nin patients receiving normal immunoglobulin for the first time, or\r\nfollowing a prolonged period between treatments, or when a different\r\nbrand of normal immunoglobulin is administered.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129009.htm", "doses": [ "See under preparations", "Antibody titres can vary widely between normal\r\nimmunoglobulin preparations from different manufacturers\u2014formulations\r\nare not interchangeable; patients should be maintained\r\non the same formulation throughout long-term treatment to avoid adverse\r\neffects", "By intramuscular injection, Hepatitis A prophylaxis\r\nin outbreaks (see notes above), adult and child over\r\n10 years, 750\u00a0mg, child under 10 years,\r\n500\u00a0mg", "Subgam\u00ae is not licensed\r\nfor prophylactic use, but due to difficulty in obtaining suitable\r\nimmunoglobulin products, the Health Protection Agency recommends intramuscular\r\nuse for prophylaxis against Hepatitis A or rubella", "Name[Subgam\u00ae (BPL) ] Normal immunoglobulin (protein 14%-18%) injection, net price 250-mg\r\nvial = \u00a311.20, 750-mg vial = \u00a328.50, 1.5-g vial = \u00a357.00Dose\u00a0by subcutaneous infusion,\r\nantibody deficiency syndromes, consult product literatureBy intramuscular injection, Hepatitis A prophylaxis\r\nin outbreaks (see notes above), adult and child over\r\n10 years, 750\u00a0mg, child under 10 years,\r\n500\u00a0mgRubella, in pregnancy, prevention of clinical attack (see also notes above), 750\u00a0mg Note\u00a0Subgam\u00ae is not licensed\r\nfor prophylactic use, but due to difficulty in obtaining suitable\r\nimmunoglobulin products, the Health Protection Agency recommends intramuscular\r\nuse for prophylaxis against Hepatitis A or rubella" ] }, "HYDROCORTISONE BUTYRATE": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "HYDROCORTISONE BUTYRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5868.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "PROPAMIDINE ISETIONATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "PROPAMIDINE ISETIONATE" ], "indications": "Indications\u00a0local treatment of infections (but \n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials)", "name": "PROPAMIDINE ISETIONATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5405.htm", "doses": [ "See preparations", "apply 4 times daily", "apply 1\u20132 times daily" ] }, "BETAMETHASONE ESTERS With salicylic acid": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "BETAMETHASONE ESTERS With salicylic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "BETAMETHASONE ESTERS", "With salicylic acid" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.; use of more than 100\u00a0g per week\r\nof 0.1% preparation likely to cause adrenal suppression", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5882.htm", "doses": [ "Apply thinly 1\u20132 times daily", "apply a few drops 1\u20132 times daily", "Name[Diprosalic\u00ae (Schering-Plough) ] Ointment, betamethasone (as dipropionate) 0.05%, salicylic acid 3%, net\r\nprice 30\u00a0g = \u00a33.18, 100\u00a0g = \u00a39.14. \r\n Label:\r\n 28, counselling, application. Potency: potent Excipients none as listed in section 13.1.3Dose\u00a0apply thinly 1\u20132 times daily; max. 60\u00a0g per week\nScalp application, betamethasone (as dipropionate) 0.05%, salicylic acid 2%, in\r\nan alcoholic basis, net price 100\u00a0mL = \u00a310.10. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include disodium\r\nedetateDose\u00a0apply a few drops 1\u20132 times daily" ] }, "CYCLOPHOSPHAMIDE": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nCyclophosphamide is used mainly in combination with other agents for treating a wide range of malignancies, including some leukaemias, lymphomas, and solid tumours. It is given by mouth or intravenously; it is inactive until metabolised by the liver. A urinary metabolite of cyclophosphamide, acrolein, can cause haemorrhagic cystitis; this is a rare but serious complication; increased fluid intake for 24\u201348 hours after intravenous injection, can prevent this complication. When high-dose therapy (e.g. more than 2\u00a0g intravenously) is used or when the patient is considered to be at high risk of cystitis (e.g. because of pelvic irradiation), mesna (given initially intravenously then by mouth) can also help prevent cystitis\u2014see under Urothelial Toxicity (section 8.1).; rheumatoid arthritis (%s\n(From Drugs affecting the immune response: British National Formulary)\nCyclophosphamide (section 8.1.1) may be used at a dose of 1 to 1.5\u00a0mg/kg daily by mouth for rheumatoid arthritis with severe systemic manifestations [unlicensed indication]; it is toxic and regular blood counts (including platelet counts) should be carried out. Cyclophosphamide can also be given intravenously in a dose of 0.5 to 1\u00a0g (with prophylactic mesna) for severe systemic rheumatoid arthritis and for other connective tissue diseases (especially with active vasculitis), repeated initially at fortnightly then at monthly intervals (according to clinical response and haematological monitoring).)", "name": "CYCLOPHOSPHAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "CYCLOPHOSPHAMIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; previous or concurrent mediastinal irradiation\u2014risk of cardiotoxicity; diabetes mellitus; avoid in\r\nacute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(cyclophosphamide)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also anorexia;\r\npancreatitis; cardiotoxicity at high doses; interstitial pulmonary\r\nfibrosis; inappropriate secretion of anti-diuretic hormone, disturbances\r\nof carbohydrate metabolism; urothelial toxicity; pigmentation of palms,\r\nnails, and soles: rarely hepatotoxicity and renal\r\ndysfunction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202842.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (manufacturer advises effective contraception\r\nduring and for at least 3 months after treatment in men or women);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "PYRAZINAMIDE": { "indications": "Indications\u00a0tuberculosis in combination with other drugs [unlicensed]", "name": "PYRAZINAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "PYRAZINAMIDE" ], "cautions": "Cautions\u00a0see Monitoring in notes above; also diabetes; gout (avoid in acute attack); interactions: Appendix 1\r\n(pyrazinamide)Hepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of liver disorder, and\r\nadvised to discontinue treatment and seek immediate medical attention\r\nif symptoms such as persistent nausea, vomiting, malaise or jaundice\r\ndevelop", "side-effects": "Side-effects\u00a0hepatotoxicity including fever, anorexia, hepatomegaly,\r\nsplenomegaly, jaundice, liver failure; nausea, vomiting, flushing,\r\ndysuria, arthralgia, sideroblastic anaemia, thrombocytopenia, rash\r\nand occasionally photosensitivity", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3912.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; see also Pregnancy" }, "BENDROFLUMETHIAZIDE": { "indications": "Indications\u00a0oedema, hypertension (see also notes above)", "name": "BENDROFLUMETHIAZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "BENDROFLUMETHIAZIDE" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202837.htm", "doses": [ "Oedema, initially 5\u201310\u00a0mg daily in the morning or on alternate days; maintenance 5\u201310\u00a0mg 1\u20133 times weekly", "Hypertension, 2.5\u00a0mg daily in the morning; higher doses rarely\r\nnecessary (see notes above)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "DANTROLENE SODIUM": { "indications": "Indications\u00a0chronic severe spasticity of voluntary muscle;\r\nmalignant hyperthermia (section 15.1.8)", "name": "DANTROLENE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants" ], "cautions": "Cautions\u00a0impaired cardiac and pulmonary function; therapeutic effect may take a few weeks to develop\u2014discontinue\r\nif no response within 6\u20138 weeks; interactions: Appendix 1 (muscle relaxants).Hepatotoxicity\u00a0Potentially life-threatening\r\nhepatotoxicity reported, usually if doses greater than 400\u00a0mg daily\r\nused, in females, patients over 30 years, if history of liver disorders,\r\nor concomitant use of hepatotoxic drugs; test liver function before and at intervals during therapy\u2014discontinue if abnormal liver function tests or symptoms of liver\r\ndisorder (counselling, see below); re-introduce only if complete reversal\r\nof hepatotoxicityCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek prompt\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain, dark urine, or pruritus developDriving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0diarrhoea (withdraw if severe, discontinue treatment\r\nif recurs on re-introduction), nausea, vomiting, anorexia, hepatotoxicity\r\n(see above), abdominal pain; pericarditis; pleural effusion, respiratory\r\ndepression; headache, drowsiness, dizziness, asthenia, fatigue, seizures,\r\nfever, chills; speech and visual disturbances; rash; less\r\ncommonly dysphagia, constipation, exacerbation of cardiac\r\ninsufficiency, tachycardia, erratic blood pressure, dyspnoea, depression,\r\nconfusion, nervousness, insomnia, increased urinary frequency, urinary\r\nincontinence or retention, haematuria, crystalluria, and increased\r\nsweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5338.htm", "doses": [ "Initially 25\u00a0mg daily, may be increased at weekly intervals\r\nto max. 100\u00a0mg 4 times daily; usual dose 75\u00a0mg 3 times daily; child 5\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid use in chronic spasticity\u2014embryotoxic in animal studies" }, "HISTRELIN": { "indications": "Indications\u00a0advanced prostate cancer", "name": "HISTRELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Men at risk of tumour \u2018flare\u2019 (see above) should be monitored closely during the first month of therapy. Caution is required in patients with metabolic bone disease because reduced bone mineral density can occur. The injection site should be rotated.; monitor patients at high risk of metabolic disease (e.g. bone disease,\r\nworsening diabetes) or cardiovascular disease before and during treatment; risk of ureteric obstruction and spinal\r\ncord compression", "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nSide-effects\u00a0The gonadorelin analogues cause side-effects similar to the menopause in women and orchidectomy in men and include hot flushes and sweating, sexual dysfunction, vaginal dryness or bleeding, and gynaecomastia or changes in breast size. Signs and symptoms of prostate or breast cancer may worsen initially (managed in prostate cancer with anti-androgens, see above). Other side-effects include hypersensitivity reactions (rashes, pruritus, asthma, and rarely anaphylaxis), injection site reactions (see Cautions), headache (rarely migraine), visual disturbances, dizziness, arthralgia and possibly myalgia, hair loss, peripheral oedema, gastro-intestinal disturbances, weight changes, sleep disorders, and mood changes.; also\r\nhepatic disorder, dyspnoea, depression, asthenia, elevated blood glucose-concentration,\r\nincreased urinary frequency, hypertrichosis; less commonly hypercholesterolaemia, palpitation, ventricular extrasystole, haematoma,\r\ntremor, anaemia, renal failure, nephrolithiasis, hypercalcaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204174.htm", "doses": [ "By subcutaneous implantation into upper\r\narm, 1\u00a0implant (50\u00a0mg) every 12 months; remove after 12 months of\r\ntreatment", "Avoid wetting arm containing implant\r\nfor 24 hours and avoid lifting heavy objects or strenuous physical\r\nactivity for 7 days after implantation" ] }, "INFLIXIMAB - DRUGS AFFECTING THE IMMUNE RESPONSE": { "indications": "Indications\u00a0see notes above; inflammatory bowel\r\ndisease (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB); ankylosing spondylitis, psoriatic\r\narthritis, rheumatoid arthritis (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB)", "name": "INFLIXIMAB - DRUGS AFFECTING THE IMMUNE RESPONSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 10.1.3; monitor for non-melanoma skin cancer before and during treatment", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201653.htm", "doses": [ "By intravenous infusion, plaque psoriasis, adult over 18 years, 5\u00a0mg/kg, repeated 2 weeks and\r\n6 weeks after initial infusion, then every 8 weeks; discontinue if\r\nno response within 14 weeks of initial infusion" ], "pregnancy": "Pregnancy\u00a0section\r\n10.1.3" }, "NABUMETONE": { "indications": "Indications\u00a0pain and inflammation in osteoarthritis and rheumatoid arthritis", "name": "NABUMETONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "NABUMETONE" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5242.htm", "doses": [ "1\u00a0g at night; severe or persistent symptoms 0.5\u20131\u00a0g in\r\nmorning and 1\u00a0g at night; elderly 0.5\u20131\u00a0g\r\ndaily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "CHLORAMBUCIL": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nChlorambucil is used either alone or in combination therapy for some lymphomas and chronic leukaemias. It is given by mouth. Side-effects, apart from bone-marrow suppression, are uncommon. However, patients occasionally develop severe widespread rashes which can progress to Stevens-Johnson syndrome or to toxic epidermal necrolysis. If a rash occurs further chlorambucil is contra-indicated and cyclophosphamide is substituted. ", "name": "CHLORAMBUCIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "CHLORAMBUCIL" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; history of epilepsy and children with nephrotic syndrome\r\n(increased risk of seizures); avoid in acute\r\nporphyria (but see section 9.8.2)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4683.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nduring treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "ADRENALINE/EPINEPHRINE - CARDIOPULMONARY RESUSCITATION": { "indications": "Indications\u00a0see notes\r\nabove", "name": "ADRENALINE/EPINEPHRINE - CARDIOPULMONARY RESUSCITATION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.3 Cardiopulmonary resuscitation", "ADRENALINE/EPINEPHRINE" ], "cautions": "Cautions\u00a0ischaemic heart disease, severe angina, obstructive\r\ncardiomyopathy, hypertension, arrhythmias, cerebrovascular\r\ndisease, occlusive vascular disease, arteriosclerosis, monitor\r\nblood pressure and ECG; cor pulmonale; organic brain damage, psychoneurosis; diabetes mellitus, hyperthyroidism, phaeochromocytoma; prostate\r\ndisorders; hypokalaemia, hypercalcaemia; susceptibility to angle-closure\r\nglaucoma; elderly; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, dry mouth, hypersalavation;\r\narrhythmias, syncope, angina, pallor, palpitation, cold extremities,\r\nhypertension (risk of cerebral haemorrhage); dyspnoea, pulmonary oedema\r\n(on excessive dosage or extreme sensitivity); anxiety, tremor, restlessness,\r\nheadache, weakness, dizziness, hallucinations; hyperglycaemia; urinary\r\nretention, difficulty in micturition; metabolic acidosis; hypokalaemia;\r\ntissue necrosis at injection site and of extremities, liver and kidneys;\r\nmydriasis, angle-closure glaucoma, and sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2732.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0may reduce placental perfusion and can delay second\r\nstage of labour; manufacturers advise use only if benefit outweighs\r\nrisk" }, "MISOPROSTOL": { "indications": "Indications\u00a0see notes above and under Dose", "name": "MISOPROSTOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.4 Prostaglandin analogues", "MISOPROSTOL" ], "cautions": "Cautions\u00a0inflammatory bowel disease; conditions where hypotension might precipitate severe\r\ncomplications (e.g. cerebrovascular disease, cardiovascular disease)", "side-effects": "Side-effects\u00a0diarrhoea (may occasionally be severe and require\r\nwithdrawal, reduced by giving single doses not exceeding 200\u00a0micrograms\r\nand by avoiding magnesium-containing antacids); also reported: abdominal\r\npain, dyspepsia, flatulence, nausea and vomiting, abnormal vaginal\r\nbleeding (including intermenstrual bleeding, menorrhagia, and postmenopausal\r\nbleeding), rashes, dizziness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2135.htm", "doses": [ "Benign gastric and duodenal ulceration and NSAID-associated\r\nulceration, adult over 18 years, 800\u00a0micrograms\r\ndaily (in 2\u20134 divided doses) with breakfast (or main meals) and at\r\nbedtime; treatment should be continued for at least 4 weeks and may\r\nbe continued for up to 8 weeks if required", "Prophylaxis of NSAID-induced gastric and duodenal ulcer, adult over 18 years, 200\u00a0micrograms 4 times daily\r\n(if not tolerated, reduced to 200\u00a0micrograms 2\u20133 times daily, but\r\nless effective)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014potent uterine stimulant (has been used to\r\ninduce abortion); teratogenic risk in first trimester; important: see also Women of Childbearing Age, above" }, "PHENOBARBITAL": { "indications": "Indications\u00a0all forms of epilepsy except typical absence\r\nseizures; status epilepticus (section 4.8.2)", "name": "PHENOBARBITAL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Phenobarbital and primidone", "PHENOBARBITAL" ], "cautions": "Cautions\u00a0\n(From Phenobarbital and primidone: British National Formulary)\nPhenobarbital is effective for tonic-clonic and focal seizures but may be sedative in adults and cause behavioural disturbances and hyperkinesia in children. It may be tried for atypical absence, atonic, and tonic seizures. Rebound seizures may be a problem on withdrawal; elderly; debilitated; children; respiratory depression (avoid if severe); avoid abrupt withdrawal (dependence\r\nwith prolonged use); history of drug or alcohol abuse; consider vitamin D supplementation in patients who are immobilised\r\nfor long periods or who have inadequate sun exposure or dietary intake\r\nof calcium; avoid in acute porphyria (%s\n(From Unsafe Drug Groups (check first): British National Formulary)\nUnsafe Drug Groups (check first)); interactions: \n(From 4.8.1 Control of the epilepsies: British National Formulary)\nInteractions\u00a0Interactions between antiepileptics are complex and may increase toxicity without a corresponding increase in antiepileptic effect. Interactions are usually caused by hepatic enzyme induction or inhibition; displacement from protein binding sites is not usually a problem. These interactions are highly variable and unpredictable.For interactions of antiepileptic drugs, see Appendix 1; for advice on hormonal contraception and enzyme-inducing drugs, see section 7.3.1 and section 7.3.2.Significant interactions that occur between antiepileptics and that may affect dosing requirements are as follows:Note\u00a0Check under each drug for possible interactions when two or more antiepileptic drugs are usedCarbamazepineoften lowers plasma concentration of clobazam, clonazepam, lamotrigine, phenytoin (but may also raise plasma-phenytoin concentration), tiagabine, topiramate, valproate, zonisamide, and an active metabolite of oxcarbazepinesometimes lowers plasma concentration of eslicarbazepine, ethosuximide, primidone (but tendency for corresponding increase in phenobarbital level), retigabine, and rufinamidesometimes raises plasma concentration of phenobarbital and primidone-derived phenobarbitalEslicarbazepineoften raises plasma concentration of phenytoinEthosuximidesometimes raises plasma concentration of phenytoin Lamotriginesometimes raises plasma concentration of an active metabolite of carbamazepine (but evidence is conflicting)Oxcarbazepine sometimes lowers plasma concentration of carbamazepine (but may raise plasma concentration of an active metabolite of carbamazepine)sometimes raises plasma concentration of phenytoin often raises plasma concentration of phenobarbital and primidone-derived phenobarbitalPhenobarbital or primidoneoften lowers plasma concentration of clonazepam, lamotrigine, phenytoin (but may also raise plasma-phenytoin concentration), tiagabine, valproate, zonisamide, and an active metabolite of oxcarbazepinesometimes lowers plasma concentration of ethosuximide, rufinamide, and topiramatePhenytoin often lowers plasma concentration of clonazepam, carbamazepine, eslicarbazepine, lamotrigine, tiagabine, topiramate, valproate, zonisamide, and an active metabolite of oxcarbazepineoften raises plasma concentration of phenobarbital and primidone-derived phenobarbitalsometimes lowers plasma concentration of ethosuximide, primidone (by increasing conversion to phenobarbital), retigabine, and rufinamideRufinamidesometimes lowers plasma concentration of carbamazepinesometimes raises plasma concentration of phenytoinTopiramate sometimes raises plasma concentration of phenytoinValproatesometimes lowers plasma concentration of an active metabolite of oxcarbazepine often raises plasma concentration of lamotrigine, phenobarbital, primidone-derived phenobarbital, phenytoin (but may also lower), and an active metabolite of carbamazepinesometimes raises plasma concentration of ethosuximide and rufinamideVigabatrin often lowers plasma concentration of phenytoin in section 4.8.1 and Appendix 1 (phenobarbital)", "side-effects": "Side-effects\u00a0hepatitis, cholestasis; hypotension; respiratory\r\ndepression; behavioural disturbances, nystagmus, irritability, drowsiness,\r\nlethargy, depression, ataxia, paradoxical excitement, hallucinations,\r\nimpaired memory and cognition, hyperactivity particularly in the elderly\r\nand in children; osteomalacia (see Cautions); megaloblastic anaemia\r\n(may be treated with folic acid), agranulocytosis,\r\nthrombocytopenia; allergic skin reactions; very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis; suicidal\r\nideation; Antiepileptic Hypersensitivity\r\nSyndrome; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129418.htm", "doses": [ "By mouth, 60\u2013180\u00a0mg at night; child 5\u20138\u00a0mg/kg daily" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "TOLCAPONE": { "indications": "Indications\u00a0adjunct to co-beneldopa or co-careldopa in Parkinson\u2019s disease with\r\n\u2018end-of-dose\u2019 motor fluctuations if another inhibitor of peripheral\r\ncatechol-O-methyltransferase inappropriate (under\r\nspecialist supervision)", "name": "TOLCAPONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Catechol-O-methyltransferase inhibitors" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; most patients receiving more than 600\u00a0mg levodopa\r\ndaily require reduction of levodopa dose by about 30%; interactions: Appendix 1 (tolcapone) Hepatotoxicity\u00a0Potentially life-threatening\r\nhepatotoxicity including fulminant hepatitis reported rarely, usually\r\nin women and during the first 6 months, but late-onset liver injury\r\nalso reported; test liver function before\r\ntreatment, and monitor every 2 weeks for first year, every 4 weeks\r\nfor next 6 months and then every 8 weeks thereafter (restart monitoring\r\nschedule if dose increased); discontinue\r\nif abnormal liver function tests or symptoms of liver disorder (counselling, see below); do not re-introduce tolcapone\r\nonce discontinuedCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek immediate\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain, dark urine, or pruritus develop", "side-effects": "Side-effects\u00a0diarrhoea, constipation, dyspepsia, abdominal\r\npain, nausea, vomiting, anorexia, xerostomia, hepatotoxicity (see\r\nabove); chest pain; confusion, dystonia, dyskinesia, drowsiness, headache,\r\ndizziness, sleep disturbances, excessive dreaming, hallucinations;\r\nsyncope; urine discoloration; sweating; neuroleptic malignant syndrome\r\nand rhabdomyolysis reported on dose reduction or withdrawal", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129262.htm", "doses": [ "100\u00a0mg 3 times daily, leave 6 hours between each dose;\r\nmax. 200\u00a0mg 3 times daily in exceptional circumstances; first daily\r\ndose should be taken at the same time as levodopa with dopa-decarboxylase\r\ninhibitor", "Continue beyond 3 weeks only if substantial improvement" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014use only\r\nif potential benefit outweighs risk" }, "BETAMETHASONE SODIUM PHOSPHATE": { "indications": "Indications\u00a0non-infected inflammatory\r\nconditions of nose", "name": "BETAMETHASONE SODIUM PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "BETAMETHASONE SODIUM PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5646.htm", "doses": [ "nose, 2\u20133 drops into each nostril twice\r\ndaily; ear, section\r\n12.1.1; eye, section 11.4.1" ] }, "LORAZEPAM - ANXIOLYTICS": { "indications": "Indications\u00a0short-term use in anxiety or insomnia (see section 4.1);\r\nstatus epilepticus (section 4.8.2); peri-operative (section 15.1.4.1)", "name": "LORAZEPAM - ANXIOLYTICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Benzodiazepines", "LORAZEPAM" ], "cautions": "Cautions\u00a0see under Diazepam; short\r\nacting; when given parenterally, facilities\r\nfor managing respiratory depression with mechanical ventilation must\r\nbe available", "side-effects": "Side-effects\u00a0see under Diazepam", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3186.htm", "doses": [ "By mouth, anxiety, 1\u20134\u00a0mg daily in\r\ndivided doses; elderly (or debilitated)\r\nhalf adult dose", "Insomnia associated with anxiety, 1\u20132\u00a0mg at bedtime; child not recommended", "By intramuscular or slow intravenous injection (into a large vein), acute\r\npanic attacks, 25\u201330\u00a0micrograms/kg (usual range 1.5\u20132.5\u00a0mg), repeated\r\nevery 6 hours if necessary; child not\r\nrecommended", "Only use intramuscular route when oral and\r\nintravenous routes not possible" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "CILAZAPRIL": { "indications": "Indications\u00a0essential hypertension; congestive heart failure\r\n(adjunct\u2014see section 2.5.5)", "name": "CILAZAPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "CILAZAPRIL" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also less commonly dry mouth, decreased appetite, aphthous stomatitis, angina, tachycardia,\r\npalpitation, flushing, dyspnoea, impotence, excessive sweating; rarely glossitis, bronchitis, interstitial lung disease,\r\ngynaecomastia, peripheral neuropathy, Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2584.htm", "doses": [ "Hypertension, initially 1\u00a0mg once daily (reduced to 500\u00a0micrograms\r\ndaily if used in addition to diuretic (see notes above),\r\nor in cardiac decompensation, in severe hypertension, in volume depletion,\r\nin the elderly, or in renal impairment), then adjusted according to\r\nresponse; usual maintenance dose 2.5\u20135\u00a0mg once daily; max. 5\u00a0mg daily", "Heart failure (adjunct), initially 500\u00a0micrograms once daily\r\nunder close medical supervision (see notes above),\r\nincreased at weekly intervals to 1\u20132.5\u00a0mg once daily if tolerated;\r\nmax. 5\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "GENTAMICIN - ANTI-INFECTIVE PREPARATIONS": { "side-effects": "Side-effects\u00a0local sensitivity", "indications": "Indications\u00a0bacterial infection in otitis externa (\n(From 12.1.1 Otitis externa: British National Formulary)\nIf infection is present, a topical anti-infective which is not used systemically (such as neomycin or clioquinol) may be used, but for only about a week as excessive use may result in fungal infections; these may be difficult to treat and require expert advice)", "name": "GENTAMICIN - ANTI-INFECTIVE PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31436.htm", "doses": [ "ear, apply 2\u20133 drops 3\u20134 times daily and\r\nat night; eye, section\r\n11.3.1" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-infective preparations", "GENTAMICIN" ], "cautions": "Cautions\u00a0avoid prolonged use (\n(From 12.1.1 Otitis externa: British National Formulary)\nIf infection is present, a topical anti-infective which is not used systemically (such as neomycin or clioquinol) may be used, but for only about a week as excessive use may result in fungal infections; these may be difficult to treat and require expert advice)" }, "PODOPHYLLOTOXIN": { "indications": "Indications\u00a0see under preparations", "name": "PODOPHYLLOTOXIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses", "Anogenital warts", "PODOPHYLLOTOXIN" ], "cautions": "Cautions\u00a0avoid normal skin and open\r\nwounds; keep away from face; very irritant to eyes", "side-effects": "Side-effects\u00a0local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6072.htm", "doses": [ "condylomata acuminata affecting the penis or the female\r\nexternal genitalia, apply twice daily for 3 consecutive days; treatment\r\nmay be repeated at weekly intervals if necessary for a total of five\r\n3-day treatment courses; direct medical supervision for\r\nlesions in the female and for lesions greater than 4\u00a0cm2 in the male; max. 50 single applications\r\n(\u2018loops\u2019) per session (consult product literature); child 2\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid" }, "METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA": { "indications": "Indications\u00a0see under Dose below", "name": "METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "METHOXY POLYETHYLENE GLYCOL-EPOETIN BETA" ], "cautions": "Cautions\u00a0see Epoetin", "side-effects": "Side-effects\u00a0see Epoetin; also hot flushes reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200088.htm", "doses": [ "Symptomatic anaemia associated with chronic kidney disease\r\nin patients on dialysis and not currently treated\r\nwith erythropoietins (see also MHRA/CHM advice), adult over 18 years, by subcutaneous or intravenous injection, initially\r\n600\u00a0nanograms/kg once every 2 weeks, adjusted according to response\r\nat intervals of at least 4 weeks; maintenance dose of double the previous\r\nfortnightly dose may be given every 4 weeks", "Symptomatic anaemia associated with chronic kidney disease in\r\npatients not on dialysis and not currently treated with erythropoietins (see also MHRA/CHM advice), adult over 18 years, by subcutaneous injection, initially 1.2\u00a0micrograms/kg once every 4 weeks, alternatively by subcutaneous or intravenous\r\ninjection, initially 600\u00a0nanograms/kg once every 2 weeks;\r\ndose adjusted according to response at intervals of at least 4 weeks;\r\npatients treated once every 2 weeks may be given a maintenance dose\r\nof double the previous fortnightly dose every 4 weeks", "Symptomatic anaemia associated with chronic kidney disease in\r\npatients currently treated with erythropoietins (see also MHRA/CHM advice), adult over 18 years, by subcutaneous or intravenous injection, consult\r\nproduct literature", "Subcutaneous route preferred in patients\r\nnot on haemodialysis. Reduce dose by approximately 25% if rise in\r\nhaemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks, or if haemoglobin\r\nconcentration approaches or exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous dose" ], "pregnancy": "Pregnancy\u00a0no evidence of harm in animal studies\u2014manufacturer\r\nadvises caution" }, "ALMOTRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine", "name": "ALMOTRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists", "ALMOTRIPTAN" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; sensitivity to sulfonamides; interactions: Appendix 1 (5HT1 agonists)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; also transient increase in blood pressure,\r\ndrowsiness; less commonly diarrhoea, dyspepsia, dry\r\nmouth, chest pain, palpitation, paraesthesia, headache, myalgia, bone\r\npain, tinnitus; very rarely myocardial infarction,\r\nand tachycardia; seizures also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106090.htm", "doses": [ "12.5\u00a0mg as soon as possible after onset repeated after\r\n2 hours if migraine recurs (patient not responding should not take\r\nsecond dose for same attack); max. 25\u00a0mg in 24 hours; child and adolescent under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "AMINOPHYLLINE": { "indications": "Indications\u00a0reversible airways obstruction, severe\r\nacute asthma", "name": "AMINOPHYLLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.3 Theophylline", "AMINOPHYLLINE" ], "cautions": "Cautions\u00a0see under Theophylline", "side-effects": "Side-effects\u00a0see under Theophylline; also allergy to ethylenediamine can cause urticaria, erythema,\r\nand exfoliative dermatitis; hypotension, arrhythmias, and convulsions\r\nespecially if given rapidly by intravenous injection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2941.htm", "doses": [ "See under preparations, below", "Plasma-theophylline concentration\r\nfor optimum response 10\u201320\u00a0mg/litre (55\u2013110\u00a0micromol/litre); measure\r\nplasma-theophylline concentration 4\u20136 hours after dose by mouth and\r\nat least 5 days after starting oral treatment; measure plasma-theophylline\r\nconcentration 4\u20136 hours after the start of intravenous infusion; narrow\r\nmargin between therapeutic and toxic dose, see also notes above", "To avoid excessive dosage\r\nin obese patients, dose should be calculated on the basis of ideal\r\nweight for height" ], "pregnancy": "Pregnancy\u00a0see under Theophylline" }, "1.7.2 Compound haemorrhoidal preparations with corticosteroids": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.7 Local preparations for anal and rectal disorders" ], "name": "1.7.2 Compound haemorrhoidal preparations with corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2274.htm", "doses": [ "apply twice daily for 5\u20137 days (3\u20134 times daily on 1st\r\nday if necessary), then once daily for a few days after symptoms have\r\ncleared", "insert 1 suppository daily after a bowel movement, for\r\n5\u20137 days (in severe cases initially 2\u20133 times daily) then 1 suppository\r\nevery other day for 1 week" ] }, "MYCOPHENOLATE MOFETIL Mycophenolic acid": { "indications": "Indications\u00a0prophylaxis of acute renal, cardiac, or hepatic\r\ntransplant rejection (in combination with ciclosporin and corticosteroids) under specialist supervision", "name": "MYCOPHENOLATE MOFETIL Mycophenolic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.1 Antiproliferative immunosuppressants", "MYCOPHENOLATE MOFETIL", "Mycophenolic acid" ], "cautions": "Cautions\u00a0see Bioavailability; full blood counts every week for 4 weeks then twice a month for 2\r\nmonths then every month in the first year (consider interrupting treatment if neutropenia develops); exclude pregnancy before starting treatment; elderly (increased risk of infection,\r\ngastro-intestinal haemorrhage and pulmonary oedema); children (higher incidence of side-effects may call\r\nfor temporary reduction of dose or interruption); active\r\nserious gastro-intestinal disease (risk of haemorrhage,\r\nulceration and perforation); delayed graft function; increased susceptibility to skin cancer (avoid exposure to strong sunlight); interactions: Appendix 1 (mycophenolate)Bone marrow suppression\u00a0Patients\r\nshould be warned to report immediately any signs or symptoms of bone\r\nmarrow suppression e.g. infection or inexplicable bruising or bleeding", "side-effects": "Side-effects\u00a0taste disturbance, gingival hyperplasia, nausea,\r\nconstipation, flatulence, anorexia, weight loss, vomiting, abdominal\r\npain, gastro-intestinal inflammation, ulceration, and bleeding, hepatitis,\r\njaundice, pancreatitis, stomatitis, oedema, tachycardia, hypertension,\r\nhypotension, vasodilatation, cough, dyspnoea, insomnia, agitation,\r\nconfusion, depression, anxiety, convulsions, paraesthesia, myasthenic\r\nsyndrome, tremor, dizziness, headache, influenza-like syndrome, infections,\r\nhyperglycaemia, renal impairment, malignancy (particularly of the\r\nskin), blood disorders (including leucopenia, anaemia, thrombocytopenia,\r\npancytopenia, and red cell aplasia\u2014\n(From 8.2.1 Antiproliferative immunosuppressants: British National Formulary)\nMycophenolate mofetil is metabolised to mycophenolic acid which has a more selective mode of action than azathioprine. It is licensed for the prophylaxis of acute rejection in renal, hepatic or cardiac transplantation when used in combination with ciclosporin and corticosteroids. There is evidence that compared with similar regimens incorporating azathioprine, mycophenolate mofetil reduces the risk of acute rejection episodes; the risk of opportunistic infections (particularly due to tissue-invasive cytomegalovirus) and the occurrence of blood disorders such as leucopenia may be higher.Cases of pure red cell aplasia have been reported with azathioprine and with mycophenolate mofetil; dose reduction or discontinuation should be considered under specialist supervision.), disturbances of electrolytes\r\nand blood lipids, arthralgia, alopecia, acne, skin hypertrophy, and\r\nrash; also reported intestinal villous atrophy, progressive\r\nmultifocal leucoencephalopathy, interstitial lung disease, pulmonary\r\nfibrosis ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129180.htm", "doses": [ "Renal transplantation, by mouth, 1\u00a0g twice\r\ndaily starting within 72 hours of transplantation or by intravenous infusion, 1\u00a0g twice daily starting\r\nwithin 24 hours of transplantation for max. 14 days (then transfer\r\nto oral therapy); child and adolescent 2\u201318 years, by mouth 600\u00a0mg/m2 twice daily (max. 2\u00a0g daily)", "Tablets and capsules not appropriate for\r\ndose titration in children with body surface area less than 1.25\u00a0m2", "Cardiac transplantation, by mouth, adult over 18 years, 1.5\u00a0g twice daily starting within\r\n5 days of transplantation", "Hepatic transplantation, by intravenous infusion, adult over 18 years, 1\u00a0g twice daily\r\nstarting within 24 hours of transplantation for 4 days (up to max.\r\n14 days), then by mouth, 1.5\u00a0g twice daily as soon\r\nas is tolerated", "Mycophenolic\r\nacid 720\u00a0mg is approximately equivalent to mycophenolate mofetil 1\u00a0g\r\nbut avoid unnecessary switching because of pharmacokinetic differences", "Name[Myfortic\u00ae (Novartis) ] Tablets, e/c, mycophenolic acid\r\n(as mycophenolate sodium) 180\u00a0mg (green), net price 120-tab pack =\r\n\u00a396.72; 360\u00a0mg (orange), 120-tab pack = \u00a3193.43. \r\n Label:\r\n 25Dose\u00a0renal transplantation, 720\u00a0mg twice daily starting within\r\n72 hours of transplantationEquivalence to mycophenolate mofetil\u00a0Mycophenolic\r\nacid 720\u00a0mg is approximately equivalent to mycophenolate mofetil 1\u00a0g\r\nbut avoid unnecessary switching because of pharmacokinetic differences" ], "pregnancy": "Pregnancy\u00a0avoid\u2014congenital malformations reported; effective\r\ncontraception required before treatment, during treatment, and for\r\n6 weeks after discontinuation of treatment" }, "SELEGILINE HYDROCHLORIDE Oral lyophilisate": { "indications": "Indications\u00a0Parkinson\u2019s disease, used alone or as adjunct to co-beneldopa or\r\nco-careldopa; symptomatic parkinsonism", "name": "SELEGILINE HYDROCHLORIDE Oral lyophilisate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Monoamine-oxidase-B inhibitors", "SELEGILINE HYDROCHLORIDE", "Oral lyophilisate" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; gastric and duodenal ulceration (avoid in active ulceration), uncontrolled hypertension (and avoid drugs that increase blood pressure), arrhythmias, angina, psychosis (and patients\r\npredisposed to confusion and psychosis), side-effects of levodopa may be increased\u2014concurrent levodopa dosage can be\r\nreduced by 10\u201330% in steps of 10% every 3\u20134 days; history of hepatic dysfunction; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (selegiline)", "side-effects": "Side-effects\u00a0nausea, constipation, diarrhoea, dry mouth, stomatitis,\r\nmouth ulcers, bradycardia, hypertension, hypotension, depression,\r\ndizziness, psychosis, impaired balance, tremor, fatigue, movement\r\ndisorders, sleeping disorders, headache, confusion, arthralgia, myalgia,\r\nmuscle cramps, myopathy, nasal congestion, hair loss, sweating; less commonly loss of appetite, angina, arrhythmias, palpitation,\r\npostural hypotension, supraventricular tachycardia, ankle oedema,\r\ndyspnoea, agitation, anxiety, micturition difficulties, leucocytopenia,\r\nthrombocytopenia, blurred vision; skin reactions; also reported hypersexuality", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73638.htm", "doses": [ "Initially 5\u00a0mg in the morning; increasing after 2\u20134 weeks\r\nif tolerated to 10\u00a0mg in the morning", "1.25-mg oral lyophilisate is equivalent to\r\n10-mg tablet", "Name[Zelapar\u00ae (Cephalon) ] Oral lyophilisates (= freeze-dried\r\ntablets), yellow, selegiline hydrochloride 1.25\u00a0mg,\r\nnet price 30-tab pack = \u00a343.16. Counselling, administrationExcipients include aspartame (section 9.4.1)Dose\u00a01.25\u00a0mg daily before breakfastCounselling\u00a0Tablets should be placed on the tongue\r\nand allowed to dissolve. Advise patient not to drink, rinse, or wash\r\nmouth out for 5 minutes after taking the tabletNote\u00a0Patients receiving 10\u00a0mg conventional selegiline hydrochloride tablets can be switched to Zelapar\u00ae 1.25\u00a0mg" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "NEFOPAM HYDROCHLORIDE": { "indications": "Indications\u00a0moderate pain", "name": "NEFOPAM HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations" ], "cautions": "Cautions\u00a0elderly, urinary\r\nretention; interactions: Appendix 1\r\n(nefopam)", "side-effects": "Side-effects\u00a0nausea, nervousness, urinary retention, dry mouth,\r\nlightheadedness; less commonly vomiting, blurred\r\nvision, drowsiness, sweating, insomnia, tachycardia, headache; confusion\r\nand hallucinations also reported; may colour urine\r\n(pink)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3489.htm", "doses": [ "By mouth, initially 60\u00a0mg (elderly 30\u00a0mg) 3 times daily, adjusted\r\naccording to response; usual range 30\u201390\u00a0mg 3 times daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0no information available\u2014avoid unless no safer treatment" }, "LIDOCAINE HYDROCHLORIDE Lidocaine hydrochloride injections": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE Lidocaine hydrochloride injections", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE", "Lidocaine hydrochloride injections" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6688.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Name[Lidocaine (Non-proprietary) ] Injection, lidocaine hydrochloride\r\n5\u00a0mg/mL (0.5%), net price 10-mL amp = 35p; 10\u00a0mg/mL (1%), 2-mL amp\r\n= 26p, 5-mL amp = 28p, 10-mL amp = 42p, 10-mL prefilled syringe =\r\n\u00a34.53; 20-mL amp = 71p; 20\u00a0mg/mL (2%), 2-mL amp = 33p, 5-mL amp =\r\n32p" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "PROPIVERINE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence; neurogenic bladder instability", "name": "PROPIVERINE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "PROPIVERINE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129985.htm", "doses": [ "adult over\r\n18 years, 15\u00a0mg 1\u20133 times daily, increased if necessary to max. 15\u00a0mg\r\n4 times daily", "Name[Detrunorm\u00ae XL (Amdipharm) ] Capsules, orange/white, m/r, propiverine\r\nhydrochloride 30\u00a0mg, net price 28-cap pack = \u00a324.45. \r\n Label:\r\n 3, 25Dose\u00a0adult over 18 years, urinary\r\nfrequency, urgency, and incontinence, 30\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (restriction of skeletal\r\ndevelopment in animals)" }, "MENINGOCOCCAL VACCINES Meningococcal group C conjugate vaccine": { "indications": "Indications\u00a0immunisation against Neisseria\r\nmeningitidis", "name": "MENINGOCOCCAL VACCINES Meningococcal group C conjugate vaccine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Meningococcal vaccines", "MENINGOCOCCAL VACCINES", "Meningococcal group C conjugate vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also rarely symptoms of meningitis reported (but no evidence\r\nthat the vaccine causes meningococcal C meningitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85593.htm", "doses": [ "See under preparations", "Name[Menjugate Kit\u00ae (Sanofi Pasteur) ] Injection, powder for reconstitution,\r\ncapsular polysaccharide antigen of Neisseria meningitidis group C (conjugated to Corynebacterium diphtheriae protein), adsorbed onto aluminium hydroxide,\r\nsingle-dose vial with diluentDose\u00a0by intramuscular injection, adult and child over\r\n1 year 0.5\u00a0mL as a single dose; for routine immunisation in child 2 months\u20131 year, 0.5\u00a0mL, see notes above and\r\nImmunisation schedule, section 14.1Available as part of childhood immunisation schedule from ImmForm" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH NORGESTIMATE": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH NORGESTIMATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Oral (low and standard strength)", "Ethinylestradiol with Norgestimate" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/34598.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "CETRORELIX": { "indications": "Indications\u00a0adjunct in the treatment of female infertility (under specialist\r\nsupervision)", "name": "CETRORELIX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "CETRORELIX" ], "side-effects": "Side-effects\u00a0nausea, headache, injection site reactions; rarely\r\nhypersensitivity reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/78257.htm", "doses": [ "By subcutaneous injection into the\r\nlower abdominal wall,", "either 250\u00a0micrograms in the morning, starting\r\non day 5 or 6 of ovarian stimulation with gonadotrophins (or each evening starting on day 5 of ovarian stimulation);\r\ncontinue throughout administration of gonadotrophin including day\r\nof ovulation induction (or evening before ovulation\r\ninduction)", "or 3\u00a0mg on day 7 of ovarian stimulation with\r\ngonadotrophins; if ovulation induction not possible on day 5 after\r\n3-mg dose, additional 250\u00a0micrograms once daily until day of ovulation\r\ninduction" ], "pregnancy": "Pregnancy\u00a0avoid in confirmed pregnancy" }, "PENCICLOVIR": { "indications": "Indications\u00a0\n(From 13.10.3 Antiviral preparations: British National Formulary)\n13.10.3 Antiviral preparations", "name": "PENCICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.3 Antiviral preparations", "PENCICLOVIR" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes", "side-effects": "Side-effects\u00a0transient stinging, burning, numbness; hypersensitivity\r\nreactions also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/39072.htm", "doses": [ "herpes labialis, apply to lesions every 2 hours during\r\nwaking hours for 4 days, starting at first sign of attack; child under 12 years, not recommended" ] }, "IDARUBICIN HYDROCHLORIDE": { "indications": "Indications\u00a0acute leukaemias (\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nIdarubicin has general properties similar to those of doxorubicin; it is mostly used in the treatment of haematological malignancies. Diarrhoea, abdominal pain, haemorrhage, cardiac disorders, rash, and red pigmentation of the urine are commonly reported. Skin and nail hyperpigmentation have been reported less frequently. Idarubicin is given intravenously and it may also be given by mouth.); advanced breast cancer after\r\nfailure of first-line chemotherapy (not including anthracyclines)", "name": "IDARUBICIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "IDARUBICIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant\r\nto tissues; interactions: Appendix\r\n1 (idarubicin) ", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4718.htm", "doses": [ "By mouth, acute non-lymphocytic leukaemia,\r\nmonotherapy, 30\u00a0mg/m2 daily for 3 days or in combination therapy, 15\u201330\u00a0mg/m2 daily for 3 days", "Advanced breast cancer, monotherapy, 45\u00a0mg/m2 as\r\na single dose or 15\u00a0mg/m2 daily for 3\r\nconsecutive days; repeat every 3\u20134 weeks", "Max. cumulative dose by mouth (for all indications) 400\u00a0mg/m2", "By intravenous administration, consult product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "FUSIDIC ACID - ANTIBACTERIAL PREPARATIONS ALSO USED SYSTEMICALLY": { "side-effects": "Side-effects\u00a0rarely hypersensitivity reactions", "indications": "Indications\u00a0staphylococcal skin infections; penicillin-resistant\r\nstaphylococcal infections (section 5.1.7); staphylococcal eye infections\r\n(section 11.3.1)", "name": "FUSIDIC ACID - ANTIBACTERIAL PREPARATIONS ALSO USED SYSTEMICALLY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6137.htm", "doses": [ "Apply 3\u20134 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.2 Antibacterial preparations also used systemically" ], "cautions": "Cautions\u00a0see notes above; avoid contact with eyes" }, "SODIUM CHLORIDE - INTRAVENOUS SODIUM": { "side-effects": "Side-effects\u00a0administration of large doses may give rise to\r\nsodium accumulation, oedema, and hyperchloraemic acidosis", "indications": "Indications\u00a0electrolyte imbalance\u2014see also section 9.2.1.2; nebuliser diluent (section 3.1.5); eye (section 11.8.1); oral hygiene (section 12.3.4); wound irrigation (section 13.11.1)", "name": "SODIUM CHLORIDE - INTRAVENOUS SODIUM", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4972.htm", "doses": [ "See notes above" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Intravenous sodium" ], "cautions": "Cautions\u00a0restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary oedema,\r\ntoxaemia of pregnancy" }, "IMIDAPRIL HYDROCHLORIDE": { "indications": "Indications\u00a0essential hypertension", "name": "IMIDAPRIL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; dry mouth, glossitis, ileus;\r\nbronchitis, dyspnoea; sleep disturbances, depression, confusion, blurred\r\nvision, tinnitus, impotence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77308.htm", "doses": [ "Initially 5\u00a0mg daily before food; if used in addition\r\nto diuretic (see notes above),\r\nin elderly, in patients with heart failure, angina or cerebrovascular\r\ndisease, or in renal or hepatic impairment, initially 2.5\u00a0mg daily;\r\nif necessary increase dose at intervals of at least 3 weeks; usual\r\nmaintenance dose 10\u00a0mg once daily; max. 20\u00a0mg daily (elderly, 10\u00a0mg\r\ndaily)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "HYDROCORTISONE With antibacterial": { "indications": "Indications\u00a0eczematous inflammation in otitis externa (see notes\r\nabove)", "name": "HYDROCORTISONE With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "HYDROCORTISONE", "With antibacterial" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31411.htm", "doses": [ "Name[Otosporin\u00ae (GSK) ] Ear drops, hydrocortisone 1%, neomycin sulphate 3400\u00a0units, polymyxin B sulphate 10\u00a0000\u00a0units/mL.\r\nNet price 5\u00a0mL = \u00a32.00; 10\u00a0mL = \u00a34.00Excipients include cetostearyl alcohol, hydroxybenzoates (parabens), polysorbate 20Dose\u00a0adult and child over 3 years, ear, apply 3 drops\r\n3\u20134 times daily" ] }, "COLESEVELAM HYDROCHLORIDE": { "indications": "Indications\u00a0primary hypercholesterolaemia as an adjunct to dietary measures,\r\neither alone or with a statin; primary and familial hypercholesterolaemia,\r\nin combination with ezetimibe, either with or without a statin", "name": "COLESEVELAM HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Bile acid sequestrants" ], "cautions": "Cautions\u00a0\n(From Bile acid sequestrants: British National Formulary)\nCautions\u00a0Bile acid sequestrants interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged. Interactions: Appendix 1 (bile acid sequestrants); also gastro-intestinal motility disorders, major gastro-intestinal surgery, inflammatory\r\nbowel disease; patients receiving ciclosporin\r\nshould have their blood-ciclosporin concentration monitored before,\r\nduring, and after treatment with colesevelam; interactions: Appendix 1 (colesevelam)", "side-effects": "Side-effects\u00a0\n(From Bile acid sequestrants: British National Formulary)\nSide-effects\u00a0As bile acid sequestrants are not absorbed, gastro-intestinal side-effects predominate. Constipation is common, but diarrhoea has occurred, as have nausea, vomiting, and gastro-intestinal discomfort. Hypertriglyceridaemia may be aggravated. An increased bleeding tendency has been reported due to hypoprothrombinaemia associated with vitamin K deficiency.; also\r\nheadache; myalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200251.htm", "doses": [ "Monotherapy, 3.75\u00a0g daily in 1\u20132 divided doses; max. 4.375\u00a0g\r\ndaily", "Combination therapy with a statin, or ezetimibe, or both, 2.5\u20133.75\u00a0g\r\ndaily in 1\u20132 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From Bile acid sequestrants: British National Formulary)\nPregnancy and breast-feeding\u00a0Bile acid sequestrants should be used with caution as although the drugs are not absorbed, they may cause fat-soluble vitamin deficiency on prolonged use." }, "ATORVASTATIN": { "indications": "Indications\u00a0primary hypercholesterolaemia, heterozygous familial hypercholesterolaemia,\r\nhomozygous familial hypercholesterolaemia or combined (mixed) hyperlipidaemia\r\nin patients who have not responded adequately to diet and other appropriate\r\nmeasures; prevention of cardiovascular events in patients at high\r\nrisk of a first cardiovascular event", "name": "ATORVASTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ; also haemorrhagic\r\nstroke", "side-effects": "Side-effects\u00a0\n(From Statins: British National Formulary)\nSide-effects\u00a0The statins have been associated with myalgia, myopathy, myositis, and rhabdomyolysis (see Muscle Effects below). Statins can alter liver function tests, and rarely cause hepatitis and jaundice; pancreatitis and hepatic failure have been reported very rarely. Other side-effects include gastro-intestinal disturbances, sleep disturbance, headache, dizziness, depression, paraesthesia, asthenia, peripheral neuropathy, amnesia, fatigue, sexual dysfunction, thrombocytopenia, arthralgia, visual disturbance, alopecia, and hypersensitivity reactions (including rash, pruritus, urticaria, and very rarely lupus erythematosus-like reactions). In very rare cases, statins can cause interstitial lung disease; if patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.Muscle effects\u00a0The risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare. Although myalgia has been reported commonly in patients receiving statins, muscle toxicity truly attributable to statin use is rare. Muscle toxicity can occur with all statins, however the likelihood increases with higher doses and in certain patients (see below). Statins should be used with caution in patients at increased risk of muscle toxicity, including those with a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. There is an increased incidence of myopathy if a statin is given at a high dose, or if it is given with a fibrate (the combination of a statin and gemfibrozil should preferably be avoided), with lipid-lowering doses of nicotinic acid, with fusidic acid (risk of rhabdomyolysis\u2014the combination of a statin and fusidic acid should be avoided; temporarily discontinue statin and restart 7 days after last fusidic acid dose), or with drugs that increase the plasma-statin concentration, such as macrolide antibiotics, imidazole and triazole antifungals, and ciclosporin\u2014see interactions: Appendix 1 (statins); close monitoring of liver function and, if muscular symptoms occur, of creatine kinase is necessary. In patients at increased risk of muscle effects, a statin should not usually be started if the baseline creatine kinase concentration is more than 5 times the upper limit of normal (some patients may present with an extremely elevated baseline creatine kinase concentration, due to e.g. a physical occupation, or rigorous exercise\u2014specialist advice should be sought regarding consideration of statin therapy in these patients).If muscular symptoms or raised creatine kinase occur during treatment, other possible causes (e.g. rigorous physical activity, hypothyroidism, infection, recent trauma, and drug or alcohol addiction) should be excluded before statin therapy is implicated. When a statin is suspected to be the cause of myopathy, and creatine kinase concentration is markedly elevated (more than 5 times upper limit of normal), or if muscular symptoms are severe, treatment should be discontinued. If symptoms resolve and creatine kinase concentrations return to normal, the statin should be reintroduced at a lower dose and the patient monitored closely; an alternative statin should be prescribed if unacceptable side-effects are experienced with a particular statin. Statins should not be discontinued in the event of small, asymptomatic elevations of creatine kinase. Routine monitoring of creatine kinase is unnecessary in asymptomatic patients.; also nasopharyngitis, epistaxis,\r\npharyngeolaryngeal pain, back pain, hyperglycaemia; less commonly blurred vision, pyrexia, anorexia, malaise, chest pain, weight gain,\r\nhypoglycaemia, tinnitus, peripheral oedema, neck pain; rarely cholestasis, Stevens-Johnson syndrome, toxic epidermal necrolysis; very rarely gynaecomastia, hearing loss", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60589.htm", "doses": [ "Primary hypercholesterolaemia and combined hyperlipidaemia,\r\nusually 10\u00a0mg once daily; if necessary, may be increased at intervals\r\nof at least 4 weeks to max. 80\u00a0mg once daily; child under 18 years see BNF for Children", "Familial hypercholesterolaemia, initially 10\u00a0mg daily, increased\r\nat intervals of at least 4 weeks to 40\u00a0mg once daily; if necessary,\r\nfurther increased to max. 80\u00a0mg once daily (or 40\u00a0mg once daily combined\r\nwith anion-exchange resin in heterozygous familial hypercholesterolaemia); child under 18 years see BNF for Children", "Prevention of cardiovascular events initially 10\u00a0mg once daily\r\nadjusted according to response" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "CHLORAMPHENICOL Single use": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "CHLORAMPHENICOL Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "CHLORAMPHENICOL", "Single use" ], "side-effects": "Side-effects\u00a0transient stinging; see also notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5379.htm", "doses": [ "See Administration in\r\nnotes above", "Name[Minims\u00ae Chloramphenicol (Bausch & Lomb) ] Eye drops, chloramphenicol 0.5%. Net price 20 \u00d7 0.5\u00a0mL = \u00a39.55" ] }, "FOLIC ACID": { "indications": "Indications\u00a0\n(From 9.1.2 Drugs used in megaloblastic anaemias: British National Formulary)\nPrevention of neural tube defects\u00a0Folic acid supplements taken before and during pregnancy can reduce the occurrence of neural tube defects. The risk of a neural tube defect occurring in a child should be assessed and folic acid given as follows:Women at a low risk of conceiving a child with a neural tube defect should be advised to take folic acid as a medicinal or food supplement at a dose of 400\u00a0micrograms daily before conception and until week 12 of pregnancy. Women who have not been taking folic acid and who suspect they are pregnant should start at once and continue until week 12 of pregnancy.Couples are at a high risk of conceiving a child with a neural tube defect if either partner has a neural tube defect (or either partner has a family history of neural tube defects), if they have had a previous pregnancy affected by a neural tube defect, or if the woman has coeliac disease (or other malabsorption state), diabetes mellitus, sickle-cell anaemia, or is taking antiepileptic medicines (see also section 4.8.1).Women in the high-risk group who wish to become pregnant (or who are at risk of becoming pregnant) should be advised to take folic acid 5\u00a0mg daily and continue until week 12 of pregnancy (women with sickle-cell disease should continue taking their normal dose of folic acid 5\u00a0mg daily (or to increase the dose to 5\u00a0mg daily) and continue this throughout pregnancy). and under dose", "name": "FOLIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.2 Drugs used in megaloblastic anaemias", "FOLIC ACID" ], "cautions": "Cautions\u00a0should never be given alone for pernicious anaemia\r\nand other vitamin B12 deficiency states (may precipitate\r\nsubacute combined degeneration of the spinal cord); interactions: Appendix 1 (folates)", "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4907.htm", "doses": [ "Folate-deficient megaloblastic anaemia, by\r\nmouth, adult and child over 1 year, 5\u00a0mg daily for 4 months (until\r\nterm in pregnant women); up to 15\u00a0mg daily may be required in malabsorption\r\nstates; child under 1 year, 500\u00a0micrograms/kg\r\ndaily (max. 5\u00a0mg) for up to 4 months; up to 10\u00a0mg daily may be required\r\nin malabsorption states", "Prevention of neural tube defects, by mouth, see notes above", "Prevention of methotrexate-induced side-effects\r\nin severe Crohn\u2019s disease [unlicensed], by mouth, see section 1.5.3", "Prevention of methotrexate-induced side-effects\r\nin rheumatic disease [unlicensed], by mouth, adult over 18 years 5\u00a0mg once weekly; child 2\u201318 years see BNF for Children", "Prevention of methotrexate-induced side-effects\r\nin severe psoriasis [unlicensed], by mouth, see section 13.5.3", "Prophylaxis in chronic haemolytic states, by mouth, adult 5\u00a0mg every\r\n1\u20137 days depending on underlying disease", "Prophylaxis of folate deficiency in dialysis, by mouth, adult 5\u00a0mg every\r\n1\u20137 days; child 1\u201312 years 250\u00a0micrograms/kg\r\n(max. 10\u00a0mg) once daily, child 12\u201318\r\nyears 5\u201310\u00a0mg once daily" ] }, "ALFENTANIL": { "indications": "Indications\u00a0analgesia especially during short operative procedure and outpatient\r\nsurgery; enhancement of anaesthesia; analgesia and suppression of\r\nrespiratory activity in patients receiving intensive care, with assisted\r\nventilation, for up to 4 days", "name": "ALFENTANIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.3 Opioid analgesics", "ALFENTANIL" ], "cautions": "Cautions\u00a0section 4.7.2 and notes above", "side-effects": "Side-effects\u00a0section 4.7.2 and notes above; also hypertension, myoclonic movements; less commonly arrhythmias, hiccup, laryngospasm; rarely epistaxis; also reported cardiac arrest, cough, convulsions,\r\nand pyrexia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6623.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "By intravenous injection, spontaneous\r\nrespiration, adult, initially up to\r\n500\u00a0micrograms over 30 seconds; supplemental, 250\u00a0micrograms", "With assisted ventilation, adult over 18 years, initially 30\u201350\u00a0micrograms/kg; supplemental, 15\u00a0micrograms/kg; child 1 month\u201318 years, initially 10\u201320\u00a0micrograms/kg;\r\nsupplemental doses up to 10\u00a0micrograms/kg", "By intravenous infusion, with assisted\r\nventilation, adult and child, initially 50\u2013100\u00a0micrograms/kg over 10 minutes or as a bolus, followed by maintenance of 0.5\u20131\u00a0micrograms/kg/minute", "Analgesia and suppression of respiratory activity during intensive\r\ncare, with assisted ventilation, by intravenous infusion, initially 2\u00a0mg/hour subsequently adjusted according to response\r\n(usual range 0.5\u201310\u00a0mg/hour); more rapid initial control may be obtained\r\nwith an intravenous dose of 5\u00a0mg given in divided portions over 10\r\nminutes (slowing if hypotension or bradycardia occur); additional\r\ndoses of 0.5\u20131\u00a0mg may be given by intravenous injection during short\r\npainful procedures" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "DILTIAZEM HYDROCHLORIDE Longer-acting formulations": { "indications": "Indications\u00a0prophylaxis and treatment of angina; hypertension", "name": "DILTIAZEM HYDROCHLORIDE Longer-acting formulations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "DILTIAZEM HYDROCHLORIDE", "Longer-acting formulations" ], "cautions": "Cautions\u00a0heart failure or significantly impaired left ventricular function, bradycardia (avoid if severe), first degree\r\nAV block, or prolonged PR interval; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0bradycardia, sino-atrial block, AV block, palpitation,\r\ndizziness, hypotension, malaise, asthenia, headache, hot flushes,\r\ngastro-intestinal disturbances, oedema (notably of ankles); rarely\r\nrashes (including erythema multiforme and exfoliative dermatitis),\r\nphotosensitivity; hepatitis, gynaecomastia, gum hyperplasia, extrapyramidal\r\nsymptoms, depression reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2681.htm", "doses": [ "Angina, 60\u00a0mg 3 times daily (elderly initially twice daily);\r\nincreased if necessary to 360\u00a0mg daily", "Longer-acting formulations, see under preparations below", "Name[Tildiem LA\u00ae (Sanofi-Aventis) ] Capsules, m/r, diltiazem\r\nhydrochloride 200\u00a0mg (pink/grey, containing white pellets),\r\nnet price 28-cap pack = \u00a36.27; 300\u00a0mg (white/yellow, containing white\r\npellets), 28-cap pack = \u00a37.22. \r\n Label:\r\n 25Dose\u00a0angina and mild to moderate hypertension, initially 200\u00a0mg\r\nonce daily before or with food, increased if necessary to 300\u2013400\u00a0mg\r\ndaily, max. 500\u00a0mg daily; elderly and\r\nin hepatic or renal impairment, initially 200\u00a0mg daily, increased\r\nif necessary to 300\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "MONTELUKAST": { "indications": "Indications\u00a0prophylaxis of asthma, see notes above and %s\n(From Management of chronic asthma: British National Formulary)\nManagement of chronic asthma;\r\nsymptomatic relief of seasonal allergic rhinitis in patients with\r\nasthma", "name": "MONTELUKAST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.2 Leukotriene receptor antagonists", "MONTELUKAST" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (leukotriene\r\nreceptor antagonists)", "side-effects": "Side-effects\u00a0abdominal pain, thirst, headache, hyperkinesia\r\n(in young children); less commonly dry mouth, dyspepsia,\r\noedema, dizziness, malaise, paraesthesia, hypoaesthesia, seizure,\r\nabnormal dreams, insomnia, sleep-walking, irritability, anxiety, restlessness,\r\nagitation, aggression, depression, arthralgia, myalgia, epistaxis,\r\nbruising, urticaria, pruritus; rarely palpitation,\r\ntremor, increased bleeding; very rarely hepatic disorders,\r\nhallucinations, suicidal thoughts and behaviour, Churg-Strauss syndrome\r\n(\n(From 3.3.2 Leukotriene receptor antagonists: British National Formulary)\nChurg-Strauss syndrome has occurred very rarely in association with the use of leukotriene receptor antagonists; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy. Prescribers should be alert to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.), erythema\r\nnodosum", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68604.htm", "doses": [ "Prophylaxis of asthma, adult and child over 15 years, 10\u00a0mg once\r\ndaily in the evening; child 6 months\u20136\r\nyears 4\u00a0mg once daily in the evening, 6\u201315 years 5\u00a0mg once daily in\r\nthe evening", "Seasonal allergic rhinitis, adult and child over 15 years, 10\u00a0mg once\r\ndaily in the evening" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential, see\r\nalso notes above" }, "TOLTERODINE TARTRATE Modified release": { "indications": "Indications\u00a0see under Dose", "name": "TOLTERODINE TARTRATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "TOLTERODINE TARTRATE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; history of QT-interval prolongation; concomitant\r\nuse with other drugs known to prolong QT interval", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\nchest pain, peripheral oedema; sinusitis, bronchitis; paraesthesia,\r\nfatigue, vertigo, weight gain; flushing also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106152.htm", "doses": [ "Urinary frequency, urgency, and incontinence, adult over 18 years, 2\u00a0mg twice daily; reduce to\r\n1\u00a0mg twice daily if necessary to minimise side-effects; child 2\u201318 years see BNF for Children", "Nocturnal enuresis associated with overactive bladder, child 5\u201318 years see BNF for Children", "Name[Detrusitol\u00ae XL (Pharmacia) ] Capsules, blue, m/r, tolterodine tartrate 4\u00a0mg, net price 28-cap pack = \u00a325.78. \r\n Label:\r\n 3, 25Dose\u00a0urinary frequency, urgency and incontinence, adult over 18 years, 4\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "MALATHION": { "indications": "Indications\u00a0see notes above and under preparations", "name": "MALATHION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.4 Parasiticidal preparations", "Malathion" ], "cautions": "Cautions\u00a0avoid contact with eyes; do not use on broken or secondarily infected skin; children under 6 months, medical\r\nsupervision required", "side-effects": "Side-effects\u00a0skin irritation and hypersensitivity reactions;\r\nchemical burns also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6199.htm", "doses": [ "Head lice, rub 0.5% preparation into dry hair and scalp,\r\nallow to dry naturally, remove by washing after 12 hours (see also\r\nnotes above); repeat application after 7 days", "Crab lice, apply 0.5% aqueous preparation over whole body, allow\r\nto dry naturally, wash off after 12 hours or overnight; repeat application\r\nafter 7 days", "Scabies, apply 0.5% preparation over whole body, and wash off\r\nafter 24 hours; if hands are washed with soap within 24 hours, they\r\nshould be retreated; see also notes above; repeat application after\r\n7 days", "For scabies, manufacturer recommends application\r\nto the body but not necessarily to the head and neck. However, application\r\nshould be extended to the scalp, neck, face, and ears" ] }, "TRIPTORELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS": { "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nGonadorelin analogues; also\r\ndry mouth, transient hypertension, paraesthesia, and increased dysuria", "indications": "Indications\u00a0prostate cancer; endometriosis, precocious\r\npuberty, reduction in size of uterine fibroids; male hypersexuality\r\nwith severe sexual deviation (section 6.7.2)", "name": "TRIPTORELIN - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128318.htm", "doses": [ "Name[Gonapeptyl Depot\u00ae (Ferring) ] advanced prostate cancer, by subcutaneous or deep intramuscular injection,\r\n3.75\u00a0mg every 4 weeks (see also notes above)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues", "TRIPTORELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Men at risk of tumour \u2018flare\u2019 (see above) should be monitored closely during the first month of therapy. Caution is required in patients with metabolic bone disease because reduced bone mineral density can occur. The injection site should be rotated.; risk of ureteric obstruction and spinal cord compression in men" }, "NIMODIPINE": { "indications": "Indications\u00a0prevention and treatment of ischaemic neurological deficits following\r\naneurysmal subarachnoid haemorrhage", "name": "NIMODIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers" ], "cautions": "Cautions\u00a0cerebral oedema or severely raised intracranial pressure; hypotension; avoid concomitant administration of nimodipine tablets and infusion, other calcium-channel blockers, or beta-blockers; concomitant nephrotoxic drugs; interactions: Appendix 1 (calcium-channel blockers, alcohol (infusion only))", "side-effects": "Side-effects\u00a0hypotension, variation in heart-rate, flushing,\r\nheadache, gastro-intestinal disorders, nausea, sweating and feeling\r\nof warmth; thrombocytopenia and ileus reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2699.htm", "doses": [ "Prevention, by mouth, 60\u00a0mg every 4 hours,\r\nstarting within 4 days of aneurysmal subarachnoid haemorrhage and\r\ncontinued for 21 days", "Treatment, by intravenous infusion via central\r\ncatheter, initially 1\u00a0mg/hour (up to 500\u00a0micrograms/hour if body-weight\r\nless than 70\u00a0kg or if blood pressure unstable), increased after 2\r\nhours to 2\u00a0mg/hour if no severe fall in blood pressure; continue for\r\nat least 5 days (max. 14 days); if surgical intervention during treatment,\r\ncontinue for at least 5 days after surgery; max. total duration of\r\nnimodipine use 21 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "IFOSFAMIDE": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nIfosfamide is related to cyclophosphamide and is given intravenously; mesna (section 8.1) is routinely given with it to reduce urothelial toxicity.", "name": "IFOSFAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; ensure satisfactory\r\nelectrolyte balance and renal function before each course (risk of tubular dysfunction, Fanconi\u2019s syndrome or\r\ndiabetes insipidus if renal toxicity not treated promptly); diabetes mellitus; avoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(ifosfamide)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also drowsiness, confusion, disorientation,\r\nrestlessness, psychosis; urothelial toxicity, renal toxicity (see\r\nCautions above); less commonly severe encephalopathy; rarely diarrhoea, constipation, convulsions, anorexia, very rarely jaundice, thrombophlebitis, syndrome of inappropriate\r\nantidiuretic hormone secretion; acute pancreatitis, arrhythmias, and\r\nheart failure also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4689.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and carcinogenic in animals); manufacturer advises adequate contraception during and for at\r\nleast 6 months after treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "CO-CODAMOL - CO-CODAMOL 8/500": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-CODAMOL - CO-CODAMOL 8/500", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-CODAMOL", "Co-codamol 8/500" ], "cautions": "Cautions\u00a0hypotension, asthma (avoid during attack) and impaired respiratory function (avoid in chronic obstructive pulmonary disease), prostatic hypertrophy; shock; myasthenia gravis; obstructive or inflammatory bowel disorders; diseases\r\nof the biliary tract; reduced dose recommended in elderly and debilitated patients, in hypothyroidism, and in adrenocortical\r\ninsufficiency; convulsive disorders; cardiac arrhythmias; acute abdomen; gallstones; alcohol dependence; interactions: Appendix 1 (opioid analgesics, paracetamol)Variation in metabolism\u00a0The capacity\r\nto metabolise codeine can vary considerably and lead to either reduced\r\ntherapeutic effect or marked increase in side-effectsDependence and withdrawal\u00a0Repeated use of opioid\r\nanalgesics, such as codeine, is associated with the development of\r\npsychological and physical dependence; although this is rarely a problem\r\nwith therapeutic use, caution in advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment", "side-effects": "Side-effects\u00a0nausea and vomiting (particularly in initial stages),\r\nconstipation, dry mouth, and biliary spasm; larger doses produce respiratory\r\ndepression, hypotension, and muscle rigidity; other side-effects include\r\nabdominal pain, anorexia, bradycardia, tachycardia, palpitation, oedema,\r\npostural hypotension, seizures, malaise, hypothermia; hallucinations,\r\nvertigo, euphoria, dysphoria, mood changes, dependence, dizziness,\r\nconfusion, drowsiness, sleep disturbances, headache; sexual dysfunction,\r\ndifficulty with micturition, urinary retention, ureteric spasm, muscle\r\nfasciculation; blood disorders (including thrombocytopenia, leucopenia,\r\nneutropenia), miosis, visual disturbances, flushing, sweating, rashes,\r\nurticaria and pruritus; pancreatitis also reported; important: liver damage (and less frequently renal damage) following overdosage with paracetamol; see Emergency Treatment of\r\nPoisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced\r\nrespiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201062.htm", "doses": [ "See under preparations", "1\u20132 tablets in water every 4\u20136 hours, max. 8 tablets daily; child 6\u201312 years \u00bd\u20131 tablet, max. 4 tablets daily", "Name[(1)Co-codamol 8/500 (Non-proprietary) ] Tablets, co-codamol 8/500 (codeine phosphate 8\u00a0mg, paracetamol 500\u00a0mg),\r\nnet price 30-tab pack = \u00a31.29, 32-tab pack = \u00a31.05, 100-tab pack =\r\n\u00a31.47. \r\n Label:\r\n 29, 30Dose\u00a01\u20132 tablets every 4\u20136 hours; max. 8 tablets daily; child 6\u201312 years \u00bd\u20131 tablet, max. 4\r\ntablets daily\nEffervescent or dispersible tablets, co-codamol 8/500 (codeine phosphate 8\u00a0mg, paracetamol 500\u00a0mg), net price 32-tab pack\r\n= \u00a31.50, 100-tab pack = \u00a34.20. \r\n Label:\r\n 13, 29, 30Brands include Paracodol\u00aeNote\u00a0The Drug Tariff allows tablets of co-codamol\r\nlabelled \u2018dispersible\u2019 to be dispensed against an order for \u2018effervescent\u2019\r\nand vice versaDose\u00a01\u20132 tablets in water every 4\u20136 hours, max. 8 tablets daily; child 6\u201312 years \u00bd\u20131 tablet, max. 4 tablets daily\nCapsules, co-codamol 8/500 (codeine phosphate 8\u00a0mg, paracetamol 500\u00a0mg),\r\nnet price 10-cap pack = \u00a31.10, 20-cap pack = \u00a31.71. \r\n Label:\r\n 29, 30Brands include Paracodol\u00aeDose\u00a01\u20132 capsules every 4 hours; max. 8 capsules daily" ], "pregnancy": "Pregnancy\u00a0codeine may depress neonatal respiration; withdrawal\r\neffects in neonates of dependent mothers; gastric stasis and risk\r\nof inhalation pneumonia in mother during labour" }, "DANTROLENE SODIUM - DRUGS FOR MALIGNANT HYPERTHERMIA": { "indications": "Indications\u00a0malignant hyperthermia; chronic\r\nsevere spasticity of voluntary muscle (section 10.2.2)", "name": "DANTROLENE SODIUM - DRUGS FOR MALIGNANT HYPERTHERMIA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.8 Drugs for malignant hyperthermia", "DANTROLENE SODIUM" ], "cautions": "Cautions\u00a0avoid extravasation (risk of tissue necrosis); interactions: Appendix 1 (muscle relaxants)", "side-effects": "Side-effects\u00a0hepatotoxicity, pulmonary oedema, dizziness, weakness,\r\nand injection-site reactions including erythema, rash, swelling, and\r\nthrombophlebitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6683.htm", "doses": [ "By rapid intravenous injection, adult, initially 2\u20133\u00a0mg/kg, then 1\u00a0mg/kg repeated\r\nas required to a cumulative max. of 10\u00a0mg/kg; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "OESTROGENS FOR HRT": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4306.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "AMPICILLIN": { "indications": "Indications\u00a0urinary-tract infections, otitis media, sinusitis, oral infections\r\n(see notes above), bronchitis, low or moderate-severity community-acquired\r\npneumonia (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy), invasive\r\nsalmonellosis; listerial meningitis (Table 1, %s\n(From Central nervous system: British National Formulary)\nCentral nervous system)", "name": "AMPICILLIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.3 Broad-spectrum penicillins" ], "cautions": "Cautions\u00a0history of allergy; erythematous\r\nrashes common in glandular fever (\n(From 5.1.1.3 Broad-spectrum penicillins: British National Formulary)\nMaculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; broad-spectrum penicillins should not therefore be used for \u2018blind\u2019 treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.); increased risk of erythematous\r\nrashes in cytomegalovirus infection, and acute or chronic lymphocytic\r\nleukaemia (\n(From 5.1.1.3 Broad-spectrum penicillins: British National Formulary)\nMaculopapular rashes commonly occur with ampicillin (and amoxicillin) but are not usually related to true penicillin allergy. They almost always occur in patients with glandular fever; broad-spectrum penicillins should not therefore be used for \u2018blind\u2019 treatment of a sore throat. The risk of rash is also increased in patients with acute or chronic lymphocytic leukaemia or in cytomegalovirus infection.); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea; rashes (discontinue\r\ntreatment); rarely, antibiotic-associated colitis; see also under Benzylpenicillin (section 5.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3728.htm", "doses": [ "By mouth, 0.25\u20131\u00a0g every 6 hours; child 1 month\u20131 year, 62.5\u00a0mg every 6 hours, dose\r\ndoubled in severe infection; 1\u20135 years, 125\u00a0mg every 6 hours, dose\r\ndoubled in severe infection; 5\u201312 years, 250\u00a0mg every 6 hours, dose\r\ndoubled in severe infection", "By intramuscular injection or intravenous injection or infusion, 500\u00a0mg every 4\u20136 hours; child under\r\n18 years see BNF for Children", "Endocarditis (in combination with another antibiotic if necessary,\r\nsee Table 1, section 5.1), by intravenous infusion, adult over 18 years, 2\u00a0g every 6\r\nhours, increased to 2\u00a0g every 4 hours e.g. in enterococcal endocarditis\r\nor if ampicillin used alone; child under\r\n18 years see BNF for Children", "Listerial meningitis (in combination with another antibiotic,\r\nsee Table 1, section 5.1), by intravenous infusion, adult over 18 years, 2\u00a0g every 4\r\nhours; child under 18\r\nyears see BNF for Children", "Ampicillin doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "FENTANYL Lozenges": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL Lozenges", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL", "Lozenges" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106077.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare", "Name[Actiq\u00ae (Flynn) ] Lozenge (buccal), with oromucosal applicator, fentanyl (as citrate)\r\n200\u00a0micrograms, net price 3 = \u00a317.54, 30 = \u00a3175.34; 400\u00a0micrograms,\r\n3 = \u00a317.54, 30 = \u00a3175.34; 600\u00a0micrograms, 3 = \u00a317.54, 30 = \u00a3175.34;\r\n800\u00a0micrograms, 3 = \u00a317.54, 30 = \u00a3175.34; 1.2\u00a0mg, 3 = \u00a317.54, 30 =\r\n\u00a3175.34; 1.6\u00a0mg, 3 = \u00a317.54, 30 = \u00a3175.34. \r\n Label:\r\n 2Dose\u00a0breakthrough pain in patients receiving opioid therapy\r\nfor chronic cancer pain, adult and child over 16 years initially 200\u00a0micrograms (over\r\n15 minutes) repeated if necessary 15 minutes after first dose (no\r\nmore than 2 dose units for each pain episode); if adequate pain relief\r\nnot achieved with 1 dose unit for consecutive breakthrough pain episodes,\r\nincrease the strength of the dose unit until adequate pain relief\r\nachieved with 4 lozenges or less dailyNote\u00a0If more than 4 episodes of breakthrough pain\r\neach day, adjust background analgesia" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "KETOTIFEN - OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0burning or stinging, punctate corneal epithelial\r\nerosion; less commonly dry eye, subconjunctival haemorrhage,\r\nphotophobia; headache, drowsiness, skin reactions, and dry mouth also\r\nreported", "indications": "Indications\u00a0seasonal allergic conjunctivitis", "name": "KETOTIFEN - OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112789.htm", "doses": [ "adult and child over 3 years, apply twice daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "KETOTIFEN" ] }, "IRON ISOMALTOSIDE 1000": { "indications": "Indications\u00a0iron deficiency anaemia, \n(From 9.1.1.2 Parenteral iron: British National Formulary)\n9.1.1.2 Parenteral iron", "name": "IRON ISOMALTOSIDE 1000", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.2 Parenteral iron", "IRON ISOMALTOSIDE 1000" ], "cautions": "Cautions\u00a0hypersensitivity can occur with parenteral\r\niron and facilities for cardiopulmonary resuscitation must be available\u2014risk of allergic reactions increased in immune or inflammatory conditions; oral iron should not be given until 5 days after last\r\ninjection; infection (discontinue if ongoing\r\nbacteraemia)", "side-effects": "Side-effects\u00a0less commonly nausea, vomiting,\r\nconstipation, abdominal pain, dyspnoea, dysphonia, flushing, numbness,\r\nfever, cramps, blurred vision, pruritus, rash, hypersensitivity reactions\r\n(including anaphylaxis), injection-site reactions; rarely diarrhoea, angioedema, tachycardia, arrhythmias, hypotension, chest\r\npain, malaise, seizures, tremor, dizziness, restlessness, loss of\r\n consciousness, altered mental status, myalgia, arthralgia, sweating; very rarely hypertension, foetal bradycardia, palpitation,\r\nheadache, paraesthesia, haemolysis, transient deafness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213591.htm", "doses": [ "By slow intravenous injection or by intravenous infusion, adult over 18 years, calculated according to body-weight and iron deficit,\r\nconsult product literature " ], "pregnancy": "Pregnancy\u00a0avoid in first trimester" }, "ZAFIRLUKAST": { "indications": "Indications\u00a0prophylaxis of asthma, see notes above and %s\n(From Management of chronic asthma: British National Formulary)\nManagement of chronic asthma", "name": "ZAFIRLUKAST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.2 Leukotriene receptor antagonists" ], "cautions": "Cautions\u00a0elderly; interactions: Appendix 1 (leukotriene receptor antagonists)Hepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise development of liver disorder\r\nand advised to seek medical attention if symptoms or signs such as\r\npersistent nausea, vomiting, malaise, or jaundice develop", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, respiratory infections,\r\nheadache, insomnia, malaise; rarely bleeding disorders,\r\nhypersensitivity reactions including angioedema and skin reactions,\r\narthralgia, myalgia, hepatitis, hyperbilirubinaemia, thrombocytopenia; very rarely Churg-Strauss syndrome (\n(From 3.3.2 Leukotriene receptor antagonists: British National Formulary)\nChurg-Strauss syndrome has occurred very rarely in association with the use of leukotriene receptor antagonists; in many of the reported cases the reaction followed the reduction or withdrawal of oral corticosteroid therapy. Prescribers should be alert to the development of eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, or peripheral neuropathy.), agranulocytosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/72980.htm", "doses": [ "adult and child over 12 years, 20\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; see also notes above" }, "IMIPENEM WITH CILASTATIN": { "indications": "Indications\u00a0aerobic and anaerobic Gram-positive and Gram-negative infections;\r\nhospital-acquired septicaemia (Table 1, section 5.1); not indicated for CNS infections", "name": "IMIPENEM WITH CILASTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.2 Carbapenems" ], "cautions": "Cautions\u00a0sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction, see Hypersensitivity Reactions); CNS disorders (e.g. epilepsy); interactions: Appendix 1 (imipenem with cilastatin)", "side-effects": "Side-effects\u00a0nausea (may reduce rate of infusion), vomiting,\r\ndiarrhoea (rarely antibiotic-associated colitis), eosinophilia, rash\r\n(rarely toxic epidermal necrolysis and Stevens-Johnson syndrome); less commonly hypotension, seizures, myoclonic activity,\r\ndizziness, drowsiness, hallucinations, confusion, leucopenia, thrombocytopenia,\r\nthrombocytosis, positive Coombs\u2019 test; rarely taste\r\ndisturbances, hepatitis, encephalopathy, anaphylactic reactions, paraesthesia,\r\ntremor, acute renal failure, polyuria, tooth, tongue or urine discoloration,\r\nhearing loss; very rarely, abdominal pain, heartburn,\r\nglossitis, tachycardia, palpitation, flushing, cyanosis, dyspnoea,\r\nhyperventilation, headache, asthenia, haemolytic anaemia, aggravation\r\nof myasthenia gravis, polyarthralgia, tinnitus, hypersalivation, hyperhidrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3802.htm", "doses": [ "By intravenous infusion, in terms\r\nof imipenem, 500\u00a0mg every 6 hours or 1\u00a0g every 8\r\nhours; less sensitive organisms or life-threatening infection, 1\u00a0g\r\nevery 6 hours; child under 1 year see BNF for Children; 1 year and\r\nolder, 15\u00a0mg/kg (max. 500\u00a0mg) every 6 hours; less sensitive organisms\r\nor life-threatening infection, 25\u00a0mg/kg (max. 1\u00a0g) every\r\n6 hours" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk (toxicity in animal studies)" }, "DIMETICONE": { "indications": "Indications\u00a0head lice", "name": "DIMETICONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.4 Parasiticidal preparations", "Dimeticone" ], "cautions": "Cautions\u00a0avoid contact with eyes; children under 6 months, medical supervision required", "side-effects": "Side-effects\u00a0skin irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129537.htm", "doses": [ "Rub into dry hair and scalp, allow to dry naturally, shampoo\r\nafter minimum 8 hours (or overnight); repeat application after 7 days" ] }, "MACROGOLS - OSMOTIC LAXATIVES": { "indications": "Indications\u00a0see\r\npreparations below", "name": "MACROGOLS - OSMOTIC LAXATIVES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "MACROGOLS" ], "cautions": "Cautions\u00a0patients with cardiovascular impairment\r\nshould not take more than 2 sachets in any 1 hour", "side-effects": "Side-effects\u00a0abdominal distension and pain, nausea, flatulence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/39863.htm", "doses": [ "See preparations below", "chronic constipation, adult and child over 12 years, 1\u20133 sachets\r\ndaily in divided doses usually for up to 2 weeks; contents of each\r\nsachet dissolved in half a glass (approx. 125\u00a0mL) of water; maintenance,\r\n1\u20132 sachets daily", "chronic constipation, adult and child over 12 years, 25\u00a0mL 1\u20133\r\ntimes daily usually for up to 2 weeks; maintenance, 25\u00a0mL 1\u20132 times\r\ndaily" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if essential\u2014no information\r\navailable" }, "ANTI-D (Rh0) IMMUNOGLOBULIN": { "indications": "Indications\u00a0see notes above", "name": "ANTI-D (Rh0) IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.3 Anti-D (Rh0) immunoglobulin", "ANTI-D (Rh0) IMMUNOGLOBULIN" ], "cautions": "Cautions\u00a0immunoglobulin A deficiency; possible interference with live virus vaccines, see under %s\n(From 14.5.1 Normal immunoglobulin: British National Formulary)\nNormal immunoglobulin may interfere with the immune response to live virus vaccines which should therefore only be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin (this does not apply to yellow fever vaccine since normal immunoglobulin does not contain antibody to this virus)., section 14.5.1,\r\nbut \n(From 14.5.3 Anti-D (Rh0) immunoglobulin: British National Formulary)\nNoteMMR vaccine may be given in the postpartum period with anti-D (Rh0) immunoglobulin injection provided that separate syringes are used and the products are administered into different limbs. If blood is transfused, the antibody response to the vaccine may be inhibited\u2014measure rubella antibodies after 6\u20138 weeks and revaccinate if necessary. about\r\nadministration with MMR vaccine", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain; hypotension,\r\nhypertension, headache, fever, malaise, asthenia, drowsiness, dizziness,\r\nback pain, arthralgia, myalgia; pruritus, rash, sweating, injection\r\nsite pain; rarely tachycardia, anaphylaxis, dyspnoea,\r\nhypotension, and urticaria; (for side-effects associated with intravenous immunoglobulins, see section 14.5.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106248.htm", "doses": [ "See preparations below", "by intramuscular or intravenous injection, to rhesus-negative woman for prevention\r\nof Rh0(D) sensitisation:" ] }, "FOLLITROPIN ALFA and BETA Follitropin alfa with lutropin alfa": { "indications": "Indications\u00a0see notes above", "name": "FOLLITROPIN ALFA and BETA Follitropin alfa with lutropin alfa", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "FOLLITROPIN ALFA and BETA", "Follitropin alfa with lutropin alfa" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0see under Human Menopausal Gonadotrophins", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200062.htm", "doses": [ "By subcutaneous or intramuscular injection, according to patient\u2019s response", "Name[Pergoveris\u00ae (Merck Serono) ] Injection, powder for reconstitution,\r\nfollitropin alfa 150\u00a0units (11\u00a0micrograms), lutropin alfa 75\u00a0units\r\n(3\u00a0micrograms), net price per vial (with solvent) = \u00a360.29. For subcutaneous\r\ninjectionElectrolytes: Na+<1\u00a0mmol/vial" ], "pregnancy": "Pregnancy\u00a0avoid" }, "LORAZEPAM - BENZODIAZEPINES": { "indications": "Indications\u00a0conscious sedation for procedures; premedication;\r\nshort-term use in anxiety or insomnia (section 4.1.2); status epilepticus (section 4.8.2)", "name": "LORAZEPAM - BENZODIAZEPINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines", "LORAZEPAM" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nLorazepam produces more prolonged sedation than temazepam and it has marked amnesic effects and %s\n(From LORAZEPAM: British National Formulary)\nLORAZEPAM; interactions: Appendix 1 (anxiolytics\r\nand hypnotics)", "side-effects": "Side-effects\u00a0see notes above and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202877.htm", "doses": [ "By mouth, 2\u20133\u00a0mg the night before operation;\r\n2\u20134\u00a0mg 1\u20132 hours before operation", "By slow intravenous injection, preferably diluted\r\nwith an equal volume of sodium chloride intravenous\r\ninfusion 0.9% or water for injections, 50\u00a0micrograms/kg 30\u201345 minutes\r\nbefore operation", "By intramuscular injection, diluted as above,\r\n50\u00a0micrograms/kg 60\u201390 minutes before operation" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "DIHYDROCODEINE TARTRATE Modified release": { "indications": "Indications\u00a0moderate to severe pain", "name": "DIHYDROCODEINE TARTRATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "DIHYDROCODEINE TARTRATE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis; severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, diarrhoea, seizures, and\r\nparaesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3526.htm", "doses": [ "By mouth, 30\u00a0mg every 4\u20136 hours when necessary\r\n(see also notes above); child over\r\n4 years 0.5\u20131\u00a0mg/kg every 4\u20136 hours", "By deep subcutaneous or intramuscular injection, up to 50\u00a0mg repeated every 4\u20136 hours\r\nif necessary; child over 4 years 0.5\u20131\u00a0mg/kg\r\nevery 4\u20136 hours", "Name[DHC Continus\u00ae (Napp) ] Tablets, m/r, dihydrocodeine\r\ntartrate 60\u00a0mg, net price 56-tab pack = \u00a35.18; 90\u00a0mg, 56-tab\r\npack = \u00a38.66; 120\u00a0mg, 56-tab pack = \u00a310.91. \r\n Label:\r\n 2, 25Dose\u00a0adult and child over 12 years, chronic severe pain, 60\u2013120\u00a0mg\r\nevery 12 hoursNote\u00a0Dihydrocodeine is an ingredient of some compound\r\nanalgesic preparations, section 4.7.1" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CHLORAL HYDRATE - CHLORAL HYDRATE": { "indications": "Indications\u00a0insomnia (short-term use)", "name": "CHLORAL HYDRATE - CHLORAL HYDRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Chloral and derivatives", "CHLORAL HYDRATE" ], "cautions": "Cautions\u00a0reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal\r\nthereafter); avoid contact with skin and mucous membranes; interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may persist\r\nthe next day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0gastric irritation (nausea and vomiting reported),\r\nabdominal distention, flatulence, headache, tolerance, dependence,\r\nexcitement, delirium (especially on abrupt withdrawal), ketonuria,\r\nand rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3157.htm", "doses": [ "Name[Chloral Elixir, Paediatric, BP 2000 ] child 1 month\u20131 year 30\u201350\u00a0mg/kg,\r\ntaken well diluted with water at bedtime" ], "pregnancy": "Pregnancy\u00a0avoid" }, "HYDROGEN PEROXIDE": { "indications": "Indications\u00a0oral hygiene, \n(From 12.3.4 Mouthwashes, gargles, and dentifrices: British National Formulary)\n12.3.4 Mouthwashes, gargles, and dentifrices", "name": "HYDROGEN PEROXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "HYDROGEN PEROXIDE" ], "side-effects": "Side-effects\u00a0hypertrophy of papillae of tongue on prolonged\r\nused", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5740.htm", "doses": [ "rinse the mouth for 2\u20133 minutes with 15\u00a0mL diluted in\r\nhalf a tumblerful of warm water 2\u20133 times daily" ] }, "MIFAMURTIDE": { "indications": "Indications\u00a0\n(From Mifamurtide: British National Formulary)\nMifamurtide", "name": "MIFAMURTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Mifamurtide", "MIFAMURTIDE" ], "cautions": "Cautions\u00a0asthma and chronic obstructive pulmonary disease\u2014consider\r\nprophylactic bronchodilator therapy; history of\r\nautoimmune, inflammatory, or collagen disease; monitor renal function, hepatic function and clotting parameters; monitor patients with history of venous thrombosis, vasculitis,\r\nor unstable cardiovascular disorders for persistent or worsening symptoms\r\nduring administration\u2014consult product literature; interactions: Appendix 1 (mifamurtide)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including anorexia,\r\nnausea, vomiting, diarrhoea, constipation, abdominal pain, dyspepsia);\r\ntachycardia, hypertension, palpitations, hypotension, phlebitis, flushing;\r\noedema, respiratory disorders (including dyspnoea, epistaxis, cough,\r\ntachypnoea, haemoptysis, pleural effusion); confusion, depression,\r\ninsomnia, headache, dizziness, paraesthesia, hypoaesthesia, tremor,\r\ndrowsiness, anxiety; hypokalaemia, anaemia, leucopenia, thrombocytopenia,\r\ngranulocytopenia; haematuria, dysuria, pollakiuria; musculoskeletal\r\npain; blurred vision; vertigo, tinnitus, hearing loss; sweating, alopecia,\r\nrash, dry skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208465.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid; effective contraception required" }, "ROTIGOTINE": { "indications": "Indications\u00a0Parkinson\u2019s disease, either used alone or as adjunct to co-beneldopa\r\nor co-careldopa; moderate to severe restless legs syndrome", "name": "ROTIGOTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "ROTIGOTINE" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; ophthalmic testing recommended; avoid\r\nexposure of patch to heat; withdraw gradually; interactions: Appendix 1 (rotigotine)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nconstipation, dry mouth, dyspepsia, nausea, vomiting, weight changes;\r\nhypertension, postural hypotension, palpitation, peripheral oedema;\r\nhiccup; asthenia, dizziness, drowsiness (including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.),\r\nsleep disturbances, dyskinesia, hallucinations, headache, syncope,\r\nsweating, rash, pruritus; less commonly abdominal\r\npain, atrial fibrillation, hypotension, confusion, paranoia, compulsive\r\nbehaviour (\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.), erectile\r\ndysfunction, and visual disturbances; rarely tachycardia,\r\nseizures, irritability, obsessive compulsive disorder, and psychotic\r\ndisorder ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129662.htm", "doses": [ "Monotherapy in Parkinson\u2019s disease, initially apply \u20182\u00a0mg/24\r\nhours\u2019 patch, increased in steps of 2\u00a0mg/24 hours at weekly intervals\r\nif required; max. 8\u00a0mg/24 hours", "Adjunctive therapy with levodopa in Parkinson\u2019s disease, initially\r\napply \u20184\u00a0mg/24 hours\u2019 patch, increased in steps of 2\u00a0mg/24 hours at\r\nweekly intervals if required; max. 16\u00a0mg/24 hours", "Restless legs syndrome, initially apply \u20181\u00a0mg/24 hours\u2019 patch,\r\nincreased in steps of 1\u00a0mg/24 hours at weekly intervals if required;\r\nmax. 3\u00a0mg/24 hours", "Apply patch to dry, non-irritated skin on\r\ntorso, thigh, or upper arm, removing after 24 hours and siting replacement\r\npatch on a different area (avoid using the same area for 14 days)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "AMANTADINE HYDROCHLORIDE - INFLUENZA": { "indications": "Indications\u00a0see under Dose; parkinsonism (section 4.9.1)", "name": "AMANTADINE HYDROCHLORIDE - INFLUENZA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.4 Influenza" ], "cautions": "Cautions\u00a0section 4.9.1", "side-effects": "Side-effects\u00a0section 4.9.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3996.htm", "doses": [ "Influenza A (see also notes above), adult and child over\r\n10 years, treatment, 100\u00a0mg daily for 4\u20135 days; prophylaxis, 100\u00a0mg\r\ndaily usually for 6 weeks or with influenza vaccination\r\nfor 2\u20133 weeks after vaccination" ], "pregnancy": "Pregnancy\u00a0section 4.9.1" }, "SALICYLIC ACID - SALICYLIC ACID": { "side-effects": "Side-effects\u00a0sensitivity, excessive drying, irritation, systemic\r\neffects after widespread use (see under Cautions)", "indications": "Indications\u00a0hyperkeratotic skin disorders; warts and calluses (section 13.7); scalp\r\nconditions (section 13.9); fungal\r\nnail infections (section 13.10.2)", "name": "SALICYLIC ACID - SALICYLIC ACID", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5990.htm", "doses": [ "See preparations" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Salicylic acid" ], "cautions": "Cautions\u00a0see notes above; avoid broken or inflamed skinSalicylate toxicity\u00a0Salicylate toxicity\r\nmay occur particularly if applied on large areas of skin or neonatal\r\nskin" }, "PERPHENAZINE - PHENOTHIAZINES AND RELATED DRUGS": { "indications": "Indications\u00a0severe nausea, vomiting (see notes above); other\r\nindications (%s\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\n4.2.1 Antipsychotic drugs)", "name": "PERPHENAZINE - PHENOTHIAZINES AND RELATED DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs", "PERPHENAZINE" ], "cautions": "Cautions\u00a0see notes in section 4.2.1", "side-effects": "Side-effects\u00a0see Perphenazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106285.htm", "doses": [ "4\u00a0mg 3 times daily, adjusted according to response; max.\r\n24\u00a0mg daily (chemotherapy-induced); elderly quarter to half adult dose; child under 14 years not recommended" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "PARACETAMOL": { "indications": "Indications\u00a0mild to moderate pain, pyrexia", "name": "PARACETAMOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations" ], "cautions": "Cautions\u00a0alcohol dependence; max. daily infusion dose 3\u00a0g in patients with hepatocellular\r\ninsufficiency, chronic alcoholism, chronic malnutrition,\r\nor dehydration; before administering, check when paracetamol last administered and\r\ncumulative paracetamol dose over previous 24 hours; interactions: Appendix 1 (paracetamol)", "side-effects": "Side-effects\u00a0side-effects rare, but rashes, blood disorders\r\n(including thrombocytopenia, leucopenia, neutropenia) reported; hypotension,\r\nflushing, and tachycardia also reported on infusion; important: liver damage (and less frequently renal damage) following overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3469.htm", "doses": [ "By mouth, 0.5\u20131\u00a0g every 4\u20136 hours to a\r\nmax. of 4\u00a0g daily; child 2 months\r\n60\u00a0mg for post-immunisation pyrexia, repeated once after 4\u20136 hours\r\nif necessary; otherwise under 3 months see BNF for Children; 3\u20136 months\r\n60\u00a0mg, 6 months\u20132 years 120\u00a0mg, 2\u20134 years 180\u00a0mg, 4\u20136 years 240\u00a0mg,\r\n6\u20138 years 240\u2013250\u00a0mg, 8\u201310 years 360\u2013375\u00a0mg, 10\u201312 years 480\u2013500\u00a0mg,\r\n12\u201316 years 480\u2013750\u00a0mg; these doses may be repeated every 4\u20136 hours\r\nwhen necessary (max. of 4 doses in 24 hours)", "By intravenous infusion over 15 minutes, adult and child over\r\n50\u00a0kg, 1\u00a0g every 4\u20136 hours, max. 4\u00a0g daily; adult and child 10\u201350\u00a0kg, 15\u00a0mg/kg every\r\n4\u20136 hours, max. 60\u00a0mg/kg daily; neonate and child less than 10\u00a0kg see BNF for Children", "By rectum, adult and child over 12 years 0.5\u20131\u00a0g every\r\n4\u20136 hours to a max. of 4\u00a0g daily; child under 3 months see BNF for Children, 3 months\u20131 year 60\u2013125\u00a0mg, 1\u20135 years 125\u2013250\u00a0mg, 5\u201312 years\r\n250\u2013500\u00a0mg; these doses may be repeated every 4\u20136 hours as necessary\r\n(max. 4 doses in 24 hours)", "For full Joint Committee on Vaccination and\r\nImmunisation recommendation on post-immunisation pyrexia, see section 14.1" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TERBINAFINE - OTHER ANTIFUNGALS": { "indications": "Indications\u00a0dermatophyte infections of the nails, ringworm infections (including\r\ntinea pedis, cruris, and corporis) where oral therapy appropriate\r\n(due to site, severity or extent)", "name": "TERBINAFINE - OTHER ANTIFUNGALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.5 Other antifungals", "TERBINAFINE" ], "cautions": "Cautions\u00a0psoriasis (risk of exacerbation); autoimmune disease (risk of lupus-erythematosus-like\r\neffect); interactions: Appendix 1 (terbinafine)", "side-effects": "Side-effects\u00a0abdominal discomfort, anorexia, nausea, diarrhoea;\r\nheadache; rash and urticaria occasionally with arthralgia or myalgia; less commonly taste disturbance; rarely liver toxicity (including jaundice, cholestasis and hepatitis)\u2014discontinue\r\ntreatment, angioedema, dizziness, malaise, paraesthesia, hypoaesthesia,\r\nphotosensitivity; very rarely psychiatric disturbances,\r\nblood disorders (including leucopenia and thrombocytopenia), lupus\r\nerythematosus-like effect, exacerbation of psoriasis,\r\nserious skin reactions (including Stevens-Johnson syndrome and toxic\r\nepidermal necrolysis)\u2014discontinue treatment if progressive skin rash;\r\nalso reported, pancreatitis, vasculitis, influenza-like symptoms,\r\nrhabdomyolysis, disturbances in smell", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129516.htm", "doses": [ "By mouth, 250\u00a0mg daily usually for 2\u20136\r\nweeks in tinea pedis, 2\u20134 weeks in tinea cruris, 4 weeks in tinea\r\ncorporis, 6 weeks\u20133 months in nail infections (occasionally longer\r\nin toenail infections); child [unlicensed]\r\nusually for 4 weeks, tinea capitis, over 1 year, body-weight 10\u201320\u00a0kg,\r\n62.5\u00a0mg once daily; body-weight 20\u201340\u00a0kg, 125\u00a0mg once daily; body-weight\r\nover 40\u00a0kg, 250\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "CYTARABINE Lipid formulation for intrathecal use": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nCytarabine acts by interfering with pyrimidine synthesis. It is given subcutaneously, intravenously, or intrathecally. Its predominant use is in the induction of remission of acute myeloblastic leukaemia. It is a potent myelosuppressant and requires careful haematological monitoring. A liposomal formulation of cytarabine for intrathecal use is licensed for lymphomatous meningitis.", "name": "CYTARABINE Lipid formulation for intrathecal use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "CYTARABINE", "Lipid formulation for intrathecal use" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (cytarabine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128310.htm", "doses": [ "See Doses", "Name[DepoCyte\u00ae (Napp) ] Intrathecal injection, cytarabine\r\nencapsulated in liposomes, net price 50-mg vial = \u00a31223.75For lymphomatous meningitisNote\u00a0The Scottish Medicines\r\nConsortium has advised (July 2007) that liposomal cytarabine suspension (DepoCyte\u00ae) is not recommended for use within NHS Scotland\r\nfor the intrathecal treatment of lymphomatous meningitis" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "SUMATRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine; cluster headache", "name": "SUMATRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists", "SUMATRIPTAN" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; history of seizures; sensitivity to sulfonamides; interactions: Appendix 1 (5HT1 agonists)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; also dyspnoea, drowsiness, transient increase\r\nin blood pressure, myalgia; also reported diarrhoea,\r\nischaemic colitis, hypotension, bradycardia or tachycardia, palpitation,\r\narrhythmias, myocardial infarction, Raynaud\u2019s syndrome, anxiety, seizures,\r\ntremor, dystonia, nystagmus, arthralgia, visual disturbances, and\r\nsweating; epistaxis with nasal spray", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129082.htm", "doses": [ "By mouth, migraine, 50\u00a0mg (some patients\r\nmay require 100\u00a0mg); dose may be repeated after at least 2 hours if\r\nmigraine recurs; max. 300\u00a0mg in 24 hours; child under 18 years see BNF for Children", "By subcutaneous injection cluster\r\nheadache or migraine, using auto-injector, 6\u00a0mg; dose may be repeated\r\nonce after at least 1 hour if headache recurs; max. 12\u00a0mg in 24 hours; child 10\u201318 years see BNF for Children", "Not for intravenous\r\ninjection which may cause coronary vasospasm and angina", "Intranasally, cluster headache [unlicensed]\r\nor migraine, 10\u201320\u00a0mg into one nostril; dose may be repeated once\r\nafter at least 2 hours if headache recurs; max. 40\u00a0mg in 24 hours; child 12\u201318 years see BNF for Children", "Patient not responding to initial dose should\r\nnot take second dose for same attack" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "FLUTICASONE PROPIONATE WITH SALMETEROL": { "indications": "Indications\u00a0see under preparations (see also Management of Chronic Asthma\r\ntable)", "name": "FLUTICASONE PROPIONATE WITH SALMETEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0see section 3.1.1.1 and\r\nCautions of Inhaled Corticosteroids (section 3.2)", "side-effects": "Side-effects\u00a0see section 3.1.1.1 and Side-effects of Inhaled\r\nCorticosteroids (section 3.2); also sinusitis, nasopharyngitis, very rarely dyspepsia, hyperglycaemia, arthralgia; also reported nausea, dizziness, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213697.htm", "doses": [ "See under preparations", "Advise patients that Seretide should not be used for relief of acute attacks, not to exceed prescribed\r\ndose, and to follow manufacturer\u2019s directions; if a previously effective\r\ndose fails to provide adequate relief, a doctor\u2019s advice should be\r\nobtained as soon as possible " ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "NICOTINIC ACID With laropiprant": { "indications": "Indications\u00a0adjunct to statin in dyslipidaemia or\r\nused alone if statin not tolerated (see also lipid-regulating drugs)", "name": "NICOTINIC ACID With laropiprant", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Nicotinic acid group", "NICOTINIC ACID", "With laropiprant" ], "cautions": "Cautions\u00a0unstable angina, acute myocardial infarction, diabetes\r\nmellitus, gout, history of peptic ulceration; interactions: Appendix 1 (nicotinic acid)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, abdominal pain, dyspepsia;\r\nflushing; pruritus, rash; less commonly tachycardia,\r\npalpitation, shortness of breath, peripheral oedema, headache, dizziness,\r\nincrease in uric acid, hypophosphataemia, prolonged prothrombin time,\r\nand reduced platelet count; rarely hypotension, syncope,\r\nrhinitis, insomnia, reduced glucose tolerance, myalgia, myopathy,\r\nmyasthenia; very rarely anorexia, rhabdomyolysis,\r\nvisual disturbance, and jaundice also reportedNote\u00a0Prostaglandin-mediated symptoms\r\n(such as flushing) can be reduced by low initial doses taken with\r\nmeals or, if patient taking aspirin, aspirin dose should be taken\r\n30 minutes before nicotinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204110.htm", "doses": [ "See under preparation", "Name[Tredaptive\u00ae (MSD) ] Tablets, m/r, nicotinic acid 1\u00a0g,\r\nlaropiprant 20\u00a0mg, net price 28-tab pack = \u00a316.73; 56-tab pack = \u00a333.46. \r\n Label:\r\n 21, 25Dose\u00a01 tablet once daily at night, increased after 4 weeks\r\nto 2 tablets once daily at night" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid\r\nunless potential benefit outweighs risk" }, "SODIUM VALPROATE Oral": { "indications": "Indications\u00a0all forms of epilepsy; migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2); mania\r\n(section 4.2.3)", "name": "SODIUM VALPROATE Oral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Valproate", "SODIUM VALPROATE", "Oral" ], "cautions": "Cautions\u00a0monitor liver function\r\nbefore therapy and during first 6 months especially in patients most\r\nat risk (see also below); measure full\r\nblood count and ensure no undue potential\r\nfor bleeding before starting and before surgery; systemic lupus erythematosus; false-positive\r\nurine tests for ketones; avoid abrupt withdrawal; consider vitamin D supplementation in patients that\r\nare immobilised for long periods or who have inadequate sun exposure\r\nor dietary intake of calcium; interactions: see Interactions in section 4.8.1 and Appendix 1 (valproate)Liver toxicity\u00a0Liver dysfunction (including fatal\r\nhepatic failure) has occurred in association with valproate (especially\r\nin children under 3 years and in those\r\nwith metabolic or degenerative\r\ndisorders, organic brain disease or severe seizure disorders associated with mental\r\nretardation) usually in first 6 months and usually involving\r\nmultiple antiepileptic therapy. Raised liver enzymes\r\nduring valproate treatment are usually transient but patients should\r\nbe reassessed clinically and liver function (including prothrombin\r\ntime) monitored until return to normal\u2014discontinue if abnormally prolonged prothrombin time (particularly\r\nin association with other relevant abnormalities).Blood or hepatic disorders\u00a0Patients or their carers should be told how to recognise signs and\r\nsymptoms of blood or liver disorders and advised to seek immediate\r\nmedical attention if symptoms developPancreatitis\u00a0Patients or their carers\r\nshould be told how to recognise signs and symptoms of pancreatitis\r\nand advised to seek immediate medical attention if symptoms such as\r\nabdominal pain, nausea, or vomiting develop; discontinue if pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0nausea, gastric irritation, diarrhoea; weight\r\ngain; hyperammonaemia, thrombocytopenia; transient hair loss (regrowth\r\nmay be curly); less frequently increased alertness,\r\naggression, hyperactivity, behavioural disturbances, ataxia, tremor,\r\nand vasculitis; rarely hepatic dysfunction (see under\r\nCautions; withdraw treatment immediately if persistent vomiting and\r\nabdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or\r\nloss of seizure control), lethargy, drowsiness, confusion, stupor,\r\nhallucinations, blood disorders (including anaemia, leucopenia, pancytopenia),\r\nhearing loss, and rash; very rarely pancreatitis\r\n(see under Cautions), peripheral oedema, increase in bleeding time,\r\nextrapyramidal symptoms, dementia, encephalopathy, coma, gynaecomastia,\r\nFanconi\u2019s syndrome, hirsutism, acne, enuresis, hyponatraemia, toxic\r\nepidermal necrolysis, and Stevens-Johnson syndrome; suicidal ideation;\r\nreduced bone mineral density (see Cautions); also reported menstrual disturbances, male infertility, syndrome of inappropriate\r\nsecretion of antidiuretic hormone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3601.htm", "doses": [ "Epilepsy, by mouth, initially 600\u00a0mg\r\ndaily in 1\u20132 divided doses, increased gradually (in steps of 150\u2013300\u00a0mg)\r\nevery 3 days; usual maintenance dose 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily),\r\nmax. 2.5\u00a0g daily; child 1 month\u201312\r\nyears, initially 10\u201315\u00a0mg/kg (max. 600\u00a0mg) daily in 1\u20132 divided doses;\r\nusual maintenance dose 25\u201330\u00a0mg/kg daily in 2 divided doses", "Initiation of valproate treatment by intravenous administration, adult and child over 12 years, initially 10\u00a0mg/kg (usually 400\u2013800\u00a0mg) by intravenous injection (over 3\u20135 minutes) followed by intravenous infusion or intravenous\r\ninjection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up\r\nto max. 2.5\u00a0g daily; usual range 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily); child 1 month\u201312 years, 10\u00a0mg/kg by intravenous\r\ninjection (over 3\u20135 minutes) followed by intravenous\r\ninfusion or intravenous injection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up to usual range 20\u201340\u00a0mg/kg\r\ndaily (doses above 40\u00a0mg/kg daily monitor clinical chemistry and haematological\r\nparameters)", "Continuation of valproate treatment by intravenous injection (over 3\u20135 minutes) or intravenous infusion in 2\u20134 divided doses, or by continuous intravenous infusion, same as established oral daily dose", "Migraine prophylaxis [unlicensed], by mouth, initially 200\u00a0mg twice daily, increased if necessary to 1.2\u20131.5\u00a0g\r\ndaily in divided doses", "Mania, see under Episenta\u00ae", "Name[Epilim\u00ae (Sanofi-Aventis) ] Tablets (crushable), scored, sodium\r\nvalproate 100\u00a0mg, net price 100-tab pack = \u00a35.60. \r\n Label:\r\n 8, 21, counselling, pancreatitis, blood, or hepatic disorder\r\nsymptoms (see above), driving (see notes above)\nTablets, e/c, lilac, sodium valproate\r\n200\u00a0mg, net price 100-tab pack = \u00a37.70; 500\u00a0mg, 100-tab pack = \u00a319.25. \r\n Label:\r\n 5, 8, 25, counselling, pancreatitis, blood, or\r\nhepatic disorder symptoms (see above), driving (see notes above)\nLiquid, red, sugar-free, sodium valproate 200\u00a0mg/5\u00a0mL, net price 300-mL pack = \u00a39.33. \r\n Label:\r\n 8, 21, counselling, pancreatitis, blood, or\r\nhepatic disorder symptoms (see above), driving (see notes above)\nSyrup, red, sodium valproate 200\u00a0mg/5\u00a0mL, net price 300-mL pack = \u00a37.78. \r\n Label:\r\n 8, 21, counselling, pancreatitis, blood, or hepatic disorder symptoms (see above), driving (see notes above)Note\u00a0May be diluted, preferably in Syrup BP; use\r\nwithin 14 days " ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nneonatal bleeding (related to hypofibrinaemia) and neonatal hepatotoxicity\r\nalso reported" }, "ENTACAPONE": { "indications": "Indications\u00a0adjunct to co-beneldopa or co-careldopa in Parkinson\u2019s disease with\r\n\u2018end-of-dose\u2019 motor fluctuations", "name": "ENTACAPONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Catechol-O-methyltransferase inhibitors", "ENTACAPONE" ], "cautions": "Cautions\u00a0ischaemic heart disease; avoid abrupt withdrawal; concurrent levodopa dose may need to be reduced\r\nby about 10\u201330%; interactions: Appendix\r\n1 (entacapone)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, constipation,\r\ndiarrhoea, urine may be coloured reddish-brown, dry mouth; ischaemic\r\nheart disease; confusion, dizziness, abnormal dreams, fatigue, insomnia,\r\ndystonia, dyskinesia, hallucinations; sweating; less commonly myocardial infarction; rarely rash; very\r\nrarely anorexia, weight loss, agitation, and urticaria; also reported hepatitis, colitis, neuroleptic malignant\r\nsyndrome, rhabdomyolysis, and skin, hair, and nail discoloration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73634.htm", "doses": [ "200\u00a0mg with each dose of levodopa with\r\ndopa-decarboxylase inhibitor; max. 2\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "CARVEDILOL": { "indications": "Indications\u00a0hypertension; angina; adjunct to diuretics, digoxin, or ACE inhibitors in symptomatic chronic heart\r\nfailure", "name": "CARVEDILOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "CARVEDILOL" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride; monitor renal function during dose titration in patients\r\nwith heart failure who also have renal impairment, low\r\nblood pressure, ischaemic heart disease, or diffuse vascular disease", "side-effects": "Side-effects\u00a0postural hypotension, dizziness, headache, fatigue,\r\ngastro-intestinal disturbances, bradycardia; occasionally diminished\r\nperipheral circulation, peripheral oedema and painful extremities,\r\ndry mouth, dry eyes, eye irritation or disturbed vision, impotence,\r\ndisturbances of micturition, influenza-like symptoms; rarely angina,\r\nAV block, exacerbation of intermittent claudication or Raynaud\u2019s phenomenon;\r\nallergic skin reactions, exacerbation of psoriasis, nasal stuffiness,\r\nwheezing, depressed mood, sleep disturbances, paraesthesia, heart\r\nfailure, changes in liver enzymes, thrombocytopenia, leucopenia also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128457.htm", "doses": [ "Hypertension, initially 12.5\u00a0mg once daily, increased\r\nafter 2 days to usual dose of 25\u00a0mg once daily; if necessary may be\r\nfurther increased at intervals of at least 2 weeks to max. 50\u00a0mg daily\r\nin single or divided doses; elderly initial dose of 12.5\u00a0mg daily may provide satisfactory control", "Angina, initially 12.5\u00a0mg twice daily, increased after 2 days\r\nto 25\u00a0mg twice daily", "Adjunct in heart failure (section 2.5.5) initially 3.125\u00a0mg twice daily\r\n(with food), dose increased at intervals of at least 2 weeks to 6.25\u00a0mg\r\ntwice daily, then to 12.5\u00a0mg twice daily, then to 25\u00a0mg twice daily;\r\nincrease to highest dose tolerated, max. 25\u00a0mg twice daily in patients\r\nwith severe heart failure or body-weight less than 85\u00a0kg and 50\u00a0mg\r\ntwice daily in patients over 85\u00a0kg" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "SALBUTAMOL Inhalation": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction; premature labour (section 7.1.3)", "name": "SALBUTAMOL Inhalation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "SALBUTAMOL", "Inhalation" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also lactic acidosis with high\r\ndoses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31917.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\n4\u00a0mg (elderly and sensitive patients initially 2\u00a0mg) 3\u20134 times daily;\r\nmax. single dose 8\u00a0mg (but unlikely to provide much extra benefit\r\nor to be tolerated); child under 2\r\nyears see BNF for Children; 2\u20136 years 1\u20132\u00a0mg 3\u20134 times daily, 6\u201312 years 2\u00a0mg 3\u20134 times\r\ndaily", "By subcutaneous or intramuscular injection, 500\u00a0micrograms, repeated\r\nevery 4 hours if necessary", "By slow intravenous injection (but\r\nsee also Management of Acute Asthma table), (dilute to a concentration\r\nof 50\u00a0micrograms/mL), 250\u00a0micrograms, repeated if necessary; child under 18 years see BNF for Children", "By intravenous infusion (but see\r\nalso Management of Acute Asthma table), initially 5\u00a0micrograms/minute,\r\nadjusted according to response and heart-rate usually in range 3\u201320\u00a0micrograms/minute,\r\nor more if necessary; child under 18\r\nyears see BNF for Children", "By aerosol inhalation (but see also Management of Acute Asthma table, or Management of Chronic Asthma\r\ntable),\r\n100\u2013200\u00a0micrograms (1\u20132 puffs); for persistent symptoms up to 4 times\r\ndaily; child 100\u00a0micrograms (1 puff),\r\nincreased to 200\u00a0micrograms (2 puffs) if necessary; for persistent\r\nsymptoms up to 4 times daily ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 200\u00a0micrograms\r\n(2 puffs); child 100\u00a0micrograms (1\r\npuff), increased to 200\u00a0micrograms (2 puffs) if necessary", "By inhalation of powder (but see\r\nalso Management of Chronic Asthma\r\ntable),\r\n200\u2013400\u00a0micrograms; for persistent symptoms up to 4 times daily; child over 5 years 200\u00a0micrograms; for persistent\r\nsymptoms up to 4 times daily (for Asmasal Clickhaler\u00ae, Salbulin Novolizer\u00ae, and Ventolin\r\nAccuhaler\u00ae doses, see under preparations) ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 400\u00a0micrograms; child 200\u00a0micrograms", "By inhalation of nebulised solution, adult and child over\r\n5 years 2.5\u20135\u00a0mg, repeated up to 4 times daily or more frequently\r\nin severe cases; child under 5 years\r\n2.5\u00a0mg, repeated up to 4 times daily or more frequently in severe\r\ncases; see also Management of Acute Asthma table and Management of Chronic Asthma\r\ntable", "Name[Airomir\u00ae (IVAX) ] Aerosol inhalation, salbutamol (as sulphate) 100\u00a0micrograms/metered inhalation, net price 200-dose\r\nunit = \u00a31.97. \r\n Label:\r\n Counselling, administration\nAutohaler (breath-actuated aerosol\r\ninhalation), salbutamol (as sulphate) 100\u00a0micrograms/metered\r\ninhalation, net price 200-dose unit = \u00a36.02. \r\n Label:\r\n Counselling, administration" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "PREPARATIONS FOR VAGINAL AND VULVAL\r\nCANDIDIASIS": { "indications": "Indications\u00a0\n(From Fungal infections: British National Formulary)\nFungal infections", "name": "PREPARATIONS FOR VAGINAL AND VULVAL\r\nCANDIDIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.2 Treatment of vaginal and vulval conditions", "7.2.2 Vaginal and vulval infections", "Fungal infections", "PREPARATIONS FOR VAGINAL AND VULVAL CANDIDIASIS" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (miconazole)", "side-effects": "Side-effects\u00a0occasional local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213818.htm", "doses": [ "See under preparations below", "insert 5-g applicatorful intravaginally twice daily for\r\n3 days", "insert 1 vaginal capsule at night for 3 nights", "insert 1 vaginal capsule at night as a single dose" ], "pregnancy": "Pregnancy\u00a0\n(From Fungal infections: British National Formulary)\nVulvovaginal candidiasis in pregnancy \u00a0Vulvovaginal candidiasis is common during pregnancy and can be treated with vaginal application of an imidazole (such as clotrimazole), and a topical imidazole cream for vulvitis. Pregnant women need a longer duration of treatment, usually about 7 days, to clear the infection. Oral antifungal treatment should be avoided during pregnancy." }, "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH GESTODENE": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH GESTODENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Oral (low and standard strength)", "Ethinylestradiol with Gestodene" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207461.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ZINC ACETATE": { "indications": "Indications\u00a0Wilson\u2019s disease (initiated under specialist\r\nsupervision)", "name": "ZINC ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Wilson\u2019s disease" ], "cautions": "Cautions\u00a0portal hypertension (risk of hepatic\r\ndecompensation when switching from chelating agent); monitor full blood count and serum cholesterol; interactions: Appendix 1 (zinc)", "side-effects": "Side-effects\u00a0gastric irritation (usually transient; may be\r\nreduced if first dose taken mid-morning or with a little protein); less commonly sideroblastic anaemia and leucopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129095.htm", "doses": [ "Dose expressed as\r\nelemental zinc", "Wilson\u2019s disease, 50\u00a0mg 3 times daily (max. 50\u00a0mg 5 times daily),\r\nadjusted according to response; child 1\u20136 years, 25\u00a0mg twice daily; 6\u201316 years, body-weight under 57\u00a0kg,\r\n25\u00a0mg 3 times daily, body-weight over 57\u00a0kg, 50\u00a0mg 3 times daily; adolescent 16\u201318 years, 50\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0reduce dose to 25\u00a0mg 3 times daily adjusted according\r\nto plasma-copper concentration and urinary copper excretion" }, "ACENOCOUMAROL": { "indications": "Indications\u00a0see under Warfarin Sodium", "name": "ACENOCOUMAROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Coumarins and phenindione", "ACENOCOUMAROL" ], "cautions": "Cautions\u00a0see under Warfarin Sodium", "side-effects": "Side-effects\u00a0see under Warfarin Sodium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2796.htm", "doses": [ "4\u00a0mg on first day, 4\u20138\u00a0mg on second day; maintenance dose\r\nusually 1\u20138\u00a0mg daily adjusted according to response" ], "pregnancy": "Pregnancy\u00a0\n(From Coumarins and phenindione: British National Formulary)\nPregnancy\u00a0 Warfarin, acenocoumarol, and phenindione are teratogenic and should not be given in the first trimester of pregnancy. Women of child-bearing age should be warned of this danger since stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality. These oral anticoagulants cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters. Difficult decisions may have to be made, particularly in women with prosthetic heart valves, atrial fibrillation, or with a history of recurrent venous thrombosis or pulmonary embolism." }, "DORZOLAMIDE": { "indications": "Indications\u00a0raised intra-ocular pressure in ocular hypertension, open-angle glaucoma,\r\npseudo-exfoliative glaucoma either as adjunct to\r\nbeta-blocker or used alone in patients unresponsive\r\nto beta-blockers or if beta-blockers contra-indicated", "name": "DORZOLAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "DORZOLAMIDE" ], "cautions": "Cautions\u00a0systemic absorption follows topical application; history of renal calculi; chronic corneal defects, history of intra-ocular\r\nsurgery; interactions: Appendix 1 (dorzolamide)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also nausea,\r\nbitter taste, dry mouth; headache, asthenia; ocular irritation, blurred\r\nvision, lacrimation, conjunctivitis, superficial punctuate keratitis,\r\neyelid inflammation; less commonly iridocyclitis; rarely hypersensitivity reactions (including urticaria,\r\nangioedema, bronchospasm), dizziness, paraesthesia, urolithiasis,\r\neyelid crusting, transient myopia, corneal oedema, epistaxis, throat\r\nirritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213678.htm", "doses": [ "Used alone, apply 3 times daily", "With topical beta-blocker, apply twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "LIDOCAINE HYDROCHLORIDE - VENTRICULAR ARRHYTHMIAS": { "indications": "Indications\u00a0ventricular arrhythmias, especially\r\nafter myocardial infarction; eye (section 11.7); local anaesthesia (section 15.2)", "name": "LIDOCAINE HYDROCHLORIDE - VENTRICULAR ARRHYTHMIAS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Ventricular arrhythmias" ], "cautions": "Cautions\u00a0lower doses in congestive cardiac\r\nfailure and following cardiac surgery; monitor ECG and have resuscitation facilities\r\navailable; elderly; interactions: Appendix 1 (lidocaine)", "side-effects": "Side-effects\u00a0dizziness, paraesthesia, or drowsiness (particularly\r\nif injection too rapid); other CNS effects include confusion, respiratory\r\ndepression and convulsions; hypotension and bradycardia (may lead\r\nto cardiac arrest); rarely hypersensitivity reactions\r\nincluding anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2441.htm", "doses": [ "By intravenous injection, in patients without\r\ngross circulatory impairment, 100\u00a0mg as a bolus over a few minutes\r\n(50\u00a0mg in lighter patients or those whose circulation is severely\r\nimpaired), followed immediately by infusion of 4\u00a0mg/minute\r\nfor 30 minutes, 2\u00a0mg/minute for 2 hours, then 1\u00a0mg/minute; reduce\r\nconcentration further if infusion continued beyond 24 hours (ECG monitoring\r\nand specialist advice for infusion)", "Following intravenous injection lidocaine has a short duration of action (lasting for 15\u201320 minutes).\r\nIf an intravenous infusion is not immediately available\r\nthe initial intravenous injection of 50\u2013100\u00a0mg can\r\nbe repeated if necessary once or twice at intervals of not less than\r\n10 minutes" ], "pregnancy": "Pregnancy\u00a0crosses the placenta but not known to be harmful\r\nin animal studies\u2014use if benefit outweighs risk" }, "CAPTOPRIL With diuretic": { "indications": "Indications\u00a0mild to moderate essential hypertension alone\r\nor with thiazide therapy and severe hypertension resistant to other\r\ntreatment; congestive heart failure with left ventricular dysfunction\r\n(adjunct\u2014see section 2.5.5); following\r\nmyocardial infarction, see dose; diabetic nephropathy (microalbuminuria\r\ngreater than 30\u00a0mg/day) in type 1 diabetes", "name": "CAPTOPRIL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "CAPTOPRIL", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; tachycardia, serum sickness,\r\nweight loss, stomatitis, maculopapular rash, photosensitivity, flushing\r\nand acidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2582.htm", "doses": [ "Hypertension, used alone, initially 12.5\u00a0mg twice daily;\r\nif used in addition to diuretic (see notes above),\r\nor in elderly, initially 6.25\u00a0mg twice daily (first dose at bedtime);\r\nusual maintenance dose 25\u00a0mg twice daily; max. 50\u00a0mg twice daily (rarely\r\n3 times daily in severe hypertension)", "Heart failure (adjunct), initially 6.25\u201312.5\u00a0mg 2\u20133 times daily\r\nunder close medical supervision (see notes above),\r\nincreased gradually at intervals of at least 2 weeks up to max. 150\u00a0mg\r\ndaily in divided doses if tolerated", "Prophylaxis after infarction in clinically stable patients with\r\nasymptomatic or symptomatic left ventricular dysfunction (radionuclide\r\nventriculography or echocardiography undertaken before initiation),\r\ninitially 6.25\u00a0mg, starting as early as 3 days after infarction, then\r\nincreased over several weeks to 150\u00a0mg daily (if tolerated) in divided\r\ndoses", "Diabetic nephropathy, 75\u2013100\u00a0mg daily in divided doses; if further\r\nblood pressure reduction required, other antihypertensives may be\r\nused in conjunction with captopril; in severe renal\r\nimpairment, initially 12.5\u00a0mg twice daily (if concomitant diuretic\r\ntherapy required, loop diuretic rather than thiazide should be chosen)", "Name[Capozide\u00ae (Squibb) ] Tablets, scored, co-zidocapt 25/50\r\n(hydrochlorothiazide 25\u00a0mg, captopril 50\u00a0mg), net price 30-tab pack = \u00a37.02" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "TRIAMTERENE": { "indications": "Indications\u00a0oedema, potassium conservation with thiazide and loop diuretics", "name": "TRIAMTERENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.3 Potassium-sparing diuretics and aldosterone antagonists", "TRIAMTERENE" ], "cautions": "Cautions\u00a0see under Amiloride Hydrochloride; may cause blue fluorescence of urine", "side-effects": "Side-effects\u00a0include gastro-intestinal disturbances, dry mouth,\r\nrashes; slight decrease in blood pressure, hyperkalaemia, hyponatraemia;\r\nphotosensitivity and blood disorders also reported; triamterene found in kidney stones", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106451.htm", "doses": [ "Initially 150\u2013250\u00a0mg daily, reducing to alternate days\r\nafter 1 week; taken in divided doses after breakfast and lunch; lower\r\ninitial dose when given with other diuretics", "Urine may look slightly blue in some\r\nlights" ], "pregnancy": "Pregnancy\u00a0not used to treat gestational hypertension" }, "AMIFOSTINE": { "indications": "Indications\u00a0see under Dose", "name": "AMIFOSTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced neutropenic infection and nephrotoxicity", "AMIFOSTINE" ], "cautions": "Cautions\u00a0ensure adequate hydration before treatment; infuse with patient supine and monitor arterial blood\r\npressure (interrupt infusion if blood pressure decreases significantly,\r\nconsult product literature); during chemotherapy\r\ninterrupt antihypertensive therapy 24 hours before treatment with amifostine and monitor closely; during radiotherapy monitor closely if concomitant antihypertensive\r\ntherapy; monitor serum-calcium concentration\r\nin patients at risk of hypocalcaemia; patients at risk\r\nof renal impairment; caution in handling\u2014risk of cutaneous\r\nreactions", "side-effects": "Side-effects\u00a0nausea, vomiting, hiccups; hypotension (managed\r\nby infusion of sodium chloride 0.9% and postural management), hypertension,\r\nflushing, arrhythmias (including rarely atrial fibrillation,\r\nsupraventricular tachycardia); sneezing; drowsiness, dizziness, syncope;\r\nhypocalcaemia; rarely chest pain, apnoea, seizures,\r\nserious skin reactions (including Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, and very rarely exfoliative\r\nand bullous dermatitis, toxicoderma), and renal failure; very\r\nrarely myocardial infarction, laryngeal oedema, and respiratory\r\narrest", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204224.htm", "doses": [ "Reduction of neutropenia-related risk of infection due\r\nto cyclophosphamide and cisplatin treatment in patients with advanced ovarian carcinoma, by\r\nintravenous infusion over 15 minutes, adult under 70 years, 910\u00a0mg/m2 started within 30 minutes before\r\nchemotherapy (reduced to 740\u00a0mg/m2 for subsequent cycles\r\nif full dose could not be given first time due to hypotension lasting\r\nmore than 5 minutes after interruption, consult product literature)", "Reduction of nephrotoxicity associated with cisplatin in patients with advanced solid tumours of non-germ-cell origin,\r\nconsult product literature", "Prevention of xerostomia during radiotherapy for head and neck\r\ncancer, consult product literature" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies; avoid" }, "CYCLOSERINE": { "indications": "Indications\u00a0in combination with other drugs, tuberculosis resistant to first-line\r\ndrugs", "name": "CYCLOSERINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "CYCLOSERINE" ], "cautions": "Cautions\u00a0monitor haematological, renal, and hepatic\r\nfunction; interactions: Appendix 1\r\n(cycloserine)", "side-effects": "Side-effects\u00a0mainly neurological, including headache, dizziness,\r\nvertigo, drowsiness, tremor, convulsions, confusion, psychosis, depression\r\n(discontinue or reduce dose if symptoms of CNS toxicity); rashes,\r\nallergic dermatitis (discontinue or reduce dose); megaloblastic anaemia;\r\nchanges in liver function tests; heart failure at high doses reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3903.htm", "doses": [ "Initially 250\u00a0mg every 12 hours for 2 weeks increased\r\naccording to blood concentration and response to max. 500\u00a0mg every\r\n12 hours; child 2\u201318 years see BNF for Children", "Blood concentration monitoring required especially\r\nin renal impairment or if dose exceeds 500\u00a0mg daily or if signs of\r\ntoxicity; blood concentration should not exceed 30\u00a0mg/litre" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014crosses the placenta" }, "CLOMIFENE CITRATE": { "indications": "Indications\u00a0anovulatory infertility\u2014see notes above", "name": "CLOMIFENE CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anti-oestrogens" ], "cautions": "Cautions\u00a0\n(From Anti-oestrogens: British National Formulary)\nAnti-oestrogens; polycystic ovary\r\nsyndrome (cysts may enlarge during treatment, also risk of exaggerated\r\nresponse to usual doses), ovarian hyperstimulation syndrome, uterine\r\nfibroids, ectopic pregnancy, incidence of multiple births increased (consider ultrasound\r\nmonitoring), visual symptoms (discontinue\r\nand initiate ophthalmological examination)CSM Advice\u00a0The CSM has recommended that clomifene should not normally be used for longer than 6 cycles (possibly increased\r\nrisk of ovarian cancer)", "side-effects": "Side-effects\u00a0visual disturbances (withdraw), ovarian hyperstimulation\r\n(withdraw), hot flushes, abdominal discomfort, occasionally nausea,\r\nvomiting, depression, insomnia, breast tenderness, headache, intermenstrual\r\nspotting, menorrhagia, endometriosis, convulsions, weight gain, rashes,\r\ndizziness, hair loss", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4389.htm", "doses": [ "50\u00a0mg daily for 5 days, starting within about 5 days of\r\nonset of menstruation (preferably on 2nd day) or at any time (normally\r\npreceded by a progestogen-induced withdrawal bleed) if cycles have\r\nceased; second course of 100\u00a0mg daily for 5 days may be given in absence\r\nof ovulation; most patients who are going to respond will do so to\r\nfirst course; 3 courses should constitute adequate therapeutic trial;\r\nlong-term cyclical therapy not recommended\u2014see CSM advice, above" ], "pregnancy": "Pregnancy\u00a0exclude pregnancy before treatment; possible effects\r\non fetal development" }, "CHARCOAL, ACTIVATED": { "indications": "Indications\u00a0reduction of absorption of poisons in\r\nthe gastro-intestinal system; see also active elimination techniques, above", "name": "CHARCOAL, ACTIVATED", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Removal and elimination", "Removal from the gastro-intestinal tract" ], "cautions": "Cautions\u00a0drowsy or comatose patient (risk\r\nof aspiration\u2014ensure airway protected); reduced gastro-intestinal motility (risk of obstruction); not for poisoning with petroleum distillates, corrosive substances, alcohols, malathion, cyanides, and metal\r\nsalts including iron and lithium salts", "side-effects": "Side-effects\u00a0black stools", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106239.htm", "doses": [ "Reduction of absorption, adult and child over 12 years, 50\u00a0g; child under 12 years, 1\u00a0g/kg (max. 50\u00a0g)", "Active elimination, see notes above", "Activated charcoal doses in BNF may differ\r\nfrom those in product literature. Suspension or reconstituted powder\r\nmay be mixed with soft drinks (e.g. caffeine-free diet cola) or fruit\r\njuices to mask the taste" ] }, "TRAMADOL HYDROCHLORIDE Modified-release 24-hourly preparations": { "indications": "Indications\u00a0moderate to severe pain", "name": "TRAMADOL HYDROCHLORIDE Modified-release 24-hourly preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "TRAMADOL HYDROCHLORIDE", "Modified-release 24-hourly preparations" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; impaired consciousness; excessive bronchial\r\nsecretions; not suitable as a substitute\r\nin opioid-dependent patientsGeneral anaesthesia\u00a0Not recommended\r\nfor analgesia during potentially light planes of general anaesthesia (possibly increased intra-operative recall reported)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndiarrhoea, retching, fatigue, paraesthesia; less commonly gastritis, and flatulence; rarely anorexia, syncope,\r\nhypertension, bronchospasm, dyspnoea, wheezing, seizures, and muscle\r\nweakness; blood disorders also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130013.htm", "doses": [ "adult and child over 12 years, by mouth, 50\u2013100\u00a0mg\r\nnot more often than every 4 hours; total of more than 400\u00a0mg daily\r\nnot usually required", "adult and child over 12 years, by intramuscular injection or by intravenous injection (over\r\n2\u20133 minutes) or by intravenous infusion, 50\u2013100\u00a0mg every 4\u20136 hours", "Postoperative pain, 100\u00a0mg initially then 50\u00a0mg every 10\u201320\r\nminutes if necessary during first hour to total max. 250\u00a0mg (including\r\ninitial dose) in first hour, then 50\u2013100\u00a0mg every\r\n4\u20136 hours; max. 600\u00a0mg daily", "Name[Tradorec XL\u00ae (MSD) ] Tablets, m/r, tramadol hydrochloride\r\n100\u00a0mg, net price 30-tab pack = \u00a314.10; 200\u00a0mg, 30-tab pack = \u00a314.98;\r\n300\u00a0mg, 30-tab pack = \u00a322.47. \r\n Label:\r\n 2, 25Dose\u00a0adult and child over 12 years, initially 100\u00a0mg once daily,\r\nincreased if necessary; usual max. 400\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0embryotoxic in animal studies\u2014manufacturers advise\r\navoid; see also notes above" }, "LOPRAZOLAM": { "indications": "Indications\u00a0insomnia (short-term use; \n(From 4.1 Hypnotics and anxiolytics: British National Formulary)\nImportant: benzodiazepine indications Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. The use of benzodiazepines to treat short-term \u2018mild\u2019 anxiety is inappropriate. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.)", "name": "LOPRAZOLAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Benzodiazepines" ], "cautions": "Cautions\u00a0see under Nitrazepam", "side-effects": "Side-effects\u00a0see under Nitrazepam; shorter\r\nacting", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3148.htm", "doses": [ "1\u00a0mg at bedtime, increased to 1.5 or 2\u00a0mg if required; elderly (or debilitated) 0.5 or 1\u00a0mg; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "CROTAMITON": { "indications": "Indications\u00a0pruritus (including pruritus after scabies\u2014%s\n(From 13.10.4 Parasiticidal preparations: British National Formulary)\n13.10.4 Parasiticidal preparations); see notes above", "name": "CROTAMITON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.3 Topical local anaesthetics and antipruritics", "CROTAMITON" ], "cautions": "Cautions\u00a0avoid use near eyes and\r\nbroken skin; use on doctor\u2019s\r\nadvice for children under 3 years", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5828.htm", "doses": [ "Pruritus, apply 2\u20133 times daily; child under 3 years, apply once daily" ] }, "BUDESONIDE - RESPIRATORY SYSTEM": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable);\r\ncroup", "name": "BUDESONIDE - RESPIRATORY SYSTEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids", "BUDESONIDE" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129490.htm", "doses": [ "See preparations below", "by inhalation of powder, adult and child over\r\n12 years, 200\u2013800\u00a0micrograms twice daily, adjusted as necessary; alternatively,\r\nin mild to moderate asthma, for patients previously stabilised on\r\na twice daily dose, 200\u2013400\u00a0micrograms (max. 800\u00a0micrograms) as a\r\nsingle dose in the evening; child 6\u201312\r\nyears 200\u2013400\u00a0micrograms twice daily, adjusted as necessary; alternatively,\r\nin mild to moderate asthma, for patients previously stabilised on\r\na twice daily dose, 200\u2013400\u00a0micrograms as a single dose in the evening" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "FLUOCINOLONE ACETONIDE With antimicrobials": { "indications": "Indications\u00a0inflammatory skin disorders such as eczemas;\r\npsoriasis, \n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "FLUOCINOLONE ACETONIDE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUOCINOLONE ACETONIDE", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5911.htm", "doses": [ "Apply thinly 1\u20132 times daily, reducing strength as condition\r\nresponds", "Name[Synalar N\u00ae (GP Pharma) ] Cream, fluocinolone acetonide 0.025%, neomycin sulphate 0.5%, net price 30\u00a0g\r\n= \u00a33.96. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include cetostearyl\r\nalcohol, hydroxybenzoates (parabens), polysorbates, propylene glycol\nOintment, fluocinolone\r\nacetonide 0.025%, neomycin sulphate 0.5%,\r\nin a greasy basis, net price 30\u00a0g = \u00a33.96. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include propylene\r\nglycol, wool fat" ] }, "LIDOCAINE HYDROCHLORIDE - LIDOCAINE": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE - LIDOCAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6687.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "DOBUTAMINE": { "indications": "Indications\u00a0inotropic support in infarction, cardiac surgery, cardiomyopathies,\r\nseptic shock, and cardiogenic shock; cardiac stress testing (consult\r\nproduct literature)", "name": "DOBUTAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.1 Inotropic sympathomimetics" ], "cautions": "Cautions\u00a0arrhythmias, acute myocardial infarction, acute heart\r\nfailure, severe hypotension, marked obstruction of cardiac ejection (such as idiopathic\r\nhypertrophic subaortic stenosis); correct hypovolaemia before starting\r\ntreatment; tolerance may develop with continuous\r\ninfusions longer than 72 hours; hyperthyroidism; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0nausea; hypotension, hypertension (marked increase\r\nin systolic blood pressure indicates overdose), arrhythmias, palpitations,\r\nchest pain; dyspnoea, bronchospasm; headache; fever; increased urinary\r\nurgency; eosinophilia; rash, phlebitis; very rarely myocardial infarction, hypokalaemia; coronary artery spasm and thrombocytopenia\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2734.htm", "doses": [ "By intravenous infusion, 2.5\u201310\u00a0micrograms/kg/minute,\r\nadjusted according to response" ], "pregnancy": "Pregnancy\u00a0no evidence of harm in animal studies\u2014manufacturers\r\nadvise use only if potential benefit outweighs risk" }, "LIQUID PARAFFIN - LIQUID PARAFFIN": { "side-effects": "Side-effects\u00a0anal seepage of paraffin and consequent anal irritation\r\nafter prolonged use, granulomatous reactions caused by absorption\r\nof small quantities of liquid paraffin (especially\r\nfrom the emulsion), lipoid pneumonia, and interference with the absorption\r\nof fat-soluble vitamins", "indications": "Indications\u00a0constipation", "name": "LIQUID PARAFFIN - LIQUID PARAFFIN", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2234.htm", "doses": [ "See under preparation", "adult over 18 years, 10\u201330\u00a0mL\r\nat night when required" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.3 Faecal softeners", "LIQUID PARAFFIN" ], "cautions": "Cautions\u00a0avoid prolonged use; contra-indicated\r\nin children under 3 years" }, "CYPROTERONE ACETATE": { "indications": "Indications\u00a0prostate cancer, see under\r\nDose and also notes above; other indications, see section 6.4.2", "name": "CYPROTERONE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Anti-androgens" ], "cautions": "Cautions\u00a0in prostate cancer, blood counts initially and throughout\r\ntreatment; monitor hepatic function (liver function tests should be performed\r\nbefore treatment, see also under Side-effects below); monitor adrenocortical function regularly; risk of recurrence of thromboembolic disease; diabetes mellitus, sickle-cell anaemia, severe depression (in other indications\r\nsome of these are contra-indicated, see section 6.4.2) Driving\u00a0Fatigue and lassitude may\r\nimpair performance of skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see section 6.4.2Hepatotoxicity\u00a0Direct hepatic toxicity including\r\njaundice, hepatitis and hepatic failure have been reported (fatalities\r\nreported at dosages of 100\u00a0mg and above, usually in men treated for\r\nadvanced prostate cancer). Liver function tests should\r\nbe performed before and regularly during treatment and whenever symptoms\r\nsuggestive of hepatotoxicity occur\u2014if confirmed cyproterone\r\nshould normally be withdrawn unless the hepatotoxicity can be explained\r\nby another cause such as metastatic disease (in which case cyproterone\r\nshould be continued only if the perceived benefit exceeds the risk)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4826.htm", "doses": [ "Prevention of flare with initial gonadorelin analogue therapy, 200\u00a0mg daily in 2\u20133 divided doses for 5\u20137 days\r\nbefore initiation of gonadorelin analogue, followed by 200\u00a0mg daily\r\nin 2\u20133 divided doses for 3\u20134 weeks after initiation of gonadorelin\r\nanalogue; max. 300\u00a0mg daily", "Long-term palliative therapy where gonadorelin analogues or orchidectomy contra-indicated, not tolerated, or where\r\noral therapy preferred, 200\u2013300\u00a0mg daily in 2\u20133 divided doses", "Hot flushes with gonadorelin analogue therapy\r\nor after orchidectomy, initially 50\u00a0mg daily, adjusted according to\r\nresponse to 50\u2013150\u00a0mg daily in 1\u20133 divided doses" ] }, "CO-AMOXICLAV": { "indications": "Indications\u00a0infections due to beta-lactamase-producing\r\nstrains (where amoxicillin alone not appropriate)\r\nincluding respiratory-tract infections, bone and joint infections,\r\ngenito-urinary and abdominal infections, cellulitis, animal bites,\r\nsevere dental infection with spreading cellulitis or dental infection\r\nnot responding to first-line antibacterial", "name": "CO-AMOXICLAV", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.3 Broad-spectrum penicillins", "CO-AMOXICLAV" ], "cautions": "Cautions\u00a0see under Ampicillin and notes above; maintain adequate hydration with high doses (particularly during\r\nparenteral therapy); interactions: Appendix\r\n1 (penicillins)Cholestatic jaundice\u00a0Cholestatic\r\njaundice can occur either during or shortly after the use of co-amoxiclav. An epidemiological study has\r\nshown that the risk of acute liver toxicity was about 6 times greater\r\nwith co-amoxiclav than with amoxicillin. Cholestatic jaundice is more common in patients above\r\nthe age of 65 years and in men; these reactions have only\r\nrarely been reported in children. Jaundice is usually self-limiting\r\nand very rarely fatal. The duration of treatment should\r\nbe appropriate to the indication and should not usually exceed 14\r\ndays", "side-effects": "Side-effects\u00a0see under Ampicillin; hepatitis,\r\ncholestatic jaundice (see above); Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, exfoliative dermatitis, vasculitis reported;\r\nrarely prolongation of bleeding time, dizziness, headache, convulsions\r\n(particularly with high doses or in renal impairment); superficial\r\nstaining of teeth with suspension, phlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85365.htm", "doses": [ "By mouth, expressed as co-amoxiclav, one 250/125 strength tablet every 8 hours; increased\r\nin severe infection to one 500/125 strength tablet\r\nevery 8 hours; neonate 0.25\u00a0mL/kg of 125/31 suspension every 8 hours; child 1 month\u20131 year, 0.25\u00a0mL/kg of 125/31 suspension\r\nevery 8 hours, dose doubled in severe infection; 1\u20136 years, 5\u00a0mL of 125/31 suspension every 8 hours or 0.25\u00a0mL/kg\r\nof 125/31 suspension every 8 hours, dose doubled\r\nin severe infection; 6\u201312 years, 5\u00a0mL of 250/62 suspension\r\nevery 8 hours or 0.15\u00a0mL/kg of 250/62 suspension every 8 hours, dose doubled in severe infection", "Severe dental infections (but not generally first-line, see notes above), expressed\r\nas co-amoxiclav, adult and child over 12 years, one 250/125 strength tablet every 8 hours for 5 days", "By intravenous injection over 3\u20134\r\nminutes or by intravenous infusion, expressed as co-amoxiclav, 1.2\u00a0g every 8 hours; neonate 30\u00a0mg/kg every 12 hours; child 1\u20133 months 30\u00a0mg/kg every 12 hours; child 3 months\u201318 years, 30\u00a0mg/kg (max. 1.2\u00a0g) every 8 hours", "Surgical prophylaxis, expressed as co-amoxiclav, 1.2\u00a0g up to 30 minutes before the procedure; for high risk procedures\r\nup to 2\u20133 further doses of 1.2\u00a0g may be given every 8 hours" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "METHOTREXATE - ANTIMETABOLITES": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nMethotrexate inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines. It is given by mouth, intravenously, intramuscularly, or intrathecally.Methotrexate is used as maintenance therapy for childhood acute lymphoblastic leukaemia. Other uses include choriocarcinoma, non-Hodgkin\u2019s lymphoma, and a number of solid tumours. Intrathecal methotrexate is used in the CNS prophylaxis of childhood acute lymphoblastic leukaemia, and as a therapy for established meningeal cancer or lymphoma.Methotrexate causes myelosuppression, mucositis, and rarely pneumonitis. It is contra-indicated in significant renal impairment because it is excreted primarily by the kidney. It is also contra-indicated in patients with severe hepatic impairment. It should also be avoided in the presence of significant pleural effusion or ascites because it can accumulate in these fluids, and its subsequent return to the circulation may cause myelosuppression. Systemic toxicity may follow intrathecal administration and blood counts should be carefully monitored.Folinic acid (section 8.1) following methotrexate administration helps to prevent methotrexate-induced mucositis or myelosuppression. and under Dose; Crohn\u2019s disease [unlicensed indication] (%s\n(From METHOTREXATE: British National Formulary)\nMETHOTREXATE); rheumatoid arthritis (%s\n(From 10.1.3 Drugs that suppress the rheumatic disease process: British National Formulary)\n10.1.3 Drugs that suppress the rheumatic disease process); psoriasis\r\n(%s\n(From 13.5.2 Preparations for psoriasis: British National Formulary)\n13.5.2 Preparations for psoriasis)", "name": "METHOTREXATE - ANTIMETABOLITES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1, notes above and section 10.1.3; interactions: Appendix 1 (methotrexate)", "side-effects": "Side-effects\u00a0see section 8.1, notes above and section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4737.htm", "doses": [ "By mouth, leukaemia in children (maintenance),\r\n15\u00a0mg/m2 weekly in combination with other drugs", "Note that the above dose is a weekly dose.", "By intravenous injection or infusion, or by intra-arterial\r\ninfusion, or by intramuscular injection, or intrathecal administration,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic; fertility may be reduced during\r\ntherapy but this may be reversible); manufacturer advises effective\r\ncontraception during and for at least 3 months after treatment in\r\nmen or women; see also Pregnancy and Reproductive\r\nFunction" }, "VERAPAMIL HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose and preparations", "name": "VERAPAMIL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "VERAPAMIL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0first-degree AV block; acute phase of myocardial infarction (avoid if bradycardia, hypotension, left ventricular\r\nfailure); patients taking beta-blockers (important: see below); interactions: Appendix 1 (calcium-channel blockers)Verapamil and beta-blockers\u00a0Verapamil injection should not be given to patients recently treated with\r\nbeta-blockers because of the risk of hypotension and asystole. The\r\nsuggestion that when verapamil injection has been given first, an\r\ninterval of 30 minutes before giving a beta-blocker is sufficient\r\nhas not been confirmed.It may also be hazardous to give verapamil and a beta-blocker\r\ntogether by mouth (should only be contemplated if myocardial function\r\nwell preserved).", "side-effects": "Side-effects\u00a0constipation; less commonly nausea, vomiting,\r\nflushing, headache, dizziness, fatigue, ankle oedema; rarely allergic\r\nreactions (erythema, pruritus, urticaria, angioedema, Stevens-Johnson\r\nsyndrome); myalgia, arthralgia, paraesthesia, erythromelalgia; increased\r\nprolactin concentration; rarely gynaecomastia and gingival hyperplasia\r\nafter long-term treatment; after intravenous administration or high\r\ndoses, hypotension, heart failure, bradycardia, heart block, and asystole; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2703.htm", "doses": [ "By mouth, supraventricular arrhythmias\r\n(but see also Contra-indications), 40\u2013120\u00a0mg 3 times daily", "Angina, 80\u2013120\u00a0mg 3 times daily", "Hypertension, 240\u2013480\u00a0mg daily in 2\u20133 divided doses", "Prophylaxis of cluster headache [unlicensed] (under specialist\r\nsupervision), 240\u2013960\u00a0mg daily in 3\u20134 divided doses", "By slow intravenous injection over\r\n2 minutes (3 minutes in elderly), supraventricular arrhythmias (but\r\nsee also Contra-indications), 5\u201310\u00a0mg (preferably with ECG monitoring);\r\nin paroxysmal tachyarrhythmias a further 5\u00a0mg after 5\u201310 minutes if\r\nrequired" ], "pregnancy": "Pregnancy\u00a0may reduce uterine blood flow with fetal hypoxia;\r\nmanufacturer advises avoid in first trimester unless absolutely necessary;\r\nmay inhibit labour" }, "OMEPRAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "OMEPRAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.5 Proton pump inhibitors", "OMEPRAZOLE" ], "cautions": "Cautions\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nCautions\u00a0Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.; interactions: Appendix 1 (proton pump inhibitors)", "side-effects": "Side-effects\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nSide-effects\u00a0Side-effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.; also agitation and impotence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106487.htm", "doses": [ "By mouth, benign gastric and duodenal\r\nulcers, 20\u00a0mg once daily for 4 weeks in duodenal ulceration or 8 weeks\r\nin gastric ulceration; in severe or recurrent cases increase to 40\u00a0mg\r\ndaily; prevention of relapse in gastric ulcer, 20\u00a0mg once daily, increased\r\nto 40\u00a0mg once daily if necessary; prevention of relapse in duodenal\r\nulcer, 20\u00a0mg once daily (range 10\u201340\u00a0mg daily)", "NSAID-associated duodenal or gastric ulcer and gastroduodenal\r\nerosions, 20\u00a0mg once daily for 4 weeks, continued for further 4 weeks\r\nif not fully healed; prophylaxis in patients with a history of NSAID-associated\r\nduodenal or gastric ulcers, gastroduodenal lesions, or dyspeptic symptoms\r\nwho require continued NSAID treatment, 20\u00a0mg once daily", "Duodenal or benign gastric ulcer associated with Helicobacter\r\npylori, see Recommended Regimens for Helicobacter pylori Eradication", "Zollinger\u2013Ellison syndrome, initially 60\u00a0mg once daily; usual\r\nrange 20\u2013120\u00a0mg daily (above 80\u00a0mg in 2 divided doses)", "Gastric acid reduction during general anaesthesia (prophylaxis\r\nof acid aspiration), 40\u00a0mg on the preceding evening then 40\u00a0mg 2\u20136\r\nhours before surgery", "Gastro-oesophageal reflux disease, 20\u00a0mg once daily for 4 weeks,\r\ncontinued for further 4\u20138 weeks if not fully healed; 40\u00a0mg once daily\r\nhas been given for 8 weeks in gastro-oesophageal reflux disease refractory\r\nto other treatment; maintenance 20\u00a0mg once daily", "Acid reflux disease (long-term management), 10\u00a0mg daily increasing\r\nto 20\u00a0mg once daily if symptoms return", "Acid-related dyspepsia, 10\u201320\u00a0mg once daily for 2\u20134 weeks according\r\nto response", "Severe ulcerating reflux oesophagitis, child over 1 year, body-weight 10\u201320\u00a0kg, 10\u00a0mg once daily increased if\r\nnecessary to 20\u00a0mg once daily for 4\u201312 weeks; body-weight over 20\u00a0kg,\r\n20\u00a0mg once daily increased if necessary to 40\u00a0mg once daily for 4\u201312\r\nweeks; to be initiated by hospital paediatrician", "By intravenous injection over 5 minutes or by intravenous infusion over 20\u201330 minutes,\r\nprophylaxis of acid aspiration [unlicensed indication], 40\u00a0mg completed\r\n1 hour before surgery", "Treatment and prevention of benign gastric ulcers, duodenal\r\nulcers, or NSAID-associated ulcers, gastro-oesophageal reflux disease,\r\n40\u00a0mg once daily until oral administration possible", "Zollinger-Ellison syndrome, initially 60\u00a0mg once daily, adjusted\r\naccording to response; daily doses above 60\u00a0mg given in 2 divided\r\ndoses", "Major peptic ulcer bleeding (following endoscopic treatment)\r\n[unlicensed indication], initial intravenous infusion of 80\u00a0mg over 40\u201360 minutes, then by continuous intravenous\r\ninfusion, 8\u00a0mg/hour for 72 hours (then change to oral therapy)", "Swallow whole, or disperse MUPS\u00ae tablets in water, or mix capsule contents or MUPS\u00ae tablets with fruit\r\njuice or yoghurt. Preparations consisting of an e/c tablet within\r\na capsule should not be opened" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "OMEGA-3-ACID ETHYL ESTERS": { "indications": "Indications\u00a0adjunct to diet and statin in type\r\nIIb or III hypertriglyceridaemia; adjunct to diet in type IV hypertriglyceridaemia;\r\nadjunct in secondary prevention in those who have had a myocardial\r\ninfarction in the preceding 3 months", "name": "OMEGA-3-ACID ETHYL ESTERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Omega-3 fatty acid compounds" ], "cautions": "Cautions\u00a0haemorrhagic disorders, anticoagulant treatment (bleeding time increased)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; less commonly taste disturbances, dizziness, and hypersensitivity reactions; rarely hepatic disorders, headache, hyperglycaemia, acne,\r\nand rash; very rarely hypotension, nasal dryness,\r\nurticaria, and increased white cell count", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112800.htm", "doses": [ "See under preparation below" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "VALGANCICLOVIR": { "indications": "Indications\u00a0induction and maintenance treatment\r\nof cytomegalovirus retinitis in AIDS patients; prevention of cytomegalovirus\r\ndisease following solid organ transplantation from a cytomegalovirus-positive\r\ndonor.", "name": "VALGANCICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.2 Cytomegalovirus infection" ], "cautions": "Cautions\u00a0see under Ganciclovir", "side-effects": "Side-effects\u00a0see under Ganciclovir", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106526.htm", "doses": [ "CMV retinitis, induction, adult over 18 years, 900\u00a0mg twice daily for 21 days then 900\u00a0mg once daily;\r\ninduction regimen may be repeated if retinitis progresses", "Prevention of cytomegalovirus disease following solid organ\r\ntransplantation (starting within 10 days of transplantation), adult over 18 years, 900\u00a0mg once daily for 100 days\r\n(for 100\u2013200 days following kidney transplantation)", "Oral valganciclovir 900\u00a0mg twice daily is\r\nequivalent to intravenous ganciclovir 5\u00a0mg/kg twice daily" ], "pregnancy": "Pregnancy\u00a0see under Ganciclovir" }, "MIZOLASTINE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, urticaria", "name": "MIZOLASTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines", "MIZOLASTINE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; weight\r\ngain; anxiety, asthenia; less commonly arthralgia\r\nand myalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68615.htm", "doses": [ "adult and child over 12 years, 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "HEPARIN": { "indications": "Indications\u00a0see under Dose", "name": "HEPARIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Heparin", "HEPARIN" ], "cautions": "Cautions\u00a0\n(From Heparin: British National Formulary)\nHeparin; also elderly; concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (heparin)Heparin-induced thrombocytopenia\u00a0Clinically important\r\nheparin-induced thrombocytopenia is immune-mediated and does not usually\r\ndevelop until after 5\u201310 days; it can be complicated by thrombosis. Platelet counts should be measured just before treatment with unfractionated\r\nor low molecular weight heparin, and regular monitoring\r\nof platelet counts is recommended if given for longer than 4 days. Signs of heparin-induced thrombocytopenia include a 50% reduction\r\nof platelet count, thrombosis, or skin allergy. If heparin-induced\r\nthrombocytopenia is strongly suspected or confirmed, the heparin should be stopped and an alternative\r\nanticoagulant, such as lepirudin or danaparoid, should be given. Ensure platelet counts return to normal range in those who require\r\nwarfarin Hyperkalaemia\u00a0Inhibition of aldosterone\r\nsecretion by unfractionated or low molecular weight heparin can result\r\nin hyperkalaemia; patients with diabetes mellitus, chronic renal failure, acidosis,\r\nraised plasma potassium or those taking potassium-sparing drugs seem\r\nto be more susceptible. The risk appears to increase with duration\r\nof therapy, and plasma-potassium concentration should\r\nbe measured in patients at risk of hyperkalaemia before starting the heparin and monitored regularly thereafter, particularly\r\nif treatment is to be continued for longer than 7 days", "side-effects": "Side-effects\u00a0haemorrhage (\n(From Heparin: British National Formulary)\nHaemorrhage\u00a0If haemorrhage occurs it is usually sufficient to withdraw unfractionated or low molecular weight heparin, but if rapid reversal of the effects of the heparin is required, protamine sulphate (section 2.8.3) is a specific antidote (but only partially reverses the effects of low molecular weight heparins).), thrombocytopenia (see Cautions), rarely rebound hyperlipidaemia following unfractionated\r\nheparin withdrawal, priapism, hyperkalaemia (see Cautions), osteoporosis\r\n(risk lower with low molecular weight heparins), alopecia on prolonged\r\nuse, injection-site reactions, skin necrosis, and hypersensitivity\r\nreactions (including urticaria, angioedema, and anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202618.htm", "doses": [ "Treatment of deep-vein thrombosis, pulmonary embolism,\r\nunstable angina, and acute peripheral arterial occlusion, by\r\nintravenous injection, loading dose of 5000\u00a0units or 75\u00a0units/kg (10\u00a0000\u00a0units in severe pulmonary embolism),\r\nfollowed by continuous intravenous infusion of 18\u00a0units/kg/hour or treatment of deep-vein thrombosis, by subcutaneous\r\ninjection of 15\u00a0000\u00a0units every 12 hours (laboratory monitoring\r\nessential\u2014preferably on a daily basis, and dose adjusted accordingly); child under 18 years see BNF for Children", "Thromboprophylaxis in medical patients (see also notes above), by subcutaneous injection, 5000\u00a0units every 8\u201312 hours", "Thrombophylaxis in surgical patients (see also notes above), by subcutaneous injection, 5000\u00a0units 2 hours before surgery,\r\nthen every 8\u201312 hours", "Thromboprophylaxis during pregnancy, (but see notes above), by subcutaneous injection, 5000\u201310\u00a0000\u00a0units every 12 hours\r\n(with monitoring); important: prevention of prosthetic\r\nheart-valve thrombosis in pregnancy calls for specialist management", "Haemodialysis by intravenous injection initially\r\n1000\u20135000\u00a0units, followed by continuous intravenous infusion of 250\u20131000\u00a0units/hour", "Myocardial infarction, see section 2.10.1", "Prevention of clotting in extracorporeal circuits, consult product\r\nliterature", "Doses above take into account the guidelines of the\r\nBritish Society for Haematology; for doses of the low molecular weight\r\nheparins, see under Low Molecular Weight Heparins " ], "pregnancy": "Pregnancy\u00a0does not cross the placenta; maternal osteoporosis\r\nreported after prolonged use; multidose vials may contain benzyl alcohol\u2014some\r\nmanufacturers advise avoid; see also notes above" }, "Supplementary preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.3 Intravenous nutrition" ], "name": "Supplementary preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/55990.htm", "doses": [ "amino acid supplement for hypercatabolic or hypermetabolic\r\nstates, 300\u2013400\u00a0mg/kg daily; max. 400\u00a0mg/kg daily, dose not to exceed\r\n20% of total amino acid intake" ] }, "DIDANOSINE": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "DIDANOSINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "DIDANOSINE" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also history\r\nof pancreatitis (preferably avoid, otherwise extreme caution, see\r\nalso below); peripheral neuropathy or hyperuricaemia (see under Side-effects); ophthalmological examination (including visual acuity, colour vision,\r\nand dilated fundus examination) recommended annually or if visual changes occur; interactions: Appendix 1 (didanosine)Pancreatitis\u00a0Suspend\r\ntreatment if serum lipase raised (even if asymptomatic) or if symptoms\r\nof pancreatitis develop; discontinue if pancreatitis confirmed. Whenever possible avoid concomitant treatment\r\nwith other drugs known to cause pancreatic toxicity (e.g. intravenous pentamidine isetionate); monitor closely if concomitant\r\ntherapy unavoidable. Since significant elevations of\r\ntriglycerides cause pancreatitis monitor closely if elevated", "side-effects": "Side-effects\u00a0see notes above; also pancreatitis (see also under\r\nCautions), liver failure, non-cirrhotic portal hypertension, anaphylactic\r\nreactions, peripheral neuropathy (switch to another antiretroviral\r\nif peripheral neuropathy develops), diabetes mellitus, hypoglycaemia,\r\nacute renal failure, rhabdomyolysis, dry eyes, retinal and optic nerve\r\nchanges, dry mouth, parotid gland enlargement, sialadenitis, alopecia,\r\nhyperuricaemia (suspend if raised significantly)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/21586.htm", "doses": [ "adult under 60\u00a0kg 250\u00a0mg\r\ndaily in 1\u20132 divided doses, 60\u00a0kg and over 400\u00a0mg daily in 1\u20132 divided\r\ndoses; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "PREDNISOLONE SODIUM PHOSPHATE": { "indications": "Indications\u00a0eczematous inflammation in otitis externa (see notes\r\nabove)", "name": "PREDNISOLONE SODIUM PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "PREDNISOLONE SODIUM PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31415.htm", "doses": [ "ear, apply 2\u20133 drops every 2\u20133 hours; reduce\r\nfrequency when relief obtained; eye, section 11.4.1" ] }, "OESTROGENS FOR HRT Conjugated oestrogens with progestogen": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT Conjugated oestrogens with progestogen", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT", "Conjugated oestrogens with progestogen" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/36177.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch", "menopausal symptoms and osteoporosis prophylaxis (see section 6.6),\r\nin women with a uterus, 1 tablet daily continuously", "Name[Premique\u00ae (Wyeth) ] Premique\u00ae Low Dose tablets, m/r,\r\nivory, s/c, conjugated oestrogen (equine) 300\u00a0micrograms and medroxyprogesterone acetate 1.5\u00a0mg, net price 3 \u00d7 28-tab\r\npack = \u00a36.52 Dose\u00a0 menopausal symptoms in women with a uterus, 1 tablet\r\ndaily continuously\nPremique\u00ae tablets, s/c, blue, conjugated\r\noestrogen (equine) 625\u00a0micrograms and medroxyprogesterone\r\nacetate 5\u00a0mg, net price 3 \u00d7 28-tab pack = \u00a310.61Dose\u00a0menopausal symptoms and osteoporosis prophylaxis (see section 6.6),\r\nin women with a uterus, 1 tablet daily continuously" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "DESFERRIOXAMINE MESILATE": { "indications": "Indications\u00a0iron poisoning; chronic\r\niron overload (section 9.1.3)", "name": "DESFERRIOXAMINE MESILATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Iron salts" ], "cautions": "Cautions\u00a0section 9.1.3", "side-effects": "Side-effects\u00a0section\r\n9.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29544.htm", "doses": [ "By continuous intravenous infusion, adult and child up\r\nto 15\u00a0mg/kg/hour, reduced after 4\u20136 hours; max. 80\u00a0mg/kg in 24 hours\r\n(in severe cases, higher doses on advice from the National Poisons\r\nInformation Service)" ], "pregnancy": "Pregnancy\u00a0section 9.1.3" }, "NIZATIDINE": { "indications": "Indications\u00a0see under Dose", "name": "NIZATIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.1 H2-receptor antagonists" ], "cautions": "Cautions\u00a0see notes above; also avoid rapid intravenous\r\ninjection (risk of arrhythmias and postural hypotension); interactions: Appendix 1 (histamine H2-antagonists) and notes above", "side-effects": "Side-effects\u00a0see notes above; also sweating; rarely nausea, fever, vasculitis, hyperuricaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2121.htm", "doses": [ "Benign gastric, duodenal or NSAID-associated ulceration,\r\ntreatment, 300\u00a0mg in the evening or 150\u00a0mg twice\r\ndaily for 4\u20138 weeks; maintenance, 150\u00a0mg at night", "Gastro-oesophageal reflux disease, 150\u2013300\u00a0mg twice daily for\r\nup to 12 weeks", "child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "TICARCILLIN WITH CLAVULANIC ACID": { "indications": "Indications\u00a0infections due to Pseudomonas and Proteus spp, see notes above", "name": "TICARCILLIN WITH CLAVULANIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.4 Antipseudomonal penicillins" ], "cautions": "Cautions\u00a0see under Benzylpenicillin (section 5.1.1.1); interactions: Appendix 1 (penicillins)Cholestatic jaundice\u00a0For a warning on cholestatic\r\njaundice possibly associated with clavulanic acid, see under Co\u2013amoxiclav.", "side-effects": "Side-effects\u00a0see under Benzylpenicillin (section 5.1.1.1); also\r\nnausea, vomiting, coagulation disorders, haemorrhagic cystitis (more\r\nfrequent in children), injection-site reactions, Stevens-Johnson syndrome,\r\ntoxic epidermal necrolysis, hypokalaemia, eosinophilia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204187.htm", "doses": [ "Expressed as a combination of ticarcillin\r\n(as sodium salt) and clavulanic acid (as potassium salt) in a ratio\r\nof 15:1", "By intravenous infusion, 3.2\u00a0g every 6\u20138 hours\r\nincreased to every 4 hours in more severe infections; child 1 month\u201318 years, body-weight under 40\u00a0kg,\r\n80\u00a0mg/kg every 8 hours, increased to every 6 hours in more severe\r\ninfections; body-weight over 40\u00a0kg, adult dose" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "SILDENAFIL": { "indications": "Indications\u00a0pulmonary arterial hypertension; erectile\r\ndysfunction (section 7.4.5)", "name": "SILDENAFIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs" ], "cautions": "Cautions\u00a0hypotension (avoid if systolic blood pressure below 90\u00a0mmHg); intravascular volume depletion; left ventricular\r\noutflow obstruction; cardiovascular disease; autonomic dysfunction; pulmonary veno-occlusive disease; anatomical\r\ndeformation of the penis, predisposition\r\nto priapism; bleeding disorders or active peptic ulceration; consider gradual withdrawal; interactions: Appendix 1 (sildenafil)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth; flushing,\r\noedema; bronchitis, cough; headache, migraine, night sweats, paraesthesia,\r\ninsomnia, anxiety, tremor, vertigo; fever, influenza-like symptoms;\r\nanaemia; back and limb pain, myalgia; visual disturbances, retinal\r\nhaemorrhage, photophobia, painful red eyes; nasal congestion, epistaxis;\r\ncellulitis, alopecia; less commonly gynaecomastia,\r\npriapism; also reported rash, retinal vascular occlusion\r\nand non-arteritic anterior ischaemic optic neuropathy (discontinue\r\nif sudden visual impairment), and sudden hearing loss (advise patient\r\nto seek medical help)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129680.htm", "doses": [ "By mouth, 20\u00a0mg 3 times daily; child under 18 years see BNF for Children", "By intravenous injection, when oral route not\r\nappropriate, 10\u00a0mg three times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no evidence of harm in animal studies" }, "ATRACURIUM BESILATE": { "indications": "Indications\u00a0neuromuscular blockade (short to intermediate duration) for surgery\r\nor during intensive care ", "name": "ATRACURIUM BESILATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.; seizures\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6650.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "Intubation and surgery, adult and child over 1 month, by\r\nintravenous injection, initially 300\u2013600\u00a0micrograms/kg, then\r\n100\u2013200\u00a0micrograms/kg as required or initially by intravenous injection, 200\u2013600\u00a0micrograms/kg followed by intravenous infusion, 300\u2013600\u00a0micrograms/kg/hour", "Intensive care, adult and child over 1 month, by intravenous injection, initially 300\u2013600\u00a0micrograms/kg (optional) then by intravenous\r\ninfusion 270\u20131770\u00a0micrograms/kg/hour (usual dose 650\u2013780\u00a0micrograms/kg/hour)" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "ESTRAMUSTINE PHOSPHATE": { "indications": "Indications\u00a0prostate cancer", "name": "ESTRAMUSTINE PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs" ], "cautions": "Cautions\u00a0see section 8.1; congestive heart failure; diabetes; hypertension; epilepsy; hypercalcaemia; avoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(estramustine)", "side-effects": "Side-effects\u00a0see section 8.1; also diarrhoea; congestive heart\r\nfailure, ischaemic heart disease, myocardial infarction; oedema (rarely\r\nangioneurotic) impotence, gynaecomastia; altered liver function", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4687.htm", "doses": [ "0.14\u20131.4\u00a0g daily in divided doses (usual initial dose\r\n560\u2013840\u00a0mg daily)", "Each dose should be taken not less\r\nthan 1 hour before or 2 hours after meals and should not be taken\r\nwith dairy products" ] }, "ROSUVASTATIN": { "indications": "Indications\u00a0primary hypercholesterolaemia (type IIa including heterozygous familial\r\nhypercholesterolaemia), mixed dyslipidaemia (type IIb), or homozygous\r\nfamilial hypercholesterolaemia in patients who have not responded\r\nadequately to diet and other appropriate measures; prevention of cardiovascular\r\nevents in patients at high risk of a first cardiovascular event", "name": "ROSUVASTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ; patients of Asian\r\norigin (see under Dose); max. dose 20\u00a0mg in patients\r\nwith risk factors for myopathy or rhabdomyolysis\r\n(including personal or family history of muscular disorders or toxicity)", "side-effects": "Side-effects\u00a0\n(From Statins: British National Formulary)\nSide-effects\u00a0The statins have been associated with myalgia, myopathy, myositis, and rhabdomyolysis (see Muscle Effects below). Statins can alter liver function tests, and rarely cause hepatitis and jaundice; pancreatitis and hepatic failure have been reported very rarely. Other side-effects include gastro-intestinal disturbances, sleep disturbance, headache, dizziness, depression, paraesthesia, asthenia, peripheral neuropathy, amnesia, fatigue, sexual dysfunction, thrombocytopenia, arthralgia, visual disturbance, alopecia, and hypersensitivity reactions (including rash, pruritus, urticaria, and very rarely lupus erythematosus-like reactions). In very rare cases, statins can cause interstitial lung disease; if patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.Muscle effects\u00a0The risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare. Although myalgia has been reported commonly in patients receiving statins, muscle toxicity truly attributable to statin use is rare. Muscle toxicity can occur with all statins, however the likelihood increases with higher doses and in certain patients (see below). Statins should be used with caution in patients at increased risk of muscle toxicity, including those with a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. There is an increased incidence of myopathy if a statin is given at a high dose, or if it is given with a fibrate (the combination of a statin and gemfibrozil should preferably be avoided), with lipid-lowering doses of nicotinic acid, with fusidic acid (risk of rhabdomyolysis\u2014the combination of a statin and fusidic acid should be avoided; temporarily discontinue statin and restart 7 days after last fusidic acid dose), or with drugs that increase the plasma-statin concentration, such as macrolide antibiotics, imidazole and triazole antifungals, and ciclosporin\u2014see interactions: Appendix 1 (statins); close monitoring of liver function and, if muscular symptoms occur, of creatine kinase is necessary. In patients at increased risk of muscle effects, a statin should not usually be started if the baseline creatine kinase concentration is more than 5 times the upper limit of normal (some patients may present with an extremely elevated baseline creatine kinase concentration, due to e.g. a physical occupation, or rigorous exercise\u2014specialist advice should be sought regarding consideration of statin therapy in these patients).If muscular symptoms or raised creatine kinase occur during treatment, other possible causes (e.g. rigorous physical activity, hypothyroidism, infection, recent trauma, and drug or alcohol addiction) should be excluded before statin therapy is implicated. When a statin is suspected to be the cause of myopathy, and creatine kinase concentration is markedly elevated (more than 5 times upper limit of normal), or if muscular symptoms are severe, treatment should be discontinued. If symptoms resolve and creatine kinase concentrations return to normal, the statin should be reintroduced at a lower dose and the patient monitored closely; an alternative statin should be prescribed if unacceptable side-effects are experienced with a particular statin. Statins should not be discontinued in the event of small, asymptomatic elevations of creatine kinase. Routine monitoring of creatine kinase is unnecessary in asymptomatic patients.; also diabetes mellitus; proteinuria; very rarely haematuria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128042.htm", "doses": [ "Hypercholesterolaemia, initially 5\u201310\u00a0mg once daily increased\r\nif necessary at intervals of at least 4 weeks to 20\u00a0mg once daily,\r\nincreased after further 4 weeks to 40\u00a0mg daily only in severe hypercholesterolaemia\r\nwith high cardiovascular risk and under specialist supervision; elderly initially 5\u00a0mg once daily; patient of asian origin, initially 5\u00a0mg once daily increased\r\nif necessary to max. 20\u00a0mg daily; child under 18 years see BNF\r\nfor Children", "Initially 5\u00a0mg once daily with concomitant\r\nfibrate increased if necessary to max. 20\u00a0mg daily", "Prevention of cardiovascular events, 20\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "CILOSTAZOL": { "indications": "Indications\u00a0intermittent claudication in patients without rest pain and no peripheral\r\ntissue necrosis (but see notes above)", "name": "CILOSTAZOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs", "CILOSTAZOL" ], "cautions": "Cautions\u00a0atrial or ventricular\r\nectopy, atrial fibrillation, atrial flutter; diabetes\r\nmellitus (higher risk of intra-ocular bleeding); concomitant drugs that increase risk of bleeding; interactions: Appendix 1 (cilostazol)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; tachycardia, palpitation,\r\nangina, arrhythmia, chest pain, oedema; rhinitis; dizziness, headache;\r\nasthenia; rash, pruritus, ecchymosis; less commonly gastritis, congestive heart failure, postural hypotension, dyspnoea,\r\npneumonia, cough, insomnia, abnormal dreams, anxiety, hyperglycaemia,\r\ndiabetes mellitus, anaemia, haemorrhage, myalgia, hypersensitivity\r\nreactions (including Stevens-Johnson syndrome and toxic epidermal\r\nnecrolysis in rare cases); rarely anorexia, hypertension,\r\nparesis, increased urinary frequency, bleeding disorders, renal impairment,\r\nconjunctivitis, tinnitus, and jaundice", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119727.htm", "doses": [ "100\u00a0mg twice daily (30 minutes before or 2 hours after\r\nfood)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "TELITHROMYCIN": { "indications": "Indications\u00a0 see notes above", "name": "TELITHROMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides", "Telithromycin", "TELITHROMYCIN" ], "cautions": "Cautions\u00a0 coronary heart disease, ventricular arrhythmias, bradycardia, hypokalaemia,\r\nhypomagnesaemia\u2014risk of QT interval prolongation; concomitant\r\nadministration of drugs that prolong QT-interval; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (telithromycin) Hepatic disorders\u00a0Patients should\r\nbe told how to recognise signs of liver disorder, and advised to discontinue\r\ntreatment and seek prompt medical attention if symptoms such as anorexia,\r\nnausea, vomiting, abdominal pain, jaundice, or dark urine developDriving\u00a0Visual disturbances or transient\r\nloss of consciousness may affect performance of skilled tasks (e.g.\r\ndriving); effects may occur after the first dose. Administration at\r\nbedtime may reduce these side-effects. Patients should be advised\r\nnot to drive or operate machinery if affected", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, flatulence, abdominal\r\npain, taste disturbances; dizziness, headache; less commonly constipation, stomatitis, anorexia, hepatitis, flushing, palpitations,\r\ndrowsiness, insomnia, nervousness, eosinophilia, blurred vision, rash,\r\nurticaria, and pruritus; rarely cholestatic jaundice,\r\narrhythmias, hypotension, transient loss of consciousness, paraesthesia,\r\nand diplopia; very rarely antibiotic-associated colitis,\r\naltered sense of smell, muscle cramp, erythema multiforme; also reported\r\npancreatitis, confusion, hallucinations and arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106519.htm", "doses": [ " 800\u00a0mg once daily for 5 days for sinusitis or exacerbation\r\nof chronic bronchitis or for 7\u201310 days in community-acquired\r\npneumonia; child under 18 years safety\r\nand efficacy not established", "Tonsillitis or pharyngitis caused by Streptococcus\r\npyogenes, adult and child over 12 years, 800\u00a0mg once daily for 5 days" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises use only if potential benefit outweighs risk" }, "PENICILLAMINE - PENICILLAMINE": { "indications": "Indications\u00a0see notes above and under Dose", "name": "PENICILLAMINE - PENICILLAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Penicillamine" ], "cautions": "Cautions\u00a0\n(From Penicillamine: British National Formulary)\nPenicillamine has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common.Patients should be warned not to expect improvement for at least 6 to 12 weeks after treatment is initiated. Penicillamine should be discontinued if there is no improvement within 1 year.Blood counts, including platelets, and urine examinations should be carried out before starting treatment and then every 1 or 2 weeks for the first 2 months then every 4 weeks to detect blood disorders and proteinuria (they should also be carried out in the week after any dose increase). A reduction in platelet count calls for discontinuation with subsequent re-introduction at a lower dosage and then, if possible, gradual increase. Proteinuria, associated with immune complex nephritis, occurs in up to 30% of patients, but may resolve despite continuation of treatment; treatment may be continued provided that renal function tests remain normal, oedema is absent, and the 24-hour urinary excretion of protein does not exceed 2\u00a0g.Nausea may occur but is not usually a problem provided that penicillamine is taken before food or on retiring and that low initial doses are used and only gradually increased. Loss of taste can occur about 6 weeks after treatment is started but usually returns 6 weeks later irrespective of whether treatment is discontinued; mineral supplements are not recommended. Rashes are a common side-effect. Those that occur in the first few months of treatment disappear when the drug is stopped and treatment may then be re-introduced at a lower dose level and gradually increased. Late rashes are more resistant and often necessitate discontinuation of treatment.Patients who are hypersensitive to penicillin may react rarely to penicillamine.; concomitant nephrotoxic\r\ndrugs (increased risk of toxicity); gold\r\ntreatment (avoid concomitant use if adverse reactions to gold); interactions: Appendix 1 (penicillamine)Blood counts and urine tests\u00a0See %s\n(From Penicillamine: British National Formulary)\nPenicillamine has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common.Patients should be warned not to expect improvement for at least 6 to 12 weeks after treatment is initiated. Penicillamine should be discontinued if there is no improvement within 1 year.Blood counts, including platelets, and urine examinations should be carried out before starting treatment and then every 1 or 2 weeks for the first 2 months then every 4 weeks to detect blood disorders and proteinuria (they should also be carried out in the week after any dose increase). A reduction in platelet count calls for discontinuation with subsequent re-introduction at a lower dosage and then, if possible, gradual increase. Proteinuria, associated with immune complex nephritis, occurs in up to 30% of patients, but may resolve despite continuation of treatment; treatment may be continued provided that renal function tests remain normal, oedema is absent, and the 24-hour urinary excretion of protein does not exceed 2\u00a0g.Nausea may occur but is not usually a problem provided that penicillamine is taken before food or on retiring and that low initial doses are used and only gradually increased. Loss of taste can occur about 6 weeks after treatment is started but usually returns 6 weeks later irrespective of whether treatment is discontinued; mineral supplements are not recommended. Rashes are a common side-effect. Those that occur in the first few months of treatment disappear when the drug is stopped and treatment may then be re-introduced at a lower dose level and gradually increased. Late rashes are more resistant and often necessitate discontinuation of treatment.Patients who are hypersensitive to penicillin may react rarely to penicillamine.. Longer intervals may be adequate\r\nin cystinuria and Wilson\u2019s disease. Consider withdrawal\r\nif platelet count falls below 120\u00a0000/mm3 or white blood\r\ncells below 2500/mm3 or if 3 successive falls within reference\r\nrange (can restart at reduced dose when counts return\r\nto within reference range but permanent withdrawal necessary\r\nif recurrence of leucopenia or thrombocytopenia)Counselling\u00a0Warn patient to\r\ntell doctor promptly if sore throat, fever, infection, non-specific\r\nillness, unexplained bleeding and bruising, purpura, mouth ulcers,\r\nor rashes develop", "side-effects": "Side-effects\u00a0(see also notes above) initially nausea, anorexia, fever,\r\nand skin reactions; taste loss (mineral supplements not recommended);\r\nblood disorders including thrombocytopenia, leucopenia, agranulocytosis\r\nand aplastic anaemia; proteinuria, rarely haematuria (withdraw immediately\r\nand seek specialist advice); haemolytic anaemia, pancreatitis, cholestatic\r\njaundice, nephrotic syndrome, lupus erythematosus-like syndrome, myasthenia\r\ngravis-like syndrome, neuropathy, polymyositis (rarely with cardiac\r\ninvolvement), dermatomyositis, mouth ulcers, stomatitis, alopecia,\r\nbronchiolitis and pneumonitis, pemphigus, Goodpasture\u2019s syndrome,\r\nand Stevens-Johnson syndrome also reported; male and female breast\r\nenlargement reported; in non-rheumatoid conditions rheumatoid arthritis-like\r\nsyndrome also reported; late rashes (consider withdrawing treatment)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5295.htm", "doses": [ "Severe active rheumatoid arthritis, administered on expert\r\nadvice, adult over 18 years, initially\r\n125\u2013250\u00a0mg daily for 1 month increased by similar amounts at intervals\r\nof not less than 4 weeks to usual maintenance of 500\u2013750\u00a0mg daily\r\nin divided doses; max. 1.5\u00a0g daily; if remission sustained for 6 months,\r\nreduction of daily dose by 125\u2013250\u00a0mg every 12 weeks may be attempted; elderly initially up to 125\u00a0mg daily for 1 month\r\nincreased by similar amounts at intervals of not less than 4 weeks;\r\nmax. 1\u00a0g daily", "Wilson\u2019s disease, autoimmune hepatitis, and cystinuria, section 9.8.1" ], "pregnancy": "Pregnancy\u00a0fetal abnormalities reported rarely; avoid if possible" }, "NICOTINIC ACID": { "indications": "Indications\u00a0adjunct to statin in dyslipidaemia or\r\nused alone if statin not tolerated (see also lipid-regulating drugs)", "name": "NICOTINIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Nicotinic acid group", "NICOTINIC ACID" ], "cautions": "Cautions\u00a0unstable angina, acute myocardial infarction, diabetes\r\nmellitus, gout, history of peptic ulceration; interactions: Appendix 1 (nicotinic acid)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, abdominal pain, dyspepsia;\r\nflushing; pruritus, rash; less commonly tachycardia,\r\npalpitation, shortness of breath, peripheral oedema, headache, dizziness,\r\nincrease in uric acid, hypophosphataemia, prolonged prothrombin time,\r\nand reduced platelet count; rarely hypotension, syncope,\r\nrhinitis, insomnia, reduced glucose tolerance, myalgia, myopathy,\r\nmyasthenia; very rarely anorexia, rhabdomyolysis,\r\nvisual disturbance, and jaundice also reportedNote\u00a0Prostaglandin-mediated symptoms\r\n(such as flushing) can be reduced by low initial doses taken with\r\nmeals or, if patient taking aspirin, aspirin dose should be taken\r\n30 minutes before nicotinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204109.htm", "doses": [ "See under preparation" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid\r\nunless potential benefit outweighs risk" }, "PEGINTERFERON ALFA": { "indications": "Indications\u00a0see under preparations", "name": "PEGINTERFERON ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon alfa", "PEGINTERFERON ALFA" ], "cautions": "Cautions\u00a0consult product literature; interactions: Appendix 1 (interferons)", "side-effects": "Side-effects\u00a0\n(From Interferon alfa: British National Formulary)\nInterferon alfa and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106504.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturers recommend avoid unless potential benefit\r\noutweighs risk (toxicity in animal studies); effective\r\ncontraception required during treatment\u2014consult product literature" }, "BISACODYL": { "indications": "Indications\u00a0see under Dose", "name": "BISACODYL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "BISACODYL" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; nausea and vomiting; colitis also\r\nreported; suppositories, local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2208.htm", "doses": [ "Constipation, by mouth, 5\u201310\u00a0mg at\r\nnight, increased if necessary to max. 20\u00a0mg at night; child (but see section\r\n1.6) 4\u201318 years 5\u201320\u00a0mg once daily, adjusted according to response", "By rectum in suppositories, 10\u00a0mg in the morning; child (but see section\r\n1.6) 2\u201318 years 5\u201310\u00a0mg once daily, adjusted according to response", "Before radiological procedures and surgery, by mouth, 10\u00a0mg in the morning and 10\u00a0mg in the evening on\r\nthe day before procedure, and by rectum in suppositories,\r\n10\u00a0mg 1\u20132 hours before procedure the following day; child 4\u201318 years see BNF for Children", "tablets act in 10\u201312 hours; suppositories\r\nact in 20\u201360 minutes" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "IVABRADINE": { "indications": "Indications\u00a0treatment of angina in patients in\r\nnormal sinus rhythm (see notes above)", "name": "IVABRADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.3 Other antianginal drugs" ], "cautions": "Cautions\u00a0mild heart failure including asymptomatic left ventricular dysfunction; monitor\r\nfor atrial fibrillation or other arrhythmias (treatment\r\nineffective); hypotension (avoid if severe); retinitis pigmentosa; elderly; interactions: Appendix 1 (ivabradine)", "side-effects": "Side-effects\u00a0bradycardia, first-degree heart block, ventricular\r\nextrasystoles; headache, dizziness; visual disturbances including\r\nphosphenes and blurred vision; less commonly nausea,\r\nconstipation, diarrhoea, palpitations, supraventricular extrasystoles,\r\ndyspnoea, vertigo, muscle cramps, eosinophilia, hyperuricaemia, and\r\nraised plasma-creatinine concentration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129514.htm", "doses": [ "Initially 5\u00a0mg twice daily, increased if necessary after\r\n3\u20134 weeks to 7.5\u00a0mg twice daily (if not tolerated reduce dose to 2.5\u20135\u00a0mg\r\ntwice daily); elderly initially 2.5\u00a0mg\r\ntwice daily", "Ventricular rate at rest should not be allowed\r\nto fall below 50 beats per minute" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "AZTREONAM Parenteral": { "indications": "Indications\u00a0Gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria\r\nmeningitidis", "name": "AZTREONAM Parenteral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.3 Other beta-lactam antibiotics", "AZTREONAM", "Parenteral" ], "cautions": "Cautions\u00a0hypersensitivity to beta-lactam antibiotics; interactions: Appendix 1 (aztreonam)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before aztreonam; a bronchodilator\r\nshould be administered before each dose ", "side-effects": "Side-effects\u00a0Specific side-effects for parenteral treatment\u00a0Rarely gastro-intestinal bleeding, antibiotic-associated\r\ncolitis, jaundice, hepatitis, hypotension, chest pain, dyspnoea, seizures,\r\nparaesthesia, confusion, dizziness, asthenia, headache, insomnia,\r\nbreast tenderness, blood disorders (including thrombocytopenia and\r\nneutropenia), myalgia, diplopia, tinnitus, halitosis; also reported\r\nnausea, vomiting, abdominal pain, diarrhoea, mouth ulcers,\r\ntaste disturbances, flushing, bronchospasm, rash (including toxic\r\nepidermal necrolysis and erythema multiforme)Specific side-effects for inhaled treatment\u00a0Wheezing,\r\nbronchospasm, cough; pyrexia; rash; rhinorrhoea, pharyngolaryngeal\r\npain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3801.htm", "doses": [ "By deep intramuscular injection or by intravenous injection over 3\u20135 minutes or by intravenous infusion, 1\u00a0g every 8 hours or 2\u00a0g every 12 hours; 2\u00a0g every 6\u20138 hours for severe infections\r\n(including systemic Pseudomonas aeruginosa and\r\nlung infections in cystic fibrosis); single doses over 1\u00a0g intravenous\r\nroute only", "Urinary-tract infections, 0.5\u20131\u00a0g every 8\u201312 hours", "child over 1 week, by\r\nintravenous injection or infusion, 30\u00a0mg/kg every 6\u20138 hours increased in severe infections for child\r\nof 2 years or older to 50\u00a0mg/kg every 6\u20138 hours; max. 8\u00a0g daily", "Gonorrhoea, cystitis, by intramuscular injection, 1\u00a0g as a single dose", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult over 18 years, 75\u00a0mg 3 times daily (at least 4 hours apart) for\r\n28 days; if additional courses required, a minimum of 28 days without\r\naztreonam nebuliser solution recommended between courses", "Name[Azactam\u00ae (Squibb) ] Injection, powder for reconstitution, aztreonam, net price 1-g vial = \u00a39.40; 2-g vial = \u00a318.82" ], "pregnancy": "Pregnancy\u00a0no information available; manufacturer of injection\r\nadvises avoid; manufacturer of powder for nebuliser solution advises\r\navoid unless essential" }, "DIPIPANONE HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe pain", "name": "DIPIPANONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes mellitus; phaeochromocytoma", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\npsychosis, restlessness, raised intracranial pressure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3528.htm", "doses": [ "See preparation below" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "TRIAMCINOLONE ACETONIDE - TOPICAL CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "TRIAMCINOLONE ACETONIDE - TOPICAL CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5928.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity." }, "PROGESTERONE": { "indications": "Indications\u00a0see under preparations", "name": "PROGESTERONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens", "PROGESTERONE" ], "cautions": "Cautions\u00a0\n(From 6.4.1.2 Progestogens: British National Formulary)\nCautions\u00a0Progestogens should be used with caution in conditions that may worsen with fluid retention e.g. epilepsy, hypertension, migraine, asthma, or cardiac dysfunction, and in those susceptible to thromboembolism (particular caution with high dose). Care is also required in those with a history of depression. Progestogens can decrease glucose tolerance and patients with diabetes should be monitored closely. For interactions see Appendix 1 (progestogens).", "side-effects": "Side-effects\u00a0see notes above; injection-site reactions; pain,\r\ndiarrhoea and flatulence can occur with rectal administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4359.htm", "doses": [ "See under preparations", "by deep intramuscular injection into buttock,\r\ndysfunctional uterine bleeding, 5\u201310\u00a0mg daily for 5\u201310 days until\r\n2 days before expected onset of menstruation" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "SPIRONOLACTONE": { "indications": "Indications\u00a0oedema\r\nand ascites in cirrhosis of the liver; malignant ascites; nephrotic\r\nsyndrome; oedema in congestive heart failure; moderate to severe heart\r\nfailure (adjunct\u2014see also section 2.5.5); resistant hypertension [unlicensed\r\nindication] (adjunct\u2014see also section 2.5); treatment\r\nof primary hyperaldosteronism", "name": "SPIRONOLACTONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.3 Potassium-sparing diuretics and aldosterone antagonists", "Aldosterone antagonists" ], "cautions": "Cautions\u00a0potential metabolic products carcinogenic\r\nin rodents; elderly; monitor electrolytes\u2014discontinue if hyperkalaemia\r\noccurs (in severe heart failure monitor potassium\r\nand creatinine 1 week after initiation and after any dose increase,\r\nmonthly for first 3 months, then every 3 months for 1 year, and then\r\nevery 6 months); acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(diuretics)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, hepatotoxicity;\r\nmalaise, confusion, drowsiness, dizziness, gynaecomastia, benign breast\r\ntumour, breast pain, menstrual disturbances, changes in libido, hypertrichosis,\r\nelectrolyte disturbances including hyperkalaemia (discontinue) and\r\nhyponatraemia, acute renal failure, hyperuricaemia, leucopenia, agranulocytosis,\r\nthrombocytopenia, leg cramps, alopecia, rash, Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2371.htm", "doses": [ "Oedema and ascites in cirrhosis of the liver, 100\u2013400\u00a0mg\r\ndaily, adjusted according to response", "Malignant ascites, initially 100\u2013200\u00a0mg daily, increased to\r\n400\u00a0mg daily if required; maintenance dose adjusted according to response", "Nephrotic syndrome, 100\u2013200\u00a0mg daily", "Oedema in congestive heart failure, initially 100\u00a0mg (range\r\n25\u2013200\u00a0mg) daily in single or divided doses; maintenance dose adjusted\r\naccording to response", "Moderate to severe heart failure (adjunct), initially 25\u00a0mg\r\nonce daily, increased according to response to max. 50\u00a0mg once daily\r\n(see section 2.5.5)", "Resistant hypertension (adjunct), 25\u00a0mg once daily [unlicensed\r\nindication] (see section 2.5)", "Primary hyperaldosteronism in patients awaiting surgery, 100\u2013400\u00a0mg\r\ndaily; long-term maintenance if surgery inappropriate, use lowest\r\neffective dose", "child under 18 years\r\nsee BNF for Children" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014feminisation\r\nof male fetus in animal studies" }, "SODIUM CROMOGLICATE - OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0burning and stinging", "indications": "Indications\u00a0allergic conjunctivitis; seasonal\r\nkeratoconjunctivitis", "name": "SODIUM CROMOGLICATE - OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5451.htm", "doses": [ "adult and child apply eye drops 4 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations" ] }, "NEDOCROMIL SODIUM - CROMOGLICATE AND RELATED THERAPY": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "NEDOCROMIL SODIUM - CROMOGLICATE AND RELATED THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.1 Cromoglicate and related therapy" ], "cautions": "Cautions\u00a0 \n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above", "side-effects": "Side-effects\u00a0\n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above; also nausea,\r\nvomiting, dyspepsia, abdominal pain, pharyngitis; rarely taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3012.htm", "doses": [ "By aerosol inhalation, adult and child over 6 years 4\u00a0mg (2 puffs)\r\n4 times daily, when control achieved may be possible to reduce to\r\ntwice daily", "Regular use is necessary" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "PREDNISOLONE - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0ulcerative colitis, and Crohn\u2019s disease;\r\nother indications, see section 6.3.2, see also preparations", "name": "PREDNISOLONE - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids", "PREDNISOLONE" ], "cautions": "Cautions\u00a0section 6.3.2; systemic absorption may occur with rectal preparations; prolonged use should be avoided", "side-effects": "Side-effects\u00a0section 6.3.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2182.htm", "doses": [ "By mouth, initially 20\u201340\u00a0mg daily (up\r\nto 60\u00a0mg daily in some cases), preferably taken in the morning after\r\nbreakfast; continued until remission occurs, followed by reducing\r\ndoses", "By rectum, see preparations" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "PHOSPHATES (RECTAL)": { "indications": "Indications\u00a0rectal use in constipation; bowel evacuation before\r\nabdominal radiological procedures, endoscopy, and surgery", "name": "PHOSPHATES (RECTAL)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "PHOSPHATES (RECTAL)" ], "cautions": "Cautions\u00a0elderly and debilitated; with enema, electrolyte disturbances, congestive heart failure,\r\nascites, uncontrolled hypertension, maintain adequate hydration", "side-effects": "Side-effects\u00a0local irritation; with enema,\r\nelectrolyte disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201703.htm", "doses": [ "See under preparations", "128\u00a0mL; child (but see section\r\n1.6) over 3 years, reduced according to body weight see BNF for Children" ] }, "GLYCOPYRRONIUM BROMIDE": { "indications": "Indications\u00a0iontophoretic treatment of hyperhidrosis;\r\nother indications section 15.1.3", "name": "GLYCOPYRRONIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.12 Antiperspirants" ], "cautions": "Cautions\u00a0see section 15.1.3 (but poorly absorbed and systemic\r\neffects unlikely)", "side-effects": "Side-effects\u00a0see section 15.1.3 (but poorly absorbed and systemic\r\neffects unlikely), tingling at administration site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106187.htm", "doses": [ "Consult product literature; only 1 site to be treated\r\nat a time, max. 2 sites treated in any 24 hours, treatment not to\r\nbe repeated within 7 days" ] }, "TOLFENAMIC ACID": { "indications": "Indications\u00a0treatment of acute migraine", "name": "TOLFENAMIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "Analgesics" ], "cautions": "Cautions\u00a0see NSAIDs, section 10.1.1", "side-effects": "Side-effects\u00a0see NSAIDs, section 10.1.1; also dysuria (most commonly\r\nin men), confusion, malaise, hallucination, paraesthesia, tremor,\r\neuphoria, fatigue, and visual disturbances reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57116.htm", "doses": [ "adult over 18 years, 200\u00a0mg\r\nat onset repeated once after 1\u20132 hours if necessary" ], "pregnancy": "Pregnancy\u00a0section 10.1.1" }, "DISTIGMINE BROMIDE": { "indications": "Indications\u00a0postoperative urinary retention (see\r\nnotes above), neurogenic bladder; myasthenia gravis (section 10.2.1)", "name": "DISTIGMINE BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Parasympathomimetics" ], "cautions": "Cautions\u00a0peptic ulcer; conditions where increased motility of the urinary or gastro-intestinal\r\ntract could be harmful; oesophagitis; cardiovascular\r\ndisease; bronchospasm; epilepsy; parkinsonism; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0abdominal pain, diarrhoea, increased salivation;\r\nbradycardia, AV block, hypotension; dyspnoea; muscle twitching; increased\r\nlacrimation, miosis; increased sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4627.htm", "doses": [ "Urinary retention, 5\u00a0mg daily, half an hour before breakfast", "Neurogenic bladder, 5\u00a0mg daily or on alternate days, half an\r\nhour before breakfast" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (may stimulate uterine\r\ncontractions)" }, "BICALUTAMIDE": { "indications": "Indications\u00a0locally advanced prostate cancer at high risk of disease progression,\r\neither alone or as adjuvant treatment to prostatectomy or radiotherapy;\r\nlocally advanced, non-metastatic prostate cancer when surgical castration\r\nor other medical intervention inappropriate; advanced prostate cancer\r\nin combination with gonadorelin analogue or surgical castration", "name": "BICALUTAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Anti-androgens", "BICALUTAMIDE" ], "cautions": "Cautions\u00a0consider periodic liver function tests; interactions: Appendix 1 (bicalutamide)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, cholestasis, jaundice; asthenia,\r\nweight gain; gynaecomastia, breast tenderness, hot flushes, impotence,\r\ndecreased libido; anaemia; alopecia, dry skin, hirsutism, pruritus; less commonly vomiting, abdominal pain, dyspepsia, interstitial\r\nlung disease, pulmonary fibrosis, depression, haematuria, thrombocytopenia,\r\nhypersensitivity reactions including angioneurotic oedema and urticaria; rarely cardiovascular disorders (including angina, heart\r\nfailure, and arrhythmias), and hepatic failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31762.htm", "doses": [ "Locally advanced prostate cancer at high risk of disease\r\nprogression, 150\u00a0mg once daily", "Locally advanced, non-metastatic prostate cancer when surgical\r\ncastration or other medical intervention inappropriate, 150\u00a0mg once\r\ndaily", "Advanced prostate cancer, in combination with gonadorelin analogue\r\nor surgical castration, 50\u00a0mg once daily (started at the same time\r\nas surgical castration or at least 3 days before gonadorelin therapy,\r\nsee also notes above)" ] }, "HEPATITIS B IMMUNOGLOBULIN For intravenous use": { "indications": "Indications\u00a0prophylaxis against hepatitis B infection", "name": "HEPATITIS B IMMUNOGLOBULIN For intravenous use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Hepatitis B", "HEPATITIS B IMMUNOGLOBULIN", "For intravenous use" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines see under Normal Immunoglobulin.", "side-effects": "Side-effects\u00a0injection site reactions; less frequently, buccal\r\nulceration, glossitis, abdominal pain, chest pain, dyspnoea, anaphylaxis,\r\ntremor, dizziness, headache, arthralgia; for side-effects associated\r\nwith intravenous immunoglobulin, see section 14.5.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202711.htm", "doses": [ "See under preparations and see also notes above", "Prevention of transmitted infection at birth\u2014consult product\r\nliterature", "Name[Hepatect\u00aeCP (Biotest UK) ] Intravenous infusion, hepatitis\r\nB-specific immunoglobulin 50\u00a0units/mL, net price 500\u00a0units (10\u00a0mL)\r\n= \u00a3300.00, 2000\u00a0units (40\u00a0mL) = \u00a31100.00Dose\u00a0by intravenous infusion, after exposure\r\nto hepatitis B virus-contaminated material\u2014consult product literaturePrevention of transmitted infection at birth\u2014consult product\r\nliteraturePrevention of hepatitis B in haemodialysed patients, prophylaxis\r\nagainst re-infection of transplanted liver\u2014consult product literature" ] }, "ETHERIFIED STARCH Hetastarch": { "indications": "Indications\u00a0low blood volume", "name": "ETHERIFIED STARCH Hetastarch", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "ETHERIFIED STARCH", "Hetastarch" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; children", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; also\r\npruritus, raised serum amylase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129620.htm", "doses": [ "See under preparations below", "Name[Hetastarch (Non-proprietary) ] Intravenous infusion, hetastarch\r\n(weight average molecular weight 450\u00a0000) 6% in sodium chloride intravenous infusion 0.9%, net price 500-mL bag = \u00a38.00Dose\u00a0by intravenous infusion, 500\u20131000\u00a0mL; usual\r\ndaily max. 1500\u00a0mL (see notes above)" ] }, "HEPATITIS B IMMUNOGLOBULIN For intramuscular use": { "indications": "Indications\u00a0prophylaxis against hepatitis B infection", "name": "HEPATITIS B IMMUNOGLOBULIN For intramuscular use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Hepatitis B", "HEPATITIS B IMMUNOGLOBULIN", "For intramuscular use" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines see under Normal Immunoglobulin.", "side-effects": "Side-effects\u00a0injection site reactions; less frequently, buccal\r\nulceration, glossitis, abdominal pain, chest pain, dyspnoea, anaphylaxis,\r\ntremor, dizziness, headache, arthralgia; for side-effects associated\r\nwith intravenous immunoglobulin, see section 14.5.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6547.htm", "doses": [ "See under preparations and see also notes above", "Prevention of transmitted infection at birth, neonate 200\u00a0units as soon as possible after birth;\r\nfor full details consult Immunisation against Infectious Disease (www.dh.gov.uk)", "Name[Hepatitis B Immunoglobulin ] Injection, hepatitis B-specific\r\nimmunoglobulin, 100\u00a0units/mL. Vials containing 200\u00a0units or 500\u00a0units,\r\navailable from selected Health Protection Agency and NHS laboratories\r\n(except for Transplant Centres, see section 14.5 under Availability), also available from BPLDose\u00a0by intramuscular injection (as soon as\r\npossible after exposure; ideally within 12\u201348 hours, but no later\r\nthan 7 days after exposure), adult and child over 10 years 500\u00a0units; child under 5 years 200\u00a0units, 5\u20139 years 300\u00a0units; neonate 200\u00a0unitsPrevention of transmitted infection at birth, neonate 200\u00a0units as soon as possible after birth;\r\nfor full details consult Immunisation against Infectious Disease (www.dh.gov.uk)" ] }, "MENINGOCOCCAL VACCINES": { "indications": "Indications\u00a0immunisation against Neisseria\r\nmeningitidis", "name": "MENINGOCOCCAL VACCINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Meningococcal vaccines", "MENINGOCOCCAL VACCINES" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also rarely symptoms of meningitis reported (but no evidence\r\nthat the vaccine causes meningococcal C meningitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129699.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "BUPIVACAINE HYDROCHLORIDE With adrenaline": { "indications": "Indications\u00a0see under Dose", "name": "BUPIVACAINE HYDROCHLORIDE With adrenaline", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Bupivacaine", "BUPIVACAINE HYDROCHLORIDE", "With adrenaline" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics; myocardial depression may be more severe and more resistant to treatment; cardiovascular disease; hypertension; hypotension; cerebral atheroma; interactions: Appendix 1 (bupivacaine)", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106199.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Doses should be adjusted according to patient\u2019s\r\nphysical status and nature of procedure\u2014important: see also under Administration, section 15.2", "Local infiltration, max. 60\u00a0mL, using a 2.5\u00a0mg/mL\r\n(0.25%) solution", "Peripheral nerve block, max. 60\u00a0mL (150\u00a0mg),\r\nusing a 2.5\u00a0mg/mL (0.25%) solution; max. 30\u00a0mL, using a 5\u00a0mg/mL (0.5%)\r\nsolution", "Epidural block", "Surgery, lumbar, 10\u201320\u00a0mL (50\u2013100\u00a0mg), using\r\na 5\u00a0mg/mL (0.5%) solution", "Surgery, caudal, 15\u201330\u00a0mL (75\u2013150\u00a0mg), using\r\na 5\u00a0mg/mL (0.5%) solution", "Labour, lumbar, 6\u201312\u00a0mL (15\u201330\u00a0mg) using a\r\n2.5\u00a0mg/mL (0.25%) or 6\u201312\u00a0mL (30\u201360\u00a0mg) using a 5\u00a0mg/mL (0.5%) solution", "Sympathetic block, 20\u201350\u00a0mL (50\u2013125\u00a0mg), using\r\na 2.5\u00a0mg/mL (0.25%) solution", "Intrathecal anaesthesia, see under preparations", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Name[Bupivacaine and Adrenaline (Non-proprietary) ] Injection, anhydrous bupivacaine\r\nhydrochloride 2.5\u00a0mg/mL (0.25%), adrenaline 1 in 200\u00a0000 (5\u00a0micrograms/mL),\r\nnet price 10-mL amp = \u00a31.40\nInjection, anhydrous bupivacaine\r\nhydrochloride 5\u00a0mg/mL (0.5%), adrenaline 1 in 200\u00a0000 (5\u00a0micrograms/mL),\r\nnet price 10-mL amp = \u00a31.50" ], "pregnancy": "Pregnancy\u00a0large doses during delivery can cause neonatal respiratory\r\ndepression, hypotonia, and bradycardia after paracervical or epidural\r\nblock; use lower doses for intrathecal use during late pregnancy" }, "ALLOPURINOL": { "indications": "Indications\u00a0prophylaxis of gout and of uric acid and calcium oxalate renal stones;\r\nprophylaxis of hyperuricaemia associated with cancer chemotherapy ", "name": "ALLOPURINOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Long-term control of gout", "ALLOPURINOL" ], "cautions": "Cautions\u00a0administer prophylactic NSAID (not aspirin or salicylates) or colchicine until at least 1 month after hyperuricaemia\r\ncorrected (usually for first 3 months) to avoid precipitating an acute\r\nattack; ensure adequate fluid intake (2\u20133\u00a0litres/day); for hyperuricaemia associated with cancer therapy, allopurinol treatment should be started before cancer therapy; interactions: Appendix 1 (allopurinol)", "side-effects": "Side-effects\u00a0rashes (withdraw therapy; if\r\nrash mild re-introduce cautiously but discontinue promptly if recurrence\u2014hypersensitivity reactions occur rarely and\r\ninclude exfoliation, fever, lymphadenopathy, arthralgia, and eosinophilia\r\nresembling Stevens-Johnson syndrome or toxic epidermal necrolysis,\r\nvasculitis, hepatitis, renal impairment, and very rarely seizures);\r\ngastro-intestinal disorders; rarely malaise, headache, vertigo, drowsiness,\r\nvisual and taste disturbances, hypertension, alopecia, hepatotoxicity,\r\nparaesthesia and neuropathy, gynaecomastia, blood disorders (including\r\nleucopenia, thrombocytopenia, haemolytic anaemia and aplastic anaemia)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5316.htm", "doses": [ "Initially 100\u00a0mg daily, preferably after food, then adjusted\r\naccording to plasma or urinary uric acid concentration; usual maintenance\r\ndose in mild conditions 100\u2013200\u00a0mg daily, in moderately severe conditions\r\n300\u2013600\u00a0mg daily, in severe conditions 700\u2013900\u00a0mg daily; doses over\r\n300\u00a0mg daily given in divided doses; child under 15 years, (in neoplastic conditions, enzyme disorders) 10\u201320\u00a0mg/kg\r\ndaily (max. 400\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0toxicity not reported; manufacturer advises use only\r\nif no safer alternative and disease carries risk for mother or child " }, "CASPOFUNGIN": { "indications": "Indications\u00a0invasive aspergillosis (\n(From Treatment of fungal infections: British National Formulary)\nTreatment of fungal infections); invasive\r\ncandidiasis (\n(From Treatment of fungal infections: British National Formulary)\nTreatment of fungal infections); empirical treatment of systemic fungal infections in patients\r\nwith neutropenia", "name": "CASPOFUNGIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.4 Echinocandin antifungals" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (caspofungin)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, vomiting; dyspnoea; headache;\r\nhypokalaemia; arthralgia; rash, pruritus, sweating, injection-site\r\nreactions; less commonly abdominal pain, dyspepsia,\r\ndry mouth, dysphagia, taste disturbances, anorexia, constipation,\r\nflatulence, cholestasis, hepatic dysfunction, ascites, palpitation,\r\narrhythmia, chest pain, heart failure, thrombophlebitis, flushing,\r\nhypotension, hypertension, bronchospasm, cough, dizziness, fatigue,\r\nparaesthesia, hypoaesthesia, sleep disturbances, tremor, anxiety,\r\ndisorientation, hyperglycaemia, renal failure, hypomagnesaemia, hypocalcaemia,\r\nmetabolic acidosis, anaemia, thrombocytopenia, leucopenia, myalgia,\r\nmuscular weakness, blurred vision, and erythema multiforme; also reported,\r\nadult respiratory distress syndrome and anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119732.htm", "doses": [ "By intravenous infusion, 70\u00a0mg on first\r\nday then 50\u00a0mg once daily (70\u00a0mg once daily if body-weight over 80\u00a0kg); child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies" }, "KETOPROFEN Modified release": { "indications": "Indications\u00a0pain and mild inflammation in rheumatic disease and\r\nother musculoskeletal disorders, and after orthopaedic surgery; acute\r\ngout; dysmenorrhoea", "name": "KETOPROFEN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "KETOPROFEN", "Modified release" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5237.htm", "doses": [ "By mouth, rheumatic disease, 100\u2013200\u00a0mg\r\ndaily in 2\u20134 divided doses; child not\r\nrecommended", "Pain and dysmenorrhoea, 50\u00a0mg up to 3 times daily; child not recommended", "By rectum in suppositories, rheumatic\r\ndisease, 100\u00a0mg at bedtime; child not\r\nrecommended", "Combined oral and rectal treatment, max. total daily dose 200\u00a0mg", "Name[Oruvail\u00ae (Sanofi-Aventis) ] Capsules, m/r, enclosing white pellets, ketoprofen 100\u00a0mg (pink/purple), net price 56-cap pack\r\n= \u00a323.93; 150\u00a0mg (pink), 28-cap pack = \u00a313.66; 200\u00a0mg (pink/white),\r\n28-cap pack = \u00a323.85. \r\n Label:\r\n 21, 25Dose\u00a0100\u2013200\u00a0mg once daily with food; child not recommendedNote\u00a0Other brands of modified-release capsules\r\ncontaining ketoprofen 100\u00a0mg and 200\u00a0mg include Ketocid\u00ae 200\u00a0mg, Ketovail\u00ae, Tiloket\u00ae CR" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "PALIPERIDONE": { "indications": "Indications\u00a0schizophrenia; psychotic or manic symptoms of\r\nschizoaffective disorder", "name": "PALIPERIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "PALIPERIDONE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; predisposition to gastro-intestinal obstruction; elderly patients with dementia and risk factors for stroke", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nabdominal pain, dry mouth, hypersalivation, vomiting; tachycardia,\r\nbradycardia, first-degree AV block, bundle branch block; drowsiness,\r\nagitation, headache, asthenia; less commonly palpitation,\r\narrhythmias, ischaemia, oedema, seizures, nightmare, syncope, menstrual\r\ndisturbances, erectile dysfunction, galactorrhoea, gynaecomastia,\r\nand rash; cerebrovascular accident also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215619.htm", "doses": [ "adult over 18 years, 6\u00a0mg\r\nonce daily in the morning, adjusted if necessary in increments of\r\n3\u00a0mg over at least 5 days; usual range 3\u201312\u00a0mg daily", "Always take with breakfast or always\r\ntake on an empty stomach" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk\u2014toxicity in animal studies; if discontinuation\r\nduring pregnancy is necessary, withdraw gradually" }, "FLURBIPROFEN - NON-STEROIDAL ANTI-INFLAMMATORY DRUGS": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other musculoskeletal\r\ndisorders; mild to moderate pain including dysmenorrhoea; migraine;\r\npostoperative analgesia; sore throat (section 12.3.1)", "name": "FLURBIPROFEN - NON-STEROIDAL ANTI-INFLAMMATORY DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also stomatitis; less\r\ncommonly paraesthesia, confusion, hallucinations, and fatigue", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5224.htm", "doses": [ "adult and child over 12 years, 150\u2013200\u00a0mg daily in 2\u20134 divided\r\ndoses, increased in acute conditions to 300\u00a0mg daily", "Dysmenorrhoea, adult and child over 12 years, initially 100\u00a0mg, then 50\u2013100\u00a0mg\r\nevery 4\u20136 hours; max. 300\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "NEOMYCIN SULPHATE - ANTIBACTERIAL PREPARATIONS ONLY USED TOPICALLY": { "side-effects": "Side-effects\u00a0sensitisation (see also notes above)", "indications": "Indications\u00a0bacterial skin infections", "name": "NEOMYCIN SULPHATE - ANTIBACTERIAL PREPARATIONS ONLY USED TOPICALLY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6123.htm", "doses": [ "apply up to 3 times daily (short-term use)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.1 Antibacterial preparations only used topically", "NEOMYCIN SULPHATE" ], "cautions": "Cautions\u00a0large areas, see belowLarge areas\u00a0If large areas of skin are being treated\r\nototoxicity may be a hazard, particularly in children, in the elderly,\r\nand in those with renal impairment" }, "LACOSAMIDE": { "indications": "Indications\u00a0\n(From Lacosamide: British National Formulary)\nLacosamide", "name": "LACOSAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Lacosamide" ], "cautions": "Cautions\u00a0risk of PR-interval prolongation (including conduction problems, severe cardiac disease, and concomitant\r\nuse of drugs that prolong PR interval), elderly; interactions: Appendix 1\r\n(lacosamide)", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, flatulence, dizziness,\r\nheadache, impaired coordination, cognitive disorder, drowsiness, tremor,\r\ndepression, fatigue, abnormal gait, blurred vision, nystagmus, pruritus; rarely multi-organ hypersensitivity reaction (see Antiepileptic Hypersensitivity\r\nSyndrome); also reported dyspepsia, dry mouth, AV block, bradycardia,\r\nPR-interval prolongation, atrial fibrillation, atrial flutter, aggression,\r\nagitation, psychosis, euphoria, confusion, hypoesthesia, dysarthria,\r\nirritability, muscle spasm, tinnitus, rash; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201445.htm", "doses": [ "By mouth or by\r\nintravenous infusion over 15\u201360 minutes (for up to 5 days), adult and child over\r\n16 years, initially 50\u00a0mg twice daily, increased weekly by 50\u00a0mg twice\r\ndaily; max. 200\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "OCTREOTIDE": { "indications": "Indications\u00a0see under Dose", "name": "OCTREOTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.3 Somatostatin analogues", "OCTREOTIDE" ], "cautions": "Cautions\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\nCautions\u00a0Growth hormone-secreting pituitary tumours can expand causing serious complications; during treatment with somatostatin analogues patients should be monitored for signs of tumour expansion (e.g. visual field defects). Ultrasound examination of the gallbladder is recommended before treatment and at intervals of 6\u201312 months during treatment (avoid abrupt withdrawal of short-acting octreotide\u2014see Side-effects below). In insulinoma an increase in the depth and duration of hypoglycaemia may occur (observe patients when initiating treatment and changing doses); in diabetes mellitus, insulin or oral antidiabetic requirements may be reduced. Patients with carcinoid tumours must only receive lanreotide after excluding the presence of an obstructive intestinal tumour.; monitor thyroid function on long-term therapy; interactions: Appendix 1 (octreotide)", "side-effects": "Side-effects\u00a0\n(From 8.3.4.3 Somatostatin analogues: British National Formulary)\n8.3.4.3 Somatostatin analogues; also arrhythmias, bradycardia,\r\ndyspnoea, headache, dizziness, dehydration, alopecia,\r\nrash; hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4842.htm", "doses": [ "Symptoms associated with carcinoid tumours with features of carcinoid syndrome,\r\nVIPomas, glucagonomas, by subcutaneous injection, initially 50\u00a0micrograms once or twice daily, gradually increased\r\naccording to response to 200\u00a0micrograms 3 times daily (higher doses\r\nrequired exceptionally); maintenance doses variable; in carcinoid\r\ntumours discontinue after 1 week if no effect; if rapid response required,\r\ninitial dose by intravenous injection (with ECG monitoring\r\nand after dilution to a concentration of 10\u201350% with sodium\r\nchloride 0.9% injection)", "Acromegaly, short-term treatment before pituitary surgery or long-term treatment in those inadequately controlled\r\nby other treatment or until radiotherapy becomes\r\nfully effective by subcutaneous injection, 100\u2013200\u00a0micrograms\r\n3 times daily; discontinue if no improvement within 3 months", "Prevention of complications following pancreatic surgery, consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0possible effect on fetal growth; manufacturer advises\r\nuse only if potential benefit outweighs risk and effective contraception\r\nrequired during treatment" }, "CO-CYPRINDIOL": { "indications": "Indications\u00a0severe acne in women refractory to prolonged\r\noral antibacterial therapy (but see notes above); moderately severe hirsutism", "name": "CO-CYPRINDIOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.2 Oral preparations for acne", "Hormone treatment for acne" ], "cautions": "Cautions\u00a0see under Combined Hormonal Contraceptives, section 7.3.1", "side-effects": "Side-effects\u00a0see under Combined Hormonal Contraceptives, section 7.3.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6044.htm", "doses": [ "1 tablet daily for 21 days starting on day 1 of menstrual\r\ncycle and repeated after a 7-day interval, usually for several months;\r\nwithdraw 3\u20134 months after acne or hirsutism completely resolved (repeat\r\ncourses may be given if recurrence); long-term treatment may be necessary\r\nfor severe symptoms" ], "pregnancy": "Pregnancy\u00a0avoid\u2014risk of feminisation of male fetus with cyproterone" }, "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength)": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Oral (low and standard strength)" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202764.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days", "Name[Estradiol valerate with Dienogest] " ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "DOXAZOSIN": { "indications": "Indications\u00a0hypertension (see notes above); benign prostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "DOXAZOSIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0care with initial dose (postural hypotension); pulmonary oedema due to aortic or mitral stenosis; cataract surgery (risk of intra-operative\r\nfloppy iris syndrome); heart failure; interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance\r\nof skilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\ndyspnoea, coughing; fatigue, vertigo, paraesthesia, sleep disturbance,\r\nanxiety; influenza-like symptoms; back pain, myalgia; less\r\ncommonly weight changes, angina, myocardial infarction, hypoaesthesia,\r\ntremor, agitation, micturition disturbance, epistaxis, arthralgia,\r\ntinnitus, and gout; very rarely cholestasis, hepatitis,\r\njaundice, bradycardia, arrhythmias, bronchospasm, hot flushes, gynaecomastia,\r\nabnormal ejaculation, leucopenia, thrombocytopenia, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2564.htm", "doses": [ "Hypertension, 1\u00a0mg daily, increased after 1\u20132 weeks to\r\n2\u00a0mg once daily, and thereafter to 4\u00a0mg once daily, if necessary;\r\nmax. 16\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "BUMETANIDE": { "indications": "Indications\u00a0oedema (\n(From 2.2.2 Loop diuretics: British National Formulary)\n2.2.2 Loop diuretics)", "name": "BUMETANIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.2 Loop diuretics", "BUMETANIDE" ], "cautions": "Cautions\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nCautions\u00a0Hypovolaemia and hypotension should be corrected before initiation of treatment with loop diuretics; electrolytes should be monitored during treatment (see also Potassium Loss, section 2.2). Loop diuretics can exacerbate diabetes (but hyperglycaemia is less likely than with thiazides) and gout. If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; an adequate urinary output should be established before initiating treatment; interactions: Appendix 1 (diuretics).", "side-effects": "Side-effects\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of loop diuretics include mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia (less common than with thiazides), acute urinary retention, electrolyte disturbances (including hyponatraemia, hypokalaemia (see section 2.2), hypocalcaemia, hypochloraemia, and hypomagnesaemia), metabolic alkalosis, blood disorders (including bone-marrow depression, thrombocytopenia, and leucopenia), hyperuricaemia, visual disturbances, tinnitus and deafness (usually with high parenteral doses and rapid administration, and in renal impairment), and hypersensitivity reactions (including rash, photosensitivity, and pruritus).; also\r\ngynaecomastia, breast pain, musculoskeletal pain (associated with\r\nhigh doses in renal failure)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2357.htm", "doses": [ "By mouth, 1\u00a0mg in the morning, repeated\r\nafter 6\u20138 hours if necessary; severe cases, 5\u00a0mg daily increased by\r\n5\u00a0mg every 12\u201324 hours according to response; elderly, 500\u00a0micrograms daily may be sufficient", "By intravenous injection, 1\u20132\u00a0mg,\r\nrepeated after 20 minutes if necessary; elderly, 500\u00a0micrograms daily may be sufficient", "By intravenous infusion, 2\u20135\u00a0mg over\r\n30\u201360 minutes; elderly, 500\u00a0micrograms\r\ndaily may be sufficient", "By intramuscular injection, 1\u00a0mg\r\ninitially then adjusted according to response; elderly, 500\u00a0micrograms daily may be sufficient" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nPregnancy\u00a0Furosemide and bumetanide should not be used to treat gestational hypertension because of the maternal hypovolaemia associated with this condition." }, "HYDROCORTISONE - CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0section 6.3.2; also local irritation", "indications": "Indications\u00a0ulcerative colitis, proctitis, proctosigmoiditis", "name": "HYDROCORTISONE - CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2180.htm", "doses": [ "By rectum see preparations", "initially 1 metered application (125\u00a0mg hydrocortisone acetate) inserted into the rectum once or twice\r\ndaily for 2\u20133 weeks, then once on alternate days; child 2\u201318 years see BNF for Children" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids", "HYDROCORTISONE" ], "cautions": "Cautions\u00a0section 6.3.2; systemic absorption may occur; prolonged\r\nuse should be avoided" }, "ISOTRETINOIN - TOPICAL RETINOIDS AND RELATED PREPARATIONS FOR ACNE": { "indications": "Indications\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne; oral treatment\r\n(\n(From 13.6.2 Oral preparations for acne: British National Formulary)\n13.6.2 Oral preparations for acne)", "name": "ISOTRETINOIN - TOPICAL RETINOIDS AND RELATED PREPARATIONS FOR ACNE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "ISOTRETINOIN" ], "cautions": "Cautions\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne;\r\nalso personal or familial history of non-melanoma skin\r\ncancer", "side-effects": "Side-effects\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nSide-effects\u00a0Local reactions include burning, erythema, stinging, pruritus, dry or peeling skin (discontinue if severe). Increased sensitivity to UVB light or sunlight occurs. Temporary changes of skin pigmentation with tretinoin have been reported. Eye irritation and oedema, and blistering or crusting of skin have been reported rarely.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61336.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "pregnancy": "Pregnancy\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "EPOETIN ALFA, BETA, THETA, and ZETA": { "indications": "Indications\u00a0see under preparations, below", "name": "EPOETIN ALFA, BETA, THETA, and ZETA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "EPOETIN ALFA, BETA, THETA, and ZETA" ], "cautions": "Cautions\u00a0\n(From Erythropoietins: British National Formulary)\nErythropoietins; also inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,\r\nreticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure uncontrolled; sudden stabbing migraine-like pain\r\nis warning of a hypertensive crisis; sickle-cell\r\ndisease (lower target haemoglobin concentration may be appropriate); ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks); epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin dose may be needed during dialysis; risk of thrombosis may be increased when used for\r\nanaemia in adults receiving cancer chemotherapy; risk of thrombosis may be increased when used for anaemia before\r\northopaedic surgery\u2014avoid in cardiovascular disease\r\nincluding recent myocardial infarction or cerebrovascular accident", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting; dose-dependent increase\r\nin blood pressure or aggravation of hypertension; in isolated patients\r\nwith normal or low blood pressure, hypertensive crisis with encephalopathy-like\r\nsymptoms and generalised tonic-clonic seizures requiring immediate\r\nmedical attention; headache; dose-dependent increase in platelet count\r\n(but thrombocytosis rare) regressing during treatment; influenza-like\r\nsymptoms (may be reduced if intravenous injection given over 5 minutes);\r\ncardiovascular events; shunt thrombosis especially if tendency to\r\nhypotension or arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue erythropoietin therapy)\u2014see also notes above, hyperkalaemia,\r\nhypersensitivity reactions (including anaphylaxis and angioedema),\r\nskin reactions, injection-site reactions, and peripheral oedema also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201277.htm", "doses": [ "See under preparations, below" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; benefits probably outweigh risk\r\nof anaemia and of transfusion in pregnancy" }, "MORPHINE SALTS Oral solutions": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Oral solutions", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Oral solutions" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3494.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[Morphine Oral Solutions] or Oral solutions of morphine can be prescribed by writing the formula:Morphine hydrochloride 5\u00a0mgChloroform\r\nwater to 5\u00a0mLNote\u00a0The proportion of morphine hydrochloride may be altered when specified by the prescriber; if\r\nabove 13\u00a0mg per 5\u00a0mL the solution becomes . For sample prescription see Controlled Drugs and Drug\r\nDependence.\r\nIt is usual to adjust the strength so that the dose volume is 5 or\r\n10\u00a0mL." ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "SODIUM CLODRONATE": { "indications": "Indications\u00a0see under Dose", "name": "SODIUM CLODRONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "SODIUM CLODRONATE" ], "cautions": "Cautions\u00a0monitor renal and hepatic function and white cell\r\ncount; also monitor serum calcium and phosphate periodically; renal dysfunction reported in patients receiving concomitant NSAIDs; maintain adequate fluid intake during treatment; consider dental check-up before initiating bisphosphonate (risk of osteonecrosis of the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, skin reactions, bronchospasm; rarely atypical femoral fractures (see MHRA/CHM advice); very rarely osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4456.htm", "doses": [ "Osteolytic lesions, hypercalcaemia and bone pain associated\r\nwith skeletal metastases in patients with breast cancer or multiple\r\nmyeloma, by mouth, 1.6\u00a0g daily in single or 2 divided\r\ndoses increased if necessary to a max. of 3.2\u00a0g daily", "Avoid food for 1 hour before and after\r\ntreatment, particularly calcium-containing products e.g. milk; also\r\navoid iron and mineral supplements and antacids; maintain adequate\r\nfluid intake", "2 tablets daily in single or two divided doses; may be\r\nincreased to max. 4 tablets daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "BUDESONIDE - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0see preparations", "name": "BUDESONIDE - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids", "BUDESONIDE" ], "cautions": "Cautions\u00a0section 6.3.2; for autoimmune hepatitis, monitor liver function tests every 2 weeks\r\nfor 1 month, then at least every 3 months; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0section 6.3.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76834.htm", "doses": [ "See preparations", "mild to moderate Crohn\u2019s disease affecting ileum or ascending\r\ncolon, chronic diarrhoea due to collagenous colitis, adult over 18 years, 3\u00a0mg 3 times daily for up to\r\n8 weeks; reduce dose for the last 2 weeks of treatment (see also section 6.3.2); child 12\u201318\r\nyears see BNF for Children", "Autoimmune hepatitis, adult over\r\n18 years, induction of remission, 3\u00a0mg 3 times daily; maintenance,\r\n3\u00a0mg twice daily", "ulcerative colitis affecting sigmoid colon and rectum, by rectum, adult over 18 years,\r\n1 metered application (budesonide 2\u00a0mg) once daily for up to 8 weeks" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "KETAMINE": { "indications": "Indications\u00a0induction and maintenance of anaesthesia (but rarely used)", "name": "KETAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.1 Intravenous anaesthetics", "Drugs used for intravenous anaesthesia", "KETAMINE" ], "cautions": "Cautions\u00a0see under Intravenous Anaesthetics and notes above; dehydration; hypertension; respiratory\r\ntract infection; increased cerebrospinal\r\nfluid pressure; predisposition to seizures, hallucinations, or nightmares; psychotic disorders; head injury or intracranial\r\nmass lesions; thyroid dysfunction; raised intra-ocular pressure; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Drugs used for intravenous anaesthesia: British National Formulary)\nDrugs used for intravenous anaesthesia; also nausea,\r\nvomiting, tachycardia, hypertension, diplopia, nystagmus, rash; less commonly arrhythmias, hypotension, bradycardia, respiratory\r\ndepression, laryngospasm; rarely hypersalivation,\r\napnoea, insomnia, cystitis (including haemorrhagic); raised intra-ocular\r\npressure also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6567.htm", "doses": [ "By intramuscular injection, short\r\nprocedures, initially 6.5\u201313\u00a0mg/kg, adjusted according to response\r\n(10\u00a0mg/kg usually produces 12\u201325 minutes of surgical anaesthesia)", "Diagnostic manoeuvres and procedures not involving intense pain,\r\ninitially 4\u00a0mg/kg", "By intravenous injection over at least 60 seconds,\r\nshort procedures, initially 1\u20134.5\u00a0mg/kg, adjusted according to response\r\n(2\u00a0mg/kg usually produces 5\u201310 minutes of surgical anaesthesia)", "By intravenous infusion of a solution containing\r\n1\u00a0mg/mL, longer procedures, induction, total dose of 0.5\u20132\u00a0mg/kg;\r\nmaintenance, 10\u201345\u00a0micrograms/kg/minute, rate adjusted according to\r\nresponse" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "OESTROGENS, TOPICAL Vaginal ring": { "indications": "Indications\u00a0see notes above", "name": "OESTROGENS, TOPICAL Vaginal ring", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.2 Treatment of vaginal and vulval conditions", "7.2.1 Preparations for vaginal and vulval changes", "Topical HRT for vaginal atrophy", "OESTROGENS, TOPICAL", "Vaginal ring" ], "cautions": "Cautions\u00a0\n(From Topical HRT for vaginal atrophy: British National Formulary)\nA cream containing an oestrogen may be applied on a short-term basis to improve the vaginal epithelium in menopausal atrophic vaginitis. It is important to bear in mind that topical oestrogens should be used in the smallest effective amount to minimise systemic effects. Modified-release vaginal tablets and an impregnated vaginal ring are now also available.The risk of endometrial hyperplasia and carcinoma is increased when systemic oestrogens are administered alone for prolonged periods (section 6.4.1.1). The endometrial safety of long-term or repeated use of topical vaginal oestrogens is uncertain; treatment should be reviewed at least annually, with special consideration given to any symptoms of endometrial hyperplasia or carcinoma.; see also Oestrogens for\r\nHRT (%s\n(From 6.4.1.1 Oestrogens and HRT: British National Formulary)\n6.4.1.1 Oestrogens and HRT); interrupt treatment periodically\r\nto assess need for continued treatment", "side-effects": "Side-effects\u00a0see notes above; see also Oestrogens\r\nfor HRT (%s\n(From 6.4.1.1 Oestrogens and HRT: British National Formulary)\n6.4.1.1 Oestrogens and HRT); local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27404.htm", "doses": [ "Name[Estring\u00ae (Pharmacia) ] Vaginal ring, releasing estradiol\r\napprox. 7.5\u00a0micrograms/24 hours, net price 1-ring pack = \u00a331.42. \r\n Label:\r\n 10, patient information leafletDose\u00a0for postmenopausal urogenital conditions (not suitable\r\nfor vasomotor symptoms or osteoporosis prophylaxis), to be inserted\r\ninto upper third of vagina and worn continuously; replace after 3\r\nmonths; max. duration of continuous treatment 2 years" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "METHYLNALTREXONE BROMIDE": { "indications": "Indications\u00a0opioid-induced constipation in terminally\r\nill patients, when response to other laxatives is inadequate", "name": "METHYLNALTREXONE BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.6 Peripheral opioid-receptor antagonists", "METHYLNALTREXONE BROMIDE" ], "cautions": "Cautions\u00a0diverticular disease; faecal impaction; patients with colostomy or peritoneal catheter", "side-effects": "Side-effects\u00a0abdominal pain, nausea, diarrhoea, flatulence;\r\ndizziness; injection site reactions, hyperhidrosis; also reported\r\ngastro-intestinal perforation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201642.htm", "doses": [ "By subcutaneous injection, adult over 18 years, body-weight under 38\u00a0kg, 150\u00a0micrograms/kg\r\non alternate days; body-weight 38\u201362\u00a0kg, 8\u00a0mg on alternate days; body-weight\r\n62\u2013114\u00a0kg, 12\u00a0mg on alternate days; body-weight over 114\u00a0kg, 150\u00a0micrograms/kg\r\non alternate days; may be given less frequently depending on response;\r\n2 consecutive doses may be given 24 hours apart if no response to\r\ntreatment on the preceding day; rotate sites of injection; max. duration\r\nof treatment 4 months", "May act within 30\u201360 minutes" ], "pregnancy": "Pregnancy\u00a0toxicity at high doses in animal studies\u2014manufacturer advises avoid unless essential" }, "FINASTERIDE - DUTASTERIDE AND FINASTERIDE": { "side-effects": "Side-effects\u00a0see notes above; also testicular pain, hypersensitivity\r\nreactions (including lip and face swelling, pruritus and rash); male\r\nbreast cancer also reported (see Cautions above)", "indications": "Indications\u00a0benign prostatic hyperplasia;\r\nmale-pattern baldness in men (section 13.9)", "name": "FINASTERIDE - DUTASTERIDE AND FINASTERIDE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4376.htm", "doses": [ "5\u00a0mg daily, review treatment at 3\u20136 months and then every\r\n6\u201312 months (may require several months\u2019 treatment before benefit\r\nis obtained)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "Anti-androgens", "Dutasteride and finasteride" ], "cautions": "Cautions\u00a0\n(From Dutasteride and finasteride: British National Formulary)\nCautions\u00a0Dutasteride and finasteride decrease serum concentration of prostate cancer markers such as prostate-specific antigen; reference values may need adjustment. Both dutasteride and finasteride are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. Women of childbearing potential should avoid handling crushed or broken tablets of finasteride and leaking capsules of dutasteride.; also obstructive\r\nuropathyMale breast cancer\u00a0Cases of male breast cancer\r\nhave been reported. Patients or their carers should be\r\ntold to promptly report to their doctor any changes in breast tissue\r\nsuch as lumps, pain, or nipple discharge" }, "TRIAMCINOLONE": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; see also notes above; rheumatic disease (section 10.1.2); skin (section 13.4)", "name": "TRIAMCINOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "TRIAMCINOLONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids; also high dosage may cause proximal myopathy, avoid in chronic therapy", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4295.htm", "doses": [ "By deep intramuscular injection, into gluteal\r\nmuscle, 40\u00a0mg of acetonide for depot effect, repeated at intervals\r\naccording to the patient\u2019s response; max. single dose 100\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "METHYLDOPA": { "indications": "Indications\u00a0hypertension", "name": "METHYLDOPA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.2 Centrally acting antihypertensive drugs", "METHYLDOPA" ], "cautions": "Cautions\u00a0monitor blood counts and liver-function\r\nbefore treatment and at intervals during first 6\u201312 weeks or if unexplained\r\nfever occurs; history of depression; positive direct Coombs\u2019 test in up to 20% of patients\r\n(may affect blood cross-matching); interference\r\nwith laboratory tests; interactions: Appendix 1 (methyldopa)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol may be enhanced", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth, stomatitis,\r\nsialadenitis; bradycardia, exacerbation of angina, postural hypotension,\r\noedema; sedation, headache, dizziness, asthenia, myalgia, arthralgia,\r\nparaesthesia, nightmares, mild psychosis, depression, impaired mental\r\nacuity, parkinsonism, Bell\u2019s palsy; hepatitis, jaundice; pancreatitis;\r\nhaemolytic anaemia; bone-marrow depression, leucopenia, thrombocytopenia,\r\neosinophilia; hypersensitivity reactions including lupus erythematosus-like\r\nsyndrome, drug fever, myocarditis, pericarditis; rashes (including\r\ntoxic epidermal necrolysis); nasal congestion, failure of ejaculation,\r\nimpotence, decreased libido, gynaecomastia, hyperprolactinaemia, amenorrhoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2553.htm", "doses": [ "Initially 250\u00a0mg 2\u20133 times daily, increased gradually\r\nat intervals of at least 2 days, max. 3\u00a0g daily; elderly initially 125\u00a0mg twice daily, increased gradually, max. 2\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "MIFEPRISTONE": { "indications": "Indications\u00a0see under dose", "name": "MIFEPRISTONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.2 Mifepristone" ], "cautions": "Cautions\u00a0asthma (avoid if severe\r\nand uncontrolled); haemorrhagic disorders and anticoagulant therapy; prosthetic heart valve or history of endocarditis (see section 5.1 table 2); risk factors for or existing cardiovascular\r\ndisease; adrenal suppression (may require corticosteroid); interactions: Appendix\r\n1 (mifepristone)Important\u00a0For warnings relating to use of gemeprost\r\nin a patient undergoing induction of abortion with mifepristone, see\r\nunder Gemeprost", "side-effects": "Side-effects\u00a0gastro-intestinal cramps; uterine contractions,\r\nvaginal bleeding (sometimes severe) may occur between administration\r\nof mifepristone and surgery (and rarely abortion\r\nmay occur before surgery); less commonly hypersensitivity\r\nreactions including rash and urticaria; rarely hypotension,\r\nmalaise, headache, fever, hot flushes, dizziness, and chills; infections\r\n(including toxic shock syndrome) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129508.htm", "doses": [ "Medical termination of intra-uterine pregnancy of\r\nup to 49 days gestation, by mouth, mifepristone 600\u00a0mg\r\nas a single dose under medical supervision followed 36\u201348 hours later\r\n(unless abortion already complete) by gemeprost 1\u00a0mg by vagina or misoprostol 400\u00a0micrograms by mouth [unlicensed]; alternative regimen, mifepristone 200\u00a0mg by\r\nmouth as a single dose followed 36\u201348 hours later (unless\r\nabortion already complete) by gemeprost 1\u00a0mg by vagina; observe for at least 3 hours (or until bleeding or pain at acceptable\r\nlevel); follow-up visit within 2 weeks to verify complete expulsion\r\nand to assess vaginal bleeding", "Medical termination of intra-uterine pregnancy of\r\n50\u201363 days gestation, by mouth, mifepristone 600\u00a0mg\r\n(200\u00a0mg also effective) as a single dose under medical supervision,\r\nfollowed 36\u201348 hours later (unless abortion already complete) by gemeprost\r\n1\u00a0mg by vagina; observe for at least 3 hours (or until\r\nbleeding or pain at acceptable level); follow-up visit within 2 weeks\r\nto verify complete expulsion and to assess vaginal bleeding", "Cervical ripening before mechanical cervical dilatation\r\nfor termination of pregnancy of up to 84 days gestation, by\r\nmouth, mifepristone 200\u00a0mg as a single dose under medical\r\nsupervision 36\u201348 hours before procedure", "Termination of pregnancy of 13\u201324 weeks gestation\r\n(in combination with a prostaglandin), by mouth, mifepristone 600\u00a0mg (200\u00a0mg may be effective) as a single\r\ndose under medical supervision followed 36\u201348 hours later by gemeprost 1\u00a0mg by vagina every 3 hours up\r\nto max. 5\u00a0mg or misoprostol (see above [unlicensed]); if abortion does not occur,\r\n24 hours after start of treatment repeat course of gemeprost 1\u00a0mg by vagina up to max. 5\u00a0mg; follow-up visit after\r\nappropriate interval to assess vaginal bleeding recommended", "Careful monitoring of blood pressure and\r\npulse essential for 3 hours after administration of gemeprost pessary (risk of profound hypotension)", "Labour induction in fetal death in utero where prostaglandin or oxytocin inappropriate, by mouth, mifepristone 600\u00a0mg daily as a single dose for 2 days under medical\r\nsupervision; if labour not started within 72 hours of first dose,\r\nanother method should be used" ] }, "METHADONE HYDROCHLORIDE": { "indications": "Indications\u00a0cough in terminal disease", "name": "METHADONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations", "3.9.1 Cough suppressants", "Palliative care" ], "cautions": "Cautions\u00a0section 4.7.2", "side-effects": "Side-effects\u00a0section 4.7.2; longer-acting than morphine therefore effects may be cumulative", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3084.htm", "doses": [ "See below" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "FLUOROMETHOLONE": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "FLUOROMETHOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "FLUOROMETHOLONE" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5431.htm", "doses": [ "adult and child over 2 years, apply every hour for 24\u201348 hours\r\nthen reduce frequency to 2\u20134 times daily" ] }, "COMBINED HORMONAL CONTRACEPTIVES Vaginal (low strength)": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Vaginal (low strength)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Vaginal (low strength)", "Ethinylestradiol with Etonogestrel" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202425.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days", "1 ring to be inserted into the vagina, removed on day\r\n22; subsequent courses repeated after 7-day ring-free interval (during\r\nwhich withdrawal bleeding occurs); for starting routines see under Dose above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "Simeticone alone": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone" ], "name": "Simeticone alone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56368.htm", "doses": [ "colic or wind pains, neonate and infant 2.5\u00a0mL with or after each\r\nfeed (max. 6 doses in 24 hours); may be added to bottle feed" ] }, "THIOTEPA": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nThiotepa is usually used as an intracavitary drug for the treatment of malignant effusions or bladder cancer (section 7.4.4). It is also occasionally used to treat breast cancer, but requires parenteral administration. and %s\n(From 7.4.4 Bladder instillations and urological surgery: British National Formulary)\n7.4.4 Bladder instillations and urological surgery", "name": "THIOTEPA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "THIOTEPA" ], "cautions": "Cautions\u00a0see section 8.1; avoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1\r\n(thiotepa)", "side-effects": "Side-effects\u00a0see section 8.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4698.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and embryotoxic in animals); see also Pregnancy and Reproductive\r\nFunction" }, "PREDNISOLONE Single use": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "PREDNISOLONE Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "PREDNISOLONE", "Single use" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5442.htm", "doses": [ "Apply every 1\u20132 hours until controlled then reduce frequency", "Name[Minims\u00ae Prednisolone Sodium Phosphate (Bausch & Lomb) ] Eye drops, prednisolone sodium phosphate 0.5%, net price 20 \u00d7 0.5\u00a0mL = \u00a310.41Excipients include disodium edetate" ] }, "ROFLUMILAST": { "indications": "Indications\u00a0\n(From 3.3.3 Phosphodiesterase type-4 inhibitors: British National Formulary)\n3.3.3 Phosphodiesterase type-4 inhibitors", "name": "ROFLUMILAST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.3 Phosphodiesterase type-4 inhibitors" ], "cautions": "Cautions\u00a0monitor body-weight; latent infection (such as tuberculosis, viral hepatitis, herpes infection); moderate\r\nto severe cardiac failure; history of psychiatric\r\nillness, or concomitant use of drugs likely\r\nto cause psychiatric events; interactions: Appendix 1 (roflumilast)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, abdominal pain, weight loss,\r\ndecreased appetite, headache, insomnia; less commonly gastritis, vomiting, gastro-oesophageal reflux, dyspepsia, palpitation,\r\nanxiety, tremor, vertigo, dizziness, malaise, muscle spasm, myalgia,\r\nback pain, rash; rarely taste disturbances, haematochezia,\r\nconstipation, respiratory tract infections, depression, nervousness,\r\nsuicidal ideation, gynaecomastia, raised creatine kinase, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/211005.htm", "doses": [ "adult over 18 years, 500\u00a0micrograms\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies; women of child-bearing age should use effective contraception " }, "SULFASALAZINE - SULFASALAZINE": { "indications": "Indications\u00a0active rheumatoid arthritis;\r\ninflammatory bowel disease, see section 1.5.1 and notes above", "name": "SULFASALAZINE - SULFASALAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Sulfasalazine", "SULFASALAZINE" ], "cautions": "Cautions\u00a0see section 1.5.1 and notes aboveBlood disorders\u00a0Patients should be\r\nadvised to report any unexplained bleeding, bruising, purpura, sore\r\nthroat, fever or malaise. A blood count\r\nshould be performed and the drug stopped immediately if there is suspicion\r\nof a blood dyscrasia.", "side-effects": "Side-effects\u00a0see section 1.5.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5309.htm", "doses": [ "By mouth, administered on expert advice,\r\nas enteric-coated tablets, initially 500\u00a0mg daily, increased by 500\u00a0mg\r\nat intervals of 1 week to a max. of 2\u20133\u00a0g daily in divided doses" ], "pregnancy": "Pregnancy\u00a0section 1.5.1" }, "MECASERMIN": { "indications": "Indications\u00a0\n(From 6.7.4 Somatomedins: British National Formulary)\n6.7.4 Somatomedins", "name": "MECASERMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.4 Somatomedins", "MECASERMIN" ], "cautions": "Cautions\u00a0correct hypothyroidism before initiating\r\ntreatment; diabetes mellitus (adjustment\r\nof antidiabetic therapy may be necessary), monitor ECG before and on termination of treatment (and during treatment\r\nif ECG abnormal), papilloedema (see under Side-effects), monitor for disorders of\r\nthe epiphysis of the hip (monitor for limping), monitor for signs of tonsillar hypertrophy (snoring, sleep apnoea,\r\nand chronic middle ear effusions)", "side-effects": "Side-effects\u00a0headache, funduscopy for papilloedema recommended\r\nif severe or recurrent headache, visual problems, nausea and vomiting\r\noccur\u2014if papilloedema confirmed consider benign intracranial hypertension\r\n(rare cases reported); cardiomegaly, ventricular hypertrophy, tachycardia;\r\nconvulsions, sleep apnoea, night terrors, dizziness, nervousness;\r\ntonsillar hypertrophy (see Cautions above); hypoglycaemia (especially\r\nin first month, and in younger children), hyperglycaemia, gynaecomastia;\r\narthralgia, myalgia; visual disturbance, impaired hearing; antibody\r\nformation; injection-site reactions (rotate site)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200158.htm", "doses": [ "By subcutaneous injection, adolescent and child over 2 years, initially 40\u00a0micrograms/kg twice daily for 1 week,\r\nif tolerated increase dose in steps of 40\u00a0micrograms/kg to max. 120\u00a0micrograms/kg\r\ntwice daily; discontinue if no response within 1 year", "Dose should be administered just before\r\nor after food; do not increase dose if a dose is missed", "Reduce dose if hypoglycaemia occurs despite\r\nadequate food intake; withhold injection if patient unable to eat" ], "pregnancy": "Pregnancy\u00a0avoid unless essential; contraception advised in\r\nwomen of child-bearing potential" }, "METOPROLOL TARTRATE Modified release": { "indications": "Indications\u00a0see under Dose", "name": "METOPROLOL TARTRATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "METOPROLOL TARTRATE", "Modified release" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2497.htm", "doses": [ "By mouth, hypertension, initially\r\n100\u00a0mg daily, increased if necessary to 200\u00a0mg daily in 1\u20132 divided\r\ndoses; max. 400\u00a0mg daily (but high doses rarely necessary)", "Angina, 50\u2013100\u00a0mg 2\u20133 times daily", "Arrhythmias, usually 50\u00a0mg 2\u20133\u00a0times daily; up to 300\u00a0mg daily\r\nin divided doses if necessary", "Migraine prophylaxis, 100\u2013200\u00a0mg daily in divided doses", "Hyperthyroidism (adjunct), 50\u00a0mg 4 times daily", "By intravenous injection, arrhythmias,\r\nup to 5\u00a0mg at rate 1\u20132\u00a0mg/minute, repeated after 5\u00a0minutes if necessary,\r\ntotal dose 10\u201315\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "In surgery, by slow intravenous injection 2\u20134\u00a0mg\r\nat induction or to control arrhythmias developing during anaesthesia;\r\n2-mg doses may be repeated to a max. of 10\u00a0mg", "Early intervention within 12 hours of infarction, by\r\nintravenous injection 5\u00a0mg every 2\u00a0minutes to a max. of 15\u00a0mg,\r\nfollowed after 15 minutes by 50\u00a0mg by mouth every 6\r\nhours for 48 hours; maintenance 200\u00a0mg daily in divided doses", "Name[Lopresor SR\u00ae (Recordati) ] Tablets, m/r, yellow, f/c, metoprolol tartrate 200\u00a0mg, net price 28-tab pack = \u00a39.80. \r\n Label:\r\n 8, 25Dose\u00a0hypertension, 200\u00a0mg daily; angina, 200\u2013400\u00a0mg daily;\r\nmigraine prophylaxis, 200\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "QUINAGOLIDE": { "indications": "Indications\u00a0see notes above and under Dose", "name": "QUINAGOLIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.1 Bromocriptine and other dopaminergic drugs", "QUINAGOLIDE" ], "cautions": "Cautions\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nCautions\u00a0see notes below; also bromocriptine and cabergoline should be used with caution in patients with a history of peptic ulcer, particularly in acromegalic patients. Treatment should be withdrawn if gastro-intestinal bleeding occurs. In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment). Bromocriptine and cabergoline should be used with caution in patients with Raynaud\u2019s syndrome and cardiovascular disease (see also Contra-indications under Bromocriptine, below). Monitor for fibrotic disease (see Fibrotic Reactions, below). Caution is also advised in patients with a history of serious mental disorders (especially psychotic disorders) and in those with acute porpyhria (see section 9.8.2). Tolerance may be reduced by alcohol.; history\r\nof psychotic illness; advise non-hormonal contraception\r\nif pregnancy not desired; interactions: Appendix 1 (quinagolide)", "side-effects": "Side-effects\u00a0nausea, vomiting, anorexia, abdominal pain, constipation\r\nor diarrhoea; syncope, hypotension (see also notes above), oedema,\r\nflushing; nasal congestion; headache, dizziness, fatigue, insomnia; very rarely psychosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/26909.htm", "doses": [ "Hyperprolactinaemia, 25\u00a0micrograms at bedtime for 3 days;\r\nincreased at intervals of 3 days in steps of 25\u00a0micrograms to usual\r\nmaintenance dose of 75\u2013150\u00a0micrograms daily; for doses higher than\r\n300\u00a0micrograms daily increase in steps of 75\u2013150\u00a0micrograms at intervals\r\nof not less than 4 weeks; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0discontinue when pregnancy confirmed unless medical\r\nreason for continuing (specialist advice needed)" }, "AMPHOTERICIN Lipid formulations": { "indications": "Indications\u00a0See under Dose", "name": "AMPHOTERICIN Lipid formulations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.3 Polyene antifungals", "AMPHOTERICIN", "Lipid formulations" ], "cautions": "Cautions\u00a0when given parenterally, toxicity common\r\n(close supervision necessary and test dose required;\r\nsee Anaphylaxis below); hepatic and renal function tests,\r\nblood counts, and plasma electrolyte (including plasma-potassium and\r\nmagnesium concentration) monitoring required; corticosteroids (avoid except to control reactions); avoid rapid infusion (risk of arrhythmias); interactions: Appendix 1 (amphotericin)Anaphylaxis\u00a0Anaphylaxis occurs rarely\r\nwith any intravenous amphotericin product and a\r\ntest dose is advisable before the first infusion; the\r\npatient should be carefully observed for at least 30 minutes after\r\nthe test dose. Prophylactic antipyretics or hydrocortisone should only be used in patients who have\r\npreviously experienced acute adverse reactions (in whom continued\r\ntreatment with amphotericin is essential)", "side-effects": "Side-effects\u00a0when given parenterally, anorexia, nausea and\r\nvomiting, diarrhoea, epigastric pain; febrile reactions, headache,\r\nmuscle and joint pain; anaemia; disturbances in renal function (including\r\nhypokalaemia and hypomagnesaemia) and renal toxicity; also cardiovascular\r\ntoxicity (including arrhythmias, blood pressure changes), blood disorders,\r\nneurological disorders (including hearing loss, diplopia, convulsions,\r\nperipheral neuropathy, encephalopathy), abnormal liver function (discontinue\r\ntreatment), rash, anaphylactoid reactions (see Anaphylaxis, above);\r\npain and thrombophlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3973.htm", "doses": [ "By intravenous infusion, see preparations", "Different preparations of intravenous amphotericin\r\nvary in their pharmacodynamics, pharmacokinetics, dosage, and administration;\r\nthese preparations should not be considered interchangeable.\r\nTo avoid confusion, prescribers should specify the brand to be dispensed.", "Name[AmBisome\u00ae (Gilead) ] Intravenous infusion, powder for\r\nreconstitution, amphotericin 50\u00a0mg encapsulated\r\nin liposomes, net price 50-mg vial = \u00a396.69Electrolytes: Na+\u00a0<\u00a00.5\u00a0mmol/vialExcipients include sucrose 900\u00a0mg/vialDose\u00a0by intravenous infusion, severe systemic\r\nor deep mycoses where toxicity (particularly nephrotoxicity) precludes\r\nuse of conventional amphotericin; suspected or\r\nproven infection in febrile neutropenic patients unresponsive to broad-spectrum\r\nantibacterials; aspergillosis, initial test dose 1\u00a0mg\r\nover 10 minutes then 3\u00a0mg/kg once daily; max. 5\u00a0mg/kg once daily [unlicensed\r\ndose]; child under 18 years see BNF for ChildrenVisceral leishmaniasis, see section 5.4.5 and product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful but manufacturers advise\r\navoid unless potential benefit outweighs risk" }, "ASPIRIN With metoclopramide": { "indications": "Indications\u00a0mild to moderate pain, pyrexia; antiplatelet (section 2.9)", "name": "ASPIRIN With metoclopramide", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "ASPIRIN", "With metoclopramide" ], "cautions": "Cautions\u00a0asthma, allergic\r\ndisease, dehydration; preferably avoid during fever or viral infection\r\nin children (risk of Reye\u2019s syndrome, see below); elderly; G6PD-deficiency (section 9.1.5); concomitant use of drugs that\r\nincrease risk of bleeding; anaemia; thyrotoxicosis; interactions: Appendix 1 (aspirin)", "side-effects": "Side-effects\u00a0generally mild and infrequent but high incidence\r\nof gastro-intestinal irritation with slight asymptomatic blood loss,\r\nblood disorders have occurred (including increased bleeding time),\r\nconfusion, tinnitus, bronchospasm and skin reactions in hypersensitive\r\npatients. Prolonged administration, see section 10.1.1. Overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85425.htm", "doses": [ "By mouth, 300\u2013900\u00a0mg every 4\u20136 hours when\r\nnecessary; max. 4\u00a0g daily; child under\r\n16 years not recommended (see Reye\u2019s Syndrome, above)", "By rectum, 450\u2013900\u00a0mg every 4 hours (max. 3.6\u00a0g\r\ndaily); child under 16 years not recommended\r\n(see Reye\u2019s Syndrome, above)", "Name[MigraMax\u00ae (Winthrop) ] Oral powder, lemon flavour, aspirin\r\n(as lysine acetylsalicylate) 900\u00a0mg, metoclopramide hydrochloride 10\u00a0mg/sachet, net price 6-sachet pack = \u00a36.61, 20-sachet pack =\r\n\u00a322.01. \r\n Label:\r\n 13, 21, 32Dose\u00a0acute migraine, adult over\r\n20 years 1 sachet in water at onset of attack, repeated after 2 hours\r\nif necessary (max. 3 sachets in 24 hours); adult under 20 years and child not recommendedImportant\u00a0Metoclopramide can cause severe extrapyramidal effects, particularly in children\r\nand young adults (for further details, see Metoclopramide)Note\u00a0Treatment should not exceed\r\n3 months due to risk of tardive dyskinesiaExcipients include aspartame (section 9.4.1)" ], "pregnancy": "Pregnancy\u00a0high doses may be related to intrauterine growth\r\nrestriction and teratogenic effects; impaired platelet function with\r\nrisk of haemorrhage, and delayed onset and increased duration of labour\r\nwith increased blood loss, can occur if used during delivery; avoid\r\nanalgesic doses if possible in last few weeks (low doses probably\r\nnot harmful); with high doses, closure of fetal ductus arteriosus\r\nin utero and possibly persistent pulmonary hypertension of newborn;\r\nkernicterus in jaundiced neonates" }, "AZELASTINE HYDROCHLORIDE - ANTIHISTAMINES": { "side-effects": "Side-effects\u00a0irritation of nasal mucosa; bitter taste (if applied\r\nincorrectly)", "indications": "Indications\u00a0allergic rhinitis", "name": "AZELASTINE HYDROCHLORIDE - ANTIHISTAMINES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5641.htm", "doses": [ "adult and child over 5 years, 140\u00a0micrograms (1 spray) into\r\neach nostril twice daily", "Preparations of azelastine hydrochloride\r\ncan be sold to the public for nasal administration in aqueous form\r\n(other than by aerosol) if supplied for the treatment of seasonal\r\nallergic rhinitis or perennial allergic rhinitis in adults and children\r\nover 5 years, subject to max. single dose of 140\u00a0micrograms per nostril,\r\nmax. daily dose of 280\u00a0micrograms per nostril, and a pack size limit\r\nof 36 doses" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Antihistamines", "AZELASTINE HYDROCHLORIDE" ] }, "PENICILLAMINE": { "indications": "Indications\u00a0see notes above and under Dose", "name": "PENICILLAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Penicillamine" ], "cautions": "Cautions\u00a0\n(From Penicillamine: British National Formulary)\nPenicillamine has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common.Patients should be warned not to expect improvement for at least 6 to 12 weeks after treatment is initiated. Penicillamine should be discontinued if there is no improvement within 1 year.Blood counts, including platelets, and urine examinations should be carried out before starting treatment and then every 1 or 2 weeks for the first 2 months then every 4 weeks to detect blood disorders and proteinuria (they should also be carried out in the week after any dose increase). A reduction in platelet count calls for discontinuation with subsequent re-introduction at a lower dosage and then, if possible, gradual increase. Proteinuria, associated with immune complex nephritis, occurs in up to 30% of patients, but may resolve despite continuation of treatment; treatment may be continued provided that renal function tests remain normal, oedema is absent, and the 24-hour urinary excretion of protein does not exceed 2\u00a0g.Nausea may occur but is not usually a problem provided that penicillamine is taken before food or on retiring and that low initial doses are used and only gradually increased. Loss of taste can occur about 6 weeks after treatment is started but usually returns 6 weeks later irrespective of whether treatment is discontinued; mineral supplements are not recommended. Rashes are a common side-effect. Those that occur in the first few months of treatment disappear when the drug is stopped and treatment may then be re-introduced at a lower dose level and gradually increased. Late rashes are more resistant and often necessitate discontinuation of treatment.Patients who are hypersensitive to penicillin may react rarely to penicillamine.; concomitant nephrotoxic\r\ndrugs (increased risk of toxicity); gold\r\ntreatment (avoid concomitant use if adverse reactions to gold); interactions: Appendix 1 (penicillamine)Blood counts and urine tests\u00a0See %s\n(From Penicillamine: British National Formulary)\nPenicillamine has a similar action to gold. More patients are able to continue treatment than with gold but side-effects are common.Patients should be warned not to expect improvement for at least 6 to 12 weeks after treatment is initiated. Penicillamine should be discontinued if there is no improvement within 1 year.Blood counts, including platelets, and urine examinations should be carried out before starting treatment and then every 1 or 2 weeks for the first 2 months then every 4 weeks to detect blood disorders and proteinuria (they should also be carried out in the week after any dose increase). A reduction in platelet count calls for discontinuation with subsequent re-introduction at a lower dosage and then, if possible, gradual increase. Proteinuria, associated with immune complex nephritis, occurs in up to 30% of patients, but may resolve despite continuation of treatment; treatment may be continued provided that renal function tests remain normal, oedema is absent, and the 24-hour urinary excretion of protein does not exceed 2\u00a0g.Nausea may occur but is not usually a problem provided that penicillamine is taken before food or on retiring and that low initial doses are used and only gradually increased. Loss of taste can occur about 6 weeks after treatment is started but usually returns 6 weeks later irrespective of whether treatment is discontinued; mineral supplements are not recommended. Rashes are a common side-effect. Those that occur in the first few months of treatment disappear when the drug is stopped and treatment may then be re-introduced at a lower dose level and gradually increased. Late rashes are more resistant and often necessitate discontinuation of treatment.Patients who are hypersensitive to penicillin may react rarely to penicillamine.. Longer intervals may be adequate\r\nin cystinuria and Wilson\u2019s disease. Consider withdrawal\r\nif platelet count falls below 120\u00a0000/mm3 or white blood\r\ncells below 2500/mm3 or if 3 successive falls within reference\r\nrange (can restart at reduced dose when counts return\r\nto within reference range but permanent withdrawal necessary\r\nif recurrence of leucopenia or thrombocytopenia)Counselling\u00a0Warn patient to\r\ntell doctor promptly if sore throat, fever, infection, non-specific\r\nillness, unexplained bleeding and bruising, purpura, mouth ulcers,\r\nor rashes develop", "side-effects": "Side-effects\u00a0(see also notes above) initially nausea, anorexia, fever,\r\nand skin reactions; taste loss (mineral supplements not recommended);\r\nblood disorders including thrombocytopenia, leucopenia, agranulocytosis\r\nand aplastic anaemia; proteinuria, rarely haematuria (withdraw immediately\r\nand seek specialist advice); haemolytic anaemia, pancreatitis, cholestatic\r\njaundice, nephrotic syndrome, lupus erythematosus-like syndrome, myasthenia\r\ngravis-like syndrome, neuropathy, polymyositis (rarely with cardiac\r\ninvolvement), dermatomyositis, mouth ulcers, stomatitis, alopecia,\r\nbronchiolitis and pneumonitis, pemphigus, Goodpasture\u2019s syndrome,\r\nand Stevens-Johnson syndrome also reported; male and female breast\r\nenlargement reported; in non-rheumatoid conditions rheumatoid arthritis-like\r\nsyndrome also reported; late rashes (consider withdrawing treatment)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5295.htm", "doses": [ "Severe active rheumatoid arthritis, administered on expert\r\nadvice, adult over 18 years, initially\r\n125\u2013250\u00a0mg daily for 1 month increased by similar amounts at intervals\r\nof not less than 4 weeks to usual maintenance of 500\u2013750\u00a0mg daily\r\nin divided doses; max. 1.5\u00a0g daily; if remission sustained for 6 months,\r\nreduction of daily dose by 125\u2013250\u00a0mg every 12 weeks may be attempted; elderly initially up to 125\u00a0mg daily for 1 month\r\nincreased by similar amounts at intervals of not less than 4 weeks;\r\nmax. 1\u00a0g daily", "Wilson\u2019s disease, autoimmune hepatitis, and cystinuria, section 9.8.1" ], "pregnancy": "Pregnancy\u00a0fetal abnormalities reported rarely; avoid if possible" }, "HYDROXOCOBALAMIN - CYANIDES": { "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, transient hypertension,\r\nperipheral oedema, dyspnoea, throat disorders, hot flush, dizziness,\r\nheadache, restlessness, memory impairment, red coloration of urine,\r\nlymphocytopenia, eye disorders, pustular rashes, pruritus, reversible\r\nred coloration of skin and mucous membranes", "indications": "Indications\u00a0poisoning with cyanides (\n(From Cyanides: British National Formulary)\nHydroxocobalamin (Cyanokit\u00ae\u2014no other preparation of hydroxocobalamin is suitable) can be considered for use in victims of smoke inhalation who show signs of significant cyanide poisoning.)", "name": "HYDROXOCOBALAMIN - CYANIDES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213582.htm", "doses": [ "By intravenous infusion, adult 5\u00a0g over 15 minutes; a second dose of 5\u00a0g can\r\nbe given over 15 minutes\u20132 hours depending on severity of poisoning\r\nand patient stability; child under\r\n18 years with body-weight 5\u00a0kg and over, 70\u00a0mg/kg (max. 5\u00a0g) over\r\n15 minutes; a second dose of 70\u00a0mg/kg (max. 5\u00a0g) can be given over\r\n15 minutes\u20132 hours depending on severity of poisoning and patient\r\nstability" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Other poisons", "Cyanides" ] }, "FOSCARNET SODIUM": { "indications": "Indications\u00a0cytomegalovirus disease [licensed for cytomegalovirus retinitis in\r\nAIDS patients only]; mucocutaneous herpes simplex virus infections\r\nunresponsive to aciclovir in immunocompromised\r\npatients", "name": "FOSCARNET SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.2 Cytomegalovirus infection" ], "cautions": "Cautions\u00a0monitor electrolytes, particularly calcium\r\nand magnesium; monitor serum creatinine\r\nevery second day during induction and every week during maintenance; ensure adequate hydration; avoid rapid infusion; interactions: Appendix 1 (foscarnet)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea (occasionally constipation\r\nand dyspepsia), abdominal pain, anorexia; changes in blood pressure\r\nand ECG; headache, fatigue, mood disturbances (including psychosis),\r\nasthenia, paraesthesia, convulsions, tremor, dizziness, and other\r\nneurological disorders; rash; impairment of renal function including\r\nacute renal failure; hypocalcaemia (sometimes symptomatic) and other\r\nelectrolyte disturbances; abnormal liver function tests; decreased\r\nhaemoglobin concentration, leucopenia, granulocytopenia, thrombocytopenia;\r\nthrombophlebitis if given undiluted by peripheral vein; genital irritation\r\nand ulceration (due to high concentrations excreted in urine); isolated\r\nreports of pancreatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4007.htm", "doses": [ "CMV disease [licensed for CMV retinitis only], by intravenous infusion, initially (induction) 60\u00a0mg/kg every\r\n8 hours or 90\u00a0mg/kg every 12 hours, for 2\u20133 weeks;\r\nmaintenance 60\u00a0mg/kg daily, increased to 90\u2013120\u00a0mg/kg if tolerated;\r\nif disease progresses on maintenance dose, repeat induction regimen", "Mucocutaneous herpes simplex infection, by intravenous\r\ninfusion, 40\u00a0mg/kg every 8 hours for 2\u20133 weeks or until lesions\r\nheal", "Foscarnet doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "ALFUZOSIN HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0benign prostatic hyperplasia", "name": "ALFUZOSIN HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "ALFUZOSIN HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers).; discontinue if angina\r\nworsens; acute heart failure; history of QT-interval\r\nprolongation; concomitant use with other drugs known to prolong QT\r\nintervalDriving\u00a0May affect performance of skilled tasks\r\ne.g. driving", "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported.; also less commonly flushes and chest pain; also reported liver damage and cholestasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207440.htm", "doses": [ "2.5\u00a0mg 3 times daily, max. 10\u00a0mg daily; elderly initially 2.5\u00a0mg twice daily", "First dose may\r\ncause collapse due to hypotensive effect (therefore should be taken\r\non retiring to bed). Patient should be\r\nwarned to lie down if symptoms such as dizziness, fatigue or sweating\r\ndevelop, and to remain lying down until they abate completely", "Name[Vasran\u00ae XL (Ranbaxy) ] Tablets, m/r, alfuzosin hydrochloride\r\n10\u00a0mg, net price 30-tab pack = \u00a311.48. \r\n Label:\r\n 21, 25, counselling, initial dose, driving, see aboveDose\u00a0benign prostatic hyperplasia 10\u00a0mg once daily" ] }, "MESTEROLONE": { "indications": "Indications\u00a0see under Dose", "name": "MESTEROLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists" ], "cautions": "Cautions\u00a0see under Testosterone and\r\nEsters", "side-effects": "Side-effects\u00a0see under Testosterone and Esters but spermatogenesis unimpaired", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4371.htm", "doses": [ "Androgen deficiency and male infertility associated with\r\nhypogonadism, 25\u00a0mg 3\u20134 times daily for several months, reduced to\r\n50\u201375\u00a0mg daily in divided doses for maintenance; child not recommended" ], "pregnancy": "Pregnancy\u00a0see under Testosterone and Esters" }, "DORZOLAMIDE With timolol": { "indications": "Indications\u00a0raised intra-ocular pressure in ocular hypertension, open-angle glaucoma,\r\npseudo-exfoliative glaucoma either as adjunct to\r\nbeta-blocker or used alone in patients unresponsive\r\nto beta-blockers or if beta-blockers contra-indicated", "name": "DORZOLAMIDE With timolol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "DORZOLAMIDE", "With timolol" ], "cautions": "Cautions\u00a0systemic absorption follows topical application; history of renal calculi; chronic corneal defects, history of intra-ocular\r\nsurgery; interactions: Appendix 1 (dorzolamide)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also nausea,\r\nbitter taste, dry mouth; headache, asthenia; ocular irritation, blurred\r\nvision, lacrimation, conjunctivitis, superficial punctuate keratitis,\r\neyelid inflammation; less commonly iridocyclitis; rarely hypersensitivity reactions (including urticaria,\r\nangioedema, bronchospasm), dizziness, paraesthesia, urolithiasis,\r\neyelid crusting, transient myopia, corneal oedema, epistaxis, throat\r\nirritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73179.htm", "doses": [ "Used alone, apply 3 times daily", "With topical beta-blocker, apply twice daily", "Name[Cosopt\u00ae (MSD) ] Ophthalmic solution (= eye drops),\r\nin Ocumeter\u00ae Plus metered-dose unit, dorzolamide (as hydrochloride)\r\n2%, timolol (as maleate) 0.5%, net price 5\u00a0mL = \u00a310.05Excipients include benzalkonium chloride\nUnit dose eye drops, dorzolamide\r\n(as hydrochloride) 2%, timolol (as maleate) 0.5%, net price 60 \u00d7 0.2\u00a0mL\r\n= \u00a328.59" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "TYPHOID VACCINE Typhoid vaccine, live (oral)": { "indications": "Indications\u00a0immunisation against typhoid fever", "name": "TYPHOID VACCINE Typhoid vaccine, live (oral)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Typhoid vaccines", "TYPHOID VACCINE", "Typhoid vaccine, live (oral)" ], "cautions": "Cautions\u00a0section 14.1; interactions: see above and Appendix\r\n1 (typhoid vaccine (oral) )", "side-effects": "Side-effects\u00a0section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129589.htm", "doses": [ "See under preparations", "Name[Vivotif\u00ae (Crucell) ] Capsules, e/c, live attenuated Salmonella typhi (Ty21a), net price 3-cap pack = \u00a314.77. \r\n Label:\r\n 25, counselling, administrationDose\u00a0adult and child over 6 years, 1 capsule on days 1, 3, and 5Counselling\u00a0Take one hour before a meal. Swallow\r\nas soon as possible after placing in mouth with a cold or lukewarm\r\ndrink; it is important to store capsules in a refrigerator" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "DIGOXIN": { "indications": "Indications\u00a0heart failure (see also section 2.5.5), supraventricular arrhythmias (particularly\r\natrial fibrillation and atrial flutter; see also section 2.3.2)", "name": "DIGOXIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.1 Positive inotropic drugs", "2.1.1 Cardiac glycosides", "DIGOXIN" ], "cautions": "Cautions\u00a0recent myocardial infarction; sick sinus syndrome; thyroid disease; reduce dose in the elderly; severe respiratory disease; hypokalaemia, hypomagnesaemia, hypercalcaemia, and hypoxia (risk of digitalis toxicity); monitor serum electrolytes and renal function; avoid rapid intravenous administration (risk of hypertension and\r\nreduced coronary flow); interactions: Appendix 1 (cardiac glycosides)", "side-effects": "Side-effects\u00a0\n(From 2.1.1 Cardiac glycosides: British National Formulary)\n2.1.1 Cardiac glycosides; also nausea, vomiting, diarrhoea;\r\narrhythmias, conduction disturbances; dizziness; blurred or yellow\r\nvision; rash, eosinophilia; less commonly depression; very rarely anorexia, intestinal ischaemia and necrosis,\r\npsychosis, apathy, confusion, headache, fatigue, weakness, gynaecomastia\r\non long-term use, and thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2312.htm", "doses": [ "Rapid digitalisation, for atrial fibrillation or flutter, by mouth, 0.75\u20131.5\u00a0mg over 24 hours in divided doses", "Maintenance, for atrial fibrillation or flutter, by mouth, according to renal function and initial loading dose; usual range\r\n125\u2013250\u00a0micrograms daily", "Heart failure (for patients in sinus rhythm), by mouth, 62.5\u2013125\u00a0micrograms once daily", "Emergency loading dose, for atrial fibrillation or flutter, by intravenous infusion (but rarely necessary), 0.75\u20131\u00a0mg\r\nover at least 2 hours (see also Cautions) then maintenance dose by mouth on the following day", "The above doses may need to be reduced if digoxin (or another cardiac glycoside) has been given in\r\nthe preceding 2 weeks. Digoxin doses in the BNF may differ from those\r\nin product literature. For plasma concentration monitoring, blood\r\nshould be taken at least 6 hours after a dose " ], "pregnancy": "Pregnancy\u00a0may need dosage adjustment" }, "DICLOFENAC SODIUM - NON-STEROIDAL ANTI-INFLAMMATORY DRUGS": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\nacute gout; postoperative pain", "name": "DICLOFENAC SODIUM - NON-STEROIDAL ANTI-INFLAMMATORY DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DICLOFENAC SODIUM" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation; injection site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5208.htm", "doses": [ "By mouth, 75\u2013150\u00a0mg daily in 2\u20133\r\ndivided doses", "By rectum in suppositories, 75\u2013150\u00a0mg\r\ndaily in divided doses", "Juvenile idiopathic arthritis, child 6 months\u201318 years, by mouth, see BNF for Children", "Postoperative pain, child 6\u201312 years, by rectum, 1\u20132\u00a0mg/kg (max. 150\u00a0mg) daily\r\nin divided doses (12.5\u00a0mg and 25\u00a0mg suppositories only) for max. 4\r\ndays", "by deep intramuscular injection into the\r\ngluteal muscle, acute exacerbations of pain and postoperative pain,\r\n75\u00a0mg once daily (twice daily in severe cases) for max. 2 days; child 2\u201318 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ISOSORBIDE DINITRATE Modified-release preparations": { "indications": "Indications\u00a0prophylaxis and treatment of angina; left ventricular\r\nfailure", "name": "ISOSORBIDE DINITRATE Modified-release preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE DINITRATE", "Modified-release preparations" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2649.htm", "doses": [ "By mouth, daily in divided doses, angina\r\n30\u2013120\u00a0mg, left ventricular failure 40\u2013160\u00a0mg, up to 240\u00a0mg if required", "By intravenous infusion, 2\u201310\u00a0mg/hour; higher\r\ndoses up to 20\u00a0mg/hour may be required", "Name[Isoket Retard\u00ae (UCB Pharma)] Retard-20 tablets, m/r, scored, isosorbide dinitrate 20\u00a0mg, net price 56-tab pack = \u00a32.58. \r\n Label:\r\n 25\nRetard-40 tablets, m/r, scored, isosorbide dinitrate 40\u00a0mg, net price 56-tab pack = \u00a36.36. \r\n Label:\r\n 25Dose\u00a0prophylaxis of angina, 40\u00a0mg daily in 1\u20132 divided doses,\r\nincreased if necessary to 60\u201380\u00a0mg daily in 2\u20133 divided doses" ], "pregnancy": "Pregnancy\u00a0may cross placenta\u2014manufacturers advise avoid unless\r\npotential benefit outweighs risk" }, "AGOMELATINE": { "indications": "Indications\u00a0major depression", "name": "AGOMELATINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs", "AGOMELATINE" ], "cautions": "Cautions\u00a0elderly; mania or hypomania; concomitant\r\nuse of drugs associated with hepatic injury; excessive alcohol consumption; obesity; non-alcoholic\r\nfatty liver disease; monitor liver function before treatment\r\nand after 6, 12 and 24 weeks of treatment, then as appropriate\r\n(discontinue if serum transaminases exceed 3 times the\r\nupper limit of reference range); interactions: Appendix 1 (agomelatine)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, constipation, abdominal pain,\r\nincreased serum transaminases (see Cautions); headache, dizziness,\r\ndrowsiness, agitation, sleep disturbances, fatigue, anxiety; back\r\npain; sweating; less commonly paraesthesia, blurred\r\nvision, and eczema; rarely hepatitis and rash; suicidal\r\nbehaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy)\r\nand pruritus also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202510.htm", "doses": [ "adult over 18 years, 25\u00a0mg\r\nat bedtime, increased if necessary after 2 weeks to 50\u00a0mg at bedtime " ], "pregnancy": "Pregnancy\u00a0caution" }, "ATROPINE SULPHATE": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal\r\ndisorders characterised by smooth muscle spasm; mydriasis and cycloplegia\r\n(section 11.5); premedication (section 15.1.3); see also notes above", "name": "ATROPINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "ATROPINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60253.htm", "doses": [ "0.6\u20131.2\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution" }, "SAPROPTERIN DIHYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose below ", "name": "SAPROPTERIN DIHYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.4 Oral nutrition", "9.4.1 Foods for special diets" ], "cautions": "Cautions\u00a0monitor blood-phenylalanine concentration\r\nbefore and after first week of treatment\u2014if unsatisfactory response\r\nincrease dose at weekly intervals to max. dose and monitor blood-phenylalanine\r\nconcentration weekly; discontinue treatment\r\nif unsatisfactory response after 1 month; monitor blood-phenylalanine and tyrosine concentrations 1\u20132 weeks\r\nafter dose adjustment and during treatment; history of convulsions", "side-effects": "Side-effects\u00a0diarrhoea, vomiting, abdominal pain; nasal congestion,\r\ncough, pharyngolaryngeal pain; headache", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202229.htm", "doses": [ "Phenylketonuria (specialist use only), by mouth, adult and child over 4 years, initially 10\u00a0mg/kg once daily, preferably in the morning,\r\nadjusted according to response; usual dose 5\u201320\u00a0mg/kg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014consider only if strict\r\ndietary management inadequate" }, "METHIONINE": { "indications": "Indications\u00a0paracetamol overdosage, \n(From Analgesics (non-opioid): British National Formulary)\nParacetamolIn cases of intravenous paracetamol poisoning contact the National Poisons Information Service for advice on risk assessment and management.\u00a0Single or repeated doses totalling as little as 10\u201315\u00a0g (20\u201330 tablets) or 150\u00a0mg/kg of paracetamol ingested within 24\u00a0hours may cause severe hepatocellular necrosis and, much less frequently, renal tubular necrosis. To avoid underestimating the potentially toxic paracetamol dose ingested by obese patients who weigh more than 110\u00a0kg, use a body-weight of 110\u00a0kg (rather than their actual body-weight) when calculating the total dose of paracetamol ingested (in mg/kg). Patients at high-risk of liver damage, including those taking enzyme-inducing drugs or who are malnourished (see below), may develop liver toxicity with as little as 75\u00a0mg/kg of paracetamol (equivalent to approx. 5\u00a0g (10 tablets) in a 70-kg patient) taken within 24 hours. Nausea and vomiting, the only early features of poisoning, usually settle within 24 hours. Persistence beyond this time, often associated with the onset of right subcostal pain and tenderness, usually indicates development of hepatic necrosis. Liver damage is maximal 3\u20134 days after ingestion and may lead to encephalopathy, haemorrhage, hypoglycaemia, cerebral oedema, and death. Therefore, despite a lack of significant early symptoms, patients who have taken an overdose of paracetamol should be transferred to hospital urgently.Administration of activated charcoal should be considered if paracetamol in excess of 150\u00a0mg/kg or 12\u00a0g, whichever is the smaller (or in excess of 75\u00a0mg/kg for those considered to be at high risk, see below), is thought to have been ingested within the previous hour.Acetylcysteine protects the liver if infused up to, and possibly beyond, 24 hours of ingesting paracetamol. It is most effective if given within 8 hours of ingestion, after which effectiveness declines. In patients who present 8\u201336 hours after a potentially toxic ingestion, acetylcysteine treatment should commence immediately even if plasma-paracetamol concentrations are not yet available; if more than 24 hours have elapsed since ingestion advice should be sought from the National Poisons Information Service. Giving acetylcysteine by mouth [unlicensed route] is an alternative if intravenous access is not possible\u2014contact the National Poisons Information Service for advice. In remote areas, methionine by mouth is an alternative only if acetylcysteine cannot be given promptly. Once the patient reaches hospital the need to continue treatment with the antidote will be assessed from the plasma-paracetamol concentration (related to the time from ingestion).Patients at risk of liver damage and therefore requiring treatment can be identified from a single measurement of the plasma-paracetamol concentration, related to the time from ingestion, provided this time interval is not less than 4 hours; earlier samples may be misleading. The concentration is plotted on a paracetamol treatment graph, with a reference line (\u2018normal treatment line\u2019) joining plots of 200\u00a0mg/litre (1.32\u00a0mmol/litre) at 4 hours and 6.25\u00a0mg/litre (0.04\u00a0mmol/litre) at 24 hours (see Paracetamol poisoning treatment graph). Those whose plasma-paracetamol concentration is on or above the normal treatment line are treated with acetylcysteine by intravenous infusion (or, if acetylcysteine is not available, with methionine by mouth, provided the overdose has been taken within 10\u201312 hours and the patient is not vomiting). Patients at high-risk of liver damage include those: taking liver enzyme-inducing drugs (e.g. carbamazepine, phenobarbital, phenytoin, primidone, rifampicin, rifabutin, efavirenz, nevirapine, alcohol and St John\u2019s wort);who are malnourished (e.g. in anorexia or bulimia, cystic fibrosis, hepatitis C, in alcoholism, or those who are HIV-positive);who have not eaten for a few days.These patients can develop toxicity at lower plasma-paracetamol concentration and should be treated if the concentration is on or above the high-risk treatment line (which joins plots that are at 50% of the plasma-paracetamol concentrations of the normal treatment line). The prognostic accuracy of plasma-paracetamol concentration taken after 15 hours is uncertain, but a concentration on or above the relevant treatment line should be regarded as carrying a serious risk of liver damage.The plasma-paracetamol concentration may be difficult to interpret when paracetamol has been ingested over several hours. If there is doubt about timing or the need for treatment then the patient should be treated with an antidote.", "name": "METHIONINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Analgesics (non-opioid)", "METHIONINE" ], "side-effects": "Side-effects\u00a0nausea, vomiting, drowsiness, irritability", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130070.htm", "doses": [ "adult and child over 6 years initially 2.5\u00a0g, followed by 3\r\nfurther doses of 2.5\u00a0g every 4 hours, child under 6 years initially 1\u00a0g, followed by 3 further doses of 1\u00a0g\r\nevery 4 hours" ] }, "DORIPENEM": { "indications": "Indications\u00a0hospital-acquired pneumonia; complicated intra-abdominal infections;\r\ncomplicated urinary-tract infections", "name": "DORIPENEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.2 Carbapenems", "DORIPENEM" ], "cautions": "Cautions\u00a0sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction, see Hypersensitivity Reactions); interactions: Appendix 1 (doripenem)", "side-effects": "Side-effects\u00a0nausea, diarrhoea; headache; phlebitis, pruritus,\r\nrash; less commonly antibiotic-associated colitis,\r\nthrombocytopenia, neutropenia; also reported, toxic epidermal necrolysis,\r\nand Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201585.htm", "doses": [ "By intravenous infusion, adult over 18 years, 500\u00a0mg every 8 hours; max. duration\r\nof treatment 14 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014no information\r\navailable" }, "PARACETAMOL With isometheptene mucate": { "indications": "Indications\u00a0mild to moderate pain, pyrexia", "name": "PARACETAMOL With isometheptene mucate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "PARACETAMOL", "With isometheptene mucate" ], "cautions": "Cautions\u00a0alcohol dependence; max. daily infusion dose 3\u00a0g in patients with hepatocellular\r\ninsufficiency, chronic alcoholism, chronic malnutrition,\r\nor dehydration; before administering, check when paracetamol last administered and\r\ncumulative paracetamol dose over previous 24 hours; interactions: Appendix 1 (paracetamol)", "side-effects": "Side-effects\u00a0side-effects rare, but rashes, blood disorders\r\n(including thrombocytopenia, leucopenia, neutropenia) reported; hypotension,\r\nflushing, and tachycardia also reported on infusion; important: liver damage (and less frequently renal damage) following overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3563.htm", "doses": [ "By mouth, 0.5\u20131\u00a0g every 4\u20136 hours to a\r\nmax. of 4\u00a0g daily; child 2 months\r\n60\u00a0mg for post-immunisation pyrexia, repeated once after 4\u20136 hours\r\nif necessary; otherwise under 3 months see BNF for Children; 3\u20136 months\r\n60\u00a0mg, 6 months\u20132 years 120\u00a0mg, 2\u20134 years 180\u00a0mg, 4\u20136 years 240\u00a0mg,\r\n6\u20138 years 240\u2013250\u00a0mg, 8\u201310 years 360\u2013375\u00a0mg, 10\u201312 years 480\u2013500\u00a0mg,\r\n12\u201316 years 480\u2013750\u00a0mg; these doses may be repeated every 4\u20136 hours\r\nwhen necessary (max. of 4 doses in 24 hours)", "By intravenous infusion over 15 minutes, adult and child over\r\n50\u00a0kg, 1\u00a0g every 4\u20136 hours, max. 4\u00a0g daily; adult and child 10\u201350\u00a0kg, 15\u00a0mg/kg every\r\n4\u20136 hours, max. 60\u00a0mg/kg daily; neonate and child less than 10\u00a0kg see BNF for Children", "By rectum, adult and child over 12 years 0.5\u20131\u00a0g every\r\n4\u20136 hours to a max. of 4\u00a0g daily; child under 3 months see BNF for Children, 3 months\u20131 year 60\u2013125\u00a0mg, 1\u20135 years 125\u2013250\u00a0mg, 5\u201312 years\r\n250\u2013500\u00a0mg; these doses may be repeated every 4\u20136 hours as necessary\r\n(max. 4 doses in 24 hours)", "For full Joint Committee on Vaccination and\r\nImmunisation recommendation on post-immunisation pyrexia, see section 14.1", "Name[Midrid\u00ae (Manx) ] Capsules, red, isometheptene\r\nmucate 65\u00a0mg, paracetamol 325\u00a0mg, net\r\nprice 30-cap pack = \u00a35.50. \r\n Label:\r\n 30, counselling, dosageDose\u00a0migraine, 2 capsules at onset of attack, followed by 1\r\ncapsule every hour if necessary; max. 5 capsules in 12 hours; child not recommended" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "LIQUID PARAFFIN ": { "indications": "Indications\u00a0constipation", "name": "LIQUID PARAFFIN ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.3 Faecal softeners", "LIQUID PARAFFIN" ], "cautions": "Cautions\u00a0avoid prolonged use; contra-indicated\r\nin children under 3 years", "side-effects": "Side-effects\u00a0anal seepage of paraffin and consequent anal irritation\r\nafter prolonged use, granulomatous reactions caused by absorption\r\nof small quantities of liquid paraffin (especially\r\nfrom the emulsion), lipoid pneumonia, and interference with the absorption\r\nof fat-soluble vitamins", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2234.htm", "doses": [ "See under preparation", "adult over 18 years, 10\u201330\u00a0mL\r\nat night when required" ] }, "LORAZEPAM - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS": { "indications": "Indications\u00a0conscious sedation for procedures; premedication;\r\nshort-term use in anxiety or insomnia (section 4.1.2); status epilepticus (section 4.8.2)", "name": "LORAZEPAM - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines", "LORAZEPAM" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nLorazepam produces more prolonged sedation than temazepam and it has marked amnesic effects and %s\n(From LORAZEPAM: British National Formulary)\nLORAZEPAM; interactions: Appendix 1 (anxiolytics\r\nand hypnotics)", "side-effects": "Side-effects\u00a0see notes above and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100105.htm", "doses": [ "By mouth, 2\u20133\u00a0mg the night before operation;\r\n2\u20134\u00a0mg 1\u20132 hours before operation", "By slow intravenous injection, preferably diluted\r\nwith an equal volume of sodium chloride intravenous\r\ninfusion 0.9% or water for injections, 50\u00a0micrograms/kg 30\u201345 minutes\r\nbefore operation", "By intramuscular injection, diluted as above,\r\n50\u00a0micrograms/kg 60\u201390 minutes before operation" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "13.10.5 Preparations for minor cuts and abrasions Preparations for boils": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.5 Preparations for minor cuts and abrasions", "Preparations for boils" ], "name": "13.10.5 Preparations for minor cuts and abrasions Preparations for boils", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6221.htm", "doses": [ "Name[Magnesium Sulphate Paste, BP] Paste, dried magnesium\r\nsulphate 45\u00a0g, glycerol 55\u00a0g, phenol 500\u00a0mg, net price 25\u00a0g = 75p, 50\u00a0g = 88pNote\u00a0Should be stirred before useDose\u00a0apply under dressing" ] }, "ZIDOVUDINE With lamivudine": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs; prevention\r\nof maternal-fetal HIV transmission (see notes above under Pregnancy\r\nand Breast-feeding)", "name": "ZIDOVUDINE With lamivudine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "ZIDOVUDINE", "With lamivudine" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also haematological toxicity particularly with high dose and advanced\r\ndisease\u2014monitor full blood count after 4 weeks of treatment, then\r\nevery 3 months; vitamin B12 deficiency\r\n(increased risk of neutropenia); if anaemia or myelosuppression\r\noccur, reduce dose or interrupt treatment according to product literature,\r\nor consider other treatment; elderly; interactions: Appendix 1 (zidovudine)", "side-effects": "Side-effects\u00a0see notes above; also anaemia (may require transfusion),\r\ntaste disturbance, chest pain, influenza-like symptoms, paraesthesia,\r\nneuropathy, convulsions, dizziness, drowsiness, anxiety, depression,\r\nloss of mental acuity, myopathy, gynaecomastia, urinary frequency,\r\nsweating, pruritus, pigmentation of nails, skin and oral mucosa", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69459.htm", "doses": [ "By mouth, 250\u2013300\u00a0mg twice daily; child 1 month\u201318 years see BNF for Children", "Prevention of maternal-fetal HIV transmission, seek specialist\r\nadvice (combination therapy preferred)", "Patients temporarily unable to take zidovudine by mouth, by intravenous infusion over 1 hour, 0.8\u20131\u00a0mg/kg\r\nevery 4 hours (approximating to 1.2\u20131.5\u00a0mg/kg every 4 hours by mouth)\r\nusually for not more than 2 weeks; child 3 months\u201318 years see BNF for Children", "Name[Combivir\u00ae (ViiV) ] Tablets, f/c, scored, zidovudine 300\u00a0mg, lamivudine 150\u00a0mg, net price 60-tab pack\r\n= \u00a3300.12Dose\u00a01 tablet twice daily; child body-weight over 14\u00a0kg see BNF for\r\nChildrenNote\u00a0Tablets may be crushed and mixed with semi-solid\r\nfood or liquid just before administration" ], "pregnancy": "Pregnancy\u00a0limited information available; manufacturer advises\r\nuse only if clearly indicated; see also Pregnancy" }, "ANAGRELIDE": { "indications": "Indications\u00a0\n(From Essential thrombocythaemia: British National Formulary)\nEssential thrombocythaemia", "name": "ANAGRELIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.4 Drugs used in platelet disorders", "Essential thrombocythaemia" ], "cautions": "Cautions\u00a0cardiovascular disease\u2014assess cardiac\r\nfunction before and during treatment; concomitant\r\naspirin in patients at risk of haemorrhage; monitor full blood count (monitor platelet count every 2 days for\r\n1 week, then weekly until maintenance dose established), liver function,\r\nserum creatinine and urea; interactions: Appendix 1 (anagrelide)Driving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; palpitation, tachycardia,\r\nfluid retention; headache, dizziness, fatigue; anaemia; rash; less commonly pancreatitis, gastro-intestinal haemorrhage,\r\ncongestive heart failure, hypertension, arrhythmias, syncope, chest\r\npain, dyspnoea, sleep disturbances, paraesthesia, hypoaesthesia, depression,\r\nnervousness, confusion, amnesia, fever, weight changes, impotence,\r\nblood disorders, myalgia, arthralgia, epistaxis, dry mouth, alopecia,\r\nskin discoloration, and pruritus; rarely gastritis,\r\ncolitis, postural hypotension, angina, myocardial infarction, vasodilatation,\r\npulmonary hypotension, pulmonary infiltrates, migraine, drowsiness,\r\nimpaired coordination, dysarthria, asthenia, tinnitus, renal failure,\r\nnocturia, visual disturbances, and gingival bleeding; allergic alveolitis\r\nand hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129351.htm", "doses": [ "Initially 500\u00a0micrograms twice daily adjusted according\r\nto response in steps of 500\u00a0micrograms daily at weekly intervals to\r\nmax. 10\u00a0mg daily (max. single dose 2.5\u00a0mg); usual dose range 1\u20133\u00a0mg\r\ndaily in divided doses; child under\r\n18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies)" }, "FONDAPARINUX SODIUM": { "indications": "Indications\u00a0prophylaxis of venous thromboembolism in medical patients immobilised\r\nbecause of acute illness, and patients undergoing major orthopaedic\r\nsurgery of the hip or leg, or abdominal surgery; treatment of deep-vein\r\nthrombosis, superficial-vein thrombosis, and pulmonary embolism; treatment\r\nof unstable angina or non-ST-segment elevation myocardial infarction;\r\ntreatment of ST-segment elevation myocardial infarction", "name": "FONDAPARINUX SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Fondaparinux", "FONDAPARINUX SODIUM" ], "cautions": "Cautions\u00a0bleeding disorders, active gastro-intestinal ulcer disease; recent intracranial haemorrhage; brain, spinal, or ophthalmic surgery; spinal or epidural anaesthesia (risk of spinal haematoma\u2014avoid if using treatment doses); risk of catheter thrombus during percutaneous coronary intervention; low body-weight; elderly\r\npatients; concomitant use of drugs that\r\nincrease risk of bleeding", "side-effects": "Side-effects\u00a0bleeding, purpura, anaemia; less commonly gastro-intestinal disturbances, oedema, hepatic impairment, chest\r\npain, dyspnoea, thrombocytopenia, thrombocythaemia, rash, pruritus; rarely hypotension, flushing, cough, vertigo, dizziness,\r\nanxiety, drowsiness, confusion, headache, hypokalaemia, hyperbilirubinaemia,\r\ninjection-site reactions; also reported atrial fibrillation, tachycardia,\r\nand pyrexia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112796.htm", "doses": [ "Prophylaxis of venous thromboembolism after surgery, by subcutaneous injection, 2.5\u00a0mg 6 hours after surgery then\r\n2.5\u00a0mg once daily; child under 17 years\r\nnot recommended", "Prophylaxis of venous thromboembolism in medical patients, by subcutaneous injection, 2.5\u00a0mg once daily; child under 17 years not recommended", "Treatment of superficial-vein thrombosis, by subcutaneous\r\ninjection, adult body-weight\r\nover 50\u00a0kg, 2.5\u00a0mg once daily for at least 30 days (max. 45 days if\r\nhigh risk of thromboembolic complications); treatment should be stopped\r\n24 hours before surgery and restarted at least 6 hours post operatively; child under 17 years not recommended", "Unstable angina and non-ST-segment elevation myocardial\r\ninfarction, by subcutaneous injection, 2.5\u00a0mg once\r\ndaily for up to 8 days (or until hospital discharge if sooner); treatment\r\nshould be stopped 24 hours before coronary artery bypass graft surgery\r\n(where possible) and restarted 48 hours post operatively; child under 17 years not recommended", "ST-segment elevation myocardial infarction, initially by intravenous injection or infusion, 2.5\u00a0mg\r\nfor first day, thereafter by subcutaneous injection 2.5\u00a0mg once daily for up to 8 days (or until hospital discharge\r\nif sooner); treatment should be stopped 24 hours before coronary artery\r\nbypass graft surgery (where possible) and restarted 48 hours post\r\noperatively; child under 17 years not\r\nrecommended", "Treatment of deep-vein thrombosis and of pulmonary embolism, by subcutaneous injection, adult body-weight under 50\u00a0kg, 5\u00a0mg every 24 hours; body-weight 50\u2013100\u00a0kg,\r\n7.5\u00a0mg every 24 hours; body-weight over 100\u00a0kg, 10\u00a0mg every 24 hours; child under 17 years not recommended", "Note An oral anticoagulant (usually warfarin, section 2.8.2) is started at the same time\r\nas fondaparinux (fondaparinux should be continued for at least 5 days\r\nand until INR \u22652 for at least 24 hours)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs possible risk\u2014no information available" }, "PINDOLOL": { "indications": "Indications\u00a0see under Dose", "name": "PINDOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2517.htm", "doses": [ "Hypertension, initially 5\u00a0mg 2\u20133 times daily or 15\u00a0mg once daily, increased as required at weekly intervals; usual\r\nmaintenance 15\u201330\u00a0mg daily; max. 45\u00a0mg daily", "Angina, 2.5\u20135\u00a0mg up to 3 times daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "FAMCICLOVIR": { "indications": "Indications\u00a0see under Dose", "name": "FAMCICLOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.1 Herpes simplex and varicella\u2013zoster infection", "FAMCICLOVIR" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (famciclovir)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea; headache,\r\nfatigue; sweating, pruritus; rarely confusion; very rarely jaundice, dizziness, drowsiness, hallucinations,\r\nthrombocytopenia, rash (including Stevens-Johnson syndrome); also\r\nreported, constipation and fever", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/14828.htm", "doses": [ "Herpes zoster, treatment, 500\u00a0mg 3 times daily for 7 days or 750\u00a0mg 1\u20132 times daily for 7 days (in immunocompromised,\r\n500\u00a0mg 3 times daily for 10 days, continue for 2 days\r\nafter crusting of lesions)", "Genital herpes, treatment of first episode,\r\n250\u00a0mg 3 times daily for 5 days, longer if new lesions appear during\r\ntreatment or if healing incomplete (500\u00a0mg twice daily for 10 days\r\nin immunocompromised or HIV-positive patients); treatment of recurrent infection, 125\u00a0mg twice daily for 5 days or 1\u00a0g twice daily for 1 day (500\u00a0mg twice daily for 5\u201310\r\ndays in immunocompromised or HIV-positive patients)", "Genital herpes, suppression, 250\u00a0mg twice daily (500\u00a0mg twice\r\ndaily in immunocompromised or HIV-positive patients); therapy interrupted\r\nevery 6\u201312 months to reassess recurrence frequency\u2014consider restarting\r\nafter two or more recurrences", "Non-genital herpes simplex, treatment in the immunocompromised,\r\n500\u00a0mg twice daily for 7 days", "child not recommended", "Famciclovir doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless potential benefit\r\noutweighs risk" }, "FOLLITROPIN ALFA and BETA Follitropin beta": { "indications": "Indications\u00a0see notes above", "name": "FOLLITROPIN ALFA and BETA Follitropin beta", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "FOLLITROPIN ALFA and BETA", "Follitropin beta" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0see under Human Menopausal Gonadotrophins", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56578.htm", "doses": [ "By subcutaneous or intramuscular injection, according to patient\u2019s response", "Name[Puregon\u00ae (Organon) ] Injection, follitropin beta 100\u00a0units/mL,\r\nnet price 0.5-mL (50-unit) vial = \u00a318.03; 200\u00a0units/mL, 0.5-mL (100-unit)\r\nvial = \u00a336.06; 300\u00a0units/mL, 0.5-mL (150-unit) vial = \u00a350.62; 400\u00a0units/mL,\r\n0.5-mL (200-unit) vial = \u00a367.49; 0.36-mL (300-unit) cartridge = \u00a397.41,\r\n0.72-mL (600-unit) cartridge = \u00a3194.82, 1.08-mL (900-unit) cartridge\r\n= \u00a3292.23, (cartridges for use with Puregon\u00ae pen).\r\nFor subcutaneous (cartridges and vials) or intramuscular injection\r\n(vials)Excipients may include neomycin and streptomycin" ], "pregnancy": "Pregnancy\u00a0avoid" }, "URSODEOXYCHOLIC ACID": { "indications": "Indications\u00a0see under Dose and under preparations", "name": "URSODEOXYCHOLIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.9 Drugs affecting intestinal secretions", "1.9.1 Drugs affecting biliary composition and flow", "URSODEOXYCHOLIC ACID" ], "cautions": "Cautions\u00a0\n(From 1.9.1 Drugs affecting biliary composition and flow: British National Formulary)\nit should be used cautiously in those with liver disease (but see below). Patients should be given dietary advice (including avoidance of excessive cholesterol and calories) and they require radiological monitoring. Long-term prophylaxis may be needed after complete dissolution of the gallstones has been confirmed because they may recur in up to 25% of patients within one year of stopping treatment.; interactions: Appendix 1 (bile acids)", "side-effects": "Side-effects\u00a0diarrhoea; very rarely abdominal\r\npain, gallstone calcification, urticaria; also reported nausea, vomiting, pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2289.htm", "doses": [ "Dissolution of gallstones, 8\u201312\u00a0mg/kg daily as a single\r\ndose at bedtime or in two divided doses, for up to\r\n2 years; treatment is continued for 3\u20134 months after\r\nstones dissolve", "Primary biliary cirrhosis, see under Ursofalk\u00ae" ], "pregnancy": "Pregnancy\u00a0no evidence of harm but manufacturer advises avoid" }, "KETOTIFEN": { "indications": "Indications\u00a0allergic rhinitis", "name": "KETOTIFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; also\r\nexcitation, irritability, nervousness; less commonly cystitis; rarely weight gain; very rarely Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3015.htm", "doses": [ "1\u00a0mg twice daily with food increased if necessary to 2\u00a0mg\r\ntwice daily; initial treatment in readily sedated patients 0.5\u20131\u00a0mg\r\nat night; child 3 years and over, 1\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "MAGNESIUM SALTS Magnesium hydroxide": { "indications": "Indications\u00a0see under preparations below", "name": "MAGNESIUM SALTS Magnesium hydroxide", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "MAGNESIUM SALTS", "Magnesium hydroxide" ], "cautions": "Cautions\u00a0elderly and debilitated; see also notes above; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0colic", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2246.htm", "doses": [ "See preparations", "Name[Magnesium Hydroxide Mixture, BP] Aqueous suspension containing about 8% hydrated magnesium\r\noxide. Do not store in cold placeDose\u00a0constipation, 30\u201345\u00a0mL with water at bedtime when required; child 3\u201312 years, 5\u201310\u00a0mL with water at bedtime when\r\nrequired" ] }, "DACARBAZINE": { "indications": "Indications\u00a0\n(From Dacarbazine and temozolomide: British National Formulary)\nDacarbazine and temozolomide", "name": "DACARBAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Dacarbazine and temozolomide" ], "cautions": "Cautions\u00a0see section 8.1; caution in handling; interactions: Appendix 1 (dacarbazine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; rarely liver necrosis due to hepatic vein thrombosis; irritant to skin\r\nand tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11773.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (carcinogenic and teratogenic in animal studies); ensure effective contraception during and for at least\r\n6 months after treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "HUMAN MENOPAUSAL GONADOTROPHINS": { "indications": "Indications\u00a0see notes above", "name": "HUMAN MENOPAUSAL GONADOTROPHINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "HUMAN MENOPAUSAL GONADOTROPHINS" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0ovarian hyperstimulation, increased risk of multiple\r\npregnancy and miscarriage, hypersensitivity reactions, gastro-intestinal\r\ndisturbances, headache, joint pain, fever, injection site reactions, very rarely thromboembolism; gynaecomastia, acne, and weight\r\ngain reported in men", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200065.htm", "doses": [ "By deep intramuscular or subcutaneous injection, according to patient\u2019s response" ], "pregnancy": "Pregnancy\u00a0avoid" }, "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin alfa": { "indications": "Indications\u00a0see under preparations, below", "name": "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin alfa", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "EPOETIN ALFA, BETA, THETA, and ZETA", "Epoetin alfa" ], "cautions": "Cautions\u00a0\n(From Erythropoietins: British National Formulary)\nErythropoietins; also inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,\r\nreticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure uncontrolled; sudden stabbing migraine-like pain\r\nis warning of a hypertensive crisis; sickle-cell\r\ndisease (lower target haemoglobin concentration may be appropriate); ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks); epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin dose may be needed during dialysis; risk of thrombosis may be increased when used for\r\nanaemia in adults receiving cancer chemotherapy; risk of thrombosis may be increased when used for anaemia before\r\northopaedic surgery\u2014avoid in cardiovascular disease\r\nincluding recent myocardial infarction or cerebrovascular accident", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting; dose-dependent increase\r\nin blood pressure or aggravation of hypertension; in isolated patients\r\nwith normal or low blood pressure, hypertensive crisis with encephalopathy-like\r\nsymptoms and generalised tonic-clonic seizures requiring immediate\r\nmedical attention; headache; dose-dependent increase in platelet count\r\n(but thrombocytosis rare) regressing during treatment; influenza-like\r\nsymptoms (may be reduced if intravenous injection given over 5 minutes);\r\ncardiovascular events; shunt thrombosis especially if tendency to\r\nhypotension or arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue erythropoietin therapy)\u2014see also notes above, hyperkalaemia,\r\nhypersensitivity reactions (including anaphylaxis and angioedema),\r\nskin reactions, injection-site reactions, and peripheral oedema also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200804.htm", "doses": [ "See under preparations, below", "Name[Binocrit\u00ae (Sandoz) ] Injection, prefilled syringe, epoetin\r\nalfa, net price 1000\u00a0units = \u00a35.09; 2000\u00a0units = \u00a310.18; 3000\u00a0units\r\n= \u00a315.27; 4000\u00a0units = \u00a320.36; 5000\u00a0units = \u00a325.46; 6000\u00a0units = \u00a330.55;\r\n8000\u00a0units = \u00a340.73; 10\u00a0000\u00a0units = \u00a350.91Note\u00a0Biosimilar medicineDose\u00a0symptomatic anaemia associated with chronic renal failure\r\nin patients on haemodialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes, initially 50\u00a0units/kg\r\n3 times weekly adjusted according to response in steps of 25\u00a0units/kg\r\n3 times weekly at intervals of at least 4 weeks; maintenance dose,\r\nusually 25\u2013100\u00a0units/kg 3 times weekly; child by intravenous injection initially as for adults;\r\nmaintenance dose, body-weight under 10\u00a0kg usually 75\u2013150\u00a0units/kg\r\n3 times weekly, body-weight 10\u201330\u00a0kg usually 60\u2013150\u00a0units/kg 3 times\r\nweekly, body-weight over 30\u00a0kg usually 30\u2013100\u00a0units/kg 3 times weeklySymptomatic anaemia associated with chronic renal failure\r\nin adults on peritoneal dialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes, initially 50\u00a0units/kg\r\ntwice weekly; maintenance dose 25\u201350\u00a0units/kg twice weeklySevere symptomatic anaemia of renal origin in adults with\r\nrenal insufficiency not yet on dialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes, initially 50\u00a0units/kg\r\n3 times weekly increased according to response in steps of 25\u00a0units/kg\r\n3 times weekly at intervals of at least 4 weeks; maintenance dose\r\n17\u201333\u00a0units/kg 3 times weekly; max. 200\u00a0units/kg 3 times weeklyNote\u00a0Reduce dose by approximately 25% if rise\r\nin haemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if\r\nhaemoglobin concentration exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous dose.Symptomatic anaemia in adults receiving cancer chemotherapy\r\n(see also MHRA/CHM advice), by subcutaneous injection (max. 1\u00a0mL per injection site),\r\ninitially 150\u00a0units/kg 3 times weekly (or 450\u00a0units/kg\r\nonce weekly), increased if appropriate rise in haemoglobin (or reticulocyte\r\ncount) not achieved after 4 weeks to 300\u00a0units/kg 3 times weekly;\r\ndiscontinue if inadequate response after 4 weeks at higher doseNote\u00a0Reduce dose by approximately 25\u201350% if rise\r\nin haemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if\r\nhaemoglobin concentration exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous dose. Discontinue approximately 4 weeks\r\nafter ending chemotherapyTo increase yield of autologous blood (to avoid homologous\r\nblood) in predonation programme in moderate anaemia either when large volume of blood required or when sufficient\r\nblood cannot be saved for elective major surgery, by intravenous\r\ninjection over 1\u20135 minutes, 600\u00a0units/kg twice weekly for\r\n3 weeks before surgery; consult product literature for details and\r\nadvice on ensuring high iron storesModerate anaemia (haemoglobin concentration 10\u201313\u00a0g/100\u00a0mL)\r\nbefore elective orthopaedic surgery in adults with expected moderate\r\nblood loss to reduce exposure to allogeneic blood transfusion or if\r\nautologous transfusion unavailable, by subcutaneous injection (max. 1\u00a0mL per injection site), 600\u00a0units/kg every week for 3 weeks\r\nbefore surgery and on day of surgery or 300\u00a0units/kg\r\ndaily for 15 days starting 10 days before surgery; consult product\r\nliterature for details" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; benefits probably outweigh risk\r\nof anaemia and of transfusion in pregnancy" }, "LABETALOL HYDROCHLORIDE": { "indications": "Indications\u00a0hypertension (including hypertension in\r\npregnancy, hypertension with angina, and hypertension following acute\r\nmyocardial infarction); hypertensive crises (see section 2.5); controlled\r\nhypotension in anaesthesia", "name": "LABETALOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride; interferes with laboratory tests for catecholamines; liver damage (see below)Liver damage\u00a0Severe hepatocellular\r\ndamage reported after both short-term and long-term\r\ntreatment. Appropriate laboratory testing needed at first\r\nsymptom of liver dysfunction and if laboratory evidence\r\nof damage (or if jaundice) labetalol should be stopped and not restarted", "side-effects": "Side-effects\u00a0postural hypotension (avoid upright position during\r\nand for 3 hours after intravenous administration), tiredness, weakness,\r\nheadache, rashes, scalp tingling, difficulty in micturition, epigastric\r\npain, nausea, vomiting; liver damage (see above); rarely lichenoid\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2488.htm", "doses": [ "By mouth, initially 100\u00a0mg (50\u00a0mg\r\nin elderly) twice daily with food, increased at intervals of 14 days\r\nto usual dose of 200\u00a0mg twice daily; up to 800\u00a0mg daily in 2 divided\r\ndoses (3\u20134 divided doses if higher); max. 2.4\u00a0g daily", "By intravenous injection, 50\u00a0mg over\r\nat least 1\u00a0minute, repeated after 5\u00a0minutes if necessary; max. total\r\ndose 200\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "By intravenous infusion, 2\u00a0mg/minute\r\nuntil satisfactory response then discontinue; usual total dose 50\u2013200\u00a0mg,\r\n(not recommended for phaeochromocytoma, see under\r\nPhaeochromocytoma, section 2.5.4) ", "Hypertension of pregnancy, 20\u00a0mg/hour, doubled every 30 minutes;\r\nusual max. 160\u00a0mg/hour", "Hypertension following myocardial infarction, 15\u00a0mg/hour, gradually\r\nincreased to max. 120\u00a0mg/hour" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "NELFINAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "NELFINAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; interactions: Appendix 1 (nelfinavir)", "side-effects": "Side-effects\u00a0see notes above; also reported, fever", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69466.htm", "doses": [ "1.25\u00a0g twice daily or 750\u00a0mg 3 times\r\ndaily; child 3\u201313 years, initially\r\n50\u201355\u00a0mg/kg twice daily (max. 1.25\u00a0g twice daily) or 25\u201330\u00a0mg/kg 3 times daily (max. 750\u00a0mg 3 times daily)" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises use\r\nonly if potential benefit outweighs risk" }, "DILTIAZEM HYDROCHLORIDE Standard formulations": { "indications": "Indications\u00a0prophylaxis and treatment of angina; hypertension", "name": "DILTIAZEM HYDROCHLORIDE Standard formulations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "DILTIAZEM HYDROCHLORIDE", "Standard formulations" ], "cautions": "Cautions\u00a0heart failure or significantly impaired left ventricular function, bradycardia (avoid if severe), first degree\r\nAV block, or prolonged PR interval; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0bradycardia, sino-atrial block, AV block, palpitation,\r\ndizziness, hypotension, malaise, asthenia, headache, hot flushes,\r\ngastro-intestinal disturbances, oedema (notably of ankles); rarely\r\nrashes (including erythema multiforme and exfoliative dermatitis),\r\nphotosensitivity; hepatitis, gynaecomastia, gum hyperplasia, extrapyramidal\r\nsymptoms, depression reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2674.htm", "doses": [ "Angina, 60\u00a0mg 3 times daily (elderly initially twice daily);\r\nincreased if necessary to 360\u00a0mg daily", "Longer-acting formulations, see under preparations below", "Name[Diltiazem (Non-proprietary) ] Tablets, m/r (but see note above), diltiazem hydrochloride 60\u00a0mg, net price 84 = \u00a33.02. \r\n Label:\r\n 25Brands include Optil\u00ae" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TESTOSTERONE AND ESTERS Intramuscular": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS Intramuscular", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS", "Intramuscular" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4368.htm", "doses": [ "See under preparations", "Name[Virormone\u00ae (Nordic) ] Injection, testosterone propionate\r\n50\u00a0mg/mL, net price 2-mL amp = \u00a34.50Dose\u00a0by intramuscular injection, androgen deficiency,\r\n50\u00a0mg 2\u20133 times weeklyDelayed puberty, 50\u00a0mg weeklyBreast cancer in women, 100\u00a0mg 2\u20133 times weekly" ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "CARTEOLOL HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "name": "CARTEOLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Beta-blockers", "CARTEOLOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From Beta-blockers: British National Formulary)\nSystemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block, or uncontrolled heart failure. Important: for a warning to avoid in asthma see below", "side-effects": "Side-effects\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5511.htm", "doses": [ "Apply twice daily" ] }, "EPHEDRINE HYDROCHLORIDE": { "indications": "Indications\u00a0nasal congestion", "name": "EPHEDRINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.2 Topical nasal decongestants", "Sympathomimetics", "EPHEDRINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see section 3.1.1.2 and notes above; also avoid\r\nexcessive or prolonged use; interactions: Appendix\r\n1 (sympathomimetics)", "side-effects": "Side-effects\u00a0local irritation, nausea, headache; after excessive\r\nuse tolerance with diminished effect, rebound congestion; cardiovascular\r\neffects also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5659.htm", "doses": [ "See below", "adult and child over 12 years, 1\u20132 drops into each nostril\r\nup to 4 times daily when required, max. duration 7 days" ], "pregnancy": "Pregnancy\u00a0see section 3.1.1.2" }, "BETAMETHASONE SODIUM PHOSPHATE - ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "indications": "Indications\u00a0eczematous inflammation in otitis\r\nexterna (\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "BETAMETHASONE SODIUM PHOSPHATE - ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31393.htm", "doses": [ "ear, apply 2\u20133 drops every 2\u20133 hours; reduce\r\nfrequency when relief obtained; eye, section 11.4.1; nose, section 12.2.1" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "BETAMETHASONE SODIUM PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided." }, "ROMIPLOSTIM": { "indications": "Indications\u00a0 \n(From Idiopathic thrombocytopenic purpura: British National Formulary)\nIdiopathic thrombocytopenic purpura", "name": "ROMIPLOSTIM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.4 Drugs used in platelet disorders", "Idiopathic thrombocytopenic purpura" ], "cautions": "Cautions\u00a0monitor full blood count and peripheral\r\nblood smears for morphological abnormalities before and during treatment; monitor platelet count weekly until 50 \u00d7 109/litre or\r\nmore for at least 4 weeks without dose adjustment, then monthly thereafterDriving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; flushing, oedema;\r\ndizziness, migraine, insomnia, fatigue, asthenia, paraesthesia; influenza-like\r\nsymptoms; arthralgia, myalgia, bone pain, muscle spasm; increased\r\nbone marrow reticulin; ecchymosis, rash; injection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204141.htm", "doses": [ "By subcutaneous injection, adult over 18 years, initially 1\u00a0microgram/kg once\r\nweekly, adjusted in steps of 1\u00a0microgram/kg at weekly intervals until\r\na stable platelet count of 50 \u00d7 109/litre or more is reached\r\n(consult product literature for dose adjustments); max. 10\u00a0micrograms/kg\r\nonce weekly; discontinue if inadequate response after 4 weeks at maximum\r\ndose" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if essential\u2014toxicity\r\nin animal studies" }, "INSULIN ZINC SUSPENSION": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN ZINC SUSPENSION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "INSULIN ZINC SUSPENSION" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4095.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "OXPRENOLOL HYDROCHLORIDE With diuretic": { "indications": "Indications\u00a0see under Dose", "name": "OXPRENOLOL HYDROCHLORIDE With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "OXPRENOLOL HYDROCHLORIDE", "With diuretic" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2513.htm", "doses": [ "Hypertension, 80\u2013160\u00a0mg daily in 2\u20133 divided doses, increased\r\nas required; max. 320\u00a0mg daily", "Angina, 80\u2013160\u00a0mg daily in 2\u20133 divided doses; max. 320\u00a0mg daily", "Arrhythmias, 40\u2013240\u00a0mg daily in 2\u20133 divided doses; max. 240\u00a0mg\r\ndaily", "Anxiety symptoms (short-term use), 40\u201380\u00a0mg daily in 1\u20132 divided\r\ndoses", "Name[Trasidrex\u00ae (Goldshield) ] Tablets, red, s/c, co-prenozide\r\n160/0.25 (oxprenolol hydrochloride 160\u00a0mg (m/r), cyclopenthiazide 250\u00a0micrograms), net price\r\n28-tab pack = \u00a310.66. \r\n Label:\r\n 8, 25Dose\u00a0hypertension, 1 tablet daily, increased if necessary to\r\n2 daily as a single dose" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "PAPAVERETUM - WITH HYOSCINE": { "indications": "Indications\u00a0premedication; enhancement of anaesthesia\r\n(but see section 15.1.4.3); postoperative analgesia; severe chronic\r\npain", "name": "PAPAVERETUM - WITH HYOSCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "PAPAVERETUM", "With hyoscine" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; supraventricular tachycardia", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nhypothermia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9339.htm", "doses": [ "By subcutaneous, intramuscular, or intravenous injection, 7.7\u201315.4\u00a0mg\r\nrepeated every 4 hours if necessary (elderly initially 7.7\u00a0mg); child up to 1\r\nmonth 115\u00a0micrograms/kg, 1\u201312 months 154\u00a0micrograms/kg, 1\u20135 years\r\n1.93\u20133.85\u00a0mg, 6\u201312 years, 3.85\u20137.7\u00a0mg", "In general the intravenous dose\r\nshould be 25\u201350% of the corresponding subcutaneous or intramuscular\r\ndose", "Name[Papaveretum and Hyoscine Injection (Non-proprietary) ] Injection, papaveretum 15.4\u00a0mg (providing the equivalent of 10\u00a0mg of anhydrous morphine), hyoscine hydrobromide 400\u00a0micrograms/mL,\r\nnet price 1-mL amp = \u00a33.57Dose\u00a0premedication, by subcutaneous or intramuscular injection, 0.5\u20131\u00a0mL" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "NELARABINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nNelarabine is licensed for the treatment of T-cell acute lymphoblastic leukaemia and T-cell lymphoblastic lymphoma in patients who have relapsed or who are refractory after receiving at least two previous regimens. It is given by intravenous infusion. Neurotoxicity is common with nelarabine and close monitoring for neurological adverse events is strongly recommended\u2014discontinue if neurotoxicity occurs.The Scottish Medicines Consortium has advised (March 2008) that the use of nelarabine (Atriance\u00ae) within NHS Scotland is restricted to bridging treatment before stem cell transplantation.", "name": "NELARABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "NELARABINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; previous or concurrent intrathecal\r\nchemotherapy or craniospinal irradiation (increased risk of neurotoxicity)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see section 8.1; also abdominal pain, constipation,\r\ntaste disturbance, anorexia, diarrhoea; hypotension, oedema; pleural\r\neffusion, wheezing, dyspnoea, cough; confusion, seizures, amnesia,\r\ndrowsiness, peripheral neurological disorders, hypoaesthesia, paraesthesia,\r\nataxia, demyelination, tremor, dizziness, headache, asthenia, fatigue;\r\npyrexia; electrolyte disturbances; blurred vision; muscle weakness,\r\nmyalgia, arthralgia; benign and malignant tumours also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200054.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nmanufacturer advises effective contraception during and for at least\r\n3 months after treatment in men and women; see also Pregnancy and Reproductive\r\nFunction" }, "TRIFLUOPERAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0see under Dose; antiemetic (section 4.6)", "name": "TRIFLUOPERAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; extrapyramidal\r\nsymptoms more frequent, especially at doses exceeding 6\u00a0mg daily;\r\nanorexia; muscle weakness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3255.htm", "doses": [ "Schizophrenia and other psychoses, short-term adjunctive\r\nmanagement of psychomotor agitation, excitement, and violent or dangerously\r\nimpulsive behaviour, adult and child over 12 years, initially 5\u00a0mg twice daily,\r\nincreased by 5\u00a0mg daily after 1 week, then at intervals of 3 days,\r\naccording to the response; elderly reduce\r\ninitial dose by at least half", "Short-term adjunctive management of severe anxiety, adult and child over\r\n12 years, 2\u20134\u00a0mg daily in divided doses, increased if necessary to\r\n6\u00a0mg daily; child 3\u20135 years up to 1\u00a0mg\r\ndaily, 6\u201312 years up to 4\u00a0mg daily; elderly reduce initial dose by at least half" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "AZITHROMYCIN - MACROLIDES": { "indications": "Indications\u00a0respiratory-tract infections; otitis media; skin and soft-tissue\r\ninfections; uncomplicated gonorrhoea [unlicensed indication], uncomplicated\r\ngenital chlamydial infections and non-gonococcal urethritis (see also\r\nTable 1, section 5.1); mild or moderate typhoid due\r\nto multiple-antibacterial-resistant organisms [unlicensed indication];\r\nLyme disease (see also section 5.1.1.3 [unlicensed indication]); prophylaxis\r\nof group A streptococcal infection (Table 2, section 5.1)", "name": "AZITHROMYCIN - MACROLIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides" ], "cautions": "Cautions\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nOral infections\u00a0The macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved. However, many organisms are now resistant to macrolides or rapidly develop resistance; their use should therefore be limited to short courses. Metronidazole (section 5.1.11) may be preferred as an alternative to a penicillin.Cautions\u00a0Macrolides should be used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. ; interactions: Appendix 1 (macrolides)", "side-effects": "Side-effects\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nSide-effects\u00a0Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-effects of the macrolides, but they are mild and less frequent with azithromycin and clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice) and rash occur less frequently. Other side-effects reported rarely or very rarely include pancreatitis, antibiotic-associated colitis, QT interval prolongation, arrhythmias, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Generally reversible hearing loss (sometimes with tinnitus) has been reported after large doses of a macrolide; it occurs commonly after long-term therapy with azithromycin. Intravenous infusion may cause local tenderness and phlebitis.; also\r\nanorexia, dyspepsia, flatulence, dizziness, headache, malaise, paraesthesia,\r\narthralgia, disturbances in taste and vision; less commonly constipation, gastritis, chest pain, oedema, anxiety, sleep disturbances,\r\nhypoaesthesia, leucopenia, photosensitivity; rarely agitation; also reported syncope, convulsions, smell disturbances,\r\ninterstitial nephritis, acute renal failure, thrombocytopenia, haemolytic\r\nanaemia, tongue discoloration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3859.htm", "doses": [ "500\u00a0mg once daily for 3 days or 500\u00a0mg\r\non first day then 250\u00a0mg once daily for 4 days; child over 6 months 10\u00a0mg/kg once daily for 3 days; or body-weight 15\u201325\u00a0kg, 200\u00a0mg once daily for 3 days; body-weight\r\n26\u201335\u00a0kg, 300\u00a0mg once daily for 3 days; body-weight 36\u201345\u00a0kg, 400\u00a0mg\r\nonce daily for 3 days", "Uncomplicated gonorrhoea [unlicensed indication] (see also Table\r\n1, section 5.1), uncomplicated genital chlamydial\r\ninfections and non-gonococcal urethritis, 1\u00a0g as a single dose", "Lyme disease (see also section 5.1.1.3), typhoid [unlicensed indications],\r\n500\u00a0mg once daily for 7\u201310 days (7 days in typhoid)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if adequate alternatives\r\nnot available" }, "ISOSORBIDE DINITRATE": { "indications": "Indications\u00a0prophylaxis and treatment of angina; left ventricular\r\nfailure", "name": "ISOSORBIDE DINITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE DINITRATE" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2653.htm", "doses": [ "By mouth, daily in divided doses, angina\r\n30\u2013120\u00a0mg, left ventricular failure 40\u2013160\u00a0mg, up to 240\u00a0mg if required", "By intravenous infusion, 2\u201310\u00a0mg/hour; higher\r\ndoses up to 20\u00a0mg/hour may be required" ], "pregnancy": "Pregnancy\u00a0may cross placenta\u2014manufacturers advise avoid unless\r\npotential benefit outweighs risk" }, "ASPIRIN With codeine phosphate 8\u00a0mg": { "indications": "Indications\u00a0mild to moderate pain, pyrexia; antiplatelet (section 2.9)", "name": "ASPIRIN With codeine phosphate 8\u00a0mg", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "ASPIRIN", "With codeine phosphate 8\u00a0mg" ], "cautions": "Cautions\u00a0asthma, allergic\r\ndisease, dehydration; preferably avoid during fever or viral infection\r\nin children (risk of Reye\u2019s syndrome, see below); elderly; G6PD-deficiency (section 9.1.5); concomitant use of drugs that\r\nincrease risk of bleeding; anaemia; thyrotoxicosis; interactions: Appendix 1 (aspirin)", "side-effects": "Side-effects\u00a0generally mild and infrequent but high incidence\r\nof gastro-intestinal irritation with slight asymptomatic blood loss,\r\nblood disorders have occurred (including increased bleeding time),\r\nconfusion, tinnitus, bronchospasm and skin reactions in hypersensitive\r\npatients. Prolonged administration, see section 10.1.1. Overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3463.htm", "doses": [ "By mouth, 300\u2013900\u00a0mg every 4\u20136 hours when\r\nnecessary; max. 4\u00a0g daily; child under\r\n16 years not recommended (see Reye\u2019s Syndrome, above)", "By rectum, 450\u2013900\u00a0mg every 4 hours (max. 3.6\u00a0g\r\ndaily); child under 16 years not recommended\r\n(see Reye\u2019s Syndrome, above)", "Name[(1)Co-codaprin (Non-proprietary) ] Dispersible tablets, co-codaprin\r\n8/400 (codeine phosphate 8\u00a0mg, aspirin 400\u00a0mg), net price 100-tab pack = \u00a342.03. \r\n Label:\r\n 13, 21, 32Dose\u00a01\u20132 tablets in water every 4\u20136 hours; max. 8 tablets dailyWhen co-codaprin tablets or dispersible tablets\r\nare prescribed and no strength is stated, tablets or dispersible tablets,\r\nrespectively, containing codeine phosphate 8\u00a0mg\r\nand aspirin 400\u00a0mg should be dispensed" ], "pregnancy": "Pregnancy\u00a0high doses may be related to intrauterine growth\r\nrestriction and teratogenic effects; impaired platelet function with\r\nrisk of haemorrhage, and delayed onset and increased duration of labour\r\nwith increased blood loss, can occur if used during delivery; avoid\r\nanalgesic doses if possible in last few weeks (low doses probably\r\nnot harmful); with high doses, closure of fetal ductus arteriosus\r\nin utero and possibly persistent pulmonary hypertension of newborn;\r\nkernicterus in jaundiced neonates" }, "PETHIDINE HYDROCHLORIDE With promethazine": { "indications": "Indications\u00a0moderate to severe pain, obstetric analgesia; peri-operative analgesia", "name": "PETHIDINE HYDROCHLORIDE With promethazine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "PETHIDINE HYDROCHLORIDE", "With promethazine" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; not suitable for severe continuing pain; accumulation of metabolites may result in neurotoxicity; cardiac arrhythmias, severe\r\ncor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nrestlessness, tremor, and hypothermia; convulsions reported in overdosage", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3544.htm", "doses": [ "Acute pain, by mouth, 50\u2013150\u00a0mg every\r\n4 hours; child 0.5\u20132\u00a0mg/kg", "By subcutaneous or intramuscular\r\ninjection, 25\u2013100\u00a0mg (elderly or debilitated, initially 25\u00a0mg), repeated after 4 hours; child, by intramuscular injection,\r\n0.5\u20132\u00a0mg/kg", "By slow intravenous injection, 25\u201350\u00a0mg (elderly or debilitated, initially 25\u00a0mg), repeated\r\nafter 4 hours", "Obstetric analgesia, by subcutaneous or intramuscular injection, 50\u2013100\u00a0mg, repeated 1\u20133 hours\r\nlater if necessary; max. 400\u00a0mg in 24 hours", "Premedication, by intramuscular injection, 25\u2013100\u00a0mg\r\n1 hour before operation (elderly or\r\ndebilitated, 25\u00a0mg); child 0.5\u20132\u00a0mg/kg", "Postoperative pain, by subcutaneous or intramuscular injection, 25\u2013100\u00a0mg (elderly or debilitated, initially 25\u00a0mg), every 2\u20133\r\nhours if necessary; child, by\r\nintramuscular injection, 0.5\u20132\u00a0mg/kg", "In the postoperative period,\r\nthe patient should be closely monitored for pain relief as well as\r\nfor side-effects especially respiratory depression", "Name[Pamergan P100\u00ae (Martindale) ] Injection, pethidine hydrochloride 50\u00a0mg, promethazine hydrochloride 25\u00a0mg/mL, net\r\nprice 2-mL amp = \u00a31.44Dose\u00a0by intramuscular injection, premedication,\r\n2\u00a0mL 60\u201390 minutes before operation; child 8\u201312 years 0.75\u00a0mL, 13\u201316 years 1\u00a0mLObstetric analgesia, 1\u20132\u00a0mL every 4 hours if necessarySevere pain, 1\u20132\u00a0mL every 4\u20136 hours if necessaryNote\u00a0Although usually given intramuscularly, may\r\nbe given intravenously after dilution to at least 10\u00a0mL with water\r\nfor injections" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "OMALIZUMAB": { "indications": "Indications\u00a0prophylaxis of allergic asthma (\n(From Omalizumab: British National Formulary)\nOmalizumab)", "name": "OMALIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.2 Allergen immunotherapy", "Omalizumab" ], "cautions": "Cautions\u00a0autoimmune disease; susceptibility to helminth infection\u2014discontinue if infection does\r\nnot respond to anthelmintic", "side-effects": "Side-effects\u00a0abdominal pain, headache, pyrexia; less\r\ncommonly dyspepsia, nausea, diarrhoea, weight increase, postural\r\nhypotension, flushing, pharyngitis, bronchospasm, cough, syncope,\r\nparaesthesia, dizziness, malaise, influenza-like illness, photosensitivity,\r\nurticaria, rash, pruritus; rarely laryngoedema, parasitic\r\ninfection, antibody formation; also reported arterial\r\nthromboembolic events, Churg-Strauss syndrome (\n(From Omalizumab: British National Formulary)\nChurg-Strauss syndrome has occurred rarely in patients given omalizumab; the reaction is usually associated with the reduction of oral corticosteroid therapy. Churg-Strauss syndrome can present as eosinophilia, vasculitic rash, cardiac complications, worsening pulmonary symptoms, or peripheral neuropathy. Hypersensitivity reactions can also occur immediately following treatment with omalizumab or sometimes more than 24 hours after the first injection.), thrombocytopenia, arthralgia, myalgia, joint swelling, alopecia,\r\nserum sickness (including fever and lymphadenopathy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129492.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n6 years, according to immunoglobulin E concentration and body-weight,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "CO-CARELDOPA": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-CARELDOPA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-CARELDOPA" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/10195.htm", "doses": [ "Expressed as levodopa, initially 100\u00a0mg (with carbidopa\r\n25\u00a0mg) 3 times daily, increased by 50\u2013100\u00a0mg (with carbidopa 12.5\u201325\u00a0mg)\r\ndaily or on alternate days according to response, up to 800\u00a0mg (with\r\ncarbidopa 200\u00a0mg) daily in divided doses", "Alternatively, initially 50\u2013100\u00a0mg (with carbidopa 10\u201312.5\u00a0mg)\r\n3\u20134 times daily, increased by 50\u2013100\u00a0mg daily or on alternate days\r\naccording to response, up to 800\u00a0mg (with carbidopa 80\u2013100\u00a0mg) daily\r\nin divided doses ", "Alternatively, initially 125\u00a0mg (with carbidopa 12.5\u00a0mg, as\r\n\u00bd tablet of co-careldopa 25/250) 1\u20132 times daily, increased by 125\u00a0mg\r\n(with carbidopa 12.5\u00a0mg) daily or on alternate days according to response", "When co-careldopa is used, the total daily dose of carbidopa\r\nshould be at least 70\u00a0mg. A lower dose may not achieve full inhibition\r\nof extracerebral dopa-decarboxylase, with a resultant\r\nincrease in side-effects.", "When transferring patients\r\nfrom another levodopa/dopa-decarboxylase inhibitor preparation, the\r\nprevious preparation should be discontinued at least 12 hours before" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "ATENOLOL With calcium-channel blocker": { "indications": "Indications\u00a0see under Dose", "name": "ATENOLOL With calcium-channel blocker", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "ATENOLOL", "With calcium-channel blocker" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2478.htm", "doses": [ "By mouth, hypertension, 25\u201350\u00a0mg\r\ndaily (higher doses rarely necessary)", "Angina, 100\u00a0mg daily in 1 or 2 doses", "Arrhythmias, 50\u2013100\u00a0mg daily", "Migraine prophylaxis [unlicensed], 50\u2013200\u00a0mg daily in divided\r\ndoses", "By intravenous injection, arrhythmias,\r\n2.5\u00a0mg at a rate of 1\u00a0mg/minute, repeated at 5-minute intervals to\r\na max. of 10\u00a0mg", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning", "By intravenous infusion, arrhythmias,\r\n150\u00a0micrograms/kg over 20\u00a0minutes, repeated every 12 hours if required", "Early intervention within 12 hours of myocardial infarction\r\n(section 2.10.1), by intravenous injection over 5 minutes, 5\u00a0mg, then by mouth, 50\u00a0mg after\r\n15 minutes, 50\u00a0mg after 12 hours, then 100\u00a0mg daily", "Name[Tenif\u00ae (AstraZeneca) ] Capsules, reddish-brown, atenolol 50\u00a0mg, nifedipine 20\u00a0mg (m/r),\r\nnet price 28-cap pack = \u00a310.63. \r\n Label:\r\n 8, 25Dose\u00a0hypertension, 1 capsule daily, increased if necessary\r\nto twice daily; elderly, 1 dailyAngina, 1 capsule twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "CYCLOPENTHIAZIDE": { "indications": "Indications\u00a0oedema, hypertension (see also notes above); heart failure", "name": "CYCLOPENTHIAZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "CYCLOPENTHIAZIDE" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ; also rarely depression", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2333.htm", "doses": [ "Heart failure, 250\u2013500\u00a0micrograms daily in the morning\r\nincreased if necessary to 1\u00a0mg daily (reduce to lowest effective dose\r\nfor maintenance)", "Hypertension, initially 250\u00a0micrograms daily in the morning,\r\nincreased if necessary to 500\u00a0micrograms daily (but see notes above)", "Oedema, up to 500\u00a0micrograms daily for a short period" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "CHLORHEXIDINE GLUCONATE With chlorobutanol": { "indications": "Indications\u00a0see under preparations below", "name": "CHLORHEXIDINE GLUCONATE With chlorobutanol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "CHLORHEXIDINE GLUCONATE", "With chlorobutanol" ], "side-effects": "Side-effects\u00a0mucosal irritation (if desquamation occurs, discontinue\r\ntreatment or dilute mouthwash with an equal volume of water); taste\r\ndisturbance; reversible brown staining of teeth, and of silicate or\r\ncomposite restorations; tongue discoloration; parotid gland swelling\r\nreportedNote\u00a0Chlorhexidine gluconate\r\nmay be incompatible with some ingredients in toothpaste; leave an\r\ninterval of at least 30 minutes between using mouthwash and toothpaste", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106176.htm", "doses": [ "Name[Eludril\u00ae (Fabre)] Mouthwash or gargle, chlorhexidine gluconate 0.1%, chlorobutanol 0.5% (mint-flavoured),\r\nnet price 90\u00a0mL = \u00a31.36, 250\u00a0mL = \u00a32.83, 500\u00a0mL = \u00a35.06 Dose\u00a0oral hygiene and plaque inhibition, adult and child over 6 years, use 10\u201315\u00a0mL\r\n(diluted with lukewarm water in measuring cup provided) 2\u20133 times\r\ndailyDenture disinfection, soak previously cleansed dentures\r\nin mouthwash (diluted with 2 volumes of water) for 60 minutes" ] }, "DOPAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0cardiogenic shock in infarction or cardiac surgery", "name": "DOPAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.1 Inotropic sympathomimetics" ], "cautions": "Cautions\u00a0correct hypovolaemia; low dose in shock due to acute myocardial infarction\u2014\n(From 2.7.1 Inotropic sympathomimetics: British National Formulary)\nShock\u00a0Shock is a medical emergency associated with a high mortality. The underlying causes of shock such as haemorrhage, sepsis, or myocardial insufficiency should be corrected. The profound hypotension of shock must be treated promptly to prevent tissue hypoxia and organ failure. Volume replacement is essential to correct the hypovolaemia associated with haemorrhage and sepsis but may be detrimental in cardiogenic shock. Depending on haemodynamic status, cardiac output may be improved by the use of sympathomimetic inotropes such as adrenaline (epinephrine), dobutamine or dopamine (see notes above). In septic shock, when fluid replacement and inotropic support fail to maintain blood pressure, the vasoconstrictor noradrenaline (norepinephrine) (section 2.7.2) may be considered. In cardiogenic shock peripheral resistance is frequently high and to raise it further may worsen myocardial performance and exacerbate tissue ischaemia.The use of sympathomimetic inotropes and vasoconstrictors should preferably be confined to the intensive care setting and undertaken with invasive haemodynamic monitoring.\u00a0For advice on the management of anaphylactic shock, see section 3.4.3.; hyperthyroidism; interactions: Appendix\r\n1 (sympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, chest pain, palpitation, tachycardia,\r\nvasoconstriction, hypotension, dyspnoea, headache; less commonly bradycardia, hypertension, gangrene, mydriasis; rarely fatal ventricular arrhythmias", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2736.htm", "doses": [ "By intravenous infusion, 2\u20135\u00a0micrograms/kg/minute\r\ninitially (see notes above)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "SELEGILINE HYDROCHLORIDE": { "indications": "Indications\u00a0Parkinson\u2019s disease, used alone or as adjunct to co-beneldopa or\r\nco-careldopa; symptomatic parkinsonism", "name": "SELEGILINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Monoamine-oxidase-B inhibitors", "SELEGILINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; gastric and duodenal ulceration (avoid in active ulceration), uncontrolled hypertension (and avoid drugs that increase blood pressure), arrhythmias, angina, psychosis (and patients\r\npredisposed to confusion and psychosis), side-effects of levodopa may be increased\u2014concurrent levodopa dosage can be\r\nreduced by 10\u201330% in steps of 10% every 3\u20134 days; history of hepatic dysfunction; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (selegiline)", "side-effects": "Side-effects\u00a0nausea, constipation, diarrhoea, dry mouth, stomatitis,\r\nmouth ulcers, bradycardia, hypertension, hypotension, depression,\r\ndizziness, psychosis, impaired balance, tremor, fatigue, movement\r\ndisorders, sleeping disorders, headache, confusion, arthralgia, myalgia,\r\nmuscle cramps, myopathy, nasal congestion, hair loss, sweating; less commonly loss of appetite, angina, arrhythmias, palpitation,\r\npostural hypotension, supraventricular tachycardia, ankle oedema,\r\ndyspnoea, agitation, anxiety, micturition difficulties, leucocytopenia,\r\nthrombocytopenia, blurred vision; skin reactions; also reported hypersexuality", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3653.htm", "doses": [ "Initially 5\u00a0mg in the morning; increasing after 2\u20134 weeks\r\nif tolerated to 10\u00a0mg in the morning", "1.25-mg oral lyophilisate is equivalent to\r\n10-mg tablet" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "INOSITOL NICOTINATE ": { "indications": "Indications\u00a0peripheral vascular disease (but see notes above); hyperlipidaemia\r\n(%s\n(From 2.12 Lipid-regulating drugs: British National Formulary)\n2.12 Lipid-regulating drugs)", "name": "INOSITOL NICOTINATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs", "INOSITOL NICOTINATE" ], "cautions": "Cautions\u00a0cerebrovascular insufficiency, unstable angina", "side-effects": "Side-effects\u00a0nausea, vomiting, hypotension, flushing, syncope,\r\noedema, headache, dizziness, paraesthesia, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2714.htm", "doses": [ "3\u00a0g daily in 2\u20133 divided doses; max. 4\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid\r\nunless potential benefit outweighs risk" }, "SEVOFLURANE": { "indications": "Indications\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "name": "SEVOFLURANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.2 Inhalational anaesthetics", "Volatile liquid anaesthetics" ], "cautions": "Cautions\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics; susceptibility to QT-interval prolongation; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics; also urinary\r\nretention, leucopenia, agitation in children; cardiac arrest, torsade\r\nde pointes, dystonia and seizures also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37118.htm", "doses": [ "Induction of anaesthesia, by inhalation using a specifically calibrated vaporiser, in oxygen or nitrous\r\noxide\u2013oxygen, adjusted according to response, adult and child over 1 month initially\r\n0.5\u20131% then increased gradually up to 8%", "Maintenance of anaesthesia, by inhalation using a specifically calibrated vaporiser, in oxygen or nitrous\r\noxide\u2013oxygen, adjusted according to response, adult and child over 1 month 0.5\u20133%" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "UNDECENOATES": { "indications": "Indications\u00a0see under preparations below", "name": "UNDECENOATES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "UNDECENOATES" ], "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6180.htm", "doses": [ "See under preparations below", "treatment of athlete\u2019s foot, apply twice daily continuing\r\nfor 7 days after lesions have healed", "treatment of athlete\u2019s foot, apply twice daily continuing\r\nfor 7 days after lesions have healed", "treatment of athlete\u2019s foot, apply twice daily continuing\r\nfor 7 days after lesions have healed" ] }, "CODEINE PHOSPHATE - COUGH SUPPRESSANTS": { "indications": "Indications\u00a0dry or painful cough; diarrhoea (section 1.4.2); pain (section 4.7.2)", "name": "CODEINE PHOSPHATE - COUGH SUPPRESSANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations", "3.9.1 Cough suppressants", "CODEINE PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From 3.9.1 Cough suppressants: British National Formulary)\nCodeine may be effective but it is constipating and can cause dependence and %s\n(From CODEINE PHOSPHATE: British National Formulary)\nCODEINE PHOSPHATE", "side-effects": "Side-effects\u00a0section 4.7.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200013.htm", "doses": [ "See under preparations below" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "AMSACRINE": { "indications": "Indications\u00a0\n(From Amsacrine: British National Formulary)\nAmsacrine", "name": "AMSACRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Amsacrine" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; also caution in handling\u2014irritant\r\nto skin and tissues", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11754.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); may reduce fertility; see also Pregnancy and Reproductive\r\nFunction" }, "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES Injectable preparations": { "indications": "Indications\u00a0contraception, see also notes above and under\r\npreparations (roles vary according to preparation)", "name": "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES Injectable preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.2 Progestogen-only contraceptives", "7.3.2.2 Parenteral progestogen-only contraceptives", "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES", "Injectable preparations" ], "cautions": "Cautions\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives and under\r\npreparations; possible risk of breast cancer, \n(From ORAL PROGESTOGEN-ONLY CONTRACEPTIVES: British National Formulary)\nBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women using, or who have recently used, a progestogen-only contraceptive pill; this relative risk may be due to an earlier diagnosis. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use; the risk disappears gradually during the 10 years after stopping and there is no excess risk by 10 years. A possible small increase in the risk of breast cancer should be weighed against the benefitsoral progestogen-only contraceptives (section 7.3.2.1); history during pregnancy\r\nof pruritus or of deterioration of otosclerosis, disturbances\r\nof lipid metabolism; interactions: \n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\nInteractions\u00a0Effectiveness of parenteral progestogen-only contraceptives is not affected by antibacterials that do not induce liver enzymes. The effectiveness of norethisterone and medroxyprogesterone acetate intramuscular injections is not affected by enzyme-inducing drugs and they may be continued as normal during courses of these drugs. However, effectiveness of the etonogestrel-releasing implant may be reduced by enzyme-inducing drugs and an alternative contraceptive method, unaffected by the interacting drug, is recommended during treatment with the enzyme-inducing drug and for at least 4 weeks after stopping. For a short course of an enzyme-inducing drug, if a change in contraceptive method is undesirable or inappropriate, the implant may be continued in combination with additional contraceptive precautions (e.g. condom) for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping it. and Appendix\r\n1 (progestogens)Counselling\u00a0Full counselling backed\r\nby patient information leaflet required before administration", "side-effects": "Side-effects\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives; injection-site\r\nreactionsCervical cancer\u00a0Use of injectable progestogen-only\r\ncontraceptives may be associated with a small increased risk of cervical\r\ncancer, similar to that seen with %s\n(From COMBINED HORMONAL CONTRACEPTIVES: British National Formulary)\nSide-effects\u00a0see notes above; also nausea, vomiting, abdominal cramps, liver impairment, hepatic tumours; fluid retention, thrombosis (more common when factor V Leiden present or in blood groups A, B, and AB; see also notes above), hypertension, changes in lipid metabolism; headache, depression, chorea, nervousness, irritability; changes in libido, breast tenderness, enlargement, and secretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence of withdrawal bleeding, amenorrhoea after discontinuation, changes in vaginal discharge, cervical erosion; contact lenses may irritate, visual disturbances; leg cramps; skin reactions, chloasma, photosensitivity; rarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women taking the combined oral contraceptive pill; this relative risk may be due to an earlier diagnosis. In users of combined oral contraceptive pills the cancers are more likely to be localised to the breast. The most important factor for diagnosing breast cancer appears to be the age at which the contraceptive is stopped rather than the duration of use; any increase in the rate of diagnosis diminishes gradually during the 10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives for 5 years or longer is associated with a small increased risk of cervical cancer; the risk diminishes after stopping and disappears by about 10 years. The risk of cervical cancer with transdermal patches and vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of breast cancer and cervical cancer should be weighed against the protective effect against cancers of the ovary and endometrium. The risk of cervical cancer with other progestogen-only\r\ncontraceptives is not yet known.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/13754.htm", "doses": [ "See under preparations", "Name[Noristerat\u00ae (Bayer) ] Injection (oily), norethisterone enantate 200\u00a0mg/mL, net price 1-mL amp = \u00a34.05. \r\n Label:\r\n Counselling, see patient information leafletDose\u00a0by deep intramuscular injection given very\r\nslowly into gluteal muscle, short-term contraception,\r\n200\u00a0mg within first 5 days of cycle or immediately after parturition\r\n(duration 8 weeks); may be repeated once after 8 weeks (withhold breast-feeding\r\nfor neonates with severe or persistent jaundice requiring medical\r\ntreatment)" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; for Implanon\u00ae or Nexplanon\u00ae if pregnancy occurs remove implant" }, "FLUOCINONIDE": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas unresponsive to\r\nless potent corticosteroids; psoriasis, \n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "FLUOCINONIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUOCINONIDE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5913.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "MERCAPTOPURINE - ANTIMETABOLITES": { "indications": "Indications\u00a0acute leukaemias and chronic\r\nmyeloid leukaemia; inflammatory bowel disease [unlicensed indication]\r\n(section 1.5.3)", "name": "MERCAPTOPURINE - ANTIMETABOLITES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; thiopurine methyltransferase status (see section 8.2.1); monitor liver\r\nfunction; interactions: Appendix 1 (mercaptopurine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also hepatotoxicity; rarely intestinal ulceration,\r\npancreatitis; very rarely lymphoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4735.htm", "doses": [ "Initially 2.5\u00a0mg/kg daily" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic); see also Pregnancy and Reproductive\r\nFunction" }, "NICOTINE": { "indications": "Indications\u00a0\n(From Nicotine replacement therapy: British National Formulary)\nNicotine replacement therapy", "name": "NICOTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.2 Nicotine dependence", "Nicotine replacement therapy" ], "cautions": "Cautions\u00a0\n(From Nicotine replacement therapy: British National Formulary)\nCautions\u00a0Most warnings for nicotine replacement therapy also apply to continued cigarette smoking, but the risk of continued smoking outweighs any risks of using nicotine preparations. Nicotine replacement therapy should be used with caution in haemodynamically unstable patients hospitalised with severe arrhythmias, myocardial infarction, or cerebrovascular accident, and in patients with phaeochromocytoma or uncontrolled hyperthyroidism. Care is also needed in patients with diabetes mellitus\u2014blood-glucose concentration should be monitored closely when initiating treatment.Specific cautions for individual preparations are usually related to the local effect of nicotine. Oral preparations should be used with caution in patients with oesophagitis, gastritis, or peptic ulcers because swallowed nicotine can aggravate these conditions. The gum may also stick to and damage dentures. Acidic beverages, such as coffee or fruit juice, may decrease the absorption of nicotine through the buccal mucosa and should be avoided for 15 minutes before the use of oral nicotine replacement therapy. Care should be taken with the inhalation cartridges in patients with obstructive lung disease, chronic throat disease, or bronchospastic disease. The nasal spray can cause worsening of bronchial asthma. Patches should not be placed on broken skin and should be used with caution in patients with skin disorders.; interactions: Appendix 1 (nicotine)", "side-effects": "Side-effects\u00a0\n(From Nicotine replacement therapy: British National Formulary)\nSide-effects\u00a0Some systemic effects occur on initiation of therapy, particularly if the patient is using high-strength preparations; however, the patient may confuse side-effects of the nicotine-replacement preparation with nicotine withdrawal symptoms. Common symptoms of nicotine withdrawal include malaise, headache, dizziness, sleep disturbance, coughing, influenza-like symptoms, depression, irritability, increased appetite, weight gain, restlessness, anxiety, drowsiness, aphthous ulcers, decreased heart rate, and impaired concentration.Mild topical reactions at the beginning of treatment are common because of the irritant effect of nicotine. Oral preparations and inhalation cartridges can cause irritation of the throat, gum, lozenges, and oral spray can cause increased salivation, and patches can cause minor skin irritation. The nasal spray commonly causes coughing, nasal irritation, epistaxis, sneezing, and watery eyes; the oral spray can cause watery eyes and blurred vision.Gastro-intestinal disturbances are common and may be caused by swallowed nicotine. Nausea, vomiting, dyspepsia, and hiccup occur most frequently. Ulcerative stomatitis has also been reported. Dry mouth is a common side-effect of lozenges, patches, oral spray, and sublingual tablets. Lozenges cause diarrhoea, constipation, dysphagia, oesophagitis, gastritis, mouth ulcers, bloating, flatulence, and less commonly, taste disturbance, thirst, gingival bleeding, and halitosis. The oral spray may also cause abdominal pain, flatulence, and taste disturbance.Palpitations may occur with nicotine replacement therapy and rarely patches and oral spray can cause arrhythmia. Patches, lozenges, and oral spray can cause chest pain. The inhalator can very rarely cause reversible atrial fibrillation.Paraesthesia is a common side-effect of oral spray. Abnormal dreams can occur with patches; removal of the patch before bed may help. Lozenges and oral spray may cause rash and hot flushes. Sweating and myalgia can occur with patches and oral spray; the patches can also cause arthralgia.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3690.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0\n(From Nicotine replacement therapy: British National Formulary)\nPregnancy \u00a0The use of nicotine replacement therapy in pregnancy is preferable to the continuation of smoking, but should be used only if smoking cessation without nicotine replacement fails. Intermittent therapy is preferable to patches but avoid liquorice-flavoured nicotine products. Patches are useful, however, if the patient is experiencing pregnancy-related nausea and vomiting. If patches are used, they should be removed before bed." }, "OFATUMUMAB": { "indications": "Indications\u00a0\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nOfatumumab causes lysis of B lymphocytes. It is licensed for treatment of chronic lymphocytic leukaemia in patients refractory to fludarabine and alemtuzumab. Infusion-related side-effects (including cytokine release syndrome\u2014see above) have been reported with ofatumumab; premedication with paracetamol, an antihistamine, and a corticosteroid is recommended.", "name": "OFATUMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.3 Anti-lymphocyte monoclonal antibodies", "OFATUMUMAB" ], "cautions": "Cautions\u00a0\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nOfatumumab causes lysis of B lymphocytes. It is licensed for treatment of chronic lymphocytic leukaemia in patients refractory to fludarabine and alemtuzumab. Infusion-related side-effects (including cytokine release syndrome\u2014see above) have been reported with ofatumumab; premedication with paracetamol, an antihistamine, and a corticosteroid is recommended.\u2014for full details consult\r\nproduct literature", "side-effects": "Side-effects\u00a0\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nOfatumumab causes lysis of B lymphocytes. It is licensed for treatment of chronic lymphocytic leukaemia in patients refractory to fludarabine and alemtuzumab. Infusion-related side-effects (including cytokine release syndrome\u2014see above) have been reported with ofatumumab; premedication with paracetamol, an antihistamine, and a corticosteroid is recommended.\u2014for full details (including monitoring\r\nand management of side-effects) consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208989.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk; use\r\neffective contraception during and for 12 months after treatment" }, "ACECLOFENAC": { "indications": "Indications\u00a0pain and inflammation in rheumatoid arthritis, osteoarthritis and\r\nankylosing spondylitis", "name": "ACECLOFENAC", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/36624.htm", "doses": [ "100\u00a0mg twice daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "DIPYRIDAMOLE": { "indications": "Indications\u00a0see notes above and under Dose", "name": "DIPYRIDAMOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "DIPYRIDAMOLE" ], "cautions": "Cautions\u00a0rapidly worsening angina, aortic stenosis, recent\r\nmyocardial infarction, left ventricular\r\noutflow obstruction, heart failure; may exacerbate migraine; hypotension; myasthenia gravis (risk of\r\nexacerbation); coagulation disorders; concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (dipyridamole)", "side-effects": "Side-effects\u00a0gastro-intestinal effects, dizziness, myalgia,\r\nthrobbing headache, hypotension, hot flushes and tachycardia; worsening\r\nsymptoms of coronary heart disease; hypersensitivity reactions such\r\nas rash, urticaria, severe bronchospasm and angioedema; increased\r\nbleeding during or after surgery; thrombocytopenia reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2811.htm", "doses": [ "By mouth, 300\u2013600\u00a0mg daily in 3\u20134\r\ndivided doses", "Modified-release preparations, see under preparation below", "By intravenous injection, diagnostic\r\nonly, consult product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "PALIPERIDONE - SECOND-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0schizophrenia; psychotic or manic symptoms of\r\nschizoaffective disorder", "name": "PALIPERIDONE - SECOND-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "PALIPERIDONE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; predisposition to gastro-intestinal obstruction; elderly patients with dementia and risk factors for stroke", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nabdominal pain, dry mouth, hypersalivation, vomiting; tachycardia,\r\nbradycardia, first-degree AV block, bundle branch block; drowsiness,\r\nagitation, headache, asthenia; less commonly palpitation,\r\narrhythmias, ischaemia, oedema, seizures, nightmare, syncope, menstrual\r\ndisturbances, erectile dysfunction, galactorrhoea, gynaecomastia,\r\nand rash; cerebrovascular accident also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215619.htm", "doses": [ "adult over 18 years, 6\u00a0mg\r\nonce daily in the morning, adjusted if necessary in increments of\r\n3\u00a0mg over at least 5 days; usual range 3\u201312\u00a0mg daily", "Always take with breakfast or always\r\ntake on an empty stomach" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk\u2014toxicity in animal studies; if discontinuation\r\nduring pregnancy is necessary, withdraw gradually" }, "HYOSCINE HYDROBROMIDE": { "indications": "Indications\u00a0motion sickness;\r\nhypersalivation associated with clozapine therapy; premedication (section 15.1.3); excessive respiratory secretions (see Prescribing in Palliative\r\nCare)", "name": "HYOSCINE HYDROBROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Hyoscine", "HYOSCINE HYDROBROMIDE" ], "cautions": "Cautions\u00a0section 1.2; also epilepsy", "side-effects": "Side-effects\u00a0section 1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200878.htm", "doses": [ "Motion sickness, by mouth, adult and child over\r\n10 years, 150\u2013300\u00a0micrograms up to 30 minutes before start of journey\r\nrepeated every 6 hours if required; max. 900\u00a0micrograms daily; child 3\u20134 years 75\u00a0micrograms up to 30 minutes before\r\nstart of journey repeated after 6 hours if required, max. 150\u00a0micrograms\r\ndaily; 4\u201310 years 75\u2013150\u00a0micrograms up to 30 minutes before start\r\nof journey repeated every 6 hours if required; max. 450\u00a0micrograms\r\ndaily", "Hypersalivation associated with clozapine therapy [unlicensed\r\nindication], by mouth, 300\u00a0micrograms up to 3 times\r\ndaily; max. 900\u00a0micrograms daily; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0section 15.1.3" }, "ANTITHYMOCYTE IMMUNOGLOBULIN (RABBIT)": { "indications": "Indications\u00a0\n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nAntithymocyte immunoglobulin (rabbit) is licensed for the prophylaxis of organ rejection in renal and heart allograft recipients and for the treatment of corticosteroid-resistant allograft rejection in renal transplantation. Tolerability is increased by pretreatment with an intravenous corticosteroid and antihistamine; an antipyretic drug such as paracetamol may also be beneficial.", "name": "ANTITHYMOCYTE IMMUNOGLOBULIN (RABBIT)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants" ], "cautions": "Cautions\u00a0\n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nAntithymocyte immunoglobulin (rabbit) is licensed for the prophylaxis of organ rejection in renal and heart allograft recipients and for the treatment of corticosteroid-resistant allograft rejection in renal transplantation. Tolerability is increased by pretreatment with an intravenous corticosteroid and antihistamine; an antipyretic drug such as paracetamol may also be beneficial.; monitor blood count", "side-effects": "Side-effects\u00a0nausea, vomiting, dysphagia, diarrhoea; hypotension;\r\ninfusion-related reactions (including cytokine release syndrome and\r\nanaphylaxis, \n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nAntithymocyte immunoglobulin (rabbit) is licensed for the prophylaxis of organ rejection in renal and heart allograft recipients and for the treatment of corticosteroid-resistant allograft rejection in renal transplantation. Tolerability is increased by pretreatment with an intravenous corticosteroid and antihistamine; an antipyretic drug such as paracetamol may also be beneficial.), serum\r\nsickness; fever, shivering, increased susceptibility to infection;\r\nincreased susceptibility to malignancy; lymphopenia, neutropenia,\r\nthrombocytopenia; myalgia; pruritus, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201462.htm", "doses": [ "Heart transplantation, by intravenous infusion over at least 6 hours, 1\u20132.5\u00a0mg/kg daily for 3\u20135 days", "Renal transplantation, by intravenous infusion over at least 6 hours, 1\u20131.5\u00a0mg/kg daily for 3\u20139 days", "Corticosteroid-resistant renal graft rejection, by intravenous\r\ninfusion over at least 6 hours, 1.5\u00a0mg/kg daily for 7\u201314 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "PRALIDOXIME CHLORIDE": { "indications": "Indications\u00a0adjunct to atropine in the treatment\r\nof poisoning by organophosphorus insecticide or nerve agent", "name": "PRALIDOXIME CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Other poisons", "Pesticides" ], "cautions": "Cautions\u00a0myasthenia gravis", "side-effects": "Side-effects\u00a0drowsiness, dizziness, disturbances of vision,\r\nnausea, tachycardia, headache, hyperventilation, and muscular weakness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29567.htm", "doses": [ "By intravenous infusion, adult and child initially\r\n30\u00a0mg/kg over 20 minutes, followed by 8\u00a0mg/kg/hour; usual max. 12\u00a0g\r\nin 24 hours", "The loading dose may be administered by intravenous injection (diluted to a concentration of 50\u00a0mg/mL\r\nwith water for injections) over at least 5 minutes if pulmonary oedema\r\nis present or if it is not practical to administer an intravenous\r\ninfusion; pralidoxime chloride doses in BNF may\r\ndiffer from those in product literature" ] }, "TERLIPRESSIN ACETATE": { "indications": "Indications\u00a0bleeding from oesophageal varices", "name": "TERLIPRESSIN ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.2 Posterior pituitary hormones and antagonists", "Posterior pituitary hormones" ], "cautions": "Cautions\u00a0see under Vasopressin", "side-effects": "Side-effects\u00a0see under Vasopressin, but\r\neffects milder", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4436.htm", "doses": [ "By intravenous injection, 2\u00a0mg followed\r\nby 1 or 2\u00a0mg every 4 to 6 hours until bleeding is controlled, for\r\nup to 72 hours" ] }, "OXYCODONE HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe pain in patients with cancer;\r\npostoperative pain; severe pain", "name": "OXYCODONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "OXYCODONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also toxic psychosis; pancreatitis", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndiarrhoea, abdominal pain, anorexia, dyspepsia; bronchospasm, dyspnoea,\r\nimpaired cough reflex; asthenia, anxiety; chills; less commonly paralytic ileus, cholestasis, gastritis, flatulence, dysphagia,\r\ntaste disturbance, belching, hiccups, vasodilatation, supraventricular\r\ntachycardia, syncope, amnesia, hypoaesthesia, restlessness, seizures,\r\nhypotonia, paraesthesia, disorientation, malaise, agitation, speech\r\ndisorder, tremor, pyrexia, amenorrhoea, thirst, dehydration, muscle\r\nfasciculation, and dry skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85407.htm", "doses": [ "By mouth, initially 5\u00a0mg every 4\u20136 hours,\r\nincreased if necessary according to severity of pain, usual max. 400\u00a0mg\r\ndaily, but some patients may require higher doses; child under 18 years see BNF for Children", "By slow intravenous injection, 1\u201310\u00a0mg every\r\n4 hours when necessary; child under\r\n18 years, not recommended", "By intravenous infusion, initially 2\u00a0mg/hour,\r\nadjusted according to response; child under 18 years not recommended", "By subcutaneous injection, initially 5\u00a0mg every\r\n4 hours when necessary; child under\r\n18 years not recommended", "By subcutaneous infusion, initially 7.5\u00a0mg/24\r\nhours adjusted according to response; child under 18 years not recommended", "Patient controlled analgesia (PCA), consult hospital protocols", "2\u00a0mg oral oxycodone is\r\napproximately equivalent to 1\u00a0mg parenteral oxycodone" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "HYDROXYCARBAMIDE": { "indications": "Indications\u00a0\n(From Hydroxycarbamide: British National Formulary)\nHydroxycarbamide; sickle-cell disease (%s\n(From HYDROXYCARBAMIDE: British National Formulary)\nHYDROXYCARBAMIDE)", "name": "HYDROXYCARBAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Hydroxycarbamide", "HYDROXYCARBAMIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (hydroxycarbamide)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127938.htm", "doses": [ "20\u201330\u00a0mg/kg daily or 80\u00a0mg/kg every third\r\nday" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nmanufacturer advises effective contraception before and during treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "ADRENALINE/EPINEPHRINE Intramuscular injection for self-administration": { "indications": "Indications\u00a0emergency treatment of acute\r\nanaphylaxis; angioedema; cardiopulmonary resuscitation (section 2.7.3); priapism [unlicensed] (section 7.4.5)", "name": "ADRENALINE/EPINEPHRINE Intramuscular injection for self-administration", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Anaphylaxis", "ADRENALINE/EPINEPHRINE", "Intramuscular injection for self-administration" ], "cautions": "Cautions\u00a0for cautions in non-life-threatening situations, see section 2.7.3Interactions\u00a0Severe anaphylaxis in\r\npatients taking beta-blockers may not respond to adrenaline, calling\r\nfor bronchodilator therapy, see intravenous salbutamol; adrenaline can cause\r\nsevere hypertension and bradycardia in those taking non-cardioselective\r\nbeta-blockers. Other interactions,\r\nsee Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0section 2.7.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215367.htm", "doses": [ "Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1\u00a0mg/mL)\r\nsolution for administration by healthcare professionals, see notes and table above", "Acute anaphylaxis, by intramuscular injection for self-administration, see under preparations", "Acute anaphylaxis when there is doubt as to the adequacy of\r\nthe circulation, by slow intravenous injection of 1\r\nin 10\u00a0000 (100\u00a0micrograms/mL) solution (extreme caution\u2014specialist\r\nuse only), see notes above", "Intravenous route should be used with extreme care by specialists only, see notes above", "by intramuscular injection, adult and child body-weight\r\nover 30\u00a0kg, 300\u00a0micrograms repeated after 5\u201315 minutes as necessary", "Name[Jext\u00ae (ALK-Abell\u00f3) ] (1)Jext\u00ae 150\u00a0micrograms (delivering a single dose of adrenaline (as tartrate)\r\n150\u00a0micrograms), adrenaline 1\u00a0mg/mL (1 in 1000), net price 1.4-mL\r\nauto-injector device = \u00a328.77Excipients include sulphitesNote\u00a01.25\u00a0mL of the solution remains in the auto-injector\r\ndevice after useDose\u00a0by intramuscular injection, child body-weight 15\u201330\u00a0kg, 150\u00a0micrograms (but on\r\nthe basis of a dose of 10\u00a0micrograms/kg, 300\u00a0micrograms may be more\r\nappropriate for some children) repeated after 5\u201315 minutes as necessary; child body-weight under 15\u00a0kg [unlicensed], 150\u00a0micrograms\r\nrepeated after 5\u201315 minutes as necessary\n(1)Jext\u00ae 300\u00a0micrograms (delivering a single dose of adrenaline (as tartrate)\r\n300\u00a0micrograms), adrenaline 1\u00a0mg/mL (1 in 1000), net price 1.4-mL\r\nauto-injector device = \u00a328.77Excipients include sulphitesNote\u00a01.1\u00a0mL of the solution remains in the auto-injector\r\ndevice after useDose\u00a0by intramuscular injection, adult and child body-weight\r\nover 30\u00a0kg, 300\u00a0micrograms repeated after 5\u201315 minutes as necessary" ], "pregnancy": "Pregnancy\u00a0section 2.7.3" }, "CO-TENIDONE": { "indications": "Indications\u00a0hypertension", "name": "CO-TENIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\n2.4 Beta-adrenoceptor blocking drugs and %s\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics); also avoid abrupt withdrawal especially in ischaemic heart disease; first-degree AV block; portal hypertension (risk of deterioration in liver function); history of obstructive airways disease (introduce\r\ncautiously and monitor lung function\u2014\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nBeta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA, see above), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers, see above). Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.); diabetes; myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked (also\r\n\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nThyrotoxicosis\u00a0Beta-blockers are used in pre-operative preparation for thyroidectomy. Administration of propranolol can reverse clinical symptoms of thyrotoxicosis within 4 days. Routine tests of increased thyroid function remain unaltered. The thyroid gland is rendered less vascular thus making surgery easier (section 6.2.2).); history of hypersensitivity\u2014may increase sensitivity to allergens\r\nand result in more serious hypersensitivity response, also may reduce response to adrenaline (epinephrine) (see also %s\n(From ADRENALINE/EPINEPHRINE: British National Formulary)\nADRENALINE/EPINEPHRINE); interactions: Appendix 1 (beta-blockers, diuretics), important: verapamil interaction, see also VERAPAMIL %s\n(From VERAPAMIL HYDROCHLORIDE: British National Formulary)\nCautions\u00a0first-degree AV block; acute phase of myocardial infarction (avoid if bradycardia, hypotension, left ventricular failure); patients taking beta-blockers (important: see below); interactions: Appendix 1 (calcium-channel blockers)Verapamil and beta-blockers\u00a0Verapamil injection should not be given to patients recently treated with beta-blockers because of the risk of hypotension and asystole. The suggestion that when verapamil injection has been given first, an interval of 30 minutes before giving a beta-blocker is sufficient has not been confirmed.It may also be hazardous to give verapamil and a beta-blocker together by mouth (should only be contemplated if myocardial function well preserved).", "side-effects": "Side-effects\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\n2.4 Beta-adrenoceptor blocking drugs; also gastro-intestinal\r\ndisturbances; bradycardia, heart failure, hypotension, conduction\r\ndisorders, peripheral vasoconstriction (including exacerbation of\r\nintermittent claudication and Raynaud\u2019s phenomenon); bronchospasm,\r\ndyspnoea; headache, fatigue, sleep disturbances, paraesthesia, dizziness,\r\nvertigo, psychoses; sexual dysfunction; altered plasma lipid concentration,\r\nmetabolic and electrolyte disturbances including hypokalaemia (see\r\nalso %s\n(From 2.2 Diuretics: British National Formulary)\nPotassium loss\u00a0Hypokalaemia can occur with both thiazide and loop diuretics. The risk of hypokalaemia depends on the duration of action as well as the potency and is thus greater with thiazides than with an equipotent dose of a loop diuretic.Hypokalaemia is dangerous in severe cardiovascular disease and in patients also being treated with cardiac glycosides. Often the use of potassium-sparing diuretics (section 2.2.3) avoids the need to take potassium supplements.In hepatic failure, hypokalaemia caused by diuretics can precipitate encephalopathy, particularly in alcoholic cirrhosis; diuretics can also increase the risk of hypomagnesaemia in alcoholic cirrhosis, leading to arrhythmias. Spironolactone, a potassium-sparing diuretic (section 2.2.3), is chosen for oedema arising from cirrhosis of the liver.Potassium supplements or potassium-sparing diuretics are seldom necessary when thiazides are used in the routine treatment of hypertension (see also section 9.2.1.1).), hyponatraemia,\r\nhypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis,\r\nhyperuricaemia and gout, purpura, blood disorders including agranulocytosis,\r\nleucopenia, and thrombocytopenia; visual disturbances; exacerbation\r\nof psoriasis, alopecia; rarely pancreatitis, intrahepatic\r\ncholestasis, jaundice, cardiac arrhythmias, dry eyes (reversible on\r\nwithdrawal), hypersensitivity reactions (including rash, pneumonitis,\r\npulmonary oedema, photosensitivity, other severe skin reactions, and\r\nallergic interstitial nephritis); overdosage: \n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200405.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0avoid; diuretics not used to treat hypertension in\r\npregnancy; see also section 2.5" }, "RALOXIFENE HYDROCHLORIDE": { "indications": "Indications\u00a0treatment and prevention of postmenopausal osteoporosis", "name": "RALOXIFENE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "Raloxifene", "RALOXIFENE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0risk factors for venous thromboembolism\r\n(discontinue if prolonged immobilisation); risk factors for stroke; breast cancer (\n(From Raloxifene: British National Formulary)\nRaloxifene); history of oestrogen-induced\r\nhypertriglyceridaemia (monitor serum triglycerides);\r\navoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1 (raloxifene)", "side-effects": "Side-effects\u00a0hot flushes, leg cramps, peripheral oedema, influenza-like\r\nsymptoms; less commonly venous thromboembolism, thrombophlebitis; rarely rashes, gastro-intestinal disturbances, hypertension,\r\narterial thromboembolism, headache (including migraine), breast discomfort,\r\nthrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73962.htm", "doses": [ "60\u00a0mg once daily" ] }, "OLANZAPINE": { "indications": "Indications\u00a0see under Dose", "name": "OLANZAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also paralytic ileus, diabetes mellitus (risk of exacerbation or ketoacidosis), low leucocyte\r\nor neutrophil count, bone-marrow depression, hypereosinophilic disorders, myeloproliferative disease; dose adjustment\r\nmay be necessary if smoking started or stopped during treatmentCNS and respiratory depression\u00a0Blood\r\npressure, pulse and respiratory rate should be monitored for at least\r\n4 hours after intramuscular injection, particularly in those also\r\nreceiving another antipsychotic or benzodiazepine", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nmild, transient antimuscarinic effects (very rarely precipitation of angle-closure glaucoma); drowsiness, speech difficulty,\r\nexacerbation of Parkinson\u2019s disease, abnormal gait, hallucinations,\r\nakathisia, asthenia, fatigue, increased appetite, increased body temperature,\r\nraised triglyceride concentration, oedema, hyperprolactinaemia (but\r\nclinical manifestations uncommon); eosinophilia; less commonly hypotension, bradycardia, QT-interval prolongation, urinary incontinence,\r\nand photosensitivity; rarely seizures, leucopenia,\r\nand rash; very rarely hepatitis, pancreatitis, hypercholesterolaemia,\r\nhypothermia, urinary retention, priapism, thrombocytopenia, neutropenia,\r\nrhabdomyolysis, and alopecia; with injection, sinus\r\npause and hypoventilation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56911.htm", "doses": [ "Schizophrenia, combination therapy for mania, preventing\r\nrecurrence in bipolar disorder, by mouth, adult over 18 years, 10\u00a0mg daily adjusted to usual\r\nrange of 5\u201320\u00a0mg daily; doses greater than 10\u00a0mg daily only after\r\nreassessment; max. 20\u00a0mg daily; child 12\u201318 years see BNF for Children", "Monotherapy for mania, by mouth, adult over 18 years, 15\u00a0mg daily adjusted to usual\r\nrange of 5\u201320\u00a0mg daily; doses greater than 15\u00a0mg only after reassessment;\r\nmax. 20\u00a0mg daily; child 12\u201318 years\r\nsee BNF for Children", "Control of agitation and disturbed behaviour in schizophrenia\r\nor mania, by intramuscular injection, adult over 18 years, initially 5\u201310\u00a0mg (usual dose\r\n10\u00a0mg) as a single dose followed by 5\u201310\u00a0mg after 2 hours if necessary; elderly initially 2.5\u20135\u00a0mg as a single dose followed\r\nby 2.5\u20135\u00a0mg after 2 hours if necessary; max. 3 injections daily for\r\n3 days; max. daily combined oral and parenteral dose 20\u00a0mg", "When one or more factors present\r\nthat might result in slower metabolism (e.g. female gender, elderly,\r\nnon-smoker) consider lower initial dose and more gradual dose increase" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk; neonatal lethargy, tremor, and hypertonia\r\nreported when used in third trimester" }, "SODIUM PHENYLBUTYRATE": { "indications": "Indications\u00a0adjunct in long-term treatment\r\nof urea cycle disorders (under specialist supervision)", "name": "SODIUM PHENYLBUTYRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Urea cycle disorders" ], "cautions": "Cautions\u00a0congestive heart failure; interactions: Appendix 1 (sodium phenylbutyrate)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, weight gain, taste\r\ndisturbance, decreased appetite; syncope, oedema; headache, depression,\r\nirritability; renal tubular acidosis, menstrual disorders; blood disorders,\r\nmetabolic acidosis, alkalosis; rash, body odour; less commonly rectal bleeding, peptic ulcer, pancreatitis, and arrhythmias", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85978.htm", "doses": [ "adult and child body-weight over 20\u00a0kg, 9.9\u201313\u00a0g/m2 daily in divided doses with meals (max. 20\u00a0g daily); child body-weight less than 20\u00a0kg, 450\u2013600\u00a0mg/kg\r\ndaily in divided doses with meals" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies;\r\nmanufacturer advises adequate contraception during administration" }, "AZITHROMYCIN Single use": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "AZITHROMYCIN Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "AZITHROMYCIN", "Single use" ], "side-effects": "Side-effects\u00a0ocular discomfort (including pruritus, burning),\r\nblurred vision", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217747.htm", "doses": [ "Purulent bacterial conjunctivitis, adult and child over 2 years, apply twice\r\ndaily for 3 days; review if no improvement after 3 days", "Trachomatous conjunctivitis, adult and child over 1 year, apply twice\r\ndaily for 3 days; review if no improvement after 3 days", "Name[Azyter\u00ae (Spectrum Thea) ] Eye drops, azithromycin (as dihydrate) 1.5%, net price 6 \u00d7 0.25-g = \u00a36.99" ], "pregnancy": "Pregnancy\u00a0caution\u2014limited information available" }, "METHYLPREDNISOLONE": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; severe inflammatory bowel disease (section 1.5); cerebral oedema associated with\r\nmalignancy; see also notes above; rheumatic disease (section 10.1.2); skin (section 13.4)", "name": "METHYLPREDNISOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids; also rapid intravenous administration of large doses associated with cardiovascular\r\ncollapse", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4284.htm", "doses": [ "By mouth, usual range 2\u201340\u00a0mg daily; see\r\nalso Administration (above)", "By intramuscular injection or slow intravenous injection or infusion, initially 10\u2013500\u00a0mg; graft rejection, up to 1\u00a0g\r\ndaily by intravenous infusion for up to 3 days" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "DIAZOXIDE": { "indications": "Indications\u00a0chronic intractable hypoglycaemia; hypertensive\r\nemergency\u2014but no longer recommended, see section 2.5", "name": "DIAZOXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.4 Treatment of hypoglycaemia", "Chronic hypoglycaemia", "DIAZOXIDE" ], "cautions": "Cautions\u00a0ischaemic heart disease; monitor blood pressure; during prolonged use monitor white cell and platelet count, and in children, regularly assess growth, bone, and psychological\r\ndevelopment; interactions: Appendix 1 (diazoxide)", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, hyperuricaemia, hypotension,\r\noedema, tachycardia, arrhythmias, extrapyramidal effects; hypertrichosis\r\non prolonged treatment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4200.htm", "doses": [ "By mouth, adult, initially 5\u00a0mg/kg daily in 2\u20133 divided doses, then adjusted according\r\nto response; usual maintenance dose 3\u20138\u00a0mg/kg daily in 2\u20133 divided\r\ndoses; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0prolonged use in second or third trimesters may produce\r\nalopecia and impaired glucose tolerance in neonate; inhibits uterine\r\nactivity during labour" }, "METHOTREXATE Parenteral preparations": { "indications": "Indications\u00a0see under dose; Crohn\u2019s disease [unlicensed\r\nindication] (section 1.5.3); malignant disease (section 8.1.3); psoriasis (section 13.5.3)", "name": "METHOTREXATE Parenteral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "METHOTREXATE", "Parenteral preparations" ], "cautions": "Cautions\u00a0section 8.1; see Monitoring, Blood Count, Liver\r\nToxicity, and Pulmonary Toxicity below; extreme caution\r\nin blood disorders (avoid if severe); peptic\r\nulceration, ulcerative colitis, diarrhoea and ulcerative\r\nstomatitis (withdraw if stomatitis develops\u2014may be first sign of gastro-intestinal toxicity); risk of accumulation\r\nin pleural effusion or ascites\u2014drain before treatment; acute porphyria (section 9.8.2); interactions: see below and Appendix 1 (methotrexate)MonitoringIn view of reports of blood dyscrasias (including fatalities)\r\nand liver cirrhosis with low-dose methotrexate patients\r\nshould:have full blood count and renal and liver\r\nfunction tests before starting treatment and repeated every 1\u20132 weeks\r\nuntil therapy stabilised, thereafter patients should be monitored\r\nevery 2\u20133 months(1)be advised to report all symptoms and signs\r\nsuggestive of infection, especially sore throatTreatment with folinic acid (as calcium folinate, section 8.1) may be\r\nrequired in acute toxicityBlood count\u00a0Bone marrow suppression can occur\r\nabruptly; factors likely to increase toxicity include advanced age, renal impairment, and concomitant use with another anti-folate drug (e.g. trimethoprim). A clinically significant drop in white cell\r\ncount or platelet count calls for immediate withdrawal of methotrexate and introduction of supportive therapyLiver toxicity\u00a0Liver cirrhosis reported. Treatment\r\nshould not be started or should be discontinued if any abnormality\r\nof liver function tests or liver biopsy is present or develops during\r\ntherapy. Abnormalities can return to normal within 2\r\nweeks after which treatment may be recommenced if judged appropriatePulmonary toxicity\u00a0Pulmonary toxicity\r\nmay be a special problem in rheumatoid arthritis (patient to seek\r\nmedical attention if dyspnoea, cough or fever); monitor\r\nfor symptoms at each visit\u2014discontinue if pneumonitis suspected.Aspirin and other NSAIDs\u00a0If aspirin or other NSAIDs are given concurrently the dose\r\nof methotrexate should be carefully monitored. Patients should be advised to avoid self-medication with over-the-counter aspirin or ibuprofen", "side-effects": "Side-effects\u00a0section 8.1; also anorexia, abdominal discomfort,\r\ndyspepsia, gastro-intestinal ulceration and bleeding, diarrhoea, toxic\r\nmegacolon, hepatotoxicity (see Cautions above); hypotension, pericarditis,\r\npericardial tamponade; pulmonary oedema, pleuritic pain, pulmonary\r\nfibrosis, interstitial pneumonitis (see also Pulmonary Toxicity above);\r\nanaphylactic reactions, urticaria; dizziness, chills, fever, drowsiness,\r\ninsomnia, malaise, headache, mood changes, neurotoxicity, confusion,\r\nparaesthesia; precipitation of diabetes; menstrual disturbances, vaginitis,\r\ncystitis, reduced libido, impotence; blood disorders; haematuria,\r\ndysuria, renal failure; osteoporosis, arthralgia, myalgia, vasculitis;\r\nconjunctivitis, visual disturbance; rash, pruritus, Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis, photosensitivity, changes in\r\nnail and skin pigmentation, telangiectasia, acne, furuncolosis, ecchymosis;\r\ninjection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215543.htm", "doses": [ "Moderate to severe active rheumatoid arthritis, by mouth, adult over 18 years,\r\n7.5\u00a0mg once weekly, adjusted according to response; max. weekly dose\r\n20\u00a0mg", "Severe active rheumatoid arthritis, by subcutaneous or by intramuscular or by intravenous injection, adult over 18 years, 7.5\u00a0mg once weekly, increased according to response\r\nby 2.5\u00a0mg weekly; max. weekly dose 25\u00a0mg", "child under 18 years see BNF for Children", "Note that the above dose is a weekly dose.\r\nTo avoid error with low-dose methotrexate, it is recommended that:", "the patient is carefully advised of the dose and frequency and the reason for taking methotrexate\r\nand any other prescribed medicine (e.g. folic acid);", "only one strength of methotrexate tablet (usually 2.5\r\nmg) is prescribed and dispensed;", "the prescription and the dispensing label clearly show\r\nthe dose and frequency of methotrexate administration;", "the patient is warned to report immediately the onset\r\nof any feature of blood disorders (e.g. sore throat, bruising, and\r\nmouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort,\r\nand dark urine), and respiratory effects (e.g. shortness of breath).", "Methotrexate treatment\r\nbooklets should be issued where appropriate, and are available for\r\npurchase from:", "GP practices can obtain supplies through their\r\nPrimary Care Trust (PCT) or Agency stores.", "NHS Hospitals can order supplies from www.nhsforms.co.uk or by emailing nhsforms@mmm.com.", "These booklets include advice for adults taking oral methotrexate\r\nfor inflammatory conditions, and a section for recording results of\r\nblood tests and dosage information.", "Name[Ebetrex\u00ae (Sandoz) ] Injection, prefilled syringe, methotrexate\r\n(as disodium salt) 10\u00a0mg/mL, net price 0.75\u00a0mL (7.5\u00a0mg) = \u00a314.78,\r\n1\u00a0mL (10\u00a0mg) = \u00a315.21, 1.5\u00a0mL (15\u00a0mg) = \u00a316.49; 20\u00a0mg/mL, 1\u00a0mL (20\u00a0mg)\r\n= \u00a317.75, 1.25\u00a0mL (25\u00a0mg) = \u00a318.39, 1.5\u00a0mL (30\u00a0mg) = \u00a320.70" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic; fertility may be reduced during\r\ntherapy but this may be reversible); effective contraception required\r\nduring and for at least 3 months after treatment in men or women;\r\nsee also section 8.1" }, "POTASSIUM CHLORIDE - ORAL POTASSIUM": { "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, flatulence; with modified-release preparations, gastro-intestinal obstruction,\r\nulceration and bleeding also reported", "indications": "Indications\u00a0potassium depletion (see notes above)", "name": "POTASSIUM CHLORIDE - ORAL POTASSIUM", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4940.htm", "doses": [ "See notes above", "Do not confuse Effervescent Potassium Tablets\r\nBPC 1968 (section 9.2.1.3) with effervescent potassium chloride tablets. Effervescent Potassium Tablets BPC 1968 do not contain\r\nchloride ions and their use should be restricted to hyperchloraemic\r\nstates (section 9.2.1.3). " ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.1 Oral potassium", "POTASSIUM CHLORIDE" ], "cautions": "Cautions\u00a0\n(From 9.2.1.1 Oral potassium: British National Formulary)\n9.2.1.1 Oral potassium; cardiac disease; elderly; with modified-release\r\npreparations, intestinal stricture, history of peptic\r\nulcer, hiatus hernia; interactions: Appendix 1 (potassium salts)" }, "OLMESARTAN MEDOXOMIL": { "indications": "Indications\u00a0hypertension (see also notes above)", "name": "OLMESARTAN MEDOXOMIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "OLMESARTAN MEDOXOMIL" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain, peripheral oedema, hypertriglyceridaemia; fatigue; influenza-like\r\nsymptoms, cough, pharyngitis, rhinitis; urinary-tract infection; haematuria,\r\nhyperuricaemia; arthritis, musculoskeletal pain; less commonly angina, vertigo, rash; very rarely headache, thrombocytopenia,\r\nmyalgia, pruritus, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127966.htm", "doses": [ "Initially 10\u00a0mg once daily; if necessary increased to\r\n20\u00a0mg once daily; max. 40\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "LORAZEPAM - DRUGS USED IN STATUS EPILEPTICUS": { "indications": "Indications\u00a0status epilepticus; febrile convulsions\r\n(section 4.8.3); convulsions due to poisoning\r\n(see Emergency Treatment of Poisoning); other indications (section 4.1.2 and section 15.1.4.1)", "name": "LORAZEPAM - DRUGS USED IN STATUS EPILEPTICUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus" ], "cautions": "Cautions\u00a0see Diazepam, section 4.1.2; when given intravenously facilities\r\nfor reversing respiratory depression with mechanical ventilation must\r\nbe immediately available (but see also notes above)", "side-effects": "Side-effects\u00a0see Diazepam, section 4.1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3624.htm", "doses": [ "By slow intravenous injection (into large\r\nvein), 4\u00a0mg repeated once after 10 minutes if necessary; child under 12 years 100\u00a0micrograms/kg (max. 4\u00a0mg)\r\nrepeated once after 10 minutes if necessary" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2, and Pregnancy" }, "METHOTREXATE - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0severe psoriasis unresponsive to conventional\r\ntherapy (specialist use only); Crohn\u2019s disease (section 1.5.3); malignant disease (section 8.1.3); rheumatoid arthritis (section 10.1.3)", "name": "METHOTREXATE - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response" ], "cautions": "Cautions\u00a0section 10.1.3; also photosensitivity\u2014psoriasis\r\nlesions aggravated by UV radiation (skin ulceration reported)", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6002.htm", "doses": [ "By mouth or by\r\nintramuscular or intravenous or subcutaneous injection, 2.5\u201310\u00a0mg\r\nonce weekly, increased according to response in steps of 2.5\u20135\u00a0mg\r\nat intervals of at least 1 week; usual dose 7.5\u201315\u00a0mg once weekly;\r\nmax. weekly dose 30\u00a0mg; child 2\u201318\r\nyears see BNF for Children", "Note that the above dose is a weekly dose.\r\nTo avoid error with low dose methotrexate, it is recommended that:", "the patient is carefully advised of the dose and frequency and the reason for taking methotrexate\r\nand any other prescribed medicine (e.g. folic acid);", "only one strength of methotrexate tablet (usually 2.5\u00a0mg) is prescribed and dispensed;", "the prescription and the dispensing label clearly show\r\nthe dose and frequency of methotrexate administration;", "the patient is warned to report immediately the onset\r\nof any feature of blood disorders (e.g. sore throat, bruising, and\r\nmouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort\r\nand dark urine), and respiratory effects (e.g. shortness of breath)." ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "NEDOCROMIL SODIUM - OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0burning and stinging; distinctive taste reported", "indications": "Indications\u00a0allergic conjunctivitis; seasonal keratoconjunctivitis", "name": "NEDOCROMIL SODIUM - OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/33389.htm", "doses": [ "Seasonal and perennial conjunctivitis, adult and child over\r\n6 years, apply twice daily increased if necessary to 4 times daily;\r\nmax. 12 weeks treatment for seasonal allergic conjunctivitis", "Seasonal keratoconjunctivitis, adult and child over 6 years, apply 4 times\r\ndaily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations" ] }, "DOXYCYCLINE - TETRACYCLINES": { "indications": "Indications\u00a0see notes above; chronic prostatitis; sinusitis, syphilis, pelvic\r\ninflammatory disease (Table 1, %s\n(From Table 1. Summary of antibacterial therapy: British National Formulary)\nTable 1. Summary of antibacterial therapy); treatment\r\nand prophylaxis of anthrax [unlicensed indication]; malaria treatment\r\nand prophylaxis (%s\n(From 5.4.1 Antimalarials: British National Formulary)\n5.4.1 Antimalarials); recurrent aphthous ulceration, adjunct to gingival\r\nscaling and root planing for periodontitis (%s\n(From 12.3.1 Drugs for oral ulceration and inflammation: British National Formulary)\n12.3.1 Drugs for oral ulceration and inflammation); oral\r\nherpes simplex (%s\n(From Oropharyngeal viral infections: British National Formulary)\nOropharyngeal viral infections); rosacea, acne vulgaris (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "DOXYCYCLINE - TETRACYCLINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "DOXYCYCLINE" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; alcohol dependence; photosensitivity reported\r\n(avoid exposure to sunlight or sun lamps)", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nanorexia, dry mouth, flushing, anxiety, and tinnitus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204180.htm", "doses": [ "200\u00a0mg on first day, then 100\u00a0mg daily; severe infections\r\n(including refractory urinary-tract infections), 200\u00a0mg daily", "Early syphilis, 100\u00a0mg twice daily for 14 days; late latent\r\nsyphilis, 100\u00a0mg twice daily for 28 days; neurosyphilis, 200\u00a0mg twice\r\ndaily for 28 days", "Uncomplicated genital chlamydia, non-gonococcal urethritis,\r\n100\u00a0mg twice daily for 7 days (14 days in pelvic inflammatory disease,\r\nsee also Table 1, section 5.1)", "Lyme disease (see also section 5.1.1.3), 100\u00a0mg twice daily for 10\u201314\r\ndays (28 days in Lyme arthritis)", "Anthrax (treatment or post-exposure prophylaxis; see also section 5.1.12), 100\u00a0mg twice daily; child (only if alternative antibacterial cannot be given) [unlicensed\r\ndose] 5\u00a0mg/kg daily in 2 divided doses (max. 200\u00a0mg daily)", "Capsules should be swallowed whole\r\nwith plenty of fluid during meals while sitting or standing", "Doxycycline doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "DANTRON With poloxamer \u2018188\u2019 (as co-danthramer)": { "indications": "Indications\u00a0only for constipation in terminally ill patients of all ages", "name": "DANTRON With poloxamer \u2018188\u2019 (as co-danthramer)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "DANTRON", "With poloxamer \u2018188\u2019 (as co-danthramer)" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; rodent studies indicate potential carcinogenic risk; avoid prolonged contact with skin (as in incontinent patients or\r\ninfants wearing nappies)\u2014risk of irritation and excoriation", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; urine may be coloured red", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2211.htm", "doses": [ "See under preparations", "adult and child over 12 years, 1\u20132 capsules at bedtime (restricted\r\nindications, see notes above)", "adult and child over 12 years, 5\u00a0mL at night (restricted indications,\r\nsee notes above)", "Name[Co-danthramer (Non-proprietary) ] Capsules, co-danthramer 25/200 (dantron 25\u00a0mg, poloxamer \u2018188\u2019 200\u00a0mg). Net price 60-cap\r\npack = \u00a312.86. \r\n Label:\r\n 14, (urine\r\nred)Dose\u00a01\u20132 capsules at bedtime; child 1 capsule at bedtime (restricted indications, see notes above)\nStrong capsules, co-danthramer 37.5/500\r\n(dantron 37.5\u00a0mg, poloxamer \u2018188\u2019 500\u00a0mg). Net\r\nprice 60-cap pack = \u00a315.55. \r\n Label:\r\n 14, (urine red)Dose\u00a0adult and child over 12 years, 1\u20132 capsules at bedtime (restricted\r\nindications, see notes above)\nSuspension, co-danthramer 25/200\r\nin 5\u00a0mL (dantron 25\u00a0mg, poloxamer \u2018188\u2019 200\u00a0mg/5\u00a0mL).\r\nNet price 300\u00a0mL = \u00a311.27, 1\u00a0litre = \u00a337.57. \r\n Label:\r\n 14, (urine red)Dose\u00a05\u201310\u00a0mL at night; child 2.5\u20135\u00a0mL (restricted indications, see notes above)Brands include Codalax\u00ae\u00a0, Danlax\u00ae\nStrong suspension, co-danthramer\r\n75/1000 in 5\u00a0mL (dantron 75\u00a0mg, poloxamer \u2018188\u2019\r\n1\u00a0g/5\u00a0mL). Net price 300\u00a0mL = \u00a330.13. \r\n Label:\r\n 14, (urine red)Dose\u00a0adult and child over 12 years, 5\u00a0mL at night (restricted indications,\r\nsee notes above)Brands include Codalax Forte\u00ae\u00a0" ], "pregnancy": "Pregnancy\u00a0manufacturers of co-danthramer and co-danthrusate\r\nadvise avoid\u2014no information available" }, "CITALOPRAM": { "indications": "Indications\u00a0depressive illness, panic disorder", "name": "CITALOPRAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors", "CITALOPRAM" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.; susceptibility to QT-interval prolongation", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; also hepatitis, palpitation, tachycardia,\r\noedema, bradycardia, postural hypotension, haemorrhage, QT-interval\r\nprolongation, coughing, yawning, confusion, impaired concentration,\r\naggression, malaise, amnesia, migraine, paraesthesia, abnormal dreams,\r\neuphoria, mydriasis, taste disturbance, increased salivation, rhinitis,\r\ntinnitus, polyuria, micturition disorders, hypokalaemia, pruritus;\r\nparadoxical increased anxiety during initial treatment of panic disorder\r\n(reduce dose)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119714.htm", "doses": [ "By mouth as tablets, depressive illness,\r\n20\u00a0mg once daily increased if necessary in steps of 20\u00a0mg daily at\r\nintervals of 3\u20134 weeks; max. 40\u00a0mg daily (elderly over 65 years, max. 20\u00a0mg daily); child under 18 years see BNF for Children and Depressive Illness in Children\r\nand Adolescents ", "Panic disorder, adult over 18\r\nyears, initially 10\u00a0mg daily increased gradually if necessary in steps\r\nof 10\u00a0mg daily, usual dose 20\u201330\u00a0mg daily; max. 40\u00a0mg daily (elderly over 65 years, max. 20\u00a0mg daily)", "By mouth as oral drops, depressive\r\nillness, 16\u00a0mg daily as a single dose increased if necessary in steps\r\nof 16\u00a0mg daily at intervals of 3\u20134 weeks; max. 32\u00a0mg daily (elderly over 65 years, max. 16\u00a0mg daily); child under 18 years see BNF for Children and Depressive Illness in Children\r\nand Adolescents ", "Panic disorder, adult over 18\r\nyears, initially 8\u00a0mg daily as a single dose increased gradually if\r\nnecessary in steps of 8\u00a0mg, usual dose 16\u201324\u00a0mg daily; max. 32\u00a0mg\r\ndaily (elderly over 65 years, max.\r\n16\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nPregnancy\u00a0Manufacturers advise that SSRIs should not be used during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when SSRIs are taken during early pregnancy. If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported; see also individual monographs." }, "INFLIXIMAB": { "indications": "Indications\u00a0see notes above; inflammatory bowel\r\ndisease (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB); ankylosing spondylitis, psoriatic\r\narthritis, rheumatoid arthritis (%s\n(From INFLIXIMAB: British National Formulary)\nINFLIXIMAB)", "name": "INFLIXIMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators", "INFLIXIMAB" ], "cautions": "Cautions\u00a0section 10.1.3; monitor for non-melanoma skin cancer before and during treatment", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201661.htm", "doses": [ "By intravenous infusion, plaque psoriasis, adult over 18 years, 5\u00a0mg/kg, repeated 2 weeks and\r\n6 weeks after initial infusion, then every 8 weeks; discontinue if\r\nno response within 14 weeks of initial infusion" ], "pregnancy": "Pregnancy\u00a0section\r\n10.1.3" }, "CYTARABINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nCytarabine acts by interfering with pyrimidine synthesis. It is given subcutaneously, intravenously, or intrathecally. Its predominant use is in the induction of remission of acute myeloblastic leukaemia. It is a potent myelosuppressant and requires careful haematological monitoring. A liposomal formulation of cytarabine for intrathecal use is licensed for lymphomatous meningitis.", "name": "CYTARABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (cytarabine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4726.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "PYRIDOXINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "PYRIDOXINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.2 Vitamin B group", "PYRIDOXINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0sensory neuropathy reported with high doses given\r\nfor extended periods", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/12862.htm", "doses": [ "Deficiency states, 20\u201350\u00a0mg up to 3 times daily", "Isoniazid-induced neuropathy, prophylaxis\r\n10\u00a0mg daily [or 20\u00a0mg daily if suitable product not available]; treatment,\r\n50\u00a0mg three times daily; child under\r\n18 years see BNF for Children", "Idiopathic sideroblastic anaemia, 100\u2013400\u00a0mg daily in divided\r\ndoses", "Penicillamine-induced neuropathy, prophylaxis in Wilson\u2019s disease\r\n[unlicensed use] (see also notes above), 20\u00a0mg daily; child under 18 years see BNF for Children", "Premenstrual syndrome [unlicensed use], 50\u2013100\u00a0mg daily (see\r\nnotes above)", "Prolonged use of pyridoxine in a dose of 10\u00a0mg daily\r\nis considered safe but the long-term use of pyridoxine in a dose of\r\n200\u00a0mg or more daily has been associated with neuropathy. The safety\r\nof long-term pyridoxine supplementation with doses above 10\u00a0mg daily\r\nhas not been established." ] }, "TADALAFIL - PHOSPHODIESTERASE TYPE-5 INHIBITORS": { "side-effects": "Side-effects\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nThe side-effects of sildenafil, tadalafil, and vardenafil include dyspepsia, nausea, vomiting, headache (including migraine), flushing, dizziness, myalgia, back pain, visual disturbances (non-arteritic anterior ischaemic optic neuropathy has been reported\u2014stop drug if sudden visual impairment occurs), and nasal congestion. Less common side-effects include painful red eyes, palpitation, tachycardia, hypotension, hypertension, epistaxis. Other side-effects reported rarely include syncope, hypersensitivity reactions (including rash, facial oedema, and Stevens-Johnson syndrome), and priapism. Serious cardiovascular events (including arrhythmia, unstable angina, and myocardial infarction), seizures, sudden hearing loss (discontinue drug and seek medical advice), and retinal vascular occlusion have also been reported. ; also\r\nincreased sweating, abdominal pain, and transient amnesia reported", "indications": "Indications\u00a0erectile dysfunction; pulmonary hypertension\r\n(section 2.5.1)", "name": "TADALAFIL - PHOSPHODIESTERASE TYPE-5 INHIBITORS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119673.htm", "doses": [ "adult over 18 years, initially\r\n10\u00a0mg at least 30 minutes before sexual activity, subsequent doses\r\nadjusted according to response, up to 20\u00a0mg as a single dose; max.\r\n1 dose in 24 hours (but daily dose of 10\u201320\u00a0mg not recommended); for\r\npatients who anticipate sexual activity at least twice weekly, 5\u00a0mg\r\nonce daily can be taken, reduced to 2.5\u00a0mg once daily according to\r\nresponse", "Effect of intermittent dosing may persist\r\nfor longer than 24 hours" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Phosphodiesterase type-5 inhibitors", "TADALAFIL" ], "cautions": "Cautions\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nCautions\u00a0Sildenafil, tadalafil, and vardenafil should be used with caution in cardiovascular disease, left ventricular outflow obstruction, anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie\u2019s disease), and in those with a predisposition to priapism (e.g. in sickle-cell disease, multiple myeloma, or leukaemia). Concomitant treatment with a phosphodiesterase type-5 inhibitor and an alpha-blocker (section 2.5.4 and section 7.4.1) can increase the risk of postural hypotension\u2014initiate treatment with a phosphodiesterase type-5 inhibitor (at a low dose) only once the patient is stable on the alpha-blocker; see also interactions: Appendix 1 (sildenafil, tadalafil, vardenafil).; interactions: Appendix 1 (tadalafil)" }, "TAMSULOSIN HYDROCHLORIDE": { "indications": "Indications\u00a0benign prostatic hyperplasia", "name": "TAMSULOSIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "TAMSULOSIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers).Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129676.htm", "doses": [ "400\u00a0micrograms daily" ] }, "AZTREONAM Inhalation": { "indications": "Indications\u00a0Gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria\r\nmeningitidis", "name": "AZTREONAM Inhalation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.3 Other beta-lactam antibiotics", "AZTREONAM", "Inhalation" ], "cautions": "Cautions\u00a0hypersensitivity to beta-lactam antibiotics; interactions: Appendix 1 (aztreonam)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before aztreonam; a bronchodilator\r\nshould be administered before each dose ", "side-effects": "Side-effects\u00a0Specific side-effects for parenteral treatment\u00a0Rarely gastro-intestinal bleeding, antibiotic-associated\r\ncolitis, jaundice, hepatitis, hypotension, chest pain, dyspnoea, seizures,\r\nparaesthesia, confusion, dizziness, asthenia, headache, insomnia,\r\nbreast tenderness, blood disorders (including thrombocytopenia and\r\nneutropenia), myalgia, diplopia, tinnitus, halitosis; also reported\r\nnausea, vomiting, abdominal pain, diarrhoea, mouth ulcers,\r\ntaste disturbances, flushing, bronchospasm, rash (including toxic\r\nepidermal necrolysis and erythema multiforme)Specific side-effects for inhaled treatment\u00a0Wheezing,\r\nbronchospasm, cough; pyrexia; rash; rhinorrhoea, pharyngolaryngeal\r\npain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/209176.htm", "doses": [ "By deep intramuscular injection or by intravenous injection over 3\u20135 minutes or by intravenous infusion, 1\u00a0g every 8 hours or 2\u00a0g every 12 hours; 2\u00a0g every 6\u20138 hours for severe infections\r\n(including systemic Pseudomonas aeruginosa and\r\nlung infections in cystic fibrosis); single doses over 1\u00a0g intravenous\r\nroute only", "Urinary-tract infections, 0.5\u20131\u00a0g every 8\u201312 hours", "child over 1 week, by\r\nintravenous injection or infusion, 30\u00a0mg/kg every 6\u20138 hours increased in severe infections for child\r\nof 2 years or older to 50\u00a0mg/kg every 6\u20138 hours; max. 8\u00a0g daily", "Gonorrhoea, cystitis, by intramuscular injection, 1\u00a0g as a single dose", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult over 18 years, 75\u00a0mg 3 times daily (at least 4 hours apart) for\r\n28 days; if additional courses required, a minimum of 28 days without\r\naztreonam nebuliser solution recommended between courses", "Name[Cayston\u00ae (Gilead) ] Powder for nebuliser solution, aztreonam\r\n(as lysine), net price 84 \u00d7 75\u00a0mg vials (with solvent and nebuliser\r\nhandset) = \u00a32566.50" ], "pregnancy": "Pregnancy\u00a0no information available; manufacturer of injection\r\nadvises avoid; manufacturer of powder for nebuliser solution advises\r\navoid unless essential" }, "CALCITRIOL - VITAMIN D": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "CALCITRIOL - VITAMIN D", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "CALCITRIOL" ], "cautions": "Cautions\u00a0see under Ergocalciferol; monitor plasma calcium, phosphate, and creatinine\r\nduring dosage titration", "side-effects": "Side-effects\u00a0see under Ergocalciferol", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5142.htm", "doses": [ "By mouth, renal osteodystrophy, initially\r\n250\u00a0nanograms daily, or on alternate days (in patients with normal\r\nor only slightly reduced plasma-calcium concentration), increased\r\nif necessary in steps of 250\u00a0nanograms at intervals of 2\u20134 weeks;\r\nusual dose 0.5\u20131 microgram daily; child not established", "Established postmenopausal osteoporosis, 250\u00a0nanograms twice\r\ndaily (monitor plasma-calcium concentration and creatinine, consult\r\nproduct literature)" ], "pregnancy": "Pregnancy\u00a0see under Ergocalciferol" }, "PERINDOPRIL ARGININE Perindopril arginine with diuretic": { "indications": "Indications\u00a0see under Perindopril Erbumine and notes above", "name": "PERINDOPRIL ARGININE Perindopril arginine with diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "PERINDOPRIL ARGININE", "Perindopril arginine with diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see under Perindopril Erbumine and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200982.htm", "doses": [ "Hypertension, initially 5\u00a0mg once daily in the morning\r\nfor 1 month, subsequently adjusted according to response; if used\r\nin addition to diuretic (see notes above),\r\nin elderly, in renal impairment, in cardiac decompensation, or in\r\nvolume depletion, initially 2.5\u00a0mg once daily; max. 10\u00a0mg daily", "Heart failure (adjunct), initially 2.5\u00a0mg once daily in the\r\nmorning under close medical supervision (see notes above),\r\nincreased after 2 weeks to max. 5\u00a0mg once daily if tolerated", "Following myocardial infarction or revascularisation, initially\r\n5\u00a0mg once daily in the morning increased after 2 weeks to 10\u00a0mg once\r\ndaily if tolerated; elderly 2.5\u00a0mg\r\nonce daily for 1 week, then 5\u00a0mg once daily for 1 week, thereafter\r\nincreased to 10\u00a0mg once daily if tolerated", "Name[Coversyl\u00ae Arginine Plus (Servier) ] Tablets, f/c, perindopril arginine\r\n5\u00a0mg, indapamide 1.25\u00a0mg, net price 30-tab pack = \u00a312.65. \r\n Label:\r\n 22" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "INFLUENZA VACCINES Seasonal influenza vaccines for intramuscular use": { "indications": "Indications\u00a0annual immunisation against seasonal\r\ninfluenza", "name": "INFLUENZA VACCINES Seasonal influenza vaccines for intramuscular use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Influenza vaccines", "INFLUENZA VACCINES", "Seasonal influenza vaccines for intramuscular use" ], "cautions": "Cautions\u00a0see section 14.1; increased\r\nrisk of fever in child under 5 years with Viroflu\u00ae, and in child 5\u20139 years with Enzira\u00ae or preparations\r\nmarketed by Pfizer or CSL Biotherapies; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nreported febrile convulsions and transient thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6493.htm", "doses": [ "By intramuscular injection, adult and child over\r\n13 years, 0.5\u00a0mL as a single dose; child 6 months\u20133 years, 0.25\u20130.5\u00a0mL; 3\u201313 years 0.5\u00a0mL; for children 6\r\nmonths to 13 years who have not received seasonal influenza vaccine\r\npreviously, repeat after 4\u20136 weeks", "By intradermal injection, see under Intanza\u00ae below", "Name[Influvac Sub-unit\u00ae (Abbott Healthcare) ] Injection, suspension of formaldehyde-inactivated influenza virus (surface antigen,\r\ngrown in fertilised hens\u2019 eggs), net price 0.5-mL prefilled syringe\r\n= \u00a35.22Excipients include gentamicin" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TRIPOTASSIUM DICITRATOBISMUTHATE": { "indications": "Indications\u00a0benign gastric and duodenal ulceration;\r\nsee also Helicobacter pylori infection, section 1.3", "name": "TRIPOTASSIUM DICITRATOBISMUTHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.3 Chelates and complexes", "TRIPOTASSIUM DICITRATOBISMUTHATE" ], "cautions": "Cautions\u00a0\n(From 1.3.3 Chelates and complexes: British National Formulary)\nThe bismuth content of tripotassium dicitratobismuthate is low but absorption has been reported; encephalopathy (described with older high-dose bismuth preparations) has not been reported.; interactions: Appendix 1 (tripotassium dicitratobismuthate)", "side-effects": "Side-effects\u00a0may darken tongue and blacken faeces; less commonly nausea, vomiting, diarrhoea, constipation,\r\nrash, and pruritus reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2130.htm", "doses": [ "2 tablets twice daily or 1 tablet 4 times\r\ndaily; taken for 28 days followed by further 28 days if necessary;\r\nmaintenance not indicated but course may be repeated after interval\r\nof 1 month; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid on theoretical grounds" }, "ERGOMETRINE MALEATE With oxytocin": { "indications": "Indications\u00a0see notes above", "name": "ERGOMETRINE MALEATE With oxytocin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics", "ERGOMETRINE MALEATE", "With oxytocin" ], "cautions": "Cautions\u00a0cardiac disease; hypertension; multiple pregnancy; acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(ergot alkaloids)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain; chest pain,\r\narrhythmias (including bradycardia), palpitation, hypertension, vasoconstriction;\r\ndyspnoea, pulmonary oedema; headache, dizziness; tinnitus; rash; very rarely myocardial infarction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4496.htm", "doses": [ "See notes above", "Name[Syntometrine\u00ae (Alliance) ] Injection, ergometrine\r\nmaleate 500\u00a0micrograms, oxytocin 5\u00a0units/mL,\r\nnet price 1-mL amp = \u00a31.35Dose\u00a0by intramuscular injection, 1\u00a0mL; by intravenous injection, no longer recommended" ] }, "ETOMIDATE": { "indications": "Indications\u00a0induction of anaesthesia", "name": "ETOMIDATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.1 Intravenous anaesthetics", "Drugs used for intravenous anaesthesia", "ETOMIDATE" ], "cautions": "Cautions\u00a0see under Intravenous Anaesthetics and notes above; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Drugs used for intravenous anaesthesia: British National Formulary)\nDrugs used for intravenous anaesthesia; also nausea,\r\nvomiting; hypotension; apnoea, hyperventilation, stridor; rash; less commonly hypersalivation, arrhythmias, hypertension,\r\nhiccups, cough, phlebitis; AV block, cardiac arrest, respiratory depression,\r\nseizures, shivering, and Stevens-Johnson syndrome also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6565.htm", "doses": [ "See under preparations", "adult and child, by slow intravenous injection, 300\u00a0micrograms/kg (max. total dose 60\u00a0mg); elderly 150\u2013200\u00a0micrograms/kg (max. total dose 60\u00a0mg)" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "TAPENTADOL Modified release": { "indications": "Indications\u00a0moderate to severe pain which can be managed only with opioid analgesics", "name": "TAPENTADOL Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "TAPENTADOL", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndecreased appetite, diarrhoea, dyspepsia, abdominal discomfort, weight\r\nloss, anxiety, tremor, ataxia, dysarthria, hypoaesthesia, paraesthesia,\r\nseizures, malaise, muscle spasms", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215627.htm", "doses": [ "adult over 18 years, by mouth, initially 50\u00a0mg every 4\u20136 hours (max. 700\u00a0mg in\r\nthe first 24 hours), adjusted according to response; max. 600\u00a0mg daily", "During the first 24 hours of treatment, an\r\nadditional dose of 50\u00a0mg may be taken 1 hour after the initial dose,\r\nif pain control not achieved", "Name[Palexia\u00ae SR (Gr\u00fcnenthal) ] Tablets, f/c, m/r, tapentadol (as\r\nhydrochloride) 50\u00a0mg (white), net price 28-tab pack = \u00a312.46, 56-tab\r\npack = \u00a324.91; 100\u00a0mg (yellow), 56-tab pack = \u00a349.82, 150\u00a0mg (pink),\r\n56-tab pack = \u00a374.73; 200\u00a0mg (orange), 56-tab pack = \u00a399.64; 250\u00a0mg\r\n(red), 56-tab pack = \u00a3124.55. \r\n Label:\r\n 2, 25Dose\u00a0severe chronic pain, initally 50\u00a0mg every 12 hours, adjusted\r\naccording to response; max. 500\u00a0mg dailyThe Scottish Medicines\r\nConsortium has\r\nadvised (May 2011) that tapentadol (Palexia\u00ae SR) is accepted for restricted use within NHS Scotland for\r\nthe management of severe chronic pain in adult patients, which can\r\nbe adequately managed only with opioid analgesics, when morphine sulphate\r\nmodified-release has failed to provide adequate pain control or is\r\nnot tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "ETODOLAC": { "indications": "Indications\u00a0pain and inflammation in rheumatoid arthritis and osteoarthritis", "name": "ETODOLAC", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "ETODOLAC" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also stomatitis, vasculitis, palpitation,\r\ndyspnoea, confusion, fatigue, paraesthesia, tremor, urinary frequency,\r\ndysuria, pyrexia, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128994.htm", "doses": [ "adult over 18 years, 300\u2013600\u00a0mg\r\ndaily in 1\u20132 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "MIDAZOLAM - DRUGS USED IN STATUS EPILEPTICUS": { "indications": "Indications\u00a0status epilepticus; febrile convulsions\r\n[unlicensed] (section 4.8.3); other indications (section 15.1.4.1)", "name": "MIDAZOLAM - DRUGS USED IN STATUS EPILEPTICUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus" ], "cautions": "Cautions\u00a0see Midazolam, section 15.1.4.1", "side-effects": "Side-effects\u00a0see Midazolam, section 15.1.4.1; also depression of consciousness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129773.htm", "doses": [ "By buccal administration, adult over 18 years [unlicensed], 10\u00a0mg repeated\r\nonce after 10 minutes if necessary; child up to 6 months [unlicensed], 300\u00a0micrograms/kg (max. 2.5\u00a0mg), 6\r\nmonths\u20131 year 2.5\u00a0mg, 1\u20135 years 5\u00a0mg, 5\u201310 years 7.5\u00a0mg, 10\u201318 years\r\n10\u00a0mg; these doses may be repeated once after 10 minutes if necessary", "Midazolam injection solution may be given\r\nby buccal administration [unlicensed indication]" ], "pregnancy": "Pregnancy\u00a0see Midazolam, section 15.1.4.1, and Pregnancy" }, "NORMAL IMMUNOGLOBULIN For intravenous use": { "indications": "Indications\u00a0 \n(From 14.5.1 Normal immunoglobulin: British National Formulary)\n14.5.1 Normal immunoglobulin", "name": "NORMAL IMMUNOGLOBULIN For intravenous use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.1 Normal immunoglobulin", "NORMAL IMMUNOGLOBULIN", "For intravenous use" ], "cautions": "Cautions\u00a0hypo- or agammaglobulinaemia with or\r\nwithout IgA deficiency; interference with live virus vaccines\u2014\n(From 14.5.1 Normal immunoglobulin: British National Formulary)\nNormal immunoglobulin may interfere with the immune response to live virus vaccines which should therefore only be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin (this does not apply to yellow fever vaccine since normal immunoglobulin does not contain antibody to this virus).Intravenous use\u00a0thrombophilic disorders, or risk factors for arterial or venous thromboembolic\r\nevents; obesity; ensure adequate hydration, renal insufficiency", "side-effects": "Side-effects\u00a0nausea, diarrhoea, chills, fever, headache, dizziness,\r\narthralgia, myalgia, muscle spasms, low back pain; rarely hypotension, anaphylaxis, cutaneous skin reactions, aseptic meningitis,\r\nacute renal failure; also reported with intravenous use, injection site reactions, abdominal pain and distension, blood\r\npressure fluctuations, haemolytic anaemia, thromboembolic events including\r\nmyocardial infarction, stroke, pulmonary embolism, and deep vein thrombosisNote\u00a0Adverse reactions are more likely to occur\r\nin patients receiving normal immunoglobulin for the first time, or\r\nfollowing a prolonged period between treatments, or when a different\r\nbrand of normal immunoglobulin is administered.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202705.htm", "doses": [ "See under preparations", "Antibody titres can vary widely between normal\r\nimmunoglobulin preparations from different manufacturers\u2014formulations\r\nare not interchangeable; patients should be maintained\r\non the same formulation throughout long-term treatment to avoid adverse\r\neffects", "Name[Intratect\u00ae (Biotest UK) ] Intravenous infusion,\r\nhuman normal immunoglobulin (protein 5%), net price 1\u00a0g (20\u00a0mL) =\r\n\u00a345.00, 2.5\u00a0g (50\u00a0mL) = \u00a3112.50, 5\u00a0g (100\u00a0mL) = \u00a3225.00, 10\u00a0g (200\u00a0mL)\r\n= \u00a3450.00, " ] }, "MEROPENEM": { "indications": "Indications\u00a0aerobic and anaerobic Gram-positive and Gram-negative infections\r\n(\n(From 5.1.2.2 Carbapenems: British National Formulary)\n5.1.2.2 Carbapenems); hospital-acquired septicaemia\r\n(Table 1, %s\n(From Blood: British National Formulary)\nBlood)", "name": "MEROPENEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.2 Carbapenems", "MEROPENEM" ], "cautions": "Cautions\u00a0sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction, see Hypersensitivity Reactions); interactions: Appendix 1 (meropenem)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea (antibiotic-associated\r\ncolitis reported), abdominal pain, disturbances in liver function\r\ntests, headache, thrombocythaemia, rash, pruritus; less commonly paraesthesia, eosinophilia, thrombocytopenia, leucopenia; rarely convulsions; also reported haemolytic anaemia, positive\r\nCoombs\u2019 test, Stevens-Johnson syndrome, toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/33502.htm", "doses": [ "By intravenous injection over 5 minutes or by intravenous infusion, 0.5\u20131\u00a0g every\r\n8 hours; child 3 months\u201312 years 10\u201320\u00a0mg/kg\r\nevery 8 hours, body-weight over 50\u00a0kg, adult dose", "Exacerbations of chronic lower respiratory-tract infection in\r\ncystic fibrosis, meningitis, 2\u00a0g every 8 hours; child 3 months\u201312 years 40\u00a0mg/kg every 8 hours, body-weight over 50\u00a0kg,\r\nadult dose" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014no information\r\navailable" }, "NICOTINIC ACID Modified release": { "indications": "Indications\u00a0adjunct to statin in dyslipidaemia or\r\nused alone if statin not tolerated (see also lipid-regulating drugs)", "name": "NICOTINIC ACID Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Nicotinic acid group", "NICOTINIC ACID", "Modified release" ], "cautions": "Cautions\u00a0unstable angina, acute myocardial infarction, diabetes\r\nmellitus, gout, history of peptic ulceration; interactions: Appendix 1 (nicotinic acid)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, abdominal pain, dyspepsia;\r\nflushing; pruritus, rash; less commonly tachycardia,\r\npalpitation, shortness of breath, peripheral oedema, headache, dizziness,\r\nincrease in uric acid, hypophosphataemia, prolonged prothrombin time,\r\nand reduced platelet count; rarely hypotension, syncope,\r\nrhinitis, insomnia, reduced glucose tolerance, myalgia, myopathy,\r\nmyasthenia; very rarely anorexia, rhabdomyolysis,\r\nvisual disturbance, and jaundice also reportedNote\u00a0Prostaglandin-mediated symptoms\r\n(such as flushing) can be reduced by low initial doses taken with\r\nmeals or, if patient taking aspirin, aspirin dose should be taken\r\n30 minutes before nicotinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128209.htm", "doses": [ "See under preparation", "Name[Niaspan\u00ae ] Tablets, m/r, nicotinic acid 500\u00a0mg;\r\n750\u00a0mg; 1\u00a0gAvailable from \u2018special-order\u2019 manufacturers\r\nor specialist importing companies" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid\r\nunless potential benefit outweighs risk" }, "EDROPHONIUM CHLORIDE - DRUGS FOR REVERSAL OF NEUROMUSCULAR BLOCKADE": { "indications": "Indications\u00a0see under Dose; myasthenia gravis (section 10.2.1)", "name": "EDROPHONIUM CHLORIDE - DRUGS FOR REVERSAL OF NEUROMUSCULAR BLOCKADE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.6 Drugs for reversal of neuromuscular blockade", "Anticholinesterases", "EDROPHONIUM CHLORIDE" ], "cautions": "Cautions\u00a0section 10.2.1; atropine should\r\nalso be given", "side-effects": "Side-effects\u00a0section 10.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6668.htm", "doses": [ "Brief reversal of non-depolarising neuromuscular blockade, by intravenous injection over several minutes, 500\u2013700\u00a0micrograms/kg\r\n(after or with atropine)", "Diagnosis of dual block, by intravenous injection, 10\u00a0mg" ], "pregnancy": "Pregnancy\u00a0section 10.2.1" }, "CARBAMAZEPINE Modified release": { "indications": "Indications\u00a0focal and secondary generalised tonic-clonic\r\nseizures, primary generalised tonic-clonic seizures; trigeminal neuralgia;\r\nprophylaxis of bipolar disorder unresponsive to lithium; adjunct in\r\nacute alcohol withdrawal [unlicensed] (section 4.10.1); diabetic neuropathy [unlicensed]\r\n(section 6.1.5)", "name": "CARBAMAZEPINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Carbamazepine and related antiepileptics", "CARBAMAZEPINE", "Modified release" ], "cautions": "Cautions\u00a0cardiac disease (see also\r\nContra-indications); skin reactions (see\r\nalso Blood, Hepatic, or Skin Disorders, below and under Side-effects); test for\r\nHLA-B*1502 allele in individuals of Han Chinese or Thai origin (avoid\r\nunless no alternative\u2014risk of Stevens-Johnson syndrome in presence\r\nof HLA-B*1502 allele); history of haematological reactions\r\nto other drugs; manufacturer recommends\r\nblood counts and hepatic and renal function tests (but evidence of\r\npractical value uncertain); may exacerbate\r\nabsence and myoclonic seizures; consider\r\nvitamin D supplementation in patients who are immobilised for long\r\nperiods or who have inadequate sun exposure or dietary intake of calcium; susceptibility to angle-closure glaucoma; cross-sensitivity reported with oxcarbazepine and with phenytoin\r\n(see also Antiepileptic Hypersensitivity\r\nSyndrome); avoid abrupt withdrawal; interactions: see Interactions in section 4.8.1 and Appendix 1 (carbamazepine)Blood, hepatic, or skin disorders\u00a0Patients or their carers should be told how to recognise signs of\r\nblood, liver, or skin disorders, and advised to seek immediate medical\r\nattention if symptoms such as fever, rash, mouth ulcers, bruising,\r\nor bleeding develop. Carbamazepine should be withdrawn\r\nimmediately in cases of aggravated liver dysfunction or acute liver\r\ndisease. Leucopenia that is severe, progressive, or associated\r\nwith clinical symptoms requires withdrawal (if necessary under cover\r\nof a suitable alternative).", "side-effects": "Side-effects\u00a0\n(From Carbamazepine and related antiepileptics: British National Formulary)\nCarbamazepine and related antiepileptics; also dry\r\nmouth, nausea, vomiting, oedema, ataxia, dizziness, drowsiness, fatigue,\r\nheadache, hyponatraemia (leading in rare cases to water intoxication),\r\nblood disorders (including eosinophilia, leucopenia, thrombocytopenia,\r\nhaemolytic anaemia, and aplastic anaemia), dermatitis, urticaria; less commonly diarrhoea, constipation, involuntary movements\r\n(including nystagmus), visual disturbances; rarely abdominal pain, anorexia, hepatitis, jaundice, vanishing bile duct\r\nsyndrome, cardiac conduction disorders, hypertension, hypotension,\r\nperipheral neuropathy, dysarthria, aggression, agitation, confusion,\r\ndepression, hallucinations, restlessness, paraesthesia, lymph node\r\nenlargement, muscle weakness, systemic lupus erythematosus, delayed\r\nmulti-organ hypersensitivity disorder (see also %s\n(From 4.8.1 Control of the epilepsies: British National Formulary)\nAntiepileptic hypersensitivity syndrome\u00a0Antiepileptic hypersensitivity syndrome is a rare but potentially fatal syndrome associated with some antiepileptic drugs (carbamazepine, lacosamide, lamotrigine, oxcarbazepine, phenobarbital, phenytoin, primidone, and rufinamide); rarely cross-sensitivity occurs between some of these antiepileptic drugs. Some other antiepileptics (eslicarbazepine, stiripentol, and zonisamide) have a theoretical risk. The symptoms usually start between 1 and 8 weeks of exposure; fever, rash, and lymphadenopathy are most commonly seen. Other systemic signs include liver dysfunction, haematological, renal, and pulmonary abnormalities, vasculitis, and multi-organ failure. If signs or symptoms of hypersensitivity syndrome occur, the drug should be withdrawn immediately, the patient must not be re-exposed, and expert advice should be sought.); very rarely pancreatitis, stomatitis, hepatic failure, taste\r\ndisturbance, exacerbation of coronary artery disease, AV block with\r\nsyncope, circulatory collapse, hypercholesterolaemia, thrombophlebitis,\r\nthromboembolism, pulmonary hypersensitivity (with dyspnoea, pneumonitis,\r\nor pneumonia), psychosis, neuroleptic malignant syndrome, osteomalacia\r\n(see Cautions), osteoporosis, galactorrhoea, gynaecomastia, impaired\r\nmale fertility, interstitial nephritis, renal failure, sexual dysfunction,\r\nurinary frequency, urinary retention, arthralgia, muscle pain, muscle\r\nspasm, conjunctivitis, angle-closure glaucoma, hearing disorders,\r\nacne, alterations in skin pigmentation, alopecia, hirsutism, sweating,\r\nphotosensitivity, purpura, Stevens-Johnson syndrome, toxic epidermal\r\nnecrolysis, aseptic meningitis; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128414.htm", "doses": [ "Different preparations may vary in bioavailability;\r\nto avoid reduced effect or excessive side-effects, it may be prudent\r\nto avoid changing the formulation", "Epilepsy, by mouth, initially 100\u2013200\u00a0mg\r\n1\u20132 times daily, increased slowly (see notes above) to usual\r\ndose of 0.8\u20131.2\u00a0g daily in divided doses; in some cases 1.6\u20132\u00a0g daily\r\nin divided doses may be needed; elderly reduce initial dose; child daily\r\nin divided doses, up to 1 year 100\u2013200\u00a0mg, 1\u20135 years 200\u2013400\u00a0mg, 5\u201310\r\nyears 400\u2013600\u00a0mg, 10\u201315 years 0.6\u20131\u00a0g", "By rectum, for short-term use (max. 7 days) when\r\noral therapy temporarily not possible; 125-mg suppository approx.\r\nequivalent to 100-mg tablet, but final adjustment should always depend\r\non clinical response (plasma concentration monitoring recommended);\r\nmax. 1\u00a0g daily in 4 divided doses", "Trigeminal neuralgia, by mouth, initially\r\n100\u00a0mg 1\u20132 times daily (but some patients may require higher initial\r\ndose), increased gradually according to response; usual dose 200\u00a0mg\r\n3\u20134 times daily, up to 1.6\u00a0g daily in some patients", "Prophylaxis of bipolar disorder unresponsive to\r\nlithium (see also section 4.2.3), by mouth, initially 400\u00a0mg\r\ndaily in divided doses increased until symptoms controlled; usual\r\nrange 400\u2013600\u00a0mg daily; max. 1.6\u00a0g daily", "Treatment of alcohol withdrawal [unlicensed indication], by mouth, initially 800\u00a0mg daily in divided doses, reduced\r\ngradually over 5 days to 200\u00a0mg daily; usual treatment duration 7\u201310\r\ndays", "Diabetic neuropathy [unlicensed indication], by mouth, initially 100\u00a0mg 1\u20132 times daily, increased gradually\r\naccording to response; usual dose 200\u00a0mg 3\u20134 times daily, up to 1.6\u00a0g\r\ndaily in some patients", "Plasma concentration for optimum response\r\n4\u201312\u00a0mg/litre (20\u201350\u00a0micromol/litre)", "Name[Carbagen\u00ae SR (Generics) ] Tablets, m/r, f/c, scored, carbamazepine\r\n200\u00a0mg, net price 56-tab pack = \u00a35.20; 400\u00a0mg, 56-tab pack = \u00a310.24. \r\n Label:\r\n 3, 8, 25, counselling, blood, hepatic or skin disorder symptoms (see above), driving (see notes above)Dose\u00a0epilepsy, adult and child over 5 years, as above;\r\ntrigeminal neuralgia, as above; bipolar disorder, as above; total\r\ndaily dose given in 1\u20132 divided doses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nmonitor plasma-carbamazepine concentration" }, "PANITUMUMAB": { "indications": "Indications\u00a0\n(From Panitumumab: British National Formulary)\nPanitumumab", "name": "PANITUMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Panitumumab", "PANITUMUMAB" ], "cautions": "Cautions\u00a0monitor for dermatological reactions\r\n(may require temporary or permanent discontinuation\u2014consult product\r\nliterature); pulmonary disease\u2014discontinue\r\nif pneumonitis or lung infiltrates occur; monitor for hypomagnesaemia and hypocalcaemia; history\r\nof, or risk factors for keratitis, ulcerative keratitis (including\r\ncontact lens use), or severe dry eye", "side-effects": "Side-effects\u00a0see section 8.1; also infusion-related reactions\r\nincluding hypertension, hypotension, tachycardia, and severe hypersensitivity\r\nreactions (possibly delayed onset); diarrhoea, abdominal pain, constipation,\r\ndry mouth and nose; dyspnoea, cough, embolism; fatigue, dizziness,\r\nheadache; hypomagnesaemia, hypocalcaemia, hypokalaemia, dehydration;\r\nocular disorders (including conjunctivitis, increased lacrimation,\r\ndry eyes, ocular hyperaemia and keratitis); skin reactions (including\r\nrash, erythema, pruritus, dry skin, acne, hand-foot syndrome and exfoliation),\r\nmucosal inflammation, hypertrichosis, and nail disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200874.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nmanufacturer advises effective contraception during and for 6 months\r\nafter treatment; see also Pregnancy and Reproductive\r\nFunction" }, "9.5.2.1 Phosphate supplements": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus" ], "name": "9.5.2.1 Phosphate supplements", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5061.htm", "doses": [ "vitamin D-resistant hypophosphataemic osteomalacia, 4\u20136\r\ntablets daily; child under 5 years\r\n2\u20133 tablets daily" ] }, "JAPANESE ENCEPHALITIS VACCINE ": { "indications": "Indications\u00a0immunisation against Japanese encephalitis", "name": "JAPANESE ENCEPHALITIS VACCINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Japanese encephalitis vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also less commonly migraine, vertigo, pharyngolaryngeal pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202695.htm", "doses": [ "See under preparation" ], "pregnancy": "Pregnancy\u00a0although manufacturer advises avoid because of limited\r\ninformation, miscarriage has been associated with Japanese encephalitis\r\nvirus infection acquired during the first 2 trimesters of pregnancy" }, "GANCICLOVIR - CYTOMEGALOVIRUS INFECTION": { "indications": "Indications\u00a0life-threatening or sight-threatening\r\ncytomegalovirus infections in immunocompromised patients only; prevention\r\nof cytomegalovirus disease during immunosuppressive therapy following\r\norgan transplantation; local treatment of CMV retinitis (section\r\n11.3.3)", "name": "GANCICLOVIR - CYTOMEGALOVIRUS INFECTION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.2 Cytomegalovirus infection" ], "cautions": "Cautions\u00a0close monitoring of full blood count (severe deterioration\r\nmay require correction and possibly treatment interruption); history of cytopenia; potential\r\ncarcinogen and teratogen; radiotherapy; ensure adequate hydration during intravenous\r\nadministration; vesicant\u2014infuse into vein\r\nwith adequate flow preferably using plastic cannula; children\r\n(possible risk of long-term carcinogenic or reproductive toxicity); interactions: Appendix 1 (ganciclovir)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, dyspepsia, abdominal\r\npain, constipation, flatulence, dysphagia, taste disturbance, hepatic\r\ndysfunction; dyspnoea, chest pain, cough; headache, insomnia, convulsions,\r\ndizziness, peripheral neuropathy, depression, anxiety, confusion,\r\nabnormal thinking, fatigue, weight loss, anorexia; infection, pyrexia,\r\nnight sweats; anaemia, leucopenia, thrombocytopenia, pancytopenia,\r\nrenal impairment; myalgia, arthralgia; macular oedema, retinal detachment,\r\nvitreous floaters, eye pain; ear pain; dermatitis, pruritus; injection-site\r\nreactions; less commonly mouth ulcers, pancreatitis,\r\narrhythmias, hypotension, anaphylactic reactions, psychosis, tremor,\r\nmale infertility, haematuria, disturbances in hearing and vision,\r\nand alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4005.htm", "doses": [ "By intravenous infusion, initially\r\n(induction) 5\u00a0mg/kg every 12 hours for 14\u201321 days for treatment or\r\nfor 7\u201314 days for prevention; maintenance (for patients at risk of\r\nrelapse of retinitis) 6\u00a0mg/kg daily on 5 days per week or 5\u00a0mg/kg daily until adequate recovery of immunity; if retinitis\r\nprogresses initial induction treatment may be repeated; child under 18 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic risk; ensure effective contraception\r\nduring treatment and barrier contraception for men during\r\nand for at least 90 days after treatment" }, "LEVOTHYROXINE SODIUM": { "indications": "Indications\u00a0hypothyroidism; see also notes above", "name": "LEVOTHYROXINE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.2 Thyroid and antithyroid drugs", "6.2.1 Thyroid hormones", "LEVOTHYROXINE SODIUM" ], "cautions": "Cautions\u00a0panhypopituitarism or predisposition to adrenal\r\ninsufficiency (initiate corticosteroid therapy before starting levothyroxine), elderly, cardiovascular disorders (including hypertension, myocardial insufficiency or myocardial infarction, see Initial Dosage below), long-standing hypothyroidism, diabetes\r\ninsipidus, diabetes mellitus (dose of antidiabetic\r\ndrugs including insulin may need to be increased); interactions: Appendix 1 (thyroid hormones)Initial dosage\u00a0Baseline ECG is valuable\r\nbecause changes induced by hypothyroidism can be confused with ischaemia. If metabolism increases too rapidly (causing diarrhoea,\r\nnervousness, rapid pulse, insomnia, tremors and sometimes anginal\r\npain where there is latent myocardial ischaemia), reduce dose or withhold\r\nfor 1\u20132 days and start again at a lower dose", "side-effects": "Side-effects\u00a0usually at excessive dosage (see Initial Dosage\r\nabove) include diarrhoea, vomiting, anginal pain, arrhythmias, palpitation,\r\ntachycardia, tremor, restlessness, excitability, insomnia; headache,\r\nflushing, sweating, fever, heat intolerance, weight-loss, muscle cramp,\r\nand muscular weakness; transient hair loss in children; hypersensitivity\r\nreactions including rash, pruritus and oedema also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4238.htm", "doses": [ "adult over 18 years, initially\r\n50\u2013100\u00a0micrograms once daily, preferably before breakfast, adjusted\r\nin steps of 25\u201350\u00a0micrograms every 3\u20134 weeks according to response\r\n(usual maintenance dose 100\u2013200\u00a0micrograms once daily); in cardiac\r\ndisease, severe hypothyroidism, and patients over 50 years, initially\r\n25\u00a0micrograms once daily, adjusted in steps of 25\u00a0micrograms every\r\n4 weeks according to response; usual maintenance dose 50\u2013200\u00a0micrograms\r\nonce daily; child under 18\r\nyears see BNF for Children (section 6.2.1)", "Congenital hypothyroidism and juvenile myxoedema, see BNF for Children (section\r\n6.2.1)" ], "pregnancy": "Pregnancy\u00a0monitor maternal serum-thyrotrophin concentration\u2014levothyroxine\r\nmay cross the placenta and excessive maternal concentration can be\r\ndetrimental to fetus" }, "VECURONIUM BROMIDE": { "indications": "Indications\u00a0neuromuscular blockade (intermediate duration) for surgery", "name": "VECURONIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs", "VECURONIUM BROMIDE" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6661.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "adult and child over 1 month, by intravenous injection, 80\u2013100\u00a0micrograms/kg; then maintenance, by intravenous injection either 20\u201330\u00a0micrograms/kg, adjusted according\r\nto response (max. 100\u00a0micrograms/kg in caesarian section), or by intravenous infusion, 0.8\u20131.4\u00a0micrograms/kg/minute,\r\nadjusted according to response; neonate see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "CARMUSTINE": { "indications": "Indications\u00a0%s\n(From 8.1.1 Alkylating drugs: British National Formulary)\nCarmustine given intravenously has similar activity to lomustine; it is given to patients with multiple myeloma, non-Hodgkin\u2019s lymphomas, and brain tumours. Cumulative renal damage and delayed pulmonary fibrosis may occur with intravenous use. Carmustine implants are licensed for intralesional use in adults for the treatment of recurrent glioblastoma multiforme as an adjunct to surgery. Carmustine implants are also licensed for high-grade malignant glioma as adjunctive treatment to surgery and radiotherapy.NICE guidance (carmustine implants and temozolomide for the treatment of newly diagnosed high-grade glioma)See Dacarbazine and Temozolomide", "name": "CARMUSTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs", "CARMUSTINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above;\r\navoid in acute porphyria (but see section 9.8.2); interactions: Appendix 1 (carmustine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; irritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128309.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and embryotoxic in animals); manufacturer advises effective contraception during treatment\r\nin men or women; see also Pregnancy and Reproductive\r\nFunction" }, "TRIFLUOPERAZINE": { "indications": "Indications\u00a0see under Dose; antiemetic (section 4.6)", "name": "TRIFLUOPERAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; extrapyramidal\r\nsymptoms more frequent, especially at doses exceeding 6\u00a0mg daily;\r\nanorexia; muscle weakness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3255.htm", "doses": [ "Schizophrenia and other psychoses, short-term adjunctive\r\nmanagement of psychomotor agitation, excitement, and violent or dangerously\r\nimpulsive behaviour, adult and child over 12 years, initially 5\u00a0mg twice daily,\r\nincreased by 5\u00a0mg daily after 1 week, then at intervals of 3 days,\r\naccording to the response; elderly reduce\r\ninitial dose by at least half", "Short-term adjunctive management of severe anxiety, adult and child over\r\n12 years, 2\u20134\u00a0mg daily in divided doses, increased if necessary to\r\n6\u00a0mg daily; child 3\u20135 years up to 1\u00a0mg\r\ndaily, 6\u201312 years up to 4\u00a0mg daily; elderly reduce initial dose by at least half" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "ALCLOMETASONE DIPROPIONATE": { "indications": "Indications\u00a0inflammatory skin disorders such as eczemas", "name": "ALCLOMETASONE DIPROPIONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "ALCLOMETASONE DIPROPIONATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5873.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "HYDROMORPHONE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0severe pain in cancer", "name": "HYDROMORPHONE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "HYDROMORPHONE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis; toxic psychosis", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, peripheral oedema, seizures, asthenia, dyskinesia,\r\nagitation, and tremor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/63579.htm", "doses": [ "See under preparations below", "Name[Palladone\u00ae SR (Napp) ] Capsules, m/r, hydromorphone\r\nhydrochloride 2\u00a0mg (yellow/clear), net price 56-cap pack\r\n= \u00a320.98; 4\u00a0mg (pale blue/clear), 56-cap pack = \u00a328.75; 8\u00a0mg (pink/clear),\r\n56-cap pack = \u00a356.08; 16\u00a0mg (brown/clear), 56-cap pack = \u00a3106.53;\r\n24\u00a0mg (dark blue/clear), 56-cap pack = \u00a3159.82. \r\n Label:\r\n 2, counselling, see belowDose\u00a04\u00a0mg every 12 hours, increased if necessary according\r\nto severity of pain; child under 12\r\nyears not recommendedCounselling\u00a0Swallow whole or open capsule and\r\nsprinkle contents on soft food" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "HYOSCINE HYDROBROMIDE - ANTIMUSCARINIC DRUGS": { "indications": "Indications\u00a0premedication, motion sickness, hypersalivation\r\nassociated with clozapine therapy (section 4.6); excessive respiratory secretions\r\n(see Prescribing in Palliative\r\nCare)", "name": "HYOSCINE HYDROBROMIDE - ANTIMUSCARINIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.3 Antimuscarinic drugs" ], "cautions": "Cautions\u00a0see notes in section 1.2 and notes above; also epilepsy", "side-effects": "Side-effects\u00a0see notes in section 1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6591.htm", "doses": [ "Premedication, by subcutaneous or intramuscular injection, 200\u2013600\u00a0micrograms 30\u201360\u00a0minutes\r\nbefore induction of anaesthesia; child 15\u00a0micrograms/kg" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk; injection\r\nmay depress neonatal respiration" }, "TRIAMCINOLONE ACETONIDE With antimicrobials": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "TRIAMCINOLONE ACETONIDE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "TRIAMCINOLONE ACETONIDE", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5933.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Aureocort\u00ae (Goldshield) ] Ointment, triamcinolone acetonide 0.1%, chlortetracycline hydrochloride 3%, in an anhydrous greasy basis containing wool fat\r\nand white soft paraffin, net price 15\u00a0g = \u00a33.51. \r\n Label:\r\n 28, counselling, application. Potency: potentExcipients include wool fatNote\u00a0Stains clothing" ] }, "MEBEVERINE HYDROCHLORIDE Compound preparations": { "indications": "Indications\u00a0adjunct in gastro-intestinal disorders characterised by smooth muscle\r\nspasm", "name": "MEBEVERINE HYDROCHLORIDE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Other antispasmodics", "MEBEVERINE HYDROCHLORIDE", "Compound preparations" ], "side-effects": "Side-effects\u00a0allergic reactions (including rash, urticaria,\r\nangioedema) reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2103.htm", "doses": [ "adult and child over 10 years 135\u2013150\u00a0mg 3 times daily preferably\r\n20 minutes before meals; child under\r\n10 years see BNF for Children", "Name[(1)Fybogel\u00ae Mebeverine (Reckitt Benckiser) ] Granules, buff, effervescent, ispaghula husk 3.5\u00a0g, mebeverine hydrochloride 135\u00a0mg/sachet, net price 10 sachets = \u00a32.50. \r\n Label:\r\n 13, 22, counselling, see belowExcipients include aspartame (section 9.4.1)Electrolytes: K+ 7\u00a0mmol/sachetDose\u00a0irritable bowel syndrome, adult and child over 12 years, 1 sachet\r\nin water, morning and evening 30 minutes before food; an additional\r\nsachet may also be taken before the midday meal if necessaryCounselling\u00a0Preparations that swell in contact\r\nwith liquid should always be carefully swallowed with water and should\r\nnot be taken immediately before going to bed" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturers advise caution" }, "ADEFOVIR DIPIVOXIL": { "indications": "Indications\u00a0chronic hepatitis B infection with either compensated\r\nliver disease with evidence of viral replication, and histologically\r\ndocumented active liver inflammation and fibrosis or decompensated liver disease ", "name": "ADEFOVIR DIPIVOXIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.3 Viral hepatitis", "5.3.3.1 Chronic hepatitis B" ], "cautions": "Cautions\u00a0monitor liver function tests every 3\r\nmonths, and viral markers for hepatitis B every 3\u20136 months during\r\ntreatment (continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation); monitor renal function before treatment then every 3 months, more frequently in renal impairment or in patients receiving nephrotoxic\r\ndrugs; elderly; discontinue\r\nif deterioration in liver function, hepatic steatosis, progressive\r\nhepatomegaly or unexplained lactic acidosis", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, abdominal pain, flatulence,\r\ndiarrhoea; asthenia, headache; renal failure; hypophosphataemia; rash\r\nand pruritus; also reported pancreatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127968.htm", "doses": [ "adult over 18 years, 10\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises use only if potential benefit outweighs risk; effective contraception\r\nrequired during treatment" }, "BACILLUS CALMETTE-GU\u00c9RIN": { "indications": "Indications\u00a0\n(From BCG bladder instillation: British National Formulary)\nBCG bladder instillation; BCG immunisation\r\n(%s\n(From 14.4 Vaccines and antisera: British National Formulary)\n14.4 Vaccines and antisera)", "name": "BACILLUS CALMETTE-GU\u00c9RIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "BCG bladder instillation" ], "cautions": "Cautions\u00a0screen for active tuberculosis (contra-indicated if tuberculosis confirmed); traumatic\r\ncatheterisation or urethral or bladder\r\ninjury (delay administration until mucosal damage healed)", "side-effects": "Side-effects\u00a0cystitis, dysuria, urinary frequency, haematuria,\r\nmalaise, fever, influenza-like syndrome; also systemic BCG infection\r\n(with fatalities)\u2014consult product literature; rarely hypersensitivity\r\nreactions (such as arthralgia and rash), orchitis, transient urethral\r\nobstruction, bladder contracture, renal abscess; ocular symptoms reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88706.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DULOXETINE - URINARY INCONTINENCE": { "indications": "Indications\u00a0moderate to severe stress urinary incontinence\r\nin women; major depressive disorder (section 4.3.4); diabetic neuropathy (section 4.3.4); generalised anxiety disorder (section 4.3.4)", "name": "DULOXETINE - URINARY INCONTINENCE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0elderly; cardiac disease; hypertension (avoid if uncontrolled); history of mania; history of seizures; raised intra-ocular\r\npressure, susceptibility to angle-closure\r\nglaucoma; bleeding disorders or concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (duloxetine)Withdrawal\u00a0Nausea, vomiting, headache, anxiety,\r\ndizziness, paraesthesia, sleep disturbances, and tremor are the most\r\ncommon features of abrupt withdrawal or marked reduction of the dose;\r\ndose should be reduced over at least 1\u20132 weeks", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, constipation, diarrhoea,\r\nabdominal pain, weight changes, decreased appetite, flatulence, dry\r\nmouth; palpitation, hot flush; insomnia, abnormal dreams, paraesthesia,\r\ndrowsiness, anxiety, headache, dizziness, fatigue, weakness, tremor,\r\nnervousness, anorexia; sexual dysfunction; visual disturbances; sweating,\r\npruritus; less commonly gastritis, halitosis, hepatitis,\r\nbruxism, tachycardia, hypertension, postural hypotension, syncope,\r\nraised cholesterol, vertigo, taste disturbance, cold extremities,\r\nimpaired temperature regulation, impaired attention, movement disorders,\r\nmuscle twitching, musculoskeletal pain, thirst, stomatitis, hypothyroidism,\r\nurinary disorders, and photosensitivity; rarely mania; very rarely angle-closure glaucoma; also reported supraventricular arrhythmia, chest pain, hallucinations, suicidal\r\nbehaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy),\r\nseizures, hypersensitivity reactions including urticaria, angioedema,\r\nrash (including Stevens-Johnson syndrome) and anaphylaxis, hyponatraemia\r\n(see Hyponatraemia and Antidepressant\r\nTherapy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129097.htm", "doses": [ "adult over 18 years, 40\u00a0mg\r\ntwice daily, assess for benefit and tolerability after 2\u20134 weeks", "Initial dose of 20\u00a0mg twice daily for 2 weeks\r\ncan minimise side-effects" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014avoid\r\nin patients with stress urinary incontinence; risk of neonatal withdrawal\r\nsymptoms if used near term" }, "ACICLOVIR - HERPES SIMPLEX AND VARICELLA\u2013ZOSTER INFECTION": { "indications": "Indications\u00a0herpes simplex and varicella\u2013zoster (see also under Dose)", "name": "ACICLOVIR - HERPES SIMPLEX AND VARICELLA\u2013ZOSTER INFECTION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.1 Herpes simplex and varicella\u2013zoster infection" ], "cautions": "Cautions\u00a0maintain adequate hydration (especially with infusion\r\nor high doses, or during renal impairment); elderly (risk of neurological reactions); interactions: Appendix 1 (aciclovir)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, headache,\r\nfatigue, rash, urticaria, pruritus, photosensitivity; very\r\nrarely hepatitis, jaundice, dyspnoea, neurological reactions\r\n(including dizziness, confusion, hallucinations, convulsions, ataxia,\r\ndysarthria, and drowsiness), acute renal failure, anaemia, thrombocytopenia\r\nand leucopenia; on intravenous infusion, severe local\r\ninflammation (sometimes leading to ulceration), and very rarely agitation, tremors, psychosis and fever", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3994.htm", "doses": [ "By mouth, non-genital herpes simplex,\r\ntreatment, 200\u00a0mg (400\u00a0mg in the immunocompromised or if absorption\r\nimpaired) 5 times daily, usually for 5 days (longer if new lesions\r\nappear during treatment or if healing incomplete); child 1 month\u20132 years, half adult dose, over 2 years,\r\nadult dose", "Genital herpes simplex, treatment of first episode, 200\u00a0mg 5 times daily or 400\u00a0mg 3 times daily usually\r\nfor 5 days, longer if new lesions appear during treatment or if healing\r\nis incomplete (400\u00a0mg 5 times daily for 7\u201310 days in immunocompromised\r\nor HIV-positive patients); treatment of recurrent infection, 800\u00a0mg 3 times daily for 2 days or 200\u00a0mg 5 times\r\ndaily for 5 days or 400\u00a0mg 3 times daily for 3\u20135\r\ndays (400\u00a0mg 3 times daily for 5\u201310 days in immunocompromised or HIV-positive\r\npatients)", "Herpes simplex, suppression, 400\u00a0mg twice daily or 200\u00a0mg 4 times daily; increased to 400\u00a0mg 3 times daily if recurrences\r\noccur on standard suppressive therapy or for suppression of genital\r\nherpes during late pregnancy (from 36 weeks gestation); therapy interrupted\r\nevery 6\u201312 months to reassess recurrence frequency\u2014consider restarting\r\nafter two or more recurrences", "Herpes simplex, prophylaxis in the immunocompromised, 200\u2013400\u00a0mg\r\n4 times daily; child 1 month\u20132 years,\r\nhalf adult dose, over 2 years, adult dose", "Varicella and herpes zoster, treatment, 800\u00a0mg 5 times daily\r\nfor 7 days (for herpes zoster in immunocompromised continue for 2\r\ndays after crusting of lesions); child, varicella, 1 month\u20132 years 200\u00a0mg 4 times daily for 5 days; 2\u20136\r\nyears 400\u00a0mg 4 times daily for 5 days; 6\u201312 years 800\u00a0mg 4 times daily\r\nfor 5 days", "Attenuation of chickenpox (if varicella\u2013zoster immunoglobulin\r\nnot indicated) [unlicensed use], adult and child 40\u00a0mg/kg daily in 4 divided\r\ndoses for 7 days starting 1 week after exposure", "By intravenous infusion, treatment\r\nof herpes simplex in the immunocompromised, severe initial genital\r\nherpes, and varicella\u2013zoster, 5\u00a0mg/kg every 8 hours usually for 5\r\ndays, doubled to 10\u00a0mg/kg every 8 hours in varicella\u2013zoster in the\r\nimmunocompromised and in simplex encephalitis (usually given for at\r\nleast 10 days in encephalitis, possibly for 14\u201321 days); prophylaxis\r\nof herpes simplex in the immunocompromised, 5\u00a0mg/kg every 8 hours", "To avoid excessive dosage in obese patients,\r\nparenteral dose should be calculated on the basis of ideal weight\r\nfor height", "neonate and infant up to 3 months, herpes simplex, 20\u00a0mg/kg every 8 hours for 14 days\r\n(21 days if CNS involvement); varicella\u2013zoster [unlicensed use] 10\u201320\u00a0mg/kg\r\nevery 8 hours for at least 7 days; child 3 months\u201312 years, herpes simplex or varicella\u2013zoster, 250\u00a0mg/m2 every 8 hours usually for 5 days, doubled to 500\u00a0mg/m2 every 8 hours for varicella\u2013zoster in the immunocompromised\r\nand in simplex encephalitis (usually given for at least 10 days in\r\nencephalitis, possibly for 14\u201321 days)", "By topical application, see section 13.10.3 (skin) and section 11.3.3 (eye)", "Aciclovir doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful\u2014manufacturers advise use\r\nonly when potential benefit outweighs risk" }, "PHOSPHATES (ORAL)": { "indications": "Indications\u00a0see preparations ", "name": "PHOSPHATES (ORAL)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.5 Bowel cleansing preparations" ], "cautions": "Cautions\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also cardiac disease (avoid\r\nin congestive cardiac failure)", "side-effects": "Side-effects\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also chest\r\npain, arrhythmias, asthenia, and renal failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202768.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0caution" }, "HEPATITIS B IMMUNOGLOBULIN": { "indications": "Indications\u00a0prophylaxis against hepatitis B infection", "name": "HEPATITIS B IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Hepatitis B", "HEPATITIS B IMMUNOGLOBULIN" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines see under Normal Immunoglobulin.", "side-effects": "Side-effects\u00a0injection site reactions; less frequently, buccal\r\nulceration, glossitis, abdominal pain, chest pain, dyspnoea, anaphylaxis,\r\ntremor, dizziness, headache, arthralgia; for side-effects associated\r\nwith intravenous immunoglobulin, see section 14.5.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213807.htm", "doses": [ "See under preparations and see also notes above" ] }, "PREDNISOLONE Rectal preparations": { "indications": "Indications\u00a0ulcerative colitis, and Crohn\u2019s disease;\r\nother indications, see section 6.3.2, see also preparations", "name": "PREDNISOLONE Rectal preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids", "PREDNISOLONE", "Rectal preparations" ], "cautions": "Cautions\u00a0section 6.3.2; systemic absorption may occur with rectal preparations; prolonged use should be avoided", "side-effects": "Side-effects\u00a0section 6.3.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215614.htm", "doses": [ "By mouth, initially 20\u201340\u00a0mg daily (up\r\nto 60\u00a0mg daily in some cases), preferably taken in the morning after\r\nbreakfast; continued until remission occurs, followed by reducing\r\ndoses", "By rectum, see preparations", "Name[Prednisolone (Non-proprietary) ] Rectal foam in aerosol pack, prednisolone 20\u00a0mg (as metasulphobenzoate sodium)/metered\r\napplication, net price 14-application canister with disposable applicators\r\n= \u00a348.00 Excipients include cetostearyl alcohol, disodium edetate, polysorbate\r\n20, sorbic acidDose\u00a0proctitis and distal ulcerative colitis, 1 metered application\r\n(20\u00a0mg prednisolone) inserted into the rectum once\r\nor twice daily for 2 weeks, continued for further 2 weeks if good\r\nresponse; child not recommended" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "MEPROBAMATE ": { "indications": "Indications\u00a0short-term use in anxiety, but see notes above", "name": "MEPROBAMATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Meprobamate", "MEPROBAMATE" ], "cautions": "Cautions\u00a0respiratory disease, muscle weakness, epilepsy (may induce seizures), history of drug or alcohol abuse, marked personality disorder; elderly and debilitated; avoid prolonged\r\nuse, abrupt withdrawal (may precipitate\r\nconvulsions); interactions: Appendix\r\n1 (anxiolytics and hypnotics) Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced ", "side-effects": "Side-effects\u00a0see under Diazepam, but incidence greater and\r\ndrowsiness most common side-effect; also gastro-intestinal disturbances,\r\nhypotension, paraesthesia, weakness, CNS effects including headache,\r\nparadoxical excitement, disturbances of vision; rarely agranulocytosis\r\nand rashes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3198.htm", "doses": [ "400\u00a0mg 3\u20134 times daily; elderly half adult dose or less; child not\r\nrecommended", "Meprobamate treatment should not be initiated in new patients, see notes above" ], "pregnancy": "Pregnancy\u00a0avoid if possible" }, "CYPROTERONE ACETATE - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS": { "side-effects": "Side-effects\u00a0see section 6.4.2Hepatotoxicity\u00a0Direct hepatic toxicity including\r\njaundice, hepatitis and hepatic failure have been reported (fatalities\r\nreported at dosages of 100\u00a0mg and above, usually in men treated for\r\nadvanced prostate cancer). Liver function tests should\r\nbe performed before and regularly during treatment and whenever symptoms\r\nsuggestive of hepatotoxicity occur\u2014if confirmed cyproterone\r\nshould normally be withdrawn unless the hepatotoxicity can be explained\r\nby another cause such as metastatic disease (in which case cyproterone\r\nshould be continued only if the perceived benefit exceeds the risk)", "indications": "Indications\u00a0prostate cancer, see under\r\nDose and also notes above; other indications, see section 6.4.2", "name": "CYPROTERONE ACETATE - GONADORELIN ANALOGUES AND GONADOTROPHIN-RELEASING HORMONE ANTAGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4826.htm", "doses": [ "Prevention of flare with initial gonadorelin analogue therapy, 200\u00a0mg daily in 2\u20133 divided doses for 5\u20137 days\r\nbefore initiation of gonadorelin analogue, followed by 200\u00a0mg daily\r\nin 2\u20133 divided doses for 3\u20134 weeks after initiation of gonadorelin\r\nanalogue; max. 300\u00a0mg daily", "Long-term palliative therapy where gonadorelin analogues or orchidectomy contra-indicated, not tolerated, or where\r\noral therapy preferred, 200\u2013300\u00a0mg daily in 2\u20133 divided doses", "Hot flushes with gonadorelin analogue therapy\r\nor after orchidectomy, initially 50\u00a0mg daily, adjusted according to\r\nresponse to 50\u2013150\u00a0mg daily in 1\u20133 divided doses" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Anti-androgens" ], "cautions": "Cautions\u00a0in prostate cancer, blood counts initially and throughout\r\ntreatment; monitor hepatic function (liver function tests should be performed\r\nbefore treatment, see also under Side-effects below); monitor adrenocortical function regularly; risk of recurrence of thromboembolic disease; diabetes mellitus, sickle-cell anaemia, severe depression (in other indications\r\nsome of these are contra-indicated, see section 6.4.2) Driving\u00a0Fatigue and lassitude may\r\nimpair performance of skilled tasks (e.g. driving)" }, "FLUTICASONE PROPIONATE - RESPIRATORY SYSTEM": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma)", "name": "FLUTICASONE PROPIONATE - RESPIRATORY SYSTEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.; also very rarely dyspepsia and arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3004.htm", "doses": [ "See preparations below" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "BUSERELIN": { "indications": "Indications\u00a0advanced prostate cancer; other indications\r\n(section 6.7.2)", "name": "BUSERELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0diabetes, hypertension, depression; see\r\nalso notes above", "side-effects": "Side-effects\u00a0\n(From Gonadorelin analogues: British National Formulary)\nSide-effects\u00a0The gonadorelin analogues cause side-effects similar to the menopause in women and orchidectomy in men and include hot flushes and sweating, sexual dysfunction, vaginal dryness or bleeding, and gynaecomastia or changes in breast size. Signs and symptoms of prostate or breast cancer may worsen initially (managed in prostate cancer with anti-androgens, see above). Other side-effects include hypersensitivity reactions (rashes, pruritus, asthma, and rarely anaphylaxis), injection site reactions (see Cautions), headache (rarely migraine), visual disturbances, dizziness, arthralgia and possibly myalgia, hair loss, peripheral oedema, gastro-intestinal disturbances, weight changes, sleep disorders, and mood changes.; worsening\r\nhypertension, palpitation, glucose intolerance,\r\naltered blood lipids, thrombocytopenia, leucopenia, nervousness, fatigue,\r\nmemory and concentration disturbances, anxiety, increased thirst,\r\nhearing disorders, musculoskeletal pain; nasal irritation, nose bleeds\r\nand altered sense of taste and smell (spray formulation only)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4824.htm", "doses": [ "By subcutaneous injection, 500\u00a0micrograms\r\nevery 8 hours for 7 days, then intranasally, 1 spray\r\ninto each nostril 6 times daily (see also notes above)", "Avoid use of nasal decongestants\r\nbefore and for at least 30 minutes after treatment." ] }, "MORPHINE SALTS": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3501.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CAPTOPRIL": { "indications": "Indications\u00a0mild to moderate essential hypertension alone\r\nor with thiazide therapy and severe hypertension resistant to other\r\ntreatment; congestive heart failure with left ventricular dysfunction\r\n(adjunct\u2014see section 2.5.5); following\r\nmyocardial infarction, see dose; diabetic nephropathy (microalbuminuria\r\ngreater than 30\u00a0mg/day) in type 1 diabetes", "name": "CAPTOPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; tachycardia, serum sickness,\r\nweight loss, stomatitis, maculopapular rash, photosensitivity, flushing\r\nand acidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2579.htm", "doses": [ "Hypertension, used alone, initially 12.5\u00a0mg twice daily;\r\nif used in addition to diuretic (see notes above),\r\nor in elderly, initially 6.25\u00a0mg twice daily (first dose at bedtime);\r\nusual maintenance dose 25\u00a0mg twice daily; max. 50\u00a0mg twice daily (rarely\r\n3 times daily in severe hypertension)", "Heart failure (adjunct), initially 6.25\u201312.5\u00a0mg 2\u20133 times daily\r\nunder close medical supervision (see notes above),\r\nincreased gradually at intervals of at least 2 weeks up to max. 150\u00a0mg\r\ndaily in divided doses if tolerated", "Prophylaxis after infarction in clinically stable patients with\r\nasymptomatic or symptomatic left ventricular dysfunction (radionuclide\r\nventriculography or echocardiography undertaken before initiation),\r\ninitially 6.25\u00a0mg, starting as early as 3 days after infarction, then\r\nincreased over several weeks to 150\u00a0mg daily (if tolerated) in divided\r\ndoses", "Diabetic nephropathy, 75\u2013100\u00a0mg daily in divided doses; if further\r\nblood pressure reduction required, other antihypertensives may be\r\nused in conjunction with captopril; in severe renal\r\nimpairment, initially 12.5\u00a0mg twice daily (if concomitant diuretic\r\ntherapy required, loop diuretic rather than thiazide should be chosen)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "LITHIUM CARBONATE": { "indications": "Indications\u00a0treatment and prophylaxis of mania, bipolar disorder, and recurrent\r\ndepression (see also notes above); aggressive or self-mutilating behaviour", "name": "LITHIUM CARBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.3 Antimanic drugs", "Lithium", "LITHIUM CARBONATE" ], "cautions": "Cautions\u00a0\n(From Lithium: British National Formulary)\nLithium; also measure serum-lithium\r\nconcentration regularly (every 3 months on stabilised regimens), measure renal function and thyroid function every\r\n6 months on stabilised regimens and advise\r\npatient to seek attention if symptoms of hypothyroidism develop (women\r\nat greater risk) e.g. lethargy, feeling cold; maintain adequate sodium and fluid intake; test renal function before initiating and if evidence of toxicity; cardiac disease (monitor cardiac function\r\nbefore initiating); QT-interval prolongation; conditions with sodium imbalance such\r\nas Addison\u2019s disease; reduce\r\ndose or discontinue in diarrhoea, vomiting, and intercurrent infection (especially if sweating profusely);\r\nconcurrent ECT treatment (seizure threshold may be lowered); psoriasis (risk of exacerbation); elderly (reduce dose); diuretic treatment; myasthenia gravis; surgery (%s\n(From 15.1 General anaesthesia: British National Formulary)\n15.1 General anaesthesia); avoid abrupt withdrawal (see notes above); interactions: Appendix 1 (lithium)Counselling\u00a0Patients should maintain\r\nadequate fluid intake and avoid dietary\r\nchanges which reduce or increase sodium intake; lithium\r\ntreatment packs are available (%s\n(From Lithium: British National Formulary)\nLithium treatment packsA lithium treatment pack may be given to patients on initiation of treatment with lithium. The pack consists of a patient information booklet, lithium alert card, and a record book for tracking serum-lithium concentration.Packs may be purchased from 3M. Tel: 0845 610 1112 Email: nhsforms@mmm.com)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, fine tremor, renal\r\nimpairment (particularly impaired urinary concentration and polyuria),\r\npolydipsia, leucocytosis; also weight gain and oedema (may respond\r\nto dose reduction); hyperparathyroidism, hyperthyroidism, hyperglycaemia,\r\nhypermagnesaemia, and hypercalcaemia reported; signs of intoxication\r\nare blurred vision, increasing gastro-intestinal disturbances (anorexia,\r\nvomiting, diarrhoea), muscle weakness, arthralgia, myalgia, increased\r\nCNS disturbances (mild drowsiness and sluggishness increasing to giddiness\r\nwith ataxia, coarse tremor, lack of coordination, dysarthria), and\r\nrequire withdrawal of treatment; with severe overdosage (serum-lithium concentration above 2\u00a0mmol/litre) hyperreflexia and\r\nhyperextension of limbs, convulsions, toxic psychoses, syncope, renal\r\nfailure, circulatory failure, coma, and occasionally, death; goitre,\r\nraised antidiuretic hormone concentration, hypothyroidism, hypokalaemia,\r\nECG changes, and kidney changes may also occur; see also Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3284.htm", "doses": [ "See under preparations below, adjusted to achieve a serum-lithium\r\nconcentration of 0.4\u20131\u00a0mmol/litre 12 hours after a dose on days 4\u20137\r\nof treatment, then every week until dosage has remained constant for\r\n4 weeks and every 3 months thereafter; doses are initially divided\r\nthroughout the day, but once daily administration is preferred when\r\nserum-lithium concentration stabilised", "Preparations vary\r\nwidely in bioavailability; changing the preparation requires\r\nthe same precautions as initiation of treatment", "(see Dose above for advice on bioavailability and serum\r\nmonitoring):adult and child over 12 years, treatment, initially 450\u2013675\u00a0mg\r\ntwice daily (elderly initially 225\u00a0mg twice daily); prophylaxis, initially\r\n450\u00a0mg twice daily (elderly 225\u00a0mg twice daily)" ], "pregnancy": "Pregnancy\u00a0avoid if possible in the first trimester (risk of\r\nteratogenicity, including cardiac abnormalities); dose requirements\r\nincreased during the second and third trimesters (but on delivery\r\nreturn abruptly to normal); close monitoring of serum-lithium concentration\r\nadvised (risk of toxicity in neonate)" }, "ISRADIPINE": { "indications": "Indications\u00a0hypertension", "name": "ISRADIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers" ], "cautions": "Cautions\u00a0sick sinus syndrome (if pacemaker not\r\nfitted); severe aortic stentosis; poor\r\ncardiac reserve; chronic heart failure; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0abdominal discomfort; tachycardia, palpitation,\r\nflushing, peripheral oedema; dyspnoea; headache, fatigue, dizziness;\r\npolyuria; rash; less commonly hypotension, weight\r\ngain; very rarely vomiting, nausea, gum hyperplasia,\r\nanorexia, drowsiness, arrhythmia, bradycardia, heart failure, cough,\r\ndepression, paraesthesia, anxiety, erectile dysfunction, blood disorders\r\n(such as thrombocytopenia, leucopenia, anaemia), arthralgia, visual\r\ndisturbance, hypersensitivity reactions; hepatitis and gynaecomastia\r\nalso reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2685.htm", "doses": [ "2.5\u00a0mg twice daily, increased if necessary after 3\u20134 weeks\r\nto 5\u00a0mg twice daily (exceptionally up to 10\u00a0mg twice daily); elderly 1.25\u00a0mg twice daily, increased if necessary\r\nafter 3\u20134 weeks according to response; maintenance dose of 2.5\u00a0mg\r\nor 5\u00a0mg once daily may be sufficient" ], "pregnancy": "Pregnancy\u00a0may inhibit labour; risk to fetus should be balanced\r\nagainst risk of uncontrolled maternal hypertension" }, "CHORIONIC GONADOTROPHIN": { "indications": "Indications\u00a0see notes above", "name": "CHORIONIC GONADOTROPHIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins" ], "cautions": "Cautions\u00a0cardiac impairment, asthma, epilepsy, migraine; prepubertal boys (risk of premature\r\nepiphyseal closure or precocious puberty)", "side-effects": "Side-effects\u00a0oedema (particularly in males\u2014reduce dose), headache,\r\ntiredness, mood changes, gynaecomastia, local reactions; may aggravate\r\novarian hyperstimulation, multiple pregnancy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4401.htm", "doses": [ "By subcutaneous or intramuscular injection, according to patient\u2019s response" ] }, "PROMETHAZINE HYDROCHLORIDE - SEDATING ANTIHISTAMINES": { "indications": "Indications\u00a0symptomatic relief of allergy such\r\nas hay fever and urticaria; emergency treatment of anaphylactic reactions;\r\nsedation (section 4.1.1); nausea\r\nand vomiting (section 4.6)", "name": "PROMETHAZINE HYDROCHLORIDE - SEDATING ANTIHISTAMINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).; avoid extravasation with intravenous injection; severe coronary artery disease", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; also\r\nrestlessness; intramuscular injection may be painful", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3106.htm", "doses": [ "By mouth, 10\u201320\u00a0mg 2\u20133 times daily; child 2\u20135 years 5\u201315\u00a0mg daily in 1\u20132 divided doses,\r\n5\u201310 years 10\u201325\u00a0mg daily in 1\u20132 divided doses", "By deep intramuscular injection,\r\n25\u201350\u00a0mg; max. 100\u00a0mg; child 5\u201310 years\r\n6.25\u201312.5\u00a0mg", "By slow intravenous injection in emergencies,\r\n25\u201350\u00a0mg as a solution containing 2.5\u00a0mg/mL in water for injections;\r\nmax. 100\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "TETRACYCLINE": { "indications": "Indications\u00a0see notes above; acne vulgaris, rosacea\r\n(%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "TETRACYCLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nacute renal failure, skin discoloration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3805.htm", "doses": [ "250\u00a0mg every 6 hours, increased in severe infections to\r\n500\u00a0mg every 6\u20138 hours", "Acne, see section 13.6.2", "Non-gonococcal urethritis, 500\u00a0mg every 6 hours for 7\u201314 days\r\n(21 days if failure or relapse after first course)", "Tablets should be swallowed whole\r\nwith plenty of fluid while sitting or standing" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "HYDROXOCOBALAMIN": { "indications": "Indications\u00a0see under dose below; cyanide poisoning (see Emergency Treatment of Poisoning)", "name": "HYDROXOCOBALAMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.2 Drugs used in megaloblastic anaemias" ], "cautions": "Cautions\u00a0should not be given before diagnosis\r\nfully established but see also notes above; interactions: Appendix 1 (hydroxocobalamin)", "side-effects": "Side-effects\u00a0nausea, headache, dizziness; fever, hypersensitivity\r\nreactions (including rash and pruritus); injection-site reactions;\r\nhypokalaemia and thrombocytosis during initial treatment; chromaturia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4902.htm", "doses": [ "By intramuscular injection, pernicious\r\nanaemia and other macrocytic anaemias without neurological involvement,\r\ninitially 1\u00a0mg 3 times a week for 2 weeks then 1\u00a0mg every 3 months", "Pernicious anaemia and other macrocytic anaemias with neurological\r\ninvolvement, initially 1\u00a0mg on alternate days until no further improvement,\r\nthen 1\u00a0mg every 2 months", "Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency, 1\u00a0mg every 2\u20133 months", "Tobacco amblyopia and Leber\u2019s optic atrophy, initially 1\u00a0mg\r\ndaily for 2 weeks, then 1\u00a0mg twice weekly until no further improvement,\r\nthereafter 1\u00a0mg every 1\u20133 months", "child see BNF for Children" ] }, "DEMECLOCYCLINE HYDROCHLORIDE": { "indications": "Indications\u00a0see notes above; also inappropriate secretion of antidiuretic hormone, %s\n(From Antidiuretic hormone antagonists: British National Formulary)\nAntidiuretic hormone antagonists", "name": "DEMECLOCYCLINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "DEMECLOCYCLINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines)., but photosensitivity\r\nmore common (avoid exposure to sunlight or sun lamps)", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\nreversible nephrogenic diabetes insipidus, acute renal failure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215537.htm", "doses": [ "150\u00a0mg every 6 hours or 300\u00a0mg every\r\n12 hours" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "RANITIDINE": { "indications": "Indications\u00a0see under Dose, other conditions where reduction of gastric acidity\r\nis beneficial (see notes above and %s\n(From 1.9.4 Pancreatin: British National Formulary)\n1.9.4 Pancreatin)", "name": "RANITIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.1 H2-receptor antagonists", "RANITIDINE" ], "cautions": "Cautions\u00a0\n(From 1.3.1 H2-receptor antagonists: British National Formulary)\nCautions\u00a0H2-receptor antagonists might mask symptoms of gastric cancer; particular care is required in patients presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment.; interactions: Appendix 1 (histamine H2-antagonists)\r\nand notes above", "side-effects": "Side-effects\u00a0see notes above; less commonly blurred vision; also reported pancreatitis, involuntary movement\r\ndisorders, interstitial nephritis, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60275.htm", "doses": [ "By mouth, benign gastric and duodenal\r\nulceration, chronic episodic dyspepsia, adult and child over 12 years, 150\u00a0mg twice\r\ndaily or 300\u00a0mg at night for 4\u20138 weeks in benign\r\ngastric and duodenal ulceration, up to 6 weeks in chronic episodic\r\ndyspepsia, and up to 8 weeks in NSAID-associated ulceration (in duodenal\r\nulcer 300\u00a0mg can be given twice daily for 4 weeks to achieve a higher\r\nhealing rate); child 3\u201312 years, (benign\r\ngastric and duodenal ulceration) 2\u20134\u00a0mg/kg (max. 150\u00a0mg) twice daily\r\nfor 4\u20138 weeks", "Prophylaxis of NSAID-associated gastric or duodenal ulcer [unlicensed\r\ndose], adult and child over 12 years, 300\u00a0mg twice daily", "Gastro-oesophageal reflux disease, adult and child over 12 years, 150\u00a0mg twice\r\ndaily or 300\u00a0mg at night for up to 8 weeks or if\r\nnecessary 12 weeks (moderate to severe, 600\u00a0mg daily in 2\u20134 divided\r\ndoses for up to 12 weeks); long-term treatment of healed gastro-oesophageal\r\nreflux disease, 150\u00a0mg twice daily; child 3\u201312 years, 2.5\u20135\u00a0mg/kg (max. 300\u00a0mg) twice daily", "Gastric acid reduction (prophylaxis of acid aspiration) in obstetrics, adult and child over\r\n12 years, by mouth, 150\u00a0mg at onset of labour, then\r\nevery 6 hours; surgical procedures, by intramuscular or slow intravenous injection, 50\u00a0mg\r\n45\u201360 minutes before induction of anaesthesia (intravenous injection\r\ndiluted to 20\u00a0mL and given over at least 2 minutes), or by\r\nmouth, 150\u00a0mg 2 hours before induction of anaesthesia and\r\nalso when possible on the preceding evening", "By intramuscular injection, 50\u00a0mg\r\nevery 6\u20138 hours", "By slow intravenous injection, adult and child over\r\n12 years, 50\u00a0mg diluted to 20\u00a0mL and given over at least 2 minutes;\r\nmay be repeated every 6\u20138 hours", "Prophylaxis of stress ulceration [unlicensed dose], adult and child over\r\n12 years, by slow intravenous injection over at least\r\n2 minutes, 50\u00a0mg diluted to 20\u00a0mL every 8 hours (may be changed to\r\n150\u00a0mg twice daily by mouth when oral feeding commences)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential, but\r\nnot known to be harmful" }, "LOCAL CORTICOSTEROID INJECTIONS Methylprednisolone acetate": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Methylprednisolone acetate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Methylprednisolone acetate" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5280.htm", "doses": [ "See under preparations", "Name[Depo-Medrone\u00ae with Lidocaine (Pharmacia) ] Injection (aqueous suspension), methylprednisolone acetate 40\u00a0mg, lidocaine hydrochloride\r\n10\u00a0mg/mL, net price 1-mL vial = \u00a33.28; 2-mL vial = \u00a35.88Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 4\u201380\u00a0mg, according to size; where appropriate\r\nmay be repeated at intervals of 7\u201335 days" ] }, "BUDESONIDE - DRUGS USED IN NASAL ALLERGY": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and treatment of allergic\r\nand vasomotor rhinitis; nasal polyps", "name": "BUDESONIDE - DRUGS USED IN NASAL ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5647.htm", "doses": [ "See preparations" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.; interactions: Appendix 1 (corticosteroids)" }, "ABACAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "ABACAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test for HLA-B*5701 allele before treatment or if restarting treatment\r\nand HLA-B*5701 status not known\u2014increased risk of hypersensitivity\r\nreaction in presence of HLA-B*5701 allele; HIV load greater than 100\u00a0000 copies/mL; patients at high risk of cardiovascular disease (especially\r\nif 10-year cardiovascular risk greater than 20%); interactions: Appendix 1 (abacavir)Hypersensitivity reactions\u00a0Life-threatening hypersensitivity\r\nreactions reported\u2014characterised by fever or rash and possibly nausea,\r\nvomiting, diarrhoea, abdominal pain, dyspnoea, cough, lethargy, malaise,\r\nheadache, and myalgia; less frequently mouth ulceration, oedema, hypotension,\r\nsore throat, acute respiratory distress syndrome, anaphylaxis, paraesthesia,\r\narthralgia, conjunctivitis, lymphadenopathy, lymphocytopenia and renal\r\nfailure; rarely myolysis; laboratory abnormalities may include raised\r\nliver function tests (\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nCautionsLactic acidosis\u00a0Life-threatening lactic acidosis associated with hepatomegaly and hepatic steatosis has been reported with nucleoside reverse transcriptase inhibitors. They should be used with caution in patients (particularly obese women) with hepatomegaly, hepatitis (especially hepatitis C treated with interferon alfa and ribavirin), liver-enzyme abnormalities and with other risk factors for liver disease and hepatic steatosis (including alcohol abuse). Treatment with the nucleoside reverse transcriptase inhibitor should be discontinued in case of symptomatic hyperlactataemia, lactic acidosis, progressive hepatomegaly or rapid deterioration of liver function. Stavudine, especially with didanosine, is associated with a higher risk of lactic acidosis and should be used only if alternative regimens are not suitable.) and creatine\r\nkinase; symptoms usually appear in the first 6 weeks, but may occur\r\nat any time; monitor for symptoms every 2 weeks for 2 months; discontinue immediately if any symptom of hypersensitivity develops\r\nand do not rechallenge (risk of more severe hypersensitivity reaction); discontinue if hypersensitivity cannot be ruled out,\r\neven when other diagnoses possible\u2014if rechallenge\r\nnecessary it must be carried out in hospital setting; if abacavir is stopped for any\r\nreason other than hypersensitivity, exclude hypersensitivity reaction\r\nas the cause and rechallenge only if medical assistance is readily\r\navailable; care needed with concomitant\r\nuse of drugs which cause skin toxicity Counselling\u00a0Patients should be told\r\nthe importance of regular dosing (intermittent therapy may increase\r\nthe risk of sensitisation), how to recognise signs of hypersensitivity,\r\nand advised to seek immediate medical attention if symptoms develop\r\nor before re-starting treatment; patients\r\nshould be advised to keep Alert Card with them at all times", "side-effects": "Side-effects\u00a0see notes above; also hypersensitivity reactions\r\n(see above); very rarely Stevens-Johnson syndrome\r\nand toxic epidermal necrolysis; rash and gastro-intestinal disturbances\r\nmore common in children", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81977.htm", "doses": [ "600\u00a0mg daily in 1\u20132 divided doses; child 3 months\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); see also Pregnancy" }, "CALCIUM SALTS - PHOSPHATE-BINDING AGENTS": { "side-effects": "Side-effects\u00a0hypercalcaemia", "indications": "Indications\u00a0hyperphosphataemia", "name": "CALCIUM SALTS - PHOSPHATE-BINDING AGENTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69193.htm", "doses": [ "initially 1 tablet 3 times daily with meals, adjusted\r\naccording to serum-phosphate concentration (usual dose 4\u20136 tablets\r\ndaily (1 or 2 tablets with each meal)); max. 12 tablets daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "CALCIUM SALTS" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; interactions: Appendix 1 (antacids, calcium salts)" }, "TADALAFIL": { "indications": "Indications\u00a0erectile dysfunction; pulmonary hypertension\r\n(section 2.5.1)", "name": "TADALAFIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Phosphodiesterase type-5 inhibitors", "TADALAFIL" ], "cautions": "Cautions\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nCautions\u00a0Sildenafil, tadalafil, and vardenafil should be used with caution in cardiovascular disease, left ventricular outflow obstruction, anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie\u2019s disease), and in those with a predisposition to priapism (e.g. in sickle-cell disease, multiple myeloma, or leukaemia). Concomitant treatment with a phosphodiesterase type-5 inhibitor and an alpha-blocker (section 2.5.4 and section 7.4.1) can increase the risk of postural hypotension\u2014initiate treatment with a phosphodiesterase type-5 inhibitor (at a low dose) only once the patient is stable on the alpha-blocker; see also interactions: Appendix 1 (sildenafil, tadalafil, vardenafil).; interactions: Appendix 1 (tadalafil)", "side-effects": "Side-effects\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nThe side-effects of sildenafil, tadalafil, and vardenafil include dyspepsia, nausea, vomiting, headache (including migraine), flushing, dizziness, myalgia, back pain, visual disturbances (non-arteritic anterior ischaemic optic neuropathy has been reported\u2014stop drug if sudden visual impairment occurs), and nasal congestion. Less common side-effects include painful red eyes, palpitation, tachycardia, hypotension, hypertension, epistaxis. Other side-effects reported rarely include syncope, hypersensitivity reactions (including rash, facial oedema, and Stevens-Johnson syndrome), and priapism. Serious cardiovascular events (including arrhythmia, unstable angina, and myocardial infarction), seizures, sudden hearing loss (discontinue drug and seek medical advice), and retinal vascular occlusion have also been reported. ; also\r\nincreased sweating, abdominal pain, and transient amnesia reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119673.htm", "doses": [ "adult over 18 years, initially\r\n10\u00a0mg at least 30 minutes before sexual activity, subsequent doses\r\nadjusted according to response, up to 20\u00a0mg as a single dose; max.\r\n1 dose in 24 hours (but daily dose of 10\u201320\u00a0mg not recommended); for\r\npatients who anticipate sexual activity at least twice weekly, 5\u00a0mg\r\nonce daily can be taken, reduced to 2.5\u00a0mg once daily according to\r\nresponse", "Effect of intermittent dosing may persist\r\nfor longer than 24 hours" ] }, "LACIDIPINE": { "indications": "Indications\u00a0hypertension", "name": "LACIDIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "LACIDIPINE" ], "cautions": "Cautions\u00a0cardiac conduction abnormalities; poor cardiac reserve; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0 flushing, palpitation, oedema; headache, dizziness; rarely gastro-intestinal disturbances, gum hyperplasia,\r\naggravation of angina, mood disturbances, asthenia, polyuria, muscle\r\ncramps, skin rash (including pruritus and erythema); overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/10269.htm", "doses": [ "Initially 2\u00a0mg as a single daily dose, preferably in the\r\nmorning; increased after 3\u20134 weeks to 4\u00a0mg daily, then if necessary\r\nto 6\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; may inhibit labour" }, "SILVER NITRATE": { "indications": "Indications\u00a0warts, verrucas, umbilical granulomas, over-granulating tissue, cauterisation", "name": "SILVER NITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses" ], "cautions": "Cautions\u00a0protect surrounding skin and avoid broken skin; not\r\nsuitable for application to face, ano-genital region,\r\nor large areas", "side-effects": "Side-effects\u00a0chemical burns on surrounding skin; stains skin\r\nand fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70872.htm", "doses": [ "Common warts and verrucas, apply moistened caustic pencil\r\ntip for 1\u20132 minutes; repeat after 24 hours up to max. 3 applications\r\nfor warts or max. 6 applications for verrucas", "Instructions in proprietary packs generally\r\nincorporate advice to remove dead skin before use by gentle filing\r\nand to cover with adhesive dressing after application", "Umbilical granulomas, apply moistened caustic pencil tip (usually\r\ncontaining silver nitrate 40%) for 1\u20132 minutes while protecting surrounding\r\nskin with soft paraffin" ] }, "FOSINOPRIL SODIUM": { "indications": "Indications\u00a0hypertension; congestive heart failure (adjunct\u2014see section 2.5.5)", "name": "FOSINOPRIL SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "FOSINOPRIL SODIUM" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; chest pain; musculoskeletal pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129300.htm", "doses": [ "Hypertension, initially 10\u00a0mg daily, increased if necessary\r\nafter 4 weeks; usual dose range 10\u201340\u00a0mg (doses over 40\u00a0mg not shown\r\nto increase efficacy); if used in addition to diuretic see notes above", "Heart failure (adjunct), initially 10\u00a0mg once daily under close\r\nmedical supervision (see notes above),\r\nincreased gradually to 40\u00a0mg once daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "FLUCLOXACILLIN": { "indications": "Indications\u00a0infections due to beta-lactamase-producing staphylococci including\r\notitis externa; adjunct in pneumonia, impetigo, cellulitis, osteomyelitis\r\nand in staphylococcal endocarditis (Table 1, section 5.1)", "name": "FLUCLOXACILLIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.2 Penicillinase-resistant penicillins" ], "cautions": "Cautions\u00a0see under Benzylpenicillin (section 5.1.1.1); risk of kernicterus in jaundiced neonates when high doses given parenterally; interactions: Appendix 1 (penicillins)Hepatic disordersCholestatic jaundice and hepatitis may occur very rarely, up\r\nto two months after treatment with flucloxacillin has been stopped. Administration for more than 2 weeks and increasing\r\nage are risk factors. Healthcare professionals are reminded that:flucloxacillin should not be used in\r\npatients with a history of hepatic dysfunction associated\r\nwith flucloxacillin;flucloxacillin should be used with\r\ncaution in patients with hepatic impairment;careful enquiry should be made about hypersensitivity\r\nreactions to beta-lactam antibacterials.", "side-effects": "Side-effects\u00a0see under Benzylpenicillin (section 5.1.1.1); also\r\ngastro-intestinal disturbances; very rarely hepatitis\r\nand cholestatic jaundice (see also Hepatic disorders above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3718.htm", "doses": [ "By mouth, 250\u2013500\u00a0mg every 6 hours, at\r\nleast 30 minutes before food; neonate see BNF for Children; child 1 month\u20132 years, 62.5\u2013125\u00a0mg\r\nevery 6 hours, at least 30 minutes before food; 2\u201310 years, 125\u2013250\u00a0mg\r\nevery 6 hours, at least 30 minutes before food", "By intramuscular injection, 250\u2013500\u00a0mg every\r\n6 hours; child 1 month\u201318 years see BNF for Children", "By slow intravenous injection or by intravenous infusion, 0.25\u20132\u00a0g every\r\n6 hours; child under 18 years see BNF for Children", "Endocarditis (in combination with another antibacterial, see\r\nTable 1, section 5.1), body-weight under 85\u00a0kg, 8\u00a0g\r\ndaily in 4 divided doses; body-weight over 85\u00a0kg, 12\u00a0g daily in 6\r\ndivided doses; child 1 month\u201318 years\r\nsee BNF for Children", "Osteomyelitis (see Table 1, section 5.1), up to 8\u00a0g daily\r\nin 3\u20134 divided doses; child under 18\r\nyears see BNF for Children", "Surgical prophylaxis, by slow intravenous\r\ninjection or by intravenous infusion, 1\u20132\u00a0g up to 30 minutes before the procedure; up to 4 further doses\r\nof 500\u00a0mg may be given every 6 hours by mouth, or by intramuscular injection, or by slow intravenous injection or by intravenous infusion for high risk procedures", "Flucloxacillin doses in\r\nBNF may differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TRAZODONE HYDROCHLORIDE": { "indications": "Indications\u00a0depressive illness, particularly where sedation is required; anxiety", "name": "TRAZODONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic-related antidepressants", "TRAZODONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\ndyspepsia, hypersalivation, hypertension, palpitation, dyspnoea, priapism\r\n(discontinue immediately), myalgia, arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106065.htm", "doses": [ "Depression, initially 150\u00a0mg (elderly 100\u00a0mg) daily in\r\ndivided doses after food or as a single dose at bedtime;\r\nmay be increased to 300\u00a0mg daily; hospital patients up to max. 600\u00a0mg\r\ndaily in divided doses; child not recommended", "Anxiety, 75\u00a0mg daily, increasing if necessary to 300\u00a0mg daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid during first trimester\u2014limited information\r\navailable; monitor infant for signs of withdrawal if used until delivery" }, "DOXEPIN": { "indications": "Indications\u00a0depressive illness, particularly where\r\nsedation is required; pruritus in eczema (section 13.3)", "name": "DOXEPIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, stomatitis, diarrhoea, flushing, and oedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129885.htm", "doses": [ "adult and child over 12 years, initially 75\u00a0mg daily in divided\r\ndoses or as a single dose at bedtime, adjusted according\r\nto response; usual maintenance 25\u2013300\u00a0mg daily (doses above 100\u00a0mg\r\ngiven in 3 divided doses); elderly start\r\nwith lower doses and adjust according to response" ], "pregnancy": "Pregnancy\u00a0use with caution\u2014limited information available" }, "INDORAMIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS": { "indications": "Indications\u00a0hypertension (see notes above); benign\r\nprostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "INDORAMIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "INDORAMIN" ], "cautions": "Cautions\u00a0avoid alcohol (enhances rate and\r\nextent of absorption); control incipient\r\nheart failure before initiating indoramin; elderly; Parkinson\u2019s disease (extrapyramidal\r\ndisorders reported); epilepsy (convulsions in animal studies); history\r\nof depression; cataract surgery (risk of\r\nintra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol may be enhanced", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\nsedation; less commonly fatigue, weight gain, failure\r\nof ejaculation; also reported extrapyramidal disorders, urinary frequency, and incontinence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9939.htm", "doses": [ "Hypertension, initially 25\u00a0mg twice daily, increased by\r\n25\u201350\u00a0mg daily at intervals of 2 weeks; max. daily dose 200\u00a0mg in\r\n2\u20133 divided doses" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "13.9 Shampoos and other preparations for scalp and hair conditions Shampoos": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.9 Shampoos and other preparations for scalp and hair conditions", "Shampoos" ], "name": "13.9 Shampoos and other preparations for scalp and hair conditions Shampoos", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6093.htm", "doses": [ "Name[Capasal\u00ae (Dermal)] Shampoo, coal tar 1%, coconut oil 1%, salicylic acid 0.5%, net\r\nprice 250\u00a0mL = \u00a34.69Excipients none as listed in section 13.1.3Dose\u00a0scaly scalp disorders including psoriasis, seborrhoeic\r\ndermatitis, dandruff, and cradle cap, apply daily as necessary" ] }, "PNEUMOCOCCAL VACCINE": { "indications": "Indications\u00a0immunisation against pneumococcal infection", "name": "PNEUMOCOCCAL VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Pneumococcal vaccines", "PNEUMOCOCCAL VACCINE" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also Revaccination, above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106195.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "ERDOSTEINE": { "indications": "Indications\u00a0symptomatic treatment of acute exacerbations of chronic bronchitis", "name": "ERDOSTEINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.7 Mucolytics" ], "cautions": "Cautions\u00a0\n(From 3.7 Mucolytics: British National Formulary)\nMucolytics should be used with caution in those with a history of peptic ulceration because they may disrupt the gastric mucosal barrier.", "side-effects": "Side-effects\u00a0very rarely nausea, vomiting,\r\ndiarrhoea, abdominal pain, taste disturbance, headache, rash, and\r\nurticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129845.htm", "doses": [ "adult over 18 years, 300\u00a0mg\r\ntwice daily for up to 10 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "ROPIVACAINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "ROPIVACAINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Ropivacaine" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics;\r\nalso acute porphyria (section 9.8.2); interactions: Appendix 1 (ropivacaine)", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects;\r\nalso hypertension, pyrexia; less commonly syncope and hypothermia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57998.htm", "doses": [ "To avoid excessive dosage in obese patients, dose may\r\nneed to be calculated on the basis of ideal body-weight", "Doses should be adjusted according to patient\u2019s\r\nphysical status and nature of procedure\u2014important see also under Administration, section 15.2", "Surgical anaesthesia", "Lumbar epidural, adult and child over 12 years, 15\u201320\u00a0mL\r\n(150\u2013200\u00a0mg) of 10\u00a0mg/mL solution or 15\u201325\u00a0mL (113\u2013188\u00a0mg)\r\nof 7.5\u00a0mg/mL solution; caesarean section, 15\u201320\u00a0mL (113\u2013150\u00a0mg) of\r\n7.5\u00a0mg/mL solution in incremental doses", "Thoracic epidural (to establish block for postoperative\r\npain), adult and child over 12 years, 5\u201315\u00a0mL (38\u2013113\u00a0mg) of 7.5\u00a0mg/mL solution", "Major nerve block (brachial plexus block), adult and child over\r\n12 years, 30\u201340\u00a0mL (225\u2013300\u00a0mg) of 7.5\u00a0mg/mL solution", "Field block, adult and child over 12 years, 1\u201330\u00a0mL\r\n(7.5\u2013225\u00a0mg) of 7.5\u00a0mg/mL solution", "Acute pain using 2\u00a0mg/mL solution", "Lumbar epidural, adult and child over 12 years, 10\u201320\u00a0mL\r\n(20\u201340\u00a0mg) followed by 10\u201315\u00a0mL (20\u201330\u00a0mg) at intervals of at least\r\n30 minutes or 6\u201310\u00a0mL/hour (12\u201320\u00a0mg/hour) as a continuous epidural infusion for labour pain or 6\u201314\u00a0mL/hour (12\u201328\u00a0mg/hour) as a continuous epidural infusion for postoperative pain", "Thoracic epidural, adult and child over 12 years, 6\u201314\u00a0mL/hour\r\n(12\u201328\u00a0mg/hour) as a continuous infusion", "Field block, adult and child over 12 years, 1\u2013100\u00a0mL\r\n(2\u2013200\u00a0mg)", "Peripheral nerve block, adult and child over 12 years, 5\u201310\u00a0mL/hour\r\n(10\u201320\u00a0mg/hour) as a continuous infusion or by intermittent injection", "child under 12 years, consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; do not use for paracervical\r\nblock in obstetrics" }, "BASILIXIMAB": { "indications": "Indications\u00a0%s\n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nBasiliximab is a monoclonal antibody that acts as an interleukin-2 receptor antagonist and prevents T-lymphocyte proliferation; it is used for prophylaxis of acute rejection in allogeneic renal transplantation. It is given with ciclosporin and corticosteroid immunosuppression regimens; its use should be confined to specialist centres.", "name": "BASILIXIMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants" ], "side-effects": "Side-effects\u00a0 severe hypersensitivity reactions and cytokine\r\nrelease syndrome have been reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/72819.htm", "doses": [ "By intravenous injection or by intravenous infusion, 20\u00a0mg within 2 hours before\r\ntransplant surgery and 20\u00a0mg 4 days after surgery; withhold second\r\ndose if severe hypersensitivity or graft loss occurs; child and adolescent 1\u201317 years, body-weight under 35\u00a0kg, 10\u00a0mg within 2 hours before\r\ntransplant surgery and 10\u00a0mg 4 days after surgery; body-weight over\r\n35\u00a0kg, adult dose" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available; adequate contraception\r\nmust be used during treatment and for 16 weeks after last dose" }, "BIPHASIC INSULIN ASPART": { "indications": "Indications\u00a0diabetes mellitus", "name": "BIPHASIC INSULIN ASPART", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "Biphasic insulins" ], "cautions": "Cautions\u00a0see section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106545.htm", "doses": [ "By subcutaneous injection, up to 10 minutes\r\nbefore or soon after a meal, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "TRIMETHOPRIM": { "indications": "Indications\u00a0urinary-tract infections, acute and chronic bronchitis; pneumocystis\r\npneumonia (section 5.4.8)", "name": "TRIMETHOPRIM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.8 Sulfonamides and trimethoprim" ], "cautions": "Cautions\u00a0predisposition to folate deficiency; elderly; manufacturer recommends\r\nblood counts on long-term therapy (but evidence of practical value\r\nunsatisfactory); neonates (specialist supervision\r\nrequired); acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(trimethoprim)Blood disorders\u00a0On long-term treatment,\r\npatients and their carers should be told how to recognise signs of\r\nblood disorders and advised to seek immediate medical attention if\r\nsymptoms such as fever, sore throat, rash, mouth ulcers, purpura,\r\nbruising or bleeding develop", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances including nausea\r\nand vomiting, pruritus, rashes, hyperkalaemia, depression of haematopoiesis;\r\nrarely erythema multiforme, toxic epidermal necrolysis, photosensitivity\r\nand other allergic reactions including angioedema and anaphylaxis;\r\naseptic meningitis and uveitis reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3894.htm", "doses": [ "Acute infections, 200\u00a0mg every 12 hours; child 1 month\u201312 years, 4\u00a0mg/kg (max. 200\u00a0mg) every\r\n12 hours; or 6 weeks\u20136 months 25\u00a0mg every 12 hours,\r\n6 months\u20136 years 50\u00a0mg every 12 hours, 6\u201312 years 100\u00a0mg every 12\r\nhours", "Prophylaxis, 100\u00a0mg at night; child under 12 years, 2\u00a0mg/kg (max.100\u00a0mg) at night; or [unlicensed dose] 6 weeks\u20136 months 12.5\u00a0mg at night, 6 months\u20136\r\nyears 25\u00a0mg at night, 6\u201312 years 50\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0teratogenic risk in first trimester (folate antagonist);\r\nmanufacturers advise avoid" }, "DIHYDROTACHYSTEROL": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "DIHYDROTACHYSTEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "DIHYDROTACHYSTEROL" ], "cautions": "Cautions\u00a0see under Ergocalciferol", "side-effects": "Side-effects\u00a0see under Ergocalciferol", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5145.htm", "doses": [ "acute, chronic, and latent forms of hypocalcaemic tetany\r\ndue to hypoparathyroidism, consult product literature" ], "pregnancy": "Pregnancy\u00a0see under Ergocalciferol" }, "TRAMADOL HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe pain", "name": "TRAMADOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; impaired consciousness; excessive bronchial\r\nsecretions; not suitable as a substitute\r\nin opioid-dependent patientsGeneral anaesthesia\u00a0Not recommended\r\nfor analgesia during potentially light planes of general anaesthesia (possibly increased intra-operative recall reported)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndiarrhoea, retching, fatigue, paraesthesia; less commonly gastritis, and flatulence; rarely anorexia, syncope,\r\nhypertension, bronchospasm, dyspnoea, wheezing, seizures, and muscle\r\nweakness; blood disorders also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/17872.htm", "doses": [ "adult and child over 12 years, by mouth, 50\u2013100\u00a0mg\r\nnot more often than every 4 hours; total of more than 400\u00a0mg daily\r\nnot usually required", "adult and child over 12 years, by intramuscular injection or by intravenous injection (over\r\n2\u20133 minutes) or by intravenous infusion, 50\u2013100\u00a0mg every 4\u20136 hours", "Postoperative pain, 100\u00a0mg initially then 50\u00a0mg every 10\u201320\r\nminutes if necessary during first hour to total max. 250\u00a0mg (including\r\ninitial dose) in first hour, then 50\u2013100\u00a0mg every\r\n4\u20136 hours; max. 600\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0embryotoxic in animal studies\u2014manufacturers advise\r\navoid; see also notes above" }, "PENICILLAMINE - WILSON\u2019S DISEASE": { "indications": "Indications\u00a0see under Dose below", "name": "PENICILLAMINE - WILSON\u2019S DISEASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Wilson\u2019s disease" ], "cautions": "Cautions\u00a0section 10.1.3; also neurological involvement in Wilson\u2019s disease", "side-effects": "Side-effects\u00a0section 10.1.3; also\r\nneuropathy (especially if previous neurological involvement in Wilson\u2019s\r\ndisease\u2014prophylactic pyridoxine recommended, see section 9.6.2)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5177.htm", "doses": [ "Wilson\u2019s disease, 1.5\u20132\u00a0g daily in divided doses before food; max.\r\n2\u00a0g daily for 1 year; maintenance 0.75\u20131\u00a0g daily; elderly 20\u00a0mg/kg daily in divided doses, adjusted according to response; child under 12 years see BNF for Children", "Autoimmune hepatitis (used rarely; after disease controlled\r\nwith corticosteroids), initially 500\u00a0mg daily in\r\ndivided doses increased slowly over 3 months; usual maintenance dose\r\n1.25\u00a0g daily; elderly not recommended", "Cystinuria, therapeutic, 1\u20133\u00a0g daily in divided doses before\r\nfood, adjusted to maintain urinary cystine below 200\u00a0mg/litre; prophylactic\r\n(maintain urinary cystine below 300\u00a0mg/litre) 0.5\u20131\u00a0g at bedtime;\r\nmaintain adequate fluid intake (at least 3\u00a0litres daily); child and elderly minimum\r\ndose to maintain urinary cystine below 200\u00a0mg/litre", "Severe active rheumatoid arthritis, section 10.1.3" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "KETOCONAZOLE": { "indications": "Indications\u00a0fungal skin infections; systemic or resistant fungal\r\ninfections (section 5.2.2); vulval candidiasis (section 7.2.2)", "name": "KETOCONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6161.htm", "doses": [ "Tinea pedis, apply twice daily; other fungal infections,\r\napply 1\u20132 times daily" ] }, "PROCHLORPERAZINE Buccal preparation": { "indications": "Indications\u00a0severe nausea, vomiting, vertigo, labyrinthine\r\ndisorders (see notes above); other indications %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE", "name": "PROCHLORPERAZINE Buccal preparation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs", "PROCHLORPERAZINE", "Buccal preparation" ], "cautions": "Cautions\u00a0see Prochlorperazine, %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE; elderly (see notes above)", "side-effects": "Side-effects\u00a0see Prochlorperazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3425.htm", "doses": [ "Doses are expressed as prochlorperazine\r\nmaleate or mesilate; 1\u00a0mg prochlorperazine maleate \u2261 1\u00a0mg prochlorperazine mesilate", "By mouth, nausea and vomiting, acute\r\nattack, 20\u00a0mg initially then 10\u00a0mg after 2 hours; prevention 5\u201310\u00a0mg\r\n2\u20133 times daily; child (over 10\u00a0kg\r\nonly) 250\u00a0micrograms/kg 2\u20133 times daily", "Labyrinthine disorders, 5\u00a0mg 3 times daily, gradually increased\r\nif necessary to 30\u00a0mg daily in divided doses, then reduced after several\r\nweeks to 5\u201310\u00a0mg daily; child not recommended", "By deep intramuscular injection, nausea and vomiting,\r\n12.5\u00a0mg when required followed if necessary after 6 hours by an oral\r\ndose, as above; child and adolescent under 18 years see BNF for Children", "Name[Buccastem\u00ae (Alliance) ] Tablets (buccal), pale yellow, prochlorperazine maleate 3\u00a0mg, net price 5 \u00d7 10-tab pack\r\n= \u00a35.89. \r\n Label:\r\n 2, counselling, administration, see under Dose belowDose\u00a0adult and child over 12 years, 1\u20132 tablets twice daily; tablets\r\nare placed high between upper lip and gum and left to dissolve" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "SODIUM CHLORIDE - ORAL SODIUM AND WATER": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.2 Oral sodium and water", "SODIUM CHLORIDE" ], "indications": "Indications\u00a0sodium depletion\u2014see also 9.2.2.1; nebuliser diluent (section 3.1.5); eye (section 11.8.1); oral hygiene\r\n(section 12.3.4); wound irrigation (section 13.11.1)", "name": "SODIUM CHLORIDE - ORAL SODIUM AND WATER", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4952.htm", "doses": [ "prophylaxis of sodium chloride deficiency\r\n4\u20138 tablets daily with water (in severe depletion up to max. 20 tablets\r\ndaily)" ] }, "MOXIFLOXACIN - QUINOLONES": { "indications": "Indications\u00a0sinusitis, community-acquired pneumonia, exacerbations of chronic\r\nbronchitis, mild to moderate pelvic inflammatory disease, or complicated\r\nskin and soft-tissue infections which have failed to respond to other\r\nantibacterials or for patients who cannot be treated with other antibacterials", "name": "MOXIFLOXACIN - QUINOLONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; interactions: Appendix 1 (quinolones)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.; also gastritis, flatulence, constipation, arrhythmias, palpitation,\r\nangina, vasodilatation, hyperlipidaemia, sweating; rarely oedema, hypertension, syncope, dysphagia, abnormal dreams, incoordination,\r\namnesia, hyperglycaemia, hyperuricaemia, myopathy, stomatitis; very rarely rhabdomyolysis, potentially life-threatening\r\nhepatic failure; on intravenous infusion, pain and\r\nphlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127959.htm", "doses": [ "By mouth, 400\u00a0mg once daily", "By intravenous infusion over 60 minutes,\r\ncommunity-acquired pneumonia, complicated skin and soft-tissue infections,\r\n400\u00a0mg once daily", "Recommended duration of treatment is 7\u201314\r\ndays for community-acquired pneumonia, 5\u201310 days in exacerbations\r\nof chronic bronchitis, 7 days in sinusitis, 14 days in pelvic inflammatory\r\ndisease, 7\u201321 days for complicated skin and soft-tissue infections" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "VINFLUNINE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\n8.1.4 Vinca alkaloids and etoposide", "name": "VINFLUNINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide", "VINFLUNINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; cardiovascular disease; QT-interval prolongation (avoid hypokalaemia or concomitant use of drugs that prolong QT-interval); interactions: Appendix 1 (vinflunine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also anorexia,\r\ndiarrhoea, dyspepsia; tachycardia, hypertension, hypotension, thrombosis;\r\noedema; insomnia, fatigue; dehydration; cutaneous reactions, sweating; less commonly increased weight, myocardial infarction, renal\r\nfailure; also reported QT-interval prolongation,\r\ninappropriate anti-diuretic hormone secretion, blurred vision", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208928.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid unless essential\u2014teratogenicity and embryotoxicity\r\nin animal studies; manufacturer advises effective\r\ncontraception during and for up to 3 months after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "OXYCODONE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0moderate to severe pain in patients with cancer;\r\npostoperative pain; severe pain", "name": "OXYCODONE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "OXYCODONE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also toxic psychosis; pancreatitis", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\ndiarrhoea, abdominal pain, anorexia, dyspepsia; bronchospasm, dyspnoea,\r\nimpaired cough reflex; asthenia, anxiety; chills; less commonly paralytic ileus, cholestasis, gastritis, flatulence, dysphagia,\r\ntaste disturbance, belching, hiccups, vasodilatation, supraventricular\r\ntachycardia, syncope, amnesia, hypoaesthesia, restlessness, seizures,\r\nhypotonia, paraesthesia, disorientation, malaise, agitation, speech\r\ndisorder, tremor, pyrexia, amenorrhoea, thirst, dehydration, muscle\r\nfasciculation, and dry skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85409.htm", "doses": [ "By mouth, initially 5\u00a0mg every 4\u20136 hours,\r\nincreased if necessary according to severity of pain, usual max. 400\u00a0mg\r\ndaily, but some patients may require higher doses; child under 18 years see BNF for Children", "By slow intravenous injection, 1\u201310\u00a0mg every\r\n4 hours when necessary; child under\r\n18 years, not recommended", "By intravenous infusion, initially 2\u00a0mg/hour,\r\nadjusted according to response; child under 18 years not recommended", "By subcutaneous injection, initially 5\u00a0mg every\r\n4 hours when necessary; child under\r\n18 years not recommended", "By subcutaneous infusion, initially 7.5\u00a0mg/24\r\nhours adjusted according to response; child under 18 years not recommended", "Patient controlled analgesia (PCA), consult hospital protocols", "2\u00a0mg oral oxycodone is\r\napproximately equivalent to 1\u00a0mg parenteral oxycodone", "Name[OxyContin\u00ae (Napp) ] Tablets, f/c, m/r, oxycodone\r\nhydrochloride 5\u00a0mg (blue), net price 28-tab pack = \u00a312.46;\r\n10\u00a0mg (white), 56-tab pack = \u00a324.91; 15\u00a0mg (grey), 56-tab pack = \u00a337.41;\r\n20\u00a0mg (pink), 56-tab pack = \u00a349.82; 30\u00a0mg (brown), 56-tab pack = \u00a374.81;\r\n40\u00a0mg (yellow), 56-tab pack = \u00a399.66; 60\u00a0mg (red), 56-tab pack = \u00a3149.66;\r\n80\u00a0mg (green), 56-tab pack = \u00a3199.33; 120\u00a0mg (purple), 56-tab pack\r\n= \u00a3299.31. \r\n Label:\r\n 2, 25Dose\u00a0initially, 10\u00a0mg every 12 hours, increased if necessary\r\naccording to severity of pain, usual max. 200\u00a0mg every 12 hours, but\r\nsome patients may require higher doses; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "PYRIMETHAMINE": { "indications": "Indications\u00a0malaria (but used only in combined preparations\r\nincorporating sulfadoxine); toxoplasmosis\u2014section 5.4.7", "name": "PYRIMETHAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Pyrimethamine", "PYRIMETHAMINE" ], "cautions": "Cautions\u00a0blood counts required with prolonged\r\ntreatment; history of seizures\u2014avoid\r\nlarge loading doses; interactions: Appendix\r\n1 (pyrimethamine)", "side-effects": "Side-effects\u00a0depression of haematopoiesis with high doses,\r\nrashes, insomnia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4026.htm", "doses": [ "Malaria, no dose stated because not recommended alone,\r\nsee Pyrimethamine with Sulfadoxine below", "Toxoplasmosis, section 5.4.7" ], "pregnancy": "Pregnancy\u00a0theoretical teratogenic risk in first trimester (folate antagonist); adequate folate supplements should be given\r\nto mother" }, "OESTROGENS FOR HRT Conjugated oestrogens only": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT Conjugated oestrogens only", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT", "Conjugated oestrogens only" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/12500.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch", "Name[Premarin\u00ae (Wyeth) ] Tablets, all s\u00a0/c, conjugated oestrogens\r\n(equine) 300\u00a0micrograms (green) net price 3 \u00d7 28-tab pack = \u00a36.07;\r\n625\u00a0micrograms (maroon), 3 \u00d7 28-tab pack = \u00a34.02; 1.25\u00a0mg (yellow),\r\n3 \u00d7 28-tab pack = \u00a33.58Dose\u00a0menopausal symptoms, 0.3\u20131.25\u00a0mg daily continuously; osteoporosis\r\nprophylaxis (see section 6.6),\r\n0.625\u20131.25\u00a0mg daily continuously; with cyclical progestogen for 12\u201314\r\ndays of each cycle in women with a uterus" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "FERROUS SULPHATE Modified-release preparations": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS SULPHATE Modified-release preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "FERROUS SULPHATE", "Modified-release preparations" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4850.htm", "doses": [ "See under preparations below and notes above", "Name[Feospan\u00ae (Intrapharm) ] Spansule\u00ae (= capsules m/r), clear/red,\r\nenclosing green and brown pellets, dried ferrous sulphate 150\u00a0mg (47\u00a0mg iron), net price 30-cap pack = \u00a33.45. \r\n Label:\r\n 25Dose\u00a01\u20132 capsules daily; child over 1 year, 1 capsule daily; can be opened and sprinkled on food" ] }, "BEZAFIBRATE": { "indications": "Indications\u00a0hyperlipidaemias of types IIa, IIb, III, IV, and V in patients who\r\nhave not responded adequately to diet and other appropriate measures;\r\nalso see notes above", "name": "BEZAFIBRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Fibrates", "BEZAFIBRATE" ], "cautions": "Cautions\u00a0correct hypothyroidism before initiating treatment (see Lipid-regulating drugs); interactions: Appendix 1 (fibrates)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, anorexia; less commonly cholestasis, weight gain, dizziness, headache,\r\nfatigue, drowsiness, renal impairment, raised serum creatinine (unrelated\r\nto renal impairment), erectile dysfunction, myotoxicity (with myasthenia\r\nor myalgia)\u2014special risk in renal impairment (see Cautions), urticaria,\r\npruritus, photosensitivity reactions; very rarely gallstones, hypoglycaemia, anaemia, leucopenia, thrombocytopenia,\r\nincreased platelet count, alopecia, Stevens-Johnson syndrome, and\r\ntoxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85737.htm", "doses": [ "See preparations below" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014embryotoxicity in animal studies" }, "IMIGLUCERASE": { "indications": "Indications\u00a0(specialist use only) non-neurological manifestations\r\nof type I or type III Gaucher\u2019s disease", "name": "IMIGLUCERASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Gaucher\u2019s disease", "IMIGLUCERASE" ], "cautions": "Cautions\u00a0monitor immunoglobulin G (IgG) antibody\r\nconcentration; when stabilised, monitor\r\nall parameters and response to treatment at intervals of 6\u201312 months", "side-effects": "Side-effects\u00a0hypersensitivity reactions (including urticaria,\r\nangioedema, cyanosis, hypotension, flushing, tachycardia, paraesthesia,\r\nbackache); less commonly nausea, vomiting, diarrhoea,\r\nabdominal cramps, headache, dizziness, fatigue, fever, arthralgia,\r\nand injection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73078.htm", "doses": [ "By intravenous infusion, initially 60\u00a0units/kg\r\nonce every 2 weeks (doses as low as 15\u00a0units/kg once every 2 weeks\r\nmay improve haematological parameters and organomegaly); maintenance,\r\nadjust dose according to response; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use with caution\u2014limited information\r\navailable" }, "CALCITRIOL - VITAMIN D AND ANALOGUES": { "indications": "Indications\u00a0mild to moderate plaque psoriasis", "name": "CALCITRIOL - VITAMIN D AND ANALOGUES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Vitamin D and analogues" ], "cautions": "Cautions\u00a0\n(From Vitamin D and analogues: British National Formulary)\nVitamin D and analogues", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106484.htm", "doses": [ "adult and child over 12 years, apply twice daily; not more\r\nthan 35% of body surface to be treated daily, max. 30\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use in restricted amounts only\r\nif clearly necessary and to monitor urine- and serum-calcium concentration" }, "LOCAL ANAESTHETICS": { "indications": "Indications\u00a0relief of pain in oral lesions", "name": "LOCAL ANAESTHETICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "LOCAL ANAESTHETICS" ], "cautions": "Cautions\u00a0avoid prolonged use; hypersensitivity; avoid anaesthesia of\r\nthe pharynx before meals\u2014risk of choking", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128438.htm", "doses": [ "rub sparingly and gently on affected areas", "Lidocaine 5% Ointment\r\nmay be prescribed" ], "pregnancy": "Pregnancy\u00a0see Lidocaine section 15.2" }, "FLUOROURACIL With salicylic acid": { "indications": "Indications\u00a0superficial malignant and pre-malignant\r\nskin lesions; other malignant disease (section 8.1.3) ", "name": "FLUOROURACIL With salicylic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.8 Sunscreens and camouflagers", "13.8.1 Sunscreen preparations", "Photodamage", "FLUOROURACIL", "With salicylic acid" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes; caution in handling\u2014irritant to tissues", "side-effects": "Side-effects\u00a0local irritation (use a topical corticosteroid\r\nfor severe discomfort associated with inflammatory reactions), photosensitivity,\r\nerythema multiforme", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217935.htm", "doses": [ "See under preparations", "Name[Actikerall\u00ae (Almirall) ] Solution, fluorouracil 0.5%, salicylic\r\nacid 10%, net price 25\u00a0mL = \u00a338.30. \r\n Label:\r\n 15Excipients none as listed in section 13.1.3Dose\u00a0low or moderately thick hyperkeratotic actinic keratosis,\r\napply to affected area once daily for up to 12 weeks; max. area of\r\nskin treated at one time, 25\u00a0cm2 (e.g. 5\u00a0cm x 5\u00a0cm)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid (teratogenic)" }, "GLYCERYL TRINITRATE - MANAGEMENT OF ANAL FISSURES": { "indications": "Indications\u00a0anal fissure; angina, left ventricular failure\r\n(section 2.6.1); extravasation (section 10.3)", "name": "GLYCERYL TRINITRATE - MANAGEMENT OF ANAL FISSURES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.7 Local preparations for anal and rectal disorders", "1.7.4 Management of anal fissures", "GLYCERYL TRINITRATE" ], "cautions": "Cautions\u00a0section 2.6.1", "side-effects": "Side-effects\u00a0section 2.6.1; also diarrhoea, burning, itching,\r\nand rectal bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129349.htm", "doses": [ "See preparations", "adult over 18 years, apply\r\n2.5\u00a0cm of ointment to anal canal every 12 hours until pain stops;\r\nmax. duration of use 8 weeks" ], "pregnancy": "Pregnancy\u00a0section 2.6.1" }, "ARIPIPRAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "ARIPIPRAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; cerebrovascular disease; elderly (reduce initial dose)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; gastro-intestinal\r\ndisturbances; tachycardia; fatigue, insomnia, akathisia, drowsiness,\r\nrestlessness, tremor, headache, asthenia; blurred vision; less commonly depression; very rarely anorexia,\r\ndysphagia, oropharyngeal spasm, laryngospasm, hepatitis, jaundice,\r\nhypersalivation, pancreatitis, oedema, thromboembolism, arrhythmias,\r\nbradycardia, hypertension, chest pain, agitation, anxiety, speech\r\ndisorder, suicidal ideation, seizures, hyponatraemia, stiffness, myalgia,\r\nrhabdomyolysis, priapism, urinary retention and incontinence, blood\r\ndisorders, sweating, alopecia, photosensitivity reactions, rash, weight\r\nloss, and impaired temperature regulation; with injection, dry mouth", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128396.htm", "doses": [ "Schizophrenia, by mouth, adult over 18 years, 10\u201315\u00a0mg once daily, usual maintenance\r\n15\u00a0mg once daily; max. 30\u00a0mg once daily; child 15\u201318 years, initially 2\u00a0mg once daily for 2 days, then 5\u00a0mg once\r\ndaily for 2 days, then 10\u00a0mg daily; thereafter increased if necessary\r\nin steps of 5\u00a0mg to max. 30\u00a0mg daily", "Treatment and recurrence prevention of mania, by mouth, adult over 18 years, 15\u00a0mg once\r\ndaily, increased if necessary; max. 30\u00a0mg once daily", "Control of agitation and disturbed behaviour in schizophrenia, by intramuscular injection, adult over 18 years, initially 5.25\u201315\u00a0mg (usual dose 9.75\u00a0mg) as a single\r\ndose followed by 5.25\u201315\u00a0mg after 2 hours if necessary; max. 3 injections\r\ndaily; max. daily combined oral and parenteral dose 30\u00a0mg" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk" }, "LIDOCAINE HYDROCHLORIDE Lidocaine for surface anaesthesia": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE Lidocaine for surface anaesthesia", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE", "Lidocaine for surface anaesthesia" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130131.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Up to 3 plasters may be used to cover large\r\nareas; plasters may be cut", "Name[Versatis\u00ae (Gr\u00fcnenthal) ] Plasters, lidocaine\r\n5% (700\u00a0mg/medicated plaster), net price 30 = \u00a372.40Excipients include hydroxybenzoates\r\n(parabens), propylene glycolDose\u00a0postherpetic neuralgia, adult over 18 years, apply to intact, dry, non-hairy, non-irritated skin\r\nonce daily for up to 12 hours, followed by a 12-hour plaster-free\r\nperiod; discontinue if no response after 4 weeksNote\u00a0Up to 3 plasters may be used to cover large\r\nareas; plasters may be cutNote\u00a0The Scottish Medicines\r\nConsortium has advised (July 2008) that Versatis\u00ae is accepted\r\nfor restricted use within NHS Scotland for the treatment of postherpetic\r\nneuralgia in patients who are intolerant of first-line systemic therapies\r\nor when they have been ineffective" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "MENADIOL SODIUM PHOSPHATE": { "indications": "Indications\u00a0\n(From 9.6.6 Vitamin K: British National Formulary)\n9.6.6 Vitamin K", "name": "MENADIOL SODIUM PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.6 Vitamin K", "MENADIOL SODIUM PHOSPHATE" ], "cautions": "Cautions\u00a0G6PD deficiency (section 9.1.5) and vitamin E deficiency (risk\r\nof haemolysis); interactions: Appendix\r\n1 (vitamins)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5151.htm", "doses": [ "10\u201340\u00a0mg daily, adjusted as necessary; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid in late pregnancy and labour unless benefit\r\noutweighs risk of neonatal haemolytic anaemia, hyperbilirubinaemia,\r\nand kernicterus in neonate" }, "RETIGABINE": { "indications": "Indications\u00a0\n(From Retigabine: British National Formulary)\nRetigabine", "name": "RETIGABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Retigabine" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; risk of urinary retention; known QT-interval prolongation (see below); interactions: see Interactions in section\r\n4.8.1 and Appendix 1 (retigabine)QT-interval prolongation\u00a0Patients with known QT-interval\r\nprolongation, or with the following risk factors for QT-interval prolongation,\r\nshould be carefully monitored while taking retigabine: cardiac failure, ventricular hypertrophy, electrolyte abnormalities, or concomitant treatment with drugs that can prolong QT interval", "side-effects": "Side-effects\u00a0increased appetite, weight gain, nausea, constipation,\r\ndyspepsia, dry mouth, peripheral oedema, malaise, drowsiness, dizziness,\r\nvertigo, amnesia, paraesthesia, tremor, impaired coordination, impaired\r\nspeech and attention, myoclonus, confusion, psychosis, anxiety, dysuria,\r\nhaematuria, diplopia, blurred vision; less commonly dysphagia, hypokinesia, urinary retention, nephrolithiasis, rash,\r\nsweating; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/214617.htm", "doses": [ "adult over 18 years, initially\r\nup to 300\u00a0mg daily in 3 divided doses, increased according to response\r\nby up to 150\u00a0mg every week up to maintenance dose of 0.6\u20131.2\u00a0g daily; elderly over 65 years, initially 150\u00a0mg daily in\r\n3 divided doses, increased according to response by up to 150\u00a0mg every\r\nweek; max. 900\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH LEVONORGESTREL": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH LEVONORGESTREL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Oral (low and standard strength)", "Ethinylestradiol with Levonorgestrel" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/34690.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "CLONIDINE HYDROCHLORIDE - CENTRALLY ACTING ANTIHYPERTENSIVE DRUGS": { "indications": "Indications\u00a0hypertension; migraine (section 4.7.4.2); menopausal flushing (section 6.4.1.1)", "name": "CLONIDINE HYDROCHLORIDE - CENTRALLY ACTING ANTIHYPERTENSIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.2 Centrally acting antihypertensive drugs" ], "cautions": "Cautions\u00a0must be withdrawn gradually to avoid\r\nsevere rebound hypertension; mild to moderate\r\nbradyarrhythmia; constipation; polyneuropathy; Raynaud\u2019s\r\nsyndrome or other occlusive peripheral\r\nvascular disease; history of depression; interactions: Appendix 1 (clonidine)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol may be enhanced", "side-effects": "Side-effects\u00a0constipation, nausea, dry mouth, vomiting, salivary\r\ngland pain, postural hypotension, dizziness, sleep disturbances, headache,\r\nmalaise, drowsiness, depression, sexual dysfunction, less\r\ncommonly bradycardia, Raynaud\u2019s syndrome, delusion, hallucination,\r\nparaesthesia, pruritus, rash, urticaria; rarely colonic\r\npseudo-obstruction, AV block, gynaecomastia, decreased lacrimation,\r\nnasal dryness, alopecia; also reported hepatitis,\r\nfluid retention, bradyarrhythmia, confusion, impaired visual accommodation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2546.htm", "doses": [ "By mouth, 50\u2013100\u00a0micrograms 3 times\r\ndaily, increased every second or third day; usual max. dose 1.2\u00a0mg\r\ndaily" ], "pregnancy": "Pregnancy\u00a0may lower fetal heart rate, but risk should be balanced\r\nagainst risk of uncontrolled maternal hypertension; avoid intravenous\r\ninjection" }, "PROTAMINE SULPHATE": { "indications": "Indications\u00a0see above", "name": "PROTAMINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.3 Protamine sulphate" ], "cautions": "Cautions\u00a0see above; also monitor activated partial thromboplastin\r\ntime or other appropriate blood clotting parameters; increased risk\r\nof allergic reaction to protamine (including previous treatment with\r\nprotamine or protamine insulin, allergy to fish, men who are infertile\r\nor who have had a vasectomy)", "side-effects": "Side-effects\u00a0nausea, vomiting, lassitude, flushing, hypotension,\r\nhypertension, bradycardia, dyspnoea, rebound bleeding, back pain;\r\nhypersensitivity reactions (including angioedema, anaphylaxis) and\r\npulmonary oedema reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2800.htm", "doses": [ "Overdosage with intravenous injection of unfractionated\r\nheparin, by intravenous injection (rate not exceeding\r\n5\u00a0mg/minute), 1\u00a0mg neutralises 80\u2013100\u00a0units heparin when given within 15 minutes of heparin; if longer\r\nthan 15 minutes since heparin, less protamine required (consult product\r\nliterature for details) as heparin rapidly excreted; max. 50\u00a0mg", "Overdosage with intravenous infusion of unfractionated\r\nheparin, by intravenous injection (rate not exceeding\r\n5\u00a0mg/minute), 25\u201350\u00a0mg once heparin infusion stopped", "Overdosage with subcutaneous injection of unfractionated\r\nheparin, 1\u00a0mg neutralises 100\u00a0units heparin; give 25\u201350\u00a0mg by intravenous injection (rate not exceeding 5\u00a0mg/minute)\r\nthen any remaining dose given by intravenous infusion over 8\u201316 hours; max. total dose 50\u00a0mg", "Overdosage with subcutaneous injection of low molecular\r\nweight heparin, by intermittent intravenous injection (rate not exceeding 5\u00a0mg/minute) or by continuous intravenous\r\ninfusion, 1\u00a0mg neutralises approx. 100\u00a0units low molecular\r\nweight heparin (consult product literature of low molecular weight\r\nheparin for details); max. 50\u00a0mg" ] }, "DICYCLOVERINE HYDROCHLORIDE": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal disorders characterised by\r\nsmooth muscle spasm", "name": "DICYCLOVERINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2059.htm", "doses": [ "10\u201320\u00a0mg 3 times daily; infant 6\u201324 months 5\u201310\u00a0mg 3\u20134 times daily, 15 minutes before feeds; child 2\u201312 years 10\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturer advises use\r\nonly if essential" }, "ADALIMUMAB": { "indications": "Indications\u00a0see under Cytokine Modulators above; Crohn\u2019s disease\r\n(section 1.5.3); psoriasis (section 13.5.3)", "name": "ADALIMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; monitor for infection before, during, and for 5 months after treatment (see also Tuberculosis below); do not initiate until\r\nactive infections are controlled; discontinue\r\nif new serious infection develops; hepatitis\r\nB virus\u2014monitor for active infection; children should\r\nbe brought up to date with current immunisation schedule (section 14.1) before initiating therapy; mild\r\nheart failure (discontinue if symptoms develop or worsen\u2014avoid in\r\nmoderate or severe heart failure); demyelinating CNS disorders (risk of exacerbation); history or development of malignancy; monitor for non-melanoma skin cancer before and during treatment,\r\nespecially in patients with a history of PUVA treatment for psoriasis\r\nor extensive immunosuppressant therapy; interactions: Appendix 1 (adalimumab)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting adalimumab. Patients who have previously received\r\nadequate treatment for tuberculosis can start adalimumab but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting adalimumab. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with adalimumab. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) develop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators and Cautions above; also vomiting, dyspepsia, gastro-intestinal\r\nhaemorrhage; dizziness, hyperlipidaemia, hypertension, oedema, flushing,\r\nchest pain, tachycardia; cough, dyspnoea; mood changes, sleep disturbances,\r\nanxiety, paraesthesia; haematuria, renal impairment; benign tumours,\r\nskin cancer; electrolyte disturbances, hyperuricaemia; musculoskeletal\r\npain; eye disorders; rash, dermatitis, onycholysis, impaired healing; less commonly dysphagia, pancreatitis, cholelithiasis, hepatic\r\nsteatosis, cholecystitis, arrhythmias, interstitial lung disease,\r\npneumonitis, tremor, erectile dysfunction, nocturia, malignancy (including\r\nsolid tumours, lymphoma, and leukaemia), rhabdomyolysis, hearing loss,\r\ntinnitus; rarely vascular occlusion, myocardial infarction,\r\ndemyelinating disorders; also reported pulmonary\r\nembolism, pleural effusion, sarcoidosis, Stevens-Johnson syndrome,\r\ncutaneous vasculitis, new onset or worsening psoriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128230.htm", "doses": [ "By subcutaneous injection, rheumatoid\r\narthritis, adult over 18 years, 40\u00a0mg\r\non alternate weeks; if necessary increased to 40\u00a0mg weekly in patients\r\nreceiving adalimumab alone; review treatment if no response within\r\n12 weeks", "Polyarticular juvenile idiopathic arthritis, child 4\u201312 years, 24\u00a0mg/m2 (max. 40\u00a0mg)\r\non alternate weeks; child 13\u201317 years,\r\n40\u00a0mg on alternate weeks; review treatment if no response within 12\r\nweeks", "Psoriatic arthritis, ankylosing spondylitis, adult over 18 years, 40\u00a0mg on alternate weeks; discontinue\r\ntreatment if no response within 12 weeks" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nrequired during treatment and for at least 5 months after last dose" }, "AMOROLFINE": { "indications": "Indications\u00a0fungal nail infections", "name": "AMOROLFINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "AMOROLFINE" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.; also avoid contact\r\nwith ears", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6150.htm", "doses": [ "Apply to infected nails 1\u20132 times weekly after filing\r\nand cleansing; allow to dry (approx. 3 minutes); treat finger nails\r\nfor 6 months, toe nails for 9\u201312 months (review at intervals of 3\r\nmonths); avoid nail varnish or artificial nails during treatment" ], "pregnancy": "Pregnancy\u00a0systemic absorption very low, but manufacturer advises\r\navoid\u2014no information available" }, "AZITHROMYCIN - ANTIBACTERIALS": { "side-effects": "Side-effects\u00a0ocular discomfort (including pruritus, burning),\r\nblurred vision", "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "AZITHROMYCIN - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217746.htm", "doses": [ "Purulent bacterial conjunctivitis, adult and child over 2 years, apply twice\r\ndaily for 3 days; review if no improvement after 3 days", "Trachomatous conjunctivitis, adult and child over 1 year, apply twice\r\ndaily for 3 days; review if no improvement after 3 days" ], "pregnancy": "Pregnancy\u00a0caution\u2014limited information available", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "AZITHROMYCIN" ] }, "AMANTADINE HYDROCHLORIDE - AMANTADINE": { "indications": "Indications\u00a0Parkinson\u2019s disease; antiviral (section 5.3.4)", "name": "AMANTADINE HYDROCHLORIDE - AMANTADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Amantadine", "AMANTADINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0congestive heart disease (may exacerbate oedema), confused or hallucinatory states, elderly; avoid abrupt withdrawal in Parkinson\u2019s\r\ndisease; interactions: Appendix 1 (amantadine)Driving\u00a0May affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, anorexia, dry\r\nmouth; palpitation, peripheral oedema, postural hypotension; anxiety,\r\nmood changes, dizziness, headache, lethargy, hallucinations, insomnia,\r\nimpaired concentration, slurred speech; myalgia; sweating and livedo\r\nreticularis; less commonly confusion, psychosis,\r\ntremor, movement disorders, seizure, neuroleptic malignant syndrome,\r\nurinary retention, urinary incontinence, visual disturbances, and\r\nrash; heart failure, leucopenia, and photosensitisation also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3645.htm", "doses": [ "Parkinson\u2019s disease, 100\u00a0mg daily increased after one\r\nweek to 100\u00a0mg twice daily, usually in conjunction with other treatment;\r\nsome patients may require higher doses, max. 400\u00a0mg daily; elderly 65 years and over, 100\u00a0mg daily adjusted\r\naccording to response", "Post-herpetic neuralgia, 100\u00a0mg twice daily for 14 days, continued\r\nfor a further 14 days if necessary" ], "pregnancy": "Pregnancy\u00a0avoid; toxicity in animal studies" }, "GEMFIBROZIL": { "indications": "Indications\u00a0hyperlipidaemias of types IIa, IIb, III, IV and V in patients who\r\nhave not responded adequately to diet and other appropriate measures;\r\nprimary prevention of cardiovascular disease in men with hyperlipidaemias\r\nthat have not responded to diet and other appropriate measures; also\r\nsee notes above", "name": "GEMFIBROZIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Fibrates" ], "cautions": "Cautions\u00a0lipid profile, blood counts, and liver-function tests\r\nbefore initiating long-term treatment; preferably avoid use with statins (high risk of rhabdomyolysis); correct hypothyroidism before initiating treatment (see Lipid-regulating Drugs); elderly; interactions: Appendix 1\r\n(fibrates)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; headache, fatigue,\r\nvertigo; eczema, rash; less commonly atrial fibrillation; rarely pancreatitis, appendicitis, disturbances in liver\r\nfunction including hepatitis and cholestatic jaundice, dizziness,\r\nparaesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia,\r\neosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia,\r\nmyositis accompanied by increase in creatine kinase (discontinue if\r\nraised significantly), blurred vision, exfoliative dermatitis, alopecia,\r\nand photosensitivity)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2853.htm", "doses": [ "1.2\u00a0g daily, usually in 2 divided doses; range 0.9\u20131.2\u00a0g\r\ndaily; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014embryotoxicity in animal studies" }, "TARS Bath preparations": { "indications": "Indications\u00a0psoriasis and occasionally\r\nchronic atopic eczema", "name": "TARS Bath preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tars", "TARS", "Bath preparations" ], "cautions": "Cautions\u00a0application to face and skin flexures; use suitable chemical protection gloves for extemporaneous\r\npreparation", "side-effects": "Side-effects\u00a0skin irritation and acne-like eruptions, photosensitivity;\r\nstains skin, hair, and fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5956.htm", "doses": [ "Apply 1\u20133 times daily starting with low-strength preparations", "For shampoo preparations see section 13.9; for\r\nuse with dressings see Appendix 5 (section A5.8.9)", "Name[Coal Tar Solution, BP] Solution, coal tar 20%, polysorbate \u201880\u2019 5%, in alcohol (96%), net\r\nprice 500\u00a0mL = \u00a38.16. \r\n Label:\r\n 15Excipients include polysorbatesDose\u00a0use 100\u00a0mL in a bathNote\u00a0Strong Coal Tar Solution\r\nBP contains coal tar 40%" ] }, "ALFUZOSIN HYDROCHLORIDE": { "indications": "Indications\u00a0benign prostatic hyperplasia", "name": "ALFUZOSIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers).; discontinue if angina\r\nworsens; acute heart failure; history of QT-interval\r\nprolongation; concomitant use with other drugs known to prolong QT\r\nintervalDriving\u00a0May affect performance of skilled tasks\r\ne.g. driving", "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported.; also less commonly flushes and chest pain; also reported liver damage and cholestasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/13894.htm", "doses": [ "2.5\u00a0mg 3 times daily, max. 10\u00a0mg daily; elderly initially 2.5\u00a0mg twice daily", "First dose may\r\ncause collapse due to hypotensive effect (therefore should be taken\r\non retiring to bed). Patient should be\r\nwarned to lie down if symptoms such as dizziness, fatigue or sweating\r\ndevelop, and to remain lying down until they abate completely" ] }, "ENALAPRIL MALEATE": { "indications": "Indications\u00a0hypertension; symptomatic heart failure (adjunct\u2014see section 2.5.5); prevention\r\nof symptomatic heart failure in patients with asymptomatic left ventricular\r\ndysfunction", "name": "ENALAPRIL MALEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "ENALAPRIL MALEATE" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also dyspnoea; depression, asthenia;\r\nblurred vision; less commonly dry mouth, peptic ulcer,\r\nanorexia, ileus; arrhythmias, palpitation, flushing; confusion, nervousness,\r\ndrowsiness, insomnia, vertigo; impotence; muscle cramps; tinnitus;\r\nalopecia, sweating; hyponatraemia; rarely stomatitis,\r\nglossitis, Raynaud\u2019s syndrome, pulmonary infiltrates, allergic alveolitis,\r\ndream abnormalities, gynaecomastia, Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, exfoliative dermatitis, pemphigus; very\r\nrarely gastro-intestinal angioedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2586.htm", "doses": [ "Hypertension, used alone, initially 5\u00a0mg once daily; if\r\nused in addition to diuretic (see notes above),\r\nor in renal impairment, lower initial doses may be required; usual\r\nmaintenance dose 20\u00a0mg once daily; max. 40\u00a0mg once daily", "Heart failure (adjunct), asymptomatic left ventricular dysfunction,\r\ninitially 2.5\u00a0mg once daily under close medical supervision (see notes above),\r\nincreased gradually over 2\u20134 weeks to 10\u201320\u00a0mg twice daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "STAVUDINE ": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs when\r\nno suitable alternative available and when prescribed for shortest\r\nperiod possible", "name": "STAVUDINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "STAVUDINE" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also history of peripheral neuropathy, excessive\r\nalcohol intake, concomitant use of isoniazid\u2014risk\r\nof peripheral neuropathy (see under Side-effects); history of pancreatitis or concomitant\r\nuse with other drugs associated with pancreatitis; interactions: Appendix 1 (stavudine)", "side-effects": "Side-effects\u00a0see notes above; also peripheral neuropathy (switch to another antiretroviral if peripheral neuropathy develops), abnormal dreams, cognitive dysfunction, drowsiness, depression,\r\npruritus; less commonly anxiety, gynaecomastia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57191.htm", "doses": [ "adult under 60\u00a0kg, 30\u00a0mg\r\nevery 12 hours preferably at least 1 hour before food; 60\u00a0kg and over,\r\n40\u00a0mg every 12 hours; child 1 month\u201318\r\nyears see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "PARECOXIB": { "indications": "Indications\u00a0short-term management of acute postoperative pain", "name": "PARECOXIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.2 Non-opioid analgesics" ], "cautions": "Cautions\u00a0section 10.1.1; dehydration; following coronary artery\r\nbypass graft surgery; interactions: Appendix 1 (NSAIDs)", "side-effects": "Side-effects\u00a0section 10.1.1; also flatulence, hypotension,\r\nhypoaesthesia, alveolar osteitis, postoperative anaemia, hypokalaemia,\r\nsweating; less commonly bradycardia, cardiovascular\r\nevents, pulmonary embolism, anorexia, malaise, hyperglycaemia, increased\r\nblood urea nitrogen, arthralgia, ecchymosis; rarely tachycardia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106534.htm", "doses": [ "By deep intramuscular injection or by intravenous injection, initially 40\u00a0mg,\r\nthen 20\u201340\u00a0mg every 6\u201312 hours when required for up to 3 days; max.\r\n80\u00a0mg daily; elderly weighing less\r\nthan 50\u00a0kg, initially 20\u00a0mg, then max. 40\u00a0mg daily; child under 18 years, not recommended" ], "pregnancy": "Pregnancy\u00a0section 10.1.1" }, "FLURBIPROFEN": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other musculoskeletal\r\ndisorders; mild to moderate pain including dysmenorrhoea; migraine;\r\npostoperative analgesia; sore throat (section 12.3.1)", "name": "FLURBIPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also stomatitis; less\r\ncommonly paraesthesia, confusion, hallucinations, and fatigue", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5224.htm", "doses": [ "adult and child over 12 years, 150\u2013200\u00a0mg daily in 2\u20134 divided\r\ndoses, increased in acute conditions to 300\u00a0mg daily", "Dysmenorrhoea, adult and child over 12 years, initially 100\u00a0mg, then 50\u2013100\u00a0mg\r\nevery 4\u20136 hours; max. 300\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ACARBOSE": { "indications": "Indications\u00a0diabetes mellitus inadequately controlled by diet or by diet with\r\noral antidiabetic drugs", "name": "ACARBOSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "ACARBOSE" ], "cautions": "Cautions\u00a0monitor liver function; may enhance hypoglycaemic effects of insulin and sulfonylureas (hypoglycaemic\r\nepisodes may be treated with oral glucose but not\r\nwith sucrose); interactions: Appendix\r\n1 (antidiabetics)", "side-effects": "Side-effects\u00a0flatulence, soft stools, diarrhoea (may need to\r\nreduce dose or withdraw), abdominal distention and pain; rarely, nausea, abnormal liver function tests and skin reactions; very rarely ileus, oedema, jaundice, and hepatitisNote\u00a0Antacids unlikely to be beneficial for treating\r\nside-effects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/7078.htm", "doses": [ "adult over 18 years, initially\r\n50\u00a0mg daily increased to 50\u00a0mg 3 times daily, then increased if necessary\r\nafter 6\u20138 weeks to 100\u00a0mg 3 times daily; max. 200\u00a0mg 3 times daily", "Tablets should be chewed with first\r\nmouthful of food or swallowed whole with a little liquid immediately\r\nbefore food. To counteract possible hypoglycaemia, patients receiving\r\ninsulin or a sulfonylurea as well as acarbose need\r\nto carry glucose (not sucrose\u2014acarbose interferes\r\nwith sucrose absorption)" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TIAPROFENIC ACID": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other\r\nmusculoskeletal disorders", "name": "TIAPROFENIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "TIAPROFENIC ACID" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5264.htm", "doses": [ "adult over 18 years, 300\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "GLATIRAMER ACETATE": { "indications": "Indications\u00a0 \n(From Glatiramer acetate: British National Formulary)\nGlatiramer acetate", "name": "GLATIRAMER ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Glatiramer acetate" ], "cautions": "Cautions\u00a0cardiac disorders", "side-effects": "Side-effects\u00a0hypersensitivity reactions; flushing, chest pain,\r\npalpitation, tachycardia, and dyspnoea may occur within minutes of\r\ninjection; nausea, constipation, dyspepsia; syncope, anxiety, asthenia,\r\ndepression, headache, tremor, sweating; oedema, lymphadenopathy; hypertonia,\r\nback pain, arthralgia, influenza-like symptoms; injection-site reactions,\r\nrash; rarely seizures", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88674.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 20\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "APREPITANT": { "indications": "Indications\u00a0adjunct to dexamethasone and a 5HT3-receptor antagonist\r\nin preventing nausea and vomiting associated with moderately and highly\r\nemetogenic chemotherapy", "name": "APREPITANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Neurokinin-receptor antagonists", "APREPITANT" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (aprepitant)", "side-effects": "Side-effects\u00a0hiccups, dyspepsia, diarrhoea, constipation, anorexia;\r\nasthenia, headache, dizziness; less commonly weight\r\nchanges, dry mouth, colitis, flatulence, stomatitis, abdominal pain,\r\nduodenal ulcer, taste disturbance, oedema, bradycardia, palpitations,\r\ncough, euphoria, anxiety, confusion, drowsiness, thirst, abnormal\r\ndreams, chills, hyperglycaemia, polyuria, anaemia, dysuria, haematuria,\r\nhyponatraemia, neutropenia, myalgia, conjunctivitis, pharyngitis,\r\nsneezing, tinnitus, sweating, pruritus, rash, acne, photosensitivity,\r\nand flushing; dyspnoea, insomnia, visual disturbances, dysarthria,\r\nurticaria, and Stevens-Johnson syndrome also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128411.htm", "doses": [ "adult over 18 years 125\u00a0mg\r\n1 hour before chemotherapy, then 80\u00a0mg daily as a single dose for\r\nthe next 2 days; consult product literature for dose of concomitant\r\ncorticosteroid and 5HT3-receptor antagonist" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014no\r\ninformation available" }, "MINOXIDIL": { "indications": "Indications\u00a0severe hypertension, in addition to a diuretic\r\nand a beta-blocker", "name": "MINOXIDIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "MINOXIDIL" ], "cautions": "Cautions\u00a0\n(From 2.5.1 Vasodilator antihypertensive drugs: British National Formulary)\nMinoxidil should be reserved for the treatment of severe hypertension resistant to other drugs. Vasodilatation is accompanied by increased cardiac output and tachycardia and the patients develop fluid retention. For this reason the addition of a beta-blocker and a diuretic (usually furosemide, in high dosage) are mandatory. Hypertrichosis is troublesome and renders this drug unsuitable for women. ; angina; after myocardial infarction (until stabilised); acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(vasodilator antihypertensives)", "side-effects": "Side-effects\u00a0sodium and water retention; weight gain, peripheral\r\noedema, tachycardia, hypertrichosis; reversible rise in creatinine\r\nand blood urea nitrogen; occasionally, gastro-intestinal disturbances,\r\nbreast tenderness, rashes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2541.htm", "doses": [ "Initially 5\u00a0mg (elderly, 2.5\u00a0mg) daily, in 1\u20132 divided doses, increased in steps of 5\u201310\u00a0mg\r\nat intervals of at least 3 days; max. 100\u00a0mg daily (seldom necessary\r\nto exceed 50\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014possible toxicity including reduced placental\r\nperfusion; neonatal hirsutism reported" }, "HALOPERIDOL": { "indications": "Indications\u00a0see under Dose; motor tics (section 4.9.3)", "name": "HALOPERIDOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also subarachnoid\r\nhaemorrhage; metabolic disturbances such as hypokalaemia, hypocalcaemia, or hypomagnesaemia; thyrotoxicosis; arteriosclerosis; dose\r\nadjustment may be necessary if smoking started or stopped during treatment", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning., but less\r\nsedating and fewer antimuscarinic or hypotensive symptoms; pigmentation\r\nand photosensitivity reactions rare; depression; weight loss; less commonly dyspnoea, oedema; rarely bronchospasm,\r\nhypoglycaemia, and inappropriate antidiuretic hormone secretion; hypertension,\r\nsweating, Stevens-Johnson syndrome, and toxic epidermal necrolysis\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3224.htm", "doses": [ "Schizophrenia and other psychoses, mania, short-term\r\nadjunctive management of psychomotor agitation, excitement, and violent\r\nor dangerously impulsive behaviour, adult and child over 12 years, by\r\nmouth, initially 0.5\u20133\u00a0mg 2\u20133 times daily or 3\u20135\u00a0mg 2\u20133 times daily in severely affected or resistant patients;\r\nin resistant schizophrenia up to 30\u00a0mg daily may be needed; adjusted\r\naccording to response to lowest effective maintenance dose (as low\r\nas 5\u201310\u00a0mg daily); elderly (or debilitated)\r\ninitially half adult dose", "By intramuscular or by\r\nintravenous injection, adult over 18 years, initially 2\u201310\u00a0mg, then every 4\u20138 hours according\r\nto response to total max. 18\u00a0mg daily; severely disturbed patients\r\nmay require initial dose of up to 18\u00a0mg; elderly (or debilitated) initially half adult dose", "Agitation and restlessness in the elderly, by mouth, initially 0.5\u20131.5\u00a0mg once or twice daily", "Short-term adjunctive management of severe anxiety, by\r\nmouth, adult over 18 years,\r\n500\u00a0micrograms twice daily", "Motor tics, adjunctive treatment in choreas and Tourette syndrome, by mouth, 0.5\u20131.5\u00a0mg 3 times daily adjusted according to\r\nresponse; 10\u00a0mg daily or more may occasionally be necessary in Tourette\r\nsyndrome; child 5\u201312 years, Tourette\r\nsyndrome, 12.5\u201325\u00a0microgram/kg twice daily, adjusted according to\r\nresponse up to max. 10\u00a0mg daily", "Intractable hiccup, by mouth, adult over 18 years, 1.5\u00a0mg 3 times daily adjusted\r\naccording to response", "Nausea and vomiting, see Prescribing in Palliative\r\nCare", "By intramuscular or intravenous\r\ninjection, 1\u20132\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "VINDESINE SULPHATE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\nThe vinca alkaloids, vinblastine, vincristine, and vindesine, are used to treat a variety of cancers including leukaemias, lymphomas, and some solid tumours (e.g. breast and lung cancer). Vinorelbine is a semi-synthetic vinca alkaloid; it is given intravenously or orally for the treatment of advanced breast cancer and for advanced non-small cell lung cancer. For the role of vinorelbine in the treatment of breast cancer, see section 8.3.4.1. Vinflunine is licensed as monotherapy for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a platinum-containing regimen.Neurotoxicity, usually as peripheral or autonomic neuropathy, occurs with all vinca alkaloids and is a limiting side-effect of vincristine; it occurs less often with vindesine, vinblastine, vinorelbine, and vinflunine. Patients with neurotoxicity commonly have peripheral paraesthesia, loss of deep tendon reflexes, abdominal pain, and constipation; ototoxicity has been reported. If symptoms of neurotoxicity are severe, doses should be reduced. Motor weakness can also occur, and increasing motor weakness calls for dose reduction or discontinuation of these drugs. Recovery from neurotoxic effects is usually slow but complete.Myelosuppression is a dose-limiting side-effect of vinblastine, vindesine, vinorelbine, and vinflunine; vincristine causes negligible myelosuppression. The vinca alkaloids cause severe local irritation and care must be taken to avoid extravasation. Severe bronchospasm has been reported following administration of the vinca alkaloids (more commonly when used in combination with mitomycin-C).", "name": "VINDESINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide", "VINDESINE SULPHATE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; neuromuscular disease; caution in handling", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; irritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4757.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "VARICELLA-ZOSTER VACCINE": { "indications": "Indications\u00a0immunisation against varicella infection\r\n(\n(From Varicella\u2013zoster vaccine: British National Formulary)\nVaricella\u2013zoster vaccine)", "name": "VARICELLA-ZOSTER VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Varicella\u2013zoster vaccine" ], "cautions": "Cautions\u00a0\n(From 14.1 Active immunity: British National Formulary)\nCautions\u00a0Most individuals can safely receive the majority of vaccines. Vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. See also Predisposition to Neurological Problems, below. For individuals with bleeding disorders, see Route of administration, below. If alcohol or disinfectant is used for cleansing the skin it should be allowed to evaporate before vaccination to prevent possible inactivation of live vaccines.When 2 or more vaccines are required (and are not available as a combined preparation), they should be given simultaneously at different sites, preferably in a different limb; if more than one injection is to be given in the same limb, they should be administered at least 2.5\u00a0cm apart (but see also BCG Vaccines). When 2 live vaccines cannot be given at the same time, they should be separated by an interval of at least 4 weeks. For interactions see Appendix 1 (vaccines).See also Cautions under individual vaccines ; also post-vaccination close-contact with susceptible individuals (\n(From Varicella\u2013zoster vaccine: British National Formulary)\nRarely, the varicella\u2013zoster vaccine virus has been transmitted from the vaccinated individual to close contacts. Therefore, contact with the following should be avoided if a vaccine-related cutaneous rash develops within 4\u20136 weeks of the first or second dose:varicella-susceptible pregnant women;individuals at high risk of severe varicella, including those with immunodeficiency or those receiving immunosuppressive therapy.Healthcare workers who develop a generalised papular or vesicular rash on vaccination should avoid contact with patients until the lesions have crusted. Those who develop a localised rash after vaccination should cover the lesions and be allowed to continue working unless in contact with patients at high risk of severe varicella.); interactions: Appendix 1 (vaccines) ", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nvaricella-like rash; rarely thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201187.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid pregnancy for 3 months after vaccination; see\r\nalso section 14.1" }, "SODIUM BICARBONATE": { "indications": "Indications\u00a0relief of\r\ndiscomfort in mild urinary-tract infections; alkalinisation of urine", "name": "SODIUM BICARBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.3 Drugs used in urological pain", "Alkalinisation of urine", "SODIUM BICARBONATE" ], "cautions": "Cautions\u00a0cardiac disease; patients on sodium-restricted diet; elderly; avoid prolonged use; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0eructation, alkalosis on prolonged use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104944.htm", "doses": [ "3\u00a0g in water every 2 hours until urinary pH exceeds 7;\r\nmaintenance of alkaline urine 5\u201310\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "SERTRALINE": { "indications": "Indications\u00a0see under Dose", "name": "SERTRALINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors", "SERTRALINE" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; pancreatitis, hepatitis, jaundice,\r\nliver failure, stomatitis, palpitation, hypertension, hypercholesterolaemia,\r\ntachycardia, postural hypotension, bronchospasm, amnesia, paraesthesia,\r\naggression, hypoglycaemia, hypothyroidism, hyperprolactinaemia, urinary\r\nincontinence, menstrual irregularities, leucopenia, and tinnitus also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3372.htm", "doses": [ "Depressive illness, initially 50\u00a0mg daily, increased if\r\nnecessary by increments of 50\u00a0mg at intervals of at least 1 week to\r\nmax. 200\u00a0mg daily; usual maintenance dose 50\u00a0mg daily; child under 18 years see BNF for Children and Depressive Illness in Children\r\nand Adolescents", "Obsessive-compulsive disorder, adult and child over 12 years initially\r\n50\u00a0mg daily, increased if necessary in steps of 50\u00a0mg at intervals\r\nof at least 1 week; max. 200\u00a0mg daily; child 6\u201312 years initially 25\u00a0mg daily, increased to 50\u00a0mg daily after\r\n1 week, further increased if necessary in steps of 50\u00a0mg at intervals\r\nof at least 1 week; max. 200\u00a0mg daily", "Panic disorder, post-traumatic stress disorder, or social anxiety\r\ndisorder, adult over 18 years, initially\r\n25\u00a0mg daily, increased after 1 week to 50\u00a0mg daily; if response is\r\npartial and if drug tolerated, dose increased in steps of 50\u00a0mg at\r\nintervals of at least 1 week to max. 200\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nPregnancy\u00a0Manufacturers advise that SSRIs should not be used during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when SSRIs are taken during early pregnancy. If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported; see also individual monographs." }, "LOPERAMIDE HYDROCHLORIDE": { "indications": "Indications\u00a0symptomatic treatment of acute diarrhoea; adjunct to rehydration\r\nin acute diarrhoea in adults and children over 4 years (but see notes\r\nabove); chronic diarrhoea in adults only", "name": "LOPERAMIDE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.2 Antimotility drugs", "LOPERAMIDE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 1.4 Acute diarrhoea: British National Formulary)\nHowever, antimotility drugs are not recommended for acute diarrhoea in young children.; interactions: Appendix 1 (loperamide)", "side-effects": "Side-effects\u00a0abdominal cramps, dizziness, drowsiness, and skin\r\nreactions including urticaria; paralytic ileus and abdominal bloating\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100273.htm", "doses": [ "Acute diarrhoea, 4\u00a0mg initially followed by 2\u00a0mg after\r\neach loose stool for up to 5 days; usual dose 6\u20138\u00a0mg daily; max. 16\u00a0mg\r\ndaily; child under 4 years not recommended;\r\n4\u20138 years, 1\u00a0mg 3\u20134 times daily for up to 3 days only; 8\u201312 years, 2\u00a0mg 4 times daily for up to 5 days", "Chronic diarrhoea in adults, initially, 4\u20138\u00a0mg daily in divided\r\ndoses, subsequently adjusted according to response and given in 2\r\ndivided doses for maintenance; max. 16\u00a0mg daily; child under 18 years see BNF for Children", "Faecal incontinence [unlicensed indication], initially 500\u00a0micrograms\r\ndaily, adjusted according to response; max. 16\u00a0mg daily in divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014no information available" }, "CO-FLUAMPICIL": { "indications": "Indications\u00a0mixed infections involving beta-lactamase-producing\r\nstaphylococci", "name": "CO-FLUAMPICIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.3 Broad-spectrum penicillins" ], "cautions": "Cautions\u00a0see under Ampicillin and Flucloxacillin; interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Ampicillin and Flucloxacillin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3739.htm", "doses": [ "By mouth, co-fluampicil, 250/250 every 6 hours, dose doubled in severe infections; child under 10 years half adult dose, dose doubled\r\nin severe infections", "By intramuscular or slow\r\nintravenous injection or by intravenous\r\ninfusion, co-fluampicil 250/250 every 6\r\nhours, dose doubled in severe infections; child under 2 years quarter adult dose, 2\u201310 years half adult dose, dose\r\ndoubled in severe infections" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TENOFOVIR DISOPROXIL": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral\r\ndrugs; chronic hepatitis B infection with either compensated\r\nliver disease (with evidence of viral replication, and histologically\r\ndocumented active liver inflammation or fibrosis) or decompensated liver disease", "name": "TENOFOVIR DISOPROXIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test renal function and serum phosphate before\r\ntreatment, then every 4 weeks (more frequently if at increased risk\r\nof renal impairment) for 1 year and then every 3 months, interrupt treatment if renal function deteriorates or serum phosphate\r\ndecreases; concomitant or recent use of nephrotoxic\r\ndrugs; interactions: Appendix 1 (tenofovir) Chronic hepatits B\u00a0 When treating\r\nchronic hepatitis B with tenofovir, monitor liver function tests every\r\n3 months and viral markers for hepatitis B every 3\u20136 months during\r\ntreatment (continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation)", "side-effects": "Side-effects\u00a0see notes above; also hypophosphataemia; rarely renal failure, proximal renal tubulopathy, nephrogenic\r\ndiabetes insipidus; also reported reduced bone density", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106524.htm", "doses": [ "adult over 18 years, 245\u00a0mg\r\nonce daily", "If a dose is more than 12 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "FUSIDIC ACID": { "indications": "Indications\u00a0staphylococcal skin infections; penicillin-resistant\r\nstaphylococcal infections (section 5.1.7); staphylococcal eye infections\r\n(section 11.3.1)", "name": "FUSIDIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.2 Antibacterial preparations also used systemically" ], "cautions": "Cautions\u00a0see notes above; avoid contact with eyes", "side-effects": "Side-effects\u00a0rarely hypersensitivity reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6137.htm", "doses": [ "Apply 3\u20134 times daily" ] }, "CEFTAZIDIME": { "indications": "Indications\u00a0see under Cefaclor; see also notes above", "name": "CEFTAZIDIME", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFTAZIDIME" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix\r\n1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3781.htm", "doses": [ "By deep intramuscular injection or intravenous injection or infusion, 1\u00a0g every 8 hours or 2\u00a0g\r\nevery 12 hours; 2\u00a0g every 8\u201312 hours or 3\u00a0g every\r\n12 hours in severe infections; single doses over 1\u00a0g intravenous route\r\nonly; elderly usual max. 3\u00a0g daily; child, up to 2 months 25\u201360\u00a0mg/kg daily in 2 divided\r\ndoses, over 2 months 30\u2013100\u00a0mg/kg daily in 2\u20133 divided doses; up to\r\n150\u00a0mg/kg daily (max. 6\u00a0g daily) in 3 divided doses if immunocompromised\r\nor meningitis; intravenous route recommended for children", "Urinary-tract and less serious infections, 0.5\u20131\u00a0g every 12\r\nhours", "Pseudomonal lung infection in cystic fibrosis, adult 100\u2013150\u00a0mg/kg daily in 3 divided doses; child up to 150\u00a0mg/kg daily (max. 6\u00a0g daily) in 3\r\ndivided doses; intravenous route recommended for children", "Surgical prophylaxis, prostatic surgery, 1\u00a0g up to 30 minutes\r\nbefore the procedure, repeated if necessary when catheter removed" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "NALOXONE HYDROCHLORIDE - ANALGESICS (OPIOID)": { "indications": "Indications\u00a0overdosage with opioids; reversal of postoperative\r\nrespiratory depression and reversal of neonatal respiratory and CNS\r\ndepression resulting from opioid administration to mother during labour\r\n(section 15.1.7)", "name": "NALOXONE HYDROCHLORIDE - ANALGESICS (OPIOID)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29533.htm", "doses": [ "By intravenous injection, 0.4\u20132\u00a0mg;\r\nif no response, repeat at intervals of 2\u20133 minutes to a max. of 10\u00a0mg\r\n(then review diagnosis); further doses may be required if respiratory\r\nfunction deteriorates; child 10\u00a0micrograms/kg;\r\nif no response, give subsequent dose of 100\u00a0micrograms/kg (then review\r\ndiagnosis); further doses may be required if respiratory function\r\ndeteriorates", "By subcutaneous or intramuscular injection, adult and child dose as for intravenous\r\ninjection but use only if intravenous route not feasible (onset of\r\naction slower)", "By continuous intravenous infusion using an infusion pump, adult and child, rate adjusted according to response (initially,\r\nrate may be set at 60% of the initial resuscitative intravenous\r\ninjection dose per hour)", "The initial resuscitative intravenous\r\ninjection dose is that which maintained satisfactory ventilation\r\nfor at least 15 minutes", "Doses used in acute opioid overdosage\r\nmay not be appropriate for the management of opioid-induced respiratory\r\ndepression and sedation in those receiving palliative care and in\r\nchronic opioid use; see also section 15.1.7 for management\r\nof postoperative respiratory depression" ], "pregnancy": "Pregnancy\u00a0section 15.1.7", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Analgesics (opioid)" ], "cautions": "Cautions\u00a0physical dependence on opioids; cardiac irritability; naloxone is short-acting, \n(From Analgesics (opioid): British National Formulary)\nAnalgesics (opioid)" }, "ASPIRIN (antiplatelet)": { "indications": "Indications\u00a0secondary prevention of thrombotic cerebrovascular\r\nor cardiovascular disease, and following by-pass surgery (see also section 2.10.1 and notes above)", "name": "ASPIRIN (antiplatelet)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs" ], "cautions": "Cautions\u00a0asthma; uncontrolled\r\nhypertension; previous peptic ulceration (but manufacturers may advise avoidance of low-dose aspirin in history of peptic ulceration); concomitant use of\r\ndrugs that increase risk of bleeding; G6PD\r\ndeficiency (section 9.1.5); dehydration; elderly; interactions: Appendix 1 (aspirin)", "side-effects": "Side-effects\u00a0bronchospasm; gastro-intestinal irritation, gastro-intestinal\r\nhaemorrhage (occasionally major), also other haemorrhage (e.g. subconjunctival)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2803.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0use with caution during third trimester; impaired\r\nplatelet function and risk of haemorrhage; delayed onset and increased\r\nduration of labour with increased blood loss; avoid analgesic doses\r\nif possible in last few weeks (low doses probably not harmful); with\r\nhigh doses, closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of newborn; kernicterus\r\nin jaundiced neonates" }, "TEMAZEPAM": { "indications": "Indications\u00a0premedication before surgery or investigatory\r\nprocedures; conscious sedation for dental procedures [unlicensed];\r\nhypnotic (section 4.1.1)", "name": "TEMAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nanxiolytic and sedative effects last about 90 minutes although there may be residual drowsiness and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\nrespiratory disease, muscle weakness and myasthenia gravis, history of drug or alcohol abuse, marked personality disorder; reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal thereafter); special precautions for intravenous injection (section 4.8.2); acute porphyria (section 9.8.2); when given parenterally, close observation required until full recovery from sedation; interactions: Appendix 1 (anxiolytics and hypnotics); interactions: Appendix 1 (anxiolytics and hypnotics)", "side-effects": "Side-effects\u00a0see notes above and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6603.htm", "doses": [ "By mouth, premedication, adult, 10\u201320\u00a0mg (up to 30\u00a0mg in exceptional circumstances)\r\n1\u20132 hours before procedure; elderly 10\u00a0mg (up to 20\u00a0mg in exceptional circumstances); child 12\u201318 years see BNF for Children", "By mouth, conscious sedation for dental procedures, adult over 18 years, 15\u201330\u00a0mg 30\u201360 minutes before\r\nprocedure", "Temazepam doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.1" }, "CIPROFLOXACIN - QUINOLONES": { "indications": "Indications\u00a0see notes above and under Dose; eye infections (%s\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials)", "name": "CIPROFLOXACIN - QUINOLONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; avoid excessive alkalinity of urine and ensure adequate fluid intake (risk of crystalluria); interactions: Appendix 1 (quinolones)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving); effects enhanced\r\nby alcohol", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.;\r\nalso flatulence, pain and phlebitis at injection site; rarely dysphagia, pancreatitis, chest pain, tachycardia, syncope, oedema,\r\nhot flushes, abnormal dreams, sweating, hyperglycaemia, and erythema\r\nnodosum; very rarely movement disorders, tinnitus,\r\nand tenosynovitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3945.htm", "doses": [ "By mouth, respiratory-tract infections,\r\n500\u2013750\u00a0mg twice daily (750\u00a0mg twice daily in pseudomonal lower respiratory-tract\r\ninfection in cystic fibrosis)", "Urinary-tract infections, 250\u2013750\u00a0mg twice daily (250\u00a0mg twice\r\ndaily for 3 days usually adequate for acute uncomplicated cystitis\r\nin women)", "Acute or chronic prostatitis, 500\u00a0mg twice daily for 28 days", "Gonorrhoea (see also Table 1, section 5.1), 500\u00a0mg as a single dose", "Most other infections, 500\u00a0mg twice daily (increased to 750\u00a0mg\r\ntwice daily in severe or deep-seated infection)", "Surgical prophylaxis [unlicensed], 750\u00a0mg 60 minutes before\r\nprocedure", "Prophylaxis of meningococcal meningitis, Table 2, section 5.1", "By intravenous infusion over 60 minutes,\r\n400\u00a0mg every 8\u201312 hours", "Anthrax (treatment and post-exposure prophylaxis,\r\nsee notes above), by mouth, 500\u00a0mg\r\ntwice daily", "By intravenous infusion over 60 minutes, 400\u00a0mg\r\nevery 12 hours", "child under 18 years\r\nsee BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "Vitamin and mineral supplements and adjuncts to synthetic diets": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.7 Multivitamin preparations" ], "name": "Vitamin and mineral supplements and adjuncts to synthetic diets", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5167.htm", "doses": [ "prevention of vitamin deficiency in disorders of carbohydrate\r\nor amino-acid metabolism and adjunct in restricted, specialised, or\r\nsynthetic diets, 1 tablet 3 times daily; use with Ketovite\u00ae Liquid for complete vitamin supplementation", "prevention of vitamin deficiency in disorders of carbohydrate\r\nor amino-acid metabolism and adjunct in restricted, specialised, or\r\nsynthetic diets, 5\u00a0mL daily; use with Ketovite\u00ae Tablets for complete vitamin supplementation" ] }, "ASCORBIC ACID": { "indications": "Indications\u00a0prevention and treatment of scurvy", "name": "ASCORBIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.3 Vitamin C", "ASCORBIC ACID" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (vitamins)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5127.htm", "doses": [ "Prophylactic, 25\u201375\u00a0mg daily; therapeutic, not less than\r\n250\u00a0mg daily in divided doses" ] }, "HYDROCORTISONE": { "indications": "Indications\u00a0mild inflammatory skin disorders such as eczemas\r\n(but for over-the-counter preparations, see below); nappy rash (see\r\nalso section 13.2.2)", "name": "HYDROCORTISONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "HYDROCORTISONE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/15416.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "VARDENAFIL": { "indications": "Indications\u00a0erectile dysfunction", "name": "VARDENAFIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.5 Drugs for erectile dysfunction", "Phosphodiesterase type-5 inhibitors", "VARDENAFIL" ], "cautions": "Cautions\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nCautions\u00a0Sildenafil, tadalafil, and vardenafil should be used with caution in cardiovascular disease, left ventricular outflow obstruction, anatomical deformation of the penis (e.g. angulation, cavernosal fibrosis, Peyronie\u2019s disease), and in those with a predisposition to priapism (e.g. in sickle-cell disease, multiple myeloma, or leukaemia). Concomitant treatment with a phosphodiesterase type-5 inhibitor and an alpha-blocker (section 2.5.4 and section 7.4.1) can increase the risk of postural hypotension\u2014initiate treatment with a phosphodiesterase type-5 inhibitor (at a low dose) only once the patient is stable on the alpha-blocker; see also interactions: Appendix 1 (sildenafil, tadalafil, vardenafil).; also elderly; bleeding disorders or active peptic ulceration; susceptibility to prolongation of QT interval (including concomitant use of drugs which prolong QT interval); interactions: Appendix 1 (vardenafil)", "side-effects": "Side-effects\u00a0\n(From Phosphodiesterase type-5 inhibitors: British National Formulary)\nThe side-effects of sildenafil, tadalafil, and vardenafil include dyspepsia, nausea, vomiting, headache (including migraine), flushing, dizziness, myalgia, back pain, visual disturbances (non-arteritic anterior ischaemic optic neuropathy has been reported\u2014stop drug if sudden visual impairment occurs), and nasal congestion. Less common side-effects include painful red eyes, palpitation, tachycardia, hypotension, hypertension, epistaxis. Other side-effects reported rarely include syncope, hypersensitivity reactions (including rash, facial oedema, and Stevens-Johnson syndrome), and priapism. Serious cardiovascular events (including arrhythmia, unstable angina, and myocardial infarction), seizures, sudden hearing loss (discontinue drug and seek medical advice), and retinal vascular occlusion have also been reported. ; also less commonly drowsiness, dyspnoea, increased lacrimation,\r\nphotosensitivity; rarely anxiety, transient amnesia,\r\nhypertonia, and raised intra-ocular pressure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127955.htm", "doses": [ "See under preparations", "adult over 18 years, initially\r\n10\u00a0mg (patients on alpha-blocker therapy 5\u00a0mg) approx. 25\u201360 minutes\r\nbefore sexual activity, subsequent doses adjusted according to response\r\nup to max. 20\u00a0mg as a single dose; max. 1 dose in 24 hours ", " Onset of effect may be delayed if taken\r\nwith high-fat meal", "adult over 18 years, 10\u00a0mg\r\napprox. 60 minutes before sexual activity; max. 10\u00a0mg in 24 hours\r\n(dose form not suitable for patients with moderate hepatic impairment,\r\nor for initiation of therapy in patients taking alpha-blockers, or\r\nif eGFR less than 30\u00a0mL/minute/1.73m2)" ] }, "AZITHROMYCIN": { "indications": "Indications\u00a0respiratory-tract infections; otitis media; skin and soft-tissue\r\ninfections; uncomplicated gonorrhoea [unlicensed indication], uncomplicated\r\ngenital chlamydial infections and non-gonococcal urethritis (see also\r\nTable 1, section 5.1); mild or moderate typhoid due\r\nto multiple-antibacterial-resistant organisms [unlicensed indication];\r\nLyme disease (see also section 5.1.1.3 [unlicensed indication]); prophylaxis\r\nof group A streptococcal infection (Table 2, section 5.1)", "name": "AZITHROMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides" ], "cautions": "Cautions\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nOral infections\u00a0The macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved. However, many organisms are now resistant to macrolides or rapidly develop resistance; their use should therefore be limited to short courses. Metronidazole (section 5.1.11) may be preferred as an alternative to a penicillin.Cautions\u00a0Macrolides should be used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. ; interactions: Appendix 1 (macrolides)", "side-effects": "Side-effects\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nSide-effects\u00a0Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-effects of the macrolides, but they are mild and less frequent with azithromycin and clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice) and rash occur less frequently. Other side-effects reported rarely or very rarely include pancreatitis, antibiotic-associated colitis, QT interval prolongation, arrhythmias, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Generally reversible hearing loss (sometimes with tinnitus) has been reported after large doses of a macrolide; it occurs commonly after long-term therapy with azithromycin. Intravenous infusion may cause local tenderness and phlebitis.; also\r\nanorexia, dyspepsia, flatulence, dizziness, headache, malaise, paraesthesia,\r\narthralgia, disturbances in taste and vision; less commonly constipation, gastritis, chest pain, oedema, anxiety, sleep disturbances,\r\nhypoaesthesia, leucopenia, photosensitivity; rarely agitation; also reported syncope, convulsions, smell disturbances,\r\ninterstitial nephritis, acute renal failure, thrombocytopenia, haemolytic\r\nanaemia, tongue discoloration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3859.htm", "doses": [ "500\u00a0mg once daily for 3 days or 500\u00a0mg\r\non first day then 250\u00a0mg once daily for 4 days; child over 6 months 10\u00a0mg/kg once daily for 3 days; or body-weight 15\u201325\u00a0kg, 200\u00a0mg once daily for 3 days; body-weight\r\n26\u201335\u00a0kg, 300\u00a0mg once daily for 3 days; body-weight 36\u201345\u00a0kg, 400\u00a0mg\r\nonce daily for 3 days", "Uncomplicated gonorrhoea [unlicensed indication] (see also Table\r\n1, section 5.1), uncomplicated genital chlamydial\r\ninfections and non-gonococcal urethritis, 1\u00a0g as a single dose", "Lyme disease (see also section 5.1.1.3), typhoid [unlicensed indications],\r\n500\u00a0mg once daily for 7\u201310 days (7 days in typhoid)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if adequate alternatives\r\nnot available" }, "EPINASTINE HYDROCHLORIDE": { "indications": "Indications\u00a0seasonal allergic conjunctivitis", "name": "EPINASTINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations" ], "side-effects": "Side-effects\u00a0burning; less commonly taste\r\ndisturbance, headache, conjunctival hyperaemia, dry eye, eye pruritus,\r\nvisual disturbance, increased lacrimation, eye pain, nasal irritation,\r\nrhinitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128430.htm", "doses": [ "adult and adolescent over 12 years, apply twice daily; max.\r\nduration of treatment 8 weeks" ] }, "VINCRISTINE SULPHATE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\nThe vinca alkaloids, vinblastine, vincristine, and vindesine, are used to treat a variety of cancers including leukaemias, lymphomas, and some solid tumours (e.g. breast and lung cancer). Vinorelbine is a semi-synthetic vinca alkaloid; it is given intravenously or orally for the treatment of advanced breast cancer and for advanced non-small cell lung cancer. For the role of vinorelbine in the treatment of breast cancer, see section 8.3.4.1. Vinflunine is licensed as monotherapy for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a platinum-containing regimen.Neurotoxicity, usually as peripheral or autonomic neuropathy, occurs with all vinca alkaloids and is a limiting side-effect of vincristine; it occurs less often with vindesine, vinblastine, vinorelbine, and vinflunine. Patients with neurotoxicity commonly have peripheral paraesthesia, loss of deep tendon reflexes, abdominal pain, and constipation; ototoxicity has been reported. If symptoms of neurotoxicity are severe, doses should be reduced. Motor weakness can also occur, and increasing motor weakness calls for dose reduction or discontinuation of these drugs. Recovery from neurotoxic effects is usually slow but complete.Myelosuppression is a dose-limiting side-effect of vinblastine, vindesine, vinorelbine, and vinflunine; vincristine causes negligible myelosuppression. The vinca alkaloids cause severe local irritation and care must be taken to avoid extravasation. Severe bronchospasm has been reported following administration of the vinca alkaloids (more commonly when used in combination with mitomycin-C).", "name": "VINCRISTINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; neuromuscular disease; caution in handling; interactions: Appendix 1 (vincristine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also rarely inappropriate secretion of antidiuretic\r\nhormone; diarrhoea, intestinal necrosis, paralytic ileus, seizures,\r\nurinary retention, muscle wasting, and eye disorders also reported;\r\nirritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4753.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenicity and fetal loss in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "ABRASIVE AGENTS ": { "indications": "Indications\u00a0acne vulgaris (but see notes above)", "name": "ABRASIVE AGENTS ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Other topical preparations for acne", "ABRASIVE AGENTS" ], "cautions": "Cautions\u00a0avoid contact with eyes; discontinue use temporarily if skin becomes irritated", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19883.htm", "doses": [ "use instead of soap 1\u20133 times daily" ] }, "IPRATROPIUM BROMIDE - ANTIMUSCARINIC BRONCHODILATORS": { "indications": "Indications\u00a0reversible airways obstruction, particularly\r\nin chronic obstructive pulmonary disease; rhinitis (section 12.2.2)", "name": "IPRATROPIUM BROMIDE - ANTIMUSCARINIC BRONCHODILATORS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.2 Antimuscarinic bronchodilators" ], "cautions": "Cautions\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nCautions\u00a0Antimuscarinic bronchodilators should be used with caution in patients with prostatic hyperplasia, bladder outflow obstruction, and those susceptible to angle-closure glaucoma (see below); interactions: Appendix 1 (antimuscarinics).Glaucoma\u00a0Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists); care needed to protect patient\u2019s eyes from nebulised drug or from drug powder.", "side-effects": "Side-effects\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nSide-effects\u00a0Dry mouth is the most common side-effect of antimuscarinic bronchodilators; also constipation, cough, paradoxical bronchospasm, headache, dizziness; less commonly nausea, tachycardia, palpitation, atrial fibrillation, urinary retention, eye pain, corneal oedema, angle-closure glaucoma, blurred vision, stomatitis, rash, and pruritus can occur. Raised intra-ocular pressure and urticaria have occurred rarely.; also\r\nthroat irritation; less commonly vomiting, diarrhoea,\r\nlaryngospasm, pharyngeal oedema, conjunctival hyperaemia, mydriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2925.htm", "doses": [ "By aerosol inhalation, 20\u201340\u00a0micrograms\r\n3\u20134 times daily; child up to 6 years\r\n20\u00a0micrograms 3 times daily, 6\u201312 years 20\u201340\u00a0micrograms 3 times daily", "By inhalation of powder, adult and child over\r\n12 years, 40\u00a0micrograms 3\u20134 times daily (may be doubled in less responsive\r\npatients)", "By inhalation of nebulised solution, reversible airways obstruction in chronic obstructive pulmonary\r\ndisease, 250\u2013500\u00a0micrograms 3\u20134 times daily", "Acute bronchospasm (but see also Management of Acute Asthma\r\ntable),\r\n500\u00a0micrograms repeated as necessary; child under 5 years 125\u2013250\u00a0micrograms, max. 1\u00a0mg daily; 6\u201312 years 250\u00a0micrograms,\r\nmax. 1\u00a0mg daily", "Advise patient not\r\nto exceed prescribed dose and to follow manufacturer\u2019s directions" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "GRASS AND TREE POLLEN EXTRACTS": { "indications": "Indications\u00a0treatment of seasonal allergic hay\r\nfever due to grass or tree pollen in patients who have failed to respond\r\nto anti-allergy drugs (\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\nImmunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or extracts of grass and tree pollen can reduce symptoms of asthma and allergic rhinoconjunctivitis. A vaccine containing extracts of wasp and bee venom is used to reduce the risk of severe anaphylaxis and systemic reactions in individuals with hypersensitivity to wasp and bee stings. An oral preparation of grass pollen extract (Grazax\u00ae) is also licensed for grass pollen-induced rhinitis and conjuctivitis. Those requiring immunotherapy must be referred to a hospital specialist for accurate diagnosis, assessment, and treatment.In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for the following indications:seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs;hypersensitivity to wasp and bee venoms.Desensitising vaccines should generally be avoided or used with particular care in patients with asthma.)", "name": "GRASS AND TREE POLLEN EXTRACTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.2 Allergen immunotherapy" ], "cautions": "Cautions\u00a0\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\nImmunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or extracts of grass and tree pollen can reduce symptoms of asthma and allergic rhinoconjunctivitis. A vaccine containing extracts of wasp and bee venom is used to reduce the risk of severe anaphylaxis and systemic reactions in individuals with hypersensitivity to wasp and bee stings. An oral preparation of grass pollen extract (Grazax\u00ae) is also licensed for grass pollen-induced rhinitis and conjuctivitis. Those requiring immunotherapy must be referred to a hospital specialist for accurate diagnosis, assessment, and treatment.In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for the following indications:seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs;hypersensitivity to wasp and bee venoms.Desensitising vaccines should generally be avoided or used with particular care in patients with asthma. and consult product literature", "side-effects": "Side-effects\u00a0\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\n3.4.2 Allergen immunotherapy and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86805.htm", "doses": [ "See under preparations below" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DANTROLENE SODIUM - SKELETAL MUSCLE RELAXANTS": { "indications": "Indications\u00a0chronic severe spasticity of voluntary muscle;\r\nmalignant hyperthermia (section 15.1.8)", "name": "DANTROLENE SODIUM - SKELETAL MUSCLE RELAXANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants" ], "cautions": "Cautions\u00a0impaired cardiac and pulmonary function; therapeutic effect may take a few weeks to develop\u2014discontinue\r\nif no response within 6\u20138 weeks; interactions: Appendix 1 (muscle relaxants).Hepatotoxicity\u00a0Potentially life-threatening\r\nhepatotoxicity reported, usually if doses greater than 400\u00a0mg daily\r\nused, in females, patients over 30 years, if history of liver disorders,\r\nor concomitant use of hepatotoxic drugs; test liver function before and at intervals during therapy\u2014discontinue if abnormal liver function tests or symptoms of liver\r\ndisorder (counselling, see below); re-introduce only if complete reversal\r\nof hepatotoxicityCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek prompt\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain, dark urine, or pruritus developDriving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0diarrhoea (withdraw if severe, discontinue treatment\r\nif recurs on re-introduction), nausea, vomiting, anorexia, hepatotoxicity\r\n(see above), abdominal pain; pericarditis; pleural effusion, respiratory\r\ndepression; headache, drowsiness, dizziness, asthenia, fatigue, seizures,\r\nfever, chills; speech and visual disturbances; rash; less\r\ncommonly dysphagia, constipation, exacerbation of cardiac\r\ninsufficiency, tachycardia, erratic blood pressure, dyspnoea, depression,\r\nconfusion, nervousness, insomnia, increased urinary frequency, urinary\r\nincontinence or retention, haematuria, crystalluria, and increased\r\nsweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5338.htm", "doses": [ "Initially 25\u00a0mg daily, may be increased at weekly intervals\r\nto max. 100\u00a0mg 4 times daily; usual dose 75\u00a0mg 3 times daily; child 5\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid use in chronic spasticity\u2014embryotoxic in animal studies" }, "LEVOFOLINIC ACID Calcium levofolinate": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nThe calcium salt of levofolinic acid, a single isomer of folinic acid, is also used for rescue therapy following methotrexate administration, for cases of methotrexate overdose, and for use with fluorouracil for colorectal cancer. The dose of calcium levofolinate is generally half that of calcium folinate.", "name": "LEVOFOLINIC ACID Calcium levofolinate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression", "LEVOFOLINIC ACID", "Calcium levofolinate" ], "cautions": "Cautions\u00a0see Folinic acid", "side-effects": "Side-effects\u00a0see Folinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202611.htm", "doses": [ "See under preparations", "Name[Calcium Levofolinate (Non-proprietary) ] Injection, levofolinic acid (as\r\ncalcium salt) 10\u00a0mg/mL, net price 17.5-mL vial = \u00a384.63" ], "pregnancy": "Pregnancy\u00a0see Folinic acid" }, "MEFLOQUINE": { "indications": "Indications\u00a0chemoprophylaxis of malaria, treatment\r\nof malaria, see notes above", "name": "MEFLOQUINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Mefloquine" ], "cautions": "Cautions\u00a0cardiac conduction disorders; epilepsy (avoid for prophylaxis); not recommended in infants under\r\n3 months (5\u00a0kg); interactions: Appendix\r\n1 (mefloquine)Driving\u00a0Dizziness or a disturbed sense of balance may\r\naffect performance of skilled tasks (e.g. driving); effects may persist\r\nfor up to 3 weeks", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, abdominal pain, diarrhoea;\r\nheadache, dizziness, sleep disturbances; less frequently anorexia, bradycardia, fatigue, abnormal dreams, fever, tinnitus,\r\nand neuropsychiatric reactions (including sensory and motor neuropathies,\r\ntremor, ataxia, anxiety, depression, panic attacks, agitation, hallucinations,\r\npsychosis, convulsions); rarely suicidal ideation; very rarely pneumonitis; also reported, circulatory disorders\r\n(including hypotension and hypertension), chest pain, tachycardia,\r\npalpitation, cardiac conduction disorders, oedema, dyspnoea, encephalopathy,\r\nleucopenia, leucocytosis, thrombocytopenia, muscle weakness, myalgia,\r\narthralgia, visual disturbances, vestibular disorders, rash (including\r\nStevens-Johnson syndrome), pruritus, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4019.htm", "doses": [ "Prophylaxis of malaria, preferably started 2\u00bd weeks before\r\nentering endemic area and continued for 4 weeks after leaving (see\r\nnotes above), adult and child body-weight over 45\u00a0kg, 250\u00a0mg once weekly;\r\nbody-weight 6\u201316\u00a0kg, 62.5\u00a0mg once weekly; body-weight 16\u201325\u00a0kg, 125\u00a0mg\r\nonce weekly; body-weight 25\u201345\u00a0kg, 187.5\u00a0mg once weekly", "Treatment of malaria, see notes above", "Inform travellers about adverse reactions\r\nof mefloquine and, if they occur, to seek medical advice on alternative\r\nantimalarials before the next dose is due. Also warn travellers about importance of avoiding mosquito bites, importance of taking prophylaxis regularly, and importance of immediate visit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "Mefloquine doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises adequate contraception during\r\nprophylaxis and for 3 months after stopping (teratogenicity in animal studies), but see also Prophylaxis Against Malaria" }, "4.7.2 Opioid analgesics": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics" ], "name": "4.7.2 Opioid analgesics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3491.htm", "doses": [] }, "ALPHA TOCOPHERYL ACETATE": { "indications": "Indications\u00a0\n(From 9.6.5 Vitamin E: British National Formulary)\n9.6.5 Vitamin E", "name": "ALPHA TOCOPHERYL ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.5 Vitamin E", "ALPHA TOCOPHERYL ACETATE" ], "cautions": "Cautions\u00a0predisposition to thrombosis; increased risk of necrotising enterocolitis in neonate\r\nweighing less than 1.5\u00a0kg; interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0diarrhoea and abdominal pain with doses more than\r\n1\u00a0g daily", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5148.htm", "doses": [ "malabsorption in cystic fibrosis, 100\u2013200\u00a0mg daily; child 1 month\u20131 year 50\u00a0mg daily; 1\u201312 years, 100\u00a0mg\r\ndaily" ], "pregnancy": "Pregnancy\u00a0no evidence of safety of high doses" }, "NEOSTIGMINE WITH GLYCOPYRRONIUM BROMIDE": { "indications": "Indications\u00a0see under Dose", "name": "NEOSTIGMINE WITH GLYCOPYRRONIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.6 Drugs for reversal of neuromuscular blockade", "Anticholinesterases", "NEOSTIGMINE WITH GLYCOPYRRONIUM BROMIDE" ], "cautions": "Cautions\u00a0bronchospasm; severe bradycardia; coronary artery disease; congestive heart failure; arrhythmias; hyperthyroidism; hypertension; pyrexia; epilepsy; parkinsonism; susceptibility to angle-closure glaucoma; interactions: Appendix 1 (parasympathomimetics,\r\nantimuscarinics)", "side-effects": "Side-effects\u00a0nausea, vomiting, changes in salivation, diarrhoea;\r\ntransient bradycardia (followed by tachycardia, palpitation, and arrhythmias);\r\nchanges in bronchial secretions; urinary urgency and retention; dilatation\r\nof the pupils with loss of accommodation; very rarely angle-closure glaucoma; signs of overdosage with neostigmine include bronchoconstriction, increased bronchial secretions, lacrimation,\r\nexcessive sweating, involuntary defaecation and micturition, miosis,\r\nnystagmus, bradycardia, heart block, arrhythmias, hypotension, agitation,\r\nexcessive dreaming, and weakness (leading to fasciculation and paralysis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203951.htm", "doses": [ "See under preparation", "reversal of non-depolarising neuromuscular blockade, by intravenous injection over 10\u201330 seconds, 1\u20132\u00a0mL or 0.02\u00a0mL/kg, dose may be repeated if required (total max.\r\n2\u00a0mL); child 0.02\u00a0mL/kg (or 0.2\u00a0mL/kg\r\nof a 1 in 10 dilution using water for injections or sodium chloride\r\ninjection 0.9%), dose may be repeated if required (total max. 2\u00a0mL)" ], "pregnancy": "Pregnancy\u00a0safety not established\u2014limited information available" }, "OLANZAPINE EMBONATE": { "indications": "Indications\u00a0maintenance in schizophrenia in patients\r\ntolerant to olanzapine by mouth", "name": "OLANZAPINE EMBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "OLANZAPINE EMBONATE" ], "cautions": "Cautions\u00a0see under Olanzapine (section 4.2.1) and notes above; observe patient for at least 3 hours after injection", "side-effects": "Side-effects\u00a0see under Olanzapine (section 4.2.1) and notes above;\r\npost-injection reactions have been reported leading to signs and symptoms\r\nof overdose", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204079.htm", "doses": [ "By deep intramuscular injection into the\r\ngluteal muscle, adult 18\u201375 years, patients taking oral olanzapine 10\u00a0mg daily, initially 210\u00a0mg\r\nevery 2 weeks or 405\u00a0mg every 4 weeks, then maintenance\r\ndose after 2 months treatment, 150\u00a0mg every 2 weeks or 300\u00a0mg every 4 weeks; patients taking oral olanzapine 15\u00a0mg\r\ndaily, initially 300\u00a0mg every 2 weeks, then maintenance dose\r\nafter 2 months treatment, 210\u00a0mg every 2 weeks or 405\u00a0mg every 4 weeks; patients taking oral olanzapine 20\u00a0mg\r\ndaily, initially 300\u00a0mg every 2 weeks, then maintenance dose\r\nafter 2 months treatment 300\u00a0mg every 2 weeks; dose adjusted according\r\nto response; max. 300\u00a0mg every 2 weeks" ], "pregnancy": "Pregnancy\u00a0see under Olanzapine (section 4.2.1)" }, "TRIENTINE DIHYDROCHLORIDE": { "indications": "Indications\u00a0Wilson\u2019s disease in patients intolerant of penicillamine", "name": "TRIENTINE DIHYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Wilson\u2019s disease", "TRIENTINE DIHYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From Wilson\u2019s disease: British National Formulary)\nTrientine is used for the treatment of Wilson\u2019s disease only in patients intolerant of penicillamine; it is not an alternative to penicillamine for rheumatoid arthritis or cystinuria. Penicillamine-induced systemic lupus erythematosus may not resolve on transfer to trientine.; interactions: Appendix 1 (trientine)", "side-effects": "Side-effects\u00a0nausea, rash; very rarely anaemia;\r\nduodenitis and colitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5180.htm", "doses": [ "adult and child over 12 years, 1.2\u20132.4\u00a0g daily in 2\u20134 divided\r\ndoses before food; child 2\u201312 years,\r\ninitially 0.6\u20131.5\u00a0g daily in 2\u20134 divided doses before food, adjusted\r\naccording to response" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; monitor maternal and neonatal serum-copper concentration;\r\nteratogenic in animal studies" }, "TESTOSTERONE AND ESTERS Buccal": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS Buccal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS", "Buccal" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128340.htm", "doses": [ "See under preparations", "Name[Striant\u00ae SR (The Urology Co. ) ] Mucoadhesive buccal tablets, m/r,\r\ntestosterone 30\u00a0mg, net price 60-tab pack = \u00a328.00. \r\n Label:\r\n Counselling, see under Dose belowDose\u00a0hypogonadism, 30\u00a0mg every 12 hours; child and adolescent under 18 years not\r\nrecommendedCounselling\u00a0Place rounded side of tablet on gum\r\nabove front teeth and hold lip firmly over the gum for 30 seconds.\r\nIf tablet detaches within 4 hours of next dose, replace with new tablet\r\nwhich is considered the second dose for the day." ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "ETOPOSIDE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\nEtoposide may be given orally or by slow intravenous infusion, the oral dose being double the intravenous dose. A preparation containing etoposide phosphate can be given by intravenous injection or infusion. Etoposide is usually given daily for 3\u20135 days and courses should not be repeated more frequently than at intervals of 21 days. It has particularly useful activity in small cell carcinoma of the bronchus, the lymphomas, and testicular cancer.", "name": "ETOPOSIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide", "ETOPOSIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (etoposide)", "side-effects": "Side-effects\u00a0see section 8.1; irritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4749.htm", "doses": [ "By mouth, 120\u2013240\u00a0mg/m2 daily\r\nfor 5 days", "By intravenous infusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "GLUTARALDEHYDE": { "indications": "Indications\u00a0warts, particularly plantar warts", "name": "GLUTARALDEHYDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses" ], "cautions": "Cautions\u00a0protect surrounding skin; not for application to face, mucosa,\r\nor anogenital areas", "side-effects": "Side-effects\u00a0rashes, skin irritation (discontinue if severe);\r\nstains skin brown", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6065.htm", "doses": [ "Apply twice daily (see also under Salicylic acid)" ] }, "HEPATITIS B IMMUNOGLOBULIN For subcutaneous use": { "indications": "Indications\u00a0prophylaxis against hepatitis B infection", "name": "HEPATITIS B IMMUNOGLOBULIN For subcutaneous use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Hepatitis B", "HEPATITIS B IMMUNOGLOBULIN", "For subcutaneous use" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines see under Normal Immunoglobulin.", "side-effects": "Side-effects\u00a0injection site reactions; less frequently, buccal\r\nulceration, glossitis, abdominal pain, chest pain, dyspnoea, anaphylaxis,\r\ntremor, dizziness, headache, arthralgia; for side-effects associated\r\nwith intravenous immunoglobulin, see section 14.5.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213808.htm", "doses": [ "See under preparations and see also notes above", "Name[Zutectra\u00ae (Biotest UK) ] Injection, hepatitis B-specific\r\nimmunoglobulin, 500\u00a0units/mL, net price 5 \u00d7 1-mL prefilled syringes\r\n= \u00a31500.00Dose\u00a0prevention of hepatitis B re-infection more than 6 months\r\nafter liver transplantation in stable HBV-DNA negative patients starting\r\n2\u20133 weeks after last dose of intravenous hepatitis B immunoglobulin, by subcutaneous injection, adult body-weight under 75\u00a0kg 500\u00a0units once weekly, increased if necessary\r\nup to 1000\u00a0units once weekly; body-weight over 75\u00a0kg 1000\u00a0units once\r\nweekly" ] }, "CERTOLIZUMAB PEGOL": { "indications": "Indications\u00a0see under Cytokine Modulators above", "name": "CERTOLIZUMAB PEGOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; monitor for infection before, during, and for 5 months\r\nafter treatment (see also Tuberculosis below); do not initiate until active infections are controlled; discontinue if new serious infection develops until\r\ninfection controlled; hepatitis B virus\u2014monitor\r\nfor active infection; mild heart failure\r\n(discontinue if symptoms develop or worsen\u2014avoid in moderate to severe heart failure); demyelinating\r\nCNS disorders (risk of exacerbation); history or development\r\nof malignancy; interactions: Appendix 1 (certolizumab\r\npegol)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting certolizumab pegol. Patients who have previously\r\nreceived adequate treatment for tuberculosis can start certolizumab\r\npegol but should be monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were\r\npreviously not treated adequately, chemoprophylaxis should ideally\r\nbe completed before starting certolizumab pegol. In patients at high risk of tuberculosis who cannot be assessed by\r\ntuberculin skin test, chemoprophylaxis can be given concurrently with\r\ncertolizumab pegol. Patients should be\r\nadvised to seek medical attention if symptoms suggestive of tuberculosis\r\n(e.g. persistent cough, weight loss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) develop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators and Cautions above; hypertension; sensory abnormalities; rash; less commonly ascites, cholestasis, gastro-intestinal disorders\r\n(including perforation and ulcer), hepatic disorders, appetite disorders;\r\ncardiomyopathies (including heart failure), dyslipidaemia, syncope,\r\noedema, dizziness, ischaemic coronary artery disorders, arrhythmias;\r\nasthma, pleural effusion, cough; peripheral neuropathy, tremor, anxiety,\r\nmood disorders; influenza-like illness; menstrual disorders, renal\r\nimpairment, haematuria; malignancy (including solid tumours, lymphoma,\r\nand leukaemia), skin cancer, benign tumours; haemorrhage, electrolyte\r\ndisorders; muscle disorders; visual disturbance, ocular inflammation;\r\necchymosis, impaired healing, alopecia, photosensitivity, acne, skin\r\ndiscoloration, nail disorders, new onset or worsening psoriasis, dermatitis; rarely cholelithiasis, splenomegaly, atrioventricular block,\r\ncerebrovascular accident, Raynaud\u2019s phenomenon, interstitial lung\r\ndisease, impaired coordination, trigeminal neuralgia, seizures, thyroid disorders, sexual dysfunction, nephropathy, tinnitus; also reported multiple sclerosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204103.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 400\u00a0mg, repeated 2 weeks and\r\n4 weeks after initial injection, then 200\u00a0mg every 2 weeks; review\r\ntreatment if no response within 12 weeks" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises adequate contraception\r\nduring treatment and for at least 5 months after last dose" }, "HISTAMINE DIHYDROCHLORIDE": { "indications": "Indications\u00a0see notes above", "name": "HISTAMINE DIHYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Histamine", "HISTAMINE DIHYDROCHLORIDE" ], "cautions": "Cautions\u00a0consult product literature; interactions: Appendix 1 (histamine)", "side-effects": "Side-effects\u00a0consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208777.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available;\r\nensure effective contraception during treatment in men and women" }, "Antacid preparations containing simeticone": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone" ], "name": "Antacid preparations containing simeticone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2039.htm", "doses": [ "10\u00a0mL between meals and at bedtime when required; child 8\u201312 years 5\u00a0mL between meals and at bedtime\r\nwhen required" ] }, "POTASSIUM CHLORIDE Modified-release preparations": { "indications": "Indications\u00a0potassium depletion (see notes above)", "name": "POTASSIUM CHLORIDE Modified-release preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.1 Oral potassium", "POTASSIUM CHLORIDE", "Modified-release preparations" ], "cautions": "Cautions\u00a0\n(From 9.2.1.1 Oral potassium: British National Formulary)\n9.2.1.1 Oral potassium; cardiac disease; elderly; with modified-release\r\npreparations, intestinal stricture, history of peptic\r\nulcer, hiatus hernia; interactions: Appendix 1 (potassium salts)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, flatulence; with modified-release preparations, gastro-intestinal obstruction,\r\nulceration and bleeding also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4942.htm", "doses": [ "See notes above", "Do not confuse Effervescent Potassium Tablets\r\nBPC 1968 (section 9.2.1.3) with effervescent potassium chloride tablets. Effervescent Potassium Tablets BPC 1968 do not contain\r\nchloride ions and their use should be restricted to hyperchloraemic\r\nstates (section 9.2.1.3). ", "Name[Slow-K\u00ae (Alliance) ] Tablets, m/r, orange, s/c, potassium chloride 600\u00a0mg (8\u00a0mmol each of K+ and Cl-), net price 100 = \u00a31.90. \r\n Label:\r\n 25, 27, counselling, swallow\r\nwhole with fluid during meals while sitting or standing" ] }, "CINACALCET": { "indications": "Indications\u00a0see under Dose and notes above", "name": "CINACALCET", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.2 Hypercalcaemia and hypercalciuria", "CINACALCET" ], "cautions": "Cautions\u00a0measure serum-calcium concentration before\r\ninitiation of treatment and within 1 week after starting treatment\r\nor adjusting dose, then monthly for secondary hyperparathyroidism and every 2\u20133 months for primary hyperparathyroidism\r\nand parathyroid carcinoma; treatment should not be initiated\r\nin patients with hypocalcaemia; in secondary\r\nhyperparathyroidism measure parathyroid hormone concentration 1\u20134\r\nweeks after starting treatment or adjusting dose, then every 1\u20133 months; dose adjustment may be necessary if smoking started or stopped\r\nduring treatment; interactions: Appendix 1 (cinacalcet)", "side-effects": "Side-effects\u00a0nausea, vomiting, anorexia; dizziness, paraesthesia,\r\nasthenia; reduced testosterone concentrations; myalgia; rash; less commonly dyspepsia, diarrhoea, and seizures; hypotension,\r\nheart failure, and allergic reactions (including angioedema) also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129073.htm", "doses": [ "Secondary hyperparathyroidism in patients with end-stage\r\nrenal disease on dialysis (but see notes above), adult over 18 years, initially 30\u00a0mg once daily,\r\nadjusted every 2\u20134 weeks to max. 180\u00a0mg daily", "Hypercalcaemia of primary hyperparathyroidism or parathyroid\r\ncarcinoma, adult over 18 years, initially\r\n30\u00a0mg twice daily, adjusted every 2\u20134 weeks according to response\r\nup to max. 90\u00a0mg 4 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "SODIUM VALPROATE Valproic acid": { "indications": "Indications\u00a0all forms of epilepsy; migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2); mania\r\n(section 4.2.3)", "name": "SODIUM VALPROATE Valproic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Valproate", "SODIUM VALPROATE", "Valproic acid" ], "cautions": "Cautions\u00a0monitor liver function\r\nbefore therapy and during first 6 months especially in patients most\r\nat risk (see also below); measure full\r\nblood count and ensure no undue potential\r\nfor bleeding before starting and before surgery; systemic lupus erythematosus; false-positive\r\nurine tests for ketones; avoid abrupt withdrawal; consider vitamin D supplementation in patients that\r\nare immobilised for long periods or who have inadequate sun exposure\r\nor dietary intake of calcium; interactions: see Interactions in section 4.8.1 and Appendix 1 (valproate)Liver toxicity\u00a0Liver dysfunction (including fatal\r\nhepatic failure) has occurred in association with valproate (especially\r\nin children under 3 years and in those\r\nwith metabolic or degenerative\r\ndisorders, organic brain disease or severe seizure disorders associated with mental\r\nretardation) usually in first 6 months and usually involving\r\nmultiple antiepileptic therapy. Raised liver enzymes\r\nduring valproate treatment are usually transient but patients should\r\nbe reassessed clinically and liver function (including prothrombin\r\ntime) monitored until return to normal\u2014discontinue if abnormally prolonged prothrombin time (particularly\r\nin association with other relevant abnormalities).Blood or hepatic disorders\u00a0Patients or their carers should be told how to recognise signs and\r\nsymptoms of blood or liver disorders and advised to seek immediate\r\nmedical attention if symptoms developPancreatitis\u00a0Patients or their carers\r\nshould be told how to recognise signs and symptoms of pancreatitis\r\nand advised to seek immediate medical attention if symptoms such as\r\nabdominal pain, nausea, or vomiting develop; discontinue if pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0nausea, gastric irritation, diarrhoea; weight\r\ngain; hyperammonaemia, thrombocytopenia; transient hair loss (regrowth\r\nmay be curly); less frequently increased alertness,\r\naggression, hyperactivity, behavioural disturbances, ataxia, tremor,\r\nand vasculitis; rarely hepatic dysfunction (see under\r\nCautions; withdraw treatment immediately if persistent vomiting and\r\nabdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or\r\nloss of seizure control), lethargy, drowsiness, confusion, stupor,\r\nhallucinations, blood disorders (including anaemia, leucopenia, pancytopenia),\r\nhearing loss, and rash; very rarely pancreatitis\r\n(see under Cautions), peripheral oedema, increase in bleeding time,\r\nextrapyramidal symptoms, dementia, encephalopathy, coma, gynaecomastia,\r\nFanconi\u2019s syndrome, hirsutism, acne, enuresis, hyponatraemia, toxic\r\nepidermal necrolysis, and Stevens-Johnson syndrome; suicidal ideation;\r\nreduced bone mineral density (see Cautions); also reported menstrual disturbances, male infertility, syndrome of inappropriate\r\nsecretion of antidiuretic hormone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200958.htm", "doses": [ "Epilepsy, by mouth, initially 600\u00a0mg\r\ndaily in 1\u20132 divided doses, increased gradually (in steps of 150\u2013300\u00a0mg)\r\nevery 3 days; usual maintenance dose 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily),\r\nmax. 2.5\u00a0g daily; child 1 month\u201312\r\nyears, initially 10\u201315\u00a0mg/kg (max. 600\u00a0mg) daily in 1\u20132 divided doses;\r\nusual maintenance dose 25\u201330\u00a0mg/kg daily in 2 divided doses", "Initiation of valproate treatment by intravenous administration, adult and child over 12 years, initially 10\u00a0mg/kg (usually 400\u2013800\u00a0mg) by intravenous injection (over 3\u20135 minutes) followed by intravenous infusion or intravenous\r\ninjection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up\r\nto max. 2.5\u00a0g daily; usual range 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily); child 1 month\u201312 years, 10\u00a0mg/kg by intravenous\r\ninjection (over 3\u20135 minutes) followed by intravenous\r\ninfusion or intravenous injection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up to usual range 20\u201340\u00a0mg/kg\r\ndaily (doses above 40\u00a0mg/kg daily monitor clinical chemistry and haematological\r\nparameters)", "Continuation of valproate treatment by intravenous injection (over 3\u20135 minutes) or intravenous infusion in 2\u20134 divided doses, or by continuous intravenous infusion, same as established oral daily dose", "Migraine prophylaxis [unlicensed], by mouth, initially 200\u00a0mg twice daily, increased if necessary to 1.2\u20131.5\u00a0g\r\ndaily in divided doses", "Mania, see under Episenta\u00ae", "Name[Depakote\u00ae (Sanofi-Aventis) ] Section 4.2.3 (bipolar disorder)" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nneonatal bleeding (related to hypofibrinaemia) and neonatal hepatotoxicity\r\nalso reported" }, "DITHRANOL": { "indications": "Indications\u00a0subacute and chronic psoriasis, see notes above", "name": "DITHRANOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Dithranol" ], "cautions": "Cautions\u00a0avoid use near eyes and\r\nsensitive areas of skin; see\r\nalso notes above", "side-effects": "Side-effects\u00a0local burning sensation and irritation; stains\r\nskin, hair, and fabrics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5979.htm", "doses": [ "See notes above and under preparations", "Some of these dithranol preparations also contain coal tar or salicylic acid\u2014for cautions, contra-indications, and side-effects\r\nsee under Tars (above) or under Salicylic Acid" ] }, "TIOCONAZOLE": { "indications": "Indications\u00a0fungal nail infections", "name": "TIOCONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "TIOCONAZOLE" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above; also local oedema, dry skin,\r\nnail discoloration, periungual inflammation, nail pain, rash, exfoliation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6177.htm", "doses": [ "Apply to nails and surrounding skin twice daily usually\r\nfor up to 6 months (may be extended to 12 months)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "LAMOTRIGINE": { "indications": "Indications\u00a0monotherapy and adjunctive treatment of focal\r\nseizures and generalised seizures including tonic-clonic seizures;\r\nseizures associated with Lennox-Gastaut syndrome; monotherapy of typical\r\nabsence seizures in children; prevention of depressive episodes associated\r\nwith bipolar disorder", "name": "LAMOTRIGINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Lamotrigine", "LAMOTRIGINE" ], "cautions": "Cautions\u00a0closely monitor and consider withdrawal\r\nif rash, fever, or other signs of hypersensitivity syndrome develop; avoid abrupt withdrawal (taper off over 2 weeks or\r\nlonger) unless serious skin reaction occurs; myoclonic seizures (may be exacerbated); Parkinson\u2019s disease (may be exacerbated); interactions: see Interactions in section 4.8.1 and Appendix 1 (lamotrigine)Blood disorders\u00a0Patients and their\r\ncarers should be alert for symptoms and signs suggestive of bone-marrow\r\nfailure, such as anaemia, bruising, or infection. Aplastic\r\nanaemia, bone-marrow depression, and pancytopenia have been associated\r\nrarely with lamotrigine", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, dry mouth, aggression,\r\nagitation, headache, drowsiness, dizziness, tremor, insomnia, ataxia,\r\nback pain, arthralgia, nystagmus, diplopia, blurred vision, rash (see\r\nSkin Reactions, below); rarely conjunctivitis; very rarely hepatic failure, movement disorders, unsteadiness,\r\nincrease in seizure frequency, exacerbation of Parkinson\u2019s disease,\r\nconfusion, hallucination, blood disorders (including anaemia, leucopenia,\r\nthrombocytopenia, pancytopenia\u2014see Blood Disorders, above), hypersensitivity\r\nsyndrome (see Antiepileptic Hypersensitivity\r\nSyndrome),\r\nlupus erythematosus-like reactions; also reported suicidal ideation, aspectic meningitisSkin reactions\u00a0Serious skin reactions including\r\nStevens-Johnson syndrome and toxic epidermal necrolysis have developed\r\n(especially in children); most rashes occur in the first 8 weeks.\r\nRash is sometimes associated with hypersensitivity syndrome (see Side-effects,\r\nabove) and is more common in patients with history of allergy or rash\r\nfrom other antiepileptic drugs. Consider withdrawal if rash or signs\r\nof hypersensitivity syndrome develop. Factors associated\r\nwith increased risk of serious skin reactions include concomitant\r\nuse of valproate, initial lamotrigine dosing higher\r\nthan recommended, and more rapid dose escalation than recommended.Counselling\u00a0Warn patients to see\r\ntheir doctor immediately if rash or signs or symptoms of hypersensitivity\r\nsyndrome develop (see Antiepileptic Hypersensitivity\r\nSyndrome)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9833.htm", "doses": [ "Do not confuse the different combinations\r\nor indications; see also notes above", "Dose titration should be repeated if restarting\r\nafter an interval of more than 5 days", "Monotherapy of seizures, adult and child over 12 years, initially\r\n25\u00a0mg once daily for 14 days, increased to 50\u00a0mg once daily for further\r\n14 days, then increased by max. 100\u00a0mg every 7\u201314 days; usual maintenance\r\n100\u2013200\u00a0mg daily in 1\u20132 divided doses (up to 500\u00a0mg daily has been\r\nrequired)", "Monotherapy of typical absence seizures, child 2\u201312 years see BNF for Children", "Adjunctive therapy of seizures with valproate, adult and child over 12 years, initially 25\u00a0mg on alternate days for 14 days then\r\n25\u00a0mg once daily for further 14 days, thereafter increased by max.\r\n50\u00a0mg every 7\u201314 days; usual maintenance, 100\u2013200\u00a0mg daily in 1\u20132\r\ndivided doses; child 2\u201312 years initially\r\n150\u00a0micrograms/kg once daily for 14 days (those weighing under 13\u00a0kg\r\nmay receive 2\u00a0mg on alternate days for first 14 days) then 300\u00a0micrograms/kg\r\nonce daily for further 14 days, thereafter increased by max. 300\u00a0micrograms/kg\r\nevery 7\u201314 days; usual maintenance 1\u20135\u00a0mg/kg daily in 1\u20132 divided\r\ndoses; max. 200\u00a0mg daily", "Adjunctive therapy of seizures (with enzyme inducing drugs) without valproate, adult and child over 12 years, initially 50\u00a0mg once daily for\r\n14 days then 50\u00a0mg twice daily for further 14 days, thereafter increased\r\nby max. 100\u00a0mg every 7\u201314 days; usual maintenance 200\u2013400\u00a0mg daily\r\nin 2 divided doses (up to 700\u00a0mg daily has been required); child 2\u201312 years initially 600\u00a0micrograms/kg daily\r\nin 2 divided doses for 14 days then 1.2\u00a0mg/kg daily in 2 divided doses\r\nfor further 14 days, thereafter increased by max. 1.2\u00a0mg/kg every\r\n7\u201314 days; usual maintenance 5\u201315\u00a0mg/kg daily in 1\u20132 divided doses;\r\nmax. 400\u00a0mg daily", "Adjunctive therapy of seizures (without enzyme inducing drugs) without valproate, adult and child over 12 years, initially 25\u00a0mg once daily for\r\n14 days, increased to 50\u00a0mg once daily for further 14 days, then increased\r\nby max. 100\u00a0mg every 7\u201314 days; usual maintenance 100\u2013200\u00a0mg daily\r\nin 1\u20132 divided doses; child 2\u201312 years\r\ninitially 300\u00a0micrograms/kg daily in 1\u20132 divided doses for 14 days\r\nthen 600\u00a0micrograms/kg daily in 1\u20132 divided doses for further 14 days,\r\nthereafter increased by max. 600\u00a0micrograms/kg every 7\u201314 days; usual\r\nmaintenance 1\u201310\u00a0mg/kg daily in 1\u20132 divided doses; max. 200\u00a0mg daily", "Monotherapy or adjunctive therapy of bipolar\r\ndisorder (without enzyme inducing drugs) without valproate, adult over 18 years, initially 25\u00a0mg\r\nonce daily for 14 days, then 50\u00a0mg daily in 1\u20132 divided doses for\r\nfurther 14 days, then 100\u00a0mg daily in 1\u20132 divided doses for further\r\n7 days; usual maintenance 200\u00a0mg daily in 1\u20132 divided doses; max.\r\n400\u00a0mg daily", "Adjunctive therapy of bipolar disorder with valproate, adult over 18 years, initially 25\u00a0mg\r\non alternate days for 14 days, then 25\u00a0mg once daily for further 14\r\ndays, then 50\u00a0mg daily in 1\u20132 divided doses for further 7 days; usual\r\nmaintenance 100\u00a0mg daily in 1\u20132 divided doses; max. 200\u00a0mg daily", "Adjunctive therapy of bipolar disorder (with enzyme inducing\r\ndrugs) without valproate, adult over 18 years, initially 50\u00a0mg once daily for 14 days, then 50\u00a0mg\r\ntwice daily for further 14 days, then 100\u00a0mg twice daily for further\r\n7 days, then 150\u00a0mg twice daily for further 7 days; usual maintenance\r\n200\u00a0mg twice daily", "Patients stabilised on lamotrigine for bipolar\r\ndisorder may require dose adjustments if other drugs are added to\r\nor withdrawn from their treatment regimens\u2014consult product literature" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "METHYLCELLULOSE": { "indications": "Indications\u00a0see notes above", "name": "METHYLCELLULOSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.1 Bulk-forming laxatives", "METHYLCELLULOSE" ], "cautions": "Cautions\u00a0see under Ispaghula Husk", "side-effects": "Side-effects\u00a0see under Ispaghula Husk", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2201.htm", "doses": [ "See preparations below", "Preparations that swell in contact\r\nwith liquid should always be carefully swallowed with water and should\r\nnot be taken immediately before going to bed", "constipation and diarrhoea, 3\u20136 tablets twice daily; in\r\nconstipation the dose should be taken with at least 300\u00a0mL liquid;\r\nin diarrhoea, ileostomy, and colostomy control, avoid liquid intake\r\nfor 30 minutes before and after dose; child 7\u201312 years see BNF for Children" ] }, "DISODIUM ETIDRONATE": { "indications": "Indications\u00a0see under Dose", "name": "DISODIUM ETIDRONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "DISODIUM ETIDRONATE" ], "cautions": "Cautions\u00a0consider dental check-up before initiating\r\nbisphosphonate (risk of osteonecrosis of\r\nthe jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0nausea, diarrhoea or constipation, abdominal pain,\r\nincreased bone pain in Paget\u2019s disease, also increased risk of fractures\r\nwith high doses in Paget\u2019s disease (discontinue if fractures occur); rarely exacerbation of asthma, skin reactions (including\r\nangioedema, rash, urticaria and pruritus), transient hyperphosphataemia,\r\nheadache, paraesthesia, peripheral neuropathy, atypical femoral fractures\r\n(see MHRA/CHM advice); very rarely osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw);\r\nblood disorders (including leucopenia, agranulocytosis and pancytopenia)\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/12505.htm", "doses": [ "Paget\u2019s disease of bone, by mouth, 5\u00a0mg/kg\r\nas a single daily dose for up to 6 months; doses above 10\u00a0mg/kg daily\r\nfor up to 3 months may be used with caution but doses above 20\u00a0mg/kg\r\ndaily are not recommended; after interval of not less than 3 months\r\nmay be repeated where evidence of reactivation\u2014including biochemical\r\nindices (avoid premature retreatment)", "Serum phosphate, serum alkaline phosphatase\r\nand (if possible) urinary hydroxyproline should be measured before\r\nstarting and at intervals of 3 months\u2014consult product literature for\r\nfurther details", "Osteoporosis, see under Didronel PMO\u00ae", "Avoid food for at least 2 hours before\r\nand after oral treatment, particularly calcium-containing products\r\ne.g. milk; also avoid iron and mineral supplements and antacids" ], "pregnancy": "Pregnancy\u00a0avoid" }, "THEOPHYLLINE Modified release": { "indications": "Indications\u00a0reversible airways obstruction, severe acute asthma; see also Management of Chronic Asthma\r\ntable and Management of Acute Asthma\r\ntable", "name": "THEOPHYLLINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.3 Theophylline", "THEOPHYLLINE", "Modified release" ], "cautions": "Cautions\u00a0\n(From 3.1.3 Theophylline: British National Formulary)\nTheophylline is metabolised in the liver. The plasma-theophylline concentration is increased in heart failure, hepatic impairment, viral infections, in the elderly, and by drugs that inhibit its metabolism. The plasma-theophylline concentration is decreased in smokers, by alcohol consumption, and by drugs that induce its metabolism. For interactions: see Appendix 1 (theophylline). Differences in the half-life of theophylline are important because the toxic dose is close to the therapeutic dose. In most individuals, satisfactory bronchodilation is associated with a plasma-theophylline concentration of 10\u201320\u00a0mg/litre (see Note below), although a lower plasma-theophylline concentration may be effective. Adverse effects can occur within the range 10\u201320\u00a0mg/litre and both the frequency and severity increase at concentrations above 20\u00a0mg/litre., also cardiac arrhythmias or other cardiac disease; hypertension; hyperthyroidism; peptic ulcer; epilepsy; elderly; fever; hypokalaemia risk, \n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nPotentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.; avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); monitor plasma-theophylline concentration (\n(From 3.1.3 Theophylline: British National Formulary)\n3.1.3 Theophylline); dose adjustment\r\nmay be necessary if smoking started or stopped during treatment", "side-effects": "Side-effects\u00a0nausea, vomiting, gastric irritation, diarrhoea,\r\npalpitation, tachycardia, arrhythmias, headache, CNS stimulation,\r\ninsomnia, convulsions; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2938.htm", "doses": [ "See under preparations below", "Plasma-theophylline concentration\r\nfor optimum response 10\u201320\u00a0mg/litre (55\u2013110 micromol/litre); 4\u20136 hours\r\nafter a dose and at least 5 days after starting treatment; narrow\r\nmargin between therapeutic and toxic dose, see also notes above", "May be appropriate to give larger evening\r\nor morning dose to achieve optimum therapeutic effect when symptoms\r\nmost severe; in patients whose night or daytime symptoms persist despite\r\nother therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning\r\ndose", "Name[Uniphyllin Continus\u00ae (Napp)] Tablets, m/r, theophylline 200\u00a0mg, net price 56-tab pack = \u00a32.95; 300\u00a0mg, 56-tab pack = \u00a34.77;\r\n400\u00a0mg, 56-tab pack = \u00a35.65. \r\n Label:\r\n 25Dose\u00a0200\u00a0mg every 12 hours, increased according to response\r\nto 400\u00a0mg every 12 hours; child 2\u201312\r\nyears, 9\u00a0mg/kg (up to 200\u00a0mg) every 12 hours; some children with chronic\r\nasthma may require 10\u201316\u00a0mg/kg (max. 400\u00a0mg) every 12 hoursNote\u00a0May be appropriate to give larger evening\r\nor morning dose to achieve optimum therapeutic effect when symptoms\r\nmost severe; in patients whose night or daytime symptoms persist despite\r\nother therapy, who are not currently receiving theophylline, total daily requirement may be added as single evening or morning\r\ndose" ], "pregnancy": "Pregnancy\u00a0neonatal irritability and apnoea have been reported;\r\nsee also section 3.1" }, "METOCLOPRAMIDE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0adults, nausea and vomiting, particularly\r\nin gastro-intestinal disorders (section 1.2) and treatment\r\nwith cytotoxics or radiotherapy; migraine (section 4.7.4.1)Patients under 20 years\u00a0Use restricted to severe\r\nintractable vomiting of known cause, vomiting of radiotherapy and\r\ncytotoxics, aid to gastro-intestinal intubation, premedication; dose\r\nshould be determined on the basis of body-weight", "name": "METOCLOPRAMIDE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Domperidone and metoclopramide", "METOCLOPRAMIDE HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0elderly, young\r\nadults (15\u201319 years old), and children; atopic allergy (including asthma); cardiac conduction disturbances (and concomitant\r\nuse of other drugs affecting cardiac conduction); may mask underlying disorders such as cerebral irritation; acute porphyria (section 9.8.2); epilepsy; interactions: Appendix 1 (metoclopramide)", "side-effects": "Side-effects\u00a0extrapyramidal effects (especially in children\r\nand young adults (15\u201319 years old)\u2014see above),\r\nhyperprolactinaemia, occasionally tardive dyskinesia on prolonged\r\nadministration; also reported, dyspnoea, anxiety, confusion, drowsiness,\r\ndizziness, tremor, restlessness, diarrhoea, depression, neuroleptic\r\nmalignant syndrome, visual disturbances, rashes, pruritus, oedema;\r\ncardiac conduction abnormalities reported following intravenous administration; rarely methaemoglobinaemia (more severe in G6PD deficiency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3439.htm", "doses": [ "By mouth or by intramuscular injection or by\r\nintravenous injection over 1\u20132 minutes, nausea and vomiting,\r\n10\u00a0mg (5\u00a0mg in young adults 15\u201319 years, body-weight under 60\u00a0kg)\r\n3 times daily; child up to 1 year (body-weight\r\nup to 10\u00a0kg) 100\u00a0micrograms/kg (max. 1\u00a0mg) twice daily, 1\u20133 years\r\n(body-weight 10\u201314\u00a0kg) 1\u00a0mg 2\u20133 times daily, 3\u20135 years (body-weight\r\n15\u201319\u00a0kg) 2\u00a0mg 2\u20133 times daily, 5\u20139 years (body-weight 20\u201329\u00a0kg) 2.5\u00a0mg\r\n3 times daily, 9\u201315 years (body-weight 30\u00a0kg and over) 5\u00a0mg 3 times\r\ndaily", "Daily dose of metoclopramide should not normally\r\nexceed 500\u00a0micrograms/kg, particularly for children and young adults\r\n(restricted use, see above)", "For diagnostic procedures, as a single dose 5\u201310 minutes before\r\nexamination, 10\u201320\u00a0mg (10\u00a0mg in young adults 15\u201319 years); child under 3 years 1\u00a0mg, 3\u20135 years 2\u00a0mg, 5\u20139 years\r\n2.5\u00a0mg, 9\u201314 years 5\u00a0mg", "Name[Maxolon SR\u00ae (Amdipharm) ] Capsules, m/r, clear, enclosing\r\nwhite granules, metoclopramide hydrochloride 15\u00a0mg,\r\nnet price 56-cap pack = \u00a37.01. \r\n Label:\r\n 25Dose\u00a0patients over 20 years, 1 capsule twice daily" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "DESMOPRESSIN": { "indications": "Indications\u00a0see under Dose", "name": "DESMOPRESSIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.2 Posterior pituitary hormones and antagonists", "Posterior pituitary hormones", "DESMOPRESSIN" ], "cautions": "Cautions\u00a0see under Vasopressin; less pressor\r\nactivity, but still considerable caution in cardiovascular\r\ndisease and in hypertension (not indicated for nocturnal enuresis or nocturia in these circumstances); elderly (avoid for nocturnal enuresis and nocturia\r\nin those over 65 years); also considerable caution in cystic fibrosis; in nocturia and nocturnal enuresis\r\nlimit fluid intake to minimum from 1 hour before dose until 8 hours\r\nafterwards; in nocturia periodic\r\nblood pressure and weight checks needed to monitor for fluid overload; interactions: Appendix 1 (desmopressin)Hyponatraemic convulsions\u00a0Patients being treated\r\nfor primary nocturnal enuresis should be warned to avoid fluid overload\r\n(including during swimming) and to stop taking desmopressin during an episode of vomiting or diarrhoea (until fluid balance\r\nnormal). The risk of hyponatraemic convulsions can also be minimised by keeping to the recommended starting doses\r\nand by avoiding concomitant use of drugs which increase secretion\r\nof vasopressin (e.g. tricyclic antidepressants)", "side-effects": "Side-effects\u00a0fluid retention, and hyponatraemia (in more serious\r\ncases with convulsions) on administration without restricting fluid\r\nintake; stomach pain, headache, nausea, vomiting, allergic reactions,\r\nand emotional disturbance in children also reported; epistaxis, nasal\r\ncongestion, rhinitis with nasal spray", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4432.htm", "doses": [ "By mouth (as desmopressin acetate)", "Diabetes insipidus, treatment, adult and child initially 300\u00a0micrograms\r\ndaily (in 3 divided doses); maintenance, 300\u2013600\u00a0micrograms daily\r\nin 3 divided doses; range 0.2\u20131.2\u00a0mg daily", "Primary nocturnal enuresis, adult (under\r\n65 years) and child over 5 years 200\u00a0micrograms\r\nat bedtime, only increased to 400\u00a0micrograms if lower dose not effective\r\n(important: see also Cautions); withdraw for at least\r\n1 week for reassessment after 3 months", "Postoperative polyuria or polydipsia, adjust dose according\r\nto urine osmolality", "Sublingually (as desmopressin base)", "Diabetes insipidus, treatment, adult and child initially 180\u00a0micrograms\r\ndaily in 3 divided doses; range 120\u2013720\u00a0micrograms daily", "Primary nocturnal enuresis, adult (under 65 years) and child over 5\r\nyears 120\u00a0micrograms at bedtime, only increased to 240\u00a0micrograms\r\nif lower dose not effective (important: see also\r\nCautions); withdraw for at least 1 week for reassessment after 3 months", "Polyuria or polydipsia after hypophysectomy, adjust dose according\r\nto urine osmolality", "Intranasally (as desmopressin acetate)", "Diabetes insipidus, diagnosis, adult and child 20\u00a0micrograms (limit fluid\r\nintake to 500\u00a0mL from 1 hour before to 8 hours after administration)", "Diabetes insipidus, treatment, adult 10\u201340\u00a0micrograms daily (in 1\u20132 divided doses); child 5\u201320\u00a0micrograms daily; infants may require lower doses", "Nocturia associated with multiple sclerosis (when other treatments\r\nhave failed), adult (under 65 years)\r\n10\u201320\u00a0micrograms at bedtime (important: see also\r\nCautions), dose not to be repeated within 24 hours", "Renal function testing (empty bladder at time of administration\r\nand limit fluid intake to 500\u00a0mL from 1 hour before until 8 hours\r\nafter administration), adult 40\u00a0micrograms; infant under 1 year 10\u00a0micrograms (restrict fluid\r\nintake to 50% at next 2 feeds to avoid fluid overload), child 1\u201315\u00a0years 20\u00a0micrograms", "Mild to moderate haemophilia and von Willebrand\u2019s disease, adult 300\u00a0micrograms (one 150-microgram spray into\r\neach nostril) 30 minutes before surgery or when bleeding; may be repeated\r\nat intervals of 12 hours (or at intervals of at least 3 days if self-administered)", "Fibrinolytic response testing, adult 300\u00a0micrograms (one 150-microgram spray into each nostril); blood\r\nsampled after 1 hour for fibrinolytic activity", "By injection (as desmopressin acetate)", "Diabetes insipidus, diagnosis (subcutaneous or intramuscular), adult and child 2\u00a0micrograms (limit fluid\r\nintake to 500\u00a0mL from 1 hour before to 8 hours after administration)", "Diabetes insipidus, treatment (subcutaneous, intramuscular or intravenous), adult 1\u20134\u00a0micrograms daily; infant and child 400\u00a0nanograms", "Renal function testing (empty bladder at time of administration\r\nand limit fluid intake to 500\u00a0mL from 1 hour before until 8 hours\r\nafter administration) (subcutaneous or intramuscular), adult and child 2\u00a0micrograms; infant 400\u00a0nanograms (restrict fluid intake to 50%\r\nat next 2 feeds)", "Mild to moderate haemophilia and von Willebrand\u2019s disease, (subcutaneous or intravenous), adult and child over 1 month 300\u00a0nanograms/kg as a single dose immediately before\r\nsurgery or after trauma; may be repeated at intervals of 12 hours", "Fibrinolytic response testing, (subcutaneous or intravenous), adult and child 300\u00a0nanograms/kg; blood\r\nsampled after 20 minutes for fibrinolytic activity", "Lumbar-puncture-associated headache, consult product literature" ], "pregnancy": "Pregnancy\u00a0small oxytocic effect in third trimester; increased\r\nrisk of pre-eclampsia" }, "LEVOBUPIVACAINE": { "indications": "Indications\u00a0see under Dose", "name": "LEVOBUPIVACAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Levobupivacaine", "LEVOBUPIVACAINE" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics; cardiovascular disease; interactions: Appendix 1 (levobupivacaine)", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects;\r\nalso sweating, pyrexia, anaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86464.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Doses should be adjusted according to patient\u2019s\r\nphysical status and nature of procedure\u2014important: see also under Administration, section 15.2", "Surgical anaesthesia", "Lumbar epidural, 10\u201320\u00a0mL (50\u2013150\u00a0mg) of 5\u00a0mg/mL\r\nor 7.5\u00a0mg/mL solution over 5 minutes; caesarean section, 15\u201330\u00a0mL\r\n(75\u2013150\u00a0mg) of 5\u00a0mg/mL solution over 15\u201320 minutes", "Intrathecal, 3\u00a0mL (15\u00a0mg) of 5\u00a0mg/mL solution", "Peripheral nerve block, 1\u201340\u00a0mL of 2.5\u00a0mg/mL\r\nor 5\u00a0mg/mL solution (max. 150\u00a0mg); ilioinguinal/iliohypogastric\r\nblock, child under 12 years\r\n0.25\u20130.5\u00a0mL/kg (0.625\u20132.5\u00a0mg/kg) of a 2.5\u00a0mg/mL or 5\u00a0mg/mL solution", "Peribulbar block, 5\u201315\u00a0mL (37.5\u2013112.5\u00a0mg) of\r\n7.5\u00a0mg/mL solution", "Local infiltration, 1\u201360\u00a0mL (max. 150\u00a0mg) of\r\n2.5\u00a0mg/mL solution", "Acute pain", "Lumbar epidural, labour pain, 6\u201310\u00a0mL (15\u201325\u00a0mg)\r\nof 2.5\u00a0mg/mL solution at intervals of at least 15 minutes or 5\u201312.5\u00a0mg/hour as a continuous epidural infusion; postoperative\r\npain, 12.5\u201318.75\u00a0mg/hour as a continuous epidural infusion; max. 400\u00a0mg\r\nin 24 hours", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought" ], "pregnancy": "Pregnancy\u00a0large doses during delivery can cause neonatal respiratory\r\ndepression, hypotonia, and bradycardia after epidural block; avoid\r\nif possible in the first trimester\u2014toxicity in animal studies; may cause fetal distress syndrome; do not use for paracervical\r\nblock in obstetrics; do not use 7.5\u00a0mg/mL strength in obstetrics" }, "BUPRENORPHINE Patches": { "indications": "Indications\u00a0see under Dose and under Patches; opioid dependence (section 4.10.3)", "name": "BUPRENORPHINE Patches", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "BUPRENORPHINE", "Patches" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also impaired consciousness; effects only partially\r\nreversed by naloxone; monitor liver functionFever or external heat\u00a0Monitor patients\r\nusing patches for increased side-effects if fever present (increased\r\nabsorption possible); avoid exposing application\r\nsite to external heat (may also increase absorption)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; can induce\r\nmild withdrawal symptoms in patients dependent on opioids; also diarrhoea,\r\nabdominal pain, anorexia, dyspepsia; vasodilatation; dyspnoea; paraesthesia,\r\nasthenia, fatigue, agitation, anxiety; less commonly flatulence, taste disturbance, angina, hypertension, syncope, hypoxia,\r\nwheezing, cough, restlessness, depersonalisation, dysarthria, impaired\r\nmemory, hypoaesthesia, tremor, influenza-like symptoms, pyrexia, rhinitis,\r\nrigors, muscle cramp, myalgia, tinnitus, dry eye, and dry skin; rarely paralytic ileus, dysphagia, impaired concentration,\r\nand psychosis; very rarely retching, hyperventilation,\r\nhiccups, and muscle fasciculation; hepatic necrosis and hepatitis\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106521.htm", "doses": [ "Moderate to severe pain, by sublingual administration, 200\u2013400\u00a0micrograms every 6\u20138 hours; child over 6 years, 16\u201325\u00a0kg, 100\u00a0micrograms every 6\u20138 hours; 25\u201337.5\u00a0kg,\r\n100\u2013200\u00a0micrograms every 6\u20138 hours; 37.5\u201350\u00a0kg, 200\u2013300\u00a0micrograms\r\nevery 6\u20138 hours", "By intramuscular or slow\r\nintravenous injection, 300\u2013600\u00a0micrograms every 6\u20138 hours; child over 6 months 3\u20136\u00a0micrograms/kg every 6\u20138 hours\r\n(max. 9\u00a0micrograms/kg)", "Premedication, by sublingual administration, 400\u00a0micrograms", "By intramuscular injection, 300\u00a0micrograms", "Intra-operative analgesia, by slow intravenous injection, 300\u2013450\u00a0micrograms", "Name[Transtec\u00ae (Napp) ] Patches, self-adhesive, skin-coloured, buprenorphine, \u201835\u2019 patch (releasing 35\u00a0micrograms/hour\r\nfor 96 hours), net price 4 = \u00a315.73; \u201852.5\u2019 patch (releasing 52.5\u00a0micrograms/hour\r\nfor 96 hours), 4 = \u00a323.61; \u201870\u2019 patch (releasing 70\u00a0micrograms/hour\r\nfor 96 hours), 4 = \u00a331.46. \r\n Label:\r\n 2Dose\u00a0moderate to severe chronic cancer pain and severe pain\r\nunresponsive to non-opioid analgesics, adult over 18 years, apply to dry, non-irritated, non-hairy skin on upper\r\ntorso, removing after no longer than 96 hours and siting replacement\r\npatch on a different area (avoid same area for at least 6 days). Patients\r\nwho have not previously received strong opioid analgesic, initially,\r\none \u201835\u00a0micrograms/hour\u2019 patch replaced after no longer than 96 hours;\r\npatients who have received strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement, consult product literature Dose adjustment\u00a0When starting, analgesic effect\r\nshould not be evaluated until the system has been\r\nworn for 24 hours (to allow for gradual increase\r\nin plasma-buprenorphine concentration)\u2014if necessary, dose should be\r\nadjusted at intervals of no longer than 96 hours using a patch of\r\nthe next strength or using 2 patches of the same\r\nstrength (applied at same time to avoid confusion).\r\nMax. 2 patches can be used at any one time. For breakthrough pain,\r\nconsider 200\u2013400\u00a0micrograms buprenorphine sublingually. Important: it may take approx. 30 hours for the plasma-buprenorphine concentration\r\nto decrease by 50% after patch is removedLong duration of action\u00a0In view of the long duration\r\nof action, patients who have severe side-effects should be monitored\r\nfor up to 30 hours after removing patch" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. and %s\n(From Opioid substitution therapy: British National Formulary)\nPregnancy\u00a0Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death. Opioid substitution therapy is recommended during pregnancy because it carries a lower risk to the fetus than continued use of illicit drugs. If a woman who is stabilised on methadone or buprenorphine for treatment of opioid dependence becomes pregnant, therapy should be continued [buprenorphine is not licensed for use in pregnancy]. Many pregnant patients choose a withdrawal regimen, but withdrawal during the first trimester should be avoided because it is associated with an increased risk of spontaneous miscarriage. Withdrawal of methadone or buprenorphine should be undertaken gradually during the second trimester; for example, the dose of methadone may be reduced by 2\u20133\u00a0mg every 3\u20135 days. If illicit drug use occurs, the patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen.Further withdrawal of methadone or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and the risk of neonatal mortality. Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.The neonate should be monitored for respiratory depression and signs of withdrawal if the mother is prescribed high doses of opioid substitute.Signs of neonatal withdrawal from opioids usually develop 24\u201372 hours after delivery but symptoms may be delayed for up to 14 days, so monitoring may be required for several weeks. Symptoms include a high-pitched cry, rapid breathing, hungry but ineffective suckling, and excessive wakefulness; severe, but rare symptoms include hypertonicity and convulsions." }, "ERGOCALCIFEROL": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "ERGOCALCIFEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "ERGOCALCIFEROL" ], "cautions": "Cautions\u00a0take care to ensure correct dose in infants; monitor plasma-calcium concentration in patients receiving\r\nhigh doses and in renal impairment (\n(From 9.6.4 Vitamin D: British National Formulary)\nImportant. All patients receiving pharmacological doses of vitamin D should have their plasma-calcium concentration checked at intervals (initially once or twice weekly) and whenever nausea or vomiting occur.); interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0symptoms of overdosage include\r\nanorexia, lassitude, nausea and vomiting, diarrhoea, constipation,\r\nweight loss, polyuria, sweating, headache, thirst, vertigo, and raised\r\nconcentrations of calcium and phosphate in plasma and urine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5135.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0high doses teratogenic in animals but therapeutic doses unlikely to be harmful" }, "EXENATIDE Modified release": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "EXENATIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "EXENATIDE", "Modified release" ], "cautions": "Cautions\u00a0elderly; pancreatitis (see below); may cause weight loss greater than 1.5\u00a0kg weekly; interactions: Appendix 1 (antidiabetics)Pancreatitis\u00a0Severe pancreatitis (sometimes fatal),\r\nincluding haemorrhagic or necrotising pancreatitis, has been reported\r\nrarely. Patients or their carers should be told how to\r\nrecognise signs and symptoms of pancreatitis and advised to seek prompt\r\nmedical attention if symptoms such as abdominal pain, nausea, and\r\nvomiting develop; discontinue permanently\r\nif pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances including nausea,\r\nvomiting, diarrhoea, dyspepsia, abdominal pain and distension, gastro-oesophageal\r\nreflux disease, decreased appetite, weight loss, headache, dizziness,\r\nagitation, asthenia, hypoglycaemia, increased sweating, injection-site\r\nreactions, antibody formation; less commonly pancreatitis\r\n(see Cautions above); rarely alopecia; very\r\nrarely anaphylactic reactions; also reported constipation,\r\nflatulence, eructation, dehydration, taste disturbance, renal impairment,\r\ndrowsiness, rash, pruritus, urticaria, and angioedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218697.htm", "doses": [ "By subcutaneous injection, adult over 18 years, initially 5\u00a0micrograms twice\r\ndaily within 1 hour before 2 main meals (at least 6 hours apart),\r\nincreased if necessary after at least 1 month to max. 10\u00a0micrograms\r\ntwice daily", "If a dose is missed, continue with\r\nthe next scheduled dose\u2014do not administer after a\r\nmeal. Some oral medications should be taken at least 1 hour before\r\nor 4 hours after exenatide injection\u2014consult product literature for\r\ndetails", "by subcutaneous injection, adult over 18 years, 2\u00a0mg once weekly", "Name[Bydureon\u00ae (Lilly) ] Injection, m/r, powder for reconstitution,\r\nexenatide, net price 2-mg vial (with solvent) = \u00a318.34. \r\n Label:\r\n 10, counselling, administrationDose\u00a0by subcutaneous injection, adult over 18 years, 2\u00a0mg once weeklyCounselling\u00a0Patients changing from standard-release\r\nexenatide formulation may experience initial transient increase in\r\nblood glucose. Some oral medications should be taken at least 1 hour\r\nbefore or 4 hours after exenatide injection\u2014consult product literature\r\nfor detailsNote\u00a0Dose of concomitant sulfonylurea may need\r\nto be reducedImportant\u00a0Effect of Bydureon\u00ae may persist for 10 weeks after discontinuation" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies.\r\nWomen of child-bearing age should use effective contraception during\r\ntreatment with modified-release exenatide and for 12 weeks after discontinuation" }, "POLYSACCHARIDE\u2013IRON COMPLEX": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "POLYSACCHARIDE\u2013IRON COMPLEX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "POLYSACCHARIDE\u2013IRON COMPLEX" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4869.htm", "doses": [ "See under preparation below and notes above", "prophylactic, 2.5\u00a0mL daily; therapeutic, 5\u00a0mL 1\u20132 times\r\ndaily (once daily if required during second and third trimester of\r\npregnancy); preterm neonate, neonate, and infant (from dropper bottle) 1 drop (approx. 500\u00a0micrograms iron) per 450\u00a0g\r\nbody-weight 3 times daily; child 2\u20136\r\nyears 2.5\u00a0mL daily, 6\u201312 years 5\u00a0mL daily" ] }, "RIFAMPICIN": { "indications": "Indications\u00a0see under Dose", "name": "RIFAMPICIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "RIFAMPICIN" ], "cautions": "Cautions\u00a0see Monitoring in notes above; also liver function tests and blood counts in hepatic disorders, alcohol dependence, and on prolonged\r\ntherapy, see also below); acute porphyria (section 9.8.2); important: effectiveness of hormonal contraceptives is reduced and alternative\r\nfamily planning advice should be offered (see also section 7.3.1); discolours soft\r\ncontact lenses; see also notes above; interactions: Appendix 1 (rifamycins)Note\u00a0If treatment interrupted re-introduce\r\nwith low dosage and increase gradually; discontinue permanently if serious side-effects developHepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of liver disorder, and\r\nadvised to discontinue treatment and seek immediate medical attention\r\nif symptoms such as persistent nausea, vomiting, malaise or jaundice\r\ndevelop", "side-effects": "Side-effects\u00a0gastro-intestinal symptoms including anorexia,\r\nnausea, vomiting, diarrhoea (antibiotic-associated colitis reported);\r\nheadache, drowsiness; those occurring mainly on intermittent therapy\r\ninclude influenza-like symptoms (with chills, fever, dizziness, bone\r\npain), respiratory symptoms (including shortness of breath), collapse\r\nand shock, haemolytic anaemia, thrombocytopenic purpura, disseminated\r\nintravascular coagulation, and acute renal failure; alterations of\r\nliver function, jaundice; flushing, urticaria, and rashes; other side-effects\r\nreported include oedema, psychoses, adrenal insufficiency, muscular\r\nweakness and myopathy, exfoliative dermatitis, toxic epidermal necrolysis,\r\nStevens-Johnson syndrome, pemphigoid reactions, leucopenia, eosinophilia,\r\nmenstrual disturbances; urine, saliva, and other body secretions coloured\r\norange-red; thrombophlebitis reported if infusion used for prolonged\r\nperiod", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3914.htm", "doses": [ "Brucellosis, legionnaires\u2019 disease, endocarditis and serious\r\nstaphylococcal infections, in combination with other drugs, by mouth or by intravenous infusion, 0.6\u20131.2\u00a0g daily (in 2\u20134 divided doses)", "Tuberculosis, in combination with other drugs, see notes above", "Leprosy, section 5.1.10", "Prophylaxis of meningococcal meningitis and Haemophilus\r\ninfluenzae (type b) infection, Table 2, section 5.1" ], "pregnancy": "Pregnancy\u00a0manufacturers advise very high doses teratogenic\r\nin animal studies in first trimester; risk of neonatal\r\nbleeding may be increased in third trimester; see also Pregnancy" }, "CEFOTAXIME": { "indications": "Indications\u00a0see under Cefaclor; gonorrhoea; surgical prophylaxis; Haemophilus\r\nepiglottitis and meningitis (Table 1, section 5.1); see\r\nalso notes above", "name": "CEFOTAXIME", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor; rarely arrhythmias following rapid injection\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3772.htm", "doses": [ "By intramuscular or intravenous injection or by\r\nintravenous infusion, 1\u00a0g every 12 hours increased in severe\r\ninfections (e.g. meningitis) to 8\u00a0g daily in 4 divided doses; higher\r\ndoses (up to 12\u00a0g daily in 3\u20134 divided doses) may be required; intramuscular\r\ndoses over 1\u00a0g divided between more than one site; neonate 50\u00a0mg/kg daily in 2\u20134 divided doses increased\r\nto 150\u2013200\u00a0mg/kg daily in severe infections; child 100\u2013150\u00a0mg/kg daily in 2\u20134 divided doses increased up to 200\u00a0mg/kg\r\ndaily in very severe infections", "Uncomplicated gonorrhoea, by intramuscular\r\ninjection, 500\u00a0mg as a single dose", "Important. If meningococcal\r\ndisease (meningitis with non-blanching rash or meningococcal septicaemia)\r\nis suspected, and the patient cannot be given benzylpenicillin (e.g. because of an allergy), a single dose of cefotaxime can be given (if available) before urgent transfer to hospital,\r\nso long as this does not delay the transfer. If a patient with suspected\r\nbacterial meningitis without non-blanching rash cannot be transferred\r\nto hospital urgently and cannot be given benzylpenicillin, a single\r\ndose of cefotaxime can be given before transfer. Suitable doses of cefotaxime by intravenous injection (or by intramuscular\r\ninjection) are adult and child over 12 years 1\u00a0g; child under 12 years 50\u00a0mg/kg; chloramphenicol (section 5.1.7) may be used if there is a history\r\nof anaphylaxis to penicillins or cephalosporins" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "TRABECTEDIN": { "indications": "Indications\u00a0\n(From Trabectedin: British National Formulary)\nTrabectedin", "name": "TRABECTEDIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Trabectedin" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; measure creatine\r\nkinase, renal function and hepatic function before starting (consult\r\nproduct literature); monitor haematological\r\nand hepatic parameters weekly during first 2 cycles and at least once\r\nbetween treatments in subsequent cycles; concomitant use with hepatotoxic drugs (avoid alcohol)", "side-effects": "Side-effects\u00a0see section 8.1; also abdominal pain, constipation,\r\ndiarrhoea, dyspepsia, taste disturbance, hepatobiliary disorders;\r\nhypotension, oedema, flushing; dyspnoea, cough; headache, insomnia,\r\nperipheral neuropathy, paraesthesia, dizziness, anorexia, asthenia,\r\nfatigue; pyrexia; hypokalaemia, dehydration, increased blood creatine\r\nkinase; myalgia, arthralgia, back pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200057.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0effective contraception recommended during and for\r\nat least 3 months after treatment in women and at least 5 months after\r\ntreatment in men; see also Pregnancy and Reproductive\r\nFunction" }, "VITAMIN A Vitamins A, C and D": { "indications": "Indications\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "name": "VITAMIN A Vitamins A, C and D", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.1 Vitamin A", "VITAMIN A", "Vitamins A, C and D" ], "cautions": "Cautions\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\nPregnancy\u00a0In view of evidence suggesting that high levels of vitamin A may cause birth defects, women who are (or may become) pregnant are advised not to take vitamin A supplements (including tablets and fish-liver oil drops), except on the advice of a doctor or an antenatal clinic; nor should they eat liver or products such as liver pat\u00e9 or liver sausage.; interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129961.htm", "doses": [ "See notes above and under preparations", "Name[Healthy Start Children\u2019s Vitamin Drops (Non-proprietary)] Oral drops, vitamin A 5000\u00a0units,\r\nvitamin D 2000\u00a0units, ascorbic acid 150\u00a0mg/mL Available free of charge to children under 4 years in families\r\non the Healthy Start Scheme, or alternatively may be available direct\r\nto the public\u2014further information for healthcare professionals can\r\nbe accessed at http://tinyurl.com/3yckebe. Beneficiaries can contact their\r\nmidwife or health visitor for further information on where to obtain\r\nsupplies.Dose\u00a0prevention of vitamin deficiency, child 1 month\u20135 years, 5 drops daily (5 drops contain vitamin A approx.\r\n700\u00a0units, vitamin D approx. 300\u00a0units, ascorbic acid approx. 20\u00a0mg)Note\u00a0Healthy Start Vitamins for women (containing ascorbic acid, vitamin D, and folic acid) are also available\r\nfree of charge to women on the Healthy Start Scheme during pregnancy\r\nand until their baby is one year old, or alternatively may be available\r\ndirect to the public\u2014further information for healthcare professionals\r\ncan be accessed at http://tinyurl.com/3yckebe. Beneficiaries can contact their\r\nmidwife or health visitor for further information on where to obtain\r\nsupplies." ], "pregnancy": "Pregnancy\u00a0excessive doses may be teratogenic; see also notes above" }, "NYSTATIN - OROPHARYNGEAL FUNGAL INFECTIONS": { "side-effects": "Side-effects\u00a0oral irritation and sensitisation, nausea reported", "indications": "Indications\u00a0oral and perioral fungal infections", "name": "NYSTATIN - OROPHARYNGEAL FUNGAL INFECTIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215693.htm", "doses": [ "Treatment, adult and child, 100\u00a0000\u00a0units 4 times daily after food, usually\r\nfor 7 days (continued for 48 hours after lesions have resolved)", "Unlicensed for treating candidiasis in neonate" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.2 Oropharyngeal anti-infective drugs", "Oropharyngeal fungal infections", "NYSTATIN" ] }, "CHLORPROMAZINE HYDROCHLORIDE": { "indications": "Indications\u00a0nausea and vomiting of terminal illness (where\r\nother drugs have failed or are not available); other indications (section 4.2.1)", "name": "CHLORPROMAZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0see Chlorpromazine Hydrochloride, section 4.2.1", "side-effects": "Side-effects\u00a0see Chlorpromazine Hydrochloride, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3413.htm", "doses": [ "By mouth, 10\u201325\u00a0mg every 4\u20136 hours; child 500\u00a0micrograms/kg every 4\u20136 hours (1\u20135 years\r\nmax. 40\u00a0mg daily, 6\u201312 years max. 75\u00a0mg daily)", "By deep intramuscular injection initially 25\u00a0mg\r\nthen 25\u201350\u00a0mg every 3\u20134 hours until vomiting stops; child 500\u00a0micrograms/kg every 6\u20138 hours (1\u20135 years\r\nmax. 40\u00a0mg daily, 6\u201312 years max. 75\u00a0mg daily)", "By rectum in suppositories, chlorpromazine 100\u00a0mg\r\nevery 6\u20138 hours [unlicensed]" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "GRISEOFULVIN - OTHER ANTIFUNGALS": { "indications": "Indications\u00a0dermatophyte infections of the skin, scalp, hair and nails where\r\ntopical therapy has failed or is inappropriate", "name": "GRISEOFULVIN - OTHER ANTIFUNGALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.5 Other antifungals", "GRISEOFULVIN" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (griseofulvin)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea; headache; also reported,\r\nabdominal pain, dyspepsia, hepatotoxicity, glossitis, taste disturbances,\r\nsleep disturbances, dizziness, fatigue, confusion, agitation, depression,\r\nimpaired coordination and hearing, peripheral neuropathy,\r\nmenstrual disturbances, renal failure, leucopenia, systemic lupus\r\nerythematosus, rash (including rarely erythema multiforme, toxic epidermal\r\nnecrolysis), and photosensitivity", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208054.htm", "doses": [ "Dermatophyte infections, 500\u00a0mg once daily or in\r\ndivided doses; in severe infection dose may be doubled, reducing when\r\nresponse occurs; child under 50\u00a0kg,\r\n10\u00a0mg/kg once daily or in divided doses", "Tinea capitis caused by Trichophyton tonsurans, 1\u00a0g once daily or in divided doses; child under 50\u00a0kg, 15\u201320\u00a0mg/kg once daily or in divided doses", "Griseofulvin doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0avoid (fetotoxicity and teratogenicity in animals); effective contraception required during and for\r\nat least 1 month after administration to women (important: effectiveness of oral contraceptives may be reduced, additional\r\ncontraceptive precautions e.g. barrier method, required); also men\r\nshould avoid fathering a child during and for at least 6 months after\r\nadministration" }, "CELECOXIB": { "indications": "Indications\u00a0pain and inflammation in osteoarthritis, rheumatoid arthritis, and\r\nankylosing spondylitis", "name": "CELECOXIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "CELECOXIB" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; monitor blood pressure before and during treatment", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; dyspnoea, influenza-like symptoms; less commonly stomatitis, palpitation, cerebral infarction,\r\nfatigue, paraesthesia, muscle cramps; rarely taste\r\ndisturbance, alopecia; very rarely seizures; also reported chest pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86688.htm", "doses": [ "Osteoarthritis, 200\u00a0mg daily in 1\u20132 divided doses, increased\r\nif necessary to max. 200\u00a0mg twice daily; child not recommended", "Rheumatoid arthritis, 100\u00a0mg twice daily, increased if necessary\r\nto 200\u00a0mg twice daily; child not recommended", "Ankylosing spondylitis, 200\u00a0mg daily in 1\u20132 divided doses, increased\r\nif necessary to max. 400\u00a0mg daily in 1\u20132 divided doses; child not recommended", "Discontinue if no improvement after 2 weeks\r\non max. dose" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also notes above" }, "MAGNESIUM SALTS": { "indications": "Indications\u00a0see under preparations below", "name": "MAGNESIUM SALTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives" ], "cautions": "Cautions\u00a0elderly and debilitated; see also notes above; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0colic", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2242.htm", "doses": [ "See preparations" ] }, "PORACTANT ALFA": { "indications": "Indications\u00a0treatment of respiratory distress syndrome or hyaline membrane disease\r\nin neonates over 700\u00a0g; prophylaxis of respiratory distress syndrome\r\nin preterm neonates 24\u201332 weeks post-menstrual age", "name": "PORACTANT ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.5 Respiratory stimulants and pulmonary surfactants", "3.5.2 Pulmonary surfactants", "PORACTANT ALFA" ], "cautions": "Cautions\u00a0\n(From 3.5.2 Pulmonary surfactants: British National Formulary)\nCautions\u00a0Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement in arterial oxygen concentration. and consult product literature", "side-effects": "Side-effects\u00a0\n(From 3.5.2 Pulmonary surfactants: British National Formulary)\nSide-effects\u00a0Pulmonary surfactants have been associated rarely with pulmonary haemorrhage and bradycardia; obstruction of the endotracheal tube by mucous secretions and intracranial haemorrhage have also been reported.; also rarely hypotension", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/20256.htm", "doses": [ "By endotracheal tube, treatment, 100\u2013200\u00a0mg/kg; further doses of 100\u00a0mg/kg may be repeated at intervals\r\nof 12 hours; max. total dose 300\u2013400\u00a0mg/kg; prophylaxis, 100\u2013200\u00a0mg/kg soon after birth (preferably within 15 minutes);\r\nfurther doses of 100\u00a0mg/kg may be repeated 6\u201312 hours later and after\r\na further 12 hours if still intubated; max. total dose 300\u2013400\u00a0mg/kg" ] }, "MORPHINE HYDROCHLORIDE": { "indications": "Indications\u00a0cough in terminal disease (see also Prescribing in Palliative\r\nCare )", "name": "MORPHINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations", "3.9.1 Cough suppressants", "Palliative care" ], "cautions": "Cautions\u00a0section 4.7.2", "side-effects": "Side-effects\u00a0section 4.7.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3086.htm", "doses": [ "Initially 5\u00a0mg every 4 hours" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "POTASSIUM CHLORIDE - INTRAVENOUS POTASSIUM": { "side-effects": "Side-effects\u00a0rapid infusion toxic to heart", "indications": "Indications\u00a0electrolyte imbalance; see also oral potassium supplements, section\r\n9.2.1.1", "name": "POTASSIUM CHLORIDE - INTRAVENOUS POTASSIUM", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4985.htm", "doses": [ "By slow intravenous infusion, depending\r\non the deficit or the daily maintenance requirements, see also notes\r\nabove" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Intravenous potassium", "POTASSIUM CHLORIDE" ], "cautions": "Cautions\u00a0for intravenous infusion the concentration\r\nof solution should not usually exceed 3\u00a0g (40\u00a0mmol)/litre; specialist advice and ECG monitoring (\n(From Intravenous potassium: British National Formulary)\nPotassium chloride and sodium chloride intravenous infusion is the initial treatment for the correction of severe hypokalaemia and when sufficient potassium cannot be taken by mouth. Ready-mixed infusion solutions should be used when possible; alternatively, potassium chloride concentrate, as ampoules containing 1.5\u00a0g (K+ 20\u00a0mmol) in 10\u00a0mL, is thoroughly mixed with 500\u00a0mL of sodium chloride 0.9% intravenous infusion and given slowly over 2 to 3 hours, with specialist advice and ECG monitoring in difficult cases. Higher concentrations of potassium chloride may be given in very severe depletion, but require specialist advice.Repeated measurement of plasma-potassium concentration is necessary to determine whether further infusions are required and to avoid the development of hyperkalaemia, which is especially likely in renal impairment.Initial potassium replacement therapy should not involve glucose infusions, because glucose may cause a further decrease in the plasma-potassium concentration.); interactions: Appendix 1 (potassium salts)" }, "LAPATINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nLapatinib, a tyrosine kinase inhibitor, is licensed for the treatment of advanced or metastatic breast cancer in patients with tumours that overexpress human epidermal growth factor receptor-2 (HER2). It is indicated, in combination with capecitabine, for patients who have had previous treatment with an anthracycline, a taxane, and trastuzumab, or for postmenopausal women in combination with an aromatase inhibitor section 8.3.4.1.", "name": "LAPATINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "LAPATINIB" ], "cautions": "Cautions\u00a0see section 8.1; low gastric pH (reduced absorption); susceptibility to QT-interval prolongation (including concomitant use of drugs that prolong QT-interval and electrolyte disturbances); monitor left ventricular function; monitor\r\nfor pulmonary toxicity; monitor liver function\r\nbefore treatment and at monthly intervals; interactions: Appendix 1 (lapatinib)", "side-effects": "Side-effects\u00a0see section 8.1; anorexia, diarrhoea (treat promptly),\r\ndecreased left ventricular ejection fraction, cardiac failure (fatal\r\ncases reported), malaise, rash, nail disorders, hyperbilirubinaemia,\r\nhepatotoxicity (discontinue permanently if severe); less commonly interstitial lung disease; respiratory failure (including fatal\r\ncases) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201427.htm", "doses": [ "In combination with capecitabine, adult over 18 years, 1.25\u00a0g once daily", "In combination with an aromatase inhibitor, adult over 18 years, 1.5\u00a0g once daily", "Always take at the same time in relation\r\nto food: either one hour before or one hour after food. Patients should\r\nreport unexpected changes in bowel habit" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity\r\nin animal studies; see also Pregnancy and Reproductive\r\nFunction" }, "LUTROPIN ALFA": { "indications": "Indications\u00a0see notes above", "name": "LUTROPIN ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "LUTROPIN ALFA" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal and pelvic pain; headache,\r\nsomnolence; injection-site reactions; ovarian hyperstimulation syndrome,\r\novarian cyst, breast pain, ectopic pregnancy; thromboembolism, adnexal\r\ntorsion, and haemoperitoneum", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106144.htm", "doses": [ "By subcutaneous injection, in conjunction\r\nwith follicle-stimulating hormone, according to response" ] }, "ALFACALCIDOL": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "ALFACALCIDOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "ALFACALCIDOL" ], "cautions": "Cautions\u00a0see under Ergocalciferol; also nephrolithiasis", "side-effects": "Side-effects\u00a0see under Ergocalciferol; also rarely nephrocalcinosis, pruritus,\r\nrash, and urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5140.htm", "doses": [ "By mouth or by\r\nintravenous injection over 30 seconds, adult and child over 20\u00a0kg, initially 1\u00a0microgram\r\ndaily (elderly 500\u00a0nanograms), adjusted to avoid hypercalcaemia; maintenance,\r\nusually 0.25\u20131\u00a0microgram daily; neonate and preterm neonate initially 50\u2013100\u00a0nanograms/kg\r\ndaily, child under 20\u00a0kg initially\r\n50\u00a0nanograms/kg daily" ], "pregnancy": "Pregnancy\u00a0see under Ergocalciferol" }, "MIVACURIUM": { "indications": "Indications\u00a0neuromuscular blockade (short duration) for surgery", "name": "MIVACURIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).; low plasma cholinesterase activity; elderly", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6654.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "By intravenous injection, 70\u2013250\u00a0micrograms/kg;\r\nmaintenance 100\u00a0micrograms/kg every 15 minutes; child 2\u20136 months initially 150\u00a0micrograms/kg, 7 months\u201312 years initially\r\n200\u00a0micrograms/kg; maintenance (child 2 months\u201312 years) 100\u00a0micrograms/kg every 6\u20139 minutes", "Doses up to 150\u00a0micrograms/kg may be given\r\nover 5\u201315 seconds, higher doses should be given over 30 seconds. In\r\npatients with asthma, cardiovascular disease or those who are sensitive\r\nto falls in arterial blood pressure give over 60 seconds", "By intravenous infusion after initial bolus intravenous\r\ndose, maintenance of block, 8\u201310\u00a0micrograms/kg/minute, adjusted if\r\nnecessary every 3 minutes by 1\u00a0microgram/kg/minute to usual dose of\r\n6\u20137\u00a0micrograms/kg/minute; child 2 months\u201312\r\nyears, usual dose 11\u201314\u00a0micrograms/kg/minute" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "FESOTERODINE FUMARATE": { "indications": "Indications\u00a0urinary frequency, urgency, and urge\r\nincontinence", "name": "FESOTERODINE FUMARATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; gastro-oesophageal reflux", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\ninsomnia; less commonly nasal dryness, pharyngolaryngeal\r\npain, cough, and vertigo", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201012.htm", "doses": [ "adult over 18 years, 4\u00a0mg\r\nonce daily, increased if necessary to max. 8\u00a0mg once daily", "Max. 4\u00a0mg daily with concomitant atazanavir,\r\nclarithromycin, indinavir, itraconazole, ketoconazole, nelfinavir,\r\nritonavir, saquinavir, or telithromycin; in patients with hepatic\r\nor renal impairment, consult product literature before concomitant\r\nuse with amprenavir, aprepitant, atazanavir, clarithromycin, diltiazem,\r\nerythromycin, fluconazole, fosamprenavir, indinavir, itraconazole,\r\nketoconazole, nelfinavir, ritonavir, saquinavir, telithromycin, verapamil,\r\nor grapefruit juice" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "INTERFERON ALFA": { "indications": "Indications\u00a0see under preparations", "name": "INTERFERON ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon alfa", "INTERFERON ALFA" ], "cautions": "Cautions\u00a0consult product literature; interactions: Appendix 1 (interferons)", "side-effects": "Side-effects\u00a0\n(From Interferon alfa: British National Formulary)\nInterferon alfa and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4791.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk (toxicity\r\nin animal studies); effective contraception required\r\nduring treatment\u2014consult product literature" }, "ISOCARBOXAZID ": { "indications": "Indications\u00a0depressive illness", "name": "ISOCARBOXAZID ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.2 Monoamine-oxidase inhibitors", "ISOCARBOXAZID" ], "cautions": "Cautions\u00a0see under Phenelzine", "side-effects": "Side-effects\u00a0see under Phenelzine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3345.htm", "doses": [ "Initially 30\u00a0mg daily in single or divided doses until\r\nimprovement occurs (increased after 4 weeks if necessary to max. 60\u00a0mg\r\ndaily for 4\u20136 weeks under close supervision), then reduced to usual\r\nmaintenance dose 10\u201320\u00a0mg daily (but up to 40\u00a0mg daily may be required); elderly 5\u201310\u00a0mg daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nPregnancy\u00a0There is an increased risk of neonatal malformations when phenelzine, isocarboxazid, or tranylcypromine is used during pregnancy. The safety of moclobemide in pregnancy has not been established. Manufacturers advise avoid use unless there are compelling reasons." }, "HEPATITIS B VACCINE": { "indications": "Indications\u00a0immunisation against hepatitis B infection", "name": "HEPATITIS B VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis B vaccine", "HEPATITIS B VACCINE" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60021.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "LETROZOLE": { "indications": "Indications\u00a0adjuvant treatment of oestrogen-receptor-positive early breast cancer\r\nin postmenopausal women; advanced breast cancer in postmenopausal\r\nwomen (including those in whom other anti-oestrogen therapy has failed);\r\nearly invasive breast cancer in postmenopausal women after standard\r\nadjuvant tamoxifen therapy; pre-operative treatment in postmenopausal\r\nwomen with localised hormone-receptor-positive breast cancer to allow\r\nsubsequent breast conserving surgery", "name": "LETROZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer" ], "cautions": "Cautions\u00a0susceptibility to osteoporosis (assess\r\nbone mineral density before treatment and at regular intervals)", "side-effects": "Side-effects\u00a0hot flushes, nausea, vomiting, fatigue, dizziness,\r\nheadache, dyspepsia, constipation, diarrhoea, depression, anorexia,\r\nappetite increase, hypercholesterolaemia, alopecia, increased sweating,\r\nrash, peripheral oedema, musculoskeletal pain, osteoporosis, bone\r\nfracture; less commonly hypertension, palpitation,\r\ntachycardia, dyspnoea, cough, drowsiness, insomnia, anxiety, memory\r\nimpairment, dysaesthesia, taste disturbance, pruritus, dry skin, urticaria,\r\nthrombophlebitis, abdominal pain, urinary frequency, urinary-tract\r\ninfection, vaginal bleeding, vaginal discharge, breast pain, pyrexia,\r\nmucosal dryness, stomatitis, cataract, eye irritation, blurred vision,\r\ntumour pain, arthritis, leucopenia, general oedema; rarely pulmonary embolism, arterial thrombosis, cerebrovascular infarction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56613.htm", "doses": [ "2.5\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nmanufacturer advises effective contraception required until postmenopausal\r\nstatus fully established " }, "AZELASTINE HYDROCHLORIDE": { "indications": "Indications\u00a0allergic conjunctivitis", "name": "AZELASTINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "AZELASTINE HYDROCHLORIDE" ], "side-effects": "Side-effects\u00a0 mild transient irritation; bitter taste reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68963.htm", "doses": [ "Seasonal allergic conjunctivitis, adult and child over 4 years, apply twice\r\ndaily, increased if necessary to 4 times daily", "Perennial conjunctivitis, adult and child over 12 years, apply twice\r\ndaily, increased if necessary to 4 times daily; max. duration of treatment\r\n6 weeks" ] }, "MEBEVERINE HYDROCHLORIDE": { "indications": "Indications\u00a0adjunct in gastro-intestinal disorders characterised by smooth muscle\r\nspasm", "name": "MEBEVERINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Other antispasmodics", "MEBEVERINE HYDROCHLORIDE" ], "side-effects": "Side-effects\u00a0allergic reactions (including rash, urticaria,\r\nangioedema) reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76587.htm", "doses": [ "adult and child over 10 years 135\u2013150\u00a0mg 3 times daily preferably\r\n20 minutes before meals; child under\r\n10 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturers advise caution" }, "TACROLIMUS - CORTICOSTEROIDS AND OTHER IMMUNOSUPPRESSANTS": { "indications": "Indications\u00a0prophylaxis of organ rejection in liver,\r\nkidney, and heart allograft recipients and allograft rejection resistant\r\nto conventional immunosuppressive regimens, see also notes above;\r\nmoderate to severe atopic eczema (section 13.5.3)", "name": "TACROLIMUS - CORTICOSTEROIDS AND OTHER IMMUNOSUPPRESSANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "TACROLIMUS" ], "cautions": "Cautions\u00a0monitor blood pressure, ECG (important: see Cardiomyopathy below), fasting blood-glucose\r\nconcentration, haematological and neurological (including visual)\r\nparameters, electrolytes, hepatic and renal function; monitor whole blood-tacrolimus trough concentration\r\n(especially during episodes of diarrhoea)\u2014consult local treatment\r\nprotocol for details; QT-interval prolongation; neurotoxicity; increased\r\nrisk of infections, malignancies, and lymphoproliferative disorders; avoid excessive exposure to UV light including sunlight; interactions: Appendix 1 (tacrolimus)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, constipation, dyspepsia,\r\nflatulence, bloating, weight changes, anorexia, gastro-intestinal\r\ninflammation, ulceration, and perforation, hepatic dysfunction, jaundice,\r\ncholestasis, ascites, bile-duct abnormalities, oedema, tachycardia,\r\nhypertension, haemorrhage, thromboembolic and ischaemic events, dyspnoea,\r\npleural effusion, parenchymal lung disorders, sleep disturbances,\r\ntremor, headache, peripheral neuropathy, mood changes, depression,\r\nconfusion, anxiety, psychosis, seizures, paraesthesia, dizziness,\r\nrenal impairment, renal failure, renal tubular necrosis, urinary abnormalities,\r\nhyperglycaemia, electrolyte disturbances (including hyperkalaemia,\r\nhypokalaemia, and hyperuricaemia), blood disorders (including anaemia,\r\nleucopenia, pancytopenia, and thrombocytopenia), arthralgia, muscle\r\ncramp, visual disturbances, photophobia, tinnitus, impaired hearing,\r\nalopecia, sweating, acne; less commonly paralytic\r\nileus, gastro-intestinal reflux disease, peritonitis, pancreatitis,\r\nheart failure, arrhythmia, cardiac arrest, cerebrovascular accident,\r\ncardiomyopathy (important: see Cardiomyopathy below),\r\npalpitation, respiratory failure, coma, speech disorder, amnesia,\r\nparalysis, influenza-like symptoms, encephalopathy, coagulation disorders,\r\nphotosensitivity, cataract, hypoglycaemia, dysmenorrhoea, hypertonia,\r\ndermatitis; rarely pericardial effusion, respiratory\r\ndistress syndrome, posterior reversible encephalopathy syndrome, dehydration,\r\nthrombotic thrombocytopenic purpura, blindness, toxic epidermal necrolysis,\r\nhirsutism; very rarely myasthenia, haemorrhagic cystitis,\r\nStevens-Johnson syndromeCardiomyopathy\u00a0Cardiomyopathy has been reported\r\nin children. Patients should be monitored by echocardiography for\r\nhypertrophic changes\u2014consider dose reduction or discontinuation if\r\nthese occur", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217767.htm", "doses": [ "See under preparations", "liver transplantation, starting 12 hours after transplantation, by mouth, 100\u2013200\u00a0micrograms/kg daily in 2 divided doses; child 300\u00a0micrograms/kg daily in 2 divided doses", "Renal transplantation, starting within 24 hours of transplantation, by mouth, 200\u2013300\u00a0micrograms/kg daily in 2 divided doses; child 300\u00a0micrograms/kg daily in 2 divided doses", "Heart transplantation with antibody induction (starting within\r\n5 days of transplantation) or without antibody induction (starting\r\nwithin 12 hours of transplantation), by mouth, 75\u00a0micrograms/kg\r\ndaily in 2 divided doses; child with\r\nantibody induction (starting within 5 days of transplantation), 100\u2013300\r\nmicrograms/kg daily in 2 divided doses; without antibody induction\r\n(starting within 12 hours of transplantation), 300\u00a0micrograms/kg daily\r\nin 2 divided doses as soon as clinically possible (8\u201312 hours after\r\ndiscontinuing intravenous infusion)", "Maintenance treatment, dose adjusted according to response and\r\nwhole blood concentration", "Rejection therapy, seek specialist advice" ], "pregnancy": "Pregnancy\u00a0exclude before treatment; avoid unless potential\r\nbenefit outweighs risk\u2014risk of premature delivery, intra-uterine growth\r\nrestriction, and hyperkalaemia; toxicity in animal studies" }, "ANTAZOLINE SULPHATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.2 Other anti-inflammatory preparations", "ANTAZOLINE SULPHATE" ], "indications": "Indications\u00a0allergic conjunctivitis", "name": "ANTAZOLINE SULPHATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5445.htm", "doses": [ "adult and child over 12 years apply 2\u20133 times daily (max. 7\r\ndays)" ] }, "ALISKIREN": { "indications": "Indications\u00a0essential hypertension", "name": "ALISKIREN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.3 Renin inhibitors", "ALISKIREN" ], "cautions": "Cautions\u00a0patients taking concomitant diuretics, on a low-sodium\r\ndiet, or who are dehydrated (first doses may cause hypotension\u2014initiate\r\nwith care); renal artery\r\nstenosis; patients at risk of renal impairment; monitor plasma-potassium concentration and renal function\r\nin diabetes mellitus and heart failure; history of angioedema (avoid in hereditary or idiopathic\r\nangioedema); interactions: Appendix 1 (aliskiren)", "side-effects": "Side-effects\u00a0diarrhoea; less commonly rash; rarely angioedema; peripheral oedema, acute renal failure\r\n(reversible on discontinuation of treatment), anaemia, and hyperkalaemia\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200250.htm", "doses": [ "adult over 18 years, 150\u00a0mg\r\nonce daily, increased if necessary to 300\u00a0mg once daily " ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available;\r\nother drugs acting on the renin-angiotensin system have been associated\r\nwith fetal malformations and neonatal death" }, "NIFEDIPINE Modified release": { "indications": "Indications\u00a0prophylaxis of angina; hypertension; Raynaud\u2019s phenomenon; premature\r\nlabour (section 7.1.3)", "name": "NIFEDIPINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "NIFEDIPINE", "Modified release" ], "cautions": "Cautions\u00a0dose form not appropriate for use\r\nin hepatic impairment or where there is a history of\r\noesophageal or gastro-intestinal obstruction, decreased lumen diameter\r\nof the gastro-intestinal tract, or inflammatory bowel disease (including\r\nCrohn\u2019s disease)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbance; hypotension, oedema,\r\nvasodilatation, palpitation; headache, dizziness, lethargy, asthenia; less commonly tachycardia, syncope, chills, nasal congestion,\r\ndyspnoea, anxiety, sleep disturbance, vertigo, migraine, paraesthesia,\r\ntremor, polyuria, dysuria, nocturia, erectile dysfunction, epistaxis,\r\nmyalgia, joint swelling, visual disturbance, sweating, hypersensitivity\r\nreactions (including angioedema, jaundice, pruritus, urticaria, and\r\nrash); rarely anorexia, gum hyperplasia, mood disturbances,\r\nhyperglycaemia, male infertility, purpura, and photosensitivity reactions;\r\nalso reported dysphagia, intestinal obstruction, intestinal ulcer,\r\nbezoar formation (with some modified-release preparations), gynaecomastia,\r\nagranulocytosis, and anaphylaxis; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2694.htm", "doses": [ "See preparations below", "Name[Adalat\u00ae LA (Bayer) ] LA 20 tablets, m/r, f/c, pink, nifedipine 20\u00a0mg, net price 28-tab pack = \u00a35.27. \r\n Label:\r\n 25\nLA 30 tablets, m/r, f/c, pink, nifedipine 30\u00a0mg, net price 28-tab pack = \u00a36.85. \r\n Label:\r\n 25\nLA 60 tablets, m/r, f/c, pink, nifedipine 60\u00a0mg, net price 28-tab pack = \u00a39.03. \r\n Label:\r\n 25Counselling\u00a0Tablet membrane may pass through gastro-intestinal\r\ntract unchanged, but being porous has no effect on efficacyCautions\u00a0dose form not appropriate for use\r\nin hepatic impairment or where there is a history of\r\noesophageal or gastro-intestinal obstruction, decreased lumen diameter\r\nof the gastro-intestinal tract, or inflammatory bowel disease (including\r\nCrohn\u2019s disease)Dose\u00a0hypertension, 20\u201330\u00a0mg once daily, increased if necessary\r\nto max. 90\u00a0mg once dailyAngina prophylaxis, 30\u00a0mg once daily, increased if necessary\r\nto max. 90\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0may inhibit labour; manufacturer advises avoid before\r\nweek 20; risk to fetus should be balanced against risk of uncontrolled\r\nmaternal hypertension; use only if other treatment options are not\r\nindicated or have failed" }, "BETAMETHASONE": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "BETAMETHASONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5418.htm", "doses": [ "Apply eye drops every 1\u20132 hours until controlled then\r\nreduce frequency; apply eye ointment 2\u20134 times daily or at night when used with eye drops" ] }, "EXEMESTANE": { "indications": "Indications\u00a0adjuvant treatment of oestrogen-receptor-positive early breast cancer\r\nin postmenopausal women following 2\u20133 years of tamoxifen therapy;\r\nadvanced breast cancer in postmenopausal women in whom anti-oestrogen\r\ntherapy has failed", "name": "EXEMESTANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (exemestane)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, dyspepsia, constipation,\r\nanorexia; dizziness, fatigue, headache, depression, insomnia; hot\r\nflushes, sweating; alopecia, rash; less commonly drowsiness,\r\nasthenia, and peripheral oedema; rarely thrombocytopenia,\r\nleucopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86293.htm", "doses": [ "25\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TEICOPLANIN": { "indications": "Indications\u00a0\n(From Vancomycin and teicoplanin: British National Formulary)\nVancomycin and teicoplanin and under\r\nDose", "name": "TEICOPLANIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Vancomycin and teicoplanin" ], "cautions": "Cautions\u00a0vancomycin sensitivity; blood counts and liver and kidney function tests required; monitor renal and auditory function during prolonged\r\ntreatment in renal impairment or if other nephrotoxic or neurotoxic\r\ndrugs given; monitor plasma-teicoplanin concentration during parenteral\r\ntreatment if severe sepsis or burns, deep-seated staphylococcal infection\r\n(including bone and joint infection), endocarditis, renal impairment,\r\nin elderly, and in intravenous drug abusers; interactions: Appendix 1 (teicoplanin)", "side-effects": "Side-effects\u00a0rash, pruritus; less commonly nausea, vomiting, diarrhoea, bronchospasm, dizziness, headache,\r\nfever, leucopenia, thrombocytopenia, eosinophilia, tinnitus, mild\r\nhearing loss, vestibular disorders, thrombophlebitis; also\r\nreported renal failure, exfoliative dermatitis, Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3878.htm", "doses": [ "By mouth, Clostridium difficile infection, 200\u00a0mg twice daily for 10 days", "By intravenous injection or infusion, adult body-weight\r\nunder 70\u00a0kg, initially 400\u00a0mg every 12 hours for 3 doses, subsequently\r\n400\u00a0mg once daily (subsequent doses can alternatively be given by intramuscular injection); body-weight over 70\u00a0kg, initially\r\n6\u00a0mg/kg every 12 hours for 3 doses, then 6\u00a0mg/kg once daily; higher\r\ndoses may be required in severe infection (including burns, septicaemia,\r\nseptic arthritis, and osteomyelitis), consult product literature", "Streptococcal endocarditis (in combination with another antibacterial\r\nif necessary, see Table 1, section 5.1), by intravenous\r\ninjection or infusion, adult initially 6\u00a0mg/kg every 12 hours for 3 doses,\r\nthen 6\u00a0mg/kg once daily", "Enterococcal endocarditis (in combination with another antibacterial,\r\nsee Table 1, section 5.1), by intravenous\r\ninjection or infusion, adult initially 10\u00a0mg/kg every 12 hours for 3 doses,\r\nthen 10\u00a0mg/kg once daily", "Surgical prophylaxis, adult, by intravenous injection, 400\u00a0mg up to 30 minutes before\r\nthe procedure; open fractures, by intravenous infusion, 800\u00a0mg up to 30 minutes before skeletal stabilisation and definitive\r\nsoft-tissue closure", "child under 18 years see BNF for Children", "Plasma-teicoplanin concentration is not measured\r\nroutinely because a relationship between plasma concentration and\r\ntoxicity has not been established. However, the plasma-teicoplanin\r\nconcentration can be used to optimise parenteral treatment in some\r\npatients (see Cautions). Pre-dose (\u2018trough\u2019) concentrations should\r\nbe greater than 10\u00a0mg/litre (greater than 15\u201320\u00a0mg/litre in endocarditis;\r\ngreater than 20\u00a0mg/litre in deep-seated infection such as bone and\r\njoint infection), but less than 60\u00a0mg/litre. Teicoplanin doses in\r\nBNF may differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "CALCIUM SALTS With magnesium carbonate": { "indications": "Indications\u00a0hyperphosphataemia", "name": "CALCIUM SALTS With magnesium carbonate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "CALCIUM SALTS", "With magnesium carbonate" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; interactions: Appendix 1 (antacids, calcium salts)", "side-effects": "Side-effects\u00a0hypercalcaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204170.htm", "doses": [ "Name[Osvaren\u00ae (Fresenius Medical Care) ] Tablets, f/c, scored, calcium acetate\r\n435\u00a0mg (calcium 110\u00a0mg or Ca2+ 2.7\u00a0mmol), heavy magnesium\r\ncarbonate 235\u00a0mg (magnesium 60\u00a0mg), net price 180-tab pack = \u00a324.00. \r\n Label:\r\n 25, counselling, with meals,\r\navoid other drugs at same time (see below)Contra-indications\u00a0hypercalcaemia, hypermagnesaemia; third-degree\r\nAV block; myasthenia gravisDose\u00a0adult over 18 years, initially\r\n1 tablet 3 times daily with meals, adjusted according to serum-phosphate\r\nconcentration (usual dose 3\u201310 tablets daily); max. 12 tablets dailyCounselling\u00a0Manufacturer advises that other drugs\r\nshould be taken at least 2 hours before or 3 hours after Osvaren\u00ae to reduce possible interference with absorption\r\nof other drugs" ] }, "TERBUTALINE SULPHATE - BETA2 AGONISTS": { "side-effects": "Side-effects\u00a0\n(From Beta2 agonists: British National Formulary)\nSide-effects\u00a0 Side-effects of the beta2 agonists include nausea, vomiting, pulmonary oedema (see Cautions above), palpitation, tachycardia, arrhythmias, myocardial ischaemia, peripheral vasodilation, headache, tremor, hyperglycaemia, hypokalaemia (see Cautions), muscle cramps and tension, and hypersensitivity reactions (including angioedema, urticaria, rash, bronchospasm, hypotension, and collapse).; also\r\nreported sleep disturbances and behavioural disturbances", "indications": "Indications\u00a0uncomplicated premature labour (\n(From 7.1.3 Myometrial relaxants: British National Formulary)\nA beta2 agonist (salbutamol or terbutaline) is used for inhibiting uncomplicated premature labour between 24 and 33 weeks of gestation and it may permit a delay in delivery of at least 48 hours. Prolonged therapy should be avoided since risk to the mother increases after 48 hours and there is a lack of evidence of benefit from further treatment; maintenance treatment is therefore not recommended.); asthma\r\n(%s\n(From 3.1.1 Adrenoceptor agonists: British National Formulary)\n3.1.1 Adrenoceptor agonists)", "name": "TERBUTALINE SULPHATE - BETA2 AGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104941.htm", "doses": [ "By intravenous infusion, 5\u00a0micrograms/minute\r\nfor 20 minutes, increased every 20 minutes in steps of 2.5\u00a0micrograms/minute\r\nuntil contractions have ceased (more than 10\u00a0micrograms/minute should seldom be given\u201420\u00a0micrograms/minute should not be exceeded), continue for 1 hour then decrease every 20 minutes\r\nin steps of 2.5\u00a0micrograms/minute to lowest dose that maintains suppression,\r\ncontinue at this level for 12 hours then by mouth (but\r\nsee notes above), 5\u00a0mg every 8 hours for as long as is desirable to\r\nprolong pregnancy (or alternatively follow the intravenous infusion by subcutaneous injection 250\u00a0micrograms every 6 hours for\r\na few days then by mouth as above)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.3 Myometrial relaxants", "Beta2 agonists", "TERBUTALINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From Beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in patients with suspected cardiovascular disease (such patients should be assessed by a cardiologist before initiating therapy\u2014see also Contra-indications, below), hypertension, mild to moderate pre-eclampsia, hyperthyroidism, and hypokalaemia (particular risk with potassium-depleting diuretics\u2014see also Hypokalaemia). It is important to monitor pulse rate (should not exceed 140 beats per minute), ECG (discontinue treatment if signs of myocardial ischaemia develop), and the patient\u2019s fluid and electrolyte status (avoid over-hydration\u2014discontinue drug immediately and initiate diuretic therapy if pulmonary oedema occurs). Beta2 agonists should also be used with caution in diabetes\u2014monitor blood glucose (risk of hyperglycaemia and ketoacidosis, especially with intravenous beta2 agonists).; interactions: Appendix 1 (sympathomimetics, beta2)" }, "CICLOSPORIN - CORTICOSTEROIDS AND OTHER IMMUNOSUPPRESSANTS": { "indications": "Indications\u00a0%s\n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nCiclosporin a calcineurin inhibitor, is a potent immunosuppressant which is virtually non-myelotoxic but markedly nephrotoxic. It has an important role in organ and tissue transplantation, for prevention of graft rejection following bone marrow, kidney, liver, pancreas, heart, lung, and heart-lung transplantation, and for prophylaxis and treatment of graft-versus-host disease., and under Dose; severe acute ulcerative colitis [unlicensed indication]\r\n(section %s\n(From CICLOSPORIN: British National Formulary)\nCICLOSPORIN); rheumatoid arthritis (%s\n(From 10.1.3 Drugs that suppress the rheumatic disease process: British National Formulary)\n10.1.3 Drugs that suppress the rheumatic disease process); atopic\r\ndermatitis and psoriasis (%s\n(From 13.5.3 Drugs affecting the immune response: British National Formulary)\n13.5.3 Drugs affecting the immune response)", "name": "CICLOSPORIN - CORTICOSTEROIDS AND OTHER IMMUNOSUPPRESSANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "CICLOSPORIN" ], "cautions": "Cautions\u00a0monitor kidney function\u2014dose dependent increase in serum creatinine and urea during first\r\nfew weeks may necessitate dose reduction in transplant patients (exclude\r\nrejection if kidney transplant) or discontinuation in non-transplant\r\npatients; monitor liver function (see Hepatic\r\nImpairment below); monitor blood pressure\u2014discontinue if hypertension develops that cannot be\r\ncontrolled by antihypertensives; hyperuricaemia; monitor serum potassium especially in renal dysfunction (risk of hyperkalaemia); monitor serum magnesium; measure blood\r\nlipids before treatment and after the first month of treatment; use with tacrolimus specifically contra-indicated; for patients other than transplant\r\nrecipients, preferably avoid other immunosuppressants (increased risk\r\nof infection and malignancies, including lymphoma and skin cancer); avoid excessive exposure to UV\r\nlight, including sunlight; interactions: Appendix 1 (ciclosporin)Additional cautions in nephrotic syndrome\u00a0Contra-indicated in uncontrolled hypertension, uncontrolled infections, and malignancy; in long-term management, perform renal biopsies at yearly intervals", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, abdominal pain, diarrhoea,\r\ngingival hyperplasia, hepatic dysfunction, hypertension, tremor, headache,\r\nparaesthesia, fatigue, renal dysfunction (renal structural changes\r\non long-term administration, see also under Cautions), hyperuricaemia,\r\nhyperkalaemia, hypomagnesaemia, hyperlipidaemia, hypercholesterolaemia,\r\nmuscle cramps, myalgia, hypertrichosis; less commonly oedema, weight gain, signs of encephalopathy, anaemia, thrombocytopenia; rarely pancreatitis, motor polyneuropathy, menstrual disturbances,\r\ngynaecomastia, microangiopathic haemolytic anaemia, haemolytic uraemic\r\nsyndrome, hyperglycaemia, muscle weakness, myopathy, visual disturbances\r\nsecondary to benign intracranial hypertension (discontinue); also reported with infusion anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31279.htm", "doses": [ "Organ transplantation, used alone, adult and child over 3 months 10\u201315\u00a0mg/kg by mouth 4\u201312 hours before transplantation followed by 10\u201315\u00a0mg/kg\r\ndaily for 1\u20132 weeks postoperatively then reduced gradually to 2\u20136\u00a0mg/kg\r\ndaily for maintenance (dose should be adjusted according to blood-ciclosporin concentration and renal function); dose lower\r\nif given concomitantly with other immunosuppressant therapy (e.g. corticosteroids); if necessary one-third corresponding\r\noral dose can be given by intravenous infusion over\r\n2\u20136 hours", "Bone-marrow transplantation, prevention and treatment of graft-versus-host\r\ndisease, adult and child over 3 months 3\u20135\u00a0mg/kg daily by intravenous infusion over 2\u20136 hours from day before transplantation to 2 weeks postoperatively\r\n(or 12.5\u201315\u00a0mg/kg daily by mouth) then 12.5\u00a0mg/kg daily by mouth for 3\u20136 months then tailed off (may take up to a\r\nyear after transplantation)", "Nephrotic syndrome, by mouth, 5\u00a0mg/kg daily in\r\n2 divided doses; child 6\u00a0mg/kg daily\r\nin 2 divided doses; maintenance treatment reduce to lowest effective\r\ndose according to proteinuria and serum creatinine measurements; discontinue\r\nafter 3 months if no improvement in glomerulonephritis or glomerulosclerosis\r\n(after 6 months in membranous glomerulonephritis)", "Patients should be stabilised on a particular brand of oral\r\nciclosporin because switching between formulations without close monitoring\r\nmay lead to clinically important changes in blood-ciclosporin concentration.\r\nPrescribing and dispensing of ciclosporin should be by brand name\r\nto avoid inadvertent switching. If it is necessary to switch a patient\r\nto a different brand of ciclosporin, the patient should be monitored\r\nclosely for changes in blood-ciclosporin concentration, serum creatinine,\r\nblood pressure, and transplant function." ], "pregnancy": "Pregnancy\u00a0crosses placenta; see Immunosuppressant Therapy" }, "PIPERACILLIN WITH TAZOBACTAM": { "indications": "Indications\u00a0see under Dose", "name": "PIPERACILLIN WITH TAZOBACTAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.4 Antipseudomonal penicillins" ], "cautions": "Cautions\u00a0see under Benzylpenicillin (section 5.1.1.1); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Benzylpenicillin (section 5.1.1.1); also\r\nnausea, vomiting, diarrhoea; less commonly stomatitis,\r\ndyspepsia, constipation, jaundice, hypotension, headache, insomnia,\r\ninjection-site reactions; rarely abdominal pain,\r\nhepatitis, eosinophilia; very rarely hypoglycaemia,\r\nhypokalaemia, pancytopenia, Stevens-Johnson syndrome, toxic epidermal\r\nnecrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202628.htm", "doses": [ "Expressed as a combination of piperacillin\r\nand tazobactam (both as sodium salts) in a ratio of 8:1", "Hospital-acquired pneumonia, septicaemia, complicated\r\nintra-abdominal infections, complicated infections involving the urinary\r\ntract or skin and soft tissues, adult and child over 12 years, by\r\nintravenous infusion, 4.5\u00a0g every 8 hours, increased to 4.5\u00a0g\r\nevery 6 hours in severe infections", "Complicated intra-abdominal infections, by\r\nintravenous infusion, child 2\u201312 years, 112.5\u00a0mg/kg (max. 4.5\u00a0g) every 8 hours", "Infections in neutropenic patients, by intravenous\r\ninfusion, adult and child over 12 years, 4.5\u00a0g every 6 hours; child 2\u201312 years, 90\u00a0mg/kg (max. 4.5\u00a0g) every 6 hours" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if potential benefit\r\noutweighs risk" }, "LEVETIRACETAM": { "indications": "Indications\u00a0\n(From Levetiracetam: British National Formulary)\nLevetiracetam", "name": "LEVETIRACETAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Levetiracetam", "LEVETIRACETAM" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; interactions: Appendix 1 (levetiracetam)", "side-effects": "Side-effects\u00a0anorexia, weight changes, abdominal pain, nausea,\r\nvomiting, dyspepsia, diarrhoea, cough, drowsiness, amnesia, ataxia,\r\nconvulsion, dizziness, headache, tremor, hyperkinesia, malaise, impaired\r\nattention, aggression, agitation, depression, insomnia, anxiety, irritability,\r\npersonality disorder, thrombocytopenia, myalgia, diplopia, blurred\r\nvision, rash; also reported pancreatitis, hepatic\r\nfailure, paraesthesia, confusion, psychosis, suicidal ideation, leucopenia,\r\nneutropenia, pancytopenia, alopecia, toxic epidermal necrolysis, Stevens-Johnson\r\nsyndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89422.htm", "doses": [ "Monotherapy of focal seizures, by mouth or by intravenous infusion, adult and child over\r\n16 years, initially 250\u00a0mg once daily increased after 1\u20132 weeks to\r\n250\u00a0mg twice daily; thereafter, increased according to response in\r\nsteps of 250\u00a0mg twice daily every 2 weeks; max. 1.5\u00a0g twice daily", "Adjunctive therapy of focal seizures, by\r\nmouth, adult and child over 12 years, body-weight over 50\u00a0kg, initially\r\n250\u00a0mg twice daily, increased by 500\u00a0mg twice daily every 2\u20134 weeks;\r\nmax. 1.5\u00a0g twice daily; child over\r\n6 months, body-weight under 50\u00a0kg, initially 10\u00a0mg/kg once daily,\r\nincreased by max. 10\u00a0mg/kg twice daily every 2 weeks; max. 30\u00a0mg/kg\r\ntwice daily; child 1\u20136 months, initially\r\n7\u00a0mg/kg once daily, increased by max. 7\u00a0mg/kg twice daily every 2\r\nweeks; max. 21\u00a0mg/kg twice daily", "By intravenous infusion, adult and child over 12 years, body-weight\r\nover 50\u00a0kg, initially 250\u00a0mg twice daily, increased by 500\u00a0mg twice\r\ndaily every 2\u20134 weeks; max. 1.5\u00a0g twice daily; child over 4 years, body-weight under 50\u00a0kg, initially 10\u00a0mg/kg once daily,\r\nincreased by max. 10\u00a0mg/kg twice daily every 2 weeks; max. 30\u00a0mg/kg\r\ntwice daily", "Adjunctive therapy of myoclonic seizures and tonic-clonic seizures, by mouth or by intravenous infusion, adult and child over 12 years, body-weight over 50\u00a0kg, initially 250\u00a0mg twice daily,\r\nincreased by 500\u00a0mg twice daily every 2\u20134 weeks; max. 1.5\u00a0g twice\r\ndaily; child 12\u201318 years, body-weight\r\nunder 50\u00a0kg, initially 10\u00a0mg/kg once daily, increased by max. 10\u00a0mg/kg\r\ntwice daily every 2 weeks; max. 30\u00a0mg/kg twice daily", "If switching between oral therapy and intravenous therapy (because\r\noral route temporarily unavailable), by intravenous infusion, same as established oral dose", "Levetiracetam doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "CAPREOMYCIN": { "indications": "Indications\u00a0in combination with other drugs, tuberculosis resistant to first-line\r\ndrugs", "name": "CAPREOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "CAPREOMYCIN" ], "cautions": "Cautions\u00a0auditory impairment; monitor renal, hepatic, auditory, and vestibular function\r\nand electrolytes; interactions: Appendix\r\n1 (capreomycin)", "side-effects": "Side-effects\u00a0hypersensitivity reactions including urticaria\r\nand rashes; leucocytosis or leucopenia, rarely thrombocytopenia; changes\r\nin liver function tests; nephrotoxicity, electrolyte disturbances;\r\nhearing loss with tinnitus and vertigo; neuromuscular block after\r\nlarge doses, pain and induration at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204182.htm", "doses": [ "By deep intramuscular injection, 1\u00a0g daily\r\n(not more than 20\u00a0mg/kg) for 2\u20134 months, then 1\u00a0g 2\u20133 times each week" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014teratogenic in animal studies" }, "SULPIRIDE": { "indications": "Indications\u00a0schizophrenia", "name": "SULPIRIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "SULPIRIDE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also excited, agitated, or aggressive patients (even low doses may aggravate symptoms)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nhepatitis ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65129.htm", "doses": [ "adult and child over 14 years, 200\u2013400\u00a0mg twice daily; max.\r\n800\u00a0mg daily in predominantly negative symptoms, and 2.4\u00a0g daily in\r\nmainly positive symptoms; elderly,\r\nlower initial dose, increased gradually according to response" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "FEXOFENADINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "FEXOFENADINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57595.htm", "doses": [ "Seasonal allergic rhinitis, 120\u00a0mg once daily; child 6\u201312 years, 30\u00a0mg twice daily", "Chronic idiopathic urticaria, adult and child over 12 years, 180\u00a0mg once\r\ndaily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "KETOPROFEN": { "indications": "Indications\u00a0pain and mild inflammation in rheumatic disease and\r\nother musculoskeletal disorders, and after orthopaedic surgery; acute\r\ngout; dysmenorrhoea", "name": "KETOPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "KETOPROFEN" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82520.htm", "doses": [ "By mouth, rheumatic disease, 100\u2013200\u00a0mg\r\ndaily in 2\u20134 divided doses; child not\r\nrecommended", "Pain and dysmenorrhoea, 50\u00a0mg up to 3 times daily; child not recommended", "By rectum in suppositories, rheumatic\r\ndisease, 100\u00a0mg at bedtime; child not\r\nrecommended", "Combined oral and rectal treatment, max. total daily dose 200\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "NORTRIPTYLINE": { "indications": "Indications\u00a0depressive illness; neuropathic pain [unlicensed]\r\n(section 4.7.3)", "name": "NORTRIPTYLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "NORTRIPTYLINE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.; manufacturer advises plasma-nortriptyline concentration\r\nmonitoring if dose above 100\u00a0mg daily, but evidence of practical value\r\nuncertain", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, stomatitis, diarrhoea, hypertension, oedema, flushing,\r\nrestlessness, fatigue, and mydriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3323.htm", "doses": [ "Depression, low dose initially increased as necessary\r\nto 75\u2013100\u00a0mg daily in divided doses or as a single\r\ndose (max. 150\u00a0mg daily); adolescent and elderly 30\u201350\u00a0mg daily in divided\r\ndoses; child not recommended for depression", "Neuropathic pain [unlicensed], initially 10\u00a0mg\r\ndaily at night, gradually increased if necessary to 75\u00a0mg daily; higher\r\ndoses under specialist supervision" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "SODIUM CROMOGLICATE - CROMOGLICATE AND RELATED THERAPY": { "indications": "Indications\u00a0prophylaxis of asthma (see\r\nalso Management of Chronic Asthma\r\ntable);\r\nfood allergy (section 1.5.4); allergic conjunctivitis (section 11.4.2); allergic rhinitis (section 12.2.1)", "name": "SODIUM CROMOGLICATE - CROMOGLICATE AND RELATED THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.1 Cromoglicate and related therapy" ], "cautions": "Cautions\u00a0\n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above; also discontinue if eosinophilic pneumonia occurs", "side-effects": "Side-effects\u00a0\n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above; also rhinitis; very rarely eosinophilic pneumonia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3007.htm", "doses": [ "By aerosol inhalation, adult and child over 5 years, 10\u00a0mg (2\r\npuffs) 4 times daily, increased if necessary to 6\u20138 times daily; or\r\nadditional dose may also be taken before exercise; maintenance, 5\u00a0mg\r\n(1 puff) 4 times daily" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "IPILIMUMAB": { "indications": "Indications\u00a0\n(From Ipilimumab: British National Formulary)\nIpilimumab causes T-cell activation. It is licensed for the treatment of unresectable or metastatic advanced melanoma in patients who have received prior therapy. Infusion-related side-effects have been reported with ipilimumab; premedication with paracetamol and an antihistamine is recommended. A corticosteroid can be used after starting ipilimumab, to treat immune-related reactions.", "name": "IPILIMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Ipilimumab", "IPILIMUMAB" ], "cautions": "Cautions\u00a0\n(From Ipilimumab: British National Formulary)\nIpilimumab causes T-cell activation. It is licensed for the treatment of unresectable or metastatic advanced melanoma in patients who have received prior therapy. Infusion-related side-effects have been reported with ipilimumab; premedication with paracetamol and an antihistamine is recommended. A corticosteroid can be used after starting ipilimumab, to treat immune-related reactions.\u2014for full details consult product\r\nliterature", "side-effects": "Side-effects\u00a0\n(From Ipilimumab: British National Formulary)\nIpilimumab causes T-cell activation. It is licensed for the treatment of unresectable or metastatic advanced melanoma in patients who have received prior therapy. Infusion-related side-effects have been reported with ipilimumab; premedication with paracetamol and an antihistamine is recommended. A corticosteroid can be used after starting ipilimumab, to treat immune-related reactions.\u2014for full details (including monitoring\r\nand management of side-effects) consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217781.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk; use\r\neffective contraception" }, "PILOCARPINE HYDROCHLORIDE": { "indications": "Indications\u00a0xerostomia following irradiation for head\r\nand neck cancer (see also notes above); dry mouth and dry eyes in Sj\u00f6gren\u2019s\r\nsyndrome", "name": "PILOCARPINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.5 Treatment of dry mouth", "Systemic treatment" ], "cautions": "Cautions\u00a0asthma and chronic obstructive pulmonary disease (avoid if uncontrolled,\r\nsee Contra-indications), cardiovascular disease (avoid if uncontrolled); cholelithiasis or biliary-tract disease, peptic ulcer, risk of increased urethral\r\nsmooth muscle tone and renal colic; maintain adequate fluid intake to avoid dehydration\r\nassociated with excessive sweating; cognitive or psychiatric disturbances; susceptibility to angle-closure glaucoma; interactions: Appendix 1 (parasympathomimetics)Counselling\u00a0Blurred vision or dizziness may affect\r\nperformance of skilled tasks (e.g. driving) particularly at night\r\nor in reduced lighting", "side-effects": "Side-effects\u00a0dyspepsia, diarrhoea, abdominal pain, nausea,\r\nvomiting, constipation; flushing, hypertension, palpitation, headache,\r\ndizziness, asthenia, influenza-like symptoms, sweating; increased\r\nurinary frequency; visual disturbances, lacrimation, ocular pain,\r\nconjunctivitis; rhinitis; rash, pruritus; less commonly flatulence, urinary urgency", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29690.htm", "doses": [ "Xerostomia following irradiation for head and neck cancer,\r\n5\u00a0mg 3 times daily with or immediately after meals (last dose always\r\nwith evening meal); if tolerated but response insufficient after 4\r\nweeks, may be increased to max. 30\u00a0mg daily in divided doses; max.\r\ntherapeutic effect normally within 4\u20138 weeks; discontinue if no improvement\r\nafter 2\u20133 months; child not recommended", "Dry mouth and dry eyes in Sj\u00f6gren\u2019s syndrome, 5\u00a0mg 4 times daily\r\n(with meals and at bedtime); if tolerated but response insufficient,\r\nmay be increased to max. 30\u00a0mg daily in divided doses; discontinue\r\nif no improvement after 2\u20133 months; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid\u2014smooth muscle stimulant; toxicity in animal studies" }, "LINAGLIPTIN": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "LINAGLIPTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0cough, nasopharyngitis; also reported pancreatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217727.htm", "doses": [ "adult over 18 years, 5\u00a0mg\r\nonce daily", "Dose of concomitant sulfonylurea\r\nmay need to be reduced" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "ETANERCEPT": { "indications": "Indications\u00a0see notes above; ankylosing spondylitis,\r\npsoriatic arthritis, polyarticular course juvenile idiopathic arthritis,\r\nrheumatoid arthritis (%s\n(From ETANERCEPT: British National Formulary)\nETANERCEPT)", "name": "ETANERCEPT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201652.htm", "doses": [ "By subcutaneous injection, plaque psoriasis,\r\n25\u00a0mg twice weekly or 50\u00a0mg once weekly for up to 24 weeks; discontinue\r\nif no response after 12 weeks; child 6\u201318 years, 800\u00a0micrograms/kg (max. 50\u00a0mg) once weekly for up to\r\n24 weeks; discontinue if no response after 12 weeks" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "ZUCLOPENTHIXOL DECANOATE": { "indications": "Indications\u00a0maintenance in schizophrenia and paranoid psychoses", "name": "ZUCLOPENTHIXOL DECANOATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections", "ZUCLOPENTHIXOL DECANOATE" ], "cautions": "Cautions\u00a0see section 4.2.1 and\r\nnotes above; QT-interval prolongation (avoid concomitant use of drugs that prolong QT interval); avoid\r\nin acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0see section 4.2.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3279.htm", "doses": [ "By deep intramuscular injection into the\r\nupper outer buttock or lateral thigh, test dose 100\u00a0mg, followed after\r\nat least 7 days by 200\u2013500\u00a0mg or more, repeated at intervals of 1\u20134\r\nweeks, adjusted according to response; max. 600\u00a0mg weekly; elderly quarter to half usual starting dose; child not recommended" ], "pregnancy": "Pregnancy\u00a0see section 4.2.1" }, "CEFTRIAXONE": { "indications": "Indications\u00a0see under Cefaclor and notes above; surgical prophylaxis;\r\nprophylaxis of meningococcal meningitis [unlicensed indication] (Table\r\n2, section 5.1)", "name": "CEFTRIAXONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFTRIAXONE" ], "cautions": "Cautions\u00a0see under Cefaclor; may displace bilirubin\r\nfrom serum albumin, administer over 60 minutes in neonates (see also Contra-indications); treatment longer than 14 days, renal failure, dehydration\u2014risk of\r\nceftriaxone precipitation in gall bladder; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor; calcium ceftriaxone precipitates in urine (particularly in very young, dehydrated or\r\nthose who are immobilised) or in gall bladder\u2014consider discontinuation\r\nif symptomatic; rarely prolongation of prothrombin time, pancreatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106102.htm", "doses": [ "By deep intramuscular injection, or by intravenous injection over at least\r\n2\u20134 minutes, or by intravenous infusion, 1\u00a0g daily; 2\u20134\u00a0g daily in severe infections; intramuscular doses\r\nover 1\u00a0g divided between more than one site; single intravenous doses\r\nabove 1\u00a0g by intravenous infusion only", "neonate, by intravenous\r\ninfusion over 60 minutes, 20\u201350\u00a0mg/kg daily (max. 50\u00a0mg/kg\r\ndaily); infant and child under 50\u00a0kg, by deep intramuscular injection, or by intravenous injection over 2\u20134 minutes, or by intravenous infusion, 20\u201350\u00a0mg/kg\r\ndaily; up to 80\u00a0mg/kg daily in severe infections; doses of 50\u00a0mg/kg\r\nand over by intravenous infusion only; 50\u00a0kg and over, adult dose ", "Endocarditis caused by haemophilus, actinobacillus,\r\ncardiobacterium, eikenella, and kingella species (\u2018HACEK organisms\u2019)\r\n(in combination with another antibacterial, see Table 1, section 5.1; [unlicensed indication]), by intravenous infusion, 2\u20134\u00a0g daily", "Early syphilis [unlicensed indication], by\r\ndeep intramuscular injection, 500\u00a0mg daily for 10 days", "Uncomplicated gonorrhoea, pelvic inflammatory disease\r\n(see also Table 1, section 5.1), by deep intramuscular\r\ninjection, 500\u00a0mg as a single dose [unlicensed dose]", "Surgical prophylaxis, by deep intramuscular\r\ninjection or by intravenous injection over at least 2\u20134 minutes, 1\u00a0g up to 30 minutes before the procedure;\r\ncolorectal surgery, by deep intramuscular injection or by intravenous infusion, 2\u00a0g\r\nup to 30 minutes before the procedure; intramuscular doses over 1\u00a0g\r\ndivided between more than one site" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "13.13 Topical circulatory preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin" ], "name": "13.13 Topical circulatory preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6448.htm", "doses": [ "apply up to 4 times daily in superficial soft-tissue injuries\r\nand superficial thrombophlebitis" ] }, "LEUPRORELIN ACETATE": { "indications": "Indications\u00a0see under Dose; prostate cancer (section 8.3.4.2)", "name": "LEUPRORELIN ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.; monitor liver function; family history\r\nof osteoporosis; chronic use of other drugs which reduce\r\nbone density including alcohol and tobacco; diabetes", "side-effects": "Side-effects\u00a0see notes above; breast tenderness; nausea, vomiting,\r\ndiarrhoea, anorexia; fever, chills; sleep disturbances, dizziness,\r\nfatigue, leucopenia, thrombocytopenia, altered blood lipids, pulmonary\r\nembolism; spinal fracture, paralysis, hypotension and worsening of\r\ndepression also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4473.htm", "doses": [ "By subcutaneous or intramuscular injection (as Prostap\u00ae SR DCS)", "Endometriosis, 3.75\u00a0mg as a single dose in first 5 days of menstrual\r\ncycle then every month for max. 6 months (course not to be repeated)", "Endometrial thinning before intra-uterine surgery, 3.75\u00a0mg as\r\na single dose (given between days 3 and 5 of menstrual cycle) 5\u20136\r\nweeks before surgery", "Reduction of size of uterine fibroids and of associated bleeding\r\nbefore surgery, 3.75\u00a0mg as a single dose every month usually for 3\u20134\r\nmonths (max. 6 months)", "By intramuscular injection (as Prostap\u00ae 3 DCS)", "Endometriosis, 11.25\u00a0mg as a single dose in first 5 days of\r\nmenstrual cycle then every 3 months for max. 6 months (course not\r\nto be repeated)" ], "pregnancy": "Pregnancy\u00a0teratogenic in animal studies; see\r\nalso notes above" }, "TINZAPARIN SODIUM": { "indications": "Indications\u00a0see notes above and under preparations", "name": "TINZAPARIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Low molecular weight heparins", "TINZAPARIN SODIUM" ], "cautions": "Cautions\u00a0see under Heparin and notes above", "side-effects": "Side-effects\u00a0see under Heparin; also less commonly headache", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2778.htm", "doses": [ "See under preparations below", "prophylaxis of deep-vein thrombosis, by subcutaneous\r\ninjection, general surgery, 3500\u00a0units 2 hours before surgery,\r\nthen 3500\u00a0units every 24 hours; orthopaedic surgery, 50\u00a0units/kg 2\r\nhours before surgery, then 50\u00a0units/kg every 24 hours or 4500\u00a0units 12 hours before surgery, then 4500\u00a0units every 24 hours", "treatment of deep-vein thrombosis and of pulmonary embolism, by subcutaneous injection, 175\u00a0units/kg once daily until\r\nadequate oral anticoagulation established" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; vials contain benzyl alcohol\u2014manufacturer\r\nadvises avoid; see also Pregnancy" }, "OXALIPLATIN": { "indications": "Indications\u00a0metastatic colorectal cancer in combination with fluorouracil and folinic acid; colon cancer\u2014see notes above", "name": "OXALIPLATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Platinum compounds", "OXALIPLATIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes\r\nabove; interactions: Appendix 1 (platinum\r\ncompounds)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129825.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies; effective contraception required during and for 4 months\r\nafter treatment in women and 6 months after treatment in men; see\r\nalso Pregnancy and Reproductive\r\nFunction" }, "MORPHINE SALTS Injection with antiemetic": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Injection with antiemetic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Injection with antiemetic" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9662.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "adult and child over 12 years, moderate to severe pain (short-term\r\nuse only) by subcutaneous, intramuscular, or intravenous injection, 1\u00a0mL, repeated not more\r\noften than every 4 hours; max. 3 doses in any 24-hour period", "Name[Cyclimorph\u00ae (Amdipharm) ] Cyclimorph-10\u00ae Injection, morphine tartrate 10\u00a0mg, cyclizine tartrate\r\n50\u00a0mg/mL, net price 1-mL amp = \u00a31.75Dose\u00a0adult and child over 12 years, moderate to severe pain (short-term\r\nuse only) by subcutaneous, intramuscular, or intravenous injection, 1\u00a0mL, repeated not more\r\noften than every 4 hours; max. 3 doses in any 24-hour period\nCyclimorph-15\u00ae Injection, morphine tartrate 15\u00a0mg, cyclizine tartrate\r\n50\u00a0mg/mL, net price 1-mL amp = \u00a31.82Dose\u00a0adult and child over 12 years, moderate to severe pain (short-term\r\nuse only) by subcutaneous, intramuscular, or intravenous injection, 1\u00a0mL, repeated not more\r\noften than every 4 hours; max. 3 doses in any 24-hour period" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "THIOPENTAL SODIUM": { "indications": "Indications\u00a0induction of general anaesthesia; anaesthesia of short duration;\r\nreduction of raised intracranial pressure if ventilation controlled;\r\nstatus epilepticus (see also section 4.8.2)", "name": "THIOPENTAL SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.1 Intravenous anaesthetics", "Drugs used for intravenous anaesthesia", "THIOPENTAL SODIUM" ], "cautions": "Cautions\u00a0\n(From Drugs used for intravenous anaesthesia: British National Formulary)\nThiopental sodium is a barbiturate that is used for induction of anaesthesia, but has no analgesic properties. Induction is generally smooth and rapid, but dose-related cardiovascular and respiratory depression can occur. Awakening from a moderate dose of thiopental is rapid because the drug redistributes into other tissues, particularly fat. However, metabolism is slow and sedative effects can persist for 24 hours. Repeated doses have a cumulative effect and recovery is much slower.; cardiovascular disease; reconstituted\r\nsolution is highly alkaline\u2014extravasation causes tissue necrosis and\r\nsevere pain; avoid intra-arterial injection; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0hypotension, arrhythmias, myocardial depression,\r\nlaryngeal spasm, cough, headache, sneezing, hypersensitivity reactions,\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/90110.htm", "doses": [ "Induction of general anaesthesia, by slow intravenous\r\ninjection usually as a 2.5% (25\u00a0mg/mL) solution, adult over 18 years, fit and premedicated, initially\r\n100\u2013150\u00a0mg (reduced in elderly or debilitated) over 10\u201315 seconds\r\n(longer in elderly or debilitated), followed by further quantity if\r\nnecessary according to response after 30\u201360 seconds; or up to 4\u00a0mg/kg (max. 500\u00a0mg); child 1 month\u201318 years, initially up to 4\u00a0mg/kg, then 1\u00a0mg/kg repeated as necessary (max. total dose 7\u00a0mg/kg)", "Raised intracranial pressure, by slow intravenous injection, 1.5\u20133\u00a0mg/kg, repeated as required", "Status epilepticus (only if other measures fail, see section 4.8.2), by slow intravenous injection as a 2.5% (25\u00a0mg/mL) solution, adult over 18 years, 75\u2013125\u00a0mg as a single dose; child 1 month\u201318 years, initially up to 4\u00a0mg/kg by slow intravenous injection, then up to\r\n8\u00a0mg/kg/hour by continuous intravenous infusion, adjusted\r\naccording to response" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery;\r\ndose should not exceed 250\u00a0mg" }, "DICLOFENAC SODIUM With misoprostol": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\nacute gout; postoperative pain", "name": "DICLOFENAC SODIUM With misoprostol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DICLOFENAC SODIUM", "With misoprostol" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation; injection site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5212.htm", "doses": [ "By mouth, 75\u2013150\u00a0mg daily in 2\u20133\r\ndivided doses", "By rectum in suppositories, 75\u2013150\u00a0mg\r\ndaily in divided doses", "Juvenile idiopathic arthritis, child 6 months\u201318 years, by mouth, see BNF for Children", "Postoperative pain, child 6\u201312 years, by rectum, 1\u20132\u00a0mg/kg (max. 150\u00a0mg) daily\r\nin divided doses (12.5\u00a0mg and 25\u00a0mg suppositories only) for max. 4\r\ndays", "prophylaxis against NSAID-induced gastroduodenal ulceration\r\nin patients requiring diclofenac for rheumatoid arthritis or osteoarthritis,\r\n1 tablet twice daily with food; child not recommended", "Name[Arthrotec\u00ae (Pharmacia) ] Arthrotec\u00ae 50 tablets, diclofenac sodium (in e/c core) 50\u00a0mg, misoprostol 200\u00a0micrograms, net price 60-tab pack = \u00a311.98; \r\n Label:\r\n 21, 25Dose\u00a0prophylaxis against NSAID-induced gastroduodenal ulceration\r\nin patients requiring diclofenac for rheumatoid arthritis or osteoarthritis,\r\n1 tablet 2\u20133 times daily with food; child not recommendedFor prescribing information\r\non misoprostol, see section 1.3.4\nArthrotec\u00ae 75 tablets, diclofenac sodium (in e/c core) 75\u00a0mg, misoprostol 200\u00a0micrograms, net price 60-tab pack = \u00a315.83. \r\n Label:\r\n 21, 25Dose\u00a0prophylaxis against NSAID-induced gastroduodenal ulceration\r\nin patients requiring diclofenac for rheumatoid arthritis or osteoarthritis,\r\n1 tablet twice daily with food; child not recommendedFor prescribing information\r\non misoprostol, see section 1.3.4Note\u00a0The BNF recommends a higher starting dose\r\nof misoprostol for prophylaxis against NSAID-induced gastroduodenal\r\nulceration than that provided by Arthrotec\u00ae (see section 1.3.4)" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "BECLOMETASONE DIPROPIONATE": { "indications": "Indications\u00a0adjunct to aminosalicylates in acute\r\nmild to moderate ulcerative colitis; asthma (section 3.2); allergic and vasomotor rhinitis (section 12.2.1); oral ulceration [unlicensed\r\nindication] (section 12.3.1)", "name": "BECLOMETASONE DIPROPIONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.2 Corticosteroids" ], "cautions": "Cautions\u00a0section 6.3.2; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0section 6.3.2; also nausea, constipation, headache,\r\nand drowsiness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200263.htm", "doses": [ "5\u00a0mg in the morning; max. duration of treatment 4 weeks; child safety and efficacy not established" ], "pregnancy": "Pregnancy\u00a0section 6.3.2" }, "PIPERAZINE With sennosides": { "indications": "Indications\u00a0threadworm and roundworm infections", "name": "PIPERAZINE With sennosides", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.5 Anthelmintics", "5.5.1 Drugs for threadworms", "PIPERAZINE", "With sennosides" ], "cautions": "Cautions\u00a0epilepsy; packs on sale to the general public carry a warning to avoid in epilepsy,\r\nor in liver or kidney disease, and to seek medical advice in pregnancy", "side-effects": "Side-effects\u00a0nausea, vomiting, colic, diarrhoea, allergic reactions\r\nincluding urticaria, bronchospasm, and rare reports of arthralgia,\r\nfever, Stevens-Johnson syndrome and angioedema; rarely dizziness,\r\nmuscular incoordination (\u2018worm wobble\u2019); drowsiness, nystagmus, vertigo,\r\nblurred vision, confusion and clonic contractions in patients with\r\nneurological or renal abnormalities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4062.htm", "doses": [ "See under Preparation, below", "Name[Pripsen\u00ae (Thornton & Ross)] Oral powder, piperazine phosphate 4\u00a0g, total sennosides (calculated as sennoside B) 15.3\u00a0mg/sachet.\r\nNet price two-dose sachet pack = \u00a31.98. \r\n Label:\r\n 13Dose\u00a0threadworms, stirred into milk or water, adult and child over\r\n6 years, content of 1 sachet as a single dose (bedtime in adults or\r\nmorning in children), repeated after 14 days; infant 3 months\u20131 year, 1 level 2.5-mL spoonful in the morning, repeated\r\nafter 14 days; child 1\u20136 years, 1 level\r\n5-mL spoonful in the morning, repeated after 14 daysRoundworms, first dose as for threadworms; repeat at monthly\r\nintervals for up to 3 months if reinfection risk" ], "pregnancy": "Pregnancy\u00a0not known to be harmful but manufacturer advises\r\navoid in first trimester" }, "INTRA-UTERINE PROGESTOGEN-ONLY SYSTEM": { "indications": "Indications\u00a0 see under preparation", "name": "INTRA-UTERINE PROGESTOGEN-ONLY SYSTEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.2 Progestogen-only contraceptives", "7.3.2.3 Intra-uterine progestogen-only device", "INTRA-UTERINE PROGESTOGEN-ONLY SYSTEM" ], "cautions": "Cautions\u00a0\n(From 7.3.2.3 Intra-uterine progestogen-only device: British National Formulary)\nCautions and contra-indications\u00a0Generally the cautions and contra-indications for the progestogen-only intra-uterine system are as for standard intra-uterine devices (section 7.3.4). Although the progestogen-only intra-uterine system produces little systemic progestogenic activity, it is usually avoided for 5 years after any evidence of breast cancer. However, the system can be considered for a woman in long-term remission from breast cancer who has menorrhagia and requires effective contraception. Since levonorgestrel is released close to the site of the main contraceptive action (on cervical mucus and endometrium) progestogenic side-effects and interactions are less likely; in particular, enzyme-inducing drugs are unlikely to significantly reduce the contraceptive effect of the progestogen-only intra-uterine system and additional contraceptive precautions are not required. ; history of depression; advanced uterine\r\natrophy; systemic lupus erythematosus with\r\npositive (or unknown) antiphospholipid antibodies; interactions: see notes above and Appendix 1 (progestogens)", "side-effects": "Side-effects\u00a0\n(From 7.3.2.3 Intra-uterine progestogen-only device: British National Formulary)\nSide-effects\u00a0Initially, changes in the pattern and duration of menstrual bleeding (spotting or prolonged bleeding) are common; endometrial disorders should be ruled out before insertion and the patient should be fully counselled (and provided with a patient information leaflet). Improvement in progestogenic side-effects, such as mastalgia and in the bleeding pattern usually occurs a few months after insertion and bleeding may often become very light or absent. Functional ovarian cysts (usually asymptomatic) can occur and usually resolve spontaneously (ultrasound monitoring recommended).; also\r\nabdominal pain, expulsion, peripheral oedema, depression (sometimes\r\nsevere), nervousness, salpingitis, pelvic inflammatory disease, pelvic\r\npain, back pain; rarely uterine perforation, hirsutism,\r\nhair loss, pruritus, migraine, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31961.htm", "doses": [ "See under preparation", "contraception and menorrhagia, insert into uterine\r\ncavity within 7 days of onset of menstruation, or any time if replacement,\r\nor any time if reasonably certain woman is not pregnant and there\r\nis no risk of conception (additional precautions (e.g. barrier methods)\r\nnecessary for next 7 days), or immediately after first-trimester termination\r\nby curettage; postpartum insertions should be delayed until at least\r\n4 weeks after delivery; effective for 5 years.", "Prevention of endometrial hyperplasia during oestrogen replacement\r\ntherapy, insert during last days of menstruation or withdrawal bleeding\r\nor any time if amenorrhoeic; effective for 4 years", "When system is removed (and not immediately\r\nreplaced) and pregnancy is not desired, remove during the first few\r\ndays of menstruation, otherwise additional precautions (e.g. barrier\r\nmethods) should be used for at least 7 days before removal" ], "pregnancy": "Pregnancy\u00a0avoid; if pregnancy occurs remove system" }, "FOLINIC ACID": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nFolinic acid (given as calcium folinate) is used to counteract the folate-antagonist action of methotrexate and thus speed recovery from methotrexate-induced mucositis or myelosuppression (\u2018folinic acid rescue\u2019).Folinic acid is also used in the management of methotrexate overdose, together with other measures to maintain fluid and electrolyte balance, and to manage possible renal failure.Folinic acid does not counteract the antibacterial activity of folate antagonists such as trimethoprim.When folinic acid and fluorouracil are used together in metastatic colorectal cancer the response-rate improves compared to that with fluorouracil alone.", "name": "FOLINIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression" ], "cautions": "Cautions\u00a0avoid simultaneous administration of methotrexate; not indicated for pernicious anaemia\r\nor other megaloblastic anaemias caused by vitamin B12 deficiency; interactions: Appendix 1 (folates)", "side-effects": "Side-effects\u00a0rarely pyrexia after parenteral use; insomnia, agitation, and depression\r\nafter high doses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204218.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; benefit outweighs risk" }, "AMBRISENTAN": { "indications": "Indications\u00a0pulmonary arterial hypertension ", "name": "AMBRISENTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "AMBRISENTAN" ], "cautions": "Cautions\u00a0not to be initiated in significant anaemia; monitor haemoglobin concentration or haematocrit after\r\n1 month and 3 months of starting treatment, and periodically thereafter (reduce dose or discontinue treatment if significant\r\ndecrease in haemoglobin concentration or haematocrit observed); monitor liver function before treatment, and monthly\r\nthereafter\u2014discontinue if liver enzymes raised significantly\r\nor if symptoms of liver impairment develop", "side-effects": "Side-effects\u00a0abdominal pain, constipation; palpitation, flushing,\r\nperipheral oedema; upper respiratory-tract disorders; headache; anaemia; less commonly hypersensitivity reactions (including angioedema\r\nand rash)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201151.htm", "doses": [ "adult over 18 years, 5\u00a0mg\r\nonce daily, increased if necessary to 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nexclude pregnancy before treatment and ensure effective contraception\r\nduring treatment; monthly pregnancy tests advised" }, "SILDENAFIL - VASODILATOR ANTIHYPERTENSIVE DRUGS": { "indications": "Indications\u00a0pulmonary arterial hypertension; erectile\r\ndysfunction (section 7.4.5)", "name": "SILDENAFIL - VASODILATOR ANTIHYPERTENSIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs" ], "cautions": "Cautions\u00a0hypotension (avoid if systolic blood pressure below 90\u00a0mmHg); intravascular volume depletion; left ventricular\r\noutflow obstruction; cardiovascular disease; autonomic dysfunction; pulmonary veno-occlusive disease; anatomical\r\ndeformation of the penis, predisposition\r\nto priapism; bleeding disorders or active peptic ulceration; consider gradual withdrawal; interactions: Appendix 1 (sildenafil)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth; flushing,\r\noedema; bronchitis, cough; headache, migraine, night sweats, paraesthesia,\r\ninsomnia, anxiety, tremor, vertigo; fever, influenza-like symptoms;\r\nanaemia; back and limb pain, myalgia; visual disturbances, retinal\r\nhaemorrhage, photophobia, painful red eyes; nasal congestion, epistaxis;\r\ncellulitis, alopecia; less commonly gynaecomastia,\r\npriapism; also reported rash, retinal vascular occlusion\r\nand non-arteritic anterior ischaemic optic neuropathy (discontinue\r\nif sudden visual impairment), and sudden hearing loss (advise patient\r\nto seek medical help)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129680.htm", "doses": [ "By mouth, 20\u00a0mg 3 times daily; child under 18 years see BNF for Children", "By intravenous injection, when oral route not\r\nappropriate, 10\u00a0mg three times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no evidence of harm in animal studies" }, "MIGLUSTAT": { "indications": "Indications\u00a0mild to moderate type I Gaucher\u2019s disease\r\n(specialist supervision only); Niemann-Pick type C disease (specialist\r\nsupervision only)", "name": "MIGLUSTAT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Other metabolic disorders " ], "cautions": "Cautions\u00a0monitor cognitive and neurological function; monitor growth and platelet count in Niemann-Pick\r\ntype C disease", "side-effects": "Side-effects\u00a0diarrhoea, flatulence, abdominal pain, dyspepsia,\r\nconstipation, nausea, vomiting, anorexia, weight changes; tremor,\r\ndizziness, headache, peripheral neuropathy, ataxia, hypoaesthesia,\r\nparaesthesia, insomnia, fatigue, asthenia; decreased libido; thrombocytopenia;\r\nmuscle spasm", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128503.htm", "doses": [ "Gaucher\u2019s disease, adult over 18 years, 100\u00a0mg 3 times daily; reduced if not tolerated to\r\n100\u00a0mg 1\u20132 times daily", "Niemann-Pick type C disease, adult and child over 12 years, 200\u00a0mg 3\r\ntimes daily; child 4\u201312 years, body\r\nsurface area less than 0.47\u00a0m2, 100\u00a0mg once daily; body\r\nsurface area 0.47\u20130.73\u00a0m2, 100\u00a0mg twice daily; body surface\r\narea 0.73\u20130.88\u00a0m2, 100\u00a0mg three times daily; body surface\r\narea 0.88\u20131.25\u00a0m2, 200\u00a0mg twice daily; body surface area\r\ngreater than 1.25\u00a0m2, adult dose" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies)\u2014effective contraception must be used during treatment;\r\nalso men should avoid fathering a child during and for 3 months after\r\ntreatment" }, "NALIDIXIC ACID": { "indications": "Indications\u00a0urinary-tract infections", "name": "NALIDIXIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); false positive urinary glucose (if tested for reducing substances); monitor\r\nblood counts, renal and liver function if treatment exceeds 2 weeks; interactions: Appendix 1 (quinolones)", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.; also reported toxic psychosis, increased intracranial pressure,\r\ncranial nerve palsy, peripheral neuropathy, and metabolic acidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3951.htm", "doses": [ "900\u00a0mg every 6 hours for 7 days, reduced in chronic infections\r\nto 600\u00a0mg every 6 hours; child 3 months\u201318\r\nyears see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "HYDROGEN PEROXIDE - OXIDISERS AND DYES": { "indications": "Indications\u00a0see under preparations below", "name": "HYDROGEN PEROXIDE - OXIDISERS AND DYES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/90347.htm", "doses": [ "superficial bacterial skin infection, apply 2\u20133 times\r\ndaily for up to 3\u00a0weeks" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.11 Skin cleansers, antiseptics, and desloughing agents", "13.11.6 Oxidisers and dyes", "HYDROGEN PEROXIDE" ], "cautions": "Cautions\u00a0large or deep wounds; avoid on healthy skin and eyes; bleaches fabric; incompatible with products containing\r\niodine or potassium permanganate" }, "OXPRENOLOL HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "OXPRENOLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2507.htm", "doses": [ "Hypertension, 80\u2013160\u00a0mg daily in 2\u20133 divided doses, increased\r\nas required; max. 320\u00a0mg daily", "Angina, 80\u2013160\u00a0mg daily in 2\u20133 divided doses; max. 320\u00a0mg daily", "Arrhythmias, 40\u2013240\u00a0mg daily in 2\u20133 divided doses; max. 240\u00a0mg\r\ndaily", "Anxiety symptoms (short-term use), 40\u201380\u00a0mg daily in 1\u20132 divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "ACITRETIN": { "indications": "Indications\u00a0severe extensive psoriasis resistant to other forms of therapy; palmoplantar\r\npustular psoriasis; severe congenital ichthyosis; severe Darier\u2019s\r\ndisease (keratosis follicularis)", "name": "ACITRETIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Oral retinoids for psoriasis" ], "cautions": "Cautions\u00a0exclude pregnancy before starting (test\r\nfor pregnancy within 2 weeks before treatment and monthly thereafter;\r\nstart treatment on day 2 or 3 of menstrual cycle)\u2014women (including those with history of infertility) should avoid\r\npregnancy and use effective contraception (ideally 2 methods of contraception,\r\none of which is a combined hormonal contraceptive or an intra-uterine\r\ndevice) for at least 1 month before, during, and for at least 3 years\r\nafter treatment (oral progestogen-only contraceptives not considered\r\neffective); avoid concomitant use of keratolytics; do not donate blood during and for 2 years after\r\nstopping therapy (teratogenic risk); check liver function at start, then every 2\u20134 weeks for first 2 months\r\nand then every 3 months; monitor serum-triglyceride\r\nand serum-cholesterol concentrations before treatment, 1 month after\r\nstarting, then every 3 months; diabetes\r\n(can alter glucose tolerance\u2014initial frequent blood glucose checks); investigate\r\natypical musculoskeletal symptoms; in children\r\nuse only in exceptional circumstances and monitor growth parameters\r\nand bone development (premature epiphyseal closure reported); avoid excessive exposure to sunlight and unsupervised use of sunlamps; interactions: Appendix 1 (retinoids)", "side-effects": "Side-effects\u00a0abdominal pain, diarrhoea, nausea, vomiting, dryness\r\nand inflammation of mucous membranes, peripheral oedema, reversible\r\nincrease in serum-cholesterol and serum-triglyceride concentrations\r\n(with high doses), headache, arthralgia, myalgia, dryness of conjunctiva\r\n(causing conjunctivitis and decreased tolerance to contact lenses),\r\nalopecia (reversible on withdrawal), abnormal hair texture, skin exfoliation,\r\npruritus, epidermal fragility, sticky skin, dermatitis, erythema,\r\nbrittle nails, paronychia; less commonly hepatitis,\r\ndizziness, visual disturbances, photosensitivity; rarely peripheral neuropathy; very rarely benign intracranial\r\nhypertension (discontinue if severe headache, nausea, vomiting, or\r\nvisual disturbances occur), bone pain, exostosis (skeletal hyperostosis\r\nand extra-osseous calcification reported following long-term treatment\r\nwith etretinate, and premature epiphyseal closure in children, see\r\nCautions above), night blindness, ulcerative keratitis; also\r\nreported taste disturbance, rectal haemorrhage, flushing,\r\nmalaise, drowsiness, granulomatous lesions, impaired hearing, tinnitus,\r\ninitial worsening of psoriasis, dry skin, sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5995.htm", "doses": [ "adult over 18 years (under\r\nexpert supervision), initially 25\u201330\u00a0mg daily (Darier\u2019s disease 10\u00a0mg\r\ndaily) for 2\u20134 weeks, then adjusted according to response, usual range\r\n25\u201350\u00a0mg daily; up to 75\u00a0mg daily for short periods in psoriasis and\r\nichthyosis (see notes above); child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic; effective contraception must be\r\nused\u2014see Cautions above" }, "OFLOXACIN - QUINOLONES": { "indications": "Indications\u00a0see under Dose", "name": "OFLOXACIN - QUINOLONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones", "OFLOXACIN" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; history of psychiatric\r\nillness; interactions: Appendix 1 (quinolones)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving); effects enhanced\r\nby alcohol", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.; also cough, nasopharyngitis, eye irritation; rarely arrhythmias, bronchospasm, abnormal dreams, hot flushes, hyperhidrosis; very rarely neuropathy, extrapyramidal symptoms, tinnitus;\r\nalso reported pneumonitis, changes in blood sugar, myopathy, rhabdomyolysis;\r\non intravenous infusion, hypotension and local reactions (including\r\nthrombophlebitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3959.htm", "doses": [ "By mouth, urinary-tract infections,\r\n200\u2013400\u00a0mg daily preferably in the morning, increased if necessary\r\nin upper urinary-tract infections to 400\u00a0mg twice daily", "Acute or chronic prostatitis, 200\u00a0mg twice daily for 28 days", "Lower respiratory-tract infections, 400\u00a0mg daily preferably\r\nin the morning, increased if necessary to 400\u00a0mg twice daily", "Skin and soft-tissue infections, 400\u00a0mg twice daily", "Uncomplicated gonorrhoea, 400\u00a0mg as a single dose", "Uncomplicated genital chlamydial infection, non-gonococcal urethritis,\r\n400\u00a0mg daily in single or divided doses for 7 days", "Pelvic inflammatory disease (see also section 5.1, table 1), 400\u00a0mg twice daily for\r\n14 days", "By intravenous infusion (over at\r\nleast 30 minutes for each 200\u00a0mg), complicated urinary-tract infection,\r\n200\u00a0mg daily", "Lower respiratory-tract infection, 200\u00a0mg twice daily", "Septicaemia, 200\u00a0mg twice daily", "Skin and soft-tissue infections, 400\u00a0mg twice daily", "Severe or complicated infections, dose may be increased to 400\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "NALOXONE HYDROCHLORIDE - ANTAGONISTS FOR CENTRAL AND RESPIRATORY DEPRESSION": { "indications": "Indications\u00a0see under Dose", "name": "NALOXONE HYDROCHLORIDE - ANTAGONISTS FOR CENTRAL AND RESPIRATORY DEPRESSION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.7 Antagonists for central and respiratory depression" ], "cautions": "Cautions\u00a0cardiovascular disease or\r\nthose receiving cardiotoxic drugs (serious adverse cardiovascular\r\neffects reported); physical dependence\r\non opioids (precipitates withdrawal); pain (see also under Titration of Dose, below); has short\r\nduration of action (repeated doses or infusion may be necessary to\r\nreverse effects of opioids with longer duration of action)Titration of dose\u00a0In postoperative\r\nuse, the dose should be titrated for each patient in order to obtain\r\nsufficient respiratory response; however, naloxone antagonises analgesia", "side-effects": "Side-effects\u00a0nausea, vomiting; hypotension, hypertension, ventricular\r\ntachycardia and fibrillation, cardiac arrest; hyperventilation, dyspnoea,\r\npulmonary oedema; headache, dizziness; less commonly diarrhoea, dry mouth, agitation, excitement, paraesthesia, tremor,\r\nsweating; very rarely seizures, erythema multiforme,\r\nand hypersensitivity reactions including anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6677.htm", "doses": [ "Reversal of postoperative respiratory depression, adult and child over\r\n12 years, by intravenous injection, 100\u2013200\u00a0micrograms\r\n(1.5\u20133\u00a0micrograms/kg); if response inadequate, give subsequent dose\r\nof 100\u00a0micrograms every 2 minutes; alternatively, subsequent doses\r\ncan be given by intramuscular injection every 1\u20132 hours; child 1 month\u201312 years see BNF for Children", "Reversal of respiratory and CNS depression resulting from opioid\r\nadministration to mother during labour, neonate, by intramuscular injection, 200\u00a0micrograms (60\u00a0micrograms/kg)\r\nas a single dose at birth; alternatively by subcutaneous or intravenous injection, 10\u00a0micrograms/kg,\r\nrepeated every 2\u20133 minutes", "Opioid overdose, see Emergency Treatment of Poisoning", "Naloxone doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "LEVOFLOXACIN - ANTIBACTERIALS": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "LEVOFLOXACIN - ANTIBACTERIALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials" ], "cautions": "Cautions\u00a0not recommended for children under 1\r\nyear", "side-effects": "Side-effects\u00a0transient ocular irritation, visual disturbances,\r\nlid margin crusting, lid or conjunctival oedema, hyperaemia, conjunctival\r\nfollicles, photophobia, headache, rhinitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129668.htm", "doses": [ "See Administration in\r\nnotes above" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014systemic quinolones have\r\ncaused arthropathy in animal studies" }, "RALTITREXED": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nRaltitrexed, a thymidylate synthase inhibitor, is given intravenously for palliation of advanced colorectal cancer when fluorouracil and folinic acid cannot be used. It is probably of similar efficacy to fluorouracil. Raltitrexed is generally well tolerated, but can cause marked myelosuppression and gastro-intestinal side-effects.", "name": "RALTITREXED", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (raltitrexed) ", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/39236.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0pregnancy must be excluded before treatment; ensure\r\neffective contraception during and for at least 6 months after treatment\r\nin men or women; see also Pregnancy and Reproductive\r\nFunction" }, "PAPAVERETUM ": { "indications": "Indications\u00a0premedication; enhancement of anaesthesia\r\n(but see section 15.1.4.3); postoperative analgesia; severe chronic\r\npain", "name": "PAPAVERETUM ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "PAPAVERETUM" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; supraventricular tachycardia", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nhypothermia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/7708.htm", "doses": [ "By subcutaneous, intramuscular, or intravenous injection, 7.7\u201315.4\u00a0mg\r\nrepeated every 4 hours if necessary (elderly initially 7.7\u00a0mg); child up to 1\r\nmonth 115\u00a0micrograms/kg, 1\u201312 months 154\u00a0micrograms/kg, 1\u20135 years\r\n1.93\u20133.85\u00a0mg, 6\u201312 years, 3.85\u20137.7\u00a0mg", "In general the intravenous dose\r\nshould be 25\u201350% of the corresponding subcutaneous or intramuscular\r\ndose" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "TIMOLOL MALEATE With diuretic": { "indications": "Indications\u00a0see under Dose; glaucoma (section 11.6)", "name": "TIMOLOL MALEATE With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "TIMOLOL MALEATE", "With diuretic" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204261.htm", "doses": [ "Hypertension, initially 10\u00a0mg daily in 1\u20132 divided doses;\r\ngradually increased if necessary to max. 60\u00a0mg daily, usual maintenance\r\ndose 10\u201330\u00a0mg daily (doses above 30\u00a0mg daily given in divided doses)", "Angina, initially 5\u00a0mg twice daily increased if necessary by\r\n10\u00a0mg daily every 3\u20134 days; max. 30\u00a0mg twice daily", "Prophylaxis after myocardial infarction, initially 5\u00a0mg twice\r\ndaily, increased after 2 days to 10\u00a0mg twice daily if tolerated", "Migraine prophylaxis, 10\u201320\u00a0mg daily in 1\u20132 divided doses", "Name[Timolol with amiloride and hydrochlorothiazide (Non-proprietary) ] Tablets, scored, timolol maleate\r\n10\u00a0mg, amiloride hydrochloride 2.5\u00a0mg, hydrochlorothiazide 25\u00a0mg,\r\nnet price 28-tab pack = \u00a329.87. \r\n Label:\r\n 8Dose\u00a0hypertension, 1\u20132 tablets daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "BACILLUS CALMETTE-GU\u00c9RIN VACCINE": { "indications": "Indications\u00a0immunisation against tuberculosis", "name": "BACILLUS CALMETTE-GU\u00c9RIN VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "BCG vaccines" ], "cautions": "Cautions\u00a0see section 14.1; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1 and notes above; also at the injection\r\nsite, subcutaneous abscess, prolonged ulceration; rarely disseminated complications such as osteitis or osteomyelitis ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201137.htm", "doses": [ "By intradermal injection adult and child over\r\n1 year, 0.1\u00a0mL; neonate and child under 1 year, 0.05\u00a0mL", "Skin is stretched\r\nbetween thumb and forefinger and needle (size 25G or 26G) inserted\r\n(bevel upwards) for about 3\u00a0mm into superficial layers of dermis (almost\r\nparallel with surface). Needle should be short with short bevel (can\r\nusually be seen through epidermis during insertion). Tense raised\r\nblanched bleb showing tips of hair follicles is sign of correct injection;\r\n7\u00a0mm bleb \u2261 0.1\u00a0mL injection, 3\u00a0mm bleb \u2261 0.05\u00a0mL injection; if considerable\r\nresistance not felt, needle too deep and should be removed and reinserted\r\nbefore giving more vaccine.", "To be injected at insertion of deltoid muscle onto humerus (keloid\r\nformation more likely with sites higher on arm); tip\r\nof shoulder should be avoided." ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "CARBIMAZOLE": { "indications": "Indications\u00a0hyperthyroidism", "name": "CARBIMAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.2 Thyroid and antithyroid drugs", "6.2.2 Antithyroid drugs", "CARBIMAZOLE" ], "side-effects": "Side-effects\u00a0nausea, mild gastro-intestinal disturbances, taste\r\ndisturbance, headache, fever, malaise, rash, pruritus, arthralgia; rarely myopathy, alopecia, bone marrow suppression (including\r\npancytopenia and agranulocytosis, see Neutropenia and Agranulocytosis\r\nabove), and jaundiceCounselling\u00a0Warn patient to tell\r\ndoctor immediately if sore throat, mouth ulcers,\r\nbruising, fever, malaise, or non-specific illness develops", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4244.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0neonatal goitre and hypothyroidism; has been associated\r\nwith congenital defects including aplasia cutis of the neonate; see\r\nalso notes above" }, "PEMETREXED": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nPemetrexed inhibits thymidylate transferase and other folate-dependent enzymes. It is licensed for use with cisplatin for the treatment of unresectable malignant pleural mesothelioma which has not previously been treated with chemotherapy (see NICE guidance, below). Pemetrexed is also licensed for use with cisplatin for the first-line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology (see NICE guidance, below), and as monotherapy for its second-line treatment (but see NICE guidance, below). It is also licensed as monotherapy for maintenance treatment in locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology that has not progressed immediately following combination therapy of a platinum compound with either gemcitabine, paclitaxel, or docetaxel. Pemetrexed is given by intravenous infusion.The Scottish Medicines Consortium has advised (July 2005) that pemetrexed (Alimta\u00ae) in combination with cisplatin is accepted for restricted use within NHS Scotland for previously untreated patients with stage III/IV unresectable malignant pleural mesothelioma.The Scottish Medicines Consortium has advised (January 2010) that pemetrexed (Alimta\u00ae) is accepted for restricted use within NHS Scotland in combination with cisplatin for the first-line treatment of locally advanced or metastatic non-small cell lung cancer other than predominantly squamous cell histology; it is restricted to patients in whom the histology of the tumour has been confirmed as adenocarcinoma or large cell carcinoma. ", "name": "PEMETREXED", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; history of cardiovascular disease; diabetes; prophylactic folic acid and\r\nvitamin B12 supplementation required (consult product literature); concomitant nephrotoxic drugs including non-steroidal\r\nanti-inflammatory drugs (consult product literature); interactions: Appendix 1 (pemetrexed)", "side-effects": "Side-effects\u00a0see section 8.1; also gastro-intestinal disturbances;\r\noedema; neuropathy; dehydration; conjunctivitis, increased lacrimation;\r\nskin disorders; less commonly colitis, arrhythmias,\r\nand interstitial pneumonitis; rarely hepatitis; peripheral\r\nischaemia, acute renal failure, Stevens-Johnson syndrome and toxic\r\nepidermal necrolysis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129178.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\nmanufacturer advises effective contraception during treatment; men\r\nmust avoid fathering a child during and for 6 months after treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "FLUPENTIXOL - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0schizophrenia and other psychoses, particularly\r\nwith apathy and withdrawal but not mania or psychomotor hyperactivity;\r\ndepression (section 4.3.4)", "name": "FLUPENTIXOL - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "FLUPENTIXOL" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; diabetes; avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; less\r\nsedating but extrapyramidal symptoms frequent; hyperglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203954.htm", "doses": [ "Psychosis, initially 3\u20139\u00a0mg twice daily adjusted according\r\nto the response; max. 18\u00a0mg daily; elderly (or debilitated) initially quarter to half adult dose; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "DICLOFENAC POTASSIUM": { "indications": "Indications\u00a0pain and inflammation in rheumatic\r\ndisease and other musculoskeletal disorders; acute gout; postoperative\r\npain; migraine; fever in ear, nose, or throat infection in children", "name": "DICLOFENAC POTASSIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DICLOFENAC POTASSIUM" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid in acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213771.htm", "doses": [ "Rheumatic disease, musculoskeletal disorders, acute gout,\r\n75\u2013150\u00a0mg daily in 2\u20133 divided doses; child over 14 years, 75\u2013100\u00a0mg daily in 2\u20133 divided doses", "Postoperative pain, 75\u2013150\u00a0mg daily in 2\u20133 divided doses; child 9\u201314 years (body-weight 35\u00a0kg and over), up\r\nto 2\u00a0mg/kg (max. 100\u00a0mg) daily in 3 divided doses; child over 14 years, 75\u2013100\u00a0mg daily in 2\u20133 divided\r\ndoses", "Migraine, 50\u00a0mg at onset, repeated after 2 hours if necessary\r\nthen after 4\u20136 hours; max. 200\u00a0mg in 24 hours; child not recommended", "Fever in ear, nose, or throat infection, child over 9 years (body-weight 35\u00a0kg and over), up to 2\u00a0mg/kg (max. 100\u00a0mg)\r\ndaily in 3 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "HYDROXYCHLOROQUINE SULPHATE": { "indications": "Indications\u00a0active rheumatoid arthritis (including juvenile idiopathic arthritis),\r\nsystemic and discoid lupus erythematosus; dermatological conditions\r\ncaused or aggravated by sunlight", "name": "HYDROXYCHLOROQUINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Antimalarials" ], "cautions": "Cautions\u00a0\n(From Antimalarials: British National Formulary)\nCautions\u00a0 Manufacturers recommend regular ophthalmological examination but the evidence of practical value is unsatisfactory (see advice of the Royal College of Ophthalmologists, below). Chloroquine and hydroxychloroquine should be used with caution in neurological disorders (especially in those with a history of epilepsy), in severe gastro-intestinal disorders, in G6PD deficiency (section 9.1.5), in acute porphyria, and in the elderly (see also above). Chloroquine and hydroxychloroquine may exacerbate psoriasis and aggravate myasthenia gravis. Concurrent use of hepatotoxic drugs should be avoided; other interactions: Appendix 1 (chloroquine and hydroxychloroquine).Screening for ocular toxicity\u00a0A review group convened by the Royal College of Ophthalmologists has updated guidelines for screening to prevent ocular toxicity on long-term treatment with chloroquine and hydroxychloroquine (Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening 2009). Chloroquine should be considered (for treating chronic inflammatory conditions) only if other drugs have failed. All patients taking chloroquine should receive ocular examination according to a protocol arranged locally between the prescriber and the ophthalmologist. The following recommendations relate to hydroxychloroquine, which is only rarely associated with toxicity.Before treatment:Assess renal and liver function (adjust dose if impaired)Ask patient about visual impairment (not corrected by glasses). If impairment or eye disease present, assessment by an optometrist is advised and any abnormality should be referred to an ophthalmologistRecord near visual acuity of each eye (with glasses where appropriate) using a standard reading chartInitiate hydroxychloroquine treatment if no abnormality detected (at a dose not exceeding hydroxychloroquine sulphate 6.5\u00a0mg/kg daily)During treatment:Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chartRefer to ophthalmologist if visual acuity changes or if vision blurred and warn patient to seek prescribing doctor\u2019s advice about stopping treatmentA child treated for juvenile idiopathic arthritis should receive slit-lamp examination routinely to check for uveitisIf long-term treatment is required (more than 5 years), individual arrangement should be agreed with the local ophthalmologistImportantTo avoid excessive dosage in obese patients, the doses of hydroxychloroquine and chloroquine should be calculated on the basis of ideal body-weight. Ocular toxicity is unlikely if the dose of chloroquine phosphate does not exceed 4\u00a0mg/kg daily (equivalent to chloroquine base approx. 2.5\u00a0mg/kg daily)", "side-effects": "Side-effects\u00a0\n(From Antimalarials: British National Formulary)\nSide-effects\u00a0The side-effects of chloroquine and hydroxychloroquine include gastro-intestinal disturbances, headache and skin reactions (rashes, pruritus); those occurring less frequently include ECG changes, convulsions, visual changes, retinal damage (see above), keratopathy, ototoxicity, hair depigmentation, hair loss, and discoloration of skin, nails, and mucous membranes. Side-effects that occur rarely include blood disorders (including thrombocytopenia, agranulocytosis, and aplastic anaemia), mental changes (including emotional disturbances and psychosis), myopathy (including cardiomyopathy and neuromyopathy), acute generalised exanthematous pustulosis, exfoliative dermatitis, Stevens-Johnson syndrome, photosensitivity, and hepatic damage; angioedema has also been reported. Important: very toxic in overdosage\u2014immediate advice from poisons centres essential (see also Emergency Treatment of Poisoning).; also\r\nreported bronchospasm", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5302.htm", "doses": [ "Administered on expert advice, 200\u2013400\u00a0mg daily (but not\r\nexceeding 6.5\u00a0mg/kg daily based on ideal body-weight, see also recommendations\r\nabove); child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Antimalarials: British National Formulary)\nPregnancy\u00a0It is not necessary to withdraw an antimalarial drug during pregnancy if the rheumatic disease is well controlled; however, the manufacturer of hydroxychloroquine advises avoiding use." }, "SODIUM VALPROATE Parenteral": { "indications": "Indications\u00a0all forms of epilepsy; migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2); mania\r\n(section 4.2.3)", "name": "SODIUM VALPROATE Parenteral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Valproate", "SODIUM VALPROATE", "Parenteral" ], "cautions": "Cautions\u00a0monitor liver function\r\nbefore therapy and during first 6 months especially in patients most\r\nat risk (see also below); measure full\r\nblood count and ensure no undue potential\r\nfor bleeding before starting and before surgery; systemic lupus erythematosus; false-positive\r\nurine tests for ketones; avoid abrupt withdrawal; consider vitamin D supplementation in patients that\r\nare immobilised for long periods or who have inadequate sun exposure\r\nor dietary intake of calcium; interactions: see Interactions in section 4.8.1 and Appendix 1 (valproate)Liver toxicity\u00a0Liver dysfunction (including fatal\r\nhepatic failure) has occurred in association with valproate (especially\r\nin children under 3 years and in those\r\nwith metabolic or degenerative\r\ndisorders, organic brain disease or severe seizure disorders associated with mental\r\nretardation) usually in first 6 months and usually involving\r\nmultiple antiepileptic therapy. Raised liver enzymes\r\nduring valproate treatment are usually transient but patients should\r\nbe reassessed clinically and liver function (including prothrombin\r\ntime) monitored until return to normal\u2014discontinue if abnormally prolonged prothrombin time (particularly\r\nin association with other relevant abnormalities).Blood or hepatic disorders\u00a0Patients or their carers should be told how to recognise signs and\r\nsymptoms of blood or liver disorders and advised to seek immediate\r\nmedical attention if symptoms developPancreatitis\u00a0Patients or their carers\r\nshould be told how to recognise signs and symptoms of pancreatitis\r\nand advised to seek immediate medical attention if symptoms such as\r\nabdominal pain, nausea, or vomiting develop; discontinue if pancreatitis is diagnosed", "side-effects": "Side-effects\u00a0nausea, gastric irritation, diarrhoea; weight\r\ngain; hyperammonaemia, thrombocytopenia; transient hair loss (regrowth\r\nmay be curly); less frequently increased alertness,\r\naggression, hyperactivity, behavioural disturbances, ataxia, tremor,\r\nand vasculitis; rarely hepatic dysfunction (see under\r\nCautions; withdraw treatment immediately if persistent vomiting and\r\nabdominal pain, anorexia, jaundice, oedema, malaise, drowsiness, or\r\nloss of seizure control), lethargy, drowsiness, confusion, stupor,\r\nhallucinations, blood disorders (including anaemia, leucopenia, pancytopenia),\r\nhearing loss, and rash; very rarely pancreatitis\r\n(see under Cautions), peripheral oedema, increase in bleeding time,\r\nextrapyramidal symptoms, dementia, encephalopathy, coma, gynaecomastia,\r\nFanconi\u2019s syndrome, hirsutism, acne, enuresis, hyponatraemia, toxic\r\nepidermal necrolysis, and Stevens-Johnson syndrome; suicidal ideation;\r\nreduced bone mineral density (see Cautions); also reported menstrual disturbances, male infertility, syndrome of inappropriate\r\nsecretion of antidiuretic hormone", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3602.htm", "doses": [ "Epilepsy, by mouth, initially 600\u00a0mg\r\ndaily in 1\u20132 divided doses, increased gradually (in steps of 150\u2013300\u00a0mg)\r\nevery 3 days; usual maintenance dose 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily),\r\nmax. 2.5\u00a0g daily; child 1 month\u201312\r\nyears, initially 10\u201315\u00a0mg/kg (max. 600\u00a0mg) daily in 1\u20132 divided doses;\r\nusual maintenance dose 25\u201330\u00a0mg/kg daily in 2 divided doses", "Initiation of valproate treatment by intravenous administration, adult and child over 12 years, initially 10\u00a0mg/kg (usually 400\u2013800\u00a0mg) by intravenous injection (over 3\u20135 minutes) followed by intravenous infusion or intravenous\r\ninjection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up\r\nto max. 2.5\u00a0g daily; usual range 1\u20132\u00a0g daily (20\u201330\u00a0mg/kg daily); child 1 month\u201312 years, 10\u00a0mg/kg by intravenous\r\ninjection (over 3\u20135 minutes) followed by intravenous\r\ninfusion or intravenous injection (over 3\u20135 minutes) in 2\u20134 divided doses or by continuous intravenous infusion up to usual range 20\u201340\u00a0mg/kg\r\ndaily (doses above 40\u00a0mg/kg daily monitor clinical chemistry and haematological\r\nparameters)", "Continuation of valproate treatment by intravenous injection (over 3\u20135 minutes) or intravenous infusion in 2\u20134 divided doses, or by continuous intravenous infusion, same as established oral daily dose", "Migraine prophylaxis [unlicensed], by mouth, initially 200\u00a0mg twice daily, increased if necessary to 1.2\u20131.5\u00a0g\r\ndaily in divided doses", "Mania, see under Episenta\u00ae", "Name[Epilim\u00ae Intravenous (Sanofi-Aventis) ] Injection, powder for reconstitution,\r\nsodium valproate, net price 400-mg vial (with 4-mL amp water for injections)\r\n= \u00a311.58" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nneonatal bleeding (related to hypofibrinaemia) and neonatal hepatotoxicity\r\nalso reported" }, "METHADONE HYDROCHLORIDE - OPIOID ANALGESICS": { "indications": "Indications\u00a0severe pain, see\r\nnotes above; cough in terminal disease (section 3.9.1); adjunct in treatment of opioid dependence\r\n(section 4.10.3)", "name": "METHADONE HYDROCHLORIDE - OPIOID ANALGESICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "METHADONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also\r\nhistory of cardiac conduction abnormalities, family history of sudden\r\ndeath (ECG monitoring recommended; see also QT-Interval Prolongation,\r\nbelow)QT-interval prolongation\u00a0Patients with the following risk\r\nfactors for QT-interval prolongation should be carefully monitored\r\nwhile taking methadone: heart or liver disease, electrolyte abnormalities,\r\nor concomitant treatment with drugs that can prolong QT interval;\r\npatients requiring more than 100\u00a0mg daily should also be monitored", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nQT-interval prolongation, torsade de pointes, hypothermia, restlessness,\r\nraised intracranial pressure, dysmenorrhoea, dry eyes, and hyperprolactinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129816.htm", "doses": [ "By mouth or by\r\nsubcutaneous or intramuscular injection, 5\u201310\u00a0mg every 6\u20138 hours, adjusted according to response; on prolonged\r\nuse not to be given more frequently than every 12 hours; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CLOBAZAM": { "indications": "Indications\u00a0adjunct in\r\nepilepsy; anxiety (short-term use)", "name": "CLOBAZAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Benzodiazepines", "CLOBAZAM" ], "cautions": "Cautions\u00a0see Diazepam, section\r\n4.1.2", "side-effects": "Side-effects\u00a0see Diazepam, section\r\n4.1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202882.htm", "doses": [ "Epilepsy, 20\u201330\u00a0mg daily, increased if necessary to max.\r\n60\u00a0mg daily; child over 3 years, not\r\nmore than half adult dose", "Anxiety, 20\u201330\u00a0mg daily in divided doses or as a single dose\r\nat bedtime, increased in severe anxiety (in hospital patients) to\r\na max. of 60\u00a0mg daily in divided doses; elderly (or debilitated) 10\u201320\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0see Pregnancy;\r\nin late pregnancy may cause neonatal hypothermia, hypotonia, respiratory\r\ndepression, and withdrawal" }, "SIMVASTATIN With ezetimibe": { "indications": "Indications\u00a0primary hypercholesterolaemia, homozygous familial hypercholesterolaemia\r\nor combined (mixed) hyperlipidaemia in patients who have not responded\r\nadequately to diet and other appropriate measures; prevention of cardiovascular\r\nevents in patients with atherosclerotic cardiovascular disease or\r\ndiabetes mellitus", "name": "SIMVASTATIN With ezetimibe", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins", "SIMVASTATIN", "With ezetimibe" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ; also 80-mg dose only\r\nfor those with severe hypercholesterolaemia and at high risk of cardiovascular\r\ncomplications", "side-effects": "Side-effects\u00a0\n(From Statins: British National Formulary)\nSide-effects\u00a0The statins have been associated with myalgia, myopathy, myositis, and rhabdomyolysis (see Muscle Effects below). Statins can alter liver function tests, and rarely cause hepatitis and jaundice; pancreatitis and hepatic failure have been reported very rarely. Other side-effects include gastro-intestinal disturbances, sleep disturbance, headache, dizziness, depression, paraesthesia, asthenia, peripheral neuropathy, amnesia, fatigue, sexual dysfunction, thrombocytopenia, arthralgia, visual disturbance, alopecia, and hypersensitivity reactions (including rash, pruritus, urticaria, and very rarely lupus erythematosus-like reactions). In very rare cases, statins can cause interstitial lung disease; if patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.Muscle effects\u00a0The risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare. Although myalgia has been reported commonly in patients receiving statins, muscle toxicity truly attributable to statin use is rare. Muscle toxicity can occur with all statins, however the likelihood increases with higher doses and in certain patients (see below). Statins should be used with caution in patients at increased risk of muscle toxicity, including those with a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. There is an increased incidence of myopathy if a statin is given at a high dose, or if it is given with a fibrate (the combination of a statin and gemfibrozil should preferably be avoided), with lipid-lowering doses of nicotinic acid, with fusidic acid (risk of rhabdomyolysis\u2014the combination of a statin and fusidic acid should be avoided; temporarily discontinue statin and restart 7 days after last fusidic acid dose), or with drugs that increase the plasma-statin concentration, such as macrolide antibiotics, imidazole and triazole antifungals, and ciclosporin\u2014see interactions: Appendix 1 (statins); close monitoring of liver function and, if muscular symptoms occur, of creatine kinase is necessary. In patients at increased risk of muscle effects, a statin should not usually be started if the baseline creatine kinase concentration is more than 5 times the upper limit of normal (some patients may present with an extremely elevated baseline creatine kinase concentration, due to e.g. a physical occupation, or rigorous exercise\u2014specialist advice should be sought regarding consideration of statin therapy in these patients).If muscular symptoms or raised creatine kinase occur during treatment, other possible causes (e.g. rigorous physical activity, hypothyroidism, infection, recent trauma, and drug or alcohol addiction) should be excluded before statin therapy is implicated. When a statin is suspected to be the cause of myopathy, and creatine kinase concentration is markedly elevated (more than 5 times upper limit of normal), or if muscular symptoms are severe, treatment should be discontinued. If symptoms resolve and creatine kinase concentrations return to normal, the statin should be reintroduced at a lower dose and the patient monitored closely; an alternative statin should be prescribed if unacceptable side-effects are experienced with a particular statin. Statins should not be discontinued in the event of small, asymptomatic elevations of creatine kinase. Routine monitoring of creatine kinase is unnecessary in asymptomatic patients.; also rarely anaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129296.htm", "doses": [ "Primary hypercholesterolaemia, combined hyperlipidaemia,\r\n10\u201320\u00a0mg daily at night, adjusted at intervals of at least 4 weeks;\r\nusual range 10\u201380\u00a0mg once daily at night; child under 18 years see BNF for Children", "Homozygous familial hypercholesterolaemia, 40\u00a0mg daily at night or 80\u00a0mg daily in 3 divided doses (with largest dose at\r\nnight)", "Heterozygous familial hypercholesterolaemia, child under 18 years see BNF for Children", "Prevention of cardiovascular events, initially 20\u201340\u00a0mg once\r\ndaily at night, adjusted at intervals of at least 4 weeks; max. 80\u00a0mg\r\nonce daily at night", "Max. 10\u00a0mg daily with concomitant ciclosporin, danazol, or fibrate (except\r\nfenofibrate). Max. 20\u00a0mg daily with concomitant amiodarone or verapamil. Max. 40\u00a0mg daily with diltiazem or amlodipine", "Name[Inegy\u00ae (MSD) (Schering-Plough) ] Tablets, simvastatin 20\u00a0mg, ezetimibe\r\n10\u00a0mg, net price 28-tab pack = \u00a333.42; simvastatin 40\u00a0mg, ezetimibe\r\n10\u00a0mg, 28-tab pack = \u00a338.98; simvastatin 80\u00a0mg, ezetimibe 10\u00a0mg, 28-tab\r\npack = \u00a341.21. Counselling, muscle effects, see notes above" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "MOEXIPRIL HYDROCHLORIDE": { "indications": "Indications\u00a0essential hypertension", "name": "MOEXIPRIL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "MOEXIPRIL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; arrhythmias, angina, chest pain,\r\nsyncope, cerebrovascular accident, myocardial infarction; appetite\r\nand weight changes; dry mouth, photosensitivity, flushing, nervousness,\r\nmood changes, anxiety, drowsiness, sleep disturbance, tinnitus, influenza-like\r\nsyndrome, sweating and dyspnoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37823.htm", "doses": [ "Monotherapy, initially 7.5\u00a0mg once daily adjusted according\r\nto response; usual range 7.5\u201315\u00a0mg once daily (max. 30\u00a0mg once daily);\r\nif used in addition to diuretic (see notes above),\r\nwith nifedipine or other antihypertensive drug,\r\nor in elderly, initially 3.75\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "TICK-BORNE ENCEPHALITIS VACCINE, INACTIVATED": { "indications": "Indications\u00a0immunisation against tick-borne encephalitis", "name": "TICK-BORNE ENCEPHALITIS VACCINE, INACTIVATED", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Tick-borne encephalitis vaccine", "TICK-BORNE ENCEPHALITIS VACCINE, INACTIVATED" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128176.htm", "doses": [ "Initial immunisation, by intramuscular injection in deltoid region or anterolateral thigh in infants, adult and child over\r\n16 years, 3 doses each of 0.5\u00a0mL, second dose after 1\u20133 months and\r\nthird dose after further 5\u201312 months; child 1\u201316 years 3 doses of 0.25\u00a0mL, second dose after 1\u20133 months and\r\nthird dose after further 5\u201312 months; elderly over 60 years and immunocompromised (including those receiving immunosuppressants),\r\nantibody concentration may be measured 4 weeks after second dose and\r\ndose repeated if protective levels not achieved", "To achieve more rapid protection, second\r\ndose may be given 14 days after first dose", "Booster doses, give first dose within 3 years after initial\r\ncourse completed, then every 3\u20135 years" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "METHYSERGIDE ": { "indications": "Indications\u00a0prevention of severe recurrent migraine, cluster headache and other\r\nvascular headaches in patients who are refractory to other treatment\r\nand whose lives are seriously disrupted (important: hospital supervision only, see notes above); diarrhoea associated\r\nwith carcinoid syndrome", "name": "METHYSERGIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.2 Prophylaxis of migraine", "METHYSERGIDE" ], "cautions": "Cautions\u00a0history of peptic ulceration; avoid abrupt withdrawal of treatment; after 6 months withdraw (gradually over 2 to 3 weeks) for reassessment\r\nfor at least 1 month (see also notes above); interactions: Appendix 1 (ergot alkaloids)", "side-effects": "Side-effects\u00a0nausea, vomiting, heartburn, abdominal discomfort,\r\ndrowsiness, and dizziness occur frequently in initial treatment; mental\r\nand behavioural disturbances, insomnia, oedema, weight gain, rashes,\r\nloss of scalp hair, cramps, arterial spasm (including coronary artery\r\nspasm with angina and possible myocardial infarction), paraesthesias\r\nof extremities, postural hypotension, and tachycardia also occur;\r\nretroperitoneal and other abnormal fibrotic reactions may occur on\r\nprolonged administration, requiring immediate withdrawal of treatment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3571.htm", "doses": [ "Initially 1\u00a0mg at bedtime, increased gradually over about\r\n2 weeks to 1\u20132\u00a0mg 3 times daily with food (see notes above); child not recommended", "Diarrhoea associated with carcinoid syndrome, usual range, 12\u201320\u00a0mg\r\ndaily (hospital supervision); child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ERGOCALCIFEROL Daily supplements": { "indications": "Indications\u00a0\n(From 9.6.4 Vitamin D: British National Formulary)\n9.6.4 Vitamin D", "name": "ERGOCALCIFEROL Daily supplements", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "ERGOCALCIFEROL", "Daily supplements" ], "cautions": "Cautions\u00a0take care to ensure correct dose in infants; monitor plasma-calcium concentration in patients receiving\r\nhigh doses and in renal impairment (\n(From 9.6.4 Vitamin D: British National Formulary)\nImportant. All patients receiving pharmacological doses of vitamin D should have their plasma-calcium concentration checked at intervals (initially once or twice weekly) and whenever nausea or vomiting occur.); interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0symptoms of overdosage include\r\nanorexia, lassitude, nausea and vomiting, diarrhoea, constipation,\r\nweight loss, polyuria, sweating, headache, thirst, vertigo, and raised\r\nconcentrations of calcium and phosphate in plasma and urine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5133.htm", "doses": [ "See notes above", "Name[Calcium and Ergocalciferol (Non-proprietary)] Tablets, calcium lactate 300\u00a0mg,\r\ncalcium phosphate 150\u00a0mg (calcium 97\u00a0mg or Ca2+ 2.4\u00a0mmol), ergocalciferol 10\u00a0micrograms (400\u00a0units). Net price 28-tab\r\npack = \u00a37.72. Counselling, crush before administration or may be chewed" ], "pregnancy": "Pregnancy\u00a0high doses teratogenic in animals but therapeutic doses unlikely to be harmful" }, "HYOSCINE HYDROBROMIDE Patches": { "indications": "Indications\u00a0motion sickness;\r\nhypersalivation associated with clozapine therapy; premedication (section 15.1.3); excessive respiratory secretions (see Prescribing in Palliative\r\nCare)", "name": "HYOSCINE HYDROBROMIDE Patches", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Hyoscine", "HYOSCINE HYDROBROMIDE", "Patches" ], "cautions": "Cautions\u00a0section 1.2; also epilepsy", "side-effects": "Side-effects\u00a0section 1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3452.htm", "doses": [ "Motion sickness, by mouth, adult and child over\r\n10 years, 150\u2013300\u00a0micrograms up to 30 minutes before start of journey\r\nrepeated every 6 hours if required; max. 900\u00a0micrograms daily; child 3\u20134 years 75\u00a0micrograms up to 30 minutes before\r\nstart of journey repeated after 6 hours if required, max. 150\u00a0micrograms\r\ndaily; 4\u201310 years 75\u2013150\u00a0micrograms up to 30 minutes before start\r\nof journey repeated every 6 hours if required; max. 450\u00a0micrograms\r\ndaily", "Hypersalivation associated with clozapine therapy [unlicensed\r\nindication], by mouth, 300\u00a0micrograms up to 3 times\r\ndaily; max. 900\u00a0micrograms daily; child under 18 years see BNF for Children", "Name[Scopoderm TTS\u00ae (Novartis Consumer Health) ] Patch, self-adhesive, pink, releasing\r\nhyoscine approx. 1\u00a0mg/72 hours when in contact with skin, net price\r\n2 = \u00a34.30. \r\n Label:\r\n 19, counselling, see belowDose\u00a0 motion sickness prevention, apply 1 patch to hairless\r\narea of skin behind ear 5\u20136 hours before journey; replace if necessary\r\nafter 72 hours, siting replacement patch behind other ear; child under 10 years not recommendedCounselling\u00a0Explain accompanying instructions\r\nto patient and in particular emphasise advice to wash hands after\r\nhandling and to wash application site after removing, and to use one\r\npatch at a time" ], "pregnancy": "Pregnancy\u00a0section 15.1.3" }, "ESMOLOL HYDROCHLORIDE": { "indications": "Indications\u00a0short-term treatment of supraventricular\r\narrhythmias (including atrial fibrillation, atrial flutter, sinus\r\ntachycardia); tachycardia and hypertension in peri-operative period", "name": "ESMOLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride; also on infusion venous irritation and thrombophlebitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2486.htm", "doses": [ "By intravenous infusion, usually within\r\nrange 50\u2013200\u00a0micrograms/kg/minute (consult product literature for\r\ndetails of dose titration and doses during peri-operative period)" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "PHENOL": { "indications": "Indications\u00a0see notes above", "name": "PHENOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.7 Local preparations for anal and rectal disorders", "1.7.3 Rectal sclerosants", "PHENOL" ], "side-effects": "Side-effects\u00a0irritation, tissue necrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2279.htm", "doses": [ "2\u20133\u00a0mL into the submucosal layer at the base of the pile;\r\nseveral injections may be given at different sites, max. total injected\r\n10\u00a0mL at any one time" ] }, "ITRACONAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "ITRACONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.1 Triazole antifungals", "ITRACONAZOLE" ], "cautions": "Cautions\u00a0absorption\r\nreduced in HIV-infection and neutropenia (monitor plasma-itraconazole concentration and increase dose if necessary); susceptibility to congestive heart failure (see also\r\nHeart Failure, below); interactions: Appendix 1 (antifungals,\r\ntriazole)Hepatotoxicity\u00a0Potentially life-threatening hepatotoxicity\r\nreported very rarely\u2014discontinue if signs of hepatitis\r\ndevelop. Avoid or use with caution if history\r\nof hepatotoxicity with other drugs or in active liver disease. Monitor liver function\r\nif treatment continues for longer than one month, if receiving other\r\nhepatotoxic drugs, if history of hepatotoxicity with other drugs,\r\nor in hepatic impairmentCounselling\u00a0Patients should be told\r\nhow to recognise signs of liver disorder and advised to seek prompt\r\nmedical attention if symptoms such as anorexia, nausea, vomiting,\r\nfatigue, abdominal pain or dark urine developHeart failureFollowing reports of heart failure, caution is advised when\r\nprescribing itraconazole to patients at high risk of\r\nheart failure. Those at risk include:patients receiving high doses and longer treatment courses;older patients and those with cardiac disease;patients receiving treatment with negative\r\ninotropic drugs, e.g. calcium channel blockers.Itraconazole should be avoided in patients with ventricular\r\ndysfunction or a history of heart failure unless the infection is\r\nserious.", "side-effects": "Side-effects\u00a0nausea, abdominal pain, rash; less commonly vomiting, dyspepsia, taste disturbances, flatulence, diarrhoea,\r\nconstipation, oedema, headache, dizziness, paraesthesia (discontinue\r\ntreatment if neuropathy), menstrual disorder, and alopecia; rarely pancreatitis, dyspnoea, hypoaesthesia, urinary frequency,\r\nleucopenia, visual disturbances, and tinnitus; also reported, heart\r\nfailure (see Cautions above), hypertriglyceridaemia, hepatitis (see\r\nHepatotoxicity above), erectile dysfunction, thrombocytopenia,\r\nhypokalaemia, myalgia, arthralgia, photosensitivity, toxic epidermal\r\nnecrolysis, and Stevens\u2013Johnson syndrome; with intravenous\r\ninjection hypertension and hyperglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202624.htm", "doses": [ "By mouth, oropharyngeal candidiasis,\r\nsee under Sporanox\u00ae oral liquid below", "Vulvovaginal candidiasis, (see also Recurrent Vulvovaginal Candidiasis, section 7.2.2) 200\u00a0mg\r\ntwice daily for 1 day", "Pityriasis versicolor, 200\u00a0mg once daily for 7 days", "Tinea corporis and tinea cruris, either 100\u00a0mg\r\nonce daily for 15 days or 200\u00a0mg once daily for 7\r\ndays", "Tinea pedis and tinea manuum, either 100\u00a0mg\r\nonce daily for 30 days or 200\u00a0mg twice daily for\r\n7 days", "Onychomycosis, either 200\u00a0mg once daily for\r\n3 months or course (\u2018pulse\u2019) of 200\u00a0mg twice daily\r\nfor 7 days, subsequent courses repeated after 21-day interval; fingernails\r\n2 courses, toenails 3 courses", "Aspergillosis, 200\u00a0mg twice daily", "Histoplasmosis, 200\u00a0mg 3 times daily for 3 days, then 200\u00a0mg\r\nonce or twice daily", "Systemic candidiasis and cryptococcosis including cryptococcal\r\nmeningitis where other antifungal drugs inappropriate or ineffective,\r\n200\u00a0mg once daily (candidiasis 100\u2013200\u00a0mg once daily) increased in\r\ninvasive or disseminated disease and in cryptococcal meningitis to\r\n200\u00a0mg twice daily", "Maintenance in HIV-infected patients to prevent relapse of underlying\r\nfungal infection and prophylaxis in neutropenia when standard therapy\r\ninappropriate, 200\u00a0mg once daily, increased to 200\u00a0mg twice daily\r\nif low plasma-itraconazole concentration (see Cautions)", "Prophylaxis in patients with haematological malignancy or undergoing\r\nbone-marrow transplant, see under Sporanox\u00ae oral\r\nliquid below", "By intravenous infusion, systemic\r\naspergillosis, candidiasis and cryptococcosis including cryptococcal\r\nmeningitis where other antifungal drugs inappropriate or ineffective,\r\nhistoplasmosis, 200\u00a0mg every 12 hours for 2 days, then 200\u00a0mg once\r\ndaily for max. 12 days", "child under 18 years\r\nsee BNF for Children", "Itraconazole doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only in life-threatening\r\nsituations (toxicity at high doses in animal studies);\r\nensure effective contraception during treatment and until the next\r\nmenstrual period following end of treatment" }, "TOBRAMYCIN Inhalation": { "indications": "Indications\u00a0see under Gentamicin and notes above", "name": "TOBRAMYCIN Inhalation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "TOBRAMYCIN", "Inhalation" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before tobramycin. Measure lung\r\nfunction before and after initial dose of tobramycin and monitor for\r\nbronchospasm; if bronchospasm occurs in a patient not using a bronchodilator,\r\nrepeat test using bronchodilator. Monitor renal function before treatment\r\nand then annually. Severe haemoptysis\u2014risk of further haemorrhage.", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.; on inhalation, cough (more frequent by inhalation of powder),\r\nbronchospasm (see Cautions), dysphonia, taste disturbances, pharyngitis,\r\nmouth ulcers, salivary hypersecretion, laryngitis, haemoptysis, epistaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85440.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate parenteral dose and monitor serum-tobramycin\r\nconcentration closely", "By intramuscular injection or by slow intravenous injection or by intravenous infusion, 3\u00a0mg/kg daily in divided\r\ndoses every 8 hours, see also notes above; in severe infections up\r\nto 5\u00a0mg/kg daily in divided doses every 6\u20138 hours (reduced to 3\u00a0mg/kg\r\nas soon as clinically indicated); child under 18 years see BNF for Children", "Urinary-tract infection, by intramuscular injection, 2\u20133\u00a0mg/kg daily as a single dose", "One-hour (\u2018peak\u2019) serum concentration should\r\nnot exceed 10\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should be\r\nless than 2\u00a0mg/litre", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult and child over 6 years, 300\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin nebuliser solution", "By inhalation of powder, adult and child over 6 years, 112\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin inhalation powder", "Name[Tobi\u00ae (Novartis) ] Nebuliser solution, tobramycin 60\u00a0mg/mL, net price 56 \u00d7 5-mL (300-mg) unit = \u00a31187.20\nPodhaler (dry powder for inhalation),\r\ntobramycin 28\u00a0mg/capsule, net price 56-cap pack (with Tobi\u00ae Podhaler device) = \u00a3447.50, 224-cap pack (with\r\n5 Tobi\u00ae Podhaler devices) =\r\n\u00a31790.00. Counselling, administration" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "CLOBETASONE BUTYRATE With antimicrobials": { "indications": "Indications\u00a0eczemas and dermatitis of all types;\r\nmaintenance between courses of more potent corticosteroids", "name": "CLOBETASONE BUTYRATE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "CLOBETASONE BUTYRATE", "With antimicrobials" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106271.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Trimovate\u00ae (GSK) ] Cream, clobetasone butyrate 0.05%, oxytetracycline 3%\r\n(as calcium salt), nystatin 100\u00a0000\u00a0units/g, net\r\nprice 30\u00a0g = \u00a33.29. \r\n Label:\r\n 28, counselling, application. Potency: moderateExcipients include cetostearyl\r\nalcohol, chlorocresol, sodium metabisulphiteNote\u00a0Stains clothing" ] }, "NEBIVOLOL": { "indications": "Indications\u00a0essential hypertension; adjunct in stable\r\nmild to moderate heart failure in patients over 70 years", "name": "NEBIVOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride; also oedema and depression", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77278.htm", "doses": [ "Hypertension, 5\u00a0mg daily; elderly initially 2.5\u00a0mg daily, increased if necessary to 5\u00a0mg daily", "Adjunct in heart failure (section 2.5.5), initially 1.25\u00a0mg once daily, then if tolerated increased\r\nat intervals of 1\u20132 weeks to 2.5\u00a0mg once daily, then to 5\u00a0mg once\r\ndaily, then to max. 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "ULIPRISTAL ACETATE": { "indications": "Indications\u00a0emergency contraception", "name": "ULIPRISTAL ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.5 Emergency contraception", "Hormonal methods", "ULIPRISTAL ACETATE" ], "cautions": "Cautions\u00a0\n(From Hormonal methods: British National Formulary)\nHormonal methods; uncontrolled severe\r\nasthma; effectiveness of combined hormonal and progestogen-only\r\ncontraceptives may be reduced\u2014additional precautions (barrier methods)\r\nrequired for 14 days for combined and parenteral progestogen-only\r\nhormonal contraceptives and 9 days for oral progestogen-only contraceptives\r\n(16 days for Qlaira\u00ae); interactions: \n(From Hormonal methods: British National Formulary)\nInteractions\u00a0The effectiveness of levonorgestrel, and possibly ulipristal, is reduced in women taking enzyme-inducing drugs (and possibly for 4 weeks after stopping); a copper intra-uterine device can be offered instead. If the copper intra-uterine device is undesirable or inappropriate, the dose of levonorgestrel should be increased to a total of 3\u00a0mg taken as a single dose [unlicensed dose\u2014advise women accordingly]. There is no need to increase the dose for emergency contraception if the patient is taking antibacterials that are not enzyme inducers. and\r\nAppendix 1 (ulipristal)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including nausea,\r\nvomiting, diarrhoea, and abdominal pain); dizziness, fatigue, headache;\r\nmenstrual irregularities (\n(From Hormonal methods: British National Formulary)\nWhen prescribing or supplying hormonal emergency contraception, women should be advised:that their next period may be early or late;that a barrier method of contraception needs to be used until the next period;to seek medical attention promptly if any lower abdominal pain occurs because this could signify an ectopic pregnancy;to return in 3 to 4 weeks if the subsequent menstrual bleed is abnormally light, heavy or brief, or is absent, or if she is otherwise concerned (if there is any doubt as to whether menstruation has occurred, a pregnancy test should be performed at least 3 weeks after unprotected intercourse).); back\r\npain, muscle spasms; less commonly tremor, hot flushes,\r\nuterine spasm, breast tenderness, dry mouth, blurred vision, pruritus,\r\nand rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204192.htm", "doses": [ "30\u00a0mg as a single dose as soon as possible after coitus,\r\nbut no later than after 120 hours" ], "pregnancy": "Pregnancy\u00a0limited information available" }, "MOMETASONE FUROATE": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "MOMETASONE FUROATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "MOMETASONE FUROATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5927.htm", "doses": [ "Apply thinly once daily (to scalp in case of lotion)" ] }, "NEOSTIGMINE METILSULFATE": { "indications": "Indications\u00a0see under Dose", "name": "NEOSTIGMINE METILSULFATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.6 Drugs for reversal of neuromuscular blockade", "Anticholinesterases", "NEOSTIGMINE METILSULFATE" ], "cautions": "Cautions\u00a0section 10.2.1 and notes above; glycopyrronium or\r\natropine should also be given", "side-effects": "Side-effects\u00a0section 10.2.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6670.htm", "doses": [ "Reversal of non-depolarising neuromuscular blockade, by intravenous injection over 1 minute, adult over 18 years, 2.5\u00a0mg repeated if necessary (max. 5\u00a0mg) after or\r\nwith glycopyrronium or atropine; child under 18 years see BNF for Children", "Myasthenia gravis, see section 10.2.1" ], "pregnancy": "Pregnancy\u00a0section 10.2.1" }, "TIZANIDINE": { "indications": "Indications\u00a0spasticity associated with multiple sclerosis\r\nor spinal cord injury or disease", "name": "TIZANIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "TIZANIDINE" ], "cautions": "Cautions\u00a0elderly; monitor\r\nliver function monthly for first 4 months and in those who develop\r\nunexplained nausea, anorexia or fatigue; concomitant administration of drugs that prolong QT interval; avoid abrupt withdrawal (risk of rebound\r\nhypertension and tachycardia, see under Withdrawal, below); interactions: Appendix 1 (muscle relaxants)Withdrawal\u00a0Rebound hypertension and tachycardia\r\ncan occur on abrupt withdrawal; to minimise risk, discontinue gradually\r\nand monitor blood pressureDriving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness, fatigue, dizziness, dry mouth, nausea,\r\ngastro-intestinal disturbances, hypotension; also reported, bradycardia,\r\ninsomnia, hallucinations and altered liver enzymes (discontinue if\r\npersistently raised\u2014consult product literature); rarely acute hepatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128999.htm", "doses": [ "adult over 18 years, initially\r\n2\u00a0mg daily as a single dose increased according to response at intervals\r\nof at least 3\u20134 days in steps of 2\u00a0mg daily (and given in divided\r\ndoses) usually up to 24\u00a0mg daily in 3\u20134 divided doses; max. 36\u00a0mg\r\ndaily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "MOXIFLOXACIN - ANTIBACTERIALS": { "side-effects": "Side-effects\u00a0taste disturbances, ocular discomfort (including\r\npain, irritation and dryness), hyperaemia; less commonly vomiting, headache, paraesthesia, corneal disorders (including keratitis,\r\nerosion, and staining), conjunctival haemorrhage, eyelid erythema,\r\nvisual disturbances, nasal discomfort, pharyngolaryngeal pain; also reported nausea, palpitation, dyspnoea, dizziness,\r\nraised intra-ocular pressure, photophobia, rash, pruritus", "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "MOXIFLOXACIN - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213680.htm", "doses": [ "adult and child over 1 month, apply 3 times daily (continue\r\ntreatment for 2\u20133 days after infection improves; review if no improvement\r\nwithin 5 days)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "MOXIFLOXACIN" ], "cautions": "Cautions\u00a0not recommended for neonates" }, "DISULFIRAM": { "indications": "Indications\u00a0\n(From Disulfiram: British National Formulary)\nDisulfiram", "name": "DISULFIRAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.1 Alcohol dependence", "Disulfiram" ], "cautions": "Cautions\u00a0ensure that alcohol not consumed for at least 24 hours before initiating treatment; see also notes above; alcohol challenge not recommended on routine basis (if considered essential\u2014specialist units only with resuscitation\r\nfacilities); respiratory disease, diabetes mellitus, epilepsy; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (disulfiram)", "side-effects": "Side-effects\u00a0initially drowsiness and fatigue; nausea, vomiting,\r\nhalitosis, reduced libido; rarely psychotic reactions\r\n(depression, paranoia, schizophrenia, mania), allergic dermatitis,\r\nperipheral neuritis, hepatic cell damage", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3687.htm", "doses": [ "200\u00a0mg daily increased if necessary; usual max. 500\u00a0mg\r\ndaily; child not recommended" ], "pregnancy": "Pregnancy\u00a0high concentrations of acetaldehyde which occur in\r\npresence of alcohol may be teratogenic; avoid in\r\nfirst trimester" }, "2.2.4 Potassium-sparing diuretics with other diuretics Amiloride with bumetanide": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "Amiloride with bumetanide" ], "name": "2.2.4 Potassium-sparing diuretics with other diuretics Amiloride with bumetanide", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202578.htm", "doses": [ "Name[Amiloride with bumetanide (Non-proprietary) ] Tablets, amiloride hydrochloride\r\n5\u00a0mg, bumetanide 1\u00a0mg, net price 28-tab pack =\r\n\u00a329.60Dose\u00a0oedema, 1\u20132\u00a0tablets daily" ] }, "ACIPIMOX": { "indications": "Indications\u00a0hyperlipidaemias of types IIb and IV in patients who have not responded\r\nadequately to diet and other appropriate measures", "name": "ACIPIMOX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Nicotinic acid group", "ACIPIMOX" ], "side-effects": "Side-effects\u00a0vasodilatation, flushing, itching, rashes, urticaria,\r\nerythema; heartburn, epigastric pain, nausea, diarrhoea, headache,\r\nmalaise, dry eyes; rarely angioedema, bronchospasm, anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2857.htm", "doses": [ "Usually 500\u2013750\u00a0mg daily in divided doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "LOTEPREDNOL ETABONATE": { "indications": "Indications\u00a0treatment of post-operative inflammation\r\nfollowing ocular surgery", "name": "LOTEPREDNOL ETABONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "LOTEPREDNOL ETABONATE" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200898.htm", "doses": [ "Apply 4 times daily starting 24 hours after surgery; max.\r\nduration of treatment 14 days" ] }, "PHENINDIONE": { "indications": "Indications\u00a0prophylaxis of embolisation in rheumatic heart disease and atrial\r\nfibrillation; prophylaxis after insertion of prosthetic heart valve;\r\nprophylaxis and treatment of venous thrombosis and pulmonary embolism", "name": "PHENINDIONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Coumarins and phenindione" ], "cautions": "Cautions\u00a0see under Warfarin Sodium; interactions: Appendix 1 (phenindione)", "side-effects": "Side-effects\u00a0see under Warfarin Sodium;\r\nalso hypersensitivity reactions including exfoliative dermatitis,\r\nexanthema, fever, leucopenia, agranulocytosis, eosinophilia, and renal\r\ndamage; micro-adenopathy and urine coloured pink or orange", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2797.htm", "doses": [ "200\u00a0mg on day 1; 100\u00a0mg on day 2, then adjusted according\r\nto response; maintenance dose usually 50\u2013150\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From Coumarins and phenindione: British National Formulary)\nPregnancy\u00a0 Warfarin, acenocoumarol, and phenindione are teratogenic and should not be given in the first trimester of pregnancy. Women of child-bearing age should be warned of this danger since stopping these drugs before the sixth week of gestation may largely avoid the risk of fetal abnormality. These oral anticoagulants cross the placenta with risk of congenital malformations, and placental, fetal, or neonatal haemorrhage, especially during the last few weeks of pregnancy and at delivery. Therefore, if at all possible, they should be avoided in pregnancy, especially in the first and third trimesters. Difficult decisions may have to be made, particularly in women with prosthetic heart valves, atrial fibrillation, or with a history of recurrent venous thrombosis or pulmonary embolism." }, "LATANOPROST": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle glaucoma; ocular hypertension", "name": "LATANOPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.; also history of herpetic keratitis (avoid in\r\nactive herpes simplex keratitis); cataract\r\nsurgery", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.; also reported herpetic keratitis, iris cyst", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57520.htm", "doses": [ "Apply once daily, preferably in the evening" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "ATOVAQUONE": { "indications": "Indications\u00a0treatment of mild to moderate Pneumocystis jirovecii (Pneumocystis carinii) pneumonia\r\nin patients intolerant of co-trimoxazole", "name": "ATOVAQUONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.8 Drugs for pneumocystis pneumonia", "ATOVAQUONE" ], "cautions": "Cautions\u00a0initial diarrhoea and difficulty in taking with food may reduce absorption\r\n(and require alternative therapy); other causes of pulmonary\r\ndisease should be sought and treated; elderly; interactions: Appendix 1 (atovaquone)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, vomiting; headache, insomnia;\r\nfever; anaemia, neutropenia, hyponatraemia; rash, pruritus; also reported,\r\nStevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27973.htm", "doses": [ "750\u00a0mg twice daily with food (particularly high fat) for\r\n21 days; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014no information available" }, "HYDROXYCARBAMIDE - SICKLE-CELL DISEASE": { "indications": "Indications\u00a0sickle-cell disease (\n(From Sickle-cell disease: British National Formulary)\nSickle-cell disease); chronic\r\nmyeloid leukaemia, cancer of the cervix (%s\n(From HYDROXYCARBAMIDE: British National Formulary)\nHYDROXYCARBAMIDE)", "name": "HYDROXYCARBAMIDE - SICKLE-CELL DISEASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Sickle-cell disease", "HYDROXYCARBAMIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; also monitor renal and hepatic function before and during treatment; monitor full blood count before treatment, then every\r\n2 weeks for the first 2 months and then every 2 months thereafter\r\n(or every 2 weeks if on max. dose); leg\r\nulcers (review treatment if cutaneous vasculitic\r\nulcerations develop); interactions: Appendix 1 (hydroxycarbamide)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also\r\nheadache; less commonly dizziness and rash; rarely reduced sperm count and activity; fever, amenorrhoea,\r\nskin cancers (in elderly patients), bleeding and hypomagnesaemia also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202854.htm", "doses": [ "By mouth, initially 15\u00a0mg/kg daily, increased\r\nevery 12 weeks in steps of 2.5\u20135\u00a0mg/kg daily according to response;\r\nusual dose 15\u201330\u00a0mg/kg daily (max. 35\u00a0mg/kg daily); child under 18 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0section 8.1.5" }, "IMIQUIMOD": { "indications": "Indications\u00a0see under Dose", "name": "IMIQUIMOD", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.7 Preparations for warts and calluses", "Anogenital warts", "IMIQUIMOD" ], "cautions": "Cautions\u00a0avoid normal or broken skin, and open wounds; not suitable for internal genital\r\nwarts; uncircumcised males (risk of phimosis\r\nor stricture of foreskin); autoimmune disease; immunosuppressed patients", "side-effects": "Side-effects\u00a0local reactions (including itching, burning sensation,\r\nerythema, erosion, oedema, excoriation, and scabbing); headache; influenza-like\r\nsymptoms; myalgia; less commonly local ulceration\r\nand alopecia; rarely Stevens-Johnson syndrome and\r\ncutaneous lupus erythematosus-like effect; very rarely dysuria in women; permanent hypopigmentation or hyperpigmentation\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77893.htm", "doses": [ "Warts (external genital and perianal), apply thinly 3\r\ntimes a week at night until lesions resolve (max. 16 weeks)", "Superficial basal cell carcinoma, apply to lesion (and 1\u00a0cm\r\nbeyond it) on 5 days each week for 6 weeks; assess response 12 weeks\r\nafter completing treatment", "Actinic keratosis, apply to lesion 3 times a week for 4 weeks;\r\nassess response after a 4 week treatment-free interval; repeat 4-week\r\ncourse if lesions persist; max. 2 courses", "child under 18 years\r\nsee BNF for Children", "Should be rubbed in and allowed to stay\r\non the treated area for 6\u201310 hours for warts or for 8 hours for basal\r\ncell carcinoma and actinic keratosis, then washed off with mild soap\r\nand water (uncircumcised males treating warts under foreskin should\r\nwash the area daily). The cream should be washed off before sexual\r\ncontact" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity or toxicity in animal studies; manufacturer advises caution" }, "PREDNISONE": { "indications": "Indications\u00a0moderate to severe rheumatoid arthritis\r\n(section 10.1.2.1)", "name": "PREDNISONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "PREDNISONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213856.htm", "doses": [ "adult over 18 years, initially\r\n10\u201320\u00a0mg at bedtime, adjusted according to response" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "TIOGUANINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nTioguanine is given by mouth for the treatment of acute leukaemias and chronic myeloid leukaemia. It can be given at various stages of treatment in short-term cycles. Tioguanine has a lower incidence of gastro-intestinal side-effects than mercaptopurine. Long-term therapy is no longer recommended because of the high risk of liver toxicity; treatment with tioguanine should be discontinued if liver toxicity develops.", "name": "TIOGUANINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; thiopurine methyltransferase status\r\n(see section 8.2.1); monitor liver\r\nfunction weekly\u2014discontinue if liver toxicity develops; interactions: Appendix 1 (tioguanine)", "side-effects": "Side-effects\u00a0see section 8.1; also stomatitis and hepatotoxicity; rarely intestinal necrosis and perforation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4740.htm", "doses": [ "100\u2013200\u00a0mg/m2 daily" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenicity reported when men receiving tioguanine have fathered children); ensure effective contraception\r\nduring treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "PHENYTOIN SODIUM": { "indications": "Indications\u00a0status epilepticus; acute\r\nsymptomatic seizures associated with head trauma or neurosurgery", "name": "PHENYTOIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus" ], "cautions": "Cautions\u00a0\n(From 4.8.2 Drugs used in status epilepticus: British National Formulary)\n4.8.2 Drugs used in status epilepticus; respiratory\r\ndepression; hypotension and heart failure; resuscitation facilities\r\nmust be available; injection solutions\r\nalkaline (irritant to tissues); see also %s\n(From PHENYTOIN: British National Formulary)\nPHENYTOIN; interactions: \n(From 4.8.1 Control of the epilepsies: British National Formulary)\nInteractions\u00a0Interactions between antiepileptics are complex and may increase toxicity without a corresponding increase in antiepileptic effect. Interactions are usually caused by hepatic enzyme induction or inhibition; displacement from protein binding sites is not usually a problem. These interactions are highly variable and unpredictable.For interactions of antiepileptic drugs, see Appendix 1; for advice on hormonal contraception and enzyme-inducing drugs, see section 7.3.1 and section 7.3.2.Significant interactions that occur between antiepileptics and that may affect dosing requirements are as follows:Note\u00a0Check under each drug for possible interactions when two or more antiepileptic drugs are usedCarbamazepineoften lowers plasma concentration of clobazam, clonazepam, lamotrigine, phenytoin (but may also raise plasma-phenytoin concentration), tiagabine, topiramate, valproate, zonisamide, and an active metabolite of oxcarbazepinesometimes lowers plasma concentration of eslicarbazepine, ethosuximide, primidone (but tendency for corresponding increase in phenobarbital level), retigabine, and rufinamidesometimes raises plasma concentration of phenobarbital and primidone-derived phenobarbitalEslicarbazepineoften raises plasma concentration of phenytoinEthosuximidesometimes raises plasma concentration of phenytoin Lamotriginesometimes raises plasma concentration of an active metabolite of carbamazepine (but evidence is conflicting)Oxcarbazepine sometimes lowers plasma concentration of carbamazepine (but may raise plasma concentration of an active metabolite of carbamazepine)sometimes raises plasma concentration of phenytoin often raises plasma concentration of phenobarbital and primidone-derived phenobarbitalPhenobarbital or primidoneoften lowers plasma concentration of clonazepam, lamotrigine, phenytoin (but may also raise plasma-phenytoin concentration), tiagabine, valproate, zonisamide, and an active metabolite of oxcarbazepinesometimes lowers plasma concentration of ethosuximide, rufinamide, and topiramatePhenytoin often lowers plasma concentration of clonazepam, carbamazepine, eslicarbazepine, lamotrigine, tiagabine, topiramate, valproate, zonisamide, and an active metabolite of oxcarbazepineoften raises plasma concentration of phenobarbital and primidone-derived phenobarbitalsometimes lowers plasma concentration of ethosuximide, primidone (by increasing conversion to phenobarbital), retigabine, and rufinamideRufinamidesometimes lowers plasma concentration of carbamazepinesometimes raises plasma concentration of phenytoinTopiramate sometimes raises plasma concentration of phenytoinValproatesometimes lowers plasma concentration of an active metabolite of oxcarbazepine often raises plasma concentration of lamotrigine, phenobarbital, primidone-derived phenobarbital, phenytoin (but may also lower), and an active metabolite of carbamazepinesometimes raises plasma concentration of ethosuximide and rufinamideVigabatrin often lowers plasma concentration of phenytoin in section 4.8.1 and Appendix 1 (phenytoin)", "side-effects": "Side-effects\u00a0intravenous injection may cause cardiovascular\r\nand CNS depression (particularly if injection too rapid) with arrhythmias,\r\nhypotension, and cardiovascular collapse; alterations in respiratory\r\nfunction (including respiratory arrest); also reported tonic seizures, purple glove syndrome; see also section 4.8.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3628.htm", "doses": [ "By slow intravenous injection or infusion (with blood pressure and ECG\r\nmonitoring), 20\u00a0mg/kg (max. 2\u00a0g) at a rate not exceeding 1\u00a0mg/kg/minute\r\n(max. 50\u00a0mg per minute), as a loading dose (see also notes above); maintenance\r\ndoses of about 100\u00a0mg, by mouth or by intravenous\r\nadministration, should be given thereafter every 6\u20138 hours,\r\nadjusted according to plasma-phenytoin concentration; child 1 month\u201312 years, 20\u00a0mg/kg at a rate not exceeding\r\n1\u00a0mg/kg/minute (max. 50\u00a0mg per minute) as a loading dose; maintenance\r\ndose of 5\u201310\u00a0mg/kg daily (max. 300\u00a0mg daily) in 2 divided doses; neonate 20\u00a0mg/kg at a rate not exceeding 1\u00a0mg/kg/minute,\r\nas a loading dose; maintenance dose of 5\u201310\u00a0mg/kg daily in 2 divided\r\ndoses", "To avoid local venous irritation each injection\r\nor infusion should be preceded and followed by an injection of sterile\r\nphysiological saline through the same needle or catheter", "Phenytoin sodium doses in BNF may differ\r\nfrom those in product literature" ], "pregnancy": "Pregnancy\u00a0see Phenytoin, section 4.8.1, and Pregnancy" }, "CLOMIPRAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0depressive illness, phobic and obsessional states; adjunctive treatment\r\nof cataplexy associated with narcolepsy", "name": "CLOMIPRAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "CLOMIPRAMINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, diarrhoea, hypertension, flushing, restlessness, fatigue,\r\naggression, impaired memory, muscle weakness, muscle hypertonia, myoclonus,\r\nmydriasis, and yawning; very rarely allergic alveolitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3307.htm", "doses": [ "Depressive illness, adult over 18 years, initially 10\u00a0mg daily, increased gradually as necessary\r\nto 30\u2013150\u00a0mg daily in divided doses or as a single\r\ndose at bedtime; max. 250\u00a0mg daily; elderly initially 10\u00a0mg daily increased carefully over approx. 10 days to\r\n30\u201375\u00a0mg daily", "Phobic and obsessional states, adult over 18 years, initially 25\u00a0mg daily (elderly 10\u00a0mg daily) increased over 2 weeks to 100\u2013150\u00a0mg daily; max. 250\u00a0mg\r\ndaily", "Adjunctive treatment of cataplexy associated with narcolepsy, adult over 18 years, initially 10\u00a0mg daily, gradually\r\nincreased until satisfactory response (range 10\u201375\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0neonatal withdrawal symptoms reported if used during\r\nthird trimester" }, "ORPHENADRINE HYDROCHLORIDE": { "indications": "Indications\u00a0parkinsonism; drug-induced extrapyramidal\r\nsymptoms (but not tardive dyskinesia, \n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinic drugs exert their antiparkinsonian action by reducing the effects of the relative central cholinergic excess that occurs as a result of dopamine deficiency. Antimuscarinic drugs can be useful in drug-induced parkinsonism, but they are generally not used in idiopathic Parkinson\u2019s disease because they are less effective than dopaminergic drugs and they are associated with cognitive impairment.The antimuscarinic drugs orphenadrine, procyclidine, and trihexyphenidyl reduce the symptoms of parkinsonism induced by antipsychotic drugs, but there is no justification for giving them routinely in the absence of parkinsonian side-effects. Tardive dyskinesia is not improved by antimuscarinic drugs and may be made worse.In idiopathic Parkinson\u2019s disease, antimuscarinic drugs reduce tremor and rigidity but they have little effect on bradykinesia. They may be useful in reducing sialorrhoea.There are no important differences between the antimuscarinic drugs, but some patients tolerate one better than another.Procyclidine can be given parenterally and is effective emergency treatment for acute drug-induced dystonic reactions.)", "name": "ORPHENADRINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.2 Antimuscarinic drugs used in parkinsonism" ], "cautions": "Cautions\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nAntimuscarinics should be used with caution in cardiovascular disease, hypertension, psychotic disorders, prostatic hypertrophy, pyrexia, in those susceptible to angle-closure glaucoma, and in the elderly. Antimuscarinics should not be withdrawn abruptly in patients taking long-term treatment. Antimuscarinics are liable to abuse. Interactions: Appendix 1 (Antimuscarinics)", "side-effects": "Side-effects\u00a0\n(From 4.9.2 Antimuscarinic drugs used in parkinsonism: British National Formulary)\nSide-effects of antimuscarinics include constipation, dry mouth, nausea, vomiting, tachycardia, dizziness, confusion, euphoria, hallucinations, impaired memory, anxiety, restlessness, urinary retention, blurred vision, and rash. Angle-closure glaucoma occurs very rarely.; less commonly seizures, drowsiness, insomnia, and impaired\r\ncoordination", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3664.htm", "doses": [ "Initially 150\u00a0mg daily in divided doses, increased gradually\r\nin steps of 50\u00a0mg every 2\u20133 days according to response; usual dose\r\nrange 150\u2013300\u00a0mg daily in divided doses; max. 400\u00a0mg daily; elderly preferably lower end of range" ], "pregnancy": "Pregnancy\u00a0caution" }, "TRIMIPRAMINE": { "indications": "Indications\u00a0depressive illness, particularly where sedation required", "name": "TRIMIPRAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "TRIMIPRAMINE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3328.htm", "doses": [ "Initially 50\u201375\u00a0mg daily in divided doses or as a single dose at bedtime, increased as necessary to 150\u2013300\u00a0mg\r\ndaily; elderly initially 10\u201325\u00a0mg 3\r\ntimes daily, maintenance half adult dose may be sufficient; child not recommended" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs\r\nrisk" }, "ISOSORBIDE MONONITRATE Modified release": { "indications": "Indications\u00a0prophylaxis of angina; adjunct in congestive\r\nheart failure", "name": "ISOSORBIDE MONONITRATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE MONONITRATE", "Modified release" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2665.htm", "doses": [ "Initially 20\u00a0mg 2\u20133 times daily or 40\u00a0mg\r\ntwice daily (10\u00a0mg twice daily in those who have not previously received\r\nnitrates); up to 120\u00a0mg daily in divided doses if required", "Name[Imdur\u00ae (AstraZeneca)] Durules\u00ae (= tablets m/r), yellow,\r\nf/c, scored, isosorbide mononitrate 60\u00a0mg, net\r\nprice 28-tab pack = \u00a310.50. \r\n Label:\r\n 25Dose\u00a0prophylaxis of angina, 1 tablet in the morning (half a\r\ntablet if headache occurs), increased to 2 tablets in the morning\r\nif required" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless potential benefit\r\noutweighs risk" }, "BETAMETHASONE SODIUM PHOSPHATE - DRUGS USED IN NASAL ALLERGY": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0non-infected inflammatory\r\nconditions of nose", "name": "BETAMETHASONE SODIUM PHOSPHATE - DRUGS USED IN NASAL ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5645.htm", "doses": [ "nose, 2\u20133 drops into each nostril 2\u20133 times\r\ndaily; ear, section\r\n12.1.1; eye, section 11.4.1" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "BETAMETHASONE SODIUM PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered." }, "Dosage in children": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Guidance on prescribing", "Prescribing for children" ], "name": "Dosage in children", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29443.htm", "doses": [] }, "DONEPEZIL HYDROCHLORIDE": { "indications": "Indications\u00a0mild to moderate dementia in Alzheimer\u2019s disease", "name": "DONEPEZIL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.11 Drugs for dementia", "DONEPEZIL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0sick sinus syndrome or\r\nother supraventricular conduction abnormalities; susceptibility to peptic ulcers; asthma, chronic obstructive pulmonary\r\ndisease; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, anorexia, diarrhoea; fatigue,\r\ninsomnia, headache, dizziness, syncope, abnormal dreams, hallucinations,\r\nagitation, aggression; muscle cramps; urinary incontinence; rash,\r\npruritus; less commonly gastric and duodenal ulcers,\r\ngastro-intestinal haemorrhage, bradycardia, seizures; rarely sino-atrial block, AV block, hepatitis, extrapyramidal symptoms;\r\npotential for bladder outflow obstruction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130019.htm", "doses": [ "Initially 5\u00a0mg once daily at bedtime, increased if necessary\r\nafter one month to max. 10\u00a0mg daily" ] }, "PROPRANOLOL HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "PROPRANOLOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "PROPRANOLOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nBeta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA, see above), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers, see above). Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.; also avoid abrupt\r\nwithdrawal especially in ischaemic heart disease; first-degree AV block; portal hypertension\r\n(risk of deterioration in liver function); diabetes; history of\r\nobstructive airways disease (introduce cautiously and monitor lung\r\nfunction\u2014\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nBeta-blockers can precipitate bronchospasm and should therefore usually be avoided in patients with a history of asthma. When there is no suitable alternative, it may be necessary for a patient with well-controlled asthma, or chronic obstructive pulmonary disease (without significant reversible airways obstruction), to receive treatment with a beta-blocker for a co-existing condition (e.g. heart failure or following myocardial infarction). In this situation, a cardioselective beta-blocker should be selected and initiated at a low dose by a specialist; the patient should be closely monitored for adverse effects. Atenolol, bisoprolol, metoprolol, nebivolol, and (to a lesser extent) acebutolol, have less effect on the beta2 (bronchial) receptors and are, therefore, relatively cardioselective, but they are not cardiospecific. They have a lesser effect on airways resistance but are not free of this side-effect.Beta-blockers are also associated with fatigue, coldness of the extremities (may be less common with those with ISA, see above), and sleep disturbances with nightmares (may be less common with the water-soluble beta-blockers, see above). Beta-blockers can affect carbohydrate metabolism, causing hypoglycaemia or hyperglycaemia in patients with or without diabetes; they can also interfere with metabolic and autonomic responses to hypoglycaemia, thereby masking symptoms such as tachycardia. However, beta-blockers are not contra-indicated in diabetes, although the cardioselective beta-blockers (see above) may be preferred. Beta-blockers should be avoided altogether in those with frequent episodes of hypoglycaemia. Beta-blockers, especially when combined with a thiazide diuretic, should be avoided for the routine treatment of uncomplicated hypertension in patients with diabetes or in those at high risk of developing diabetes.); myasthenia gravis; symptoms of hypoglycaemia and thyrotoxicosis may be masked (also see notes above); psoriasis; history of hypersensitivity\u2014may increase sensitivity\r\nto allergens and result in more serious hypersensitivity response, also may reduce response to adrenaline (epinephrine) (see also %s\n(From 3.4.3 Allergic emergencies: British National Formulary)\n3.4.3 Allergic emergencies); interactions: Appendix 1\r\n(beta-blockers), important: verapamil\r\ninteraction, see also VERAPAMIL %s\n(From 2.6.2 Calcium-channel blockers: British National Formulary)\n2.6.2 Calcium-channel blockers ", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nbradycardia, heart failure, hypotension, conduction disorders, peripheral\r\nvasoconstriction (including exacerbation of intermittent claudication\r\nand Raynaud\u2019s phenomenon); bronchospasm (see above), dyspnoea; headache,\r\nfatigue, sleep disturbances, paraesthesia, dizziness, vertigo, psychoses;\r\nsexual dysfunction; purpura, thrombocytopenia; visual disturbances;\r\nexacerbation of psoriasis, alopecia; rarely rashes\r\nand dry eyes (reversible on withdrawal); overdosage: \n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2457.htm", "doses": [ "By mouth, hypertension, initially\r\n80\u00a0mg twice daily, increased at weekly intervals as required; maintenance\r\n160\u2013320\u00a0mg daily", "Prophylaxis of variceal bleeding in portal hypertension, initially\r\n40\u00a0mg twice daily, increased to 80\u00a0mg twice daily according to heart\r\nrate; max. 160\u00a0mg twice daily", "Phaeochromocytoma (only with an alpha-blocker), 60\u00a0mg daily\r\nfor 3\u00a0days before surgery or 30\u00a0mg daily in patients\r\nunsuitable for surgery", "Angina, initially 40\u00a0mg 2\u20133\u00a0times daily; maintenance 120\u2013240\u00a0mg\r\ndaily", "Arrhythmias, hypertrophic cardiomyopathy, anxiety tachycardia,\r\nand thyrotoxicosis (adjunct), 10\u201340\u00a0mg 3\u20134\u00a0times daily", "Anxiety with symptoms such as palpitation, sweating, tremor,\r\n40\u00a0mg once daily, increased to 40\u00a0mg 3 times daily if necessary", "Prophylaxis after myocardial infarction, 40\u00a0mg 4 times daily\r\nfor 2\u20133 days, then 80\u00a0mg twice daily, beginning 5 to 21 days after\r\ninfarction", "Essential tremor, initially 40\u00a0mg 2\u20133\u00a0times daily; maintenance\r\n80\u2013160\u00a0mg daily", "Migraine prophylaxis, 80\u2013240\u00a0mg daily in divided doses", "By intravenous injection, arrhythmias\r\nand thyrotoxic crisis, 1\u00a0mg over 1 minute; if necessary repeat at\r\n2-minute intervals; max. total dose 10\u00a0mg (5\u00a0mg in anaesthesia)", "Excessive bradycardia can be countered with intravenous injection of atropine sulphate 0.6\u20132.4\u00a0mg in divided doses of 600\u00a0micrograms; for overdosage see Emergency Treatment of Poisoning " ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "ADAPALENE": { "indications": "Indications\u00a0mild to moderate acne", "name": "ADAPALENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "ADAPALENE" ], "cautions": "Cautions\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/59055.htm", "doses": [ "adult and child over 12 years, apply thinly once daily in the\r\nevening" ], "pregnancy": "Pregnancy\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES": { "indications": "Indications\u00a0contraception, see also notes above and under\r\npreparations (roles vary according to preparation)", "name": "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.2 Progestogen-only contraceptives", "7.3.2.2 Parenteral progestogen-only contraceptives", "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES" ], "cautions": "Cautions\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives and under\r\npreparations; possible risk of breast cancer, \n(From ORAL PROGESTOGEN-ONLY CONTRACEPTIVES: British National Formulary)\nBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women using, or who have recently used, a progestogen-only contraceptive pill; this relative risk may be due to an earlier diagnosis. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use; the risk disappears gradually during the 10 years after stopping and there is no excess risk by 10 years. A possible small increase in the risk of breast cancer should be weighed against the benefitsoral progestogen-only contraceptives (section 7.3.2.1); history during pregnancy\r\nof pruritus or of deterioration of otosclerosis, disturbances\r\nof lipid metabolism; interactions: \n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\nInteractions\u00a0Effectiveness of parenteral progestogen-only contraceptives is not affected by antibacterials that do not induce liver enzymes. The effectiveness of norethisterone and medroxyprogesterone acetate intramuscular injections is not affected by enzyme-inducing drugs and they may be continued as normal during courses of these drugs. However, effectiveness of the etonogestrel-releasing implant may be reduced by enzyme-inducing drugs and an alternative contraceptive method, unaffected by the interacting drug, is recommended during treatment with the enzyme-inducing drug and for at least 4 weeks after stopping. For a short course of an enzyme-inducing drug, if a change in contraceptive method is undesirable or inappropriate, the implant may be continued in combination with additional contraceptive precautions (e.g. condom) for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping it. and Appendix\r\n1 (progestogens)Counselling\u00a0Full counselling backed\r\nby patient information leaflet required before administration", "side-effects": "Side-effects\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives; injection-site\r\nreactionsCervical cancer\u00a0Use of injectable progestogen-only\r\ncontraceptives may be associated with a small increased risk of cervical\r\ncancer, similar to that seen with %s\n(From COMBINED HORMONAL CONTRACEPTIVES: British National Formulary)\nSide-effects\u00a0see notes above; also nausea, vomiting, abdominal cramps, liver impairment, hepatic tumours; fluid retention, thrombosis (more common when factor V Leiden present or in blood groups A, B, and AB; see also notes above), hypertension, changes in lipid metabolism; headache, depression, chorea, nervousness, irritability; changes in libido, breast tenderness, enlargement, and secretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence of withdrawal bleeding, amenorrhoea after discontinuation, changes in vaginal discharge, cervical erosion; contact lenses may irritate, visual disturbances; leg cramps; skin reactions, chloasma, photosensitivity; rarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women taking the combined oral contraceptive pill; this relative risk may be due to an earlier diagnosis. In users of combined oral contraceptive pills the cancers are more likely to be localised to the breast. The most important factor for diagnosing breast cancer appears to be the age at which the contraceptive is stopped rather than the duration of use; any increase in the rate of diagnosis diminishes gradually during the 10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives for 5 years or longer is associated with a small increased risk of cervical cancer; the risk diminishes after stopping and disappears by about 10 years. The risk of cervical cancer with transdermal patches and vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of breast cancer and cervical cancer should be weighed against the protective effect against cancers of the ovary and endometrium. The risk of cervical cancer with other progestogen-only\r\ncontraceptives is not yet known.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/13751.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; for Implanon\u00ae or Nexplanon\u00ae if pregnancy occurs remove implant" }, "MAGNESIUM SULPHATE": { "indications": "Indications\u00a0see notes above; constipation (%s\n(From 1.6.4 Osmotic laxatives: British National Formulary)\n1.6.4 Osmotic laxatives); severe acute asthma (%s\n(From Management of severe acute asthma: British National Formulary)\nManagement of severe acute asthma); paste for boils (%s\n(From 13.10.5 Preparations for minor cuts and abrasions: British National Formulary)\n13.10.5 Preparations for minor cuts and abrasions)", "name": "MAGNESIUM SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.3 Magnesium", "MAGNESIUM SULPHATE" ], "cautions": "Cautions\u00a0\n(From 9.5.1.3 Magnesium: British National Formulary)\nHypomagnesaemia often causes secondary hypocalcaemia, and also hypokalaemia and hyponatraemia.; in severe hypomagnesaemia\r\nadminister initially via controlled infusion device (preferably syringe\r\npump); monitor blood pressure, respiratory\r\nrate, urinary output and for signs of overdosage (loss\r\nof patellar reflexes, weakness, nausea, sensation of warmth, flushing,\r\ndrowsiness, double vision, and slurred speech); interactions: Appendix 1 (magnesium,\r\nparenteral)", "side-effects": "Side-effects\u00a0generally associated with hypermagnesaemia, nausea,\r\nvomiting, thirst, flushing of skin, hypotension, arrhythmias, coma,\r\nrespiratory depression, drowsiness, confusion, loss of tendon reflexes,\r\nmuscle weakness; colic and diarrhoea following oral administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/12751.htm", "doses": [ "Hypomagnesaemia, see notes above", "Arrhythmias, see notes above", "Prevention of seizures in pre-eclampsia [unlicensed indication],\r\ninitially by intravenous injection over 5\u201315 minutes,\r\n4\u00a0g followed by intravenous infusion, 1\u00a0g/hour for\r\n24 hours; if seizure occurs, additional dose by intravenous\r\ninjection, 2\u00a0g", "Treatment of seizures and prevention of seizure recurrence in\r\neclampsia, initially by intravenous injection over\r\n5\u201315 minutes, 4\u00a0g, followed by intravenous infusion, 1\u00a0g/hour for 24 hours after seizure or delivery, whichever is later;\r\nif seizure recurs, increase the infusion rate to 1.5\u20132\u00a0g/hour or give\r\nan additional dose by intravenous injection, 2\u00a0g", "For intravenous injection,\r\nconcentration of magnesium sulphate heptahydrate should not exceed\r\n20% (dilute 1 part of magnesium sulphate injection 50% with at least\r\n1.5 parts of water for injections)", "Magnesium sulphate heptahydrate 1\u00a0g equivalent\r\nto Mg2+ approx. 4\u00a0mmol " ], "pregnancy": "Pregnancy\u00a0not known to be harmful for short-term intravenous\r\nadministration in eclampsia, but excessive doses in third trimester\r\ncause neonatal respiratory depression" }, "RITUXIMAB": { "indications": "Indications\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.; severe active rheumatoid arthritis\r\n(%s\n(From RITUXIMAB: British National Formulary)\nRITUXIMAB)", "name": "RITUXIMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.3 Anti-lymphocyte monoclonal antibodies" ], "cautions": "Cautions\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.\u2014for full details consult product literature", "side-effects": "Side-effects\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.\u2014but for full details (including\r\nmonitoring and management of side-effects) consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70421.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit to mother outweighs\r\nrisk of B-lymphocyte depletion in fetus\u2014effective contraception required\r\nduring and for 12 months after treatment" }, "MAGNESIUM SALTS Magnesium sulphate": { "indications": "Indications\u00a0see under preparations below", "name": "MAGNESIUM SALTS Magnesium sulphate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "MAGNESIUM SALTS", "Magnesium sulphate" ], "cautions": "Cautions\u00a0elderly and debilitated; see also notes above; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0colic", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2250.htm", "doses": [ "See preparations", "Name[Magnesium Sulphate] \r\n Label:\r\n 13, 23Dose\u00a0rapid bowel evacuation (acts in 2\u20134 hours) 5\u201310\u00a0g in a\r\nglass of water preferably before breakfastNote\u00a0Magnesium sulphate is\r\non sale to the public as Epsom Salts" ] }, "SODIUM FEREDETATE": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "SODIUM FEREDETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "SODIUM FEREDETATE" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4872.htm", "doses": [ "See under preparation below and notes above", "therapeutic, 5\u00a0mL increasing gradually to 10\u00a0mL 3 times\r\ndaily; child under 1 year, see BNF for Children; child 1\u20135 years, therapeutic, 2.5\u00a0mL 3 times daily,\r\n6\u201312 years, therapeutic, 5\u00a0mL 3 times daily" ] }, "FLURBIPROFEN - DRUGS FOR ORAL ULCERATION AND INFLAMMATION": { "indications": "Indications\u00a0relief of sore throat", "name": "FLURBIPROFEN - DRUGS FOR ORAL ULCERATION AND INFLAMMATION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "FLURBIPROFEN" ], "cautions": "Cautions\u00a0section 10.1.1", "side-effects": "Side-effects\u00a0taste disturbance, mouth ulcers (move lozenge\r\naround mouth); see also section 10.1.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82156.htm", "doses": [ "adult and child over 12 years, allow 1 lozenge to dissolve\r\nslowly in the mouth every 3\u20136 hours, max. 5 lozenges in 24 hours,\r\nfor max. 3 days" ], "pregnancy": "Pregnancy\u00a0section 10.1.1" }, "PARACETAMOL With tramadol": { "indications": "Indications\u00a0mild to moderate pain, pyrexia", "name": "PARACETAMOL With tramadol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "PARACETAMOL", "With tramadol" ], "cautions": "Cautions\u00a0alcohol dependence; max. daily infusion dose 3\u00a0g in patients with hepatocellular\r\ninsufficiency, chronic alcoholism, chronic malnutrition,\r\nor dehydration; before administering, check when paracetamol last administered and\r\ncumulative paracetamol dose over previous 24 hours; interactions: Appendix 1 (paracetamol)", "side-effects": "Side-effects\u00a0side-effects rare, but rashes, blood disorders\r\n(including thrombocytopenia, leucopenia, neutropenia) reported; hypotension,\r\nflushing, and tachycardia also reported on infusion; important: liver damage (and less frequently renal damage) following overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129017.htm", "doses": [ "By mouth, 0.5\u20131\u00a0g every 4\u20136 hours to a\r\nmax. of 4\u00a0g daily; child 2 months\r\n60\u00a0mg for post-immunisation pyrexia, repeated once after 4\u20136 hours\r\nif necessary; otherwise under 3 months see BNF for Children; 3\u20136 months\r\n60\u00a0mg, 6 months\u20132 years 120\u00a0mg, 2\u20134 years 180\u00a0mg, 4\u20136 years 240\u00a0mg,\r\n6\u20138 years 240\u2013250\u00a0mg, 8\u201310 years 360\u2013375\u00a0mg, 10\u201312 years 480\u2013500\u00a0mg,\r\n12\u201316 years 480\u2013750\u00a0mg; these doses may be repeated every 4\u20136 hours\r\nwhen necessary (max. of 4 doses in 24 hours)", "By intravenous infusion over 15 minutes, adult and child over\r\n50\u00a0kg, 1\u00a0g every 4\u20136 hours, max. 4\u00a0g daily; adult and child 10\u201350\u00a0kg, 15\u00a0mg/kg every\r\n4\u20136 hours, max. 60\u00a0mg/kg daily; neonate and child less than 10\u00a0kg see BNF for Children", "By rectum, adult and child over 12 years 0.5\u20131\u00a0g every\r\n4\u20136 hours to a max. of 4\u00a0g daily; child under 3 months see BNF for Children, 3 months\u20131 year 60\u2013125\u00a0mg, 1\u20135 years 125\u2013250\u00a0mg, 5\u201312 years\r\n250\u2013500\u00a0mg; these doses may be repeated every 4\u20136 hours as necessary\r\n(max. 4 doses in 24 hours)", "For full Joint Committee on Vaccination and\r\nImmunisation recommendation on post-immunisation pyrexia, see section 14.1", "2 tablets not more often than every 6 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended", "Name[Tramacet\u00ae (Gr\u00fcnenthal) ] Tablets, f/c, yellow, tramadol hydrochloride 37.5\u00a0mg, paracetamol 325\u00a0mg, net price 60-tab pack\r\n= \u00a39.68. \r\n Label:\r\n 2, 25, 29, 30Dose\u00a02 tablets not more often than every 6 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended\nEffervescent tablets, pink, tramadol\r\nhydrochloride 37.5\u00a0mg, paracetamol 325\u00a0mg, net price 60-tab pack =\r\n\u00a39.68. \r\n Label:\r\n 2, 13, 29, 30Electrolytes: Na+ 7.8\u00a0mmol/tabletDose\u00a02 tablets not more often than every 6 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "BACILLUS CALMETTE-GU\u00c9RIN VACCINE Intradermal": { "indications": "Indications\u00a0immunisation against tuberculosis", "name": "BACILLUS CALMETTE-GU\u00c9RIN VACCINE Intradermal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "BCG vaccines", "BACILLUS CALMETTE-GU\u00c9RIN VACCINE", "Intradermal" ], "cautions": "Cautions\u00a0see section 14.1; interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1 and notes above; also at the injection\r\nsite, subcutaneous abscess, prolonged ulceration; rarely disseminated complications such as osteitis or osteomyelitis ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6458.htm", "doses": [ "By intradermal injection adult and child over\r\n1 year, 0.1\u00a0mL; neonate and child under 1 year, 0.05\u00a0mL", "Skin is stretched\r\nbetween thumb and forefinger and needle (size 25G or 26G) inserted\r\n(bevel upwards) for about 3\u00a0mm into superficial layers of dermis (almost\r\nparallel with surface). Needle should be short with short bevel (can\r\nusually be seen through epidermis during insertion). Tense raised\r\nblanched bleb showing tips of hair follicles is sign of correct injection;\r\n7\u00a0mm bleb \u2261 0.1\u00a0mL injection, 3\u00a0mm bleb \u2261 0.05\u00a0mL injection; if considerable\r\nresistance not felt, needle too deep and should be removed and reinserted\r\nbefore giving more vaccine.", "To be injected at insertion of deltoid muscle onto humerus (keloid\r\nformation more likely with sites higher on arm); tip\r\nof shoulder should be avoided.", "Name[Bacillus Calmette-Gu\u00e9rin Vaccine ] Injection (powder for suspension), freeze-dried preparation of live bacteria of a strain derived from\r\nthe bacillus of Calmette and Gu\u00e9rin.Available from health organisations or direct from ImmForm (SSI\r\nbrand, multidose vial with diluent)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "SITAGLIPTIN WITH METFORMIN": { "indications": "Indications\u00a0type 2 diabetes mellitus not controlled\r\nby metformin alone or by metformin in combination\r\nwith either a sulfonylurea or pioglitazone or insulin", "name": "SITAGLIPTIN WITH METFORMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs" ], "cautions": "Cautions\u00a0determine renal function before treatment\r\nand at least annually (at least twice a year in patients with additional\r\nrisk factors for renal impairment, or if deterioration suspected); discontinue if symptoms of acute pancreatitis (persistent,\r\nsevere abdominal pain); interactions: Appendix 1 (antidiabetics)Lactic acidosis\u00a0Use with caution in renal impairment\u2014increased risk of lactic acidosis; avoid if eGFR less than 50\u00a0mL/minute/1.73\u00a0m2. Withdraw or interrupt treatment in those at risk of\r\ntissue hypoxia or sudden deterioration in renal function, such as\r\nthose with dehydration, severe infection, shock, sepsis, acute heart\r\nfailure, respiratory failure or hepatic impairment, or those who have\r\nrecently had a myocardial infarction", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including nausea,\r\nvomiting, abdominal pain, flatulence, diarrhoea (usually transient),\r\nconstipation), taste disturbance, anorexia; peripheral oedema, upper\r\nrespiratory tract infection, nasopharyngitis; pain; less commonly dry mouth, headache, drowsiness, dizziness, hypoglycaemia, osteoarthritis; very rarely lactic acidosis (withdraw treatment), decreased\r\nvitamin-B12 absorption, erythema, pruritus, and urticaria; also reported pancreatitis, hepatitis, rash, cutaneous vasculitis,\r\nand Stevens-Johnson syndrome ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207519.htm", "doses": [ "See under preparation" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "PRILOCAINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under preparations", "name": "PRILOCAINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Prilocaine", "PRILOCAINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics;\r\nsevere or untreated hypertension; concomitant use of drugs that cause methaemoglobinaemia; acute porphyria (section 9.8.2); interactions: Appendix 1 (prilocaine)", "side-effects": "Side-effects\u00a0\n(From Prilocaine: British National Formulary)\nPrilocaine and %s\n(From 15.2 Local anaesthesia: British National Formulary)\nToxicity and side-effects\u00a0A single application of a topical lidocaine preparation does not generally cause systemic side-effects. Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection.The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. CNS effects include a feeling of inebriation and lightheadedness followed by drowsiness, numbness of the tongue and perioral region, restlessness, paraesthesia (including sensations of hot and cold), dizziness, blurred vision, nausea and vomiting, muscle twitching, tremors, and convulsions. Transient excitation may also occur, followed by depression with drowsiness, respiratory failure, unconsciousness, and coma. Effects on the cardiovascular system include myocardial depression and peripheral vasodilatation resulting in hypotension and bradycardia; arrhythmias and cardiac arrest can occur.Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.;\r\nalso hypertension", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/83074.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "See under preparations\u2014important: see also\r\nAdministration, section 15.2" ], "pregnancy": "Pregnancy\u00a0large doses during delivery can cause neonatal respiratory\r\ndepression, hypotonia, and bradycardia after epidural block; avoid\r\nparacervical or pudendal block in obstetrics (neonatal methaemoglobinaemia\r\nreported); use lower doses for intrathecal use during late pregnancy" }, "GLYCOPYRRONIUM BROMIDE - ANTIPERSPIRANTS": { "side-effects": "Side-effects\u00a0see section 15.1.3 (but poorly absorbed and systemic\r\neffects unlikely), tingling at administration site", "indications": "Indications\u00a0iontophoretic treatment of hyperhidrosis;\r\nother indications section 15.1.3", "name": "GLYCOPYRRONIUM BROMIDE - ANTIPERSPIRANTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106187.htm", "doses": [ "Consult product literature; only 1 site to be treated\r\nat a time, max. 2 sites treated in any 24 hours, treatment not to\r\nbe repeated within 7 days" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.12 Antiperspirants" ], "cautions": "Cautions\u00a0see section 15.1.3 (but poorly absorbed and systemic\r\neffects unlikely)" }, "DEXAMETHASONE - GLUCOCORTICOID THERAPY": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; diagnosis of Cushing\u2019s disease, congenital adrenal hyperplasia;\r\ncerebral oedema associated with malignancy; croup (section\r\n3.1); nausea and vomiting with chemotherapy (section 8.1); rheumatic disease (section 10.1.2); eye (section 11.4.1); see also notes above", "name": "DEXAMETHASONE - GLUCOCORTICOID THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "DEXAMETHASONE" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids; also perineal irritation may follow\r\nintravenous administration of the phosphate ester", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4272.htm", "doses": [ "By mouth, usual range 0.5\u201310\u00a0mg daily; child 10\u2013100\u00a0micrograms/kg daily; see also Administration\r\n(above)", "By intramuscular injection or slow intravenous injection or infusion, see under preparations", "By intramuscular injection or slow intravenous injection or infusion, 0.4\u201320\u00a0mg; child 200\u2013400\u00a0micrograms/kg daily", "Cerebral oedema, by intravenous injection 8\u201316\u00a0mg\r\ninitially, then 5\u00a0mg by intramuscular injection or intravenous injection every 6 hours as\r\nrequired for 2\u20134 days then gradually reduced and stopped over 5\u20137\r\ndays", "Adjunctive treatment of bacterial meningitis, (starting before\r\nor with first dose of antibacterial treatment), [unlicensed indication], by intravenous injection 8.3\u00a0mg every 6 hours for 4 days; child 3 months\u201318 years see BNF for Children", "by intramuscular injection or slow intravenous injection or infusion, 0.4\u201320\u00a0mg; child 167\u2013333\u00a0micrograms/kg daily", "Cerebral oedema associated with malignancy, by intravenous\r\ninjection 8.3\u00a0mg initially, then 3.3\u00a0mg by intramuscular\r\ninjection every 6 hours as required for 2\u20134 days then gradually\r\nreduced and stopped over 5\u20137 days", "Adjunctive treatment of bacterial meningitis, (starting before\r\nor with first dose of antibacterial treatment), [unlicensed indication], by intravenous injection 8.3\u00a0mg every 6 hours for 4 days; child 3 months\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "OXYTOCIN": { "indications": "Indications\u00a0see under Dose and notes above", "name": "OXYTOCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics", "OXYTOCIN" ], "cautions": "Cautions\u00a0induction or enhancement of labour\u2014presence of borderline\r\ncephalopelvic disproportion (avoid if significant), secondary\r\nuterine inertia, mild or moderate pregnancy-induced\r\nhypertension or cardiac disease, women over 35 years or with history\r\nof lower-uterine segment caesarean section (see also under Contra-indications\r\nbelow); risk factors for disseminated intravascular coagulation; monitor for disseminated intravascular coagulation\r\nafter parturition; avoid large infusion volumes and\r\nrestrict fluid intake by mouth (risk of hyponatraemia and water-intoxication\u2014see\r\nalso Appendix 4); effects\r\nenhanced by concomitant prostaglandins (very careful\r\nmonitoring of uterine activity); caudal block anaesthesia\r\n(may enhance hypertensive effects of sympathomimetic vasopressors); see also interactions: Appendix 1 (oxytocin)", "side-effects": "Side-effects\u00a0nausea, vomiting; arrhythmia; headache; rarely disseminated intravascular coagulation, rash, and\r\nanaphylactoid reactions (with dyspnoea, hypotension, or shock); uterine\r\nspasm (may occur at low doses), uterine hyperstimulation (usually\r\nwith excessive doses\u2014may cause fetal distress, asphyxia, and death,\r\nor may lead to hypertonicity, tetanic contractions, soft-tissue damage\r\nor uterine rupture); water intoxication and hyponatraemia associated\r\nwith high doses with large infusion volumes of electrolyte-free fluid\r\n(see also under Dose below); placental abruption and amniotic fluid\r\nembolism also reported on overdose", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4501.htm", "doses": [ "Induction of labour for medical reasons or stimulation\r\nof labour in hypotonic uterine inertia, by intravenous infusion (not to be started for at least 6 hours after administration of\r\nvaginal prostaglandin), initially 0.001\u20130.004\u00a0units/minute, increased\r\nat intervals of at least 30 minutes until a maximum of 3\u20134 contractions\r\noccur every 10 minutes (0.01\u00a0units/minute is often adequate) up to\r\nmax. 0.02\u00a0units/minute; if regular contractions not established after\r\ntotal of 5\u00a0units stop induction attempt (may be repeated next day\r\nstarting again at 0.001\u20130.004\u00a0units/minute)", "Careful monitoring of fetal heart rate\r\nand uterine motility essential for dose titration (avoid intravenous injection during labour);\r\ndiscontinue immediately in uterine hyperactivity or fetal distress ", "Caesarean section, by slow intravenous injection immediately after delivery, 5\u00a0units", "Prevention of postpartum haemorrhage, after delivery\r\nof placenta, by slow intravenous injection, 5\u00a0units\r\n(if infusion used for induction or enhancement of labour, increase\r\nrate during third stage and for next few hours).", "Avoid rapid intravenous injection (may\r\ntransiently reduce blood pressure)", "Can be given in a dose of 10\u00a0units by intramuscular injection [unlicensed route] instead of oxytocin with ergometrine (Syntometrine\u00ae), see notes above", "Treatment of postpartum haemorrhage, by slow\r\nintravenous injection, 5\u00a0units (dose may be repeated), followed\r\nin severe cases by intravenous infusion of 40\u00a0units\r\nin 500\u00a0mL infusion fluid at a rate sufficient to control uterine atony", "Avoid rapid intravenous injection (may\r\ntransiently reduce blood pressure); prolonged administration, see\r\nwarning below", "Incomplete, inevitable, or missed miscarriage, by slow intravenous injection, 5\u00a0units followed if necessary by intravenous infusion, 0.02\u20130.04\u00a0units/minute or faster", "Prolonged intravenous administration\r\nat high doses with large volume of fluid (which is possible in inevitable\r\nor missed miscarriage or postpartum haemorrhage) may cause water intoxication\r\nwith hyponatraemia. To avoid: use electrolyte-containing\r\ndiluent (i.e. not glucose), increase oxytocin concentration to reduce fluid, restrict fluid intake by mouth; monitor\r\nfluid and electrolytes.", "Oxytocin doses in the BNF may differ from\r\nthose in the product literature" ] }, "VASOPRESSIN": { "indications": "Indications\u00a0pituitary diabetes insipidus; bleeding from oesophageal varices", "name": "VASOPRESSIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.2 Posterior pituitary hormones and antagonists", "Posterior pituitary hormones" ], "cautions": "Cautions\u00a0heart failure, hypertension, asthma, epilepsy, migraine or other conditions\r\nwhich might be aggravated by water retention; avoid fluid overload", "side-effects": "Side-effects\u00a0fluid retention, pallor, tremor, sweating, vertigo,\r\nheadache, nausea, vomiting, belching, abdominal cramps, desire to\r\ndefaecate, hypersensitivity reactions (including anaphylaxis), constriction\r\nof coronary arteries (may cause anginal attacks and myocardial ischaemia),\r\nperipheral ischaemia and rarely gangrene", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4428.htm", "doses": [ "By subcutaneous or intramuscular injection, diabetes insipidus, 5\u201320\u00a0units every\r\nfour hours", "By intravenous infusion, initial control of variceal\r\nbleeding, 20\u00a0units over 15 minutes" ], "pregnancy": "Pregnancy\u00a0oxytocic effect in third trimester" }, "FLUTICASONE PROPIONATE - CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and treatment of\r\nallergic rhinitis and perennial rhinitis; nasal polyps", "name": "FLUTICASONE PROPIONATE - CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5652.htm", "doses": [ "Rhinitis, 100\u00a0micrograms (2 sprays) into each nostril\r\nonce daily, preferably in the morning, increased to max. twice daily\r\nif required; when control achieved reduce to 50\u00a0micrograms (1 spray)\r\ninto each nostril once daily; child 4\u201311 years, 50\u00a0micrograms (1 spray) into each nostril once daily,\r\npreferably in the morning, increased to max. twice daily if required", "Nasal polyps, see Flixonase Nasule\u00ae below" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "FLUTICASONE PROPIONATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.; interactions: Appendix 1 (corticosteroids)" }, "TOBRAMYCIN - AMINOGLYCOSIDES": { "indications": "Indications\u00a0see under Gentamicin and notes above", "name": "TOBRAMYCIN - AMINOGLYCOSIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "TOBRAMYCIN" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before tobramycin. Measure lung\r\nfunction before and after initial dose of tobramycin and monitor for\r\nbronchospasm; if bronchospasm occurs in a patient not using a bronchodilator,\r\nrepeat test using bronchodilator. Monitor renal function before treatment\r\nand then annually. Severe haemoptysis\u2014risk of further haemorrhage.", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.; on inhalation, cough (more frequent by inhalation of powder),\r\nbronchospasm (see Cautions), dysphonia, taste disturbances, pharyngitis,\r\nmouth ulcers, salivary hypersecretion, laryngitis, haemoptysis, epistaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202815.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate parenteral dose and monitor serum-tobramycin\r\nconcentration closely", "By intramuscular injection or by slow intravenous injection or by intravenous infusion, 3\u00a0mg/kg daily in divided\r\ndoses every 8 hours, see also notes above; in severe infections up\r\nto 5\u00a0mg/kg daily in divided doses every 6\u20138 hours (reduced to 3\u00a0mg/kg\r\nas soon as clinically indicated); child under 18 years see BNF for Children", "Urinary-tract infection, by intramuscular injection, 2\u20133\u00a0mg/kg daily as a single dose", "One-hour (\u2018peak\u2019) serum concentration should\r\nnot exceed 10\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should be\r\nless than 2\u00a0mg/litre", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult and child over 6 years, 300\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin nebuliser solution", "By inhalation of powder, adult and child over 6 years, 112\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin inhalation powder" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "TERAZOSIN": { "indications": "Indications\u00a0mild to moderate hypertension (see notes\r\nabove); benign prostatic hyperplasia (section 7.4.1)", "name": "TERAZOSIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "TERAZOSIN" ], "cautions": "Cautions\u00a0first dose may cause collapse due to\r\nhypotension (within 30\u201390 minutes, therefore should be taken on retiring\r\nto bed) (may also occur with rapid dose increase); cataract surgery\r\n(risk of intra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also reported weight gain, dsypnoea, paraesthesia, nervousness,\r\ndecreased libido, thrombocytopenia, back pain, and pain in extremities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112802.htm", "doses": [ "Hypertension, 1\u00a0mg at bedtime (compliance with bedtime\r\ndose important, see Cautions); dose doubled after 7 days if necessary;\r\nusual maintenance dose 2\u201310\u00a0mg once daily; more than 20\u00a0mg daily rarely\r\nimproves efficacy" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "MICAFUNGIN": { "indications": "Indications\u00a0see under Dose", "name": "MICAFUNGIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.4 Echinocandin antifungals" ], "cautions": "Cautions\u00a0monitor renal function; interactions: Appendix 1 (micafungin)Hepatotoxicity\u00a0Potentially life-threatening hepatotoxicity\r\nreported. Monitor liver function\u2014discontinue if significant and persistent abnormalities in liver\r\nfunction tests develop. Use with caution in hepatic impairment (avoid if severe) or if receiving other hepatotoxic drugs. Risk of hepatic side-effects greater in children under\r\n1 year of age", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain; headache,\r\nfever; hypokalaemia, hypomagnesaemia, hypocalcaemia, leucopenia, anaemia;\r\nrash, phlebitis; less commonly dyspepsia, constipation,\r\nhepatomegaly, hepatitis and cholestasis (see also Hepatotoxicity above),\r\ntaste disturbances, anorexia, tachycardia, palpitation, bradycardia,\r\nblood pressure changes, flushing, dyspnoea, sleep disturbances, anxiety,\r\nconfusion, dizziness, tremor, pancytopenia, thrombocytopenia, eosinophilia,\r\nhyponatraemia, hypophosphataemia, hyperkalaemia, hyperhidrosis, and\r\npruritus; rarely haemolytic anaemia; also reported\r\nrenal failure (more frequent in children)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201531.htm", "doses": [ "By intravenous infusion, invasive\r\ncandidiasis, adult body-weight over\r\n40\u00a0kg, 100\u00a0mg once daily (increased to 200\u00a0mg daily if inadequate\r\nresponse) for at least 14 days; body-weight under 40\u00a0kg, 2\u00a0mg/kg once\r\ndaily (increased to 4\u00a0mg/kg daily if inadequate response) for at least\r\n14 days; child under 18 years see BNF for Children", "Oesophageal candidiasis, adult body-weight over 40\u00a0kg, 150\u00a0mg once daily; body-weight under 40\u00a0kg,\r\n3\u00a0mg/kg once daily; child 16\u201318 years\r\nsee BNF for Children", "Prophylaxis of candidiasis in patients undergoing bone-marrow\r\ntransplantation or who are expected to become neutropenic for over\r\n10 days, adult body-weight over 40\u00a0kg,\r\n50\u00a0mg once daily; body-weight under 40\u00a0kg, 1\u00a0mg/kg once daily; continue\r\nfor at least 7 days after neutrophil count in desirable range; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies" }, "MORPHINE SALTS Modified-release 12-hourly oral preparations": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Modified-release 12-hourly oral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Modified-release 12-hourly oral preparations" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3499.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[MST Continus\u00ae (Napp) ] Tablets, m/r, f/c, morphine sulphate 5\u00a0mg (white), net price 60-tab pack = \u00a33.29; 10\u00a0mg (brown),\r\n60-tab pack = \u00a35.16; 15\u00a0mg (green), 60-tab pack = \u00a39.61; 30\u00a0mg (purple),\r\n60-tab pack = \u00a312.41; 60\u00a0mg (orange), 60-tab pack = \u00a324.22; 100\u00a0mg\r\n(grey), 60-tab pack = \u00a338.34; 200\u00a0mg (green), 60-tab pack = \u00a381.34. \r\n Label:\r\n 2, 25\nSuspension (= sachet of granules\r\nto mix with water), m/r, pink, morphine sulphate\r\n20\u00a0mg/sachet, net price 30-sachet pack = \u00a324.58; 30\u00a0mg/sachet, 30-sachet\r\npack = \u00a325.54; 60\u00a0mg/sachet, 30-sachet pack = \u00a351.09; 100\u00a0mg/sachet,\r\n30-sachet pack = \u00a385.15; 200\u00a0mg/sachet pack, 30-sachet pack = \u00a3170.30. \r\n Label:\r\n 2, 13Dose\u00a0every 12 hours, dose adjusted according to daily morphine requirements; for further advice on determining\r\ndose, see Prescribing in Palliative\r\nCare;\r\ndosage requirements should be reviewed if the brand is alteredNote\u00a0Prescriptions must also specify \u2018tablets\u2019\r\nor \u2018suspension\u2019 (i.e. \u2018MST Continus tablets\u2019 or \u2018MST Continus suspension\u2019)" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "HEXETIDINE": { "indications": "Indications\u00a0oral hygiene", "name": "HEXETIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "HEXETIDINE" ], "side-effects": "Side-effects\u00a0local irritation; very rarely taste disturbance and transient anaesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5738.htm", "doses": [ "adult and child over 6 years, use 15\u00a0mL undiluted 2\u20133 times\r\ndaily" ] }, "INSULIN Highly purified animal": { "indications": "Indications\u00a0diabetes mellitus; diabetic ketoacidosis\r\n(section 6.1.3)", "name": "INSULIN Highly purified animal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins", "INSULIN", "Highly purified animal" ], "cautions": "Cautions\u00a0section 6.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above; transient\r\noedema; local reactions and fat hypertrophy at injection site; rarely hypersensitivity reactions including urticaria, rash;\r\noverdose causes hypoglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4085.htm", "doses": [ "By subcutaneous, intramuscular or intravenous injection or intravenous infusion, according to requirements", "Name[Hypurin\u00ae Bovine Neutral (Wockhardt) ] Injection, soluble insulin (bovine, highly purified) 100\u00a0units/mL. Net price 10-mL vial = \u00a318.48;\r\ncartridges (for Autopen\u00ae Classic) 5 \u00d7 3\u00a0mL = \u00a327.72Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "FLUTAMIDE": { "indications": "Indications\u00a0 advanced prostate cancer, see also notes above", "name": "FLUTAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.2 Gonadorelin analogues and gonadotrophin-releasing hormone antagonists", "Anti-androgens" ], "cautions": "Cautions\u00a0cardiac disease (oedema\r\nreported); also liver function tests, monthly for first\r\n4 months, periodically thereafter and at the first sign\r\nor symptom of liver disorder (e.g. pruritus, dark urine, persistent\r\nanorexia, jaundice, abdominal pain, unexplained influenza-like symptoms); avoid excessive alcohol consumption; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (flutamide)", "side-effects": "Side-effects\u00a0gynaecomastia (sometimes with galactorrhoea);\r\nnausea, vomiting, diarrhoea, increased appetite, insomnia, tiredness;\r\nother side-effects reported include decreased libido, reduced sperm\r\ncount, gastric and chest pain, hypertension, headache, dizziness,\r\noedema, blurred vision, thirst, rash, pruritus, haemolytic anaemia,\r\nsystemic lupus erythematosus-like syndrome, and lymphoedema; hepatic\r\ninjury (with transaminase abnormalities, cholestatic jaundice, hepatic\r\nnecrosis, hepatic encephalopathy and occasional fatality) reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4828.htm", "doses": [ "250\u00a0mg 3 times daily (see also notes above)" ] }, "ZOLMITRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine; cluster headache\r\n(nasal route only) [unlicensed use]", "name": "ZOLMITRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; should not be taken within 24 hours of any other 5HT1-receptor\r\nagonist; interactions: Appendix 1 (5HT1 agonists)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; also abdominal pain, dry mouth; palpitation;\r\ndrowsiness, paraesthesia, headache; myalgia, muscle weakness; less commonly tachycardia, transient increase in blood pressure,\r\npolyuria; rarely urticaria; very rarely gastro-intestinal and splenic infarction, ischaemic colitis, angina,\r\nmyocardial infarction; with nasal spray, taste disturbance,\r\nand epistaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61033.htm", "doses": [ "By mouth, migraine, adult over 18 years, 2.5\u00a0mg repeated after not less than 2 hours if migraine\r\nrecurs (increase to 5\u00a0mg for subsequent attacks in patients not achieving\r\nsatisfactory relief with 2.5-mg dose); max. 10\u00a0mg in 24 hours; child 12\u201318 years see BNF for Children", "Intranasally, cluster headache [unlicensed] or\r\nmigraine, adult over 18 years, 5\u00a0mg\r\n(1 spray) into one nostril as soon as possible after onset, repeated\r\nafter not less than 2 hours if headache recurs; max. 10\u00a0mg in 24 hours; child 12\u201318 years see BNF for Children", "Max. 5\u00a0mg in 24 hours with concomitant cimetidine,\r\nfluvoxamine, moclobemide, or quinolone antibiotics" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "THYROTROPIN ALFA": { "indications": "Indications\u00a0see notes above and product literature", "name": "THYROTROPIN ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Thyrotrophin" ], "cautions": "Cautions\u00a0presence of thyroglobulin autoantibodies\r\nmay give false negative results ", "side-effects": "Side-effects\u00a0nausea, vomiting; headache, dizziness, fatigue; less commonly asthenia, paraesthesia, back pain, influenza-like\r\nsymptoms, rash, urticaria; rarely diarrhoea; very rarely palpitation, flushing, dyspnoea, pain at site\r\nof metastases, tremor, arthralgia, myalgia, hyperhidrosis, and injection-site\r\nreactions including pain, pruritus, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128356.htm", "doses": [ "By intramuscular injection into the gluteal\r\nmuscle, 900\u00a0micrograms every 24 hours for 2 doses, consult product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0avoid" }, "SOTALOL HYDROCHLORIDE": { "indications": "Indications\u00a0life-threatening arrhythmias including\r\nventricular tachyarrhythmias; symptomatic non-sustained ventricular\r\ntachyarrhythmias; prophylaxis of paroxysmal atrial tachycardia or\r\nfibrillation, paroxysmal AV re-entrant tachycardias (both nodal and\r\ninvolving accessory pathways), and paroxysmal supraventricular tachycardia\r\nafter cardiac surgery; maintenance of sinus rhythm following cardioversion\r\nof atrial fibrillation or flutter", "name": "SOTALOL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "SOTALOL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride; correct hypokalaemia, hypomagnesaemia,\r\nor other electrolyte disturbances; severe or prolonged\r\ndiarrhoea", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride; arrhythmogenic (pro-arrhythmic) effect (torsade de pointes\u2014increased\r\nrisk in women)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2522.htm", "doses": [ "By mouth with ECG monitoring and\r\nmeasurement of corrected QT interval, arrhythmias, initially 80\u00a0mg\r\ndaily in 1\u20132 divided doses increased gradually at intervals of 2\u20133\r\ndays to usual dose of 160\u2013320\u00a0mg daily in 2 divided doses; higher\r\ndoses of 480\u2013640\u00a0mg daily for life-threatening ventricular arrhythmias\r\nunder specialist supervision" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "MAGNESIUM SALTS Magnesium hydroxide with liquid paraffin": { "indications": "Indications\u00a0see under preparations below", "name": "MAGNESIUM SALTS Magnesium hydroxide with liquid paraffin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "MAGNESIUM SALTS", "Magnesium hydroxide with liquid paraffin" ], "cautions": "Cautions\u00a0elderly and debilitated; see also notes above; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0colic", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2248.htm", "doses": [ "See preparations", "Name[Liquid Paraffin and Magnesium Hydroxide\r\nOral Emulsion, BP ] Oral emulsion, 25% liquid\r\nparaffin in aqueous suspension containing 6% hydrated magnesium\r\noxideDose\u00a0constipation, 5\u201320\u00a0mL when requiredNote\u00a0Liquid paraffin and magnesium\r\nhydroxide preparations on sale to the public include: Milpar\u00ae\u00a0" ] }, "TENOXICAM": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other musculoskeletal\r\ndisorders", "name": "TENOXICAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5260.htm", "doses": [ "By mouth, rheumatic disease, adult over 18 years, 20\u00a0mg daily", "Acute musculoskeletal disorders, adult over 18 years, 20\u00a0mg daily for 7 days; max. duration of treatment\r\n14 days (including treatment by intravenous or intramuscular injection)", "By intravenous or intramuscular injection, adult over 18 years, initial treatment for 1\u20132 days if oral administration\r\nnot possible, 20\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "PRAMIPEXOLE": { "indications": "Indications\u00a0Parkinson\u2019s disease, used alone or\r\nas an adjunct to co-beneldopa\r\nor co-careldopa; moderate to severe restless legs syndrome", "name": "PRAMIPEXOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "PRAMIPEXOLE" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; psychotic disorders; ophthalmological\r\ntesting recommended (risk of visual disorders); severe cardiovascular disease; risk of\r\npostural hypotension (especially on initiation)\u2014monitor blood pressure; interactions: Appendix 1 (pramipexole)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, constipation, vomiting, weight changes, decreased appetite,\r\nhypotension (including postural hypotension), peripheral oedema, dizziness,\r\ndyskinesia, hyperkinesia, drowsiness (including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.),\r\nheadache, sleep disturbances, confusion, hallucinations, restlessness,\r\nvisual disturbances; less commonly hiccups, cardiac\r\nfailure, syncope, pneumonia, dyspnoea, binge eating, compulsive behaviour\r\n(\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.), amnesia,\r\ndelusion, paranoia, pruritus, rash; also reported paradoxical worsening of restless legs syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204131.htm", "doses": [ "Doses and strengths are stated in terms\r\nof pramipexole (base); equivalent strengths in\r\nterms of pramipexole dihydrochloride monohydrate\r\n(salt) are as follows: 88\u00a0micrograms base \u2261 125\u00a0micrograms\r\nsalt; 180\u00a0micrograms base \u2261 250\u00a0micrograms salt; 350\u00a0micrograms base \u2261 500\u00a0micrograms salt;700\u00a0micrograms\r\nbase \u2261 1\u00a0mg salt", "Parkinson\u2019s disease, adult over\r\n18 years, initially 88\u00a0micrograms 3 times daily, dose doubled every\r\n5\u20137 days if tolerated to 350\u00a0micrograms 3 times daily; further increased\r\nif necessary by 180\u00a0micrograms 3 times daily at weekly intervals;\r\nmax. 3.3\u00a0mg daily in 3 divided doses", "During dose titration and maintenance, levodopa dose may be reduced", "Restless legs syndrome, adult over 18 years, initially 88\u00a0micrograms once daily 2\u20133 hours before\r\nbedtime, dose doubled every 4\u20137 days if necessary; max. 540\u00a0micrograms\r\ndaily" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014no information\r\navailable" }, "DIAZEPAM - SKELETAL MUSCLE RELAXANTS": { "indications": "Indications\u00a0muscle spasm of varied aetiology, including tetanus; other indications\r\n(section\r\n4.1.2, section\r\n4.8, section 15.1.4.1)", "name": "DIAZEPAM - SKELETAL MUSCLE RELAXANTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "DIAZEPAM" ], "cautions": "Cautions\u00a0section\r\n4.1.2; special precautions for intravenous injection (section 4.8.2)", "side-effects": "Side-effects\u00a0section\r\n4.1.2; also hypotonia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106296.htm", "doses": [ "Muscle spasm, by mouth, 2\u201315\u00a0mg daily\r\nin divided doses, increased if necessary in spastic conditions to\r\n60\u00a0mg daily according to response", "Cerebral spasticity in selected cases, child 2\u201340\u00a0mg daily in divided doses", "By intramuscular or by\r\nslow intravenous injection (into a large vein at a rate of\r\nnot more than 5\u00a0mg/minute), in acute muscle spasm, 10\u00a0mg repeated\r\nif necessary after 4 hours", "Only use intramuscular route when oral and\r\nintravenous routes not possible; emulsion formulation preferred for\r\nintravenous injection; special precautions for intravenous injection,\r\nsee section 4.8.2", "Tetanus, adult and child, by intravenous injection (emulsion\r\npreparation preferred), 100\u2013300\u00a0micrograms/kg repeated every 1\u20134 hours; by intravenous infusion (or by nasoduodenal\r\ntube), 3\u201310\u00a0mg/kg over 24 hours, adjusted according to response" ], "pregnancy": "Pregnancy\u00a0section 4.1.2" }, "TIOTROPIUM": { "indications": "Indications\u00a0maintenance treatment of chronic obstructive pulmonary disease", "name": "TIOTROPIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.2 Antimuscarinic bronchodilators", "TIOTROPIUM" ], "cautions": "Cautions\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nCautions\u00a0Antimuscarinic bronchodilators should be used with caution in patients with prostatic hyperplasia, bladder outflow obstruction, and those susceptible to angle-closure glaucoma (see below); interactions: Appendix 1 (antimuscarinics).Glaucoma\u00a0Acute angle-closure glaucoma has been reported with nebulised ipratropium, particularly when given with nebulised salbutamol (and possibly other beta2 agonists); care needed to protect patient\u2019s eyes from nebulised drug or from drug powder.; also cardiac rhythm disorders (with Spiriva\u00ae Respimat\u00ae)", "side-effects": "Side-effects\u00a0\n(From 3.1.2 Antimuscarinic bronchodilators: British National Formulary)\nSide-effects\u00a0Dry mouth is the most common side-effect of antimuscarinic bronchodilators; also constipation, cough, paradoxical bronchospasm, headache, dizziness; less commonly nausea, tachycardia, palpitation, atrial fibrillation, urinary retention, eye pain, corneal oedema, angle-closure glaucoma, blurred vision, stomatitis, rash, and pruritus can occur. Raised intra-ocular pressure and urticaria have occurred rarely.; less commonly taste disturbance, gastro-oesophageal reflux\r\ndisease, pharyngitis, dysphonia, dysphagia, dysuria, epistaxis, oropharyngeal\r\ncandidiasis; rarely intestinal obstruction (including\r\nparalytic ileus), laryngitis, insomnia, urinary-tract infection, skin\r\ninfection, sinusitis, dental caries, gingivitis, glossitis, skin ulcer; also reported dehydration, joint swelling, dry skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119675.htm", "doses": [ "See under preparations below", "by inhalation of powder, adult over 18 years, 18\u00a0micrograms once daily", "by inhalation, adult over 18 years, 5\u00a0micrograms (2 puffs) once daily" ] }, "ADRENALINE/EPINEPHRINE": { "indications": "Indications\u00a0emergency treatment of acute\r\nanaphylaxis; angioedema; cardiopulmonary resuscitation (section 2.7.3); priapism [unlicensed] (section 7.4.5)", "name": "ADRENALINE/EPINEPHRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Anaphylaxis" ], "cautions": "Cautions\u00a0for cautions in non-life-threatening situations, see section 2.7.3Interactions\u00a0Severe anaphylaxis in\r\npatients taking beta-blockers may not respond to adrenaline, calling\r\nfor bronchodilator therapy, see intravenous salbutamol; adrenaline can cause\r\nsevere hypertension and bradycardia in those taking non-cardioselective\r\nbeta-blockers. Other interactions,\r\nsee Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0section 2.7.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100076.htm", "doses": [ "Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1\u00a0mg/mL)\r\nsolution for administration by healthcare professionals, see notes and table above", "Acute anaphylaxis, by intramuscular injection for self-administration, see under preparations", "Acute anaphylaxis when there is doubt as to the adequacy of\r\nthe circulation, by slow intravenous injection of 1\r\nin 10\u00a0000 (100\u00a0micrograms/mL) solution (extreme caution\u2014specialist\r\nuse only), see notes above", "Intravenous route should be used with extreme care by specialists only, see notes above" ], "pregnancy": "Pregnancy\u00a0section 2.7.3" }, "PALIFERMIN": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nPalifermin, a human keratinocyte growth factor, is licensed for the management of oral mucositis in patients with haematological malignancies receiving myeloablative radiochemotherapy with autologous haematopoietic stem-cell support.", "name": "PALIFERMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression", "PALIFERMIN" ], "side-effects": "Side-effects\u00a0oral paraesthesia, taste disturbance, thickening\r\nand discoloration of tongue; fever; oedema; arthralgia; rash, pruritus,\r\nerythema, skin hyperpigmentation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129660.htm", "doses": [ "By intravenous injection, 60\u00a0micrograms/kg\r\nonce daily for 3 doses (third dose given 24\u201348 hours before myeloablative\r\ntherapy) then 3 further doses at least 24 hours after myeloablative\r\ntherapy, and more than 4 days after most recent palifermin\r\ninjection, starting on same day as (but after) stem-cell infusion; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "DEXAMETHASONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "DEXAMETHASONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5426.htm", "doses": [ "Apply eye drops every 30\u201360 minutes until controlled\r\nthen reduce frequency to 4\u20136 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use." }, "TARS Non-proprietary preparations": { "indications": "Indications\u00a0psoriasis and occasionally\r\nchronic atopic eczema", "name": "TARS Non-proprietary preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tars", "TARS", "Non-proprietary preparations" ], "cautions": "Cautions\u00a0application to face and skin flexures; use suitable chemical protection gloves for extemporaneous\r\npreparation", "side-effects": "Side-effects\u00a0skin irritation and acne-like eruptions, photosensitivity;\r\nstains skin, hair, and fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5942.htm", "doses": [ "Apply 1\u20133 times daily starting with low-strength preparations", "For shampoo preparations see section 13.9; for\r\nuse with dressings see Appendix 5 (section A5.8.9)", "Name[Calamine and Coal Tar Ointment, BP] Ointment, calamine 12.5\u00a0g, strong coal tar solution 2.5\u00a0g, zinc\r\noxide 12.5\u00a0g, hydrous wool fat 25\u00a0g, white soft paraffin 47.5\u00a0gExcipients include wool fatDose\u00a0apply 1\u20132 times daily" ] }, "PRAVASTATIN SODIUM": { "indications": "Indications\u00a0adjunct to diet for primary hypercholesterolaemia or combined (mixed)\r\nhyperlipidaemias in patients who have not responded adequately to\r\ndietary control; adjunct to diet to prevent cardiovascular events\r\nin patients with hypercholesterolaemia; prevention of cardiovascular\r\nevents in patients with previous myocardial infarction or unstable\r\nangina; reduction of hyperlipidaemia in patients receiving immunosuppressive\r\ntherapy following solid-organ transplantation", "name": "PRAVASTATIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins", "PRAVASTATIN SODIUM" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ", "side-effects": "Side-effects\u00a0\n(From Statins: British National Formulary)\nSide-effects\u00a0The statins have been associated with myalgia, myopathy, myositis, and rhabdomyolysis (see Muscle Effects below). Statins can alter liver function tests, and rarely cause hepatitis and jaundice; pancreatitis and hepatic failure have been reported very rarely. Other side-effects include gastro-intestinal disturbances, sleep disturbance, headache, dizziness, depression, paraesthesia, asthenia, peripheral neuropathy, amnesia, fatigue, sexual dysfunction, thrombocytopenia, arthralgia, visual disturbance, alopecia, and hypersensitivity reactions (including rash, pruritus, urticaria, and very rarely lupus erythematosus-like reactions). In very rare cases, statins can cause interstitial lung disease; if patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.Muscle effects\u00a0The risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare. Although myalgia has been reported commonly in patients receiving statins, muscle toxicity truly attributable to statin use is rare. Muscle toxicity can occur with all statins, however the likelihood increases with higher doses and in certain patients (see below). Statins should be used with caution in patients at increased risk of muscle toxicity, including those with a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. There is an increased incidence of myopathy if a statin is given at a high dose, or if it is given with a fibrate (the combination of a statin and gemfibrozil should preferably be avoided), with lipid-lowering doses of nicotinic acid, with fusidic acid (risk of rhabdomyolysis\u2014the combination of a statin and fusidic acid should be avoided; temporarily discontinue statin and restart 7 days after last fusidic acid dose), or with drugs that increase the plasma-statin concentration, such as macrolide antibiotics, imidazole and triazole antifungals, and ciclosporin\u2014see interactions: Appendix 1 (statins); close monitoring of liver function and, if muscular symptoms occur, of creatine kinase is necessary. In patients at increased risk of muscle effects, a statin should not usually be started if the baseline creatine kinase concentration is more than 5 times the upper limit of normal (some patients may present with an extremely elevated baseline creatine kinase concentration, due to e.g. a physical occupation, or rigorous exercise\u2014specialist advice should be sought regarding consideration of statin therapy in these patients).If muscular symptoms or raised creatine kinase occur during treatment, other possible causes (e.g. rigorous physical activity, hypothyroidism, infection, recent trauma, and drug or alcohol addiction) should be excluded before statin therapy is implicated. When a statin is suspected to be the cause of myopathy, and creatine kinase concentration is markedly elevated (more than 5 times upper limit of normal), or if muscular symptoms are severe, treatment should be discontinued. If symptoms resolve and creatine kinase concentrations return to normal, the statin should be reintroduced at a lower dose and the patient monitored closely; an alternative statin should be prescribed if unacceptable side-effects are experienced with a particular statin. Statins should not be discontinued in the event of small, asymptomatic elevations of creatine kinase. Routine monitoring of creatine kinase is unnecessary in asymptomatic patients.; less commonly abnormal urination (including dysuria, nocturia and frequency); very rarely fulminant hepatic necrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2869.htm", "doses": [ "Hypercholesterolaemia or combined hyperlipidaemias, 10\u201340\u00a0mg\r\nonce daily at night, adjusted at intervals of at least 4 weeks; child under 18 years see BNF for Children", "Familial hypercholesterolaemia, child under 18 years see BNF for Children", "Prevention of cardiovascular events, 40\u00a0mg once daily at night", "Post-transplantation hyperlipidaemia, initially 20\u00a0mg once daily\r\nat night, increased if necessary (under close medical supervision)\r\nto max. 40\u00a0mg once daily at night" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "SULFASALAZINE - AMINOSALICYLATES": { "indications": "Indications\u00a0treatment of mild to moderate and severe\r\nulcerative colitis and maintenance of remission; active Crohn\u2019s disease;\r\nrheumatoid arthritis (section 10.1.3)", "name": "SULFASALAZINE - AMINOSALICYLATES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.1 Aminosalicylates", "SULFASALAZINE" ], "cautions": "Cautions\u00a0\n(From 1.5.1 Aminosalicylates: British National Formulary)\nCautions\u00a0Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment (more frequently in renal impairment). Blood disorders can occur with aminosalicylates (see recommendation below).; also history of allergy or asthma; G6PD deficiency (%s\n(From 9.1.5 G6PD deficiency: British National Formulary)\n9.1.5 G6PD deficiency); slow acetylator status; risk of haematological and hepatic toxicity (differential white cell, red cell, and platelet counts initially\r\nand at monthly intervals for first 3 months; liver function tests\r\nat monthly intervals for first 3 months); maintain adequate fluid intake; upper gastro-intestinal side-effects common over 4\u00a0g daily; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(aminosalicylates)Blood disorders\u00a0See %s\n(From 1.5.1 Aminosalicylates: British National Formulary)\nBlood disordersPatients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.", "side-effects": "Side-effects\u00a0see notes above; also cough, insomnia, dizziness,\r\nfever, blood disorders (including Heinz body anaemia, megaloblastic\r\nanaemia), proteinuria, tinnitus, stomatitis, taste disturbances, and\r\npruritus; less commonly dyspnoea, depression, convulsions,\r\nvasculitis, and alopecia; also reported loss of appetite, hypersensitivity\r\nreactions (including exfoliative dermatitis, epidermal necrolysis,\r\nphotosensitivity, anaphylaxis, serum sickness), ataxia, hallucinations,\r\naseptic meningitis, oligospermia, crystalluria, disturbances of smell,\r\nand parotitis; yellow-orange discoloration of skin, urine, and other\r\nbody fluids; some soft contact lenses may be stained", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2166.htm", "doses": [ "By mouth, acute attack 1\u20132\u00a0g 4 times daily\r\n(but see cautions) until remission occurs (if necessary corticosteroids may also be given), reducing to a maintenance\r\ndose of 500\u00a0mg 4 times daily; child 2\u201312 years see BNF for Children", "By rectum, in suppositories, alone or in conjunction\r\nwith oral treatment 0.5\u20131\u00a0g morning and night after a bowel movement; child 5\u201312 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0theoretical risk of neonatal haemolysis in third\r\ntrimester; adequate folate supplements should be given to mother" }, "METFORMIN HYDROCHLORIDE": { "indications": "Indications\u00a0diabetes\r\nmellitus (see notes above); polycystic ovary syndrome [unlicensed\r\nindication]", "name": "METFORMIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.2 Biguanides", "METFORMIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 6.1.2.2 Biguanides: British National Formulary)\nVery rarely, metformin can provoke lactic acidosis. It is most likely to occur in patients with renal impairment, see Lactic Acidosis below.Metformin is used for the symptomatic management of polycystic ovary syndrome [unlicensed indication]; however, treatment should be initiated by a specialist. Metformin improves insulin sensitivity, may aid weight reduction, helps to normalise menstrual cycle (increasing the rate of spontaneous ovulation), and may improve hirsutism.; determine renal function before treatment and at least annually (at\r\nleast twice a year in patients with additional risk factors for renal\r\nimpairment, or if deterioration suspected); interactions: Appendix 1 (antidiabetics)Lactic acidosis\u00a0Use with caution\r\nin renal impairment\u2014increased risk of lactic acidosis; avoid in significant renal impairment. NICE%s\n(From Modified release: British National Formulary)\n(1)NICE clinical guideline 87 (May 2009): Type 2 diabetes: The management of type 2 diabetes recommends that the dose\r\nshould be reviewed if eGFR less than 45\u00a0mL/minute/1.73\u00a0m2 and to avoid if eGFR less than 30\u00a0mL/minute/1.73\u00a0m2. Withdraw or interrupt treatment\r\nin those at risk of tissue hypoxia or sudden deterioration in renal\r\nfunction, such as those with dehydration, severe infection, shock,\r\nsepsis, acute heart failure, respiratory failure or hepatic impairment,\r\nor those who have recently had a myocardial infarction", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, diarrhoea (usually\r\ntransient), abdominal pain, taste disturbance, rarely lactic acidosis (withdraw treatment), decreased vitamin-B12 absorption, erythema, pruritus and urticaria; hepatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129176.htm", "doses": [ "Diabetes mellitus, adult and child over 10 years initially\r\n500\u00a0mg with breakfast for at least 1 week then 500\u00a0mg with breakfast\r\nand evening meal for at least 1 week then 500\u00a0mg with breakfast, lunch\r\nand evening meal; usual max. 2\u00a0g daily in divided doses", "Polycystic ovary syndrome [unlicensed], initially 500\u00a0mg with\r\nbreakfast for 1 week, then 500\u00a0mg with breakfast and evening meal\r\nfor 1 week, then 1.5\u20131.7\u00a0g daily in 2\u20133 divided doses", "Metformin doses in the BNF may differ from\r\nthose in the product literature" ], "pregnancy": "Pregnancy\u00a0used in pregnancy for both pre-existing and gestational\r\ndiabetes\u2014see also section 6.1.2" }, "INSULIN DETEMIR": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN DETEMIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "INSULIN DETEMIR" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129027.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n2 years, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "PHYTOMENADIONE": { "indications": "Indications\u00a0\n(From 9.6.6 Vitamin K: British National Formulary)\n9.6.6 Vitamin K", "name": "PHYTOMENADIONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.6 Vitamin K" ], "cautions": "Cautions\u00a0intravenous injections should be given\r\nvery slowly (see also below); interactions: Appendix 1 (vitamins)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5152.htm", "doses": [ "See notes above and section 2.8.2" ], "pregnancy": "Pregnancy\u00a0use if potential benefit outweighs risk" }, "CARGLUMIC ACID": { "indications": "Indications\u00a0hyperammonaemia due to N-acetylglutamate synthase\r\ndeficiency and organic acidaemia under specialist supervision", "name": "CARGLUMIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Urea cycle disorders" ], "side-effects": "Side-effects\u00a0sweating; less commonly diarrhoea,\r\nvomiting, bradycardia, pyrexia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127946.htm", "doses": [ "Hyperammonaemia due to N-acetylglutamate\r\nsynthase deficiency, adult and child initially 100\u2013250\u00a0mg/kg daily in 2\u20134 divided\r\ndoses immediately before food, adjusted according to plasma\u2013ammonia\r\nconcentration; maintenance 10\u2013100\u00a0mg/kg daily in 2\u20134 divided doses", "Hyperammonaemia due to organic acidaemia, adult and child initially 100\u2013250\u00a0mg/kg\r\ndaily in 2\u20134 divided doses immediately before food, adjusted according\r\nto plasma-ammonia concentration" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014no information\r\navailable" }, "EPHEDRINE HYDROCHLORIDE ": { "indications": "Indications\u00a0reversible airways obstruction, but \n(From 3.1.1.2 Other adrenoceptor agonists: British National Formulary)\nEphedrine is less suitable and less safe for use as a bronchodilator than the selective beta2 agonists, because it is more likely to cause arrhythmias and other side-effects; it should be avoided whenever possible.", "name": "EPHEDRINE HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.2 Other adrenoceptor agonists" ], "cautions": "Cautions\u00a0hyperthyroidism; diabetes mellitus; ischaemic heart disease; hypertension; elderly; prostatic hypertrophy (risk of acute retention); interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0tachycardia; anxiety, restlessness, insomnia;\r\ntremor, arrhythmias, dry mouth, and cold extremities also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2916.htm", "doses": [ "15\u201360\u00a0mg 3 times daily; child up to 1 year 7.5\u00a0mg 3 times daily, 1\u20135 years 15\u00a0mg 3 times daily,\r\n6\u201312 years 30\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "PANCREATIN Higher-strength preparations": { "indications": "Indications\u00a0see above", "name": "PANCREATIN Higher-strength preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.9 Drugs affecting intestinal secretions", "1.9.4 Pancreatin", "PANCREATIN", "Higher-strength preparations" ], "cautions": "Cautions\u00a0see above and (for higher-strength preparations) see below", "side-effects": "Side-effects\u00a0see above and (for higher-strength preparations)\r\nsee below", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2304.htm", "doses": [ "See preparations", "Name[Pancrease HL\u00ae (Janssen) ] Capsules, enclosing light brown\r\ne/c minitablets of pancreatin (pork), providing\r\nminimum of: protease 1250\u00a0units, lipase 25\u00a0000\u00a0units, amylase 22\u00a0500\u00a0units.\r\nNet price 100 = \u00a340.38. Counselling, see above and under doseDose\u00a0adult and child over 15 years, 1\u20132 capsules during each meal\r\nand 1 capsule with snacks swallowed whole or contents mixed with slightly\r\nacidic liquid or soft food (then swallowed immediately without chewing)" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TAMSULOSIN HYDROCHLORIDE With dutasteride": { "indications": "Indications\u00a0benign prostatic hyperplasia", "name": "TAMSULOSIN HYDROCHLORIDE With dutasteride", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "TAMSULOSIN HYDROCHLORIDE", "With dutasteride" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers).Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207484.htm", "doses": [ "400\u00a0micrograms daily", "Name[Combodart\u00ae (GSK) ] Capsules, m/r, brown/orange, tamsulosin hydrochloride 400\u00a0micrograms, dutasteride 500\u00a0micrograms, net price 30-cap pack = \u00a319.80. \r\n Label:\r\n 25, counselling, drivingDose\u00a0benign prostatic hyperplasia, 1 capsule daily" ] }, "PIRACETAM": { "indications": "Indications\u00a0adjunctive treatment of cortical myoclonus", "name": "PIRACETAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; increased risk of bleeding (gastric ulcer, history of haemorrhagic\r\nstroke, concomitant drugs that increase\r\nbleeding), underlying disorders of haemostasis, major surgery", "side-effects": "Side-effects\u00a0weight gain, nervousness, hyperkinesia; less commonly drowsiness, depression, asthenia; also reported abdominal pain, nausea, vomiting, diarrhoea,\r\nheadache, anxiety, confusion, hallucination, vertigo, ataxia, insomnia,\r\nhaemorrhagic disorder, dermatitis, pruritus, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3673.htm", "doses": [ "Initially 7.2\u00a0g daily in 2\u20133 divided doses, increased\r\naccording to response by 4.8\u00a0g every 3\u20134 days to max. 24\u00a0g daily (subsequently,\r\nattempts should be made to reduce dose of concurrent therapy); child under 16 years not recommended", "Follow the oral solution with a\r\nglass of water (or soft drink) to reduce bitter taste." ], "pregnancy": "Pregnancy\u00a0avoid" }, "TELMISARTAN": { "indications": "Indications\u00a0hypertension (see also notes above); prevention of cardiovascular\r\nevents in patients with established atherosclerotic cardiovascular\r\ndisease, or type 2 diabetes mellitus with target-organ damage", "name": "TELMISARTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain; influenza-like symptoms including pharyngitis and sinusitis;\r\nurinary-tract infection; arthralgia, myalgia, back pain, leg cramps;\r\neczema; less commonly dry mouth, flatulence, anxiety,\r\nvertigo, tendinitis-like symptoms, abnormal vision, increased sweating; rarely bradycardia, tachycardia, dyspnoea, insomnia, depression,\r\nblood disorders, increase in uric acid, eosinophilia, rash, and pruritus;\r\nsyncope and asthenia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81217.htm", "doses": [ "Hypertension, usually 40\u00a0mg once daily (but 20\u00a0mg may\r\nbe sufficient), increased if necessary after at least 4 weeks, to\r\nmax. 80\u00a0mg once daily", "Prevention of cardiovascular events, 80\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "OXYBUTYNIN HYDROCHLORIDE Transdermal preparations": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence, neurogenic bladder instability,\r\nand nocturnal enuresis associated with overactive bladder", "name": "OXYBUTYNIN HYDROCHLORIDE Transdermal preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence", "OXYBUTYNIN HYDROCHLORIDE", "Transdermal preparations" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also less commonly anorexia, facial flushing; rarely night terrors; application site reactions with patches; also reported cognitive impairment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129279.htm", "doses": [ "adult and child over 12 years, initially 5\u00a0mg 2\u20133 times daily,\r\nincreased if necessary to max. 5\u00a0mg 4 times daily; elderly initially 2.5\u20133\u00a0mg twice daily, increased\r\nto 5\u00a0mg twice daily according to response and tolerance; child 5\u201312 years, neurogenic bladder instability,\r\n2.5\u20133\u00a0mg twice daily, increased to 5\u00a0mg 2\u20133 times daily; child under 5 years see BNF for Children; child 5\u201318 years, nocturnal enuresis associated with\r\noveractive bladder, 2.5\u20133\u00a0mg twice daily increased to 5\u00a0mg 2\u20133 times\r\ndaily (last dose before bedtime)", "Name[Kentera\u00ae (Orion) ] Patches, self-adhesive, oxybutynin\r\n36\u00a0mg (releasing oxybutynin approx. 3.9\u00a0mg/24 hours), net price 8-patch\r\npack = \u00a327.20. \r\n Label:\r\n 3, counselling, administrationDose\u00a0adult over 18 years, urinary\r\nfrequency, urgency and incontinence, apply 1 patch twice weekly to\r\nclean, dry, unbroken skin on abdomen, hip or buttock, remove after\r\nevery 3\u20134 days and site replacement patch on a different area (avoid\r\nusing same area for 7 days)Note\u00a0The Scottish Medicines Consortium has advised (July 2005) that Kentera\u00ae should be\r\nrestricted for use in patients who benefit from oral oxybutynin but\r\ncannot tolerate its side-effects" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless essential\u2014toxicity\r\nin animal studies" }, "GALSULFASE": { "indications": "Indications\u00a0 (specialist use only) mucopolysaccharidosis\r\nVI", "name": "GALSULFASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Mucopolysaccharidosis", "GALSULFASE" ], "cautions": "Cautions\u00a0respiratory disease; acute\r\nfebrile or respiratory illness (consider delaying treatment)Infusion-related reactions\u00a0%s\n(From Mucopolysaccharidosis: British National Formulary)\nInfusion-related reactions\u00a0Infusion-related reactions often occur with administration of laronidase, idursulfase, and galsulfase; they can be managed by slowing the infusion rate or interrupting the infusion, and can be minimised by pre-treatment with an antihistamine and an antipyretic. Recurrent infusion-related reactions may require pre-treatment with a corticosteroid\u2014consult product literature for details.", "side-effects": "Side-effects\u00a0abdominal pain, umbilical hernia, gastroenteritis;\r\nchest pain, hypertension; dyspnoea, apnoea, nasal congestion; rigors,\r\nmalaise, areflexia; pharyngitis; conjunctivitis, corneal opacity;\r\near pain; facial oedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130122.htm", "doses": [ "By intravenous infusion, adult and child over\r\n5 years, 1\u00a0mg/kg once weekly" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "DISOPYRAMIDE": { "indications": "Indications\u00a0prevention and treatment of ventricular and supraventricular arrhythmias,\r\nincluding after myocardial infarction; maintenance of sinus rhythm\r\nafter cardioversion", "name": "DISOPYRAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias", "DISOPYRAMIDE" ], "cautions": "Cautions\u00a0monitor for hypotension, hypoglycaemia, ventricular\r\ntachycardia, ventricular fibrillation or torsade de pointes (discontinue if occur); monitor serum potassium; atrial flutter\r\nor atrial tachycardia with partial block, structural\r\nheart disease, heart failure (avoid if severe); prostatic enlargement; susceptibility to angle-closure glaucoma; myasthenia gravis; elderly; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (disopyramide)", "side-effects": "Side-effects\u00a0ventricular tachycardia, ventricular fibrillation\r\nor torsade de pointes (usually associated with prolongation of QRS\r\ncomplex or QT interval\u2014see Cautions above), myocardial depression,\r\nhypotension, AV block; antimuscarinic effects include dry mouth, blurred\r\nvision, urinary retention, and very rarely angle-closure glaucoma;\r\ngastro-intestinal irritation; psychosis, cholestatic jaundice, hypoglycaemia\r\nalso reported (see Cautions above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2421.htm", "doses": [ "By mouth, 300\u2013800\u00a0mg daily in divided\r\ndoses", "By slow intravenous injection, 2\u00a0mg/kg\r\nover at least 5 minutes to a max. of 150\u00a0mg, with ECG monitoring,\r\nfollowed immediately either by 200\u00a0mg by mouth, then 200\u00a0mg every 8 hours for 24 hours or 400\u00a0micrograms/kg/hour by intravenous infusion; max. 300\u00a0mg in first hour and 800\u00a0mg\r\ndaily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; may induce labour if used in third trimester" }, "SODIUM OXYBATE": { "indications": "Indications\u00a0narcolepsy with\r\ncataplexy (under specialist supervision)", "name": "SODIUM OXYBATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Sodium oxybate", "SODIUM OXYBATE" ], "cautions": "Cautions\u00a0history of drug abuse or depression; epilepsy; body mass index\r\nof 40\u00a0kg/m2 or greater (higher risk of sleep apnoea); elderly; respiratory disorders; heart failure and hypertension (high sodium content); risk of discontinuation effects\r\nincluding rebound cataplexy and withdrawal symptoms; interactions: Appendix 1 (sodium oxybate)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain, taste\r\ndisturbance, anorexia; hypertension, palpitation, peripheral oedema;\r\ndyspnoea; sleep disorders, confusion, disorientation, paraesthesia,\r\nhypoaesthesia, impaired attention, depression, drowsiness, anxiety,\r\ndizziness, headache, tremor, asthenia, fatigue; urinary incontinence,\r\nnocturnal enuresis; arthralgia, back pain, muscle cramps; blurred\r\nvision; nasal congestion, vertigo; sweating, rash; less commonly faecal incontinence, myoclonus, psychosis, paranoia, hallucination,\r\nagitation, and amnesia; respiratory depression, dependence, seizures,\r\nsuicidal ideation, sleep apnoea, and urticaria also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129625.htm", "doses": [ "adult over 18 years, initially\r\n2.25\u00a0g on retiring and repeated 2.5\u20134 hours later, increased according\r\nto response in steps of 1.5\u00a0g daily in 2 divided doses at intervals\r\nof 1\u20132 weeks; max. 9\u00a0g daily in two divided doses", "Dose titration should be repeated if restarting\r\nafter interval of more than 14 days", "Dilute each dose with 60\u00a0mL water;\r\nprepare both doses before retiring. Observe the same time interval\r\n(2\u20133 hours) each night between the last meal and the first dose" ], "pregnancy": "Pregnancy\u00a0avoid" }, "MERCAPTAMINE": { "indications": "Indications\u00a0(specialist use only) nephropathic cystinosis", "name": "MERCAPTAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Nephropathic cystinosis" ], "cautions": "Cautions\u00a0leucocyte-cystine concentration and haematological\r\nmonitoring required\u2014consult product literature; dose of phosphate supplement may need to be adjusted if transferring\r\nfrom phosphocysteamine to mercaptamine", "side-effects": "Side-effects\u00a0breath and body odour, nausea, vomiting, diarrhoea,\r\nanorexia, abdominal pain, gastroenteritis, dyspepsia, encephalopathy,\r\nheadache, malaise, fever, rash; less commonly gastro-intestinal\r\nulcer, seizures, hallucinations, somnolence, nervousness, leucopenia,\r\nnephrotic syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73091.htm", "doses": [ "Initial doses should be one-sixth to one-quarter of the\r\nexpected maintenance dose, increased gradually over 4\u20136 weeks ", "Maintenance, adult and child over 50\u00a0kg body-weight,\r\n2\u00a0g daily in 4 divided doses", "child up to 12 years, 1.3\u00a0g/m2 (approx. 50\u00a0mg/kg) daily in 4 divided doses" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic and toxic in animal studies" }, "DEXAMETHASONE With antibacterials": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "DEXAMETHASONE With antibacterials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "DEXAMETHASONE", "With antibacterials" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5428.htm", "doses": [ "Apply eye drops every 30\u201360 minutes until controlled\r\nthen reduce frequency to 4\u20136 times daily", "Name[Maxitrol\u00ae (Alcon) ] Eye drops, dexamethasone 0.1%, neomycin 0.35% (as sulphate), polymyxin B sulphate 6000\u00a0units/mL, net price 5\u00a0mL = \u00a31.68Excipients include benzalkonium chloride, polysorbate 20\nEye ointment, dexamethasone 0.1%, neomycin 0.35% (as sulphate), polymyxin B sulphate 6000\u00a0units/g, net price 3.5\u00a0g = \u00a31.44Excipients include hydroxybenzoates (parabens), wool fatDose\u00a0apply 3\u20134 times daily or at night when\r\nused with eye drops" ] }, "DOXAPRAM HYDROCHLORIDE ": { "indications": "Indications\u00a0see under Dose", "name": "DOXAPRAM HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.5 Respiratory stimulants and pulmonary surfactants", "3.5.1 Respiratory stimulants" ], "cautions": "Cautions\u00a0give with\r\noxygen in severe irreversible airways obstruction or severely decreased\r\nlung compliance (because of increased work load of breathing); give with beta2 agonist in bronchoconstriction; hypertension (avoid if severe), impaired cardiac reserve; phaeochromocytoma; interactions: Appendix 1 (doxapram)", "side-effects": "Side-effects\u00a0nausea, vomiting; hypertension, tachycardia, bradycardia,\r\nextrasystoles, arrhythmias, chest pain, flushing; dyspnoea, cough,\r\nbronchospasm, laryngospasm; pyrexia, headache, dizziness, hyperactivity,\r\nconfusion, hallucination, convulsions; urinary retention, incontinence,\r\nperineal warmth; muscle spasms", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106059.htm", "doses": [ "Postoperative respiratory depression, by\r\nintravenous injection over at least 30 seconds, 1\u20131.5\u00a0mg/kg\r\nrepeated if necessary after intervals of 1 hour or alternatively by intravenous infusion, 2\u20133\u00a0mg/minute\r\nadjusted according to response; child not recommended", "Acute respiratory failure, by intravenous\r\ninfusion, 1.5\u20134\u00a0mg/minute adjusted according to response (given\r\nconcurrently with oxygen and whenever possible monitor with frequent\r\nmeasurement of blood gas tensions); child not recommended" ], "pregnancy": "Pregnancy\u00a0no evidence of harm, but manufacturer advises avoid\r\nunless benefit outweighs risk" }, "NITROFURANTOIN": { "indications": "Indications\u00a0urinary-tract infections", "name": "NITROFURANTOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.13 Urinary-tract infections", "NITROFURANTOIN" ], "cautions": "Cautions\u00a0anaemia; diabetes\r\nmellitus; electrolyte imbalance; vitamin B and folate deficiency; pulmonary disease; on long-term therapy, monitor liver function and monitor for pulmonary symptoms, especially\r\nin the elderly (discontinue if deterioration\r\nin lung function); susceptibility to peripheral\r\nneuropathy; false positive urinary glucose (if tested for reducing substances); urine may be coloured yellow or brown; interactions: Appendix 1 (nitrofurantoin)", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, and diarrhoea; acute\r\nand chronic pulmonary reactions (pulmonary fibrosis reported; possible\r\nassociation with lupus erythematosus-like syndrome); peripheral neuropathy;\r\nalso reported, hypersensitivity reactions (including angioedema, anaphylaxis,\r\nsialadenitis, urticaria, rash and pruritus); rarely, cholestatic jaundice,\r\nhepatitis, exfoliative dermatitis, erythema multiforme, pancreatitis,\r\narthralgia, blood disorders (including agranulocytosis, thrombocytopenia,\r\nand aplastic anaemia), benign intracranial hypertension, and transient\r\nalopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3963.htm", "doses": [ "Acute uncomplicated infection, 50\u00a0mg every 6 hours with\r\nfood for 7 days (3 days usually adequate in women); child over 3 months, 750\u00a0micrograms/kg every 6 hours", "Severe chronic recurrent infection, 100\u00a0mg every 6 hours with\r\nfood for 7 days (dose reduced or discontinued if severe nausea)", "Prophylaxis (but see Cautions), 50\u2013100\u00a0mg at night; child over 3 months, 1\u00a0mg/kg at night" ], "pregnancy": "Pregnancy\u00a0avoid at term\u2014may produce neonatal haemolysis" }, "SIMVASTATIN": { "indications": "Indications\u00a0primary hypercholesterolaemia, homozygous familial hypercholesterolaemia\r\nor combined (mixed) hyperlipidaemia in patients who have not responded\r\nadequately to diet and other appropriate measures; prevention of cardiovascular\r\nevents in patients with atherosclerotic cardiovascular disease or\r\ndiabetes mellitus", "name": "SIMVASTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins", "SIMVASTATIN" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ; also 80-mg dose only\r\nfor those with severe hypercholesterolaemia and at high risk of cardiovascular\r\ncomplications", "side-effects": "Side-effects\u00a0\n(From Statins: British National Formulary)\nSide-effects\u00a0The statins have been associated with myalgia, myopathy, myositis, and rhabdomyolysis (see Muscle Effects below). Statins can alter liver function tests, and rarely cause hepatitis and jaundice; pancreatitis and hepatic failure have been reported very rarely. Other side-effects include gastro-intestinal disturbances, sleep disturbance, headache, dizziness, depression, paraesthesia, asthenia, peripheral neuropathy, amnesia, fatigue, sexual dysfunction, thrombocytopenia, arthralgia, visual disturbance, alopecia, and hypersensitivity reactions (including rash, pruritus, urticaria, and very rarely lupus erythematosus-like reactions). In very rare cases, statins can cause interstitial lung disease; if patients develop symptoms such as dyspnoea, cough, and weight loss, they should seek medical attention.Muscle effects\u00a0The risk of myopathy, myositis, and rhabdomyolysis associated with statin use is rare. Although myalgia has been reported commonly in patients receiving statins, muscle toxicity truly attributable to statin use is rare. Muscle toxicity can occur with all statins, however the likelihood increases with higher doses and in certain patients (see below). Statins should be used with caution in patients at increased risk of muscle toxicity, including those with a personal or family history of muscular disorders, previous history of muscular toxicity, a high alcohol intake, renal impairment, hypothyroidism, and in the elderly. There is an increased incidence of myopathy if a statin is given at a high dose, or if it is given with a fibrate (the combination of a statin and gemfibrozil should preferably be avoided), with lipid-lowering doses of nicotinic acid, with fusidic acid (risk of rhabdomyolysis\u2014the combination of a statin and fusidic acid should be avoided; temporarily discontinue statin and restart 7 days after last fusidic acid dose), or with drugs that increase the plasma-statin concentration, such as macrolide antibiotics, imidazole and triazole antifungals, and ciclosporin\u2014see interactions: Appendix 1 (statins); close monitoring of liver function and, if muscular symptoms occur, of creatine kinase is necessary. In patients at increased risk of muscle effects, a statin should not usually be started if the baseline creatine kinase concentration is more than 5 times the upper limit of normal (some patients may present with an extremely elevated baseline creatine kinase concentration, due to e.g. a physical occupation, or rigorous exercise\u2014specialist advice should be sought regarding consideration of statin therapy in these patients).If muscular symptoms or raised creatine kinase occur during treatment, other possible causes (e.g. rigorous physical activity, hypothyroidism, infection, recent trauma, and drug or alcohol addiction) should be excluded before statin therapy is implicated. When a statin is suspected to be the cause of myopathy, and creatine kinase concentration is markedly elevated (more than 5 times upper limit of normal), or if muscular symptoms are severe, treatment should be discontinued. If symptoms resolve and creatine kinase concentrations return to normal, the statin should be reintroduced at a lower dose and the patient monitored closely; an alternative statin should be prescribed if unacceptable side-effects are experienced with a particular statin. Statins should not be discontinued in the event of small, asymptomatic elevations of creatine kinase. Routine monitoring of creatine kinase is unnecessary in asymptomatic patients.; also rarely anaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2871.htm", "doses": [ "Primary hypercholesterolaemia, combined hyperlipidaemia,\r\n10\u201320\u00a0mg daily at night, adjusted at intervals of at least 4 weeks;\r\nusual range 10\u201380\u00a0mg once daily at night; child under 18 years see BNF for Children", "Homozygous familial hypercholesterolaemia, 40\u00a0mg daily at night or 80\u00a0mg daily in 3 divided doses (with largest dose at\r\nnight)", "Heterozygous familial hypercholesterolaemia, child under 18 years see BNF for Children", "Prevention of cardiovascular events, initially 20\u201340\u00a0mg once\r\ndaily at night, adjusted at intervals of at least 4 weeks; max. 80\u00a0mg\r\nonce daily at night", "Max. 10\u00a0mg daily with concomitant ciclosporin, danazol, or fibrate (except\r\nfenofibrate). Max. 20\u00a0mg daily with concomitant amiodarone or verapamil. Max. 40\u00a0mg daily with diltiazem or amlodipine" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "PENTAMIDINE ISETIONATE": { "indications": "Indications\u00a0see under Dose (should only be given by specialists)", "name": "PENTAMIDINE ISETIONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.8 Drugs for pneumocystis pneumonia" ], "cautions": "Cautions\u00a0risk of severe hypotension following\r\nadministration (monitor blood pressure\r\nbefore starting treatment, during administration, and at regular intervals,\r\nuntil treatment concluded; patient should\r\nbe lying down when receiving drug parenterally); hypokalaemia, hypomagnesaemia, coronary heart disease, bradycardia, history of\r\nventricular arrhythmias, concomitant use\r\nwith other drugs which prolong QT-interval; hypertension or hypotension; hyperglycaemia or hypoglycaemia; leucopenia, thrombocytopenia, or anaemia; carry out laboratory\r\nmonitoring according to product literature; care required to protect personnel during handling and administration; interactions: Appendix 1 (pentamidine isetionate)", "side-effects": "Side-effects\u00a0severe reactions, sometimes fatal, due to hypotension,\r\nhypoglycaemia, pancreatitis, and arrhythmias; also leucopenia, thrombocytopenia,\r\nacute renal failure, hypocalcaemia; also reported: azotaemia, abnormal\r\nliver-function tests, anaemia, hyperkalaemia, nausea and vomiting,\r\ndizziness, syncope, flushing, hyperglycaemia, rash, and taste disturbances;\r\nStevens-Johnson syndrome reported; on inhalation, bronchoconstriction\r\n(may be prevented by prior use of bronchodilators), cough, and shortness\r\nof breath; discomfort, pain, induration, abscess formation, and muscle\r\nnecrosis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4054.htm", "doses": [ "Treatment of Pneumocystis jirovecii (Pneumocystis\r\ncarinii) pneumonia, by intravenous infusion, 4\u00a0mg/kg once daily for at least 14 days", "Prophylaxis of Pneumocystis jirovecii (Pneumocystis\r\ncarinii) pneumonia, by inhalation of nebulised solution (using suitable equipment\u2014consult product literature), 300\u00a0mg every\r\n4 weeks or 150\u00a0mg every 2 weeks [unlicensed for primary\r\nprevention]", "Visceral leishmaniasis (kala-azar, section 5.4.5), by deep intramuscular injection, 3\u20134\u00a0mg/kg on alternate days to max. total of 10 injections; course\r\nmay be repeated if necessary", "Cutaneous leishmaniasis, by deep intramuscular injection, 3\u20134\u00a0mg/kg once or twice weekly until condition resolves (but see\r\nalso section 5.4.5)", "Trypanosomiasis, by deep intramuscular injection or intravenous infusion, 4\u00a0mg/kg\r\ndaily or on alternate days to total of 7\u201310 injections", "Direct intravenous injection should be avoided\r\nwhenever possible and never given rapidly; intramuscular\r\ninjections should be deep and preferably given into the buttock" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "IMIPRAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0depressive illness; nocturnal enuresis in children\r\n(section 7.4.2)", "name": "IMIPRAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "IMIPRAMINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\npalpitation, flushing, restlessness, headache, fatigue; very\r\nrarely abdominal pain, stomatitis, hypertension, oedema,\r\ncardiac decompensation, allergic alveolitis, aggression, myoclonus,\r\nperipheral vasospasm, and mydriasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3318.htm", "doses": [ "Depression, initially up to 75\u00a0mg daily in divided doses\r\nincreased gradually to 150\u2013200\u00a0mg (up to 300\u00a0mg in hospital patients);\r\nup to 150\u00a0mg may be given as a single dose at bedtime; elderly initially 10\u00a0mg daily, increased gradually\r\nto 30\u201350\u00a0mg daily; child not recommended\r\nfor depression", "Nocturnal enuresis, child 6\u20138 years 25\u00a0mg, 8\u201311 years 25\u201350\u00a0mg, over 11 years 50\u201375\u00a0mg\r\nat bedtime; max. period of treatment (including gradual withdrawal)\r\n3 months\u2014full physical examination before further course" ], "pregnancy": "Pregnancy\u00a0colic, tachycardia, dyspnoea, irritability, muscle\r\nspasms, respiratory depression, and withdrawal symptoms reported in\r\nneonates when used in the third trimester" }, "BUPIVACAINE HYDROCHLORIDE": { "indications": "Indications\u00a0see under Dose", "name": "BUPIVACAINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Bupivacaine", "BUPIVACAINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics; myocardial depression may be more severe and more resistant to treatment; cardiovascular disease; hypertension; hypotension; cerebral atheroma; interactions: Appendix 1 (bupivacaine)", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6699.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Doses should be adjusted according to patient\u2019s\r\nphysical status and nature of procedure\u2014important: see also under Administration, section 15.2", "Local infiltration, max. 60\u00a0mL, using a 2.5\u00a0mg/mL\r\n(0.25%) solution", "Peripheral nerve block, max. 60\u00a0mL (150\u00a0mg),\r\nusing a 2.5\u00a0mg/mL (0.25%) solution; max. 30\u00a0mL, using a 5\u00a0mg/mL (0.5%)\r\nsolution", "Epidural block", "Surgery, lumbar, 10\u201320\u00a0mL (50\u2013100\u00a0mg), using\r\na 5\u00a0mg/mL (0.5%) solution", "Surgery, caudal, 15\u201330\u00a0mL (75\u2013150\u00a0mg), using\r\na 5\u00a0mg/mL (0.5%) solution", "Labour, lumbar, 6\u201312\u00a0mL (15\u201330\u00a0mg) using a\r\n2.5\u00a0mg/mL (0.25%) or 6\u201312\u00a0mL (30\u201360\u00a0mg) using a 5\u00a0mg/mL (0.5%) solution", "Sympathetic block, 20\u201350\u00a0mL (50\u2013125\u00a0mg), using\r\na 2.5\u00a0mg/mL (0.25%) solution", "Intrathecal anaesthesia, see under preparations", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought" ], "pregnancy": "Pregnancy\u00a0large doses during delivery can cause neonatal respiratory\r\ndepression, hypotonia, and bradycardia after paracervical or epidural\r\nblock; use lower doses for intrathecal use during late pregnancy" }, "ETHERIFIED STARCH": { "indications": "Indications\u00a0low blood volume", "name": "ETHERIFIED STARCH", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "ETHERIFIED STARCH" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; children", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; also\r\npruritus, raised serum amylase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128329.htm", "doses": [ "See under preparations below" ] }, "Hypertonic sodium chloride": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.7 Mucolytics" ], "name": "Hypertonic sodium chloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215495.htm", "doses": [ "by inhalation of nebulised solution, 4\u00a0mL\r\n2\u20134 times daily" ] }, "PROPANTHELINE BROMIDE": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal\r\ndisorders characterised by smooth muscle spasm; urinary frequency\r\n(section 7.4.2); gustatory\r\nsweating (section 6.1.5)", "name": "PROPANTHELINE BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "PROPANTHELINE BROMIDE" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2094.htm", "doses": [ "adult and child over 12 years, 15\u00a0mg 3 times daily at least\r\n1 hour before meals and 30\u00a0mg at night, max. 120\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "CHLORAL HYDRATE ": { "indications": "Indications\u00a0insomnia (short-term use)", "name": "CHLORAL HYDRATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Chloral and derivatives", "CHLORAL HYDRATE" ], "cautions": "Cautions\u00a0reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal\r\nthereafter); avoid contact with skin and mucous membranes; interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may persist\r\nthe next day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0gastric irritation (nausea and vomiting reported),\r\nabdominal distention, flatulence, headache, tolerance, dependence,\r\nexcitement, delirium (especially on abrupt withdrawal), ketonuria,\r\nand rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3156.htm", "doses": [ "Name[Chloral Mixture, BP 2000 ] 5\u201320\u00a0mL; child 1\u201312 years\r\n30\u201350\u00a0mg/kg (max. 1\u00a0g), taken well diluted with water at bedtime" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DIAZOXIDE - CHRONIC HYPOGLYCAEMIA": { "indications": "Indications\u00a0chronic intractable hypoglycaemia; hypertensive\r\nemergency\u2014but no longer recommended, see section 2.5", "name": "DIAZOXIDE - CHRONIC HYPOGLYCAEMIA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.4 Treatment of hypoglycaemia", "Chronic hypoglycaemia", "DIAZOXIDE" ], "cautions": "Cautions\u00a0ischaemic heart disease; monitor blood pressure; during prolonged use monitor white cell and platelet count, and in children, regularly assess growth, bone, and psychological\r\ndevelopment; interactions: Appendix 1 (diazoxide)", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, hyperuricaemia, hypotension,\r\noedema, tachycardia, arrhythmias, extrapyramidal effects; hypertrichosis\r\non prolonged treatment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4200.htm", "doses": [ "By mouth, adult, initially 5\u00a0mg/kg daily in 2\u20133 divided doses, then adjusted according\r\nto response; usual maintenance dose 3\u20138\u00a0mg/kg daily in 2\u20133 divided\r\ndoses; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0prolonged use in second or third trimesters may produce\r\nalopecia and impaired glucose tolerance in neonate; inhibits uterine\r\nactivity during labour" }, "2.2.4 Potassium-sparing diuretics with other diuretics Triamterene with thiazides": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "Triamterene with thiazides" ], "name": "2.2.4 Potassium-sparing diuretics with other diuretics Triamterene with thiazides", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2383.htm", "doses": [ "Name[Dyazide\u00ae (Goldshield) ] Tablets, peach, scored, co-triamterzide\r\n50/25 (triamterene 50\u00a0mg, hydrochlorothiazide 25\u00a0mg), net price 30-tab pack = 95p. \r\n Label:\r\n 14, (see above), 21Dose\u00a0hypertension, 1 tablet daily after breakfast, increased\r\nif necessary, max. 4 dailyOedema, 2 tablets daily (1 after breakfast and 1 after\r\nmidday meal) increased to 3 daily if necessary (2 after breakfast\r\nand 1 after midday meal); usual maintenance in oedema, 1 daily or\r\n2 on alternate days; max. 4 daily" ] }, "MOXONIDINE": { "indications": "Indications\u00a0mild to moderate essential hypertension", "name": "MOXONIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.2 Centrally acting antihypertensive drugs", "MOXONIDINE" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal (if concomitant treatment with beta-blocker has to\r\nbe stopped, discontinue beta-blocker first, then moxonidine after a few days); severe coronary artery\r\ndisease; unstable angina; first-degree AV block; moderate heart\r\nfailure; interactions: see Appendix\r\n1 (moxonidine)", "side-effects": "Side-effects\u00a0dry mouth, diarrhoea, nausea, vomiting, dyspepsia,\r\ndizziness, somnolence, insomnia, back pain, rash, pruritus; less commonly bradycardia, tinnitus, angioedema, oedema,\r\nnervousness, neck pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129030.htm", "doses": [ "200\u00a0micrograms once daily in the morning, increased if\r\nnecessary after 3 weeks to 400\u00a0micrograms daily in 1\u20132 divided doses;\r\nmax. 600\u00a0micrograms daily in 2 divided doses (max. single dose 400\u00a0micrograms)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "LISINOPRIL": { "indications": "Indications\u00a0hypertension (but see notes above); symptomatic\r\nheart failure (adjunct\u2014\n(From 2.5.5 Drugs affecting the renin-angiotensin system: British National Formulary)\n2.5.5 Drugs affecting the renin-angiotensin system); short-term\r\ntreatment following myocardial infarction in haemodynamically stable\r\npatients; renal complications of diabetes mellitus", "name": "LISINOPRIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "LISINOPRIL" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also less commonly tachycardia, palpitation, cerebrovascular accident, myocardial infarction,\r\nRaynaud\u2019s syndrome, confusion, mood changes, vertigo, sleep disturbances,\r\nasthenia, impotence; rarely dry mouth, gynaecomastia,\r\nalopecia, psoriasis; very rarely allergic alveolitis,\r\npulmonary infiltrates, profuse sweating, pemphigus, Stevens-Johnson\r\nsyndrome, and toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119720.htm", "doses": [ "Hypertension, initially 10\u00a0mg once daily; if used in addition\r\nto diuretic (see notes above) or\r\nin cardiac decompensation or in volume depletion, initially 2.5\u20135\u00a0mg\r\nonce daily; usual maintenance dose 20\u00a0mg once daily; max. 80\u00a0mg once\r\ndaily", "Heart failure (adjunct), initially 2.5\u00a0mg once daily under close\r\nmedical supervision (see notes above);\r\nincreased in steps no greater than 10\u00a0mg at intervals of at least\r\n2 weeks up to max. 35\u00a0mg once daily if tolerated", "Prophylaxis after myocardial infarction, systolic blood pressure\r\nover 120\u00a0mmHg, 5\u00a0mg within 24 hours, followed by further 5\u00a0mg 24 hours\r\nlater, then 10\u00a0mg after a further 24 hours, and continuing with 10\u00a0mg\r\nonce daily for 6 weeks (or continued if heart failure); systolic blood\r\npressure 100\u2013120\u00a0mmHg, initially 2.5\u00a0mg once daily, increased to maintenance\r\ndose of 5\u00a0mg once daily", "Should not be started after\r\nmyocardial infarction if systolic blood pressure less than 100\u00a0mmHg; temporarily reduce maintenance dose to 5\u00a0mg and if necessary 2.5\u00a0mg\r\ndaily if systolic blood pressure 100\u00a0mmHg or less during treatment;\r\nwithdraw if prolonged hypotension occurs (systolic blood pressure\r\nless than 90\u00a0mmHg for more than 1 hour)", "Renal complications of diabetes mellitus, initially 2.5\u20135\u00a0mg\r\nonce daily adjusted according to response; usual dose range 10\u201320\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "PANCURONIUM BROMIDE": { "indications": "Indications\u00a0neuromuscular blockade (long duration) for surgery or during intensive\r\ncare", "name": "PANCURONIUM BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs", "PANCURONIUM BROMIDE" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89542.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "Intubation, by intravenous injection, adult and child over\r\n1 month, initially 100\u00a0micrograms/kg then 20\u00a0micrograms/kg as required; neonate see BNF for Children", "Intensive care, by intravenous injection, initially\r\n100\u00a0micrograms/kg (optional) then 60\u00a0micrograms/kg every 60\u201390 minutes" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "PROPOFOL": { "indications": "Indications\u00a0see under Dose", "name": "PROPOFOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.1 Intravenous anaesthetics", "Drugs used for intravenous anaesthesia", "PROPOFOL" ], "cautions": "Cautions\u00a0see under Intravenous Anaesthetics and notes above; cardiac impairment; respiratory impairment; elderly; hypovolaemia; epilepsy; hypotension; raised intracranial pressure; monitor blood-lipid concentration if risk of fat overload or if sedation longer than 3 days; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Drugs used for intravenous anaesthesia: British National Formulary)\nDrugs used for intravenous anaesthesia; also hypotension,\r\ntachycardia, flushing; transient apnoea, hyperventilation, coughing,\r\nand hiccup during induction; headache; less commonly thrombosis, phlebitis; rarely arrhythmia, headache,\r\nvertigo, shivering, euphoria; very rarely pancreatitis,\r\npulmonary oedema, sexual disinhibition, and discoloration of urine;\r\nserious and sometimes fatal side-effects reported with prolonged infusion\r\nof doses exceeding 5\u00a0mg/kg/hour, including metabolic acidosis, rhabdomyolysis,\r\nhyperkalaemia, and cardiac failure, dystonia and dyskinesia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106513.htm", "doses": [ "Induction of anaesthesia using 0.5% or 1% injection, by slow intravenous injection or infusion, adult under 55 years, 1.5\u20132.5\u00a0mg/kg at a rate of 20\u201340\u00a0mg every 10 seconds\r\nuntil response; adult over 55 years\r\nor debilitated, 1\u20131.5\u00a0mg/kg at a rate of 20\u00a0mg every 10 seconds until\r\nresponse; child 1 month\u201318 years see BNF for Children", "Induction of anaesthesia using 2% injection, by intravenous\r\ninfusion, adult under 55 years,\r\n1.5\u20132.5\u00a0mg/kg at a rate of 20\u201340\u00a0mg every 10 seconds; adult over 55 years or debilitated, 1\u20131.5\u00a0mg/kg at\r\na rate of 20\u00a0mg every 10 seconds until response; child 3\u201318 years see BNF for Children", "Maintenance of anaesthesia using 1% injection, by intravenous\r\ninfusion, 4\u201312\u00a0mg/kg/hour (3\u20136\u00a0mg/kg/hour in elderly or debilitated) or by slow intravenous injection, 25\u201350\u00a0mg repeated according\r\nto response; child 1 month\u201318 years\r\nsee BNF for Children", "Maintenance of anaesthesia using 2% injection, by intravenous\r\ninfusion, 4\u201312\u00a0mg/kg/hour (3\u20136\u00a0mg/kg/hour in elderly or debilitated); child 3\u201318 years see BNF for Children", "Sedation of ventilated patients in intensive care using 1% or 2% injection, by intravenous infusion, adult and child over\r\n16 years, 0.3\u20134\u00a0mg/kg/hour", "Induction of sedation for surgical and diagnostic procedures\r\nusing 0.5% or 1% injection, adult, initially by slow intravenous injection over 1\u20135\r\nminutes, 0.5\u20131\u00a0mg/kg, dose and rate of administration adjusted according\r\nto desired level of sedation and response; child 1 month\u201318 years see BNF for Children", "Maintenance of sedation for surgical and diagnostic procedures\r\nusing 0.5% injection, by intravenous infusion, adult, 1.5\u20134.5\u00a0mg/kg/hour, dose and rate of administration\r\nadjusted according to desired level of sedation and response (additionally,\r\nif rapid increase in sedation required, by slow intravenous\r\ninjection, 10\u201320\u00a0mg); patients over 55 years or debilitated\r\nmay require lower dose and rate of administration; child 17\u201318 years see BNF for Children", "Maintenance of sedation for surgical and diagnostic procedures\r\nusing 1% injection, by intravenous infusion, adult, 1.5\u20134.5\u00a0mg/kg/hour, dose and rate of administration\r\nadjusted according to desired level of sedation and response (additionally,\r\nif rapid increase in sedation required, by slow intravenous\r\ninjection, 10\u201320\u00a0mg); patients over 55 years or debilitated\r\nmay require lower dose and rate of administration; child 1 month\u201318 years see BNF for Children", "Maintenance of sedation for surgical and diagnostic procedures\r\nusing 2% injection, by intravenous infusion, adult, 1.5\u20134.5\u00a0mg/kg/hour, dose and rate of administration\r\nadjusted according to desired level of sedation and response (additionally,\r\nif rapid increase in sedation required, by slow intravenous\r\ninjection using 0.5% or 1% injection, 10\u201320\u00a0mg);\r\npatients over 55 years or debilitated may require lower dose and rate\r\nof administration; child 3\u201318 years\r\nsee BNF for Children" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery;\r\nmax. dose for maintenance of anaesthesia 6\u00a0mg/kg/hour" }, "ACICLOVIR - ANTIVIRAL PREPARATIONS": { "indications": "Indications\u00a0\n(From 13.10.3 Antiviral preparations: British National Formulary)\n13.10.3 Antiviral preparations; herpes simplex and varicella\u2013zoster\r\ninfections (%s\n(From ACICLOVIR: British National Formulary)\nACICLOVIR); eye infections (%s\n(From ACICLOVIR: British National Formulary)\nACICLOVIR)", "name": "ACICLOVIR - ANTIVIRAL PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.3 Antiviral preparations" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes", "side-effects": "Side-effects\u00a0transient stinging or burning; occasionally erythema,\r\nitching or drying of the skin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6183.htm", "doses": [ "Apply to lesions every 4 hours (5 times daily) for 5\u201310\r\ndays, starting at first sign of attack" ], "pregnancy": "Pregnancy\u00a0not known to be harmful\u2014manufacturers advise use\r\nonly when potential benefit outweighs risk; limited absorption from\r\ntopical aciclovir preparations" }, "2.2.4 Potassium-sparing diuretics with other diuretics Amiloride with cyclopenthiazide": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics", "Amiloride with cyclopenthiazide" ], "name": "2.2.4 Potassium-sparing diuretics with other diuretics Amiloride with cyclopenthiazide", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215697.htm", "doses": [ "Name[Navispare\u00ae (Goldshield) ] Tablets, f/c, orange, amiloride\r\nhydrochloride 2.5\u00a0mg, cyclopenthiazide 250\u00a0micrograms, net price 28-tab pack = \u00a33.24Excipients include glutenDose\u00a0hypertension, 1\u20132\u00a0tablets in the morning" ] }, "ANTIBACTERIALS": { "indications": "Indications\u00a0acne vulgaris", "name": "ANTIBACTERIALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical antibacterials for acne", "ANTIBACTERIALS" ], "cautions": "Cautions\u00a0some manufacturers advise preparations\r\ncontaining alcohol are not suitable for use with benzoyl peroxide", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106486.htm", "doses": [ "adult and child over 12 years, apply thinly once daily" ] }, "HYDROMORPHONE HYDROCHLORIDE": { "indications": "Indications\u00a0severe pain in cancer", "name": "HYDROMORPHONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "HYDROMORPHONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis; toxic psychosis", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, peripheral oedema, seizures, asthenia, dyskinesia,\r\nagitation, and tremor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85403.htm", "doses": [ "See under preparations below" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "SODIUM CROMOGLICATE - CROMOGLICATE": { "side-effects": "Side-effects\u00a0local irritation; rarely transient\r\nbronchospasm", "indications": "Indications\u00a0prophylaxis of allergic rhinitis", "name": "SODIUM CROMOGLICATE - CROMOGLICATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/22925.htm", "doses": [ "adult and child, 1 spray into each nostril 4\u20136 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Cromoglicate", "SODIUM CROMOGLICATE" ] }, "BENZYDAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0painful inflammatory conditions of oropharynx", "name": "BENZYDAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "BENZYDAMINE HYDROCHLORIDE" ], "side-effects": "Side-effects\u00a0occasional numbness or stinging; rarely hypersensitivity\r\nreactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5682.htm", "doses": [ "adult and adolescent over 12 years, rinse or gargle, using\r\n15\u00a0mL (dilute with an equal volume of water if stinging occurs) every\r\n1\u00bd\u20133 hours as required, usually for not more than 7 days", "adult, 4\u20138\u00a0sprays onto\r\naffected area every 1\u00bd\u20133 hours; child under 6 years 1\u00a0spray per 4\u00a0kg body-weight to max. 4\u00a0sprays every\r\n1\u00bd\u20133 hours; 6\u201312 years 4\u00a0sprays every 1\u00bd\u20133 hours" ] }, "NORFLOXACIN": { "indications": "Indications\u00a0see under Dose", "name": "NORFLOXACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; interactions: Appendix 1 (quinolones)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.; also tinnitus, epiphora; rarely pancreatitis; very rarely arrhythmias; also reported, polyneuropathy and\r\nexfoliative dermatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3956.htm", "doses": [ "\u2018Lower\u2019 urinary-tract infections, 400\u00a0mg twice daily for\r\n7\u201310 days (for 3 days for uncomplicated infections in women)", "Chronic relapsing \u2018lower\u2019 urinary-tract infections, 400\u00a0mg twice\r\ndaily for up to 12 weeks; may be reduced to 400\u00a0mg once daily if adequate\r\nsuppression within first 4 weeks", "Chronic prostatitis, 400\u00a0mg twice daily for 28 days" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "PLERIXAFOR": { "indications": "Indications\u00a0\n(From 9.1.7 Drugs used to mobilise stem cells: British National Formulary)\n9.1.7 Drugs used to mobilise stem cells", "name": "PLERIXAFOR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.7 Drugs used to mobilise stem cells" ], "cautions": "Cautions\u00a0monitor platelet and white blood cell\r\ncount", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth, oral\r\nhypoaesthesia; dizziness, headache, insomnia, fatigue; arthralgia,\r\nmusculoskeletal pain; erythema, sweating; injection-site reactions; less commonly hypersensitivity reactions including dyspnoea\r\nand periorbital swelling", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203910.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 240\u00a0micrograms/kg daily 6\u201311\r\nhours before initiation of apheresis; usual duration 2\u20134 days (max.\r\n7 days)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential and use\r\neffective contraception during treatment\u2014teratogenic in animal studies" }, "TEMOZOLOMIDE": { "indications": "Indications\u00a0\n(From Dacarbazine and temozolomide: British National Formulary)\nDacarbazine and temozolomide", "name": "TEMOZOLOMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Dacarbazine and temozolomide" ], "cautions": "Cautions\u00a0see section 8.1; interactions: Appendix 1 (temozolomide)", "side-effects": "Side-effects\u00a0see section 8.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77218.htm", "doses": [ "Consult product literature; child under 3 years not recommended" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and embryotoxic in animal studies); manufacturer advises adequate contraception during treatment;\r\nmen should avoid fathering a child during and for at least 6 months\r\nafter treatment; see also Pregnancy and Reproductive\r\nFunction" }, "LOCAL CORTICOSTEROID INJECTIONS Hydrocortisone acetate": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Hydrocortisone acetate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Hydrocortisone acetate" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/8992.htm", "doses": [ "See under preparations", "Name[Hydrocortistab\u00ae (Sovereign) ] Injection (aqueous suspension),\r\nhydrocortisone acetate 25\u00a0mg/mL, net price 1-mL\r\namp = \u00a36.45Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 5\u201350\u00a0mg according to size; where appropriate\r\nmay be repeated at intervals of 21 days; not more than 3 joints should\r\nbe treated on any one day; child 5\u201330\u00a0mg\r\n(divided)" ] }, "PROPIVERINE HYDROCHLORIDE": { "indications": "Indications\u00a0urinary frequency, urgency and incontinence; neurogenic bladder instability", "name": "PROPIVERINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/74196.htm", "doses": [ "adult over\r\n18 years, 15\u00a0mg 1\u20133 times daily, increased if necessary to max. 15\u00a0mg\r\n4 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (restriction of skeletal\r\ndevelopment in animals)" }, "PILOCARPINE Single use": { "indications": "Indications\u00a0see notes above; dry mouth (%s\n(From 12.3.5 Treatment of dry mouth: British National Formulary)\n12.3.5 Treatment of dry mouth)", "name": "PILOCARPINE Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Miotics", "PILOCARPINE", "Single use" ], "cautions": "Cautions\u00a0\n(From Miotics: British National Formulary)\nCautions\u00a0A darkly pigmented iris may require a higher concentration of the miotic or more frequent administration and care should be taken to avoid overdosage. Retinal detachment has occurred in susceptible individuals and those with retinal disease; therefore fundus examination is advised before starting treatment with a miotic. Care is also required in conjunctival or corneal damage. Intra-ocular pressure and visual fields should be monitored in those with chronic simple glaucoma and those receiving long-term treatment with a miotic. Miotics should be used with caution in patients with peptic ulceration, gastro-intestinal spasm, cardiac disease, hypertension, hypotension, marked vasomotor instability, asthma, epilepsy, Parkinson\u2019s disease, hyperthyroidism, and urinary-tract obstruction.Counselling\u00a0Blurred vision may affect performance of skilled tasks (e.g. driving) particularly at night or in reduced lighting", "side-effects": "Side-effects\u00a0\n(From Miotics: British National Formulary)\nMiotics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5495.htm", "doses": [ "Apply up to 4 times daily; long-acting preparations, see\r\nunder preparations below", "Name[Minims\u00ae Pilocarpine Nitrate (Bausch & Lomb) ] Eye drops, pilocarpine nitrate 2%, net price 20 \u00d7 0.5\u00a0mL = \u00a310.36" ] }, "CO-AMILOZIDE": { "indications": "Indications\u00a0potassium conservation in the treatment\r\nof hypertension, congestive heart failure, or hepatic cirrhosis with\r\nascites and oedema", "name": "CO-AMILOZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.4 Potassium-sparing diuretics with other diuretics" ], "cautions": "Cautions\u00a0see Amiloride (section 2.2.3), and\r\nThiazides and related diuretics (section 2.2.1)", "side-effects": "Side-effects\u00a0see Amiloride (section 2.2.3), and Thiazides and related diuretics\r\n(section 2.2.1); also\r\nfever, flushing, respiratory distress, restlessness, sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215050.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0see Amiloride (section 2.2.3), and Thiazides and related diuretics\r\n(section 2.2.1)" }, "Local treatment": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.5 Treatment of dry mouth" ], "name": "Local treatment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29725.htm", "doses": [ "ACBS: patients suffering from dry mouth as a result of\r\nhaving (or having undergone) radiotherapy, or sicca syndrome, spray\r\n2\u20133 times onto oral and pharyngeal mucosa, when required", "ACBS: patients suffering from dry mouth as a result of\r\nhaving (or having undergone) radiotherapy, or sicca syndrome" ] }, "BETAMETHASONE SODIUM PHOSPHATE With antibacterial": { "indications": "Indications\u00a0eczematous inflammation in otitis\r\nexterna (\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "BETAMETHASONE SODIUM PHOSPHATE With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "BETAMETHASONE SODIUM PHOSPHATE", "With antibacterial" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31395.htm", "doses": [ "Name[Betnesol-N\u00ae (UCB Pharma) ] Drops (for ear, eye, or nose), betamethasone sodium phosphate 0.1%, neomycin\r\nsulphate 0.5%. Net price 10\u00a0mL = \u00a32.39Excipients include benzalkonium chloride, disodium edetateDose\u00a0ear, apply 2\u20133 drops 3\u20134 times daily; eye, section 11.4.1; nose, section 12.2.3" ] }, "LAMIVUDINE": { "indications": "Indications\u00a0see preparations below", "name": "LAMIVUDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "LAMIVUDINE" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; interactions: Appendix 1 (lamivudine)Chronic hepatitis B\u00a0Recurrent hepatitis\r\nin patients with chronic hepatitis B may occur on discontinuation of lamivudine. When treating chronic hepatitis\r\nB with lamivudine, monitor liver function tests\r\nevery 3 months, and viral markers of hepatitis B every 3\u20136 months,\r\nmore frequently in patients with advanced liver disease or following\r\ntransplantation (monitoring to continue for at least 1 year after\r\ndiscontinuation)", "side-effects": "Side-effects\u00a0see notes above; also peripheral neuropathy, muscle\r\ndisorders including rhabdomyolysis, nasal symptoms, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82000.htm", "doses": [ "See preparations below", "chronic hepatitis B infection either with\r\ncompensated liver disease (with evidence of viral replication and\r\nhistology of active liver inflammation or fibrosis) when first-line\r\ntreatments cannot be used, or (in combination with\r\nanother antiviral drug without cross-resistance to lamivudine) with\r\ndecompensated liver disease, 100\u00a0mg daily; child [unlicensed indication] 2\u201311 years, 3\u00a0mg/kg once daily (max. 100\u00a0mg\r\ndaily); 12\u201317 years, adult dose", "Patients receiving lamivudine for concomitant HIV infection should continue to receive lamivudine in a dose appropriate for HIV infection" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "BEZAFIBRATE Modified release": { "indications": "Indications\u00a0hyperlipidaemias of types IIa, IIb, III, IV, and V in patients who\r\nhave not responded adequately to diet and other appropriate measures;\r\nalso see notes above", "name": "BEZAFIBRATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Fibrates", "BEZAFIBRATE", "Modified release" ], "cautions": "Cautions\u00a0correct hypothyroidism before initiating treatment (see Lipid-regulating drugs); interactions: Appendix 1 (fibrates)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, anorexia; less commonly cholestasis, weight gain, dizziness, headache,\r\nfatigue, drowsiness, renal impairment, raised serum creatinine (unrelated\r\nto renal impairment), erectile dysfunction, myotoxicity (with myasthenia\r\nor myalgia)\u2014special risk in renal impairment (see Cautions), urticaria,\r\npruritus, photosensitivity reactions; very rarely gallstones, hypoglycaemia, anaemia, leucopenia, thrombocytopenia,\r\nincreased platelet count, alopecia, Stevens-Johnson syndrome, and\r\ntoxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2846.htm", "doses": [ "See preparations below", "Name[Bezalip\u00ae Mono (Actavis) ] Tablets, m/r, f/c, bezafibrate 400\u00a0mg, net price 30-tab pack = \u00a37.63. \r\n Label:\r\n 21, 25Dose\u00a0400\u00a0mg once daily (dose form not appropriate in patients\r\nwith renal impairment)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014embryotoxicity in animal studies" }, "BUPROPION HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From Bupropion: British National Formulary)\nBupropion", "name": "BUPROPION HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.2 Nicotine dependence", "Bupropion", "BUPROPION HYDROCHLORIDE" ], "cautions": "Cautions\u00a0elderly; predisposition\r\nto seizures (prescribe only if benefit clearly outweighs risk) including concomitant use of drugs that lower seizure\r\nthreshold, alcohol abuse, history of head trauma, and diabetes; measure blood pressure before and during treatment; interactions: Appendix 1 (bupropion)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0dry mouth, gastro-intestinal disturbances, taste\r\ndisturbance; agitation, anxiety, dizziness, depression, headache,\r\nimpaired concentration, insomnia (reduced by avoiding dose at bedtime),\r\ntremor; fever; pruritus, rash, sweating; less commonly chest pain, flushing, hypertension, tachycardia, anorexia, asthenia,\r\nconfusion, tinnitus, and visual disturbances; rarely hepatitis, jaundice, palpitation, postural hypotension, vasodilatation,\r\nabnormal dreams, ataxia, dystonia, depersonalisation, hallucinations,\r\nhostility, incoordination, irritability, impaired memory, paraesthesia,\r\nseizures, twitching, blood-glucose changes, urinary frequency, urinary\r\nretention, exacerbation of psoriasis, and Stevens-Johnson syndrome; very rarely aggression, delusions, paranoid ideation, and\r\nrestlessness; also reported suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86305.htm", "doses": [ "adult over 18 years, start\r\n1\u20132 weeks before target stop date, initially 150\u00a0mg daily for 6 days\r\nthen 150\u00a0mg twice daily (max. single dose 150\u00a0mg, max. daily dose\r\n300\u00a0mg; minimum 8 hours between doses); period of treatment 7\u20139 weeks;\r\ndiscontinue if abstinence not achieved at 7 weeks; consider max. 150\u00a0mg\r\ndaily in patients with risk factors for seizures; elderly max. 150\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "CLONIDINE HYDROCHLORIDE - CLONIDINE HYDROCHLORIDE": { "indications": "Indications\u00a0prevention of recurrent migraine\r\n(but see notes above), vascular headache, menopausal flushing; hypertension\r\n(%s\n(From 2.5.2 Centrally acting antihypertensive drugs: British National Formulary)\n2.5.2 Centrally acting antihypertensive drugs)", "name": "CLONIDINE HYDROCHLORIDE - CLONIDINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.2 Prophylaxis of migraine", "CLONIDINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0depressive illness; heart failure; Raynaud\u2019s syndrome; concurrent antihypertensive therapy; cerebrovascular disease; polyneuropathy; constipation; interactions: Appendix 1 (clonidine)", "side-effects": "Side-effects\u00a0constipation, dry mouth, nausea, vomiting; postural\r\nhypotension; depression, sleep disorder, dizziness, headache, drowsiness;\r\nerectile dysfunction; less commonly Raynaud\u2019s syndrome,\r\nparaesthesia, hallucination, rash, and pruritus; rarely AV block, gynaecomastia, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3568.htm", "doses": [ "adult over 18 years, 50\u00a0micrograms\r\ntwice daily, increased after 2 weeks to 75\u00a0micrograms twice daily\r\nif necessary" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk" }, "NEOSTIGMINE": { "indications": "Indications\u00a0myasthenia gravis; other indications\r\n(section 15.1.6)", "name": "NEOSTIGMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.1 Drugs that enhance neuromuscular transmission", "Anticholinesterases" ], "cautions": "Cautions\u00a0asthma (extreme caution), bradycardia, arrhythmias, recent myocardial infarction, epilepsy, hypotension, parkinsonism, vagotonia, peptic ulceration, hyperthyroidism; atropine or other antidote to muscarinic effects may be necessary\r\n(particularly when neostigmine is given by injection),\r\nbut not given routinely because it may mask signs of overdosage; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, increased salivation, diarrhoea,\r\nabdominal cramps (more marked with higher doses); signs of overdosage\r\ninclude bronchoconstriction, increased bronchial secretions, lacrimation,\r\nexcessive sweating, involuntary defaecation and micturition, miosis,\r\nnystagmus, bradycardia, heart block, arrhythmias, hypotension, agitation,\r\nexcessive dreaming, and weakness eventually leading to fasciculation\r\nand paralysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5325.htm", "doses": [ "By mouth, neostigmine bromide 15\u201330\u00a0mg at suitable intervals throughout day, total daily\r\ndose 75\u2013300\u00a0mg (but see also notes above); neonate 1\u20135\u00a0mg every 4 hours, half an hour before feeds; child up to 6 years initially 7.5\u00a0mg, 6\u201312 years\r\ninitially 15\u00a0mg, usual total daily dose 15\u201390\u00a0mg", "By subcutaneous or intramuscular\r\ninjection, adult and child over 12 years, neostigmine metilsulfate 1\u20132.5\u00a0mg at suitable intervals throughout day (usual\r\ntotal daily dose 5\u201320\u00a0mg); neonate 150\u00a0micrograms/kg\r\nevery 6\u20138 hours 30 minutes before feeds, increased to max. 300\u00a0micrograms/kg\r\nevery 4 hours, if necessary [unlicensed]; child 1 month\u201312 years 200\u2013500\u00a0micrograms as required" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "GLYCERYL TRINITRATE Parenteral preparations": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE Parenteral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE", "Parenteral preparations" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2631.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations", "Name[Nitronal\u00ae (Merck Serono) ] Injection, glyceryl trinitrate 1\u00a0mg/mL. To be diluted before use or given undiluted with syringe\r\npump. Net price 5-mL vial = \u00a31.80; 50-mL vial = \u00a314.76" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "AMITRIPTYLINE HYDROCHLORIDE Compound preparations": { "indications": "Indications\u00a0depressive illness (but not recommended, see\r\nnotes above); neuropathic pain [unlicensed] (section 4.7.3); migraine prophylaxis [unlicensed]\r\n(section 4.7.4.2)", "name": "AMITRIPTYLINE HYDROCHLORIDE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic antidepressants", "AMITRIPTYLINE HYDROCHLORIDE", "Compound preparations" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\nabdominal pain, stomatitis, palpitation, oedema, hypertension, restlessness,\r\nfatigue, mydriasis, and increased intra-ocular pressure; high rate\r\nof fatality in overdose\u2014\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nOverdosage\u00a0Limited quantities of tricyclic antidepressants should be prescribed at any one time because their cardiovascular and epileptogenic effects are dangerous in overdosage. In particular, overdosage with dosulepin and amitriptyline is associated with a relatively high rate of fatality. Lofepramine is associated with the lowest risk of fatality in overdosage, in comparison with other tricyclic antidepressant drugs. For advice on overdosage see Emergency Treatment of Poisoning.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3356.htm", "doses": [ "Depression (but not recommended, see notes above), adult and child over\r\n16 years, initially 75\u00a0mg (elderly and adolescents 30\u201375\u00a0mg) daily in divided doses or as a single dose at bedtime increased gradually as necessary\r\nto 150\u2013200\u00a0mg", "Neuropathic pain [unlicensed indication], initially 10\u00a0mg daily\r\nat night, gradually increased if necessary to 75\u00a0mg daily; higher\r\ndoses under specialist supervision", "Migraine prophylaxis [unlicensed indication], initially 10\u00a0mg\r\nat night, increased if necessary to maintenance of 50\u201375\u00a0mg at night;\r\nmax. 150\u00a0mg at night", "Name[Triptafen\u00ae (Goldshield) ] Tablets, pink, s/c, amitriptyline\r\nhydrochloride 25\u00a0mg, perphenazine 2\u00a0mg,\r\nnet price 100-tab pack = \u00a333.13. \r\n Label:\r\n 2Dose\u00a0depression with anxiety, adult over 18 years, 1 tablet 3 times daily; an additional\r\ntablet may be taken at bedtime when required" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk" }, "DUTASTERIDE": { "indications": "Indications\u00a0benign prostatic hyperplasia", "name": "DUTASTERIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "Anti-androgens", "Dutasteride and finasteride", "DUTASTERIDE" ], "cautions": "Cautions\u00a0\n(From Dutasteride and finasteride: British National Formulary)\nCautions\u00a0Dutasteride and finasteride decrease serum concentration of prostate cancer markers such as prostate-specific antigen; reference values may need adjustment. Both dutasteride and finasteride are excreted in semen and use of a condom is recommended if sexual partner is pregnant or likely to become pregnant. Women of childbearing potential should avoid handling crushed or broken tablets of finasteride and leaking capsules of dutasteride.; interactions: Appendix 1 (dutasteride)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127921.htm", "doses": [ "500\u00a0micrograms daily, review treatment at 3\u20136 months and\r\nthen every 6\u201312 months (may require several months treatment before\r\nbenefit is obtained)" ] }, "LEPIRUDIN": { "indications": "Indications\u00a0thromboembolic disease requiring parenteral anticoagulation in patients\r\nwith heparin-induced thrombocytopenia type II", "name": "LEPIRUDIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Hirudins", "LEPIRUDIN" ], "cautions": "Cautions\u00a0recent bleeding or risk of bleeding including recent active peptic ulcer, recent puncture of large vessels, organ\r\nbiopsy, recent major surgery, stroke, bleeding disorders, severe hypertension, bacterial\r\nendocarditis, elderly; concomitant use\r\nof drugs that increase risk of bleeding; determine activated partial thromboplastin time 4 hours after start\r\nof treatment (or after infusion rate altered) and at least once daily\r\nthereafter", "side-effects": "Side-effects\u00a0bleeding, reduced haemoglobin concentration without\r\nobvious source of bleeding; rarely hot flushes, shock,\r\ncough, stridor, dyspnea, fever, chills", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69377.htm", "doses": [ "Initially by slow intravenous injection (of 5\u00a0mg/mL solution), 400\u00a0micrograms/kg followed by continuous\r\nintravenous infusion of 150\u00a0micrograms/kg/hour (max. 16.5\u00a0mg/hour),\r\nadjusted according to activated partial thromboplastin time, for 2\u201310\r\ndays (longer if necessary)" ], "pregnancy": "Pregnancy\u00a0avoid" }, "CEFUROXIME": { "indications": "Indications\u00a0see under Cefaclor; surgical prophylaxis; more active against Haemophilus influenzae; Lyme disease", "name": "CEFUROXIME", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFUROXIME" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3787.htm", "doses": [ "By mouth (as cefuroxime axetil),\r\n250\u00a0mg twice daily in most infections including mild to moderate lower\r\nrespiratory-tract infections (e.g. bronchitis); doubled for more severe\r\nlower respiratory-tract infections or if pneumonia suspected", "Urinary-tract infection, 125\u00a0mg twice daily, doubled in pyelonephritis", "child over 3 months, 125\u00a0mg twice\r\ndaily, if necessary doubled in child over 2 years with otitis media", "Lyme disease (see also section 5.1.1.3), adult and child over 12 years, 500\u00a0mg twice\r\ndaily for 14\u201321 days (for 28 days in Lyme arthritis) [unlicensed duration]", "By intramuscular injection or intravenous injection or infusion, 750\u00a0mg every 6\u20138 hours; 1.5\u00a0g every 6\u20138\r\nhours in severe infections; single doses over 750\u00a0mg intravenous route\r\nonly", "child usual dose 60\u00a0mg/kg daily\r\n(range 30\u2013100\u00a0mg/kg daily) in 3\u20134 divided doses (2\u20133 divided doses\r\nin neonates)", "Surgical prophylaxis, 1.5\u00a0g by intravenous injection up to 30 minutes before the procedure; up to 3 further doses of\r\n750\u00a0mg may be given by intramuscular or intravenous injection every 8 hours for high-risk\r\nprocedures", "Open fractures, prophylaxis (see also Table 2, section 5.1), by intravenous injection or infusion, 1.5\u00a0g every 8 hours until soft-tissue closure (max. duration 72\r\nhours)" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "Capsaicin": { "cautions": "Cautions\u00a0avoid contact with eyes, inflamed or broken skin;\r\nwash hands immediately after use (or wash hands 30 minutes after application\r\nif hands treated); not to be used under tight bandages; avoid hot\r\nshower or bath just before or after application (burning sensation\r\nenhanced); avoid inhalation of vapours", "name": "Capsaicin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.2 Rubefacients, topical NSAIDs, capsaicin, and poultices" ], "side-effects": "Side-effects\u00a0transient burning sensation during initial treatment\r\n(particularly if too much used or if administered less than 3\u20134 times\r\ndaily); rarely cough, sneezing, eye irritation; dyspnoea\r\nand exacerbation of asthma also reported ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5357.htm", "doses": [ "post-herpetic neuralgia (important: after lesions have healed), apply sparingly up to 3\u20134 times daily (not\r\nmore often than every 4 hours)", "Painful diabetic neuropathy, under specialist supervision, apply\r\nsparingly 3\u20134 times daily (not more often than every 4 hours) for\r\n8 weeks then review" ] }, "CEFADROXIL": { "indications": "Indications\u00a0see under Cefaclor; see also notes above", "name": "CEFADROXIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFADROXIL" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129328.htm", "doses": [ "0.5\u20131\u00a0g twice daily; skin, soft-tissue, and uncomplicated\r\nurinary-tract infections, 1\u00a0g daily; child 6\u201318 years, body-weight under 40\u00a0kg, 500\u00a0mg twice daily; body-weight\r\nover 40\u00a0kg, adult dose" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "VERAPAMIL HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0see under Dose and preparations", "name": "VERAPAMIL HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "VERAPAMIL HYDROCHLORIDE", "Modified release" ], "cautions": "Cautions\u00a0first-degree AV block; acute phase of myocardial infarction (avoid if bradycardia, hypotension, left ventricular\r\nfailure); patients taking beta-blockers (important: see below); interactions: Appendix 1 (calcium-channel blockers)Verapamil and beta-blockers\u00a0Verapamil injection should not be given to patients recently treated with\r\nbeta-blockers because of the risk of hypotension and asystole. The\r\nsuggestion that when verapamil injection has been given first, an\r\ninterval of 30 minutes before giving a beta-blocker is sufficient\r\nhas not been confirmed.It may also be hazardous to give verapamil and a beta-blocker\r\ntogether by mouth (should only be contemplated if myocardial function\r\nwell preserved).", "side-effects": "Side-effects\u00a0constipation; less commonly nausea, vomiting,\r\nflushing, headache, dizziness, fatigue, ankle oedema; rarely allergic\r\nreactions (erythema, pruritus, urticaria, angioedema, Stevens-Johnson\r\nsyndrome); myalgia, arthralgia, paraesthesia, erythromelalgia; increased\r\nprolactin concentration; rarely gynaecomastia and gingival hyperplasia\r\nafter long-term treatment; after intravenous administration or high\r\ndoses, hypotension, heart failure, bradycardia, heart block, and asystole; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2705.htm", "doses": [ "By mouth, supraventricular arrhythmias\r\n(but see also Contra-indications), 40\u2013120\u00a0mg 3 times daily", "Angina, 80\u2013120\u00a0mg 3 times daily", "Hypertension, 240\u2013480\u00a0mg daily in 2\u20133 divided doses", "Prophylaxis of cluster headache [unlicensed] (under specialist\r\nsupervision), 240\u2013960\u00a0mg daily in 3\u20134 divided doses", "By slow intravenous injection over\r\n2 minutes (3 minutes in elderly), supraventricular arrhythmias (but\r\nsee also Contra-indications), 5\u201310\u00a0mg (preferably with ECG monitoring);\r\nin paroxysmal tachyarrhythmias a further 5\u00a0mg after 5\u201310 minutes if\r\nrequired", "Name[Half Securon SR\u00ae (Abbott) ] Tablets, m/r, f/c, verapamil hydrochloride\r\n120\u00a0mg, net price 28-tab pack = \u00a37.71. \r\n Label:\r\n 25Dose\u00a0 see Securon SR\u00ae" ], "pregnancy": "Pregnancy\u00a0may reduce uterine blood flow with fetal hypoxia;\r\nmanufacturer advises avoid in first trimester unless absolutely necessary;\r\nmay inhibit labour" }, "DEXAMFETAMINE SULPHATE": { "indications": "Indications\u00a0narcolepsy; refractory attention deficit hyperactivity disorder (under\r\nspecialist supervision)", "name": "DEXAMFETAMINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.4 CNS\r\nstimulants and drugs used for attention deficit hyperactivity disorder", "DEXAMFETAMINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder: British National Formulary)\nDrug treatment of ADHD should be part of a comprehensive treatment programme. The choice of medication should take into consideration co-morbid conditions (such as tic disorders, Tourette syndrome, and epilepsy), the adverse effect profile, potential for drug misuse, and preferences of the patient and carers. Methylphenidate and atomoxetine are used for the management of ADHD; dexamfetamine is an alternative in children who do not respond to these drugs. Before initiation of drug therapy, and every 6 months thereafter, pulse, blood pressure, weight, and height should be measured.The need to continue drug treatment for ADHD should be reviewed at least annually. This may involve suspending treatment.; also anorexia; mild hypertension (contra-indicated if moderate or severe); psychosis or bipolar disorder; monitor\r\nfor aggressive behaviour or hostility during initial treatment; history of epilepsy (discontinue if\r\nseizures occur); tics and Tourette syndrome (use with caution)\u2014discontinue if\r\ntics occur; monitor growth in children (see\r\nalso below); susceptibility to angle-closure glaucoma; avoid abrupt withdrawal; data on safety and efficacy of long-term use not complete; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(sympathomimetics)Special cautions in children\u00a0Monitor height and\r\nweight as growth restriction may occur during prolonged therapy (drug-free\r\nperiods may allow catch-up in growth but withdraw slowly to avoid\r\ninducing depression or renewed hyperactivity)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving); effects of alcohol unpredictable", "side-effects": "Side-effects\u00a0nausea, diarrhoea, dry mouth, abdominal cramps,\r\nanorexia (increased appetite also reported), weight loss, taste disturbance,\r\nischaemic colitis, palpitations, tachycardia, chest pain, hypertension,\r\nhypotension, cardiomyopathy, myocardial infarction, cardiovascular\r\ncollapse, cerebral vasculitis, stroke, headache, restlessness, depression,\r\nhyperreflexia, hyperactivity, impaired concentration, ataxia, anxiety,\r\naggression, dizziness, confusion, sleep disturbances, dysphoria, euphoria,\r\nirritability, nervousness, malaise, obsessive-compulsive behaviour,\r\nparanoia, psychosis, panic attack, tremor, seizures (see also Cautions),\r\nneuroleptic malignant syndrome, anhedonia, growth restriction in children\r\n(see also under Cautions and notes above), pyrexia,\r\nrenal impairment, sexual dysfunction, acidosis, rhabdomyolysis, mydriasis,\r\nvisual disturbances, alopecia, rash, sweating, urticaria; central\r\nstimulants have provoked choreoathetoid movements and dyskinesia,\r\ntics and Tourette syndrome in predisposed individuals (see also Cautions); very rarely angle-closure glaucoma; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3375.htm", "doses": [ "Narcolepsy, initially 10\u00a0mg (elderly 5\u00a0mg) daily in divided doses increased at weekly intervals by 10\u00a0mg\r\n(elderly 5\u00a0mg) daily to a max. of 60\u00a0mg\r\ndaily", "Refractory attention deficit hyperactivity disorder, adult over 18 years [unlicensed use], initially 5\u00a0mg\r\ntwice daily, increased at weekly intervals according to response;\r\nmax. 60\u00a0mg daily; child 6\u201318 years,\r\ninitially 2.5\u00a0mg 2\u20133 times daily, increased if necessary at weekly\r\nintervals by 5\u00a0mg daily, usual max. 1\u00a0mg/kg (up to 20\u00a0mg) daily (40\u00a0mg\r\ndaily has been required in some children)", "Maintenance dose given in 2\u20134 divided doses" ], "pregnancy": "Pregnancy\u00a0avoid (retrospective evidence of uncertain significance\r\nsuggesting possible embryotoxicity)" }, "TERAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS": { "indications": "Indications\u00a0mild to moderate hypertension (see notes\r\nabove); benign prostatic hyperplasia (section 7.4.1)", "name": "TERAZOSIN - ALPHA-ADRENOCEPTOR BLOCKING DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "TERAZOSIN" ], "cautions": "Cautions\u00a0first dose may cause collapse due to\r\nhypotension (within 30\u201390 minutes, therefore should be taken on retiring\r\nto bed) (may also occur with rapid dose increase); cataract surgery\r\n(risk of intra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also reported weight gain, dsypnoea, paraesthesia, nervousness,\r\ndecreased libido, thrombocytopenia, back pain, and pain in extremities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112802.htm", "doses": [ "Hypertension, 1\u00a0mg at bedtime (compliance with bedtime\r\ndose important, see Cautions); dose doubled after 7 days if necessary;\r\nusual maintenance dose 2\u201310\u00a0mg once daily; more than 20\u00a0mg daily rarely\r\nimproves efficacy" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "FLUVOXAMINE MALEATE": { "indications": "Indications\u00a0depressive illness, obsessive-compulsive disorder", "name": "FLUVOXAMINE MALEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.3 Selective serotonin re-uptake inhibitors" ], "cautions": "Cautions\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nDepressive illness in children and adolescentsThe balance of risks and benefits for the treatment of depressive illness in individuals under 18 years is considered unfavourable for the SSRIs citalopram, escitalopram, paroxetine, and sertraline, and for mirtazapine and venlafaxine. Clinical trials have failed to show efficacy and have shown an increase in harmful outcomes. However, it is recognised that specialists may sometimes decide to use these drugs in response to individual clinical need; children and adolescents should be monitored carefully for suicidal behaviour, self-harm or hostility, particularly at the beginning of treatment.Only fluoxetine has been shown in clinical trials to be effective for treating depressive illness in children and adolescents. However, it is possible that, in common with the other SSRIs, it is associated with a small risk of self-harm and suicidal thoughts. Overall, the balance of risks and benefits for fluoxetine in the treatment of depressive illness in individuals under 18 years is considered favourable, but children and adolescents must be carefully monitored as above.", "side-effects": "Side-effects\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nSide-effects\u00a0SSRIs are less sedating and have fewer antimuscarinic and cardiotoxic effects than tricyclic antidepressants (section 4.3.1). Side-effects of the SSRIs include gastro-intestinal effects (dose-related and fairly common\u2014include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea, constipation), anorexia with weight loss (increased appetite and weight gain also reported) and hypersensitivity reactions including rash (consider discontinuation\u2014may be sign of impending serious systemic reaction, possibly associated with vasculitis), urticaria, angioedema, anaphylaxis, arthralgia, myalgia and photosensitivity; other side-effects include dry mouth, nervousness, anxiety, headache, insomnia, tremor, dizziness, asthenia, hallucinations, drowsiness, convulsions (see Cautions above), galactorrhoea, sexual dysfunction, urinary retention, sweating, hypomania or mania (see Cautions above), movement disorders and dyskinesias, visual disturbances, hyponatraemia (see Hyponatraemia and Antidepressant Therapy), and bleeding disorders including ecchymoses and purpura. Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy). Angle-closure glaucoma may very rarely be precipitated by treatment with SSRIs.Overdosage: for advice on overdosage with SSRIs see Emergency Treatment of Poisoning; palpitation, tachycardia, malaise; less commonly postural hypotension, confusion, ataxia; rarely abnormal liver function, usually symptomatic (discontinue\r\ntreatment); also reported paraesthesia, taste disturbance,\r\nneuroleptic malignant syndrome-like event", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3367.htm", "doses": [ "Depression, adult over\r\n18 years, initially 50\u2013100\u00a0mg daily in the evening, increased gradually\r\nif necessary to max. 300\u00a0mg daily (over 150\u00a0mg in divided doses);\r\nusual maintenance dose 100\u00a0mg daily", "Obsessive-compulsive disorder, initially 50\u00a0mg in the evening\r\nincreased gradually if necessary after some weeks to max. 300\u00a0mg daily\r\n(over 150\u00a0mg in divided doses); usual maintenance dose 100\u2013300\u00a0mg\r\ndaily; child over 8 years initially\r\n25\u00a0mg daily increased if necessary in steps of 25\u00a0mg every 4\u20137 days\r\nto max. 200\u00a0mg daily (over 50\u00a0mg in 2 divided doses)", "If no improvement in obsessive-compulsive\r\ndisorder within 10 weeks, treatment should be reconsidered" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.3 Selective serotonin re-uptake inhibitors: British National Formulary)\nPregnancy\u00a0Manufacturers advise that SSRIs should not be used during pregnancy unless the potential benefit outweighs the risk. There is a small increased risk of congenital heart defects when SSRIs are taken during early pregnancy. If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, and persistent pulmonary hypertension in the newborn has been reported; see also individual monographs." }, "NIFEDIPINE": { "indications": "Indications\u00a0prophylaxis of angina; hypertension; Raynaud\u2019s phenomenon; premature\r\nlabour (section 7.1.3)", "name": "NIFEDIPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers", "NIFEDIPINE" ], "cautions": "Cautions\u00a0\n(From 2.6.2 Calcium-channel blockers: British National Formulary)\nNifedipine relaxes vascular smooth muscle and dilates coronary and peripheral arteries. It has more influence on vessels and less on the myocardium than does verapamil, and unlike verapamil has no anti-arrhythmic activity. It rarely precipitates heart failure because any negative inotropic effect is offset by a reduction in left ventricular work. Short-acting formulations of nifedipine are not recommended for angina or long-term management of hypertension; their use may be associated with large variations in blood pressure and reflex tachycardia. Nicardipine has similar effects to those of nifedipine and may produce less reduction of myocardial contractility. Amlodipine and felodipine also resemble nifedipine and nicardipine in their effects and do not reduce myocardial contractility and they do not produce clinical deterioration in heart failure. They have a longer duration of action and can be given once daily. Nifedipine, nicardipine, amlodipine, and felodipine are used for the treatment of angina (section 2.10.1) or hypertension. All are valuable in forms of angina associated with coronary vasospasm. Side-effects associated with vasodilatation such as flushing and headache (which become less obtrusive after a few days), and ankle swelling (which may respond only partially to diuretics) are common. ; also withdraw if ischaemic pain\r\noccurs or existing pain worsens shortly after initiating treatment; poor cardiac reserve; heart failure or significantly impaired left ventricular function\r\n(heart failure deterioration observed); severe hypotension; elderly; diabetes mellitus; acute\r\nporphyria (but \n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(calcium-channel blockers)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbance; hypotension, oedema,\r\nvasodilatation, palpitation; headache, dizziness, lethargy, asthenia; less commonly tachycardia, syncope, chills, nasal congestion,\r\ndyspnoea, anxiety, sleep disturbance, vertigo, migraine, paraesthesia,\r\ntremor, polyuria, dysuria, nocturia, erectile dysfunction, epistaxis,\r\nmyalgia, joint swelling, visual disturbance, sweating, hypersensitivity\r\nreactions (including angioedema, jaundice, pruritus, urticaria, and\r\nrash); rarely anorexia, gum hyperplasia, mood disturbances,\r\nhyperglycaemia, male infertility, purpura, and photosensitivity reactions;\r\nalso reported dysphagia, intestinal obstruction, intestinal ulcer,\r\nbezoar formation (with some modified-release preparations), gynaecomastia,\r\nagranulocytosis, and anaphylaxis; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106042.htm", "doses": [ "See preparations below", "angina prophylaxis (but not recommended, see notes above)\r\nand Raynaud\u2019s phenomenon, initially 5\u00a0mg 3 times daily, adjusted according\r\nto response to 20\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0may inhibit labour; manufacturer advises avoid before\r\nweek 20; risk to fetus should be balanced against risk of uncontrolled\r\nmaternal hypertension; use only if other treatment options are not\r\nindicated or have failed" }, "BEE AND WASP ALLERGEN EXTRACTS": { "indications": "Indications\u00a0hypersensitivity to wasp or bee venom\r\n(see notes above)", "name": "BEE AND WASP ALLERGEN EXTRACTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.2 Allergen immunotherapy", "BEE AND WASP ALLERGEN EXTRACTS" ], "cautions": "Cautions\u00a0\n(From 3.4.2 Allergen immunotherapy: British National Formulary)\nImmunotherapy using allergen vaccines containing house dust mite, animal dander (cat or dog), or extracts of grass and tree pollen can reduce symptoms of asthma and allergic rhinoconjunctivitis. A vaccine containing extracts of wasp and bee venom is used to reduce the risk of severe anaphylaxis and systemic reactions in individuals with hypersensitivity to wasp and bee stings. An oral preparation of grass pollen extract (Grazax\u00ae) is also licensed for grass pollen-induced rhinitis and conjuctivitis. Those requiring immunotherapy must be referred to a hospital specialist for accurate diagnosis, assessment, and treatment.In view of concerns about the safety of desensitising vaccines, it is recommended that they are used by specialists and only for the following indications:seasonal allergic hay fever (caused by pollen) that has not responded to anti-allergic drugs;hypersensitivity to wasp and bee venoms.Desensitising vaccines should generally be avoided or used with particular care in patients with asthma. and consult product literature", "side-effects": "Side-effects\u00a0consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60107.htm", "doses": [ "By subcutaneous injection, consult product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DARBEPOETIN ALFA": { "indications": "Indications\u00a0 see under Dose below", "name": "DARBEPOETIN ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "DARBEPOETIN ALFA" ], "cautions": "Cautions\u00a0see Epoetin", "side-effects": "Side-effects\u00a0see Epoetin; also, oedema,\r\ninjection-site pain; isolated reports of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue therapy)\u2014see also notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106108.htm", "doses": [ "Symptomatic anaemia associated with chronic renal failure\r\nin patients on dialysis (see also MHRA/CHM advice), adult and child over\r\n11 years, by subcutaneous or intravenous injection, initially 450\u00a0nanograms/kg once weekly,\r\nadjusted according to response by approx. 25% at intervals of at least\r\n4 weeks; maintenance dose, given once weekly or once\r\nevery 2 weeks" ], "pregnancy": "Pregnancy\u00a0no evidence of harm in animal studies\u2014manufacturer\r\nadvises caution " }, "13.9 Shampoos and other preparations for scalp and hair conditions Other scalp preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.9 Shampoos and other preparations for scalp and hair conditions", "Other scalp preparations" ], "name": "13.9 Shampoos and other preparations for scalp and hair conditions Other scalp preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6106.htm", "doses": [ "Name[Polytar Plus\u00ae (GSK)] Liquid, tar blend 1%, net price\r\n500\u00a0mL = \u00a33.91Excipients include arachis (peanut) oil, fragrance,\r\nimidurea, polysorbate 80Dose\u00a0scalp disorders including psoriasis, seborrhoea, pruritus,\r\nand dandruff, apply 1\u20132 times weekly" ] }, "BETAMETHASONE ESTERS": { "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "BETAMETHASONE ESTERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "BETAMETHASONE ESTERS" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.; use of more than 100\u00a0g per week\r\nof 0.1% preparation likely to cause adrenal suppression", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5883.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "ETHERIFIED STARCH Hypertonic solution": { "indications": "Indications\u00a0low blood volume", "name": "ETHERIFIED STARCH Hypertonic solution", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "ETHERIFIED STARCH", "Hypertonic solution" ], "cautions": "Cautions\u00a0see notes above; also diabetes", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; also\r\npruritus, raised serum amylase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128330.htm", "doses": [ "See under preparations below", "Name[HyperHAES\u00ae (Fresenius Kabi) ] Intravenous infusion, hydroxyethyl\r\nstarch (weight average molecular weight 200\u00a0000) 6% in sodium chloride\r\nintravenous infusion 7.2%, net price 250-mL bag = \u00a328.00 Cautions\u00a0see notes above; also diabetesDose\u00a0by intravenous injection over 2\u20135 minutes,\r\n4\u00a0mL/kg as a single dose, followed immediately by administration of\r\nappropriate replacement fluids" ] }, "DALTEPARIN SODIUM": { "indications": "Indications\u00a0see notes above and under preparations", "name": "DALTEPARIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Low molecular weight heparins", "DALTEPARIN SODIUM" ], "cautions": "Cautions\u00a0see under Heparin and notes above", "side-effects": "Side-effects\u00a0see under Heparin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2774.htm", "doses": [ "See under preparations below", "prophylaxis of deep-vein thrombosis, in surgical patients, by subcutaneous injection, moderate risk, 2500\u00a0units 1\u20132\r\nhours before surgery then 2500\u00a0units every 24 hours; high risk, 2500\u00a0units\r\n1\u20132 hours before surgery, then 2500\u00a0units 8\u201312 hours later (or 5000\u00a0units on the evening before surgery, then 5000\u00a0units\r\non the following evening), then 5000\u00a0units every 24 hours", "treatment of deep-vein thrombosis and of pulmonary embolism, by subcutaneous injection, 200\u00a0units/kg (max. 18\u00a0000\u00a0units)\r\nas a single daily dose (or 100\u00a0units/kg twice daily\r\nif increased risk of haemorrhage) until adequate oral anticoagulation\r\nestablished", "For monitoring, blood should\r\nbe taken 3\u20134 hours after a dose (recommended plasma concentration\r\nof anti-Factor Xa 0.5\u20131\u00a0unit/mL); monitoring not required for once-daily\r\ntreatment regimen and not generally necessary for twice-daily regimen", "unstable coronary artery disease (including non-ST-segment-elevation\r\nmyocardial infarction), by subcutaneous injection,\r\n120\u00a0units/kg every 12 hours (max. 10\u00a0000\u00a0units twice daily) for up\r\nto 8 days; beyond 8 days (if awaiting angiography or revascularisation)\r\nwomen body-weight less than 80\u00a0kg and men less than 70\u00a0kg, 5000 units\r\nevery 12 hours, women body-weight greater than 80\u00a0kg and men greater\r\nthan 70\u00a0kg, 7500\u00a0units every 12 hours, until day of procedure (max.\r\n45 days)" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; multidose vial contains\r\nbenzyl alcohol\u2014manufacturer advises avoid; see also Pregnancy" }, "CLOMETHIAZOLE": { "indications": "Indications\u00a0see under Dose; alcohol withdrawal (section 4.10.1)", "name": "CLOMETHIAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Clomethiazole" ], "cautions": "Cautions\u00a0cardiac and respiratory\r\ndisease (confusional state may indicate hypoxia), chronic pulmonary insufficiency, sleep\r\napnoea syndrome; history of drug abuse; avoid prolonged use (and abrupt withdrawal thereafter); marked personality disorder; elderly; excessive sedation may occur (particularly with higher\r\ndoses); interactions: Appendix 1 (anxiolytics\r\nand hypnotics)Driving \u00a0Drowsiness may persist the\r\nnext day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0nasal congestion and irritation (increased nasopharyngeal\r\nand bronchial secretions), conjunctival irritation, headache; rarely gastro-intestinal disturbances, paradoxical excitement,\r\nconfusion, dependence, rash, urticaria, bullous eruption, anaphylaxis,\r\nalterations in liver enzymes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3163.htm", "doses": [ "Severe insomnia in the elderly (short-term use), 1\u20132 capsules\r\nat bedtime; child not recommended", "Restlessness and agitation in the elderly, 1 capsule 3 times\r\ndaily", "Alcohol withdrawal (but see section 4.10.1), initially 2\u20134 capsules, if\r\nnecessary repeated after some hours; day 1 (first 24 hours), 9\u201312\r\ncapsules in 3\u20134 divided doses; day 2, 6\u20138 capsules in 3\u20134 divided\r\ndoses; day 3, 4\u20136 capsules in 3\u20134 divided doses; then gradually reduced\r\nover days 4\u20136; total treatment for not more than 9 days" ], "pregnancy": "Pregnancy\u00a0avoid if possible\u2014especially during first and third\r\ntrimesters" }, "KETOTIFEN - SEDATING ANTIHISTAMINES": { "indications": "Indications\u00a0allergic rhinitis", "name": "KETOTIFEN - SEDATING ANTIHISTAMINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; also\r\nexcitation, irritability, nervousness; less commonly cystitis; rarely weight gain; very rarely Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3015.htm", "doses": [ "1\u00a0mg twice daily with food increased if necessary to 2\u00a0mg\r\ntwice daily; initial treatment in readily sedated patients 0.5\u20131\u00a0mg\r\nat night; child 3 years and over, 1\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "DOCETAXEL": { "indications": "Indications\u00a0adjuvant treatment of operable node-positive and operable node-negative\r\nbreast cancer, in combination with doxorubicin and cyclophosphamide;\r\nwith doxorubicin for initial chemotherapy of locally advanced or metastatic\r\nbreast cancer; monotherapy for locally advanced or metastatic breast\r\ncancer where cytotoxic chemotherapy with an anthracycline or an alkylating\r\ndrug has failed; with capecitabine for locally advanced or metastatic\r\nbreast cancer where cytotoxic chemotherapy with an anthracycline has\r\nfailed; with trastuzumab for initial chemotherapy of metastatic breast\r\ncancer which overexpresses human epidermal growth factor-2; locally\r\nadvanced or metastatic non-small cell lung cancer where first-line\r\nchemotherapy has failed; with cisplatin for unresectable, locally\r\nadvanced or metastatic non-small cell lung cancer; with prednisolone\r\nfor hormone-refractory metastatic prostate cancer; with cisplatin\r\nand fluorouracil for initial treatment of metastatic gastric adenocarcinoma,\r\nincluding adenocarcinoma of the gastro-oesophageal junction; with\r\ncisplatin and fluorouracil for induction treatment of locally advanced\r\nsquamous cell carcinoma of the head and neck", "name": "DOCETAXEL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Taxanes", "DOCETAXEL" ], "cautions": "Cautions\u00a0see section 8.1 and notes\r\nabove; avoid in acute porphyria (but\r\nsee section 9.8.2); interactions: Appendix 1\r\n(docetaxel)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213604.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity and reduced fertility in animal studies); manufacturer advises effective contraception\r\nduring and for at least 3 months after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "RIFAMPICIN WITH ISONIAZID": { "indications": "Indications\u00a0tuberculosis, \n(From 5.1.9 Antituberculosis drugs: British National Formulary)\n5.1.9 Antituberculosis drugs; prevention of tuberculosis (Table\r\n2, %s\n(From Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive(1): British National Formulary)\nPrevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive(1))", "name": "RIFAMPICIN WITH ISONIAZID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.9 Antituberculosis drugs", "RIFAMPICIN WITH ISONIAZID" ], "cautions": "Cautions\u00a0see Monitoring in notes above; also\r\nliver function tests and blood counts in hepatic disorders, alcohol dependence, and on prolonged therapy (see also below); slow acetylator status (increased risk of side-effects); epilepsy; history of psychosis; alcohol dependence, malnutrition, diabetes mellitus, HIV\r\ninfection (risk of peripheral neuritis); acute porphyria (section 9.8.2); important: effectiveness of hormonal contraceptives is reduced and alternative\r\nfamily planning advice should be offered (see also section 7.3.1); discolours soft contact lenses; see also notes above; interactions: Appendix 1 (rifamycins, isoniazid)Note\u00a0Increased risk of side-effects\r\nif treatment interrupted and then re-introducedHepatic disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of liver disorder, and\r\nadvised to discontinue treatment and seek immediate medical attention\r\nif symptoms such as persistent nausea, vomiting, malaise, or jaundice\r\ndevelop", "side-effects": "Side-effects\u00a0gastro-intestinal symptoms including anorexia,\r\nnausea, vomiting, constipation, diarrhoea (antibiotic-associated colitis\r\nreported), alterations in liver function, jaundice, hepatitis (especially\r\nover age of 35 years); peripheral neuritis with high doses (pyridoxine\r\nprophylaxis, see notes above), optic neuritis, headache, drowsiness,\r\nconvulsions, psychotic episodes, vertigo; blood disorders (including\r\nleucopenia, haemolytic anaemia, aplastic anaemia, eosinophilia); dry\r\nmouth; flushing, urticaria, rash (including erythema multiforme),\r\npurpura; also reported pancreatitis, oedema, interstitial pneumonitis,\r\npsychoses, hyperreflexia, hyperglycaemia, adrenal insufficiency, gynaecomastia,\r\nmenstrual disturbances, difficulty with micturition, muscular weakness,\r\nmyopathy, systemic lupus erythematosus-like syndrome, pellagra, exfoliative\r\ndermatitis, toxic epidermal necrolysis, Stevens-Johnson syndrome,\r\nand pemphigoid reactions; urine, saliva, and other body secretions\r\ncoloured orange-red; hearing loss and tinnitus (in patients with end\r\nstage renal impairment); those occurring mainly on intermittent therapy\r\ninclude influenza-like symptoms (with chills, fever, dizziness, bone\r\npain), respiratory symptoms (including shortness of breath), collapse\r\nand shock, haemolytic anaemia, thrombocytopenic purpura, disseminated\r\nintravascular coagulation, and acute renal failure; when used with\r\ntyramine or histamine rich foods, tachycardia, palpitation, hypotension,\r\nflushing, headache, dizziness, and sweating also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201688.htm", "doses": [ "See preparations", "adult 50\u00a0kg and over, 2\r\ntablets daily, preferably before breakfast" ], "pregnancy": "Pregnancy\u00a0see Pregnancy; isoniazid\r\nnot known to be harmful, but prophylactic pyridoxine recommended;\r\nmanufacturers advise very high doses of rifampicin teratogenic in animal studies in first trimester; risk of neonatal bleeding\r\nmay be increased by rifampicin in third trimester" }, "CIPROFLOXACIN": { "indications": "Indications\u00a0superficial bacterial infections, \n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials; corneal ulcers", "name": "CIPROFLOXACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials" ], "cautions": "Cautions\u00a0not recommended for children under 1\r\nyear", "side-effects": "Side-effects\u00a0local burning and itching; lid margin crusting;\r\nhyperaemia; taste disturbances; corneal staining, keratitis, lid oedema,\r\nlacrimation, photophobia, corneal infiltrates; nausea and visual disturbances\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23382.htm", "doses": [ "Superficial bacterial infection, see Administration in\r\nnotes above", "Corneal ulcer, apply eye drops throughout\r\nday and night, day 1 apply every 15 minutes for 6 hours then every\r\n30 minutes, day 2 apply every hour, days 3\u201314 apply every 4 hours\r\n(max. duration of treatment 21 days)", "Apply eye ointment throughout day and night;\r\napply 1.25\u00a0cm ointment every 1\u20132 hours for 2 days then every 4 hours\r\nfor next 12 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "RUPATADINE": { "indications": "Indications\u00a0symptomatic relief of allergic rhinitis,\r\nurticaria", "name": "RUPATADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).; also susceptibility to QT-interval prolongation (including cardiac disease and hypokalaemia); elderly", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; also\r\nasthenia; less commonly pyrexia, irritability, increased\r\nappetite, arthralgia, and myalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203879.htm", "doses": [ "adult and child over 12 years, 10\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014limited information\r\navailable; see also notes above" }, "XYLOMETAZOLINE HYDROCHLORIDE": { "indications": "Indications\u00a0nasal congestion", "name": "XYLOMETAZOLINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.2 Topical nasal decongestants", "Sympathomimetics" ], "cautions": "Cautions\u00a0see under Ephedrine Hydrochloride section 3.1.1.2 and notes above; also\r\navoid excessive or prolonged use", "side-effects": "Side-effects\u00a0see under Ephedrine Hydrochloride and notes above; in small\r\nchildren, also restlessness, sleep disturbances, and hallucinations\r\n(discontinue treatment)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5664.htm", "doses": [ "See below" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "MOMETASONE FUROATE - TOPICAL CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "indications": "Indications\u00a0severe inflammatory skin disorders such as eczemas\r\nunresponsive to less potent corticosteroids; psoriasis,\r\n\n(From 13.4 Topical corticosteroids: British National Formulary)\n13.4 Topical corticosteroids", "name": "MOMETASONE FUROATE - TOPICAL CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5927.htm", "doses": [ "Apply thinly once daily (to scalp in case of lotion)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "MOMETASONE FUROATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity." }, "MEPIVACAINE HYDROCHLORIDE With adrenaline": { "indications": "Indications\u00a0infiltration anaesthesia and nerve\r\nblock in dentistry", "name": "MEPIVACAINE HYDROCHLORIDE With adrenaline", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Mepivacaine", "MEPIVACAINE HYDROCHLORIDE", "With adrenaline" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/209343.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "adult and child over 3 years, consult expert dental sources; important: see also Administration", "Name[Scandonest\u00ae 2% Special (Septodont) ] Injection, mepivacaine hydrochloride\r\n20\u00a0mg/mL, adrenaline 1 in 100\u00a0000 (10\u00a0micrograms/mL), net price 2.2-mL\r\ncartridge = 36p Excipients include sulphites" ], "pregnancy": "Pregnancy\u00a0use with caution in early pregnancy" }, "IMATINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nImatinib, a tyrosine kinase inhibitor, is licensed for the treatment of newly diagnosed chronic myeloid leukaemia where bone marrow transplantation is not considered first-line treatment, and for chronic myeloid leukaemia in chronic phase after failure of interferon alfa, or in accelerated phase, or in blast crisis (see NICE guidance below). It is also licensed for the treatment of c-kit (CD117)-positive unresectable or metastatic malignant gastro-intestinal stromal tumours (GIST), and as adjuvant treatment following resection of c-kit (CD117)-positive GIST, in patients at significant risk of relapse. Imatinib is licensed for the treatment of newly diagnosed acute lymphoblastic leukaemia in combination with other chemotherapy, and as monotherapy for relapsed or refractory acute lymphoblastic leukaemia. Imatinib is also licensed for the treatment of unresectable dermatofibrosarcoma protuberans and for patients with recurrent or metastatic dermatofibrosarcoma protuberans who cannot have surgery.Imatinib is also licensed for the treatment of myelodysplastic/myeloproliferative diseases associated with platelet-derived growth factor receptor gene rearrangement and for the treatment of advanced hypereosinophilic syndrome and chronic eosinophilic leukaemia.", "name": "IMATINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors" ], "cautions": "Cautions\u00a0see section 8.1; cardiac disease; monitor for fluid retention; monitor liver\r\nfunction; interactions: Appendix 1\r\n(imatinib)", "side-effects": "Side-effects\u00a0see section 8.1; also abdominal pain, appetite\r\nchanges, constipation, diarrhoea, flatulence, gastro-oesophageal reflux,\r\ntaste disturbance, weight changes, dry mouth; oedema (including pulmonary\r\noedema, pleural effusion, and ascites), flushing, haemorrhage; cough,\r\ndyspnoea; dizziness, headache, insomnia, hypoaesthesia, paraesthesia,\r\nfatigue; influenza-like symptoms; cramps, arthralgia; visual disturbances,\r\nincreased lacrimation, conjunctivitis, dry eyes; epistaxis; dry skin,\r\nsweating, rash, pruritus, photosensitivity; less commonly gastric ulceration, pancreatitis, hepatic dysfunction (rarely hepatic\r\nfailure, hepatic necrosis), dysphagia, heart failure, tachycardia,\r\npalpitation, syncope, hypertension, hypotension, cold extremities,\r\ncough, acute respiratory failure, depression, drowsiness, anxiety,\r\nperipheral neuropathy, tremor, migraine, impaired memory, vertigo,\r\ngynaecomastia, menorrhagia, irregular menstruation, sexual dysfunction,\r\nelectrolyte disturbances, renal failure, urinary frequency, gout,\r\ntinnitus, hearing loss; skin hyperpigmentation; rarely intestinal obstruction, gastro-intestinal perforation, inflammatory\r\nbowel disease, arrhythmia, atrial fibrillation, myocardial infarction,\r\nangina, pulmonary fibrosis, pulmonary hypertension, increased intracranial\r\npressure, convulsions, confusion, haemolytic anaemia, rhabdomyolysis,\r\nmyopathy, aseptic necrosis of bone, cataract, glaucoma, angioedema,\r\nexfoliative dermatitis, and Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106029.htm", "doses": [ "Chronic phase chronic myeloid leukaemia, adult 400\u00a0mg once daily, increased if necessary to\r\nmax. 800\u00a0mg daily (in 2 divided doses); child (chronic and advanced phase) 2\u201318 years 340\u00a0mg/m2 (max.\r\n800\u00a0mg) daily (in 1\u20132 divided doses), increased to 570\u00a0mg/m2 (max. 800\u00a0mg) daily if necessary (consult product literature)", "Accelerated phase and blast crisis chronic myeloid leukaemia, adult 600\u00a0mg once daily, increased if necessary to\r\nmax. 800\u00a0mg daily (in 2 divided doses)", "Acute lymphoblastic leukaemia, adult 600\u00a0mg once daily", "Gastro-intestinal stromal tumours, adult 400\u00a0mg once daily", "Dermatofibrosarcoma protuberans, adult 800\u00a0mg daily in 2 divided doses", "Myelodysplastic/myeloproliferative diseases, adult 400\u00a0mg once daily", "Advanced hypereosinophilic syndrome and chronic eosinophilic\r\nleukaemia, adult 100\u2013400\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk; effective contraception required during treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "APRACLONIDINE": { "indications": "Indications\u00a0control of intra-ocular pressure", "name": "APRACLONIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.2 Ocular diagnostic and peri-operative preparations and photodynamic treatment", "Ocular peri-operative drugs", "APRACLONIDINE" ], "cautions": "Cautions\u00a0history of angina, severe coronary insufficiency, recent\r\nmyocardial infarction, heart failure, cerebrovascular disease, vasovagal attack, chronic renal failure; depression; monitor intra-ocular\r\npressure and visual fields; loss of effect\r\nmay occur over time; suspend treatment\r\nif reduction in vision occurs in end-stage glaucoma; monitor for excessive reduction in intra-ocular pressure following\r\nperi-operative use; interactions: Appendix\r\n1 (apraclonidine)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0dry mouth, taste disturbance; hyperaemia, ocular\r\npruritus, discomfort and lacrimation (withdraw if ocular intolerance\r\nincluding oedema of lids and conjunctiva); headache, asthenia, dry\r\nnose; lid retraction, conjunctival blanching and mydriasis reported\r\nafter peri-operative use; since absorption may follow topical application\r\nsystemic effects (see Clonidine, section 2.5.2) may occur", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5560.htm", "doses": [ "See under preparations below", "control or prevention of postoperative elevation of intra-ocular\r\npressure after anterior segment laser surgery, apply 1 drop 1 hour\r\nbefore laser procedure then 1 drop immediately after completion of\r\nprocedure; child not recommended", "short-term adjunctive treatment of chronic glaucoma in\r\npatients not adequately controlled by another drug (see note below),\r\napply 1 drop 3 times daily usually for max. 1 month; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014toxicity in animal studies" }, "BOTULINUM TOXIN TYPE B": { "indications": "Indications\u00a0spasmodic torticollis (cervical dystonia)\u2014specialist\r\nuse only", "name": "BOTULINUM TOXIN TYPE B", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders", "Torsion dystonias and other involuntary movements" ], "cautions": "Cautions\u00a0history of dysphagia or\r\naspiration; tolerance\r\nmay occur", "side-effects": "Side-effects\u00a0increased electrophysiologic jitter in some distant\r\nmuscles; dry mouth, dyspepsia, dysphagia, worsening torticollis, neck\r\npain, myasthenia, voice changes, taste disturbances, headache, blurred\r\nvision; also reported exaggerated muscle weakness\r\nand aspiration (seek medical attention if swallowing, speech, or respiratory\r\ndisorders)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106097.htm", "doses": [ "By intramuscular injection, initially 5000\u201310\u00a0000\u00a0units\r\ndivided between 2\u20134 most affected muscles; adjust dose and frequency\r\naccording to response; important: not interchangeable\r\nwith other botulinum toxin preparations" ], "pregnancy": "Pregnancy\u00a0low risk of systemic absorption but avoid unless\r\nessential" }, "BOTULINUM TOXIN TYPE A": { "indications": "Indications\u00a0\n(From Torsion dystonias and other involuntary movements: British National Formulary)\nTorsion dystonias and other involuntary movements; preparations\r\nare not interchangeable and should be used under\r\nspecialist supervision", "name": "BOTULINUM TOXIN TYPE A", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders", "Torsion dystonias and other involuntary movements", "BOTULINUM TOXIN TYPE A" ], "cautions": "Cautions\u00a0history of dysphagia or\r\naspiration; chronic\r\nrespiratory disorder; neurological disorders\r\n(can lead to increased sensitivity and exaggerated muscle weakness); excessive weakness or atrophy in target muscleSpecific cautions for blepharospasm or hemifacial spasm\u00a0Caution if risk of angle-closure glaucoma; reduced blinking can lead to corneal exposure, persistent\r\nepithelial defect and corneal ulceration (especially in those with\r\nVIIth nerve disorders)\u2014careful testing\r\nof corneal sensation in previously operated eyes, avoidance of injection in lower lid area to avoid ectropion, and vigorous treatment of epithelial defect needed", "side-effects": "Side-effects\u00a0increased electrophysiologic jitter in some distant\r\nmuscles; misplaced injections may paralyse nearby muscle groups and\r\nexcessive doses may paralyse distant muscles; influenza-like symptoms; rarely arrhythmias, myocardial infarction, seizures, and\r\nantibody formation (substantial deterioration in response); very rarely exaggerated muscle weakness, dysphagia, and\r\naspiration (seek medical attention if swallowing, speech, or respiratory\r\ndisorders)Specific side-effects for blepharospasm or hemifacial spasm\u00a0ptosis; keratitis, lagophthalmos, dry eye, irritation, photophobia,\r\nlacrimation; facial oedema, ecchymosis; less commonly dry mouth, facial weakness (including drooping), dizziness, paraesthesia,\r\nheadache, tiredness, ectropion, entropion, diplopia, visual disturbances,\r\nconjunctivitis, dermatitis; rarely eyelid bruising\r\nand swelling (minimised by applying gentle pressure at injection site\r\nimmediately after injection); very rarely angle-closure\r\nglaucoma, corneal ulceration, corneal epithelial defect, corneal perforationSpecific side-effects in paediatric cerebral palsy\u00a0drowsiness, malaise, abnormal gait, paraesthesia, urinary incontinence,\r\nmyalgia, pain in extremitiesSpecific side-effects for temporary improvement of moderate\r\nto severe wrinkles between the eyebrows\u00a0facial oedema,\r\nheadache; ptosis; less commonly nausea, dry mouth,\r\ndizziness, asthenia, anxiety, paraesthesia, muscle cramp, visual disturbances,\r\ntinnitus, blepharitis, photosensitivity reactions, and dry skinSpecific side-effects in spasmodic torticollis\u00a0dysphagia and pooling of saliva (occurs most frequently after injection\r\ninto sternomastoid muscle), nausea, dry mouth; rhinitis; drowsiness,\r\nheadache, dizziness, malaise, numbness, stiffness, hypertonia, back\r\npain, weakness; less commonly diarrhoea, vomiting,\r\ncolitis, dyspnoea, voice alteration, tremor, skeletal pain, myalgia,\r\ndiplopia, eye pain, ptosis, and sweatingSpecific side-effects in axillary hyperhidrosis\u00a0paraesthesia, pain in extremities, non-axillary sweating, hot flushes,\r\nabnormal skin odour, pruritus, subcutaneous nodule, alopecia; less commonly myalgia and joint painSpecific side-effects in focal upper-limb spasticity associated\r\nwith stroke\u00a0dysphagia; hypertonia, purpura; less\r\ncommonly nausea, dry mouth, cough, haematoma, peripheral\r\noedema, depression, insomnia, vertigo, amnesia, malaise, paraesthesia,\r\ndysaesthesia, headache, pain in extremities, arthralgia, and bursitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23649.htm", "doses": [ "Consult product literature (important: specific to each individual preparation and not interchangeable)" ], "pregnancy": "Pregnancy\u00a0low risk of systemic absorption but avoid unless\r\nessential" }, "ALITRETINOIN": { "indications": "Indications\u00a0severe chronic hand eczema refractory\r\nto potent topical corticosteroids", "name": "ALITRETINOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.1 Preparations for eczema", "Oral retinoid for eczema" ], "cautions": "Cautions\u00a0avoid blood donation during treatment\r\nand for at least 1 month after stopping treatment; monitor serum lipids (more frequently in those with\r\ndiabetes, history of hyperlipidaemia, or risk factors for cardiovascular\r\ndisease)\u2014discontinue if uncontrolled hyperlipidaemia; history of depression; dry eye syndrome; interactions: Appendix 1 (retinoids)Pregnancy prevention\u00a0In women of\r\nchild-bearing potential, exclude pregnancy 1 month before treatment,\r\nup to 3 days before treatment, every month during treatment (unless\r\nthere are compelling reasons to indicate that there is no risk of\r\npregnancy), and 5 weeks after stopping treatment\u2014perform pregnancy\r\ntest in the first 3 days of the menstrual cycle. Women must practise effective contraception for at least 1 month\r\nbefore starting treatment, during treatment, and for at least 1 month\r\nafter stopping treatment. Women should be advised to use at least\r\n1 method of contraception but ideally they should use 2 methods of\r\ncontraception. Oral progestogen-only contraceptives are not considered\r\neffective. Barrier methods should not be used alone but can be used\r\nin conjunction with other contraceptive methods. Each prescription for alitretinoin should be limited to a supply\r\nof up to 30 days\u2019 treatment and dispensed within 7 days of the date\r\nstated on the prescription. Women should\r\nbe advised to discontinue treatment and to seek prompt medical attention\r\nif they become pregnant during treatment or within 1 month of stopping\r\ntreatment", "side-effects": "Side-effects\u00a0raised serum concentration of triglycerides and\r\nof cholesterol (risk of pancreatitis if triglycerides above 9\u00a0mmol/litre),\r\nflushing; headache; changes in thyroid function tests; anaemia; myalgia,\r\nraised creatine kinase, arthralgia; conjunctivitis, dry eyes (may\r\nrespond to lubricating eye ointment or tear replacement therapy)\u2014sometimes\r\ndecreased tolerance to contact lenses, eye irritation; dryness of\r\nskin and lips, cheilitis, erythema, alopecia; less commonly epistaxis, hyperostosis, ankylosing spondylitis, blurred vision,\r\ncataracts, pruritus, and asteototic eczema; rarely benign intracranial hypertension (discontinue if severe headache,\r\nnausea, vomiting, papilloedema, or visual disturbances occur) and\r\nvasculitis; also reported keratitis and impaired night vision", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201617.htm", "doses": [ "adult over 18 years, 30\u00a0mg\r\nonce daily, reduced to 10\u00a0mg once daily if not tolerated; patients\r\nwith diabetes, history of hyperlipidaemia, or risk factors for cardiovascular\r\ndisease, initially 10\u00a0mg once daily, increased if necessary up to\r\nmax. 30\u00a0mg daily", "Duration of treatment 12\u201324 weeks; discontinue\r\nif no response after 12 weeks. Course may be repeated in those who\r\nrelapse. See also Pregnancy Prevention, above" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic; effective contraception must be\r\nused\u2014see Pregnancy Prevention above" }, "RIBAVIRIN": { "indications": "Indications\u00a0severe respiratory syncytial virus bronchiolitis in infants and children;\r\nin combination with peginterferon alfa or interferon alfa for chronic hepatitis C in patients without liver decompensation\r\n(see also section 5.3.3.2)", "name": "RIBAVIRIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.5 Respiratory syncytial virus", "RIBAVIRIN" ], "cautions": "Cautions\u00a0Specific cautions for inhaled treatment\u00a0Maintain standard supportive respiratory and fluid management therapy; monitor electrolytes closely; monitor equipment for precipitation; pregnant\r\nwomen (and those planning pregnancy) should avoid exposure to aerosolSpecific cautions for oral treatment\u00a0Exclude pregnancy before treatment; effective contraception essential\r\nduring treatment and for 4 months after treatment in women and for\r\n7 months after treatment in men; routine\r\nmonthly pregnancy tests recommended; condoms must be\r\nused if partner of male patient is pregnant (ribavirin excreted in semen); cardiac disease (assessment including ECG recommended\r\nbefore and during treatment\u2014discontinue if deterioration); gout; determine full blood\r\ncount, platelets, electrolytes, serum creatinine, liver function tests\r\nand uric acid before starting treatment and then on weeks 2 and 4\r\nof treatment, then as indicated clinically\u2014adjust dose if adverse reactions or laboratory abnormalities develop\r\n(consult product literature); eye examination\r\nrecommended before treatment; eye examination also recommended\r\nduring treatment if pre-existing ophthalmological disorder or if decrease\r\nin vision reported\u2014discontinue treatment if ophthalmological disorder\r\ndeteriorates or if new ophthalmological disorder develops; test thyroid function before treatment and then every\r\n3 months in children; risk of growth retardation\r\nin children, the reversibility of which is uncertain\u2014if possible,\r\nconsider starting treatment after pubertal growth spurtInteractions: Appendix 1 (ribavirin)", "side-effects": "Side-effects\u00a0Specific side-effects for inhaled treatment\u00a0Worsening\r\nrespiration, bacterial pneumonia, and pneumothorax reported; rarely\r\nnon-specific anaemia and haemolysisSpecific side-effects for oral treatment\u00a0Haemolytic\r\nanaemia (anaemia may be improved by epoetin); also (in combination\r\nwith peginterferon alfa or interferon alfa) nausea, vomiting, dyspepsia,\r\n abdominal pain, flatulence, constipation, diarrhoea, colitis, chest\r\npain, palpitation, tachycardia, peripheral oedema, changes in blood\r\npressure, syncope, flushing, cough, dyspnoea, headache, dizziness,\r\nasthenia, impaired concentration and memory, sleep disturbances, abnormal\r\ndreams, anxiety, depression, suicidal ideation (more frequent in children),\r\npsychoses, dysphagia, weight loss, dysphonia, paraesthesia, hypoaesthesia,\r\nataxia, hypertonia, influenza-like symptoms, thyroid disorders, hyperglycaemia,\r\nmenstrual disturbances, breast pain, prostatitis, sexual dysfunction,\r\nmicturition disorders, leucopenia, thrombocytopenia, lymphadenopathy,\r\ndehydration, hypocalcaemia, myalgia, arthralgia, hyperuricaemia, visual\r\ndisturbances, eye pain, dry eyes, hearing impairment, tinnitus, earache,\r\ndry mouth, taste disturbances, mouth ulcers, stomatitis, glossitis,\r\ntooth disorder, gingivitis, alopecia, pruritus, dry skin, rash (including\r\nvery rarely Stevens-Johnson syndrome and toxic epidermal necrolysis),\r\nincreased sweating, psoriasis, photosensitivity, and acne; less commonly pancreatitis, gastro-intestinal bleeding,\r\nand hypertriglyceridaemia; rarely peptic ulcer, arrhythmias,\r\ncardiomyopathy, myocardial infarction, pericarditis, stroke, interstitial\r\npneumonitis, pulmonary embolism, seizures, renal failure, vasculitis,\r\nrheumatoid arthritis, systemic lupus erythematosus, sarcoidosis, optic\r\nneuropathy, and retinal haemorrhage; very rarely aplastic\r\nanaemia and peripheral ischaemia; in children also\r\ngrowth retardation (including decrease in height and weight), pallor,\r\ntachypnoea, hyperkinesia, virilism, and skin discoloration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127964.htm", "doses": [ "See preparations below", "chronic hepatitis C (in combination with interferon alfa\r\nor peginterferon alfa), adult over\r\n18 years, body-weight under 75\u00a0kg, 400\u00a0mg in the morning and 600\u00a0mg\r\nin the evening; body-weight 75\u00a0kg and over, 600\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0avoid; teratogenicity in animal studies;\r\nsee also Cautions above" }, "SALBUTAMOL Oral": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction; premature labour (section 7.1.3)", "name": "SALBUTAMOL Oral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "SALBUTAMOL", "Oral" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also lactic acidosis with high\r\ndoses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2881.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\n4\u00a0mg (elderly and sensitive patients initially 2\u00a0mg) 3\u20134 times daily;\r\nmax. single dose 8\u00a0mg (but unlikely to provide much extra benefit\r\nor to be tolerated); child under 2\r\nyears see BNF for Children; 2\u20136 years 1\u20132\u00a0mg 3\u20134 times daily, 6\u201312 years 2\u00a0mg 3\u20134 times\r\ndaily", "By subcutaneous or intramuscular injection, 500\u00a0micrograms, repeated\r\nevery 4 hours if necessary", "By slow intravenous injection (but\r\nsee also Management of Acute Asthma table), (dilute to a concentration\r\nof 50\u00a0micrograms/mL), 250\u00a0micrograms, repeated if necessary; child under 18 years see BNF for Children", "By intravenous infusion (but see\r\nalso Management of Acute Asthma table), initially 5\u00a0micrograms/minute,\r\nadjusted according to response and heart-rate usually in range 3\u201320\u00a0micrograms/minute,\r\nor more if necessary; child under 18\r\nyears see BNF for Children", "By aerosol inhalation (but see also Management of Acute Asthma table, or Management of Chronic Asthma\r\ntable),\r\n100\u2013200\u00a0micrograms (1\u20132 puffs); for persistent symptoms up to 4 times\r\ndaily; child 100\u00a0micrograms (1 puff),\r\nincreased to 200\u00a0micrograms (2 puffs) if necessary; for persistent\r\nsymptoms up to 4 times daily ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 200\u00a0micrograms\r\n(2 puffs); child 100\u00a0micrograms (1\r\npuff), increased to 200\u00a0micrograms (2 puffs) if necessary", "By inhalation of powder (but see\r\nalso Management of Chronic Asthma\r\ntable),\r\n200\u2013400\u00a0micrograms; for persistent symptoms up to 4 times daily; child over 5 years 200\u00a0micrograms; for persistent\r\nsymptoms up to 4 times daily (for Asmasal Clickhaler\u00ae, Salbulin Novolizer\u00ae, and Ventolin\r\nAccuhaler\u00ae doses, see under preparations) ", "Prophylaxis of allergen- or exercise-induced bronchospasm, 400\u00a0micrograms; child 200\u00a0micrograms", "By inhalation of nebulised solution, adult and child over\r\n5 years 2.5\u20135\u00a0mg, repeated up to 4 times daily or more frequently\r\nin severe cases; child under 5 years\r\n2.5\u00a0mg, repeated up to 4 times daily or more frequently in severe\r\ncases; see also Management of Acute Asthma table and Management of Chronic Asthma\r\ntable", "Name[Salbutamol (Non-proprietary) ] Tablets, salbutamol (as sulphate) 2\u00a0mg, net price 28-tab pack = \u00a320.60; 4\u00a0mg, 28-tab\r\npack = \u00a319.00\nOral solution, salbutamol (as sulphate) 2\u00a0mg/5\u00a0mL, net price 150\u00a0mL = \u00a31.53Brands include Salapin\u00ae (sugar-free)" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "SUGAMMADEX": { "indications": "Indications\u00a0reversal of neuromuscular blockade\r\ninduced by rocuronium or vecuronium", "name": "SUGAMMADEX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.6 Drugs for reversal of neuromuscular blockade", "Other drugs for reversal of neuromuscular blockade", "SUGAMMADEX" ], "cautions": "Cautions\u00a0recurrence of neuromuscular blockade\u2014monitor\r\nrespiratory function until fully recovered; recovery may be delayed in cardiovascular disease and\r\nelderly; pre-existing coagulation disorders or use of anticoagulants (unrelated\r\nto surgery); wait 24 hours before re-administering rocuronium\r\nor vecuronium; interactions: Appendix\r\n1 (sugammadex)", "side-effects": "Side-effects\u00a0taste disturbances; less commonly allergic reactions; bronchospasm also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201175.htm", "doses": [ "Routine reversal of neuromuscular blockade induced by\r\nrocuronium or vecuronium, by intravenous injection, adult over 18 years, 2\u20134\u00a0mg/kg (consult product literature);\r\na further dose of 4\u00a0mg/kg may be required if recurrence of neuromuscular\r\nblockade occurs", "Routine reversal of neuromuscular blockade induced by rocuronium, by intravenous injection, child 2\u201318 years, 2\u00a0mg/kg (consult product literature)", "Immediate reversal of neuromuscular blockade induced by rocuronium, by intravenous injection, adult over 18 years, 16\u00a0mg/kg (consult product literature)" ], "pregnancy": "Pregnancy\u00a0use with caution\u2014no information available" }, "CARBOPROST": { "indications": "Indications\u00a0postpartum\r\nhaemorrhage due to uterine atony in patients unresponsive to ergometrine\r\nand oxytocin", "name": "CARBOPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics" ], "cautions": "Cautions\u00a0history of glaucoma or\r\nraised intra-ocular pressure, asthma, hypertension, hypotension, anaemia, jaundice, diabetes, epilepsy; uterine scars; excessive dosage may cause uterine rupture; interactions: Appendix 1 (prostaglandins)", "side-effects": "Side-effects\u00a0nausea, vomiting and diarrhoea, hyperthermia and\r\nflushing, bronchospasm; less frequent effects include raised blood\r\npressure, dyspnoea, and pulmonary oedema; chills, headache, diaphoresis,\r\ndizziness; cardiovascular collapse also reported; erythema and pain\r\nat injection site reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4485.htm", "doses": [ "By deep intramuscular injection, 250\u00a0micrograms\r\nrepeated if necessary at intervals of not less than 15 minutes; total dose should not exceed 2\u00a0mg (8 doses)" ] }, "MIANSERIN HYDROCHLORIDE": { "indications": "Indications\u00a0depressive illness, particularly where sedation is required", "name": "MIANSERIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.1 Tricyclic and related antidepressant drugs", "Tricyclic-related antidepressants" ], "cautions": "Cautions\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nCautions\u00a0Tricyclic and related antidepressant drugs should be used with caution in patients with cardiovascular disease (see also Contra-indications, below); because of the risk of arrhythmias, patients with concomitant conditions such as hyperthyroidism and phaeochromocytoma should be treated with care. Care is also needed in patients with epilepsy and diabetes.Tricyclic antidepressant drugs have antimuscarinic activity, and therefore caution is needed in patients with prostatic hypertrophy, chronic constipation, increased intra-ocular pressure, urinary retention, or those with a susceptibility to angle-closure glaucoma. Tricyclic and related antidepressant drugs should be used with caution in patients with a significant risk of suicide, or a history of psychosis or bipolar disorder, because antidepressant therapy may aggravate these conditions; treatment should be stopped if the patient enters a manic phase.Elderly patients are particularly susceptible to many of the side-effects of tricyclic antidepressants; low initial doses should be used, with close monitoring, particularly for psychiatric and cardiac side-effects.Blood counts\u00a0A full blood count is recommended every 4 weeks during the first 3 months of treatment;\r\nclinical monitoring should continue subsequently and treatment should be stopped and a full blood count obtained if fever, sore throat, stomatitis, or other signs of infection\r\ndevelop", "side-effects": "Side-effects\u00a0\n(From 4.3.1 Tricyclic and related antidepressant drugs: British National Formulary)\nSide-effects\u00a0Arrhythmias and heart block occasionally follow the use of tricyclic antidepressants, particularly amitriptyline, and may be a factor in the sudden death of patients with cardiac disease; other cardiovascular side-effects include postural hypotension, tachycardia, and ECG changes. The tricyclic-related antidepressant drugs may be associated with a lower risk of cardiotoxicity in overdosage.Central nervous system side-effects are common, particularly in the elderly, and include anxiety, dizziness, agitation, confusion, sleep disturbances, irritability, and paraesthesia; drowsiness is associated with some of the tricyclic antidepressants (see under Choice, below). Convulsions, hallucinations, delusions, mania, and hypomania may occur (see also under Cautions, above), and, rarely, extrapyramidal symptoms including tremor and dysarthria.Antimuscarinic side-effects include dry mouth, blurred vision (very rarely precipitation of angle-closure glaucoma), constipation (rarely leading to paralytic ileus, particularly in the elderly), and urinary retention. Tricyclic-related antidepressant drugs have a lower incidence of antimuscarinic side-effects than older tricyclics.Endocrine effects include breast enlargement, galactorrhoea, and gynaecomastia. Sexual dysfunction may occur. Changes in blood sugar, increased appetite, and weight gain can accompany treatment with tricyclic antidepressant drugs, but anorexia and weight loss are also seen. Hepatic and haematological reactions may occur and have been particularly associated with mianserin. Another side-effect to which the elderly are particularly susceptible is hyponatraemia (see Hyponatraemia and Antidepressant Therapy, section 4.3). Other class side-effects include nausea, vomiting, taste disturbance, tinnitus, rash, urticaria, pruritus, photosensitivity, alopecia, and sweating.The patient should be encouraged to persist with treatment as some tolerance to these side-effects seems to develop. They are reduced if low doses are given initially and then gradually increased, but this must be balanced against the need to obtain a full therapeutic effect as soon as possible. Neuroleptic malignant syndrome (section 4.2.1) may, very rarely, occur in the course of antidepressant drug treatment.Suicidal behaviour has been linked with antidepressants (see Suicidal Behaviour and Antidepressant Therapy).; also\r\njaundice, oedema, blood dyscrasias, arthritis, and arthralgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3333.htm", "doses": [ "adult over 18 years, initially\r\n30\u201340\u00a0mg (elderly 30\u00a0mg) daily in divided doses or as a single dose at bedtime, increased gradually as necessary; usual\r\ndose range 30\u201390\u00a0mg" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ACETAZOLAMIDE": { "indications": "Indications\u00a0reduction of intra-ocular pressure in open-angle glaucoma, secondary\r\nglaucoma, and peri-operatively in angle-closure glaucoma; diuresis\r\n(section 2.2.7); epilepsy", "name": "ACETAZOLAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "ACETAZOLAMIDE" ], "cautions": "Cautions\u00a0not generally recommended for prolonged\r\nuse but if given monitor blood count and plasma-electrolyte\r\nconcentration; pulmonary obstruction and impaired alveolar ventilation (risk of acidosis); elderly; diabetes mellitus; renal calculi; avoid extravasation\r\nat injection site (risk of necrosis); interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also nausea,\r\nvomiting, diarrhoea, taste disturbance, loss of appetite, paraesthesia,\r\nflushing, headache, dizziness, fatigue, irritability, excitement,\r\nataxia, depression, thirst, polyuria, reduced libido; less\r\ncommonly melaena, drowsiness, confusion, hearing disturbances,\r\nfever, glycosuria, metabolic acidosis and electrolyte disturbances\r\non long-term therapy, haematuria, crystalluria, renal and ureteric\r\ncolic, renal lesions or calculi, renal failure, blood disorders, bone\r\nmarrow suppression, rash (including Stevens-Johnson syndrome and toxic\r\nepidermal necrosis); rarely fulminant hepatic necrosis,\r\nhepatitis, cholestatic jaundice, flaccid paralysis, convulsions, photosensitivity; also reported transient myopia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5520.htm", "doses": [ "Glaucoma, by mouth or by intravenous injection, 0.25\u20131\u00a0g daily in divided\r\ndoses", "Epilepsy, by mouth or by intravenous injection, 0.25\u20131\u00a0g daily in divided doses; child 8\u201330\u00a0mg/kg daily, max. 750\u00a0mg daily", "Dose by intramuscular injection, as for intravenous injection but preferably avoided because of\r\nalkalinity" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid, especially in first trimester\r\n(toxicity in animal studies)" }, "FERROUS SULPHATE WITH ASCORBIC ACID": { "indications": "Indications\u00a0prophylaxis and treatment of iron deficiency\r\nanaemia and treatment of concurrent vitamin C deficiency", "name": "FERROUS SULPHATE WITH ASCORBIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "FERROUS SULPHATE WITH ASCORBIC ACID" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron, vitamins)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201565.htm", "doses": [ "adult and child over 12 years, 1 tablet daily before food" ] }, "BENDAMUSTINE HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From 8.1.1 Alkylating drugs: British National Formulary)\nBendamustine given intravenously is licensed for the treatment of chronic lymphocytic leukaemia, non-Hodgkin\u2019s lymphoma, and for the treatment of multiple myeloma.", "name": "BENDAMUSTINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.1 Alkylating drugs" ], "cautions": "Cautions\u00a0see section 8.1; cardiac disorders\u2014monitor\r\nserum potassium and ECG; avoid in acute porphyria (but see section 9.8.2); interactions: see Appendix 1 (bendamustine)", "side-effects": "Side-effects\u00a0see section 8.1; also\r\nanorexia, diarrhoea, constipation, haemorrhage, hypotension, hypertension,\r\npalpitation, angina, arrhythmias, respiratory dysfunction, insomnia,\r\npain, chills, malaise, infection, pyrexia, amenorrhoea, dehydration,\r\nelectrolyte disturbances (including hypokalaemia); less commonly pericardial effusion; rarely acute circulatory\r\nfailure, drowsiness, voice changes, sweating; very rarely taste disturbance, tachycardia, myocardial infarction, cardiac failure,\r\npulmonary fibrosis, paraesthesia, peripheral neuropathy, neurological\r\ndisorders, ataxia, anticholinergic syndrome, encephalitis, phlebitis,\r\nmultiple organ failure, haemolysis; also reported secondary tumours, Stevens-Johnson syndrome, toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/211004.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and mutagenic in animal studies); effective contraception required during treatment in men\r\nor women, and for 6 months after treatment in men; see also Pregnancy and Reproductive\r\nfunction" }, "PIROXICAM ": { "indications": "Indications\u00a0rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis\r\n(see also CHMP advice below)", "name": "PIROXICAM ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs). and CHMP\r\nadvice below", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5255.htm", "doses": [ "By mouth, max. 20\u00a0mg once daily (see\r\nalso CHMP advice below); child 6\u201318\r\nyears, juvenile idiopathic arthritis, see BNF for Children", "The CHMP has recommended restrictions on the use of piroxicam\r\nbecause of the increased risk of gastro-intestinal side effects and\r\nserious skin reactions. The CHMP has advised that:", "piroxicam should be initiated only by physicians\r\nexperienced in treating inflammatory or degenerative rheumatic diseases", "piroxicam should not be used as first-line treatment", "in adults, use of piroxicam should be limited to the symptomatic\r\nrelief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis", "piroxicam dose should not exceed 20\u00a0mg daily", "piroxicam should no longer be used for the treatment of\r\nacute painful and inflammatory conditions", "treatment should be reviewed 2 weeks after\r\ninitiating piroxicam, and periodically thereafter", "concomitant administration of a gastro-protective agent\r\n(section 1.3) should\r\nbe considered", "Topical preparations containing piroxicam\r\nare not affected by these restrictions" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "DARIFENACIN": { "indications": "Indications\u00a0urinary frequency, urgency, and incontinence", "name": "DARIFENACIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also less commonly ulcerative stomatitis, oedema, hypertension,\r\ndyspnoea, cough, rhinitis, weakness, insomnia, impotence, and vaginitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129897.htm", "doses": [ "adult over 18 years, 7.5\u00a0mg\r\nonce daily, increased if necessary after 2 weeks to 15\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "ARTEMETHER WITH LUMEFANTRINE": { "indications": "Indications\u00a0treatment of acute uncomplicated falciparum malaria; treatment of\r\nbenign malaria [unlicensed indication]", "name": "ARTEMETHER WITH LUMEFANTRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Artemether with lumefantrine", "ARTEMETHER WITH LUMEFANTRINE" ], "cautions": "Cautions\u00a0electrolyte disturbances, concomitant use with other drugs known to cause QT-interval\r\nprolongation; monitor patients unable to\r\ntake food (greater risk of recrudescence); avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (artemether with lumefantrine)Driving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving) ", "side-effects": "Side-effects\u00a0abdominal pain, anorexia, diarrhoea, vomiting,\r\nnausea; palpitation, prolonged QT interval; cough; headache, dizziness,\r\nsleep disturbances, asthenia, paraesthesia; arthralgia, myalgia; pruritus,\r\nrash; less commonly ataxia, hypoaesthesia, and clonus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106530.htm", "doses": [ "Treatment of malaria, see notes above" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies with\r\nartemether; manufacturer advises use only if potential benefit outweighs\r\nrisk" }, "GENTAMICIN": { "indications": "Indications\u00a0septicaemia and neonatal sepsis; meningitis and other CNS infections;\r\nbiliary-tract infection, acute pyelonephritis or prostatitis, endocarditis\r\n(\n(From 5.1.4 Aminoglycosides: British National Formulary)\nEndocarditis\u00a0Gentamicin is used in combination with other antibiotics for the treatment of bacterial endocarditis (Table 1, section 5.1). Serum-gentamicin concentration should be determined twice each week (more often in renal impairment). Streptomycin may be used as an alternative in gentamicin-resistant enterococcal endocarditis.); pneumonia\r\nin hospital patients, adjunct in listerial meningitis (Table 1, %s\n(From Central nervous system: British National Formulary)\nCentral nervous system); eye (%s\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials); ear (%s\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "GENTAMICIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "GENTAMICIN" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3833.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate dose and monitor serum-gentamicin concentration\r\nclosely", "Multiple daily dose regimen, by intramuscular or by slow intravenous injection over at least 3 minutes or by intravenous\r\ninfusion, 3\u20135\u00a0mg/kg daily (in divided doses every 8 hours),\r\nsee also notes above; child under 18\r\nyears see BNF for Children", "Endocarditis (in combination with other antibacterials, see\r\nTable 1, section 5.1), adult 1\u00a0mg/kg every 8 hours; child under\r\n18 years see BNF for Children", "Once daily dose regimen (see notes above and also consult local\r\nguidelines), by intravenous infusion, initially 5\u20137\u00a0mg/kg,\r\nthen adjust according to serum-gentamicin concentration; child under 18 years see BNF for Children", "Surgical prophylaxis, adult over\r\n18 years, by slow intravenous injection over at least\r\n3 minutes, 1.5\u00a0mg/kg up to 30 minutes before the procedure (up to\r\n3 further doses of 1.5\u00a0mg/kg may be given every 8 hours for high-risk\r\nprocedures) or (for joint replacement surgery) by intravenous infusion, 5\u00a0mg/kg as a single dose up to 30\r\nminutes before the procedure", "By intrathecal injection, seek specialist advice,\r\n1\u00a0mg daily (increased if necessary to 5\u00a0mg daily); only preservative-free,\r\nintrathecal preparation should be used; child under 18 years see BNF for Children", "For multiple daily dose regimen, one-hour\r\n(\u2018peak\u2019) serum concentration should be 5\u201310\u00a0mg/litre (3\u20135\u00a0mg/litre\r\nfor endocarditis); pre-dose (\u2018trough\u2019) concentration should be less\r\nthan 2\u00a0mg/litre (less than 1\u00a0mg/litre for endocarditis). For once-daily\r\ndose regimen, consult local guidelines on monitoring serum-gentamicin\r\nconcentration" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "CALCIPOTRIOL With betamethasone": { "indications": "Indications\u00a0see under Dose", "name": "CALCIPOTRIOL With betamethasone", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Vitamin D and analogues", "CALCIPOTRIOL", "With betamethasone" ], "cautions": "Cautions\u00a0\n(From Vitamin D and analogues: British National Formulary)\nVitamin D and analogues; avoid use on face; avoid excessive exposure\r\nto sunlight and sunlamps", "side-effects": "Side-effects\u00a0see notes above; also photosensitivity, dry skin; rarely facial or perioral dermatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106478.htm", "doses": [ "Plaque psoriasis, apply ointment once or twice daily;\r\nmax. 100\u00a0g weekly (less with scalp solution, see\r\nbelow); child over 6 years, apply twice\r\ndaily; 6\u201312 years max. 50\u00a0g weekly; over 12 years max. 75\u00a0g weekly", "Patient information leaflet for Dovonex\u00ae ointment advises liberal application (but note\r\nmax. recommended weekly dose, above)", "Scalp psoriasis, apply scalp solution twice daily; max. 60\u00a0mL\r\nweekly (less with ointment, see below); child under 18 years see BNF for Children", "When preparations used together max. total calcipotriol 5\u00a0mg in any one week (e.g. scalp solution\r\n60\u00a0mL with ointment 30\u00a0g or scalp solution 30\u00a0mL\r\nwith ointment 60\u00a0g)", "scalp psoriasis, apply 1\u20134\u00a0g to scalp once daily, shampoo\r\noff after leaving on scalp overnight or during day; usual duration\r\nof therapy 4 weeks; if necessary, treatment may be continued beyond\r\n4 weeks or repeated, on the advice of a specialist; child under 18 years see BNF for Children", "Name[Dovobet\u00ae (LEO) ] Ointment, betamethasone (as dipropionate) 0.05%, calcipotriol (as monohydrate)\r\n50\u00a0micrograms/g, net price 60\u00a0g = \u00a332.99, 120\u00a0g = \u00a361.27. \r\n Label:\r\n 28Excipients include butylated\r\nhydroxytolueneDose\u00a0stable plaque psoriasis, apply once daily to max. 30%\r\nof body surface (max. 15\u00a0g daily) for 4 weeks; if necessary, treatment\r\nmay be continued beyond 4 weeks or repeated, on the advice of a specialist; child under 18 years see BNF for Children\nGel, betamethasone (as dipropionate)\r\n0.05%, calcipotriol (as monohydrate) 50 micrograms/g, net price 60\u00a0g\r\n= \u00a336.50, 2 \u00d7 60\u00a0g = \u00a367.79. \r\n Label:\r\n 28Excipients include butylated hydroxytolueneDose\u00a0scalp psoriasis, apply 1\u20134\u00a0g to scalp once daily, shampoo\r\noff after leaving on scalp overnight or during day; usual duration\r\nof therapy 4 weeks; if necessary, treatment may be continued beyond\r\n4 weeks or repeated, on the advice of a specialist; child under 18 years see BNF for ChildrenMild to moderate plaque psoriasis, apply once daily to max.\r\n30% of body surface (max. 15\u00a0g daily) for 8 weeks; if necessary, treatment\r\nmay be continued beyond 8 weeks or repeated, on the advice of a specialist; child under 18 years see BNF for ChildrenNote\u00a0When different preparations containing calcipotriol\r\nused together, max. total calcipotriol 5\u00a0mg in any one week" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless essential" }, "NORMAL IMMUNOGLOBULIN": { "indications": "Indications\u00a0 \n(From 14.5.1 Normal immunoglobulin: British National Formulary)\n14.5.1 Normal immunoglobulin", "name": "NORMAL IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.1 Normal immunoglobulin", "NORMAL IMMUNOGLOBULIN" ], "cautions": "Cautions\u00a0hypo- or agammaglobulinaemia with or\r\nwithout IgA deficiency; interference with live virus vaccines\u2014\n(From 14.5.1 Normal immunoglobulin: British National Formulary)\nNormal immunoglobulin may interfere with the immune response to live virus vaccines which should therefore only be given at least 3 weeks before or 3 months after an injection of normal immunoglobulin (this does not apply to yellow fever vaccine since normal immunoglobulin does not contain antibody to this virus).Intravenous use\u00a0thrombophilic disorders, or risk factors for arterial or venous thromboembolic\r\nevents; obesity; ensure adequate hydration, renal insufficiency", "side-effects": "Side-effects\u00a0nausea, diarrhoea, chills, fever, headache, dizziness,\r\narthralgia, myalgia, muscle spasms, low back pain; rarely hypotension, anaphylaxis, cutaneous skin reactions, aseptic meningitis,\r\nacute renal failure; also reported with intravenous use, injection site reactions, abdominal pain and distension, blood\r\npressure fluctuations, haemolytic anaemia, thromboembolic events including\r\nmyocardial infarction, stroke, pulmonary embolism, and deep vein thrombosisNote\u00a0Adverse reactions are more likely to occur\r\nin patients receiving normal immunoglobulin for the first time, or\r\nfollowing a prolonged period between treatments, or when a different\r\nbrand of normal immunoglobulin is administered.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128177.htm", "doses": [ "See under preparations", "Antibody titres can vary widely between normal\r\nimmunoglobulin preparations from different manufacturers\u2014formulations\r\nare not interchangeable; patients should be maintained\r\non the same formulation throughout long-term treatment to avoid adverse\r\neffects" ] }, "PHENOXYMETHYLPENICILLIN": { "indications": "Indications\u00a0oral infections (see notes above); tonsillitis, otitis media, erysipelas,\r\ncellulitis; group A streptococcal infection, rheumatic fever and pneumococcal\r\ninfection prophylaxis (Table 2, %s\n(From Table 2. Summary of antibacterial prophylaxis: British National Formulary)\nTable 2. Summary of antibacterial prophylaxis)", "name": "PHENOXYMETHYLPENICILLIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin" ], "cautions": "Cautions\u00a0see under Benzylpenicillin; interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0see under Benzylpenicillin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3710.htm", "doses": [ "500\u00a0mg every 6 hours increased up to 1\u00a0g every 6 hours\r\nin severe infections; child up to 1\r\nyear 62.5\u00a0mg every 6 hours, increased up to 12.5\u00a0mg/kg every 6 hours\r\nin severe infections; 1\u20136 years, 125\u00a0mg every 6 hours, increased up\r\nto 12.5\u00a0mg/kg every 6 hours in severe infections; 6\u201312 years, 250\u00a0mg\r\nevery 6 hours, increased up to 12.5\u00a0mg/kg every 6 hours in severe\r\ninfections", "Phenoxymethylpenicillin doses in the BNF may differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "HYDROXYPROPYL GUAR": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "HYDROXYPROPYL GUAR" ], "indications": "Indications\u00a0dry eye conditions", "name": "HYDROXYPROPYL GUAR", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217867.htm", "doses": [ "Apply as required " ] }, "Nasal staphylococci": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.3 Nasal preparations for infection" ], "name": "Nasal staphylococci", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5678.htm", "doses": [ "for eradication of nasal carriage of staphylococci, apply\r\nto nostrils 4 times daily for 10 days; for preventing nasal carriage\r\nof staphylococci, apply to nostrils twice daily" ] }, "TAFLUPROST": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle\r\nglaucoma; ocular hypertension", "name": "TAFLUPROST", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203885.htm", "doses": [ "Apply once daily, preferably in the evening; child under 18 years, not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "SULFASALAZINE": { "indications": "Indications\u00a0active rheumatoid arthritis;\r\ninflammatory bowel disease, see section 1.5.1 and notes above", "name": "SULFASALAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Sulfasalazine", "SULFASALAZINE" ], "cautions": "Cautions\u00a0see section 1.5.1 and notes aboveBlood disorders\u00a0Patients should be\r\nadvised to report any unexplained bleeding, bruising, purpura, sore\r\nthroat, fever or malaise. A blood count\r\nshould be performed and the drug stopped immediately if there is suspicion\r\nof a blood dyscrasia.", "side-effects": "Side-effects\u00a0see section 1.5.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5309.htm", "doses": [ "By mouth, administered on expert advice,\r\nas enteric-coated tablets, initially 500\u00a0mg daily, increased by 500\u00a0mg\r\nat intervals of 1 week to a max. of 2\u20133\u00a0g daily in divided doses" ], "pregnancy": "Pregnancy\u00a0section 1.5.1" }, "METRONIDAZOLE - METRONIDAZOLE AND TINIDAZOLE": { "indications": "Indications\u00a0anaerobic infections (including dental), see under Dose below; protozoal\r\ninfections (section\r\n5.4.2); Helicobacter pylori eradication (section 1.3); skin (section 13.10.1.2)", "name": "METRONIDAZOLE - METRONIDAZOLE AND TINIDAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.11 Metronidazole and tinidazole", "METRONIDAZOLE" ], "cautions": "Cautions\u00a0disulfiram-like reaction with alcohol; avoid in acute porphyria (section 9.8.2); clinical and laboratory\r\nmonitoring advised if treatment exceeds 10 days; interactions: Appendix 1 (metronidazole)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (including nausea\r\nand vomiting), taste disturbances, furred tongue, oral mucositis,\r\nanorexia; very rarely hepatitis, jaundice, pancreatitis,\r\ndrowsiness, dizziness, headache, ataxia, psychotic disorders, darkening\r\nof urine, thrombocytopenia, pancytopenia, myalgia, arthralgia, visual\r\ndisturbances, rash, pruritus, and erythema multiforme; on prolonged\r\nor intensive therapy peripheral neuropathy, transient epileptiform\r\nseizures, and leucopenia; also reported aseptic meningitis, optic\r\nneuropathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3934.htm", "doses": [ "Anaerobic infections (usually treated for 7 days and for\r\n10\u201314 days in Clostridium difficile infection), by mouth, either 400\u00a0mg every 8 hours or 500\u00a0mg every 8 hours, child 1\u20132 months 7.5\u00a0mg/kg every 12 hours, 2 months\u201312 years 7.5\u00a0mg/kg\r\n(max. 400\u00a0mg) every 8 hours; by rectum, 1\u00a0g every 8\r\nhours for 3 days, then 1\u00a0g every 12 hours, child every 8 hours for 3 days, then every 12 hours, 1 month\u20131 year 125\u00a0mg,\r\n1\u20135 years 250\u00a0mg, 5\u201310 years 500\u00a0mg, over 10 years, adult dose; by intravenous infusion over 20 minutes, 500\u00a0mg every 8 hours; child under 18 years see BNF for Children", "Leg ulcers and pressure sores, by mouth, 400\u00a0mg\r\nevery 8 hours for 7 days", "Bacterial vaginosis, by mouth, 400\u2013500\u00a0mg twice\r\ndaily for 5\u20137 days or 2\u00a0g as a single dose", "Pelvic inflammatory disease (see also Table 1, section 5.1), by mouth, 400\u00a0mg\r\ntwice daily for 14 days; child 12\u201318\r\nyears see BNF for Children", "Acute ulcerative gingivitis, by mouth, 200\u2013250\u00a0mg\r\nevery 8 hours for 3 days; child 1\u20133\r\nyears 50\u00a0mg every 8 hours for 3 days; 3\u20137 years 100\u00a0mg every 12 hours;\r\n7\u201310 years 100\u00a0mg every 8 hours", "Acute oral infections, by mouth, 200\u00a0mg every\r\n8 hours for 3\u20137 days (see also notes above); child 1\u20133 years 50\u00a0mg every 8 hours for 3\u20137 days; 3\u20137 years 100\u00a0mg every\r\n12 hours; 7\u201310 years 100\u00a0mg every 8 hours", "Surgical prophylaxis, by mouth, 400\u2013500\u00a0mg\r\n2 hours before surgery; up to 3 further doses of 400\u2013500\u00a0mg may be\r\ngiven every 8 hours for high-risk procedures; child 1 month\u201318 years see BNF for Children", "By rectum, 1\u00a0g 2 hours before surgery; up to\r\n3 further doses of 1\u00a0g may be given every 8 hours for high-risk procedures; child 5\u201318 years see BNF for Children", "By intravenous infusion (if rectal administration\r\ninappropriate), 500\u00a0mg up to 30 minutes before the procedure; up to\r\n3 further doses of 500\u00a0mg may be given every 8 hours for high-risk\r\nprocedures; child under 18 years see BNF for Children", "Metronidazole doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoidance of high-dose regimens" }, "CLOFAZIMINE": { "indications": "Indications\u00a0leprosy", "name": "CLOFAZIMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.10 Antileprotic drugs" ], "cautions": "Cautions\u00a0may discolour soft contact lenses; avoid if persistent abdominal pain and diarrhoea", "side-effects": "Side-effects\u00a0nausea, vomiting (hospitalise if persistent),\r\nabdominal pain; headache, tiredness; brownish-black discoloration\r\nof lesions and skin including areas exposed to light; reversible hair\r\ndiscoloration; dry skin; red discoloration of faeces, urine and other\r\nbody fluids; also rash, pruritus, photosensitivity, acne-like eruptions,\r\nanorexia, eosinophilic enteropathy, bowel obstruction, dry eyes, dimmed\r\nvision, macular and subepithelial corneal pigmentation; elevation\r\nof blood sugar, weight loss, splenic infarction, lymphadenopathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3928.htm", "doses": [ "Leprosy, see notes above", "Lepromatous lepra reactions, dosage increased to 300\u00a0mg daily\r\nfor max. of 3 months" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "Other preparations for biliary disorders": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.9 Drugs affecting intestinal secretions", "1.9.1 Drugs affecting biliary composition and flow" ], "name": "Other preparations for biliary disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2293.htm", "doses": [ "1\u20132 capsules 3 times daily before food (but see notes\r\nabove)" ] }, "METHOTREXATE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nMethotrexate inhibits the enzyme dihydrofolate reductase, essential for the synthesis of purines and pyrimidines. It is given by mouth, intravenously, intramuscularly, or intrathecally.Methotrexate is used as maintenance therapy for childhood acute lymphoblastic leukaemia. Other uses include choriocarcinoma, non-Hodgkin\u2019s lymphoma, and a number of solid tumours. Intrathecal methotrexate is used in the CNS prophylaxis of childhood acute lymphoblastic leukaemia, and as a therapy for established meningeal cancer or lymphoma.Methotrexate causes myelosuppression, mucositis, and rarely pneumonitis. It is contra-indicated in significant renal impairment because it is excreted primarily by the kidney. It is also contra-indicated in patients with severe hepatic impairment. It should also be avoided in the presence of significant pleural effusion or ascites because it can accumulate in these fluids, and its subsequent return to the circulation may cause myelosuppression. Systemic toxicity may follow intrathecal administration and blood counts should be carefully monitored.Folinic acid (section 8.1) following methotrexate administration helps to prevent methotrexate-induced mucositis or myelosuppression. and under Dose; Crohn\u2019s disease [unlicensed indication] (%s\n(From METHOTREXATE: British National Formulary)\nMETHOTREXATE); rheumatoid arthritis (%s\n(From 10.1.3 Drugs that suppress the rheumatic disease process: British National Formulary)\n10.1.3 Drugs that suppress the rheumatic disease process); psoriasis\r\n(%s\n(From 13.5.2 Preparations for psoriasis: British National Formulary)\n13.5.2 Preparations for psoriasis)", "name": "METHOTREXATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites" ], "cautions": "Cautions\u00a0see section 8.1, notes above and section 10.1.3; interactions: Appendix 1 (methotrexate)", "side-effects": "Side-effects\u00a0see section 8.1, notes above and section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4737.htm", "doses": [ "By mouth, leukaemia in children (maintenance),\r\n15\u00a0mg/m2 weekly in combination with other drugs", "Note that the above dose is a weekly dose.", "By intravenous injection or infusion, or by intra-arterial\r\ninfusion, or by intramuscular injection, or intrathecal administration,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic; fertility may be reduced during\r\ntherapy but this may be reversible); manufacturer advises effective\r\ncontraception during and for at least 3 months after treatment in\r\nmen or women; see also Pregnancy and Reproductive\r\nFunction" }, "FLECAINIDE ACETATE Modified release": { "indications": "Indications\u00a0capsules, tablets, and injection: AV nodal reciprocating\r\ntachycardia, arrhythmias associated with accessory conducting pathways\r\n(e.g. Wolff-Parkinson-White syndrome), disabling symptoms of paroxysmal\r\natrial fibrillation in patients without left ventricular dysfunction\r\n(arrhythmias of recent onset will respond more readily)Immediate-release tablets only: symptomatic\r\nsustained ventricular tachycardia, disabling symptoms of premature\r\nventricular contractions or non-sustained ventricular tachycardia\r\nin patients resistant to or intolerant of other therapyInjection only: ventricular tachyarrhythmias\r\nresistant to other treatment", "name": "FLECAINIDE ACETATE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias", "FLECAINIDE ACETATE", "Modified release" ], "cautions": "Cautions\u00a0patients with pacemakers (especially\r\nthose who may be pacemaker dependent because stimulation threshold\r\nmay rise appreciably); atrial fibrillation\r\nfollowing heart surgery; elderly (accumulation may occur); ECG monitoring and resuscitation\r\nfacilities must be available during intravenous use; interactions: Appendix 1 (flecainide)", "side-effects": "Side-effects\u00a0oedema, pro-arrhythmic effects; dyspnoea; dizziness,\r\nasthenia, fatigue, fever; visual disturbances; rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia,\r\nconvulsions, peripheral neuropathy; also reported gastro-intestinal disturbances, anorexia, hepatic dysfunction, flushing,\r\nsyncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia,\r\nataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal\r\ndeposits, tinnitus, increased antinuclear antibodies, hypersensitivity\r\nreactions (including rash, urticaria, and photosensitivity), increased\r\nsweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200795.htm", "doses": [ "By mouth (initiated under direction\r\nof hospital consultant), ventricular arrhythmias, initially 100\u00a0mg\r\ntwice daily (max. 400\u00a0mg daily usually reserved for rapid control\r\nor in heavily built patients), reduced after 3\u20135 days to the lowest\r\ndose that controls arrhythmia", "Supraventricular arrhythmias, 50\u00a0mg twice daily, increased if\r\nrequired to max. 300\u00a0mg daily", "By slow intravenous injection (in\r\nhospital), 2\u00a0mg/kg over 10\u201330 minutes, max. 150\u00a0mg, with ECG monitoring;\r\nfollowed if required by infusion at a rate of 1.5\u00a0mg/kg/hour\r\nfor 1\u00a0hour, subsequently reduced to 100\u2013250\u00a0micrograms/kg/hour for\r\nup to 24 hours; max. cumulative dose in first 24 hours, 600\u00a0mg; transfer\r\nto oral treatment, as above", "Name[Tambocor\u00ae XL (Meda) ] Capsules, m/r, grey/pink, flecainide\r\nacetate 200\u00a0mg, net price 30-cap pack = \u00a314.77. \r\n Label:\r\n 25Dose\u00a0supraventricular arrhythmias, 200\u00a0mg once dailyNote\u00a0Not to be used to control arrhythmias in\r\nacute situations; patients stabilised on 200\u00a0mg daily immediate-release\r\nflecainide may be transferred to Tambocor\u00ae XL" ], "pregnancy": "Pregnancy\u00a0used in pregnancy to treat maternal and fetal arrhythmias\r\nin specialist centres; toxicity reported in animal studies; infant hyperbilirubinaemia also reported" }, "SODIUM TETRADECYL SULPHATE": { "indications": "Indications\u00a0sclerotherapy of varicose veins", "name": "SODIUM TETRADECYL SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.13 Local sclerosants", "SODIUM TETRADECYL SULPHATE" ], "cautions": "Cautions\u00a0see under Ethanolamine Oleate", "side-effects": "Side-effects\u00a0see under Ethanolamine Oleate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2876.htm", "doses": [ "by slow injection into empty isolated segment of vein,\r\n0.1\u20131\u00a0mL according to site and condition being treated (consult product\r\nliterature)" ] }, "AZATHIOPRINE - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0see under Inflammatory Bowel Disease; autoimmune conditions and\r\nprophylaxis of transplant rejection (section 8.2.1); rheumatoid arthritis (section 10.1.3); severe refractory eczema (section 13.5.3)", "name": "AZATHIOPRINE - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "AZATHIOPRINE" ], "cautions": "Cautions\u00a0section 8.2.1", "side-effects": "Side-effects\u00a0section 8.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201295.htm", "doses": [ "Severe acute Crohn\u2019s disease, maintenance of remission\r\nof Crohn\u2019s disease or ulcerative colitis [unlicensed indications], adult over 18 years, by mouth, 2\u20132.5\u00a0mg/kg\r\ndaily; some patients may respond to lower doses" ], "pregnancy": "Pregnancy\u00a0section 8.2.1" }, "C1-ESTERASE INHIBITOR": { "indications": "Indications\u00a0acute attacks of hereditary angioedema;\r\nprophylaxis prior to surgery or major dental procedures [unlicensed]", "name": "C1-ESTERASE INHIBITOR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Angioedema", "C1-ESTERASE INHIBITOR" ], "cautions": "Cautions\u00a0vaccination against hepatitis A and hepatitis B may be required", "side-effects": "Side-effects\u00a0rarely injection-site reactions,\r\nhypersensitivity reactions (including anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202416.htm", "doses": [ "By slow intravenous injection or intravenous infusion, adult and child 20\u00a0units/kg" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "PALONOSETRON": { "indications": "Indications\u00a0prevention of nausea and vomiting induced\r\nby moderately and severely emetogenic chemotherapy", "name": "PALONOSETRON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "5HT3-receptor antagonists", "PALONOSETRON" ], "cautions": "Cautions\u00a0history of constipation; intestinal obstruction; concomitant\r\nuse of drugs that prolong QT intervalDriving\u00a0Dizziness or drowsiness may\r\naffect performance of skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0diarrhoea, constipation; headache, dizziness; less commonly dyspepsia, abdominal pain, dry mouth, flatulence,\r\nchanges in blood pressure, tachycardia, bradycardia, arrhythmia, myocardial\r\nischaemia, hiccups, drowsiness, asthenia, insomnia, anxiety, euphoria,\r\nparaesthesia, peripheral neuropathy, anorexia, motion sickness, influenza-like\r\nsymptoms, urinary retention, glycosuria, hyperglycaemia, electrolyte\r\ndisturbance, arthralgia, eye irritation, amblyopia, tinnitus, rash,\r\npruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129251.htm", "doses": [ "By intravenous injection (over 30 seconds),\r\n250\u00a0micrograms as a single dose 30 minutes before treatment; child and adolescent under 18 years not recommended" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "GALANTAMINE": { "indications": "Indications\u00a0mild to moderate dementia in Alzheimer\u2019s disease", "name": "GALANTAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.11 Drugs for dementia", "GALANTAMINE" ], "cautions": "Cautions\u00a0cardiac disease (including sick sinus syndrome or other supraventricular\r\nconduction abnormalities, unstable angina, congestive heart failure); electrolyte disturbances; susceptibility\r\nto peptic ulcers; asthma, chronic obstructive pulmonary disease, pulmonary infection; avoid in urinary\r\nretention, gastro-intestinal obstruction, and while recovering\r\nfrom bladder or gastro-intestinal surgery; history of seizures; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0vomiting, nausea, abdominal pain, diarrhoea, dyspepsia,\r\nanorexia, weight loss, bradycardia, hypertension, syncope, hallucination,\r\ndepression, dizziness, tremor, headache, drowsiness, malaise, muscle\r\nspasm, sweating; less commonly taste disturbance,\r\npalpitation, arrhythmias, first-degree AV block, hypotension, flushing,\r\nparaesthesia, dehydration, muscular weakness, blurred vision, tinnitus; rarely hepatitis, exacerbation of Parkinson\u2019s disease, seizures", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89495.htm", "doses": [ "Initially 4\u00a0mg twice daily for 4 weeks increased to 8\u00a0mg\r\ntwice daily for 4 weeks; maintenance 8\u201312\u00a0mg twice daily" ] }, "MEBEVERINE HYDROCHLORIDE Modified release": { "indications": "Indications\u00a0adjunct in gastro-intestinal disorders characterised by smooth muscle\r\nspasm", "name": "MEBEVERINE HYDROCHLORIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Other antispasmodics", "MEBEVERINE HYDROCHLORIDE", "Modified release" ], "side-effects": "Side-effects\u00a0allergic reactions (including rash, urticaria,\r\nangioedema) reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76588.htm", "doses": [ "adult and child over 10 years 135\u2013150\u00a0mg 3 times daily preferably\r\n20 minutes before meals; child under\r\n10 years see BNF for Children", "Name[Colofac\u00ae MR (Abbott Healthcare) ] Capsules, m/r, mebeverine\r\nhydrochloride 200\u00a0mg, net price 60-cap pack = \u00a36.67. \r\n Label:\r\n 25Dose\u00a0irritable bowel syndrome, 1 capsule twice daily; child 12\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturers advise caution" }, "GANIRELIX": { "indications": "Indications\u00a0adjunct in the treatment of female infertility (under specialist\r\nsupervision)", "name": "GANIRELIX", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins" ], "side-effects": "Side-effects\u00a0nausea, headache, malaise, injection-site reactions; very rarely hypersensitivity reactions including rash, facial\r\noedema, and dyspnoea also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89834.htm", "doses": [ "By subcutaneous injection preferably into\r\nthe upper leg (rotate injection sites to prevent lipoatrophy), 250\u00a0micrograms\r\nin the morning (or each afternoon) starting on day 5 or day 6 of ovarian\r\nstimulation with gonadotrophins; continue throughout administration\r\nof gonadotrophins including day of ovulation induction (if administering\r\nin afternoon, give last dose in afternoon before ovulation\r\ninduction)" ], "pregnancy": "Pregnancy\u00a0avoid in confirmed pregnancy\u2014toxicity in animal studies" }, "METHOTREXATE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0see under dose; Crohn\u2019s disease [unlicensed\r\nindication] (section 1.5.3); malignant disease (section 8.1.3); psoriasis (section 13.5.3)", "name": "METHOTREXATE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "METHOTREXATE" ], "cautions": "Cautions\u00a0section 8.1; see Monitoring, Blood Count, Liver\r\nToxicity, and Pulmonary Toxicity below; extreme caution\r\nin blood disorders (avoid if severe); peptic\r\nulceration, ulcerative colitis, diarrhoea and ulcerative\r\nstomatitis (withdraw if stomatitis develops\u2014may be first sign of gastro-intestinal toxicity); risk of accumulation\r\nin pleural effusion or ascites\u2014drain before treatment; acute porphyria (section 9.8.2); interactions: see below and Appendix 1 (methotrexate)MonitoringIn view of reports of blood dyscrasias (including fatalities)\r\nand liver cirrhosis with low-dose methotrexate patients\r\nshould:have full blood count and renal and liver\r\nfunction tests before starting treatment and repeated every 1\u20132 weeks\r\nuntil therapy stabilised, thereafter patients should be monitored\r\nevery 2\u20133 months(1)be advised to report all symptoms and signs\r\nsuggestive of infection, especially sore throatTreatment with folinic acid (as calcium folinate, section 8.1) may be\r\nrequired in acute toxicityBlood count\u00a0Bone marrow suppression can occur\r\nabruptly; factors likely to increase toxicity include advanced age, renal impairment, and concomitant use with another anti-folate drug (e.g. trimethoprim). A clinically significant drop in white cell\r\ncount or platelet count calls for immediate withdrawal of methotrexate and introduction of supportive therapyLiver toxicity\u00a0Liver cirrhosis reported. Treatment\r\nshould not be started or should be discontinued if any abnormality\r\nof liver function tests or liver biopsy is present or develops during\r\ntherapy. Abnormalities can return to normal within 2\r\nweeks after which treatment may be recommenced if judged appropriatePulmonary toxicity\u00a0Pulmonary toxicity\r\nmay be a special problem in rheumatoid arthritis (patient to seek\r\nmedical attention if dyspnoea, cough or fever); monitor\r\nfor symptoms at each visit\u2014discontinue if pneumonitis suspected.Aspirin and other NSAIDs\u00a0If aspirin or other NSAIDs are given concurrently the dose\r\nof methotrexate should be carefully monitored. Patients should be advised to avoid self-medication with over-the-counter aspirin or ibuprofen", "side-effects": "Side-effects\u00a0section 8.1; also anorexia, abdominal discomfort,\r\ndyspepsia, gastro-intestinal ulceration and bleeding, diarrhoea, toxic\r\nmegacolon, hepatotoxicity (see Cautions above); hypotension, pericarditis,\r\npericardial tamponade; pulmonary oedema, pleuritic pain, pulmonary\r\nfibrosis, interstitial pneumonitis (see also Pulmonary Toxicity above);\r\nanaphylactic reactions, urticaria; dizziness, chills, fever, drowsiness,\r\ninsomnia, malaise, headache, mood changes, neurotoxicity, confusion,\r\nparaesthesia; precipitation of diabetes; menstrual disturbances, vaginitis,\r\ncystitis, reduced libido, impotence; blood disorders; haematuria,\r\ndysuria, renal failure; osteoporosis, arthralgia, myalgia, vasculitis;\r\nconjunctivitis, visual disturbance; rash, pruritus, Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis, photosensitivity, changes in\r\nnail and skin pigmentation, telangiectasia, acne, furuncolosis, ecchymosis;\r\ninjection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128179.htm", "doses": [ "Moderate to severe active rheumatoid arthritis, by mouth, adult over 18 years,\r\n7.5\u00a0mg once weekly, adjusted according to response; max. weekly dose\r\n20\u00a0mg", "Severe active rheumatoid arthritis, by subcutaneous or by intramuscular or by intravenous injection, adult over 18 years, 7.5\u00a0mg once weekly, increased according to response\r\nby 2.5\u00a0mg weekly; max. weekly dose 25\u00a0mg", "child under 18 years see BNF for Children", "Note that the above dose is a weekly dose.\r\nTo avoid error with low-dose methotrexate, it is recommended that:", "the patient is carefully advised of the dose and frequency and the reason for taking methotrexate\r\nand any other prescribed medicine (e.g. folic acid);", "only one strength of methotrexate tablet (usually 2.5\r\nmg) is prescribed and dispensed;", "the prescription and the dispensing label clearly show\r\nthe dose and frequency of methotrexate administration;", "the patient is warned to report immediately the onset\r\nof any feature of blood disorders (e.g. sore throat, bruising, and\r\nmouth ulcers), liver toxicity (e.g. nausea, vomiting, abdominal discomfort,\r\nand dark urine), and respiratory effects (e.g. shortness of breath).", "Methotrexate treatment\r\nbooklets should be issued where appropriate, and are available for\r\npurchase from:", "GP practices can obtain supplies through their\r\nPrimary Care Trust (PCT) or Agency stores.", "NHS Hospitals can order supplies from www.nhsforms.co.uk or by emailing nhsforms@mmm.com.", "These booklets include advice for adults taking oral methotrexate\r\nfor inflammatory conditions, and a section for recording results of\r\nblood tests and dosage information." ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic; fertility may be reduced during\r\ntherapy but this may be reversible); effective contraception required\r\nduring and for at least 3 months after treatment in men or women;\r\nsee also section 8.1" }, "BERACTANT": { "indications": "Indications\u00a0treatment of respiratory distress syndrome in preterm neonates over\r\n700\u00a0g; prophylaxis of respiratory distress syndrome in preterm neonates\r\nless than 32 weeks post-menstrual age", "name": "BERACTANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.5 Respiratory stimulants and pulmonary surfactants", "3.5.2 Pulmonary surfactants", "BERACTANT" ], "cautions": "Cautions\u00a0\n(From 3.5.2 Pulmonary surfactants: British National Formulary)\nCautions\u00a0Continuous monitoring is required to avoid hyperoxaemia caused by rapid improvement in arterial oxygen concentration. and consult product literature", "side-effects": "Side-effects\u00a0\n(From 3.5.2 Pulmonary surfactants: British National Formulary)\nSide-effects\u00a0Pulmonary surfactants have been associated rarely with pulmonary haemorrhage and bradycardia; obstruction of the endotracheal tube by mucous secretions and intracranial haemorrhage have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3055.htm", "doses": [ "By endotracheal tube, phospholipid 100\u00a0mg/kg\r\nequivalent to a volume of 4\u00a0mL/kg, preferably within 8 hours of birth\r\n(preferably within 15 minutes of birth for prophylaxis); dose may\r\nbe repeated within 48 hours at intervals of at least 6 hours for up\r\nto 4 doses" ] }, "HYDROXYCARBAMIDE - HYDROXYCARBAMIDE": { "indications": "Indications\u00a0\n(From Hydroxycarbamide: British National Formulary)\nHydroxycarbamide; sickle-cell disease (%s\n(From HYDROXYCARBAMIDE: British National Formulary)\nHYDROXYCARBAMIDE)", "name": "HYDROXYCARBAMIDE - HYDROXYCARBAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Hydroxycarbamide", "HYDROXYCARBAMIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (hydroxycarbamide)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127938.htm", "doses": [ "20\u201330\u00a0mg/kg daily or 80\u00a0mg/kg every third\r\nday" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nmanufacturer advises effective contraception before and during treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "FOSAMPRENAVIR": { "indications": "Indications\u00a0HIV infection in combination with other\r\nantiretroviral drugs", "name": "FOSAMPRENAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; interactions: Appendix 1 (fosamprenavir)Rash\u00a0Rash may occur, usually in the second week\r\nof therapy; discontinue permanently if severe rash with\r\nsystemic or allergic symptoms or, mucosal involvement; if rash mild or moderate, may continue without interruption\u2014usually\r\nresolves within 2 weeks and may respond to antihistamines", "side-effects": "Side-effects\u00a0see notes above; also reported, rash including\r\nrarely Stevens-Johnson syndrome (see also Rash above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128976.htm", "doses": [ "With low-dose ritonavir, 700\u00a0mg twice daily; child 6\u201318 years see BNF for Children", "700\u00a0mg fosamprenavir is equivalent to approx.\r\n600\u00a0mg amprenavir" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies; manufacturer\r\nadvises use only if potential benefit outweighs risk" }, "DULOXETINE - OTHER ANTIDEPRESSANT DRUGS": { "indications": "Indications\u00a0major depressive disorder; generalised\r\nanxiety disorder; diabetic neuropathy (section 6.1.5); stress urinary incontinence\r\n(section 7.4.2)", "name": "DULOXETINE - OTHER ANTIDEPRESSANT DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs" ], "cautions": "Cautions\u00a0section 7.4.2", "side-effects": "Side-effects\u00a0section 7.4.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129245.htm", "doses": [ "Major depression, adult over 18 years, 60\u00a0mg once daily", "Generalised anxiety disorder, adult over 18 years, initially 30\u00a0mg daily, increased if necessary to\r\n60\u00a0mg once daily; max. 120\u00a0mg daily", "Diabetic neuropathy, adult over\r\n18 years, 60\u00a0mg once daily; max. 120\u00a0mg daily in divided doses", "In diabetic neuropathy, discontinue if inadequate\r\nresponse after 2 months; review treatment at least every 3 months" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014use only\r\nif potential benefit outweighs risk; risk of neonatal withdrawal symptoms\r\nif used near term" }, "CIPROFIBRATE": { "indications": "Indications\u00a0hyperlipidaemias of types IIa, IIb, III, and IV in patients who have\r\nnot responded adequately to diet; also see notes above", "name": "CIPROFIBRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Fibrates" ], "cautions": "Cautions\u00a0see under Bezafibrate", "side-effects": "Side-effects\u00a0see under Bezafibrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2847.htm", "doses": [ "100\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014embryotoxicity in animal studies" }, "GLIBENCLAMIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "GLIBENCLAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4168.htm", "doses": [ "Initially 5\u00a0mg daily with or immediately after breakfast,\r\ndose adjusted according to response (elderly avoid, see notes above); max. 15\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "CLONAZEPAM": { "indications": "Indications\u00a0all forms of epilepsy; myoclonus; status epilepticus\r\n(section 4.8.2)", "name": "CLONAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 4.8.1 Control of the epilepsies: British National Formulary)\n4.8.1 Control of the epilepsies; elderly and debilitated patients, respiratory disease, spinal or cerebellar\r\nataxia; history of alcohol or drug abuse, depression\r\nor suicidal ideation; avoid sudden withdrawal; myasthenia gravis (avoid if unstable); acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness, fatigue, dizziness,\r\nmuscle hypotonia, co-ordination disturbances; also poor concentration,\r\nrestlessness, confusion, amnesia, dependence, and withdrawal; salivary\r\nor bronchial hypersecretion in infants and small children; rarely gastro-intestinal symptoms, respiratory depression,\r\nheadache, paradoxical effects including aggression and anxiety, sexual\r\ndysfunction, urinary incontinence, urticaria, pruritus, reversible\r\nhair loss, skin pigmentation changes; dysarthria, and visual disturbances\r\non long-term treatment; blood disorders reported; suicidal ideation; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3607.htm", "doses": [ "1\u00a0mg (elderly 500\u00a0micrograms)\r\ninitially at night for 4 nights, increased according to response over\r\n2\u20134 weeks to usual maintenance dose of 4\u20138\u00a0mg usually at night (may\r\nbe given in 3\u20134 divided doses if necessary); child up to 1 year, initially 250\u00a0micrograms increased as above to usual\r\nmaintenance dose of 0.5\u20131\u00a0mg, 1\u20135 years, initially 250\u00a0micrograms\r\nincreased as above to 1\u20133\u00a0mg, 5\u201312 years, initially 500\u00a0micrograms\r\nincreased as above to 3\u20136\u00a0mg", "Clonazepam doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "DYDROGESTERONE": { "indications": "Indications\u00a0HRT (section 6.4.1.1)", "name": "DYDROGESTERONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens" ], "cautions": "Cautions\u00a0see notes above", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201030.htm", "doses": [ "See under combined preparations (section 6.4.1.1)" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "LOPINAVIR WITH RITONAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral\r\ndrugs", "name": "LOPINAVIR WITH RITONAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; concomitant use with drugs that prolong QT or PR interval; cardiac conduction disorders, structural heart disease; patients at\r\nhigh risk of cardiovascular disease (especially if 10-year cardiovascular\r\nrisk greater than 20%); pancreatitis (see below); monitor liver function before and during\r\ntreatment; interactions: Appendix 1\r\n(lopinavir, ritonavir)Pancreatitis\u00a0Signs and symptoms suggestive of\r\npancreatitis (including raised serum lipase) should be evaluated\u2014discontinue if pancreatitis diagnosed", "side-effects": "Side-effects\u00a0see notes above; also colitis, weight changes,\r\nhypertension, anxiety, neuropathy, sexual dysfunction, amenorrhoea,\r\nmenorrhagia, arthralgia, night sweats; less commonly gastro-intestinal ulcer, rectal bleeding, dry mouth, stomatitis,\r\nmyocardial infarction, AV block, cerebrovascular accident, deep vein\r\nthrombosis, abnormal dreams, convulsions, tremor, nephritis, haematuria,\r\nvisual disturbances, tinnitus, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106116.htm", "doses": [ "See preparations below" ], "pregnancy": "Pregnancy\u00a0avoid oral solution due to high propylene glycol\r\ncontent; use tablets only if potential benefit outweighs risk (toxicity\r\nin animal studies)" }, "METHYLPHENIDATE HYDROCHLORIDE": { "indications": "Indications\u00a0attention deficit hyperactivity disorder (under specialist supervision);\r\nnarcolepsy [unlicensed indication]", "name": "METHYLPHENIDATE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.4 CNS\r\nstimulants and drugs used for attention deficit hyperactivity disorder", "METHYLPHENIDATE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.4 CNS stimulants and drugs used for attention deficit hyperactivity disorder: British National Formulary)\nDrug treatment of ADHD should be part of a comprehensive treatment programme. The choice of medication should take into consideration co-morbid conditions (such as tic disorders, Tourette syndrome, and epilepsy), the adverse effect profile, potential for drug misuse, and preferences of the patient and carers. Methylphenidate and atomoxetine are used for the management of ADHD; dexamfetamine is an alternative in children who do not respond to these drugs. Before initiation of drug therapy, and every 6 months thereafter, pulse, blood pressure, weight, and height should be measured.The need to continue drug treatment for ADHD should be reviewed at least annually. This may involve suspending treatment.; also monitor for psychiatric disorders; anxiety or agitation; tics or a family history of Tourette syndrome; drug or alcohol dependence; epilepsy (discontinue if increased seizure frequency); susceptibility to angle-closure glaucoma; avoid abrupt withdrawal; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0abdominal pain, nausea, vomiting, diarrhoea, dyspepsia,\r\ndry mouth, anorexia, reduced weight gain; tachycardia, palpitation,\r\narrhythmias, changes in blood pressure; cough, nasopharyngitis; tics\r\n(very rarely Tourette syndrome), insomnia, nervousness,\r\nasthenia, depression, irritability, aggression, headache, drowsiness,\r\ndizziness, movement disorders; fever; arthralgia; rash, pruritus,\r\nalopecia; growth restriction; less commonly constipation,\r\ndyspnoea, abnormal dreams, confusion, suicidal ideation, urinary frequency,\r\nhaematuria, muscle cramps, epistaxis; rarely angina,\r\nsweating, and visual disturbances; very rarely hepatic\r\ndysfunction, myocardial infarction, cerebral arteritis, psychosis,\r\nneuroleptic malignant syndrome, tolerance and dependence, blood disorders\r\nincluding leucopenia and thrombocytopenia, angle-closure glaucoma,\r\nexfoliative dermatitis, and erythema multiforme; supraventricular\r\ntachycardia, bradycardia, and convulsions also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31969.htm", "doses": [ "Attention deficit hyperactivity disorder, adult over 18 years [unlicensed use], 5\u00a0mg 2\u20133 times\r\ndaily increased if necessary at weekly intervals according to response,\r\nmax. 100\u00a0mg daily in 2\u20133 divided doses; child 6\u201318 years, initially 5\u00a0mg 1\u20132 times daily, increased if necessary\r\nat weekly intervals by 5\u201310\u00a0mg daily; usual max. 60\u00a0mg daily in 2\u20133\r\ndivided doses but may be increased to 2.1\u00a0mg/kg daily in 2\u20133 divided\r\ndoses (max. 90\u00a0mg daily) under the direction of a specialist; discontinue\r\nif no response after 1 month; child 4\u20136 years see BNF for Children", "If effect wears off in evening (with\r\nrebound hyperactivity) a dose at bedtime may be appropriate (establish\r\nneed with trial bedtime dose)", "Treatment may be started using a modified-release\r\npreparation", "Narcolepsy [unlicensed indication], 10\u201360\u00a0mg (usually 20\u201330\u00a0mg)\r\ndaily in divided doses before meals" ], "pregnancy": "Pregnancy\u00a0limited experience\u2014avoid unless potential benefit\r\noutweighs risk" }, "ADALIMUMAB - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0see under Inflammatory Bowel Disease;\r\nankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis,\r\njuvenile idiopathic arthritis, (section 10.1.3); psoriasis (section 13.5.3)", "name": "ADALIMUMAB - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200265.htm", "doses": [ "By subcutaneous injection, severe active\r\nCrohn\u2019s disease, adult over 18 years,\r\ninitially 80\u00a0mg, then 40\u00a0mg 2 weeks after initial dose or accelerated regimen, initially 160\u00a0mg in 4 divided doses over 1\u20132\r\ndays, then 80\u00a0mg 2 weeks after initial dose; maintenance, 40\u00a0mg on\r\nalternate weeks, increased if necessary to 40\u00a0mg weekly; review treatment\r\nif no response within 12 weeks of initial dose" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "BIPHASIC ISOPHANE INSULIN Highly purified animal": { "indications": "Indications\u00a0diabetes mellitus", "name": "BIPHASIC ISOPHANE INSULIN Highly purified animal", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "Biphasic insulins", "BIPHASIC ISOPHANE INSULIN", "Highly purified animal" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61228.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements", "Name[Hypurin\u00ae Porcine 30/70 Mix (Wockhardt) ] Injection, biphasic isophane insulin (porcine, highly purified),\r\n30% soluble, 70% isophane, 100\u00a0units/mL, net price 10-mL\r\nvial = \u00a316.80; cartridges (for Autopen\u00ae Classic) 5 \u00d7 3\u00a0mL = \u00a325.20Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed; the proportions of\r\nthe two components should be checked carefully (the\r\norder in which the proportions are stated may not be the same in other\r\ncountries)" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES Implants": { "indications": "Indications\u00a0contraception, see also notes above and under\r\npreparations (roles vary according to preparation)", "name": "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES Implants", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.2 Progestogen-only contraceptives", "7.3.2.2 Parenteral progestogen-only contraceptives", "PARENTERAL PROGESTOGEN-ONLY CONTRACEPTIVES", "Implants" ], "cautions": "Cautions\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives and under\r\npreparations; possible risk of breast cancer, \n(From ORAL PROGESTOGEN-ONLY CONTRACEPTIVES: British National Formulary)\nBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women using, or who have recently used, a progestogen-only contraceptive pill; this relative risk may be due to an earlier diagnosis. The most important risk factor appears to be the age at which the contraceptive is stopped rather than the duration of use; the risk disappears gradually during the 10 years after stopping and there is no excess risk by 10 years. A possible small increase in the risk of breast cancer should be weighed against the benefitsoral progestogen-only contraceptives (section 7.3.2.1); history during pregnancy\r\nof pruritus or of deterioration of otosclerosis, disturbances\r\nof lipid metabolism; interactions: \n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\nInteractions\u00a0Effectiveness of parenteral progestogen-only contraceptives is not affected by antibacterials that do not induce liver enzymes. The effectiveness of norethisterone and medroxyprogesterone acetate intramuscular injections is not affected by enzyme-inducing drugs and they may be continued as normal during courses of these drugs. However, effectiveness of the etonogestrel-releasing implant may be reduced by enzyme-inducing drugs and an alternative contraceptive method, unaffected by the interacting drug, is recommended during treatment with the enzyme-inducing drug and for at least 4 weeks after stopping. For a short course of an enzyme-inducing drug, if a change in contraceptive method is undesirable or inappropriate, the implant may be continued in combination with additional contraceptive precautions (e.g. condom) for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping it. and Appendix\r\n1 (progestogens)Counselling\u00a0Full counselling backed\r\nby patient information leaflet required before administration", "side-effects": "Side-effects\u00a0\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives; injection-site\r\nreactionsCervical cancer\u00a0Use of injectable progestogen-only\r\ncontraceptives may be associated with a small increased risk of cervical\r\ncancer, similar to that seen with %s\n(From COMBINED HORMONAL CONTRACEPTIVES: British National Formulary)\nSide-effects\u00a0see notes above; also nausea, vomiting, abdominal cramps, liver impairment, hepatic tumours; fluid retention, thrombosis (more common when factor V Leiden present or in blood groups A, B, and AB; see also notes above), hypertension, changes in lipid metabolism; headache, depression, chorea, nervousness, irritability; changes in libido, breast tenderness, enlargement, and secretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence of withdrawal bleeding, amenorrhoea after discontinuation, changes in vaginal discharge, cervical erosion; contact lenses may irritate, visual disturbances; leg cramps; skin reactions, chloasma, photosensitivity; rarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the risk of having breast cancer diagnosed in women taking the combined oral contraceptive pill; this relative risk may be due to an earlier diagnosis. In users of combined oral contraceptive pills the cancers are more likely to be localised to the breast. The most important factor for diagnosing breast cancer appears to be the age at which the contraceptive is stopped rather than the duration of use; any increase in the rate of diagnosis diminishes gradually during the 10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives for 5 years or longer is associated with a small increased risk of cervical cancer; the risk diminishes after stopping and disappears by about 10 years. The risk of cervical cancer with transdermal patches and vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of breast cancer and cervical cancer should be weighed against the protective effect against cancers of the ovary and endometrium. The risk of cervical cancer with other progestogen-only\r\ncontraceptives is not yet known.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213809.htm", "doses": [ "See under preparations", "Name[Nexplanon\u00ae (Organon) ] Implant, containing etonogestrel\r\n68\u00a0mg in radiopaque flexible rod, net price = \u00a379.46. Counselling,\r\nsee patient information leafletDose\u00a0by subdermal implantation, no hormonal\r\ncontraceptive use in previous month, 1 implant inserted during first\r\n5 days of cycle; postpartum, 1 implant inserted 21\u201328 days after delivery;\r\nin breast-feeding mothers, 1 implant inserted after 28 days postpartum;\r\nabortion or miscarriage in the second trimester, 1 implant inserted\r\n21\u201328 days after abortion or miscarriage; abortion or miscarriage\r\nin first trimester, 1 implant inserted within 5 days; changing from\r\nother hormonal contraceptive, consult product literature; remove implant\r\nwithin 3 years of insertion" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; for Implanon\u00ae or Nexplanon\u00ae if pregnancy occurs remove implant" }, "CABERGOLINE": { "indications": "Indications\u00a0see notes above and under Dose", "name": "CABERGOLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.1 Bromocriptine and other dopaminergic drugs", "CABERGOLINE" ], "cautions": "Cautions\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nCautions\u00a0see notes below; also bromocriptine and cabergoline should be used with caution in patients with a history of peptic ulcer, particularly in acromegalic patients. Treatment should be withdrawn if gastro-intestinal bleeding occurs. In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment). Bromocriptine and cabergoline should be used with caution in patients with Raynaud\u2019s syndrome and cardiovascular disease (see also Contra-indications under Bromocriptine, below). Monitor for fibrotic disease (see Fibrotic Reactions, below). Caution is also advised in patients with a history of serious mental disorders (especially psychotic disorders) and in those with acute porpyhria (see section 9.8.2). Tolerance may be reduced by alcohol.; also monthly pregnancy tests during the amenorrhoeic period; advise non-hormonal contraception if pregnancy not\r\ndesired (see also Pregnancy, below); interactions: Appendix 1 (cabergoline)", "side-effects": "Side-effects\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nSide-effects\u00a0Nausea, constipation, and headache are common side-effects of bromocriptine and cabergoline. Paraesthesia has been reported rarely. Other reported side-effects include hypotension (see also Hypotensive Reactions, below), drowsiness (see also Driving, below), dyskinesia, pathological gambling, increased libido, hypersexuality, leg cramps, allergic skin reactions, alopecia, and peripheral oedema. Bromocriptine and cabergoline have been associated with pleuritis, pleural effusion, cardiac valvulopathy, pericardial effusion, constrictive pericarditis, and retroperitoneal, pleural, and pulmonary fibrosis (see Fibrotic Reactions). ; also\r\ncardiac valvulopathy, dyspepsia, gastritis, epigastric and abdominal\r\npain, angina, syncope, depression, confusion, hallucinations, breast\r\npain; rarely vomiting, palpitation, epistaxis, digital\r\nvasospasm, hot flushes, transient hemianopia, muscle weakness; also reported erythromelalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/21316.htm", "doses": [ "Prevention of lactation (but see notes above and under\r\nContra-indications), during first day postpartum, 1\u00a0mg as a single\r\ndose; suppression of established lactation (but see notes above) 250\u00a0micrograms\r\nevery 12\u00a0hours for 2 days; child under\r\n16 years, not recommended", "Hyperprolactinaemic disorders, 500\u00a0micrograms weekly (as a single\r\ndose or as 2 divided doses on separate days) increased\r\nat monthly intervals in steps of 500\u00a0micrograms until optimal therapeutic\r\nresponse (usually 1\u00a0mg weekly, range 0.25\u20132\u00a0mg weekly) with monthly\r\nmonitoring of serum prolactin levels; reduce initial dose and increase\r\nmore gradually if patient intolerant; over 1\u00a0mg weekly give as divided\r\ndoses; up to 4.5\u00a0mg weekly has been used in hyperprolactinaemic patients; child under 16 years, not recommended", "Parkinson\u2019s disease, section 4.9.1" ], "pregnancy": "Pregnancy\u00a0exclude pregnancy before starting and discontinue\r\n1 month before intended conception (ovulatory cycles persist for 6\r\nmonths)\u2014discontinue if pregnancy occurs during treatment (specialist\r\nadvice needed)" }, "SILVER SULFADIAZINE": { "indications": "Indications\u00a0prophylaxis and treatment of infection in burn\r\nwounds; as an adjunct to short-term treatment of infection in leg\r\nulcers and pressure sores; as an adjunct to prophylaxis of infection\r\nin skin graft donor sites and extensive abrasions; for conservative\r\nmanagement of finger-tip injuries", "name": "SILVER SULFADIAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.1 Antibacterial preparations only used topically", "SILVER SULFADIAZINE" ], "cautions": "Cautions\u00a0G6PD deficiency; may inactivate enzymatic debriding agents\u2014concomitant use may be\r\ninappropriate; for large amounts see also interactions: Appendix 1 (sulfonamides)Large areas\u00a0Plasma-sulfadiazine concentrations may approach therapeutic levels with side-effects and interactions as for sulfonamides (see section 5.1.8) if large areas of skin are treated.\r\nOwing to the association of sulfonamides with severe blood and skin\r\ndisorders, treatment should be stopped immediately if blood disorders\r\nor rashes develop\u2014but leucopenia developing 2\u20133 days after starting\r\ntreatment of burns patients is reported usually to be self-limiting\r\nand silver sulfadiazine need\r\nnot usually be discontinued provided blood counts are monitored carefully\r\nto ensure return to normality within a few days. Argyria\r\nmay also occur if large areas of skin are treated (or if application\r\nis prolonged).", "side-effects": "Side-effects\u00a0allergic reactions including burning, itching\r\nand rashes; argyria reported following prolonged use; leucopenia reported\r\n(monitor blood levels)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6133.htm", "doses": [ "burns, apply daily or more frequently if very exudative;\r\nleg ulcers or pressure sores, apply daily or on alternate days (not\r\nrecommended if ulcer very exudative); finger-tip injuries, apply every\r\n2\u20133 days; consult product literature for details" ], "pregnancy": "Pregnancy\u00a0risk of neonatal haemolysis and methaemoglobinaemia\r\nin third trimester" }, "BACLOFEN": { "indications": "Indications\u00a0chronic severe spasticity resulting\r\nfrom disorders such as multiple sclerosis or traumatic partial section\r\nof spinal cord", "name": "BACLOFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants" ], "cautions": "Cautions\u00a0psychiatric illness, Parkinson\u2019s disease, cerebrovascular disease, elderly; respiratory impairment; epilepsy; history of peptic\r\nulcer (avoid oral route in active peptic\r\nulceration); diabetes; hypertonic bladder sphincter; avoid abrupt\r\nwithdrawal (risk of hyperactive state, may exacerbate\r\nspasticity, and precipitate autonomic dysfunction including hyperthermia,\r\npsychiatric reactions and convulsions, see also under Withdrawal below); interactions: Appendix 1 (muscle relaxants)Withdrawal\u00a0Serious side-effects can occur on abrupt\r\nwithdrawal; to minimise risk, discontinue by gradual dose reduction\r\nover at least 1\u20132 weeks (longer if symptoms occur)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, dry mouth; hypotension,\r\nrespiratory or cardiovascular depression; sedation, drowsiness, confusion,\r\ndizziness, ataxia, hallucinations, nightmares, headache, euphoria,\r\ninsomnia, depression, anxiety, agitation, tremor; seizure; urinary\r\ndisturbances; myalgia; visual disorders; rash, hyperhidrosis; rarely taste disturbances, abdominal pain, changes in hepatic\r\nfunction, paraesthesia, erectile dysfunction, dysarthria; very rarely hypothermia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5335.htm", "doses": [ "By mouth, adult and child over 10 years, initially\r\n5\u00a0mg 3 times daily, gradually increased; usual maintenance dose up\r\nto 60\u00a0mg daily in divided doses (max. 100\u00a0mg daily); child 1\u20132 years, initially 300\u00a0micrograms/kg daily\r\nin 4 divided doses, increased gradually to usual maintenance dose\r\n0.75\u20132\u00a0mg/kg (max. 40\u00a0mg) daily in divided doses (or 10\u201320\u00a0mg daily in divided doses); child 2\u20136 years, initially 300\u00a0micrograms/kg daily in 4 divided doses,\r\nincreased gradually to usual maintenance dose of 0.75\u20132\u00a0mg/kg (max.\r\n40\u00a0mg) daily in divided doses (or 20\u201330\u00a0mg daily\r\nin divided doses); child 6\u20138 years,\r\ninitially 300\u00a0micrograms/kg daily in 4 divided doses, increased gradually\r\nto usual maintenance dose of 0.75\u20132\u00a0mg/kg (max. 40\u00a0mg) daily in divided\r\ndoses (or 30\u201340\u00a0mg daily in divided doses); child 8\u201310 years, initially 300\u00a0micrograms/kg daily\r\nin 4 divided doses, increased gradually to usual maintenance dose\r\nof 0.75\u20132\u00a0mg/kg (max. 60\u00a0mg) daily in divided doses", "Review treatment if no benefit within 6 weeks\r\nof achieving maximum dose", "By intrathecal injection, specialist\r\nuse only, severe chronic spasticity unresponsive to oral antispastic\r\ndrugs (or where side-effects of oral therapy unacceptable) or as alternative to ablative neurosurgical procedures, adult over 18 years, initial test dose 25\u201350\u00a0micrograms over at least 1 minute via catheter or lumbar puncture,\r\nincreased in 25-microgram steps (not more often than every 24 hours)\r\nto max. 100\u00a0micrograms to determine appropriate dose, then\r\ndose-titration phase, most often using infusion pump (implanted\r\ninto chest wall or abdominal wall tissues) to establish maintenance\r\ndose (ranging from 12\u00a0micrograms to 2\u00a0mg daily for spasticity\r\nof spinal origin or 22\u00a0micrograms to 1.4\u00a0mg daily\r\nfor spasticity of cerebral origin) retaining some spasticity to avoid\r\nsensation of paralysis; child 4\u201318\r\nyears (spasticity of cerebral or spinal origin only), initial test dose 25\u201350\u00a0micrograms then titrated as for adult, initial maintenance dose 25\u2013200\u00a0micrograms\r\ndaily, adjusted according to response", "Consult product literature\r\nfor details on test dose and titration\u2014important to monitor patients closely in appropriately equipped and staffed environment\r\nduring screening and immediately after pump implantation. Resuscitation equipment must be available for immediate\r\nuse" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk (toxicity in animal studies)" }, "LIDOCAINE HYDROCHLORIDE With prilocaine": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE With prilocaine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE", "With prilocaine" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6693.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Shorter application time of 15\u201330 minutes\r\nis recommended for children with atopic dermatitis (30 minutes before\r\nremoval of mollusca)", "Name[EMLA\u00ae (AstraZeneca)] Cream, lidocaine 2.5%, prilocaine\r\n2.5%, net price 5-g tube = \u00a31.73; 30-g tube (surgical pack) = \u00a310.25;\r\n5 \u00d7 5-g tube with 12 occlusive dressings (premedication pack) = \u00a39.75Dose\u00a0adult and child over 1 year, anaesthesia before minor skin\r\nprocedures including venepuncture, apply thick layer under occlusive\r\ndressing 1\u20135 hours before procedure (2\u20135 hours before procedures on\r\nlarge areas e.g. split skin grafting); max. 2 doses in 24 hours for child 1\u201312 years; child under 3 months, apply max. 1\u00a0g under occlusive dressing for max.\r\n1 hour before procedure; max. 1 dose in 24 hours, child 3\u201312 months, apply max. 2\u00a0g under occlusive dressing for max. 4\r\nhours before procedure; max. 2 doses in 24 hoursNote\u00a0Shorter application time of 15\u201330 minutes\r\nis recommended for children with atopic dermatitis (30 minutes before\r\nremoval of mollusca)Anaesthesia on genital skin before injection of local\r\nanaesthetics, apply under occlusive dressing for 15 minutes (in adult\r\nmen) and 60 minutes (in adult women)Anaesthesia before surgical treatment of lesions on genital\r\nmucosa in adults, apply up to 10\u00a0g 5\u201310 minutes before procedureAnaesthesia before cervical curettage in adults, administer\r\n10\u00a0g in lateral vaginal fornices for 10 minutesAnaesthesia before mechanical cleansing or debridement\r\nof leg ulcer in adults, apply up to 10\u00a0g for 30\u201360 minutes" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "NAFTIDROFURYL OXALATE": { "indications": "Indications\u00a0see under Dose", "name": "NAFTIDROFURYL OXALATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs", "NAFTIDROFURYL OXALATE" ], "side-effects": "Side-effects\u00a0nausea, epigastric pain, rash, hepatitis, hepatic\r\nfailure", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60478.htm", "doses": [ "Peripheral vascular disease (see notes above), 100\u2013200\u00a0mg\r\n3 times daily", "Cerebral vascular disease, 100\u00a0mg 3 times daily" ] }, "FLUVASTATIN Modified release": { "indications": "Indications\u00a0adjunct to diet in primary hypercholesterolaemia or combined (mixed)\r\nhyperlipidaemia (types IIa and IIb); prevention of coronary events\r\nafter percutaneous coronary intervention", "name": "FLUVASTATIN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Statins", "FLUVASTATIN", "Modified release" ], "cautions": "Cautions\u00a0\n(From Statins: British National Formulary)\nHypothyroidism should be managed adequately before starting treatment with a statin (see Lipid-regulating drugs). Statins should be used with caution in those with a history of liver disease or with a high alcohol intake\u2014see also Hepatic impairment, below. There is little information available on a rational approach to liver-function monitoring; however, a NICE guideline(1) suggests that liver enzymes should be measured before treatment, and repeated within 3 months and at 12 months of starting treatment, unless indicated at other times by signs or symptoms suggestive of hepatotoxicity. Those with serum transaminases that are raised, but less than 3 times the upper limit of the reference range, should not be routinely excluded from statin therapy. Those with serum transaminases of more than 3 times the upper limit of the reference range should discontinue statin therapy. Statins should be used with caution in those with risk factors for myopathy or rhabdomyolysis (see Muscle Effects below); patients should be advised to report unexplained muscle pain. ", "side-effects": "Side-effects\u00a0see notes above; also very rarely vasculitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88747.htm", "doses": [ "Hypercholesterolaemia or combined hyperlipidaemia, initially\r\n20\u201340\u00a0mg daily in the evening, adjusted at intervals of at least 4\r\nweeks; up to 80\u00a0mg daily (given in 2 divided doses) may be required; child under 18 years see BNF for Children", "Following percutaneous coronary intervention, 80\u00a0mg daily", "Name[Lescol\u00ae XL (Novartis) ] Tablets, m/r, yellow, fluvastatin (as sodium salt) 80\u00a0mg, net price 28-tab pack = \u00a319.20. \r\n Label:\r\n 25, counselling, muscle effects,\r\nsee notes aboveDose\u00a080\u00a0mg once daily (dose form not appropriate for initial\r\ndose titration)" ], "pregnancy": "Pregnancy\u00a0\n(From Statins: British National Formulary)\nPregnancy\u00a0Statins should be avoided in pregnancy as congenital anomalies have been reported and the decreased synthesis of cholesterol possibly affects fetal development. Adequate contraception is required during treatment and for 1 month afterwards." }, "OXAZEPAM": { "indications": "Indications\u00a0anxiety (short-term use; see section 4.1)", "name": "OXAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Benzodiazepines", "OXAZEPAM" ], "cautions": "Cautions\u00a0see under Diazepam; short\r\nacting", "side-effects": "Side-effects\u00a0see under Diazepam", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3190.htm", "doses": [ "Anxiety, 15\u201330\u00a0mg (elderly or debilitated 10\u201320\u00a0mg) 3\u20134\r\ntimes daily; child not recommended", "Insomnia associated with anxiety, 15\u201325\u00a0mg (max. 50\u00a0mg) at bedtime; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "CEFACLOR": { "indications": "Indications\u00a0infections due to sensitive Gram-positive and Gram-negative bacteria,\r\nbut \n(From 5.1.2.1 Cephalosporins: British National Formulary)\n5.1.2.1 Cephalosporins", "name": "CEFACLOR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins" ], "cautions": "Cautions\u00a0sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction, see also notes above and Hypersensitivity Reactions); false positive urinary glucose (if\r\ntested for reducing substances) and false\r\npositive Coombs\u2019 test; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0diarrhoea (rarely antibiotic-associated colitis),\r\nnausea and vomiting, abdominal discomfort, headache; allergic reactions\r\nincluding rashes, pruritus, urticaria, serum sickness-like reactions\r\nwith rashes, fever and arthralgia, and anaphylaxis; Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis reported; disturbances in liver\r\nenzymes, transient hepatitis and cholestatic jaundice; other side-effects\r\nreported include eosinophilia and blood disorders (including thrombocytopenia,\r\nleucopenia, agranulocytosis, aplastic anaemia and haemolytic anaemia);\r\nreversible interstitial nephritis, hyperactivity, nervousness, sleep\r\ndisturbances, hallucinations, confusion, hypertonia, and dizziness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3763.htm", "doses": [ "250\u00a0mg every 8 hours, doubled for severe infections; max.\r\n4\u00a0g daily; child over 1 month, 20\u00a0mg/kg\r\ndaily in 3 divided doses, doubled for severe infections,\r\nmax. 1\u00a0g daily; or 1 month\u20131 year, 62.5\u00a0mg every\r\n8 hours; 1\u20135 years, 125\u00a0mg; over 5 years, 250\u00a0mg; doses doubled for\r\nsevere infections" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ETHINYLESTRADIOL": { "indications": "Indications\u00a0\n(From 8.3.1 Oestrogens: British National Formulary)\n8.3.1 Oestrogens; other indications (%s\n(From Ethinylestradiol: British National Formulary)\nEthinylestradiol)", "name": "ETHINYLESTRADIOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.1 Oestrogens", "ETHINYLESTRADIOL" ], "cautions": "Cautions\u00a0see section 6.4.1.1; interactions: Appendix 1 (oestrogens)", "side-effects": "Side-effects\u00a0see section 6.4.1.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100122.htm", "doses": [ "Prostate cancer (palliative), 0.15\u20131.5\u00a0mg daily" ] }, "DOPEXAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0inotropic support and vasodilator in exacerbations of chronic heart\r\nfailure and in heart failure associated with cardiac surgery", "name": "DOPEXAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.1 Inotropic sympathomimetics" ], "cautions": "Cautions\u00a0myocardial infarction, recent angina, hypokalaemia, hyperglycaemia; correct\r\nhypovolaemia before starting and during treatment, monitor blood pressure, pulse, plasma potassium, and blood glucose; hyperthyroidism; avoid abrupt withdrawal; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting; tachycardia, bradycardia, arrhythmias,\r\nangina, myocardial infarction; tremor, headache; dyspnoea; reversible\r\nthrombocytopenia; sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2741.htm", "doses": [ "By intravenous infusion into central or\r\nlarge peripheral vein, 500\u00a0nanograms/kg/minute, may be increased to\r\n1\u00a0microgram/kg/minute and further increased up to 6\u00a0micrograms/kg/minute\r\nin increments of 0.5\u20131\u00a0microgram/kg/minute at intervals of not less\r\nthan 15 minutes" ], "pregnancy": "Pregnancy\u00a0no information available\u2014manufacturer advises avoid" }, "GONADORELIN": { "indications": "Indications\u00a0see preparations below", "name": "GONADORELIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Hypothalamic hormones" ], "cautions": "Cautions\u00a0pituitary adenoma", "side-effects": "Side-effects\u00a0rarely, nausea, headache, abdominal pain, increased\r\nmenstrual bleeding; rarely, hypersensitivity reaction on repeated\r\nadministration of large doses; irritation at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4417.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ETHERIFIED STARCH Tetrastarch": { "indications": "Indications\u00a0low blood volume", "name": "ETHERIFIED STARCH Tetrastarch", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "ETHERIFIED STARCH", "Tetrastarch" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; children", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; also\r\npruritus, raised serum amylase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201288.htm", "doses": [ "See under preparations below", "by intravenous infusion, up to 30\u00a0mL/kg\r\ndaily (see notes above)", "Name[Tetraspan\u00ae (Braun) ] Intravenous infusion, hydroxyethyl\r\nstarch (weight average molecular weight 130 000) 6% in sodium chloride\r\n0.625%, containing Na+ 140\u00a0mmol, K+ 4\u00a0mmol,\r\nMg2+ 1\u00a0mmol, Cl-118\u00a0mmol, Ca2+ 2.5\u00a0mmol,\r\nacetate 24\u00a0mmol, malate 5\u00a0mmol/litre, net price 500-mL bag = \u00a313.50Dose\u00a0by intravenous infusion, up to 50\u00a0mL/kg\r\ndaily (see notes above)\nIntravenous infusion, hydroxyethyl\r\nstarch (weight average molecular weight 130 000) 10% in sodium chloride\r\n0.625%, containing Na+ 140\u00a0mmol, K+4\u00a0mmol, Mg2+ 1\u00a0mmol, Cl- 118\u00a0mmol, Ca2+ 2.5\u00a0mmol,\r\nacetate 24\u00a0mmol, malate 5\u00a0mmol/litre, net price 500-mL bag = \u00a317.50Dose\u00a0by intravenous infusion, up to 30\u00a0mL/kg\r\ndaily (see notes above)" ] }, "NITISINONE": { "indications": "Indications\u00a0hereditary tyrosinaemia type I (specialist\r\nuse only)", "name": "NITISINONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Tyrosinaemia type I", "NITISINONE" ], "cautions": "Cautions\u00a0slit-lamp examination of eyes recommended\r\nbefore treatment; monitor liver function\r\nregularly; monitor platelet and white blood\r\ncell count every 6 months", "side-effects": "Side-effects\u00a0thrombocytopenia, leucopenia, granulocytopenia;\r\nconjunctivitis, photophobia, corneal opacity, keratitis, eye pain; less commonly leucocytosis, blepharitis, pruritus, exfoliative\r\ndermatitis, and erythematous rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130125.htm", "doses": [ "adult and child initially 500\u00a0micrograms/kg twice daily, adjusted\r\naccording to response; max. 2\u00a0mg/kg daily", "Capsules can be opened and the contents suspended\r\nin a small amount of water or formula diet and taken immediately" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "BEXAROTENE": { "indications": "Indications\u00a0skin manifestations of cutaneous T-cell lymphoma refractory to previous\r\nsystemic treatment", "name": "BEXAROTENE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Bexarotene", "BEXAROTENE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; hyperlipidaemia (avoid if uncontrolled), hypothyroidism (avoid if uncontrolled); hypersensitivity to retinoids; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (bexarotene)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106421.htm", "doses": [ "Initially 300\u00a0mg/m2 daily as a single dose\r\nwith a meal; adjust dose according to response" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nduring and for at least 1 month after treatment in men or women; see\r\nalso Pregnancy and Reproductive\r\nFunction" }, "RISPERIDONE": { "indications": "Indications\u00a0schizophrenia and other psychoses\r\nin patients tolerant to risperidone by mouth", "name": "RISPERIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.2 Antipsychotic depot injections" ], "cautions": "Cautions\u00a0see Risperidone (section 4.2.1) and notes above", "side-effects": "Side-effects\u00a0see Risperidone (section 4.2.1) and notes above; also\r\nhypertension; depression, paraesthesia; less commonly apathy, weight loss, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119707.htm", "doses": [ "By deep intramuscular injection into the\r\ndeltoid or gluteal muscle, patients taking oral risperidone up to\r\n4\u00a0mg daily, initially 25\u00a0mg every 2 weeks; patients taking oral risperidone\r\nover 4\u00a0mg daily, initially 37.5\u00a0mg every 2 weeks; dose adjusted at\r\nintervals of at least 4 weeks in steps of 12.5\u00a0mg to max. 50\u00a0mg every\r\n2 weeks; child under 18 years not recommended", "During initiation risperidone by mouth may\r\nneed to be continued for 4\u20136 weeks; risperidone by mouth may also\r\nbe used during dose adjustment of depot injection" ], "pregnancy": "Pregnancy\u00a0see Risperidone (section 4.2.1)" }, "ERTAPENEM": { "indications": "Indications\u00a0abdominal infections; acute gynaecological infections; community-acquired\r\npneumonia; diabetic foot infections of the skin and soft-tissue; prophylaxis\r\nfor colorectal surgery", "name": "ERTAPENEM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.2 Carbapenems" ], "cautions": "Cautions\u00a0sensitivity to beta-lactam antibacterials (avoid if history of immediate hypersensitivity reaction, see Hypersensitivity Reactions); elderly, CNS disorders\u2014risk of seizures; interactions: Appendix 1 (ertapenem)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, headache, injection-site\r\nreactions, rash (also reported with eosinophilia and systemic symptoms),\r\npruritus, raised platelet count; less commonly dry\r\nmouth, taste disturbances, dyspepsia, abdominal pain, anorexia, constipation,\r\nmelaena, antibiotic-associated colitis, bradycardia, hypotension,\r\nchest pain, oedema, pharyngeal discomfort, dyspnoea, dizziness, sleep\r\ndisturbances, confusion, asthenia, seizures, raised glucose, petechiae; rarely dysphagia, cholecystitis, liver disorder (including\r\njaundice), arrhythmia, increase in blood pressure, syncope, nasal\r\ncongestion, cough, wheezing, anxiety, depression, agitation, tremor,\r\npelvic peritonitis, renal impairment, muscle cramp, scleral disorder,\r\nblood disorders (including neutropenia, thrombocytopenia, haemorrhage),\r\nhypoglycaemia, electrolyte disturbances; also reported hallucinations,\r\ndyskinesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119728.htm", "doses": [ "By intravenous infusion, adult and adolescent over 13 years, 1\u00a0g once daily; child 3 months\u201313 years, 15\u00a0mg/kg every 12 hours (max. 1\u00a0g daily)", "Surgical prophylaxis, colorectal surgery, adult over 18 years, 1\u00a0g completed within 1 hour before surgery" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "EPHEDRINE HYDROCHLORIDE - VASOCONSTRICTOR SYMPATHOMIMETICS": { "indications": "Indications\u00a0see under Dose", "name": "EPHEDRINE HYDROCHLORIDE - VASOCONSTRICTOR SYMPATHOMIMETICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.7 Sympathomimetics", "2.7.2 Vasoconstrictor sympathomimetics", "EPHEDRINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0hyperthyroidism, diabetes mellitus, ischaemic heart disease, hypertension, susceptibility\r\nto angle-closure glaucoma, elderly; may cause acute urine retention in prostatic hypertrophy; interactions: Appendix 1 (sympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, anorexia; tachycardia (sometimes\r\nbradycardia), arrhythmias, anginal pain, vasoconstriction with hypertension,\r\nvasodilation with hypotension, dizziness and flushing; dyspnoea; headache,\r\nanxiety, restlessness, confusion, psychoses, insomnia, tremor; difficulty\r\nin micturition, urine retention; sweating, hypersalivation; changes\r\nin blood-glucose concentration; very rarely angle-closure glaucoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2751.htm", "doses": [ "Reversal of hypotension from spinal or epidural anaesthesia, by slow intravenous injection of a solution containing ephedrine hydrochloride 3\u00a0mg/mL, 3\u20136\u00a0mg (max. 9\u00a0mg) repeated\r\nevery 3\u20134 minutes according to response to max. 30\u00a0mg" ], "pregnancy": "Pregnancy\u00a0increased fetal heart rate reported with parenteral\r\nephedrine" }, "ANAKINRA": { "indications": "Indications\u00a0see under Cytokine Modulators above", "name": "ANAKINRA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection; history of asthma (risk of serious infection); interactions: Appendix 1 (anakinra) Blood disorders\u00a0Neutropenia reported commonly. Monitor neutrophil count before treatment, then every month for 6\r\nmonths, then every 3 months\u2014discontinue\r\nif neutropenia develops. Patients should\r\nbe instructed to seek medical advice if symptoms suggestive of neutropenia\r\n(such as fever, sore throat, infection) develop", "side-effects": "Side-effects\u00a0injection-site reactions; headache; infections,\r\nneutropenia (see also Cautions), and antibody formation; also\r\nreported malignancy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128232.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 100\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; effective contraception\r\nmust be used during treatment" }, "ARACHIS OIL": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.3 Faecal softeners", "ARACHIS OIL" ], "indications": "Indications\u00a0see notes above", "name": "ARACHIS OIL", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201285.htm", "doses": [ "See below", "to soften impacted faeces, 130\u00a0mL; the enema should be\r\nwarmed before use; child (but see section\r\n1.6) under 3 years not recommended; over 3 years reduce adult\r\ndose in proportion to body-weight (medical supervision only), see BNF for Children" ] }, "DAUNORUBICIN Lipid formulation": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nDaunorubicin also has general properties similar to those of doxorubicin. It should be given by intravenous infusion and is indicated for acute leukaemias. A liposomal formulation for intravenous use is licensed for AIDS-related Kaposi\u2019s sarcoma.", "name": "DAUNORUBICIN Lipid formulation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "DAUNORUBICIN", "Lipid formulation" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37026.htm", "doses": [ "See Doses", "Name[DaunoXome\u00ae (Gilead) ] Concentrate for intravenous infusion, daunorubicin encapsulated in liposomes. For\r\ndilution before use, net price 50-mg vial = \u00a3137.67For advanced AIDS-related Kaposi\u2019s sarcoma" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and carcinogenic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "ZINC SULPHATE": { "indications": "Indications\u00a0zinc deficiency or supplementation in zinc-losing\r\nconditions", "name": "ZINC SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.4 Zinc", "ZINC SULPHATE" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (zinc)", "side-effects": "Side-effects\u00a0abdominal pain, dyspepsia, nausea, vomiting, diarrhoea,\r\ngastric irritation; irritability, headache, lethargy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5085.htm", "doses": [ "See preparation below and notes above", "adult and child over 30\u00a0kg, 1 tablet in water 1\u20133 times daily\r\nafter food; child under 10\u00a0kg, \u00bd tablet\r\ndaily; 10\u201330\u00a0kg, \u00bd tablet 1\u20133 times daily" ], "pregnancy": "Pregnancy\u00a0crosses placenta; risk theoretically minimal, but\r\nno information available" }, "ALUMINIUM HYDROXIDE Aluminium-only preparations": { "indications": "Indications\u00a0dyspepsia; hyperphosphataemia (section 9.5.2.2)", "name": "ALUMINIUM HYDROXIDE Aluminium-only preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone", "Aluminium- and magnesium-containing antacids", "ALUMINIUM HYDROXIDE", "Aluminium-only preparations" ], "cautions": "Cautions\u00a0\n(From 1.1.1 Antacids and simeticone: British National Formulary)\nAluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and trisilicate), being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects. Aluminium accumulation does not appear to be a risk if renal function is normal.; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2021.htm", "doses": [ "Name[Alu-Cap\u00ae (Meda)] Capsules, green/red, dried aluminium hydroxide 475\u00a0mg (low Na+). Net price\r\n120-cap pack = \u00a34.57Dose\u00a0antacid, 1 capsule 4 times daily and at bedtime; child not recommended for antacid therapy" ] }, "NAPROXEN With esomeprazole": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\ndysmenorrhoea; acute gout", "name": "NAPROXEN With esomeprazole", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "NAPROXEN", "With esomeprazole" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213720.htm", "doses": [ "Rheumatic disease, 0.5\u20131\u00a0g daily in 1\u20132 divided doses; child 2\u201318 years, juvenile idiopathic arthritis,\r\nsee BNF for Children", "Acute musculoskeletal disorders and dysmenorrhoea, 500\u00a0mg initially,\r\nthen 250\u00a0mg every 6\u20138 hours as required; max. dose after first day\r\n1.25\u00a0g daily; child under 18 years,\r\nsee BNF for Children", "Acute gout, 750\u00a0mg initially, then 250\u00a0mg every 8 hours until\r\nattack has passed; child under 16 years\r\nnot recommended", "Name[Vimovo\u00ae (AstraZeneca) ] Tablets, f/c, m/r, naproxen 500\u00a0mg,\r\nesomeprazole (as magnesium trihydrate) 20\u00a0mg, net price 60-tab pack\r\n= \u00a314.95. \r\n Label:\r\n 22, 25Note\u00a0Naproxen component is gastro-resistantDose\u00a0patients requiring naproxen for osteoarthritis, rheumatoid\r\narthritis, or ankylosing spondylitis, who are at risk of NSAID-associated\r\nduodenal or gastric ulcer and when treatment with lower doses of naproxen\r\nor other NSAIDs ineffective, adult over\r\n18 years, 1 tablet twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "BECLOMETASONE DIPROPIONATE - CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and\r\ntreatment of allergic and vasomotor rhinitis", "name": "BECLOMETASONE DIPROPIONATE - CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60776.htm", "doses": [ "adult and child over 6 years, 100\u00a0micrograms (2 sprays) into\r\neach nostril twice daily; max. total 400\u00a0micrograms (8 sprays) daily;\r\nwhen symptoms controlled, dose reduced to 50\u00a0micrograms (1 spray)\r\ninto each nostril twice daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "BECLOMETASONE DIPROPIONATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered." }, "QUINAPRIL With diuretic": { "indications": "Indications\u00a0essential hypertension; congestive heart failure\r\n(adjunct\u2014see section 2.5.5)", "name": "QUINAPRIL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "QUINAPRIL", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; asthenia, chest pain, oedema,\r\nflatulence, nervousness, depression, insomnia, blurred vision, impotence,\r\nand back pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2602.htm", "doses": [ "Hypertension, initially 10\u00a0mg once daily; with a diuretic\r\n(see notes above),\r\nin elderly, or in renal impairment initially 2.5\u00a0mg daily; usual maintenance\r\ndose 20\u201340\u00a0mg daily in single or 2 divided doses; up to 80\u00a0mg daily\r\nhas been given", "Heart failure (adjunct), initial dose 2.5\u00a0mg daily under close\r\nmedical supervision (see notes above),\r\nincreased gradually to 10\u201320\u00a0mg daily in 1\u20132 divided doses if tolerated;\r\nmax. 40\u00a0mg daily", "Name[Accuretic\u00ae (Pfizer) ] Tablets, pink, f/c, scored, quinapril (as hydrochloride) 10\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a311.75" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "TESTOSTERONE AND ESTERS": { "indications": "Indications\u00a0see under preparations", "name": "TESTOSTERONE AND ESTERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.2 Male sex hormones and antagonists", "TESTOSTERONE AND ESTERS" ], "cautions": "Cautions\u00a0cardiac impairment, elderly, ischaemic heart\r\ndisease, hypertension, epilepsy, migraine, diabetes mellitus, skeletal metastases\r\n(risk of hypercalcaemia), undertake regular examination\r\nof the prostate and breast during treatment; monitor\r\nfull blood count, lipid profile and liver function; pre-pubertal boys (\n(From 6.4.2 Male sex hormones and antagonists: British National Formulary)\nCaution should be used when androgens or chorionic gonadotrophin are used in treating boys with delayed puberty since the fusion of epiphyses is hastened and may result in short stature; skeletal maturation should be monitored. and under Side-effects); interactions: Appendix 1 (testosterone)Women\u00a0Regularly assess for androgenic side-effects; women should be advised to report any signs of virilisation e.g.\r\ndeepening of the voice or hirsutism", "side-effects": "Side-effects\u00a0prostate abnormalities and prostate cancer, headache,\r\ndepression, gastro-intestinal bleeding, nausea, vomiting, cholestatic\r\njaundice, changes in libido, gynaecomastia, polycythaemia, anxiety,\r\nirritability, nervousness, asthenia, paraesthesia, hypertension, electrolyte\r\ndisturbances including sodium retention with oedema and hypercalcaemia,\r\nweight gain; increased bone growth, muscle cramps, arthralgia; androgenic\r\neffects such as hirsutism, male-pattern baldness, seborrhoea, acne,\r\npruritus, excessive frequency and duration of penile erection, precocious\r\nsexual development and premature closure of epiphyses in pre-pubertal\r\nmales, suppression of spermatogenesis in men and virilism in women; rarely liver tumours; sleep apnoea also reported; with patches, buccal tablets, and gel, local irritation and allergic reactions (including\r\nburn-like lesions with patches), and taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4364.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid; causes masculinisation of female fetus" }, "MACROGOLS": { "indications": "Indications\u00a0see\r\npreparations below", "name": "MACROGOLS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "MACROGOLS" ], "cautions": "Cautions\u00a0with high doses, impaired gag reflex,\r\nreflux oesophagitis, impaired consciousness", "side-effects": "Side-effects\u00a0abdominal distension and pain, nausea, flatulence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128336.htm", "doses": [ "See preparations below", "chronic constipation and prevention of faecal impaction, child under 2 years see BNF for Children; 2\u20136 years 1 sachet daily, adjusted according to response\r\n(max. 4 sachets daily); 6\u201312 years 2 sachets daily, adjusted according\r\nto response (max. 4 sachets daily)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if essential\u2014no information\r\navailable" }, "PHENTOLAMINE MESILATE": { "indications": "Indications\u00a0hypertensive episodes due to phaeochromocytoma\r\ne.g. during surgery; diagnosis of phaeochromocytoma (but \n(From Phaeochromocytoma: British National Formulary)\nPhaeochromocytoma)", "name": "PHENTOLAMINE MESILATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "Phaeochromocytoma", "PHENTOLAMINE MESILATE" ], "cautions": "Cautions\u00a0monitor blood pressure (avoid\r\nin hypotension), heart rate; gastritis, peptic ulcer; elderly; interactions: Appendix 1\r\n(alpha-blockers)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia, dizziness,\r\nflushing; nausea and vomiting, diarrhoea, nasal congestion; also acute\r\nor prolonged hypotension, angina, chest pain, arrhythmias", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19517.htm", "doses": [ "Hypertensive episodes, by intravenous injection, 2\u20135\u00a0mg repeated if necessary", "Diagnosis of phaeochromocytoma, consult product literature" ], "pregnancy": "Pregnancy\u00a0use with caution\u2014may cause marked decrease in maternal\r\nblood pressure with resulting fetal anoxia" }, "MICONAZOLE NITRATE": { "indications": "Indications\u00a0fungal skin infections; oral and intestinal fungal\r\ninfections (section 12.3.2); vaginal candidiasis (section 7.2.2)", "name": "MICONAZOLE NITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.; interactions:\r\nAppendix 1 (miconazole)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6163.htm", "doses": [ "Apply twice daily continuing for 10 days after lesions\r\nhave healed; nail infections, apply 1\u20132 times daily" ] }, "MITOXANTRONE": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nMitoxantrone is structurally related to doxorubicin; it is used for metastatic breast cancer. Mitoxantrone is also licensed for treatment of non-Hodgkin\u2019s lymphoma, adult acute non-lymphocytic leukaemia, and non-resectable primary hepatocellular carcinoma. It is given intravenously and is well tolerated, but myelosuppression and dose-related cardiotoxicity occur; cardiac examinations are recommended after a cumulative dose of 160\u00a0mg/m2.", "name": "MITOXANTRONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; intrathecal administration not recommended; interactions: Appendix 1 (mitoxantrone) ", "side-effects": "Side-effects\u00a0see section 8.1 and notes above, anorexia, diarrhoea, abdominal pain, gastro-intestinal bleeding,\r\nconstipation, dyspnoea, drowsiness, confusion, paraesthesia, anxiety,\r\namenorrhoea, and transient blue-green discoloration of urine and blue\r\ndiscoloration of skin and nails also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4721.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nduring and for at least 6 months after treatment in men or women;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "SULFADIAZINE": { "indications": "Indications\u00a0prevention of rheumatic fever recurrence, toxoplasmosis [unlicensed]\u2014see section 5.4.7", "name": "SULFADIAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.8 Sulfonamides and trimethoprim" ], "cautions": "Cautions\u00a0see under Co-trimoxazole; interactions: Appendix 1 (sulfonamides)", "side-effects": "Side-effects\u00a0see under Co-trimoxazole; also\r\nhypothyroidism, benign intracranial hypertension, optic neuropathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3890.htm", "doses": [ "Prevention of rheumatic fever, by mouth, 1\u00a0g daily (500\u00a0mg daily for patients less than 30\u00a0kg)" ], "pregnancy": "Pregnancy\u00a0neonatal haemolysis and methaemoglobinaemia in third\r\ntrimester; fear of increased risk of kernicterus in neonates appears\r\nto be unfounded" }, "DESFERRIOXAMINE MESILATE - IRON OVERLOAD": { "indications": "Indications\u00a0\n(From Iron overload: British National Formulary)\nIron overload; iron poisoning, \n(From Iron salts: British National Formulary)\nIron salts", "name": "DESFERRIOXAMINE MESILATE - IRON OVERLOAD", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Iron overload", "DESFERRIOXAMINE MESILATE" ], "cautions": "Cautions\u00a0eye and ear examinations before treatment and at 3-month intervals\r\nduring treatment; monitor body-weight and\r\nheight in children at 3-month intervals\u2014risk of growth retardation\r\nwith excessive doses; aluminium-related\r\nencephalopathy (may exacerbate neurological dysfunction); interactions: Appendix 1 (desferrioxamine)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain; headache; pyrexia;\r\ngrowth retardation and bone disorders (see Cautions); arthralgia,\r\nmyalgia; hearing disturbances; injection-site reactions; rarely diarrhoea, hepatic impairment, hypotension (especially when given\r\ntoo rapidly by intravenous injection), anaphylaxis, Yersinia and mucormycosis\r\ninfections, blood dyscrasias (including thrombocytopenia and leucopenia),\r\nleg cramps, bone pain, visual disturbances (including lens opacity\r\nand retinopathy), rash; very rarely acute respiratory\r\ndistress, neurological disturbances (including dizziness, neuropathy,\r\nconvulsions, and paraesthesia), renal impairment; muscle spasms also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128327.htm", "doses": [ "See notes above; iron poisoning, see Emergency Treatment of Poisoning", "For full details and warnings relating to\r\nadministration, consult product literature" ], "pregnancy": "Pregnancy\u00a0teratogenic in animal studies; manufacturer\r\nadvises use only if potential benefit outweighs risk" }, "PIROXICAM - PIROXICAM": { "indications": "Indications\u00a0rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis\r\n(see also CHMP advice below)", "name": "PIROXICAM - PIROXICAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "PIROXICAM" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs). and CHMP\r\nadvice below", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/76838.htm", "doses": [ "By mouth, max. 20\u00a0mg once daily (see\r\nalso CHMP advice below); child 6\u201318\r\nyears, juvenile idiopathic arthritis, see BNF for Children", "The CHMP has recommended restrictions on the use of piroxicam\r\nbecause of the increased risk of gastro-intestinal side effects and\r\nserious skin reactions. The CHMP has advised that:", "piroxicam should be initiated only by physicians\r\nexperienced in treating inflammatory or degenerative rheumatic diseases", "piroxicam should not be used as first-line treatment", "in adults, use of piroxicam should be limited to the symptomatic\r\nrelief of osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis", "piroxicam dose should not exceed 20\u00a0mg daily", "piroxicam should no longer be used for the treatment of\r\nacute painful and inflammatory conditions", "treatment should be reviewed 2 weeks after\r\ninitiating piroxicam, and periodically thereafter", "concomitant administration of a gastro-protective agent\r\n(section 1.3) should\r\nbe considered", "Topical preparations containing piroxicam\r\nare not affected by these restrictions", "osteoarthritis, rheumatic disease and acute musculoskeletal\r\ndisorders, 1 tablet daily (may be halved in elderly); child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "POLIOMYELITIS VACCINES Live (oral) (Sabin) vaccine": { "indications": "Indications\u00a0immunisation against poliomyelitis ", "name": "POLIOMYELITIS VACCINES Live (oral) (Sabin) vaccine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Poliomyelitis vaccines", "POLIOMYELITIS VACCINES", "Live (oral) (Sabin) vaccine" ], "cautions": "Cautions\u00a0see section 14.1; also for live vaccine, interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0\n(From Poliomyelitis vaccines: British National Formulary)\nLive (oral) poliomyelitis vaccine is available only for use during outbreaks. The live (oral) vaccine poses a very rare risk of vaccine-associated paralytic polio because the attenuated strain of the virus can revert to a virulent form. For this reason the live (oral) vaccine must not be used for immunosuppressed individuals or their household contacts. The use of inactivated poliomyelitis vaccine removes the risk of vaccine-associated paralytic polio altogether. and %s\n(From 14.1 Active immunity: British National Formulary)\nSide-effects\u00a0Injection of a vaccine may be followed by local reactions such as pain, inflammation, redness, and lymphangitis. An induration or sterile abscess may develop at the injection site. Gastro-intestinal disturbances, fever, headache, irritability, loss of appetite, fatigue, myalgia, and malaise are among the most commonly reported side-effects. Other side-effects include influenza-like symptoms, dizziness, paraesthesia, asthenia, drowsiness, arthralgia, rash, and lymphadenopathy. Hypersensitivity reactions, such as bronchospasm, angioedema, urticaria, and anaphylaxis, are very rare but can be fatal (see section 3.4.3 for management of allergic emergencies).Oral vaccines such as cholera, live poliomyelitis, rotavirus, and live typhoid can also cause gastro-intestinal disturbances such as nausea, vomiting, abdominal pain and cramps, and diarrhoea.See also Predisposition to neurological problems, below.Some vaccines (e.g. poliomyelitis) produce very few reactions, while others (e.g. measles, mumps and rubella) may cause a very mild form of the disease. Occasionally more serious adverse reactions can occur\u2014these should always be reported to the CHM (see Adverse Reactions to Drugs).See also Preterm Birth.Post-immunisation pyrexia in infantsThe parent should be advised that if pyrexia develops after childhood immunisation, and the infant seems distressed, a dose of paracetamol can be given and, if necessary, a second dose can be given 6 hours later; ibuprofen may be used if paracetamol is unsuitable. The parent should be warned to seek medical advice if the pyrexia persists.For post-immunisation pyrexia in an infant aged 2\u20133 months, the dose of paracetamol is 60\u00a0mg; the dose of ibuprofen is 50\u00a0mg (on a doctor\u2019s advice). An oral syringe can be obtained from any pharmacy to give the small volume required.Predisposition to neurological problems When there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended; advice on the management of fever (see Post-immunisation pyrexia in infants, above) should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended.Children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and perinatal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule.When there is a still evolving neurological problem, including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable.Further information on adverse effects associated with specific vaccines can be found under individual vaccines.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6513.htm", "doses": [ "See under preparations", "Name[Poliomyelitis Vaccine, Live (Oral) (GSK) ] A suspension of suitable live attenuated strains of poliomyelitis\r\nvirus, types 1, 2, and 3. Available in single-dose and 10-dose containersExcipients include neomycin and polymyxin BDose\u00a0control of outbreaks, 3 drops; may be given on a lump\r\nof sugar; not to be given with foods which contain preservativesNote\u00a0Live poliomyelitis vaccine loses potency\r\nonce the container has been opened\u2014any vaccine remaining at the end\r\nof an immunisation session should be discarded; whenever possible\r\nsessions should be arranged to avoid undue wastage." ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "QUETIAPINE": { "indications": "Indications\u00a0schizophrenia; mania, either alone or with mood stabilisers; depression\r\nin bipolar disorder; adjunctive treatment in major depressive disorder", "name": "QUETIAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also cerebrovascular disease; patients at risk\r\nof aspiration pneumonia; treatment of depression\r\nin patients under 25 years (increased risk of suicide)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\ndry mouth, constipation, dyspepsia; tachycardia, hypertension, elevated\r\nplasma-triglyceride and -cholesterol concentrations, peripheral oedema;\r\ndrowsiness, headache, irritability, dysarthria, asthenia; leucopenia,\r\nneutropenia; blurred vision; rhinitis; less commonly dysphagia, seizures, restless legs syndrome, hyponatraemia, and\r\neosinophilia; rarely jaundice and priapism; very rarely hepatitis, angioedema, Stevens-Johnson syndrome,\r\nand rhabdomyolysis; suicidal behaviour (particularly on initiation)\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65596.htm", "doses": [ "Schizophrenia, adult over\r\n18 years, 25\u00a0mg twice daily on day 1, 50\u00a0mg twice daily on day 2,\r\n100\u00a0mg twice daily on day 3, 150\u00a0mg twice daily on day 4, then adjusted\r\naccording to response, usual range 300\u2013450\u00a0mg daily in 2 divided doses;\r\nmax. 750\u00a0mg daily; elderly initially\r\n25\u00a0mg daily as a single dose, increased in steps of 25\u201350\u00a0mg daily\r\nin 2 divided doses; child 12\u201318 years\r\nsee BNF for Children", "Treatment of mania in bipolar disorder, adult over 18 years, 50\u00a0mg twice daily on day 1, 100\u00a0mg twice daily on\r\nday 2, 150\u00a0mg twice daily on day 3, 200\u00a0mg twice daily on day 4, then\r\nadjusted according to response in steps of up to 200\u00a0mg daily to max.\r\n800\u00a0mg daily; usual range 400\u2013800\u00a0mg daily in 2 divided doses; elderly initially 25\u00a0mg daily as a single dose, increased\r\nin steps of 25\u201350\u00a0mg daily in 2 divided doses; child 12\u201318 years see BNF for Children", "Treatment of depression in bipolar disorder, adult over 18 years, 50\u00a0mg once daily (at bedtime)\r\non day 1, 100\u00a0mg once daily on day 2, 200\u00a0mg once daily on day 3,\r\n300\u00a0mg once daily on day 4; adjust according to response, usual dose\r\n300\u00a0mg once daily, max. 600\u00a0mg daily", "Prevention of mania and depression in bipolar disorder, adult over 18 years, continue at the dose effective\r\nfor treatment of bipolar disorder and adjust to lowest effective dose;\r\nusual range 300\u2013800\u00a0mg in 2 divided doses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy notes; also use only if potential\r\nbenefit outweighs risk" }, "BRINZOLAMIDE With timolol": { "indications": "Indications\u00a0reduction of intra-ocular pressure in ocular hypertension and open-angle\r\nglaucoma either as adjunct to beta-blockers or prostaglandin\r\nanalogues or used alone in patients unresponsive\r\nto beta-blockers or if beta-blockers contra-indicated", "name": "BRINZOLAMIDE With timolol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Carbonic anhydrase inhibitors and systemic drugs", "BRINZOLAMIDE", "With timolol" ], "cautions": "Cautions\u00a0systemic absorption follows topical application; renal tubular immaturity or abnormality; interactions: Appendix 1 (brinzolamide)", "side-effects": "Side-effects\u00a0\n(From Carbonic anhydrase inhibitors and systemic drugs: British National Formulary)\nCarbonic anhydrase inhibitors and systemic drugs; also taste\r\ndisturbances, dry mouth, headache, ocular disturbances (including\r\ncorneal erosion, corneal oedema, photophobia, and reduced visual acuity); less commonly nausea, vomiting, diarrhoea, dyspepsia, oesophagitis,\r\nflatulence, oral hypoaesthesia and paraesthesia, chest pain, bradycardia,\r\npalpitation, dyspnoea, cough, upper respiratory tract congestion,\r\npharyngitis, depression, sleep disturbances, nervousness, malaise,\r\ndrowsiness, amnesia, dizziness, paraesthesia, sinusitis, decreased\r\nlibido, erectile dysfunction, renal pain, epistaxis, nasal dryness,\r\nthroat irritation, tinnitus, alopecia; also reported arrhythmia, tachycardia, hypertension, peripheral oedema, asthma,\r\ntremor, vertigo, rhinitis, dermatitis, erythema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202584.htm", "doses": [ "Apply twice daily increased to max. 3 times daily if necessary", "Name[Azarga\u00ae (Alcon) ] Ophthalmic suspension (= eye drops),\r\nbrinzolamide 10\u00a0mg, timolol (as maleate) 5\u00a0mg/mL, net price 5\u00a0mL =\r\n\u00a311.05Excipients include benzalkonium chloride, disodium edetateDose\u00a0for raised intra-ocular pressure in open-angle glaucoma\r\nor ocular hypertension when beta-blocker alone not adequate, adult over 18 years apply twice daily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "ADRENALINE/EPINEPHRINE - ANAPHYLAXIS": { "indications": "Indications\u00a0emergency treatment of acute\r\nanaphylaxis; angioedema; cardiopulmonary resuscitation (section 2.7.3); priapism [unlicensed] (section 7.4.5)", "name": "ADRENALINE/EPINEPHRINE - ANAPHYLAXIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Anaphylaxis" ], "cautions": "Cautions\u00a0for cautions in non-life-threatening situations, see section 2.7.3Interactions\u00a0Severe anaphylaxis in\r\npatients taking beta-blockers may not respond to adrenaline, calling\r\nfor bronchodilator therapy, see intravenous salbutamol; adrenaline can cause\r\nsevere hypertension and bradycardia in those taking non-cardioselective\r\nbeta-blockers. Other interactions,\r\nsee Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0section 2.7.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100076.htm", "doses": [ "Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1\u00a0mg/mL)\r\nsolution for administration by healthcare professionals, see notes and table above", "Acute anaphylaxis, by intramuscular injection for self-administration, see under preparations", "Acute anaphylaxis when there is doubt as to the adequacy of\r\nthe circulation, by slow intravenous injection of 1\r\nin 10\u00a0000 (100\u00a0micrograms/mL) solution (extreme caution\u2014specialist\r\nuse only), see notes above", "Intravenous route should be used with extreme care by specialists only, see notes above" ], "pregnancy": "Pregnancy\u00a0section 2.7.3" }, "OESTROGENS FOR HRT Estradiol with progestogen": { "indications": "Indications\u00a0see notes above and under preparations", "name": "OESTROGENS FOR HRT Estradiol with progestogen", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "OESTROGENS FOR HRT", "Estradiol with progestogen" ], "cautions": "Cautions\u00a0prolonged exposure\r\nto unopposed oestrogens may increase risk of developing endometrial\r\ncancer (\n(From Hormone replacement therapy: British National Formulary)\nRisk of endometrial cancer\u00a0The increased risk of endometrial cancer depends on the dose and duration of oestrogen-only HRT, see HRT Risk table for details.In women with a uterus, the addition of a progestogen cyclically (for at least 10 days per 28-day cycle) reduces the additional risk of endometrial cancer; this additional risk is eliminated if a progestogen is given continuously. However, this should be weighed against the increased risk of breast cancer.); migraine (or migraine-like headaches); diabetes\r\n(increased risk of heart disease); history of breast\r\nnodules or fibrocystic disease\u2014closely monitor breast status (risk\r\nof breast cancer, \n(From Hormone replacement therapy: British National Formulary)\nRisk of breast cancer\u00a0It is estimated that using all types of HRT, including tibolone, increases the risk of breast cancer within 1\u20132 years of initiating treatment, see HRT Risk table for details. The increased risk is related to the duration of HRT use (but not to the age at which HRT is started) and this excess risk disappears within 5 years of stopping.Radiological detection of breast cancer can be made more difficult as mammographic density can increase with HRT use; tibolone has only a limited effect on mammographic density.); risk factors\r\nfor oestrogen-dependent tumours (e.g. breast cancer in first-degree\r\nrelative); uterine fibroids may increase\r\nin size, symptoms of endometriosis may\r\nbe exacerbated; history of endometrial\r\nhyperplasia; factors predisposing to thromboembolism (\n(From Hormone replacement therapy: British National Formulary)\nRisk of venous thromboembolism\u00a0Women using combined or oestrogen-only HRT are at an increased risk of deep vein thrombosis and of pulmonary embolism especially in the first year of use, see HRT Risk table for details.In women who have predisposing factors (such as a personal or family history of deep vein thrombosis or pulmonary embolism, severe varicose veins, obesity, trauma, or prolonged bed-rest) it is prudent to review the need for HRT, as in some cases the risks of HRT may exceed the benefits. See below for advice on surgery.Travel involving prolonged immobility further increases the risk of deep vein thrombosis, see under Travel in section 7.3.1.); presence of antiphospholipid antibodies (increased risk of thrombotic\r\nevents); increased risk of gall-bladder\r\ndisease reported; hypophyseal tumours; acute porphyria (\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(oestrogens)Other conditions\u00a0The product literature advises\r\ncaution in other conditions including hypertension, renal disease,\r\nasthma, epilepsy, sickle-cell disease, melanoma, otosclerosis, multiple\r\nsclerosis, and systemic lupus erythematosus (but care required if\r\nantiphospholipid antibodies present, see above). Evidence for caution\r\nin these conditions is unsatisfactory and many women with these conditions\r\nmay stand to benefit from HRT.", "side-effects": "Side-effects\u00a0see notes above for risks of long-term use; nausea\r\nand vomiting, abdominal cramps and bloating, weight changes, breast\r\nenlargement and tenderness, premenstrual-like syndrome, sodium and\r\nfluid retention, cholestatic jaundice, glucose intolerance, altered\r\nblood lipids\u2014may lead to pancreatitis, rashes and chloasma, changes\r\nin libido, depression, mood changes, headache, migraine, dizziness,\r\nleg cramps (rule out venous thrombosis), vaginal candidiasis, contact\r\nlenses may irritate; transdermal delivery systems may cause contact\r\nsensitisation (possible severe hypersensitivity reaction on continued\r\nexposure), and headache has been reported on vigorous exerciseWithdrawal bleeding\u00a0Cyclical HRT (where a progestogen\r\nis taken for 12\u201314 days of each 28-day oestrogen treatment cycle)\r\nusually results in regular withdrawal bleeding towards\r\nthe end of the progestogen. The aim of continuous combined HRT (where\r\na combination of oestrogen and progestogen is taken, usually in a\r\nsingle tablet, throughout each 28-day treatment cycle) is to avoid\r\nbleeding, but irregular bleeding may occur during\r\nthe early treatment stages (if it continues endometrial abnormality\r\nshould be excluded and consideration given to cyclical HRT instead)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4320.htm", "doses": [ "See under preparations", "Patch should be removed\r\nafter 3\u20134 days (or once a week in case of 7-day patch) and replaced\r\nwith fresh patch on slightly different site; recommended sites: clean,\r\ndry, unbroken areas of skin on trunk below waistline; not to be applied\r\non or near breasts or under waistband. If patch falls off in bath\r\nallow skin to cool before applying new patch", "Name[Trisequens\u00ae (Novo Nordisk) ] Tablets, 12 blue, estradiol 2\u00a0mg;\r\n10 white, estradiol 2\u00a0mg, norethisterone acetate\r\n1\u00a0mg; 6 red, estradiol 1\u00a0mg, net price 3 \u00d7 28-tab pack = \u00a311.10Dose\u00a0menopausal symptoms and osteoporosis prophylaxis (see section 6.6),\r\nin women with a uterus, 1 blue tablet daily for 12 days followed by\r\n1 white tablet for 10 days, then 1 red tablet daily for 6 days; subsequent\r\ncourses are repeated without interval" ], "pregnancy": "Pregnancy\u00a0see Combined Hormonal Contraceptives, section 7.3.1" }, "NALOXONE HYDROCHLORIDE": { "indications": "Indications\u00a0overdosage with opioids; reversal of postoperative\r\nrespiratory depression and reversal of neonatal respiratory and CNS\r\ndepression resulting from opioid administration to mother during labour\r\n(section 15.1.7)", "name": "NALOXONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Specific drugs", "Analgesics (opioid)" ], "cautions": "Cautions\u00a0physical dependence on opioids; cardiac irritability; naloxone is short-acting, \n(From Analgesics (opioid): British National Formulary)\nAnalgesics (opioid)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29533.htm", "doses": [ "By intravenous injection, 0.4\u20132\u00a0mg;\r\nif no response, repeat at intervals of 2\u20133 minutes to a max. of 10\u00a0mg\r\n(then review diagnosis); further doses may be required if respiratory\r\nfunction deteriorates; child 10\u00a0micrograms/kg;\r\nif no response, give subsequent dose of 100\u00a0micrograms/kg (then review\r\ndiagnosis); further doses may be required if respiratory function\r\ndeteriorates", "By subcutaneous or intramuscular injection, adult and child dose as for intravenous\r\ninjection but use only if intravenous route not feasible (onset of\r\naction slower)", "By continuous intravenous infusion using an infusion pump, adult and child, rate adjusted according to response (initially,\r\nrate may be set at 60% of the initial resuscitative intravenous\r\ninjection dose per hour)", "The initial resuscitative intravenous\r\ninjection dose is that which maintained satisfactory ventilation\r\nfor at least 15 minutes", "Doses used in acute opioid overdosage\r\nmay not be appropriate for the management of opioid-induced respiratory\r\ndepression and sedation in those receiving palliative care and in\r\nchronic opioid use; see also section 15.1.7 for management\r\nof postoperative respiratory depression" ], "pregnancy": "Pregnancy\u00a0section 15.1.7" }, "DIAZEPAM": { "indications": "Indications\u00a0status epilepticus; febrile convulsions (section 4.8.3); convulsions due to poisoning\r\n(see Emergency Treatment of Poisoning); other indications (section 4.1.2, section 10.2.2, and section 15.1.4.1)", "name": "DIAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus", "DIAZEPAM" ], "cautions": "Cautions\u00a0see Diazepam, section 4.1.2; when given intravenously\r\nfacilities for reversing respiratory depression with mechanical ventilation\r\nmust be immediately available (but see also notes above)", "side-effects": "Side-effects\u00a0see Diazepam, section 4.1.2; hypotension\r\nand apnoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3619.htm", "doses": [ "Status epilepticus (but see notes above), febrile\r\nconvulsions, and convulsions due to poisoning, by intravenous\r\ninjection, 10\u00a0mg at a rate of 1\u00a0mL (5\u00a0mg) per minute, repeated\r\nonce after 10 minutes if necessary; child under 12 years, 300\u2013400\u00a0micrograms/kg (max. 10\u00a0mg) [unlicensed dose],\r\nrepeated once after 10 minutes if necessary", "By rectum as rectal solution, adult and child over\r\n12 years, 10\u201320\u00a0mg, repeated once after 10\u201315 minutes if necessary; elderly 10\u00a0mg; neonate [unlicensed] 1.25\u20132.5\u00a0mg; child 1\r\nmonth\u20131 year [unlicensed] 5\u00a0mg; 1\u20132 years 5\u00a0mg; 2\u201312 years 5\u201310\u00a0mg" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2, and Pregnancy" }, "ALIMEMAZINE TARTRATE": { "indications": "Indications\u00a0urticaria and pruritus, premedication", "name": "ALIMEMAZINE TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Sedating antihistamines", "ALIMEMAZINE TARTRATE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).; see also %s\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\n4.2.1 Antipsychotic drugs", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; see also %s\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\n4.2.1 Antipsychotic drugs", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3110.htm", "doses": [ "Urticaria and pruritus, 10\u00a0mg 2\u20133 times daily, in severe\r\ncases up to max. 100\u00a0mg daily has been used; elderly 10\u00a0mg 1\u20132 times daily; child under\r\n2 years, see BNF for Children, 2\u20135 years 2.5\u00a0mg 3\u20134 times daily, 5\u201312 years 5\u00a0mg 3\u20134 times\r\ndaily", "Premedication, child 2\u20137 years\r\nup to 2\u00a0mg/kg 1\u20132 hours before operation" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "RETAPAMULIN": { "indications": "Indications\u00a0superficial bacterial skin infections\r\n(see also notes above)", "name": "RETAPAMULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.1 Antibacterial preparations only used topically" ], "side-effects": "Side-effects\u00a0local reactions including irritation, erythema,\r\npain, contact dermatitis, and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200783.htm", "doses": [ "adult over 18 years, apply\r\nthinly twice daily for 5 days; max. area of skin treated 100\u00a0cm2 or lesion length 10\u00a0cm; child 9 months\u201318 years, apply thinly twice daily for 5 days; max. area\r\nof skin treated 2% of body surface area", "Review treatment if no response within 2\u20133\r\ndays" ] }, "TERBINAFINE - ANTIFUNGAL PREPARATIONS": { "indications": "Indications\u00a0fungal skin infections", "name": "TERBINAFINE - ANTIFUNGAL PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "TERBINAFINE" ], "cautions": "Cautions\u00a0avoid contact with eyes", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200829.htm", "doses": [ "Apply thinly 1\u20132 times daily for up to 1 week in tinea\r\npedis, 1\u20132 weeks in tinea corporis and tinea cruris, 2 weeks in cutaneous\r\ncandidiasis and pityriasis versicolor; review after 2 weeks; child see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014animal studies suggest\r\nno adverse effects" }, "ROPINIROLE Modified release": { "indications": "Indications\u00a0Parkinson\u2019s disease, either used alone or as adjunct to co-beneldopa\r\nor co-careldopa; moderate to severe restless legs syndrome", "name": "ROPINIROLE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "ROPINIROLE", "Modified release" ], "cautions": "Cautions\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; severe cardiovascular disease (risk of hypotension\u2014monitor\r\nblood pressure), major psychotic disorders; elderly; avoid abrupt withdrawal; dose adjustment\r\nmay be necessary if smoking started or stopped during treatment; interactions: Appendix 1 (ropinirole)", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists; also\r\nnausea, vomiting, abdominal pain, dyspepsia, gastro-oesophageal reflux\r\ndisease, constipation; hypotension; syncope, peripheral oedema; drowsiness\r\n(including %s\n(From Dopamine-receptor agonists: British National Formulary)\nDrivingSudden onset of sleep\u00a0Excessive daytime sleepiness and sudden onset of sleep can occur with co-careldopa, co-beneldopa, and dopamine-receptor agonists.Patients starting treatment with these drugs should be warned of the risk and of the need to exercise caution when driving or operating machinery. Those who have experienced excessive sedation or sudden onset of sleep should refrain from driving or operating machines until these effects have stopped occurring.Management of excessive daytime sleepiness should focus on the identification of an underlying cause, such as depression or concomitant medication. Patients should be counselled on improving sleep behaviour.Hypotensive reactions\u00a0Hypotensive reactions can occur in some patients taking dopamine-receptor agonists; these can be particularly problematic during the first few days of treatment and care should be exercised when driving or operating machinery.),\r\ndizziness, nervousness, fatigue, dyskinesia, hallucinations, confusion; less commonly psychosis, compulsive behaviour (\n(From Dopamine-receptor agonists: British National Formulary)\nPatients and their carers should be informed about the risk of impulse control disorders. There is no evidence that ergot- and non-ergot-derived dopamine-receptor agonists differ in their propensity to cause impulse control disorders, so switching between dopamine-receptor agonists to control these side-effects is not recommended. If the patient develops an impulse control disorder, the dopamine-receptor agonist or levodopa should be withdrawn or the dose reduced until the symptoms resolve.); very rarely hepatic disorders; also reported paradoxical worsening of restless legs syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218828.htm", "doses": [ "Parkinson\u2019s disease, initially 750\u00a0micrograms daily\r\nin 3 divided doses, increased by increments of 750\u00a0micrograms daily\r\nat weekly intervals to 3\u00a0mg daily in 3 divided doses; further increased\r\nby increments of 1.5\u20133\u00a0mg daily at weekly intervals according to response;\r\nusual range 9\u201316\u00a0mg daily in 3 divided doses (but higher doses may\r\nbe required if used with levodopa); max. 24\u00a0mg daily in 3 divided\r\ndoses", "When administered as adjunct to levodopa, concurrent dose of levodopa may be reduced by\r\napprox. 20%; ropinirole doses in the BNF may differ\r\nfrom those in product literature", "Restless legs syndrome, adult over 18 years initially 250\u00a0micrograms at night for 2 days, increased\r\nif tolerated to 500\u00a0micrograms at night for 5 days and then to 1\u00a0mg\r\nat night for 7 days; further increased at weekly intervals in steps\r\nof 500\u00a0micrograms daily according to response; usual dose 2\u00a0mg at\r\nnight; max. 4\u00a0mg daily", "Repeat dose titration if restarting after\r\ninterval of more than a few days", "Parkinson\u2019s disease in patients transferring from ropinirole\r\nimmediate-release tablets, initially ropinirole m/r once daily substituted\r\nfor total daily dose equivalent of ropinirole immediate-release tablets;\r\nif control not maintained after switching, titrate dose as above", "When administered as adjunct to levodopa,\r\nconcurrent dose of levodopa may gradually be reduced by approx. 30%", "Name[Ropinirole m/r preparations ] Tablets, m/r, ropinirole 2\u00a0mg; 4\u00a0mg;\r\n8\u00a0mg. \r\n Label:\r\n 10, 25, counselling, driving, see notes aboveBrands include Ralnea XL\u00ae, Spiroco\r\nXL\u00aeDose\u00a0initial treatment of Parkinson\u2019s disease, 2\u00a0mg once daily\r\nfor 1 week, then 4\u00a0mg once daily; increased according to response\r\nby 2\u00a0mg at intervals of at least 1 week up to 8\u00a0mg once daily; if\r\nstill no response, increase by 2\u20134\u00a0mg at intervals of at least 2 weeks\r\nas necessary; max. 24\u00a0mg once dailyParkinson\u2019s disease in patients transferring from ropinirole\r\nimmediate-release tablets, initially ropinirole m/r once daily substituted\r\nfor total daily dose equivalent of ropinirole immediate-release tablets;\r\nif control not maintained after switching, titrate dose as aboveNote\u00a0Consider slower titration in patients over\r\n75 yearsNote\u00a0When administered as adjunct to levodopa,\r\nconcurrent dose of levodopa may gradually be reduced by approx. 30%Note\u00a0If treatment interrupted for 1 day or more,\r\nconsider re-initiation with immediate-release tablets" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity\r\nin animal studies" }, "BETHANECHOL CHLORIDE ": { "indications": "Indications\u00a0urinary retention, but see notes above", "name": "BETHANECHOL CHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Parasympathomimetics" ], "cautions": "Cautions\u00a0autonomic neuropathy (use lower initial\r\ndose); interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain, increased\r\nsalivation, eructation; flushing, hypotension, bradycardia; bronchoconstriction,\r\nrhinorrhoea; headache; increased lacrimation; increased sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4623.htm", "doses": [ "10\u201325\u00a0mg 3\u20134 times daily half an hour before food" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available " }, "INDACATEROL": { "indications": "Indications\u00a0maintenance treatment of chronic obstructive\r\npulmonary disease", "name": "INDACATEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "INDACATEROL" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.; convulsive disorders", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; also peripheral oedema, cough,\r\npharyngolaryngeal pain, nasopharyngitis, sinusitis, rhinorrhoea; less commonly atrial fibrillation, non-cardiac chest pain,\r\nparaesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213791.htm", "doses": [ "By inhalation of powder, adult over 18 years, 150\u00a0micrograms once daily, increased\r\nto max. 300\u00a0micrograms once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "DAPTOMYCIN": { "indications": "Indications\u00a0see under Dose", "name": "DAPTOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Daptomycin" ], "cautions": "Cautions\u00a0interference with assay for prothrombin time and INR\u2014take\r\nblood sample immediately before daptomycin dose; interactions: Appendix 1 (daptomycin)Muscle effects\u00a0Myalgia, muscle weakness, and myositis\r\nmay occur uncommonly; rhabdomyolysis is very rare. Monitor\r\ncreatine kinase before treatment and then weekly during treatment\r\n(more frequently if creatine kinase elevated more than 5 times upper\r\nlimit of normal before treatment, or if receiving another drug known\r\nto cause myopathy (preferably avoid concomitant use), or if eGFR less\r\nthan 80\u00a0mL/minute/1.73\u00a0m2). If unexplained muscle pain, tenderness, weakness, or cramps develop\r\nduring treatment, measure creatine kinase every 2 days; discontinue if unexplained muscular symptoms and creatine\r\nkinase elevated markedly", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, flatulence,\r\ndiarrhoea (antibiotic-associated colitis reported), constipation,\r\nhypertension, hypotension, headache, anxiety, insomnia, dizziness,\r\nasthenia, anaemia, arthralgia, rash, pruritus, injection-site reactions; less commonly dyspepsia, anorexia, taste disturbance, glossitis,\r\nflushing, arrhythmias, tremor, paraesthesia, hyperglycaemia, renal\r\nfailure, eosinophilia, thrombocythaemia, electrolyte disturbances,\r\nmuscle effects (see Cautions); rarely jaundice; also reported syncope, wheezing, eosinophilic\r\npneumonia, peripheral neuropathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129715.htm", "doses": [ "By slow intravenous injection over\r\n2 minutes or by intravenous infusion, complicated skin and soft-tissue infections caused by Gram-positive\r\nbacteria, adult over 18 years, 4\u00a0mg/kg\r\nonce daily; increased to 6\u00a0mg/kg once daily if associated with Staphylococcus aureus bacteraemia ", "Right-sided endocarditis caused by Staphylococcus\r\naureus, adult over 18 years,\r\n6\u00a0mg/kg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "INSULIN LISPRO": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN LISPRO", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins" ], "cautions": "Cautions\u00a0section 6.1.1; children\r\n(use only if benefit likely compared to soluble insulin); interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/39955.htm", "doses": [ "By subcutaneous injection shortly before\r\nmeals or when necessary shortly after meals, according to requirements", "By subcutaneous infusion, or intravenous injection, or intravenous infusion, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "OXYTETRACYCLINE": { "indications": "Indications\u00a0see notes above; acne vulgaris, rosacea (%s\n(From 13.6 Acne and rosacea: British National Formulary)\n13.6 Acne and rosacea)", "name": "OXYTETRACYCLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines", "OXYTETRACYCLINE" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3828.htm", "doses": [ "250\u2013500\u00a0mg every 6 hours", "Acne, see section 13.6.2" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "SULFINPYRAZONE": { "indications": "Indications\u00a0gout prophylaxis, hyperuricaemia", "name": "SULFINPYRAZONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Long-term control of gout", "SULFINPYRAZONE" ], "cautions": "Cautions\u00a0see under Probenecid; regular blood counts advisable; cardiac disease (may cause salt and\r\nwater retention); interactions: Appendix 1 (sulfinpyrazone)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, occasionally allergic\r\nskin reactions, salt and water retention; rarely blood disorders,\r\ngastro-intestinal ulceration and bleeding, acute renal failure, raised\r\nliver enzymes, jaundice and hepatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207431.htm", "doses": [ "Initially 100\u2013200\u00a0mg daily with food (or milk) increasing\r\nover 2\u20133 weeks to 600\u00a0mg daily (rarely 800\u00a0mg daily), continued until\r\nserum uric acid concentration normal then reduced for maintenance\r\n(maintenance dose may be as low as 200\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014no information available" }, "BENZOYL PEROXIDE": { "indications": "Indications\u00a0acne vulgaris", "name": "BENZOYL PEROXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Benzoyl peroxide and azelaic acid", "BENZOYL PEROXIDE" ], "cautions": "Cautions\u00a0avoid contact with eyes, mouth, and mucous membranes; may bleach fabrics and hair; avoid excessive exposure to sunlight", "side-effects": "Side-effects\u00a0skin irritation (reduce frequency or suspend use\r\nuntil irritation subsides and re-introduce at reduced frequency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81449.htm", "doses": [ "Apply 1\u20132 times daily preferably after washing with soap\r\nand water, start treatment with lower-strength preparations", "May bleach clothing" ] }, "LORAZEPAM": { "indications": "Indications\u00a0conscious sedation for procedures; premedication;\r\nshort-term use in anxiety or insomnia (section 4.1.2); status epilepticus (section 4.8.2)", "name": "LORAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines", "LORAZEPAM" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nLorazepam produces more prolonged sedation than temazepam and it has marked amnesic effects and %s\n(From LORAZEPAM: British National Formulary)\nLORAZEPAM; interactions: Appendix 1 (anxiolytics\r\nand hypnotics)", "side-effects": "Side-effects\u00a0see notes above and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100105.htm", "doses": [ "By mouth, 2\u20133\u00a0mg the night before operation;\r\n2\u20134\u00a0mg 1\u20132 hours before operation", "By slow intravenous injection, preferably diluted\r\nwith an equal volume of sodium chloride intravenous\r\ninfusion 0.9% or water for injections, 50\u00a0micrograms/kg 30\u201345 minutes\r\nbefore operation", "By intramuscular injection, diluted as above,\r\n50\u00a0micrograms/kg 60\u201390 minutes before operation" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "HEPATITIS A VACCINE - WITH HEPATITIS B VACCINE": { "indications": "Indications\u00a0immunisation against hepatitis A infection", "name": "HEPATITIS A VACCINE - WITH HEPATITIS B VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis A vaccine", "HEPATITIS A VACCINE", "With hepatitis B vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; for\r\ncombination vaccines, see also Typhoid vaccine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200786.htm", "doses": [ "See under preparations", "Primary course should be completed with Ambirix\u00ae (single component vaccines given at appropriate\r\nintervals may be used for booster dose); the deltoid region is the\r\npreferred site of injection in older children; anterolateral thigh\r\nis the preferred site in infants; not to be injected into the buttock\r\n(vaccine efficacy reduced); subcutaneous route used for patients with\r\nbleeding disorders (but immune response may be reduced)", "Name[Ambirix\u00ae (GSK) ] Injection, suspension of inactivated\r\nhepatitis A virus (grown in human diploid cells) 720\u00a0ELISA units/mL\r\nadsorbed onto aluminium hydroxide, and recombinant (DNA) hepatitis\r\nB surface antigen (grown in yeast cells) 20\u00a0micrograms/mL adsorbed\r\nonto aluminium phosphate, net price 1-mL prefilled syringe = \u00a331.18Excipients include neomycinDose\u00a0child 1\u201315 years, by intramuscular injection (see note below); primary course,\r\n2 doses of 1\u00a0mL, the second 6\u201312 months after initial doseNote\u00a0Primary course should be completed with Ambirix\u00ae (single component vaccines given at appropriate\r\nintervals may be used for booster dose); the deltoid region is the\r\npreferred site of injection in older children; anterolateral thigh\r\nis the preferred site in infants; not to be injected into the buttock\r\n(vaccine efficacy reduced); subcutaneous route used for patients with\r\nbleeding disorders (but immune response may be reduced)Important\u00a0Ambirix\u00ae is not recommended for post-exposure prophylaxis following\r\npercutaneous (needle-stick), ocular, or mucous membrane exposure to\r\nhepatitis B virus" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "HYOSCINE HYDROBROMIDE - HYOSCINE": { "indications": "Indications\u00a0motion sickness;\r\nhypersalivation associated with clozapine therapy; premedication (section 15.1.3); excessive respiratory secretions (see Prescribing in Palliative\r\nCare)", "name": "HYOSCINE HYDROBROMIDE - HYOSCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Hyoscine", "HYOSCINE HYDROBROMIDE" ], "cautions": "Cautions\u00a0section 1.2; also epilepsy", "side-effects": "Side-effects\u00a0section 1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200878.htm", "doses": [ "Motion sickness, by mouth, adult and child over\r\n10 years, 150\u2013300\u00a0micrograms up to 30 minutes before start of journey\r\nrepeated every 6 hours if required; max. 900\u00a0micrograms daily; child 3\u20134 years 75\u00a0micrograms up to 30 minutes before\r\nstart of journey repeated after 6 hours if required, max. 150\u00a0micrograms\r\ndaily; 4\u201310 years 75\u2013150\u00a0micrograms up to 30 minutes before start\r\nof journey repeated every 6 hours if required; max. 450\u00a0micrograms\r\ndaily", "Hypersalivation associated with clozapine therapy [unlicensed\r\nindication], by mouth, 300\u00a0micrograms up to 3 times\r\ndaily; max. 900\u00a0micrograms daily; child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0section 15.1.3" }, "TEGAFUR WITH URACIL": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nTegafur (in combination with uracil) is given by mouth, together with calcium folinate, in the management of metastatic colorectal cancer. Tegafur is a prodrug of fluorouracil; uracil inhibits the degradation of fluorouracil. Tegafur (with uracil) has been shown to be of similar efficacy as a combination of fluorouracil and folinic acid for metastatic colorectal cancer. For NICE guidance on capecitabine and tegafur with uracil for metastatic colorectal cancer, see above.", "name": "TEGAFUR WITH URACIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "TEGAFUR WITH URACIL" ], "cautions": "Cautions\u00a0see section 8.1; cardiac disease; interactions: Appendix 1 (fluorouracil)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106027.htm", "doses": [ "adult, tegafur 300\u00a0mg/m2 (with uracil 672\u00a0mg/m2) daily in 3 divided doses\r\nfor 28 days; subsequent courses repeated after 7-day interval; for\r\ndose adjustment due to toxicity, consult product literature " ], "pregnancy": "Pregnancy\u00a0avoid; manufacturer advises effective contraception\r\nduring and for 3 months after treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "ADAPALENE With benzoyl peroxide": { "indications": "Indications\u00a0mild to moderate acne", "name": "ADAPALENE With benzoyl peroxide", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "ADAPALENE", "With benzoyl peroxide" ], "cautions": "Cautions\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207990.htm", "doses": [ "adult and child over 12 years, apply thinly once daily in the\r\nevening", "Name[Epiduo\u00ae (Galderma) ] Gel, adapalene 0.1%, benzoyl peroxide\r\n2.5%, net price 45\u00a0g = \u00a317.91. \r\n Label:\r\n 11Excipients include disodium edetate, polysorbate 80, propylene\r\nglycolDose\u00a0adult and child over 12 years, acne vulgaris, apply thinly\r\nonce daily in the eveningNote\u00a0May bleach clothing and hair" ], "pregnancy": "Pregnancy\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "NICOTINAMIDE": { "indications": "Indications\u00a0see under preparation", "name": "NICOTINAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Other topical preparations for acne", "NICOTINAMIDE" ], "cautions": "Cautions\u00a0avoid contact with eyes and mucous membranes (including nose and mouth); reduce frequency\r\nof application if excessive dryness, irritation or peeling", "side-effects": "Side-effects\u00a0dryness of skin; also pruritus, erythema, burning\r\nand irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/35674.htm", "doses": [ "inflammatory acne vulgaris, apply twice daily; reduce\r\nto once daily or on alternate days if irritation occurs" ] }, "PREDNISOLONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "PREDNISOLONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5439.htm", "doses": [ "Apply every 1\u20132 hours until controlled then reduce frequency" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "PREDNISOLONE" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use." }, "PEGFILGRASTIM": { "indications": "Indications\u00a0(specialist use only) reduction in duration of neutropenia and incidence\r\nof febrile neutropenia in cytotoxic chemotherapy for malignancy (except\r\nchronic myeloid leukaemia and myelodysplastic syndromes)", "name": "PEGFILGRASTIM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.6 Drugs used in neutropenia" ], "cautions": "Cautions\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nCautions\u00a0Granulocyte-colony stimulating factors should be used with caution in patients with pre-malignant or malignant myeloid conditions. Full blood counts including differential white cell and platelet counts should be monitored. Treatment should be withdrawn in patients who develop signs of pulmonary infiltration. There have been reports of pulmonary infiltrates leading to acute respiratory distress syndrome\u2014patients with a history of pulmonary infiltrates or pneumonia may be at higher risk. Granulocyte-colony stimulating factors should be used with caution in patients with sickle-cell disease. Spleen size should be monitored during treatment because there is a risk of splenomegaly and rupture.; also acute leukaemia and myelosuppressive chemotherapy; interactions: Appendix 1 (filgrastim)", "side-effects": "Side-effects\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nSide-effects\u00a0Side-effects of granulocyte-colony stimulating factors include gastro-intestinal disturbances, anorexia, headache, asthenia, fever, musculoskeletal pain, bone pain, rash, alopecia, injection-site reactions, thrombocytopenia, and leucocytosis. Less commonly chest pain can occur. Pulmonary side-effects, particularly interstitial pneumonia (see Cautions above), cutaneous vasculitis and acute febrile neutrophilic dermatosis have rarely been reported.; also very rarely splenic rupture", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127939.htm", "doses": [ "Dose expressed as\r\nfilgrastim", "By subcutaneous injection, adult over 18 years, 6\u00a0mg (0.6\u00a0mL) for each chemotherapy cycle, starting\r\n24 hours after chemotherapy" ], "pregnancy": "Pregnancy\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nPregnancy\u00a0There have been reports of toxicity in animal studies and manufacturers advise not to use granulocyte-colony stimulating factors during pregnancy unless the potential benefit outweighs the risk." }, "ATAZANAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "ATAZANAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; also concomitant use with drugs that prolong PR interval; cardiac conduction disorders; predisposition to QT interval prolongation (including electrolyte disturbances, concomitant\r\nuse of drugs that prolong QT interval); interactions: Appendix 1 (atazanavir)", "side-effects": "Side-effects\u00a0see notes above; also AV block (in children); less commonly mouth ulcers, dry mouth, hypertension, syncope,\r\nchest pain, dyspnoea, peripheral neuropathy, abnormal dreams, amnesia,\r\ndisorientation, depression, anxiety, weight changes, increased appetite,\r\ngynaecomastia, nephrolithiasis, urinary frequency, haematuria, proteinuria,\r\narthralgia, and alopecia; rarely hepatosplenomegaly,\r\noedema, palpitation, and abnormal gait; also reported, cholelithiasis,\r\ncholecystitis, and torsade de pointes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128409.htm", "doses": [ "With low-dose ritonavir, 300\u00a0mg once daily; child 6\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; theoretical risk of hyperbilirubinaemia in neonate\r\nif used at term " }, "TADALAFIL - VASODILATOR ANTIHYPERTENSIVE DRUGS": { "indications": "Indications\u00a0pulmonary arterial hypertension;\r\nerectile dysfunction (section 7.4.5)", "name": "TADALAFIL - VASODILATOR ANTIHYPERTENSIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "TADALAFIL" ], "cautions": "Cautions\u00a0hypotension (avoid if systolic blood pressure below 90\u00a0mmHg); aortic and mitral\r\nvalve disease; pericardial constriction; congestive cardiomyopathy; left ventricular dysfunction; life-threatening\r\narrhythmias; coronary artery disease; uncontrolled hypertension; pulmonary veno-occlusive disease; predisposition\r\nto priapism; anatomical deformation of\r\nthe penis; hereditary degenerative retinal\r\ndisorders; interactions: Appendix 1\r\n(tadalafil)", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, gastro-oesophageal\r\nreflux, chest pain, palpitation, flushing, hypotension, nasopharyngitis,\r\nepistaxis, headache, myalgia, back and limb pain, increased uterine\r\nbleeding, blurred vision, facial oedema, rash; less commonly tachycardia, hypertension, seizures, amnesia, priapism, hyperhidrosis; also reported unstable angina, arrhythmia, myocardial infarction,\r\nstroke, hearing loss, non-arteritic anterior ischaemic optic neuropathy,\r\nretinal vascular occlusion, visual field defect, Stevens-Johnson syndrome ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213711.htm", "doses": [ "adult over 18 years, 40\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "MEFENAMIC ACID": { "indications": "Indications\u00a0pain and inflammation in rheumatoid arthritis\r\nand osteoarthritis; postoperative pain; mild to moderate pain; dysmenorrhoea\r\nand menorrhagia", "name": "MEFENAMIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "MEFENAMIC ACID" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; epilepsy; acute porphyria (%s\n(From Drugs unsafe for use in acute porphyrias: British National Formulary)\nDrugs unsafe for use in acute porphyrias) ", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; also diarrhoea or rashes (withdraw\r\ntreatment), stomatitis; less commonly paraesthesia\r\nand fatigue; rarely hypotension, palpitation, glucose\r\nintolerance, thrombocytopenia, haemolytic anaemia (positive\r\nCoombs\u2019 test), and aplastic anaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5240.htm", "doses": [ "adult over 18 years, 500\u00a0mg\r\n3 times daily", "child 12\u201318 years, acute pain\r\nincluding dysmenorrhoea, menorrhagia, 500\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "CANDESARTAN CILEXETIL": { "indications": "Indications\u00a0hypertension; heart failure with impaired left ventricular systolic\r\nfunction in conjunction with an ACE inhibitor, or when ACE inhibitors\r\nare not tolerated (see also section 2.5.5)", "name": "CANDESARTAN CILEXETIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also vertigo, headache; very rarely nausea, hepatitis, blood disorders, hyponatraemia,\r\nback pain, arthralgia, myalgia, rash, urticaria, pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64864.htm", "doses": [ "Hypertension, initially 8\u00a0mg (intravascular volume depletion\r\n4\u00a0mg) once daily, increased if necessary at intervals of 4 weeks to\r\nmax. 32\u00a0mg once daily; usual maintenance dose 8\u00a0mg once daily", "Heart failure, initially 4\u00a0mg once daily, increased at intervals\r\nof at least 2 weeks to \u2018target\u2019 dose of 32\u00a0mg once daily or to max.\r\ntolerated dose" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "DESLORATADINE": { "indications": "Indications\u00a0symptomatic relief of allergic rhinitis and urticaria", "name": "DESLORATADINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines", "DESLORATADINE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.; rarely myalgia; very rarely hallucinations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106055.htm", "doses": [ "5\u00a0mg once daily; child 1\u20136\r\nyears 1.25\u00a0mg once daily, 6\u201312 years 2.5\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "DOXORUBICIN HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nDoxorubicin is used to treat the acute leukaemias, Hodgkin\u2019s and non-Hodgkin\u2019s lymphomas, paediatric malignancies, and some solid tumours including breast cancer. It is given by injection into a fast-running infusion, commonly at 21-day intervals. Extravasation can cause severe tissue necrosis. Doxorubicin is largely excreted in the bile and an elevated bilirubin concentration is an indication for reducing the dose. Diarrhoea, dehydration, and red coloration of the urine can commonly occur, and renal damage has been reported. Supraventricular tachycardia related to drug administration is an uncommon complication. Higher cumulative doses are associated with cardiomyopathy and it is usual to limit total cumulative doses to 450\u00a0mg/m2 because symptomatic and potentially fatal heart failure is common above this dose. Patients should be assessed before treatment by echocardiography; the elderly, and those with cardiac disease, hypertension, or who have received myocardial irradiation, should be treated cautiously. Cardiac monitoring may assist in determining safe dosage. Caution is necessary with concomitant use of cardiotoxic drugs, or drugs that reduce cardiac contractility. Some evidence suggests that weekly low-dose administration may be less cardiotoxic. Doxorubicin is also given by bladder instillation for the treatment of transitional cell carcinoma, papillary bladder tumours and carcinoma in-situ. and %s\n(From 7.4.4 Bladder instillations and urological surgery: British National Formulary)\n7.4.4 Bladder instillations and urological surgery", "name": "DOXORUBICIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "DOXORUBICIN HYDROCHLORIDE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues; interactions: Appendix 1 (doxorubicin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60614.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); manufacturer of liposomal product advises effective contraception\r\nduring and for at least 6 months after treatment in men or women;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "ACRIVASTINE": { "indications": "Indications\u00a0symptomatic relief of allergy such\r\nas hay fever, chronic idiopathic urticaria", "name": "ACRIVASTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines", "ACRIVASTINE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204092.htm", "doses": [ "adult and child over 12 years, 8\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "POLIOMYELITIS VACCINES": { "indications": "Indications\u00a0immunisation against poliomyelitis ", "name": "POLIOMYELITIS VACCINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Poliomyelitis vaccines", "POLIOMYELITIS VACCINES" ], "cautions": "Cautions\u00a0see section 14.1; also for live vaccine, interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0\n(From Poliomyelitis vaccines: British National Formulary)\nLive (oral) poliomyelitis vaccine is available only for use during outbreaks. The live (oral) vaccine poses a very rare risk of vaccine-associated paralytic polio because the attenuated strain of the virus can revert to a virulent form. For this reason the live (oral) vaccine must not be used for immunosuppressed individuals or their household contacts. The use of inactivated poliomyelitis vaccine removes the risk of vaccine-associated paralytic polio altogether. and %s\n(From 14.1 Active immunity: British National Formulary)\nSide-effects\u00a0Injection of a vaccine may be followed by local reactions such as pain, inflammation, redness, and lymphangitis. An induration or sterile abscess may develop at the injection site. Gastro-intestinal disturbances, fever, headache, irritability, loss of appetite, fatigue, myalgia, and malaise are among the most commonly reported side-effects. Other side-effects include influenza-like symptoms, dizziness, paraesthesia, asthenia, drowsiness, arthralgia, rash, and lymphadenopathy. Hypersensitivity reactions, such as bronchospasm, angioedema, urticaria, and anaphylaxis, are very rare but can be fatal (see section 3.4.3 for management of allergic emergencies).Oral vaccines such as cholera, live poliomyelitis, rotavirus, and live typhoid can also cause gastro-intestinal disturbances such as nausea, vomiting, abdominal pain and cramps, and diarrhoea.See also Predisposition to neurological problems, below.Some vaccines (e.g. poliomyelitis) produce very few reactions, while others (e.g. measles, mumps and rubella) may cause a very mild form of the disease. Occasionally more serious adverse reactions can occur\u2014these should always be reported to the CHM (see Adverse Reactions to Drugs).See also Preterm Birth.Post-immunisation pyrexia in infantsThe parent should be advised that if pyrexia develops after childhood immunisation, and the infant seems distressed, a dose of paracetamol can be given and, if necessary, a second dose can be given 6 hours later; ibuprofen may be used if paracetamol is unsuitable. The parent should be warned to seek medical advice if the pyrexia persists.For post-immunisation pyrexia in an infant aged 2\u20133 months, the dose of paracetamol is 60\u00a0mg; the dose of ibuprofen is 50\u00a0mg (on a doctor\u2019s advice). An oral syringe can be obtained from any pharmacy to give the small volume required.Predisposition to neurological problems When there is a personal or family history of febrile convulsions, there is an increased risk of these occurring during fever from any cause including immunisation, but this is not a contra-indication to immunisation. In children who have had a seizure associated with fever without neurological deterioration, immunisation is recommended; advice on the management of fever (see Post-immunisation pyrexia in infants, above) should be given before immunisation. When a child has had a convulsion not associated with fever, and the neurological condition is not deteriorating, immunisation is recommended.Children with stable neurological disorders (e.g. spina bifida, congenital brain abnormality, and perinatal hypoxic-ischaemic encephalopathy) should be immunised according to the recommended schedule.When there is a still evolving neurological problem, including poorly controlled epilepsy, immunisation should be deferred and the child referred to a specialist. Immunisation is recommended if a cause for the neurological disorder is identified. If a cause is not identified, immunisation should be deferred until the condition is stable.Further information on adverse effects associated with specific vaccines can be found under individual vaccines.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6514.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "MINOCYCLINE ": { "indications": "Indications\u00a0see notes above; meningococcal carrier state; acne vulgaris (%s\n(From 13.6.2 Oral preparations for acne: British National Formulary)\n13.6.2 Oral preparations for acne)", "name": "MINOCYCLINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).; if treatment continued for longer\r\nthan 6 months, monitor every 3 months for hepatotoxicity, pigmentation\r\nand for systemic lupus erythematosus\u2014discontinue if these develop\r\nor if pre-existing systemic lupus erythematosus worsens", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ; also\r\ndizziness and vertigo (more common in women); rarely anorexia, tinnitus, impaired hearing, hyperaesthesia, paraesthesia,\r\nacute renal failure, pigmentation (sometimes irreversible), and alopecia; very rarely systemic lupus erythematosus, discoloration\r\nof conjunctiva, tears, and sweat", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3823.htm", "doses": [ "100\u00a0mg twice daily", "Acne, see section 13.6.2 and under preparations, below", "Prophylaxis of asymptomatic meningococcal carrier state (but\r\nno longer recommended, see notes above), 100\u00a0mg twice daily for 5\r\ndays usually followed by rifampicin", "Tablets or capsules should be swallowed\r\nwhole with plenty of fluid while sitting or standing" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "ETANERCEPT - DRUGS AFFECTING THE IMMUNE RESPONSE": { "indications": "Indications\u00a0see notes above; ankylosing spondylitis,\r\npsoriatic arthritis, polyarticular course juvenile idiopathic arthritis,\r\nrheumatoid arthritis (%s\n(From ETANERCEPT: British National Formulary)\nETANERCEPT)", "name": "ETANERCEPT - DRUGS AFFECTING THE IMMUNE RESPONSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201652.htm", "doses": [ "By subcutaneous injection, plaque psoriasis,\r\n25\u00a0mg twice weekly or 50\u00a0mg once weekly for up to 24 weeks; discontinue\r\nif no response after 12 weeks; child 6\u201318 years, 800\u00a0micrograms/kg (max. 50\u00a0mg) once weekly for up to\r\n24 weeks; discontinue if no response after 12 weeks" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "GEFITINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nGefitinib, a tyrosine kinase inhibitor, is licensed for the treatment of locally advanced or metastatic non-small cell lung cancer with activating mutations of epidermal growth factor receptor.NICE guidanceGefitinib for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer (July 2010)Gefitinib is recommended as an option for the first-line treatment of locally advanced or metastatic non-small-cell lung cancer if the patient tests positive for the epidermal growth receptor tyrosine kinase (EGFR-TK) mutation and the manufacturer provides gefitinib at the fixed price agreed under the patient access scheme.", "name": "GEFITINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors" ], "cautions": "Cautions\u00a0monitor liver function\u2014consider discontinuing\r\nif severe changes in liver function occur; monitor for worsening of dyspnoea, cough and fever\u2014discontinue if\r\ninterstitial lung disease confirmed; patients\r\nshould seek immediate medical advice if they experience any ocular\r\nsymptoms; interactions: Appendix 1\r\n(gefitinib)", "side-effects": "Side-effects\u00a0see section 8.1; also\r\nanorexia, diarrhoea, dry mouth; epistaxis, interstitial lung disease\u2014discontinue\r\nif confirmed; asthenia; pyrexia; haematuria, proteinuria; dry eye,\r\nconjunctivitis, blepharitis; nail disorder, skin reactions (including\r\ndry skin, rash, acne, and pruritus); less commonly pancreatitis, corneal erosion; rarely hepatitis,\r\ntoxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203890.htm", "doses": [ "adult over 18 years, 250\u00a0mg\r\nonce daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies; see also Pregnancy and Reproductive\r\nFunction " }, "SODIUM PICOSULFATE WITH MAGNESIUM CITRATE": { "indications": "Indications\u00a0see preparations", "name": "SODIUM PICOSULFATE WITH MAGNESIUM CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.5 Bowel cleansing preparations" ], "cautions": "Cautions\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also recent gastro-intestinal surgery; cardiac\r\ndisease (avoid\r\nin congestive cardiac failure) ", "side-effects": "Side-effects\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also anal\r\ndiscomfort, sleep disturbances, fatigue, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202770.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0caution" }, "FLUORIDES": { "indications": "Indications\u00a0prophylaxis of dental caries\u2014\n(From 9.5.3 Fluoride: British National Formulary)\n9.5.3 Fluoride", "name": "FLUORIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.3 Fluoride", "FLUORIDES" ], "side-effects": "Side-effects\u00a0occasional white flecks on teeth with recommended\r\ndoses; rarely yellowish-brown discoloration if recommended\r\ndoses are exceeded", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5072.htm", "doses": [ "Dose expressed as\r\nfluoride ion (F-)", "Water content less than F- 300\u00a0micrograms/litre (0.3\r\nparts per million), child up to 6 months\r\nnone; 6 months\u20133 years F- 250\u00a0micrograms daily, 3\u20136 years\r\nF- 500\u00a0micrograms daily, over 6 years F- 1\u00a0mg\r\ndaily", "Water content between F- 300 and 700\u00a0micrograms/litre\r\n(0.3\u20130.7 parts per million), child up\r\nto 3 years none, 3\u20136 years F- 250\u00a0micrograms daily, over\r\n6 years F- 500\u00a0micrograms daily", "Water content above F- 700\u00a0micrograms/litre (0.7\r\nparts per million), supplements not advised", "These doses reflect the recommendations of\r\nthe British Dental Association, the British Society of Paediatric\r\nDentistry and the British Association for the Study of Community Dentistry\r\n(Br Dent J 1997; 182: 6\u20137)" ] }, "PHENELZINE ": { "indications": "Indications\u00a0depressive illness", "name": "PHENELZINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.2 Monoamine-oxidase inhibitors", "PHENELZINE" ], "cautions": "Cautions\u00a0diabetes mellitus, cardiovascular\r\ndisease, epilepsy, blood disorders, concurrent electroconvulsive\r\ntherapy; elderly (great caution); monitor blood pressure (risk of postural hypotension\r\nand hypertensive responses\u2014discontinue if palpitations or frequent headaches); if possible avoid abrupt withdrawal; severe\r\nhypertensive reactions to certain drugs and foods\u2014\n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nInteractions\u00a0MAOIs inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters. The metabolism of some amine drugs such as indirect-acting sympathomimetics (present in many cough and decongestant preparations, section 3.10) is also inhibited and their pressor action may be potentiated; the pressor effect of tyramine (in some foods, such as mature cheese, pickled herring, broad bean pods, and Bovril\u00ae, Oxo\u00ae, Marmite\u00ae or any similar meat or yeast extract or fermented soya bean extract) may also be dangerously potentiated. These interactions may cause a dangerous rise in blood pressure. An early warning symptom may be a throbbing headache. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or \u2018going off\u2019. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Patients should also avoid alcoholic drinks or de-alcoholised (low alcohol) drinks.Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Some psychiatrists use selected tricyclics in conjunction with MAOIs but this is hazardous, indeed potentially lethal, except in experienced hands and there is no evidence that the combination is more effective than when either constituent is used alone. The combination of tranylcypromine with clomipramine is particularly dangerous.Conversely, an MAOI should not be started until at least 7\u201314 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped.In addition, an MAOI should not be started for at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose).For other interactions with MAOIs including those with opioid analgesics (notably pethidine), see Appendix 1 (MAOIs). For guidance on interactions relating to the reversible monoamine oxidase inhibitor, moclobemide, see Reversible MAOIs; for guidance on interactions relating to SSRIs, see Selective Serotonin Re-uptake Inhibitors.; avoid in agitated patients; acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); surgery (%s\n(From 15.1 General anaesthesia: British National Formulary)\n15.1 General anaesthesia); interactions: \n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nInteractions\u00a0MAOIs inhibit monoamine oxidase, thereby causing an accumulation of amine neurotransmitters. The metabolism of some amine drugs such as indirect-acting sympathomimetics (present in many cough and decongestant preparations, section 3.10) is also inhibited and their pressor action may be potentiated; the pressor effect of tyramine (in some foods, such as mature cheese, pickled herring, broad bean pods, and Bovril\u00ae, Oxo\u00ae, Marmite\u00ae or any similar meat or yeast extract or fermented soya bean extract) may also be dangerously potentiated. These interactions may cause a dangerous rise in blood pressure. An early warning symptom may be a throbbing headache. Patients should be advised to eat only fresh foods and avoid food that is suspected of being stale or \u2018going off\u2019. This is especially important with meat, fish, poultry or offal; game should be avoided. The danger of interaction persists for up to 2 weeks after treatment with MAOIs is discontinued. Patients should also avoid alcoholic drinks or de-alcoholised (low alcohol) drinks.Other antidepressants should not be started for 2 weeks after treatment with MAOIs has been stopped (3 weeks if starting clomipramine or imipramine). Some psychiatrists use selected tricyclics in conjunction with MAOIs but this is hazardous, indeed potentially lethal, except in experienced hands and there is no evidence that the combination is more effective than when either constituent is used alone. The combination of tranylcypromine with clomipramine is particularly dangerous.Conversely, an MAOI should not be started until at least 7\u201314 days after a tricyclic or related antidepressant (3 weeks in the case of clomipramine or imipramine) has been stopped.In addition, an MAOI should not be started for at least 2 weeks after a previous MAOI has been stopped (then started at a reduced dose).For other interactions with MAOIs including those with opioid analgesics (notably pethidine), see Appendix 1 (MAOIs). For guidance on interactions relating to the reversible monoamine oxidase inhibitor, moclobemide, see Reversible MAOIs; for guidance on interactions relating to SSRIs, see Selective Serotonin Re-uptake Inhibitors. and Appendix\r\n1 (MAOIs)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0commonly postural hypotension (especially in elderly)\r\nand dizziness; less common side-effects include drowsiness, insomnia,\r\nheadache, weakness and fatigue, dry mouth, constipation and other\r\ngastro-intestinal disturbances, oedema, myoclonic movement, hyperreflexia,\r\nelevated liver enzymes; agitation and tremors, nervousness, euphoria,\r\narrhythmias, blurred vision, nystagmus, difficulty in micturition,\r\nsweating, convulsions, rashes, purpura, leucopenia, sexual disturbances,\r\nand weight gain with inappropriate appetite may also occur; psychotic\r\nepisodes with hypomanic behaviour, confusion, and hallucinations may\r\nbe induced in susceptible persons; suicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy);\r\njaundice has been reported and, on rare occasions, fatal progressive\r\nhepatocellular necrosis; paraesthesia, peripheral neuritis, peripheral\r\nneuropathy may be due to pyridoxine deficiency; hyponatraemia (see\r\nHyponatraemia and Antidepressant Therapy, section 4.3)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3343.htm", "doses": [ "15\u00a0mg 3 times daily, increased if necessary to 4 times\r\ndaily after 2 weeks (hospital patients, max. 30\u00a0mg 3 times daily),\r\nthen reduced gradually to lowest possible maintenance dose (15\u00a0mg\r\non alternate days may be adequate); child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nPregnancy\u00a0There is an increased risk of neonatal malformations when phenelzine, isocarboxazid, or tranylcypromine is used during pregnancy. The safety of moclobemide in pregnancy has not been established. Manufacturers advise avoid use unless there are compelling reasons." }, "LEUPRORELIN ACETATE - DRUGS AFFECTING GONADOTROPHINS": { "indications": "Indications\u00a0see under Dose; prostate cancer (section 8.3.4.2)", "name": "LEUPRORELIN ACETATE - DRUGS AFFECTING GONADOTROPHINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.; monitor liver function; family history\r\nof osteoporosis; chronic use of other drugs which reduce\r\nbone density including alcohol and tobacco; diabetes", "side-effects": "Side-effects\u00a0see notes above; breast tenderness; nausea, vomiting,\r\ndiarrhoea, anorexia; fever, chills; sleep disturbances, dizziness,\r\nfatigue, leucopenia, thrombocytopenia, altered blood lipids, pulmonary\r\nembolism; spinal fracture, paralysis, hypotension and worsening of\r\ndepression also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4473.htm", "doses": [ "By subcutaneous or intramuscular injection (as Prostap\u00ae SR DCS)", "Endometriosis, 3.75\u00a0mg as a single dose in first 5 days of menstrual\r\ncycle then every month for max. 6 months (course not to be repeated)", "Endometrial thinning before intra-uterine surgery, 3.75\u00a0mg as\r\na single dose (given between days 3 and 5 of menstrual cycle) 5\u20136\r\nweeks before surgery", "Reduction of size of uterine fibroids and of associated bleeding\r\nbefore surgery, 3.75\u00a0mg as a single dose every month usually for 3\u20134\r\nmonths (max. 6 months)", "By intramuscular injection (as Prostap\u00ae 3 DCS)", "Endometriosis, 11.25\u00a0mg as a single dose in first 5 days of\r\nmenstrual cycle then every 3 months for max. 6 months (course not\r\nto be repeated)" ], "pregnancy": "Pregnancy\u00a0teratogenic in animal studies; see\r\nalso notes above" }, "CETIRIZINE HYDROCHLORIDE": { "indications": "Indications\u00a0symptomatic relief of allergy such as hay fever, chronic idiopathic\r\nurticaria", "name": "CETIRIZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.1 Antihistamines", "Non-sedating antihistamines", "CETIRIZINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nCautions and contra-indications\u00a0Sedating antihistamines have significant antimuscarinic activity and they should therefore be used with caution in prostatic hypertrophy, urinary retention, susceptibility to angle-closure glaucoma, and pyloroduodenal obstruction. Caution may be required in epilepsy. Children and the elderly are more susceptible to side-effects. Many antihistamines should be avoided in acute porphyria but some are thought to be safe, see section 9.8.2. Interactions: Appendix 1 (antihistamines).", "side-effects": "Side-effects\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nSide-effects\u00a0Drowsiness is a significant side-effect with most of the older antihistamines although paradoxical stimulation may occur rarely, especially with high doses or in children and the elderly. Drowsiness may diminish after a few days of treatment and is considerably less of a problem with the newer antihistamines (see also notes above). Side-effects that are more common with the older antihistamines include headache, psychomotor impairment, and antimuscarinic effects such as urinary retention, dry mouth, blurred vision, and gastro-intestinal disturbances.Other rare side-effects of antihistamines include hypotension, palpitation, arrhythmias, extrapyramidal effects, dizziness, confusion, depression, sleep disturbances, tremor, convulsions, hypersensitivity reactions (including bronchospasm, angioedema, and anaphylaxis, rashes, and photosensitivity reactions), blood disorders, liver dysfunction, and angle-closure glaucoma.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106464.htm", "doses": [ "adult and child over 12 years, 10\u00a0mg once daily; child 1\u20132 years see BNF for Children, 2\u20136 years\r\n2.5\u00a0mg twice daily, 6\u201312 years 5\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 3.4.1 Antihistamines: British National Formulary)\nPregnancy\u00a0Most manufacturers of antihistamines advise avoiding their use during pregnancy; however, there is no evidence of teratogenicity except for hydroxyzine where toxicity has been reported with high doses in animal studies. The use of sedating antihistamines in the latter part of the third trimester may cause adverse effects in neonates such as irritability, paradoxical excitability, and tremor." }, "BENZOIC ACID": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "BENZOIC ACID" ], "indications": "Indications\u00a0ringworm (tinea), but see notes above", "name": "BENZOIC ACID", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6152.htm", "doses": [ "apply twice daily" ] }, "PENTOXIFYLLINE ": { "indications": "Indications\u00a0peripheral vascular disease (but see notes above); venous leg ulcers\r\n[unlicensed indication] (%s\n(From A5.8.7 Compression bandages: British National Formulary)\nA5.8.7 Compression bandages)", "name": "PENTOXIFYLLINE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.4 Peripheral vasodilators and related drugs", "PENTOXIFYLLINE" ], "cautions": "Cautions\u00a0hypotension, coronary artery disease; avoid in acute\r\nporphyria (section 9.8.2); interactions: Appendix 1\r\n(pentoxifylline)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, dizziness, agitation,\r\nsleep disturbances, headache; rarely angina, hypotension; very rarely bleeding; also reported intrahepatic\r\ncholestasis, tachycardia, flushing, thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2717.htm", "doses": [ "400\u00a0mg 2\u20133 times daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available" }, "GOSERELIN - DRUGS AFFECTING GONADOTROPHINS": { "indications": "Indications\u00a0see under Dose; prostate cancer (section 8.3.4.2); early\r\nand advanced breast cancer (section\r\n8.3.4.1)", "name": "GOSERELIN - DRUGS AFFECTING GONADOTROPHINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.2 Drugs affecting gonadotrophins", "Gonadorelin analogues", "GOSERELIN" ], "cautions": "Cautions\u00a0\n(From Gonadorelin analogues: British National Formulary)\nCautions\u00a0Non-hormonal, barrier methods of contraception should be used during entire treatment period with gonadorelin analogues; also use with caution in patients with metabolic bone disease because decrease in bone mineral density can occur.; polycystic ovarian disease; diabetes", "side-effects": "Side-effects\u00a0see notes above; withdrawal bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/104938.htm", "doses": [ "By subcutaneous injection into anterior\r\nabdominal wall (as Zoladex\u00ae)", "Endometriosis, 3.6\u00a0mg every 28 days; max. duration of treatment\r\n6 months (do not repeat)", "Endometrial thinning before intra-uterine surgery, 3.6\u00a0mg (may\r\nbe repeated after 28 days if uterus is large or to allow flexible\r\nsurgical timing)", "Before surgery in women who have anaemia due to uterine fibroids,\r\n3.6\u00a0mg every 28 days (with supplementary iron); max. duration of treatment\r\n3 months", "Pituitary desensitisation before induction of ovulation by gonadotrophins\r\nfor in vitro fertilisation (under specialist supervision),\r\nafter exclusion of pregnancy, 3.6\u00a0mg to achieve pituitary down-regulation\r\n(usually 1\u20133 weeks) then gonadotrophin is administered (stopping gonadotrophin\r\non administration of chorionic gonadotrophin at\r\nappropriate stage of follicular development)" ], "pregnancy": "Pregnancy\u00a0use non-hormonal contraceptives during treatment;\r\nsee also notes above" }, "VALSARTAN": { "indications": "Indications\u00a0hypertension; heart failure when ACE inhibitors cannot be used, or\r\nin conjunction with an ACE inhibitor when a beta-blocker cannot be\r\nused (see also section 2.5.5); myocardial infarction with\r\nleft ventricular failure or left ventricular systolic dysfunction\r\n(adjunct\u2014see section 2.5.5 and section 2.10.1)", "name": "VALSARTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; renal impairment; less\r\ncommonly gastro-intestinal disturbance, syncope, fatigue,\r\ncough, headache, acute renal failure; neutropenia, thrombocytopenia,\r\nmyalgia, and hypersensitivity reactions (including rash, pruritus,\r\nvasculitis, and serum sickness) also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56945.htm", "doses": [ "Hypertension, usually 80\u00a0mg once daily (initially 40\u00a0mg\r\nonce daily in intravascular volume depletion); if necessary increased\r\nat intervals of 4 weeks up to max. 320\u00a0mg daily", "Heart failure, initially 40\u00a0mg twice daily increased at intervals\r\nof at least 2 weeks up to max. 160\u00a0mg twice daily", "Myocardial infarction, initially 20\u00a0mg twice daily increased\r\nover several weeks to 160\u00a0mg twice daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "HAEMOPHILUS TYPE B CONJUGATE VACCINE": { "indications": "Indications\u00a0\n(From Haemophilus type B conjugate vaccine: British National Formulary)\nHaemophilus type B conjugate vaccine", "name": "HAEMOPHILUS TYPE B CONJUGATE VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Haemophilus type B conjugate vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also\r\natopic dermatitis and hypotonia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201136.htm", "doses": [ "Primary immunisation, see under Diphtheria", "Booster dose, see notes above and under\r\npreparation below" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "PANTOPRAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "PANTOPRAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.5 Proton pump inhibitors" ], "cautions": "Cautions\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nCautions\u00a0Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.; interactions: Appendix 1 (proton pump inhibitors)", "side-effects": "Side-effects\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nSide-effects\u00a0Side-effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.; also hyperlipidaemia, weight changes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/56356.htm", "doses": [ "By mouth, benign gastric ulcer, adult over 18 years, 40\u00a0mg daily for 8 weeks; in\r\nsevere cases increase up to 80\u00a0mg daily", "Duodenal ulcer, adult over 18\r\nyears, 40\u00a0mg daily for 4 weeks; in severe cases increase up to 80\u00a0mg\r\ndaily", "Duodenal or benign gastric ulcer associated with Helicobacter\r\npylori, see Recommended Regimens for Helicobacter pylori Eradication", "Prophylaxis of NSAID-associated gastric or duodenal ulcer in\r\npatients with an increased risk of gastroduodenal complications who\r\nrequire continued NSAID treatment, adult over 18 years, 20\u00a0mg daily", "Gastro-oesophageal reflux disease, adult and child over 12 years, 20\u201380\u00a0mg\r\ndaily in the morning for 4 weeks, continued for further 4 weeks if\r\nnot fully healed; maintenance 20\u00a0mg daily, increased to 40\u00a0mg daily\r\nif symptoms return", "Zollinger\u2013Ellison syndrome (and other hypersecretory conditions), adult over 18 years, initially 80\u00a0mg once daily adjusted\r\naccording to response (elderly max.\r\n40\u00a0mg daily); daily doses above 80\u00a0mg given in 2 divided doses", "By intravenous injection over at\r\nleast 2 minutes or by intravenous infusion, adult over 18 years, duodenal ulcer,\r\ngastric ulcer, and gastro-oesophageal reflux, 40\u00a0mg daily until oral\r\nadministration can be resumed", "Zollinger\u2013Ellison syndrome (and other hypersecretory conditions), adult over 18 years, initially 80\u00a0mg (160\u00a0mg if rapid\r\nacid control required) then 80\u00a0mg once daily adjusted according to\r\nresponse; daily doses above 80\u00a0mg given in 2 divided doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014fetotoxic in animals" }, "DINOPROSTONE": { "indications": "Indications\u00a0see\r\nnotes above and under preparations below", "name": "DINOPROSTONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics" ], "cautions": "Cautions\u00a0history of asthma, glaucoma\r\nand raised intra-ocular pressure; hypertension; history of epilepsy; uterine\r\nscarring; monitor uterine activity and fetal status (particular care if history of uterine\r\nhypertony); uterine rupture; see also notes above; monitor for disseminated intravascular coagulation after parturition; risk factors for disseminated intravascular coagulation; effect of oxytocin enhanced (care needed in monitoring uterine activity when used in sequence); interactions: Appendix 1 (prostaglandins)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea; other side-effects\r\ninclude uterine hypertonus, severe uterine contractions, pulmonary\r\nor amniotic fluid embolism, abruptio placenta, fetal distress, maternal\r\nhypertension, bronchospasm, rapid cervical dilation, fever, backache;\r\nuterine hypercontractility with or without fetal bradycardia, low\r\nApgar scores; cardiac arrest, uterine rupture, stillbirth or neonatal\r\ndeath also reported; vaginal symptoms (warmth, irritation, pain);\r\nafter intravenous administration\u2014flushing, shivering, headache, dizziness,\r\ntemporary pyrexia and raised white blood cell count; disseminated\r\nintravascular coagulation reported; also local tissue reaction and\r\nerythema after intravenous administration and possibility of infection\r\nafter extra-amniotic administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4487.htm", "doses": [ "See under preparations, below", "Do not confuse dose of Prostin\r\nE2\u00ae vaginal gel with that of Prostin\r\nE2\u00ae vaginal tablets\u2014not bioequivalent." ] }, "VITAMIN A Vitamins A and D": { "indications": "Indications\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "name": "VITAMIN A Vitamins A and D", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.1 Vitamin A", "VITAMIN A", "Vitamins A and D" ], "cautions": "Cautions\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\nPregnancy\u00a0In view of evidence suggesting that high levels of vitamin A may cause birth defects, women who are (or may become) pregnant are advised not to take vitamin A supplements (including tablets and fish-liver oil drops), except on the advice of a doctor or an antenatal clinic; nor should they eat liver or products such as liver pat\u00e9 or liver sausage.; interactions: Appendix 1 (vitamins)", "side-effects": "Side-effects\u00a0\n(From 9.6.1 Vitamin A: British National Formulary)\n9.6.1 Vitamin A", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5092.htm", "doses": [ "See notes above and under preparations", "Name[Halibut-liver Oil (Non-proprietary)] Capsules, vitamin A 4000\u00a0units [also contains vitamin D], net price 100-cap pack = \u00a31.05" ], "pregnancy": "Pregnancy\u00a0excessive doses may be teratogenic; see also notes above" }, "DESFLURANE": { "indications": "Indications\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "name": "DESFLURANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.2 Inhalational anaesthetics", "Volatile liquid anaesthetics" ], "cautions": "Cautions\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6891.htm", "doses": [ "Induction of anaesthesia (but not recommended\u2014see notes above), by inhalation through\r\nspecifically calibrated vaporiser, adult 4\u201311%", "Maintenance of anaesthesia, by inhalation through\r\nspecifically calibrated vaporiser, adult 2\u20136% in nitrous oxide\u2013oxygen; 2.5\u20138.5% in oxygen or oxygen-enriched\r\nair; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "SAQUINAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "SAQUINAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors", "SAQUINAVIR" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; monitor ECG before starting treatment and then on day 3 or 4 of treatment\u2014discontinue if QT interval over 480\u00a0milliseconds, if\r\nQT interval more than 20\u00a0milliseconds above baseline, or if prolongation\r\nof PR interval; concomitant use of garlic (avoid garlic capsules\u2014reduces plasma-saquinavir concentration); interactions: Appendix 1 (saquinavir)Counselling\u00a0Patients should be told\r\nhow to recognise signs of arrhythmia and advised to seek medical attention\r\nif symptoms such as palpitation or syncope develop", "side-effects": "Side-effects\u00a0see notes above; also dyspnoea, increased appetite,\r\nperipheral neuropathy, convulsions, changes in libido, renal impairment,\r\ndry mouth, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57221.htm", "doses": [ "With low-dose ritonavir, adult previously treated with antiretroviral therapy, 1\u00a0g every 12 hours; child 16\u201318 years see BNF for Children", "With low-dose ritonavir, adult not previously treated with antiretroviral therapy, 500\u00a0mg every\r\n12 hours for 7 days then 1\u00a0g every 12 hours; child 16\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk " }, "POLYSTYRENE SULPHONATE RESINS": { "indications": "Indications\u00a0hyperkalaemia associated with anuria\r\nor severe oliguria, and in dialysis patients", "name": "POLYSTYRENE SULPHONATE RESINS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.1 Oral potassium", "Management of hyperkalaemia", "POLYSTYRENE SULPHONATE RESINS" ], "cautions": "Cautions\u00a0children (impaction of resin with excessive\r\ndosage or inadequate dilution); monitor\r\nfor electrolyte disturbances (stop if plasma-potassium\r\nconcentration below 5\u00a0mmol/litre); sodium-containing resin in congestive heart failure, hypertension, and oedema; interactions: Appendix 1 (polystyrene sulphonate\r\nresins)", "side-effects": "Side-effects\u00a0faecal impaction following rectal administration,\r\ngastro-intestinal concretions following oral administration, intestinal\r\nnecrosis reported with concomitant use of sorbitol, gastric irritation,\r\nanorexia, nausea, vomiting, constipation (discontinue treatment\u2014avoid\r\nmagnesium-containing laxatives), diarrhoea, hypomagnesaemia; gastro-intestinal\r\nobstruction, ulceration, necrosis, and ischaemic colitis also reported;\r\nwith calcium-containing resin, hypercalcaemia (including\r\nin dialysed patients and occasionally in those with renal impairment);\r\nwith sodium-containing resin, sodium retention, hypocalcaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4947.htm", "doses": [ "By mouth, 15\u00a0g 3\u20134 times daily in a small\r\namount of water or syrup (not fruit juice which has a high potassium\r\ncontent); child 0.5\u20131\u00a0g/kg daily in\r\ndivided doses", "By rectum, as an enema, 30\u00a0g in 150\u00a0mL of water\r\nor 10% glucose, retained for 9 hours followed by irrigation to remove\r\nresin from colon; neonate and child, 0.5\u20131\u00a0g/kg daily" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if potential benefit\r\noutweighs risk\u2014no information available" }, "SODIUM BICARBONATE - BICARBONATE AND LACTATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Bicarbonate and lactate", "SODIUM BICARBONATE" ], "indications": "Indications\u00a0metabolic acidosis, see also notes above", "name": "SODIUM BICARBONATE - BICARBONATE AND LACTATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4989.htm", "doses": [ "By slow intravenous injection, a strong\r\nsolution (up to 8.4%), or by continuous intravenous infusion, a weaker solution (usually 1.26%), an amount appropriate to the\r\nbody base deficit (see notes above)" ] }, "ZOLEDRONIC ACID": { "indications": "Indications\u00a0see under preparations", "name": "ZOLEDRONIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates" ], "cautions": "Cautions\u00a0correct disturbances of calcium metabolism\r\n(e.g. vitamin D deficiency, hypocalcaemia) before starting; monitor serum electrolytes, calcium,\r\nphosphate and magnesium; cardiac disease\r\n(avoid fluid overload); consider dental\r\ncheck-up before initiating bisphosphonate (risk of osteonecrosis of the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)Renal function\u00a0Renal impairment and renal failure\r\nhave been reported. Before each dose ensure patient is\r\nhydrated and assess renal function. Continue to monitor renal function\r\nin patients at risk, such as those with pre-existing renal impairment,\r\nthose of advanced age, those taking concomitant nephrotoxic drugs\r\nor diuretics, or those who are dehydrated. Use with\r\ncaution with concomitant medicines that affect renal function", "side-effects": "Side-effects\u00a0 hypophosphataemia, anaemia, influenza-like symptoms\r\nincluding bone pain, myalgia, arthralgia, fever and rigors; gastro-intestinal\r\ndisturbances; atrial fibrillation; headache, dizziness, conjunctivitis,\r\nrenal impairment (rarely acute renal failure); less commonly anorexia, taste disturbance, dry mouth, stomatitis, chest pain,\r\nhypertension, hypotension, dyspnoea, cough, paraesthesia, tremor,\r\nanxiety, lethargy, sleep disturbance, blurred vision, weight gain,\r\npruritus, rash, sweating, muscle cramps, haematuria, proteinuria,\r\nurinary frequency, hypersensitivity reactions (including angioedema),\r\nasthenia, peripheral oedema, thrombocytopenia, leucopenia, hypomagnesaemia,\r\nhypokalaemia, also injection-site reactions; rarely bradycardia, confusion, hyperkalaemia, hypernatraemia, pancytopenia,\r\nosteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw),\r\natypical femoral fractures (see MHRA/CHM advice); very rarely uveitis and episcleritis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106146.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "CISPLATIN": { "indications": "Indications\u00a0\n(From Platinum compounds: British National Formulary)\nCisplatin is used alone or in combination for the treatment of testicular, lung, cervical, bladder, head and neck, and ovarian cancer (but carboplatin is preferred for ovarian cancer). It is given intravenously. Cisplatin requires intensive intravenous hydration and treatment may be complicated by severe nausea and vomiting. Cisplatin is toxic, causing nephrotoxicity (monitoring of renal function is essential), ototoxicity, peripheral neuropathy, hypomagnesaemia and myelosuppression. It is, however, increasingly given in a day-care setting.", "name": "CISPLATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Platinum compounds", "CISPLATIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes\r\nabove; interactions: Appendix 1 (platinum\r\ncompounds)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11767.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "BIPHASIC ISOPHANE INSULIN": { "indications": "Indications\u00a0diabetes mellitus", "name": "BIPHASIC ISOPHANE INSULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "Biphasic insulins" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4122.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "FLUCYTOSINE": { "indications": "Indications\u00a0systemic yeast and fungal infections; adjunct to amphotericin in cryptococcal meningitis (see Cryptococcosis), adjunct to amphotericin in severe systemic candidiasis and in other severe or long-standing\r\ninfections", "name": "FLUCYTOSINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.2 Antifungal drugs", "5.2.5 Other antifungals" ], "cautions": "Cautions\u00a0elderly; blood\r\ndisorders; liver- and kidney-function tests\r\nand blood counts required (weekly in blood disorders); interactions: Appendix 1 (flucytosine)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, rashes; less frequently\r\ncardiotoxicity, confusion, hallucinations, convulsions, headache,\r\nsedation, vertigo, alterations in liver function tests (hepatitis\r\nand hepatic necrosis reported), and toxic epidermal necrolysis; blood\r\ndisorders including thrombocytopenia, leucopenia, and aplastic anaemia\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3976.htm", "doses": [ "By intravenous infusion over 20\u201340\r\nminutes, 200\u00a0mg/kg daily in 4 divided doses usually for not more than\r\n7 days; extremely sensitive organisms, 100\u2013150\u00a0mg/kg daily may be\r\nsufficient; child under 18 years see BNF for Children", "Cryptococcal meningitis (adjunct to amphotericin, see Cryptococcosis) 100\u00a0mg/kg daily in 4 divided\r\ndoses for 2 weeks [unlicensed duration]; child under 18 years see BNF for Children", "For plasma concentration monitoring, blood\r\nshould be taken shortly before starting the next infusion; plasma\r\nconcentration for optimum response 25\u201350\u00a0mg/litre (200\u2013400\u00a0micromol/litre)\u2014should\r\nnot be allowed to exceed 80\u00a0mg/litre (620\u00a0micromol/litre)" ], "pregnancy": "Pregnancy\u00a0teratogenic in animal studies; manufacturer\r\nadvises use only if potential benefit outweighs risk" }, "HALOPERIDOL - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0see under Dose; motor tics (section 4.9.3)", "name": "HALOPERIDOL - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also subarachnoid\r\nhaemorrhage; metabolic disturbances such as hypokalaemia, hypocalcaemia, or hypomagnesaemia; thyrotoxicosis; arteriosclerosis; dose\r\nadjustment may be necessary if smoking started or stopped during treatment", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning., but less\r\nsedating and fewer antimuscarinic or hypotensive symptoms; pigmentation\r\nand photosensitivity reactions rare; depression; weight loss; less commonly dyspnoea, oedema; rarely bronchospasm,\r\nhypoglycaemia, and inappropriate antidiuretic hormone secretion; hypertension,\r\nsweating, Stevens-Johnson syndrome, and toxic epidermal necrolysis\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3224.htm", "doses": [ "Schizophrenia and other psychoses, mania, short-term\r\nadjunctive management of psychomotor agitation, excitement, and violent\r\nor dangerously impulsive behaviour, adult and child over 12 years, by\r\nmouth, initially 0.5\u20133\u00a0mg 2\u20133 times daily or 3\u20135\u00a0mg 2\u20133 times daily in severely affected or resistant patients;\r\nin resistant schizophrenia up to 30\u00a0mg daily may be needed; adjusted\r\naccording to response to lowest effective maintenance dose (as low\r\nas 5\u201310\u00a0mg daily); elderly (or debilitated)\r\ninitially half adult dose", "By intramuscular or by\r\nintravenous injection, adult over 18 years, initially 2\u201310\u00a0mg, then every 4\u20138 hours according\r\nto response to total max. 18\u00a0mg daily; severely disturbed patients\r\nmay require initial dose of up to 18\u00a0mg; elderly (or debilitated) initially half adult dose", "Agitation and restlessness in the elderly, by mouth, initially 0.5\u20131.5\u00a0mg once or twice daily", "Short-term adjunctive management of severe anxiety, by\r\nmouth, adult over 18 years,\r\n500\u00a0micrograms twice daily", "Motor tics, adjunctive treatment in choreas and Tourette syndrome, by mouth, 0.5\u20131.5\u00a0mg 3 times daily adjusted according to\r\nresponse; 10\u00a0mg daily or more may occasionally be necessary in Tourette\r\nsyndrome; child 5\u201312 years, Tourette\r\nsyndrome, 12.5\u201325\u00a0microgram/kg twice daily, adjusted according to\r\nresponse up to max. 10\u00a0mg daily", "Intractable hiccup, by mouth, adult over 18 years, 1.5\u00a0mg 3 times daily adjusted\r\naccording to response", "Nausea and vomiting, see Prescribing in Palliative\r\nCare", "By intramuscular or intravenous\r\ninjection, 1\u20132\u00a0mg" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "INSULIN ASPART": { "indications": "Indications\u00a0diabetes mellitus", "name": "INSULIN ASPART", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins" ], "cautions": "Cautions\u00a0section 6.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82517.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n2 years, immediately before meals or when necessary shortly after\r\nmeals, according to requirements", "By subcutaneous infusion, or intravenous injection, or intravenous infusion, adult and child over 2 years, according\r\nto requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "COLESTYRAMINE": { "indications": "Indications\u00a0hyperlipidaemias, particularly type IIa,\r\nin patients who have not responded adequately to diet and other appropriate\r\nmeasures; primary prevention of coronary heart disease in men aged\r\n35\u201359 years with primary hypercholesterolaemia who have not responded\r\nto diet and other appropriate measures; pruritus associated with partial\r\nbiliary obstruction and primary biliary cirrhosis (section 1.9.2); diarrhoeal disorders (section 1.9.2)", "name": "COLESTYRAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.12 Lipid-regulating drugs", "Bile acid sequestrants", "COLESTYRAMINE" ], "cautions": "Cautions\u00a0\n(From Bile acid sequestrants: British National Formulary)\nCautions\u00a0Bile acid sequestrants interfere with the absorption of fat-soluble vitamins; supplements of vitamins A, D, K, and folic acid may be required when treatment is prolonged. Interactions: Appendix 1 (bile acid sequestrants); interactions: Appendix 1 (colestyramine)", "side-effects": "Side-effects\u00a0\n(From Bile acid sequestrants: British National Formulary)\nSide-effects\u00a0As bile acid sequestrants are not absorbed, gastro-intestinal side-effects predominate. Constipation is common, but diarrhoea has occurred, as have nausea, vomiting, and gastro-intestinal discomfort. Hypertriglyceridaemia may be aggravated. An increased bleeding tendency has been reported due to hypoprothrombinaemia associated with vitamin K deficiency.;\r\nintestinal obstruction reported rarely and hyperchloraemic acidosis\r\nreported on prolonged use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2839.htm", "doses": [ "Lipid reduction, initially 4\u00a0g daily increased by 4\u00a0g\r\nat weekly intervals to 12\u201324\u00a0g daily in 1\u20134 divided doses, then adjusted\r\nas required; max. 36\u00a0g daily", "Pruritus, see section 1.9.2", "Diarrhoeal disorders, see section 1.9.2", "child 6\u201312 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From Bile acid sequestrants: British National Formulary)\nPregnancy and breast-feeding\u00a0Bile acid sequestrants should be used with caution as although the drugs are not absorbed, they may cause fat-soluble vitamin deficiency on prolonged use." }, "BROMOCRIPTINE": { "indications": "Indications\u00a0Parkinson\u2019s disease; endocrine disorders\r\n(section 6.7.1)", "name": "BROMOCRIPTINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "BROMOCRIPTINE" ], "cautions": "Cautions\u00a0see Bromocriptine in section 6.7.1 and notes above", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists and Bromocriptine, %s\n(From BROMOCRIPTINE: British National Formulary)\nSide-effects\u00a0see notes above; also nasal congestion; less commonly vomiting, postural hypotension, fatigue, dizziness, dry mouth; also, particularly with high doses, confusion, psychomotor excitation, hallucinations; rarely diarrhoea, gastro-intestinal bleeding, gastric ulcer, abdominal pain, tachycardia, bradycardia, arrhythmia, insomnia, psychosis, visual disturbances, tinnitus; very rarely vasospasm of fingers and toes particularly in patients with Raynaud\u2019s syndrome, and effects like neuroleptic malignant syndrome on withdrawal; urinary incontinence, leucopenia, thrombocytopenia, hyponatraemia, reversible hearing loss, increased libido, and hypersexuality also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106288.htm", "doses": [ "First week 1\u20131.25\u00a0mg at night, second week 2\u20132.5\u00a0mg at\r\nnight, third week 2.5\u00a0mg twice daily, fourth week 2.5\u00a0mg 3 times daily\r\nthen increasing by 2.5\u00a0mg every 3\u201314 days according to response to\r\na usual range of 10\u201330\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0see Bromocriptine, section 6.7.1" }, "DANTRON": { "indications": "Indications\u00a0only for constipation in terminally ill patients of all ages", "name": "DANTRON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "DANTRON" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; rodent studies indicate potential carcinogenic risk; avoid prolonged contact with skin (as in incontinent patients or\r\ninfants wearing nappies)\u2014risk of irritation and excoriation", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; urine may be coloured red", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/33195.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0manufacturers of co-danthramer and co-danthrusate\r\nadvise avoid\u2014no information available" }, "ROTAVIRUS VACCINE": { "indications": "Indications\u00a0immunisation against gastro-enteritis\r\ncaused by rotavirus", "name": "ROTAVIRUS VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Rotavirus vaccine" ], "cautions": "Cautions\u00a0\n(From 14.1 Active immunity: British National Formulary)\nCautions\u00a0Most individuals can safely receive the majority of vaccines. Vaccination may be postponed if the individual is suffering from an acute illness; however, it is not necessary to postpone immunisation in patients with minor illnesses without fever or systemic upset. See also Predisposition to Neurological Problems, below. For individuals with bleeding disorders, see Route of administration, below. If alcohol or disinfectant is used for cleansing the skin it should be allowed to evaporate before vaccination to prevent possible inactivation of live vaccines.When 2 or more vaccines are required (and are not available as a combined preparation), they should be given simultaneously at different sites, preferably in a different limb; if more than one injection is to be given in the same limb, they should be administered at least 2.5\u00a0cm apart (but see also BCG Vaccines). When 2 live vaccines cannot be given at the same time, they should be separated by an interval of at least 4 weeks. For interactions see Appendix 1 (vaccines).See also Cautions under individual vaccines ; also diarrhoea\r\nor vomiting (postpone vaccination); immunosuppressed close contacts (%s\n(From Rotavirus vaccine: British National Formulary)\nRotavirus vaccine); interactions: Appendix 1 (vaccines)", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201156.htm", "doses": [ "By mouth, child over 6 weeks, 2 doses of 1.5\u00a0mL, separated by an interval of at\r\nleast 4 weeks; course should be completed before 24 weeks of age (preferably\r\nbefore 16 weeks)" ] }, "PIMOZIDE": { "indications": "Indications\u00a0see under Dose", "name": "PIMOZIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ECG monitoring\u00a0Following reports of sudden unexplained\r\ndeath, an ECG is recommended before treatment. It is also recommended that patients taking pimozide should have an annual ECG (if the QT interval is prolonged, treatment should be reviewed and\r\neither withdrawn or dose reduced under close supervision) and that pimozide should not be given with other antipsychotic drugs (including depot preparations), tricyclic antidepressants\r\nor other drugs which prolong the QT interval, such as certain antimalarials,\r\nanti-arrhythmic drugs and certain antihistamines and should not be given with drugs which cause electrolyte disturbances\r\n(especially diuretics)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; less\r\nsedating; serious arrhythmias reported; glycosuria and, rarely, hyponatraemia\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3239.htm", "doses": [ "Schizophrenia, adult and child over 12 years, initially 2\u00a0mg daily, increased\r\naccording to response in steps of 2\u20134\u00a0mg at intervals of not less\r\nthan 1 week; usual dose range 2\u201320\u00a0mg daily; elderly half usual starting dose", "Monosymptomatic hypochondriacal psychosis, paranoid psychosis, adult and child over\r\n12 years, initially 4\u00a0mg daily, increased according to response in\r\nsteps of 2\u20134\u00a0mg at intervals of not less than 1 week; max. 16\u00a0mg daily; elderly half usual starting dose" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "METHADONE HYDROCHLORIDE - PALLIATIVE CARE": { "indications": "Indications\u00a0cough in terminal disease", "name": "METHADONE HYDROCHLORIDE - PALLIATIVE CARE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.9 Cough preparations", "3.9.1 Cough suppressants", "Palliative care", "METHADONE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0section 4.7.2", "side-effects": "Side-effects\u00a0section 4.7.2; longer-acting than morphine therefore effects may be cumulative", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3085.htm", "doses": [ "See below", "2.5\u20135\u00a0mL every 4\u20136 hours, reduced to twice daily on prolonged\r\nuse" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "SORAFENIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nSorafenib, an inhibitor of multiple kinases, is licensed for the treatment of advanced renal cell carcinoma when treatment with interferon alfa or interleukin-2 has failed or is contra-indicated (but see NICE Guidance below). It is also licensed for the treatment of hepatocellular carcinoma.", "name": "SORAFENIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "SORAFENIB" ], "cautions": "Cautions\u00a0major surgical procedures; cardiac ischaemia; susceptibility\r\nto QT-interval prolongation; interactions: Appendix 1 (sorafenib) ", "side-effects": "Side-effects\u00a0see section 8.1; also diarrhoea, constipation,\r\ndyspepsia, dysphagia, anorexia, hypertension, haemorrhage, flushing,\r\nhoarseness, fatigue, asthenia, depression, peripheral neuropathy,\r\nfever, erectile dysfunction, renal failure, hypophosphataemia, arthralgia,\r\nmyalgia, tinnitus, rash, pruritus, erythema, dry skin, desquamation,\r\nacne, hand-foot skin reaction; less commonly gastro-intestinal perforations, myocardial infarction, congestive heart failure,\r\nhypertensive crisis, interstitial lung disease-like events, reversible\r\nposterior leucoencephalopathy, thyroid dysfunction, and Stevens-Johnson\r\nsyndrome; rarely hepatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129970.htm", "doses": [ "adult over 18 years, 400\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies; see also Pregnancy and Reproductive\r\nFunction" }, "FLUPENTIXOL - OTHER ANTIDEPRESSANT DRUGS": { "indications": "Indications\u00a0depressive illness; psychoses (section 4.2.1)", "name": "FLUPENTIXOL - OTHER ANTIDEPRESSANT DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs", "FLUPENTIXOL" ], "cautions": "Cautions\u00a0cardiovascular disease (including cardiac disorders and cerebral arteriosclerosis), QT-interval\r\nprolongation (avoid concomitant administration\r\nof drugs that prolong QT interval); diabetes; senile confusional states, parkinsonism; elderly; acute porphyria (section 9.8.2); see also section 4.2.1; interactions: Appendix 1 (antipsychotics)", "side-effects": "Side-effects\u00a0section 4.2.1; also hypersalivation, dyspnoea,\r\nasthenia, hyperglycaemia, myalgia; torsade de pointes and sudden death\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203959.htm", "doses": [ "adult over 18 years, initially\r\n1\u00a0mg (elderly 500\u00a0micrograms) in the\r\nmorning, increased after 1 week to 2\u00a0mg (elderly 1\u00a0mg) if necessary; max. 3\u00a0mg (elderly 1.5\u00a0mg) daily, doses above 2\u00a0mg (elderly 1\u00a0mg) in divided doses, last dose before 4\u00a0pm; discontinue if no\r\nresponse after 1 week at max. dosage", "Although drowsiness may occur, can\r\nalso have an alerting effect so should not be taken in the evening" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk" }, "ICHTHAMMOL": { "indications": "Indications\u00a0chronic lichenified eczema", "name": "ICHTHAMMOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.1 Preparations for eczema", "Topical preparations for eczema", "ICHTHAMMOL" ], "side-effects": "Side-effects\u00a0skin irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5965.htm", "doses": [ "Apply 1\u20133 times daily" ] }, "VIGABATRIN": { "indications": "Indications\u00a0\n(From Vigabatrin: British National Formulary)\nVigabatrin", "name": "VIGABATRIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Vigabatrin", "VIGABATRIN" ], "cautions": "Cautions\u00a0elderly; closely\r\nmonitor neurological function; avoid sudden\r\nwithdrawal; history of psychosis, depression, or behavioural problems; absence seizures (may be exacerbated); interactions: see Interactions in section 4.8.1 and Appendix 1 (vigabatrin)Visual field defects\u00a0Vigabatrin is associated with visual field defects. The onset of symptoms varies\r\nfrom 1 month to several years after starting. In most cases, visual\r\nfield defects have persisted despite discontinuation, and further\r\ndeterioration after discontinuation cannot be excluded. Product literature advises visual field testing before treatment\r\nand at 6-month intervals. Patients should\r\nbe warned to report any new visual symptoms that develop and those\r\nwith symptoms should be referred for an urgent ophthalmological opinion. Gradual withdrawal of vigabatrin should be considered.", "side-effects": "Side-effects\u00a0nausea, abdominal pain; oedema; drowsiness (rarely encephalopathic symptoms including marked sedation,\r\nstupor, and confusion with non-specific slow wave EEG\u2014reduce dose\r\nor withdraw), fatigue, excitation (in children), agitation, dizziness,\r\nheadache, nervousness, depression, aggression, irritability, paranoia,\r\nimpaired concentration, impaired memory, tremor, paraesthesia, speech\r\ndisorder, weight gain; visual field defects (see under Cautions),\r\nblurred vision, nystagmus, diplopia; less commonly ataxia, psychosis, mania, and rash; occasional increase in seizure\r\nfrequency (especially if myoclonic); rarely suicidal\r\nideation and retinal disorders (including peripheral retinal neuropathy); very rarely hepatitis, optic neuritis, and optic atrophy; also reported movement disorders in infantile spasms", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3616.htm", "doses": [ "With current antiepileptic therapy, initially 1\u00a0g daily\r\nin single or 2 divided doses then increased according to response\r\nin steps of 500\u00a0mg at weekly intervals; usual range 2\u20133\u00a0g daily (max.\r\n3\u00a0g daily); child initially 40\u00a0mg/kg\r\n(body-weight over 25\u00a0kg, max. 1\u00a0g) daily in single or 2 divided doses,\r\nthen adjusted according to response; usual maintenance dose, body-weight\r\n10\u201315\u00a0kg, 0.5\u20131\u00a0g daily; body-weight 15\u201330\u00a0kg, 1\u20131.5\u00a0g daily; body-weight\r\n30\u201350\u00a0kg, 1.5\u20133\u00a0g daily; body-weight over 50\u00a0kg, 2\u20133\u00a0g daily", "Infantile spasms (West\u2019s syndrome), monotherapy, 50\u00a0mg/kg daily, adjusted according to response over 7 days; up\r\nto 150\u00a0mg/kg daily used with good tolerability" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "CARMELLOSE SODIUM": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "CARMELLOSE SODIUM" ], "indications": "Indications\u00a0dry eye conditions", "name": "CARMELLOSE SODIUM", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201235.htm", "doses": [ "Apply as required" ] }, "FERROUS SULPHATE With folic acid": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS SULPHATE With folic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron", "FERROUS SULPHATE", "With folic acid" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4877.htm", "doses": [ "See under preparations below and notes above", "Name[Ferrograd Folic\u00ae (Teofarma) ] Tablets, f/c, red/yellow, dried ferrous sulphate 325\u00a0mg (105\u00a0mg iron) for sustained release, folic acid 350\u00a0micrograms, net price 30-tab pack = \u00a31.89. \r\n Label:\r\n 25Dose\u00a0adult and child over 12 years, 1 tablet daily before food" ] }, "PERPHENAZINE": { "indications": "Indications\u00a0severe nausea, vomiting (see notes above); other\r\nindications (%s\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\n4.2.1 Antipsychotic drugs)", "name": "PERPHENAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs", "PERPHENAZINE" ], "cautions": "Cautions\u00a0see notes in section 4.2.1", "side-effects": "Side-effects\u00a0see Perphenazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106285.htm", "doses": [ "4\u00a0mg 3 times daily, adjusted according to response; max.\r\n24\u00a0mg daily (chemotherapy-induced); elderly quarter to half adult dose; child under 14 years not recommended" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "TAMOXIFEN": { "indications": "Indications\u00a0see under Dose and notes above; mastalgia [unlicensed indication]\r\n(section 6.7.2)", "name": "TAMOXIFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.4 Hormone antagonists", "8.3.4.1 Breast cancer", "TAMOXIFEN" ], "cautions": "Cautions\u00a0occasional cystic ovarian swellings in\r\npremenopausal women; increased risk of thromboembolic\r\nevents, especially when used with cytotoxics (see also below); endometrial changes (important: see below); porphyria, interactions: Appendix 1 (tamoxifen)Endometrial changes\u00a0Increased endometrial\r\nchanges, including hyperplasia, polyps, cancer, and uterine sarcoma\r\nreported; prompt investigation required\r\nif abnormal vaginal bleeding including menstrual irregularities, vaginal\r\ndischarge, and pelvic pain or pressure in those receiving (or who\r\nhave received) tamoxifen. Patients should be informed of the risk of endometrial cancer and\r\ntold to report relevant symptoms promptly", "side-effects": "Side-effects\u00a0hot flushes, vaginal bleeding and vaginal discharge\r\n(important: see also Endometrial Changes under Cautions),\r\nsuppression of menstruation in some premenopausal women, pruritus\r\nvulvae, gastro-intestinal disturbances, headache, light-headedness,\r\ntumour flare, decreased platelet counts; occasionally oedema, rarely\r\nhypercalcaemia if bony metastases, alopecia, rashes, uterine fibroids;\r\nalso visual disturbances (including corneal changes, cataracts, retinopathy);\r\nleucopenia (sometimes with anaemia and thrombocytopenia), rarely neutropenia;\r\nhypertriglyceridaemia reported rarely (sometimes with pancreatitis);\r\nthromboembolic events reported (see below); liver enzyme changes (rarely\r\nfatty liver, cholestasis, hepatitis); rarely interstitial pneumonitis,\r\nhypersensitivity reactions including angioedema, Stevens-Johnson syndrome,\r\nbullous pemphigoid; see also notes aboveRisk of thromboembolism\u00a0Tamoxifen can increase\r\nthe risk of thromboembolism particularly during and immediately after\r\nmajor surgery or periods of immobility (consider interrupting treatment\r\nto initiate anticoagulant measures). Patients should\r\nbe made aware of the symptoms of thromboembolism and advised to report\r\nsudden breathlessness and any pain in the calf of one leg", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4837.htm", "doses": [ "Breast cancer, 20\u00a0mg daily", "Anovulatory infertility, 20\u00a0mg daily on days 2, 3, 4 and 5 of\r\ncycle; if necessary the daily dose may be increased to 40\u00a0mg then\r\n80\u00a0mg for subsequent courses; if cycles irregular, start initial course\r\non any day, with subsequent course starting 45 days later or on day 2 of cycle if menstruation occurs" ], "pregnancy": "Pregnancy\u00a0avoid\u2014possible effects on fetal development; effective\r\ncontraception must be used during treatment and for 2 months after\r\nstopping" }, "COLLAGENASE": { "indications": "Indications\u00a0Dupuytren\u2019s contracture in patients\r\nwith a palpable cord", "name": "COLLAGENASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.1 Enzymes", "Collagenase", "COLLAGENASE" ], "cautions": "Cautions\u00a0coagulation disorders or use of anticoagulants", "side-effects": "Side-effects\u00a0paraesthesia, hypoaesthesia, burning sensation,\r\nlymphadenopathy, arthralgia, myalgia, joint swelling, injection site\r\nreactions, ecchymosis, hyperhidrosis; less commonly complex regional pain syndrome, monoplegia, tremor, crepitus, muscle\r\nspasm and weakness, tendon rupture, ligament injury, wound dehiscence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215593.htm", "doses": [ "By intralesional injection into palpable\r\ncord, adult over 18 years, 580\u00a0micrograms;\r\nif necessary repeat at intervals of approx. 4 weeks; max. 3 injections\r\nper cord; max. 8 injections in total; only one cord may be treated\r\nat a time", "reconstitution and injected volumes vary\r\nwith site of injection\u2014consult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "COLECALCIFEROL": { "indications": "Indications\u00a0see notes above", "name": "COLECALCIFEROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.4 Vitamin D", "COLECALCIFEROL" ], "cautions": "Cautions\u00a0see under Ergocalciferol", "side-effects": "Side-effects\u00a0see under Ergocalciferol", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202864.htm", "doses": [ "See notes above" ], "pregnancy": "Pregnancy\u00a0see under Ergocalciferol" }, "SODIUM CITRATE (RECTAL)": { "indications": "Indications\u00a0rectal use in constipation", "name": "SODIUM CITRATE (RECTAL)", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives", "SODIUM CITRATE (RECTAL)" ], "cautions": "Cautions\u00a0elderly and debilitated; see also notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2255.htm", "doses": [ "See under preparations", "adult and child over 3 years, 5\u201310\u00a0mL (but see section\r\n1.6)" ] }, "REMIFENTANIL": { "indications": "Indications\u00a0supplementation of general anaesthesia during induction and analgesia\r\nduring maintenance of anaesthesia (consult product literature for\r\nuse in patients undergoing cardiac surgery); analgesia and sedation\r\nin ventilated, intensive care patients", "name": "REMIFENTANIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.3 Opioid analgesics" ], "cautions": "Cautions\u00a0section 4.7.2 (but\r\nno dose adjustment necessary in renal impairment) and notes above", "side-effects": "Side-effects\u00a0section 4.7.2 and notes above; also hypertension; less\r\ncommonly hypoxia; rarely asystole; AV block\r\nand convulsions also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57717.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "Induction of anaesthesia, adult and child over 12 years, by\r\nintravenous infusion, 0.5\u20131\u00a0micrograms/kg/minute, with or without an initial dose by intravenous injection of 0.25\u20131\u00a0microgram/kg over at least 30 seconds", "If patient to be intubated more than 8 minutes\r\nafter start of intravenous infusion, initial intravenous injection\r\ndose is not necessary", "Maintenance of anaesthesia in ventilated patients, adult and child over\r\n12 years, by intravenous infusion, 0.05\u20132\u00a0micrograms/kg/minute\r\n(with or without an initial dose by intravenous\r\ninjection of 0.25\u20131\u00a0micrograms/kg over at least 30 seconds)\r\naccording to anaesthetic technique and adjusted according to response;\r\nin light anaesthesia supplemental doses by intravenous injection every 2\u20135 minutes; child 1\u201312 years,\r\n0.05\u20131.3\u00a0micrograms/kg/minute (with or without an\r\ninitial dose by intravenous injection of 0.1\u20131\u00a0microgram/kg\r\nover at least 30 seconds) according to anaesthetic technique and adjusted\r\naccording to response", "Maintenance of anaesthesia with spontaneous respiration, adult and child over\r\n12 years, by intravenous infusion, initially 40\u00a0nanograms/kg/minute\r\nadjusted according to response, usual range 25\u2013100\u00a0nanograms/kg/minute", "Analgesia and sedation in ventilated, intensive-care patients\r\nfor max. 3 days, by intravenous infusion, adult over 18 years, initially 100\u2013150\u00a0nanograms/kg/minute\r\nadjusted according to response in steps of 25\u00a0nanograms/kg/minute\r\n(allow at least 5 minutes between dose adjustments); usual range 6\u2013740\u00a0nanograms/kg/minute;\r\nif an infusion rate of 200\u00a0nanograms/kg/minute does not produce adequate\r\nsedation add another sedative (consult product literature for details)", "Additional analgesia during stimulating or painful procedures\r\nin ventilated, intensive-care patients, by intravenous infusion, adult over 18 years, maintain infusion\r\nrate of at least 100\u00a0nanograms/kg/minute for at least 5 minutes before\r\nprocedure and adjust every 2\u20135 minutes according to requirements,\r\nusual range 250\u2013750\u00a0nanograms/kg/minute", "Cardiac surgery, consult product literature", "Remifentanil doses in BNF may differ from\r\nthose in product literature" ], "pregnancy": "Pregnancy\u00a0no information available: see also section 4.7.2" }, "FLUTICASONE PROPIONATE Fluticasone furoate": { "indications": "Indications\u00a0prophylaxis and treatment of\r\nallergic rhinitis and perennial rhinitis; nasal polyps", "name": "FLUTICASONE PROPIONATE Fluticasone furoate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "FLUTICASONE PROPIONATE", "Fluticasone furoate" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202786.htm", "doses": [ "Rhinitis, 100\u00a0micrograms (2 sprays) into each nostril\r\nonce daily, preferably in the morning, increased to max. twice daily\r\nif required; when control achieved reduce to 50\u00a0micrograms (1 spray)\r\ninto each nostril once daily; child 4\u201311 years, 50\u00a0micrograms (1 spray) into each nostril once daily,\r\npreferably in the morning, increased to max. twice daily if required", "Nasal polyps, see Flixonase Nasule\u00ae below", "Name[Avamys\u00ae (GSK) ] Nasal spray, fluticasone furoate\r\n27.5\u00a0micrograms/metered spray, net price 120-spray unit = \u00a36.44Excipients include benzalkonium chloride, disodium edetate, polysorbate 80Dose\u00a0prophylaxis and treatment of allergic rhinitis, adult and child over\r\n12 years, 55\u00a0micrograms (2 sprays) into each nostril once daily; when\r\ncontrol achieved reduce to minimum effective dose, 27.5\u00a0micrograms\r\n(1 spray) into each nostril once daily may be sufficient; child 6\u201312 years, 27.5\u00a0micrograms (1 spray) into\r\neach nostril once daily, increased if necessary to 55\u00a0micrograms (2\r\nsprays) into each nostril once daily; when control achieved reduce\r\nto 27.5\u00a0micrograms (1 spray) into each nostril once daily" ] }, "MARAVIROC": { "indications": "Indications\u00a0CCR5-tropic HIV infection in combination\r\nwith other antiretroviral drugs in patients previously treated with\r\nantiretrovirals", "name": "MARAVIROC", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Other antiretrovirals" ], "cautions": "Cautions\u00a0cardiovascular disease; chronic hepatitis B or C; interactions: Appendix 1 (maraviroc)", "side-effects": "Side-effects\u00a0nausea, diarrhoea, abdominal pain, flatulence,\r\nanorexia, depression, insomnia, malaise, headache, anaemia, rash; less commonly seizures, renal failure, proteinuria, myositis; rarely hepatitis, angina, pancytopenia, granulocytopenia,\r\nStevens-Johnson syndrome; see also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200277.htm", "doses": [ "adult over 18 years, 300\u00a0mg\r\ntwice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "OLMESARTAN MEDOXOMIL With calcium-channel blocker and diuretic": { "indications": "Indications\u00a0hypertension (see also notes above)", "name": "OLMESARTAN MEDOXOMIL With calcium-channel blocker and diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "OLMESARTAN MEDOXOMIL", "With calcium-channel blocker and diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain, peripheral oedema, hypertriglyceridaemia; fatigue; influenza-like\r\nsymptoms, cough, pharyngitis, rhinitis; urinary-tract infection; haematuria,\r\nhyperuricaemia; arthritis, musculoskeletal pain; less commonly angina, vertigo, rash; very rarely headache, thrombocytopenia,\r\nmyalgia, pruritus, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218764.htm", "doses": [ "Initially 10\u00a0mg once daily; if necessary increased to\r\n20\u00a0mg once daily; max. 40\u00a0mg daily", "Name[Sevikar HCT\u00ae (Daiichi Sankyo) ] Tablets 20/5/12.5, light orange,\r\nf/c, olmesartan medoxomil 20\u00a0mg, amlodipine (as besilate) 5\u00a0mg, hydrochlorothiazide\r\n12.5\u00a0mg, net price 28-tab pack = \u00a316.95\nTablets 40/5/12.5, light yellow,\r\nf/c, olmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 5\u00a0mg, hydrochlorothiazide\r\n12.5\u00a0mg, net price 28-tab pack = \u00a316.95\nTablets 40/10/12.5, greyish-red,\r\nf/c, olmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 10\u00a0mg, hydrochlorothiazide\r\n12.5\u00a0mg, net price 28-tab pack = \u00a316.95\nTablets 40/5/25, light yellow, f/c,\r\nolmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 5\u00a0mg, hydrochlorothiazide\r\n25\u00a0mg, net price 28-tab pack = \u00a316.95\nTablets 40/10/25, greyish-red, f/c,\r\nolmesartan medoxomil 40\u00a0mg, amlodipine (as besilate) 10\u00a0mg, hydrochlorothiazide\r\n25\u00a0mg, net price 28-tab pack = \u00a316.95" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "METHYLPREDNISOLONE Intramuscular depot": { "indications": "Indications\u00a0suppression of inflammatory and allergic\r\ndisorders; severe inflammatory bowel disease (section 1.5); cerebral oedema associated with\r\nmalignancy; see also notes above; rheumatic disease (section 10.1.2); skin (section 13.4)", "name": "METHYLPREDNISOLONE Intramuscular depot", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.3 Corticosteroids", "6.3.2 Glucocorticoid therapy", "METHYLPREDNISOLONE", "Intramuscular depot" ], "cautions": "Cautions\u00a0\n(From Cautions and contra-indications of corticosteroids: British National Formulary)\nCautions and contra-indications of corticosteroids; also rapid intravenous administration of large doses associated with cardiovascular\r\ncollapse", "side-effects": "Side-effects\u00a0\n(From Side-effects of corticosteroids: British National Formulary)\nSide-effects of corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4290.htm", "doses": [ "By mouth, usual range 2\u201340\u00a0mg daily; see\r\nalso Administration (above)", "By intramuscular injection or slow intravenous injection or infusion, initially 10\u2013500\u00a0mg; graft rejection, up to 1\u00a0g\r\ndaily by intravenous infusion for up to 3 days", "Name[Depo-Medrone\u00ae (Pharmacia) ] Injection (aqueous suspension), methylprednisolone acetate 40\u00a0mg/mL. Net price 1-mL vial\r\n= \u00a32.87; 2-mL vial = \u00a35.15; 3-mL vial = \u00a37.47. \r\n Label:\r\n 10, steroid cardDose\u00a0by deep intramuscular injection into gluteal\r\nmuscle, 40\u2013120\u00a0mg, a second injection may be given after 2\u20133 weeks\r\nif required" ], "pregnancy": "Pregnancy\u00a0\n(From Pregnancy and breast-feeding: British National Formulary)\nPregnancy and breast-feeding" }, "DOXEPIN HYDROCHLORIDE": { "indications": "Indications\u00a0pruritus in eczema; depressive illness\r\n(section 4.3.1)", "name": "DOXEPIN HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.3 Topical local anaesthetics and antipruritics" ], "cautions": "Cautions\u00a0susceptibility to angle-closure glaucoma; urinary retention; mania; cardiac arrhythmias; severe\r\nheart disease; avoid application to large\r\nareas; interactions: Appendix 1 (antidepressants,\r\ntricyclic) Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness; local burning, stinging, irritation,\r\ntingling and rash; systemic side-effects such as antimuscarinic effects,\r\nheadache, fever, dizziness, gastro-intestinal disturbances also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/74563.htm", "doses": [ "adult and child over 12 years, apply thinly 3\u20134 times daily;\r\nusual max. 3\u00a0g per application; usual total max. 12\u00a0g daily; coverage\r\nshould be less than 10% of body surface area" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "PAZOPANIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nPazopanib, a tyrosine kinase inhibitor, is licensed for advanced renal cell carcinoma, as first-line treatment and for patients who have had previous treatment with cytokine therapy for advanced disease.", "name": "PAZOPANIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors" ], "cautions": "Cautions\u00a0see section 8.1; monitor liver function\r\nbefore treatment and at least monthly for the first 4 months\u2014consult\r\nproduct literature; control blood pressure\r\nbefore initiating and monitor blood pressure\r\nthroughout treatment (consider dose reduction or interruption if hypertension\r\nuncontrolled despite anti-hypertensive therapy); susceptibility to QT-interval prolongation (including electrolyte\r\ndisturbances, concomitant use of drugs that prolong QT-interval); patients at risk of myocardial\r\ninfarction, ischaemic stroke or\r\ntransient ischaemic attack, cardiac disease; increased\r\nrisk of haemorrhage; increased risk of\r\ngastro-intestinal perforation or fistulas; discontinue treatment 7 days before elective surgery and restart\r\nonly if adequate wound healing; monitor\r\nthyroid function; monitor for proteinuria; interactions: Appendix 1 (pazopanib)", "side-effects": "Side-effects\u00a0see section 8.1; also\r\nabdominal pain, dyspepsia, diarrhoea, weight loss, anorexia, taste\r\ndisturbance, flatulence, hepatic dysfunction, hyperbilirubinaemia,\r\nhypertension, flushing, chest pain, oedema, epistaxis, voice changes,\r\nheadache, dizziness, malaise, paraesthesia, hypothyroidism, proteinuria\r\n(discontinue if grade 4), blood disorders (including thrombocytopenia),\r\nmuscle spasm, myalgia, sweating, skin reactions, dry skin, hair and\r\nskin discoloration; less commonly hepatic failure,\r\ngastro-intestinal perforation, peritonitis, pancreatitis, fistula,\r\ncardiac dysfunction, transient ischaemic attack, stroke, myocardial\r\ninfarction, myocardial ischaemia, bradycardia, haemorrhage, hypertensive\r\ncrisis, QT-interval prolongation, pulmonary embolism, peripheral neuropathy,\r\nmenstrual disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208714.htm", "doses": [ "adult over 18 years, 800\u00a0mg\r\nonce daily; adjust dose in steps of 200\u00a0mg according to tolerability\r\n(max. 800\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity in animal studies; effective contraception\r\nadvised during treatment; see also Pregnancy and Reproductive\r\nFunction" }, "METHADONE HYDROCHLORIDE - OPIOID SUBSTITUTION THERAPY": { "indications": "Indications\u00a0adjunct in treatment of opioid dependence,\r\nsee notes above; analgesia (%s\n(From 4.7.2 Opioid analgesics: British National Formulary)\n4.7.2 Opioid analgesics); cough in terminal disease (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "METHADONE HYDROCHLORIDE - OPIOID SUBSTITUTION THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.3 Opioid dependence", "Opioid substitution therapy" ], "cautions": "Cautions\u00a0see Methadone, section 4.7.2", "side-effects": "Side-effects\u00a0see Methadone, section 4.7.2; overdosage: see Emergency Treatment of PoisoningImportant\u00a0Methadone, even in low\r\ndoses is a special hazard for children; non-dependent\r\nadults are also at risk of toxicity; dependent adults are at risk if tolerance is incorrectly assessed\r\nduring inductionIncompatibility\u00a0Syrup preserved with hydroxybenzoate\r\n(parabens) esters may be incompatible with methadone hydrochloride.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3701.htm", "doses": [ "Initially 10\u201340\u00a0mg daily, increased by up to 10\u00a0mg daily\r\n(max. weekly increase 30\u00a0mg) until no signs of withdrawal or intoxication;\r\nusual dose range 60\u2013120\u00a0mg daily; child not recommended (see also important note above)", "Methadone hydrochloride doses in the BNF\r\nmay differ from those in the product literature" ], "pregnancy": "Pregnancy\u00a0\n(From Opioid substitution therapy: British National Formulary)\nPregnancy\u00a0Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death. Opioid substitution therapy is recommended during pregnancy because it carries a lower risk to the fetus than continued use of illicit drugs. If a woman who is stabilised on methadone or buprenorphine for treatment of opioid dependence becomes pregnant, therapy should be continued [buprenorphine is not licensed for use in pregnancy]. Many pregnant patients choose a withdrawal regimen, but withdrawal during the first trimester should be avoided because it is associated with an increased risk of spontaneous miscarriage. Withdrawal of methadone or buprenorphine should be undertaken gradually during the second trimester; for example, the dose of methadone may be reduced by 2\u20133\u00a0mg every 3\u20135 days. If illicit drug use occurs, the patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen.Further withdrawal of methadone or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and the risk of neonatal mortality. Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.The neonate should be monitored for respiratory depression and signs of withdrawal if the mother is prescribed high doses of opioid substitute.Signs of neonatal withdrawal from opioids usually develop 24\u201372 hours after delivery but symptoms may be delayed for up to 14 days, so monitoring may be required for several weeks. Symptoms include a high-pitched cry, rapid breathing, hungry but ineffective suckling, and excessive wakefulness; severe, but rare symptoms include hypertonicity and convulsions." }, "ISOSORBIDE MONONITRATE": { "indications": "Indications\u00a0prophylaxis of angina; adjunct in congestive\r\nheart failure", "name": "ISOSORBIDE MONONITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE MONONITRATE" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2657.htm", "doses": [ "Initially 20\u00a0mg 2\u20133 times daily or 40\u00a0mg\r\ntwice daily (10\u00a0mg twice daily in those who have not previously received\r\nnitrates); up to 120\u00a0mg daily in divided doses if required" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless potential benefit\r\noutweighs risk" }, "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH NORETHISTERONE": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Oral (low and standard strength) - ETHINYLESTRADIOL WITH NORETHISTERONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Oral (low and standard strength)", "Ethinylestradiol with Norethisterone" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/34608.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "HEPATITIS A VACCINE - SINGLE COMPONENT": { "indications": "Indications\u00a0immunisation against hepatitis A infection", "name": "HEPATITIS A VACCINE - SINGLE COMPONENT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis A vaccine", "HEPATITIS A VACCINE", "Single component" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; for\r\ncombination vaccines, see also Typhoid vaccine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/40231.htm", "doses": [ "See under preparations", "Name[Avaxim\u00ae (Sanofi Pasteur) ] Injection, suspension of formaldehyde-inactivated hepatitis A virus (GBM grown in\r\nhuman diploid cells) 320 antigen units/mL adsorbed onto aluminium\r\nhydroxide, net price 0.5-mL prefilled syringe = \u00a318.10Excipients include neomycinDose\u00a0by intramuscular injection (see note below), adult and child over\r\n16 years, 0.5\u00a0mL as a single dose; booster dose 0.5\u00a0mL 6\u201312 months\r\nafter initial doseNote\u00a0Booster dose may be delayed by up to 3 years\r\nif not given after recommended interval following primary dose with Avaxim\u00ae. The deltoid region is the preferred site of injection.\r\nThe subcutaneous route may be used for patients with bleeding disorders;\r\nnot to be injected into the buttock (vaccine efficacy reduced)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "TINIDAZOLE": { "indications": "Indications\u00a0anaerobic infections, see under Dose below; protozoal infections\r\n(section\r\n5.4.2); Helicobacter pylori eradication (section 1.3)", "name": "TINIDAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.11 Metronidazole and tinidazole" ], "cautions": "Cautions\u00a0see under Metronidazole; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (tinidazole)", "side-effects": "Side-effects\u00a0see under Metronidazole", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3942.htm", "doses": [ "Anaerobic infections, 2\u00a0g initially, followed by 1\u00a0g daily or 500\u00a0mg twice daily, usually for 5\u20136 days", "Bacterial vaginosis and acute ulcerative gingivitis, a single\r\n2-g dose", "Abdominal surgery prophylaxis, a single 2-g dose approximately\r\n12 hours before surgery" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid in first trimester" }, "FENTANYL": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201310.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CIPROFLOXACIN - ANTIBACTERIALS": { "indications": "Indications\u00a0superficial bacterial infections, \n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials; corneal ulcers", "name": "CIPROFLOXACIN - ANTIBACTERIALS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials" ], "cautions": "Cautions\u00a0not recommended for children under 1\r\nyear", "side-effects": "Side-effects\u00a0local burning and itching; lid margin crusting;\r\nhyperaemia; taste disturbances; corneal staining, keratitis, lid oedema,\r\nlacrimation, photophobia, corneal infiltrates; nausea and visual disturbances\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23382.htm", "doses": [ "Superficial bacterial infection, see Administration in\r\nnotes above", "Corneal ulcer, apply eye drops throughout\r\nday and night, day 1 apply every 15 minutes for 6 hours then every\r\n30 minutes, day 2 apply every hour, days 3\u201314 apply every 4 hours\r\n(max. duration of treatment 21 days)", "Apply eye ointment throughout day and night;\r\napply 1.25\u00a0cm ointment every 1\u20132 hours for 2 days then every 4 hours\r\nfor next 12 days" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "TACROLIMUS": { "indications": "Indications\u00a0prophylaxis of organ rejection in liver,\r\nkidney, and heart allograft recipients and allograft rejection resistant\r\nto conventional immunosuppressive regimens, see also notes above;\r\nmoderate to severe atopic eczema (section 13.5.3)", "name": "TACROLIMUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "TACROLIMUS" ], "cautions": "Cautions\u00a0monitor blood pressure, ECG (important: see Cardiomyopathy below), fasting blood-glucose\r\nconcentration, haematological and neurological (including visual)\r\nparameters, electrolytes, hepatic and renal function; monitor whole blood-tacrolimus trough concentration\r\n(especially during episodes of diarrhoea)\u2014consult local treatment\r\nprotocol for details; QT-interval prolongation; neurotoxicity; increased\r\nrisk of infections, malignancies, and lymphoproliferative disorders; avoid excessive exposure to UV light including sunlight; interactions: Appendix 1 (tacrolimus)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, constipation, dyspepsia,\r\nflatulence, bloating, weight changes, anorexia, gastro-intestinal\r\ninflammation, ulceration, and perforation, hepatic dysfunction, jaundice,\r\ncholestasis, ascites, bile-duct abnormalities, oedema, tachycardia,\r\nhypertension, haemorrhage, thromboembolic and ischaemic events, dyspnoea,\r\npleural effusion, parenchymal lung disorders, sleep disturbances,\r\ntremor, headache, peripheral neuropathy, mood changes, depression,\r\nconfusion, anxiety, psychosis, seizures, paraesthesia, dizziness,\r\nrenal impairment, renal failure, renal tubular necrosis, urinary abnormalities,\r\nhyperglycaemia, electrolyte disturbances (including hyperkalaemia,\r\nhypokalaemia, and hyperuricaemia), blood disorders (including anaemia,\r\nleucopenia, pancytopenia, and thrombocytopenia), arthralgia, muscle\r\ncramp, visual disturbances, photophobia, tinnitus, impaired hearing,\r\nalopecia, sweating, acne; less commonly paralytic\r\nileus, gastro-intestinal reflux disease, peritonitis, pancreatitis,\r\nheart failure, arrhythmia, cardiac arrest, cerebrovascular accident,\r\ncardiomyopathy (important: see Cardiomyopathy below),\r\npalpitation, respiratory failure, coma, speech disorder, amnesia,\r\nparalysis, influenza-like symptoms, encephalopathy, coagulation disorders,\r\nphotosensitivity, cataract, hypoglycaemia, dysmenorrhoea, hypertonia,\r\ndermatitis; rarely pericardial effusion, respiratory\r\ndistress syndrome, posterior reversible encephalopathy syndrome, dehydration,\r\nthrombotic thrombocytopenic purpura, blindness, toxic epidermal necrolysis,\r\nhirsutism; very rarely myasthenia, haemorrhagic cystitis,\r\nStevens-Johnson syndromeCardiomyopathy\u00a0Cardiomyopathy has been reported\r\nin children. Patients should be monitored by echocardiography for\r\nhypertrophic changes\u2014consider dose reduction or discontinuation if\r\nthese occur", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217767.htm", "doses": [ "See under preparations", "liver transplantation, starting 12 hours after transplantation, by mouth, 100\u2013200\u00a0micrograms/kg daily in 2 divided doses; child 300\u00a0micrograms/kg daily in 2 divided doses", "Renal transplantation, starting within 24 hours of transplantation, by mouth, 200\u2013300\u00a0micrograms/kg daily in 2 divided doses; child 300\u00a0micrograms/kg daily in 2 divided doses", "Heart transplantation with antibody induction (starting within\r\n5 days of transplantation) or without antibody induction (starting\r\nwithin 12 hours of transplantation), by mouth, 75\u00a0micrograms/kg\r\ndaily in 2 divided doses; child with\r\nantibody induction (starting within 5 days of transplantation), 100\u2013300\r\nmicrograms/kg daily in 2 divided doses; without antibody induction\r\n(starting within 12 hours of transplantation), 300\u00a0micrograms/kg daily\r\nin 2 divided doses as soon as clinically possible (8\u201312 hours after\r\ndiscontinuing intravenous infusion)", "Maintenance treatment, dose adjusted according to response and\r\nwhole blood concentration", "Rejection therapy, seek specialist advice" ], "pregnancy": "Pregnancy\u00a0exclude before treatment; avoid unless potential\r\nbenefit outweighs risk\u2014risk of premature delivery, intra-uterine growth\r\nrestriction, and hyperkalaemia; toxicity in animal studies" }, "IBUPROFEN": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including juvenile idiopathic\r\narthritis) and other musculoskeletal disorders; mild to moderate pain\r\nincluding dysmenorrhoea; postoperative analgesia; migraine; dental\r\npain; fever with discomfort and pain in children; post-immunisation\r\npyrexia (section\r\n14.1)", "name": "IBUPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "IBUPROFEN" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5193.htm", "doses": [ "adult and child over 12 years, initially 300\u2013400\u00a0mg 3\u20134 times\r\ndaily; increased if necessary to max. 2.4\u00a0g daily; maintenance dose\r\nof 0.6\u20131.2\u00a0g daily may be adequate", "Pain and fever in children, child 1\u20133 months, see BNF for Children; child 3\u20136 months (body-weight\r\nover 5\u00a0kg), 50\u00a0mg 3 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided\r\ndoses); child 6 months\u20131 year, 50\u00a0mg\r\n3\u20134 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided doses); child 1\u20134 years, 100\u00a0mg 3 times daily (max. 30\u00a0mg/kg\r\ndaily in 3\u20134 divided doses); child 4\u20137\r\nyears, 150\u00a0mg 3 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided doses); child 7\u201310 years, 200\u00a0mg 3 times daily (up to 30\u00a0mg/kg\r\ndaily (max. 2.4\u00a0g) in 3\u20134 divided doses); child 10\u201312 years, 300\u00a0mg 3 times daily (up to 30\u00a0mg/kg daily (max. 2.4\u00a0g)\r\nin 3\u20134 divided doses) ", "Rheumatic disease in children (including juvenile idiopathic\r\narthritis), child 3 months\u201318 years\r\n(body-weight over 5\u00a0kg), 30\u201340\u00a0mg/kg (max. 2.4\u00a0g) daily in 3\u20134 divided\r\ndoses; in systemic juvenile idiopathic arthritis up to 60\u00a0mg/kg (max.\r\n2.4\u00a0g) daily [unlicensed] in 4\u20136 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "BENZOYL PEROXIDE With antimicrobials": { "indications": "Indications\u00a0acne vulgaris", "name": "BENZOYL PEROXIDE With antimicrobials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Benzoyl peroxide and azelaic acid", "BENZOYL PEROXIDE", "With antimicrobials" ], "cautions": "Cautions\u00a0avoid contact with eyes, mouth, and mucous membranes; may bleach fabrics and hair; avoid excessive exposure to sunlight", "side-effects": "Side-effects\u00a0skin irritation (reduce frequency or suspend use\r\nuntil irritation subsides and re-introduce at reduced frequency)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128158.htm", "doses": [ "Apply 1\u20132 times daily preferably after washing with soap\r\nand water, start treatment with lower-strength preparations", "May bleach clothing", "Name[Duac\u00ae Once Daily (GSK) ] Gel, benzoyl peroxide 5%, clindamycin\r\n1% (as phosphate) in an aqueous basis, net price 25\u00a0g = \u00a39.95, 50\u00a0g\r\n= \u00a319.90Excipients include disodium edetateDose\u00a0apply once daily in the evening" ] }, "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin theta": { "indications": "Indications\u00a0see under preparations, below", "name": "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin theta", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "EPOETIN ALFA, BETA, THETA, and ZETA", "Epoetin theta" ], "cautions": "Cautions\u00a0\n(From Erythropoietins: British National Formulary)\nErythropoietins; also inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,\r\nreticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure uncontrolled; sudden stabbing migraine-like pain\r\nis warning of a hypertensive crisis; sickle-cell\r\ndisease (lower target haemoglobin concentration may be appropriate); ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks); epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin dose may be needed during dialysis; risk of thrombosis may be increased when used for\r\nanaemia in adults receiving cancer chemotherapy; risk of thrombosis may be increased when used for anaemia before\r\northopaedic surgery\u2014avoid in cardiovascular disease\r\nincluding recent myocardial infarction or cerebrovascular accident", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting; dose-dependent increase\r\nin blood pressure or aggravation of hypertension; in isolated patients\r\nwith normal or low blood pressure, hypertensive crisis with encephalopathy-like\r\nsymptoms and generalised tonic-clonic seizures requiring immediate\r\nmedical attention; headache; dose-dependent increase in platelet count\r\n(but thrombocytosis rare) regressing during treatment; influenza-like\r\nsymptoms (may be reduced if intravenous injection given over 5 minutes);\r\ncardiovascular events; shunt thrombosis especially if tendency to\r\nhypotension or arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue erythropoietin therapy)\u2014see also notes above, hyperkalaemia,\r\nhypersensitivity reactions (including anaphylaxis and angioedema),\r\nskin reactions, injection-site reactions, and peripheral oedema also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208136.htm", "doses": [ "See under preparations, below", "By intravenous injection, adult over 18 years, initially 40\u00a0units/kg 3 times weekly, increased according\r\nto response to 80\u00a0units/kg 3 times weekly after 4 weeks, with further\r\nincreases if needed at intervals of 4 weeks in steps of 25% of the\r\nprevious dose; maintenance dose, adjusted if necessary in steps of\r\n25%; weekly maintenance dose may be given in 2 divided doses in stable\r\npatients; max. 700\u00a0units/kg weekly", "Name[Eporatio\u00ae (Ratiopharm UK) ] Injection, prefilled syringe, epoetin\r\ntheta, net price 1000\u00a0units = \u00a35.99; 2000\u00a0units = \u00a311.98; 3000\u00a0units\r\n= \u00a317.98; 4000\u00a0units = \u00a323.97; 5000\u00a0units = \u00a329.96; 10 000\u00a0units =\r\n\u00a359.92; 20 000\u00a0units = \u00a3119.84; 30 000\u00a0units = \u00a3179.75Note \u00a0If epoetin theta is substituted for another\r\nepoetin the same route of administration should be usedDose\u00a0symptomatic anaemia associated with chronic renal failure\r\n(see also MHRA/CHM advice), by subcutaneous injection, adult over 18 years, initially 20\u00a0units/kg 3 times weekly, increased after\r\n4 weeks according to response to 40\u00a0units/kg 3 times weekly, with\r\nfurther increases if needed at 4-weekly intervals in steps of 25%\r\nof the previous dose; maintenance dose, adjusted if necessary in steps\r\nof 25%; weekly maintenance dose may be given as a single dose or in\r\n3 divided doses; max. 700\u00a0units/kg weeklyBy intravenous injection, adult over 18 years, initially 40\u00a0units/kg 3 times weekly, increased according\r\nto response to 80\u00a0units/kg 3 times weekly after 4 weeks, with further\r\nincreases if needed at intervals of 4 weeks in steps of 25% of the\r\nprevious dose; maintenance dose, adjusted if necessary in steps of\r\n25%; weekly maintenance dose may be given in 2 divided doses in stable\r\npatients; max. 700\u00a0units/kg weeklyNote\u00a0Subcutaneous route preferred in patients\r\nnot on haemodialysis. Reduce dose by 25\u201350% if rise in haemoglobin\r\nconcentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin concentration\r\napproaches or exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration continues\r\nto rise, despite dose reduction, suspend treatment until haemoglobin\r\nconcentration decreases and then restart at a dose approximately 25%\r\nlower than the previous doseSymptomatic anaemia in adults with non-myeloid malignancies\r\nreceiving cancer chemotherapy (see also MHRA/CHM advice), by subcutaneous injection, initially 20\u00a0000\u00a0units once weekly,\r\nincreased if necessary after 4 weeks (if a rise in haemoglobin of\r\nat least 1\u00a0g/100\u00a0mL not achieved) to 40\u00a0000\u00a0units once weekly, with\r\nfurther increase if needed after 4 weeks to max. 60\u00a0000\u00a0units once\r\nweeklyNote\u00a0Discontinue treatment if haemoglobin concentration\r\ndoes not increase by at least 1\u00a0g/100\u00a0mL after 12 weeks of therapy\r\n(response unlikely). Reduce dose by 25\u201350% if rise in haemoglobin\r\nconcentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin concentration\r\nexceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration continues to rise,\r\ndespite dose reduction, suspend treatment until haemoglobin concentration\r\ndecreases and then restart at a dose approximately 25% lower than\r\nthe previous dose. Discontinue approximately 4 weeks after ending\r\nchemotherapy" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; benefits probably outweigh risk\r\nof anaemia and of transfusion in pregnancy" }, "GLIMEPIRIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus", "name": "GLIMEPIRIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.1 Sulfonylureas", "GLIMEPIRIDE" ], "cautions": "Cautions\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nCautions\u00a0Sulfonylureas can encourage weight gain and should be prescribed only if poor control and symptoms persist despite adequate attempts at dieting; metformin (section 6.1.2.2) is considered the drug of choice in obese patients. Caution is needed in the elderly and in patients with G6PD deficiency (section 9.1.5).; manufacturer recommends\r\nregular hepatic and haematological monitoring but limited evidence\r\nof clinical value; interactions: Appendix\r\n1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129593.htm", "doses": [ "Initially 1\u00a0mg daily, adjusted according to response in\r\n1-mg steps at 1\u20132 week intervals; usual max. 4\u00a0mg daily (exceptionally,\r\nup to 6\u00a0mg daily may be used); taken shortly before or with first\r\nmain meal" ], "pregnancy": "Pregnancy\u00a0\n(From 6.1.2.1 Sulfonylureas: British National Formulary)\nPregnancy\u00a0The use of sulfonylureas in pregnancy should generally be avoided because of the risk of neonatal hypoglycaemia; however, glibenclamide can be used during the second and third trimesters of pregnancy in women with gestational diabetes, see section 6.1.2." }, "VILDAGLIPTIN": { "indications": "Indications\u00a0type 2 diabetes mellitus (in combination\r\nwith metformin or with a sulfonylurea or with pioglitazone\u2014see also notes above)", "name": "VILDAGLIPTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "VILDAGLIPTIN" ], "cautions": "Cautions\u00a0monitor liver function (see\r\nbelow); heart failure (avoid if moderate\r\nor severe); interactions: Appendix 1 (antidiabetics)Liver toxicity\u00a0Rare reports of liver dysfunction; monitor liver function before treatment and every 3 months for first\r\nyear and periodically thereafter; advise\r\npatients to seek prompt medical attention if symptoms such as nausea,\r\nvomiting, abdominal pain, fatigue, and dark urine develop; discontinue if jaundice or other signs of liver dysfunction\r\noccur", "side-effects": "Side-effects\u00a0nausea, peripheral oedema, headache, tremor, asthenia,\r\ndizziness; less commonly constipation, hypoglycaemia,\r\narthralgia; rarely hepatic dysfunction (see also\r\nLiver Toxicity above); very rarely nasopharyngitis,\r\nupper respiratory tract infection; pancreatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201003.htm", "doses": [ "adult over 18 years, in\r\ncombination with metformin or pioglitazone, 50\u00a0mg twice daily; in\r\ncombination with a sulfonylurea, 50\u00a0mg daily in the morning" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "BROMOCRIPTINE - DOPAMINE-RECEPTOR AGONISTS": { "indications": "Indications\u00a0Parkinson\u2019s disease; endocrine disorders\r\n(section 6.7.1)", "name": "BROMOCRIPTINE - DOPAMINE-RECEPTOR AGONISTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists", "BROMOCRIPTINE" ], "cautions": "Cautions\u00a0see Bromocriptine in section 6.7.1 and notes above", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists and Bromocriptine, %s\n(From BROMOCRIPTINE: British National Formulary)\nSide-effects\u00a0see notes above; also nasal congestion; less commonly vomiting, postural hypotension, fatigue, dizziness, dry mouth; also, particularly with high doses, confusion, psychomotor excitation, hallucinations; rarely diarrhoea, gastro-intestinal bleeding, gastric ulcer, abdominal pain, tachycardia, bradycardia, arrhythmia, insomnia, psychosis, visual disturbances, tinnitus; very rarely vasospasm of fingers and toes particularly in patients with Raynaud\u2019s syndrome, and effects like neuroleptic malignant syndrome on withdrawal; urinary incontinence, leucopenia, thrombocytopenia, hyponatraemia, reversible hearing loss, increased libido, and hypersexuality also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106288.htm", "doses": [ "First week 1\u20131.25\u00a0mg at night, second week 2\u20132.5\u00a0mg at\r\nnight, third week 2.5\u00a0mg twice daily, fourth week 2.5\u00a0mg 3 times daily\r\nthen increasing by 2.5\u00a0mg every 3\u201314 days according to response to\r\na usual range of 10\u201330\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0see Bromocriptine, section 6.7.1" }, "TEMAZEPAM - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS": { "indications": "Indications\u00a0premedication before surgery or investigatory\r\nprocedures; conscious sedation for dental procedures [unlicensed];\r\nhypnotic (section 4.1.1)", "name": "TEMAZEPAM - SEDATIVE AND ANALGESIC PERI-OPERATIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\nanxiolytic and sedative effects last about 90 minutes although there may be residual drowsiness and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\nrespiratory disease, muscle weakness and myasthenia gravis, history of drug or alcohol abuse, marked personality disorder; reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal thereafter); special precautions for intravenous injection (section 4.8.2); acute porphyria (section 9.8.2); when given parenterally, close observation required until full recovery from sedation; interactions: Appendix 1 (anxiolytics and hypnotics); interactions: Appendix 1 (anxiolytics and hypnotics)", "side-effects": "Side-effects\u00a0see notes above and Diazepam, %s\n(From DIAZEPAM: British National Formulary)\ndrowsiness and lightheadedness the next day; confusion and ataxia (especially in the elderly); amnesia; dependence; paradoxical increase in aggression (see also section 4.1); muscle weakness; occasionally: headache, vertigo, dizziness, slurred speech, hypotension, salivation changes, gastro-intestinal disturbances, visual disturbances, dysarthria, tremor, changes in libido, gynaecomastia, incontinence, urinary retention; rarely apnoea, respiratory depression, blood disorders, jaundice, skin reactions; on intravenous injection, pain, thrombophlebitis; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6603.htm", "doses": [ "By mouth, premedication, adult, 10\u201320\u00a0mg (up to 30\u00a0mg in exceptional circumstances)\r\n1\u20132 hours before procedure; elderly 10\u00a0mg (up to 20\u00a0mg in exceptional circumstances); child 12\u201318 years see BNF for Children", "By mouth, conscious sedation for dental procedures, adult over 18 years, 15\u201330\u00a0mg 30\u201360 minutes before\r\nprocedure", "Temazepam doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.1" }, "TIBOLONE": { "indications": "Indications\u00a0short-term treatment of symptoms of oestrogen deficiency (including\r\nwomen being treated with gonadotrophin releasing hormone analogues);\r\nosteoporosis prophylaxis in women at risk of fractures (second-line)", "name": "TIBOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.1 Oestrogens and HRT", "TIBOLONE" ], "cautions": "Cautions\u00a0see Hormone Replacement Therapy and under Oestrogens for HRT; vaginal bleeding\r\n(investigate for endometrial cancer if bleeding continues beyond 6\r\nmonths or after stopping treatment); history\r\nof liver disease, epilepsy, migraine, diabetes mellitus, hypercholesterolaemia; withdraw if signs of thromboembolic disease, abnormal\r\nliver function tests or cholestatic jaundice; see also Note below; interactions: Appendix 1\r\n(tibolone)", "side-effects": "Side-effects\u00a0see notes above; also abdominal pain, weight changes,\r\nvaginal bleeding, leucorrhoea, facial hair, and rarely amnesia; gastro-intestinal disturbances, oedema, dizziness, headache,\r\nmigraine, depression, breast cancer (see notes above and %s\n(From Hormone replacement therapy: British National Formulary)\nHormone replacement therapy), arthralgia, myalgia, visual\r\ndisturbances, seborrhoeic dermatitis, rash and pruritus also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4331.htm", "doses": [ "2.5\u00a0mg daily", "Unsuitable for use in the premenopause (unless\r\nbeing treated with gonadotrophin-releasing hormone analogue) and as\r\n(or with) an oral contraceptive; also unsuitable for use within 12\r\nmonths of last menstrual period (may cause irregular bleeding); induce\r\nwithdrawal bleed with progestogen if transferring from another form\r\nof HRT" ], "pregnancy": "Pregnancy\u00a0avoid; toxicity in animal studies" }, "FLUOROURACIL": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nFluorouracil is used to treat a number of solid tumours, including gastro-intestinal tract cancers and breast cancer. It is commonly used with folinic acid in advanced colorectal cancer. It may also be used topically for certain malignant and pre-malignant skin lesions. Toxicity is unusual, but may include myelosuppression, mucositis, and rarely a cerebellar syndrome. On prolonged infusion, a desquamative hand\u2013foot syndrome may occur.; pre-malignant and malignant skin lesions (%s\n(From FLUOROURACIL: British National Formulary)\nFLUOROURACIL)", "name": "FLUOROURACIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "FLUOROURACIL" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues; interactions: Appendix 1 (fluorouracil)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also local irritation with topical preparation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4732.htm", "doses": [ "By intravenous injection or infusion or by intra-arterial\r\ninfusion, consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic); see also Pregnancy and Reproductive\r\nFunction" }, "SODIUM HYALURONATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "SODIUM HYALURONATE" ], "indications": "Indications\u00a0dry eye conditions", "name": "SODIUM HYALURONATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201464.htm", "doses": [ "Apply as required" ] }, "ABACAVIR With lamivudine and zidovudine": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "ABACAVIR With lamivudine and zidovudine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "ABACAVIR", "With lamivudine and zidovudine" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test for HLA-B*5701 allele before treatment or if restarting treatment\r\nand HLA-B*5701 status not known\u2014increased risk of hypersensitivity\r\nreaction in presence of HLA-B*5701 allele; HIV load greater than 100\u00a0000 copies/mL; patients at high risk of cardiovascular disease (especially\r\nif 10-year cardiovascular risk greater than 20%); interactions: Appendix 1 (abacavir)Hypersensitivity reactions\u00a0Life-threatening hypersensitivity\r\nreactions reported\u2014characterised by fever or rash and possibly nausea,\r\nvomiting, diarrhoea, abdominal pain, dyspnoea, cough, lethargy, malaise,\r\nheadache, and myalgia; less frequently mouth ulceration, oedema, hypotension,\r\nsore throat, acute respiratory distress syndrome, anaphylaxis, paraesthesia,\r\narthralgia, conjunctivitis, lymphadenopathy, lymphocytopenia and renal\r\nfailure; rarely myolysis; laboratory abnormalities may include raised\r\nliver function tests (\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nCautionsLactic acidosis\u00a0Life-threatening lactic acidosis associated with hepatomegaly and hepatic steatosis has been reported with nucleoside reverse transcriptase inhibitors. They should be used with caution in patients (particularly obese women) with hepatomegaly, hepatitis (especially hepatitis C treated with interferon alfa and ribavirin), liver-enzyme abnormalities and with other risk factors for liver disease and hepatic steatosis (including alcohol abuse). Treatment with the nucleoside reverse transcriptase inhibitor should be discontinued in case of symptomatic hyperlactataemia, lactic acidosis, progressive hepatomegaly or rapid deterioration of liver function. Stavudine, especially with didanosine, is associated with a higher risk of lactic acidosis and should be used only if alternative regimens are not suitable.) and creatine\r\nkinase; symptoms usually appear in the first 6 weeks, but may occur\r\nat any time; monitor for symptoms every 2 weeks for 2 months; discontinue immediately if any symptom of hypersensitivity develops\r\nand do not rechallenge (risk of more severe hypersensitivity reaction); discontinue if hypersensitivity cannot be ruled out,\r\neven when other diagnoses possible\u2014if rechallenge\r\nnecessary it must be carried out in hospital setting; if abacavir is stopped for any\r\nreason other than hypersensitivity, exclude hypersensitivity reaction\r\nas the cause and rechallenge only if medical assistance is readily\r\navailable; care needed with concomitant\r\nuse of drugs which cause skin toxicity Counselling\u00a0Patients should be told\r\nthe importance of regular dosing (intermittent therapy may increase\r\nthe risk of sensitisation), how to recognise signs of hypersensitivity,\r\nand advised to seek immediate medical attention if symptoms develop\r\nor before re-starting treatment; patients\r\nshould be advised to keep Alert Card with them at all times", "side-effects": "Side-effects\u00a0see notes above; also hypersensitivity reactions\r\n(see above); very rarely Stevens-Johnson syndrome\r\nand toxic epidermal necrolysis; rash and gastro-intestinal disturbances\r\nmore common in children", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106113.htm", "doses": [ "600\u00a0mg daily in 1\u20132 divided doses; child 3 months\u201318 years see BNF for Children", "Name[Trizivir\u00ae (ViiV) ] Tablets, blue-green, f/c, abacavir (as sulphate) 300\u00a0mg, lamivudine 150\u00a0mg, zidovudine\r\n300\u00a0mg, net price 60-tab pack = \u00a3509.06. \r\n Label:\r\n Counselling, hypersensitivity reactionsDose\u00a01 tablet twice daily; child under 18 years, body-weight over 30\u00a0kg see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); see also Pregnancy" }, "HYALURONIDASE": { "indications": "Indications\u00a0enhance permeation of subcutaneous or intramuscular injections, local anaesthetics and subcutaneous infusions; promote\r\nresorption of excess fluids and blood", "name": "HYALURONIDASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.3 Drugs for the treatment of soft-tissue disorders and topical pain\r\nrelief", "10.3.1 Enzymes", "Hyaluronidase" ], "cautions": "Cautions\u00a0infants or elderly (control speed and total volume\r\nand avoid overhydration especially in renal impairment)", "side-effects": "Side-effects\u00a0oedema; rarely local irritation,\r\ninfection, bleeding, bruising; occasional severe allergy (including\r\nanaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/17504.htm", "doses": [ "With subcutaneous or intramuscular injection, 1500\u00a0units dissolved directly in solution to be injected (ensure\r\ncompatibility)", "With local anaesthetics, 1500\u00a0units mixed\r\nwith local anaesthetic solution (ophthalmology, 15\u00a0units/mL)", "Hypodermoclysis, 1500\u00a0units dissolved in 1\u00a0mL water for injections\r\nor 0.9% sodium chloride injection, administered\r\nbefore start of 500\u20131000\u00a0mL infusion fluid", "Extravasation (see notes above) or haematoma, 1500\u00a0units dissolved in 1\u00a0mL\r\nwater for injections or 0.9% sodium chloride injection,\r\ninfiltrated into affected area (as soon as possible after extravasation)" ] }, "POTASSIUM CHLORIDE": { "indications": "Indications\u00a0potassium depletion (see notes above)", "name": "POTASSIUM CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.1 Oral potassium", "POTASSIUM CHLORIDE" ], "cautions": "Cautions\u00a0\n(From 9.2.1.1 Oral potassium: British National Formulary)\n9.2.1.1 Oral potassium; cardiac disease; elderly; with modified-release\r\npreparations, intestinal stricture, history of peptic\r\nulcer, hiatus hernia; interactions: Appendix 1 (potassium salts)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, flatulence; with modified-release preparations, gastro-intestinal obstruction,\r\nulceration and bleeding also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4940.htm", "doses": [ "See notes above", "Do not confuse Effervescent Potassium Tablets\r\nBPC 1968 (section 9.2.1.3) with effervescent potassium chloride tablets. Effervescent Potassium Tablets BPC 1968 do not contain\r\nchloride ions and their use should be restricted to hyperchloraemic\r\nstates (section 9.2.1.3). " ] }, "CHLORAL HYDRATE - CLORAL BETAINE": { "indications": "Indications\u00a0insomnia (short-term use)", "name": "CHLORAL HYDRATE - CLORAL BETAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Chloral and derivatives", "CHLORAL HYDRATE", "Cloral betaine" ], "cautions": "Cautions\u00a0reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal\r\nthereafter); avoid contact with skin and mucous membranes; interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may persist\r\nthe next day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0gastric irritation (nausea and vomiting reported),\r\nabdominal distention, flatulence, headache, tolerance, dependence,\r\nexcitement, delirium (especially on abrupt withdrawal), ketonuria,\r\nand rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3159.htm", "doses": [ "See under preparations below", "15\u201345\u00a0mL (chloral hydrate 0.4\u20131.3\u00a0g)\r\nwith water or milk, at bedtime, max. 70\u00a0mL (chloral hydrate 2\u00a0g) daily; child 2\u201312 years, 1\u20131.75\u00a0mL/kg\r\n(chloral hydrate 30\u201350\u00a0mg/kg), max. 35\u00a0mL (chloral hydrate 1\u00a0g) daily", "Name[Welldorm\u00ae (Marlborough) ] Tablets, blue-purple, f/c, cloral\r\nbetaine 707\u00a0mg (\u2261\u00a0chloral hydrate 414\u00a0mg), net price 30-tab pack =\r\n\u00a312.10. \r\n Label:\r\n 19, 27Dose\u00a0adult and child over 12 years, 1\u20132 tablets with water or milk\r\nat bedtime, max. 5 tablets (chloral hydrate 2\u00a0g)\r\ndaily\nElixir, red, chloral hydrate 143.3\u00a0mg/5\u00a0mL, net price 150-mL pack = \u00a38.70. \r\n Label:\r\n 19, 27Dose\u00a015\u201345\u00a0mL (chloral hydrate 0.4\u20131.3\u00a0g)\r\nwith water or milk, at bedtime, max. 70\u00a0mL (chloral hydrate 2\u00a0g) daily; child 2\u201312 years, 1\u20131.75\u00a0mL/kg\r\n(chloral hydrate 30\u201350\u00a0mg/kg), max. 35\u00a0mL (chloral hydrate 1\u00a0g) daily" ], "pregnancy": "Pregnancy\u00a0avoid" }, "ALUMINIUM ACETATE": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Astringent preparations", "ALUMINIUM ACETATE" ], "indications": "Indications\u00a0inflammation in otitis externa (\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "ALUMINIUM ACETATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5589.htm", "doses": [ "Insert into meatus or apply on a ribbon gauze dressing\r\nor sponge wick which should be kept saturated with the ear drops" ] }, "TACROLIMUS Modified release": { "indications": "Indications\u00a0prophylaxis of organ rejection in liver,\r\nkidney, and heart allograft recipients and allograft rejection resistant\r\nto conventional immunosuppressive regimens, see also notes above;\r\nmoderate to severe atopic eczema (section 13.5.3)", "name": "TACROLIMUS Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "TACROLIMUS", "Modified release" ], "cautions": "Cautions\u00a0monitor blood pressure, ECG (important: see Cardiomyopathy below), fasting blood-glucose\r\nconcentration, haematological and neurological (including visual)\r\nparameters, electrolytes, hepatic and renal function; monitor whole blood-tacrolimus trough concentration\r\n(especially during episodes of diarrhoea)\u2014consult local treatment\r\nprotocol for details; QT-interval prolongation; neurotoxicity; increased\r\nrisk of infections, malignancies, and lymphoproliferative disorders; avoid excessive exposure to UV light including sunlight; interactions: Appendix 1 (tacrolimus)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, constipation, dyspepsia,\r\nflatulence, bloating, weight changes, anorexia, gastro-intestinal\r\ninflammation, ulceration, and perforation, hepatic dysfunction, jaundice,\r\ncholestasis, ascites, bile-duct abnormalities, oedema, tachycardia,\r\nhypertension, haemorrhage, thromboembolic and ischaemic events, dyspnoea,\r\npleural effusion, parenchymal lung disorders, sleep disturbances,\r\ntremor, headache, peripheral neuropathy, mood changes, depression,\r\nconfusion, anxiety, psychosis, seizures, paraesthesia, dizziness,\r\nrenal impairment, renal failure, renal tubular necrosis, urinary abnormalities,\r\nhyperglycaemia, electrolyte disturbances (including hyperkalaemia,\r\nhypokalaemia, and hyperuricaemia), blood disorders (including anaemia,\r\nleucopenia, pancytopenia, and thrombocytopenia), arthralgia, muscle\r\ncramp, visual disturbances, photophobia, tinnitus, impaired hearing,\r\nalopecia, sweating, acne; less commonly paralytic\r\nileus, gastro-intestinal reflux disease, peritonitis, pancreatitis,\r\nheart failure, arrhythmia, cardiac arrest, cerebrovascular accident,\r\ncardiomyopathy (important: see Cardiomyopathy below),\r\npalpitation, respiratory failure, coma, speech disorder, amnesia,\r\nparalysis, influenza-like symptoms, encephalopathy, coagulation disorders,\r\nphotosensitivity, cataract, hypoglycaemia, dysmenorrhoea, hypertonia,\r\ndermatitis; rarely pericardial effusion, respiratory\r\ndistress syndrome, posterior reversible encephalopathy syndrome, dehydration,\r\nthrombotic thrombocytopenic purpura, blindness, toxic epidermal necrolysis,\r\nhirsutism; very rarely myasthenia, haemorrhagic cystitis,\r\nStevens-Johnson syndromeCardiomyopathy\u00a0Cardiomyopathy has been reported\r\nin children. Patients should be monitored by echocardiography for\r\nhypertrophic changes\u2014consider dose reduction or discontinuation if\r\nthese occur", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200015.htm", "doses": [ "See under preparations", "Renal transplantation, starting within 24 hours of transplantation, by mouth, 200\u2013300\u00a0micrograms/kg once daily in the morning", "child not recommended", "Name[Advagraf\u00ae (Astellas) ] Capsules, m/r, tacrolimus (as monohydrate)\r\n500\u00a0micrograms (yellow/orange), net price 50-cap pack = \u00a335.79; 1\u00a0mg\r\n(white/orange), 50-cap pack = \u00a371.59, 100-cap pack = \u00a3143.17; 3\u00a0mg\r\n(orange), 50-cap pack = \u00a3214.76; 5\u00a0mg (red/orange), 50-cap pack =\r\n\u00a3266.92. \r\n Label:\r\n 23, 25, counselling, drivingNote\u00a0Tacrolimus is incompatible with PVCDose\u00a0liver transplantation, starting 12\u201318 hours after transplantation, by mouth, 100\u2013200\u00a0micrograms/kg once daily in the morningRenal transplantation, starting within 24 hours of transplantation, by mouth, 200\u2013300\u00a0micrograms/kg once daily in the morningRejection therapy, seek specialist advicechild not recommended" ], "pregnancy": "Pregnancy\u00a0exclude before treatment; avoid unless potential\r\nbenefit outweighs risk\u2014risk of premature delivery, intra-uterine growth\r\nrestriction, and hyperkalaemia; toxicity in animal studies" }, "LEVOFLOXACIN - QUINOLONES": { "indications": "Indications\u00a0see under Dose", "name": "LEVOFLOXACIN - QUINOLONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.12 Quinolones", "LEVOFLOXACIN" ], "cautions": "Cautions\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nCautions\u00a0Quinolones should be used with caution in patients with a history of epilepsy or conditions that predispose to seizures, in G6PD deficiency (section 9.1.5), myasthenia gravis (risk of exacerbation), and in children or adolescents (arthropathy has developed in weight-bearing joints in young animals\u2014see below). Exposure to excessive sunlight should be avoided (discontinue if photosensitivity occurs). Quinolones can prolong the QT interval. Moxifloxacin is contra-indicated in patients with risk factors for QT interval prolongation (e.g. electrolyte disturbances, acute myocardial infarction, heart failure with reduced left ventricular ejection fraction, bradycardia, congenital long QT syndrome, concomitant use with other drugs known to prolong the QT interval, history of symptomatic arrhythmias) and the other quinolones should be used with caution in these patients. The CSM has warned that quinolones may induce convulsions in patients with or without a history of convulsions; taking NSAIDs at the same time may also induce them. Other interactions: Appendix 1 (quinolones).Use in children\u00a0Quinolones cause arthropathy in the weight-bearing joints of immature animals and are therefore generally not recommended in children and growing adolescents. However, the significance of this effect in humans is uncertain and in some specific circumstances short-term use of either ciprofloxacin or nalidixic acid may be justified in children. For further details see BNF for Children.Tendon damageTendon damage (including rupture) has been reported rarely in patients receiving quinolones. Tendon rupture may occur within 48 hours of starting treatment; cases have also been reported several months after stopping a quinolone. Healthcare professionals are reminded that:quinolones are contra-indicated in patients with a history of tendon disorders related to quinolone use;patients over 60 years of age are more prone to tendon damage;the risk of tendon damage is increased by the concomitant use of corticosteroids;if tendinitis is suspected, the quinolone should be discontinued immediately.Contra-indications\u00a0quinolone hypersensitivity. See also Cautions above.; history of psychiatric\r\nillness; interactions: Appendix 1 (quinolones)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nSide-effects\u00a0Side-effects of the quinolones include nausea, vomiting, dyspepsia, abdominal pain, diarrhoea (rarely antibiotic-associated colitis), headache, dizziness, rash (very rarely Stevens-Johnson syndrome and toxic epidermal necrolysis). Less frequent side-effects include anorexia, sleep disturbances, asthenia, confusion, anxiety, depression, hallucinations, tremor, blood disorders (including eosinophilia, leucopenia, thrombocytopenia), arthralgia, myalgia, disturbances in vision and taste. Other side-effects reported rarely or very rarely include hepatic dysfunction (including jaundice and hepatitis), hypotension, vasculitis, dyspnoea (more frequent with moxifloxacin), convulsions, psychoses, paraesthesia, renal failure, interstitial nephritis, tendon inflammation and damage (see also Tendon Damage above), photosensitivity, disturbances in hearing and smell. The drug should be discontinued if psychiatric, neurological or hypersensitivity reactions (including severe rash) occur.;\r\nalso flatulence, constipation; rarely tachycardia; very rarely pneumonitis, peripheral neuropathy, and hypoglycaemia;\r\nalso reported, rhabdomyolysis, potentially life-threatening hepatic\r\nfailure; local reactions and transient hypotension reported with infusion", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215577.htm", "doses": [ "By mouth, acute sinusitis, 500\u00a0mg\r\ndaily for 10\u201314 days", "Exacerbation of chronic bronchitis, 250\u2013500\u00a0mg daily for 7\u201310\r\ndays", "Community-acquired pneumonia, 500\u00a0mg once or twice daily for\r\n7\u201314 days", "Urinary-tract infections, 250\u00a0mg daily for 7\u201310 days (for 3\r\ndays in uncomplicated infection)", "Chronic prostatitis, 500\u00a0mg once daily for 28 days", "Skin and soft tissue infections, 250\u00a0mg daily or 500\u00a0mg once or twice daily for 7\u201314 days", "By intravenous infusion (over at\r\nleast 60 minutes for 500\u00a0mg), community-acquired pneumonia, 500\u00a0mg\r\nonce or twice daily", "Complicated urinary-tract infections, 250\u00a0mg daily, increased\r\nin severe infections", "Skin and soft tissue infections, 500\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.12 Quinolones: British National Formulary)\nPregnancy\u00a0Quinolones should be avoided in pregnancy because they have been shown to cause arthropathy in animal studies; safer alternatives are available; however, a single dose of ciprofloxacin may be used for the prevention of a secondary case of meningococcal meningitis" }, "VARENICLINE": { "indications": "Indications\u00a0\n(From Varenicline: British National Formulary)\nVarenicline", "name": "VARENICLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.2 Nicotine dependence", "Varenicline" ], "cautions": "Cautions\u00a0risk of relapse, irritability, depression,\r\nand insomnia on discontinuation (consider dose tapering on completion\r\nof 12-week course); history of psychiatric\r\nillness (may exacerbate underlying illness including depression); history of cardiovascular diseaseMHRA/CHM adviceSuicidal behaviour and vareniclinePatients should be advised to discontinue treatment\r\nand seek prompt medical advice if they develop agitation, depressed\r\nmood, or suicidal thoughts. Patients with\r\na history of psychiatric illness should be monitored closely while taking varenicline", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, appetite changes,\r\ndry mouth, taste disturbance; headache, drowsiness, dizziness, sleep\r\ndisorders, abnormal dreams; less commonly thirst,\r\nweight gain, aphthous stomatitis, gingival pain, chest pain, hypertension,\r\ntachycardia, atrial fibrillation, palpitation, depression, anxiety,\r\nhallucinations, panic attack, mood swings, dysarthria, asthenia, tremor,\r\nincoordination, hypertonia, restlessness, hypoaesthesia, impaired\r\ntemperature regulation, menorrhagia, vaginal discharge, sexual dysfunction,\r\ndysuria, arthralgia, muscle spasm, visual disturbances, eye pain,\r\nlacrimation, tinnitus, acne, sweating, rash, and pruritus; myocardial\r\ninfarction, anxiety, depression, aggression, irrational behaviour,\r\npsychosis, suicidal ideation (see MHRA/CHM advice above), and Stevens-Johnson\r\nsyndrome also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129834.htm", "doses": [ "adult over 18 years, starting\r\nusually 1\u20132 weeks before target stop date (up to max. 5 weeks before\r\ntarget stop date), initially 500\u00a0micrograms once daily for 3 days,\r\nincreased to 500\u00a0micrograms twice daily for 4 days, then 1\u00a0mg twice\r\ndaily for 11 weeks (reduce to 500\u00a0micrograms twice daily if not tolerated);\r\n12-week course can be repeated in abstinent individuals to reduce\r\nrisk of relapse" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "GEMCITABINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nGemcitabine is used intravenously; it is given alone for elderly patients or for palliative treatment, or with cisplatin as first-line treatment for locally advanced or metastatic non-small cell lung cancer. It is also used in the treatment of locally advanced or metastatic pancreatic cancer (see NICE guidance below). Combined with cisplatin, gemcitabine is also licensed for the treatment of advanced bladder cancer. Combined with carboplatin, gemcitabine is licensed for the treatment of locally advanced or metastatic epithelial ovarian cancer which has relapsed after a recurrence-free interval of at least 6 months following previous platinum-based therapy. Combined with paclitaxel, gemcitabine is also licensed for the treatment of metastatic breast cancer which has relapsed after previous chemotherapy including an anthracycline (see NICE guidance below). Gemcitabine is generally well tolerated but it can cause mild gastro-intestinal side-effects, musculoskeletal pain, influenza-like symptoms and rashes; renal impairment and pulmonary toxicity have also been reported. Haemolytic uraemic syndrome has been reported rarely and gemcitabine should be discontinued if signs of microangiopathic haemolytic anaemia occur.", "name": "GEMCITABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "GEMCITABINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (gemcitabine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37650.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nmanufacturer advises effective contraception during treatment; men\r\nmust avoid fathering a child during and for 6 months after treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "ERGOMETRINE MALEATE": { "indications": "Indications\u00a0see notes above", "name": "ERGOMETRINE MALEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics" ], "cautions": "Cautions\u00a0cardiac disease; hypertension; multiple pregnancy; acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(ergot alkaloids)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain; chest pain,\r\narrhythmias (including bradycardia), palpitation, hypertension, vasoconstriction;\r\ndyspnoea, pulmonary oedema; headache, dizziness; tinnitus; rash; very rarely myocardial infarction", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4492.htm", "doses": [ "See notes above" ] }, "ATROPINE SULPHATE - ANTIMUSCARINIC DRUGS": { "indications": "Indications\u00a0premedication; intra-operative\r\nbradycardia; with anticholinesterases for reversal of non-depolarising\r\nneuromuscular block; antidote to organophosphorous poisoning (see Emergency Treatment of Poisoning); symptomatic relief of gastro-intestinal\r\ndisorders characterised by smooth muscle spasm (section 1.2); bradycardia (section 2.3.1); cardiopulmonary\r\nresuscitation (section 2.7.3); cycloplegia,\r\nanterior uveitis (section 11.5)", "name": "ATROPINE SULPHATE - ANTIMUSCARINIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.3 Antimuscarinic drugs", "ATROPINE SULPHATE" ], "cautions": "Cautions\u00a0see notes in section 1.2Duration of action\u00a0Since atropine\r\nhas a shorter duration of action than neostigmine, late unopposed bradycardia may result; close monitoring of the\r\npatient is necessary", "side-effects": "Side-effects\u00a0see notes in section 1.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6585.htm", "doses": [ "Premedication, by intravenous injection, 300\u2013600\u00a0micrograms immediately before induction of anaesthesia; child under 12 years see BNF for Children", "By subcutaneous or intramuscular injection, 300\u2013600\u00a0micrograms 30\u201360 minutes before induction of anaesthesia; child under 12 years see BNF for Children", "Intra-operative bradycardia, by intravenous\r\ninjection, 300\u2013600\u00a0micrograms (larger doses in emergencies); child under 12 years see BNF for Children", "Control of muscarinic side-effects of neostigmine in reversal of competitive neuromuscular block, by intravenous\r\ninjection, 0.6\u20131.2\u00a0mg; child under 12 years see BNF for Children", "Control of muscarinic side-effects of edrophonium in reversal of competitive neuromuscular block [unlicensed indication], by intravenous injection, 600\u00a0micrograms; child under 18 years see BNF for Children", "Arrhythmias after myocardial infarction, see section 2.3.1" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; use with caution" }, "INDORAMIN - ALPHA-BLOCKERS": { "side-effects": "Side-effects\u00a0\n(From Alpha-blockers: British National Formulary)\nSide-effects\u00a0Side-effects of alpha1-selective alpha blockers include drowsiness, hypotension (notably postural hypotension), syncope, asthenia, dizziness, depression, headache, dry mouth, gastro-intestinal disturbances, oedema, blurred vision, intra-operative floppy iris syndrome (most strongly associated with tamsulosin), rhinitis, erectile disorders (including priapism), tachycardia, and palpitations. Hypersensitivity reactions including rash, pruritus and angioedema have also been reported. and %s\n(From INDORAMIN: British National Formulary)\nINDORAMIN", "indications": "Indications\u00a0 benign prostatic hyperplasia; hypertension\r\n(section 2.5.4)", "name": "INDORAMIN - ALPHA-BLOCKERS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/13903.htm", "doses": [ "20\u00a0mg twice daily; increased if necessary by 20\u00a0mg every\r\n2 weeks to max. 100\u00a0mg daily in divided doses; elderly, 20\u00a0mg at night may be adequate" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.1 Drugs for urinary retention", "Alpha-blockers", "INDORAMIN" ], "cautions": "Cautions\u00a0\n(From Alpha-blockers: British National Formulary)\nCautions\u00a0Since alpha1-selective alpha blockers reduce blood pressure, patients receiving antihypertensive treatment may require reduced dosage and specialist supervision. Caution is required in the elderly and in patients undergoing cataract surgery (risk of intra-operative floppy iris syndrome). For interactions, see Appendix 1 (alpha-blockers). and %s\n(From INDORAMIN: British National Formulary)\nINDORAMIN" }, "DABIGATRAN ETEXILATE": { "indications": "Indications\u00a0\n(From Dabigatran etexilate: British National Formulary)\nDabigatran etexilate", "name": "DABIGATRAN ETEXILATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Dabigatran etexilate" ], "cautions": "Cautions\u00a0\n(From Dabigatran etexilate: British National Formulary)\nDabigatran etexilate; also elderly; body-weight less than 50\u00a0kg; recent surgery; anaesthesia with postoperative\r\nindwelling epidural catheter (risk of paralysis\u2014give initial dose\r\nat least 2 hours after catheter removal and monitor neurological signs); bacterial endocarditis (increased risk of bleeding); bleeding disorders; active\r\ngastro-intestinal ulceration; assess renal function\r\nbefore treatment in all patients and at least annually in elderly\r\nand patients with renal impairment; concomitant use of\r\ndrugs that increase risk of bleeding; interactions: Appendix 1 (dabigatran etexilate)", "side-effects": "Side-effects\u00a0nausea, dyspepsia, diarrhoea, abdominal pain,\r\nanaemia, haemorrhage\u2014\n(From Dabigatran etexilate: British National Formulary)\nDabigatran etexilate; less commonly hepatobiliary disorders, vomiting, dysphagia,\r\ngastro-intestinal ulcer, gastro-oesophageal reflux, oesophagitis,\r\nthrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201055.htm", "doses": [ "Prophylaxis of venous thromboembolism following total\r\nknee replacement surgery, adult over\r\n18 years, 110\u00a0mg (elderly over 75 years,\r\n75\u00a0mg) 1\u20134 hours after surgery, then 220\u00a0mg (elderly over 75 years or patient receiving concomitant\r\ntreatment with amiodarone or verapamil, 150\u00a0mg) once daily for 9 days", "Prophylaxis of venous thromboembolism following total hip replacement\r\nsurgery, adult over 18 years, 110\u00a0mg\r\n(elderly over 75 years, 75\u00a0mg) 1\u20134\r\nhours after surgery, then 220\u00a0mg (elderly over 75 years or patient receiving concomitant\r\ntreatment with amiodarone or verapamil, 150\u00a0mg) once daily for 27\u201334\r\ndays", "Prophylaxis of stroke and systemic embolism in non-valvular\r\natrial fibrillation (see notes above), adult over 18 years, 150\u00a0mg (elderly over 80 years, patients at high risk of bleeding, or receiving concomitant\r\ntreatment with verapamil, 110\u00a0mg) twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014toxicity\r\nin animal studies" }, "RUFINAMIDE": { "indications": "Indications\u00a0\n(From Rufinamide: British National Formulary)\nRufinamide", "name": "RUFINAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Rufinamide", "RUFINAMIDE" ], "cautions": "Cautions\u00a0closely monitor and consider withdrawal\r\nif rash, fever, or other signs of hypersensitivity syndrome develop (see also Antiepileptic Hypersensitivity\r\nSyndrome); avoid abrupt withdrawal; interactions: see Interactions in section 4.8.1 and Appendix 1 (rufinamide)", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, diarrhoea, dyspepsia,\r\nabdominal pain, weight loss, anorexia; rhinitis, epistaxis; dizziness,\r\nheadache, drowsiness, insomnia, anxiety, fatigue, increase in seizure\r\nfrequency, impaired coordination, hyperactivity, tremor, gait disturbances;\r\ninfluenza-like symptoms; oligomenorrhoea; back pain; nystagmus, diplopia,\r\nblurred vision; rash and acne; hypersensitivity syndrome (see Antiepileptic Hypersensitivity\r\nSyndrome)\r\nalso reportedHypersensitivity syndrome\u00a0Serious hypersensitivity\r\nsyndrome (see Side-effects) has developed, especially in children\r\nand upon initiation of therapy; consider withdrawal if rash or signs\r\nor symptoms of hypersensitivity syndrome developCounselling\u00a0Warn patients to seek\r\nimmediate medical attention if signs or symptoms of hypersensitivity\r\ndevelop", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200118.htm", "doses": [ "adult and child over 4 years body-weight over 30\u00a0kg, initially\r\n200\u00a0mg twice daily increased according to response in steps of 200\u00a0mg\r\ntwice daily at intervals of not less than 2 days; body-weight 30\u201350\u00a0kg\r\nmax. 900\u00a0mg twice daily; body-weight 50\u201370\u00a0kg max. 1.2\u00a0g twice daily;\r\nbody-weight over 70\u00a0kg max. 1.6\u00a0g twice daily; child over 4 years body-weight less than 30\u00a0kg, initially 100\u00a0mg twice\r\ndaily increased according to response in steps of 100\u00a0mg twice daily\r\nat intervals of not less than 2 days; max. 500\u00a0mg twice daily (max.\r\n300\u00a0mg twice daily if adjunctive therapy with valproate)" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "MEPACRINE HYDROCHLORIDE": { "indications": "Indications\u00a0giardiasis; discoid lupus erythematosus (Antimalarials, section 10.1.3)", "name": "MEPACRINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.4 Antigiardial drugs" ], "cautions": "Cautions\u00a0hepatic impairment, elderly, history of psychosis; avoid in psoriasis; interactions: Appendix 1 (mepacrine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; dizziness, headache;\r\nwith large doses nausea, vomiting and occasionally transient acute\r\ntoxic psychosis and CNS stimulation; on prolonged treatment yellow\r\ndiscoloration of skin and urine, chronic dermatoses (including severe\r\nexfoliative dermatitis), hepatitis, aplastic anaemia; also reported\r\nblue/black discoloration of palate and nails and corneal deposits\r\nwith visual disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4046.htm", "doses": [ "Giardiasis [unlicensed], 100\u00a0mg every 8 hours for 5\u20137\r\ndays" ] }, "DORNASE ALFA": { "indications": "Indications\u00a0management of cystic fibrosis patients with a forced vital capacity\r\n(FVC) of greater than 40% of predicted to improve pulmonary function", "name": "DORNASE ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.7 Mucolytics", "Dornase alfa", "DORNASE ALFA" ], "side-effects": "Side-effects\u00a0rarely dyspepsia, chest pain,\r\ndysphonia, dyspnoea, pharyngitis, laryngitis, pyrexia, conjunctivitis,\r\nrhinitis, rash, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/20298.htm", "doses": [ "adult and child over 5 years, by inhalation of nebulised\r\nsolution (by jet nebuliser), 2500\u00a0units (2.5\u00a0mg) once daily\r\n(patients over 21 years may benefit from twice daily dosage)" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturer advises\r\nuse only if potential benefit outweighs risk" }, "ARSENIC TRIOXIDE": { "indications": "Indications\u00a0\n(From Arsenic trioxide: British National Formulary)\nArsenic trioxide", "name": "ARSENIC TRIOXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Arsenic trioxide", "ARSENIC TRIOXIDE" ], "cautions": "Cautions\u00a0see section 8.1; correct electrolyte abnormalities\r\nbefore treatment; ECG required before and\r\nduring treatment\u2014consult product literature; avoid concomitant administration with drugs causing QT interval prolongation, hypokalaemia, and hypomagnesaemia; previous treatment with anthracyclines (increased risk of QT interval prolongation); interactions: Appendix 1 (arsenic trioxide)", "side-effects": "Side-effects\u00a0see section 8.1; diarrhoea, leucocyte activation\r\nsyndrome (unexplained fever, dyspnoea, weight gain, pulmonary infiltrates,\r\npleural or pericardial effusions, with or without leucocytosis\u2014treat\r\nwith high dose corticosteroids, consult product literature); hyperglycaemia,\r\nhypokalaemia, QT interval prolongation, atrial fibrillation, atrial\r\nflutter, haemorrhage, pleuritic pain, musculoskeletal pain, paraesthesia,\r\nfatigue; less commonly abdominal pain, tachycardia,\r\nvasculitis, hypotension, oedema, pneumonitis, seizures, renal failure,\r\nblurred vision, and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129340.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and embryotoxic in animal studies); manufacturer advises effective contraception during treatment\r\nin men and women; see also Pregnancy and Reproductive\r\nfunction" }, "ENALAPRIL MALEATE With diuretic": { "indications": "Indications\u00a0hypertension; symptomatic heart failure (adjunct\u2014see section 2.5.5); prevention\r\nof symptomatic heart failure in patients with asymptomatic left ventricular\r\ndysfunction", "name": "ENALAPRIL MALEATE With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "ENALAPRIL MALEATE", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also dyspnoea; depression, asthenia;\r\nblurred vision; less commonly dry mouth, peptic ulcer,\r\nanorexia, ileus; arrhythmias, palpitation, flushing; confusion, nervousness,\r\ndrowsiness, insomnia, vertigo; impotence; muscle cramps; tinnitus;\r\nalopecia, sweating; hyponatraemia; rarely stomatitis,\r\nglossitis, Raynaud\u2019s syndrome, pulmonary infiltrates, allergic alveolitis,\r\ndream abnormalities, gynaecomastia, Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, exfoliative dermatitis, pemphigus; very\r\nrarely gastro-intestinal angioedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2588.htm", "doses": [ "Hypertension, used alone, initially 5\u00a0mg once daily; if\r\nused in addition to diuretic (see notes above),\r\nor in renal impairment, lower initial doses may be required; usual\r\nmaintenance dose 20\u00a0mg once daily; max. 40\u00a0mg once daily", "Heart failure (adjunct), asymptomatic left ventricular dysfunction,\r\ninitially 2.5\u00a0mg once daily under close medical supervision (see notes above),\r\nincreased gradually over 2\u20134 weeks to 10\u201320\u00a0mg twice daily if tolerated", "Name[Innozide\u00ae (MSD) ] Tablets, yellow, scored, enalapril maleate 20\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a312.82Note\u00a0Non-proprietary tablets containing enalapril\r\nmaleate (20\u00a0mg) and hydrochlorothiazide (12.5\u00a0mg) are available" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "AGALSIDASE ALFA and BETA": { "indications": "Indications\u00a0Fabry\u2019s disease (specialist\r\nuse only)", "name": "AGALSIDASE ALFA and BETA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Fabry\u2019s disease", "AGALSIDASE ALFA and BETA" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (agalsidase\r\nalfa and beta)Infusion-related reactions\u00a0Infusion-related\r\nreactions very common; manage by slowing the infusion rate or interrupting\r\nthe infusion, or minimise by pre-treatment with an antihistamine,\r\nantipyretic, or corticosteroid\u2014consult product literature", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, taste disturbances;\r\ntachycardia, bradycardia, palpitation, hypertension, hypotension,\r\nchest pain, oedema, flushing; dyspnoea, cough, rhinorrhoea; headache,\r\nfatigue, dizziness, asthenia, paraesthesia, syncope, neuropathic pain,\r\ntremor, sleep disturbances; influenza-like symptoms, nasopharyngitis;\r\nmuscle spasms, myalgia, arthralgia; eye irritation; tinnitus; hypersensitivity\r\nreactions, angioedema, pruritus, urticaria, rash, acne; less\r\ncommonly cold extremities, parosmia, ear pain and swelling,\r\nskin discoloration, and injection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129635.htm", "doses": [ "By intravenous infusion, adult and child over\r\n7 years 200\u00a0micrograms/kg every 2 weeks" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "MEDROXYPROGESTERONE ACETATE - SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE": { "indications": "Indications\u00a0\n(From 8.3.2 Progestogens: British National Formulary)\n8.3.2 Progestogens; contraception (%s\n(From 7.3.2.2 Parenteral progestogen-only contraceptives: British National Formulary)\n7.3.2.2 Parenteral progestogen-only contraceptives); other\r\nindications (%s\n(From 6.4.1.2 Progestogens: British National Formulary)\n6.4.1.2 Progestogens)", "name": "MEDROXYPROGESTERONE ACETATE - SEX HORMONES AND HORMONE ANTAGONISTS IN MALIGNANT DISEASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.2 Progestogens", "MEDROXYPROGESTERONE ACETATE" ], "cautions": "Cautions\u00a0see section\r\n6.4.1.2 and notes above; interactions: Appendix 1 (progestogens)", "side-effects": "Side-effects\u00a0see section\r\n6.4.1.2 and notes above; glucocorticoid effects at high\r\ndose may lead to a cushingoid syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4811.htm", "doses": [ "See preparations below", " endometrial and renal cell cancer, 200\u2013400\u00a0mg daily;\r\nbreast cancer, 400\u2013800\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014genital malformations and cardiac defects reported;\r\nsee also Parenteral Progestogen-only Contraceptives (section 7.3.2.2)" }, "ALPRAZOLAM": { "indications": "Indications\u00a0short-term use in anxiety (see section 4.1)", "name": "ALPRAZOLAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.2 Anxiolytics", "Benzodiazepines" ], "cautions": "Cautions\u00a0see under Diazepam", "side-effects": "Side-effects\u00a0see under Diazepam", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3173.htm", "doses": [ "250\u2013500\u00a0micrograms 3 times daily (elderly or debilitated 250\u00a0micrograms 2\u20133 times daily), increased if necessary\r\nto a total of 3\u00a0mg daily; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "ECULIZUMAB": { "indications": "Indications\u00a0paroxysmal nocturnal haemoglobinuria,\r\nin those with a history of blood transfusions (specialist use only)", "name": "ECULIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Paroxysmal nocturnal haemoglobinuria ", "ECULIZUMAB" ], "cautions": "Cautions\u00a0active systemic infection; monitor for intravascular haemolysis (including serum-lactate\r\ndehydrogenase concentration) for at least 8 weeks after discontinuationMeningococcal infection\u00a0Vaccinate\r\nagainst Neisseria meningitidis at least 2 weeks\r\nbefore treatment (tetravalent vaccine against serotypes A, C, W135\r\nand Y recommended); revaccinate according to current medical guidelines. Advise patient to report promptly any signs of meningococcal\r\ninfection. Other immunisations should also be up to date (section 14.1)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances; oedema; cough,\r\nnasopharyngitis; headache, dizziness, fatigue, dysgeusia, paraesthesia;\r\ninfection (including meningococcal infection); spontaneous erection,\r\ndysuria; arthralgia, myalgia; blood disorders (including thrombocytopenia);\r\nalopecia, pruritus, rash; influenza-like symptoms; infusion-related\r\nreactions; less commonly anorexia, gingival pain,\r\njaundice, palpitation, haematoma, hypotension, chest pain, syncope,\r\nhot flushing, epistaxis, anxiety, depression, mood changes, sleep\r\ndisturbances, Graves\u2019 disease, menstrual disorders, renal impairment,\r\nmalignant melanoma, muscle spasms, myelodysplastic syndrome, visual\r\ndisturbances, tinnitus, hyperhidrosis, petechiae, and skin depigmentation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200191.htm", "doses": [ "By intravenous infusion, adult over 18 years, initially 600\u00a0mg once a week\r\nfor 4 weeks, then 900\u00a0mg on week 5; maintenance, 900\u00a0mg once every\r\n12\u201316 days" ], "pregnancy": "Pregnancy\u00a0no information available\u2014use only if potential benefit\r\noutweighs risk; human IgG antibodies known to cross placenta; manufacturer\r\nadvises effective contraception during and for 5 months after treatment" }, "RIZATRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine", "name": "RIZATRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; interactions: Appendix 1 (5HT1 agonists)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0see under 5HT1-receptor\r\nagonists above; drowsiness, palpitation, tachycardia, dry mouth,\r\ndiarrhoea, dyspepsia, thirst, pharyngeal discomfort, dyspnoea, headache,\r\nparaesthesia, decreased alertness, insomnia, tremor, ataxia, nervousness,\r\nvertigo, confusion, myalgia and muscle weakness, sweating, urticaria,\r\npruritus, blurred vision; rarely syncope, hypertension,\r\ntoxic epidermal necrolysis; seizures and taste disturbance reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73593.htm", "doses": [ "10\u00a0mg as soon as possible after onset repeated after 2\r\nhours if migraine recurs (patient not responding should not take second\r\ndose for same attack); max. 20\u00a0mg in 24 hours; child and adolescent under 18 years not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "DIPHTHERIA-CONTAINING VACCINES Diphtheria-containing vaccines for children under 10 years": { "indications": "Indications\u00a0\n(From Diphtheria vaccines: British National Formulary)\nDiphtheria vaccines", "name": "DIPHTHERIA-CONTAINING VACCINES Diphtheria-containing vaccines for children under 10 years", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Diphtheria vaccines", "DIPHTHERIA-CONTAINING VACCINES", "Diphtheria-containing vaccines for children under 10 years" ], "cautions": "Cautions\u00a0see section 14.1 and see also individual components\r\nof vaccines", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nrestlessness, sleep disturbances, and unusual crying in infants", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129022.htm", "doses": [ "See under preparations", "Name[Adsorbed Diphtheria, Tetanus, Pertussis (Acellular, Component)\r\nand Poliomyelitis (Inactivated) Vaccine ] Injection, suspension of diphtheria\r\ntoxoid, tetanus toxoid, acellular pertussis and inactivated poliomyelitis\r\nvaccine components adsorbed on a mineral carrier, net price 0.5-mL\r\nprefilled syringe = \u00a317.56Excipients may include neomycin\r\nand polymyxin BDose\u00a0by intramuscular injection, child 3\u201310 years, first booster dose 3 years after\r\nprimary immunisation, 0.5\u00a0mL; see also notes on booster dosesBrands include Infanrix-IPV\u00ae; available as part\r\nof childhood immunisation schedule, from health organisations or ImmForm" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "PERPHENAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0see under Dose; antiemetic (section 4.6)", "name": "PERPHENAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "PERPHENAZINE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; hypothyroidism", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; less\r\nsedating; extrapyramidal symptoms, especially dystonia, more frequent,\r\nparticularly at high dosage; rarely systemic lupus erythematosus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3238.htm", "doses": [ "Schizophrenia and other psychoses, mania, short-term adjunctive\r\nmanagement of anxiety, severe psychomotor agitation, excitement, and\r\nviolent or dangerously impulsive behaviour, initially 4\u00a0mg 3 times\r\ndaily adjusted according to the response; max. 24\u00a0mg daily; elderly quarter to half adult dose (but see Cautions); child under 14 years not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "PHENYLEPHRINE HYDROCHLORIDE With tropicamide": { "indications": "Indications\u00a0mydriasis; see also notes above", "name": "PHENYLEPHRINE HYDROCHLORIDE With tropicamide", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.5 Mydriatics and cycloplegics", "Sympathomimetics", "PHENYLEPHRINE HYDROCHLORIDE", "With tropicamide" ], "cautions": "Cautions\u00a0children and elderly (avoid 10% strength); cardiovascular\r\ndisease (avoid or use 2.5% strength only); corneal epithelial damage; ocular hyperaemia; susceptibility to angle-closure glaucoma; tachycardia; hyperthyroidism; diabetes; cerebral arteriosclerosis; asthma; prostate disorders; see also notes above", "side-effects": "Side-effects\u00a0\n(From 11.5 Mydriatics and cycloplegics: British National Formulary)\n11.5 Mydriatics and cycloplegics; also eye pain and stinging; blurred\r\nvision, photophobia; systemic effects include palpitations, tachycardia,\r\narrhythmias, hypertension, coronary artery spasm; very rarely dry mouth, tremor, headache, angle-closure glaucoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218824.htm", "doses": [ "Name[Mydriasert\u00ae (Spectrum Thea) ] Ophthalmic insert, phenylephrine\r\nhydrochloride 5.4\u00a0mg, tropicamide 280\u00a0micrograms, net price 1\u00a0unit\r\n= \u00a34.20Dose\u00a0for pre-operative mydriasis, or for diagnostic procedures\r\nwhen monotherapy insufficient, adult over 18 years, apply 1\u00a0insert into the lower conjunctival sac up\r\nto max. 2 hours before procedure; remove insert within 30 minutes\r\nof satisfactory mydriasis, and within 2 hours of applicationNote\u00a0Patients with severe dry eyes may require\r\na drop of saline to improve insert tolerance" ] }, "PRILOCAINE HYDROCHLORIDE For dental use": { "indications": "Indications\u00a0see under preparations", "name": "PRILOCAINE HYDROCHLORIDE For dental use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Prilocaine", "PRILOCAINE HYDROCHLORIDE", "For dental use" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics;\r\nsevere or untreated hypertension; concomitant use of drugs that cause methaemoglobinaemia; acute porphyria (section 9.8.2); interactions: Appendix 1 (prilocaine)", "side-effects": "Side-effects\u00a0\n(From Prilocaine: British National Formulary)\nPrilocaine and %s\n(From 15.2 Local anaesthesia: British National Formulary)\nToxicity and side-effects\u00a0A single application of a topical lidocaine preparation does not generally cause systemic side-effects. Toxic effects after administration of local anaesthetics are a result of excessively high plasma concentrations; severe toxicity usually results from inadvertent intravascular injection or too rapid injection.The systemic toxicity of local anaesthetics mainly involves the central nervous and cardiovascular systems. CNS effects include a feeling of inebriation and lightheadedness followed by drowsiness, numbness of the tongue and perioral region, restlessness, paraesthesia (including sensations of hot and cold), dizziness, blurred vision, nausea and vomiting, muscle twitching, tremors, and convulsions. Transient excitation may also occur, followed by depression with drowsiness, respiratory failure, unconsciousness, and coma. Effects on the cardiovascular system include myocardial depression and peripheral vasodilatation resulting in hypotension and bradycardia; arrhythmias and cardiac arrest can occur.Hypersensitivity reactions occur mainly with the ester-type local anaesthetics, such as tetracaine; reactions are less frequent with the amide types, such as articaine, bupivacaine, levobupivacaine, lidocaine, mepivacaine, prilocaine, and ropivacaine. Cross-sensitivity reactions may be avoided by using the alternative chemical type.;\r\nalso hypertension", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6704.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "See under preparations\u2014important: see also\r\nAdministration, section 15.2", "Name[Citanest 3% with Octapressin\u00ae (Dentsply) ] Injection, prilocaine hydrochloride 30\u00a0mg/mL, felypressin 0.03\u00a0unit/mL, net price 2.2-mL cartridge and\r\nself-aspirating cartridge (both) = 47p" ], "pregnancy": "Pregnancy\u00a0large doses during delivery can cause neonatal respiratory\r\ndepression, hypotonia, and bradycardia after epidural block; avoid\r\nparacervical or pudendal block in obstetrics (neonatal methaemoglobinaemia\r\nreported); use lower doses for intrathecal use during late pregnancy" }, "ISOTRETINOIN": { "indications": "Indications\u00a0\n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne; oral treatment\r\n(\n(From 13.6.2 Oral preparations for acne: British National Formulary)\n13.6.2 Oral preparations for acne)", "name": "ISOTRETINOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.1 Topical preparations for acne", "Topical retinoids and related preparations for acne", "ISOTRETINOIN" ], "cautions": "Cautions\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nTopical retinoids and related preparations for acne;\r\nalso personal or familial history of non-melanoma skin\r\ncancer", "side-effects": "Side-effects\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nSide-effects\u00a0Local reactions include burning, erythema, stinging, pruritus, dry or peeling skin (discontinue if severe). Increased sensitivity to UVB light or sunlight occurs. Temporary changes of skin pigmentation with tretinoin have been reported. Eye irritation and oedema, and blistering or crusting of skin have been reported rarely.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/61336.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "pregnancy": "Pregnancy\u00a0(topical application only) \n(From Topical retinoids and related preparations for acne: British National Formulary)\nPregnancy\u00a0Topical retinoids are contra-indicated in pregnancy; women of child-bearing age must use effective contraception (oral progestogen-only contraceptives not considered effective)." }, "FLUPENTIXOL": { "indications": "Indications\u00a0depressive illness; psychoses (section 4.2.1)", "name": "FLUPENTIXOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs", "FLUPENTIXOL" ], "cautions": "Cautions\u00a0cardiovascular disease (including cardiac disorders and cerebral arteriosclerosis), QT-interval\r\nprolongation (avoid concomitant administration\r\nof drugs that prolong QT interval); diabetes; senile confusional states, parkinsonism; elderly; acute porphyria (section 9.8.2); see also section 4.2.1; interactions: Appendix 1 (antipsychotics)", "side-effects": "Side-effects\u00a0section 4.2.1; also hypersalivation, dyspnoea,\r\nasthenia, hyperglycaemia, myalgia; torsade de pointes and sudden death\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203959.htm", "doses": [ "adult over 18 years, initially\r\n1\u00a0mg (elderly 500\u00a0micrograms) in the\r\nmorning, increased after 1 week to 2\u00a0mg (elderly 1\u00a0mg) if necessary; max. 3\u00a0mg (elderly 1.5\u00a0mg) daily, doses above 2\u00a0mg (elderly 1\u00a0mg) in divided doses, last dose before 4\u00a0pm; discontinue if no\r\nresponse after 1 week at max. dosage", "Although drowsiness may occur, can\r\nalso have an alerting effect so should not be taken in the evening" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk" }, "PRUCALOPRIDE": { "indications": "Indications\u00a0chronic constipation in women when\r\nother laxatives fail to provide an adequate response", "name": "PRUCALOPRIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.7 5HT4-receptor agonists", "PRUCALOPRIDE" ], "cautions": "Cautions\u00a0history of arrhythmias or\r\nischaemic heart disease; concomitant use with drugs that prolong QT interval; severe, unstable chronic illness", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, dyspepsia, flatulence,\r\ndiarrhoea, rectal bleeding; headache, dizziness, fatigue; polyuria; less commonly anorexia, palpitation, tremor, and fever", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208070.htm", "doses": [ "adult over 18 years, 2\u00a0mg\r\nonce daily; elderly over 65 years,\r\ninitially 1\u00a0mg once daily, increased if necessary to 2\u00a0mg once daily", "Review treatment if no response after 4 weeks" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid and recommends effective\r\ncontraception during treatment" }, "LACTULOSE": { "indications": "Indications\u00a0constipation (may take up to 48 hours to act), hepatic encephalopathy\r\n(portal systemic encephalopathy)", "name": "LACTULOSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.4 Osmotic laxatives" ], "cautions": "Cautions\u00a0lactose intolerance; interactions: Appendix 1 (lactulose)", "side-effects": "Side-effects\u00a0nausea (can be reduced by administration with\r\nwater, fruit juice or with meals), vomiting, flatulence, cramps, and\r\nabdominal discomfort ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2240.htm", "doses": [ "See under preparations below" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; see also Pregnancy" }, "NYSTATIN": { "indications": "Indications\u00a0oral and perioral fungal infections", "name": "NYSTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.2 Oropharyngeal anti-infective drugs", "Oropharyngeal fungal infections", "NYSTATIN" ], "side-effects": "Side-effects\u00a0oral irritation and sensitisation, nausea reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215693.htm", "doses": [ "Treatment, adult and child, 100\u00a0000\u00a0units 4 times daily after food, usually\r\nfor 7 days (continued for 48 hours after lesions have resolved)", "Unlicensed for treating candidiasis in neonate" ] }, "HYDRALAZINE HYDROCHLORIDE": { "indications": "Indications\u00a0moderate to severe hypertension (adjunct); heart failure (with long-acting\r\nnitrate, but see section 2.5.5); hypertensive emergencies (including during pregnancy) (see section 2.5)", "name": "HYDRALAZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "HYDRALAZINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0coronary artery disease (may provoke angina, avoid after myocardial infarction\r\nuntil stabilised), cerebrovascular disease; occasionally blood pressure reduction too rapid even\r\nwith low parenteral doses; manufacturer\r\nadvises test for antinuclear factor and for proteinuria every 6 months\r\nand check acetylator status before increasing dose above 100\u00a0mg daily, but evidence of clinical value unsatisfactory; interactions: Appendix 1 (hydralazine)", "side-effects": "Side-effects\u00a0tachycardia, palpitation, flushing, hypotension,\r\nfluid retention, gastro-intestinal disturbances; headache, dizziness;\r\nsystemic lupus erythematosus-like syndrome after long-term therapy\r\nwith over 100\u00a0mg daily (or less in women and in slow acetylator individuals)\r\n(see also notes above); rarely rashes, fever, peripheral neuritis,\r\npolyneuritis, paraesthesia, arthralgia, myalgia, increased lacrimation,\r\nnasal congestion, dyspnoea, agitation, anxiety, anorexia; blood disorders\r\n(including leucopenia, thrombocytopenia, haemolytic anaemia), abnormal\r\nliver function, jaundice, raised plasma creatinine, proteinuria and\r\nhaematuria reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2539.htm", "doses": [ "By mouth, hypertension, 25\u00a0mg twice\r\ndaily, increased to usual max. 50\u00a0mg twice daily (see notes above)", "Heart failure (initiated in hospital) 25\u00a0mg 3\u20134 times daily,\r\nincreased every 2 days if necessary; usual maintenance dose 50\u201375\u00a0mg\r\n4 times daily", "By slow intravenous injection, hypertensive\r\nemergencies and hypertension with renal complications, 5\u201310\u00a0mg diluted\r\nwith 10\u00a0mL sodium chloride 0.9%; may be repeated\r\nafter 20\u201330 minutes (see Cautions)", "By intravenous infusion, hypertensive\r\nemergencies and hypertension with renal complications, initially 200\u2013300\u00a0micrograms/minute;\r\nmaintenance usually 50\u2013150\u00a0micrograms/minute" ], "pregnancy": "Pregnancy\u00a0neonatal thrombocytopenia reported, but risk should\r\nbe balanced against risk of uncontrolled maternal hypertension; manufacturer\r\nadvises avoid before third trimester" }, "CISATRACURIUM": { "indications": "Indications\u00a0neuromuscular blockade (intermediate duration) for surgery or during\r\nintensive care", "name": "CISATRACURIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Non-depolarising neuromuscular blocking drugs", "CISATRACURIUM" ], "cautions": "Cautions\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nCautions\u00a0Allergic cross-reactivity between neuromuscular blocking drugs has been reported; caution is advised in cases of hypersensitivity to these drugs. Their activity is prolonged in patients with myasthenia gravis and in hypothermia, and lower doses are required. Non-depolarising neuromuscular blocking drugs should be used with great care in those with other neuromuscular disorders and those with fluid and electrolyte disturbances, as response is unpredictable. Resistance can develop in patients with burns, who may require increased doses; low plasma cholinesterase activity in these patients requires dose titration for mivacurium. The rate of administration of neuromuscular blocking drugs should be reduced in patients with cardiovascular disease. Interactions: Appendix 1 (muscle relaxants).", "side-effects": "Side-effects\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nSide-effects\u00a0Benzylisoquinolinium non-depolarising neuromuscular blocking drugs (except cisatracurium) are associated with histamine release, which can cause skin flushing, hypotension, tachycardia, bronchospasm, and very rarely anaphylactoid reactions. Most aminosteroid neuromuscular blocking drugs produce minimal histamine release. Drugs with vagolytic activity can counteract any bradycardia that occurs during surgery. Acute myopathy has also been reported after prolonged use in intensive care.; also\r\nbradycardia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38920.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose should be calculated on the basis of ideal body-weight", "Intubation and surgery, by intravenous injection, adult and child over 1 month, initially 150\u00a0micrograms/kg; maintenance, by\r\nintravenous injection, adult and child over 12 years, 30\u00a0micrograms/kg\r\napprox. every 20 minutes; child 2\u201312\r\nyears, 20\u00a0micrograms/kg approx. every 10 minutes; or maintenance, by intravenous infusion, adult and child over\r\n2 years, initially 180\u00a0micrograms/kg/hour, then after stabilisation, 60\u2013120\u00a0micrograms/kg/hour", "Lower doses can be used for children over\r\n2 years when not for intubation", "Intensive care, adult initially\r\n150\u00a0micrograms/kg (optional) by intravenous injection, then by intravenous infusion 180\u00a0micrograms/kg/hour\r\nadjusted according to response (usual range 30\u2013600\u00a0micrograms/kg/hour)" ], "pregnancy": "Pregnancy\u00a0\n(From Non-depolarising neuromuscular blocking drugs: British National Formulary)\nPregnancy\u00a0Non-depolarising neuromuscular blocking drugs are highly ionised at physiological pH and are therefore unlikely to cross the placenta in significant amounts." }, "GRISEOFULVIN": { "indications": "Indications\u00a0tinea pedis; resistant fungal infections\r\n(section 5.2.5)", "name": "GRISEOFULVIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129234.htm", "doses": [ "Apply 400\u00a0micrograms (1 spray) to an area approx. 13\u00a0cm2 once daily, increased to 1.2\u00a0mg (3 sprays, allowing each\r\nspray to dry between applications) once daily if necessary; max. treatment\r\nduration 4 weeks" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "ETHINYLESTRADIOL - OESTROGENS": { "side-effects": "Side-effects\u00a0see section 6.4.1.1", "indications": "Indications\u00a0\n(From 8.3.1 Oestrogens: British National Formulary)\n8.3.1 Oestrogens; other indications (%s\n(From Ethinylestradiol: British National Formulary)\nEthinylestradiol)", "name": "ETHINYLESTRADIOL - OESTROGENS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100122.htm", "doses": [ "Prostate cancer (palliative), 0.15\u20131.5\u00a0mg daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.1 Oestrogens", "ETHINYLESTRADIOL" ], "cautions": "Cautions\u00a0see section 6.4.1.1; interactions: Appendix 1 (oestrogens)" }, "IDURSULFASE": { "indications": "Indications\u00a0(specialist use only) mucopolysaccharidosis\r\nII", "name": "IDURSULFASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Mucopolysaccharidosis", "IDURSULFASE" ], "cautions": "Cautions\u00a0severe respiratory disease; acute febrile respiratory illness (consider delaying\r\ntreatment)Infusion-related reactions\u00a0%s\n(From Mucopolysaccharidosis: British National Formulary)\nInfusion-related reactions\u00a0Infusion-related reactions often occur with administration of laronidase, idursulfase, and galsulfase; they can be managed by slowing the infusion rate or interrupting the infusion, and can be minimised by pre-treatment with an antihistamine and an antipyretic. Recurrent infusion-related reactions may require pre-treatment with a corticosteroid\u2014consult product literature for details.", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, swollen tongue;\r\narrhythmia, tachycardia, chest pain, cyanosis, peripheral oedema,\r\nhypertension, hypotension, flushing; bronchospasm, hypoxia, cough,\r\nwheezing, tachypnoea, dyspnoea; headache, dizziness, tremor; pyrexia;\r\narthralgia; facial oedema, urticaria, pruritus, rash, infusion-site\r\nswelling, erythema; pulmonary embolism and anaphylaxis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130120.htm", "doses": [ "By intravenous infusion, adult and child over\r\n5 years, 500\u00a0micrograms/kg once weekly" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "CANAKINUMAB": { "indications": "Indications\u00a0\n(From Canakinumab: British National Formulary)\nCanakinumab is a recombinant human monoclonal antibody that selectively inhibits interleukin-1 beta receptor binding. It is licensed for the treatment of cryopyrin-associated periodic syndrome, including severe forms of familial cold auto-inflammatory syndrome (or familial cold urticaria), Muckle-Wells syndrome, and neonatal-onset multisystem inflammatory disease (also known as chronic infantile neurological cutaneous and articular syndrome). These are rare inherited auto-inflammatory disorders.", "name": "CANAKINUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Canakinumab" ], "cautions": "Cautions\u00a0history of recurrent infection or predisposition to infection; monitor neutrophil count before starting treatment, 1\u20132 months after\r\nstarting treatment, and periodically thereafter; patients should receive all recommended vaccinations (including pneumococcal\r\nand inactivated influenza vaccine) before starting treatment; avoid live vaccines unless potential benefit outweighs\r\nrisk\u2014consult product literature and section 14.1 for further informationTuberculosis\u00a0Patients should be evaluated\r\nfor latent and active tuberculosis before starting treatment and monitored\r\nfor signs and symptoms of tuberculosis during and after treatment", "side-effects": "Side-effects\u00a0vertigo, increased susceptibility to infection,\r\ninjection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208484.htm", "doses": [ "By subcutaneous injection, adult and child over\r\n4 years, body-weight 15\u201340\u00a0kg, 2\u00a0mg/kg every 8 weeks; if response\r\ninadequate 7 days after starting treatment, consider a second dose\r\nof 2\u00a0mg/kg; if a full response is then achieved, subsequent dosing\r\nshould be 4\u00a0mg/kg every 8 weeks; body-weight over 40\u00a0kg, 150\u00a0mg every\r\n8 weeks; if response inadequate 7 days after starting treatment, consider\r\na second dose of 150\u00a0mg; if a full response is then achieved,\r\nsubsequent dosing should be 300\u00a0mg every 8 weeks" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk; effective contraception required during treatment\r\nand for up to 3 months after last dose" }, "GALANTAMINE Modified release": { "indications": "Indications\u00a0mild to moderate dementia in Alzheimer\u2019s disease", "name": "GALANTAMINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.11 Drugs for dementia", "GALANTAMINE", "Modified release" ], "cautions": "Cautions\u00a0cardiac disease (including sick sinus syndrome or other supraventricular\r\nconduction abnormalities, unstable angina, congestive heart failure); electrolyte disturbances; susceptibility\r\nto peptic ulcers; asthma, chronic obstructive pulmonary disease, pulmonary infection; avoid in urinary\r\nretention, gastro-intestinal obstruction, and while recovering\r\nfrom bladder or gastro-intestinal surgery; history of seizures; interactions: Appendix 1 (parasympathomimetics)", "side-effects": "Side-effects\u00a0vomiting, nausea, abdominal pain, diarrhoea, dyspepsia,\r\nanorexia, weight loss, bradycardia, hypertension, syncope, hallucination,\r\ndepression, dizziness, tremor, headache, drowsiness, malaise, muscle\r\nspasm, sweating; less commonly taste disturbance,\r\npalpitation, arrhythmias, first-degree AV block, hypotension, flushing,\r\nparaesthesia, dehydration, muscular weakness, blurred vision, tinnitus; rarely hepatitis, exacerbation of Parkinson\u2019s disease, seizures", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129261.htm", "doses": [ "Initially 4\u00a0mg twice daily for 4 weeks increased to 8\u00a0mg\r\ntwice daily for 4 weeks; maintenance 8\u201312\u00a0mg twice daily", "Name[Reminyl\u00ae XL (Shire) ] Capsules, m/r, galantamine (as hydrobromide)\r\n8\u00a0mg (white), net price 28-cap pack = \u00a351.88; 16\u00a0mg (pink), 28-cap\r\npack = \u00a364.90; 24\u00a0mg (beige), 28-cap pack = \u00a379.80. \r\n Label:\r\n 3, 21, 25Dose\u00a0initially 8\u00a0mg once daily for 4 weeks increased to 16\u00a0mg\r\nonce daily for 4 weeks; maintenance 16\u201324\u00a0mg daily" ] }, "BENZYL BENZOATE ": { "indications": "Indications\u00a0scabies (but see notes above)", "name": "BENZYL BENZOATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.4 Parasiticidal preparations", "Benzyl benzoate" ], "cautions": "Cautions\u00a0children (not recommended, see also under Dose, below), avoid contact with eyes and mucous membranes; do not use\r\non broken or secondarily infected skin", "side-effects": "Side-effects\u00a0skin irritation, burning sensation especially\r\non genitalia and excoriations, occasionally rashes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6190.htm", "doses": [ "Apply over the whole body; repeat without bathing on the\r\nfollowing day and wash off 24 hours later; a third application may\r\nbe required in some cases", "Not recommended for children\u2014dilution to\r\nreduce irritant effect also reduces efficacy. Some manufacturers recommend\r\napplication to the body but to exclude the head and neck. However,\r\napplication should be extended to the scalp, neck, face, and ears" ] }, "PROMETHAZINE HYDROCHLORIDE": { "indications": "Indications\u00a0nausea, vomiting, vertigo, labyrinthine\r\ndisorders, motion sickness; allergy and urticaria (section\r\n3.4.1); sedation (section\r\n4.1.1)", "name": "PROMETHAZINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines" ], "cautions": "Cautions\u00a0see Promethazine Hydrochloride, section 3.4.1", "side-effects": "Side-effects\u00a0see Promethazine Hydrochloride, section 3.4.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3408.htm", "doses": [ "By mouth, 20\u201325\u00a0mg at bedtime on night\r\nbefore travel, repeat following morning if necessary; child 2\u20135 years 5\u00a0mg at night, and following morning\r\nif necessary, 5\u201310 years 10\u00a0mg at night, and following morning if\r\nnecessary" ], "pregnancy": "Pregnancy\u00a0see notes in section 3.4.1" }, "RETEPLASE": { "indications": "Indications\u00a0acute myocardial infarction (see notes above and %s\n(From 2.10.1 Management of stable angina and acute coronary syndromes: British National Formulary)\n2.10.1 Management of stable angina and acute coronary syndromes)", "name": "RETEPLASE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.10 Stable angina, acute coronary syndromes, and fibrinolysis", "2.10.2 Fibrinolytic drugs", "RETEPLASE" ], "cautions": "Cautions\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nCautions\u00a0Thrombolytic drugs should be used with caution if there is a risk of bleeding including that from venepuncture or invasive procedures. They should also be used with caution in external chest compression, elderly, hypertension, conditions in which thrombolysis might give rise to embolic complications such as enlarged left atrium with atrial fibrillation (risk of dissolution of clot and subsequent embolisation), and recent or concurrent use of drugs that increase the risk of bleeding.", "side-effects": "Side-effects\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nSide-effects\u00a0Side-effects of thrombolytics are mainly nausea and vomiting and bleeding. When thrombolytics are used in myocardial infarction, reperfusion arrhythmias and recurrent ischaemia and angina may occur. Reperfusion may also cause cerebral and pulmonary oedema. Hypotension can also occur and can usually be controlled by elevating the patient\u2019s legs, or by reducing the rate of infusion or stopping it temporarily. Back pain, fever, and convulsions have been reported. Bleeding is usually limited to the site of injection, but intracerebral haemorrhage or bleeding from other sites can occur. Serious bleeding calls for discontinuation of the thrombolytic and may require administration of coagulation factors and antifibrinolytic drugs (e.g. tranexamic acid). Rarely further embolism may occur (either due to clots that break away from the original thrombus or to cholesterol crystal emboli). Thrombolytics can cause allergic reactions (including rash, flushing and uveitis) and anaphylaxis has been reported (for details of management see Allergic Emergencies, section 3.4.3). Guillain-Barr\u00e9 syndrome has been reported rarely after streptokinase treatment.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60578.htm", "doses": [ "By intravenous injection (initiated within\r\n12 hours of symptom onset), 10\u00a0units over not more than 2 minutes,\r\nfollowed after 30 minutes by a further 10\u00a0units" ], "pregnancy": "Pregnancy\u00a0\n(From 2.10.2 Fibrinolytic drugs: British National Formulary)\nPregnancy\u00a0Thrombolytic drugs can possibly lead to premature separation of the placenta in the first 18 weeks of pregnancy. There is also a risk of maternal haemorrhage throughout pregnancy and post-partum, and also a theoretical risk of fetal haemorrhage throughout pregnancy." }, "CONESTAT ALFA": { "indications": "Indications\u00a0acute attacks of hereditary angioedema\r\nin patients with C1-esterase inhibitor deficiency", "name": "CONESTAT ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Angioedema", "CONESTAT ALFA" ], "cautions": "Cautions\u00a0test for immunoglobulin E (IgE) antibodies against\r\nrabbit allergens before starting treatment, repeat antibody testing\r\nannually or after 10 treatments\u2014consult product literature", "side-effects": "Side-effects\u00a0headache; less commonly nausea,\r\ndiarrhoea, abdominal discomfort, throat irritation, vertigo, paraesthesia,\r\nurticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217749.htm", "doses": [ "By slow intravenous injection over 5 minutes, adult over 18 years, body-weight under 84\u00a0kg, 50\u00a0units/kg\r\nas a single dose; body-weight over 84\u00a0kg, 4200\u00a0units as a single dose;\r\ndose may be repeated if necessary (max. 2 doses in 24 hours)" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014toxicity\r\nin animal studies" }, "CHLOROQUINE With proguanil": { "indications": "Indications\u00a0chemoprophylaxis and treatment of malaria;\r\nrheumatoid arthritis and lupus erythematosus (section 10.1.3)", "name": "CHLOROQUINE With proguanil", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Chloroquine", "CHLOROQUINE", "With proguanil" ], "cautions": "Cautions\u00a0may exacerbate psoriasis; neurological disorders (avoid for prophylaxis if history of epilepsy, \n(From Prophylaxis against malaria: British National Formulary)\nBoth chloroquine and mefloquine are unsuitable for malaria prophylaxis in individuals with a history of epilepsy. In areas without chloroquine resistance proguanil 200\u00a0mg daily alone is recommended; in areas with chloroquine resistance, doxycycline or Malarone\u00ae may be considered); may aggravate myasthenia gravis; severe\r\ngastro-intestinal disorders; G6PD deficiency (\n(From 9.1.5 G6PD deficiency: British National Formulary)\n9.1.5 G6PD deficiency); ophthalmic examination and long-term therapy,\r\nsee under Chloroquine, %s\n(From Antimalarials: British National Formulary)\nA review group convened by the Royal College of Ophthalmologists has updated guidelines for screening to prevent ocular toxicity on long-term treatment with chloroquine and hydroxychloroquine (Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening 2009). Chloroquine should be considered (for treating chronic inflammatory conditions) only if other drugs have failed. All patients taking chloroquine should receive ocular examination according to a protocol arranged locally between the prescriber and the ophthalmologist. The following recommendations relate to hydroxychloroquine, which is only rarely associated with toxicity.Before treatment:Assess renal and liver function (adjust dose if impaired)Ask patient about visual impairment (not corrected by glasses). If impairment or eye disease present, assessment by an optometrist is advised and any abnormality should be referred to an ophthalmologistRecord near visual acuity of each eye (with glasses where appropriate) using a standard reading chartInitiate hydroxychloroquine treatment if no abnormality detected (at a dose not exceeding hydroxychloroquine sulphate 6.5\u00a0mg/kg daily)During treatment:Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chartRefer to ophthalmologist if visual acuity changes or if vision blurred and warn patient to seek prescribing doctor\u2019s advice about stopping treatmentA child treated for juvenile idiopathic arthritis should receive slit-lamp examination routinely to check for uveitisIf long-term treatment is required (more than 5 years), individual arrangement should be agreed with the local ophthalmologist; avoid concurrent therapy with hepatotoxic drugs\u2014other interactions: Appendix 1 (chloroquine and hydroxychloroquine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, headache; also\r\nhypotension, convulsions, visual disturbances, depigmentation or loss\r\nof hair, skin reactions (rashes, pruritus); rarely, bone-marrow suppression,\r\nhypersensitivity reactions such as urticaria and angioedema; other\r\nside-effects (not usually associated with malaria prophylaxis or treatment),\r\nsee under Chloroquine, section 10.1.3; very\r\ntoxic in overdosage\u2014immediate advice from poisons\r\ncentres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69547.htm", "doses": [ "Doses expressed as chloroquine base", "Prophylaxis of malaria, preferably started 1 week before entering\r\nendemic area and continued for 4 weeks after leaving (see notes above),\r\n310\u00a0mg once weekly; infant up to 12\r\nweeks body-weight under 6\u00a0kg, 37.5\u00a0mg once weekly; 12 weeks\u20131 year\r\nbody-weight 6\u201310\u00a0kg, 75\u00a0mg once weekly; child 1\u20134 years body-weight 10\u201316\u00a0kg, 112.5\u00a0mg once weekly; 4\u20138 years\r\nbody-weight 16\u201325\u00a0kg, 150\u00a0mg once weekly (or 155\u00a0mg once weekly if\r\ntablets used); 8\u201313 years body-weight 25\u201345\u00a0kg, 225\u00a0mg once weekly\r\n(or 232.5\u00a0mg once weekly if tablets used); over 13 years body-weight\r\nover 45\u00a0kg, adult dose", "Treatment of benign malarias, see notes above", "Warn travellers about importance of avoiding mosquito bites, importance of taking\r\nprophylaxis regularly, and importance of immediate\r\nvisit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "Chloroquine doses in BNF\r\nmay differ from those in product literature", "Name[(1)Paludrine/Avloclor\u00ae (AstraZeneca)] Tablets, travel pack of 14 tablets\r\nof chloroquine phosphate 250\u00a0mg (\u2261\u00a0chloroquine base 155\u00a0mg) and 98 tablets of proguanil hydrochloride 100\u00a0mg, net price 112-tab pack = \u00a38.79. \r\n Label:\r\n 5, 21, counselling, prophylaxis,\r\nsee above" ], "pregnancy": "Pregnancy\u00a0benefit of prophylaxis and treatment in malaria outweighs\r\nrisk; see also Benign Malarias (treatment) and Prophylaxis Against Malaria" }, "CEFALEXIN": { "indications": "Indications\u00a0see under Cefaclor", "name": "CEFALEXIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFALEXIN" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3791.htm", "doses": [ "250\u00a0mg every 6 hours or 500\u00a0mg every\r\n8\u201312 hours increased to 1\u20131.5\u00a0g every 6\u20138 hours for severe infections; child 25\u00a0mg/kg daily in divided doses, doubled for\r\nsevere infections, max. 100\u00a0mg/kg daily; or under\r\n1 year 125\u00a0mg every 12 hours, 1\u20135 years 125\u00a0mg every 8 hours, 5\u201312\r\nyears 250\u00a0mg every 8 hours ", "Prophylaxis of recurrent urinary-tract infection, adult 125\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "ETHANOLAMINE OLEATE": { "indications": "Indications\u00a0sclerotherapy of varicose\r\nveins", "name": "ETHANOLAMINE OLEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.13 Local sclerosants", "ETHANOLAMINE OLEATE" ], "cautions": "Cautions\u00a0extravasation may cause necrosis of tissues", "side-effects": "Side-effects\u00a0allergic reactions (including anaphylaxis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2874.htm", "doses": [ "by slow injection into empty isolated segment of vein,\r\n2\u20135\u00a0mL divided between 3\u20134 sites; repeated at weekly intervals" ] }, "EPLERENONE": { "indications": "Indications\u00a0adjunct in stable patients with left\r\nventricular dysfunction with evidence of heart failure, following\r\nmyocardial infarction (start therapy within 3\u201314 days of event)", "name": "EPLERENONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.3 Potassium-sparing diuretics and aldosterone antagonists", "Aldosterone antagonists", "EPLERENONE" ], "cautions": "Cautions\u00a0measure plasma-potassium concentration\r\nbefore treatment, during initiation, and when dose changed; elderly; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0diarrhoea, nausea; hypotension; dizziness; hyperkalaemia;\r\nrash; less commonly flatulence, vomiting, atrial\r\nfibrillation, postural hypotension, arterial thrombosis, dyslipidaemia,\r\npharyngitis, headache, insomnia, gynaecomastia, pyelonephritis, hyponatraemia,\r\ndehydration, eosinophilia, asthenia, malaise, back pain, leg cramps,\r\nimpaired renal function, azotaemia, sweating and pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129018.htm", "doses": [ "Initially 25\u00a0mg once daily, increased within 4 weeks to\r\n50\u00a0mg once daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014no information available" }, "BUPRENORPHINE - OPIOID SUBSTITUTION THERAPY": { "indications": "Indications\u00a0adjunct in the treatment of opioid dependence;\r\npremedication, peri-operative analgesia, analgesia in other situations\r\n(section 4.7.2)", "name": "BUPRENORPHINE - OPIOID SUBSTITUTION THERAPY", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.3 Opioid dependence", "Opioid substitution therapy", "BUPRENORPHINE" ], "cautions": "Cautions\u00a0see Buprenorphine in section 4.7.2 and notes above; caution if pre-existing\r\nliver enzyme abnormalities, hepatitis B or C infection,\r\nor concomitant use of hepatotoxic drugs", "side-effects": "Side-effects\u00a0see Buprenorphine, section 4.7.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201580.htm", "doses": [ "By sublingual administration, adult and child over\r\n16 years, initially, 0.8\u20134\u00a0mg on day 1, adjusted if necessary by 2\u20134\u00a0mg\r\ndaily to usual dose of 12\u201324\u00a0mg daily (max. 32\u00a0mg daily); withdraw\r\ngradually" ], "pregnancy": "Pregnancy\u00a0\n(From Opioid substitution therapy: British National Formulary)\nPregnancy\u00a0Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death. Opioid substitution therapy is recommended during pregnancy because it carries a lower risk to the fetus than continued use of illicit drugs. If a woman who is stabilised on methadone or buprenorphine for treatment of opioid dependence becomes pregnant, therapy should be continued [buprenorphine is not licensed for use in pregnancy]. Many pregnant patients choose a withdrawal regimen, but withdrawal during the first trimester should be avoided because it is associated with an increased risk of spontaneous miscarriage. Withdrawal of methadone or buprenorphine should be undertaken gradually during the second trimester; for example, the dose of methadone may be reduced by 2\u20133\u00a0mg every 3\u20135 days. If illicit drug use occurs, the patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen.Further withdrawal of methadone or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and the risk of neonatal mortality. Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.The neonate should be monitored for respiratory depression and signs of withdrawal if the mother is prescribed high doses of opioid substitute.Signs of neonatal withdrawal from opioids usually develop 24\u201372 hours after delivery but symptoms may be delayed for up to 14 days, so monitoring may be required for several weeks. Symptoms include a high-pitched cry, rapid breathing, hungry but ineffective suckling, and excessive wakefulness; severe, but rare symptoms include hypertonicity and convulsions." }, "DEXAMETHASONE Single use": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "DEXAMETHASONE Single use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "DEXAMETHASONE", "Single use" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/68968.htm", "doses": [ "Apply eye drops every 30\u201360 minutes until controlled\r\nthen reduce frequency to 4\u20136 times daily", "Name[Minims\u00ae Dexamethasone (Bausch & Lomb) ] Eye drops, dexamethasone sodium phosphate 0.1%, net price 20 \u00d7 0.5\u00a0mL = \u00a39.76Excipients include disodium edetate" ] }, "VASOPRESSIN Synthetic vasopressin": { "indications": "Indications\u00a0pituitary diabetes insipidus; bleeding from oesophageal varices", "name": "VASOPRESSIN Synthetic vasopressin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.2 Posterior pituitary hormones and antagonists", "Posterior pituitary hormones", "VASOPRESSIN", "Synthetic vasopressin" ], "cautions": "Cautions\u00a0heart failure, hypertension, asthma, epilepsy, migraine or other conditions\r\nwhich might be aggravated by water retention; avoid fluid overload", "side-effects": "Side-effects\u00a0fluid retention, pallor, tremor, sweating, vertigo,\r\nheadache, nausea, vomiting, belching, abdominal cramps, desire to\r\ndefaecate, hypersensitivity reactions (including anaphylaxis), constriction\r\nof coronary arteries (may cause anginal attacks and myocardial ischaemia),\r\nperipheral ischaemia and rarely gangrene", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4430.htm", "doses": [ "By subcutaneous or intramuscular injection, diabetes insipidus, 5\u201320\u00a0units every\r\nfour hours", "By intravenous infusion, initial control of variceal\r\nbleeding, 20\u00a0units over 15 minutes", "Name[Pitressin\u00ae (Goldshield) ] Injection, argipressin (synthetic vasopressin) 20\u00a0units/mL. Net price 1-mL amp = \u00a317.14 (hosp.\r\nonly)" ], "pregnancy": "Pregnancy\u00a0oxytocic effect in third trimester" }, "RISEDRONATE SODIUM": { "indications": "Indications\u00a0see under Dose", "name": "RISEDRONATE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "RISEDRONATE SODIUM" ], "cautions": "Cautions\u00a0oesophageal abnormalities and other factors\r\nwhich delay transit or emptying (e.g. stricture or achalasia\u2014see also under Side-effects); correct hypocalcaemia before starting, correct other disturbances of bone and mineral metabolism (e.g.\r\nvitamin-D deficiency) at onset of treatment; consider dental check-up before initiating bisphosphonate (risk of osteonecrosis of the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0abdominal pain, dyspepsia, nausea, diarrhoea,\r\nconstipation, headache, musculoskeletal pain; less commonly oesophagitis, oesophageal ulcer, dysphagia, gastritis, duodenitis,\r\nuveitis; rarely glossitis, oesophageal stricture,\r\natypical femoral fractures (see MHRA/CHM advice); also reported gastroduodenal ulceration, hepatic disorders,\r\nStevens-Johnson syndrome, toxic epidermal necrolysis, hair loss, cutaneous\r\nvasculitis, osteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)Oesophageal reactions\u00a0Patients should\r\nbe advised to stop taking the tablets and seek medical attention if\r\nthey develop symptoms of oesophageal irritation such as dysphagia,\r\npain on swallowing, retrosternal pain, or heartburn", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119694.htm", "doses": [ "Paget\u2019s disease of bone, 30\u00a0mg daily for 2 months; may\r\nbe repeated if necessary after at least 2 months", "Treatment of postmenopausal osteoporosis to reduce risk of vertebral\r\nor hip fractures, 5\u00a0mg daily or 35\u00a0mg once weekly", "Prevention of osteoporosis (including corticosteroid-induced\r\nosteoporosis) in postmenopausal women, 5\u00a0mg daily", "Treatment of osteoporosis in men at high risk of fractures,\r\n35\u00a0mg once weekly", "child see BNF for Children", "Swallow tablets whole with full glass\r\nof water; on rising, take on an empty stomach at least 30 minutes\r\nbefore first food or drink of the day or, if taking\r\nat any other time of the day, avoid food and drink for at least 2\r\nhours before or after risedronate (particularly avoid calcium-containing\r\nproducts e.g. milk; also avoid iron and mineral supplements and antacids);\r\nstand or sit upright for at least 30 minutes; do not take tablets\r\nat bedtime or before rising" ], "pregnancy": "Pregnancy\u00a0avoid" }, "TINIDAZOLE - METRONIDAZOLE AND TINIDAZOLE": { "indications": "Indications\u00a0anaerobic infections, see under Dose below; protozoal infections\r\n(section\r\n5.4.2); Helicobacter pylori eradication (section 1.3)", "name": "TINIDAZOLE - METRONIDAZOLE AND TINIDAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.11 Metronidazole and tinidazole" ], "cautions": "Cautions\u00a0see under Metronidazole; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (tinidazole)", "side-effects": "Side-effects\u00a0see under Metronidazole", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3942.htm", "doses": [ "Anaerobic infections, 2\u00a0g initially, followed by 1\u00a0g daily or 500\u00a0mg twice daily, usually for 5\u20136 days", "Bacterial vaginosis and acute ulcerative gingivitis, a single\r\n2-g dose", "Abdominal surgery prophylaxis, a single 2-g dose approximately\r\n12 hours before surgery" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid in first trimester" }, "TENOFOVIR DISOPROXIL With emtricitabine": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral\r\ndrugs; chronic hepatitis B infection with either compensated\r\nliver disease (with evidence of viral replication, and histologically\r\ndocumented active liver inflammation or fibrosis) or decompensated liver disease", "name": "TENOFOVIR DISOPROXIL With emtricitabine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "TENOFOVIR DISOPROXIL", "With emtricitabine" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test renal function and serum phosphate before\r\ntreatment, then every 4 weeks (more frequently if at increased risk\r\nof renal impairment) for 1 year and then every 3 months, interrupt treatment if renal function deteriorates or serum phosphate\r\ndecreases; concomitant or recent use of nephrotoxic\r\ndrugs; interactions: Appendix 1 (tenofovir) Chronic hepatits B\u00a0 When treating\r\nchronic hepatitis B with tenofovir, monitor liver function tests every\r\n3 months and viral markers for hepatitis B every 3\u20136 months during\r\ntreatment (continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation)", "side-effects": "Side-effects\u00a0see notes above; also hypophosphataemia; rarely renal failure, proximal renal tubulopathy, nephrogenic\r\ndiabetes insipidus; also reported reduced bone density", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129299.htm", "doses": [ "adult over 18 years, 245\u00a0mg\r\nonce daily", "HIV infection in combination with other antiretroviral\r\ndrugs, adult over 18 years, 1 tablet\r\nonce daily", "Name[Truvada\u00ae (Gilead) ] Tablets, blue, f/c, tenofovir disoproxil (as fumarate) 245\u00a0mg, emtricitabine 200\u00a0mg, net price\r\n30-tab pack = \u00a3418.50. \r\n Label:\r\n 21, counselling, administrationCounselling\u00a0Patients with swallowing difficulties\r\nmay disperse tablet in half a glass of water, orange juice, or grape\r\njuice (but bitter taste)Dose\u00a0HIV infection in combination with other antiretroviral\r\ndrugs, adult over 18 years, 1 tablet\r\nonce dailyMissed dose\u00a0If a dose is more than 12 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "LENOGRASTIM": { "indications": "Indications\u00a0(specialist use only) reduction in the duration of neutropenia and\r\nassociated complications following peripheral stem cells or bone-marrow\r\ntransplantation for non-myeloid malignancy, or following treatment\r\nwith cytotoxic chemotherapy associated with a significant incidence\r\nof febrile neutropenia; mobilisation of peripheral blood progenitor\r\ncells for harvesting and subsequent infusion", "name": "LENOGRASTIM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.6 Drugs used in neutropenia" ], "cautions": "Cautions\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nCautions\u00a0Granulocyte-colony stimulating factors should be used with caution in patients with pre-malignant or malignant myeloid conditions. Full blood counts including differential white cell and platelet counts should be monitored. Treatment should be withdrawn in patients who develop signs of pulmonary infiltration. There have been reports of pulmonary infiltrates leading to acute respiratory distress syndrome\u2014patients with a history of pulmonary infiltrates or pneumonia may be at higher risk. Granulocyte-colony stimulating factors should be used with caution in patients with sickle-cell disease. Spleen size should be monitored during treatment because there is a risk of splenomegaly and rupture.", "side-effects": "Side-effects\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nSide-effects\u00a0Side-effects of granulocyte-colony stimulating factors include gastro-intestinal disturbances, anorexia, headache, asthenia, fever, musculoskeletal pain, bone pain, rash, alopecia, injection-site reactions, thrombocytopenia, and leucocytosis. Less commonly chest pain can occur. Pulmonary side-effects, particularly interstitial pneumonia (see Cautions above), cutaneous vasculitis and acute febrile neutrophilic dermatosis have rarely been reported.; also\r\nmucositis, splenic rupture, and toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23073.htm", "doses": [ "Following bone-marrow transplantation, by intravenous\r\ninfusion or subcutaneous injection, adult and child over\r\n2 years 19.2\u00a0million\u00a0units/m2 daily started the day after\r\ntransplantation, continued until neutrophil count stable in acceptable\r\nrange (max. 28 days)", "Following peripheral stem cells transplantation, by intravenous\r\ninfusion or subcutaneous injection, adult 19.2\u00a0million units/m2 daily started\r\nthe day after transplantation, continued until neutrophil count stable\r\nin acceptable range (max. 28 days); child see BNF for Children", "Cytotoxic-induced neutropenia, by subcutaneous injection, adult 19.2\u00a0million\u00a0units/m2 daily started the day after completion of chemotherapy, continued\r\nuntil neutrophil count stable in acceptable range (max. 28 days); child see BNF for Children", "Mobilisation of peripheral blood progenitor cells, used alone, by subcutaneous injection, adult 1.28\u00a0million\u00a0units/kg daily for 4\u20136 days (5\u20136 days in healthy donors);\r\nused following adjunctive myelosuppressive chemotherapy (to improve\r\nyield), by subcutaneous injection, 19.2\u00a0million\u00a0units/m2 daily, started 1\u20135 days after completion of chemotherapy\r\nand continued until neutrophil count in acceptable range; for timing\r\nof leucopheresis consult product literature; child see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nPregnancy\u00a0There have been reports of toxicity in animal studies and manufacturers advise not to use granulocyte-colony stimulating factors during pregnancy unless the potential benefit outweighs the risk." }, "LOCAL CORTICOSTEROID INJECTIONS": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5276.htm", "doses": [ "See under preparations" ] }, "XIPAMIDE": { "indications": "Indications\u00a0oedema, hypertension (see also notes above)", "name": "XIPAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics", "XIPAMIDE" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics); also acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2351.htm", "doses": [ "Oedema, initially 40\u00a0mg daily in the morning, increased\r\nto 80\u00a0mg in resistant cases; maintenance 20\u00a0mg in the morning", "Hypertension, 20\u00a0mg daily in the morning" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "LEVOMEPROMAZINE": { "indications": "Indications\u00a0see under Dose", "name": "LEVOMEPROMAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "LEVOMEPROMAZINE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; diabetes; patients receiving large initial\r\ndoses should remain supineElderly\u00a0Risk of postural hypotension; not recommended for ambulant patients over 50 years unless risk of hypotensive reaction assessed", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; occasionally\r\nraised erythrocyte sedimentation rate occurs; hyperglycaemia also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3232.htm", "doses": [ "Schizophrenia, by mouth initially 25\u201350\u00a0mg daily in\r\ndivided doses increased as necessary; bedpatients initially 100\u2013200\u00a0mg\r\ndaily usually in 3 divided doses, increased if necessary to 1\u00a0g daily; elderly, see Cautions", "Pain in palliative care", "Restlessness and confusion\r\nin palliative care; child 1\u201318 years see BNF for Children", "Nausea and vomiting in palliative care, by mouth,\r\nor by subcutaneous infusion; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "BROMOCRIPTINE - BROMOCRIPTINE AND OTHER DOPAMINERGIC DRUGS": { "indications": "Indications\u00a0see notes above\r\nand under Dose; Parkinson\u2019s disease (%s\n(From 4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease: British National Formulary)\n4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease)", "name": "BROMOCRIPTINE - BROMOCRIPTINE AND OTHER DOPAMINERGIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.7 Other endocrine drugs", "6.7.1 Bromocriptine and other dopaminergic drugs", "BROMOCRIPTINE" ], "cautions": "Cautions\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nCautions\u00a0see notes below; also bromocriptine and cabergoline should be used with caution in patients with a history of peptic ulcer, particularly in acromegalic patients. Treatment should be withdrawn if gastro-intestinal bleeding occurs. In hyperprolactinaemic patients, the source of the hyperprolactinaemia should be established (i.e. exclude pituitary tumour before treatment). Bromocriptine and cabergoline should be used with caution in patients with Raynaud\u2019s syndrome and cardiovascular disease (see also Contra-indications under Bromocriptine, below). Monitor for fibrotic disease (see Fibrotic Reactions, below). Caution is also advised in patients with a history of serious mental disorders (especially psychotic disorders) and in those with acute porpyhria (see section 9.8.2). Tolerance may be reduced by alcohol.; also specialist evaluation\u2014monitor\r\nfor pituitary enlargement, particularly during pregnancy; monitor visual field to detect secondary field loss\r\nin macroprolactinoma; contraceptive advice\r\nif appropriate (oral contraceptives may increase prolactin concentration); interactions: Appendix 1 (bromocriptine)", "side-effects": "Side-effects\u00a0\n(From 6.7.1 Bromocriptine and other dopaminergic drugs: British National Formulary)\nSide-effects\u00a0Nausea, constipation, and headache are common side-effects of bromocriptine and cabergoline. Paraesthesia has been reported rarely. Other reported side-effects include hypotension (see also Hypotensive Reactions, below), drowsiness (see also Driving, below), dyskinesia, pathological gambling, increased libido, hypersexuality, leg cramps, allergic skin reactions, alopecia, and peripheral oedema. Bromocriptine and cabergoline have been associated with pleuritis, pleural effusion, cardiac valvulopathy, pericardial effusion, constrictive pericarditis, and retroperitoneal, pleural, and pulmonary fibrosis (see Fibrotic Reactions). ; also\r\nnasal congestion; less commonly vomiting, postural\r\nhypotension, fatigue, dizziness, dry mouth; also, particularly with high doses, confusion, psychomotor excitation, hallucinations; rarely diarrhoea, gastro-intestinal bleeding, gastric ulcer,\r\nabdominal pain, tachycardia, bradycardia, arrhythmia, insomnia, psychosis,\r\nvisual disturbances, tinnitus; very rarely vasospasm\r\nof fingers and toes particularly in patients with Raynaud\u2019s syndrome,\r\nand effects like neuroleptic malignant syndrome on withdrawal; urinary\r\nincontinence, leucopenia, thrombocytopenia, hyponatraemia, reversible\r\nhearing loss, increased libido, and hypersexuality also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4461.htm", "doses": [ "Prevention or suppression of lactation (but see notes\r\nabove and under Cautions), 2.5\u00a0mg on day 1 (prevention) or daily for\r\n2\u20133 days (suppression); then 2.5\u00a0mg twice daily for 14 days", "Hypogonadism,\r\ngalactorrhoea, infertility, initially 1\u20131.25\u00a0mg at bedtime, increased\r\ngradually; usual dose 7.5\u00a0mg daily in divided doses, increased if\r\nnecessary to max. 30\u00a0mg daily, usual dose in infertility without hyperprolactinaemia,\r\n2.5\u00a0mg twice daily", "Acromegaly, initially 1\u20131.25\u00a0mg at bedtime, increase gradually\r\nto 5\u00a0mg every 6 hours", "Prolactinoma, initially 1\u20131.25\u00a0mg at bedtime; increased gradually\r\nto 5\u00a0mg every 6 hours (occasional patients may require up to 30\u00a0mg\r\ndaily)", "child under 15 years, not recommended" ], "pregnancy": "Pregnancy\u00a0see Cautions above" }, "PHENOBARBITAL SODIUM": { "indications": "Indications\u00a0status epilepticus; other forms of\r\nepilepsy except absence seizures (section 4.8.1)", "name": "PHENOBARBITAL SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.2 Drugs used in status epilepticus", "PHENOBARBITAL SODIUM" ], "cautions": "Cautions\u00a0see Phenobarbital, section 4.8.1; interactions: see Interactions in section\r\n4.8.1 and Appendix 1 (phenobarbital) ", "side-effects": "Side-effects\u00a0see Phenobarbital, section 4.8.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129417.htm", "doses": [ "Status epilepticus, by intravenous injection (dilute injection 1 in 10 with water for injections), 10\u00a0mg/kg at\r\na rate of not more than 100\u00a0mg/minute; max. 1\u00a0g", "For therapeutic purposes phenobarbital and\r\nphenobarbital sodium may be considered equivalent in effect" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "FOLLITROPIN ALFA and BETA": { "indications": "Indications\u00a0see notes above", "name": "FOLLITROPIN ALFA and BETA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0see under Human Menopausal Gonadotrophins", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/38657.htm", "doses": [ "By subcutaneous or intramuscular injection, according to patient\u2019s response" ], "pregnancy": "Pregnancy\u00a0avoid" }, "CEFIXIME": { "indications": "Indications\u00a0see under Cefaclor (acute infections only); gonorrhoea [unlicensed\r\nindication] (see also Table 1, section 5.1)", "name": "CEFIXIME", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3768.htm", "doses": [ "adult and child over 10 years, 200\u2013400\u00a0mg daily in 1\u20132 divided\r\ndoses; child over 6 months 8\u00a0mg/kg\r\ndaily in 1\u20132 divided doses or 6 months\u20131 year 75\u00a0mg\r\ndaily; 1\u20134 years 100\u00a0mg daily; 5\u201310 years 200\u00a0mg daily", "Uncomplicated gonorrhoea [unlicensed indication] (see also Table\r\n1, section 5.1), 400\u00a0mg as a single dose" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "VARICELLA\u2013ZOSTER IMMUNOGLOBULIN": { "indications": "Indications\u00a0prophylaxis against varicella infection", "name": "VARICELLA\u2013ZOSTER IMMUNOGLOBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.5 Immunoglobulins", "14.5.2 Disease-specific immunoglobulins", "Varicella\u2013zoster", "VARICELLA\u2013ZOSTER IMMUNOGLOBULIN" ], "cautions": "Cautions\u00a0IgA deficiency; interference with live virus vaccines\u2014see under Normal Immunoglobulins", "side-effects": "Side-effects\u00a0injection site swelling and pain; rarely anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6551.htm", "doses": [ "By intramuscular injection, prophylaxis\r\n(as soon as possible\u2014not later than 10 days after exposure), adult and child over\r\n14 years, 1\u00a0g; neonate, infant and child up\r\nto 5 years 250\u00a0mg, 5\u201310 years 500\u00a0mg, 10\u201314 years 750\u00a0mg; give second\r\ndose if further exposure occurs more than 3 weeks after first dose" ] }, "FLECAINIDE ACETATE": { "indications": "Indications\u00a0capsules, tablets, and injection: AV nodal reciprocating\r\ntachycardia, arrhythmias associated with accessory conducting pathways\r\n(e.g. Wolff-Parkinson-White syndrome), disabling symptoms of paroxysmal\r\natrial fibrillation in patients without left ventricular dysfunction\r\n(arrhythmias of recent onset will respond more readily)Immediate-release tablets only: symptomatic\r\nsustained ventricular tachycardia, disabling symptoms of premature\r\nventricular contractions or non-sustained ventricular tachycardia\r\nin patients resistant to or intolerant of other therapyInjection only: ventricular tachyarrhythmias\r\nresistant to other treatment", "name": "FLECAINIDE ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias", "FLECAINIDE ACETATE" ], "cautions": "Cautions\u00a0patients with pacemakers (especially\r\nthose who may be pacemaker dependent because stimulation threshold\r\nmay rise appreciably); atrial fibrillation\r\nfollowing heart surgery; elderly (accumulation may occur); ECG monitoring and resuscitation\r\nfacilities must be available during intravenous use; interactions: Appendix 1 (flecainide)", "side-effects": "Side-effects\u00a0oedema, pro-arrhythmic effects; dyspnoea; dizziness,\r\nasthenia, fatigue, fever; visual disturbances; rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia,\r\nconvulsions, peripheral neuropathy; also reported gastro-intestinal disturbances, anorexia, hepatic dysfunction, flushing,\r\nsyncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia,\r\nataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal\r\ndeposits, tinnitus, increased antinuclear antibodies, hypersensitivity\r\nreactions (including rash, urticaria, and photosensitivity), increased\r\nsweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2427.htm", "doses": [ "By mouth (initiated under direction\r\nof hospital consultant), ventricular arrhythmias, initially 100\u00a0mg\r\ntwice daily (max. 400\u00a0mg daily usually reserved for rapid control\r\nor in heavily built patients), reduced after 3\u20135 days to the lowest\r\ndose that controls arrhythmia", "Supraventricular arrhythmias, 50\u00a0mg twice daily, increased if\r\nrequired to max. 300\u00a0mg daily", "By slow intravenous injection (in\r\nhospital), 2\u00a0mg/kg over 10\u201330 minutes, max. 150\u00a0mg, with ECG monitoring;\r\nfollowed if required by infusion at a rate of 1.5\u00a0mg/kg/hour\r\nfor 1\u00a0hour, subsequently reduced to 100\u2013250\u00a0micrograms/kg/hour for\r\nup to 24 hours; max. cumulative dose in first 24 hours, 600\u00a0mg; transfer\r\nto oral treatment, as above" ], "pregnancy": "Pregnancy\u00a0used in pregnancy to treat maternal and fetal arrhythmias\r\nin specialist centres; toxicity reported in animal studies; infant hyperbilirubinaemia also reported" }, "CABERGOLINE - DOPAMINE-RECEPTOR AGONISTS": { "indications": "Indications\u00a0alone or as adjunct to co-beneldopa\r\nor co-careldopa in Parkinson\u2019s disease where dopamine-receptor agonists\r\nother than ergot derivative not appropriate; endocrine disorders (section 6.7.1)", "name": "CABERGOLINE - DOPAMINE-RECEPTOR AGONISTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Dopamine-receptor agonists" ], "cautions": "Cautions\u00a0see Cabergoline in section 6.7.1 and notes above", "side-effects": "Side-effects\u00a0\n(From Dopamine-receptor agonists: British National Formulary)\nDopamine-receptor agonists and Cabergoline, %s\n(From CABERGOLINE: British National Formulary)\nSide-effects\u00a0see notes above; also cardiac valvulopathy, dyspepsia, gastritis, epigastric and abdominal pain, angina, syncope, depression, confusion, hallucinations, breast pain; rarely vomiting, palpitation, epistaxis, digital vasospasm, hot flushes, transient hemianopia, muscle weakness; also reported erythromelalgia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128145.htm", "doses": [ "Initially 1\u00a0mg daily, increased by increments of 0.5\u20131\u00a0mg\r\nat 7 or 14 day intervals; max. 3\u00a0mg daily", "Concurrent dose of levodopa may be decreased gradually while dose of cabergoline is increased" ], "pregnancy": "Pregnancy\u00a0see Cabergoline, section 6.7.1" }, "MACROGOLS - BOWEL CLEANSING PREPARATIONS": { "indications": "Indications\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations", "name": "MACROGOLS - BOWEL CLEANSING PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.5 Bowel cleansing preparations", "MACROGOLS" ], "cautions": "Cautions\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also heart failure", "side-effects": "Side-effects\u00a0\n(From 1.6.5 Bowel cleansing preparations: British National Formulary)\n1.6.5 Bowel cleansing preparations; also fatigue,\r\nsleep disturbances, and anal discomfort", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129888.htm", "doses": [ "See preparations", "bowel evacuation for surgery, colonoscopy or radiological\r\nexamination, adult over 18 years, 1\u00a0litre\r\nof reconstituted solution on the evening before procedure and 1\u00a0litre\r\nof reconstituted solution early on the morning of procedure; alternatively,\r\n2\u00a0litres of reconstituted solution on the evening before procedure;\r\ntreatment should be completed at least 1 hour before colonoscopy", "One pair of sachets (A and B) should\r\nbe reconstituted in 1\u00a0litre of water and taken over 1\u20132 hours. Solid\r\nfood should not be taken during treatment until procedure completed.\r\n1\u00a0litre of other clear fluid should also be taken during treatment.\r\nTreatment can be stopped if bowel motions become watery and clear" ], "pregnancy": "Pregnancy\u00a0manufacturers advise use only if essential\u2014no information\r\navailable" }, "HAEM ARGINATE": { "indications": "Indications\u00a0acute porphyrias (acute intermittent\r\nporphyria, porphyria variegata, hereditary coproporphyria)", "name": "HAEM ARGINATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.2 Acute porphyrias", "HAEM ARGINATE" ], "side-effects": "Side-effects\u00a0rarely hypersensitivity reactions\r\nand fever; pain and thrombophlebitis at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82477.htm", "doses": [ "By intravenous infusion, adult and child 3\u00a0mg/kg\r\nonce daily (max. 250\u00a0mg daily) for 4 days; if response inadequate,\r\nrepeat 4-day course with close biochemical monitoring" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential" }, "CHLOROQUINE - CHLOROQUINE": { "indications": "Indications\u00a0chemoprophylaxis and treatment of malaria;\r\nrheumatoid arthritis and lupus erythematosus (section 10.1.3)", "name": "CHLOROQUINE - CHLOROQUINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Chloroquine", "CHLOROQUINE" ], "cautions": "Cautions\u00a0may exacerbate psoriasis; neurological disorders (avoid for prophylaxis if history of epilepsy, \n(From Prophylaxis against malaria: British National Formulary)\nBoth chloroquine and mefloquine are unsuitable for malaria prophylaxis in individuals with a history of epilepsy. In areas without chloroquine resistance proguanil 200\u00a0mg daily alone is recommended; in areas with chloroquine resistance, doxycycline or Malarone\u00ae may be considered); may aggravate myasthenia gravis; severe\r\ngastro-intestinal disorders; G6PD deficiency (\n(From 9.1.5 G6PD deficiency: British National Formulary)\n9.1.5 G6PD deficiency); ophthalmic examination and long-term therapy,\r\nsee under Chloroquine, %s\n(From Antimalarials: British National Formulary)\nA review group convened by the Royal College of Ophthalmologists has updated guidelines for screening to prevent ocular toxicity on long-term treatment with chloroquine and hydroxychloroquine (Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening 2009). Chloroquine should be considered (for treating chronic inflammatory conditions) only if other drugs have failed. All patients taking chloroquine should receive ocular examination according to a protocol arranged locally between the prescriber and the ophthalmologist. The following recommendations relate to hydroxychloroquine, which is only rarely associated with toxicity.Before treatment:Assess renal and liver function (adjust dose if impaired)Ask patient about visual impairment (not corrected by glasses). If impairment or eye disease present, assessment by an optometrist is advised and any abnormality should be referred to an ophthalmologistRecord near visual acuity of each eye (with glasses where appropriate) using a standard reading chartInitiate hydroxychloroquine treatment if no abnormality detected (at a dose not exceeding hydroxychloroquine sulphate 6.5\u00a0mg/kg daily)During treatment:Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chartRefer to ophthalmologist if visual acuity changes or if vision blurred and warn patient to seek prescribing doctor\u2019s advice about stopping treatmentA child treated for juvenile idiopathic arthritis should receive slit-lamp examination routinely to check for uveitisIf long-term treatment is required (more than 5 years), individual arrangement should be agreed with the local ophthalmologist; avoid concurrent therapy with hepatotoxic drugs\u2014other interactions: Appendix 1 (chloroquine and hydroxychloroquine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, headache; also\r\nhypotension, convulsions, visual disturbances, depigmentation or loss\r\nof hair, skin reactions (rashes, pruritus); rarely, bone-marrow suppression,\r\nhypersensitivity reactions such as urticaria and angioedema; other\r\nside-effects (not usually associated with malaria prophylaxis or treatment),\r\nsee under Chloroquine, section 10.1.3; very\r\ntoxic in overdosage\u2014immediate advice from poisons\r\ncentres essential (see also Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69510.htm", "doses": [ "Doses expressed as chloroquine base", "Prophylaxis of malaria, preferably started 1 week before entering\r\nendemic area and continued for 4 weeks after leaving (see notes above),\r\n310\u00a0mg once weekly; infant up to 12\r\nweeks body-weight under 6\u00a0kg, 37.5\u00a0mg once weekly; 12 weeks\u20131 year\r\nbody-weight 6\u201310\u00a0kg, 75\u00a0mg once weekly; child 1\u20134 years body-weight 10\u201316\u00a0kg, 112.5\u00a0mg once weekly; 4\u20138 years\r\nbody-weight 16\u201325\u00a0kg, 150\u00a0mg once weekly (or 155\u00a0mg once weekly if\r\ntablets used); 8\u201313 years body-weight 25\u201345\u00a0kg, 225\u00a0mg once weekly\r\n(or 232.5\u00a0mg once weekly if tablets used); over 13 years body-weight\r\nover 45\u00a0kg, adult dose", "Treatment of benign malarias, see notes above", "Warn travellers about importance of avoiding mosquito bites, importance of taking\r\nprophylaxis regularly, and importance of immediate\r\nvisit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "Chloroquine doses in BNF\r\nmay differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0benefit of prophylaxis and treatment in malaria outweighs\r\nrisk; see also Benign Malarias (treatment) and Prophylaxis Against Malaria" }, "ALENDRONIC ACID": { "indications": "Indications\u00a0see under Dose", "name": "ALENDRONIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.2 Bisphosphonates and other drugs affecting bone metabolism", "Bisphosphonates", "ALENDRONIC ACID" ], "cautions": "Cautions\u00a0upper gastro-intestinal disorders (dysphagia, symptomatic\r\noesophageal disease, gastritis, duodenitis, or ulcers\u2014see also under\r\nContra-indications and Side-effects); history (within 1 year) of ulcers,\r\nactive gastro-intestinal bleeding, or surgery of the upper gastro-intestinal\r\ntract; correct disturbances of calcium\r\nand mineral metabolism (e.g. vitamin-D deficiency, hypocalcaemia)\r\nbefore starting and monitor serum-calcium concentration\r\nduring treatment; consider dental check-up before\r\ninitiating bisphosphonate (risk of osteonecrosis\r\nof the jaw, see Bisphosphonates: Osteonecrosis\r\nof the Jaw); exclude other causes of osteoporosis; atypical femoral fractures, see MHRA/CHM advice; interactions: Appendix 1 (bisphosphonates)", "side-effects": "Side-effects\u00a0oesophageal reactions (see below), abdominal pain\r\nand distension, dyspepsia, regurgitation, melaena, diarrhoea or constipation,\r\nflatulence, musculoskeletal pain, headache; rarely rash, pruritus, erythema, photosensitivity, uveitis, scleritis,\r\ntransient decrease in serum calcium and phosphate; nausea, vomiting,\r\ngastritis, peptic ulceration, hypersensitivity reactions (including\r\nurticaria and angioedema), atypical femoral fractures with long-term\r\nuse (see MHRA/CHM advice);\r\nmyalgia, malaise, and fever at initiation of treatment; very\r\nrarely severe skin reactions (including Stevens-Johnson syndrome),\r\nosteonecrosis of the jaw (see Bisphosphonates: Osteonecrosis\r\nof the Jaw)Oesophageal reactions\u00a0Severe oesophageal reactions\r\n(oesophagitis, oesophageal ulcers, oesophageal stricture and oesophageal\r\nerosions) have been reported; patients should be advised\r\nto stop taking the tablets and to seek medical attention if they develop\r\nsymptoms of oesophageal irritation such as dysphagia, new or worsening\r\nheartburn, pain on swallowing or retrosternal pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129540.htm", "doses": [ "Treatment of postmenopausal osteoporosis, 10\u00a0mg daily or 70\u00a0mg once weekly", "Treatment of osteoporosis in men, 10\u00a0mg daily", "Prevention and treatment of corticosteroid-induced osteoporosis\r\nin postmenopausal women not receiving hormone replacement therapy,\r\n10\u00a0mg daily", "Tablets should be swallowed whole\r\nwith plenty of water while sitting or standing; to be taken on an\r\nempty stomach at least 30 minutes before breakfast (or another oral\r\nmedicine); patient should stand or sit upright for at least 30 minutes\r\nafter taking tablet" ], "pregnancy": "Pregnancy\u00a0avoid" }, "BETAXOLOL": { "indications": "Indications\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "name": "BETAXOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Beta-blockers" ], "cautions": "Cautions\u00a0\n(From Beta-blockers: British National Formulary)\nSystemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block, or uncontrolled heart failure. Important: for a warning to avoid in asthma see below", "side-effects": "Side-effects\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5508.htm", "doses": [ "Apply twice daily" ] }, "GOLIMUMAB": { "indications": "Indications\u00a0see under Cytokine Modulators above", "name": "GOLIMUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators", "GOLIMUMAB" ], "cautions": "Cautions\u00a0predisposition to infection; monitor for infection before, during, and for 5 months\r\nafter treatment (see also Tuberculosis below); do not initiate until active infections are controlled; discontinue if new serious infection develops until\r\ninfection controlled; hepatitis B virus\u2014monitor\r\nfor active infection; mild heart failure\r\n(discontinue if symptoms develop or worsen); demyelinating disorders (risk of exacerbation); history\r\nor development of malignancy; interactions: Appendix 1 (golimumab)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Active tuberculosis\r\nshould be treated with standard treatment (section 5.1.9) for at least 2 months before\r\nstarting golimumab. Patients who have previously received\r\nadequate treatment for tuberculosis can start golimumab but should\r\nbe monitored every 3 months for possible recurrence. In patients without active tuberculosis but who were previously not\r\ntreated adequately, chemoprophylaxis should ideally be completed before\r\nstarting golimumab. In patients at high\r\nrisk of tuberculosis who cannot be assessed by tuberculin skin test,\r\nchemoprophylaxis can be given concurrently with golimumab. Patients should be advised to seek medical attention\r\nif symptoms suggestive of tuberculosis (e.g. persistent cough, weight\r\nloss, and fever) developBlood disorders\u00a0Patients should be\r\nadvised to seek medical attention if symptoms suggestive of blood\r\ndisorders (such as fever, sore throat, bruising, or bleeding) develop", "side-effects": "Side-effects\u00a0see under Cytokine Modulators and under Cautions above; also constipation, dyspepsia, hypertension,\r\ninsomnia, dizziness, paraesthesia, asthenia, alopecia, dermatitis; less commonly taste disturbance, gastritis, colitis, stomatitis,\r\ngastro-oesophageal reflux disease, cholelithiasis, hepatic disorders,\r\nhyperlipidaemia, arrhythmia, ischaemic coronary artery disorders,\r\nRaynaud\u2019s syndrome, heart failure, thrombosis, flushing, bronchospasm,\r\ndemyelinating disorders, hyperglycaemia, thyroid disorders, menstrual\r\ndisorders, malignancy, bone fractures, visual disturbance, eye irritation,\r\nnew onset or worsening psoriasis; rarely interstitial\r\nlung disease, renal impairment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213706.htm", "doses": [ "By subcutaneous injection, adult over 18 years, 50\u00a0mg once a month on the same\r\ndate each month, review treatment if no response after 3\u20134 doses;\r\nbody-weight over 100\u00a0kg, if inadequate response to 3\u20134 doses of 50\u00a0mg\r\nonce a month, dose can be increased to 100\u00a0mg once a month, review\r\ntreatment if inadequate response to this higher dose after 3\u20134 doses ", "If dose administered more than 2 weeks late,\r\nsubsequent doses should be administered on the new monthly due date" ], "pregnancy": "Pregnancy\u00a0use only if essential; manufacturer advises adequate\r\ncontraception during treatment and for at least 6 months after last\r\ndose" }, "DIAZOXIDE - VASODILATOR ANTIHYPERTENSIVE DRUGS": { "indications": "Indications\u00a0hypertensive emergency including severe hypertension\r\nassociated with renal disease (but no longer recommended\u2014see section 2.5); hypoglycaemia\r\n(section 6.1.4)", "name": "DIAZOXIDE - VASODILATOR ANTIHYPERTENSIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs" ], "cautions": "Cautions\u00a0ischaemic heart disease; interactions: Appendix 1 (diazoxide)", "side-effects": "Side-effects\u00a0tachycardia, hypotension, hyperglycaemia, sodium\r\nand water retention; rarely cardiomegaly, hyperosmolar\r\nnon-ketotic coma, leucopenia, thrombocytopenia, and hirsuitism", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2536.htm", "doses": [ "By rapid intravenous injection (less than\r\n30\u00a0seconds), 1\u20133\u00a0mg/kg to max. single dose of 150\u00a0mg (see below);\r\nmay be repeated after 5\u201315\u00a0minutes if required", "Single doses of 300\u00a0mg have been associated\r\nwith angina and with myocardial and cerebral infarction" ], "pregnancy": "Pregnancy\u00a0prolonged use may produce alopecia, hypertrichosis,\r\nand impaired glucose tolerance in neonate; inhibits uterine activity\r\nduring labour" }, "PROCHLORPERAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0see under Dose; antiemetic (section 4.6)", "name": "PROCHLORPERAZINE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also hypotension\r\nmore likely after intramuscular injection", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; less\r\nsedating; extrapyramidal symptoms, particularly dystonias, more frequent;\r\nrespiratory depression may occur in susceptible patients", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3241.htm", "doses": [ "By mouth, schizophrenia and other\r\npsychoses, mania, prochlorperazine maleate or mesilate,\r\n12.5\u00a0mg twice daily for 7 days adjusted at intervals of 4\u20137 days to\r\nusual dose of 75\u2013100\u00a0mg daily according to response; child not recommended", "Short-term adjunctive management of severe anxiety, 15\u201320\u00a0mg\r\ndaily in divided doses; max. 40\u00a0mg daily; child not recommended", "By deep intramuscular injection, psychoses, mania, prochlorperazine mesilate 12.5\u201325\u00a0mg 2\u20133 times daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "PREDNISOLONE": { "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "PREDNISOLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "PREDNISOLONE" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use.", "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5439.htm", "doses": [ "Apply every 1\u20132 hours until controlled then reduce frequency" ] }, "LATANOPROST WITH TIMOLOL": { "indications": "Indications\u00a0see under preparation", "name": "LATANOPROST WITH TIMOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides" ], "cautions": "Cautions\u00a0before initiating treatment, advise patients\r\nof possible change in eye colour; monitor\r\nfor eye colour change (see also notes above); history of herpetic keratitis (avoid in\r\nactive herpes simplex keratitis); aphakia, or pseudophakia with torn posterior lens capsule or anterior chamber lenses; risk factors for iritis, uveitis, and cystoid macular\r\noedema; not to be used within 5 minutes\r\nof use of thiomersal-containing preparations; consider\r\nalso other cautions of beta-blockers (section 2.4)Interactions\u00a0Since systemic absorption\r\nmay follow topical application of a beta-blocker, the possibility\r\nof interactions, in particular with drugs such as verapamil, should\r\nbe borne in mind. See also Appendix 1 (beta-blockers)", "side-effects": "Side-effects\u00a0brown pigmentation particularly in those with\r\nmixed-colour irides; ocular irritation and pain; darkening, thickening\r\nand lengthening of eye lashes; transient punctate epithelial erosion; less commonly blepharitis, conjunctival hyperaemia, corneal\r\ndisorders, eyelid oedema and rash, skin rash; rarely dyspnoea, exacerbation of asthma, iritis, uveitis, local oedema,\r\ndarkening of palpebral skin; very rarely chest pain,\r\nexacerbation of angina; local side-effects of eye drops also include\r\nerythema, dry eyes and allergic reactions including anaphylaxis and\r\nblepharoconjunctivitis; consider also other side-effects of beta-blockers\r\n(section 2.4)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201207.htm", "doses": [ "See under preparation" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "NADOLOL": { "indications": "Indications\u00a0see under Dose", "name": "NADOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "NADOLOL" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2503.htm", "doses": [ "Hypertension, initially 80\u00a0mg once daily, increased in\r\nincrements of up to 80\u00a0mg at weekly intervals if required; max. 240\u00a0mg\r\ndaily (higher doses rarely necessary)", "Angina, initially 40\u00a0mg once daily, increased at weekly intervals\r\nif required; usual max. 160\u00a0mg daily (rarely up to 240\u00a0mg may be required)", "Arrhythmias, initially 40\u00a0mg once daily, increased at weekly\r\nintervals up to 160\u00a0mg if required; reduce to 40\u00a0mg if bradycardia\r\noccurs", "Migraine prophylaxis, initially 40\u00a0mg once daily, increased\r\nin 40\u00a0mg increments at weekly intervals according to response; usual\r\nmaintenance dose 80\u2013160\u00a0mg once daily", "Thyrotoxicosis (adjunct), 80\u2013160\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin zeta": { "indications": "Indications\u00a0see under preparations, below", "name": "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin zeta", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "EPOETIN ALFA, BETA, THETA, and ZETA", "Epoetin zeta" ], "cautions": "Cautions\u00a0\n(From Erythropoietins: British National Formulary)\nErythropoietins; also inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,\r\nreticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure uncontrolled; sudden stabbing migraine-like pain\r\nis warning of a hypertensive crisis; sickle-cell\r\ndisease (lower target haemoglobin concentration may be appropriate); ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks); epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin dose may be needed during dialysis; risk of thrombosis may be increased when used for\r\nanaemia in adults receiving cancer chemotherapy; risk of thrombosis may be increased when used for anaemia before\r\northopaedic surgery\u2014avoid in cardiovascular disease\r\nincluding recent myocardial infarction or cerebrovascular accident", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting; dose-dependent increase\r\nin blood pressure or aggravation of hypertension; in isolated patients\r\nwith normal or low blood pressure, hypertensive crisis with encephalopathy-like\r\nsymptoms and generalised tonic-clonic seizures requiring immediate\r\nmedical attention; headache; dose-dependent increase in platelet count\r\n(but thrombocytosis rare) regressing during treatment; influenza-like\r\nsymptoms (may be reduced if intravenous injection given over 5 minutes);\r\ncardiovascular events; shunt thrombosis especially if tendency to\r\nhypotension or arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue erythropoietin therapy)\u2014see also notes above, hyperkalaemia,\r\nhypersensitivity reactions (including anaphylaxis and angioedema),\r\nskin reactions, injection-site reactions, and peripheral oedema also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201278.htm", "doses": [ "See under preparations, below", "Name[Retacrit\u00ae (Hospira) ] Injection, prefilled syringe, epoetin\r\nzeta, net price 1000\u00a0units = \u00a35.66; 2000\u00a0units = \u00a311.31; 3000\u00a0units\r\n= \u00a316.97; 4000\u00a0units = \u00a322.63; 5000\u00a0units = \u00a328.28; 6000\u00a0units = \u00a333.94;\r\n8000\u00a0units = \u00a345.25; 10\u00a0000\u00a0units = \u00a356.57; 20\u00a0000\u00a0units = \u00a3113.13;\r\n30 000\u00a0units = \u00a3169.70; 40\u00a0000\u00a0units = \u00a3226.26Excipients include phenylalanine up to 500\u00a0micrograms/syringe (section 9.4.1)Note\u00a0Biosimilar medicineDose\u00a0symptomatic anaemia associated with chronic renal failure\r\nin patients on haemodialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes or by subcutaneous injection (max. 1\u00a0mL per injection\r\nsite), initially 50\u00a0units/kg 3 times weekly adjusted according to\r\nresponse in steps of 25\u00a0units/kg 3 times weekly at intervals of at\r\nleast 4 weeks; maintenance dose, usually 25\u2013100\u00a0units/kg 3 times weekly; child by intravenous injection initially\r\nas for adults; maintenance dose, body-weight under 10\u00a0kg usually 75\u2013150\u00a0units/kg\r\n3 times weekly, body-weight 10\u201330\u00a0kg usually 60\u2013150\u00a0units/kg 3 times\r\nweekly, body-weight over 30\u00a0kg usually 30\u2013100\u00a0units/kg 3 times weeklySymptomatic anaemia associated with chronic renal failure\r\nin adults on peritoneal dialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes or by subcutaneous injection (max. 1\u00a0mL per injection\r\nsite), initially 50\u00a0units/kg twice weekly; maintenance dose 25\u201350\u00a0units/kg\r\ntwice weeklySevere symptomatic anaemia of renal origin in adults with\r\nrenal insufficiency not yet on dialysis (see also MHRA/CHM advice), by intravenous injection over 1\u20135 minutes or by subcutaneous injection (max. 1\u00a0mL per injection\r\nsite), initially 50\u00a0units/kg 3 times weekly increased according to\r\nresponse in steps of 25\u00a0units/kg 3 times weekly at intervals of at\r\nleast 4 weeks; maintenance dose 17\u201333\u00a0units/kg 3 times weekly; max.\r\n200\u00a0units/kg 3 times weeklyNote\u00a0Avoid increasing haemoglobin concentration\r\nat a rate exceeding 2\u00a0g/100\u00a0mL over 4 weeksSymptomatic anaemia in adults receiving cancer chemotherapy\r\n(see also MHRA/CHM advice), by subcutaneous injection (max. 1\u00a0mL per injection site),\r\ninitially 150\u00a0units/kg 3 times weekly (or 450\u00a0units/kg\r\nonce weekly), increased if appropriate rise in haemoglobin (or reticulocyte\r\ncount) not achieved after 4 weeks to 300\u00a0units/kg 3 times weekly;\r\ndiscontinue if inadequate response after 4 weeks at higher doseNote\u00a0Reduce dose by approximately 25\u201350% if rise\r\nin haemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if\r\nhaemoglobin concentration exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous dose. Discontinue approximately 4 weeks\r\nafter ending chemotherapyTo increase yield of autologous blood (to avoid homologous blood)\r\nin predonation programme in moderate anaemia either when large volume of blood required or when sufficient\r\nblood cannot be saved for elective major surgery, by intravenous\r\ninjection over 1\u20135 minutes, 600\u00a0units/kg twice weekly for\r\n3 weeks before surgery; consult product literature for details and\r\nadvice on ensuring high iron storesModerate anaemia (haemoglobin concentration 10\u201313\u00a0g/100\u00a0mL)\r\nbefore elective orthopaedic surgery in adults with expected moderate\r\nblood loss to reduce exposure to allogeneic blood transfusion or if\r\nautologous transfusion unavailable, by subcutaneous injection (max. 1\u00a0mL per injection site), 600\u00a0units/kg every week for 3 weeks\r\nbefore surgery and on day of surgery or 300\u00a0units/kg\r\ndaily for 15 days starting 10 days before surgery; consult product\r\nliterature for details" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; benefits probably outweigh risk\r\nof anaemia and of transfusion in pregnancy" }, "DEXAMETHASONE - INTRAVITREAL CORTICOSTEROIDS": { "indications": "Indications\u00a0\n(From Intravitreal corticosteroids: British National Formulary)\nIntravitreal corticosteroids\u2014specialist\r\nuse only", "name": "DEXAMETHASONE - INTRAVITREAL CORTICOSTEROIDS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids", "Intravitreal corticosteroids", "DEXAMETHASONE" ], "cautions": "Cautions\u00a0monitor intra-ocular pressure and for\r\nsigns of ocular infection; history of ocular\r\nherpes simplex; aphakia; retinal vein occlusion with significant retinal ischaemia; concomitant administration of anticoagulant or antiplatelet drugs", "side-effects": "Side-effects\u00a0headache, raised intra-ocular pressure, vitreous\r\ndetachment, retinal detachment, blepharitis, eyelid pruritus, cataract,\r\nvisual disturbance; also reported glaucoma, ocular\r\ninfection (including endophthalmitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213540.htm", "doses": [ "By intravitreal injection, 700\u00a0micrograms\r\ninto the affected eye", "Concurrent administration to both eyes not\r\nrecommended. For further information on administration and repeat\r\ndosing, consult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014no information available" }, "TARS Proprietary preparations": { "indications": "Indications\u00a0psoriasis and occasionally\r\nchronic atopic eczema", "name": "TARS Proprietary preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Tars", "TARS", "Proprietary preparations" ], "cautions": "Cautions\u00a0application to face and skin flexures; use suitable chemical protection gloves for extemporaneous\r\npreparation", "side-effects": "Side-effects\u00a0skin irritation and acne-like eruptions, photosensitivity;\r\nstains skin, hair, and fabric", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5953.htm", "doses": [ "Apply 1\u20133 times daily starting with low-strength preparations", "For shampoo preparations see section 13.9; for\r\nuse with dressings see Appendix 5 (section A5.8.9)", "Name[Psoriderm\u00ae (Dermal)] Cream, coal tar 6%, lecithin 0.4%, net price 225\u00a0mL = \u00a39.42Excipients include isopropyl palmitate, propylene glycolDose\u00a0psoriasis, apply to skin or scalp 1\u20132 times daily\nScalp lotion\u2014section 13.9" ] }, "SODIUM BICARBONATE - ORAL BICARBONATE": { "indications": "Indications\u00a0\n(From 9.2.1.3 Oral bicarbonate: British National Formulary)\n9.2.1.3 Oral bicarbonate", "name": "SODIUM BICARBONATE - ORAL BICARBONATE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4965.htm", "doses": [ "See notes above" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.3 Oral bicarbonate" ], "cautions": "Cautions\u00a0\n(From 9.2.1.3 Oral bicarbonate: British National Formulary)\nSodium supplements may increase blood pressure or cause fluid retention and pulmonary oedema in those at risk; hypokalaemia may be exacerbated.; respiratory acidosis; interactions: Appendix 1 (antacids)" }, "CO-DYDRAMOL - WITH DIHYDROCODEINE TARTRATE 20 OR 30\u00a0MG": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-DYDRAMOL - WITH DIHYDROCODEINE TARTRATE 20 OR 30\u00a0MG", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations", "CO-DYDRAMOL", "With dihydrocodeine tartrate 20 or 30\u00a0mg" ], "cautions": "Cautions\u00a0section 4.7.2; also alcohol dependence; severe cor pulmonale; interactions: Appendix 1 (opioid analgesics, paracetamol)", "side-effects": "Side-effects\u00a0section 4.7.2; also\r\nabdominal pain, paralytic ileus, pancreatitis, paraesthesia, blood\r\ndisorders (including thrombocytopenia, leucopenia, neutropenia); important: liver damage (and less frequently renal damage)\r\nfollowing overdosage with paracetamol; see Emergency\r\nTreatment of Poisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced respiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208679.htm", "doses": [ "See under preparations", "severe pain, 1\u20132 tablets every 4\u20136 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended", "Name[Remedeine\u00ae (Napp) ] Tablets, paracetamol 500\u00a0mg, dihydrocodeine tartrate 20\u00a0mg, net price\r\n112-tab pack = \u00a310.58. \r\n Label:\r\n 2, 29, 30Dose\u00a0severe pain, 1\u20132 tablets every 4\u20136 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended\nForte tablets, paracetamol 500\u00a0mg, dihydrocodeine tartrate 30\u00a0mg, net price\r\n56-tab pack = \u00a36.54. \r\n Label:\r\n 2, 29, 30Dose\u00a0severe pain, 1\u20132 tablets every 4\u20136 hours; max. 8 tablets\r\ndaily; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0withdrawal effects in neonates of dependant mothers" }, "SODIUM CHLORIDE With other ingredients": { "indications": "Indications\u00a0electrolyte imbalance\u2014see also section 9.2.1.2; nebuliser diluent (section 3.1.5); eye (section 11.8.1); oral hygiene (section 12.3.4); wound irrigation (section 13.11.1)", "name": "SODIUM CHLORIDE With other ingredients", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Intravenous sodium", "SODIUM CHLORIDE", "With other ingredients" ], "cautions": "Cautions\u00a0restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary oedema,\r\ntoxaemia of pregnancy", "side-effects": "Side-effects\u00a0administration of large doses may give rise to\r\nsodium accumulation, oedema, and hyperchloraemic acidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4975.htm", "doses": [ "See notes above", "Name[Sodium Chloride and Glucose Intravenous\r\nInfusion (Non-proprietary) ] Intravenous infusion, sodium\r\nchloride 0.18% (Na+ and Cl\u2013 each 30\u00a0mmol/litre), glucose 4%In hospitals, usually 500-mL packs and sometimes other sizes\r\nare available\nIntravenous infusion, sodium\r\nchloride 0.45% (Na+ and Cl\u2013 each 75\u00a0mmol/litre), glucose 2.5%In hospitals, usually 500-mL packs and sometimes other sizes\r\nare available\nIntravenous infusion, sodium\r\nchloride 0.45% (Na+ and Cl\u2013 each 75\u00a0mmol/litre), glucose 5%In hospitals, usually 500-mL packs and sometimes other sizes\r\nare available\nIntravenous infusion, sodium\r\nchloride 0.9% (Na+ and Cl\u2013 each 150\u00a0mmol/litre), glucose 5%In hospitals, usually 500-mL packs and sometimes other sizes\r\nare availableNote\u00a0See above for warning on hyponatraemia especially\r\nin children and elderly" ] }, "PIZOTIFEN": { "indications": "Indications\u00a0prevention of vascular headache including classical migraine, common\r\nmigraine, and cluster headache", "name": "PIZOTIFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.2 Prophylaxis of migraine", "PIZOTIFEN" ], "cautions": "Cautions\u00a0urinary retention; susceptibility to angle-closure glaucoma; history of epilepsy; interactions: Appendix 1 (pizotifen)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0dry mouth, nausea; dizziness, drowsiness, increased\r\nappetite, weight gain; less commonly constipation; rarely anxiety, aggression, insomnia, paraesthesia, hallucination,\r\ndepression, arthralgia, myalgia; very rarely seizures,\r\nurticaria, rash; jaundice, hepatitis, and muscle cramps\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77496.htm", "doses": [ "Initially 500\u00a0micrograms at night increased gradually\r\nto usual dose of 1.5\u00a0mg at night or in 3 divided\r\ndoses; may be further increased up to max. daily dose 4.5\u00a0mg (but\r\nrarely necessary), max. single dose 3\u00a0mg; child over 5 years, up to 1.5\u00a0mg daily in divided doses; max. single dose\r\nat night 1\u00a0mg" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk" }, "MUPIROCIN": { "indications": "Indications\u00a0bacterial skin infections (see also notes above)", "name": "MUPIROCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.1 Antibacterial preparations", "13.10.1.1 Antibacterial preparations only used topically", "MUPIROCIN" ], "side-effects": "Side-effects\u00a0local reactions including urticaria, pruritus,\r\nburning sensation, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6121.htm", "doses": [ "adult and child over 1 year, apply up to 3 times daily for\r\nup to 10 days; child under 1 year see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014no information available" }, "RITONAVIR": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs; low\r\ndoses used to increase effect of some protease inhibitors", "name": "RITONAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors", "RITONAVIR" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; concomitant use with drugs that prolong PR interval; cardiac conduction disorders, structural heart disease; pancreatitis (see below); interactions: Appendix 1 (ritonavir)Pancreatitis\u00a0Signs and symptoms suggestive of\r\npancreatitis (including raised serum lipase) should be evaluated\u2014discontinue if pancreatitis diagnosed", "side-effects": "Side-effects\u00a0see notes and Cautions above; also diarrhoea (may\r\nimpair absorption\u2014close monitoring required), vasodilatation, cough,\r\nthroat irritation, anxiety, perioral and peripheral paraesthesia,\r\nhyperaesthesia, fever, decreased blood thyroxine concentration, electrolyte\r\ndisturbances, raised uric acid, dry mouth, mouth ulcers, and sweating; less commonly increased prothrombin time and dehydration;\r\nsyncope, postural hypotension, seizures, menorrhagia, and renal failure\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57196.htm", "doses": [ "Initially 300\u00a0mg every 12 hours for 3 days, increased\r\nin steps of 100\u00a0mg every 12 hours over not longer than 14 days to\r\n600\u00a0mg every 12 hours; child over 2\r\nyears initially 250\u00a0mg/m2 every 12 hours, increased by\r\n50\u00a0mg/m2 at intervals of 2\u20133 days to 350\u00a0mg/m2 every 12 hours (max. 600\u00a0mg every 12 hours)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "TOBRAMYCIN - ANTIBACTERIALS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "TOBRAMYCIN" ], "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "TOBRAMYCIN - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213676.htm", "doses": [ "adult and child over 1 year, apply twice daily for 6\u20138 days;\r\nin severe infection, apply 4 times daily on the first day, then twice\r\ndaily for 5\u20137 days" ] }, "CHLORPROMAZINE HYDROCHLORIDE - PHENOTHIAZINES AND RELATED DRUGS": { "indications": "Indications\u00a0nausea and vomiting of terminal illness (where\r\nother drugs have failed or are not available); other indications (section 4.2.1)", "name": "CHLORPROMAZINE HYDROCHLORIDE - PHENOTHIAZINES AND RELATED DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0see Chlorpromazine Hydrochloride, section 4.2.1", "side-effects": "Side-effects\u00a0see Chlorpromazine Hydrochloride, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3413.htm", "doses": [ "By mouth, 10\u201325\u00a0mg every 4\u20136 hours; child 500\u00a0micrograms/kg every 4\u20136 hours (1\u20135 years\r\nmax. 40\u00a0mg daily, 6\u201312 years max. 75\u00a0mg daily)", "By deep intramuscular injection initially 25\u00a0mg\r\nthen 25\u201350\u00a0mg every 3\u20134 hours until vomiting stops; child 500\u00a0micrograms/kg every 6\u20138 hours (1\u20135 years\r\nmax. 40\u00a0mg daily, 6\u201312 years max. 75\u00a0mg daily)", "By rectum in suppositories, chlorpromazine 100\u00a0mg\r\nevery 6\u20138 hours [unlicensed]" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "CYCLIZINE": { "indications": "Indications\u00a0nausea, vomiting, vertigo, motion sickness, labyrinthine\r\ndisorders", "name": "CYCLIZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines", "CYCLIZINE" ], "cautions": "Cautions\u00a0section 3.4.1; severe heart failure; may counteract haemodynamic\r\nbenefits of opioids; interactions: Appendix 1 (antihistamines)", "side-effects": "Side-effects\u00a0section 3.4.1; also\r\nhypertension, paraesthesia, and twitching", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3405.htm", "doses": [ "By mouth, cyclizine hydrochloride\r\n50\u00a0mg up to 3 times daily; child 6\u201312\r\nyears 25\u00a0mg up to 3 times daily", "For motion sickness, take 1\u20132 hours before\r\ndeparture", "By intramuscular or intravenous\r\ninjection, cyclizine lactate 50\u00a0mg 3 times\r\ndaily" ], "pregnancy": "Pregnancy\u00a0section 3.4.1" }, "OXCARBAZEPINE": { "indications": "Indications\u00a0\n(From Carbamazepine and related antiepileptics: British National Formulary)\nCarbamazepine and related antiepileptics", "name": "OXCARBAZEPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Carbamazepine and related antiepileptics", "OXCARBAZEPINE" ], "cautions": "Cautions\u00a0hypersensitivity to carbamazepine (see also Antiepileptic Hypersensitivity\r\nSyndrome); avoid abrupt withdrawal; hyponatraemia (monitor plasma-sodium concentration in patients at risk), heart failure (monitor body-weight), cardiac conduction disorders; avoid in acute\r\nporphyria (section 9.8.2); interactions: see Interactions in section\r\n4.8.1 and Appendix 1 (oxcarbazepine)Blood, hepatic, or skin disorders\u00a0Patients or their carers should be told how to recognise signs of\r\nblood, liver, or skin disorders, and advised to seek immediate medical\r\nattention if symptoms such as lethargy, confusion, muscular twitching,\r\nfever, rash, blistering, mouth ulcers, bruising, or bleeding develop", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, diarrhoea, abdominal\r\npain; dizziness, headache, drowsiness, agitation, amnesia, asthenia,\r\nataxia, confusion, impaired concentration, depression, tremor; hyponatraemia;\r\nacne, alopecia, rash, nystagmus, visual disorders including diplopia; less commonly urticaria, leucopenia; very rarely hepatitis, pancreatitis, arrhythmias, blood disorders, multi-organ\r\nhypersensitivity (see also Antiepileptic Hypersensitivity\r\nSyndrome),\r\nsystemic lupus erythematosus, Stevens-Johnson syndrome, and toxic\r\nepidermal necrolysis; hypertension and hypothyroidism also reported;\r\nsuicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201572.htm", "doses": [ "Initially 300\u00a0mg twice daily increased according to response\r\nin steps of up to 600\u00a0mg daily at weekly intervals; usual dose range\r\n0.6\u20132.4\u00a0g daily in divided doses; child 6\u201318 years, 8\u201310\u00a0mg/kg daily in 2 divided doses increased according\r\nto response in steps of up to 10\u00a0mg/kg daily at weekly intervals (in\r\nadjunctive therapy, maintenance dose approx. 30\u00a0mg/kg daily); max.\r\n46\u00a0mg/kg daily in divided doses", "In adjunctive therapy, the dose\r\nof concomitant antiepileptics may need to be reduced when using high\r\ndoses of oxcarbazepine" ], "pregnancy": "Pregnancy\u00a0see Pregnancy " }, "MORPHINE SALTS Suppositories": { "indications": "Indications\u00a0see notes above and under Dose; acute diarrhoea (%s\n(From 1.4.2 Antimotility drugs: British National Formulary)\n1.4.2 Antimotility drugs); cough in terminal care (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants)", "name": "MORPHINE SALTS Suppositories", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "MORPHINE SALTS", "Suppositories" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also pancreatitis, cardiac arrhythmias, severe cor pulmonale", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nparalytic ileus, abdominal pain, anorexia, dyspepsia, exacerbation\r\nof pancreatitis, taste disturbance; hypertension, hypothermia, syncope;\r\nbronchospasm, inhibition of cough reflex; restlessness, seizures,\r\nparaesthesia, asthenia, malaise, disorientation, excitation, agitation,\r\ndelirium, raised intracranial pressure; amenorrhoea; myoclonus, muscle\r\nfasciculation, rhabdomyolysis, and nystagmus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/9664.htm", "doses": [ "The patient should be closely monitored\r\nfor pain relief as well as for side-effects especially respiratory\r\ndepression. See also notes above.", "Acute pain, by subcutaneous injection (not suitable for oedematous patients) or by intramuscular injection, initially 10\u00a0mg (elderly or frail 5\u00a0mg) every 4 hours (or more frequently\r\nduring titration), adjusted according to response; neonate initially 100\u00a0micrograms/kg every 6 hours,\r\nadjusted according to response; child 1\u20136 months initially 100\u2013200\u00a0micrograms/kg every 6 hours, adjusted\r\naccording to response; child 6 months\u20132\r\nyears initially 100\u2013200\u00a0micrograms/kg every 4 hours, adjusted according\r\nto response; child 2\u201312 years initially\r\n200\u00a0micrograms/kg every 4 hours, adjusted according to response; child 12\u201318 years initially 2.5\u201310\u00a0mg every 4 hours,\r\nadjusted according to response", "By slow intravenous injection, initially 5\u00a0mg\r\n(reduce dose in elderly or frail) every\r\n4 hours (or more frequently during titration), adjusted according\r\nto response; neonate initially 50\u00a0micrograms/kg\r\nevery 6 hours, adjusted according to response; child 1\u20136 months initially 100\u00a0micrograms/kg every 6 hours, adjusted according\r\nto response; child 6 months\u201312 years\r\ninitially 100\u00a0micrograms/kg every 4 hours, adjusted according to response", "Premedication, by subcutaneous or intramuscular injection, up to 10\u00a0mg 60\u201390 minutes\r\nbefore operation; child, by\r\nintramuscular injection, 150\u00a0micrograms/kg", "Patient controlled analgesia (PCA), consult hospital protocols", "Myocardial infarction, by slow intravenous injection (1\u20132\u00a0mg/minute), 5\u201310\u00a0mg followed by a further 5\u201310\u00a0mg if necessary; elderly or frail patients, reduce dose by half", "Acute pulmonary oedema, by slow intravenous injection (2\u00a0mg/minute) 5\u201310\u00a0mg; elderly or\r\nfrail patients, reduce dose by half", "Chronic pain, by mouth or by subcutaneous injection (not suitable for oedematous\r\npatients) or by intramuscular injection, initially 5\u201310\u00a0mg every 4 hours, adjusted according to response;\r\nsee also Prescribing in Palliative\r\nCare", "By rectum, initially 15\u201330\u00a0mg every 4 hours,\r\nadjusted according to response", "The doses stated above refer equally to morphine hydrochloride and sulphate", "Name[Morphine (Non-proprietary) ] Suppositories, morphine sulphate 10\u00a0mg, net price 12 = \u00a311.21; 15\u00a0mg, 12 = \u00a311.56; 20\u00a0mg,\r\n12 = \u00a333.22; 30\u00a0mg, 12 = \u00a313.70. \r\n Label:\r\n 2Note\u00a0Both the strength of the suppositories and\r\nthe morphine salt contained in them must be specified\r\nby the prescriber" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CIDOFOVIR": { "indications": "Indications\u00a0cytomegalovirus retinitis in AIDS patients for whom other drugs are\r\ninappropriate", "name": "CIDOFOVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.2 Cytomegalovirus infection", "CIDOFOVIR" ], "cautions": "Cautions\u00a0monitor renal function (serum creatinine\r\nand urinary protein) and neutrophil count within 24 hours before each\r\ndose; co-treatment with probenecid and prior hydration with intravenous fluids necessary to minimise\r\npotential nephrotoxicity (see below); diabetes\r\nmellitus (increased risk of ocular hypotony); interactions: Appendix 1 (cidofovir)Nephrotoxicity\u00a0Do not initiate treatment\r\nin renal impairment (assess creatinine clearance and proteinuria\u2014consult\r\nproduct literature); discontinue treatment\r\nand give intravenous fluids if renal function deteriorates\u2014consult\r\nproduct literatureOcular disorders\u00a0Regular ophthalmological\r\nexaminations recommended; iritis and uveitis\r\nhave been reported which may respond to a topical corticosteroid with\r\nor without a cycloplegic drug\u2014discontinue cidofovir if no response to topical corticosteroid or if condition worsens,\r\nor if iritis or uveitis recurs after successful treatment", "side-effects": "Side-effects\u00a0nephrotoxicity (see Cautions above); nausea, vomiting,\r\ndiarrhoea; dyspnoea; headache, fever, asthenia; neutropenia;\r\ndecreased intra-ocular pressure, iritis, uveitis (see Cautions above);\r\nalopecia, rash; less commonly Fanconi syndrome; also\r\nreported, hearing impairment and pancreatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64327.htm", "doses": [ "Initial (induction) treatment, adult over 18 years, by intravenous infusion over 1 hour,\r\n5\u00a0mg/kg once weekly for 2 weeks (give probenecid and intravenous fluids with each dose, see below)", "Maintenance treatment, beginning 2 weeks after completion of\r\ninduction, adult over 18 years, by intravenous infusion over 1 hour, 5\u00a0mg/kg once every 2\r\nweeks (give probenecid and intravenous fluids with\r\neach dose, see below)", "By mouth (preferably after food), probenecid 2\u00a0g 3 hours before cidofovir infusion followed\r\nby probenecid 1\u00a0g at 2 hours and 1\u00a0g at 8 hours\r\nafter the end of cidofovir infusion (total probenecid 4\u00a0g); for cautions, contra-indications and side-effects\r\nof probenecid see section 10.1.4", " Sodium chloride 0.9%, by intravenous infusion, 1\u00a0litre over 1 hour\r\nimmediately before cidofovir infusion (if tolerated\r\nan additional 1\u00a0litre may be given over 1\u20133 hours, starting at the\r\nsame time as the cidofovir infusion or immediately\r\nafterwards)" ], "pregnancy": "Pregnancy\u00a0avoid (toxicity in animal studies);\r\neffective contraception required during and for 1 month after treatment;\r\nalso men should avoid fathering a child during and for 3 months after\r\ntreatment" }, "TETRACAINE": { "indications": "Indications\u00a0see under preparation; eye (section 11.7)", "name": "TETRACAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Tetracaine", "TETRACAINE" ], "cautions": "Cautions\u00a0see Cautions of Local Anaesthetics", "side-effects": "Side-effects\u00a0see Toxicity and Side-effectsImportant\u00a0Rapid and extensive absorption may result\r\nin systemic side-effects (see also notes above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/40704.htm", "doses": [ "adult and child over 1 month, apply contents of tube to site\r\nof venepuncture or venous cannulation and cover with occlusive dressing;\r\nremove gel and dressing after 30 minutes for venepuncture and after\r\n45 minutes for venous cannulation; neonate see BNF for Children", "adult and child over 5 years, contents of max. 5\u00a0tubes applied\r\nat separate sites at a single time; child 1 month\u20135 years, contents of max. 1\u00a0tube applied at separate sites\r\nat a single time" ] }, "CODEINE PHOSPHATE - OPIOID ANALGESICS": { "indications": "Indications\u00a0mild to moderate pain; diarrhoea (section 1.4.2); cough suppression (section 3.9.1)", "name": "CODEINE PHOSPHATE - OPIOID ANALGESICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "CODEINE PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also cardiac arrhythmias; acute abdomen; gallstonesVariation in metabolism\u00a0The capacity to metabolise\r\ncodeine can vary considerably and lead to either reduced therapeutic\r\neffect or marked increase in side-effects", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, anorexia, seizures, malaise, hypothermia, antidiuretic\r\neffect, and muscle fasciculation; pancreatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3515.htm", "doses": [ "By mouth, 30\u201360\u00a0mg every 4 hours when necessary,\r\nto a max. of 240\u00a0mg daily; child 1\u201312\r\nyears, 3\u00a0mg/kg daily in divided doses", "By intramuscular injection, 30\u201360\u00a0mg every 4\r\nhours when necessary" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "EDROPHONIUM CHLORIDE - DRUGS THAT ENHANCE NEUROMUSCULAR TRANSMISSION": { "indications": "Indications\u00a0see under Dose and notes above; reversal\r\nof non-depolarising neuromuscular blockade and diagnosis of dual block\r\n(section 15.1.6)", "name": "EDROPHONIUM CHLORIDE - DRUGS THAT ENHANCE NEUROMUSCULAR TRANSMISSION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.1 Drugs that enhance neuromuscular transmission", "Anticholinesterases" ], "cautions": "Cautions\u00a0see under %s\n(From NEOSTIGMINE: British National Formulary)\nCautions\u00a0asthma (extreme caution), bradycardia, arrhythmias, recent myocardial infarction, epilepsy, hypotension, parkinsonism, vagotonia, peptic ulceration, hyperthyroidism; atropine or other antidote to muscarinic effects may be necessary (particularly when neostigmine is given by injection), but not given routinely because it may mask signs of overdosage; interactions: Appendix 1 (parasympathomimetics)Neostigmine; have resuscitation facilities; extreme caution in respiratory distress (\n(From Anticholinesterases: British National Formulary)\nEdrophonium has a very brief action and it is therefore used mainly for the diagnosis of myasthenia gravis. However, such testing should be performed only by those experienced in its use; other means of establishing the diagnosis are available. A single test-dose usually causes substantial improvement in muscle power (lasting about 5 minutes) in patients with the disease (if respiration already impaired, only in conjunction with someone skilled at intubation).Edrophonium can also be used to determine whether a patient with myasthenia is receiving inadequate or excessive treatment with cholinergic drugs. If treatment is excessive an injection of edrophonium will either have no effect or will intensify symptoms (if respiration already impaired, give only in conjunction with someone skilled at intubation). Conversely, transient improvement may be seen if the patient is being inadequately treated. The test is best performed just before the next dose of anticholinesterase. ) and in asthmaNote\u00a0Severe cholinergic reactions can be counteracted\r\nby injection of atropine sulphate (which should\r\nalways be available)", "side-effects": "Side-effects\u00a0see under Neostigmine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5329.htm", "doses": [ "Diagnosis of myasthenia gravis, by intravenous\r\ninjection, 2\u00a0mg followed after 30 seconds (if no adverse reaction\r\nhas occurred) by 8\u00a0mg; in adults without suitable veins, by\r\nintramuscular injection, 10\u00a0mg; child under 12 years see BNF for Children", "Detection of overdosage or underdosage of cholinergic drugs, by intravenous injection, 2\u00a0mg (preferably just before next\r\ndose of anticholinesterase, see notes above); child under 12 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see under Neostigmine" }, "TERBUTALINE SULPHATE - SELECTIVE BETA2 AGONISTS": { "indications": "Indications\u00a0asthma and other conditions associated with reversible\r\nairways obstruction; premature labour (section 7.1.3)", "name": "TERBUTALINE SULPHATE - SELECTIVE BETA2 AGONISTS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "TERBUTALINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2897.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\ninitially 2.5\u00a0mg 3 times daily for 1\u20132 weeks, then up to 5\u00a0mg 3 times\r\ndaily; child 1 month\u20137 years 75\u00a0micrograms/kg\r\n3 times daily; 7\u201315 years 2.5\u00a0mg 2\u20133 times daily", "By subcutaneous or slow intravenous injection, 250\u2013500\u00a0micrograms up\r\nto 4 times daily; child 2\u201315 years\r\n10\u00a0micrograms/kg to a max. of 300\u00a0micrograms", "By continuous intravenous infusion as a solution containing 3\u20135\u00a0micrograms/mL, 90\u2013300\u00a0micrograms/hour\r\nfor 8\u201310 hours; child 1 month\u201318 years,\r\ninitially 2\u20134\u00a0micrograms/kg as a loading dose, then 1\u201310\u00a0micrograms/kg/hour\r\naccording to response and heart rate (max. 300\u00a0micrograms/hour); high\r\ndoses with close monitoring", "By inhalation of powder (Turbohaler\u00ae), adult and child over 5 years, 500\u00a0micrograms (1 inhalation);\r\nfor persistent symptoms up to 4 times daily (but see Management of Chronic Asthma\r\ntable)", "By inhalation of nebulised solution (but see also Management of Acute Asthma table), 5\u201310\u00a0mg 2\u20134 times daily;\r\nadditional doses may be necessary in severe acute asthma; child under 5 years 5\u00a0mg 2\u20134 times daily, 5\u201312 years\r\n5\u201310\u00a0mg 2\u20134 times daily [unlicensed dose]" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "LOCAL CORTICOSTEROID INJECTIONS Betamethasone": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Betamethasone", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Betamethasone" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130063.htm", "doses": [ "See under preparations", "Name[Betnesol\u00ae (UCB Pharma) ] Injection, betamethasone (as sodium phosphate) 4\u00a0mg/mL, net price 1-mL amp = \u00a31.23. " ] }, "LIDOCAINE HYDROCHLORIDE Lidocaine for ear, nose, and oropharyngeal use": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE Lidocaine for ear, nose, and oropharyngeal use", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE", "Lidocaine for ear, nose, and oropharyngeal use" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/74859.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Name[Lidocaine with phenylephrine (Non-proprietary)] Topical solution, lidocaine hydrochloride\r\n5%, phenylephrine hydrochloride 0.5%, net price\r\n2.5\u00a0mL (with nasal applicator) = \u00a39.98Dose\u00a0anaesthesia before nasal surgery, endoscopy, laryngoscopy,\r\nor removal of foreign bodies from the nose, adult and child over 12 years, up to max.\r\n8 sprays" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "SOMATROPIN": { "indications": "Indications\u00a0see under Dose", "name": "SOMATROPIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Growth hormone", "SOMATROPIN" ], "cautions": "Cautions\u00a0diabetes mellitus (adjustment of antidiabetic\r\ntherapy may be necessary), papilloedema (see under Side-effects), relative deficiencies of\r\nother pituitary hormones (notably hypothyroidism\u2014manufacturers recommend periodic thyroid function tests but limited\r\nevidence of clinical value), history of malignant disease, disorders of the epiphysis of the hip (monitor for\r\nlimping), resolved intracranial hypertension\r\n(monitor closely), initiation of treatment\r\nclose to puberty not recommended in child born small for gestational\r\nage; Silver-Russell syndrome; rotate subcutaneous injection sites to prevent lipoatrophy; interactions: Appendix 1 (somatropin)", "side-effects": "Side-effects\u00a0headache, funduscopy for papilloedema recommended\r\nif severe or recurrent headache, visual problems, nausea and vomiting\r\noccur\u2014if papilloedema confirmed consider benign intracranial hypertension\r\n(rare cases reported); fluid retention (peripheral oedema), arthralgia,\r\nmyalgia, carpal tunnel syndrome, paraesthesia, antibody formation,\r\nhypothyroidism, insulin resistance, hyperglycaemia, hypoglycaemia,\r\nreactions at injection site; leukaemia in children with growth hormone\r\ndeficiency also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4414.htm", "doses": [ "Gonadal dysgenesis (Turner syndrome), by subcutaneous\r\ninjection, 45\u201350\u00a0micrograms/kg daily or 1.4\u00a0mg/m2 daily", "Deficiency of growth hormone in children, by subcutaneous or intramuscular injection, 23\u201339\u00a0micrograms/kg\r\ndaily or 0.7\u20131\u00a0mg/m2 daily", "Growth disturbance in short children born small for gestational\r\nage whose growth has not caught up by 4 years or later, by\r\nsubcutaneous injection, 35\u00a0micrograms/kg daily or 1\u00a0mg/m2 daily", "Prader-Willi syndrome, by subcutaneous injection in children with growth velocity greater than 1\u00a0cm/year, in combination\r\nwith energy-restricted diet, 35\u00a0micrograms/kg daily or 1\u00a0mg/m2 daily; max. 2.7\u00a0mg daily", "Chronic renal insufficiency in children (renal function decreased\r\nto less than 50%), by subcutaneous injection, 45\u201350\u00a0micrograms/kg\r\ndaily or 1.4\u00a0mg/m2 daily (higher doses\r\nmay be needed) adjusted if necessary after 6 months", "Adult growth hormone deficiency, by subcutaneous injection, initially 150\u2013300\u00a0micrograms daily, gradually increased if required\r\nto max. 1\u00a0mg daily; use minimum effective dose (requirements may decrease\r\nwith age)", "SHOX deficiency in children, by subcutaneous injection, 45\u201350\u00a0micrograms/kg daily", "Dose formerly expressed in units; somatropin 1\u00a0mg \u2261 3\u00a0units" ], "pregnancy": "Pregnancy\u00a0discontinue if pregnancy occurs\u2014no information available" }, "CINNARIZINE With dimenhydrinate": { "indications": "Indications\u00a0vestibular disorders, such as vertigo,\r\ntinnitus, nausea, and vomiting in M\u00e9ni\u00e8re\u2019s disease; motion sickness", "name": "CINNARIZINE With dimenhydrinate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines", "CINNARIZINE", "With dimenhydrinate" ], "cautions": "Cautions\u00a0section 3.4.1; also Parkinson\u2019s disease", "side-effects": "Side-effects\u00a0section 3.4.1; also rarely weight gain, sweating, lichen planus, and lupus-like\r\nskin reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130011.htm", "doses": [ "Vestibular disorders, 30\u00a0mg 3 times daily; child 5\u201312 years 15\u00a0mg 3 times daily", "Motion sickness, 30\u00a0mg 2 hours before travel then 15\u00a0mg every\r\n8 hours during journey if necessary; child 5\u201312 years, 15\u00a0mg 2 hours before travel then 7.5\u00a0mg every 8 hours\r\nduring journey if necessary", "Name[Arlevert\u00ae (Hampton) ] Tablets, cinnarizine 20\u00a0mg, dimenhydrinate\r\n40\u00a0mg, net price 100-tab pack = \u00a324.00. \r\n Label:\r\n 2Dose\u00a0adult over 18 years, 1\r\ntablet 3 times daily" ], "pregnancy": "Pregnancy\u00a0section 3.4.1" }, "CLONAZEPAM - BENZODIAZEPINES": { "indications": "Indications\u00a0all forms of epilepsy; myoclonus; status epilepticus\r\n(section 4.8.2)", "name": "CLONAZEPAM - BENZODIAZEPINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 4.8.1 Control of the epilepsies: British National Formulary)\n4.8.1 Control of the epilepsies; elderly and debilitated patients, respiratory disease, spinal or cerebellar\r\nataxia; history of alcohol or drug abuse, depression\r\nor suicidal ideation; avoid sudden withdrawal; myasthenia gravis (avoid if unstable); acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness, fatigue, dizziness,\r\nmuscle hypotonia, co-ordination disturbances; also poor concentration,\r\nrestlessness, confusion, amnesia, dependence, and withdrawal; salivary\r\nor bronchial hypersecretion in infants and small children; rarely gastro-intestinal symptoms, respiratory depression,\r\nheadache, paradoxical effects including aggression and anxiety, sexual\r\ndysfunction, urinary incontinence, urticaria, pruritus, reversible\r\nhair loss, skin pigmentation changes; dysarthria, and visual disturbances\r\non long-term treatment; blood disorders reported; suicidal ideation; overdosage: see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3607.htm", "doses": [ "1\u00a0mg (elderly 500\u00a0micrograms)\r\ninitially at night for 4 nights, increased according to response over\r\n2\u20134 weeks to usual maintenance dose of 4\u20138\u00a0mg usually at night (may\r\nbe given in 3\u20134 divided doses if necessary); child up to 1 year, initially 250\u00a0micrograms increased as above to usual\r\nmaintenance dose of 0.5\u20131\u00a0mg, 1\u20135 years, initially 250\u00a0micrograms\r\nincreased as above to 1\u20133\u00a0mg, 5\u201312 years, initially 500\u00a0micrograms\r\nincreased as above to 3\u20136\u00a0mg", "Clonazepam doses in BNF may differ from those\r\nin product literature" ], "pregnancy": "Pregnancy\u00a0see Benzodiazepines, section 4.1.2" }, "RITUXIMAB - ANTI-LYMPHOCYTE MONOCLONAL ANTIBODIES": { "indications": "Indications\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.; severe active rheumatoid arthritis\r\n(%s\n(From RITUXIMAB: British National Formulary)\nRITUXIMAB)", "name": "RITUXIMAB - ANTI-LYMPHOCYTE MONOCLONAL ANTIBODIES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.3 Anti-lymphocyte monoclonal antibodies" ], "cautions": "Cautions\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.\u2014for full details consult product literature", "side-effects": "Side-effects\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nRituximab causes lysis of B lymphocytes. It is licensed for the treatment of chemotherapy-resistant or relapsed stage III\u2013IV follicular non-Hodgkin\u2019s lymphoma and, in combination with other chemotherapy, for previously untreated stage III\u2013IV follicular lymphoma, and for previously untreated or relapsed chronic lymphocytic leukaemia (see NICE guidance below). Rituximab is also licensed for maintenance therapy in patients with follicular non-Hodgkin\u2019s lymphoma that has responded to induction therapy (see NICE guidance below). It is also licensed for use in combination with other chemotherapy for the treatment of diffuse large B-cell non-Hodgkin\u2019s lymphoma (see NICE guidance below). Full resuscitation facilities should be at hand and as with other cytotoxics, treatment should be undertaken under the close supervision of a specialist. See section 10.1.3 for the role of rituximab in rheumatoid arthritis.Rituximab should be used with caution in patients receiving cardiotoxic chemotherapy or with a history of cardiovascular disease because exacerbation of angina, arrhythmia, and heart failure have been reported. Transient hypotension occurs frequently during infusion and antihypertensives may need to be withheld for 12 hours before infusion. Progressive multifocal leucoencephalopathy (which is usually fatal or causes severe disability) has been reported in association with rituximab; patients should be monitored for cognitive, neurological, or psychiatric signs and symptoms. If progressive multifocal leucoencephalopathy is suspected, suspend treatment until it has been excluded.\u2014but for full details (including\r\nmonitoring and management of side-effects) consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70421.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit to mother outweighs\r\nrisk of B-lymphocyte depletion in fetus\u2014effective contraception required\r\nduring and for 12 months after treatment" }, "SEVELAMER CARBONATE": { "indications": "Indications\u00a0hyperphosphataemia in patients on haemodialysis\r\nor peritoneal dialysis, and patients with chronic kidney disease not\r\non dialysis who have a serum-phosphate concentration of 1.78\u00a0mmol/litre\r\nor more", "name": "SEVELAMER CARBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "SEVELAMER CARBONATE" ], "cautions": "Cautions\u00a0gastro-intestinal disorders; interactions: Appendix 1 (sevelamer)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, constipation,\r\ndiarrhoea, dyspepsia, flatulence; also reported intestinal\r\nobstruction and perforation, ileus, pruritus, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213553.htm", "doses": [ "adult over 18 years, initially\r\n2.4\u20134.8\u00a0g daily in 3 divided doses with meals, adjusted according\r\nto serum-phosphate concentration every 2\u20134 weeks (usual dose approx.\r\n6\u00a0g daily in 3 divided doses) " ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "BUDESONIDE": { "indications": "Indications\u00a0prophylaxis and treatment of allergic\r\nand vasomotor rhinitis; nasal polyps", "name": "BUDESONIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "BUDESONIDE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.; interactions: Appendix 1 (corticosteroids)", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5648.htm", "doses": [ "See preparations", "rhinitis, adult and child over 12 years, 128\u00a0micrograms (2 sprays) into\r\neach nostril once daily in the morning or 64\u00a0micrograms\r\n(1 spray) into each nostril twice daily; when control achieved reduce\r\nto 64\u00a0micrograms (1 spray) into each nostril once daily; max. duration\r\nof treatment 3 months" ] }, "GLYCERYL TRINITRATE - NITRATES": { "indications": "Indications\u00a0anal fissure (section 1.7.4); extravasation (section 10.3)Sublingual: prophylaxis and treatment of anginaBuccal: prophylaxis and treatment of angina;\r\nadjunct in unstable angina; acute and congestive heart failureInjection: control of hypertension and myocardial\r\nischaemia during and after cardiac surgery; induction of controlled\r\nhypotension during surgery; congestive heart failure; unstable anginaTransdermal: see under preparations below", "name": "GLYCERYL TRINITRATE - NITRATES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "GLYCERYL TRINITRATE" ], "cautions": "Cautions\u00a0hypothyroidism; malnutrition; hypothermia; recent history of myocardial infarction; heart failure due to obstruction; hypoxaemia or other ventilation and perfusion\r\nabnormalities; susceptibility to angle-closure\r\nglaucoma; metal-containing transdermal systems should\r\nbe removed before magnetic resonance imaging procedures, cardioversion,\r\nor diathermy; avoid abrupt withdrawal; monitor blood pressure and heart rate during intravenous infusion; tolerance (\n(From 2.6.1 Nitrates: British National Formulary)\nTolerance\u00a0Many patients on long-acting or transdermal nitrates rapidly develop tolerance (with reduced therapeutic effects). Reduction of blood-nitrate concentrations to low levels for 4 to 8 hours each day usually maintains effectiveness in such patients. If tolerance is suspected during the use of transdermal patches they should be left off for several consecutive hours in each 24 hours; in the case of modified-release tablets of isosorbide dinitrate (and conventional formulations of isosorbide mononitrate), the second of the two daily doses should be given after about 8 hours rather than after 12 hours. Conventional formulations of isosorbide mononitrate should not usually be given more than twice daily unless small doses are used; modified-release formulations of isosorbide mononitrate should only be given once daily, and used in this way do not produce tolerance.); interactions: Appendix 1 (nitrates)", "side-effects": "Side-effects\u00a0postural hypotension, tachycardia (but paradoxical\r\nbradycardia also reported); throbbing headache, dizziness; less commonly nausea, vomiting, heartburn, flushing, syncope,\r\ntemporary hypoxaemia, rash, application site reactions with transdermal\r\npatches; very rarely angle-closure glaucomaInjection\u00a0Specific side-effects following injection\r\n(particularly if given too rapidly) include severe hypotension, diaphoresis,\r\napprehension, restlessness, muscle twitching, retrosternal discomfort,\r\npalpitation, abdominal pain; prolonged administration has been associated\r\nwith methaemoglobinaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2633.htm", "doses": [ "Sublingually, 0.3\u20131\u00a0mg, repeated as required;\r\nsee also under preparations", "By buccal administration, see under\r\npreparation", "By intravenous infusion, 10\u2013200\u00a0micrograms/minute,\r\nadjusted according to response; max. 400\u00a0micrograms/minute; consult\r\nproduct literature for recommended starting doses specific to indication", "By transdermal application, see under\r\npreparations" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "DAUNORUBICIN": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nDaunorubicin also has general properties similar to those of doxorubicin. It should be given by intravenous infusion and is indicated for acute leukaemias. A liposomal formulation for intravenous use is licensed for AIDS-related Kaposi\u2019s sarcoma.", "name": "DAUNORUBICIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "DAUNORUBICIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60609.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and carcinogenic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "DIPHTHERIA-CONTAINING VACCINES Diphtheria antitoxin": { "indications": "Indications\u00a0\n(From Diphtheria vaccines: British National Formulary)\nDiphtheria vaccines", "name": "DIPHTHERIA-CONTAINING VACCINES Diphtheria antitoxin", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Diphtheria vaccines", "DIPHTHERIA-CONTAINING VACCINES", "Diphtheria antitoxin" ], "cautions": "Cautions\u00a0see section 14.1 and see also individual components\r\nof vaccines", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nrestlessness, sleep disturbances, and unusual crying in infants", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6481.htm", "doses": [ "See under preparations", "Name[Diphtheria Antitoxin ] Dose\u00a0prophylaxis, not recommended therefore no dose stated\r\n(see notes above)Treatment, consult product literatureAvailable from Centre for Infections (Tel (020) 8200 6868) or\r\nin Northern Ireland from Public Health Laboratory, Belfast City Hospital\r\n(Tel (028) 9032 9241)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "BECLOMETASONE DIPROPIONATE - DRUGS USED IN NASAL ALLERGY": { "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "indications": "Indications\u00a0prophylaxis and\r\ntreatment of allergic and vasomotor rhinitis", "name": "BECLOMETASONE DIPROPIONATE - DRUGS USED IN NASAL ALLERGY", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60776.htm", "doses": [ "adult and child over 6 years, 100\u00a0micrograms (2 sprays) into\r\neach nostril twice daily; max. total 400\u00a0micrograms (8 sprays) daily;\r\nwhen symptoms controlled, dose reduced to 50\u00a0micrograms (1 spray)\r\ninto each nostril twice daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "BECLOMETASONE DIPROPIONATE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered." }, "RITUXIMAB - CYTOKINE MODULATORS": { "indications": "Indications\u00a0see under Cytokine Modulators above; malignant disease\r\n(section 8.2.3)", "name": "RITUXIMAB - CYTOKINE MODULATORS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 8.2.3; predisposition\r\nto infection; hepatitis B virus\u2014monitor\r\nfor active infectionAlert card\u00a0Patients with rheumatoid\r\narthritis should be provided with the patient alert card before administration", "side-effects": "Side-effects\u00a0section 8.2.3 and under Cytokine Modulators; also dyspepsia; hypertension, hypotension; rhinitis,\r\nsore throat; asthenia, paraesthesia, migraine; arthralgia, muscle\r\nspasm; urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129937.htm", "doses": [ "By intravenous infusion, adult, rheumatoid arthritis (in combination with\r\nmethotrexate), 1\u00a0g, repeated 2 weeks after initial infusion", "Patients should receive premedication\r\nbefore each infusion (consult product literature for details) and\r\nbe provided with a patient alert card" ], "pregnancy": "Pregnancy\u00a0section 8.2.3" }, "DOXORUBICIN HYDROCHLORIDE Lipid formulation": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nDoxorubicin is used to treat the acute leukaemias, Hodgkin\u2019s and non-Hodgkin\u2019s lymphomas, paediatric malignancies, and some solid tumours including breast cancer. It is given by injection into a fast-running infusion, commonly at 21-day intervals. Extravasation can cause severe tissue necrosis. Doxorubicin is largely excreted in the bile and an elevated bilirubin concentration is an indication for reducing the dose. Diarrhoea, dehydration, and red coloration of the urine can commonly occur, and renal damage has been reported. Supraventricular tachycardia related to drug administration is an uncommon complication. Higher cumulative doses are associated with cardiomyopathy and it is usual to limit total cumulative doses to 450\u00a0mg/m2 because symptomatic and potentially fatal heart failure is common above this dose. Patients should be assessed before treatment by echocardiography; the elderly, and those with cardiac disease, hypertension, or who have received myocardial irradiation, should be treated cautiously. Cardiac monitoring may assist in determining safe dosage. Caution is necessary with concomitant use of cardiotoxic drugs, or drugs that reduce cardiac contractility. Some evidence suggests that weekly low-dose administration may be less cardiotoxic. Doxorubicin is also given by bladder instillation for the treatment of transitional cell carcinoma, papillary bladder tumours and carcinoma in-situ. and %s\n(From 7.4.4 Bladder instillations and urological surgery: British National Formulary)\n7.4.4 Bladder instillations and urological surgery", "name": "DOXORUBICIN HYDROCHLORIDE Lipid formulation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "DOXORUBICIN HYDROCHLORIDE", "Lipid formulation" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant to tissues; interactions: Appendix 1 (doxorubicin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60706.htm", "doses": [ "See Doses", "Name[Caelyx\u00ae (Schering-Plough) ] Concentrate for intravenous infusion, pegylated doxorubicin hydrochloride 2\u00a0mg/mL\r\nencapsulated in liposomes. For dilution before use, net price 10-mL\r\nvial = \u00a3360.23, 25-mL vial = \u00a3712.49For AIDS-related Kaposi\u2019s sarcoma in patients\r\nwith low CD4 count and extensive mucocutaneous or visceral disease,\r\nfor advanced ovarian cancer when platinum-based chemotherapy has failed,\r\nfor progressive multiple myeloma (in combination with bortezomib)\r\nin patients who have received at least one prior therapy and who have\r\nundergone or are unsuitable for bone-marrow transplantation, and as\r\nmonotherapy for metastatic breast cancer in patients with increased\r\ncardiac risk" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and toxic in animal studies); manufacturer of liposomal product advises effective contraception\r\nduring and for at least 6 months after treatment in men or women;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "SODIUM CROMOGLICATE": { "indications": "Indications\u00a0prophylaxis of allergic rhinitis", "name": "SODIUM CROMOGLICATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Cromoglicate", "SODIUM CROMOGLICATE" ], "side-effects": "Side-effects\u00a0local irritation; rarely transient\r\nbronchospasm", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5654.htm", "doses": [ "adult and child, 1 spray into each nostril 2\u20134 times daily" ] }, "JAPANESE ENCEPHALITIS VACCINE - JAPANESE ENCEPHALITIS VACCINE": { "indications": "Indications\u00a0immunisation against Japanese encephalitis", "name": "JAPANESE ENCEPHALITIS VACCINE - JAPANESE ENCEPHALITIS VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Japanese encephalitis vaccine", "JAPANESE ENCEPHALITIS VACCINE" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also less commonly migraine, vertigo, pharyngolaryngeal pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202696.htm", "doses": [ "See under preparation", "by intramuscular injection in deltoid region, adult over 18 years 2 doses of 0.5\u00a0mL separated by\r\ninterval of 28 days; booster dose 1\u20132 years after completing primary\r\ncourse, but for those at continued risk the booster dose should be\r\ngiven 1 year after completing the primary course" ], "pregnancy": "Pregnancy\u00a0although manufacturer advises avoid because of limited\r\ninformation, miscarriage has been associated with Japanese encephalitis\r\nvirus infection acquired during the first 2 trimesters of pregnancy" }, "LOCAL CORTICOSTEROID INJECTIONS Dexamethasone": { "indications": "Indications\u00a0local inflammation of joints and soft\r\ntissues (for details, consult product literature)", "name": "LOCAL CORTICOSTEROID INJECTIONS Dexamethasone", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.2 Corticosteroids", "10.1.2.2 Local corticosteroid injections", "LOCAL CORTICOSTEROID INJECTIONS", "Dexamethasone" ], "cautions": "Cautions\u00a0\n(From 10.1.2.2 Local corticosteroid injections: British National Formulary)\nFull aseptic precautions are essential; infected areas should be avoided. Occasionally an acute inflammatory reaction develops after an intra-articular or soft-tissue injection of a corticosteroid. This may be a reaction to the microcrystalline suspension of the corticosteroid used, but must be distinguished from sepsis introduced into the injection site. and consult product literature; see also %s\n(From 6.3.2 Glucocorticoid therapy: British National Formulary)\n6.3.2 Glucocorticoid therapy", "side-effects": "Side-effects\u00a0see notes above and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208585.htm", "doses": [ "See under preparations", "by intra-articular injection (for details\r\nconsult product literature), 0.33\u20133.3\u00a0mg according to size (by soft-tissue infiltration 1.7\u20135\u00a0mg); where appropriate\r\nmay be repeated at intervals of 3\u201321 days", "Name[Dexamethasone (Non-proprietary) ] Injection, dexamethasone (as sodium phosphate) 4\u00a0mg/mL, net price 1-mL amp = 83p, 2-mL vial\r\n= \u00a31.27Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 0.3\u20133\u00a0mg according to size; where appropriate\r\nmay be repeated at intervals of 3\u201321 days according to response\nInjection, dexamethasone (as sodium\r\nphosphate) 3.3\u00a0mg/mL, net price 1-mL amp = \u00a31.00, 2-mL vial = \u00a31.98Dose\u00a0by intra-articular injection (for details\r\nconsult product literature), 0.33\u20133.3\u00a0mg according to size (by soft-tissue infiltration 1.7\u20135\u00a0mg); where appropriate\r\nmay be repeated at intervals of 3\u201321 days" ] }, "CORIFOLLITROPIN ALFA": { "indications": "Indications\u00a0controlled ovarian stimulation in combination\r\nwith a gonadotrophin-releasing hormone antagonist", "name": "CORIFOLLITROPIN ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins" ], "cautions": "Cautions\u00a0risk factors for thromboembolism; risk of ovarian hyperstimulation syndrome; acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0nausea; headache, fatigue; ovarian hyperstimulation,\r\npelvic pain, breast pain; less commonly vomiting,\r\nabdominal distension and pain, diarrhoea, constipation, dizziness,\r\novarian torsion; also reported ectopic pregnancy,\r\nmiscarriage, and multiple pregnancies", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207516.htm", "doses": [ "By subcutaneous injection, body-weight\r\nunder 60\u00a0kg, 100\u00a0micrograms; body-weight over 60\u00a0kg, 150\u00a0micrograms" ] }, "ENTECAVIR": { "indications": "Indications\u00a0chronic hepatitis B infection either with compensated\r\nliver disease (with evidence of viral replication, and histologically\r\ndocumented active liver inflammation or fibrosis) or decompensated liver disease", "name": "ENTECAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.3 Viral hepatitis", "5.3.3.1 Chronic hepatitis B", "ENTECAVIR" ], "cautions": "Cautions\u00a0monitor liver function tests every 3\r\nmonths, and viral markers for hepatitis B every 3\u20136 months during\r\ntreatment (continue monitoring for at least 1 year after discontinuation\u2014recurrent\r\nhepatitis may occur on discontinuation); HIV infection\u2014risk of HIV resistance in patients not receiving \u2018highly\r\nactive antiretroviral therapy\u2019; lamivudine-resistant\r\nchronic hepatitis B\u2014risk of entecavir resistance; discontinue if deterioration in liver function, hepatic steatosis,\r\nprogressive hepatomegaly or unexplained lactic acidosis", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, diarrhoea, raised\r\nserum amylase and lipase, headache, fatigue, dizziness, sleep disturbances; less commonly thrombocytopenia, rash, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129893.htm", "doses": [ "Compensated liver disease not previously treated with\r\nnucleoside analogues, adult over 18\r\nyears, 500\u00a0micrograms once daily", " Compensated liver disease with lamivudine-resistant chronic\r\nhepatitis B (but see notes above), adult over 18 years, 1\u00a0mg once daily; consider other treatment if inadequate\r\nresponse after 6 months", "To be taken at least 2 hours before\r\nor 2 hours after food", "Decompensated liver disease, adult over 18 years, 1\u00a0mg once daily", "To be taken at least 2 hours before\r\nor 2 hours after food" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises use only if potential benefit outweighs risk; effective contraception\r\nrequired during treatment" }, "ZIDOVUDINE": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs; prevention\r\nof maternal-fetal HIV transmission (see notes above under Pregnancy\r\nand Breast-feeding)", "name": "ZIDOVUDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also haematological toxicity particularly with high dose and advanced\r\ndisease\u2014monitor full blood count after 4 weeks of treatment, then\r\nevery 3 months; vitamin B12 deficiency\r\n(increased risk of neutropenia); if anaemia or myelosuppression\r\noccur, reduce dose or interrupt treatment according to product literature,\r\nor consider other treatment; elderly; interactions: Appendix 1 (zidovudine)", "side-effects": "Side-effects\u00a0see notes above; also anaemia (may require transfusion),\r\ntaste disturbance, chest pain, influenza-like symptoms, paraesthesia,\r\nneuropathy, convulsions, dizziness, drowsiness, anxiety, depression,\r\nloss of mental acuity, myopathy, gynaecomastia, urinary frequency,\r\nsweating, pruritus, pigmentation of nails, skin and oral mucosa", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4002.htm", "doses": [ "By mouth, 250\u2013300\u00a0mg twice daily; child 1 month\u201318 years see BNF for Children", "Prevention of maternal-fetal HIV transmission, seek specialist\r\nadvice (combination therapy preferred)", "Patients temporarily unable to take zidovudine by mouth, by intravenous infusion over 1 hour, 0.8\u20131\u00a0mg/kg\r\nevery 4 hours (approximating to 1.2\u20131.5\u00a0mg/kg every 4 hours by mouth)\r\nusually for not more than 2 weeks; child 3 months\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0limited information available; manufacturer advises\r\nuse only if clearly indicated; see also Pregnancy" }, "TIMOLOL MALEATE": { "indications": "Indications\u00a0see under Dose; glaucoma (section 11.6)", "name": "TIMOLOL MALEATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2527.htm", "doses": [ "Hypertension, initially 10\u00a0mg daily in 1\u20132 divided doses;\r\ngradually increased if necessary to max. 60\u00a0mg daily, usual maintenance\r\ndose 10\u201330\u00a0mg daily (doses above 30\u00a0mg daily given in divided doses)", "Angina, initially 5\u00a0mg twice daily increased if necessary by\r\n10\u00a0mg daily every 3\u20134 days; max. 30\u00a0mg twice daily", "Prophylaxis after myocardial infarction, initially 5\u00a0mg twice\r\ndaily, increased after 2 days to 10\u00a0mg twice daily if tolerated", "Migraine prophylaxis, 10\u201320\u00a0mg daily in 1\u20132 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "CORTICOSTEROIDS": { "indications": "Indications\u00a0oral and perioral lesions", "name": "CORTICOSTEROIDS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "CORTICOSTEROIDS" ], "side-effects": "Side-effects\u00a0occasional exacerbation of local infection; thrush\r\nor other candidal infections", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5691.htm", "doses": [ "adult and child over 12 years, 1 lozenge 4 times daily, allowed\r\nto dissolve slowly in the mouth in contact with the ulcer; child under 12 years, only on medical advice" ] }, "DARUNAVIR": { "indications": "Indications\u00a0HIV infection in combination with other\r\nantiretroviral drugs", "name": "DARUNAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors", "DARUNAVIR" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nProtease inhibitors; also sulfonamide\r\nsensitivity; monitor liver function before\r\nand during treatment; interactions: Appendix 1 (darunavir)Rash\u00a0Mild to moderate rash occurs commonly, usually\r\nwithin the first 4 weeks of therapy and resolves without stopping\r\ntreatment. Severe skin rash (including Stevens-Johnson syndrome and\r\ntoxic epidermal necrolysis) occurs less frequently and may be accompanied\r\nby fever, malaise, arthralgia, myalgia, oral lesions, conjunctivitis,\r\nhepatitis, or eosinophilia; treatment should be stopped\r\nif severe rash develops", "side-effects": "Side-effects\u00a0\n(From Protease inhibitors: British National Formulary)\nProtease inhibitors; also haematemesis, myocardial\r\ninfarction, angina, QT interval prolongation, syncope, bradycardia,\r\ntachycardia, palpitation, hypertension, flushing, peripheral oedema,\r\ndyspnoea, cough, peripheral neuropathy, anxiety, confusion, memory\r\nimpairment, depression, abnormal dreams, convulsions, increased appetite,\r\nweight changes, pyrexia, hypothyroidism, osteoporosis, gynaecomastia,\r\nerectile dysfunction, reduced libido, dysuria, polyuria, nephrolithiasis,\r\nrenal failure, arthralgia, visual disturbances, dry eyes, conjunctival\r\nhyperaemia, rhinorrheoa, throat irritation, dry mouth, stomatisis,\r\nnail discoloration, acne, seborrhoeic dermatitis, eczema, increased\r\nsweating, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130111.htm", "doses": [ "With low-dose ritonavir, adult over 18 years previously treated with antiretroviral therapy, 600\u00a0mg\r\ntwice daily or (if no resistance to darunavir, if\r\nplasma HIV-RNA concentration less than 100 000 copies/mL, and if CD4\r\ncell count greater than 100 cells \u00d7106/litre)\r\n800\u00a0mg once daily; child 6\u201318 years\r\nsee BNF for Children", "With low-dose ritonavir, adult over 18 years not previously treated with antiretroviral therapy,\r\n800\u00a0mg once daily", "If a dose is more than\r\n6 hours late on the twice daily regimen (or more than 12 hours late\r\non the once daily regimen), the missed dose should not be taken and\r\nthe next dose should be taken at the normal time" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "SODIUM NITROPRUSSIDE": { "indications": "Indications\u00a0hypertensive emergencies (see section 2.5); controlled\r\nhypotension in anaesthesia; acute or chronic heart failure", "name": "SODIUM NITROPRUSSIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs" ], "cautions": "Cautions\u00a0hypothyroidism, hyponatraemia, ischaemic heart disease, impaired cerebral circulation, elderly; hypothermia; monitor\r\nblood pressure (including intra-arterial blood pressure) and blood-cyanide concentration, and if treatment exceeds 3 days,\r\nalso blood-thiocyanate concentration; avoid sudden withdrawal\u2014terminate\r\ninfusion over 15\u201330 minutes; protect infusion\r\nfrom light; interactions: Appendix\r\n1 (sodium nitroprusside)", "side-effects": "Side-effects\u00a0associated with over rapid reduction in blood\r\npressure (reduce infusion rate): headache, dizziness, nausea, retching,\r\nabdominal pain, perspiration, palpitation, anxiety, retrosternal discomfort;\r\noccasionally reduced platelet count, acute transient phlebitisCyanide\u00a0Side-effects caused by excessive plasma\r\nconcentration of the cyanide metabolite include tachycardia, sweating,\r\nhyperventilation, arrhythmias, marked metabolic acidosis (discontinue\r\nand give antidote, see Cyanides, Emergency Treatment of Poisoning)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2542.htm", "doses": [ "Hypertensive emergencies, by intravenous infusion, initially 0.5\u20131.5\u00a0micrograms/kg/minute, then increased in steps\r\nof 500\u00a0nanograms/kg/minute every 5 minutes within range 0.5\u20138\u00a0micrograms/kg/minute\r\n(lower doses if already receiving other antihypertensives); stop if\r\nresponse unsatisfactory with max. dose in 10 minutes", "Lower initial dose of 300\u00a0nanograms/kg/minute\r\nhas been used", "Maintenance of blood pressure at 30\u201340% lower than pretreatment\r\ndiastolic blood pressure, 20\u2013400\u00a0micrograms/minute (lower doses for\r\npatients being treated with other antihypertensives)", "Controlled hypotension in surgery, by intravenous infusion, max. 1.5\u00a0micrograms/kg/minute", "Heart failure, by intravenous infusion, initially\r\n10\u201315\u00a0micrograms/minute, increased every 5\u201310 minutes as necessary;\r\nusual range 10\u2013200\u00a0micrograms/minute normally for max. 3 days" ], "pregnancy": "Pregnancy\u00a0avoid prolonged use\u2014potential for accumulation of\r\ncyanide in fetus" }, "MEBENDAZOLE": { "indications": "Indications\u00a0threadworm, roundworm, whipworm, and hookworm infections", "name": "MEBENDAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.5 Anthelmintics", "5.5.1 Drugs for threadworms", "MEBENDAZOLE" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (mebendazole)Note\u00a0The package insert in the Vermox\u00ae pack includes the statement that it is not suitable for women known\r\nto be pregnant or children under 2 years", "side-effects": "Side-effects\u00a0abdominal pain; less commonly diarrhoea, flatulence; rarely hepatitis,\r\nconvulsions, dizziness, neutropenia, urticaria, alopecia, rash (including\r\nStevens-Johnson syndrome and toxic epidermal necrolysis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4059.htm", "doses": [ "Threadworms, adult and child over 2 years, 100\u00a0mg as a single dose; if reinfection\r\noccurs second dose may be needed after 2 weeks; child under 2 years, see BNF for Children", "Whipworms, adult and child over 2 years, 100\u00a0mg twice daily for 3 days; child under 2 years, see BNF for Children", "Roundworms\u2014section\r\n5.5.2", "Hookworms\u2014section 5.5.4" ], "pregnancy": "Pregnancy\u00a0manufacturer advises toxicity in animal studies" }, "FOSAPREPITANT": { "indications": "Indications\u00a0adjunct to dexamethasone and a 5HT3-receptor antagonist in preventing nausea and\r\nvomiting associated with moderately and highly emetogenic chemotherapy", "name": "FOSAPREPITANT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Neurokinin-receptor antagonists" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (aprepitant)", "side-effects": "Side-effects\u00a0see Aprepitant", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200971.htm", "doses": [ "By intravenous infusion, over 20\u201330 minutes, adult over 18 years, 150\u00a0mg 30 minutes before chemotherapy\r\non day 1 of cycle only; consult product literature for dose of concomitant\r\ncorticosteroid and 5HT3-receptor antagonist " ], "pregnancy": "Pregnancy\u00a0see Aprepitant" }, "TRYPTOPHAN": { "indications": "Indications\u00a0see notes above", "name": "TRYPTOPHAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs" ], "cautions": "Cautions\u00a0eosinophilia-myalgia syndrome has been\r\nreported (withhold treatment if increased eosinophil\r\ncount, myalgia, arthralgia, fever, dyspnoea, neuropathy, oedema or\r\nskin lesions develop until possibility of eosinophilia-myalgia syndrome\r\nexcluded); interactions: Appendix 1 (tryptophan)", "side-effects": "Side-effects\u00a0drowsiness, nausea, headache, light-headedness,\r\nsuicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy);\r\neosinophilia-myalgia syndrome, see Cautions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/17513.htm", "doses": [ "1\u00a0g 3 times daily; max. 6\u00a0g daily; elderly lower dose may be appropriate especially in renal or hepatic impairment; child not recommended" ], "pregnancy": "Pregnancy\u00a0no information available" }, "DICLOFENAC SODIUM - PHOTODAMAGE": { "side-effects": "Side-effects\u00a0as for topical NSAIDs, see section 10.3.2; also\r\nparaesthesia; application of large amounts may result in systemic\r\neffects, see section 10.1", "indications": "Indications\u00a0actinic keratosis", "name": "DICLOFENAC SODIUM - PHOTODAMAGE", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106184.htm", "doses": [ "Apply thinly twice daily for 60\u201390 days; max. 8\u00a0g daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.8 Sunscreens and camouflagers", "13.8.1 Sunscreen preparations", "Photodamage", "DICLOFENAC SODIUM" ], "cautions": "Cautions\u00a0as for topical NSAIDs, see section 10.3.2" }, "FOLINIC ACID Calcium folinate": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nFolinic acid (given as calcium folinate) is used to counteract the folate-antagonist action of methotrexate and thus speed recovery from methotrexate-induced mucositis or myelosuppression (\u2018folinic acid rescue\u2019).Folinic acid is also used in the management of methotrexate overdose, together with other measures to maintain fluid and electrolyte balance, and to manage possible renal failure.Folinic acid does not counteract the antibacterial activity of folate antagonists such as trimethoprim.When folinic acid and fluorouracil are used together in metastatic colorectal cancer the response-rate improves compared to that with fluorouracil alone.", "name": "FOLINIC ACID Calcium folinate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression", "FOLINIC ACID", "Calcium folinate" ], "cautions": "Cautions\u00a0avoid simultaneous administration of methotrexate; not indicated for pernicious anaemia\r\nor other megaloblastic anaemias caused by vitamin B12 deficiency; interactions: Appendix 1 (folates)", "side-effects": "Side-effects\u00a0rarely pyrexia after parenteral use; insomnia, agitation, and depression\r\nafter high doses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4744.htm", "doses": [ "See under preparations", "Prevention of methotrexate-induced adverse\r\neffects, usually started 12\u201324 hours after start of methotrexate infusion, by intramuscular injection, or by intravenous injection, or by intravenous infusion, 15\u00a0mg, repeated every 6 hours for\r\n24 hours (may be continued by mouth); consult local treatment protocol\r\nfor further information", "Adjunct to fluorouracil in colorectal cancer,\r\nconsult product literature", "Name[Calcium Folinate (Non-proprietary) ] Tablets, scored, folinic acid (as\r\ncalcium salt) 15\u00a0mg, net price 10-tab pack = \u00a339.20, 30-tab pack =\r\n\u00a385.74Brands include Refolinon\u00aeNote\u00a0Not all strengths and pack sizes are available\r\nfrom all manufacturers\nInjection, folinic acid (as calcium\r\nsalt) 3\u00a0mg/mL, net price 1-mL amp = \u00a34.00, 10-mL amp = \u00a34.62; 7.5\u00a0mg/mL,\r\nnet price 2-mL amp = \u00a37.80; 10\u00a0mg/mL, net price 5-mL vial = \u00a319.41,\r\n10-mL vial = \u00a335.09, 30-mL vial = \u00a394.69, 35-mL vial = \u00a390.98Brands include Refolinon\u00aeNote\u00a0Not all strengths and pack sizes are available\r\nfrom all manufacturers\nInjection, powder for reconstitution,\r\nfolinic acid (as calcium salt), net price 15-mg vial = \u00a34.46; 30-mg\r\nvial = \u00a38.36Dose\u00a0Note\u00a0Doses expressed as folinic acidPrevention of methotrexate-induced adverse\r\neffects, usually started 12\u201324 hours after start of methotrexate infusion, by intramuscular injection, or by intravenous injection, or by intravenous infusion, 15\u00a0mg, repeated every 6 hours for\r\n24 hours (may be continued by mouth); consult local treatment protocol\r\nfor further informationSuspected methotrexate overdosage, by intravenous injection or by intravenous infusion (at a max. rate of 160\u00a0mg/minute), initial dose equal to or exceeding\r\ndose of methotrexate; consult poisons information centres for advice on continuing managementAdjunct to fluorouracil in colorectal cancer,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; benefit outweighs risk" }, "PRAZOSIN": { "indications": "Indications\u00a0hypertension (\n(From 2.5.4 Alpha-adrenoceptor blocking drugs: British National Formulary)\n2.5.4 Alpha-adrenoceptor blocking drugs); congestive\r\nheart failure (but \n(From Heart failure: British National Formulary)\nHeart failure); Raynaud\u2019s syndrome (see also %s\n(From 2.6.4 Peripheral vasodilators and related drugs: British National Formulary)\nManagement of Raynaud\u2019s syndrome includes avoidance of exposure to cold and stopping smoking. More severe symptoms may require vasodilator treatment, which is most often successful in primary Raynaud\u2019s syndrome. Nifedipine (section 2.6.2) is useful for reducing the frequency and severity of vasospastic attacks. Alternatively, naftidrofuryl may produce symptomatic improvement; inositol nicotinate (a nicotinic acid derivative) may also be considered. Pentoxifylline, prazosin, and moxisylyte are not established as being effective for the treatment of Raynaud\u2019s syndrome.); benign prostatic hyperplasia (%s\n(From 7.4.1 Drugs for urinary retention: British National Formulary)\n7.4.1 Drugs for urinary retention)", "name": "PRAZOSIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "PRAZOSIN" ], "cautions": "Cautions\u00a0first dose may cause collapse due to\r\nhypotension (therefore should be taken on retiring to bed); elderly; cataract surgery\r\n(risk of intra-operative floppy iris syndrome); interactions: Appendix 1 (alpha-blockers)Driving\u00a0May affect performance of\r\nskilled tasks e.g. driving", "side-effects": "Side-effects\u00a0see section 7.4.1; also\r\ndyspnoea; nervousness; urinary frequency; less commonly insomnia, paraesthesia, sweating, arthralgia, eye disorders, tinnitus,\r\nand epistaxis; rarely pancreatitis, flushing, vasculitis,\r\nbradycardia, hallucinations, worsening of narcolepsy, gynaecomastia,\r\nurinary incontinence, and alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2575.htm", "doses": [ "Hypertension (see notes above), 500\u00a0micrograms 2\u20133 times\r\ndaily for 3\u20137 days, the initial dose on retiring to bed at night (to\r\navoid collapse, see Cautions); increased to 1\u00a0mg 2\u20133 times daily for\r\na further 3\u20137 days; further increased if necessary to max. 20\u00a0mg daily\r\nin divided doses", "Congestive heart failure (but see section 2.5.5), 500\u00a0micrograms 2\u20134 times daily (initial dose\r\nat bedtime, see above), increasing to 4\u00a0mg daily in divided doses;\r\nmaintenance 4\u201320\u00a0mg daily in divided doses (but rarely used)", "Raynaud\u2019s syndrome (but efficacy not established, see section 2.6.4), initially\r\n500\u00a0micrograms twice daily (initial dose at bedtime, see above) increased,\r\nif necessary, after 3\u20137 days to usual maintenance 1\u20132\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0no evidence of teratogenicity; manufacturers advise\r\nuse only when potential benefit outweighs risk" }, "REPAGLINIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus (as monotherapy or in combination with metformin\r\nwhen metformin alone inadequate)", "name": "REPAGLINIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs" ], "cautions": "Cautions\u00a0substitute insulin during intercurrent\r\nillness (such as myocardial infarction, coma, infection,\r\nand trauma) and during surgery (omit repaglinide on morning of surgery\r\nand recommence when eating and drinking normally); debilitated\r\nand malnourished patients; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0abdominal pain, diarrhoea, constipation, nausea,\r\nvomiting; rarely hypoglycaemia, hypersensitivity\r\nreactions including pruritus, rashes, vasculitis, urticaria, and visual\r\ndisturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/73892.htm", "doses": [ "adult over 18 years, initially\r\n500\u00a0micrograms within 30 minutes before main meals (1\u00a0mg if transferring\r\nfrom another oral hypoglycaemic), adjusted according to response at\r\nintervals of 1\u20132 weeks; up to 4\u00a0mg may be given as a single dose,\r\nmax. 16\u00a0mg daily; elderly over 75 years,\r\nnot recommended" ], "pregnancy": "Pregnancy\u00a0avoid" }, "GELATIN": { "indications": "Indications\u00a0low blood volume (but \n(From Plasma substitutes: British National Formulary)\nPlasma substitutes)", "name": "GELATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "GELATIN" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200800.htm", "doses": [ "By intravenous infusion, initially 500\u20131000\u00a0mL\r\nof a 3.5\u20134% solution (see notes above)" ], "pregnancy": "Pregnancy\u00a0manufacturer of Geloplasma\u00ae advises\r\navoid at the end of pregnancy" }, "NORETHISTERONE - FEMALE SEX HORMONES": { "indications": "Indications\u00a0see under Dose; HRT (section 6.4.1.1); contraception (section 7.3.1 and section 7.3.2); malignant disease (section\r\n8.3.2)", "name": "NORETHISTERONE - FEMALE SEX HORMONES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.4 Sex hormones", "6.4.1 Female sex hormones", "6.4.1.2 Progestogens" ], "cautions": "Cautions\u00a0\n(From 6.4.1.2 Progestogens: British National Formulary)\nCautions\u00a0Progestogens should be used with caution in conditions that may worsen with fluid retention e.g. epilepsy, hypertension, migraine, asthma, or cardiac dysfunction, and in those susceptible to thromboembolism (particular caution with high dose). Care is also required in those with a history of depression. Progestogens can decrease glucose tolerance and patients with diabetes should be monitored closely. For interactions see Appendix 1 (progestogens).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4350.htm", "doses": [ "Endometriosis, by mouth, 10\u201315\u00a0mg daily\r\nfor 4\u20136 months or longer, starting on day 5 of cycle (if spotting\r\noccurs increase dose to 20\u201325\u00a0mg daily, reduced once bleeding has\r\nstopped)", "Dysfunctional uterine bleeding, menorrhagia (but see notes above), by mouth, 5\u00a0mg 3 times daily for 10 days to arrest bleeding;\r\nto prevent bleeding 5\u00a0mg twice daily from day 19 to 26", "Dysmenorrhoea (but see notes above), by mouth, 5\u00a0mg 3 times daily from day 5 to 24 for 3\u20134 cycles", "Premenstrual syndrome (but not recommended, see notes above), by mouth, 5\u00a0mg 2\u20133 times daily from day 19 to 26 for several\r\ncycles", "Postponement of menstruation, by mouth, 5\u00a0mg\r\n3 times daily starting 3 days before expected onset (menstruation\r\noccurs 2\u20133 days after stopping)" ], "pregnancy": "Pregnancy\u00a0section 8.3.2" }, "ABCIXIMAB": { "indications": "Indications\u00a0prevention of ischaemic cardiac complications in patients undergoing\r\npercutaneous coronary intervention; short-term prevention of myocardial\r\ninfarction in patients with unstable angina not responding to conventional\r\ntreatment and who are scheduled for percutaneous coronary intervention\r\n(use under specialist supervision)", "name": "ABCIXIMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs" ], "cautions": "Cautions\u00a0measure baseline prothrombin time, activated clotting time, activated partial thromboplastin time,\r\nplatelet count, haemoglobin and haematocrit; monitor haemoglobin and haematocrit 12 hours and 24 hours after start\r\nof treatment and platelet count 2\u20134 hours and 24 hours after start\r\nof treatment; concomitant use of drugs that increase\r\nrisk of bleeding; discontinue if uncontrollable\r\nserious bleeding occurs or emergency cardiac surgery needed; consult product literature for details of procedures to minimise\r\nbleeding; elderly", "side-effects": "Side-effects\u00a0bleeding manifestations; nausea, vomiting, hypotension,\r\nbradycardia, chest pain, back pain, headache, fever, puncture site\r\npain, thrombocytopenia; rarely cardiac tamponade,\r\nadult respiratory distress, hypersensitivity reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81418.htm", "doses": [ "adult initially by intravenous injection over 1 minute, 250\u00a0micrograms/kg,\r\nthen by intravenous infusion, 125\u00a0nanograms/kg/minute\r\n(max. 10\u00a0micrograms/minute); for prevention of ischaemic complications\r\nstart 10\u201360 minutes before percutaneous coronary intervention and\r\ncontinue infusion for 12 hours; for unstable angina start up to 24\r\nhours before possible percutaneous coronary intervention and continue\r\ninfusion for 12 hours after intervention" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "LEVOFOLINIC ACID": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nThe calcium salt of levofolinic acid, a single isomer of folinic acid, is also used for rescue therapy following methotrexate administration, for cases of methotrexate overdose, and for use with fluorouracil for colorectal cancer. The dose of calcium levofolinate is generally half that of calcium folinate.", "name": "LEVOFOLINIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression" ], "cautions": "Cautions\u00a0see Folinic acid", "side-effects": "Side-effects\u00a0see Folinic acid", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/204219.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see Folinic acid" }, "CO-CARELDOPA With entacapone": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-CARELDOPA With entacapone", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-CARELDOPA", "With entacapone" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128294.htm", "doses": [ "Expressed as levodopa, initially 100\u00a0mg (with carbidopa\r\n25\u00a0mg) 3 times daily, increased by 50\u2013100\u00a0mg (with carbidopa 12.5\u201325\u00a0mg)\r\ndaily or on alternate days according to response, up to 800\u00a0mg (with\r\ncarbidopa 200\u00a0mg) daily in divided doses", "Alternatively, initially 50\u2013100\u00a0mg (with carbidopa 10\u201312.5\u00a0mg)\r\n3\u20134 times daily, increased by 50\u2013100\u00a0mg daily or on alternate days\r\naccording to response, up to 800\u00a0mg (with carbidopa 80\u2013100\u00a0mg) daily\r\nin divided doses ", "Alternatively, initially 125\u00a0mg (with carbidopa 12.5\u00a0mg, as\r\n\u00bd tablet of co-careldopa 25/250) 1\u20132 times daily, increased by 125\u00a0mg\r\n(with carbidopa 12.5\u00a0mg) daily or on alternate days according to response", "When co-careldopa is used, the total daily dose of carbidopa\r\nshould be at least 70\u00a0mg. A lower dose may not achieve full inhibition\r\nof extracerebral dopa-decarboxylase, with a resultant\r\nincrease in side-effects.", "When transferring patients\r\nfrom another levodopa/dopa-decarboxylase inhibitor preparation, the\r\nprevious preparation should be discontinued at least 12 hours before", "only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily", "only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily", "only 1 tablet to be taken for each dose; max. 7 tablets\r\ndaily", "Name[Stalevo\u00ae (Orion) ] Tablets, f/c, brown, levodopa 50\u00a0mg,\r\ncarbidopa 12.5\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily\nTablets, f/c, brown, levodopa 75\u00a0mg,\r\ncarbidopa 18.75\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily\nTablets, f/c, brown, levodopa 100\u00a0mg,\r\ncarbidopa 25\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily\nTablets, f/c, brown, levodopa 125\u00a0mg,\r\ncarbidopa 31.25\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily\nTablets, f/c, brown, levodopa 150\u00a0mg,\r\ncarbidopa 37.5\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 10 tablets\r\ndaily\nTablets, f/c, brown, levodopa 200\u00a0mg,\r\ncarbidopa 50\u00a0mg, entacapone 200\u00a0mg, net price 30-tab pack = \u00a320.79,\r\n100-tab pack = \u00a369.31. \r\n Label:\r\n 10, 14 (urine\r\nreddish-brown), 25, counselling, driving, see notes aboveDose\u00a0only 1 tablet to be taken for each dose; max. 7 tablets\r\ndailyNote\u00a0Patients receiving standard-release co-careldopa\r\nor co-beneldopa alone, initiate Stalevo\u00ae at a dose\r\nthat provides similar (or slightly lower) amount of levodopaPatients with dyskinesia or receiving more than 800\u00a0mg levodopa\r\ndaily, introduce entacapone before transferring to Stalevo\u00ae (levodopa dose may need to be reduced by 10\u201330% initially)Patients receiving entacapone and standard-release co-careldopa\r\nor co-beneldopa, initiate Stalevo\u00ae at a dose that\r\nprovides similar (or slightly higher) amount of levodopa" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "IBUPROFEN Modified release": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including juvenile idiopathic\r\narthritis) and other musculoskeletal disorders; mild to moderate pain\r\nincluding dysmenorrhoea; postoperative analgesia; migraine; dental\r\npain; fever with discomfort and pain in children; post-immunisation\r\npyrexia (section\r\n14.1)", "name": "IBUPROFEN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "IBUPROFEN", "Modified release" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5197.htm", "doses": [ "adult and child over 12 years, initially 300\u2013400\u00a0mg 3\u20134 times\r\ndaily; increased if necessary to max. 2.4\u00a0g daily; maintenance dose\r\nof 0.6\u20131.2\u00a0g daily may be adequate", "Pain and fever in children, child 1\u20133 months, see BNF for Children; child 3\u20136 months (body-weight\r\nover 5\u00a0kg), 50\u00a0mg 3 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided\r\ndoses); child 6 months\u20131 year, 50\u00a0mg\r\n3\u20134 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided doses); child 1\u20134 years, 100\u00a0mg 3 times daily (max. 30\u00a0mg/kg\r\ndaily in 3\u20134 divided doses); child 4\u20137\r\nyears, 150\u00a0mg 3 times daily (max. 30\u00a0mg/kg daily in 3\u20134 divided doses); child 7\u201310 years, 200\u00a0mg 3 times daily (up to 30\u00a0mg/kg\r\ndaily (max. 2.4\u00a0g) in 3\u20134 divided doses); child 10\u201312 years, 300\u00a0mg 3 times daily (up to 30\u00a0mg/kg daily (max. 2.4\u00a0g)\r\nin 3\u20134 divided doses) ", "Rheumatic disease in children (including juvenile idiopathic\r\narthritis), child 3 months\u201318 years\r\n(body-weight over 5\u00a0kg), 30\u201340\u00a0mg/kg (max. 2.4\u00a0g) daily in 3\u20134 divided\r\ndoses; in systemic juvenile idiopathic arthritis up to 60\u00a0mg/kg (max.\r\n2.4\u00a0g) daily [unlicensed] in 4\u20136 divided doses", "Name[Brufen Retard\u00ae (Abbott) ] Tablets, m/r, ibuprofen 800\u00a0mg, net price 56-tab pack = \u00a36.48. \r\n Label:\r\n 25, 27Dose\u00a0adult and child over 12 years, 2 tablets daily as a single\r\ndose, preferably in the early evening, increased in severe cases to\r\n3 tablets daily in 2 divided doses" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "BETAMETHASONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS": { "side-effects": "Side-effects\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\n11.4.1 Corticosteroids", "indications": "Indications\u00a0local treatment of inflammation (short-term)", "name": "BETAMETHASONE - CORTICOSTEROIDS AND OTHER ANTI-INFLAMMATORY PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5418.htm", "doses": [ "Apply eye drops every 1\u20132 hours until controlled then\r\nreduce frequency; apply eye ointment 2\u20134 times daily or at night when used with eye drops" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.4 Corticosteroids and other anti-inflammatory preparations", "11.4.1 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 11.4.1 Corticosteroids: British National Formulary)\nTopical corticosteroids are applied frequently for the first 24\u201348 hours; once inflammation is controlled, the frequency of application is reduced. They should normally only be used under expert supervision; three main dangers are associated with their use:a \u2018red eye\u2019, when the diagnosis is unconfirmed, may be due to herpes simplex virus, and a corticosteroid may aggravate the condition, leading to corneal ulceration, with possible damage to vision and even loss of the eye. Bacterial, fungal, and amoebic infections pose a similar hazard;\u2018steroid glaucoma\u2019 can follow the use of corticosteroid eye preparations in susceptible individuals;a \u2018steroid cataract\u2019 can follow prolonged use." }, "TOPIRAMATE": { "indications": "Indications\u00a0\n(From Topiramate: British National Formulary)\nTopiramate", "name": "TOPIRAMATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Topiramate", "TOPIRAMATE" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; risk of metabolic acidosis; risk of nephrolithiasis\u2014ensure adequate hydration (especially\r\nin strenuous activity or warm environment); avoid in acute\r\nporphyria (section 9.8.2); interactions: see Interactions in section 4.8.1 and Appendix 1 (topiramate)Important\u00a0Topiramate has been associated\r\nwith acute myopia with secondary angle-closure glaucoma, typically\r\noccurring within 1 month of starting treatment. Choroidal effusions resulting in anterior displacement of the lens\r\nand iris have also been reported. If raised intra-ocular pressure occurs:seek specialist ophthalmological advice;use appropriate measures to reduce intra-ocular pressure;stop topiramate as rapidly as feasible", "side-effects": "Side-effects\u00a0nausea, diarrhoea, vomiting, constipation, dyspepsia,\r\nabdominal pain, dry mouth, taste disturbance, gastritis, appetite\r\nchanges, dyspnoea, impaired attention, cognitive impairment, movement\r\ndisorders, seizures, tremor, malaise, impaired coordination, speech\r\ndisorder, drowsiness, dizziness, sleep disturbance, anxiety, confusion,\r\nparaesthesia, aggression, mood changes, depression, agitation, irritability,\r\nnephrolithiasis, urinary disorders, anaemia, arthralgia, muscle spasm,\r\nmyalgia, muscular weakness, visual disturbances, nystagmus, tinnitus,\r\nepistaxis, alopecia, rash, pruritus; less commonly pancreatitis, flatulence, abdominal distension, gingival bleeding,\r\nsalivation, halitosis, thirst, glossodynia, bradycardia, palpitation,\r\nhypotension, postural hypotension, flushing, altered sense of smell,\r\nperipheral neuropathy, suicidal ideation, psychosis, panic attack,\r\ninfluenza-like symptoms, sexual dysfunction, urinary calculus, haematuria,\r\nblood disorders (including leucopenia, neutropenia, and thrombocytopenia),\r\nhypokalaemia, metabolic acidosis, dry eye, photophobia, blepharospasm,\r\nincreased lacrimation, mydriasis, hearing loss, reduced sweating,\r\nskin discoloration; rarely Raynaud\u2019s syndrome, periorbital\r\noedema, unilateral blindness, Stevens-Johnson syndrome, abnormal skin\r\nodour, calcinosis; very rarely angle-closure glaucoma; also reported encephalopathy, hyperammonaemia, maculopathy,\r\ntoxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213574.htm", "doses": [ "Monotherapy in epilepsy, initially 25\u00a0mg at night for\r\n1 week then increased in steps of 25\u201350\u00a0mg taken\r\nin 2 divided doses at intervals of 1\u20132 weeks; usual dose 100\u2013200\u00a0mg\r\ndaily in 2 divided doses, adjusted according to response; max. 500\u00a0mg\r\ndaily (doses of 1\u00a0g daily have been used in refractory epilepsy); child 6\u201318 years, initially 0.5\u20131\u00a0mg/kg (max. 25\u00a0mg)\r\nat night for 1 week then increased in steps of 0.5\u20131\u00a0mg/kg\r\n(max. 50\u00a0mg) taken in 2 divided doses at intervals of 1\u20132 weeks; initial\r\ntarget dose 100\u00a0mg daily in 2 divided doses; max. 15\u00a0mg/kg (max. 500\u00a0mg)\r\ndaily", "Adjunctive therapy in epilepsy, initially 25\u201350\u00a0mg at night\r\nfor 1 week then increased in steps of 25\u201350\u00a0mg taken\r\nin 2 divided doses at intervals of 1\u20132 weeks; usual dose 200\u2013400\u00a0mg\r\ndaily in 2 divided doses; max. 400\u00a0mg daily; child 2\u201318 years, initially 1\u20133\u00a0mg/kg (max. 25\u00a0mg) at night for 1 week then increased in steps of 1\u20133\u00a0mg/kg (max. 50\u00a0mg) taken\r\nin 2 divided doses at intervals of 1\u20132 weeks; usual dose 5\u20139\u00a0mg/kg\r\ndaily in 2 divided doses; max. 15\u00a0mg/kg (max. 400\u00a0mg) daily", "Migraine prophylaxis, adult over\r\n18 years, initially 25\u00a0mg at night for 1 week then increased in steps of 25\u00a0mg at weekly intervals; usual dose 50\u2013100\u00a0mg\r\ndaily in 2 divided doses; max. 200\u00a0mg daily; child 16\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "INDINAVIR ": { "indications": "Indications\u00a0HIV infection in combination with nucleoside reverse transcriptase\r\ninhibitors", "name": "INDINAVIR ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; also ensure adequate hydration (risk of nephrolithiasis especially in\r\nchildren); patients at risk of nephrolithiasis\r\n(monitor for nephrolithiasis); patients\r\nat high risk of cardiovascular disease (especially if 10-year cardiovascular\r\nrisk greater than 20%); interactions: Appendix 1 (indinavir)", "side-effects": "Side-effects\u00a0see notes above; also reported, dry mouth, hypoaesthesia,\r\ndry skin, hyperpigmentation, alopecia, paronychia, interstitial nephritis\r\n(with medullary calcification and cortical atrophy in asymptomatic\r\nsevere leucocyturia), nephrolithiasis (may require interruption or\r\ndiscontinuation; more frequent in children), dysuria, haematuria,\r\ncrystalluria, proteinuria, pyuria (in children), pyelonephritis; haemolytic\r\nanaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/57103.htm", "doses": [ "adult over 18 years, seek\r\nspecialist advice" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies; manufacturer\r\nadvises use only if potential benefit outweighs risk; theoretical\r\nrisk of hyperbilirubinaemia and renal stones in neonate if used at\r\nterm " }, "RIVAROXABAN": { "indications": "Indications\u00a0\n(From Rivaroxaban: British National Formulary)\nRivaroxaban", "name": "RIVAROXABAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants", "Rivaroxaban" ], "cautions": "Cautions\u00a0\n(From Rivaroxaban: British National Formulary)\nRivaroxaban; also bleeding disorders; concomitant use of drugs that increase risk of bleeding; severe hypertension; active or recent gastro-intestinal ulceration; vascular retinopathy; anaesthesia with postoperative indwelling epidural\r\ncatheter (risk of paralysis\u2014monitor neurological signs and wait at\r\nleast 18 hours after rivaroxaban dose before removing catheter and\r\ndo not give next dose until at least 6 hours after catheter removal); recent surgery; interactions: Appendix 1 (rivaroxaban)", "side-effects": "Side-effects\u00a0nausea; haemorrhage (\n(From Rivaroxaban: British National Formulary)\nRivaroxaban); less commonly constipation, diarrhoea, dyspepsia, dry mouth, vomiting, hypotension,\r\noedema, tachycardia, thrombocythaemia, syncope, dizziness, headache,\r\nrenal impairment, pain in extremities, pruritus, and rash; jaundice\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201627.htm", "doses": [ "Prophylaxis of venous thromboembolism following knee replacement\r\nsurgery, adult over 18 years, 10\u00a0mg\r\nonce daily for 2 weeks starting 6\u201310 hours after surgery", "Prophylaxis of venous thromboembolism following hip replacement\r\nsurgery, adult over 18 years, 10\u00a0mg\r\nonce daily for 5 weeks starting 6\u201310 hours after surgery" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "AMISULPRIDE": { "indications": "Indications\u00a0schizophrenia", "name": "AMISULPRIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "Second-generation antipsychotic drugs", "AMISULPRIDE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\ninsomnia, anxiety, agitation, drowsiness, gastro-intestinal disorders\r\nsuch as constipation, nausea, vomiting, and dry mouth; less\r\ncommonly bradycardia; rarely seizures; urticaria\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129412.htm", "doses": [ "Acute psychotic episode, 400\u2013800\u00a0mg daily in 2 divided\r\ndoses, adjusted according to response; max. 1.2\u00a0g daily; child under 18 years not recommended", "Predominantly negative symptoms, 50\u2013300\u00a0mg daily; child under 18 years not recommended " ], "pregnancy": "Pregnancy\u00a0avoid" }, "BIPHASIC INSULIN LISPRO": { "indications": "Indications\u00a0diabetes mellitus", "name": "BIPHASIC INSULIN LISPRO", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "Biphasic insulins", "BIPHASIC INSULIN LISPRO" ], "cautions": "Cautions\u00a0see section 6.1.1.1 and Insulin Lispro; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/77951.htm", "doses": [ "By subcutaneous injection, up to 15 minutes\r\nbefore or soon after a meal, according to requirements" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "TOLVAPTAN": { "indications": "Indications\u00a0see notes above", "name": "TOLVAPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.2 Posterior pituitary hormones and antagonists", "Tolvaptan", "TOLVAPTAN" ], "cautions": "Cautions\u00a0ensure adequate fluid intake (monitor\r\nfor dehydration in patients who are fluid-restricted); discontinue if rapid rise in serum sodium (greater\r\nthan 12\u00a0mmol/litre in 24 hours); diabetes\r\nmellitus; pseudohyponatraemia associated\r\nwith diabetes mellitus (exclude before treatment); interactions: Appendix 1 (tolvaptan)", "side-effects": "Side-effects\u00a0nausea, constipation, dry mouth; postural hypotension;\r\nthirst, decreased appetite, fever, asthenia; hyperglycaemia; urinary\r\nfrequency; hyperkalaemia, dehydration, ecchymosis, increased blood\r\ncreatinine; pruritus; less commonly taste disturbance; also reported hypernatraemia, hyperuricaemia, hypoglycaemia,\r\nsyncope, and dizziness", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203991.htm", "doses": [ "adult over 18 years, 15\u00a0mg\r\nonce daily, increased as required to max. 60\u00a0mg daily " ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "CLOFARABINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nClofarabine is licensed for the treatment of acute lymphoblastic leukaemia in patients aged 1 to 21 years who have relapsed or are refractory after receiving at least two previous regimens. It is given by intravenous infusion.", "name": "CLOFARABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "CLOFARABINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; cardiac disease", "side-effects": "Side-effects\u00a0see section 8.1; also\r\ndiarrhoea, abdominal pain, jaundice; tachycardia, flushing, hypotension,\r\npericardial effusion, oedema, haematoma; dyspnoea, cough; anxiety,\r\nagitation, dizziness, drowsiness, headache, paraesthesia, peripheral\r\nneuropathy, restlessness; haematuria; arthralgia, myalgia; rash, pruritus,\r\nhand-foot (desquamative) syndrome, sweating; pancreatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129823.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (teratogenic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "ZUCLOPENTHIXOL ACETATE": { "indications": "Indications\u00a0short-term management of acute psychosis, mania,\r\nor exacerbations of chronic psychosis", "name": "ZUCLOPENTHIXOL ACETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "ZUCLOPENTHIXOL ACETATE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3260.htm", "doses": [ "By deep intramuscular injection into the\r\ngluteal muscle or lateral thigh, 50\u2013150\u00a0mg (elderly 50\u2013100\u00a0mg), repeated if necessary after 2\u20133 days (1\r\nadditional dose may be needed 1\u20132 days after the first injection);\r\nmax. cumulative dose 400\u00a0mg in 2 weeks and max. 4 injections; max.\r\nduration of treatment 2 weeks\u2014if maintenance treatment necessary change\r\nto an oral antipsychotic 2\u20133 days after last injection, or to a longer acting antipsychotic depot injection given concomitantly\r\nwith last injection of zuclopenthixol acetate; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "PROCHLORPERAZINE": { "indications": "Indications\u00a0severe nausea, vomiting, vertigo, labyrinthine\r\ndisorders (see notes above); other indications %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE", "name": "PROCHLORPERAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0see Prochlorperazine, %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE; elderly (see notes above)", "side-effects": "Side-effects\u00a0see Prochlorperazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3420.htm", "doses": [ "Doses are expressed as prochlorperazine\r\nmaleate or mesilate; 1\u00a0mg prochlorperazine maleate \u2261 1\u00a0mg prochlorperazine mesilate", "By mouth, nausea and vomiting, acute\r\nattack, 20\u00a0mg initially then 10\u00a0mg after 2 hours; prevention 5\u201310\u00a0mg\r\n2\u20133 times daily; child (over 10\u00a0kg\r\nonly) 250\u00a0micrograms/kg 2\u20133 times daily", "Labyrinthine disorders, 5\u00a0mg 3 times daily, gradually increased\r\nif necessary to 30\u00a0mg daily in divided doses, then reduced after several\r\nweeks to 5\u201310\u00a0mg daily; child not recommended", "By deep intramuscular injection, nausea and vomiting,\r\n12.5\u00a0mg when required followed if necessary after 6 hours by an oral\r\ndose, as above; child and adolescent under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "TERBUTALINE SULPHATE Oral and parenteral": { "indications": "Indications\u00a0asthma and other conditions associated with reversible\r\nairways obstruction; premature labour (section 7.1.3)", "name": "TERBUTALINE SULPHATE Oral and parenteral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "TERBUTALINE SULPHATE", "Oral and parenteral" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2894.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\ninitially 2.5\u00a0mg 3 times daily for 1\u20132 weeks, then up to 5\u00a0mg 3 times\r\ndaily; child 1 month\u20137 years 75\u00a0micrograms/kg\r\n3 times daily; 7\u201315 years 2.5\u00a0mg 2\u20133 times daily", "By subcutaneous or slow intravenous injection, 250\u2013500\u00a0micrograms up\r\nto 4 times daily; child 2\u201315 years\r\n10\u00a0micrograms/kg to a max. of 300\u00a0micrograms", "By continuous intravenous infusion as a solution containing 3\u20135\u00a0micrograms/mL, 90\u2013300\u00a0micrograms/hour\r\nfor 8\u201310 hours; child 1 month\u201318 years,\r\ninitially 2\u20134\u00a0micrograms/kg as a loading dose, then 1\u201310\u00a0micrograms/kg/hour\r\naccording to response and heart rate (max. 300\u00a0micrograms/hour); high\r\ndoses with close monitoring", "By inhalation of powder (Turbohaler\u00ae), adult and child over 5 years, 500\u00a0micrograms (1 inhalation);\r\nfor persistent symptoms up to 4 times daily (but see Management of Chronic Asthma\r\ntable)", "By inhalation of nebulised solution (but see also Management of Acute Asthma table), 5\u201310\u00a0mg 2\u20134 times daily;\r\nadditional doses may be necessary in severe acute asthma; child under 5 years 5\u00a0mg 2\u20134 times daily, 5\u201312 years\r\n5\u201310\u00a0mg 2\u20134 times daily [unlicensed dose]", "Name[Bricanyl\u00ae (AstraZeneca) ] Tablets, scored, terbutaline\r\nsulphate 5\u00a0mg, net price 100- tab pack= \u00a34.09\nSyrup, sugar-free, terbutaline\r\nsulphate 1.5\u00a0mg/5\u00a0mL, net price 100\u00a0mL = \u00a32.00\nInjection, terbutaline\r\nsulphate 500\u00a0micrograms/mL, net price 1-mL amp = 30p; 5-mL\r\namp = \u00a31.40" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "NABILONE": { "indications": "Indications\u00a0nausea and vomiting caused by cytotoxic chemotherapy, unresponsive\r\nto conventional antiemetics (under close observation, preferably in\r\nhospital setting)", "name": "NABILONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Cannabinoid", "NABILONE" ], "cautions": "Cautions\u00a0history of psychiatric disorder; elderly; hypertension; heart disease; adverse\r\neffects on mental state can persist for 48\u201372 hours after stoppingDriving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0drowsiness, vertigo, euphoria, dry mouth, ataxia,\r\nvisual disturbance, concentration difficulties, sleep disturbance,\r\ndysphoria, hypotension, headache and nausea; also confusion, disorientation,\r\nhallucinations, psychosis, depression, decreased coordination, tremors,\r\ntachycardia, decreased appetite, and abdominal painBehavioural effects\u00a0Patients should\r\nbe made aware of possible changes of mood and other adverse behavioural\r\neffects", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3449.htm", "doses": [ "Initially 1\u00a0mg twice daily, increased if necessary to\r\n2\u00a0mg twice daily, throughout each cycle of cytotoxic therapy and,\r\nif necessary, for 48 hours after the last dose of each cycle; max.\r\n6\u00a0mg daily given in 3 divided doses. The first dose should be taken\r\nthe night before initiation of cytotoxic treatment and the second\r\ndose 1\u20133 hours before the first dose of cytotoxic drug; adolescent and child under 18 years consult local treatment protocol [unlicensed use]" ], "pregnancy": "Pregnancy\u00a0avoid unless essential" }, "LORMETAZEPAM": { "indications": "Indications\u00a0insomnia (short-term use; \n(From 4.1 Hypnotics and anxiolytics: British National Formulary)\nImportant: benzodiazepine indications Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. The use of benzodiazepines to treat short-term \u2018mild\u2019 anxiety is inappropriate. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.)", "name": "LORMETAZEPAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Benzodiazepines" ], "cautions": "Cautions\u00a0see under Nitrazepam", "side-effects": "Side-effects\u00a0see under Nitrazepam; shorter\r\nacting", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3150.htm", "doses": [ "0.5\u20131.5\u00a0mg at bedtime; elderly (or debilitated) 500\u00a0micrograms; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "KETOROLAC TROMETAMOL": { "indications": "Indications\u00a0short-term management of moderate to severe\r\nacute postoperative pain only", "name": "KETOROLAC TROMETAMOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.2 Non-opioid analgesics" ], "cautions": "Cautions\u00a0section 10.1.1; avoid\r\nin acute porphyria (section 9.8.2); interactions: Appendix 1 (NSAIDs)", "side-effects": "Side-effects\u00a0section 10.1.1; also gastro-intestinal disturbances,\r\ntaste disturbances, dry mouth; flushing, bradycardia, palpitation,\r\nchest pain, hypertension, pallor; dyspnoea, asthma; malaise, euphoria,\r\npsychosis, paraesthesia, convulsions, abnormal dreams, hyperkinesia,\r\nconfusion, hallucinations; urinary frequency, thirst, sweating; hyponatraemia,\r\nhyperkalaemia, myalgia; visual disturbances (including optic neuritis);\r\npurpura, pain at injection site", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6619.htm", "doses": [ "adult and child over 16 years, by mouth, 10\u00a0mg\r\nevery 4\u20136 hours (elderly every 6\u20138\r\nhours) as required; max. 40\u00a0mg daily; max. duration of treatment 7\r\ndays", "adult and child over 16 years, by intramuscular injection or by intravenous injection over at least\r\n15 seconds, initially 10\u00a0mg, then 10\u201330\u00a0mg every 4\u20136 hours as required\r\n(up to every 2 hours during initial postoperative period); max. 90\u00a0mg\r\ndaily (elderly and patients weighing\r\nless than 50\u00a0kg max. 60\u00a0mg daily); max. duration of treatment 2 days; child 6 months\u201316 years see BNF for Children", "When converting from parenteral to oral administration,\r\ntotal combined dose on the day of converting should not exceed 90\u00a0mg\r\n(60\u00a0mg in the elderly and patients weighing less than 50\u00a0kg) of which\r\nthe oral component should not exceed 40\u00a0mg" ], "pregnancy": "Pregnancy\u00a0section 10.1.1" }, "FLUMAZENIL": { "indications": "Indications\u00a0reversal of sedative effects of benzodiazepines in anaesthetic, intensive\r\ncare, and clinical procedures; overdosage with benzodiazepines (see Emergency Treatment of Poisoning)", "name": "FLUMAZENIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.7 Antagonists for central and respiratory depression", "FLUMAZENIL" ], "cautions": "Cautions\u00a0short-acting (repeat doses may be necessary\u2014benzodiazepine\r\neffects may persist for at least 24 hours); benzodiazepine dependence (may precipitate withdrawal symptoms); prolonged benzodiazepine therapy for epilepsy (risk\r\nof convulsions); history of panic disorders\r\n(risk of recurrence); ensure neuromuscular\r\nblockade cleared before giving; avoid rapid injection\r\nin high-risk or anxious patients and following major surgery; head injury (rapid reversal of benzodiazepine sedation\r\nmay cause convulsions); elderly; children", "side-effects": "Side-effects\u00a0nausea and vomiting; less commonly palpitation, anxiety, fear; also reported transient\r\nhypertension, tachycardia, flushing, agitation, convulsions (particularly\r\nin those with epilepsy), dizziness, sensory disturbance, chills, sweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129247.htm", "doses": [ "Anaesthesia and clinical procedures, by intravenous\r\ninjection, 200\u00a0micrograms over 15 seconds, then 100\u00a0micrograms\r\nat 60-second intervals if required; usual dose range, 300\u2013600\u00a0micrograms;\r\nmax. total dose 1\u00a0mg; child 1 month\u201318\r\nyears see BNF for Children", "Intensive care, by intravenous injection, 300\u00a0micrograms\r\nover 15 seconds, then 100\u00a0micrograms at 60-second intervals if required;\r\nmax. total dose 2\u00a0mg; then if drowsiness recurs either, by intravenous injection, 300\u00a0micrograms, or by intravenous infusion, 100\u2013400\u00a0micrograms/hour,\r\nadjusted according to response; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TACROLIMUS - PREPARATIONS FOR ECZEMA AND PSORIASIS": { "indications": "Indications\u00a0short-term treatment of moderate to severe atopic\r\neczema (including flares) either unresponsive to, or in patients intolerant\r\nof conventional therapy in adults and children over 16 years; short-term\r\ntreatment of moderate to severe atopic eczema (including flares) unresponsive\r\nto conventional therapy in children over 2 years; prevention of flares\r\nin patients with moderate to severe atopic eczema and 4 or more flares\r\na year who have responded to initial treatment (for a maximum of 6\r\nweeks) with topical tacrolimus; see also notes above; other\r\nindications section 8.2.2", "name": "TACROLIMUS - PREPARATIONS FOR ECZEMA AND PSORIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "TACROLIMUS" ], "cautions": "Cautions\u00a0UV light (avoid excessive exposure to\r\nsunlight and sunlamps); alcohol consumption\r\n(risk of facial flushing and skin irritation)", "side-effects": "Side-effects\u00a0application-site reactions including rash, irritation,\r\npain and paraesthesia; herpes simplex infection, Kaposi\u2019s varicelliform\r\neruption; application-site infections; less commonly acne; also reported rosacea and skin malignancy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119636.htm", "doses": [ "Short-term treatment, adult and child over 16 years initially\r\napply 0.1% ointment thinly twice daily until lesion clears (consider\r\nother treatment if eczema worsens or no improvement after 2 weeks);\r\nreduce to once daily or switch to 0.03% ointment if condition allows; child 2\u201316 years, initially apply 0.03% ointment\r\nthinly twice daily for up to 3 weeks (consider other treatment if\r\neczema worsens or if no improvement after 2 weeks) then reduce to\r\nonce daily until lesion clears" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential; toxicity\r\nin animal studies following systemic administration" }, "SODIUM AUROTHIOMALATE": { "indications": "Indications\u00a0active\r\nprogressive rheumatoid arthritis", "name": "SODIUM AUROTHIOMALATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Gold" ], "cautions": "Cautions\u00a0\n(From Gold: British National Formulary)\nSodium aurothiomalate should be discontinued in the presence of blood disorders, gastro-intestinal bleeding (associated with ulcerative enterocolitis), or unexplained proteinuria (associated with immune complex nephritis) which is repeatedly above 300\u00a0mg/litre. ; elderly, history of urticaria, eczema, colitis; monitor for pulmonary fibrosis\r\nwith annual chest X-ray; interactions: Appendix 1 (sodium aurothiomalate)Counselling\u00a0Patients should be advised\r\nto seek prompt medical attention if diarrhoea, sore throat, fever,\r\ninfection, non-specific illness, unexplained bleeding and bruising,\r\npurpura, mouth ulcers, metallic taste, rash, breathlessness, or cough\r\ndevelop", "side-effects": "Side-effects\u00a0\n(From Gold: British National Formulary)\nSodium aurothiomalate should be discontinued in the presence of blood disorders, gastro-intestinal bleeding (associated with ulcerative enterocolitis), or unexplained proteinuria (associated with immune complex nephritis) which is repeatedly above 300\u00a0mg/litre. ; also\r\nsevere anaphylactic reactions; stomatitis, taste disturbances, colitis,\r\nhepatotoxicity with cholestatic jaundice, pulmonary fibrosis, peripheral\r\nneuropathy, mouth ulcers, proteinuria, blood disorders (sometimes\r\nsudden and fatal), nephrotic syndrome, gold deposits in eye, alopecia,\r\nand skin reactions (including, on prolonged parenteral treatment,\r\nirreversible pigmentation in sun-exposed areas)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5290.htm", "doses": [ "By deep intramuscular injection, administered\r\non expert advice, see notes above" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid but limited data suggests\r\nusually not necessary to withdraw if condition well controlled\u2014consider\r\nreducing dose and frequency" }, "MIDAZOLAM - BENZODIAZEPINES": { "indications": "Indications\u00a0conscious sedation for procedures; sedation in intensive care; sedation\r\nin anaesthesia; premedication; induction of anaesthesia; status epilepticus\r\n(section 4.8.2)", "name": "MIDAZOLAM - BENZODIAZEPINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.4 Sedative and analgesic peri-operative drugs", "15.1.4.1 Benzodiazepines" ], "cautions": "Cautions\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\n15.1.4.1 Benzodiazepines; cardiac disease; respiratory disease; myasthenia\r\ngravis; neonates; children (particularly if cardiovascular impairment); risk of airways obstruction and hypoventilation in\r\nchildren under 6 months (monitor respiratory rate and oxygen saturation); history of drug or alcohol abuse; reduce\r\ndose in elderly and debilitated; risk of severe hypotension in hypovolaemia, vasoconstriction, hypothermia; avoid prolonged use (and abrupt withdrawal thereafter); concentration of midazolam in children under 15\u00a0kg not to exceed 1\u00a0mg/mL; interactions: Appendix 1 (anxiolytics and hypnotics)", "side-effects": "Side-effects\u00a0\n(From 15.1.4.1 Benzodiazepines: British National Formulary)\n15.1.4.1 Benzodiazepines; gastro-intestinal disturbances,\r\nincreased appetite, jaundice; hypotension, cardiac arrest, heart rate\r\nchanges, anaphylaxis, thrombosis; laryngospasm, bronchospasm, respiratory\r\ndepression and respiratory arrest (particularly with high doses or\r\non rapid injection); drowsiness, confusion, ataxia, amnesia, headache,\r\neuphoria, hallucinations, convulsions (more common in neonates), dizziness,\r\nvertigo, involuntary movements, paradoxical excitement and aggression\r\n(especially in children and elderly), dysarthria; urinary retention,\r\nincontinence, changes in libido; blood disorders; muscle weakness;\r\nvisual disturbances; salivation changes; skin reactions; injection-site\r\nreactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6601.htm", "doses": [ "Conscious sedation for procedures, by slow\r\nintravenous injection (approx. 2\u00a0mg/minute) 5\u201310 minutes before\r\nprocedure, initially 2\u20132.5\u00a0mg (elderly 0.5\u20131\u00a0mg), increased if necessary in steps of 1\u00a0mg (elderly 0.5\u20131\u00a0mg); usual total dose 3.5\u20135\u00a0mg (max.\r\n7.5\u00a0mg), elderly max. 3.5\u00a0mg; child 1 month\u201318 years see BNF for Children", "By rectum, child 6 months\u201318 years see BNF for Children", "By mouth, child 1 month\u201318 years see BNF for Children", "By buccal administration, child 6 months\u201318 years see BNF for Children", "Sedative in combined anaesthesia, by intravenous injection, 30\u2013100\u00a0micrograms/kg repeated as required or by continuous\r\nintravenous infusion, 30\u2013100\u00a0micrograms/kg/hour (elderly lower doses needed); child not recommended", "Premedication, by deep intramuscular injection, adult over 18 years, 70\u2013100\u00a0micrograms/kg\r\n(elderly or debilitated 25\u201350\u00a0micrograms/kg)\r\n20\u201360 minutes before induction", "By intravenous injection, adult over 18 years, 1\u20132\u00a0mg 5\u201330 minutes before procedure, repeated as\r\nrequired (elderly or debilitated 0.5\u00a0mg,\r\nrepeat dose slowly as required)", "By rectum, child 6 months\u201312 years see BNF for Children", "By mouth, child 1 month\u201318 years see BNF for Children", "Induction (but rarely used), by slow intravenous injection, 150\u2013200\u00a0micrograms/kg (elderly or\r\ndebilitated 50\u2013150\u00a0micrograms/kg) given in divided doses (max. 5\u00a0mg)\r\nat intervals of 2 minutes; max. total dose 600\u00a0micrograms/kg; child 7\u201318 years initially 150\u00a0micrograms/kg (max.\r\n7.5\u00a0mg) given in steps of 50\u00a0micrograms/kg (max. 2.5\u00a0mg) over 2\u20135\r\nminutes; wait for 2\u20135 minutes then give additional doses of 50\u00a0micrograms/kg\r\n(max. 2.5\u00a0mg) every 2 minutes if necessary; max. total dose 500\u00a0micrograms/kg\r\n(not exceeding 25\u00a0mg)", "Sedation of patients receiving intensive care, by slow\r\nintravenous injection, initially 30\u2013300\u00a0micrograms/kg given\r\nin steps of 1\u20132.5\u00a0mg every 2 minutes, then by slow intravenous\r\ninjection or by continuous intravenous\r\ninfusion, 30\u2013200\u00a0micrograms/kg/hour; reduce dose (or reduce\r\nor omit initial dose) in hypovolaemia, vasoconstriction, or hypothermia;\r\nlower doses may be adequate if opioid analgesic also used; child under 12 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0avoid regular use (risk of neonatal withdrawal symptoms);\r\nuse only if clear indication such as seizure control (high doses during\r\nlate pregnancy or labour may cause neonatal hypothermia, hypotonia,\r\nand respiratory depression)" }, "METRONIDAZOLE - AMOEBICIDES": { "indications": "Indications\u00a0see under Dose below; anaerobic infections, section 5.1.11", "name": "METRONIDAZOLE - AMOEBICIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.2 Amoebicides" ], "cautions": "Cautions\u00a0section 5.1.11", "side-effects": "Side-effects\u00a0section 5.1.11", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4040.htm", "doses": [ "By mouth, invasive intestinal amoebiasis,\r\nextra-intestinal amoebiasis (including liver abcess), 800\u00a0mg every\r\n8 hours for 5 days in intestinal infection (for 5\u201310 days in extra-intestinal\r\ninfection); child 1\u20133 years 200\u00a0mg\r\nevery 8 hours; 3\u20137 years 200\u00a0mg every 6 hours; 7\u201310 years 400\u00a0mg every\r\n8 hours", "Urogenital trichomoniasis, 200\u00a0mg every 8 hours for 7 days or 400\u2013500\u00a0mg every 12 hours for 5\u20137 days, or 2\u00a0g as a single dose; child 1\u20133 years\r\n50\u00a0mg every 8 hours for 7 days; 3\u20137 years 100\u00a0mg every 12 hours; 7\u201310\r\nyears 100\u00a0mg every 8 hours", "Giardiasis, 2\u00a0g daily for 3 days or 400\u00a0mg\r\n3 times daily for 5 days or 500\u00a0mg twice daily for\r\n7\u201310 days; child 1\u20133 years 500\u00a0mg daily\r\nfor 3 days; 3\u20137 years 600\u2013800\u00a0mg daily; 7\u201310 years 1\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0section 5.1.11" }, "LOFEXIDINE HYDROCHLORIDE": { "indications": "Indications\u00a0management of symptoms of opioid withdrawal", "name": "LOFEXIDINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.3 Opioid dependence", "Adjunctive therapy and symptomatic treatment" ], "cautions": "Cautions\u00a0severe coronary insufficiency, recent myocardial infarction, cerebrovascular disease, bradycardia, hypotension (monitor pulse rate and blood pressure); history of QT prolongation, concomitant administration of drugs that prolong QT interval; metabolic disturbances; withdraw gradually over 2\u20134 days (or longer) to minimise\r\nrisk of rebound hypertension and associated symptoms; depression; interactions: Appendix\r\n1 (lofexidine)", "side-effects": "Side-effects\u00a0dry mucous membranes; hypotension, bradycardia;\r\ndizziness, drowsiness; QT-interval prolongation also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3699.htm", "doses": [ "adult and child over 12 years, initially 800\u00a0micrograms daily\r\nin divided doses, increased as necessary in steps of 400\u2013800\u00a0micrograms\r\ndaily to max. 2.4\u00a0mg daily in divided doses; max. single dose 800\u00a0micrograms;\r\nrecommended duration of treatment 7\u201310 days if no opioid use (but\r\nlonger may be required)" ], "pregnancy": "Pregnancy\u00a0use only if benefit outweighs risk\u2014no information\r\navailable" }, "Diagnostic agents": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "BCG vaccines", "Diagnostic agents" ], "name": "Diagnostic agents", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129586.htm", "doses": [ "by intradermal injection, for Mantoux test,\r\n2\u00a0units (0.1\u00a0mL of 20\u00a0units/mL strength) for routine Mantoux test;\r\nif first test is negative and a further test is considered appropriate\r\n10\u00a0units (0.1\u00a0mL of 100\u00a0units/mL strength)" ] }, "PROCHLORPERAZINE - PHENOTHIAZINES AND RELATED DRUGS": { "indications": "Indications\u00a0severe nausea, vomiting, vertigo, labyrinthine\r\ndisorders (see notes above); other indications %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE", "name": "PROCHLORPERAZINE - PHENOTHIAZINES AND RELATED DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0see Prochlorperazine, %s\n(From PROCHLORPERAZINE: British National Formulary)\nPROCHLORPERAZINE; elderly (see notes above)", "side-effects": "Side-effects\u00a0see Prochlorperazine, section 4.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3420.htm", "doses": [ "Doses are expressed as prochlorperazine\r\nmaleate or mesilate; 1\u00a0mg prochlorperazine maleate \u2261 1\u00a0mg prochlorperazine mesilate", "By mouth, nausea and vomiting, acute\r\nattack, 20\u00a0mg initially then 10\u00a0mg after 2 hours; prevention 5\u201310\u00a0mg\r\n2\u20133 times daily; child (over 10\u00a0kg\r\nonly) 250\u00a0micrograms/kg 2\u20133 times daily", "Labyrinthine disorders, 5\u00a0mg 3 times daily, gradually increased\r\nif necessary to 30\u00a0mg daily in divided doses, then reduced after several\r\nweeks to 5\u201310\u00a0mg daily; child not recommended", "By deep intramuscular injection, nausea and vomiting,\r\n12.5\u00a0mg when required followed if necessary after 6 hours by an oral\r\ndose, as above; child and adolescent under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see notes in section 4.2.1" }, "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin beta": { "indications": "Indications\u00a0see under preparations, below", "name": "EPOETIN ALFA, BETA, THETA, and ZETA Epoetin beta", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Erythropoietins", "EPOETIN ALFA, BETA, THETA, and ZETA", "Epoetin beta" ], "cautions": "Cautions\u00a0\n(From Erythropoietins: British National Formulary)\nErythropoietins; also inadequately treated or poorly controlled blood pressure (monitor closely blood pressure,\r\nreticulocyte counts, haemoglobin, and electrolytes), interrupt treatment if blood pressure uncontrolled; sudden stabbing migraine-like pain\r\nis warning of a hypertensive crisis; sickle-cell\r\ndisease (lower target haemoglobin concentration may be appropriate); ischaemic vascular disease; thrombocytosis (monitor platelet count for first 8 weeks); epilepsy; malignant disease; increase in unfractionated or low molecular weight heparin dose may be needed during dialysis; risk of thrombosis may be increased when used for\r\nanaemia in adults receiving cancer chemotherapy; risk of thrombosis may be increased when used for anaemia before\r\northopaedic surgery\u2014avoid in cardiovascular disease\r\nincluding recent myocardial infarction or cerebrovascular accident", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting; dose-dependent increase\r\nin blood pressure or aggravation of hypertension; in isolated patients\r\nwith normal or low blood pressure, hypertensive crisis with encephalopathy-like\r\nsymptoms and generalised tonic-clonic seizures requiring immediate\r\nmedical attention; headache; dose-dependent increase in platelet count\r\n(but thrombocytosis rare) regressing during treatment; influenza-like\r\nsymptoms (may be reduced if intravenous injection given over 5 minutes);\r\ncardiovascular events; shunt thrombosis especially if tendency to\r\nhypotension or arteriovenous shunt complications; very rarely sudden loss of efficacy because of pure red cell aplasia, particularly\r\nfollowing subcutaneous administration in patients with chronic renal\r\nfailure (discontinue erythropoietin therapy)\u2014see also notes above, hyperkalaemia,\r\nhypersensitivity reactions (including anaphylaxis and angioedema),\r\nskin reactions, injection-site reactions, and peripheral oedema also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65387.htm", "doses": [ "See under preparations, below", "symptomatic anaemia associated with chronic renal failure\r\n(see also MHRA/CHM advice), by subcutaneous injection, adult and child over 3 years, initially\r\n20\u00a0units/kg 3 times weekly for 4 weeks, increased according to response\r\nat intervals of 4 weeks in steps of 20\u00a0units/kg 3 times weekly; total\r\nweekly dose may be divided into daily doses; maintenance dose, initially\r\nreduce dose by half then adjust according to response at intervals\r\nof 1\u20132 weeks; total weekly maintenance dose may be given as a single\r\ndose or in 3 or 7 divided doses; max. 720\u00a0units/kg weekly", "Name[NeoRecormon\u00ae (Roche) ] Injection, prefilled syringe, epoetin\r\nbeta, net price 500\u00a0units = \u00a33.75; 2000\u00a0units = \u00a314.98; 3000\u00a0units\r\n= \u00a322.47; 4000\u00a0units = \u00a329.96; 5000\u00a0units = \u00a337.47; 6000\u00a0units = \u00a344.94;\r\n10\u00a0000\u00a0units = \u00a370.14; 20\u00a0000\u00a0units = \u00a3140.28; 30\u00a0000\u00a0units = \u00a3224.69Excipients include phenylalanine up to 300\u00a0micrograms/syringe (section\r\n9.4.1) Dose\u00a0symptomatic anaemia associated with chronic renal failure\r\n(see also MHRA/CHM advice), by subcutaneous injection, adult and child, initially 20\u00a0units/kg\r\n3 times weekly for 4 weeks, increased according to response at intervals\r\nof 4 weeks in steps of 20\u00a0units/kg 3 times weekly; total weekly dose\r\nmay be divided into daily doses; maintenance dose, initially reduce\r\ndose by half then adjust according to response at intervals of 1\u20132\r\nweeks; total weekly maintenance dose may be given as a single dose\r\nor in 3 or 7 divided doses; max. 720\u00a0units/kg weeklyBy intravenous injection over 2 minutes, adult and child, initially\r\n40\u00a0units/kg 3 times weekly for 4 weeks, increased according to response\r\nto 80\u00a0units/kg 3 times weekly after 4 weeks, with further increases\r\nif needed at intervals of 4 weeks in steps of 20\u00a0units/kg 3 times\r\nweekly; maintenance dose, initially reduce dose by half then adjust\r\naccording to response at intervals of 1\u20132 weeks; max. 720\u00a0units/kg\r\nweeklyNote\u00a0Subcutaneous route preferred in patients\r\nnot on haemodialysis. Reduce dose by approximately 25% if rise in\r\nhaemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin\r\nconcentration approaches or exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous dosePrevention of anaemia of prematurity in neonates with\r\nbirth-weight of 0.75\u20131.5\u00a0kg and gestational age of less than 34 weeks, by subcutaneous injection, 250\u00a0units/kg 3 times weekly preferably\r\nstarting within 3 days of birth and continued for 6 weeksSymptomatic anaemia in adults with non-myeloid malignancies\r\nreceiving chemotherapy (see also MHRA/CHM advice), by subcutaneous injection, initially 450\u00a0units/kg weekly\r\n(as a single dose or in 3\u20137 divided doses), increased if necessary\r\nafter 4 weeks (if a rise in haemoglobin of at least 1\u00a0g/100\u00a0mL not\r\nachieved) to 900\u00a0units/kg weekly (as a single dose or in 3\u20137 divided\r\ndoses); if adequate response obtained reduce dose by 25\u201350%; max.\r\n60\u00a0000\u00a0units weeklyNote\u00a0Discontinue treatment if haemoglobin concentration\r\ndoes not increase by at least 1\u00a0g/100\u00a0mL after 8 weeks of therapy\r\n(response unlikely). Reduce dose by approximately 25\u201350% if rise in\r\nhaemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin\r\nconcentration exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration continues\r\nto rise, despite dose reduction, suspend treatment until haemoglobin\r\nconcentration decreases and then restart at a dose approximately 25%\r\nlower than the previous dose. Discontinue approximately 4 weeks after\r\nending chemotherapyTo increase yield of autologous blood (to avoid homologous\r\nblood) in predonation programme in moderate anaemia when blood-conserving\r\nprocedures are insufficient or unavailable, consult product literature\nMultidose injection, powder for\r\nreconstitution, epoetin beta, net price 50\u00a0000-unit vial = \u00a3374.48\r\n(with solvent)Excipients include phenylalanine up to 5\u00a0mg/vial\r\n(section 9.4.1), benzyl alcohol (avoid in neonates, see Excipients ) Note\u00a0Avoid contact of reconstituted\r\ninjection with glass; use only plastic materialsDose\u00a0symptomatic anaemia associated with chronic renal failure\r\n(see also MHRA/CHM advice), by subcutaneous injection, adult and child over 3 years, initially\r\n20\u00a0units/kg 3 times weekly for 4 weeks, increased according to response\r\nat intervals of 4 weeks in steps of 20\u00a0units/kg 3 times weekly; total\r\nweekly dose may be divided into daily doses; maintenance dose, initially\r\nreduce dose by half then adjust according to response at intervals\r\nof 1\u20132 weeks; total weekly maintenance dose may be given as a single\r\ndose or in 3 or 7 divided doses; max. 720\u00a0units/kg weeklyBy intravenous injection over 2 minutes, adult and child over\r\n3 years, initially 40\u00a0units/kg 3 times weekly for 4 weeks, increased\r\naccording to response to 80\u00a0units/kg 3 times weekly after 4 weeks,\r\nwith further increases if needed at intervals of 4 weeks in steps\r\nof 20\u00a0units/kg 3 times weekly; maintenance dose, initially reduce\r\ndose by half then adjust according to response at intervals of 1\u20132\r\nweeks; max. 720\u00a0units/kg weeklyNote\u00a0Subcutaneous route preferred in patients\r\nnot on haemodialysis. Reduce dose by approximately 25% if rise in\r\nhaemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin\r\nconcentration approaches or exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration\r\ncontinues to rise, despite dose reduction, suspend treatment until\r\nhaemoglobin concentration decreases and then restart at a dose approximately\r\n25% lower than the previous doseSymptomatic anaemia in adults with non-myeloid malignancies\r\nreceiving chemotherapy (see also MHRA/CHM advice), by subcutaneous injection, initially 450\u00a0units/kg weekly\r\n(as a single dose or in 3\u20137 divided doses), increased if necessary\r\nafter 4 weeks (if a rise in haemoglobin of at least 1\u00a0g/100\u00a0mL not\r\nachieved) to 900\u00a0units/kg weekly (as a single dose or in 3\u20137 divided\r\ndoses); if adequate response obtained reduce dose by 25\u201350%; max.\r\n60\u00a0000\u00a0units weeklyNote\u00a0Discontinue treatment if haemoglobin concentration\r\ndoes not increase by at least 1\u00a0g/100\u00a0mL after 8 weeks of therapy\r\n(response unlikely). Reduce dose by approximately 25\u201350% if rise in\r\nhaemoglobin concentration exceeds 2\u00a0g/100\u00a0mL over 4 weeks or if haemoglobin\r\nconcentration exceeds 12\u00a0g/100\u00a0mL; if haemoglobin concentration continues\r\nto rise, despite dose reduction, suspend treatment until haemoglobin\r\nconcentration decreases and then restart at a dose approximately 25%\r\nlower than the previous dose. Discontinue approximately 4 weeks after\r\nending chemotherapyTo increase yield of autologous blood (to avoid homologous\r\nblood) in predonation programme in moderate anaemia when blood-conserving\r\nprocedures are insufficient or unavailable, consult product literature" ], "pregnancy": "Pregnancy\u00a0no evidence of harm; benefits probably outweigh risk\r\nof anaemia and of transfusion in pregnancy" }, "HYDROCORTISONE Compound preparations": { "indications": "Indications\u00a0mild inflammatory skin disorders such as eczemas\r\n(but for over-the-counter preparations, see below); nappy rash (see\r\nalso section 13.2.2)", "name": "HYDROCORTISONE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "HYDROCORTISONE", "Compound preparations" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5850.htm", "doses": [ "Apply thinly 1\u20132 times daily", "Name[Calmurid HC\u00ae (Galderma) ] Cream, hydrocortisone 1%, urea 10%, lactic acid 5%, net price 100\u00a0g = \u00a38.76. \r\n Label:\r\n 28, counselling, application. Potency: moderateExcipients none as listed in section 13.1.3Note\u00a0If stinging occurs, manufacturer advises\r\ndilute to half-strength with aqueous cream for 1 week then transfer\r\nto undiluted preparation (but see section\r\n13.1.1 for advice to avoid dilution where possible)" ] }, "CINNARIZINE": { "indications": "Indications\u00a0vestibular disorders, such as vertigo,\r\ntinnitus, nausea, and vomiting in M\u00e9ni\u00e8re\u2019s disease; motion sickness", "name": "CINNARIZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines", "CINNARIZINE" ], "cautions": "Cautions\u00a0section 3.4.1; also Parkinson\u2019s disease", "side-effects": "Side-effects\u00a0section 3.4.1; also rarely weight gain, sweating, lichen planus, and lupus-like\r\nskin reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3402.htm", "doses": [ "Vestibular disorders, 30\u00a0mg 3 times daily; child 5\u201312 years 15\u00a0mg 3 times daily", "Motion sickness, 30\u00a0mg 2 hours before travel then 15\u00a0mg every\r\n8 hours during journey if necessary; child 5\u201312 years, 15\u00a0mg 2 hours before travel then 7.5\u00a0mg every 8 hours\r\nduring journey if necessary" ], "pregnancy": "Pregnancy\u00a0section 3.4.1" }, "TRAVOPROST With timolol": { "indications": "Indications\u00a0raised intra-ocular pressure in open-angle glaucoma; ocular hypertension", "name": "TRAVOPROST With timolol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Prostaglandin analogues and prostamides", "TRAVOPROST", "With timolol" ], "cautions": "Cautions\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nCautions\u00a0Before initiating treatment, patients should be monitored for possible change in eye colour since an increase in the brown pigment in the iris may occur; particular care is required in those with mixed coloured irides and those receiving treatment to one eye only. Use with caution in patients with aphakia, pseudophakia with torn posterior lens capsule or anterior chamber lenses, and in those with known risk factors for cystoid macular oedema, iritis, or uveitis. Care is also needed in patients with brittle or severe asthma. Do not use within 5 minutes of thiomersal-containing preparations. For use in contact lens wearers see Contact Lenses.", "side-effects": "Side-effects\u00a0\n(From Prostaglandin analogues and prostamides: British National Formulary)\nSide-effects\u00a0Side-effects of prostaglandin analogues and prostamides include brown pigmentation particularly in those with mixed-colour irides, blepharitis, ocular irritation and pain, conjunctival hyperaemia, transient punctate epithelial erosion, skin rash, dry eyes, headache, and photophobia; they may also cause, darkening, thickening and lengthening of eye lashes. Less frequent side-effects include eyelid oedema and rash, keratitis, blurred vision, and conjunctivitis. There have been rare reports of dyspnoea, exacerbation of asthma, dizziness, arthralgia, myalgia, iritis, uveitis, local oedema, darkening of palpebral skin. Very rarely chest pain, palpitations, and exacerbation of angina has also been reported.; also\r\nreported hypotension, bradycardia, browache", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129689.htm", "doses": [ "Apply once daily, preferably in the evening; child under 18 years, not recommended", "Name[DuoTrav\u00ae (Alcon) ] Eye drops, travoprost 40\u00a0micrograms,\r\ntimolol (as maleate) 5\u00a0mg/mL, net price 2.5\u00a0mL = \u00a312.54, triple pack\r\n(3 x 2.5\u00a0mL) = \u00a335.68Excipients include benzalkonium chloride, disodium edetateDose\u00a0for raised intra-ocular pressure in patients with open-angle\r\nglaucoma or ocular hypertension when beta-blocker or prostaglandin\r\nanalogue alone not adequate, apply once daily; child and adolescent under 18 years, not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "NICORANDIL": { "indications": "Indications\u00a0prophylaxis and treatment of stable angina (including risk reduction\r\nof acute coronary syndromes in patients at high risk)", "name": "NICORANDIL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.3 Other antianginal drugs" ], "cautions": "Cautions\u00a0hypovolaemia; low systolic blood pressure; acute pulmonary\r\noedema; acute myocardial infarction with\r\nacute left ventricular failure and low filling pressures; interactions: Appendix 1 (nicorandil)Driving\u00a0Patients should be warned\r\nnot to drive or operate machinery until it is established that their\r\nperformance is unimpaired", "side-effects": "Side-effects\u00a0nausea, vomiting, rectal bleeding, cutaneous vasodilation\r\nwith flushing, increase in heart rate (at high doses), dizziness,\r\nheadache (especially on initiation, usually transitory), weakness; less commonly oral ulceration, hypotension, myalgia, angioedema; rarely intestinal ulceration, anal ulceration, abdominal\r\npain, hepatitis, cholestasis, jaundice, skin ulceration, rash, pruritus", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27014.htm", "doses": [ "Initially 10\u00a0mg twice daily (if susceptible to headache\r\n5\u00a0mg twice daily); usual dose 10\u201320\u00a0mg twice daily; up to 30\u00a0mg twice\r\ndaily may be used" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "PYRIDOSTIGMINE BROMIDE": { "indications": "Indications\u00a0myasthenia gravis", "name": "PYRIDOSTIGMINE BROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.1 Drugs that enhance neuromuscular transmission", "Anticholinesterases", "PYRIDOSTIGMINE BROMIDE" ], "cautions": "Cautions\u00a0see under Neostigmine; weaker muscarinic action", "side-effects": "Side-effects\u00a0see under Neostigmine", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5332.htm", "doses": [ "By mouth, 30\u2013120\u00a0mg at suitable intervals\r\nthroughout day, total daily dose 0.3\u20131.2\u00a0g (but see also notes above); child under 18 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0see under Neostigmine" }, "ACETYLCYSTEINE - TEAR DEFICIENCY, OCULAR LUBRICANTS, AND ASTRINGENTS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "ACETYLCYSTEINE" ], "indications": "Indications\u00a0tear deficiency, impaired or abnormal mucus production", "name": "ACETYLCYSTEINE - TEAR DEFICIENCY, OCULAR LUBRICANTS, AND ASTRINGENTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5540.htm", "doses": [ "Apply 3\u20134 times daily" ] }, "BOCEPREVIR": { "indications": "Indications\u00a0in combination with ribavirin and peginterferon alfa for chronic\r\nhepatitis C infection of genotype 1 in patients with compensated liver\r\ndisease", "name": "BOCEPREVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.3 Viral hepatitis", "5.3.3.2 Chronic hepatitis C" ], "cautions": "Cautions\u00a0monitor full blood count before starting\r\ntreatment and then on weeks 4 and 8 of treatment, then as indicated\r\nclinically; predisposition to QT interval\r\nprolongation (including concomitant use with other drugs known to\r\nprolong QT interval); interactions: Appendix 1 (boceprevir)", "side-effects": "Side-effects\u00a0in combination with ribavirin and peginterferon\r\nalfa, anaemia, nausea, vomiting, abdominal pain, gastro-oesophageal\r\nreflux, flatulence, diarrhoea, constipation, haemorrhoids, dry mouth,\r\ndisturbances in taste and smell, mouth ulcers, stomatitis, tooth disorder,\r\npalpitation, blood pressure changes, syncope, peripheral oedema, hypertriglyceridaemia,\r\ncough, dyspnoea, dizziness, headache, decreased appetite, weight loss,\r\nanxiety, depression, insomnia, agitation, amnesia, asthenia, hypoaesthesia,\r\nparaesthesia, tremor, influenza-like symptoms, hyperglycaemia, hypothyroidism,\r\nchanges in libido, erectile dysfunction, polyuria, leucopenia, thrombocytopenia,\r\narthralgia, myalgia, muscle spasms, hyperuricaemia, visual disturbances,\r\ndry eyes, tinnitus, alopecia, rash, pruritus, hyperhidrosis, psoriasis; less commonly gingivitis, tongue discoloration, hypersalivation,\r\ndysphagia, pancreatitis, colitis, hyperbilirubinaemia, arrhythmias,\r\nvenous thromboembolism, flushing, pallor, dysphonia, hyperaesthesia,\r\nhomicidal and suicidal ideation, hyperthyroidism, amenorrhoea, menorrhagia,\r\ndysuria, hypokalaemia, hypercalcaemia, gout, retinal ischaemia, retinopathy,\r\nconjunctival haemorrhage, eye pain, increased lacrimation, photophobia,\r\nhearing impairment, photosensitivity, skin ulceration; rarely cholecystitis, acute myocardial infarction, coronary artery disease,\r\npericarditis, pleural fibrosis, respiratory failure, bipolar disorder,\r\nhallucinations, encephalopathy, thyroid neoplasms, aspermia, sarcoidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/217023.htm", "doses": [ "In combination with ribavirin and peginterferon alfa, adult over 18 years, 800\u00a0mg 3 times daily (for duration\r\nof treatment consult product literature)", "If a dose is more than 6 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; see also under Ribavirin" }, "SODIUM PICOSULFATE": { "indications": "Indications\u00a0constipation; bowel evacuation before\r\nabdominal radiological and endoscopic procedures on the colon, and\r\nsurgery (section 1.6.5); acts within 6\u201312 hours", "name": "SODIUM PICOSULFATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.2 Stimulant laxatives", "SODIUM PICOSULFATE" ], "cautions": "Cautions\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives; active inflammatory\r\nbowel disease (avoid if fulminant)", "side-effects": "Side-effects\u00a0\n(From 1.6.2 Stimulant laxatives: British National Formulary)\n1.6.2 Stimulant laxatives", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23454.htm", "doses": [ "5\u201310\u00a0mg at night; child (but see section\r\n1.6) 1 month\u20134 years 2.5\u201310\u00a0mg once daily, adjusted according\r\nto response; 4\u201318 years 2.5\u201320\u00a0mg once daily, adjusted according to\r\nresponse", "Sodium picosulfate doses in BNF may differ\r\nfrom those in product literature" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE": { "indications": "Indications\u00a0immunisation against measles, mumps,\r\nand rubella", "name": "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Measles, Mumps and Rubella (MMR) vaccine", "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE" ], "cautions": "Cautions\u00a0see section 14.1; also,\r\nafter immunoglobulin administration or blood transfusion, leave an\r\ninterval of at least 3 months before MMR immunisation as antibody\r\nresponse to measles component may be reduced\u2014see also Anti-D (Rh0) immunoglobulin; interactions: Appendix 1 (vaccines)Hypersensitivity to egg\u00a0There is increasing evidence\r\nthat MMR vaccine can be given safely even when the child has had an\r\nanaphylactic reaction to food containing egg (dislike of egg or refusal\r\nto eat egg is not a contra-indication). For children\r\nwith a confirmed anaphylactic reaction to egg-containing food, MMR\r\nvaccine may be administered in a hospital setting", "side-effects": "Side-effects\u00a0see section 14.1 and notes above; also less commonly sleep disturbances, unusual crying in infants; also reported peripheral\r\nand optic neuritis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201517.htm", "doses": [ "By intramuscular or deep subcutaneous\r\ninjection, adult and child over 9 months (but see also notes above), primary\r\nimmunisation, 2 doses each of 0.5\u00a0mL, see Immunisation Schedule, section 14.1; see also notes above for use\r\nin outbreaks, for contacts of cases, and for travel" ], "pregnancy": "Pregnancy\u00a0avoid pregnancy for at least 1 month after vaccination;\r\nsee also section 14.1" }, "BIPHASIC ISOPHANE INSULIN Human sequence": { "indications": "Indications\u00a0diabetes mellitus", "name": "BIPHASIC ISOPHANE INSULIN Human sequence", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.2 Intermediate- and long-acting insulins", "Biphasic insulins", "BIPHASIC ISOPHANE INSULIN", "Human sequence" ], "cautions": "Cautions\u00a0section 6.1.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see under Insulin (section 6.1.1.1);\r\nprotamine may cause allergic reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/86397.htm", "doses": [ "By subcutaneous injection, according to\r\nrequirements", "Name[Insuman\u00ae Comb 50 (Sanofi-Aventis) ] Injection, biphasic isophane\r\ninsulin (human, crb), 50% soluble, 50% isophane, 100\u00a0units/mL,\r\nnet price 5 \u00d7 3-mL cartridge (for ClikSTAR\u00ae and Autopen\u00ae 24) = \u00a317.50Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed; the proportions of\r\nthe two components should be checked carefully (the\r\norder in which the proportions are stated may not be the same in other\r\ncountries)" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "PENTOSTATIN": { "indications": "Indications\u00a0\n(From Pentostatin: British National Formulary)\nPentostatin", "name": "PENTOSTATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Pentostatin" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; interactions: Appendix 1 (pentostatin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/11781.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nmanufacturer advises that men should not father children during and\r\nfor 6 months after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "PSEUDOEPHEDRINE HYDROCHLORIDE": { "indications": "Indications\u00a0\n(From 3.10 Systemic nasal decongestants: British National Formulary)\n3.10 Systemic nasal decongestants", "name": "PSEUDOEPHEDRINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.10 Systemic nasal decongestants", "PSEUDOEPHEDRINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 3.10 Systemic nasal decongestants: British National Formulary)\nSystemic decongestants should be used with caution in diabetes, hypertension, hyperthyroidism, susceptibility to angle-closure glaucoma, prostatic hypertrophy, ischaemic heart disease, and should be avoided in patients taking monoamine oxidase inhibitors; interactions: Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0nausea, vomiting, hypertension, tachycardia, headache,\r\nanxiety, restlessness, insomnia; rarely hallucinations,\r\nrash; very rarely angle-closure glaucoma; urinary\r\nretention also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3136.htm", "doses": [ "60\u00a0mg 3\u20134 times daily; child 6\u201312 years 30\u00a0mg 3\u20134 times daily" ], "pregnancy": "Pregnancy\u00a0defective closure of the abdominal wall (gastroschisis)\r\nreported very rarely in newborns after first trimester exposure" }, "TIMOLOL Once-daily preparations": { "indications": "Indications\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "name": "TIMOLOL Once-daily preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Beta-blockers", "TIMOLOL", "Once-daily preparations" ], "cautions": "Cautions\u00a0\n(From Beta-blockers: British National Formulary)\nSystemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block, or uncontrolled heart failure. Important: for a warning to avoid in asthma see below", "side-effects": "Side-effects\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/112792.htm", "doses": [ "Apply twice daily; long-acting preparations, apply once\r\ndaily", "Name[Nyogel\u00ae (Novartis) ] Eye gel (= eye drops), timolol (as\r\nmaleate) 0.1%, net price 5\u00a0g = \u00a32.85 Excipients include benzalkonium\r\nchlorideDose\u00a0apply once daily, preferably in the morning" ] }, "TELAPREVIR": { "indications": "Indications\u00a0in combination with ribavirin and peginterferon alfa for chronic\r\nhepatitis C infection of genotype 1 in patients with compensated liver\r\ndisease", "name": "TELAPREVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.3 Viral hepatitis", "5.3.3.2 Chronic hepatitis C", "TELAPREVIR" ], "cautions": "Cautions\u00a0monitor full blood count, platelets, electrolytes,\r\nserum creatinine, uric acid, and liver and thyroid function tests\r\nbefore starting treatment and then on weeks 2, 4, 8, and 12 of treatment,\r\nthen as indicated clinically; electrolyte disturbances; prolongation\r\nof QT interval, bradycardia, heart failure with reduced left ventricular\r\nejection fraction, concomitant use with other drugs known to prolong\r\nQT interval; congenital or family history of QT interval prolongation,\r\nfamily history of sudden death; effectiveness of hormonal contraceptives\r\nreduced during treatment and for 2 months after stopping telaprevir\u2014effective\r\nnon-hormonal methods of contraception necessary during this time (see\r\nalso Cautions under Ribavirin); interactions: Appendix 1 (telaprevir)Rash\u00a0Rash occurs very commonly. If rash mild or\r\nmoderate, may continue without interruption, but monitor for deterioration.\r\nIf severe rash or if rash accompanied by blistering, mucosal ulceration,\r\nor systemic symptoms, discontinue telaprevir permanently, and if rash\r\ndoes not improve within 7 days of discontinuation consider discontinuation\r\nof ribavirin and peginterferon alfaCounselling\u00a0Patients should be told to seek immediate\r\nmedical attention if a rash develops or if an existing rash worsens", "side-effects": "Side-effects\u00a0in combination with ribavirin and peginterferon\r\nalfa, rash (including eczema and rarely Stevens-Johnson syndrome;\r\nsee also Rash above), pruritus, anaemia, nausea, vomiting, diarrhoea,\r\nhaemorrhoids, anal fissure, hyperbilirubinaemia, taste disturbances,\r\nsyncope, peripheral oedema, hypothyroidism, hypokalaemia, thrombocytopenia,\r\nlymphopenia, hyperuricaemia; less commonly proctitis,\r\ngout, retinopathy, urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218507.htm", "doses": [ "In combination with ribavirin and peginterferon alfa, adult over 18 years, 750\u00a0mg every 8 hours (for duration\r\nof treatment consult product literature)", "If a dose is more than 4 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; see Cautions above and\r\nalso see under Ribavirin" }, "ZUCLOPENTHIXOL": { "indications": "Indications\u00a0schizophrenia and other psychoses", "name": "ZUCLOPENTHIXOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "ZUCLOPENTHIXOL" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; urinary\r\nfrequency or incontinence; weight loss (less common than weight gain)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3262.htm", "doses": [ "By mouth, initially 20\u201330\u00a0mg daily in divided\r\ndoses, increasing to a max. of 150\u00a0mg daily if necessary; usual maintenance\r\ndose 20\u201350\u00a0mg daily; max. single dose 40\u00a0mg; elderly (or debilitated) initially quarter to half adult dose; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "ZANAMIVIR": { "indications": "Indications\u00a0see notes above", "name": "ZANAMIVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.4 Influenza", "ZANAMIVIR" ], "cautions": "Cautions\u00a0asthma and chronic\r\npulmonary disease (risk of bronchospasm\u2014short-acting bronchodilator\r\nshould be available; avoid in severe asthma unless close\r\nmonitoring possible and appropriate facilities available to treat\r\nbronchospasm); uncontrolled chronic illness; other inhaled drugs should be administered before zanamivir)", "side-effects": "Side-effects\u00a0rash; less commonly bronchospasm,\r\ndyspnoea, angioedema, urticaria; rarely Stevens-Johnson\r\nsyndrome, toxic epidermal necrolysis; also reported neuropsychiatric\r\ndisorders (especially in children and adolescents)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/82111.htm", "doses": [ "By inhalation of powder, post-exposure\r\nprophylaxis of influenza, adult and child over 5 years, 10\u00a0mg once daily for 10 days", "Prevention of influenza during an epidemic, adult and child over 5 years, 10\u00a0mg once\r\ndaily for up to 28 days", "Treatment of influenza, adult and child over 5 years, 10\u00a0mg twice\r\ndaily for 5 days (for up to 10 days if resistance to oseltamivir suspected\r\n[unlicensed duration])" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk (e.g.\r\nduring a pandemic); see also notes above" }, "FLUNISOLIDE": { "indications": "Indications\u00a0prophylaxis and treatment of allergic rhinitis", "name": "FLUNISOLIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.2 Drugs acting on the nose", "12.2.1 Drugs used in nasal allergy", "Corticosteroids", "FLUNISOLIDE" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Corticosteroid nasal preparations should be avoided in the presence of untreated nasal infections, and also after nasal surgery (until healing has occurred); they should also be avoided in pulmonary tuberculosis. Patients transferred from systemic corticosteroids may experience exacerbation of some symptoms. Systemic absorption may follow nasal administration particularly if high doses are used or if treatment is prolonged; for cautions and side-effects of systemic corticosteroids, see section 6.3.2. The risk of systemic effects may be greater with nasal drops than with nasal sprays; drops are administered incorrectly more often than sprays. The height of children receiving prolonged treatment with nasal corticosteroids should be monitored; if growth is slowed, referral to a paediatrician should be considered.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local side-effects include dryness, irritation of nose and throat, and epistaxis. Nasal ulceration has been reported, but occurs commonly with nasal preparations containing fluticasone furoate or mometasone furoate. Nasal septal perforation (usually following nasal surgery) occurs very rarely. Raised intra-ocular pressure or glaucoma may occur rarely. Headache, smell and taste disturbances may also occur. Hyperactivity, sleep disturbances, anxiety, depression, and aggression have been reported particularly in children. Hypersensitivity reactions, including bronchospasm, have been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5650.htm", "doses": [ "adult, 50\u00a0micrograms (2\r\nsprays) into each nostril twice daily, increased if necessary to max.\r\n3 times daily then reduced for maintenance; child 5\u201314 years initially 25\u00a0micrograms (1 spray) into each nostril up\r\nto 3 times daily" ] }, "ALEMTUZUMAB": { "indications": "Indications\u00a0%s\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nAlemtuzumab causes lysis of B and T lymphocytes and is licensed for use in patients with chronic lymphocytic leukaemia for whom fludarabine treatment is not appropriate. In common with rituximab, it causes infusion-related side-effects including cytokine release syndrome (see above); premedication with paracetamol, an antihistamine, and a corticosteroid is recommended.The Scottish Medicines Consortium has advised (August 2008) that alemtuzumab is accepted for restricted use within NHS Scotland for the treatment of B-cell chronic lymphocytic leukaemia (B-CLL) when fludarabine combination chemotherapy is not appropriate. Alemtuzumab is restricted to use in patients with previously untreated B-CLL, with the cytogenetic abnormality 17p-deletion.", "name": "ALEMTUZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.3 Anti-lymphocyte monoclonal antibodies" ], "cautions": "Cautions\u00a0\n(From 8.2.3 Anti-lymphocyte monoclonal antibodies: British National Formulary)\nAlemtuzumab causes lysis of B and T lymphocytes and is licensed for use in patients with chronic lymphocytic leukaemia for whom fludarabine treatment is not appropriate. In common with rituximab, it causes infusion-related side-effects including cytokine release syndrome (see above); premedication with paracetamol, an antihistamine, and a corticosteroid is recommended.The Scottish Medicines Consortium has advised (August 2008) that alemtuzumab is accepted for restricted use within NHS Scotland for the treatment of B-cell chronic lymphocytic leukaemia (B-CLL) when fludarabine combination chemotherapy is not appropriate. Alemtuzumab is restricted to use in patients with previously untreated B-CLL, with the cytogenetic abnormality 17p-deletion.\u2014for full details consult product literature", "side-effects": "Side-effects\u00a0see notes above\u2014for full details (including monitoring\r\nand management of side-effects) consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106036.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0avoid; use effective contraception during and for\r\n6 months after treatment in men or women" }, "FLUTICASONE PROPIONATE - TOPICAL CORTICOSTEROIDS": { "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "indications": "Indications\u00a0inflammatory skin disorders such as dermatitis\r\nand eczemas unresponsive to less potent corticosteroids", "name": "FLUTICASONE PROPIONATE - TOPICAL CORTICOSTEROIDS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19234.htm", "doses": [ "Apply thinly 1\u20132 times daily" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "FLUTICASONE PROPIONATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity." }, "RALTEGRAVIR": { "indications": "Indications\u00a0HIV infection in combination with other\r\nantiretroviral drugs ", "name": "RALTEGRAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Other antiretrovirals", "RALTEGRAVIR" ], "cautions": "Cautions\u00a0risk factors for myopathy or rhabdomyolysis; chronic hepatitis B or C (greater risk of hepatic side-effects); interactions: Appendix 1 (raltegravir)", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, abdominal pain, flatulence,\r\nhypertriglyceridaemia, dizziness, headache, insomnia, abnormal dreams,\r\nasthenia, rash (Stevens-Johnson syndrome reported); less commonly gastritis, hepatitis, pancreatitis, dry mouth, gastro-oesophageal\r\nreflux, taste disturbances, pain on swallowing, peptic ulcer, constipation,\r\nrectal bleeding, lipodystrophy (see Lipodystrophy Syndrome), palpitation, ventricular extrasystoles, bradycardia, hypertension,\r\nflushing, chest pain, oedema, dysphonia, epistaxis, nasal congestion,\r\ndrowsiness, anxiety, appetite changes, confusion, impaired memory\r\nand attention, depression, pyrexia, chills, carpal tunnel syndrome,\r\ntremor, peripheral neuropathy, erectile dysfunction, gynaecomastia,\r\nmenopausal symptoms, osteopenia, renal failure, nocturia, polydipsia,\r\nanaemia, thrombocytopenia, neutropenia, arthralgia, myalgia, rhabdomyolysis,\r\nvisual disturbances, tinnitus, gingivitis, glossitis, acne, pruritus,\r\nhyperhidrosis, dry skin, skin papilloma, and alopecia; also\r\nreported suicidal ideation; see also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201008.htm", "doses": [ "400\u00a0mg twice daily; child 16\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "ANTHRAX VACCINE": { "indications": "Indications\u00a0pre-exposure immunisation against anthrax;\r\npost-exposure immunisation (%s\n(From Anthrax vaccine: British National Formulary)\nAnthrax vaccine)", "name": "ANTHRAX VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Anthrax vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201157.htm", "doses": [ "By intramuscular injection in deltoid region,\r\ninitial course 3 doses of 0.5\u00a0mL at intervals of 3 weeks followed\r\nby a fourth dose after an interval of 6 months; booster, 0.5\u00a0mL every\r\n12 months" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "3.1.4 Compound bronchodilator preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators" ], "name": "3.1.4 Compound bronchodilator preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213767.htm", "doses": [ "bronchospasm in chronic obstructive pulmonary disease, by inhalation of nebulised solution, adult and child over 12 years, 1 vial (2.5\u00a0mL)\r\n3\u20134 times daily" ] }, "CALCIUM SALTS Oral preparations": { "indications": "Indications\u00a0see notes above; calcium deficiency", "name": "CALCIUM SALTS Oral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.1 Calcium and magnesium", "9.5.1.1 Calcium supplements", "CALCIUM SALTS", "Oral preparations" ], "cautions": "Cautions\u00a0sarcoidosis; history of nephrolithiasis; avoid calcium chloride in respiratory acidosis or\r\nrespiratory failure; interactions: Appendix 1 (antacids, calcium\r\nsalts)", "side-effects": "Side-effects\u00a0rarely gastro-intestinal disturbances; with injection, bradycardia, arrhythmias, peripheral vasodilatation,\r\nfall in blood pressure, sweating, injection-site reactions, severe\r\ntissue damage with extravasation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5035.htm", "doses": [ "By mouth, daily in divided doses, see notes above", "By slow intravenous injection, acute hypocalcaemia,\r\ncalcium gluconate 1\u20132\u00a0g (Ca2+ 2.25\u20134.5\u00a0mmol); child see BNF for Children", "Name[Calcium Lactate (Non-proprietary)] Tablets, calcium lactate 300\u00a0mg\r\n(calcium 39\u00a0mg or Ca2+ 1\u00a0mmol), net price 84 = \u00a32.91" ] }, "ADRENALINE/EPINEPHRINE Intramuscular or subcutaneous": { "indications": "Indications\u00a0emergency treatment of acute\r\nanaphylaxis; angioedema; cardiopulmonary resuscitation (section 2.7.3); priapism [unlicensed] (section 7.4.5)", "name": "ADRENALINE/EPINEPHRINE Intramuscular or subcutaneous", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.4 Antihistamines, hyposensitisation, and allergic emergencies", "3.4.3 Allergic emergencies", "Anaphylaxis", "ADRENALINE/EPINEPHRINE", "Intramuscular or subcutaneous" ], "cautions": "Cautions\u00a0for cautions in non-life-threatening situations, see section 2.7.3Interactions\u00a0Severe anaphylaxis in\r\npatients taking beta-blockers may not respond to adrenaline, calling\r\nfor bronchodilator therapy, see intravenous salbutamol; adrenaline can cause\r\nsevere hypertension and bradycardia in those taking non-cardioselective\r\nbeta-blockers. Other interactions,\r\nsee Appendix 1 (sympathomimetics).", "side-effects": "Side-effects\u00a0section 2.7.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/100081.htm", "doses": [ "Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1\u00a0mg/mL)\r\nsolution for administration by healthcare professionals, see notes and table above", "Acute anaphylaxis, by intramuscular injection for self-administration, see under preparations", "Acute anaphylaxis when there is doubt as to the adequacy of\r\nthe circulation, by slow intravenous injection of 1\r\nin 10\u00a0000 (100\u00a0micrograms/mL) solution (extreme caution\u2014specialist\r\nuse only), see notes above", "Intravenous route should be used with extreme care by specialists only, see notes above", "Name[(1)Minijet\u00ae Adrenaline 1 in 1000 (UCB Pharma) ] Injection, adrenaline (as hydrochloride)\r\n1 in 1000 (1\u00a0mg/mL), net price 1\u00a0mL (with 25 gauge \u00d7 0.25 inch needle\r\nfor subcutaneous injection) = \u00a310.79, 1\u00a0mL (with 21 gauge \u00d7 1.5 inch\r\nneedle for intramuscular injection) = \u00a36.36 (both disposable syringes) Excipients include sulphites" ], "pregnancy": "Pregnancy\u00a0section 2.7.3" }, "DULOXETINE": { "indications": "Indications\u00a0moderate to severe stress urinary incontinence\r\nin women; major depressive disorder (section 4.3.4); diabetic neuropathy (section 4.3.4); generalised anxiety disorder (section 4.3.4)", "name": "DULOXETINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0elderly; cardiac disease; hypertension (avoid if uncontrolled); history of mania; history of seizures; raised intra-ocular\r\npressure, susceptibility to angle-closure\r\nglaucoma; bleeding disorders or concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (duloxetine)Withdrawal\u00a0Nausea, vomiting, headache, anxiety,\r\ndizziness, paraesthesia, sleep disturbances, and tremor are the most\r\ncommon features of abrupt withdrawal or marked reduction of the dose;\r\ndose should be reduced over at least 1\u20132 weeks", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia, constipation, diarrhoea,\r\nabdominal pain, weight changes, decreased appetite, flatulence, dry\r\nmouth; palpitation, hot flush; insomnia, abnormal dreams, paraesthesia,\r\ndrowsiness, anxiety, headache, dizziness, fatigue, weakness, tremor,\r\nnervousness, anorexia; sexual dysfunction; visual disturbances; sweating,\r\npruritus; less commonly gastritis, halitosis, hepatitis,\r\nbruxism, tachycardia, hypertension, postural hypotension, syncope,\r\nraised cholesterol, vertigo, taste disturbance, cold extremities,\r\nimpaired temperature regulation, impaired attention, movement disorders,\r\nmuscle twitching, musculoskeletal pain, thirst, stomatitis, hypothyroidism,\r\nurinary disorders, and photosensitivity; rarely mania; very rarely angle-closure glaucoma; also reported supraventricular arrhythmia, chest pain, hallucinations, suicidal\r\nbehaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy),\r\nseizures, hypersensitivity reactions including urticaria, angioedema,\r\nrash (including Stevens-Johnson syndrome) and anaphylaxis, hyponatraemia\r\n(see Hyponatraemia and Antidepressant\r\nTherapy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129097.htm", "doses": [ "adult over 18 years, 40\u00a0mg\r\ntwice daily, assess for benefit and tolerability after 2\u20134 weeks", "Initial dose of 20\u00a0mg twice daily for 2 weeks\r\ncan minimise side-effects" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014avoid\r\nin patients with stress urinary incontinence; risk of neonatal withdrawal\r\nsymptoms if used near term" }, "BIVALIRUDIN": { "indications": "Indications\u00a0unstable angina or non-ST-segment elevation\r\nmyocardial infarction in patients planned for urgent or early intervention;\r\nanticoagulation for patients undergoing percutaneous coronary intervention\r\n(including patients with ST-segment elevation myocardial infarction\r\nundergoing primary percutaneous coronary intervention)", "name": "BIVALIRUDIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.1 Parenteral anticoagulants", "Hirudins", "BIVALIRUDIN" ], "cautions": "Cautions\u00a0exposure to lepirudin (theoretical risk from lepirudin antibodies); brachytherapy procedures; concomitant use of drugs that increase risk of bleeding", "side-effects": "Side-effects\u00a0bleeding (discontinue), thrombosis, ecchymosis; less commonly nausea, vomiting, tachycardia, bradycardia,\r\nhypotension, angina, dyspnoea, allergic reactions (including isolated\r\nreports of anaphylaxis), headache, thrombocytopenia, anaemia, back\r\nand chest pain, and injection-site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129015.htm", "doses": [ "Unstable angina or non-ST-segment elevation myocardial\r\ninfarction (in addition to aspirin and clopidogrel), initially by intravenous injection, 100\u00a0micrograms/kg then by\r\nintravenous infusion 250\u00a0micrograms/kg/hour (for up to 72\r\nhours in medically managed patients); patients proceeding to percutaneous\r\ncoronary intervention or coronary artery bypass surgery without cardiopulmonary bypass, additional bolus dose by intravenous\r\ninjection 500\u00a0micrograms/kg, then by intravenous infusion 1.75\u00a0mg/kg/hour for duration of procedure; following percutaneous\r\ncoronary intervention, reduce infusion rate to 250\u00a0micrograms/kg/hour\r\nfor 4\u201312 hours as necessary; patients proceeding to coronary artery\r\nbypass surgery with cardiopulmonary bypass, discontinue\r\nintravenous infusion 1 hour before procedure and treat with unfractionated\r\nheparin", "Anticoagulation in patients undergoing percutaneous coronary\r\nintervention (in addition to aspirin and clopidogrel), initially by intravenous injection, 750\u00a0micrograms/kg then by\r\nintravenous infusion 1.75\u00a0mg/kg/hour for up to 4 hours after\r\nprocedure; a reduced infusion rate of 250\u00a0micrograms/kg/hour may be\r\ncontinued for a further 4\u201312 hours if necessary" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014no information available" }, "PROGUANIL HYDROCHLORIDE": { "indications": "Indications\u00a0chemoprophylaxis of malaria", "name": "PROGUANIL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.4 Antiprotozoal drugs", "5.4.1 Antimalarials", "Proguanil", "PROGUANIL HYDROCHLORIDE" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (proguanil)", "side-effects": "Side-effects\u00a0mild gastric intolerance, diarrhoea, and constipation;\r\noccasionally mouth ulcers and stomatitis; very rarely cholestasis, vasculitis, skin reactions, and hair loss", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/69573.htm", "doses": [ "Prophylaxis of malaria, preferably started 1 week before\r\nentering endemic area and continued for 4 weeks after leaving (see\r\nnotes above), 200\u00a0mg once daily; infant up to 12 weeks body-weight under 6\u00a0kg, 25\u00a0mg once daily; 12 weeks\u20131\r\nyear body-weight 6\u201310\u00a0kg, 50\u00a0mg once daily; child 1\u20134 years body-weight 10\u201316\u00a0kg, 75\u00a0mg once daily; 4\u20138 years body-weight\r\n16\u201325\u00a0kg, 100\u00a0mg once daily; 8\u201313 years, body-weight 25\u201345\u00a0kg, 150\u00a0mg\r\nonce daily; over 13 years body-weight over 45\u00a0kg, adult dose", "Warn travellers about importance of avoiding mosquito bites, importance of taking\r\nprophylaxis regularly, and importance of immediate\r\nvisit to doctor if ill within 1 year and especially within 3 months of return. For details, see notes above", "Proguanil doses in BNF may differ from those\r\nin product literature." ], "pregnancy": "Pregnancy\u00a0benefit of prophylaxis in malaria outweighs risk;\r\nadequate folate supplements should be given to mother; see also Prophylaxis Against Malaria" }, "MOMETASONE FUROATE - CORTICOSTEROIDS": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "MOMETASONE FUROATE - CORTICOSTEROIDS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.2 Corticosteroids" ], "cautions": "Cautions\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nCautions of inhaled corticosteroids\u00a0Inhaled corticosteroids should be used with caution in patients with systemic infection, see Infections (section 6.3.2).Paradoxical bronchospasm\u00a0The potential for paradoxical bronchospasm (calling for discontinuation and alternative therapy) should be borne in mind\u2014mild bronchospasm may be prevented by inhalation of a short-acting beta2 agonist beforehand (or by transfer from an aerosol inhalation to a dry powder inhalation).CFC-free inhalers\u00a0Chlorofluorocarbon (CFC) propellants in pressurised aerosol inhalers have been replaced by hydrofluoroalkane (HFA) propellants.Doses for corticosteroid CFC-free pressurised metered-dose inhalers may be different from traditional CFC-containing inhalers and may differ between brands, see MHRA/CHM advice below. For interactions: see Appendix 1 (corticosteroids)MHRA/CHM advice (July 2008)Beclometasone dipropionate CFC-free pressurised metered-dose inhalers (Qvar\u00ae and Clenil Modulite\u00ae) are not interchangeable and should be prescribed by brand name; Qvar\u00ae has extra-fine particles, is more potent than traditional beclometasone dipropionate CFC-containing inhalers, and is approximately twice as potent as Clenil Modulite\u00ae;Fostair\u00ae is a combination beclometasone dipropionate and formoterol fumarate CFC-free pressurised metered-dose inhaler; Fostair\u00ae has extra-fine particles and is more potent than traditional beclometasone dipropionate CFC-free inhalers.", "side-effects": "Side-effects\u00a0\n(From 3.2 Corticosteroids: British National Formulary)\nSide-effects of inhaled corticosteroids\u00a0Inhaled corticosteroids have considerably fewer systemic effects than oral corticosteroids (section 6.3.2), but adverse effects have been reported.High doses of inhaled corticosteroids (see Management of Chronic Asthma table) used for prolonged periods can induce adrenal suppression. Inhaled corticosteroids have been associated with adrenal crisis and coma in children; excessive doses should be avoided. Patients using high doses of inhaled corticosteroids should be given a \u2018steroid card\u2019 (section 6.3.2) and specific written advice to consider corticosteroid replacement during an episode of stress, such as severe intercurrent illness or an operation.High doses of inhaled corticosteroid have been associated with lower respiratory tract infections, including pneumonia, in older patients with chronic obstructive pulmonary disease.Bone mineral density may be reduced following long-term inhalation of higher doses of corticosteroids, predisposing patients to osteoporosis (section 6.6). It is therefore sensible to ensure that the dose of an inhaled corticosteroid is no higher than necessary to keep a patient\u2019s asthma under good control.In children, growth restriction associated with systemic corticosteroid therapy does not seem to occur with recommended doses of inhaled therapy; although initial growth velocity may be reduced, there appears to be no effect on achieving normal adult height. However, the height of children receiving prolonged treatment of inhaled corticosteroid should be monitored; if growth is slowed, referral to a paediatrician should be considered. Large-volume spacer devices should be used for administering inhaled corticosteroids in children under 15 years (see NICE guidance, section 3.1.5); they are also useful in older children and adults, particularly if high doses are required. Spacer devices increase airway deposition and reduce oropharyngeal deposition.A small risk of glaucoma with prolonged high doses of inhaled corticosteroids has been reported. Hoarseness, throat irritation, dysphonia, and candidiasis of the mouth or throat may occur with inhaled corticosteroids (see also below). Hypersensitivity reactions (including rash and angioedema) have been reported rarely. Paradoxical bronchospasm has been reported very rarely. Anxiety, depression, sleep disturbances, and behavioural changes including hyperactivity, irritability, and aggression (particularly in children), hyperglycaemia, cataracts, skin thinning and bruising have also been reported.Candidiasis\u00a0The risk of oral candidiasis can be reduced by using a spacer device with the corticosteroid inhaler; rinsing the mouth with water (or cleaning a child\u2019s teeth) after inhalation of a dose may also be helpful. Antifungal oral suspension or oral gel (section 12.3.2) can be used to treat oral candidiasis without discontinuing therapy.; also pharyngitis, headache; less commonly dyspepsia, weight increase, palpitation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127924.htm", "doses": [ "By inhalation of powder, adult and child over\r\n12 years, 400\u00a0micrograms as a single dose in the evening or in 2 divided\r\ndoses, reduced to 200\u00a0micrograms once daily if control maintained;\r\ndose may be increased to max. 400\u00a0micrograms twice daily in severe\r\nasthma" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "FERROUS FUMARATE": { "indications": "Indications\u00a0iron-deficiency anaemia", "name": "FERROUS FUMARATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.1 Iron-deficiency anaemias", "9.1.1.1 Oral iron" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (iron)", "side-effects": "Side-effects\u00a0\n(From 9.1.1.1 Oral iron: British National Formulary)\nSide-effects\u00a0Gastro-intestinal irritation can occur with iron salts. Nausea and epigastric pain are dose-related, but the relationship between dose and altered bowel habit (constipation or diarrhoea) is less clear. Oral iron, particularly modified-release preparations, can exacerbate diarrhoea in patients with inflammatory bowel disease; care is also needed in patients with intestinal strictures and diverticular disease.Iron preparations taken orally can be constipating, particularly in older patients and occasionally lead to faecal impaction.If side-effects occur, the dose may be reduced; alternatively, another iron salt may be used, but an improvement in tolerance may simply be a result of a lower content of elemental iron. The incidence of side-effects due to ferrous sulphate is no greater than with other iron salts when compared on the basis of equivalent amounts of elemental iron.Iron preparations are a common cause of accidental overdose in children. For the treatment of iron overdose, see Emergency Treatment of Poisoning, Iron salts.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4853.htm", "doses": [ "See under preparations below and notes above" ] }, "LISINOPRIL With diuretic": { "indications": "Indications\u00a0hypertension (but see notes above); symptomatic\r\nheart failure (adjunct\u2014\n(From 2.5.5 Drugs affecting the renin-angiotensin system: British National Formulary)\n2.5.5 Drugs affecting the renin-angiotensin system); short-term\r\ntreatment following myocardial infarction in haemodynamically stable\r\npatients; renal complications of diabetes mellitus", "name": "LISINOPRIL With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "LISINOPRIL", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also less commonly tachycardia, palpitation, cerebrovascular accident, myocardial infarction,\r\nRaynaud\u2019s syndrome, confusion, mood changes, vertigo, sleep disturbances,\r\nasthenia, impotence; rarely dry mouth, gynaecomastia,\r\nalopecia, psoriasis; very rarely allergic alveolitis,\r\npulmonary infiltrates, profuse sweating, pemphigus, Stevens-Johnson\r\nsyndrome, and toxic epidermal necrolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2596.htm", "doses": [ "Hypertension, initially 10\u00a0mg once daily; if used in addition\r\nto diuretic (see notes above) or\r\nin cardiac decompensation or in volume depletion, initially 2.5\u20135\u00a0mg\r\nonce daily; usual maintenance dose 20\u00a0mg once daily; max. 80\u00a0mg once\r\ndaily", "Heart failure (adjunct), initially 2.5\u00a0mg once daily under close\r\nmedical supervision (see notes above);\r\nincreased in steps no greater than 10\u00a0mg at intervals of at least\r\n2 weeks up to max. 35\u00a0mg once daily if tolerated", "Prophylaxis after myocardial infarction, systolic blood pressure\r\nover 120\u00a0mmHg, 5\u00a0mg within 24 hours, followed by further 5\u00a0mg 24 hours\r\nlater, then 10\u00a0mg after a further 24 hours, and continuing with 10\u00a0mg\r\nonce daily for 6 weeks (or continued if heart failure); systolic blood\r\npressure 100\u2013120\u00a0mmHg, initially 2.5\u00a0mg once daily, increased to maintenance\r\ndose of 5\u00a0mg once daily", "Should not be started after\r\nmyocardial infarction if systolic blood pressure less than 100\u00a0mmHg; temporarily reduce maintenance dose to 5\u00a0mg and if necessary 2.5\u00a0mg\r\ndaily if systolic blood pressure 100\u00a0mmHg or less during treatment;\r\nwithdraw if prolonged hypotension occurs (systolic blood pressure\r\nless than 90\u00a0mmHg for more than 1 hour)", "Renal complications of diabetes mellitus, initially 2.5\u20135\u00a0mg\r\nonce daily adjusted according to response; usual dose range 10\u201320\u00a0mg\r\nonce daily", "Name[Zestoretic\u00ae (AstraZeneca) ] Zestoretic 10 tablets, peach, lisinopril (as dihydrate) 10\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a32.27\nZestoretic 20 tablets, lisinopril (as dihydrate) 20\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price 28-tab pack = \u00a33.84" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "BAMBUTEROL HYDROCHLORIDE": { "indications": "Indications\u00a0asthma and other conditions associated\r\nwith reversible airways obstruction", "name": "BAMBUTEROL HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2900.htm", "doses": [ "20\u00a0mg once daily at bedtime if patient has previously\r\ntolerated beta2 agonists; other patients, initially 10\u00a0mg\r\nonce daily at bedtime, increased if necessary after 1\u20132 weeks to 20\u00a0mg\r\nonce daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014no information available;\r\nsee also section 3.1" }, "BENZYLPENICILLIN SODIUM": { "indications": "Indications\u00a0throat\r\ninfections, otitis media, endocarditis, meningococcal disease, pneumonia,\r\ncellulitis (Table 1, section 5.1); anthrax;\r\nintrapartum prophylaxis against group B streptococcal infection; see\r\nalso notes above", "name": "BENZYLPENICILLIN SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.1 Penicillins", "5.1.1.1 Benzylpenicillin and phenoxymethylpenicillin" ], "cautions": "Cautions\u00a0history of allergy; false-positive urinary glucose (if tested for reducing substances); interactions: Appendix 1 (penicillins)", "side-effects": "Side-effects\u00a0hypersensitivity reactions including urticaria,\r\nfever, joint pains, rashes, angioedema, anaphylaxis, serum sickness-like\r\nreaction; rarely CNS toxicity including convulsions\r\n(especially with high doses or in severe renal impairment), interstitial\r\nnephritis, haemolytic anaemia, leucopenia, thrombocytopenia, and coagulation\r\ndisorders; also reported diarrhoea (including antibiotic-associated\r\ncolitis)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3708.htm", "doses": [ "By intramuscular or by slow intravenous injection or by infusion, 0.6\u20131.2\u00a0g every 6 hours, increased if necessary\r\nin more serious infections (single doses over 1.2\u00a0g intravenous route\r\nonly; see also below); neonate under\r\n7 days, 25\u00a0mg/kg every 12 hours, dose doubled in severe infection; neonate 7\u201328 days, 25\u00a0mg/kg every 8 hours, dose doubled\r\nin severe infection; child 1 month\u201318\r\nyears, 25\u00a0mg/kg every 6 hours (increased in severe infection to 50\u00a0mg/kg\r\nevery 4\u20136 hours (max. 2.4\u00a0g every 4 hours); intravenous route recommended\r\nin neonates and infants", "Endocarditis (in combination with another antibacterial if necessary,\r\nsee Table 1, section 5.1), by slow intravenous injection or by infusion, 1.2\u00a0g every 4 hours,\r\nincreased if necessary (e.g. in enterococcal endocarditis or if benzylpenicillin\r\nused alone) to 2.4\u00a0g every 4 hours; child 1 month\u201318 years see BNF for Children", "Anthrax (in combination with other antibacterials, see also section 5.1.12), by slow intravenous injection or by infusion, 2.4\u00a0g every 4 hours; child under 18 years see BNF for Children", "Intrapartum prophylaxis against group B streptococcal infection, by slow intravenous injection or by infusion, initially 3\u00a0g then 1.5\u00a0g every 4 hours until\r\ndelivery", "Meningitis, meningococcal disease, by slow intravenous\r\ninjection or by infusion,\r\n2.4\u00a0g every 4 hours; neonate, 75\u00a0mg/kg\r\nevery 8 hours; child 1 month\u201318 years,\r\n50\u00a0mg/kg every 4\u20136 hours (max. 2.4\u00a0g every 4 hours)", "Important. If meningococcal\r\ndisease (meningitis with non-blanching rash or meningococcal septicaemia)\r\nis suspected, a single dose of benzylpenicillin should be given before transferring the patient to hospital urgently,\r\nso long as this does not delay the transfer. If a patient with suspected\r\nbacterial meningitis without non-blanching rash cannot be transferred\r\nto hospital urgently, a single dose of benzylpenicillin should be\r\ngiven before the transfer. Suitable doses of benzylpenicillin by intravenous\r\ninjection (or by intramuscular injection) are: adult 1.2\u00a0g; infant under 1 year 300\u00a0mg; child 1\u20139 years 600\u00a0mg, 10 years and over as for\r\nadult. In penicillin allergy, cefotaxime (section 5.1.2) may be an alternative; chloramphenicol (section 5.1.7) may be used if there is a history\r\nof anaphylaxis to penicillins", "By intrathecal injection, not recommended", "Benzylpenicillin doses\r\nin BNF may differ from those in product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "CARBOMERS Single use": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "CARBOMERS", "Single use" ], "indications": "Indications\u00a0dry eyes including keratoconjunctivitis sicca, unstable tear film", "name": "CARBOMERS Single use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215482.htm", "doses": [ "Apply 3\u20134 times daily or as required", "Name[Viscotears\u00ae (Novartis)] Liquid gel (= eye drops), carbomer\r\n980 (polyacrylic acid) 0.2%, net price 30 \u00d7 0.6-mL single-dose units\r\n= \u00a35.42" ] }, "DOXYCYCLINE - DRUGS FOR ORAL ULCERATION AND INFLAMMATION": { "indications": "Indications\u00a0see preparations; oral herpes (section 12.3.2); other indications (section 5.1.3)", "name": "DOXYCYCLINE - DRUGS FOR ORAL ULCERATION AND INFLAMMATION", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "DOXYCYCLINE" ], "cautions": "Cautions\u00a0section 5.1.3; monitor for superficial fungal\r\ninfection, particularly if predisposition to oral candidiasis", "side-effects": "Side-effects\u00a0section 5.1.3; fungal superinfection", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128197.htm", "doses": [ "See preparations", "Doxycycline stains teeth; avoid in children\r\nunder 12 years of age", "periodontitis (as an adjunct to gingival scaling and root\r\nplaning), 20\u00a0mg twice daily for 3 months; child under 12 years not recommended" ], "pregnancy": "Pregnancy\u00a0section 5.1.3" }, "ETHERIFIED STARCH Pentastarch": { "indications": "Indications\u00a0low blood volume", "name": "ETHERIFIED STARCH Pentastarch", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "ETHERIFIED STARCH", "Pentastarch" ], "cautions": "Cautions\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; children", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.; also\r\npruritus, raised serum amylase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/23300.htm", "doses": [ "See under preparations below", "Name[HAES-steril\u00ae (Fresenius Kabi) ] Intravenous infusion, pentastarch\r\n(weight average molecular weight 200\u00a0000) 10% in sodium chloride intravenous infusion 0.9%, net price 500\u00a0mL = \u00a316.50Dose\u00a0by intravenous infusion, up to 1500\u00a0mL\r\ndaily (see notes above)" ] }, "PHENOXYBENZAMINE HYDROCHLORIDE": { "indications": "Indications\u00a0hypertensive episodes in phaeochromocytoma", "name": "PHENOXYBENZAMINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.4 Alpha-adrenoceptor blocking drugs", "Phaeochromocytoma", "PHENOXYBENZAMINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0elderly; congestive\r\nheart failure; severe ischaemic heart disease (see also Contra-indications); cerebrovascular disease (avoid if history of cerebrovascular accident); monitor\r\nblood pressure regularly during infusion; carcinogenic in animals; avoid in acute porphyria (section 9.8.2); avoid extravasation (irritant\r\nto tissues)", "side-effects": "Side-effects\u00a0postural hypotension with dizziness and marked\r\ncompensatory tachycardia, lassitude, nasal congestion, miosis, inhibition\r\nof ejaculation; rarely gastro-intestinal disturbances; decreased sweating\r\nand dry mouth after intravenous infusion; idiosyncratic profound hypotension\r\nwithin few minutes of starting infusion; convulsions following rapid\r\nintravenous infusion also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/19515.htm", "doses": [ "See under preparations", "phaeochromocytoma, 10\u00a0mg daily, increased by 10\u00a0mg daily;\r\nusual dose 1\u20132\u00a0mg/kg daily in 2 divided doses" ], "pregnancy": "Pregnancy\u00a0hypotension may occur in newborn" }, "Other compounds": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.2 Vitamin B group" ], "name": "Other compounds", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5124.htm", "doses": [ "Peyronie\u2019s disease, scleroderma, 12\u00a0g daily in divided doses after\r\nfood" ] }, "CICLOSPORIN - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0severe active rheumatoid arthritis when\r\nconventional second-line therapy inappropriate or ineffective; severe\r\nacute ulcerative colitis [unlicensed indication] (section 1.5.3); graft-versus-host disease (section 8.2.2); atopic\r\ndermatitis and psoriasis (section 13.5.3)", "name": "CICLOSPORIN - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Drugs affecting the immune response", "CICLOSPORIN" ], "cautions": "Cautions\u00a0section 8.2.2Additional cautions in rheumatoid arthritis\u00a0 Contra-indicated in abnormal\r\nrenal function, uncontrolled hypertension (see also below), uncontrolled infections, and malignancy. Measure serum\r\ncreatinine at least twice before treatment and monitor\r\nevery 2 weeks for first 3 months, then every 4 weeks (or more frequently\r\nif dose increased or concomitant NSAIDs introduced or increased (see\r\nalso interactions: Appendix 1\r\n(ciclosporin)), reduce dose if serum creatinine\r\nincreases more than 30% above baseline in more than 1 measurement;\r\nif above 50%, reduce dose by 50% (even if within normal range) and\r\ndiscontinue if reduction not successful within 1 month; monitor blood pressure (discontinue if hypertension\r\ndevelops that cannot be controlled by antihypertensive therapy); monitor hepatic function if concomitant NSAIDs given.", "side-effects": "Side-effects\u00a0section 8.2.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106294.htm", "doses": [ "By mouth, administered in accordance with\r\nexpert advice, initially 2.5\u00a0mg/kg daily in 2 divided doses, if necessary\r\nincreased gradually after 6 weeks; max. 4\u00a0mg/kg daily (discontinue\r\nif response insufficient after 3 months); dose adjusted according\r\nto response for maintenance and treatment reviewed after 6 months\r\n(continue only if benefits outweigh risks); child and under 18 years, not recommended ", "For preparations and counselling and\r\nfor advice on conversion between the preparations, see section 8.2.2" ], "pregnancy": "Pregnancy\u00a0see section 8.2.2" }, "CHLOROQUINE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS": { "indications": "Indications\u00a0active rheumatoid arthritis, systemic\r\nand discoid lupus erythematosus; malaria (section\r\n5.4.1)", "name": "CHLOROQUINE - DRUGS THAT SUPPRESS THE RHEUMATIC DISEASE PROCESS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Antimalarials", "CHLOROQUINE" ], "cautions": "Cautions\u00a0\n(From Antimalarials: British National Formulary)\nCautions\u00a0 Manufacturers recommend regular ophthalmological examination but the evidence of practical value is unsatisfactory (see advice of the Royal College of Ophthalmologists, below). Chloroquine and hydroxychloroquine should be used with caution in neurological disorders (especially in those with a history of epilepsy), in severe gastro-intestinal disorders, in G6PD deficiency (section 9.1.5), in acute porphyria, and in the elderly (see also above). Chloroquine and hydroxychloroquine may exacerbate psoriasis and aggravate myasthenia gravis. Concurrent use of hepatotoxic drugs should be avoided; other interactions: Appendix 1 (chloroquine and hydroxychloroquine).Screening for ocular toxicity\u00a0A review group convened by the Royal College of Ophthalmologists has updated guidelines for screening to prevent ocular toxicity on long-term treatment with chloroquine and hydroxychloroquine (Hydroxychloroquine and Ocular Toxicity: Recommendations on Screening 2009). Chloroquine should be considered (for treating chronic inflammatory conditions) only if other drugs have failed. All patients taking chloroquine should receive ocular examination according to a protocol arranged locally between the prescriber and the ophthalmologist. The following recommendations relate to hydroxychloroquine, which is only rarely associated with toxicity.Before treatment:Assess renal and liver function (adjust dose if impaired)Ask patient about visual impairment (not corrected by glasses). If impairment or eye disease present, assessment by an optometrist is advised and any abnormality should be referred to an ophthalmologistRecord near visual acuity of each eye (with glasses where appropriate) using a standard reading chartInitiate hydroxychloroquine treatment if no abnormality detected (at a dose not exceeding hydroxychloroquine sulphate 6.5\u00a0mg/kg daily)During treatment:Ask patient about visual symptoms and monitor visual acuity annually using the standard reading chartRefer to ophthalmologist if visual acuity changes or if vision blurred and warn patient to seek prescribing doctor\u2019s advice about stopping treatmentA child treated for juvenile idiopathic arthritis should receive slit-lamp examination routinely to check for uveitisIf long-term treatment is required (more than 5 years), individual arrangement should be agreed with the local ophthalmologistImportantTo avoid excessive dosage in obese patients, the doses of hydroxychloroquine and chloroquine should be calculated on the basis of ideal body-weight. Ocular toxicity is unlikely if the dose of chloroquine phosphate does not exceed 4\u00a0mg/kg daily (equivalent to chloroquine base approx. 2.5\u00a0mg/kg daily)", "side-effects": "Side-effects\u00a0\n(From Antimalarials: British National Formulary)\nSide-effects\u00a0The side-effects of chloroquine and hydroxychloroquine include gastro-intestinal disturbances, headache and skin reactions (rashes, pruritus); those occurring less frequently include ECG changes, convulsions, visual changes, retinal damage (see above), keratopathy, ototoxicity, hair depigmentation, hair loss, and discoloration of skin, nails, and mucous membranes. Side-effects that occur rarely include blood disorders (including thrombocytopenia, agranulocytosis, and aplastic anaemia), mental changes (including emotional disturbances and psychosis), myopathy (including cardiomyopathy and neuromyopathy), acute generalised exanthematous pustulosis, exfoliative dermatitis, Stevens-Johnson syndrome, photosensitivity, and hepatic damage; angioedema has also been reported. Important: very toxic in overdosage\u2014immediate advice from poisons centres essential (see also Emergency Treatment of Poisoning).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106292.htm", "doses": [ "Administered on expert advice, by mouth, adult over 18 years, chloroquine (base) 150\u00a0mg daily; max. 2.5\u00a0mg/kg daily based on ideal body-weight,\r\nsee also recommendations above", "Chloroquine base 150\u00a0mg\r\n\u2261 chloroquine sulphate 200\u00a0mg \u2261 chloroquine phosphate 250\u00a0mg (approx.)." ], "pregnancy": "Pregnancy\u00a0\n(From Antimalarials: British National Formulary)\nPregnancy\u00a0It is not necessary to withdraw an antimalarial drug during pregnancy if the rheumatic disease is well controlled; however, the manufacturer of hydroxychloroquine advises avoiding use." }, "MAGNESIUM TRISILICATE": { "indications": "Indications\u00a0dyspepsia", "name": "MAGNESIUM TRISILICATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone", "Aluminium- and magnesium-containing antacids", "MAGNESIUM TRISILICATE" ], "cautions": "Cautions\u00a0\n(From 1.1.1 Antacids and simeticone: British National Formulary)\nMagnesium-containing antacids tend to be laxative; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0diarrhoea, belching due to liberated carbon dioxide;\r\nsilica-based renal stones reported on long-term treatment", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2029.htm", "doses": [ "1\u20132 tablets chewed when required" ] }, "COMBINED HORMONAL CONTRACEPTIVES Transdermal (standard strength) - ETHINYLESTRADIOL WITH NORELGESTROMIN": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Transdermal (standard strength) - ETHINYLESTRADIOL WITH NORELGESTROMIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Transdermal (standard strength)", "Ethinylestradiol with Norelgestromin" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127952.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days", "1 patch to be applied once weekly for three weeks, followed\r\nby a 7-day patch-free interval; subsequent courses repeated after\r\n7-day patch-free interval (during which withdrawal bleeding occurs);\r\nfor starting routines see under Dose above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "MINOXIDIL - VASODILATOR ANTIHYPERTENSIVE DRUGS": { "indications": "Indications\u00a0severe hypertension, in addition to a diuretic\r\nand a beta-blocker", "name": "MINOXIDIL - VASODILATOR ANTIHYPERTENSIVE DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.1 Vasodilator antihypertensive drugs", "MINOXIDIL" ], "cautions": "Cautions\u00a0\n(From 2.5.1 Vasodilator antihypertensive drugs: British National Formulary)\nMinoxidil should be reserved for the treatment of severe hypertension resistant to other drugs. Vasodilatation is accompanied by increased cardiac output and tachycardia and the patients develop fluid retention. For this reason the addition of a beta-blocker and a diuretic (usually furosemide, in high dosage) are mandatory. Hypertrichosis is troublesome and renders this drug unsuitable for women. ; angina; after myocardial infarction (until stabilised); acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias); interactions: Appendix 1\r\n(vasodilator antihypertensives)", "side-effects": "Side-effects\u00a0sodium and water retention; weight gain, peripheral\r\noedema, tachycardia, hypertrichosis; reversible rise in creatinine\r\nand blood urea nitrogen; occasionally, gastro-intestinal disturbances,\r\nbreast tenderness, rashes", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2541.htm", "doses": [ "Initially 5\u00a0mg (elderly, 2.5\u00a0mg) daily, in 1\u20132 divided doses, increased in steps of 5\u201310\u00a0mg\r\nat intervals of at least 3 days; max. 100\u00a0mg daily (seldom necessary\r\nto exceed 50\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0avoid\u2014possible toxicity including reduced placental\r\nperfusion; neonatal hirsutism reported" }, "ISOSORBIDE DINITRATE Short-acting tablets and sprays": { "indications": "Indications\u00a0prophylaxis and treatment of angina; left ventricular\r\nfailure", "name": "ISOSORBIDE DINITRATE Short-acting tablets and sprays", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE DINITRATE", "Short-acting tablets and sprays" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2641.htm", "doses": [ "By mouth, daily in divided doses, angina\r\n30\u2013120\u00a0mg, left ventricular failure 40\u2013160\u00a0mg, up to 240\u00a0mg if required", "By intravenous infusion, 2\u201310\u00a0mg/hour; higher\r\ndoses up to 20\u00a0mg/hour may be required", "Name[Isosorbide Dinitrate (Non-proprietary)] Tablets, isosorbide dinitrate 10\u00a0mg, net price 56-tab pack = \u00a311.23; 20\u00a0mg, 56-tab pack = \u00a312.38" ], "pregnancy": "Pregnancy\u00a0may cross placenta\u2014manufacturers advise avoid unless\r\npotential benefit outweighs risk" }, "INFLIXIMAB - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0see under Inflammatory Bowel Disease; ankylosing spondylitis,\r\nrheumatoid arthritis (section 10.1.3); psoriasis (section 13.5.3)", "name": "INFLIXIMAB - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0see section 10.1.3;\r\nalso history of dysplasia or colon carcinomaHypersensitivity reactions\u00a0Risk of delayed hypersensitivity if drug-free interval exceeds\r\n16 weeks", "side-effects": "Side-effects\u00a0see section 10.1.3;\r\nalso hepatosplenic T-cell lymphoma", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128211.htm", "doses": [ "By intravenous infusion, severe active\r\nCrohn\u2019s disease, adult over 18 years,\r\ninitially 5\u00a0mg/kg, then 5\u00a0mg/kg 2 weeks after initial dose; then if\r\nthe condition has responded, maintenance 5\u00a0mg/kg 6 weeks after initial\r\ndose, then 5\u00a0mg/kg every 8 weeks; child 6\u201318 years, initially 5\u00a0mg/kg, then 5\u00a0mg/kg 2 weeks and 6 weeks\r\nafter initial dose, then 5\u00a0mg/kg every 8 weeks; interval between maintenance\r\ndoses adjusted according to response; discontinue if no response within\r\n10 weeks of initial dose", "Fistulating Crohn\u2019s disease, adult over 18 years, initially 5\u00a0mg/kg, then 5\u00a0mg/kg 2 weeks and 6 weeks\r\nafter initial dose, then if condition has responded, consult product\r\nliterature for guidance on further doses; child under 18 years, see BNF for Children", "Severe active ulcerative colitis, adult over 18 years, initially 5\u00a0mg/kg, then 5\u00a0mg/kg 2 weeks and 6 weeks\r\nafter initial dose, then 5\u00a0mg/kg every 8 weeks; discontinue if no\r\nresponse 14 weeks after initial dose" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "PROMETHAZINE HYDROCHLORIDE ": { "indications": "Indications\u00a0sedation (short-term use); allergy and urticaria\r\n(section\r\n3.4.1); nausea and vomiting (section 4.6)", "name": "PROMETHAZINE HYDROCHLORIDE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Antihistamines" ], "cautions": "Cautions\u00a0see\r\nPromethazine Hydrochloride, section 3.4.1", "side-effects": "Side-effects\u00a0see\r\nPromethazine Hydrochloride, section 3.4.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3165.htm", "doses": [ "By mouth, 25\u201350\u00a0mg; child 2\u20135 years 15\u201320\u00a0mg, 5\u201310 years 20\u201325\u00a0mg", "By deep intramuscular injection, 25\u201350\u00a0mg; child 5\u201310 years 6.25\u201312.5\u00a0mg" ], "pregnancy": "Pregnancy\u00a0see\r\nnotes in section 3.4.1" }, "CLARITHROMYCIN Modified release": { "indications": "Indications\u00a0respiratory-tract infections, mild to moderate skin and soft-tissue\r\ninfections, otitis media; Lyme disease (see also section 5.1.1.3); prevention of pertussis (Table\r\n2, section 5.1); Helicobacter pylori eradication (section 1.3)", "name": "CLARITHROMYCIN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.5 Macrolides", "CLARITHROMYCIN", "Modified release" ], "cautions": "Cautions\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nOral infections\u00a0The macrolides are an alternative for oral infections in penicillin-allergic patients or where a beta-lactamase producing organism is involved. However, many organisms are now resistant to macrolides or rapidly develop resistance; their use should therefore be limited to short courses. Metronidazole (section 5.1.11) may be preferred as an alternative to a penicillin.Cautions\u00a0Macrolides should be used with caution in patients with a predisposition to QT interval prolongation (including electrolyte disturbances and concomitant use of drugs that prolong the QT interval). Macrolides may aggravate myasthenia gravis. ; interactions: Appendix 1 (macrolides)", "side-effects": "Side-effects\u00a0\n(From 5.1.5 Macrolides: British National Formulary)\nSide-effects\u00a0Nausea, vomiting, abdominal discomfort, and diarrhoea are the most common side-effects of the macrolides, but they are mild and less frequent with azithromycin and clarithromycin than with erythromycin. Hepatotoxicity (including cholestatic jaundice) and rash occur less frequently. Other side-effects reported rarely or very rarely include pancreatitis, antibiotic-associated colitis, QT interval prolongation, arrhythmias, Stevens-Johnson syndrome, and toxic epidermal necrolysis. Generally reversible hearing loss (sometimes with tinnitus) has been reported after large doses of a macrolide; it occurs commonly after long-term therapy with azithromycin. Intravenous infusion may cause local tenderness and phlebitis.; also\r\ndyspepsia, tooth and tongue discoloration, smell and taste disturbances,\r\nstomatitis, glossitis, and headache; less commonly arthralgia and myalgia; rarely tinnitus; very rarely dizziness, insomnia, nightmares, anxiety, confusion,\r\npsychosis, paraesthesia, convulsions, hypoglycaemia, renal failure,\r\ninterstitial nephritis, leucopenia, and thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60385.htm", "doses": [ "By mouth, adult and child over 12 years, 250\u00a0mg every\r\n12 hours for 7 days, increased in pneumonia or severe infections to\r\n500\u00a0mg every 12 hours for up to 14 days (see also Table 1, section 5.1); child body-weight under 8\u00a0kg, 7.5\u00a0mg/kg twice daily; 8\u201311\u00a0kg, 62.5\u00a0mg\r\ntwice daily; 12\u201319\u00a0kg, 125\u00a0mg twice daily; 20\u201329\u00a0kg, 187.5\u00a0mg twice\r\ndaily; 30\u201340\u00a0kg, 250\u00a0mg twice daily", "Lyme disease (see also section 5.1.1.3), adult and child over 12 years, 500\u00a0mg every\r\n12 hours for 14\u201321 days [unlicensed duration]; child 1 month\u201312 years see BNF for Children", "By intravenous infusion into larger\r\nproximal vein, adult and child over 12 years, 500\u00a0mg twice daily; child 1 month\u201312 years see BNF for Children", "Name[Klaricid XL\u00ae (Abbott) ] Tablets, m/r, yellow, clarithromycin 500\u00a0mg, net price 7-tab pack = \u00a36.46, 14-tab pack = \u00a312.71. \r\n Label:\r\n 9, 21, 25Dose\u00a0500\u00a0mg once daily (doubled in severe infections) for 7\u201314\r\ndays" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "PRIMIDONE": { "indications": "Indications\u00a0all forms of epilepsy except typical absence seizures; essential\r\ntremor (section 4.9.3)", "name": "PRIMIDONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Phenobarbital and primidone", "PRIMIDONE" ], "cautions": "Cautions\u00a0see under Phenobarbital; interactions: see Interactions in section 4.8.1 and Appendix 1 (phenobarbital)", "side-effects": "Side-effects\u00a0see Phenobarbital; also nausea, visual\r\ndisturbances; less commonly vomiting, headache, dizziness; rarely psychosis, lupus erythematosus, arthralgia; also reported Dupuytren\u2019s contracture", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128250.htm", "doses": [ "Epilepsy, adult and child over 9 years, initially 125\u00a0mg daily at bedtime,\r\nincreased by 125\u00a0mg every 3 days to 500\u00a0mg daily in 2 divided doses,\r\nthen increased according to response by 250\u00a0mg every 3 days to usual\r\nmaintenance 0.75\u20131.5\u00a0g daily in 2 divided doses; child under 9 years, initially 125\u00a0mg daily at bedtime, increased by 125\u00a0mg\r\nevery 3 days according to response; usual maintenance, child under 2 years, 250\u2013500\u00a0mg daily in 2 divided\r\ndoses; 2\u20135 years, 500\u2013750\u00a0mg daily in 2 divided doses; 5\u20139 years 0.75\u20131\u00a0g\r\ndaily in 2 divided doses", "Essential tremor, initially 50\u00a0mg daily, increased gradually\r\nover 2\u20133 weeks according to response; max. 750\u00a0mg daily", "Monitor plasma concentrations\r\nof derived phenobarbital; optimum\r\nrange as for phenobarbital" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "13.2.1.1 Emollient bath and shower preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.2 Emollient and barrier preparations", "13.2.1 Emollients" ], "name": "13.2.1.1 Emollient bath and shower preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200782.htm", "doses": [ "for dry skin conditions including dermatitis, ichthyosis,\r\nand pruritus of the elderly; add 15\u201320\u00a0mL/bath, (infant and child 5\u201310\u00a0mL)", "for dry, chapped, or itchy skin conditions, apply to wet\r\nor dry skin and rinse, or apply to dry skin after showering" ] }, "DASATINIB": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nDasatinib, a tyrosine kinase inhibitor, is licensed for the treatment of chronic myeloid leukaemia in those who have resistance to or intolerance of previous therapy, including imatinib. It is also licensed for newly diagnosed Philadelphia chromosome-positive chronic myeloid leukaemia in the chronic phase and for acute lymphoblastic leukaemia (Philadelphia chromosome positive) in those who have resistance to or intolerance of previous therapy. The Scottish Medicines Consortium has advised (April 2007) that the use of dasatinib (Sprycel\u00ae) in NHS Scotland is restricted to patients in the chronic phase of chronic myeloid leukaemia.", "name": "DASATINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "DASATINIB" ], "cautions": "Cautions\u00a0see section 8.1; susceptibility to QT-interval prolongation\r\n(correct hypokalaemia or hypomagnesaemia before starting treatment); risk of cardiac dysfunction (monitor closely); interactions: Appendix 1 (dasatinib)Pulmonary arterial hypertension\u00a0Patients should\r\nbe evaluated for signs and symptoms of underlying cardiopulmonary\r\ndisease before starting treatment; echocardiography should be performed\r\nat the start of treatment in patients with symptoms of cardiac disease\r\nand considered for patients with risk factors for cardiac or pulmonary\r\ndisease.Treatment should be interrupted or the dose reduced in patients\r\nwho develop dyspnoea or fatigue, while they are evaluated for common\r\naetiologies (e.g. pleural effusion, pulmonary oedema, anaemia or lung\r\ninfiltration); pulmonary arterial hypertension should be considered\r\nin the absence of these conditions, and if there is no improvement\r\nfollowing dose reduction or interruption.If pulmonary arterial hypertension is confirmed, dasatinib should\r\nbe permanently discontinued", "side-effects": "Side-effects\u00a0see section 8.1; also diarrhoea, anorexia, weight\r\nchanges, abdominal pain, taste disturbance, constipation, dyspepsia,\r\ncolitis, gastritis; arrhythmias, congestive heart failure, hypertension,\r\nchest pain, flushing, haemorrhage (including gastro-intestinal and\r\nCNS haemorrhage), palpitation; dyspnoea, pulmonary hypertension, cough,\r\noedema (more common in patients over 65 years old), pleural effusion;\r\ndepression, dizziness, headache, insomnia, neuropathy; influenza-like\r\nsymptoms; musculoskeletal pain; visual disturbances; tinnitus; acne,\r\ndry skin, sweating, pruritus, dermatitis, urticaria; less\r\ncommonly pancreatitis, hepatitis, cholestasis, cholecystitis,\r\noesophagitis, hypotension, transient ischaemic attack, thrombophlebitis,\r\nsyncope, asthma, seizures, amnesia, tremor, drowsiness, gynaecomastia,\r\nirregular menstruation, urinary frequency, proteinuria, hypocalcaemia,\r\nrhabdomyolysis, hypersensitivity reactions (including erythema nodosum),\r\nphotosensitivity, and pigmentation and nail disorders; rarely cor pulmonale; thrombosis and interstitial lung disease also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129968.htm", "doses": [ "Chronic phase chronic myeloid leukaemia, adult over 18 years 100\u00a0mg once daily, increased\r\nif necessary to max. 140\u00a0mg once daily", "Accelerated and blast phase chronic myeloid leukaemia,\r\nacute lymphoblastic leukaemia, adult over 18 years 140\u00a0mg once daily, increased if necessary to max.\r\n180\u00a0mg once daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies; effective\r\ncontraception required during treatment; see also Pregnancy and Reproductive\r\nFunction" }, "POLYMYXIN B SULPHATE With other antibacterials": { "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "POLYMYXIN B SULPHATE With other antibacterials", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "POLYMYXIN B SULPHATE", "With other antibacterials" ], "side-effects": "Side-effects\u00a0local irritation and dermatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5402.htm", "doses": [ "See Administration in\r\nnotes above", "Name[Polyfax\u00ae (TEVA UK) ] Eye ointment, polymyxin\r\nB sulphate 10\u00a0000\u00a0units, bacitracin zinc 500\u00a0units/g. Net\r\nprice 4\u00a0g = \u00a33.26" ] }, "RANOLAZINE": { "indications": "Indications\u00a0as adjunctive therapy in the treatment\r\nof stable angina in patients inadequately controlled or intolerant\r\nof first-line antianginal therapies", "name": "RANOLAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.3 Other antianginal drugs" ], "cautions": "Cautions\u00a0moderate to severe congestive heart failure; QT interval prolongation; elderly; body-weight less than 60\u00a0kg; interactions: Appendix 1 (ranolazine)", "side-effects": "Side-effects\u00a0constipation, nausea, vomiting; dizziness, headache,\r\nasthenia; less commonly abdominal pain, weight loss,\r\ndry mouth, dyspepsia, flatulence; hot flush, hypotension, syncope,\r\nprolonged QT interval, peripheral oedema; dysponea, cough, epistaxis;\r\nlethargy, hypoaesthesia, drowsiness, tremor, anxiety, insomnia, anorexia;\r\ndysuria, haematuria, chromaturia; dehydration; pain in extremities,\r\nmuscle cramp, joint swelling; visual disturbance; tinnitus; pruritus,\r\nsweating; rarely pancreatitis, erosive duodenitis;\r\ncold extremities; throat tightness; amnesia, loss of consciousness,\r\ndisorientation; erectile dysfunction; parosmia, impaired hearing;\r\nallergic dermatitis, urticaria, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202731.htm", "doses": [ "adult over 18 years, initially\r\n375\u00a0mg twice daily, increased after 2\u20134 weeks to 500\u00a0mg twice daily\r\nand then adjusted according to response to max. 750\u00a0mg twice daily\r\n(reduce dose to 375\u2013500\u00a0mg twice daily if not tolerated)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014no information\r\navailable" }, "ALUMINIUM HYDROXIDE Co-magaldrox": { "indications": "Indications\u00a0dyspepsia; hyperphosphataemia (section 9.5.2.2)", "name": "ALUMINIUM HYDROXIDE Co-magaldrox", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.1 Antacids and simeticone", "Aluminium- and magnesium-containing antacids", "ALUMINIUM HYDROXIDE", "Co-magaldrox" ], "cautions": "Cautions\u00a0\n(From 1.1.1 Antacids and simeticone: British National Formulary)\nAluminium- and magnesium-containing antacids (e.g. aluminium hydroxide, and magnesium carbonate, hydroxide and trisilicate), being relatively insoluble in water, are long-acting if retained in the stomach. They are suitable for most antacid purposes. Magnesium-containing antacids tend to be laxative whereas aluminium-containing antacids may be constipating; antacids containing both magnesium and aluminium may reduce these colonic side-effects. Aluminium accumulation does not appear to be a risk if renal function is normal.; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2025.htm", "doses": [ "Name[Mucogel\u00ae (Chemidex)] Suspension, sugar-free, co-magaldrox\r\n195/220 (magnesium hydroxide 195\u00a0mg, dried aluminium hydroxide 220\u00a0mg/5\u00a0mL\r\n(low Na+)). Net price 500\u00a0mL = \u00a31.71Dose\u00a0adult and child over 12 years, 10\u201320\u00a0mL 3 times daily, 20\u201360\r\nminutes after meals, and at bedtime or when required" ] }, "SODIUM CHLORIDE": { "indications": "Indications\u00a0electrolyte imbalance\u2014see also section 9.2.1.2; nebuliser diluent (section 3.1.5); eye (section 11.8.1); oral hygiene (section 12.3.4); wound irrigation (section 13.11.1)", "name": "SODIUM CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.1 Electrolytes and water", "Intravenous sodium" ], "cautions": "Cautions\u00a0restrict intake in impaired renal function, cardiac failure, hypertension, peripheral and pulmonary oedema,\r\ntoxaemia of pregnancy", "side-effects": "Side-effects\u00a0administration of large doses may give rise to\r\nsodium accumulation, oedema, and hyperchloraemic acidosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4972.htm", "doses": [ "See notes above" ] }, "ISOSORBIDE DINITRATE Parenteral preparations": { "indications": "Indications\u00a0prophylaxis and treatment of angina; left ventricular\r\nfailure", "name": "ISOSORBIDE DINITRATE Parenteral preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.1 Nitrates", "ISOSORBIDE DINITRATE", "Parenteral preparations" ], "cautions": "Cautions\u00a0see under Glyceryl Trinitrate", "side-effects": "Side-effects\u00a0see under Glyceryl Trinitrate", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2655.htm", "doses": [ "By mouth, daily in divided doses, angina\r\n30\u2013120\u00a0mg, left ventricular failure 40\u2013160\u00a0mg, up to 240\u00a0mg if required", "By intravenous infusion, 2\u201310\u00a0mg/hour; higher\r\ndoses up to 20\u00a0mg/hour may be required", "Name[Isoket\u00ae (UCB Pharma) ] Injection 0.1%, isosorbide\r\ndinitrate 1\u00a0mg/mL. To be diluted before use. Net price 10-mL\r\namp = \u00a32.69Note\u00a0Glass or polyethylene infusion apparatus\r\nis preferable; loss of potency if PVC used" ], "pregnancy": "Pregnancy\u00a0may cross placenta\u2014manufacturers advise avoid unless\r\npotential benefit outweighs risk" }, "MINOXIDIL - ANDROGENETIC ALOPECIA": { "indications": "Indications\u00a0androgenetic alopecia (men and women)", "name": "MINOXIDIL - ANDROGENETIC ALOPECIA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.9 Shampoos and other preparations for scalp and hair conditions", "Androgenetic alopecia", "MINOXIDIL" ], "cautions": "Cautions\u00a0flammable; wash hands after application", "side-effects": "Side-effects\u00a0section 2.5.1; also headache, local irritation; less\r\ncommonly hypotension, changes in hair colour or texture (discontinue\r\nif increased hair loss persists for more than 2 weeks)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6113.htm", "doses": [ "See under preparations below", "apply 1\u00a0mL twice daily to affected areas of scalp; discontinue\r\nif no improvement after 1 year", "apply 1\u00a0mL twice daily to affected areas of scalp; discontinue\r\nif no improvement after 1 year", "apply half a capful twice daily to affected areas of scalp;\r\ndiscontinue if no improvement after 16 weeks" ], "pregnancy": "Pregnancy\u00a0section 2.5.1" }, "NALTREXONE HYDROCHLORIDE": { "indications": "Indications\u00a0adjunct to prevent relapse in formerly\r\nopioid-dependent patients (who have remained opioid-free for at least\r\n7\u201310 days); adjunct to prevent relapse in formerly alcohol-dependent\r\npatients [unlicensed]", "name": "NALTREXONE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.3 Opioid dependence", "Opioid-receptor antagonists" ], "cautions": "Cautions\u00a0liver function tests needed before and\r\nduring treatment; test for opioid dependence\r\nwith naloxone before treatment; avoid concomitant\r\nuse of opioids but increased dose of opioid analgesic may be required\r\nfor pain (monitor for opioid intoxication)Note\u00a0Patients should be warned that\r\nan attempt to overcome the blockade of opioid receptors by overdosing\r\ncould result in acute opioid intoxication", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, constipation,\r\nreduced appetite, increased thirst; chest pain; anxiety, sleep disorders,\r\nheadache, reduced energy, increased energy, irritability, emotional\r\nlability, dizziness; chills; urinary retention; delayed ejaculation,\r\ndecreased potency; arthralgia, myalgia; increased lacrimation; rash,\r\nand increased sweating; rarely hepatic dysfunction,\r\nsuicidal ideation, and speech disorders; very rarely hallucinations, tremor, and idiopathic thrombocytopenia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3703.htm", "doses": [ "Relapse prevention in opioid dependence, adult over 18 years (initiate in specialist clinics\r\nonly), 25\u00a0mg initially then 50\u00a0mg daily; total weekly dose (350\u00a0mg)\r\nmay be divided and given on 3 days of the week for improved compliance\r\n(e.g. 100\u00a0mg on Monday and Wednesday, and 150\u00a0mg on Friday)", "Relapse prevention in alcohol dependence [unlicensed indication], adult and child over\r\n16 years, 25\u00a0mg on first day, increased to 50\u00a0mg daily if tolerated" ], "pregnancy": "Pregnancy\u00a0use only if benefit outweighs risk" }, "ATROPINE SULPHATE - ANTIMUSCARINICS": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal\r\ndisorders characterised by smooth muscle spasm; mydriasis and cycloplegia\r\n(section 11.5); premedication (section 15.1.3); see also notes above", "name": "ATROPINE SULPHATE - ANTIMUSCARINICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "ATROPINE SULPHATE" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60253.htm", "doses": [ "0.6\u20131.2\u00a0mg at night" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution" }, "LEVOMENTHOL": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.3 Topical local anaesthetics and antipruritics", "LEVOMENTHOL" ], "indications": "Indications\u00a0pruritus", "name": "LEVOMENTHOL", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208042.htm", "doses": [ "apply 1\u20132 times daily" ] }, "TICAGRELOR": { "indications": "Indications\u00a0in combination with aspirin for the prevention of atherothrombotic\r\nevents in patients with acute coronary syndrome", "name": "TICAGRELOR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "TICAGRELOR" ], "cautions": "Cautions\u00a0patients at increased risk of bleeding\r\n(e.g. from recent trauma, surgery, gastro-intestinal bleeding, or\r\ncoagulation disorders); concomitant use\r\nof drugs that increase risk of bleeding; discontinue 7 days before elective surgery if antiplatelet effect\r\nnot desirable; bradycardia, sick sinus syndrome, or second- or third-degree AV block (unless pacemaker fitted); asthma or chronic obstructive pulmonary\r\ndisease; history of hyperuricaemia; monitor renal function 1 month after initiation", "side-effects": "Side-effects\u00a0dyspnoea, haemorrhage, bruising; less\r\ncommonly nausea, vomiting, diarrhoea, abdominal pain, dyspepsia,\r\ngastritis, dizziness, headache, rash, pruritus; rarely constipation, paraesthesia, confusion, hyperuricaemia, raised serum\r\ncreatinine, vertigo", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215689.htm", "doses": [ "adult over 18 years, (with\r\naspirin\u2014see notes above) initially 180\u00a0mg as a single dose,\r\nthen 90\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "AZTREONAM": { "indications": "Indications\u00a0Gram-negative infections including Pseudomonas aeruginosa, Haemophilus influenzae, and Neisseria\r\nmeningitidis", "name": "AZTREONAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.3 Other beta-lactam antibiotics" ], "cautions": "Cautions\u00a0hypersensitivity to beta-lactam antibiotics; interactions: Appendix 1 (aztreonam)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before aztreonam; a bronchodilator\r\nshould be administered before each dose ", "side-effects": "Side-effects\u00a0Specific side-effects for parenteral treatment\u00a0Rarely gastro-intestinal bleeding, antibiotic-associated\r\ncolitis, jaundice, hepatitis, hypotension, chest pain, dyspnoea, seizures,\r\nparaesthesia, confusion, dizziness, asthenia, headache, insomnia,\r\nbreast tenderness, blood disorders (including thrombocytopenia and\r\nneutropenia), myalgia, diplopia, tinnitus, halitosis; also reported\r\nnausea, vomiting, abdominal pain, diarrhoea, mouth ulcers,\r\ntaste disturbances, flushing, bronchospasm, rash (including toxic\r\nepidermal necrolysis and erythema multiforme)Specific side-effects for inhaled treatment\u00a0Wheezing,\r\nbronchospasm, cough; pyrexia; rash; rhinorrhoea, pharyngolaryngeal\r\npain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3800.htm", "doses": [ "By deep intramuscular injection or by intravenous injection over 3\u20135 minutes or by intravenous infusion, 1\u00a0g every 8 hours or 2\u00a0g every 12 hours; 2\u00a0g every 6\u20138 hours for severe infections\r\n(including systemic Pseudomonas aeruginosa and\r\nlung infections in cystic fibrosis); single doses over 1\u00a0g intravenous\r\nroute only", "Urinary-tract infections, 0.5\u20131\u00a0g every 8\u201312 hours", "child over 1 week, by\r\nintravenous injection or infusion, 30\u00a0mg/kg every 6\u20138 hours increased in severe infections for child\r\nof 2 years or older to 50\u00a0mg/kg every 6\u20138 hours; max. 8\u00a0g daily", "Gonorrhoea, cystitis, by intramuscular injection, 1\u00a0g as a single dose", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult over 18 years, 75\u00a0mg 3 times daily (at least 4 hours apart) for\r\n28 days; if additional courses required, a minimum of 28 days without\r\naztreonam nebuliser solution recommended between courses" ], "pregnancy": "Pregnancy\u00a0no information available; manufacturer of injection\r\nadvises avoid; manufacturer of powder for nebuliser solution advises\r\navoid unless essential" }, "FLUORIDES Tablets": { "indications": "Indications\u00a0prophylaxis of dental caries\u2014\n(From 9.5.3 Fluoride: British National Formulary)\n9.5.3 Fluoride", "name": "FLUORIDES Tablets", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.3 Fluoride", "FLUORIDES", "Tablets" ], "side-effects": "Side-effects\u00a0occasional white flecks on teeth with recommended\r\ndoses; rarely yellowish-brown discoloration if recommended\r\ndoses are exceeded", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5074.htm", "doses": [ "Dose expressed as\r\nfluoride ion (F-)", "Water content less than F- 300\u00a0micrograms/litre (0.3\r\nparts per million), child up to 6 months\r\nnone; 6 months\u20133 years F- 250\u00a0micrograms daily, 3\u20136 years\r\nF- 500\u00a0micrograms daily, over 6 years F- 1\u00a0mg\r\ndaily", "Water content between F- 300 and 700\u00a0micrograms/litre\r\n(0.3\u20130.7 parts per million), child up\r\nto 3 years none, 3\u20136 years F- 250\u00a0micrograms daily, over\r\n6 years F- 500\u00a0micrograms daily", "Water content above F- 700\u00a0micrograms/litre (0.7\r\nparts per million), supplements not advised", "These doses reflect the recommendations of\r\nthe British Dental Association, the British Society of Paediatric\r\nDentistry and the British Association for the Study of Community Dentistry\r\n(Br Dent J 1997; 182: 6\u20137)", "Name[Fluor-a-day\u00ae (Dental Health)] Tablets, buff, sodium fluoride 1.1\u00a0mg\r\n(F- 500\u00a0micrograms), net price 200-tab pack = \u00a32.54; 2.2\u00a0mg\r\n(F- 1\u00a0mg), 200-tab pack = \u00a32.54Dental prescribing on NHS\u00a0 May be prescribed as\r\nSodium Fluoride Tablets" ] }, "FLUORIDES Toothpastes": { "indications": "Indications\u00a0prophylaxis of dental caries\u2014\n(From 9.5.3 Fluoride: British National Formulary)\n9.5.3 Fluoride", "name": "FLUORIDES Toothpastes", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.3 Fluoride", "FLUORIDES", "Toothpastes" ], "side-effects": "Side-effects\u00a0occasional white flecks on teeth with recommended\r\ndoses; rarely yellowish-brown discoloration if recommended\r\ndoses are exceeded", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119750.htm", "doses": [ "Dose expressed as\r\nfluoride ion (F-)", "Water content less than F- 300\u00a0micrograms/litre (0.3\r\nparts per million), child up to 6 months\r\nnone; 6 months\u20133 years F- 250\u00a0micrograms daily, 3\u20136 years\r\nF- 500\u00a0micrograms daily, over 6 years F- 1\u00a0mg\r\ndaily", "Water content between F- 300 and 700\u00a0micrograms/litre\r\n(0.3\u20130.7 parts per million), child up\r\nto 3 years none, 3\u20136 years F- 250\u00a0micrograms daily, over\r\n6 years F- 500\u00a0micrograms daily", "Water content above F- 700\u00a0micrograms/litre (0.7\r\nparts per million), supplements not advised", "These doses reflect the recommendations of\r\nthe British Dental Association, the British Society of Paediatric\r\nDentistry and the British Association for the Study of Community Dentistry\r\n(Br Dent J 1997; 182: 6\u20137)", "adult and adolescent over 16 years, apply 2\u00a0cm 3 times daily\r\nafter meals using a toothbrush", "Name[Duraphat\u00ae (Colgate-Palmolive) ] Duraphat\u00ae \u20182800\u00a0ppm\u2019 toothpaste, sodium fluoride 0.619%. Net price 75\u00a0mL = \u00a33.26, dual\r\npack (2\u00d775\u00a0mL) = \u00a35.54. \r\n Label:\r\n Counselling, see belowDose\u00a0adult and child over 10 years, apply 1\u00a0cm twice daily using\r\na toothbrushCounselling\u00a0Brush teeth for 1 minute before spitting\r\nout. Avoid drinking or rinsing mouth for 30 minutes after useDental prescribing on NHS\u00a0 May be prescribed as\r\nSodium Fluoride Toothpaste 0.619%\nDuraphat\u00ae \u20185000\u00a0ppm\u2019 toothpaste, sodium fluoride 1.1%. Net price 51\u00a0g = \u00a36.50. \r\n Label:\r\n Counselling, see belowDose\u00a0adult and adolescent over 16 years, apply 2\u00a0cm 3 times daily\r\nafter meals using a toothbrushCounselling\u00a0Brush teeth for 3 minutes before spitting\r\noutDental prescribing on NHS\u00a0 May be prescribed as\r\nSodium Fluoride Toothpaste 1.1%" ] }, "TIAGABINE": { "indications": "Indications\u00a0\n(From Tiagabine: British National Formulary)\nTiagabine", "name": "TIAGABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Tiagabine" ], "cautions": "Cautions\u00a0avoid in acute porphyria (section 9.8.2); avoid abrupt withdrawal; interactions: Appendix 1 (tiagabine)Driving\u00a0May impair performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0 diarrhoea; dizziness, tiredness, nervousness,\r\ntremor, impaired concentration, emotional lability, speech impairment; rarely confusion, depression, drowsiness, psychosis, non-convulsive\r\nstatus epilepticus, bruising, and visual disturbances; suicidal ideation;\r\nleucopenia also reported ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106094.htm", "doses": [ "Adjunctive therapy, adult and child over 12 years, initially\r\n5\u201310\u00a0mg daily in 1\u20132 divided doses, increased in steps of 5\u201310\u00a0mg\r\ndaily at weekly intervals; usual maintenance dose with enzyme-inducing\r\ndrugs, 30\u201345\u00a0mg daily in 2\u20133 divided doses; initial maintenance\r\ndose without enzyme-inducing drugs, 15\u201330\u00a0mg daily\r\nin 2\u20133 divided doses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "CLOTRIMAZOLE - ANTI-INFECTIVE PREPARATIONS": { "side-effects": "Side-effects\u00a0occasional local irritation or sensitivity", "indications": "Indications\u00a0fungal infection in otitis externa (\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "CLOTRIMAZOLE - ANTI-INFECTIVE PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5603.htm", "doses": [ "ear, apply 2\u20133 times daily continuing for\r\nat least 14 days after disappearance of infection; skin, section 13.10.2" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-infective preparations", "CLOTRIMAZOLE" ] }, "ETRAVIRINE": { "indications": "Indications\u00a0in combination with other antiretroviral\r\ndrugs (including a boosted protease inhibitor) for HIV infection resistant\r\nto other non-nucleoside reverse transcriptase inhibitors and protease\r\ninhibitors", "name": "ETRAVIRINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Non-nucleoside reverse transcriptase inhibitors" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (etravirine)Hypersensitivity reactions\u00a0Rash, usually in the\r\nsecond week, is the most common side-effect and appears more frequently\r\nin women. Life-threatening hypersensitivity reactions reported usually\r\nduring week 3\u20136 of treatment and characterised by rash, eosinophilia,\r\nand systemic symptoms (including fever, general malaise, myalgia,\r\narthralgia, blistering, oral lesions, conjunctivitis, and hepatitis). Discontinue permanently if hypersensitivity reaction or severe rash\r\ndevelop. If rash mild or moderate (without\r\nsigns of hypersensitivity reaction), may continue without interruption\u2014usually\r\nresolves within 2 weeksCounselling\u00a0Patients should be told\r\nhow to recognise hypersensitivity reactions and advised to seek immediate\r\nmedical attention if hypersensitivity reaction or severe rash develop", "side-effects": "Side-effects\u00a0rash (including Stevens-Johnson syndrome rarely\r\nand toxic epidermal necrolysis very rarely; see also Hypersensitivity\r\nReactions above); gastro-oesophageal reflux, nausea, abdominal pain,\r\nflatulence, gastritis; myocardial infarction, hypertension; peripheral\r\nneuropathy; diabetes, hyperlipidaemia (see also Lipodystrophy Syndrome); renal failure; anaemia; less commonly pancreatitis,\r\nhaematemesis, hepatitis, angina, bronchospasm, drowsiness, malaise,\r\ngynaecomastia, blurred vision, dry mouth, and sweating; also reported,\r\nhaemorrhagic stroke and hypersensitivity reactions; see also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201547.htm", "doses": [ "adult over 18 years, 200\u00a0mg\r\ntwice daily after food", "If a dose is more than 6 hours late,\r\nthe missed dose should not be taken and the next dose should be taken\r\nat the normal time" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "FENTANYL - ANALGESICS": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL - ANALGESICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201310.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "TORASEMIDE": { "indications": "Indications\u00a0oedema (\n(From 2.2.2 Loop diuretics: British National Formulary)\n2.2.2 Loop diuretics), hypertension", "name": "TORASEMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.2 Loop diuretics" ], "cautions": "Cautions\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nCautions\u00a0Hypovolaemia and hypotension should be corrected before initiation of treatment with loop diuretics; electrolytes should be monitored during treatment (see also Potassium Loss, section 2.2). Loop diuretics can exacerbate diabetes (but hyperglycaemia is less likely than with thiazides) and gout. If there is an enlarged prostate, urinary retention can occur, although this is less likely if small doses and less potent diuretics are used initially; an adequate urinary output should be established before initiating treatment; interactions: Appendix 1 (diuretics).", "side-effects": "Side-effects\u00a0\n(From 2.2.2 Loop diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of loop diuretics include mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia (less common than with thiazides), acute urinary retention, electrolyte disturbances (including hyponatraemia, hypokalaemia (see section 2.2), hypocalcaemia, hypochloraemia, and hypomagnesaemia), metabolic alkalosis, blood disorders (including bone-marrow depression, thrombocytopenia, and leucopenia), hyperuricaemia, visual disturbances, tinnitus and deafness (usually with high parenteral doses and rapid administration, and in renal impairment), and hypersensitivity reactions (including rash, photosensitivity, and pruritus).; also\r\ndry mouth; rarely limb paraesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/17603.htm", "doses": [ "Oedema, 5\u00a0mg once daily, preferably in the morning, increased\r\nif required to 20\u00a0mg once daily; usual max. 40\u00a0mg daily", "Hypertension, 2.5\u00a0mg daily, increased if necessary to 5\u00a0mg once\r\ndaily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014toxicity in animal studies" }, "Coumarins and phenindione": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.8 Anticoagulants and protamine", "2.8.2 Oral anticoagulants" ], "name": "Coumarins and phenindione", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201052.htm", "doses": [] }, "ABACAVIR With lamivudine": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "ABACAVIR With lamivudine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors", "ABACAVIR", "With lamivudine" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also test for HLA-B*5701 allele before treatment or if restarting treatment\r\nand HLA-B*5701 status not known\u2014increased risk of hypersensitivity\r\nreaction in presence of HLA-B*5701 allele; HIV load greater than 100\u00a0000 copies/mL; patients at high risk of cardiovascular disease (especially\r\nif 10-year cardiovascular risk greater than 20%); interactions: Appendix 1 (abacavir)Hypersensitivity reactions\u00a0Life-threatening hypersensitivity\r\nreactions reported\u2014characterised by fever or rash and possibly nausea,\r\nvomiting, diarrhoea, abdominal pain, dyspnoea, cough, lethargy, malaise,\r\nheadache, and myalgia; less frequently mouth ulceration, oedema, hypotension,\r\nsore throat, acute respiratory distress syndrome, anaphylaxis, paraesthesia,\r\narthralgia, conjunctivitis, lymphadenopathy, lymphocytopenia and renal\r\nfailure; rarely myolysis; laboratory abnormalities may include raised\r\nliver function tests (\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nCautionsLactic acidosis\u00a0Life-threatening lactic acidosis associated with hepatomegaly and hepatic steatosis has been reported with nucleoside reverse transcriptase inhibitors. They should be used with caution in patients (particularly obese women) with hepatomegaly, hepatitis (especially hepatitis C treated with interferon alfa and ribavirin), liver-enzyme abnormalities and with other risk factors for liver disease and hepatic steatosis (including alcohol abuse). Treatment with the nucleoside reverse transcriptase inhibitor should be discontinued in case of symptomatic hyperlactataemia, lactic acidosis, progressive hepatomegaly or rapid deterioration of liver function. Stavudine, especially with didanosine, is associated with a higher risk of lactic acidosis and should be used only if alternative regimens are not suitable.) and creatine\r\nkinase; symptoms usually appear in the first 6 weeks, but may occur\r\nat any time; monitor for symptoms every 2 weeks for 2 months; discontinue immediately if any symptom of hypersensitivity develops\r\nand do not rechallenge (risk of more severe hypersensitivity reaction); discontinue if hypersensitivity cannot be ruled out,\r\neven when other diagnoses possible\u2014if rechallenge\r\nnecessary it must be carried out in hospital setting; if abacavir is stopped for any\r\nreason other than hypersensitivity, exclude hypersensitivity reaction\r\nas the cause and rechallenge only if medical assistance is readily\r\navailable; care needed with concomitant\r\nuse of drugs which cause skin toxicity Counselling\u00a0Patients should be told\r\nthe importance of regular dosing (intermittent therapy may increase\r\nthe risk of sensitisation), how to recognise signs of hypersensitivity,\r\nand advised to seek immediate medical attention if symptoms develop\r\nor before re-starting treatment; patients\r\nshould be advised to keep Alert Card with them at all times", "side-effects": "Side-effects\u00a0see notes above; also hypersensitivity reactions\r\n(see above); very rarely Stevens-Johnson syndrome\r\nand toxic epidermal necrolysis; rash and gastro-intestinal disturbances\r\nmore common in children", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129292.htm", "doses": [ "600\u00a0mg daily in 1\u20132 divided doses; child 3 months\u201318 years see BNF for Children", "Name[Kivexa\u00ae (ViiV) ] Tablets, orange, f/c, abacavir (as sulphate) 600\u00a0mg, lamivudine 300\u00a0mg, net\r\nprice 30-tab pack = \u00a3352.25. \r\n Label:\r\n Counselling, hypersensitivity reactionsDose\u00a0adult body-weight\r\nover 40\u00a0kg, 1 tablet once daily; child 12\u201318 years see BNF for Children " ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); see also Pregnancy" }, "CEFPODOXIME": { "indications": "Indications\u00a0see under Dose", "name": "CEFPODOXIME", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.2 Cephalosporins, carbapenems, and other beta-lactams", "5.1.2.1 Cephalosporins", "CEFPODOXIME" ], "cautions": "Cautions\u00a0see under Cefaclor; interactions: Appendix 1 (cephalosporins)", "side-effects": "Side-effects\u00a0see under Cefaclor", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3777.htm", "doses": [ "Upper respiratory-tract infections (but in pharyngitis\r\nand tonsillitis reserved for infections which are recurrent, chronic,\r\nor resistant to other antibacterials), 100\u00a0mg twice daily (200\u00a0mg\r\ntwice daily in sinusitis); child 15\r\ndays\u20136 months 4\u00a0mg/kg every 12 hours, 6 months\u20132 years 40\u00a0mg every\r\n12 hours, 3\u20138 years 80\u00a0mg every 12 hours, over 9 years 100\u00a0mg every\r\n12 hours", "Lower respiratory-tract infections (including bronchitis and\r\npneumonia), 100\u2013200\u00a0mg twice daily; child 15 days\u20136 months 4\u00a0mg/kg every 12 hours, 6 months\u20132 years 40\u00a0mg\r\nevery 12 hours, 3\u20138 years 80\u00a0mg every 12 hours, over 9 years 100\u00a0mg\r\nevery 12 hours", "Skin and soft-tissue infections, 200\u00a0mg twice daily; child 15 days\u20136 months 4\u00a0mg/kg every 12 hours, 6\r\nmonths\u20132 years 40\u00a0mg every 12 hours, 3\u20138 years 80\u00a0mg every 12 hours,\r\nover 9 years 100\u00a0mg every 12 hours", "Uncomplicated urinary-tract infections, 100\u00a0mg twice daily (200\u00a0mg\r\ntwice daily in uncomplicated upper urinary-tract infections); child 15 days\u20136 months 4\u00a0mg/kg every 12 hours, 6\r\nmonths\u20132 years 40\u00a0mg every 12 hours, 3\u20138 years 80\u00a0mg every 12 hours,\r\nover 9 years 100\u00a0mg every 12 hours" ], "pregnancy": "Pregnancy\u00a0see under Cefaclor" }, "EFAVIRENZ": { "indications": "Indications\u00a0HIV infection in combination with other antiretroviral drugs", "name": "EFAVIRENZ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Non-nucleoside reverse transcriptase inhibitors", "EFAVIRENZ" ], "cautions": "Cautions\u00a0elderly; history\r\nof mental illness or seizures; monitor liver function if receiving other\r\nhepatotoxic drugs; interactions: Appendix\r\n1 (efavirenz)Rash\u00a0Rash, usually in the first 2 weeks, is the\r\nmost common side-effect; discontinue if severe rash with\r\nblistering, desquamation, mucosal involvement or fever; if rash mild or moderate, may continue without interruption\u2014usually\r\nresolves within 1 monthPsychiatric disorders\u00a0Patients or\r\ntheir carers should be advised to seek immediate medical attention\r\nif symptoms such as severe depression, psychosis or suicidal ideation\r\noccur", "side-effects": "Side-effects\u00a0rash including Stevens-Johnson syndrome (see Rash\r\nabove); abdominal pain, diarrhoea, nausea, vomiting; anxiety, depression,\r\nsleep disturbances, abnormal dreams, dizziness, headache, fatigue,\r\nimpaired concentration (administration at bedtime especially in first\r\n2\u20134 weeks reduces CNS effects); pruritus; less commonly pancreatitis, hepatitis, flushing, psychosis, mania, suicidal ideation,\r\namnesia, ataxia, tremor, convulsions, gynaecomastia, blurred vision,\r\ntinnitus; rarely hepatic failure, photosensitivity;\r\nalso reported raised serum cholesterol (see Lipodystrophy Syndrome); see also Osteonecrosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/78548.htm", "doses": [ "See preparations below", "600\u00a0mg once daily; child 3\u201318 years see BNF for Children", "600\u00a0mg once daily; child body-weight over 40\u00a0kg see BNF for Children", "720\u00a0mg once daily; child 3\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (effective contraception\r\nrequired during treatment and for 12 weeks after treatment); use efavirenz\r\nonly if no alternative available" }, "ERGOTAMINE TARTRATE ": { "indications": "Indications\u00a0treatment of acute migraine and migraine variants unresponsive to analgesics", "name": "ERGOTAMINE TARTRATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "Ergot alkaloids", "ERGOTAMINE TARTRATE" ], "cautions": "Cautions\u00a0risk of peripheral vasospasm (see below); elderly; dependence (see Ergot Alkaloids above); cardiac\r\ndisease; anaemia; interactions: Appendix 1 (ergot alkaloids)Peripheral vasospasm\u00a0Warn patient\r\nto stop treatment immediately if numbness or tingling of extremities\r\ndevelops and to contact doctor.", "side-effects": "Side-effects\u00a0abdominal pain, nausea, vomiting; dizziness; less commonly diarrhoea, pain and weakness in extremities,\r\ncyanosis, peripheral vasoconstriction, paraesthesia, and hypoaesthesia; rarely intestinal ischaemia, arrhythmias, increased blood\r\npressure, bradycardia, tachycardia, dyspnoea, ergotism (including\r\nabsence of pulse and numbness in extremities), myalgia, rash, and\r\nurticaria; very rarely myocardial ischaemia, myocardial\r\ninfarction, heart-valve fibrosis, and gangrene; constipation, dry\r\nmouth, cerebral ischaemia, thrombosis, drowsiness, sleep disturbances,\r\ntremor, seizures, extrapyramidal effects, anxiety, depression, confusion,\r\nhallucinations, renal artery spasm, urinary retention, blood disorders,\r\nblurred vision, and arthralgia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3560.htm", "doses": [ "Name[Migril\u00ae (Wockhardt) ] 1 tablet at onset, followed after 30 minutes by \u00bd\u20131 tablet,\r\nrepeated every 30 minutes if necessary; max. 3 tablets in 24 hours,\r\n4 tablets per attack, 6 tablets in one week (but see also notes above); child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid; oxytocic effect on the uterus" }, "BLEOMYCIN": { "indications": "Indications\u00a0squamous cell carcinoma; see also notes above", "name": "BLEOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "BLEOMYCIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant\r\nto tissues; interactions: Appendix\r\n1 (bleomycin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4708.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic and carcinogenic in animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "INOSINE PRANOBEX ": { "indications": "Indications\u00a0see under Dose", "name": "INOSINE PRANOBEX ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.2 Herpesvirus infections", "5.3.2.1 Herpes simplex and varicella\u2013zoster infection", "INOSINE PRANOBEX" ], "cautions": "Cautions\u00a0history of gout or hyperuricaemia", "side-effects": "Side-effects\u00a0reversible increase in serum and urinary uric\r\nacid; less commonly nausea, vomiting, epigastric\r\ndiscomfort, headache, vertigo, fatigue, arthralgia, rashes and itching; rarely diarrhoea, constipation, anxiety, sleep disturbances,\r\nand polyuria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4000.htm", "doses": [ "Mucocutaneous herpes simplex, 1\u00a0g 4 times daily for 7\u201314\r\ndays", "Adjunctive treatment of genital warts, 1\u00a0g 3 times daily for\r\n14\u201328 days", "Subacute sclerosing panencephalitis, 50\u2013100\u00a0mg/kg daily in 6\r\ndivided doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "METHOCARBAMOL ": { "indications": "Indications\u00a0short-term symptomatic relief of muscle spasm (but see notes above)", "name": "METHOCARBAMOL ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "Other muscle relaxants", "METHOCARBAMOL" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (muscle\r\nrelaxants)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving); effects\r\nof alcohol enhanced", "side-effects": "Side-effects\u00a0nausea, vomiting, dyspepsia; hypersensitivity\r\nreactions (including urticaria, angioedema, anaphylaxis); fever, headache,\r\ndrowsiness, dizziness, hypotension, bradycardia, confusion,\r\namnesia, restlessness, anxiety, tremor, seizures; blurred vision,\r\nnasal congestion; rash, pruritus; leucopenia, cholestatic jaundice", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5346.htm", "doses": [ "1.5\u00a0g 4 times daily; may be reduced to 750\u00a0mg 3 times\r\ndaily; elderly up to 750\u00a0mg 4 times\r\ndaily may be sufficient; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "AMILORIDE HYDROCHLORIDE": { "indications": "Indications\u00a0oedema; potassium conservation when used as an adjunct to thiazide\r\nor loop diuretics for hypertension, congestive heart failure, or hepatic\r\ncirrhosis with ascites", "name": "AMILORIDE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.3 Potassium-sparing diuretics and aldosterone antagonists", "AMILORIDE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0monitor\r\nelectrolytes; diabetes mellitus; elderly; interactions: Appendix 1 (diuretics)", "side-effects": "Side-effects\u00a0abdominal pain, gastro-intestinal bleeding, dry\r\nmouth, thirst, diarrhoea, constipation, anorexia, jaundice, dyspepsia,\r\nflatulence, vomiting, nausea, angina, arrhythmias, palpitation, postural\r\nhypotension, dyspnoea, cough, nasal congestion, confusion, headache,\r\ninsomnia, weakness, tremor, agitation, dizziness, malaise, paraesthesia,\r\nencephalopathy, urinary disturbances, sexual dysfunction, hyperkalaemia,\r\nmuscle cramp, arthralgia, visual disturbance, raised intra-ocular\r\npressure, tinnitus, alopecia, pruritus, rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106450.htm", "doses": [ "Used alone, initially 10\u00a0mg daily or 5\u00a0mg\r\ntwice daily, adjusted according to response; max. 20\u00a0mg daily", "With other diuretics, congestive heart failure and hypertension,\r\ninitially 5\u201310\u00a0mg daily; cirrhosis with ascites, initially 5\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0not used to treat gestational hypertension" }, "CICLOSPORIN": { "indications": "Indications\u00a0%s\n(From 8.2.2 Corticosteroids and other immunosuppressants: British National Formulary)\nCiclosporin a calcineurin inhibitor, is a potent immunosuppressant which is virtually non-myelotoxic but markedly nephrotoxic. It has an important role in organ and tissue transplantation, for prevention of graft rejection following bone marrow, kidney, liver, pancreas, heart, lung, and heart-lung transplantation, and for prophylaxis and treatment of graft-versus-host disease., and under Dose; severe acute ulcerative colitis [unlicensed indication]\r\n(section %s\n(From CICLOSPORIN: British National Formulary)\nCICLOSPORIN); rheumatoid arthritis (%s\n(From 10.1.3 Drugs that suppress the rheumatic disease process: British National Formulary)\n10.1.3 Drugs that suppress the rheumatic disease process); atopic\r\ndermatitis and psoriasis (%s\n(From 13.5.3 Drugs affecting the immune response: British National Formulary)\n13.5.3 Drugs affecting the immune response)", "name": "CICLOSPORIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.2 Corticosteroids and other immunosuppressants", "CICLOSPORIN" ], "cautions": "Cautions\u00a0monitor kidney function\u2014dose dependent increase in serum creatinine and urea during first\r\nfew weeks may necessitate dose reduction in transplant patients (exclude\r\nrejection if kidney transplant) or discontinuation in non-transplant\r\npatients; monitor liver function (see Hepatic\r\nImpairment below); monitor blood pressure\u2014discontinue if hypertension develops that cannot be\r\ncontrolled by antihypertensives; hyperuricaemia; monitor serum potassium especially in renal dysfunction (risk of hyperkalaemia); monitor serum magnesium; measure blood\r\nlipids before treatment and after the first month of treatment; use with tacrolimus specifically contra-indicated; for patients other than transplant\r\nrecipients, preferably avoid other immunosuppressants (increased risk\r\nof infection and malignancies, including lymphoma and skin cancer); avoid excessive exposure to UV\r\nlight, including sunlight; interactions: Appendix 1 (ciclosporin)Additional cautions in nephrotic syndrome\u00a0Contra-indicated in uncontrolled hypertension, uncontrolled infections, and malignancy; in long-term management, perform renal biopsies at yearly intervals", "side-effects": "Side-effects\u00a0anorexia, nausea, vomiting, abdominal pain, diarrhoea,\r\ngingival hyperplasia, hepatic dysfunction, hypertension, tremor, headache,\r\nparaesthesia, fatigue, renal dysfunction (renal structural changes\r\non long-term administration, see also under Cautions), hyperuricaemia,\r\nhyperkalaemia, hypomagnesaemia, hyperlipidaemia, hypercholesterolaemia,\r\nmuscle cramps, myalgia, hypertrichosis; less commonly oedema, weight gain, signs of encephalopathy, anaemia, thrombocytopenia; rarely pancreatitis, motor polyneuropathy, menstrual disturbances,\r\ngynaecomastia, microangiopathic haemolytic anaemia, haemolytic uraemic\r\nsyndrome, hyperglycaemia, muscle weakness, myopathy, visual disturbances\r\nsecondary to benign intracranial hypertension (discontinue); also reported with infusion anaphylaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31279.htm", "doses": [ "Organ transplantation, used alone, adult and child over 3 months 10\u201315\u00a0mg/kg by mouth 4\u201312 hours before transplantation followed by 10\u201315\u00a0mg/kg\r\ndaily for 1\u20132 weeks postoperatively then reduced gradually to 2\u20136\u00a0mg/kg\r\ndaily for maintenance (dose should be adjusted according to blood-ciclosporin concentration and renal function); dose lower\r\nif given concomitantly with other immunosuppressant therapy (e.g. corticosteroids); if necessary one-third corresponding\r\noral dose can be given by intravenous infusion over\r\n2\u20136 hours", "Bone-marrow transplantation, prevention and treatment of graft-versus-host\r\ndisease, adult and child over 3 months 3\u20135\u00a0mg/kg daily by intravenous infusion over 2\u20136 hours from day before transplantation to 2 weeks postoperatively\r\n(or 12.5\u201315\u00a0mg/kg daily by mouth) then 12.5\u00a0mg/kg daily by mouth for 3\u20136 months then tailed off (may take up to a\r\nyear after transplantation)", "Nephrotic syndrome, by mouth, 5\u00a0mg/kg daily in\r\n2 divided doses; child 6\u00a0mg/kg daily\r\nin 2 divided doses; maintenance treatment reduce to lowest effective\r\ndose according to proteinuria and serum creatinine measurements; discontinue\r\nafter 3 months if no improvement in glomerulonephritis or glomerulosclerosis\r\n(after 6 months in membranous glomerulonephritis)", "Patients should be stabilised on a particular brand of oral\r\nciclosporin because switching between formulations without close monitoring\r\nmay lead to clinically important changes in blood-ciclosporin concentration.\r\nPrescribing and dispensing of ciclosporin should be by brand name\r\nto avoid inadvertent switching. If it is necessary to switch a patient\r\nto a different brand of ciclosporin, the patient should be monitored\r\nclosely for changes in blood-ciclosporin concentration, serum creatinine,\r\nblood pressure, and transplant function." ], "pregnancy": "Pregnancy\u00a0crosses placenta; see Immunosuppressant Therapy" }, "DEXTRAN 70 Hypertonic solution": { "indications": "Indications\u00a0short-term blood volume expansion", "name": "DEXTRAN 70 Hypertonic solution", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.2 Parenteral preparations for fluid and electrolyte imbalance", "9.2.2.2 Plasma and plasma substitutes", "Plasma substitutes", "DEXTRAN 70", "Hypertonic solution" ], "cautions": "Cautions\u00a0see notes above; severe hyperglycaemia and hyperosmolality", "side-effects": "Side-effects\u00a0\n(From Plasma substitutes: British National Formulary)\nCautions\u00a0Plasma substitutes should be used with caution in patients with cardiac disease, severe liver disease, or renal impairment; urine output should be monitored. Care should be taken to avoid haematocrit concentration from falling below 25\u201330% and the patient should be monitored for hypersensitivity reactions.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106201.htm", "doses": [ "See under preparation below", "Name[RescueFlow\u00ae (Pharmacosmos) ] Intravenous infusion, dextran 70\r\nintravenous infusion 6% in sodium chloride intravenous infusion 7.5%.\r\nNet price 250-mL bag = \u00a328.50Cautions\u00a0see notes above; severe hyperglycaemia and hyperosmolalityDose\u00a0initial treatment of hypovolaemia with hypotension induced\r\nby traumatic injury, by intravenous infusion over 2\u20135\r\nminutes, 250\u00a0mL, followed immediately by administration of isotonic\r\nfluids" ], "pregnancy": "Pregnancy\u00a0avoid\u2014reports of anaphylaxis in mother causing fetal\r\nanoxia, neurological damage and death" }, "HYDROGEN PEROXIDE - MOUTHWASHES, GARGLES, AND DENTIFRICES": { "side-effects": "Side-effects\u00a0hypertrophy of papillae of tongue on prolonged\r\nused", "indications": "Indications\u00a0oral hygiene, \n(From 12.3.4 Mouthwashes, gargles, and dentifrices: British National Formulary)\n12.3.4 Mouthwashes, gargles, and dentifrices", "name": "HYDROGEN PEROXIDE - MOUTHWASHES, GARGLES, AND DENTIFRICES", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/70490.htm", "doses": [ "rinse the mouth with 10\u00a0mL for about 1 minute up to 4\r\ntimes daily (after meals and at bedtime)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.4 Mouthwashes, gargles, and dentifrices", "HYDROGEN PEROXIDE" ] }, "MELOXICAM": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease; exacerbation of osteoarthritis\r\n(short-term); ankylosing spondylitis", "name": "MELOXICAM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/55870.htm", "doses": [ "By mouth, osteoarthritis, adult and child over\r\n16 years, 7.5\u00a0mg once daily, increased if necessary to max. 15\u00a0mg\r\nonce daily", "Rheumatoid arthritis, ankylosing spondylitis, adult and child over\r\n16 years, 15\u00a0mg once daily, may be reduced to 7.5\u00a0mg once daily; elderly 7.5\u00a0mg daily", "child over 12 years,\r\nsee BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ELETRIPTAN": { "indications": "Indications\u00a0treatment of acute migraine", "name": "ELETRIPTAN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.4 Antimigraine drugs", "4.7.4.1 Treatment of acute migraine", "5HT1-receptor agonists", "ELETRIPTAN" ], "cautions": "Cautions\u00a0see under 5HT1-receptor agonists above; interactions: Appendix 1 (5HT1 agonists)", "side-effects": "Side-effects\u00a0 see under 5HT1-receptor\r\nagonists above; also abdominal pain, dry mouth, dyspepsia;\r\ntachycardia, palpitation; drowsiness, headache; pharyngitis, rhinitis,\r\nchills; myasthenia, myalgia; sweating; less commonly diarrhoea, glossitis, thirst, anorexia, taste disturbance; dyspnoea,\r\nyawning, oedema, agitation, confusion, euphoria, depression, insomnia,\r\ndepersonalisation, tremor, dysarthria, stupor, movement disorders,\r\nhypertonia, urinary frequency, arthralgia, photophobia, visual disturbances,\r\ntinnitus, rash, and pruritus; rarely constipation,\r\noesophagitis, bradycardia, asthma, syncope, lymphadenopathy, and menorrhagia;\r\nischaemic colitis and hypertension also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106532.htm", "doses": [ "adult over 18 years, 40\u00a0mg\r\nrepeated after 2 hours if migraine recurs (patient not responding\r\nto initial dose should not take second dose for same attack); increase\r\nto 80\u00a0mg for subsequent attacks if 40-mg dose inadequate; max. 80\u00a0mg\r\nin 24 hours" ], "pregnancy": "Pregnancy\u00a0\n(From 5HT1-receptor agonists: British National Formulary)\nPregnancy\u00a0There is limited experience of using 5HT1-receptor agonists during pregnancy; manufacturers advise that they should be avoided unless the potential benefit outweighs the risk." }, "CLADRIBINE": { "indications": "Indications\u00a0\n(From 8.1.3 Antimetabolites: British National Formulary)\nCladribine is given by intravenous infusion for the treatment of hairy cell leukaemia. It is also given for chronic lymphocytic leukaemia in patients who have failed to respond to standard regimens containing an alkylating agent. Cladribine produces severe myelosuppression, with neutropenia, anaemia, and thrombocytopenia; haemolytic anaemia has also been reported. High doses of cladribine have been associated with acute renal failure and severe neurotoxicity. and under preparations", "name": "CLADRIBINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.3 Antimetabolites", "CLADRIBINE" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; use irradiated blood\r\nonly", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also constipation, diarrhoea,\r\nabdominal pain, flatulence; oedema, tachycardia; cough, dyspnoea;\r\ndizziness, insomnia, anxiety, headache; chills, asthenia, malaise;\r\nmyalgia, arthralgia; sweating, rash, pruritus, and purpura", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129733.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nmanufacturer advises that men should not father children during and\r\nfor 6 months after treatment; see also Pregnancy and Reproductive\r\nFunction" }, "COMBINED HORMONAL CONTRACEPTIVES Vaginal (low strength) - ETHINYLESTRADIOL WITH ETONOGESTREL": { "indications": "Indications\u00a0contraception; menstrual\r\nsymptoms (section\r\n6.4.1.2)", "name": "COMBINED HORMONAL CONTRACEPTIVES Vaginal (low strength) - ETHINYLESTRADIOL WITH ETONOGESTREL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.1 Combined hormonal contraceptives", "COMBINED HORMONAL CONTRACEPTIVES", "Vaginal (low strength)", "Ethinylestradiol with Etonogestrel" ], "cautions": "Cautions\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; risk factors for venous thromboembolism (see below\r\nand also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.), arterial\r\ndisease and migraine, see below; personal or family history of hypertriglyceridaemia\r\n(increased risk of pancreatitis); hyperprolactinaemia\r\n(seek specialist advice); history of severe\r\ndepression especially if induced by hormonal contraceptive; undiagnosed breast mass; gene mutations associated with breast cancer (e.g.\r\nBRCA 1); sickle-cell disease; inflammatory bowel disease including Crohn\u2019s\r\ndisease; reduced efficacy of contraceptive\r\npatch in women with body-weight \u2265\u00a090\u00a0kg; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; interactions: %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nInteractions\u00a0The effectiveness of combined oral contraceptives, progestogen-only oral contraceptives (section 7.3.2.1), contraceptive patches, and vaginal rings can be considerably reduced by interaction with drugs that induce hepatic enzyme activity (e.g. carbamazepine, eslicarbazepine, nelfinavir, nevirapine, oxcarbazepine, phenytoin, phenobarbital, primidone, ritonavir, St John\u2019s Wort, topiramate, and, above all, rifabutin and rifampicin). A condom together with a long-acting method, such as an injectable contraceptive, may be more suitable for patients with HIV infection or at risk of HIV infection; advice on the possibility of interaction with antiretroviral drugs should be sought from HIV specialists.Women taking combined hormonal contraceptives who require enzyme-inducing drugs should be advised to change to a contraceptive method that is unaffected by enzyme-inducers (e.g. some parenteral progestogen-only contraceptives (section 7.3.2.2), intra-uterine devices) for the duration of treatment and for 4 weeks after stopping. If a change in contraceptive method is undesirable or inappropriate the following options should be discussed:For a short course (2 months or less) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), continue with a combined oral contraceptive providing ethinylestradiol 30\u00a0micrograms or more daily and use a \u2018tricycling\u2019 regimen (i.e. taking 3 packets of monophasic tablets without a break followed by a shortened tablet-free interval of 4 days [unlicensed use]). Additional contraceptive precautions should also be used whilst taking the enzyme-inducing drug and for 4 weeks after stopping. Another option is to follow the advice for long-term courses, below.For women using combined hormonal contraceptive patches or vaginal rings, additional contraceptive precautions are also required whilst taking the enzyme-inducing drug and for 4 weeks after stopping. If concomitant administration runs beyond the 3 weeks of patch or vaginal ring use, a new treatment cycle should be started immediately, without a patch-free or ring-free break.For a long-term course (over 2 months) of an enzyme-inducing drug (except rifampicin or rifabutin\u2014see below), adjust the dose of combined oral contraceptive to provide ethinylestradiol 50\u00a0micrograms or more daily [unlicensed use] and use a \u2018tricycling\u2019 regimen (as above); continue for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping. If breakthrough bleeding occurs (and all other causes are ruled out) it is recommended that the dose of ethinylestradiol is increased by increments of 10\u00a0micrograms up to a maximum of 70\u00a0micrograms daily [unlicensed use], or to use additional precautions, or to change to a method unaffected by enzyme-inducing drugs.Contraceptive patches and vaginal rings are not recommended for women taking enzyme-inducing drugs over a long period.For any course of rifampicin or rifabutin, an alternative method of contraception (such as an IUD) is always recommended because they are such potent enzyme-inducing drugs. Since enzyme activity does not return to normal for several weeks after stopping an enzyme-inducing drug, appropriate contraceptive measures are required for 4 to 8 weeks after stopping.For information on interactions of oral progestogen-only contraceptives, see also section 7.3.2.1; for information on interactions of parenteral progestogen-only contraceptives, see also section 7.3.2.2; for information on interactions of the intra-uterine progestogen-only device, see also section 7.3.2.3; for information on interactions of hormonal emergency contraception, see also section 7.3.5.Antibacterials that do not induce liver enzymes\u00a0Latest recommendations are that no additional contraceptive precautions are required when combined oral contraceptives are used with antibacterials that do not induce liver enzymes, unless diarrhoea or vomiting occur (see above). These recommendations should be discussed with the woman, who should also be advised that guidance in patient information leaflets may differ. It is also currently recommended that no additional contraceptive precautions are required when contraceptive patches or vaginal rings are used with antibacterials that do not induce liver enzymes. There have been concerns that some antibacterials that do not induce liver enzymes (e.g. ampicillin, doxycycline) reduce the efficacy of combined oral contraceptives by impairing the bacterial flora responsible for recycling ethinylestradiol from the large bowel. However, there is a lack of evidence to support this interaction. and Appendix 1 (oestrogens, progestogens)Risk factors for venous thromboembolism\u00a0See also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nRisk of venous thromboembolism\u00a0There is an increased risk of venous thromboembolic disease (particularly during the first year) in users of oral contraceptives, but this risk is considerably smaller than that associated with pregnancy (about 60 cases of venous thromboembolic disease per 100\u00a0000 pregnancies). In all cases the risk of venous thromboembolism increases with age and in the presence of other risk factors for venous thromboembolism, such as obesity.The incidence of venous thromboembolism in healthy, non-pregnant women who are not taking an oral contraceptive is about 5\u201310 cases per 100\u00a0000 women per year. For those using combined oral contraceptives containing second-generation progestogens, such as levonorgestrel, this incidence is about 20 per 100\u00a0000 women per year of use. The risk of venous thromboembolism with transdermal patches may be slightly increased compared with combined oral contraceptives that contain levonorgestrel. Some studies have reported a greater risk of venous thromboembolism in women using combined oral contraceptives containing the third-generation progestogens desogestrel and gestodene; the incidence in these women is about 40 per 100\u00a0000 women per year of use. The absolute risk of venous thromboembolism in women using combined oral contraceptives containing these third-generation progestogens is very small and well below the risk associated with pregnancy. The risk of venous thromboembolism in women using a combined oral contraceptive containing drospirenone may be similar to that associated with combined oral contraceptives containing third-generation progestogens. The risk of venous thromboembolism associated with vaginal ring use compared to the risk with other combined hormonal contraceptives is unknown.Provided that women are informed of the relative risks of venous thromboembolism and accept them, the choice of oral contraceptive is for the woman together with the prescriber jointly to make in light of her individual medical history and any contra-indications.. Use with caution if any of following factors present but avoid if two or more factors present:family\r\nhistory of venous thromboembolism in first-degree relative\r\naged under 45 years (avoid contraceptive containing\r\ndesogestrel or gestodene, or avoid if known prothrombotic coagulation abnormality e.g. factor V Leiden\r\nor antiphospholipid antibodies (including lupus anticoagulant));obesity\u2014body mass index \u2265 30\u00a0kg/m2 (avoid if body mass index \u2265 35\u00a0kg/m2 unless no suitable\r\nalternative);long-term\r\nimmobilisation e.g. in a wheelchair (avoid\r\nif confined to bed or leg in plaster\r\ncast);history\r\nof superficial thrombophlebitis;age over 35 years (avoid if over 50 years);smoking.Risk factors for arterial disease\u00a0Use with caution if any one of following factors present but avoid if two or more factors present:family history of arterial disease in first degree relative aged under 45 years (avoid\r\nif atherogenic lipid profile);diabetes mellitus (avoid if diabetes complications present);hypertension\u2014blood pressure\r\nabove systolic 140\u00a0mmHg or diastolic 90\u00a0mmHg (avoid if blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg);smoking (avoid\r\nif smoking 40 or more cigarettes daily);age over 35 years (avoid if over 50 years);obesity (avoid\r\nif body mass index \u2265 35\u00a0kg/m2 unless\r\nno suitable alternative);migraine without aura (avoid if migraine with aura (focal symptoms), or severe migraine frequently lasting\r\nover 72 hours despite treatment, or migraine treated with ergot derivatives).Migraine\u00a0Women should report any increase in headache\r\nfrequency or onset of focal symptoms (discontinue immediately and\r\nrefer urgently to neurology expert if focal neurological symptoms\r\nnot typical of aura persist for more than 1 hour\u2014see also %s\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\nReason to stop immediately\u00a0Combined hormonal contraceptives or hormone replacement therapy (HRT) should be stopped (pending investigation and treatment), if any of the following occur:sudden severe chest pain (even if not radiating to left arm);sudden breathlessness (or cough with blood-stained sputum);unexplained swelling or severe pain in calf of one leg;severe stomach pain;serious neurological effects including unusual severe, prolonged headache especially if first time or getting progressively worse or sudden partial or complete loss of vision or sudden disturbance of hearing or other perceptual disorders or dysphasia or bad fainting attack or collapse or first unexplained epileptic seizure or weakness, motor disturbances, very marked numbness suddenly affecting one side or one part of body;hepatitis, jaundice, liver enlargement;blood pressure above systolic 160\u00a0mmHg or diastolic 95\u00a0mmHg;prolonged immobility after surgery or leg injury;detection of a risk factor which contra-indicates treatment (see Cautions and Contra-indications under Combined Hormonal Contraceptives below or under Oestrogens for HRT (section 6.4.1.1)). in notes above)", "side-effects": "Side-effects\u00a0\n(From 7.3.1 Combined hormonal contraceptives: British National Formulary)\n7.3.1 Combined hormonal contraceptives; also nausea,\r\nvomiting, abdominal cramps, liver impairment, hepatic tumours; fluid\r\nretention, thrombosis (more common when factor V Leiden present or\r\nin blood groups A, B, and AB; see also notes above), hypertension,\r\nchanges in lipid metabolism; headache, depression, chorea, nervousness,\r\nirritability; changes in libido, breast tenderness, enlargement, and\r\nsecretion; reduced menstrual loss, \u2018spotting\u2019 in early cycles, absence\r\nof withdrawal bleeding, amenorrhoea after discontinuation, changes\r\nin vaginal discharge, cervical erosion; contact lenses may irritate,\r\nvisual disturbances; leg cramps; skin reactions, chloasma, photosensitivity;\r\nrarely gallstones and systemic lupus erythematosusBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women taking the combined\r\noral contraceptive pill; this relative risk may be due to an earlier\r\ndiagnosis. In users of combined oral contraceptive pills the cancers\r\nare more likely to be localised to the breast. The most important\r\nfactor for diagnosing breast cancer appears to be the age at which\r\nthe contraceptive is stopped rather than the duration of use; any\r\nincrease in the rate of diagnosis diminishes gradually during the\r\n10 years after stopping and disappears by 10 yearsCervical cancer\u00a0Use of combined oral contraceptives\r\nfor 5 years or longer is associated with a small increased risk of\r\ncervical cancer; the risk diminishes after stopping and disappears\r\nby about 10 years. The risk of cervical cancer with transdermal patches\r\nand vaginal rings is not yet knownNote\u00a0The possible small increase in the risk of\r\nbreast cancer and cervical cancer should be weighed against the protective\r\neffect against cancers of the ovary and endometrium", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202425.htm", "doses": [ "By\r\nmouth, each tablet should be taken at approximately\r\nsame time each day; if delayed, contraceptive protection may be lost\r\n(see missed pill)", "21-day combined (monophasic) preparations,\r\n1 tablet daily for 21 days; subsequent courses repeated after a 7-day\r\ninterval (during which withdrawal bleeding occurs); if reasonably\r\ncertain woman is not pregnant, first course can be started on any\r\nday of cycle\u2014if starting on day 6 of cycle or later, additional precautions\r\n(barrier methods) necessary during first 7 days", "Every day (ED) combined (monophasic) preparations, 1 active tablet daily for 21 days, followed by\r\n1 inactive tablet daily for 7 days (see also Combined\r\nOral Contraceptives table, below); subsequent\r\ncourses repeated without interval (withdrawal bleeding occurs when inactive tablets being taken); if reasonably certain woman\r\nis not pregnant, first course can be started on any day of cycle\u2014if\r\nstarting on day 6 of cycle or later, additional precautions (barrier\r\nmethods) necessary during first 7 days", "Phasic preparations, see Combined Oral Contraceptives table, below", "If previous contraceptive used correctly, or pregnancy can reasonably\r\nbe excluded, start the first active tablet of new\r\nbrand immediately", "Changing to Qlaira\u00ae: start the first active Qlaira\u00ae tablet on the day after taking the last\r\nactive tablet of the previous brand", "Changing from Qlaira\u00ae: start the new brand\r\nafter taking the last active Qlaira\u00ae tablet; if the\r\ninactive tablets are taken before starting new brand, additional precautions\r\n(barrier methods) should be used during first 7 days of taking the\r\nnew brand", "If previous\r\ncontraceptive used correctly, or pregnancy can reasonably be excluded,\r\nstart new brand immediately, additional precautions (barrier methods)\r\nnecessary for first 7 days", "Changing to Qlaira\u00ae: start any day, additional\r\nprecautions (barrier methods) necessary for first 9 days", "Start\r\nany day, additional precautions (barrier methods) necessary during\r\nfirst 7 days (9 days for Qlaira\u00ae)", "Start 3\r\nweeks after birth (increased risk of thrombosis if started earlier);\r\nlater than 3 weeks postpartum additional precautions (barrier methods)\r\nnecessary for first 7 days (9 days for Qlaira\u00ae)", "Start same day", "By transdermal application, apply first\r\npatch on day 1 of cycle, change patch on days 8 and 15; remove third\r\npatch on day 22 and apply new patch after 7-day patch-free interval\r\nto start subsequent contraceptive cycle", "If first patch applied later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Apply\r\npatch on the first day of withdrawal bleeding; if no withdrawal bleeding\r\nwithin 5 days of taking last active tablet, rule\r\nout pregnancy before applying first patch. Unless patch is applied\r\non first day of withdrawal bleeding, additional precautions (barrier\r\nmethods) should be used concurrently for first 7 days", "From an\r\nimplant, apply first patch on the day implant removed; from an injection,\r\napply first patch when next injection due; from oral progestogen,\r\nfirst patch may be applied on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days ", "Start 4\r\nweeks after birth; if started later than 4 weeks after birth additional\r\nprecautions (barrier methods) should be used for first 7 days", "Before 20 weeks\u2019\r\ngestation start immediately; no additional contraception required\r\nif started immediately. After 20 weeks\u2019 gestation start on day 21\r\nafter abortion or on the first day of first spontaneous menstruation;\r\nadditional precautions (barrier methods) should be used for first\r\n7 days after applying the patch", "By vagina, insert ring into vagina on day 1 of cycle and\r\nleave in for 3 weeks; remove ring on day 22; subsequent courses repeated\r\nafter 7-day ring-free interval (during which withdrawal bleeding occurs) ", "If first ring inserted later than day 1,\r\nadditional precautions (barrier methods) should be used for the next\r\n7 days", "Insert ring at the latest on the day after the usual tablet-free,\r\npatch-free, or inactive-tablet interval. If previous contraceptive\r\nused correctly, or pregnancy can reasonably be excluded, can switch\r\nto ring on any day of cycle", "From an\r\nimplant or intra-uterine progestogen-only device, insert ring on the\r\nday implant or intra-uterine progestogen-only device removed; from\r\nan injection, insert ring when next injection due; from oral preparation,\r\nfirst ring may be inserted on any day after stopping pill. For all\r\nmethods additional precautions (barrier methods) should be used concurrently\r\nfor first 7 days", "Start immediately", "Start 4 weeks after birth or abortion; if started later than\r\n4 weeks after birth or abortion, additional precautions (barrier methods)\r\nshould be used for first 7 days", "1 ring to be inserted into the vagina, removed on day\r\n22; subsequent courses repeated after 7-day ring-free interval (during\r\nwhich withdrawal bleeding occurs); for starting routines see under Dose above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "LOSARTAN POTASSIUM": { "indications": "Indications\u00a0hypertension (including reduction of stroke risk in hypertension\r\nwith left ventricular hypertrophy); chronic heart failure when ACE\r\ninhibitors are unsuitable or contra-indicated; diabetic nephropathy\r\nin type 2 diabetes mellitus (see also notes above)", "name": "LOSARTAN POTASSIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).; severe heart failure", "side-effects": "Side-effects\u00a0see notes above; vertigo; less commonly gastro-intestinal disturbances, angina, palpitation, oedema, dyspnoea,\r\nheadache, sleep disorders, malaise, urticaria, pruritus, rash; rarely hepatitis, atrial fibrillation, cerebrovascular accident,\r\nsyncope, paraesthesia; also reported pancreatitis, anaphylaxis, cough,\r\ndepression, erectile dysfunction, anaemia, thrombocytopenia, hyponatraemia,\r\narthralgia, myalgia, renal impairment, rhabdomyolysis, tinnitus, photosensitivity,\r\nand vasculitis (including Henoch-Sch\u00f6nlein purpura)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27526.htm", "doses": [ "Hypertension, diabetic nephropathy in type 2 diabetes\r\nmellitus, usually 50\u00a0mg once daily (intravascular volume depletion,\r\ninitially 25\u00a0mg once daily); if necessary increased after several\r\nweeks to 100\u00a0mg once daily; elderly over 75 years initially 25\u00a0mg daily", "Chronic heart failure, initially 12.5\u00a0mg once daily, increased\r\nat weekly intervals to max. 150\u00a0mg once daily if tolerated" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "TRANDOLAPRIL With calcium-channel blocker": { "indications": "Indications\u00a0mild to moderate hypertension; following myocardial\r\ninfarction in patients with left ventricular dysfunction", "name": "TRANDOLAPRIL With calcium-channel blocker", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.1 Angiotensin-converting enzyme inhibitors", "TRANDOLAPRIL", "With calcium-channel blocker" ], "cautions": "Cautions\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nCautions\u00a0ACE inhibitors need to be initiated with care in patients receiving diuretics (important: see Concomitant diuretics, below); first doses can cause hypotension especially in patients taking high doses of diuretics, on a low-sodium diet, on dialysis, dehydrated, or with heart failure (see above). They should also be used with caution in peripheral vascular disease or generalised atherosclerosis owing to risk of clinically silent renovascular disease; for use in pre-existing renovascular disease, see Renal Effects above. The risk of agranulocytosis is possibly increased in collagen vascular disease (blood counts recommended). ACE inhibitors should be used with care in patients with severe or symptomatic aortic stenosis (risk of hypotension) and in hypertrophic cardiomyopathy. They should also be used with care (or avoided) in those with a history of idiopathic or hereditary angioedema. If jaundice or marked elevations of hepatic enzymes occur during treatment then the ACE inhibitor should be discontinued\u2014risk of hepatic necrosis (see also Hepatic impairment, below). Interactions: Appendix 1 (ACE inhibitors).Anaphylactoid reactions\u00a0To prevent anaphylactoid reactions, ACE inhibitors should be avoided during dialysis with high-flux polyacrylonitrile membranes and during low-density lipoprotein apheresis with dextran sulphate; they should also be withheld before desensitisation with wasp or bee venom.Concomitant diuretics\u00a0ACE inhibitors can cause a very rapid fall in blood pressure in volume-depleted patients; treatment should therefore be initiated with very low doses. If the dose of diuretic is greater than 80\u00a0mg furosemide or equivalent, the ACE inhibitor should be initiated under close supervision and in some patients the diuretic dose may need to be reduced or the diuretic discontinued at least 24\u00a0hours beforehand (may not be possible in heart failure\u2014risk of pulmonary oedema). If high-dose diuretic therapy cannot be stopped, close observation is recommended after administration of the first dose of ACE inhibitor, for at least 2 hours or until the blood pressure has stabilised.", "side-effects": "Side-effects\u00a0see notes above; also ileus, dry mouth; tachycardia,\r\npalpitation, arrhythmias, angina, transient ischaemic attacks, cerebral\r\nhaemorrhage, myocardial infarction, syncope; dyspnoea, bronchitis;\r\nasthenia, nervousness, sleep disturbances; hot flushes; alopecia,\r\nsweating, skin reactions including Stevens-Johnson syndrome, toxic\r\nepidermal necrolysis, and psoriasis-like efflorescence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64845.htm", "doses": [ "Hypertension, initially 500\u00a0micrograms once daily, increased\r\nat intervals of 2\u20134 weeks; usual range 1\u20132\u00a0mg once daily; max. 4\u00a0mg\r\ndaily; if used in addition to diuretic see notes above", "Prophylaxis after myocardial infarction (starting as early as\r\n3 days after infarction), initially 500\u00a0micrograms once daily, gradually\r\nincreased to max. 4\u00a0mg once daily", "If symptomatic hypotension develops during\r\ntitration, do not increase dose further; if possible, reduce dose\r\nof any adjunctive treatment and if this is not effective or feasible,\r\nreduce dose of trandolapril", "Name[Tarka\u00ae (Abbott) ] Capsules, pink, trandolapril 2\u00a0mg, verapamil hydrochloride 180\u00a0mg (m/r), net\r\nprice 28 cap-pack = \u00a310.29. \r\n Label:\r\n 25" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.1 Angiotensin-converting enzyme inhibitors: British National Formulary)\nPregnancy\u00a0ACE inhibitors should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "CANNABIS EXTRACT": { "indications": "Indications\u00a0adjunct in moderate to severe spasticity in multiple sclerosis (specialist\r\nuse only)", "name": "CANNABIS EXTRACT", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.2 Drugs used in neuromuscular disorders", "10.2.2 Skeletal muscle relaxants", "CANNABIS EXTRACT" ], "cautions": "Cautions\u00a0significant cardiovascular disease; history of epilepsy; monitor\r\noral mucosa\u2014interrupt treatment if lesions or persistent soreness; interactions: Appendix 1 (cannabis extract)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving); effects of alcohol may be enhanced", "side-effects": "Side-effects\u00a0increased or decreased appetite, taste disturbance,\r\nconstipation, diarrhoea, nausea, vomiting, dry mouth, mouth ulcers,\r\noral pain, dizziness, vertigo, malaise, depression, disorientation,\r\ndissociation, mood disturbance, amnesia, impaired attention, drowsiness,\r\ndysarthria, blurred vision; less commonly abdominal\r\npain, oromucosal and tooth discoloration, stomatitis, palpitation,\r\ntachycardia, hypertension, pharyngitis, syncope, hallucinations, paranoia,\r\ndelusions, suicidal thoughts; also reported anxiety,\r\nseizures", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213714.htm", "doses": [ "Consult product literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risks, and recommends effective contraception during and\r\nfor 3 months after treatment in men and women" }, "PILOCARPINE": { "indications": "Indications\u00a0see notes above; dry mouth (%s\n(From 12.3.5 Treatment of dry mouth: British National Formulary)\n12.3.5 Treatment of dry mouth)", "name": "PILOCARPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Miotics", "PILOCARPINE" ], "cautions": "Cautions\u00a0\n(From Miotics: British National Formulary)\nCautions\u00a0A darkly pigmented iris may require a higher concentration of the miotic or more frequent administration and care should be taken to avoid overdosage. Retinal detachment has occurred in susceptible individuals and those with retinal disease; therefore fundus examination is advised before starting treatment with a miotic. Care is also required in conjunctival or corneal damage. Intra-ocular pressure and visual fields should be monitored in those with chronic simple glaucoma and those receiving long-term treatment with a miotic. Miotics should be used with caution in patients with peptic ulceration, gastro-intestinal spasm, cardiac disease, hypertension, hypotension, marked vasomotor instability, asthma, epilepsy, Parkinson\u2019s disease, hyperthyroidism, and urinary-tract obstruction.Counselling\u00a0Blurred vision may affect performance of skilled tasks (e.g. driving) particularly at night or in reduced lighting", "side-effects": "Side-effects\u00a0\n(From Miotics: British National Formulary)\nMiotics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5496.htm", "doses": [ "Apply up to 4 times daily; long-acting preparations, see\r\nunder preparations below" ] }, "METHENAMINE HIPPURATE ": { "indications": "Indications\u00a0prophylaxis and long-term treatment of chronic or recurrent lower\r\nurinary-tract infections", "name": "METHENAMINE HIPPURATE ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.13 Urinary-tract infections" ], "cautions": "Cautions\u00a0avoid concurrent administration with sulfonamides\r\n(risk of crystalluria) or urinary alkalinising agents; interactions: Appendix 1 (methenamine)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances, bladder irritation,\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3966.htm", "doses": [ "1\u00a0g every 12 hours (may be increased in patients with\r\ncatheters to 1\u00a0g every 8 hours); child 6\u201312 years 500\u00a0mg every 12 hours" ], "pregnancy": "Pregnancy\u00a0use with caution" }, "DIETHYLSTILBESTROL": { "indications": "Indications\u00a0\n(From 8.3.1 Oestrogens: British National Formulary)\n8.3.1 Oestrogens", "name": "DIETHYLSTILBESTROL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.3 Sex hormones and hormone antagonists in malignant disease", "8.3.1 Oestrogens", "DIETHYLSTILBESTROL" ], "cautions": "Cautions\u00a0cardiovascular disease", "side-effects": "Side-effects\u00a0sodium retention with oedema, thromboembolism,\r\njaundice, feminising effects in men; see also notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4798.htm", "doses": [ "Breast cancer, 10\u201320\u00a0mg daily", "Prostate cancer, 1\u20133\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0in first trimester, high doses associated with vaginal\r\ncarcinoma, urogenital abnormalities, and reduced fertility in female\r\noffspring; increased risk of hypospadias in male offspring" }, "SUXAMETHONIUM CHLORIDE": { "indications": "Indications\u00a0neuromuscular blockade (short duration)", "name": "SUXAMETHONIUM CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.5 Neuromuscular blocking drugs", "Depolarising neuromuscular blocking drugs" ], "cautions": "Cautions\u00a0\n(From Depolarising neuromuscular blocking drugs: British National Formulary)\nSuxamethonium acts by mimicking acetylcholine at the neuromuscular junction but hydrolysis is much slower than for acetylcholine; depolarisation is therefore prolonged, resulting in neuromuscular blockade. Unlike the non-depolarising neuromuscular blocking drugs, its action cannot be reversed and recovery is spontaneous; anticholinesterases such as neostigmine potentiate the neuromuscular block.Suxamethonium should be given after anaesthetic induction because paralysis is usually preceded by painful muscle fasciculations. While tachycardia occurs with single use, bradycardia may occur with repeated doses in adults and with the first dose in children. Premedication with atropine reduces bradycardia as well as the excessive salivation associated with suxamethonium use.Prolonged paralysis may occur in dual block, which occurs with high or repeated doses of suxamethonium and is caused by the development of a non-depolarising block following the initial depolarising block; edrophonium (section 15.1.6) may be used to confirm the diagnosis of dual block. Individuals with myasthenia gravis are resistant to suxamethonium but can develop dual block resulting in delayed recovery. Prolonged paralysis may also occur in those with low or atypical plasma cholinesterase. Assisted ventilation should be continued until muscle function is restored.; hypersensitivity to other neuromuscular blocking drugs; patients with cardiac, respiratory, or neuromuscular disease; raised intra-ocular pressure (avoid in penetrating\r\neye injury); severe sepsis (risk of hyperkalaemia); interactions: Appendix 1 (muscle relaxants)", "side-effects": "Side-effects\u00a0\n(From Depolarising neuromuscular blocking drugs: British National Formulary)\nDepolarising neuromuscular blocking drugs; also increased\r\ngastric pressure; hyperkalaemia; postoperative muscle pain, myoglobinuria,\r\nmyoglobinaemia; increased intra-ocular pressure; flushing, rash; rarely arrhythmias, cardiac arrest; bronchospasm, apnoea,\r\nprolonged respiratory depression; limited jaw mobility; very\r\nrarely anaphylactic reactions, malignant hyperthermia; also reported hypertension, hypotension, rhabdomyolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6663.htm", "doses": [ "By intravenous injection, adult, 1\u20131.5\u00a0mg/kg; child under 1 year, 2\u00a0mg/kg; child 1\u201318\r\nyears, 1\u00a0mg/kg", "By intramuscular injection (onset in 2\u20133 minutes), child 1 month\u20131 year, up to 4\u20135\u00a0mg/kg; child 1\u201312 years, up to 4\u00a0mg/kg; max. 150\u00a0mg", "Doses of suxamethonium in BNF may differ\r\nfrom those in product literature" ], "pregnancy": "Pregnancy\u00a0mildly prolonged maternal neuromuscular blockade\r\nmay occur" }, "TELMISARTAN With diuretic": { "indications": "Indications\u00a0hypertension (see also notes above); prevention of cardiovascular\r\nevents in patients with established atherosclerotic cardiovascular\r\ndisease, or type 2 diabetes mellitus with target-organ damage", "name": "TELMISARTAN With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "TELMISARTAN", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).", "side-effects": "Side-effects\u00a0see notes above; also gastro-intestinal disturbances;\r\nchest pain; influenza-like symptoms including pharyngitis and sinusitis;\r\nurinary-tract infection; arthralgia, myalgia, back pain, leg cramps;\r\neczema; less commonly dry mouth, flatulence, anxiety,\r\nvertigo, tendinitis-like symptoms, abnormal vision, increased sweating; rarely bradycardia, tachycardia, dyspnoea, insomnia, depression,\r\nblood disorders, increase in uric acid, eosinophilia, rash, and pruritus;\r\nsyncope and asthenia also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119722.htm", "doses": [ "Hypertension, usually 40\u00a0mg once daily (but 20\u00a0mg may\r\nbe sufficient), increased if necessary after at least 4 weeks, to\r\nmax. 80\u00a0mg once daily", "Prevention of cardiovascular events, 80\u00a0mg once daily", "Name[Micardis Plus\u00ae (Boehringer Ingelheim) ] Tablets 40/12.5, red/white, telmisartan 40\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price\r\n28-tab pack = \u00a312.50\nTablets 80/12.5, red/white, telmisartan 80\u00a0mg, hydrochlorothiazide 12.5\u00a0mg, net price\r\n28-tab pack = \u00a317.00\nTablets 80/25, yellow/white, telmisartan\r\n80\u00a0mg, hydrochlorothiazide 25\u00a0mg, net price 28-tab pack = \u00a317.00" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "CO-TRIMOXAZOLE": { "indications": "Indications\u00a0see restrictions above", "name": "CO-TRIMOXAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.8 Sulfonamides and trimethoprim" ], "cautions": "Cautions\u00a0 maintain adequate fluid intake; avoid\r\nin blood disorders (unless under specialist supervision); monitor blood counts on prolonged treatment; discontinue immediately if blood disorders or rash\r\ndevelop; predisposition to folate deficiency or hyperkalaemia; elderly (see Restrictions on the\r\nuse of Co-trimoxazole above); asthma; G6PD deficiency (section 9.1.5); avoid in infants under 6 weeks\r\n(except for treatment or prophylaxis of pneumocystis pneumonia); interactions: Appendix 1 (trimethoprim, sulfamethoxazole)", "side-effects": "Side-effects\u00a0nausea, diarrhoea; headache; hyperkalaemia; rash\r\n(very rarely including Stevens-Johnson syndrome, toxic epidermal necrolysis,\r\nphotosensitivity)\u2014discontinue immediately; less commonly vomiting; very rarely glossitis, stomatitis, anorexia,\r\nliver damage (including jaundice and hepatic necrosis), pancreatitis,\r\nantibiotic-associated colitis, myocarditis, cough and shortness of\r\nbreath, pulmonary infiltrates, aseptic meningitis, depression, convulsions,\r\nperipheral neuropathy, ataxia, tinnitus, vertigo, hallucinations,\r\nhypoglycaemia, blood disorders (including leucopenia, thrombocytopenia,\r\nmegaloblastic anaemia, eosinophilia), hyponatraemia, renal disorders\r\nincluding interstitial nephritis, arthralgia, myalgia, vasculitis,\r\nsystemic lupus erythematosus and uveitis; rhabdomyolysis reported\r\nin HIV-infected patients", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3884.htm", "doses": [ "By mouth, 960\u00a0mg every 12 hours; child, every 12 hours, 6 weeks\u20135 months, 120\u00a0mg;\r\n6 months\u20135 years, 240\u00a0mg; 6\u201312 years, 480\u00a0mg", "By intravenous infusion, 960\u00a0mg every 12 hours\r\nincreased to 1.44\u00a0g every 12 hours in severe infections; child 36\u00a0mg/kg daily in 2 divided doses increased\r\nto 54\u00a0mg/kg daily in severe infections", "Treatment of Pneumocystis jirovecii (Pneumocystis carinii) infections (undertaken where facilities\r\nfor appropriate monitoring available\u2014consult microbiologist and product\r\nliterature), by mouth or by\r\nintravenous infusion, adult and child over 4 weeks, 120\u00a0mg/kg\r\ndaily in 2\u20134 divided doses for 14\u201321 days", "Prophylaxis of Pneumocystis jirovecii (Pneumocystis carinii) infections, by mouth, 960\u00a0mg once daily (may be reduced to 480\u00a0mg once daily to improve\r\ntolerance) or 960\u00a0mg on alternate days (3 times a\r\nweek) or 960\u00a0mg twice daily on alternate days (3\r\ntimes a week); child 6 weeks\u20135 months,\r\n120\u00a0mg twice daily on 3 consecutive or alternate days per week or on 7 days per week; 6 months\u20135 years, 240\u00a0mg; 6\u201312 years,\r\n480\u00a0mg", "480\u00a0mg of co-trimoxazole consists of sulfamethoxazole 400\u00a0mg and trimethoprim 80\u00a0mg" ], "pregnancy": "Pregnancy\u00a0teratogenic risk in first trimester (trimethoprim\r\na folate antagonist). Neonatal haemolysis and methaemoglobinaemia\r\nin third trimester; fear of increased risk of kernicterus in neonates\r\nappears to be unfounded" }, "LIRAGLUTIDE": { "indications": "Indications\u00a0\n(From 6.1.2.3 Other antidiabetic drugs: British National Formulary)\n6.1.2.3 Other antidiabetic drugs", "name": "LIRAGLUTIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs" ], "cautions": "Cautions\u00a0discontinue if symptoms of acute pancreatitis\r\n(persistent, severe abdominal pain); interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances including nausea,\r\nvomiting, constipation, diarrhoea, dyspepsia, abdominal pain and distension,\r\nflatulence, gastritis, gastro-oesophageal reflux disease, decreased\r\nappetite; headache, dizziness, fatigue; fever, bronchitis, nasopharyngitis;\r\nhypoglycaemia; injection site reactions; also reported acute pancreatitis, thyroid neoplasm, goitre, increased blood calcitonin,\r\nangioedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203878.htm", "doses": [ "By subcutaneous injection, adult over 18 years, initially 0.6\u00a0mg once daily,\r\nincreased after at least 1 week to 1.2\u00a0mg once daily, further increased\r\nif necessary after an interval of at least 1 week to max. 1.8\u00a0mg once\r\ndaily", "Dose of concomitant sulfonylurea may need\r\nto be reduced" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "GABAPENTIN": { "indications": "Indications\u00a0monotherapy and adjunctive treatment of focal seizures with or without\r\nsecondary generalisation; peripheral neuropathic pain (section 4.7.3); migraine prophylaxis [unlicensed] (section 4.7.4.2)", "name": "GABAPENTIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Gabapentin and pregabalin", "GABAPENTIN" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; elderly; diabetes mellitus; mixed seizures (including absences); false positive\r\nreadings with some urinary protein tests; history of psychotic illness; interactions: Appendix 1 (gabapentin)", "side-effects": "Side-effects\u00a0nausea, vomiting, gingivitis, diarrhoea, abdominal\r\npain, dyspepsia, constipation, dry mouth or throat, flatulence, weight\r\ngain, increased appetite, anorexia, hypertension, vasodilatation,\r\noedema, dyspnoea, cough, pharyngitis, hostility, confusion, emotional\r\nlability, depression, vertigo, anxiety, nervousness, abnormal thoughts,\r\ndrowsiness, dizziness, malaise, ataxia, convulsions, movement disorders, speech disorder,\r\namnesia, tremor, insomnia, headache, paraesthesia, nystagmus, abnormal\r\nreflexes, fever, flu syndrome, impotence, leucopenia, arthralgia,\r\nmyalgia, twitching, visual disturbances, rhinitis, rash, pruritus,\r\nacne; less commonly palpitation; also reported pancreatitis, hepatitis, hallucinations, blood glucose fluctuations\r\nin patients with diabetes, breast hypertrophy, gynaecomastia, acute\r\nrenal failure, incontinence, thrombocytopenia, tinnitus, Stevens-Johnson\r\nsyndrome, alopecia, hypersensitivity syndrome; suicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129255.htm", "doses": [ "Epilepsy, 300\u00a0mg once daily on day 1, then 300\u00a0mg\r\ntwice daily on day 2, then 300\u00a0mg 3 times daily on day 3 or initially 300\u00a0mg 3 times daily on day 1; then increased according\r\nto response in steps of 300\u00a0mg (in 3 divided doses) every 2\u20133 days;\r\nusual dose 0.9\u20133.6\u00a0g daily in 3 divided doses (max. 4.8\u00a0g daily in\r\n3 divided doses); child 6\u201312 years\r\n(adjunctive therapy only) initially 10\u00a0mg/kg (max. 300\u00a0mg) once daily\r\non day 1, then 10\u00a0mg/kg (max. 300\u00a0mg) twice daily on day 2, then 10\u00a0mg/kg\r\n(max. 300\u00a0mg) 3 times daily on day 3; usual dose 25\u201335\u00a0mg/kg daily\r\nin 3 divided doses; max. 70\u00a0mg/kg daily in 3 divided doses; child 2\u20136 years see BNF for Children", "Neuropathic pain, adult over 18 years, 300\u00a0mg once daily on day 1, then 300\u00a0mg twice daily\r\non day 2, then 300\u00a0mg 3 times daily on day 3 or initially\r\n300\u00a0mg 3 times daily on day 1, then increased according to response\r\nin steps of 300\u00a0mg (in 3 divided doses) every 2\u20133 days up to max.\r\n3.6\u00a0g daily", "Migraine prophylaxis [unlicensed], initially 300\u00a0mg\r\ndaily, increased according to response up to 2.4\u00a0g daily in divided\r\ndoses" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "DICOBALT EDETATE": { "indications": "Indications\u00a0severe poisoning with cyanides", "name": "DICOBALT EDETATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "Emergency treatment of poisoning", "Other poisons", "Cyanides" ], "cautions": "Cautions\u00a0owing to toxicity to be used only for\r\ndefinite cyanide poisoning when patient tending to lose, or has lost,\r\nconsciousness; not to\r\nbe used as a precautionary measure", "side-effects": "Side-effects\u00a0hypotension, tachycardia, and vomiting; anaphylactoid\r\nreactions including facial and laryngeal oedema and cardiac abnormalities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/29552.htm", "doses": [ "By intravenous injection, adult 300\u00a0mg over 1 minute (5 minutes if condition\r\nless serious) followed immediately by 50\u00a0mL of glucose intravenous infusion 50%; if response inadequate a second dose of\r\nboth may be given, but risk of cobalt toxicity; child consult the National Poisons Information Service" ] }, "LYMECYCLINE": { "indications": "Indications\u00a0see notes above", "name": "LYMECYCLINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.3 Tetracyclines" ], "cautions": "Cautions\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nCautions\u00a0Tetracyclines may increase muscle weakness in patients with myasthenia gravis, and exacerbate systemic lupus erythematosus. Antacids, and aluminium, calcium, iron, magnesium and zinc salts decrease the absorption of tetracyclines; milk also reduces the absorption of demeclocycline, oxytetracycline, and tetracycline. Other interactions: Appendix 1 (tetracyclines).", "side-effects": "Side-effects\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nSide-effects\u00a0Side-effects of the tetracyclines include nausea, vomiting, diarrhoea (antibiotic-associated colitis reported occasionally), dysphagia, and oesophageal irritation. Other rare side-effects include hepatotoxicity, pancreatitis, blood disorders, photosensitivity (particularly with demeclocycline), and hypersensitivity reactions (including rash, exfoliative dermatitis, Stevens-Johnson syndrome, urticaria, angioedema, anaphylaxis, pericarditis). Headache and visual disturbances may indicate benign intracranial hypertension (discontinue treatment); bulging fontanelles have been reported in infants. ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3821.htm", "doses": [ "408\u00a0mg every 12 hours, increased to 1.224\u20131.632\u00a0g daily\r\nin severe infections", "Acne, 408\u00a0mg daily for at least 8 weeks" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.3 Tetracyclines: British National Formulary)\nPregnancy\u00a0Tetracyclines should not be given to pregnant women. Effects on skeletal development have been documented when tetracyclines have been used in the first trimester in animal studies. Administration during the second or third trimester may cause discoloration of the child\u2019s teeth, and maternal hepatotoxicity has been reported with large parenteral doses." }, "VINBLASTINE SULPHATE": { "indications": "Indications\u00a0\n(From 8.1.4 Vinca alkaloids and etoposide: British National Formulary)\nThe vinca alkaloids, vinblastine, vincristine, and vindesine, are used to treat a variety of cancers including leukaemias, lymphomas, and some solid tumours (e.g. breast and lung cancer). Vinorelbine is a semi-synthetic vinca alkaloid; it is given intravenously or orally for the treatment of advanced breast cancer and for advanced non-small cell lung cancer. For the role of vinorelbine in the treatment of breast cancer, see section 8.3.4.1. Vinflunine is licensed as monotherapy for the treatment of advanced or metastatic transitional cell carcinoma of the urothelial tract after failure of a platinum-containing regimen.Neurotoxicity, usually as peripheral or autonomic neuropathy, occurs with all vinca alkaloids and is a limiting side-effect of vincristine; it occurs less often with vindesine, vinblastine, vinorelbine, and vinflunine. Patients with neurotoxicity commonly have peripheral paraesthesia, loss of deep tendon reflexes, abdominal pain, and constipation; ototoxicity has been reported. If symptoms of neurotoxicity are severe, doses should be reduced. Motor weakness can also occur, and increasing motor weakness calls for dose reduction or discontinuation of these drugs. Recovery from neurotoxic effects is usually slow but complete.Myelosuppression is a dose-limiting side-effect of vinblastine, vindesine, vinorelbine, and vinflunine; vincristine causes negligible myelosuppression. The vinca alkaloids cause severe local irritation and care must be taken to avoid extravasation. Severe bronchospasm has been reported following administration of the vinca alkaloids (more commonly when used in combination with mitomycin-C).", "name": "VINBLASTINE SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.4 Vinca alkaloids and etoposide" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling; interactions: Appendix 1 (vinblastine)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; irritant to tissues", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4750.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (limited experience suggests fetal harm; teratogenic\r\nin animal studies); see also Pregnancy and Reproductive\r\nFunction" }, "NATEGLINIDE": { "indications": "Indications\u00a0type 2 diabetes mellitus in combination with metformin (section 6.1.2.2) when metformin alone inadequate", "name": "NATEGLINIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.2 Antidiabetic drugs", "6.1.2.3 Other antidiabetic drugs", "NATEGLINIDE" ], "cautions": "Cautions\u00a0substitute insulin during intercurrent\r\nillness (such as myocardial infarction, coma, infection,\r\nand trauma) and during surgery (omit nateglinide on morning of surgery\r\nand recommence when eating and drinking normally); elderly, debilitated and malnourished\r\npatients; interactions: Appendix 1\r\n(antidiabetics)", "side-effects": "Side-effects\u00a0hypoglycaemia; hypersensitivity reactions including\r\npruritus, rashes and urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106130.htm", "doses": [ "adult over 18 years, initially\r\n60\u00a0mg 3 times daily within 30 minutes before main meals, adjusted\r\naccording to response up to max. 180\u00a0mg 3 times daily" ], "pregnancy": "Pregnancy\u00a0avoid\u2014toxicity in animal studies" }, "DISOPYRAMIDE Modified release": { "indications": "Indications\u00a0prevention and treatment of ventricular and supraventricular arrhythmias,\r\nincluding after myocardial infarction; maintenance of sinus rhythm\r\nafter cardioversion", "name": "DISOPYRAMIDE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.3 Anti-arrhythmic drugs", "2.3.2 Drugs for arrhythmias", "Supraventricular and ventricular arrhythmias", "DISOPYRAMIDE", "Modified release" ], "cautions": "Cautions\u00a0monitor for hypotension, hypoglycaemia, ventricular\r\ntachycardia, ventricular fibrillation or torsade de pointes (discontinue if occur); monitor serum potassium; atrial flutter\r\nor atrial tachycardia with partial block, structural\r\nheart disease, heart failure (avoid if severe); prostatic enlargement; susceptibility to angle-closure glaucoma; myasthenia gravis; elderly; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (disopyramide)", "side-effects": "Side-effects\u00a0ventricular tachycardia, ventricular fibrillation\r\nor torsade de pointes (usually associated with prolongation of QRS\r\ncomplex or QT interval\u2014see Cautions above), myocardial depression,\r\nhypotension, AV block; antimuscarinic effects include dry mouth, blurred\r\nvision, urinary retention, and very rarely angle-closure glaucoma;\r\ngastro-intestinal irritation; psychosis, cholestatic jaundice, hypoglycaemia\r\nalso reported (see Cautions above)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2425.htm", "doses": [ "By mouth, 300\u2013800\u00a0mg daily in divided\r\ndoses", "By slow intravenous injection, 2\u00a0mg/kg\r\nover at least 5 minutes to a max. of 150\u00a0mg, with ECG monitoring,\r\nfollowed immediately either by 200\u00a0mg by mouth, then 200\u00a0mg every 8 hours for 24 hours or 400\u00a0micrograms/kg/hour by intravenous infusion; max. 300\u00a0mg in first hour and 800\u00a0mg\r\ndaily", "Name[Rythmodan Retard\u00ae (Sanofi-Aventis) ] Tablets, m/r, scored, f/c, disopyramide (as phosphate) 250\u00a0mg, net price 60-tab pack\r\n= \u00a327.72. \r\n Label:\r\n 25Dose\u00a0250\u2013375\u00a0mg every 12 hours" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk; may induce labour if used in third trimester" }, "KETOPROFEN With omeprazole": { "indications": "Indications\u00a0pain and mild inflammation in rheumatic disease and\r\nother musculoskeletal disorders, and after orthopaedic surgery; acute\r\ngout; dysmenorrhoea", "name": "KETOPROFEN With omeprazole", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "KETOPROFEN", "With omeprazole" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/207444.htm", "doses": [ "By mouth, rheumatic disease, 100\u2013200\u00a0mg\r\ndaily in 2\u20134 divided doses; child not\r\nrecommended", "Pain and dysmenorrhoea, 50\u00a0mg up to 3 times daily; child not recommended", "By rectum in suppositories, rheumatic\r\ndisease, 100\u00a0mg at bedtime; child not\r\nrecommended", "Combined oral and rectal treatment, max. total daily dose 200\u00a0mg", "Name[Axorid\u00ae (Meda) ] Capsules, m/r, ketoprofen 100\u00a0mg,\r\nomeprazole 20\u00a0mg (yellow/white), net price 30-cap pack = \u00a313.80; ketoprofen\r\n200\u00a0mg, omeprazole 20\u00a0mg (white), 30-cap pack = \u00a313.80. \r\n Label:\r\n 21, 25Excipients include propylene\r\nglycol (see Excipients)Note\u00a0Capsules enclose microgranules\r\ncontaining modified-release ketoprofen and gastro-resistant omperazoleDose\u00a0(expressed as ketoprofen) patients requiring ketoprofen\r\nfor osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis,\r\nwho are at risk of NSAID-associated duodenal or gastric ulcer or gastroduodenal\r\nerosions, adult and child over 15 years, 100\u00a0mg (with omeprazole 20\u00a0mg)\r\nonce daily increased to 200\u00a0mg (with omeprazole 20\u00a0mg) once daily\r\ndepending on severity of symptoms" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ISOFLURANE": { "indications": "Indications\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "name": "ISOFLURANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.2 Inhalational anaesthetics", "Volatile liquid anaesthetics" ], "cautions": "Cautions\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Volatile liquid anaesthetics: British National Formulary)\nVolatile liquid anaesthetics", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6579.htm", "doses": [ "Induction of anaesthesia, by inhalation using specifically calibrated vaporiser, in oxygen or nitrous\r\noxide\u2013oxygen, increased gradually according to response\r\nfrom 0.5% to 3%", "Maintenance of anaesthesia, by inhalation using\r\nspecifically calibrated vaporiser, 1\u20132.5% in nitrous oxide\u2013oxygen; an additional 0.5\u20131% may be required when given with oxygen\r\nalone; caesarean section, 0.5\u20130.75% in nitrous oxide\u2013oxygen" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "CARMELLOSE SODIUM Single use": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "CARMELLOSE SODIUM", "Single use" ], "indications": "Indications\u00a0dry eye conditions", "name": "CARMELLOSE SODIUM Single use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106171.htm", "doses": [ "Apply as required", "Name[Celluvisc\u00ae (Allergan)] Eye drops, carmellose sodium 0.5%,\r\nnet price 30 \u00d7 0.4\u00a0mL = \u00a35.75, 90 \u00d7 0.4\u00a0mL = \u00a315.53; 1%, 30 \u00d7 0.4\u00a0mL\r\n= \u00a33.00, 60 \u00d7 0.4\u00a0mL = \u00a310.99" ] }, "FLUORIDES Mouthwashes": { "indications": "Indications\u00a0prophylaxis of dental caries\u2014\n(From 9.5.3 Fluoride: British National Formulary)\n9.5.3 Fluoride", "name": "FLUORIDES Mouthwashes", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.3 Fluoride", "FLUORIDES", "Mouthwashes" ], "side-effects": "Side-effects\u00a0occasional white flecks on teeth with recommended\r\ndoses; rarely yellowish-brown discoloration if recommended\r\ndoses are exceeded", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5082.htm", "doses": [ "Dose expressed as\r\nfluoride ion (F-)", "Water content less than F- 300\u00a0micrograms/litre (0.3\r\nparts per million), child up to 6 months\r\nnone; 6 months\u20133 years F- 250\u00a0micrograms daily, 3\u20136 years\r\nF- 500\u00a0micrograms daily, over 6 years F- 1\u00a0mg\r\ndaily", "Water content between F- 300 and 700\u00a0micrograms/litre\r\n(0.3\u20130.7 parts per million), child up\r\nto 3 years none, 3\u20136 years F- 250\u00a0micrograms daily, over\r\n6 years F- 500\u00a0micrograms daily", "Water content above F- 700\u00a0micrograms/litre (0.7\r\nparts per million), supplements not advised", "These doses reflect the recommendations of\r\nthe British Dental Association, the British Society of Paediatric\r\nDentistry and the British Association for the Study of Community Dentistry\r\n(Br Dent J 1997; 182: 6\u20137)", "Name[Duraphat\u00ae (Colgate-Palmolive)] Weekly dental rinse (= mouthwash),\r\nblue, sodium fluoride 0.2%. Net price 150\u00a0mL = \u00a32.13. Counselling,\r\nsee aboveDose\u00a0child 6 years and over,\r\nfor weekly use, rinse with 10\u00a0mLDental prescribing on NHS\u00a0 May be prescribed as\r\nSodium Fluoride Mouthwash 0.2%" ] }, "GLYCOPYRRONIUM BROMIDE - ANTIMUSCARINIC DRUGS": { "side-effects": "Side-effects\u00a0section 1.2", "indications": "Indications\u00a0drying secretions\r\n(see Prescribing in Palliative\r\nCare); premedication; intra-operative bradycardia; with neostigmine for reversal of non-depolarising neuromuscular block; hyperhidrosis\r\n(section 13.12)", "name": "GLYCOPYRRONIUM BROMIDE - ANTIMUSCARINIC DRUGS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6590.htm", "doses": [ "Premedication, by intramuscular or intravenous injection, 200\u2013400\u00a0micrograms or 4\u20135\u00a0micrograms/kg (max. 400\u00a0micrograms); child 1 month\u201312 years, 4\u20138\u00a0micrograms/kg (max. 200\u00a0micrograms)", "Intra-operative bradycardia, by intravenous\r\ninjection, 200\u2013400\u00a0micrograms or 4\u20135\u00a0micrograms/kg\r\n(max. 400\u00a0micrograms), repeated if necessary; child 1 month\u201318 years, 4\u20138\u00a0micrograms/kg (max. 200\u00a0micrograms), repeated\r\nif necessary", "Control of muscarinic side-effects of neostigmine in reversal of non-depolarising neuromuscular block, by intravenous\r\ninjection, 200\u00a0micrograms per 1\u00a0mg of neostigmine, or 10\u201315\u00a0micrograms/kg; child 1 month\u201312 years, 10\u00a0micrograms/kg (max. 500\u00a0micrograms)" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.3 Antimuscarinic drugs", "GLYCOPYRRONIUM BROMIDE" ], "cautions": "Cautions\u00a0section 1.2" }, "TIMOLOL": { "indications": "Indications\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "name": "TIMOLOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Beta-blockers", "TIMOLOL" ], "cautions": "Cautions\u00a0\n(From Beta-blockers: British National Formulary)\nSystemic absorption can follow topical application to the eyes; therefore, eye drops containing a beta-blocker are contra-indicated in patients with bradycardia, heart block, or uncontrolled heart failure. Important: for a warning to avoid in asthma see below", "side-effects": "Side-effects\u00a0\n(From Beta-blockers: British National Formulary)\nBeta-blockers", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129638.htm", "doses": [ "Apply twice daily; long-acting preparations, apply once\r\ndaily" ] }, "CALCIPOTRIOL": { "indications": "Indications\u00a0see under Dose", "name": "CALCIPOTRIOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Vitamin D and analogues", "CALCIPOTRIOL" ], "cautions": "Cautions\u00a0\n(From Vitamin D and analogues: British National Formulary)\nVitamin D and analogues; avoid use on face; avoid excessive exposure\r\nto sunlight and sunlamps", "side-effects": "Side-effects\u00a0see notes above; also photosensitivity, dry skin; rarely facial or perioral dermatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130056.htm", "doses": [ "Plaque psoriasis, apply ointment once or twice daily;\r\nmax. 100\u00a0g weekly (less with scalp solution, see\r\nbelow); child over 6 years, apply twice\r\ndaily; 6\u201312 years max. 50\u00a0g weekly; over 12 years max. 75\u00a0g weekly", "Patient information leaflet for Dovonex\u00ae ointment advises liberal application (but note\r\nmax. recommended weekly dose, above)", "Scalp psoriasis, apply scalp solution twice daily; max. 60\u00a0mL\r\nweekly (less with ointment, see below); child under 18 years see BNF for Children", "When preparations used together max. total calcipotriol 5\u00a0mg in any one week (e.g. scalp solution\r\n60\u00a0mL with ointment 30\u00a0g or scalp solution 30\u00a0mL\r\nwith ointment 60\u00a0g)" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid unless essential" }, "KAOLIN, LIGHT ": { "indications": "Indications\u00a0diarrhoea but see notes above", "name": "KAOLIN, LIGHT ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.1 Adsorbents and bulk-forming drugs", "KAOLIN, LIGHT" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (kaolin)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2149.htm", "doses": [ "10\u201320\u00a0mL every 4 hours" ] }, "EPTIFIBATIDE": { "indications": "Indications\u00a0in combination with aspirin and unfractionated heparin for the prevention\r\nof early myocardial infarction in patients with unstable angina or\r\nnon-ST-segment-elevation myocardial infarction and with last episode\r\nof chest pain within 24 hours (use under specialist supervision)", "name": "EPTIFIBATIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs" ], "cautions": "Cautions\u00a0risk of bleeding, concomitant drugs that increase risk of bleeding\u2014discontinue immediately if uncontrolled serious bleeding; measure baseline prothrombin time, activated partial\r\nthromboplastin time, platelet count, haemoglobin, haematocrit and\r\nserum creatinine; monitor haemoglobin,\r\nhaematocrit and platelets within 6 hours after start of treatment\r\nthen at least once daily; discontinue if\r\nthrombolytic therapy, intra-aortic balloon pump or emergency cardiac\r\nsurgery necessary", "side-effects": "Side-effects\u00a0bleeding manifestations; very rarely anaphylaxis and rash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/81460.htm", "doses": [ "Initially by intravenous injection, 180\u00a0micrograms/kg,\r\nthen by intravenous infusion, 2\u00a0micrograms/kg/minute\r\nfor up to 72 hours (up to 96 hours if percutaneous coronary intervention\r\nduring treatment)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014no information available" }, "BALSALAZIDE SODIUM": { "indications": "Indications\u00a0treatment of mild to moderate ulcerative colitis and maintenance\r\nof remission", "name": "BALSALAZIDE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.1 Aminosalicylates" ], "cautions": "Cautions\u00a0\n(From 1.5.1 Aminosalicylates: British National Formulary)\nCautions\u00a0Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment (more frequently in renal impairment). Blood disorders can occur with aminosalicylates (see recommendation below).; also history of asthma; interactions: Appendix\r\n1 (aminosalicylates)Blood disorders\u00a0See %s\n(From 1.5.1 Aminosalicylates: British National Formulary)\nBlood disordersPatients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.", "side-effects": "Side-effects\u00a0see notes above; also cholelithiasis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/64157.htm", "doses": [ "Acute attack, 2.25\u00a0g 3 times daily until remission occurs\r\nor for up to max. 12 weeks", "Maintenance, 1.5\u00a0g twice daily, adjusted according to response\r\n(max. 6\u00a0g daily)", "child under 18 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid" }, "DIPYRIDAMOLE Modified release": { "indications": "Indications\u00a0see notes above and under Dose", "name": "DIPYRIDAMOLE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.9 Antiplatelet drugs", "DIPYRIDAMOLE", "Modified release" ], "cautions": "Cautions\u00a0rapidly worsening angina, aortic stenosis, recent\r\nmyocardial infarction, left ventricular\r\noutflow obstruction, heart failure; may exacerbate migraine; hypotension; myasthenia gravis (risk of\r\nexacerbation); coagulation disorders; concomitant use of drugs that increase risk of bleeding; interactions: Appendix 1 (dipyridamole)", "side-effects": "Side-effects\u00a0gastro-intestinal effects, dizziness, myalgia,\r\nthrobbing headache, hypotension, hot flushes and tachycardia; worsening\r\nsymptoms of coronary heart disease; hypersensitivity reactions such\r\nas rash, urticaria, severe bronchospasm and angioedema; increased\r\nbleeding during or after surgery; thrombocytopenia reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/60544.htm", "doses": [ "By mouth, 300\u2013600\u00a0mg daily in 3\u20134\r\ndivided doses", "Modified-release preparations, see under preparation below", "By intravenous injection, diagnostic\r\nonly, consult product literature", "Name[Persantin\u00ae Retard (Boehringer Ingelheim) ] Capsules, m/r, red/orange containing\r\nyellow pellets, dipyridamole 200\u00a0mg, net price\r\n60-cap pack = \u00a39.00. \r\n Label:\r\n 21, 25Dose\u00a0secondary prevention of ischaemic stroke and transient\r\nischaemic attacks (used alone or with aspirin),\r\nadjunct to oral anticoagulation for prophylaxis of thromboembolism\r\nassociated with prosthetic heart valves, 200\u00a0mg twice daily preferably\r\nwith foodNote\u00a0Dispense in original container (pack contains\r\na desiccant) and discard any capsules remaining 6 weeks after opening" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "TRETINOIN": { "indications": "Indications\u00a0\n(From Tretinoin: British National Formulary)\nTretinoin; acne (%s\n(From 13.6.1 Topical preparations for acne: British National Formulary)\n13.6.1 Topical preparations for acne); photodamage (%s\n(From 13.8.1 Sunscreen preparations: British National Formulary)\n13.8.1 Sunscreen preparations)", "name": "TRETINOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Tretinoin" ], "cautions": "Cautions\u00a0exclude pregnancy before starting treatment; monitor haematological and coagulation profile, liver\r\nfunction, serum calcium and plasma lipids before and during treatment; increased risk of thromboembolism during first month\r\nof treatment; interactions: Appendix\r\n1 (retinoids)", "side-effects": "Side-effects\u00a0retinoic acid syndrome (fever, dyspnoea, acute\r\nrespiratory distress, pulmonary infiltrates, pleural effusion, hyperleucocytosis,\r\nhypotension, oedema, weight gain, hepatic, renal and multi-organ failure)\r\nrequires immediate treatment\u2014consult product literature; gastro-intestinal\r\ndisturbances, pancreatitis; arrhythmias, flushing, oedema; headache,\r\nbenign intracranial hypertension (mainly in children\u2014consider dose\r\nreduction if intractable headache in children), shivering, dizziness,\r\nconfusion, anxiety, depression, insomnia, paraesthesia, visual and\r\nhearing disturbances; raised liver enzymes, serum creatinine and lipids;\r\nbone and chest pain, alopecia, erythema, rash, pruritus, sweating,\r\ndry skin and mucous membranes, cheilitis; thromboembolism,\r\nhypercalcaemia, and genital ulceration reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/65167.htm", "doses": [ "adult and child 45\u00a0mg/m2 daily in 2 divided doses,\r\nmax. duration of treatment 90 days (consult product literature for\r\ndetails of concomitant chemotherapy)" ], "pregnancy": "Pregnancy\u00a0teratogenic; effective contraception must be used\r\nfor at least 1 month before oral treatment, during treatment and for\r\nat least 1 month after stopping (oral progestogen-only contraceptives\r\nnot considered effective)" }, "Other compound alginate preparations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.1 Dyspepsia and gastro-oesophageal reflux disease", "1.1.2 Compound alginates and proprietary indigestion preparations" ], "cautions": "Cautions\u00a0diabetes mellitus (high sugar content)", "name": "Other compound alginate preparations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2042.htm", "doses": [ "adult and child over 6 years, 1\u20132 tablets chewed 4 times daily\r\n(after meals and at bedtime)", "5\u201315\u00a0mL 4 times daily (after meals and at bedtime); child 6\u201312 years, 5\u201310\u00a0mL 4 times daily (after meals\r\nand at bedtime)" ] }, "GRANISETRON": { "indications": "Indications\u00a0see under Dose", "name": "GRANISETRON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "5HT3-receptor antagonists", "GRANISETRON" ], "cautions": "Cautions\u00a0QT-interval prolongation (avoid concomitant use of drugs that prolong QT interval)", "side-effects": "Side-effects\u00a0constipation, nausea, diarrhoea, vomiting, abdominal\r\npain; headache, drowsiness, asthenia; fever; rarely hepatic dysfunction, chest pain, arrhythmia; very rarely anorexia, dizziness, insomnia, agitation, movement disorders, and\r\nrash", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202667.htm", "doses": [ "Nausea and vomiting induced by cytotoxic chemotherapy\r\nor radiotherapy, by mouth, 1\u20132\u00a0mg within 1 hour before\r\nstart of treatment, then 2\u00a0mg daily in 1\u20132 divided doses during treatment;\r\nwhen intravenous infusion also used, max. combined total 9\u00a0mg in 24\r\nhours; child 20\u00a0micrograms/kg (max.\r\n1\u00a0mg) within 1 hour before start of treatment, then 20\u00a0micrograms/kg\r\n(max. 1\u00a0mg) twice daily for up to 5 days during treatment", "By intravenous injection (diluted in 15\u00a0mL sodium chloride 0.9% and given over not less than 30 seconds) or by intravenous infusion (over 5 minutes),\r\nprevention, 3\u00a0mg before start of cytotoxic therapy (up to 2 additional\r\n3-mg doses may be given within 24 hours); treatment, as for prevention\r\n(the two additional doses must not be given less than 10 minutes apart);\r\nmax. 9\u00a0mg in 24 hours; child, by intravenous infusion, (over 5 minutes), prevention, 40\u00a0micrograms/kg\r\n(max. 3\u00a0mg) before start of cytotoxic therapy; treatment, as for prevention\u2014one\r\nadditional dose of 40\u00a0micrograms/kg (max. 3\u00a0mg) may be given within\r\n24 hours (not less than 10 minutes after initial dose)", "Postoperative nausea and vomiting, by intravenous injection (diluted to 5\u00a0mL and given over 30 seconds), prevention, 1\u00a0mg before\r\ninduction of anaesthesia; treatment, 1\u00a0mg, given as for prevention;\r\nmax. 2\u00a0mg in one day; child not recommended" ], "pregnancy": "Pregnancy\u00a0use only when compelling reasons\u2014no information available" }, "GLUCAGON": { "indications": "Indications\u00a0see notes above and under Dose", "name": "GLUCAGON", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.4 Treatment of hypoglycaemia" ], "cautions": "Cautions\u00a0\n(From 6.1.4 Treatment of hypoglycaemia: British National Formulary)\n6.1.4 Treatment of hypoglycaemia, insulinoma, glucagonoma; ineffective\r\nin chronic hypoglycaemia, starvation, and adrenal insufficiency", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, hypokalaemia,\r\nhypotension, rarely hypersensitivity reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4196.htm", "doses": [ "Insulin-induced hypoglycaemia, by subcutaneous, intramuscular, or intravenous\r\ninjection, adult and child over 8 years (or body-weight over 25\u00a0kg), 1\u00a0mg; child under 8 years (or body-weight under 25\u00a0kg),\r\n500\u00a0micrograms; if no response within 10 minutes intravenous glucose must be given", "Diagnostic aid, consult product literature", "Beta-blocker poisoning, see Emergency Treatment of Poisoning", "1\u00a0unit of glucagon = 1\u00a0mg\r\nof glucagon" ] }, "ERIBULIN": { "indications": "Indications\u00a0\n(From Eribulin: British National Formulary)\nEribulin", "name": "ERIBULIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Eribulin" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; susceptibility to\r\nQT-interval prolongation (including electrolyte disturbances, concomitant\r\nuse of drugs that prolong QT-interval); interactions: Appendix 1 (eribulin)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/214616.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid unless essential (teratogenic in animal\r\nsudies); ensure effective contraception during and for up\r\nto 3 months after treatment in men or women; see also Pregnancy and Reproductive\r\nFunction" }, "ASENAPINE": { "indications": "Indications\u00a0treatment of moderate to severe manic\r\nepisodes associated with bipolar disorder", "name": "ASENAPINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.3 Antimanic drugs", "Antipsychotic drugs", "ASENAPINE" ], "cautions": "Cautions\u00a0see section 4.2.1; also\r\ndementia with Lewy Bodies", "side-effects": "Side-effects\u00a0see section 4.2.1; also\r\ntaste disturbance, tongue swelling, glossodynia, anxiety, speech disturbance,\r\ndysphagia, transient oral hypoaesthesia and paraesthesia, rhabdomyolysis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/218176.htm", "doses": [ "Monotherapy, adult over\r\n18 years initially 10\u00a0mg twice daily, reduced to 5\u00a0mg twice daily\r\naccording to response", "Combination therapy, adult over\r\n18 years initially 5\u00a0mg twice daily, increased if necessary to 10\u00a0mg\r\ntwice daily according to response" ], "pregnancy": "Pregnancy\u00a0use only if potential benefit outweighs risk\u2014toxicity\r\nin animal studies" }, "CODEINE PHOSPHATE - ANTIMOTILITY DRUGS": { "indications": "Indications\u00a0see notes above; cough suppression (%s\n(From 3.9.1 Cough suppressants: British National Formulary)\n3.9.1 Cough suppressants); pain (%s\n(From 4.7.2 Opioid analgesics: British National Formulary)\n4.7.2 Opioid analgesics)", "name": "CODEINE PHOSPHATE - ANTIMOTILITY DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.4 Acute diarrhoea", "1.4.2 Antimotility drugs", "CODEINE PHOSPHATE" ], "cautions": "Cautions\u00a0section 4.7.2; tolerance and dependence\r\nmay occur with prolonged use; interactions: Appendix 1 (opioid analgesics)", "side-effects": "Side-effects\u00a0section 4.7.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208394.htm", "doses": [ "Acute diarrhoea, adult and child over 12 years, 30\u00a0mg 3\u20134 times daily (range\r\n15\u201360\u00a0mg)" ], "pregnancy": "Pregnancy\u00a0section 4.7.2" }, "MESALAZINE": { "indications": "Indications\u00a0treatment of mild to moderate ulcerative colitis and maintenance\r\nof remission; see also under preparations", "name": "MESALAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.1 Aminosalicylates" ], "cautions": "Cautions\u00a0\n(From 1.5.1 Aminosalicylates: British National Formulary)\nCautions\u00a0Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment (more frequently in renal impairment). Blood disorders can occur with aminosalicylates (see recommendation below).; elderly; interactions: Appendix 1\r\n(aminosalicylates)Blood disorders\u00a0See %s\n(From 1.5.1 Aminosalicylates: British National Formulary)\nBlood disordersPatients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2168.htm", "doses": [ "See under preparations, below", "The delivery characteristics of oral mesalazine preparations may vary; these preparations should\r\nnot be considered interchangeable" ], "pregnancy": "Pregnancy\u00a0negligible quantities cross placenta" }, "GLUCOSAMINE - GLUCOSAMINE": { "indications": "Indications\u00a0symptomatic relief of mild to moderate osteoarthritis of the knee", "name": "GLUCOSAMINE - GLUCOSAMINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.5 Other drugs for rheumatic diseases", "Glucosamine", "GLUCOSAMINE" ], "cautions": "Cautions\u00a0impaired glucose tolerance (monitor blood-glucose\r\nconcentration before treatment and periodically thereafter); predisposition to cardiovascular disease (monitor\r\ncholesterol); asthma; interactions: Appendix 1 (glucosamine)", "side-effects": "Side-effects\u00a0nausea, abdominal pain, dyspepsia, flatulence,\r\ndiarrhoea, constipation, drowsiness, headache, fatigue; less\r\ncommonly flushing, rash, pruritus; also reported visual disturbances, hair loss", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213649.htm", "doses": [ "See under preparations", "adult over 18 years, 1\r\nsachet (dissolved in at least 250\u00a0mL of water) once daily; review\r\ntreatment if no benefit after 2\u20133 months", "See under preparations", "adult over 18 years, 1\u00a0tablet\r\nonce daily; review treatment if no benefit after 2\u20133 months" ], "pregnancy": "Pregnancy\u00a0manufacturers advise avoid\u2014no information available" }, "PIMECROLIMUS": { "indications": "Indications\u00a0short-term treatment of mild to moderate atopic eczema (including\r\nflares) when topical corticosteroids cannot be used; see also notes above", "name": "PIMECROLIMUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.3 Drugs affecting the immune response", "PIMECROLIMUS" ], "cautions": "Cautions\u00a0UV light (avoid excessive exposure to\r\nsunlight and sunlamps), avoid other topical\r\ntreatments except emollients at treatment site; alcohol consumption (risk of facial flushing and skin irritation)", "side-effects": "Side-effects\u00a0burning sensation, pruritus, erythema, skin infections\r\n(including folliculitis and less commonly impetigo,\r\nherpes simplex and zoster, molluscum contagiosum); rarely papilloma, skin discoloration, local reactions including pain, paraesthesia,\r\npeeling, dryness, oedema, and worsening of eczema; skin malignancy\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119692.htm", "doses": [ "Short-term treatment, apply twice daily until symptoms\r\nresolve (stop treatment if eczema worsens or no response after 6 weeks); child under 2 years not recommended" ] }, "MICONAZOLE": { "indications": "Indications\u00a0see preparations", "name": "MICONAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.2 Oropharyngeal anti-infective drugs", "Oropharyngeal fungal infections", "MICONAZOLE" ], "cautions": "Cautions\u00a0avoid in acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(antifungals, imidazole)", "side-effects": "Side-effects\u00a0nausea, vomiting; rash; with buccal tablets, abdominal pain, taste disturbance, burning sensation at application\r\nsite, pruritus, and oedema; with oral gel, very rarely diarrhoea (usually on long-term treatment),\r\nhepatitis, toxic epidermal necrolysis, and Stevens-Johnson syndrome", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200948.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid if possible\u2014toxicity at\r\nhigh doses in animal studies" }, "SOLIFENACIN SUCCINATE": { "indications": "Indications\u00a0urinary frequency, urgency and urge\r\nincontinence", "name": "SOLIFENACIN SUCCINATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.4 Drugs for genito-urinary disorders", "7.4.2 Drugs for urinary frequency, enuresis, and incontinence", "Urinary incontinence" ], "cautions": "Cautions\u00a0\n(From Urinary incontinence: British National Formulary)\nCautions\u00a0Antimuscarinic drugs should be used with caution in the elderly (especially if frail), in those with autonomic neuropathy, and in those susceptible to angle-closure glaucoma. They should also be used with caution in hiatus hernia with reflux oesophagitis. Antimuscarinics can worsen hyperthyroidism, coronary artery disease, congestive heart failure, hypertension, prostatic hyperplasia, arrhythmias, and tachycardia. For interactions, see Appendix 1 (antimuscarinics).; neurogenic bladder disorder", "side-effects": "Side-effects\u00a0\n(From Urinary incontinence: British National Formulary)\nSide-effects\u00a0Side-effects of antimuscarinic drugs include dry mouth, gastro-intestinal disturbances including constipation, flatulence, taste disturbances, blurred vision, dry eyes, drowsiness, dizziness, fatigue, difficulty in micturition (less commonly urinary retention), palpitation, and skin reactions (including dry skin, rash, and photosensitivity); also headache, diarrhoea, angioedema, arrhythmias, and tachycardia. Central nervous system stimulation, such as restlessness, disorientation, hallucination, and convulsion may occur; children are at higher risk of these effects. Antimuscarinic drugs can reduce sweating, leading to heat sensations and fainting in hot environments or in patients with fever, and very rarely may precipitate angle-closure glaucoma.; also\r\ngastro-oesophageal reflux, oedema", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129099.htm", "doses": [ "adult over 18 years, 5\u00a0mg\r\ndaily, increased if necessary to 10\u00a0mg once daily", "Max. 5\u00a0mg daily with concomitant itraconazole, ketoconazole, nelfinavir, or ritonavir" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014no information available" }, "HYOSCINE BUTYLBROMIDE": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal or genito-urinary disorders\r\ncharacterised by smooth muscle spasm; bowel colic and excessive respiratory\r\nsecretions (see Bowel Colic and Excessive\r\nRespiratory Secretions)", "name": "HYOSCINE BUTYLBROMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "HYOSCINE BUTYLBROMIDE" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2084.htm", "doses": [ "By mouth (but poorly absorbed, see\r\nnotes above), smooth muscle spasm, 20\u00a0mg 4 times daily; child 6\u201312 years, 10\u00a0mg 3 times daily", "Irritable bowel syndrome, 10\u00a0mg 3 times daily, increased if\r\nrequired up to 20\u00a0mg 4 times daily", "By intramuscular or slow intravenous injection, acute spasm and spasm\r\nin diagnostic procedures, 20\u00a0mg repeated after 30 minutes if necessary\r\n(may be repeated more frequently in endoscopy), max. 100\u00a0mg daily; child 2\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk" }, "CARBETOCIN": { "indications": "Indications\u00a0prevention of uterine atony after caesarean\r\nsection", "name": "CARBETOCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.1 Prostaglandins and oxytocics" ], "cautions": "Cautions\u00a0hyponatraemia; cardiovascular disease (avoid if severe); migraine; asthma", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, metallic taste;\r\nflushing, hypotension, chest pain; dyspnoea; headache, tremor, dizziness;\r\nanaemia; back pain; pruritus; feeling of warmth, chills; tachycardia\r\nand sweating also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129655.htm", "doses": [ "By slow intravenous injection over 1 minute,\r\na single dose of 100\u00a0micrograms, as soon as possible after delivery,\r\npreferably before removal of placenta" ] }, "FUSIDIC ACID - ANTIBACTERIALS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "FUSIDIC ACID" ], "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "FUSIDIC ACID - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5385.htm", "doses": [ "See under preparation below", "apply twice daily" ] }, "FOLINIC ACID Disodium folinate": { "indications": "Indications\u00a0\n(From Chemotherapy-induced mucositis and myelosuppression: British National Formulary)\nFolinic acid (given as calcium folinate) is used to counteract the folate-antagonist action of methotrexate and thus speed recovery from methotrexate-induced mucositis or myelosuppression (\u2018folinic acid rescue\u2019).Folinic acid is also used in the management of methotrexate overdose, together with other measures to maintain fluid and electrolyte balance, and to manage possible renal failure.Folinic acid does not counteract the antibacterial activity of folate antagonists such as trimethoprim.When folinic acid and fluorouracil are used together in metastatic colorectal cancer the response-rate improves compared to that with fluorouracil alone.", "name": "FOLINIC ACID Disodium folinate", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Chemotherapy-induced mucositis and myelosuppression", "FOLINIC ACID", "Disodium folinate" ], "cautions": "Cautions\u00a0avoid simultaneous administration of methotrexate; not indicated for pernicious anaemia\r\nor other megaloblastic anaemias caused by vitamin B12 deficiency; interactions: Appendix 1 (folates)", "side-effects": "Side-effects\u00a0rarely pyrexia after parenteral use; insomnia, agitation, and depression\r\nafter high doses", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88404.htm", "doses": [ "See under preparations", "Adjunct to fluorouracil in colorectal cancer,\r\nconsult product literature", "Name[Sodiofolin\u00ae (Medac) ] Injection, folinic acid (as disodium\r\nsalt) 50\u00a0mg/mL, net price 2-mL vial = \u00a335.09, 8-mL vial = \u00a3126.25,\r\n18-mL vial = \u00a3284.07Dose\u00a0as an antidote to methotrexate, by intravenous injection or infusion, consult product literatureAdjunct to fluorouracil in colorectal cancer,\r\nconsult product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; benefit outweighs risk" }, "MELATONIN": { "indications": "Indications\u00a0insomnia (short-term use)", "name": "MELATONIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Melatonin", "MELATONIN" ], "cautions": "Cautions\u00a0autoimmune disease (manufacturer\r\nadvises avoid\u2014no information available); interactions: Appendix 1 (melatonin)", "side-effects": "Side-effects\u00a0less commonly abdominal pain,\r\ndyspepsia, dry mouth, mouth ulceration, weight gain, hypertension,\r\nchest pain, malaise, dizziness, restlessness, nervousness, irritability,\r\nanxiety, migraine, proteinuria, glycosuria, pruritus, rash, dry skin; rarely thirst, flatulence, halitosis, salivation, vomiting,\r\ngastritis, hypertriglyceridaemia, angina, palpitation, syncope, hot\r\nflushes, aggression, impaired memory, restless legs syndrome, paraesthesia,\r\nmood changes, priapism, increased libido, prostatitis, polyuria, haematuria,\r\nleucopenia, thrombocytopenia, electrolyte disturbances, muscle spasm,\r\narthritis, lacrimation, visual disturbances, nail disorder", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200928.htm", "doses": [ "adult over 55 years, 2\u00a0mg\r\nonce daily 1\u20132 hours before bedtime for up to 13 weeks; child 1 month\u201318 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0no information available\u2014avoid" }, "ORAL PROGESTOGEN-ONLY CONTRACEPTIVES": { "indications": "Indications\u00a0contraception", "name": "ORAL PROGESTOGEN-ONLY CONTRACEPTIVES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.3 Contraceptives", "7.3.2 Progestogen-only contraceptives", "7.3.2.1 Oral progestogen-only contraceptives", "ORAL PROGESTOGEN-ONLY CONTRACEPTIVES" ], "cautions": "Cautions\u00a0arterial disease; sex-steroid dependent\r\ncancer; past ectopic pregnancy; malabsorption syndromes; active trophoblastic disease (until return to normal of urine- and\r\nplasma-gonadotrophin concentration)\u2014seek specialist advice; systemic lupus erythematosus with positive (or unknown)\r\nantiphospholipid antibodies; functional\r\novarian cysts; history of jaundice in pregnancy; interactions: \n(From 7.3.2.1 Oral progestogen-only contraceptives: British National Formulary)\nInteractions\u00a0Effectiveness of oral progestogen-only preparations is not affected by antibacterials that do not induce liver enzymes. The efficacy of oral progestogen-only preparations is, however, reduced by enzyme-inducing drugs and an alternative contraceptive method, unaffected by the interacting drug, is recommended during treatment with an enzyme-inducing drug and for at least 4 weeks afterwards\u2014see section 7.3.1 and Appendix 1 (progestogens). For a short course of an enzyme-inducing drug, if a change in contraceptive method is undesirable or inappropriate, the progestogen-only oral method may be continued in combination with additional contraceptive precautions (e.g. barrier methods) for the duration of treatment with the enzyme-inducing drug and for 4 weeks after stopping.Surgery\u00a0All progestogen-only contraceptives (including those given by injection) are suitable for use as an alternative to combined oral contraceptives before major elective surgery, before all surgery to the legs, or before surgery which involves prolonged immobilisation of a lower limb.Starting routine\u00a0One tablet daily, on a continuous basis, starting on day 1 of cycle and taken at the same time each day (if delayed by longer than 3 hours (12 hours for Cerazette\u00ae) contraceptive protection may be lost). Additional contraceptive precautions are not necessary when initiating treatment.Changing from a combined oral contraceptive\u00a0Start on the day following completion of the combined oral contraceptive course without a break (or in the case of ED tablets omitting the inactive ones).After childbirth\u00a0Oral progestogen-only contraceptives can be started up to and including day 21 postpartum without the need for additional contraceptive precautions. If started more than 21 days postpartum, additional contraceptive precautions are required for 2 days. and Appendix 1 (progestogens)Other conditions\u00a0The product literature advises\r\ncaution in patients with history of thromboembolism, hypertension,\r\ndiabetes mellitus and migraine; evidence for caution in these conditions\r\nis unsatisfactory", "side-effects": "Side-effects\u00a0menstrual\r\nirregularities (see also notes above); nausea, vomiting, headache,\r\ndizziness, breast discomfort, depression, skin disorders, disturbance\r\nof appetite, weight changes, changes in libidoBreast cancer\u00a0There is a small increase in the\r\nrisk of having breast cancer diagnosed in women using, or who have\r\nrecently used, a progestogen-only contraceptive pill; this relative\r\nrisk may be due to an earlier diagnosis. The most important risk factor\r\nappears to be the age at which the contraceptive is stopped rather\r\nthan the duration of use; the risk disappears gradually during the\r\n10 years after stopping and there is no excess risk by 10 years. A\r\npossible small increase in the risk of breast cancer should be weighed\r\nagainst the benefits", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119670.htm", "doses": [ "1 tablet daily at same time each day, starting on day\r\n1 of cycle then continuously; if administration delayed for 3 hours\r\n(12 hours for Cerazette\u00ae) or more it should be\r\nregarded as a \u2018missed pill\u2019, see notes above" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "ZOLPIDEM TARTRATE": { "indications": "Indications\u00a0insomnia (short-term use\u2014up to 4 weeks)", "name": "ZOLPIDEM TARTRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Zaleplon, zolpidem, and zopiclone", "ZOLPIDEM TARTRATE" ], "cautions": "Cautions\u00a0depression, muscle weakness and myasthenia gravis, history of drug or alcohol abuse; elderly; avoid prolonged use (and abrupt withdrawal\r\nthereafter); interactions: Appendix 1 (anxiolytics\r\nand hypnotics)Driving\u00a0Drowsiness may persist the\r\nnext day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0diarrhoea, nausea, vomiting, dizziness, headache,\r\ndrowsiness, hallucination, agitation, asthenia, amnesia; dependence,\r\nmemory disturbances, nightmares, depression, confusion, perceptual\r\ndisturbances or diplopia, tremor, ataxia, falls, skin reactions, changes\r\nin libido; paradoxical effects (see Paradoxical Effects), muscular weakness, and sleep-walking also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106509.htm", "doses": [ "adult over 18 years, 10\u00a0mg\r\nat bedtime; elderly (or debilitated)\r\n5\u00a0mg" ], "pregnancy": "Pregnancy\u00a0avoid regular use (risk of neonatal withdrawal symptoms);\r\nhigh doses during late pregnancy or labour may cause neonatal hypothermia,\r\nhypotonia, and respiratory depression" }, "TERBUTALINE SULPHATE Inhalation": { "indications": "Indications\u00a0asthma and other conditions associated with reversible\r\nairways obstruction; premature labour (section 7.1.3)", "name": "TERBUTALINE SULPHATE Inhalation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "TERBUTALINE SULPHATE", "Inhalation" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2898.htm", "doses": [ "By mouth (but use by inhalation preferred),\r\ninitially 2.5\u00a0mg 3 times daily for 1\u20132 weeks, then up to 5\u00a0mg 3 times\r\ndaily; child 1 month\u20137 years 75\u00a0micrograms/kg\r\n3 times daily; 7\u201315 years 2.5\u00a0mg 2\u20133 times daily", "By subcutaneous or slow intravenous injection, 250\u2013500\u00a0micrograms up\r\nto 4 times daily; child 2\u201315 years\r\n10\u00a0micrograms/kg to a max. of 300\u00a0micrograms", "By continuous intravenous infusion as a solution containing 3\u20135\u00a0micrograms/mL, 90\u2013300\u00a0micrograms/hour\r\nfor 8\u201310 hours; child 1 month\u201318 years,\r\ninitially 2\u20134\u00a0micrograms/kg as a loading dose, then 1\u201310\u00a0micrograms/kg/hour\r\naccording to response and heart rate (max. 300\u00a0micrograms/hour); high\r\ndoses with close monitoring", "By inhalation of powder (Turbohaler\u00ae), adult and child over 5 years, 500\u00a0micrograms (1 inhalation);\r\nfor persistent symptoms up to 4 times daily (but see Management of Chronic Asthma\r\ntable)", "By inhalation of nebulised solution (but see also Management of Acute Asthma table), 5\u201310\u00a0mg 2\u20134 times daily;\r\nadditional doses may be necessary in severe acute asthma; child under 5 years 5\u00a0mg 2\u20134 times daily, 5\u201312 years\r\n5\u201310\u00a0mg 2\u20134 times daily [unlicensed dose]", "Name[Bricanyl\u00ae (AstraZeneca) ] Turbohaler\u00ae (= dry powder inhaler), terbutaline sulphate 500\u00a0micrograms/metered inhalation,\r\nnet price 100-dose unit = \u00a36.92. \r\n Label:\r\n Counselling, administration\nRespules\u00ae (= single-dose units for\r\nnebulisation), terbutaline sulphate 2.5\u00a0mg/mL,\r\nnet price 20 \u00d7 2-mL units (5-mg) = \u00a34.04" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "FENOPROFEN": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease and other\r\nmusculoskeletal disorders; mild to moderate pain", "name": "FENOPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; upper respiratory-tract infection,\r\nnasopharyngitis, and cystitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5221.htm", "doses": [ "300\u2013600\u00a0mg 3\u20134 times daily; max. 3\u00a0g daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "ZOPICLONE": { "indications": "Indications\u00a0insomnia (short-term use\u2014up to 4 weeks)", "name": "ZOPICLONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Zaleplon, zolpidem, and zopiclone", "ZOPICLONE" ], "cautions": "Cautions\u00a0elderly; muscle\r\nweakness and myasthenia gravis, history of drug abuse, psychiatric illness; avoid prolonged use (risk of tolerance\r\nand withdrawal symptoms); interactions: Appendix 1 (anxiolytics and hypnotics)Driving\u00a0Drowsiness may persist the\r\nnext day and affect performance of skilled tasks (e.g. driving); effects of alcohol enhanced", "side-effects": "Side-effects\u00a0taste disturbance; less commonly nausea, vomiting; dizziness, drowsiness, dry mouth, headache; rarely amnesia, confusion, depression, hallucinations, nightmares; very rarely light headedness, incoordination; paradoxical\r\neffects (see Paradoxical Effects) and sleep-walking also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3168.htm", "doses": [ "adult over 18 years, 7.5\u00a0mg\r\nat bedtime; elderly initially 3.75\u00a0mg\r\nat bedtime increased if necessary" ], "pregnancy": "Pregnancy\u00a0avoid regular use (risk of neonatal withdrawal symptoms);\r\nhigh doses during late pregnancy or labour may cause neonatal hypothermia,\r\nhypotonia, and respiratory depression" }, "PHENYTOIN": { "indications": "Indications\u00a0all forms of epilepsy except absence seizures;\r\nstatus epilepticus (section 4.8.2); trigeminal neuralgia if carbamazepine inappropriate (see also section 4.7.3)", "name": "PHENYTOIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.8 Antiepileptic drugs", "4.8.1 Control of the epilepsies", "Phenytoin" ], "cautions": "Cautions\u00a0cross-sensitivity reported with carbamazepine (see also Antiepileptic Hypersensitivity\r\nSyndrome); avoid abrupt withdrawal; HLA-B*1502 allele in individuals\r\nof Han Chinese or Thai origin\u2014avoid unless essential (increased risk\r\nof Stevens-Johnson syndrome); manufacturer recommends blood counts\r\n(but evidence of practical value uncertain); consider vitamin D supplementation in patients who are immobilised\r\nfor long periods or who have inadequate sun exposure or dietary intake\r\nof calcium; enteral feeding (interrupt\r\nfeeding for 2 hours before and after dose; more frequent monitoring\r\nmay be necessary); avoid in acute porphyria (section 9.8.2); interactions: see Interactions in section 4.8.1 and Appendix 1 (phenytoin)Blood or skin disorders\u00a0Patients\r\nor their carers should be told how to recognise signs of blood or\r\nskin disorders, and advised to seek immediate medical attention if\r\nsymptoms such as fever, rash, mouth ulcers, bruising, or bleeding\r\ndevelop. Leucopenia that is severe, progressive,\r\nor associated with clinical symptoms requires withdrawal (if necessary under cover of a suitable alternative)", "side-effects": "Side-effects\u00a0nausea, vomiting, constipation, drowsiness, insomnia,\r\ntransient nervousness, tremor, paraesthesia, dizziness, headache,\r\nanorexia; gingival hypertrophy and tenderness (maintain good oral\r\nhygiene); rash (discontinue; if mild re-introduce cautiously but discontinue\r\nimmediately if recurrence), acne, hirsutism, coarsening of facial\r\nappearance; rarely hepatotoxicity (discontinue immediately\r\nand do not readminister), peripheral neuropathy, dyskinesia, lymphadenopathy,\r\nosteomalacia (see Cautions); blood disorders (including megaloblastic\r\nanaemia, leucopenia, thrombocytopenia, and aplastic anaemia), polyarteritis\r\nnodosa, lupus erythematosus, Stevens-Johnson syndrome, and toxic epidermal\r\nnecrolysis; also reported polyarthropathy, pneumonitis,\r\ninterstitial nephritis, hypersensitivity syndrome (see Antiepileptic Hypersensitivity\r\nSyndrome);\r\nsuicidal ideation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3595.htm", "doses": [ "By mouth, initially 3\u20134\u00a0mg/kg daily or 150\u2013300\u00a0mg daily (as a single dose or in 2 divided doses) increased gradually as necessary (with plasma-phenytoin concentration monitoring); usual dose 200\u2013500\u00a0mg\r\ndaily (exceptionally, higher doses may be used); child initially 5\u00a0mg/kg daily in 2 divided doses, usual dose range 4\u20138\u00a0mg/kg\r\ndaily (max. 300\u00a0mg daily)", "Take preferably with or after food" ], "pregnancy": "Pregnancy\u00a0changes in plasma-protein binding make interpretation\r\nof plasma-phenytoin concentrations difficult\u2014monitor unbound fraction;\r\nsee also Pregnancy" }, "CO-DYDRAMOL ": { "indications": "Indications\u00a0mild to moderate pain", "name": "CO-DYDRAMOL ", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.1 Non-opioid analgesics and compound analgesic preparations" ], "cautions": "Cautions\u00a0section 4.7.2; also alcohol dependence; severe cor pulmonale; interactions: Appendix 1 (opioid analgesics, paracetamol)", "side-effects": "Side-effects\u00a0section 4.7.2; also\r\nabdominal pain, paralytic ileus, pancreatitis, paraesthesia, blood\r\ndisorders (including thrombocytopenia, leucopenia, neutropenia); important: liver damage (and less frequently renal damage)\r\nfollowing overdosage with paracetamol; see Emergency\r\nTreatment of Poisoning for paracetamol and analgesics (opioid); for reversal of opioid-induced respiratory depression, see section 15.1.7", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208638.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0withdrawal effects in neonates of dependant mothers" }, "MITOMYCIN": { "indications": "Indications\u00a0\n(From 8.1.2 Anthracyclines and other cytotoxic antibiotics: British National Formulary)\nMitomycin is given intravenously to treat upper gastro-intestinal and breast cancers and by bladder instillation for superficial bladder tumours. It causes delayed bone-marrow toxicity and therefore it is usually administered at 6-weekly intervals. Prolonged use may result in permanent bone-marrow damage. It may also cause lung fibrosis and renal damage. and %s\n(From 7.4.4 Bladder instillations and urological surgery: British National Formulary)\n7.4.4 Bladder instillations and urological surgery", "name": "MITOMYCIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.2 Anthracyclines and other cytotoxic antibiotics", "MITOMYCIN" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; caution in handling\u2014irritant\r\nto tissues", "side-effects": "Side-effects\u00a0see section 8.1 and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4720.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0avoid (teratogenic in animal studies);\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "SALICYLIC ACID - ANTIFUNGAL PREPARATIONS": { "indications": "Indications\u00a0fungal nail infections, particularly\r\ntinea; hyperkeratotic skin disorders (section 13.5.2); warts and calluses (section 13.7)", "name": "SALICYLIC ACID - ANTIFUNGAL PREPARATIONS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "SALICYLIC ACID" ], "cautions": "Cautions\u00a0avoid broken or inflamed skin Salicylate toxicity\u00a0Salicylate toxicity\r\ncan occur particularly if applied on large areas of skin", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6170.htm", "doses": [ "adult and child over 5 years, apply twice daily and after washing" ], "pregnancy": "Pregnancy\u00a0avoid" }, "DAPSONE": { "indications": "Indications\u00a0leprosy, dermatitis\r\nherpetiformis; Pneumocystis jirovecii (Pneumocystis carinii) pneumonia (section 5.4.8)", "name": "DAPSONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.10 Antileprotic drugs", "DAPSONE" ], "cautions": "Cautions\u00a0cardiac or pulmonary\r\ndisease; anaemia (treat severe anaemia before starting); susceptibility to haemolysis including G6PD deficiency (section 9.1.5); avoid in acute porphyria (section 9.8.2); interactions: Appendix 1\r\n(dapsone)Blood disorders\u00a0On long-term treatment,\r\npatients and their carers should be told how to recognise signs of\r\nblood disorders and advised to seek immediate medical attention if\r\nsymptoms such as fever, sore throat, rash, mouth ulcers, purpura,\r\nbruising or bleeding develop", "side-effects": "Side-effects\u00a0(dose-related and uncommon at doses used for leprosy),\r\nhaemolysis, methaemoglobinaemia, neuropathy, allergic dermatitis (rarely\r\nincluding toxic epidermal necrolysis and Stevens-Johnson syndrome),\r\nanorexia, nausea, vomiting, tachycardia, headache, insomnia, psychosis,\r\nhepatitis, agranulocytosis; dapsone syndrome (rash\r\nwith fever and eosinophilia)\u2014discontinue immediately (may progress\r\nto exfoliative dermatitis, hepatitis, hypoalbuminaemia, psychosis\r\nand death)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3927.htm", "doses": [ "Leprosy, 1\u20132\u00a0mg/kg daily, see notes above", "Dermatitis herpetiformis, see specialist literature" ], "pregnancy": "Pregnancy\u00a0folic acid 5\u00a0mg daily should be given to mother throughout\r\npregnancy; neonatal haemolysis and methaemoglobinaemia reported in\r\nthird trimester" }, "FAMOTIDINE": { "indications": "Indications\u00a0see under Dose", "name": "FAMOTIDINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.1 H2-receptor antagonists", "FAMOTIDINE" ], "cautions": "Cautions\u00a0\n(From 1.3.1 H2-receptor antagonists: British National Formulary)\nCautions\u00a0H2-receptor antagonists might mask symptoms of gastric cancer; particular care is required in patients presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment.; interactions: Appendix 1 (histamine H2-antagonists)\r\nand notes above", "side-effects": "Side-effects\u00a0see notes above; also constipation; less\r\ncommonly dry mouth, nausea, vomiting, flatulence, taste disorders,\r\nanorexia, fatigue; very rarely chest tightness, interstitial\r\npneumonia, seizures, paraesthesia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106212.htm", "doses": [ "Benign gastric and duodenal ulceration, treatment, 40\u00a0mg\r\nat night for 4\u20138 weeks; maintenance (duodenal ulceration), 20\u00a0mg at\r\nnight", "Reflux oesophagitis, 20\u201340\u00a0mg twice daily for 6\u201312\u00a0weeks; maintenance,\r\n20\u00a0mg twice daily", "child not recommended" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "CICLOSPORIN - CHRONIC BOWEL DISORDERS": { "indications": "Indications\u00a0severe acute ulcerative colitis refractory\r\nto corticosteroid treatment [unlicensed indication]; transplantation\r\nand graft-versus-host disease, nephrotic syndrome (section 8.2.2); rheumatoid arthritis (section 10.1.3); atopic dermatitis and psoriasis (section 13.5.3)", "name": "CICLOSPORIN - CHRONIC BOWEL DISORDERS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "CICLOSPORIN" ], "cautions": "Cautions\u00a0section 8.2.2", "side-effects": "Side-effects\u00a0section 8.2.2", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201297.htm", "doses": [ "By continuous intravenous infusion, adult over 18 years, 2\u00a0mg/kg daily over 24 hours;\r\ndose adjusted according to blood-ciclosporin concentration and response" ], "pregnancy": "Pregnancy\u00a0see Immunosuppresant therapy" }, "SELENIUM": { "indications": "Indications\u00a0selenium deficiency", "name": "SELENIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.5 Selenium" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (selenium)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129917.htm", "doses": [ "By mouth or by\r\nintramuscular injection or by intravenous\r\ninjection, 100\u2013500\u00a0micrograms daily" ] }, "NYSTATIN - ANTIFUNGAL PREPARATIONS": { "side-effects": "Side-effects\u00a0see notes above", "indications": "Indications\u00a0skin infections due to Candida spp.; oral\r\nfungal infections (section 12.3.2)", "name": "NYSTATIN - ANTIFUNGAL PREPARATIONS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6166.htm", "doses": [ "apply 2\u20133 times daily continuing for 7 days after lesions\r\nhave healed." ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.10 Anti-infective skin preparations", "13.10.2 Antifungal preparations", "NYSTATIN" ], "cautions": "Cautions\u00a0\n(From 13.10.2 Antifungal preparations: British National Formulary)\nCautions\u00a0Contact with eyes and mucous membranes should be avoided." }, "LOSARTAN POTASSIUM With diuretic": { "indications": "Indications\u00a0hypertension (including reduction of stroke risk in hypertension\r\nwith left ventricular hypertrophy); chronic heart failure when ACE\r\ninhibitors are unsuitable or contra-indicated; diabetic nephropathy\r\nin type 2 diabetes mellitus (see also notes above)", "name": "LOSARTAN POTASSIUM With diuretic", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.5 Hypertension and heart failure", "2.5.5 Drugs affecting the renin-angiotensin system", "2.5.5.2 Angiotensin-II receptor antagonists", "LOSARTAN POTASSIUM", "With diuretic" ], "cautions": "Cautions\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nCautions\u00a0Angiotensin-II receptor antagonists should be used with caution in renal artery stenosis (see also Renal Effects under ACE Inhibitors, section 2.5.5.1). Monitoring of plasma-potassium concentration is advised, particularly in the elderly and in patients with renal impairment; lower initial doses may be appropriate in these patients. Angiotensin-II receptor antagonists should be used with caution in aortic or mitral valve stenosis and in hypertrophic cardiomyopathy. Those with primary aldosteronism, and Afro-Caribbean patients (particularly those with left ventricular hypertrophy), may not benefit from an angiotensin-II receptor antagonist. Interactions: Appendix 1 (angiotensin-II receptor antagonists).; severe heart failure", "side-effects": "Side-effects\u00a0see notes above; vertigo; less commonly gastro-intestinal disturbances, angina, palpitation, oedema, dyspnoea,\r\nheadache, sleep disorders, malaise, urticaria, pruritus, rash; rarely hepatitis, atrial fibrillation, cerebrovascular accident,\r\nsyncope, paraesthesia; also reported pancreatitis, anaphylaxis, cough,\r\ndepression, erectile dysfunction, anaemia, thrombocytopenia, hyponatraemia,\r\narthralgia, myalgia, renal impairment, rhabdomyolysis, tinnitus, photosensitivity,\r\nand vasculitis (including Henoch-Sch\u00f6nlein purpura)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215497.htm", "doses": [ "Hypertension, diabetic nephropathy in type 2 diabetes\r\nmellitus, usually 50\u00a0mg once daily (intravascular volume depletion,\r\ninitially 25\u00a0mg once daily); if necessary increased after several\r\nweeks to 100\u00a0mg once daily; elderly over 75 years initially 25\u00a0mg daily", "Chronic heart failure, initially 12.5\u00a0mg once daily, increased\r\nat weekly intervals to max. 150\u00a0mg once daily if tolerated", "Name[Losartan potassium with hydrochlorothiazide (Non-proprietary) ] Tablets, losartan potassium 100\u00a0mg,\r\nhydrochlorothiazide 25\u00a0mg, net price 28\u2013tab pack = \u00a33.81" ], "pregnancy": "Pregnancy\u00a0\n(From 2.5.5.2 Angiotensin-II receptor antagonists: British National Formulary)\nPregnancy\u00a0Angiotensin-II receptor antagonists should be avoided in pregnancy unless essential. They may adversely affect fetal and neonatal blood pressure control and renal function; skull defects and oligohydramnios have also been reported." }, "ALUMINIUM HYDROXIDE": { "indications": "Indications\u00a0hyperphosphataemia; dyspepsia (section 1.1)", "name": "ALUMINIUM HYDROXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.2 Phosphorus", "9.5.2.2 Phosphate-binding agents", "ALUMINIUM HYDROXIDE" ], "cautions": "Cautions\u00a0\n(From 9.5.2.2 Phosphate-binding agents: British National Formulary)\n9.5.2.2 Phosphate-binding agents; interactions: Appendix 1 (antacids)", "side-effects": "Side-effects\u00a0constipation; hyperaluminaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5065.htm", "doses": [ "phosphate-binding agent in renal failure, 4\u201320 capsules\r\ndaily in divided doses with meals" ] }, "CHORIOGONADOTROPIN ALFA": { "indications": "Indications\u00a0see notes above", "name": "CHORIOGONADOTROPIN ALFA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.5 Hypothalamic and pituitary hormones and anti-oestrogens", "6.5.1 Hypothalamic and anterior pituitary hormones and anti-oestrogens", "Anterior pituitary hormones", "Gonadotrophins", "CHORIOGONADOTROPIN ALFA" ], "cautions": "Cautions\u00a0acute porphyria (section 9.8.2)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain; headache, tiredness;\r\ninjection-site reactions; ovarian hyperstimulation syndrome; rarely\r\ndiarrhoea, depression, irritability, breast pain; ectopic pregnancy\r\nand ovarian torsion reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106142.htm", "doses": [ "By subcutaneous injection, according to\r\npatient\u2019s response " ] }, "NEDOCROMIL SODIUM": { "indications": "Indications\u00a0prophylaxis of asthma (see also Management of Chronic Asthma\r\ntable)", "name": "NEDOCROMIL SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.3 Cromoglicate\r\nand related therapy, leukotriene receptor antagonists, and phosphodiesterase\r\ntype-4 inhibitors", "3.3.1 Cromoglicate and related therapy" ], "cautions": "Cautions\u00a0 \n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above", "side-effects": "Side-effects\u00a0\n(From 3.3.1 Cromoglicate and related therapy: British National Formulary)\n3.3.1 Cromoglicate and related therapy above; also nausea,\r\nvomiting, dyspepsia, abdominal pain, pharyngitis; rarely taste disturbances", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3012.htm", "doses": [ "By aerosol inhalation, adult and child over 6 years 4\u00a0mg (2 puffs)\r\n4 times daily, when control achieved may be possible to reduce to\r\ntwice daily", "Regular use is necessary" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "TOBRAMYCIN Parenteral": { "indications": "Indications\u00a0see under Gentamicin and notes above", "name": "TOBRAMYCIN Parenteral", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides", "TOBRAMYCIN", "Parenteral" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides); interactions: Appendix 1 (aminoglycosides)Specific cautions for inhaled treatment\u00a0Other\r\ninhaled drugs should be administered before tobramycin. Measure lung\r\nfunction before and after initial dose of tobramycin and monitor for\r\nbronchospasm; if bronchospasm occurs in a patient not using a bronchodilator,\r\nrepeat test using bronchodilator. Monitor renal function before treatment\r\nand then annually. Severe haemoptysis\u2014risk of further haemorrhage.", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function.; on inhalation, cough (more frequent by inhalation of powder),\r\nbronchospasm (see Cautions), dysphonia, taste disturbances, pharyngitis,\r\nmouth ulcers, salivary hypersecretion, laryngitis, haemoptysis, epistaxis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37241.htm", "doses": [ "To avoid excessive dosage in obese patients, use ideal\r\nweight for height to calculate parenteral dose and monitor serum-tobramycin\r\nconcentration closely", "By intramuscular injection or by slow intravenous injection or by intravenous infusion, 3\u00a0mg/kg daily in divided\r\ndoses every 8 hours, see also notes above; in severe infections up\r\nto 5\u00a0mg/kg daily in divided doses every 6\u20138 hours (reduced to 3\u00a0mg/kg\r\nas soon as clinically indicated); child under 18 years see BNF for Children", "Urinary-tract infection, by intramuscular injection, 2\u20133\u00a0mg/kg daily as a single dose", "One-hour (\u2018peak\u2019) serum concentration should\r\nnot exceed 10\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should be\r\nless than 2\u00a0mg/litre", "Chronic pulmonary Pseudomonas aeruginosa infection in patients with cystic fibrosis, by inhalation\r\nof nebulised solution, adult and child over 6 years, 300\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin nebuliser solution", "By inhalation of powder, adult and child over 6 years, 112\u00a0mg every\r\n12 hours for 28 days, subsequent courses repeated after 28-day interval\r\nwithout tobramycin inhalation powder", "Name[Tobramycin (Non-proprietary) ] Injection, tobramycin (as sulphate) 40\u00a0mg/mL, net price 1-mL (40-mg)\r\nvial = \u00a34.00, 2-mL (80-mg) vial = \u00a34.16, 6-mL (240-mg) vial = \u00a319.20" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "DROPERIDOL": { "indications": "Indications\u00a0prevention and treatment of postoperative\r\nnausea and vomiting ", "name": "DROPERIDOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Phenothiazines and related drugs" ], "cautions": "Cautions\u00a0section 4.2.1; also chronic obstructive pulmonary disease or respiratory failure; electrolyte disturbances; history of alcohol abuse; continuous pulse oximetry required if risk of ventricular arrhythmia\u2014continue\r\nfor 30 minutes following administration; interactions: Appendix 1 (droperidol)", "side-effects": "Side-effects\u00a0section 4.2.1; also\r\nanxiety, cardiac arrest, hallucinations, and inappropriate antidiuretic\r\nhormone secretion", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202671.htm", "doses": [ "Prevention and treatment of postoperative nausea and vomiting, adult over 18 years, by intravenous injection, 0.625\u20131.25\u00a0mg (elderly 625\u00a0micrograms)\r\n30 minutes before end of surgery, repeated every 6 hours as required; child over 2 years (second-line use only) 20\u201350\u00a0micrograms/kg\r\n(max. 1.25\u00a0mg) ", "Prevention of nausea and vomiting caused by opioid analgesics\r\nin postoperative patient-controlled analgesia (PCA), adult over 18 years, by intravenous injection, 15\u201350\u00a0micrograms of droperidol for every 1\u00a0mg of morphine in PCA\r\n(max. 5\u00a0mg droperidol daily); elderly reduce dose" ], "pregnancy": "Pregnancy\u00a0section 4.2.1" }, "NICARDIPINE HYDROCHLORIDE": { "indications": "Indications\u00a0prophylaxis of angina; mild to moderate hypertension", "name": "NICARDIPINE HYDROCHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.6 Nitrates, calcium-channel blockers, and other antianginal drugs", "2.6.2 Calcium-channel blockers" ], "cautions": "Cautions\u00a0withdraw if ischaemic pain occurs\r\nor existing pain worsens within 30 minutes of initiating treatment\r\nor increasing dose; congestive heart failure or significantly impaired left ventricular function; elderly; interactions: Appendix 1 (calcium-channel blockers)", "side-effects": "Side-effects\u00a0dizziness, headache, peripheral oedema, flushing,\r\npalpitation, nausea; also gastro-intestinal disturbances, drowsiness,\r\ninsomnia, tinnitus, hypotension, rashes, dyspnoea, paraesthesia, frequency\r\nof micturition; thrombocytopenia, depression and impotence reported; overdosage, see Emergency Treatment of Poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2687.htm", "doses": [ "Initially 20\u00a0mg 3 times daily, increased, after at least\r\nthree days, to 30\u00a0mg 3 times daily (usual range 60\u2013120\u00a0mg daily)" ], "pregnancy": "Pregnancy\u00a0may inhibit labour; toxicity in animal studies; manufacturer advises avoid, but risk to fetus should be\r\nbalanced against risk of uncontrolled maternal hypertension" }, "CODEINE PHOSPHATE": { "indications": "Indications\u00a0mild to moderate pain; diarrhoea (section 1.4.2); cough suppression (section 3.9.1)", "name": "CODEINE PHOSPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "CODEINE PHOSPHATE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also cardiac arrhythmias; acute abdomen; gallstonesVariation in metabolism\u00a0The capacity to metabolise\r\ncodeine can vary considerably and lead to either reduced therapeutic\r\neffect or marked increase in side-effects", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, anorexia, seizures, malaise, hypothermia, antidiuretic\r\neffect, and muscle fasciculation; pancreatitis also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3515.htm", "doses": [ "By mouth, 30\u201360\u00a0mg every 4 hours when necessary,\r\nto a max. of 240\u00a0mg daily; child 1\u201312\r\nyears, 3\u00a0mg/kg daily in divided doses", "By intramuscular injection, 30\u201360\u00a0mg every 4\r\nhours when necessary" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "CHLORAMPHENICOL": { "indications": "Indications\u00a0see notes above", "name": "CHLORAMPHENICOL", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.7 Some other antibacterials", "Chloramphenicol" ], "cautions": "Cautions\u00a0avoid repeated courses and prolonged treatment; blood counts\r\nrequired before and periodically during treatment; monitor plasma-chloramphenicol concentration in\r\nneonates (see below); interactions: Appendix 1 (chloramphenicol)", "side-effects": "Side-effects\u00a0blood disorders including reversible and irreversible\r\naplastic anaemia (with reports of resulting leukaemia), peripheral\r\nneuritis, optic neuritis, headache, depression, urticaria, erythema\r\nmultiforme, nausea, vomiting, diarrhoea, stomatitis, glossitis, dry\r\nmouth; nocturnal haemoglobinuria reported; grey syndrome (abdominal\r\ndistension, pallid cyanosis, circulatory collapse) may follow excessive\r\ndoses in neonates with immature hepatic metabolism", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3867.htm", "doses": [ "By mouth or by\r\nintravenous injection or infusion, 12.5\u00a0mg/kg every 6 hours (exceptionally, can be doubled for severe\r\ninfections such as septicaemia and meningitis, providing high doses\r\nreduced as soon as clinically indicated); child over 1 month, haemophilus epiglottitis and pyogenic meningitis,\r\n12.5\u201325\u00a0mg/kg every 6 hours (high dosages decreased as soon as clinically\r\nindicated); neonate under 2 weeks,\r\n12.5\u00a0mg/kg twice daily; 2 weeks\u20131 month, 12.5\u00a0mg/kg 2\u20134 times daily", "Plasma concentration monitoring required\r\nin neonates and preferred in those under 4 years of age, in the elderly,\r\nand in hepatic impairment; recommended peak plasma concentration (approx.\r\n2 hours after administration by mouth, intravenous injection or infusion)\r\n10\u201325\u00a0mg/litre; pre-dose (\u2018trough\u2019) concentration should not exceed\r\n15\u00a0mg/litre" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid; neonatal \u2018grey syndrome\u2019\r\nif used in third trimester" }, "SALBUTAMOL - BETA2 AGONISTS": { "side-effects": "Side-effects\u00a0\n(From Beta2 agonists: British National Formulary)\nSide-effects\u00a0 Side-effects of the beta2 agonists include nausea, vomiting, pulmonary oedema (see Cautions above), palpitation, tachycardia, arrhythmias, myocardial ischaemia, peripheral vasodilation, headache, tremor, hyperglycaemia, hypokalaemia (see Cautions), muscle cramps and tension, and hypersensitivity reactions (including angioedema, urticaria, rash, bronchospasm, hypotension, and collapse).", "indications": "Indications\u00a0uncomplicated premature labour (\n(From 7.1.3 Myometrial relaxants: British National Formulary)\nA beta2 agonist (salbutamol or terbutaline) is used for inhibiting uncomplicated premature labour between 24 and 33 weeks of gestation and it may permit a delay in delivery of at least 48 hours. Prolonged therapy should be avoided since risk to the mother increases after 48 hours and there is a lack of evidence of benefit from further treatment; maintenance treatment is therefore not recommended.); asthma\r\n(%s\n(From 3.1.1 Adrenoceptor agonists: British National Formulary)\n3.1.1 Adrenoceptor agonists)", "name": "SALBUTAMOL - BETA2 AGONISTS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4515.htm", "doses": [ "By intravenous infusion, initially 10\u00a0micrograms/minute,\r\nrate increased gradually according to response at 10-minute intervals\r\nuntil contractions diminish then increase rate slowly until contractions\r\ncease (max. rate 45\u00a0micrograms/minute); maintain rate for 1\u00a0hour after\r\ncontractions have stopped, then gradually reduce by 50% every 6\u00a0hours;\r\nthen by mouth (but see notes above), 4\u00a0mg every 6\u20138\u00a0hours" ], "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.1 Drugs used in obstetrics", "7.1.3 Myometrial relaxants", "Beta2 agonists" ], "cautions": "Cautions\u00a0\n(From Beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in patients with suspected cardiovascular disease (such patients should be assessed by a cardiologist before initiating therapy\u2014see also Contra-indications, below), hypertension, mild to moderate pre-eclampsia, hyperthyroidism, and hypokalaemia (particular risk with potassium-depleting diuretics\u2014see also Hypokalaemia). It is important to monitor pulse rate (should not exceed 140 beats per minute), ECG (discontinue treatment if signs of myocardial ischaemia develop), and the patient\u2019s fluid and electrolyte status (avoid over-hydration\u2014discontinue drug immediately and initiate diuretic therapy if pulmonary oedema occurs). Beta2 agonists should also be used with caution in diabetes\u2014monitor blood glucose (risk of hyperglycaemia and ketoacidosis, especially with intravenous beta2 agonists).; interactions: Appendix 1 (sympathomimetics, beta2)" }, "SALICYLATES Salicylic acid": { "indications": "Indications\u00a0mild oral and perioral lesions", "name": "SALICYLATES Salicylic acid", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.3 Drugs acting on the oropharynx", "12.3.1 Drugs for oral ulceration and inflammation", "SALICYLATES", "Salicylic acid" ], "cautions": "Cautions\u00a0not to be applied to dentures\u2014leave at\r\nleast 30 minutes before re-insertion of dentures; frequent\r\napplication, especially in children, may give rise to salicylate poisoning", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5698.htm", "doses": [ "Name[Pyralvex\u00ae (Norgine)] Oral paint, brown, rhubarb extract\r\n(anthraquinone glycosides 0.5%), salicylic acid 1%. Net price 10\u00a0mL with brush = \u00a33.25Dose\u00a0adult and child over 16 years, apply 3\u20134 times daily; max.\r\nduration 7 days" ] }, "INTERFERON BETA": { "indications": "Indications\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and under preparations", "name": "INTERFERON BETA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.2 Drugs affecting the immune response", "8.2.4 Other immunomodulating drugs", "Interferon beta" ], "cautions": "Cautions\u00a0\n(From Interferon beta: British National Formulary)\nCautions\u00a0Caution is advised in those with severe hepatic or renal impairment or a history of cardiac disorders, depressive disorders (avoid in severe depression or in those with suicidal ideation), seizures, or severe myelosupression. Patients should be monitored for signs of hepatic injury. and consult product literature", "side-effects": "Side-effects\u00a0\n(From Interferon beta: British National Formulary)\nInterferon beta and consult product literature", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/37090.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk (toxicity\r\nin animal studies); effective contraception required\r\nduring treatment\u2014consult product literature" }, "LIDOCAINE HYDROCHLORIDE With adrenaline": { "indications": "Indications\u00a0see under Dose; ventricular arrhythmias\r\n(section 2.3.2); eye (section 11.7); oral lesions (section 12.3.1)", "name": "LIDOCAINE HYDROCHLORIDE With adrenaline", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.2 Local anaesthesia", "Lidocaine", "LIDOCAINE HYDROCHLORIDE", "With adrenaline" ], "cautions": "Cautions\u00a0See Cautions of Local Anaesthetics and section 2.3.2; hypertension; topical preparations can damage plastic cuffs of endotracheal\r\ntubes", "side-effects": "Side-effects\u00a0see Toxicity and Side-effects and section 2.3.2; also methaemoglobinaemia (see\r\nunder Prilocaine for treatment), nystagmus, rash; hypoglycaemia\r\nalso reported following intrathecal or extradural administration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6690.htm", "doses": [ "To avoid excessive dosage in obese patients,\r\ndose may need to be calculated on the basis of ideal body-weight", "Infiltration anaesthesia, according to patient\u2019s weight and\r\nnature of procedure, max. 200\u00a0mg (or 500\u00a0mg if given in solutions\r\ncontaining adrenaline)\u2014see also Administration and important warning below", "Intravenous regional anaesthesia and nerve blocks, seek expert\r\nadvice", "Surface anaesthesia, see preparations below", "The licensed doses stated above may not be appropriate in some\r\nsettings and expert advice should be sought", "Name[Xylocaine\u00ae (AstraZeneca) ] Injection, anhydrous lidocaine hydrochloride\r\n10\u00a0mg/mL (1%), adrenaline 1 in 200\u00a0000 (5\u00a0micrograms/mL), net price\r\n20-mL vial = 99p Excipients include sulphites\nInjection, anhydrous lidocaine hydrochloride\r\n20\u00a0mg/mL (2%), adrenaline 1 in 200\u00a0000 (5\u00a0micrograms/mL), net price\r\n20-mL vial = \u00a31.37 Excipients include sulphites" ], "pregnancy": "Pregnancy\u00a0large doses can cause fetal bradycardia; large doses\r\nduring delivery can cause neonatal respiratory depression, hypotonia,\r\nor bradycardia after paracervical or epidural block" }, "EDROPHONIUM CHLORIDE": { "indications": "Indications\u00a0see under Dose; myasthenia gravis (section 10.2.1)", "name": "EDROPHONIUM CHLORIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.6 Drugs for reversal of neuromuscular blockade", "Anticholinesterases", "EDROPHONIUM CHLORIDE" ], "cautions": "Cautions\u00a0section 10.2.1; atropine should\r\nalso be given", "side-effects": "Side-effects\u00a0section 10.2.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6668.htm", "doses": [ "Brief reversal of non-depolarising neuromuscular blockade, by intravenous injection over several minutes, 500\u2013700\u00a0micrograms/kg\r\n(after or with atropine)", "Diagnosis of dual block, by intravenous injection, 10\u00a0mg" ], "pregnancy": "Pregnancy\u00a0section 10.2.1" }, "NILOTINIB": { "indications": "Indications\u00a0 \n(From Protein kinase inhibitors: British National Formulary)\nNilotinib, a tyrosine kinase inhibitor, is licensed for the treatment of newly diagnosed chronic myeloid leukaemia in the chronic phase, and also for patients with chronic or accelerated phase chronic myeloid leukaemia who have resistance to or intolerance of previous therapy, including imatinib.", "name": "NILOTINIB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "NILOTINIB" ], "cautions": "Cautions\u00a0see section 8.1; history of pancreatitis; susceptibility to QT-interval prolongation (including\r\nelectrolyte disturbances, concomitant use of drugs that prolong QT\r\ninterval); interactions: Appendix 1\r\n(nilotinib)", "side-effects": "Side-effects\u00a0see section 8.1; also abdominal pain, constipation,\r\ndiarrhoea, dyspepsia, flatulence, anorexia, weight changes; palpitation,\r\nQT-interval prolongation, hypertension, oedema, flushing; dyspnoea,\r\ncough, dysphonia; headache, fatigue, asthenia, dizziness, paraesthesia,\r\ninsomnia, vertigo; hypomagnesaemia, hyperkalaemia, blood glucose changes;\r\nbone pain, arthralgia, muscle spasm; urticaria, erythema, hyperhidrosis,\r\ndry skin, rash, pruritus; less commonly hepatitis,\r\npancreatitis, dry mouth, chest pain, cardiac failure, arrhythmias,\r\npericardial effusion, coronary artery disease, cardiomegaly, cardiac\r\nmurmur, bradycardia, hypertensive crisis, haemorrhage, melaena, haematoma,\r\npleural effusion, interstitial lung disease, migraine, hypoaesthesia,\r\nhyperaesthesia, depression, anxiety, tremor, influenza-like symptoms,\r\nhyperthyroidism, breast pain, gynaecomastia, erectile dysfunction,\r\ndysuria, urinary frequency, hypokalaemia, hyponatraemia, hypocalcaemia,\r\nhypophosphataemia, dehydration, decreased visual acuity, conjunctivitis,\r\ndry eyes, epistaxis, and ecchymosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200922.htm", "doses": [ "Newly diagnosed chronic myeloid leukaemia, chronic phase, adult over 18 years, 300\u00a0mg twice daily", "Chronic and accelerated phase chronic myeloid leukaemia (see\r\nnotes above), adult over\r\n18 years, 400\u00a0mg twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk\u2014toxicity in animal studies; effective\r\ncontraception required during treatment; see also Pregnancy and Reproductive\r\nFunction" }, "TOCILIZUMAB": { "indications": "Indications\u00a0see under Cytokine Modulators above", "name": "TOCILIZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.3 Drugs that suppress the rheumatic disease process", "Cytokine modulators" ], "cautions": "Cautions\u00a0predisposition to infection or history of recurrent or chronic infection; interrupt treatment if serious infection occurs; history of intestinal ulceration or diverticulitis; monitor hepatic transaminases every 4\u20138 weeks for\r\nfirst 6 months, then every 12 weeks; monitor\r\nneutrophil and platelet counts 4\u20138 weeks after starting treatment\r\nand then as indicated; low platelet or absolute neutrophil\r\ncount (discontinue if absolute neutrophil count less than 0.5 \u00d7 109/litre or platelet count less than 50 \u00d7 103/microlitre); monitor lipid profile 4\u20138 weeks after starting treatment and then\r\nas indicated; monitor for demyelinating\r\ndisorders; interactions: Appendix 1\r\n(tocilizumab)Tuberculosis\u00a0Patients should be evaluated\r\nfor tuberculosis before treatment. Patients with latent\r\ntuberculosis should be treated with standard therapy (section 5.1.9) before starting tocilizumabCounselling\u00a0Patients should be advised\r\nto seek immediate medical attention if symptoms of infection occur,\r\nor if symptoms of diverticular perforation such as abdominal pain,\r\nhaemorrhage, or fever accompanying change in bowel habits occur", "side-effects": "Side-effects\u00a0abdominal pain, mouth ulceration, gastritis, raised\r\nhepatic transaminases; dizziness, peripheral oedema, hypertension,\r\nhypercholesterolaemia; headache; infection (including upper respiratory-tract\r\ninfection); antibody formation, hypersensitivity, leucopenia, neutropenia;\r\nrash, pruritus; less commonly gastric ulcer, gastro-intestinal\r\nperforation, hypertriglyceridaemia, hypothyroidism, nephrolithiasis,\r\ninfusion related reactions, anaphylaxis, and thrombocytopenia also\r\nreported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203908.htm", "doses": [ "By intravenous infusion, adult over 18 years, 8\u00a0mg/kg (max. 800\u00a0mg) once every\r\n4 weeks; for details of dose adjustment in patients with liver enzyme\r\nabnormalities, or low absolute neutrophil or platelet count, consult\r\nproduct literature" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential (toxicity\r\nin animal studies); effective contraception required\r\nduring and for 3 months after treatment" }, "FORMOTEROL FUMARATE": { "indications": "Indications\u00a0reversible airways obstruction (including nocturnal asthma and prophylaxis\r\nof exercise-induced bronchospasm) in patients requiring long-term\r\nregular bronchodilator therapy, see also %s\n(From Management of chronic asthma: British National Formulary)\nManagement of chronic asthma;\r\nchronic obstructive pulmonary diseaseNote\u00a0For use in asthma only in patients who regularly\r\nuse an inhaled corticosteroid, \n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nLong-acting beta2 agonists\u00a0Formoterol (eformoterol) and salmeterol are longer-acting beta2 agonists which are administered by inhalation. They should be used for asthma only in patients who regularly use an inhaled corticosteroid (see CHM advice below). They have a role in the long-term control of chronic asthma (see Management of Chronic Asthma table) and they can be useful in nocturnal asthma. Salmeterol should not be used for the relief of an asthma attack; it has a slower onset of action than salbutamol or terbutaline. Formoterol is licensed for short-term symptom relief and for the prevention of exercise-induced bronchospasm; its speed of onset of action is similar to that of salbutamol. Combination inhalers that contain a long-acting beta2 agonist and a corticosteroid (section 3.2) ensure that long-acting beta2 agonists are not used without concomitant corticosteroids, but reduce the flexibility to adjust the dose of each component.", "name": "FORMOTEROL FUMARATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system", "3.1 Bronchodilators", "3.1.1 Adrenoceptor agonists", "3.1.1.1 Selective beta2 agonists", "FORMOTEROL FUMARATE" ], "cautions": "Cautions\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nCautions\u00a0Beta2 agonists should be used with caution in hyperthyroidism, cardiovascular disease, arrhythmias, susceptibility to QT-interval prolongation, and hypertension. Beta2 agonists should be used with caution in diabetes\u2014monitor blood glucose (risk of ketoacidosis, especially when beta2 agonist given intravenously). Interactions: Appendix 1 (sympathomimetics, beta2).Hypokalaemia\u00a0Potentially serious hypokalaemia may result from beta2 agonist therapy. Particular caution is required in severe asthma, because this effect may be potentiated by concomitant treatment with theophylline and its derivatives, corticosteroids, and diuretics, and by hypoxia. Plasma-potassium concentration should therefore be monitored in severe asthma.", "side-effects": "Side-effects\u00a0\n(From 3.1.1.1 Selective beta2 agonists: British National Formulary)\nSide-effects\u00a0Side-effects of the beta2 agonists include fine tremor (particularly in the hands), nervous tension, headache, muscle cramps, and palpitation. Other side-effects include tachycardia, arrhythmias, peripheral vasodilation, myocardial ischaemia, and disturbances of sleep and behaviour. Paradoxical bronchospasm (occasionally severe), urticaria, angioedema, hypotension, and collapse have also been reported. High doses of beta2 agonists are associated with hypokalaemia (see Hypokalaemia above).; very rarely QT-\r\ninterval prolongation; taste disturbances, nausea, dizziness, rash,\r\nand pruritus also reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/130024.htm", "doses": [ "See under preparations below", "Advise patients not to exceed prescribed\r\ndose, and to follow manufacturer\u2019s directions; if a previously effective\r\ndose of inhaled formoterol fails to provide adequate relief, a doctor\u2019s\r\nadvice should be obtained as soon as possible", "by inhalation of powder, asthma, adult and child over\r\n6 years, 12\u00a0micrograms twice daily, increased to 24\u00a0micrograms twice\r\ndaily in more severe airways obstruction (see also CHM advice)", "Chronic obstructive pulmonary disease, 12\u00a0micrograms twice daily" ], "pregnancy": "Pregnancy\u00a0see section 3.1" }, "POTASSIUM BICARBONATE": { "indications": "Indications\u00a0\n(From 9.2.1.3 Oral bicarbonate: British National Formulary)\n9.2.1.3 Oral bicarbonate", "name": "POTASSIUM BICARBONATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.2 Fluids and electrolytes", "9.2.1 Oral preparations for fluid and electrolyte imbalance", "9.2.1.3 Oral bicarbonate" ], "cautions": "Cautions\u00a0elderly; cardiac\r\ndisease; interactions: Appendix 1 (potassium\r\nsalts)", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, and\r\nflatulence", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4967.htm", "doses": [ "See notes above" ] }, "RILUZOLE": { "indications": "Indications\u00a0to extend life in patients with amyotrophic lateral sclerosis, initiated\r\nby specialists experienced in the management of motor neurone disease", "name": "RILUZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders" ], "cautions": "Cautions\u00a0history of abnormal hepatic function\r\n(consult product literature for details)Blood disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of neutropenia and advised\r\nto seek immediate medical attention if symptoms such as fever occur; white blood cell counts should be determined in febrile\r\nillness; neutropenia requires discontinuation of riluzoleInterstitial lung disease\u00a0Perform\r\nchest radiography if symptoms such as dry cough or dyspnoea develop; discontinue if interstitial lung disease is diagnosedDriving\u00a0Dizziness or vertigo may\r\naffect performance of skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0nausea, vomiting, diarrhoea, abdominal pain; tachycardia;\r\nasthenia, headache, dizziness, drowsiness, oral paraesthesia; less commonly interstitial lung disease, pancreatitis, angioedema,\r\nand anaemia; rarely neutropenia; very rarely hepatitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/40688.htm", "doses": [ "50\u00a0mg twice daily; child not recommended" ], "pregnancy": "Pregnancy\u00a0avoid\u2014no information available" }, "MOCLOBEMIDE": { "indications": "Indications\u00a0depressive illness; social anxiety disorder", "name": "MOCLOBEMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.2 Monoamine-oxidase inhibitors", "Reversible MAOIs", "MOCLOBEMIDE" ], "cautions": "Cautions\u00a0avoid in agitated or excited patients (or give with sedative for\r\nup to 2\u20133 weeks), thyrotoxicosis, may provoke\r\nmanic episodes in bipolar disorders; interactions: \n(From Reversible MAOIs: British National Formulary)\nInteractions\u00a0Moclobemide is claimed to cause less potentiation of the pressor effect of tyramine than the traditional (irreversible) MAOIs, but patients should avoid consuming large amounts of tyramine-rich food (such as mature cheese, yeast extracts and fermented soya bean products).The risk of drug interactions is also claimed to be less but patients still need to avoid sympathomimetics such as ephedrine and pseudoephedrine. In addition, moclobemide should not be given with another antidepressant. Owing to its short duration of action no treatment-free period is required after it has been stopped but it should not be started until at least a week after a tricyclic or related antidepressant or an SSRI or related antidepressant has been stopped (at least 5 weeks in the case of fluoxetine), or for at least a week after an MAOI has been stopped. For other interactions, see Appendix 1 (moclobemide). and Appendix\r\n1 (moclobemide)", "side-effects": "Side-effects\u00a0sleep disturbances, dizziness, gastro-intestinal\r\ndisorders, headache, restlessness, agitation; paraesthesia, dry mouth,\r\nvisual disturbances, oedema, skin reactions, confusional states reported; rarely raised liver enzymes, galactorrhoea; hyponatraemia\r\n(see Hyponatraemia and Antidepressant Therapy, section 4.3)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3350.htm", "doses": [ "Depression, initially 300\u00a0mg daily usually in divided\r\ndoses after food, adjusted according to response; usual range 150\u2013600\u00a0mg\r\ndaily; child not recommended", "Social anxiety disorder, initially 300\u00a0mg daily increased on\r\nfourth day to 600\u00a0mg daily in 2 divided doses, continued for 8\u201312\r\nweeks to assess efficacy; child not\r\nrecommended" ], "pregnancy": "Pregnancy\u00a0\n(From 4.3.2 Monoamine-oxidase inhibitors: British National Formulary)\nPregnancy\u00a0There is an increased risk of neonatal malformations when phenelzine, isocarboxazid, or tranylcypromine is used during pregnancy. The safety of moclobemide in pregnancy has not been established. Manufacturers advise avoid use unless there are compelling reasons." }, "SALICYLIC ACID": { "indications": "Indications\u00a0hyperkeratotic skin disorders; warts and calluses (section 13.7); scalp\r\nconditions (section 13.9); fungal\r\nnail infections (section 13.10.2)", "name": "SALICYLIC ACID", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.5 Preparations for eczema and psoriasis", "13.5.2 Preparations for psoriasis", "Topical preparations for psoriasis", "Salicylic acid" ], "cautions": "Cautions\u00a0see notes above; avoid broken or inflamed skinSalicylate toxicity\u00a0Salicylate toxicity\r\nmay occur particularly if applied on large areas of skin or neonatal\r\nskin", "side-effects": "Side-effects\u00a0sensitivity, excessive drying, irritation, systemic\r\neffects after widespread use (see under Cautions)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5990.htm", "doses": [ "See preparations" ] }, "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE Combined vaccines": { "indications": "Indications\u00a0immunisation against measles, mumps,\r\nand rubella", "name": "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE Combined vaccines", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Measles, Mumps and Rubella (MMR) vaccine", "MEASLES, MUMPS AND RUBELLA VACCINE, LIVE", "Combined vaccines" ], "cautions": "Cautions\u00a0see section 14.1; also,\r\nafter immunoglobulin administration or blood transfusion, leave an\r\ninterval of at least 3 months before MMR immunisation as antibody\r\nresponse to measles component may be reduced\u2014see also Anti-D (Rh0) immunoglobulin; interactions: Appendix 1 (vaccines)Hypersensitivity to egg\u00a0There is increasing evidence\r\nthat MMR vaccine can be given safely even when the child has had an\r\nanaphylactic reaction to food containing egg (dislike of egg or refusal\r\nto eat egg is not a contra-indication). For children\r\nwith a confirmed anaphylactic reaction to egg-containing food, MMR\r\nvaccine may be administered in a hospital setting", "side-effects": "Side-effects\u00a0see section 14.1 and notes above; also less commonly sleep disturbances, unusual crying in infants; also reported peripheral\r\nand optic neuritis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201519.htm", "doses": [ "By intramuscular or deep subcutaneous\r\ninjection, adult and child over 9 months (but see also notes above), primary\r\nimmunisation, 2 doses each of 0.5\u00a0mL, see Immunisation Schedule, section 14.1; see also notes above for use\r\nin outbreaks, for contacts of cases, and for travel", "Name[Priorix\u00ae (GSK) ] Injection, powder for reconstitution,\r\nlive attenuated, measles virus (Schwarz strain) and mumps virus (RIT\r\n4385 strain) prepared in chick embryo cells, and rubella virus (Wistar\r\nRA 27/3 strain); net price single-dose vial (with syringe containing\r\nsolvent) = \u00a36.37Excipients include neomycinAlso available as part of childhood immunisation schedule from\r\nhealth organisations or ImmForm" ], "pregnancy": "Pregnancy\u00a0avoid pregnancy for at least 1 month after vaccination;\r\nsee also section 14.1" }, "PNEUMOCOCCAL VACCINE Pneumococcal polysaccharide vaccine": { "indications": "Indications\u00a0immunisation against pneumococcal infection", "name": "PNEUMOCOCCAL VACCINE Pneumococcal polysaccharide vaccine", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Pneumococcal vaccines", "PNEUMOCOCCAL VACCINE", "Pneumococcal polysaccharide vaccine" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1; also Revaccination, above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6510.htm", "doses": [ "See under preparations", "Name[Pneumovax\u00ae II (Sanofi Pasteur) ] Injection, polysaccharide from each\r\nof 23 capsular types of pneumococcus, net price 0.5-mL vial = \u00a38.32Dose\u00a0by intramuscular or subcutaneous injection, adult and child over 2 years, 0.5\u00a0mL; revaccination, see notes above" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "OLSALAZINE SODIUM": { "indications": "Indications\u00a0treatment of mild ulcerative colitis and maintenance of remission", "name": "OLSALAZINE SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.1 Aminosalicylates", "OLSALAZINE SODIUM" ], "cautions": "Cautions\u00a0\n(From 1.5.1 Aminosalicylates: British National Formulary)\nCautions\u00a0Renal function should be monitored before starting an oral aminosalicylate, at 3 months of treatment, and then annually during treatment (more frequently in renal impairment). Blood disorders can occur with aminosalicylates (see recommendation below).; interactions: Appendix 1 (aminosalicylates)Blood disorders\u00a0See %s\n(From 1.5.1 Aminosalicylates: British National Formulary)\nBlood disordersPatients receiving aminosalicylates should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise that occurs during treatment. A blood count should be performed and the drug stopped immediately if there is suspicion of a blood dyscrasia.", "side-effects": "Side-effects\u00a0see notes above; watery diarrhoea common; also\r\nreported, tachycardia, palpitation, pyrexia, blurred vision, and photosensitivity", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2173.htm", "doses": [ "adult and child over 12 years, acute attack, 1\u00a0g daily in divided\r\ndoses after meals increased if necessary over 1 week to max. 3\u00a0g daily\r\n(max. single dose 1\u00a0g); maintenance, 500\u00a0mg twice daily after meals", "child under 12 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless potential benefit\r\noutweighs risk" }, "DICLOFENAC SODIUM": { "indications": "Indications\u00a0pain and inflammation in rheumatic disease (including\r\njuvenile idiopathic arthritis) and other musculoskeletal disorders;\r\nacute gout; postoperative pain", "name": "DICLOFENAC SODIUM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "DICLOFENAC SODIUM" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; avoid\r\nin acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; suppositories may cause rectal\r\nirritation; injection site reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5208.htm", "doses": [ "By mouth, 75\u2013150\u00a0mg daily in 2\u20133\r\ndivided doses", "By rectum in suppositories, 75\u2013150\u00a0mg\r\ndaily in divided doses", "Juvenile idiopathic arthritis, child 6 months\u201318 years, by mouth, see BNF for Children", "Postoperative pain, child 6\u201312 years, by rectum, 1\u20132\u00a0mg/kg (max. 150\u00a0mg) daily\r\nin divided doses (12.5\u00a0mg and 25\u00a0mg suppositories only) for max. 4\r\ndays", "by deep intramuscular injection into the\r\ngluteal muscle, acute exacerbations of pain and postoperative pain,\r\n75\u00a0mg once daily (twice daily in severe cases) for max. 2 days; child 2\u201318 years, see BNF for Children" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "NEOMYCIN SULPHATE - AMINOGLYCOSIDES": { "indications": "Indications\u00a0bowel sterilisation before surgery, see also notes above", "name": "NEOMYCIN SULPHATE - AMINOGLYCOSIDES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides), but too toxic for systemic use; interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function., but poorly\r\nabsorbed on oral administration; increased salivation, impaired intestinal\r\nabsorption with steatorrhoea and diarrhoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3841.htm", "doses": [ "By mouth, pre-operative bowel sterilisation,\r\n1\u00a0g every hour for 4 hours, then 1\u00a0g every 4 hours for 2\u20133 days", "Hepatic coma, up to 4\u00a0g daily in divided doses usually for 5\u20137\r\ndays" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "CYANOCOBALAMIN ": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.2 Drugs used in megaloblastic anaemias" ], "indications": "Indications\u00a0see notes above", "name": "CYANOCOBALAMIN ", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4904.htm", "doses": [ "By mouth, vitamin B12 deficiency\r\nof dietary origin, 50\u2013150\u00a0micrograms daily taken between meals; child 50\u2013105\u00a0micrograms daily in 1\u20133 divided doses", "By intramuscular injection, initially 1\u00a0mg repeated\r\n10 times at intervals of 2\u20133 days, maintenance 1\u00a0mg every month, but\r\nsee notes above" ] }, "TERIPARATIDE": { "indications": "Indications\u00a0treatment of osteoporosis in postmenopausal\r\nwomen and in men at increased risk of fractures; treatment of corticosteroid-induced\r\nosteoporosis; see also notes above", "name": "TERIPARATIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.6 Drugs affecting bone metabolism", "6.6.1 Calcitonin and parathyroid hormone", "TERIPARATIDE" ], "side-effects": "Side-effects\u00a0gastro-intestinal disorders (including nausea,\r\nreflux and haemorrhoids); palpitation; dyspnoea; headache, fatigue,\r\nasthenia, depression, dizziness, vertigo; anaemia, increased sweating,\r\nmuscle cramps, sciatica, myalgia, arthralgia; less commonly urinary disorders, hypercalcaemia; injection-site reactions; rarely hypersensitivity reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128204.htm", "doses": [ "By subcutaneous injection, 20\u00a0micrograms\r\ndaily; max. duration of treatment 24 months (course not to be repeated)" ], "pregnancy": "Pregnancy\u00a0avoid" }, "PREPARATIONS FOR VAGINAL AND VULVAL\r\nCANDIDIASIS - PREPARATIONS FOR VAGINAL AND VULVAL CANDIDIASIS": { "indications": "Indications\u00a0\n(From Fungal infections: British National Formulary)\nFungal infections", "name": "PREPARATIONS FOR VAGINAL AND VULVAL\r\nCANDIDIASIS - PREPARATIONS FOR VAGINAL AND VULVAL CANDIDIASIS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "7 Obstetrics, gynaecology, and urinary-tract disorders", "7.2 Treatment of vaginal and vulval conditions", "7.2.2 Vaginal and vulval infections", "Fungal infections", "PREPARATIONS FOR VAGINAL AND VULVAL CANDIDIASIS" ], "cautions": "Cautions\u00a0interactions: Appendix 1 (miconazole)", "side-effects": "Side-effects\u00a0occasional local irritation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213818.htm", "doses": [ "See under preparations below", "insert 5-g applicatorful intravaginally twice daily for\r\n3 days", "insert 1 vaginal capsule at night for 3 nights", "insert 1 vaginal capsule at night as a single dose" ], "pregnancy": "Pregnancy\u00a0\n(From Fungal infections: British National Formulary)\nVulvovaginal candidiasis in pregnancy \u00a0Vulvovaginal candidiasis is common during pregnancy and can be treated with vaginal application of an imidazole (such as clotrimazole), and a topical imidazole cream for vulvitis. Pregnant women need a longer duration of treatment, usually about 7 days, to clear the infection. Oral antifungal treatment should be avoided during pregnancy." }, "FLUORIDES Oral drops": { "indications": "Indications\u00a0prophylaxis of dental caries\u2014\n(From 9.5.3 Fluoride: British National Formulary)\n9.5.3 Fluoride", "name": "FLUORIDES Oral drops", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.5 Minerals", "9.5.3 Fluoride", "FLUORIDES", "Oral drops" ], "side-effects": "Side-effects\u00a0occasional white flecks on teeth with recommended\r\ndoses; rarely yellowish-brown discoloration if recommended\r\ndoses are exceeded", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5078.htm", "doses": [ "Dose expressed as\r\nfluoride ion (F-)", "Water content less than F- 300\u00a0micrograms/litre (0.3\r\nparts per million), child up to 6 months\r\nnone; 6 months\u20133 years F- 250\u00a0micrograms daily, 3\u20136 years\r\nF- 500\u00a0micrograms daily, over 6 years F- 1\u00a0mg\r\ndaily", "Water content between F- 300 and 700\u00a0micrograms/litre\r\n(0.3\u20130.7 parts per million), child up\r\nto 3 years none, 3\u20136 years F- 250\u00a0micrograms daily, over\r\n6 years F- 500\u00a0micrograms daily", "Water content above F- 700\u00a0micrograms/litre (0.7\r\nparts per million), supplements not advised", "These doses reflect the recommendations of\r\nthe British Dental Association, the British Society of Paediatric\r\nDentistry and the British Association for the Study of Community Dentistry\r\n(Br Dent J 1997; 182: 6\u20137)", "Name[En-De-Kay\u00ae (Manx)] Fluodrops\u00ae (= paediatric drops),\r\nsugar-free, sodium fluoride 550\u00a0micrograms (F- 250\u00a0micrograms)/0.15\u00a0mL.\r\nNet price 60\u00a0mL = \u00a32.38Dental prescribing on NHS\u00a0May be prescribed as\r\nSodium Fluoride Oral Drops" ] }, "BUPRENORPHINE": { "indications": "Indications\u00a0see under Dose and under Patches; opioid dependence (section 4.10.3)", "name": "BUPRENORPHINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "BUPRENORPHINE" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also impaired consciousness; effects only partially\r\nreversed by naloxone; monitor liver functionFever or external heat\u00a0Monitor patients\r\nusing patches for increased side-effects if fever present (increased\r\nabsorption possible); avoid exposing application\r\nsite to external heat (may also increase absorption)", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; can induce\r\nmild withdrawal symptoms in patients dependent on opioids; also diarrhoea,\r\nabdominal pain, anorexia, dyspepsia; vasodilatation; dyspnoea; paraesthesia,\r\nasthenia, fatigue, agitation, anxiety; less commonly flatulence, taste disturbance, angina, hypertension, syncope, hypoxia,\r\nwheezing, cough, restlessness, depersonalisation, dysarthria, impaired\r\nmemory, hypoaesthesia, tremor, influenza-like symptoms, pyrexia, rhinitis,\r\nrigors, muscle cramp, myalgia, tinnitus, dry eye, and dry skin; rarely paralytic ileus, dysphagia, impaired concentration,\r\nand psychosis; very rarely retching, hyperventilation,\r\nhiccups, and muscle fasciculation; hepatic necrosis and hepatitis\r\nalso reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3513.htm", "doses": [ "Moderate to severe pain, by sublingual administration, 200\u2013400\u00a0micrograms every 6\u20138 hours; child over 6 years, 16\u201325\u00a0kg, 100\u00a0micrograms every 6\u20138 hours; 25\u201337.5\u00a0kg,\r\n100\u2013200\u00a0micrograms every 6\u20138 hours; 37.5\u201350\u00a0kg, 200\u2013300\u00a0micrograms\r\nevery 6\u20138 hours", "By intramuscular or slow\r\nintravenous injection, 300\u2013600\u00a0micrograms every 6\u20138 hours; child over 6 months 3\u20136\u00a0micrograms/kg every 6\u20138 hours\r\n(max. 9\u00a0micrograms/kg)", "Premedication, by sublingual administration, 400\u00a0micrograms", "By intramuscular injection, 300\u00a0micrograms", "Intra-operative analgesia, by slow intravenous injection, 300\u2013450\u00a0micrograms" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour. and %s\n(From Opioid substitution therapy: British National Formulary)\nPregnancy\u00a0Acute withdrawal of opioids should be avoided in pregnancy because it can cause fetal death. Opioid substitution therapy is recommended during pregnancy because it carries a lower risk to the fetus than continued use of illicit drugs. If a woman who is stabilised on methadone or buprenorphine for treatment of opioid dependence becomes pregnant, therapy should be continued [buprenorphine is not licensed for use in pregnancy]. Many pregnant patients choose a withdrawal regimen, but withdrawal during the first trimester should be avoided because it is associated with an increased risk of spontaneous miscarriage. Withdrawal of methadone or buprenorphine should be undertaken gradually during the second trimester; for example, the dose of methadone may be reduced by 2\u20133\u00a0mg every 3\u20135 days. If illicit drug use occurs, the patient should be re-stabilised at the optimal maintenance dose and consideration should be given to stopping the withdrawal regimen.Further withdrawal of methadone or buprenorphine in the third trimester is not recommended because maternal withdrawal, even if mild, is associated with fetal distress, stillbirth, and the risk of neonatal mortality. Drug metabolism can be increased in the third trimester; it may be necessary to either increase the dose of methadone or change to twice-daily consumption (or a combination of both strategies) to prevent withdrawal symptoms from developing.The neonate should be monitored for respiratory depression and signs of withdrawal if the mother is prescribed high doses of opioid substitute.Signs of neonatal withdrawal from opioids usually develop 24\u201372 hours after delivery but symptoms may be delayed for up to 14 days, so monitoring may be required for several weeks. Symptoms include a high-pitched cry, rapid breathing, hungry but ineffective suckling, and excessive wakefulness; severe, but rare symptoms include hypertonicity and convulsions." }, "DEXAMETHASONE With antibacterial": { "indications": "Indications\u00a0eczematous inflammation in otitis externa\r\n(\n(From 12.1.1 Otitis externa: British National Formulary)\n12.1.1 Otitis externa)", "name": "DEXAMETHASONE With antibacterial", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "12 Ear, nose, and oropharynx", "12.1 Drugs acting on the ear", "12.1.1 Otitis externa", "Anti-inflammatory preparations", "Corticosteroids", "DEXAMETHASONE", "With antibacterial" ], "cautions": "Cautions\u00a0\n(From Corticosteroids: British National Formulary)\nCautions\u00a0Prolonged use of topical corticosteroid ear preparations should be avoided.", "side-effects": "Side-effects\u00a0\n(From Corticosteroids: British National Formulary)\nSide-effects\u00a0Local sensitivity reactions may occur.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/31401.htm", "doses": [ "Name[Sofradex\u00ae (Sanofi-Aventis) ] Drops (for ear or eye), dexamethasone (as sodium metasulphobenzoate) 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%. Net price 10\u00a0mL =\r\n\u00a36.25Excipients include polysorbate 80Dose\u00a0ear, apply 2\u20133 drops 3\u20134 times daily; eye, section 11.4.1" ] }, "FENTANYL Tablets": { "indications": "Indications\u00a0severe chronic pain, breakthrough pain; parenteral indications (section 15.1.4.3)", "name": "FENTANYL Tablets", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.7 Analgesics", "4.7.2 Opioid analgesics", "FENTANYL", "Tablets" ], "cautions": "Cautions\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nCautions\u00a0Opioids should be used with caution in patients with impaired respiratory function (avoid in chronic obstructive pulmonary disease) and asthma (avoid during an acute attack), hypotension, urethral stenosis, shock, myasthenia gravis, prostatic hypertrophy, obstructive or inflammatory bowel disorders, diseases of the biliary tract, and convulsive disorders. A reduced dose is recommended in elderly or debilitated patients, in hypothyroidism, and in adrenocortical insufficiency. Repeated use of opioid analgesics is associated with the development of psychological and physical dependence; although this is rarely a problem with therapeutic use, caution is advised if prescribing for patients with a history of drug dependence. Avoid abrupt withdrawal after long-term treatment. Transdermal preparations (fentanyl or buprenorphine patches) are not suitable for acute pain or in those patients whose analgesic requirements are changing rapidly because the long time to steady state prevents rapid titration of the dose. Interactions: Appendix 1 (opioid analgesics; important: special hazard with pethidine and possibly other opioids and MAOIs).Palliative care\u00a0In the control of pain in terminal illness, the cautions listed above should not necessarily be a deterrent to the use of opioid analgesics.; also diabetes\r\nmellitus, impaired consciousness, cerebral tumour; see also %s\n(From Patches: British National Formulary)\nPatchesTransdermal fentanylFever or external heat\u00a0Monitor patients using patches for increased side-effects if fever present (increased absorption possible); avoid exposing application site to external heat, for example a hot bath or sauna (may also increase absorption)Respiratory depression\u00a0Risk of fatal respiratory depression, particularly in patients not previously treated with a strong opioid analgesic; manufacturer recommends use only in opioid tolerant patientsCounselling\u00a0Patients and carers should be informed about safe use, including correct administration and disposal, strict adherence to dosage instructions, and the symptoms and signs of opioid overdosage. Patches should be removed immediately in case of breathing difficulties, marked drowsiness, confusion, dizziness, or impaired speech, and patients and carers should seek prompt medical attention.Prescriptions\u00a0Prescriptions for fentanyl patches can be written to show the strength in terms of the release rate and it is acceptable to write \u2018Fentanyl 25 patches\u2019 to prescribe patches that release fentanyl 25\u00a0micrograms per hour. The dosage should be expressed in terms of the interval between applying a patch and replacing it with a new one, e.g. \u2018one patch to be applied every 72 hours\u2019. The total quantity of patches to be supplied should be written in words and figures.FentanylDurogesic DTrans\u00ae", "side-effects": "Side-effects\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nSide-effects\u00a0Opioid analgesics share many side-effects, although qualitative and quantitative differences exist. The most common side-effects include nausea and vomiting (particularly in initial stages), constipation, dry mouth, and biliary spasm; larger doses produce muscle rigidity, hypotension, and respiratory depression (for reversal of opioid-induced respiratory depression, see section 15.1.7). Other common side-effects of opioid analgesics include bradycardia, tachycardia, palpitation, oedema, postural hypotension, hallucinations, vertigo, euphoria, dysphoria, mood changes, dependence, dizziness, confusion, drowsiness, sleep disturbances, headache, sexual dysfunction, difficulty with micturition, urinary retention, ureteric spasm, miosis, visual disturbances, sweating, flushing, rash, urticaria, and pruritus. Overdosage: see Emergency Treatment of Poisoning.Long-term use of opioid analgesics can cause hypogonadism and adrenal insufficiency in both men and women. This is thought to be dose related and can lead to amenorrhoea, reduced libido, infertility, depression, and erectile dysfunction. Long-term use of opioid analgesics has also been associated with a state of abnormal pain sensitivity (hyperalgesia). Pain associated with hyperalgesia is usually distinct from pain associated with disease progression or breakthrough pain, and is often more diffuse and less defined. Treatment of hyperalgesia involves reducing the dose of opioid medication or switching therapy; cases of suspected hyperalgesia should be referred to a specialist pain team.; also\r\nabdominal pain, dyspepsia, diarrhoea, gastro-oesophageal reflux disease,\r\nstomatitis, anorexia, hypertension, vasodilation, dyspnoea, aesthenia,\r\nmyoclonus, anxiety, tremor, appetite changes, rhinitis, pharyngitis,\r\nparaesthesia, application-site reactions; less commonly ileus, flatulence, hypoventilation, impaired concentration, impaired\r\ncoordination, amnesia, speech disorder, malaise, seizures, pyrexia,\r\nthirst, blood disorders (including thrombocytopenia), chills; rarely hiccups; very rarely arrhythmia,\r\napnoea, haemoptysis, ataxia, delusions, bladder pain", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/202699.htm", "doses": [ "Chronic intractable pain, by transdermal route, apply to dry, non-irritated, non-irradiated, non-hairy skin on\r\ntorso or upper arm, removing after 72 hours and siting replacement\r\npatch on a different area (avoid using the same area for several days). adult over 16 years not currently treated with a strong opioid analgesic (but see Transdermal Fentanyl), initial dose, one \u201812\u2019 or \u201825\u00a0micrograms/hour\u2019\r\npatch replaced after 72 hours; adult and child over 2 years currently\r\ntreated with a strong opioid analgesic, initial dose based\r\non previous 24-hour opioid requirement (consult product literature)", "When starting, evaluation of the\r\nanalgesic effect should not be made before the system\r\nhas been worn for 24 hours (to allow for the gradual\r\nincrease in plasma-fentanyl concentration)\u2014previous\r\nanalgesic therapy should be phased out gradually from time of first\r\npatch application; if necessary dose should be adjusted at 48\u201372-hour\r\nintervals in steps of 12\u201325\u00a0micrograms/hour. More than one patch may\r\nbe used at a time (but applied at the same time to\r\navoid confusion)\u2014consider additional or alternative analgesic therapy\r\nif dose required exceeds 300\u00a0micrograms/hour (important: it may take up to 25 hours for the plasma-fentanyl concentration to decrease by 50%\u2014replacement opioid therapy should\r\nbe initiated at a low dose and increased gradually).", "In view of the long duration\r\nof action, patients who have had severe side-effects should be monitored\r\nfor up to 24 hours after patch removal", "Breakthrough pain, see under oral preparations", "(from oral morphine to transdermal\r\nfentanyl) see Prescribing in Palliative\r\nCare", "Name[Effentora\u00ae (Cephalon) ] Tablets (buccal), fentanyl, sugar-free\r\n(as citrate) 100\u00a0micrograms, net price 4-tab pack = \u00a319.96,\r\n28-tab pack = \u00a3139.72; 200\u00a0micrograms, 4-tab pack = \u00a319.96, 28-tab\r\npack = \u00a3139.72; 400\u00a0micrograms, 4-tab pack = \u00a319.96, 28-tab pack =\r\n\u00a3139.72; 600\u00a0micrograms, 4-tab pack = \u00a319.96; 800\u00a0micrograms, 4-tab\r\npack = \u00a319.96, 28-tab pack = \u00a3139.72. \r\n Label:\r\n 2, counselling, administrationElectrolytes: Na+ 0.35\u00a0mmol/100\u00a0microgram\r\ntablet, Na+ 0.70\u00a0mmol/tablet (all other strengths)Dose\u00a0breakthrough pain in patients receiving opioid therapy\r\nfor chronic cancer pain, adult over\r\n18 years, initially 100\u00a0micrograms repeated if necessary 30 minutes\r\nafter first dose (no more than 2 dose units for each pain episode);\r\nadjust dose according to response\u2014consult product literature; max.\r\n800\u00a0micrograms per episode of breakthrough pain; leave at least 4\r\nhours between treatment of episodes of breakthrough pain during titrationCounselling\u00a0Place tablet between cheek and gum\r\nand leave to dissolve; if more than 1 tablet required, place second\r\ntablet on the other side of the mouth; tablet may alternatively be\r\nplaced under the tongue (sublingually)The Scottish Medicines\r\nConsortium has advised that Effentora\u00ae buccal tablets should\r\nbe restricted for the management of breakthrough pain in adult patients\r\nusing opioid therapy for chronic cancer pain, when other short-acting\r\nopioids are unsuitable" ], "pregnancy": "Pregnancy\u00a0\n(From 4.7.2 Opioid analgesics: British National Formulary)\nHepatic impairment\u00a0Opioid analgesics may precipitate coma in patients with hepatic impairment; avoid use or reduce dose.Renal impairment\u00a0The effects of opioid analgesia are increased and prolonged and there is increased cerebral sensitivity when patients with renal impairment are treated with opioid analgesics; avoid use or reduce dose.Pregnancy\u00a0Respiratory depression and withdrawal symptoms can occur in the neonate if opioid analgesics are used during delivery; also gastric stasis and inhalation pneumonia has been reported in the mother if opioid analgesics are used during labour." }, "LITHIUM CITRATE": { "indications": "Indications\u00a0see under Lithium Carbonate and notes above", "name": "LITHIUM CITRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.3 Antimanic drugs", "Lithium", "LITHIUM CITRATE" ], "cautions": "Cautions\u00a0see under Lithium Carbonate and notes aboveCounselling\u00a0Patients should maintain an adequate\r\nfluid intake and should avoid dietary changes which might reduce or\r\nincrease sodium intake; lithium treatment cards are available from\r\npharmacies (see above)", "side-effects": "Side-effects\u00a0see under Lithium Carbonate and notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3290.htm", "doses": [ "See under preparations below, adjusted to achieve serum-lithium\r\nconcentration of 0.4\u20131\u00a0mmol/litre as described under Lithium\r\nCarbonate", "Preparations vary widely in bioavailability; changing the preparation requires the same precautions as initiation\r\nof treatment", "(see Dose above for advice on bioavailability and serum\r\nmonitoring):Treatment and prophylaxis, initially 1.04\u20133.12\u00a0g\r\ndaily in 2 divided doses (elderly or patients less than 50\u00a0kg, 520\u00a0mg\r\ntwice daily); child not recommended" ], "pregnancy": "Pregnancy\u00a0see Lithium Carbonate" }, "INSULIN Human sequence": { "indications": "Indications\u00a0diabetes mellitus; diabetic ketoacidosis\r\n(section 6.1.3)", "name": "INSULIN Human sequence", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "6 Endocrine system", "6.1 Drugs used in diabetes", "6.1.1 Insulins", "6.1.1.1 Short-acting insulins", "INSULIN", "Human sequence" ], "cautions": "Cautions\u00a0section 6.1.1; interactions: Appendix 1 (antidiabetics)", "side-effects": "Side-effects\u00a0see notes above; transient\r\noedema; local reactions and fat hypertrophy at injection site; rarely hypersensitivity reactions including urticaria, rash;\r\noverdose causes hypoglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4090.htm", "doses": [ "By subcutaneous, intramuscular or intravenous injection or intravenous infusion, according to requirements", "Name[Humulin S\u00ae (Lilly) ] Injection, soluble insulin (human, prb) 100\u00a0units/mL. Net price 10-mL vial = \u00a315.68; 5 \u00d7 3-mL\r\ncartridge (for most Autopen\u00ae Classic or HumaPen\u00ae) = \u00a319.08Counselling\u00a0Show container to patient and confirm\r\nthat patient is expecting the version dispensed" ], "pregnancy": "Pregnancy\u00a0section 6.1.1" }, "13.2.1.1 Emollient bath and shower preparations With antimicrobials": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.2 Emollient and barrier preparations", "13.2.1 Emollients", "13.2.1.1 Emollient bath and shower preparations", "With antimicrobials" ], "name": "13.2.1.1 Emollient bath and shower preparations With antimicrobials", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/85566.htm", "doses": [ "Name[Oilatum\u00ae Plus (Stiefel)] Bath additive, benzalkonium chloride\r\n6%, triclosan 2%, light liquid paraffin 52.5%, net price 500\u00a0mL = \u00a36.98Excipients include acetylated\r\nlanolin alcohols, isopropyl palmitateDose\u00a0for topical treatment of eczema including eczema at risk\r\nfrom infection, add 1\u20132 capfuls/bath (infant over 6 months 1\u00a0mL); do not use undiluted" ] }, "ISOTRETINOIN - ORAL RETINOID FOR ACNE": { "indications": "Indications\u00a0\n(From Oral retinoid for acne: British National Formulary)\nOral retinoid for acne", "name": "ISOTRETINOIN - ORAL RETINOID FOR ACNE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.6 Acne and rosacea", "13.6.2 Oral preparations for acne", "Oral retinoid for acne", "ISOTRETINOIN" ], "cautions": "Cautions\u00a0\n(From Oral retinoid for acne: British National Formulary)\nOral retinoid for acne; also avoid blood donation during treatment and for at least 1 month after\r\ntreatment; history of depression; monitor all patients for depression; measure hepatic function and serum lipids before treatment, 1 month\r\nafter starting and then every 3 months (reduce dose or discontinue\r\nif transaminase or serum lipids persistently raised); discontinue if uncontrolled hypertriglyceridaemia or pancreatitis; diabetes; dry eye syndrome (associated with risk of keratitis); avoid keratolytics; interactions: Appendix 1 (retinoids)Pregnancy prevention\u00a0In women of child-bearing potential, exclude pregnancy up to 3 days\r\nbefore treatment (start treatment on day 2 or 3 of menstrual cycle),\r\nevery month during treatment (unless there are compelling reasons\r\nto indicate that there is no risk of pregnancy), and 5 weeks after\r\nstopping treatment\u2014perform pregnancy test in the first 3 days of the\r\nmenstrual cycle. Women must practise effective contraception\r\nfor at least 1 month before starting treatment, during treatment,\r\nand for at least 1 month after stopping treatment. Women\r\nshould be advised to use at least 1 method of contraception, but ideally\r\nthey should use 2 methods of contraception. Oral progestogen-only\r\ncontraceptives are not considered effective. Barrier methods should\r\nnot be used alone, but can be used in conjunction with other contraceptive\r\nmethods. Each prescription for isotretinoin should be limited to a\r\nsupply of up to 30 days\u2019 treatment and dispensed within 7 days of\r\nthe date stated on the prescription. Women should be advised to discontinue\r\ntreatment and to seek prompt medical attention if they become pregnant\r\nduring treatment or within 1 month of stopping treatment.Counselling\u00a0Warn patient to avoid\r\nwax epilation (risk of epidermal stripping), dermabrasion, and laser\r\nskin treatments (risk of scarring) during treatment and for at least\r\n6 months after stopping; patient should\r\navoid exposure to UV light (including sunlight) and use sunscreen\r\nand emollient (including lip balm) preparations from the start of\r\ntreatment.", "side-effects": "Side-effects\u00a0dryness of skin (with dermatitis, scaling, thinning,\r\nerythema, pruritus), epidermal fragility (trauma may cause blistering),\r\ndryness of lips (sometimes cheilitis), dryness of eyes (with blepharitis\r\nand conjunctivitis), dryness of pharyngeal mucosa (with hoarseness),\r\ndryness of nasal mucosa (with epistaxis), headache, myalgia and arthralgia,\r\nraised plasma-triglyceride concentration (risk of pancreatitis if\r\ntriglycerides above 9\u00a0mmol/litre), raised serum-cholesterol concentration\r\n(with reduced high-density lipoprotein concentration), raised blood-glucose\r\nconcentration, raised serum-transaminase concentration, haematuria\r\nand proteinuria, thrombocytopenia, thrombocytosis, neutropenia and\r\nanaemia; rarely mood changes (depression, aggressive\r\nbehaviour, anxiety, and very rarely psychosis and suicidal ideation)\u2014expert\r\nreferral required, skin reactions (including reports of Stevens-Johnson\r\nsyndrome and toxic epidermal necrolysis), alopecia; very rarely nausea, hepatitis, inflammatory bowel disease, gastro-intestinal\r\nhaemorrhage, haemorrhagic diarrhoea (discontinue treatment), benign\r\nintracranial hypertension (avoid concomitant tetracyclines), convulsions,\r\nmalaise, drowsiness, dizziness, diabetes mellitus, lymphadenopathy,\r\nhyperuricaemia, glomerulonephritis, tendinitis, arthritis, raised\r\nserum-creatine kinase concentration, bone changes (including reduced\r\nbone density, early epiphyseal closure, and skeletal hyperostosis)\r\nand calcification of tendons and ligaments following long-term administration,\r\nvisual disturbances (papilloedema, corneal opacities, cataracts, decreased\r\nnight vision, photophobia, blurred vision, colour blindness)\u2014expert\r\nreferral required and consider withdrawal, decreased tolerance to\r\ncontact lenses, keratitis, impaired hearing, Gram-positive infections\r\nof skin and mucous membranes, exacerbation of acne, acne fulminans,\r\nallergic vasculitis and granulomatous lesions, paronychia, hirsutism,\r\nnail dystrophy, skin hyperpigmentation, photosensitivity, increased\r\nsweating", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106181.htm", "doses": [ "adult and child over 12 years, 500\u00a0micrograms/kg daily (in\r\n1\u20132 divided doses), increased if necessary to 1\u00a0mg/kg daily, for 16\u201324\r\nweeks (repeat treatment course after a period of at least 8 weeks\r\nif relapse after first course); max. cumulative dose 150\u00a0mg/kg per\r\ncourse" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenic; effective contraception must be\r\nused\u2014see Pregnancy Prevention above" }, "INDAPAMIDE": { "indications": "Indications\u00a0essential hypertension", "name": "INDAPAMIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.2 Diuretics", "2.2.1 Thiazides and related diuretics" ], "cautions": "Cautions\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nCautions\u00a0See also section 2.2. Thiazides and related diuretics can exacerbate diabetes, gout, and systemic lupus erythematosus. Electrolytes should be monitored, particularly with high doses, long-term use, or in renal impairment. Thiazides and related diuretics should also be used with caution in nephrotic syndrome, hyperaldosteronism, and malnourishment; interactions: Appendix 1 (diuretics); also acute porphyria (%s\n(From 9.8.2 Acute porphyrias: British National Formulary)\n9.8.2 Acute porphyrias)", "side-effects": "Side-effects\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nSide-effects\u00a0Side-effects of thiazides and related diuretics include mild gastro-intestinal disturbances, postural hypotension, altered plasma-lipid concentrations, metabolic and electrolyte disturbances including hypokalaemia (see also notes above), hyponatraemia, hypomagnesaemia, hypercalcaemia, hyperglycaemia, hypochloraemic alkalosis, hyperuricaemia, and gout. Less common side-effects include blood disorders such as agranulocytosis, leucopenia, and thrombocytopenia, and impotence. Pancreatitis, intrahepatic cholestasis, cardiac arrhythmias, headache, dizziness, paraesthesia, visual disturbances, and hypersensitivity reactions (including pneumonitis, pulmonary oedema, photosensitivity, and severe skin reactions) have also been reported. ; also\r\npalpitation, diuresis with doses above 2.5\u00a0mg daily", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2339.htm", "doses": [ "2.5\u00a0mg daily in the morning" ], "pregnancy": "Pregnancy\u00a0\n(From 2.2.1 Thiazides and related diuretics: British National Formulary)\nPregnancy\u00a0Thiazides and related diuretics should not be used to treat gestational hypertension. They may cause neonatal thrombocytopenia, bone marrow suppression, jaundice, electrolyte disturbances, and hypoglycaemia; placental perfusion may also be reduced. Stimulation of labour, uterine inertia, and meconium staining have also been reported." }, "NEOMYCIN SULPHATE - ANTIBACTERIALS": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.3 Anti-infective eye preparations", "11.3.1 Antibacterials", "NEOMYCIN SULPHATE" ], "indications": "Indications\u00a0\n(From 11.3.1 Antibacterials: British National Formulary)\n11.3.1 Antibacterials", "name": "NEOMYCIN SULPHATE - ANTIBACTERIALS", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5393.htm", "doses": [ "See Administration in\r\nnotes above" ] }, "BETAINE": { "indications": "Indications\u00a0(specialist use only) adjunctive treatment of homocystinuria", "name": "BETAINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Homocystinuria", "BETAINE" ], "cautions": "Cautions\u00a0monitor plasma-methionine concentration\r\nbefore and during treatment\u2014interrupt treatment\r\nif symptoms of cerebral oedema occur", "side-effects": "Side-effects\u00a0less commonly gastro-intestinal\r\ndisorders, anorexia, reversible cerebral oedema (see Cautions), agitation,\r\ndepression, personality disorder, sleep disturbances, urinary incontinence,\r\nalopecia, and urticaria", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200938.htm", "doses": [ "adult and child over 10 years, 3\u00a0g twice daily, adjusted according\r\nto response; max. 20\u00a0g/day; child under\r\n10 years 50\u00a0mg/kg twice daily, dose and frequency adjusted according\r\nto response; max. 75\u00a0mg/kg twice daily " ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid unless essential\u2014limited\r\ninformation available" }, "CLOBETASONE BUTYRATE": { "indications": "Indications\u00a0eczemas and dermatitis of all types;\r\nmaintenance between courses of more potent corticosteroids", "name": "CLOBETASONE BUTYRATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "13 Skin", "13.4 Topical corticosteroids", "CLOBETASONE BUTYRATE" ], "cautions": "Cautions\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nCautions\u00a0Avoid prolonged use of a topical corticosteroid on the face (and keep away from eyes). In children avoid prolonged use and use potent or very potent corticosteroids under specialist supervision; extreme caution is required in dermatoses of infancy including nappy rash\u2014treatment should be limited to 5\u20137 days.Psoriasis\u00a0The use of potent or very potent corticosteroids in psoriasis can result in rebound relapse, development of generalised pustular psoriasis, and local and systemic toxicity.", "side-effects": "Side-effects\u00a0\n(From 13.4 Topical corticosteroids: British National Formulary)\nSide-effects\u00a0Mild and moderately potent topical corticosteroids are associated with few side-effects but care is required in the use of potent and very potent corticosteroids. Absorption through the skin can rarely cause adrenal suppression and even Cushing\u2019s syndrome (section 6.3.2), depending on the area of the body being treated and the duration of treatment. Absorption is greatest where the skin is thin or raw, and from intertriginous areas; it is increased by occlusion. Local side-effects include:spread and worsening of untreated infection;thinning of the skin which may be restored over a period after stopping treatment but the original structure may never return;irreversible striae atrophicae and telangiectasia;contact dermatitis;perioral dermatitis;acne, or worsening of acne or rosacea;mild depigmentation which may be reversible;hypertrichosis also reported.In order to minimise the side-effects of a topical corticosteroid, it is important to apply it thinly to affected areas only, no more frequently than twice daily, and to use the least potent formulation which is fully effective.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5895.htm", "doses": [ "Apply thinly 1\u20132 times daily" ] }, "TETRABENAZINE": { "indications": "Indications\u00a0see Dose", "name": "TETRABENAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.3 Drugs used in essential tremor, chorea, tics, and related disorders", "TETRABENAZINE" ], "cautions": "Cautions\u00a0avoid abrupt withdrawal; susceptibility to QT-interval\r\nprolongation (including concomitant use of drugs that prolong QT interval); interactions: Appendix 1 (tetrabenazine)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0dysphagia, nausea, vomiting, diarrhoea, constipation,\r\nhypotension, depression, anxiety, insomnia, confusion, drowsiness,\r\nparkinsonism; less commonly altered consciousness\r\nlevel, extrapyramidal disorders, hyperthermia; rarely neuroleptic malignant syndrome; very rarely rhabdomyolysis; also reported dry mouth, dyspepsia, bradycardia, disorientation,\r\nagitation, dizziness, amnesia, ataxia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/215692.htm", "doses": [ "Movement disorders due to Huntington\u2019s chorea, hemiballismus,\r\nsenile chorea, and related neurological conditions, initially 25\u00a0mg\r\n3 times daily, increased by 25\u00a0mg every 3\u20134 days as tolerated to max.\r\n200\u00a0mg daily", "Lower initial doses may be necessary in elderly\r\npatients", "Moderate to severe tardive dyskinesia, initially 12.5\u00a0mg daily,\r\ngradually increased according to response" ], "pregnancy": "Pregnancy\u00a0avoid unless essential\u2014toxicity in animal studies" }, "CARNITINE": { "indications": "Indications\u00a0primary and secondary carnitine deficiency", "name": "CARNITINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.8 Metabolic disorders", "9.8.1 Drugs used in metabolic disorders", "Carnitine deficiency", "CARNITINE" ], "cautions": "Cautions\u00a0diabetes mellitus; monitoring of free and acyl carnitine in blood\r\nand urine recommended", "side-effects": "Side-effects\u00a0nausea, vomiting, abdominal pain, diarrhoea, body\r\nodour; side-effects may be dose-related\u2014monitor tolerance during first\r\nweek and after any dose increase", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27711.htm", "doses": [ "Primary deficiency, by mouth, up to 200\u00a0mg/kg\r\ndaily in 2\u20134 divided doses; usual max. 3\u00a0g daily; by intravenous\r\ninjection over 2\u20133 minutes, up to 100\u00a0mg/kg daily in 2\u20134 divided doses", "Secondary deficiency, by intravenous injection over 2\u20133 minutes, 20\u00a0mg/kg after each dialysis session (dosage adjusted\r\naccording to plasma-carnitine concentration); maintenance\r\n(if benefit gained from first intravenous course), by mouth, 1\u00a0g daily" ], "pregnancy": "Pregnancy\u00a0appropriate to use; no evidence of teratogenicity\r\nin animal studies" }, "EMTRICITABINE": { "indications": "Indications\u00a0HIV infection\r\nin combination with other antiretroviral drugs", "name": "EMTRICITABINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Nucleoside reverse transcriptase inhibitors" ], "cautions": "Cautions\u00a0\n(From Nucleoside reverse transcriptase inhibitors: British National Formulary)\nNucleoside reverse transcriptase inhibitors; also on discontinuation, monitor patients with hepatitis B (risk of exacerbation\r\nof hepatitis); interactions: Appendix\r\n1 (emtricitabine)", "side-effects": "Side-effects\u00a0see notes above; also abnormal dreams, pruritus,\r\nand hyperpigmentation", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/128251.htm", "doses": [ "See preparations" ], "pregnancy": "Pregnancy\u00a0see Pregnancy" }, "MERCAPTOPURINE - DRUGS AFFECTING THE IMMUNE RESPONSE": { "indications": "Indications\u00a0see under Inflammatory Bowel disease; acute leukaemias and chronic\r\nmyeloid leukaemia (section 8.1.3)", "name": "MERCAPTOPURINE - DRUGS AFFECTING THE IMMUNE RESPONSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "MERCAPTOPURINE" ], "cautions": "Cautions\u00a0section 8.1.3", "side-effects": "Side-effects\u00a0section 8.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201299.htm", "doses": [ "Severe acute Crohn\u2019s disease, maintenance of remission\r\nof Crohn\u2019s disease or ulcerative colitis [unlicensed indications], adult over 18 years, by mouth, 1\u20131.5\u00a0mg/kg\r\ndaily; some patients may respond to lower doses" ], "pregnancy": "Pregnancy\u00a0section 8.1.3" }, "BRIMONIDINE TARTRATE With timolol": { "indications": "Indications\u00a0raised intra-ocular pressure, see notes above", "name": "BRIMONIDINE TARTRATE With timolol", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.6 Treatment of glaucoma", "Sympathomimetics", "BRIMONIDINE TARTRATE", "With timolol" ], "cautions": "Cautions\u00a0severe cardiovascular disease; cerebral or coronary\r\ninsufficiency, Raynaud\u2019s syndrome, thromboangiitis obliterans, postural hypotension, depression; children 2\u201312 years (increased risk of drowsiness); interactions: Appendix 1 (brimonidine)Driving\u00a0Drowsiness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0dry mouth, gastro-intestinal disturbances, taste\r\ndisturbances, upper respiratory symptoms, headache, drowsiness, dizziness,\r\nmalaise, ocular disturbances (including hyperaemia, burning, stinging,\r\npruritus, pain and dryness), visual disturbances, eyelid inflammation,\r\nphotophobia, corneal erosion and staining, conjunctival disturbances\r\n(including blanching, follicles, and infection); less commonly palpitation, arrhythmia, bradycardia, tachycardia, depression, nasal\r\ndryness; rarely dyspnoea; very rarely hypertension, hypotension, syncope, insomnia, iritis, miosis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129337.htm", "doses": [ "Apply twice daily", "Name[Combigan\u00ae (Allergan) ] Eye drops, brimonidine tartrate\r\n0.2%, timolol (as maleate) 0.5%, net price 5-mL = \u00a310.00Excipients include benzalkonium chlorideDose\u00a0for raised intra-ocular pressure in open-angle glaucoma\r\nand for ocular hypertension when beta-blocker alone not adequate,\r\napply twice daily" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if benefit outweighs\r\nrisk" }, "PANCREATIN": { "indications": "Indications\u00a0see above", "name": "PANCREATIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.9 Drugs affecting intestinal secretions", "1.9.4 Pancreatin", "PANCREATIN" ], "cautions": "Cautions\u00a0see above and (for higher-strength preparations) see below", "side-effects": "Side-effects\u00a0see above and (for higher-strength preparations)\r\nsee below", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2305.htm", "doses": [ "See preparations", "adult and child 5\u201310\u00a0g just before meals washed down or mixed\r\nwith a little milk or water" ], "pregnancy": "Pregnancy\u00a0not known to be harmful" }, "INDOMETACIN Modified release": { "indications": "Indications\u00a0pain and moderate\r\nto severe inflammation in rheumatic disease and other acute musculoskeletal\r\ndisorders; acute gout; dysmenorrhoea; premature labour (section 7.1.3)", "name": "INDOMETACIN Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs", "INDOMETACIN", "Modified release" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).; also epilepsy, parkinsonism, psychiatric disturbances; during prolonged therapy\r\nophthalmic and blood examinations particularly advisable; avoid rectal administration in proctitis and haemorrhoidsDriving\u00a0Dizziness may affect performance\r\nof skilled tasks (e.g. driving)", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.; rarely confusion,\r\nconvulsions, psychiatric disturbances, syncope, blood disorders (particularly\r\nthrombocytopenia), hyperglycaemia, peripheral neuropathy, intestinal\r\nstrictures; also reported hyperkalaemia; suppositories\r\nmay cause rectal irritation and occasional bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5231.htm", "doses": [ "By mouth, rheumatic disease, 50\u2013200\u00a0mg\r\ndaily in divided doses; child see BNF for Children", "Acute gout, 150\u2013200\u00a0mg daily in divided doses", "Dysmenorrhoea, up to 75\u00a0mg daily", "By rectum in suppositories, 100\u00a0mg\r\nat night and in the morning if required; child not recommended", "Combined oral and rectal treatment, max. total daily dose 150\u2013200\u00a0mg", "Name[Indometacin m/r preparations ] Capsules, m/r, indometacin 75\u00a0mg. \r\n Label:\r\n 21, 25, counselling, driving, see aboveBrands include Indolar SR\u00ae, Pardelprin\u00aeDose\u00a075\u00a0mg 1\u20132 times daily (once daily in dysmenorrhoea); child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "CHLORPROMAZINE HYDROCHLORIDE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS": { "indications": "Indications\u00a0see under Dose; antiemetic in palliative care\r\n(section 4.6)", "name": "CHLORPROMAZINE HYDROCHLORIDE - FIRST-GENERATION ANTIPSYCHOTIC DRUGS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.2 Drugs used in psychoses and related disorders", "4.2.1 Antipsychotic drugs", "First-generation antipsychotic drugs", "CHLORPROMAZINE HYDROCHLORIDE" ], "cautions": "Cautions\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nCautions\u00a0Antipsychotic drugs should be used with caution in patients with cardiovascular disease; an ECG may be required (see individual drug monographs), particularly if physical examination identifies cardiovascular risk factors, if there is a personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. Antipsychotic drugs should also be used with caution in Parkinson\u2019s disease (may be exacerbated by antipsychotics), epilepsy (and conditions predisposing to seizures), depression, myasthenia gravis, prostatic hypertrophy, or a susceptibility to angle-closure glaucoma. Caution is also required in severe respiratory disease and in patients with a history of jaundice or who have blood dyscrasias (perform blood counts if unexplained infection or fever develops). As photosensitisation may occur with higher dosages, patients should avoid direct sunlight. Patients with schizophrenia should have physical health monitoring (including cardiovascular disease risk assessment) at least once per year. Interactions: Appendix 1 (antipsychotics). Contra-indications\u00a0Antipsychotic drugs may be contra-indicated in comatose states, CNS depression, and phaeochromocytoma. ; also diabetes; patients should remain supine,\r\nwith blood pressure monitoring for 30 minutes after intramuscular\r\ninjection; dose adjustment may be necessary\r\nif smoking started or stopped during treatment", "side-effects": "Side-effects\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nSide-effects\u00a0Side-effects caused by antipsychotic drugs are common and contribute significantly to non-adherence to therapy.Extrapyramidal symptoms occur most frequently with the piperazine phenothiazines (fluphenazine, perphenazine, prochlorperazine, and trifluoperazine), the butyrophenones (benperidol and haloperidol), and the first-generation depot preparations. They are easy to recognise but cannot be predicted accurately because they depend on the dose, the type of drug, and on individual susceptibility.Extrapyramidal symptoms consist of:parkinsonian symptoms (including tremor), which may occur more commonly in adults or the elderly and may appear gradually;dystonia (abnormal face and body movements) and dyskinesia, which occur more commonly in children or young adults and appear after only a few doses;akathisia (restlessness), which characteristically occurs after large initial doses and may resemble an exacerbation of the condition being treated;tardive dyskinesia (rhythmic, involuntary movements of tongue, face, and jaw), which usually develops on long-term therapy or with high dosage, but it may develop on short-term treatment with low doses\u2014short-lived tardive dyskinesia may occur after withdrawal of the drug.Parkinsonian symptoms remit if the drug is withdrawn and may be suppressed by the administration of antimuscarinic drugs (section 4.9.2). However, routine administration of such drugs is not justified because not all patients are affected and they may unmask or worsen tardive dyskinesia.Tardive dyskinesia is the most serious manifestation of extrapyramidal symptoms; it is of particular concern because it may be irreversible on withdrawing therapy and treatment is usually ineffective. However, some manufacturers suggest that drug withdrawal at the earliest signs of tardive dyskinesia (fine vermicular movements of the tongue) may halt its full development. Tardive dyskinesia occurs fairly frequently, especially in the elderly, and treatment must be carefully and regularly reviewed.Most antipsychotic drugs, both first- and second-generation, increase prolactin concentration to some extent because dopamine inhibits prolactin release. Aripiprazole reduces prolactin because it is a dopamine-receptor partial agonist. Risperidone, amisulpride, and first-generation antipsychotic drugs are most likely to cause symptomatic hyperprolactinaemia. The clinical symptoms of hyperprolactinaemia include sexual dysfunction, reduced bone mineral density, menstrual disturbances, breast enlargement, and galactorrhoea. Sexual dysfunction is one of the main causes of non-adherence to antipsychotic medication; physical illness, psychiatric illness, and substance misuse are contributing factors. Antipsychotic-induced sexual dysfunction is caused by more than one mechanism. Reduced dopamine transmission and hyperprolactinaemia decrease libido; antimuscarinic effects can cause disorders of arousal; and alpha1-adrenoceptor antagonists are associated with erection and ejaculation problems in men. Risperidone and haloperidol commonly cause sexual dysfunction. If sexual dysfunction is thought to be antipsychotic-induced, dose reduction or switching medication should be considered. Antipsychotic drugs have been associated with cardiovascular side-effects such as tachycardia, arrhythmias (see under Monitoring), and hypotension (see below). QT-interval prolongation is a particular concern with pimozide (see ECG monitoring in pimozide monograph) and haloperidol. There is also a higher probability of QT-interval prolongation in patients using any intravenous antipsychotic drug, or any antipsychotic drug or combination of antipsychotic drugs with doses exceeding the recommended maximum. Cases of sudden death have occurred.Hyperglycaemia and sometimes diabetes can occur with antipsychotic drugs, particularly clozapine, olanzapine, quetiapine, and risperidone. All antipsychotic drugs may cause weight gain, but the risk and extent varies. Clozapine and olanzapine commonly cause weight gain.Hypotension and interference with temperature regulation are dose-related side-effects that are liable to cause dangerous falls and hypothermia or hyperthermia in the elderly. Clozapine, chlorpromazine, and quetiapine can cause postural hypotension (especially during initial dose titration) which may be associated with syncope or reflex tachycardia in some patients.Neuroleptic malignant syndrome (hyperthermia, fluctuating level of consciousness, muscle rigidity, and autonomic dysfunction with pallor, tachycardia, labile blood pressure, sweating, and urinary incontinence) is a rare but potentially fatal side-effect of all antipsychotic drugs. Discontinuation of the antipsychotic drug is essential because there is no proven effective treatment, but bromocriptine and dantrolene have been used. The syndrome, which usually lasts for 5\u20137 days after drug discontinuation, may be unduly prolonged if depot preparations have been used.Hypersalivation associated with clozapine therapy can be treated with hyoscine hydrobromide [unlicensed indication], provided that the patient is not at particular risk from the additive antimuscarinic side-effects of hyoscine and clozapine.Other side-effects include: drowsiness; apathy; agitation, excitement and insomnia; convulsions; dizziness; headache; confusion; gastro-intestinal disturbances; nasal congestion; antimuscarinic symptoms (such as dry mouth, constipation, difficulty with micturition, and blurred vision; very rarely, precipitation of angle-closure glaucoma); venous thromboembolism; blood dyscrasias (such as agranulocytosis and leucopenia), photosensitisation, contact sensitisation and rashes, and jaundice (including cholestatic); corneal and lens opacities, and purplish pigmentation of the skin, cornea, conjunctiva, and retina.Overdosage: for poisoning with phenothiazines and related compounds and atypical antipsychotic drugs, see Emergency Treatment of Poisoning.; also\r\nhyperglycaemia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3211.htm", "doses": [ "By mouth, schizophrenia and other\r\npsychoses, mania, short-term adjunctive management of severe anxiety,\r\npsychomotor agitation, excitement, and violent or dangerously impulsive\r\nbehaviour, initially 25\u00a0mg 3 times daily (or 75\u00a0mg\r\nat night), adjusted according to response, to usual maintenance dose\r\nof 75\u2013300\u00a0mg daily (but up to 1\u00a0g daily may be required in psychoses); elderly (or debilitated) third to half adult dose; child (childhood schizophrenia and autism) 1\u20136 years\r\n500\u00a0micrograms/kg every 4\u20136 hours (max. 40\u00a0mg daily); 6\u201312 years 10\u00a0mg\r\n3 times daily (max. 75\u00a0mg daily)", "Intractable hiccup, 25\u201350\u00a0mg 3\u20134 times daily", "By deep intramuscular injection,\r\n(for relief of acute symptoms but see also Cautions and Side-effects),\r\n25\u201350\u00a0mg every 6\u20138 hours; child 1\u20136\r\nyears 500\u00a0micrograms/kg every 6\u20138 hours (max. 40\u00a0mg daily); 6\u201312 years\r\n500\u00a0micrograms/kg every 6\u20138 hours (max. 75\u00a0mg daily)", "By rectum in suppositories as chlorpromazine\r\nbase 100\u00a0mg every 6\u20138 hours [unlicensed]", "For equivalent therapeutic effect 100\u00a0mg\r\nchlorpromazine base given rectally as a suppository\r\n\u2261 20\u201325\u00a0mg chlorpromazine hydrochloride by intramuscular injection \u2261 40\u201350\u00a0mg of chlorpromazine base or hydrochloride by mouth" ], "pregnancy": "Pregnancy\u00a0\n(From 4.2.1 Antipsychotic drugs: British National Formulary)\nPregnancy\u00a0Extrapyramidal effects and withdrawal syndrome have been reported occasionally in the neonate when antipsychotic drugs are taken during the third trimester of pregnancy. Following maternal use of antipsychotic drugs in the third trimester, neonates should be monitored for symptoms including agitation, hypertonia, hypotonia, tremor, drowsiness, feeding problems, and respiratory distress. See also under individual drugs." }, "ADALIMUMAB - DRUGS AFFECTING THE IMMUNE RESPONSE": { "indications": "Indications\u00a0see under Inflammatory Bowel Disease;\r\nankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis,\r\njuvenile idiopathic arthritis, (section 10.1.3); psoriasis (section 13.5.3)", "name": "ADALIMUMAB - DRUGS AFFECTING THE IMMUNE RESPONSE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.5 Chronic bowel disorders", "1.5.3 Drugs affecting the immune response", "Cytokine modulators" ], "cautions": "Cautions\u00a0section 10.1.3", "side-effects": "Side-effects\u00a0section 10.1.3", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/200265.htm", "doses": [ "By subcutaneous injection, severe active\r\nCrohn\u2019s disease, adult over 18 years,\r\ninitially 80\u00a0mg, then 40\u00a0mg 2 weeks after initial dose or accelerated regimen, initially 160\u00a0mg in 4 divided doses over 1\u20132\r\ndays, then 80\u00a0mg 2 weeks after initial dose; maintenance, 40\u00a0mg on\r\nalternate weeks, increased if necessary to 40\u00a0mg weekly; review treatment\r\nif no response within 12 weeks of initial dose" ], "pregnancy": "Pregnancy\u00a0section 10.1.3" }, "DIPHTHERIA-CONTAINING VACCINES": { "indications": "Indications\u00a0\n(From Diphtheria vaccines: British National Formulary)\nDiphtheria vaccines", "name": "DIPHTHERIA-CONTAINING VACCINES", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Diphtheria vaccines", "DIPHTHERIA-CONTAINING VACCINES" ], "cautions": "Cautions\u00a0see section 14.1 and see also individual components\r\nof vaccines", "side-effects": "Side-effects\u00a0see section 14.1; also\r\nrestlessness, sleep disturbances, and unusual crying in infants", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201091.htm", "doses": [ "See under preparations" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "HEPATITIS B VACCINE Single component": { "indications": "Indications\u00a0immunisation against hepatitis B infection", "name": "HEPATITIS B VACCINE Single component", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Hepatitis B vaccine", "HEPATITIS B VACCINE", "Single component" ], "cautions": "Cautions\u00a0see section 14.1", "side-effects": "Side-effects\u00a0see section 14.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129410.htm", "doses": [ "See under preparations", "Name[Fendrix\u00ae (GSK) ] Injection, suspension of hepatitis\r\nB surface antigen (prepared from yeast cells by recombinant DNA technique)\r\n40\u00a0micrograms/mL adsorbed onto aluminium phosphate, net price 0.5-mL\r\nprefilled syringe = \u00a338.10Excipients include traces of thiomersalDose\u00a0adult and child over 15 years with renal insufficiency (including\r\npre-haemodialysis and haemodialysis patients), by intramuscular\r\ninjection (see note below) 4 doses of 20\u00a0micrograms, the second\r\n1 month, the third 2 months and the fourth 6 months after the first\r\ndose; immunisation schedule and booster doses may need to be adjusted\r\nin those with low antibody concentration Note\u00a0Deltoid muscle is preferred site of injection;\r\nnot to be injected into the buttock (vaccine efficacy reduced)" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "CO-BENELDOPA Modified release": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-BENELDOPA Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-BENELDOPA", "Modified release" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3638.htm", "doses": [ "Expressed as levodopa, initially 50\u00a0mg\r\n3\u20134 times daily (100\u00a0mg 3 times daily in advanced disease), increased\r\nby 100\u00a0mg daily once or twice weekly according to response; usual\r\nmaintenance dose 400\u2013800\u00a0mg daily in divided doses; elderly initially 50\u00a0mg once or twice daily, increased\r\nby 50\u00a0mg daily every 3\u20134 days according to response", "When transferring patients from another levodopa/dopa-decarboxylase\r\ninhibitor preparation, the previous preparation should be discontinued\r\n12 hours before (although interval can be shorter)", "When administered as an adjunct to other\r\nantiparkinsonian drugs, once therapeutic effect apparent, the other\r\ndrugs may be reduced or withdrawn", "When switching from modified-release levodopa\r\nto dispersible co-beneldopa, reduce dose by approx. 30%", "Patients transferring from immediate-release levodopa/dopa-decarboxylase\r\ninhibitor preparations, initially 1 capsule substituted for every\r\n100\u00a0mg of levodopa and given at same dosage frequency,\r\nincreased every 2\u20133 days according to response; average increase of\r\n50% needed over previous levodopa dose and titration\r\nmay take up to 4 weeksSupplementary dose of immediate-release Madopar\u00ae may be needed with first morning dose; if response\r\nstill poor to total daily dose of Madopar\u00ae CR plus Madopar\u00ae corresponding to 1.2\u00a0g levodopa, consider alternative therapy", "Name[Madopar\u00ae CR (Roche) ] Capsules, m/r, dark green/light\r\nblue, co-beneldopa 25/100 (benserazide 25\u00a0mg (as\r\nhydrochloride), levodopa 100\u00a0mg), net price 100-cap\r\npack = \u00a312.77. \r\n Label:\r\n 5, 10, 14, 25, counselling, driving, see notes aboveDose\u00a0patients not taking levodopa/dopa-decarboxylase inhibitor\r\ntherapy, initially 1 capsule 3 times daily (max. initial dose 6 capsules\r\ndaily)Patients transferring from immediate-release levodopa/dopa-decarboxylase\r\ninhibitor preparations, initially 1 capsule substituted for every\r\n100\u00a0mg of levodopa and given at same dosage frequency,\r\nincreased every 2\u20133 days according to response; average increase of\r\n50% needed over previous levodopa dose and titration\r\nmay take up to 4 weeksSupplementary dose of immediate-release Madopar\u00ae may be needed with first morning dose; if response\r\nstill poor to total daily dose of Madopar\u00ae CR plus Madopar\u00ae corresponding to 1.2\u00a0g levodopa, consider alternative therapy" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "DICYCLOVERINE HYDROCHLORIDE Compound preparations": { "indications": "Indications\u00a0symptomatic relief of gastro-intestinal disorders characterised by\r\nsmooth muscle spasm", "name": "DICYCLOVERINE HYDROCHLORIDE Compound preparations", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.2 Antispasmodics and other drugs altering gut motility", "Antimuscarinics", "DICYCLOVERINE HYDROCHLORIDE", "Compound preparations" ], "cautions": "Cautions\u00a0\n(From Antimuscarinics: British National Formulary)\nCautions\u00a0Antimuscarinics should be used with caution in Down\u2019s syndrome, in children and in the elderly; they should also be used with caution in gastro-oesophageal reflux disease, diarrhoea, ulcerative colitis, autonomic neuropathy, acute myocardial infarction, hypertension, conditions characterised by tachycardia (including hyperthyroidism, cardiac insufficiency, cardiac surgery), pyrexia, and in individuals susceptible to angle-closure glaucoma. Interactions: Appendix 1 (antimuscarinics).", "side-effects": "Side-effects\u00a0see notes above", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2063.htm", "doses": [ "10\u201320\u00a0mg 3 times daily; infant 6\u201324 months 5\u201310\u00a0mg 3\u20134 times daily, 15 minutes before feeds; child 2\u201312 years 10\u00a0mg 3 times daily", "Name[Kolanticon\u00ae (Peckforton)] Gel, sugar-free,\r\ndicycloverine hydrochloride 2.5\u00a0mg, dried aluminium hydroxide 200\u00a0mg, light magnesium oxide 100\u00a0mg, simeticone 20\u00a0mg/5\u00a0mL, net\r\nprice 200\u00a0mL = \u00a32.21, 500\u00a0mL = \u00a33.94Dose\u00a0adult and child over 12 years, 10\u201320\u00a0mL every 4 hours when\r\nrequired" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; manufacturer advises use\r\nonly if essential" }, "FILGRASTIM": { "indications": "Indications\u00a0(specialist use only) reduction in duration of neutropenia and incidence\r\nof febrile neutropenia in cytotoxic chemotherapy for malignancy (except\r\nchronic myeloid leukaemia and myelodysplastic syndromes); reduction\r\nin duration of neutropenia (and associated sequelae) in myeloablative\r\ntherapy followed by bone-marrow transplantation; mobilisation of peripheral\r\nblood progenitor cells for harvesting and subsequent autologous or\r\nallogeneic infusion; severe congenital neutropenia, cyclic neutropenia,\r\nor idiopathic neutropenia and history of severe or recurrent infections\r\n(distinguish carefully from other haematological disorders, consult\r\nproduct literature); persistent neutropenia in advanced HIV infection", "name": "FILGRASTIM", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.6 Drugs used in neutropenia" ], "cautions": "Cautions\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nCautions\u00a0Granulocyte-colony stimulating factors should be used with caution in patients with pre-malignant or malignant myeloid conditions. Full blood counts including differential white cell and platelet counts should be monitored. Treatment should be withdrawn in patients who develop signs of pulmonary infiltration. There have been reports of pulmonary infiltrates leading to acute respiratory distress syndrome\u2014patients with a history of pulmonary infiltrates or pneumonia may be at higher risk. Granulocyte-colony stimulating factors should be used with caution in patients with sickle-cell disease. Spleen size should be monitored during treatment because there is a risk of splenomegaly and rupture.; also\r\nregular morphological and cytogenetic bone-marrow examinations recommended\r\nin severe congenital neutropenia (possible risk of myelodysplastic\r\nsyndromes or leukaemia); secondary acute myeloid leukaemia; osteoporotic bone disease (monitor bone\r\ndensity if given for more than 6 months); interactions: Appendix 1 (filgrastim)", "side-effects": "Side-effects\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nSide-effects\u00a0Side-effects of granulocyte-colony stimulating factors include gastro-intestinal disturbances, anorexia, headache, asthenia, fever, musculoskeletal pain, bone pain, rash, alopecia, injection-site reactions, thrombocytopenia, and leucocytosis. Less commonly chest pain can occur. Pulmonary side-effects, particularly interstitial pneumonia (see Cautions above), cutaneous vasculitis and acute febrile neutrophilic dermatosis have rarely been reported.; also\r\nmucositis, splenic enlargement, hepatomegaly, transient hypotension,\r\nepistaxis, urinary abnormalities (including dysuria, proteinuria,\r\nand haematuria), osteoporosis, exacerbation of rheumatoid arthritis,\r\nanaemia, transient decrease in blood glucose, pseudogout, and raised\r\nuric acid; very rarely splenic rupture", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4927.htm", "doses": [ "Cytotoxic-induced neutropenia, preferably by subcutaneous\r\ninjection or by intravenous infusion (over 30 minutes), adult and child, 500\u00a0000\u00a0units/kg daily started at least 24\r\nhours after cytotoxic chemotherapy, continued until neutrophil count\r\nin normal range, usually for up to 14 days (up to 38 days in acute\r\nmyeloid leukaemia)", "Myeloablative therapy followed by bone-marrow transplantation, by intravenous infusion over 30 minutes or over 24 hours or by subcutaneous infusion over 24 hours,\r\n1\u00a0million\u00a0units/kg daily, started at least 24 hours following cytotoxic\r\nchemotherapy (and within 24 hours of bone-marrow infusion), then adjusted\r\naccording to neutrophil count (consult product literature)", "Mobilisation of peripheral blood progenitor cells for autologous\r\ninfusion, used alone, by subcutaneous injection or by subcutaneous infusion over 24 hours,\r\n1 million\u00a0units/kg daily for 5\u20137 days; used following adjunctive myelosuppressive\r\nchemotherapy (to improve yield), by subcutaneous injection, 500\u00a0000\u00a0units/kg daily, started the day after completing chemotherapy\r\nand continued until neutrophil count in normal range; for timing of\r\nleucopheresis consult product literature", "Mobilisation of peripheral blood progenitor cells in normal\r\ndonors for allogeneic infusion, by subcutaneous injection, adult under 60 years and child over 16 years, 1\u00a0million units/kg daily for\r\n4\u20135 days; for timing of leucopheresis consult product literature", "Severe chronic neutropenia, by subcutaneous injection, adult and child, in severe congenital neutropenia, initially 1.2 million\u00a0units/kg\r\ndaily in single or divided doses (initially 500\u00a0000\u00a0units/kg daily\r\nin idiopathic or cyclic neutropenia), adjusted according to response\r\n(consult product literature)", "Persistent neutropenia in HIV infection, by subcutaneous\r\ninjection, initially 100\u00a0000\u00a0units/kg daily, increased as\r\nnecessary until neutrophil count in normal range (usual max. 400\u00a0000\u00a0units/kg\r\ndaily), then adjusted to maintain neutrophil count in normal range\r\n(consult product literature)" ], "pregnancy": "Pregnancy\u00a0\n(From 9.1.6 Drugs used in neutropenia: British National Formulary)\nPregnancy\u00a0There have been reports of toxicity in animal studies and manufacturers advise not to use granulocyte-colony stimulating factors during pregnancy unless the potential benefit outweighs the risk." }, "NEOMYCIN SULPHATE": { "indications": "Indications\u00a0bowel sterilisation before surgery, see also notes above", "name": "NEOMYCIN SULPHATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.1 Antibacterial drugs", "5.1.4 Aminoglycosides" ], "cautions": "Cautions\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nCautions\u00a0The main side-effects of the aminoglycosides are dose-related, therefore, care must be taken with dosage, and, whenever possible, parenteral treatment should not exceed 7 days. Renal function should be assessed before starting an aminoglycoside and during treatment. If possible, dehydration should be corrected before starting an aminoglycoside. Auditory and vestibular function should also be monitored during treatment. In order to optimise the dose and avoid toxicity, serum-aminoglycoside concentrations should be monitored in patients receiving parenteral aminoglycosides (see also Serum Concentrations). Ototoxicity and nephrotoxicity occur most commonly in the elderly; therefore, monitoring is particularly important in these patients, who may require reduced doses.Aminoglycosides should be used with caution in those with conditions characterised by muscular weakness (avoid in myasthenia gravis). Aminoglycosides should preferably not be given with potentially ototoxic diuretics (e.g. furosemide); if concurrent use is unavoidable administration of the aminoglycoside and of the diuretic should be separated by as long a period as practicable. Interactions: Appendix 1 (aminoglycosides), but too toxic for systemic use; interactions: Appendix 1 (aminoglycosides)", "side-effects": "Side-effects\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nSide-effects\u00a0The important side-effects of the aminoglycosides are nephrotoxicity and irreversible ototoxicity (including vestibular and auditory damage). Rash occurs commonly with streptomycin, but less frequently with the other aminoglycosides. Rare side-effects include nausea, vomiting, antibiotic-associated colitis, peripheral neuropathy, electrolyte disturbances (notably hypomagnesaemia on prolonged therapy, but also hypocalcaemia and hypokalaemia), and stomatitis. Side-effects reported very rarely include blood disorders and CNS effects (including headache, encephalopathy, and convulsions). Aminoglycosides may impair neuromuscular transmission; large doses given during surgery have been responsible for a transient myasthenic syndrome in patients with normal neuromuscular function., but poorly\r\nabsorbed on oral administration; increased salivation, impaired intestinal\r\nabsorption with steatorrhoea and diarrhoea", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3841.htm", "doses": [ "By mouth, pre-operative bowel sterilisation,\r\n1\u00a0g every hour for 4 hours, then 1\u00a0g every 4 hours for 2\u20133 days", "Hepatic coma, up to 4\u00a0g daily in divided doses usually for 5\u20137\r\ndays" ], "pregnancy": "Pregnancy\u00a0\n(From 5.1.4 Aminoglycosides: British National Formulary)\nPregnancy\u00a0There is a risk of auditory or vestibular nerve damage in the infant when aminoglycosides are used in the second and third trimesters of pregnancy. The risk is greatest with streptomycin (section 5.1.9). The risk is probably very small with gentamicin and tobramycin, but their use should be avoided unless essential (if given, serum-aminoglycoside concentration monitoring is essential)." }, "BISOPROLOL FUMARATE": { "indications": "Indications\u00a0see under Dose", "name": "BISOPROLOL FUMARATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "2 Cardiovascular system", "2.4 Beta-adrenoceptor blocking drugs", "BISOPROLOL FUMARATE" ], "cautions": "Cautions\u00a0see under Propranolol Hydrochloride; ensure heart failure not worsening before increasing\r\ndose", "side-effects": "Side-effects\u00a0see under Propranolol Hydrochloride; also less commonly depression, muscle weakness,\r\nand cramp; rarely hypertriglyceridaemia, syncope,\r\nand hearing impairment; very rarely conjunctivitis", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/2482.htm", "doses": [ "Hypertension and angina, usually 10\u00a0mg once daily (5\u00a0mg\r\nmay be adequate in some patients); max. 20\u00a0mg daily", "Adjunct in heart failure (section 2.5.5), initially 1.25\u00a0mg once daily (in the morning)\r\nfor 1 week then, if well tolerated, increased to 2.5\u00a0mg once daily\r\nfor 1 week, then 3.75\u00a0mg once daily for 1 week, then 5\u00a0mg once daily\r\nfor 4 weeks, then 7.5\u00a0mg once daily for 4 weeks, then 10\u00a0mg once daily;\r\nmax. 10\u00a0mg daily" ], "pregnancy": "Pregnancy\u00a0\n(From 2.4 Beta-adrenoceptor blocking drugs: British National Formulary)\nPregnancy\u00a0Beta-blockers may cause intra-uterine growth restriction, neonatal hypoglycaemia, and bradycardia; the risk is greater in severe hypertension. The use of labetalol in maternal hypertension is not known to be harmful, except possibly in the first trimester. Information on the safety of carvedilol during pregnancy is lacking. If beta-blockers are used close to delivery, infants should be monitored for signs of beta-blockade (and alpha-blockade with labetalol or carvedilol). For the treatment of hypertension in pregnancy, see section 2.5." }, "PHYTOMENADIONE Colloidal formulation": { "indications": "Indications\u00a0\n(From 9.6.6 Vitamin K: British National Formulary)\n9.6.6 Vitamin K", "name": "PHYTOMENADIONE Colloidal formulation", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.6 Vitamins", "9.6.6 Vitamin K", "PHYTOMENADIONE", "Colloidal formulation" ], "cautions": "Cautions\u00a0reduce dose in elderly; liver impairment (glycocholic acid may displace bilirubin); reports of anaphylactoid reactions", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/27678.htm", "doses": [ "See notes above and section 2.8.2", "Name[Konakion\u00ae MM (Roche) ] Injection, phytomenadione 10\u00a0mg/mL in a mixed micelles vehicle, net price 1-mL amp = 38pExcipients include glycocholic acid 54.6\u00a0mg/amp, lecithinCautions\u00a0reduce dose in elderly; liver impairment (glycocholic acid may displace bilirubin); reports of anaphylactoid reactionsNote\u00a0Konakion\u00ae MM may be administered by slow intravenous injection or by intravenous\r\ninfusion in glucose 5% (see Appendix 4); not for intramuscular injection" ], "pregnancy": "Pregnancy\u00a0use if potential benefit outweighs risk" }, "COLCHICINE": { "indications": "Indications\u00a0acute gout; short-term prophylaxis during initial therapy with allopurinol and uricosuric drugs; prophylaxis of familial\r\nMediterranean fever (recurrent polyserositis)", "name": "COLCHICINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.4 Gout and cytotoxic-induced hyperuricaemia", "Acute attacks of gout" ], "cautions": "Cautions\u00a0\n(From Acute attacks of gout: British National Formulary)\nAcute attacks of gout; also elderly; gastro-intestinal disease; cardiac disease; interactions: Appendix 1 (colchicine)", "side-effects": "Side-effects\u00a0nausea, vomiting, and abdominal pain; excessive\r\ndoses may cause profuse diarrhoea, gastro-intestinal haemorrhage,\r\nrash, renal and hepatic damage; rarely peripheral\r\nneuritis, inhibition of spermatogenesis, myopathy, alopecia, and with\r\nprolonged treatment blood disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/5312.htm", "doses": [ "Acute gout, 500\u00a0micrograms 2\u20134 times daily until\r\nsymptoms relieved, max. 6\u00a0mg per course; course not to be repeated\r\nwithin 3 days", "Prevention of gout attacks during initial treatment\r\nwith allopurinol or uricosuric drugs, 500\u00a0micrograms\r\ntwice daily", "Prophylaxis of familial\r\nMediterranean fever [unlicensed], 0.5\u20132\u00a0mg once daily", "BNF doses may differ from those in the product\r\nliterature" ], "pregnancy": "Pregnancy\u00a0avoid\u2014teratogenicity in animal studies" }, "MITOTANE": { "indications": "Indications\u00a0\n(From Mitotane: British National Formulary)\nMitotane", "name": "MITOTANE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Mitotane" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; risk of accumulation\r\nin overweight patients; monitor plasma-mitotane\r\nconcentration\u2014consult product literature; avoid in acute porphyria (section 9.8.2); interactions: Appendix 1 (mitotane)Driving\u00a0CNS effects may affect performance\r\nof skilled tasks (e.g. driving)Counselling\u00a0Warn patient to contact\r\ndoctor immediately if injury, infection, or illness occurs (because\r\nof risk of acute adrenal insufficiency)", "side-effects": "Side-effects\u00a0see section 8.1 and notes above; also gastro-intestinal disturbances\r\n(including nausea, vomiting, diarrhoea, epigastric discomfort), anorexia,\r\nliver disorders; hypercholesterolaemia, hypertriglyceridaemia; ataxia,\r\nconfusion, asthenia, myasthenia, paraesthesia, drowsiness, neuropathy,\r\ncognitive impairment, movement disorder, dizziness, headache; gynaecomastia;\r\n prolonged bleeding time, leucopenia, thrombocytopenia, anaemia; rash; rarely hypersalivation, hypertension, postural hypotension,\r\nflushing, pyrexia, haematuria, proteinuria, haemorrhagic cystitis,\r\nhypouricaemia, visual disturbances, and ocular disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129550.htm", "doses": [ "adult over 18 years, initially\r\n2\u20133\u00a0g daily, (up to 6\u00a0g daily in severe illness) in 2\u20133 divided doses,\r\nadjusted according to plasma-mitotane concentration; reduce dose or\r\ninterrupt treatment if signs of toxicity; discontinue if inadequate\r\nresponse after 3 months", "Plasma-mitotane concentration for optimum\r\nresponse 14\u201320\u00a0mg/litre" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014women of childbearing\r\nage should use effective contraception during and after treatment;\r\nsee also Pregnancy and Reproductive\r\nFunction" }, "BUPRENORPHINE WITH NALOXONE": { "indications": "Indications\u00a0adjunct in the treatment of opioid\r\ndependence", "name": "BUPRENORPHINE WITH NALOXONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.10 Drugs used in substance dependence", "4.10.3 Opioid dependence", "Opioid substitution therapy", "BUPRENORPHINE WITH NALOXONE" ], "cautions": "Cautions\u00a0see Buprenorphine", "side-effects": "Side-effects\u00a0see under Buprenorphine in section 4.7.2 and Naloxone in section 15.1.7; also weight loss, arthralgia; less commonly yawning, heat stroke, hypothermia, vaginitis,\r\nanaemia, thrombocytopenia, leucopenia, lymphadenopathy, leucocytosis,\r\nhaematuria, urinary calculus, conjunctivitis, exfoliative dermatitis,\r\nacne, skin nodule, alopecia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/213816.htm", "doses": [ "See under preparation", "expressed as buprenorphine, adult and child over 15 years, initially\r\n2\u20134\u00a0mg once daily (an additional dose of 2\u20134\u00a0mg may be administered\r\non day 1 depending on the individual patient\u2019s requirement), increased\r\nin steps of 2\u20138\u00a0mg according to response; max. 24\u00a0mg daily; total\r\nweekly dose may be divided and given on alternate days or 3 times\r\nweekly (but max. 24\u00a0mg daily)", "The Scottish Medicines\r\nConsortium has advised (February 2007) that Suboxone\u00ae should be restricted for use in patients in whom\r\nmethadone is not suitable" ], "pregnancy": "Pregnancy\u00a0reproductive toxicity in animal studies\u2014switch\r\nto buprenorphine; see also notes above" }, "PROMETHAZINE TEOCLATE": { "indications": "Indications\u00a0nausea, vertigo, labyrinthine disorders,\r\nmotion sickness (acts longer than the hydrochloride)", "name": "PROMETHAZINE TEOCLATE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.6 Drugs used in nausea and vertigo", "Antihistamines" ], "cautions": "Cautions\u00a0section 3.4.1; severe coronary artery disease; asthma, bronchitis, bronchiectasis; Reye\u2019s syndrome", "side-effects": "Side-effects\u00a0section 3.4.1", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3410.htm", "doses": [ "25\u201375\u00a0mg, max. 100\u00a0mg, daily; child 5\u201310 years, 12.5\u201337.5\u00a0mg daily", "Motion sickness prevention, adult and child over 10 years, 25\u00a0mg at\r\nbedtime on night before travel or 25\u00a0mg 1\u20132 hours\r\nbefore travel; child 5\u201310 years, 12.5\u00a0mg\r\nat bedtime on night before travel or 12.5\u00a0mg 1\u20132\r\nhours before travel", "Motion sickness treatment, adult and child over 10 years, 25\u00a0mg at\r\nonset, then 25\u00a0mg at bedtime for 2 days; child 5\u201310 years, 12.5\u00a0mg at onset, then 12.5\u00a0mg at bedtime for 2 days", "Severe vomiting during pregnancy [unlicensed], 25\u00a0mg at bedtime,\r\nincreased if necessary to max. 100\u00a0mg daily (but see also Vomiting During Pregnancy)" ], "pregnancy": "Pregnancy\u00a0section 3.4.1" }, "VENLAFAXINE Modified release": { "indications": "Indications\u00a0major depression, generalised anxiety disorder", "name": "VENLAFAXINE Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.3 Antidepressant drugs", "4.3.4 Other antidepressant drugs", "VENLAFAXINE", "Modified release" ], "cautions": "Cautions\u00a0heart disease (monitor\r\nblood pressure); diabetes; history of epilepsy; history or family history\r\nof mania; susceptibility to angle-closure glaucoma; concomitant use of drugs that increase risk of bleeding, history of bleeding disorders; interactions: Appendix 1 (venlafaxine)Driving\u00a0May affect performance of\r\nskilled tasks (e.g. driving)Withdrawal\u00a0Gastro-intestinal disturbances, headache,\r\nanxiety, dizziness, paraesthesia, tremor, sleep disturbances, and\r\nsweating are most common features of withdrawal if treatment stopped\r\nabruptly or if dose reduced markedly; dose should be reduced over\r\nseveral weeks", "side-effects": "Side-effects\u00a0constipation, nausea, anorexia, weight changes,\r\nvomiting; hypertension, palpitation, vasodilatation, changes in serum\r\ncholesterol; chills, yawning; dizziness, dry mouth, insomnia, nervousness,\r\ndrowsiness, asthenia, headache, abnormal dreams, anxiety, confusion,\r\nhypertonia, sensory disturbances, tremor; difficulty with micturition,\r\nsexual dysfunction, menstrual disturbances; visual disturbances, mydriasis\r\n(very rarely angle-closure glaucoma); sweating; less commonly bruxism, diarrhoea, taste disturbance, postural\r\nhypotension, arrhythmias, agitation, apathy, incoordination, hallucinations,\r\nmyoclonus, angioedema, urinary retention, bleeding disorders (including\r\necchymosis and gastro-intestinal haemorrhage), tinnitus, alopecia,\r\nphotosensitivity, and rash; rarely mania, hypomania,\r\nseizures, extrapyramidal symptoms including akathisia, urinary incontinence; also reported hepatitis, pancreatitis, hypotension, QT-interval\r\nprolongation, aggression, neuroleptic malignant syndrome, delirium,\r\nvertigo, syndrome of inappropriate anti-diuretic hormone secretion\r\n(see Hyponatraemia and Antidepressant\r\nTherapy),\r\nhyperprolactinaemia, blood dyscrasias, rhabdomyolysis, pruritus, urticaria,\r\nStevens-Johnson syndrome; suicidal behaviour (see Suicidal Behaviour and Antidepressant\r\nTherapy)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/208497.htm", "doses": [ "Depression, adult over\r\n18 years, initially 75\u00a0mg daily in 2 divided doses increased if necessary\r\nat intervals of at least 2 weeks; max. 375\u00a0mg daily; child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)", "Generalised anxiety disorder and social anxiety disorder, see\r\nunder preparations below", "Faster dose titration may be necessary in\r\nsome patients", "Faster dose titration may be necessary in\r\nsome patients", "Name[Venlafaxine m/r preparations ] Capsules, m/r, venlafaxine (as hydrochloride)\r\n75\u00a0mg; 150\u00a0mg. \r\n Label:\r\n 3, 25, counselling, drivingBrands include Alventa XL\u00ae, Bonilux XL\u00ae, Depefex\u00ae XL, Foraven XL\u00ae, Politid XL\u00ae, Ranfaxine XL\u00ae, Tifaxin XL\u00ae, Venaxx XL\u00ae, Vensir XL\u00ae, Winfex\u00ae XLDose\u00a0depression, adult over\r\n18 years, 75\u00a0mg once daily, increased if necessary at intervals of\r\nat least 2 weeks; max. 375\u00a0mg once daily; child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)Note\u00a0Faster dose titration may be necessary in\r\nsome patientsGeneralised anxiety disorder, adult over 18 years, 75\u00a0mg once daily, increased if necessary at intervals\r\nof at least 2 weeks; max. 225\u00a0mg once dailySocial anxiety disorder, adult over 18 years, recommended dose 75\u00a0mg once daily (no evidence of\r\ngreater efficacy at higher doses); dose may be increased at intervals\r\nof at least 2 weeks; max. 225\u00a0mg once daily\nTablets, m/r, venlafaxine (as hydrochloride)\r\n37.5\u00a0mg; 75\u00a0mg; 150\u00a0mg; 225\u00a0mg. \r\n Label:\r\n 3, 25, counselling, drivingBrands include Venlalic\u00ae XLDose\u00a0depression, adult over\r\n18 years, 75\u00a0mg once daily, increased if necessary at intervals of\r\nat least 2 weeks; max. 375\u00a0mg once daily; child under 18 years not recommended (see Depressive Illness in Children\r\nand Adolescents)Note\u00a0Faster dose titration may be necessary in\r\nsome patients" ], "pregnancy": "Pregnancy\u00a0avoid unless potential benefit outweighs risk\u2014toxicity\r\nin animal studies; risk of withdrawal effects in\r\nneonate" }, "HYDROXYPROPYL GUAR Single use": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "11 Eye", "11.8 Miscellaneous ophthalmic preparations", "11.8.1 Tear deficiency, ocular lubricants, and astringents", "HYDROXYPROPYL GUAR", "Single use" ], "indications": "Indications\u00a0dry eye conditions", "name": "HYDROXYPROPYL GUAR Single use", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/203900.htm", "doses": [ "Apply as required ", "Name[Systane\u00ae (Alcon)] Eye drops, hydroxypropyl guar, net\r\nprice 28 \u00d7 0.8\u00a0mL = \u00a34.66" ] }, "PIPERAZINE": { "indications": "Indications\u00a0threadworm and roundworm infections", "name": "PIPERAZINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.5 Anthelmintics", "5.5.1 Drugs for threadworms", "PIPERAZINE" ], "cautions": "Cautions\u00a0epilepsy; packs on sale to the general public carry a warning to avoid in epilepsy,\r\nor in liver or kidney disease, and to seek medical advice in pregnancy", "side-effects": "Side-effects\u00a0nausea, vomiting, colic, diarrhoea, allergic reactions\r\nincluding urticaria, bronchospasm, and rare reports of arthralgia,\r\nfever, Stevens-Johnson syndrome and angioedema; rarely dizziness,\r\nmuscular incoordination (\u2018worm wobble\u2019); drowsiness, nystagmus, vertigo,\r\nblurred vision, confusion and clonic contractions in patients with\r\nneurological or renal abnormalities", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/127943.htm", "doses": [ "See under Preparation, below" ], "pregnancy": "Pregnancy\u00a0not known to be harmful but manufacturer advises\r\navoid in first trimester" }, "CO-CARELDOPA Modified release": { "indications": "Indications\u00a0Parkinson\u2019s\r\ndisease, \n(From Levodopa: British National Formulary)\nLevodopa", "name": "CO-CARELDOPA Modified release", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.9 Drugs used in parkinsonism and related disorders", "4.9.1 Dopaminergic drugs used in Parkinson\u2019s disease", "Levodopa", "CO-CARELDOPA", "Modified release" ], "cautions": "Cautions\u00a0\n(From Levodopa: British National Formulary)\nCautions\u00a0Levodopa should be used with caution in severe pulmonary or cardiovascular disease (including history of myocardial infarction with residual arrhythmia), psychiatric illness (avoid if severe and discontinue if deterioration), endocrine disorders (including hyperthyroidism, Cushing\u2019s syndrome, diabetes mellitus, osteomalacia, and phaeochromocytoma), and in those with a history of convulsions or peptic ulcer. Levodopa should be used with caution in patients susceptible to angle-closure glaucoma, and in hepatic or renal impairment. Patients should be advised to avoid abrupt withdrawal (risk of neuroleptic malignant syndrome and rhabdomyolysis), and to be aware of the potential for excessive drowsiness and sudden onset of sleep (see Driving); interactions: Appendix 1 (levodopa).", "side-effects": "Side-effects\u00a0\n(From Levodopa: British National Formulary)\nSide-effects\u00a0Side-effects of levodopa include nausea, vomiting, taste disturbances, dry mouth, anorexia, arrhythmias, palpitations, postural hypotension, syncope, drowsiness (see Driving), fatigue, dementia, psychosis, confusion, euphoria, abnormal dreams, insomnia, depression (very rarely with suicidal ideation), anxiety, dizziness, dystonia, dyskinesia, and chorea.Less commonly weight changes, constipation, diarrhoea, hypersalivation, dysphagia, flatulence, hypertension, chest pain, oedema, hoarseness, ataxia, hand tremor, malaise, weakness, muscle cramps, and reddish discoloration of the urine and other body fluids may occur. Rare side-effects include abdominal pain, gastro-intestinal bleeding, duodenal ulcer, dyspepsia, phlebitis, dyspnoea, agitation, paraesthesia, bruxism, trismus, hiccups, neuroleptic malignant syndrome (associated with abrupt withdrawal), convulsions, reduced mental acuity, disorientation, headache, urinary retention, urinary incontinence, priapism, activation of malignant melanoma, leucopenia, haemolytic and non-haemolytic anaemia, thrombocytopenia, agranulocytosis, blurred vision, blepharospasm, diplopia, activation of Horner\u2019s syndrome, pupil dilatation, oculogyric crisis, flushing, alopecia, exanthema, Henoch-Sch\u00f6nlein purpura, and sweating; very rarely angle-closure glaucoma may occur; compulsive behaviour (see Impulse Control Disorders) and false positive tests for urinary ketones have also been reported.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3643.htm", "doses": [ "Expressed as levodopa, initially 100\u00a0mg (with carbidopa\r\n25\u00a0mg) 3 times daily, increased by 50\u2013100\u00a0mg (with carbidopa 12.5\u201325\u00a0mg)\r\ndaily or on alternate days according to response, up to 800\u00a0mg (with\r\ncarbidopa 200\u00a0mg) daily in divided doses", "Alternatively, initially 50\u2013100\u00a0mg (with carbidopa 10\u201312.5\u00a0mg)\r\n3\u20134 times daily, increased by 50\u2013100\u00a0mg daily or on alternate days\r\naccording to response, up to 800\u00a0mg (with carbidopa 80\u2013100\u00a0mg) daily\r\nin divided doses ", "Alternatively, initially 125\u00a0mg (with carbidopa 12.5\u00a0mg, as\r\n\u00bd tablet of co-careldopa 25/250) 1\u20132 times daily, increased by 125\u00a0mg\r\n(with carbidopa 12.5\u00a0mg) daily or on alternate days according to response", "When co-careldopa is used, the total daily dose of carbidopa\r\nshould be at least 70\u00a0mg. A lower dose may not achieve full inhibition\r\nof extracerebral dopa-decarboxylase, with a resultant\r\nincrease in side-effects.", "When transferring patients\r\nfrom another levodopa/dopa-decarboxylase inhibitor preparation, the\r\nprevious preparation should be discontinued at least 12 hours before", "Patients transferring from immediate-release levodopa/dopa-decarboxylase\r\ninhibitor preparations, 1 Sinemet\u00ae CR tablet twice daily can be substituted for a daily dose of levodopa 300\u2013400\u00a0mg in immediate-release Sinemet\u00ae tablets (substitute Sinemet\u00ae CR to provide approx. 10% more levodopa per day and extend dosing interval\r\nby 30\u201350%); dose and interval then adjusted according to response\r\nat intervals of not less than 3 days", "Name[Sinemet\u00ae CR (MSD) ] Tablets, m/r, peach, scored, co-careldopa 50/200 (carbidopa 50\u00a0mg (anhydrous), levodopa 200\u00a0mg), net price 60-tab pack = \u00a311.60. \r\n Label:\r\n 10, 14, 25, counselling, driving, see notes aboveDose\u00a0patients not receiving levodopa/dopa-decarboxylase inhibitor\r\ntherapy, initially, 1 Sinemet\u00ae CR tablet twice daily; both dose and interval then adjusted according\r\nto response at intervals of not less than 3 daysPatients transferring from immediate-release levodopa/dopa-decarboxylase\r\ninhibitor preparations, 1 Sinemet\u00ae CR tablet twice daily can be substituted for a daily dose of levodopa 300\u2013400\u00a0mg in immediate-release Sinemet\u00ae tablets (substitute Sinemet\u00ae CR to provide approx. 10% more levodopa per day and extend dosing interval\r\nby 30\u201350%); dose and interval then adjusted according to response\r\nat intervals of not less than 3 days" ], "pregnancy": "Pregnancy\u00a0\n(From Levodopa: British National Formulary)\nPregnancy\u00a0Levodopa should be used with caution in pregnancy\u2014toxicity has occurred in animal studies.Breast-feeding\u00a0Levodopa may suppress lactation. It is present in milk\u2014avoid." }, "NITROUS OXIDE": { "indications": "Indications\u00a0\n(From Nitrous oxide: British National Formulary)\nNitrous oxide", "name": "NITROUS OXIDE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "15 Anaesthesia", "15.1 General anaesthesia", "15.1.2 Inhalational anaesthetics", "Nitrous oxide" ], "cautions": "Cautions\u00a0\n(From Nitrous oxide: British National Formulary)\nNitrous oxide; interactions: Appendix 1 (anaesthetics, general)", "side-effects": "Side-effects\u00a0\n(From Nitrous oxide: British National Formulary)\nNitrous oxide", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/6582.htm", "doses": [ "Maintenance of anaesthesia in conjunction with other anaesthetic\r\nagents, by inhalation using suitable anaesthetic apparatus,\r\n50\u201366% in oxygen", "Analgesia, by inhalation using suitable apparatus,\r\nup to 50% in oxygen, according to the patient\u2019s needs" ], "pregnancy": "Pregnancy\u00a0may depress neonatal respiration if used during delivery" }, "CHOLERA VACCINE": { "indications": "Indications\u00a0\n(From Cholera vaccine: British National Formulary)\nCholera vaccine", "name": "CHOLERA VACCINE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "14 Immunological products and vaccines", "14.4 Vaccines and antisera", "Cholera vaccine" ], "cautions": "Cautions\u00a0see section 14.1 and notes above", "side-effects": "Side-effects\u00a0see section 14.1; also rarely respiratory symptoms such as rhinitis and cough; very rarely sore throat, insomnia", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201081.htm", "doses": [ "adult and child over 6 years 2 doses separated by an interval\r\nof 1\u20136 weeks; child 2\u20136 years 3 doses\r\neach separated by an interval of 1\u20136 weeks", "If more than 6 weeks have elapsed between\r\ndoses, the primary course should be restarted", "A single booster dose can be given 2 years after primary course\r\nfor adults and children over 6 years, and 6 months after primary course\r\nfor children 2\u20136 years. If more than 2 years have elapsed since the\r\nlast vaccination, the primary course should be repeated", "Dissolve effervescent sodium bicarbonate\r\ngranules in a glassful of water (approximately 150\u00a0mL). For adults\r\nand children over 6 years, add vaccine suspension to make one dose.\r\nFor child 2\u20136 years, discard half (approximately 75\u00a0mL) of the solution,\r\nthen add vaccine suspension to make one dose. Drink within 2 hours.\r\nFood, drink, and other oral medicines should be avoided for 1 hour\r\nbefore and after vaccination" ], "pregnancy": "Pregnancy\u00a0see section 14.1" }, "TEMSIROLIMUS": { "indications": "Indications\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nTemsirolimus is a protein kinase inhibitor licensed for the first-line treatment of advanced renal cell carcinoma (see NICE Guidance above), and for the treatment of relapsed or refractory mantle cell lymphoma. Hypersensitivity reactions, including some life-threatening and rare fatal reactions, are associated with temsirolimus therapy, usually during administration of the first dose. Symptoms include flushing, chest pain, dyspnoea, apnoea, hypotension, loss of consciousness, and anaphylaxis. Where possible, patients should receive an intravenous dose of antihistamine 30 minutes before starting the temsirolimus infusion. The infusion may have to be stopped temporarily for the treatment of infusion-related effects\u2014consult product literature for appropriate management. If adverse reactions are not managed with dose delays, a dose reduction should be considered\u2014consult product literature.", "name": "TEMSIROLIMUS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Protein kinase inhibitors", "TEMSIROLIMUS" ], "cautions": "Cautions\u00a0\n(From Protein kinase inhibitors: British National Formulary)\nTemsirolimus is a protein kinase inhibitor licensed for the first-line treatment of advanced renal cell carcinoma (see NICE Guidance above), and for the treatment of relapsed or refractory mantle cell lymphoma. Hypersensitivity reactions, including some life-threatening and rare fatal reactions, are associated with temsirolimus therapy, usually during administration of the first dose. Symptoms include flushing, chest pain, dyspnoea, apnoea, hypotension, loss of consciousness, and anaphylaxis. Where possible, patients should receive an intravenous dose of antihistamine 30 minutes before starting the temsirolimus infusion. The infusion may have to be stopped temporarily for the treatment of infusion-related effects\u2014consult product literature for appropriate management. If adverse reactions are not managed with dose delays, a dose reduction should be considered\u2014consult product literature.; monitor respiratory\r\nfunction; monitor blood lipids; interactions: Appendix 1 (temsirolimus)", "side-effects": "Side-effects\u00a0\n(From Side-effects of cytotoxic drugs: British National Formulary)\nSide-effects of cytotoxic drugs; also abdominal pain, diarrhoea,\r\nanorexia, taste disturbance, gastro-intestinal haemorrhage, bowel\r\nperforation, dysphagia; hypertension, oedema, thrombosis, thrombophlebitis;\r\ncough, dyspnoea, chest pain, interstitial lung disease, hypersensitivity\r\nreactions (\n(From Protein kinase inhibitors: British National Formulary)\nTemsirolimus is a protein kinase inhibitor licensed for the first-line treatment of advanced renal cell carcinoma (see NICE Guidance above), and for the treatment of relapsed or refractory mantle cell lymphoma. Hypersensitivity reactions, including some life-threatening and rare fatal reactions, are associated with temsirolimus therapy, usually during administration of the first dose. Symptoms include flushing, chest pain, dyspnoea, apnoea, hypotension, loss of consciousness, and anaphylaxis. Where possible, patients should receive an intravenous dose of antihistamine 30 minutes before starting the temsirolimus infusion. The infusion may have to be stopped temporarily for the treatment of infusion-related effects\u2014consult product literature for appropriate management. If adverse reactions are not managed with dose delays, a dose reduction should be considered\u2014consult product literature.); insomnia, anxiety, depression,\r\ndrowsiness, paraesthesia, dizziness, asthenia; increased susceptibility\r\nto infection (including urinary-tract infection and pneumonia), pyrexia;\r\nhyperglycaemia; renal failure; hypophosphataemia, hypokalaemia, hypercholesterolaemia,\r\nhyperlipidaemia; myalgia, arthralgia; eye disorders; rhinitis, epistaxis;\r\nskin disorders (including rash and acne), folliculitis, impaired wound\r\nhealing; less commonly intracerebral bleeding", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/201455.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid (toxicity in animal studies); ensure effective contraception during treatment in men\r\nand women; see also Pregnancy and Reproductive\r\nFunction" }, "MESNA": { "indications": "Indications\u00a0\n(From Urothelial toxicity: British National Formulary)\nUrothelial toxicity", "name": "MESNA", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "Treatment for cytotoxic-induced side-effects", "Urothelial toxicity" ], "cautions": "Cautions\u00a0false positive urinary ketones; false positive or false negative urinary erythrocytes", "side-effects": "Side-effects\u00a0nausea, vomiting, colic, diarrhoea, fatigue, headache,\r\nlimb and joint pains, depression, irritability, rash, hypotension\r\nand tachycardia; rarely hypersensitivity reactions\r\n(more common in patients with auto-immune disorders)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/4702.htm", "doses": [ "Calculated according to oxazaphosphorine (cyclophosphamide or ifosfamide) treatment\u2014consult product literature" ], "pregnancy": "Pregnancy\u00a0not known to be harmful; see also Pregnancy and Reproductive\r\nFunction" }, "TIPRANAVIR": { "indications": "Indications\u00a0HIV infection resistant to other protease inhibitors, in combination\r\nwith other antiretroviral drugs in patients previously treated with\r\nantiretrovirals", "name": "TIPRANAVIR", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "5 Infections", "5.3 Antiviral drugs", "5.3.1 HIV infection", "Protease inhibitors", "TIPRANAVIR" ], "cautions": "Cautions\u00a0\n(From Protease inhibitors: British National Formulary)\nCautions\u00a0Protease inhibitors are associated with hyperglycaemia and should be used with caution in diabetes (see Lipodystrophy Syndrome). Caution is also needed in patients with haemophilia who may be at increased risk of bleeding.; also patients at risk of increased bleeding from trauma, surgery or other\r\npathological conditions; concomitant use\r\nof drugs that increase risk of bleeding; interactions: Appendix 1 (tipranavir)Hepatotoxicity\u00a0Potentially life-threatening hepatotoxicity\r\nreported; monitor liver function before treatment then\r\nevery 2 weeks for 1 month, then every 3 months. Discontinue\r\nif signs or symptoms of hepatitis develop or if liver-function abnormality\r\ndevelops (consult product literature)", "side-effects": "Side-effects\u00a0see notes above; also dyspnoea, anorexia, peripheral\r\nneuropathy, influenza-like symptoms, renal impairment and photosensitivity; rarely dehydration", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129519.htm", "doses": [ "See preparations", "with low-dose ritonavir, 500\u00a0mg twice daily; child 12\u201318 years see BNF for Children", "with low-dose ritonavir, child 2\u201312 years see BNF for Children" ], "pregnancy": "Pregnancy\u00a0manufacturer advises use only if potential benefit\r\noutweighs risk\u2014toxicity in animal studies" }, "DEFERIPRONE": { "indications": "Indications\u00a0\n(From Iron overload: British National Formulary)\nIron overload", "name": "DEFERIPRONE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "9 Nutrition and blood", "9.1 Anaemias and some other blood disorders", "9.1.3 Drugs used in hypoplastic, haemolytic, and renal anaemias", "Iron overload", "DEFERIPRONE" ], "cautions": "Cautions\u00a0monitor neutrophil count weekly and discontinue treatment if neutropenia develops; monitor plasma-zinc concentrationBlood disorders\u00a0Patients or their\r\ncarers should be told how to recognise signs of neutropenia and advised to seek immediate medical attention if symptoms such\r\nas fever or sore throat develop", "side-effects": "Side-effects\u00a0gastro-intestinal disturbances (reducing dose\r\nand increasing gradually may improve tolerance), increased appetite;\r\nheadache; red-brown urine discoloration; neutropenia, agranulocytosis;\r\nzinc deficiency; arthropathy", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/89096.htm", "doses": [ "adult and child over 6 years 25\u00a0mg/kg 3 times daily (max. 100\u00a0mg/kg\r\ndaily)" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid before intended conception\r\nand during pregnancy\u2014teratogenic and embryotoxic in animal studies; contraception advised in women of child-bearing potential" }, "TEMOPORFIN": { "indications": "Indications\u00a0advanced head and neck squamous cell carcinoma refractory to, or\r\nunsuitable for, other treatments", "name": "TEMOPORFIN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Porfimer sodium and temoporfin" ], "cautions": "Cautions\u00a0see section 8.1; avoid exposure of skin and eyes\r\nto direct sunlight or bright indoor light for at least 15 days after\r\nadministration; avoid prolonged exposure\r\nof injection site arm to direct sunlight for 6 months after administration, if extravasation occurs protect area from light for\r\nat least 3 months; interactions: Appendix\r\n1 (temoporfin)", "side-effects": "Side-effects\u00a0see section 8.1; also constipation, dysphagia;\r\nhaemorrhage, oedema; giddiness, trismus, facial pain; injection site\r\npain, blistering, scarring, erythema, skin necrosis, hyperpigmentation,\r\nphotosensitivity (see Cautions above; sunscreens ineffective)", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/119668.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0toxicity in animal studies\u2014manufacturer\r\nadvises avoid pregnancy for at least 3 months after treatment; see\r\nalso Pregnancy and Reproductive\r\nFunction" }, "ISPAGHULA HUSK": { "indications": "Indications\u00a0see notes above", "name": "ISPAGHULA HUSK", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.6 Laxatives", "1.6.1 Bulk-forming laxatives", "ISPAGHULA HUSK" ], "cautions": "Cautions\u00a0adequate fluid intake should be maintained to avoid\r\nintestinal obstruction\u2014it may be necessary to supervise elderly or\r\ndebilitated patients or those with intestinal narrowing or decreased\r\nmotility", "side-effects": "Side-effects\u00a0flatulence, abdominal distension, gastro-intestinal\r\nobstruction or impaction; hypersensitivity reported", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/106214.htm", "doses": [ "See preparations below", "Preparations that swell in contact\r\nwith liquid should always be carefully swallowed with water and should\r\nnot be taken immediately before going to bed", "1 sachet in water 1\u20133 times daily, preferably after meals; child (but see section\r\n1.6) 6\u201312 years see BNF for Children" ] }, "DEXIBUPROFEN": { "indications": "Indications\u00a0pain and inflammation associated with osteoarthritis and other musculoskeletal\r\ndisorders; mild to moderate pain and inflammation including dysmenorrhoea\r\nand dental pain", "name": "DEXIBUPROFEN", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "10 Musculoskeletal and joint diseases", "10.1 Drugs used in rheumatic diseases and gout", "10.1.1 Non-steroidal anti-inflammatory drugs" ], "cautions": "Cautions\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nCautions and contra-indications\u00a0NSAIDs should be used with caution in the elderly (risk of serious side-effects and fatalities, see also Prescribing for the Elderly ), in allergic disorders (they are contra-indicated in patients with a history of hypersensitivity to aspirin or any other NSAID\u2014which includes those in whom attacks of asthma, angioedema, urticaria or rhinitis have been precipitated by aspirin or any other NSAID), and in coagulation defects. Long-term use of some NSAIDs is associated with reduced female fertility, which is reversible on stopping treatment. Caution is also required in patients with connective-tissue disorders, see Side-effects below.\u00a0In patients with cardiac impairment, caution is required since NSAIDs may impair renal function (see also Side-effects, below). All NSAIDs are contra-indicated in severe heart failure. Non-selective NSAIDs should be used with caution in uncontrolled hypertension, heart failure, ischaemic heart disease, peripheral artery disease, cerebrovascular disease, and when used long term in patients with risk factors for cardiovascular events. The selective inhibitors of cyclo-oxygenase-2 (celecoxib, etoricoxib, and parecoxib) are contra-indicated in ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, and mild to severe heart failure. The selective inhibitors of cyclo-oxygenase-2 should be used with caution in patients with a history of cardiac failure, left ventricular dysfunction, hypertension, in patients with oedema for any other reason, and in patients with risk factors for cardiovascular events.NSAIDs and cardiovascular eventsAll NSAID use (including cyclo-oxygenase-2 selective inhibitors) can, to varying degrees, be associated with a small increased risk of thrombotic events (e.g. myocardial infarction and stroke) independent of baseline cardiovascular risk factors or duration of NSAID use; however, the greatest risk may be in those receiving high doses long term.Cyclo-oxygenase-2 selective inhibitors, diclofenac (150\u00a0mg daily) and ibuprofen (2.4\u00a0g daily) are associated with an increased risk of thrombotic events. The increased risk for diclofenac is similar to that of licensed doses of etoricoxib. Naproxen (1\u00a0g daily) is associated with a lower thrombotic risk, and low doses of ibuprofen (1.2\u00a0g daily or less) have not been associated with an increased risk of myocardial infarction.The lowest effective dose of NSAID should be prescribed for the shortest period of time to control symptoms and the need for long-term treatment should be reviewed periodically.\u00a0All NSAIDs (including cyclo-oxygenase-2 selective inhibitors) are contra-indicated in patients with active gastro-intestinal ulceration or bleeding. Piroxicam, ketoprofen, and ketorolac are contra-indicated in patients with any history of gastro-intestinal bleeding, ulceration, or perforation. Other non-selective NSAIDs are contra-indicated in patients with a history of recurrent gastro-intestinal ulceration or haemorrhage (two or more distinct episodes), and in patients with a history of gastro-intestinal bleeding or perforation related to previous NSAID therapy (see also NSAIDS and Gastro-intestinal Events). While it is preferable to avoid NSAIDs in patients with active or previous gastro-intestinal ulceration or bleeding, and to withdraw them if gastro-intestinal lesions develop, nevertheless patients with serious rheumatic diseases (e.g. rheumatoid arthritis) are usually dependent on NSAIDs for effective relief of pain and stiffness. Patients at risk of gastro-intestinal ulceration (including the elderly), who need NSAID treatment should receive gastroprotective treatment; for advice on the prophylaxis and treatment of NSAID-associated gastro-intestinal ulcers, see section 1.3. NSAIDs should also be used with caution in Crohn\u2019s disease or ulcerative colitis, as these conditions may be exacerbated.For interactions of NSAIDs, see Appendix 1 (NSAIDs).", "side-effects": "Side-effects\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nSide-effects\u00a0Gastro-intestinal disturbances including discomfort, nausea, diarrhoea, and occasionally bleeding and ulceration occur (see also NSAIDs and Gastro-intestinal Events, below and Cautions above). Systemic as well as local effects of NSAIDs contribute to gastro-intestinal damage; taking oral formulations with milk or food, or using enteric-coated formulations, or changing the route of administration may only partially reduce symptoms such as dyspepsia.NSAIDs and gastro-intestinal eventsAll NSAIDs are associated with serious gastro-intestinal toxicity; the risk is higher in the elderly. Evidence on the relative safety of non-selective NSAIDs indicates differences in the risks of serious upper gastro-intestinal side-effects\u2014piroxicam (see also CHMP advice), ketoprofen, and ketorolac are associated with the highest risk; indometacin, diclofenac, and naproxen are associated with intermediate risk, and ibuprofen with the lowest risk (although high doses of ibuprofen have been associated with intermediate risk). Selective inhibitors of cyclo-oxygenase-2 are associated with a lower risk of serious upper gastro-intestinal side-effects than non-selective NSAIDs.Recommendations are that NSAIDs associated with a low risk e.g. ibuprofen are generally preferred, to start at the lowest recommended dose and not to use more than one oral NSAID at a time. See also Cautions and Contra-indications.The combination of a NSAID and low-dose aspirin can increase the risk of gastro-intestinal side-effects; this combination should be used only if absolutely necessary and the patient should be monitored closely.Other side-effects include hypersensitivity reactions (particularly rashes, angioedema, and bronchospasm\u2014see below), headache, dizziness, nervousness, depression, drowsiness, insomnia, vertigo, hearing disturbances such as tinnitus, photosensitivity, and haematuria. Blood disorders have also occurred. Fluid retention may occur (rarely precipitating congestive heart failure); blood pressure may be raised. AsthmaAny degree of worsening of asthma may be related to the ingestion of NSAIDs, either prescribed or (in the case of ibuprofen and others) purchased over the counter.Renal failure may be provoked by NSAIDs, especially in patients with pre-existing renal impairment (important, see Renal impairment, above). Rarely, papillary necrosis or interstitial fibrosis associated with NSAIDs can lead to renal failure. Hepatic damage, alveolitis, pulmonary eosinophilia, pancreatitis, visual disturbances, Stevens-Johnson syndrome, and toxic epidermal necrolysis are other rare side-effects. Induction of or exacerbation of colitis or Crohn\u2019s disease has been reported. Aseptic meningitis has been reported rarely with NSAIDs\u2014patients with connective-tissue disorders such as systemic lupus erythematosus may be especially susceptible.Overdosage: see Emergency Treatment of Poisoning, Analgesics, non-opioid.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/129442.htm", "doses": [ "600\u2013900\u00a0mg daily in up to 3 divided doses; increased if\r\nnecessary to max. 1.2\u00a0g daily (900\u00a0mg daily for dysmenorrhoea); max.\r\nsingle dose 400\u00a0mg (300\u00a0mg for dysmenorrhoea); child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From 10.1.1 Non-steroidal anti-inflammatory drugs: British National Formulary)\nPregnancy\u00a0Most manufacturers advise avoiding the use of NSAIDs during pregnancy or avoiding them unless the potential benefit outweighs the risk. NSAIDs should be avoided during the third trimester because use is associated with a risk of closure of fetal ductus arteriosus in utero and possibly persistent pulmonary hypertension of the newborn. In addition, the onset of labour may be delayed and its duration may be increased. See also individual monographs for celecoxib and etoricoxib." }, "TEMAZEPAM - HYPNOTICS": { "indications": "Indications\u00a0insomnia (short-term use; \n(From 4.1 Hypnotics and anxiolytics: British National Formulary)\nImportant: benzodiazepine indications Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or causing the patient unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness. The use of benzodiazepines to treat short-term \u2018mild\u2019 anxiety is inappropriate. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or causing the patient extreme distress.);\r\nsee also %s\n(From TEMAZEPAM: British National Formulary)\nTEMAZEPAM for peri-operative use", "name": "TEMAZEPAM - HYPNOTICS", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "4 Central nervous system", "4.1 Hypnotics and anxiolytics", "4.1.1 Hypnotics", "Benzodiazepines" ], "cautions": "Cautions\u00a0see under Nitrazepam", "side-effects": "Side-effects\u00a0see under Nitrazepam; shorter\r\nacting", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3152.htm", "doses": [ "10\u201320\u00a0mg at bedtime, exceptional circumstances 30\u201340\u00a0mg; elderly (or debilitated) 10\u00a0mg at bedtime, exceptional\r\ncircumstances 20\u00a0mg; child not recommended" ], "pregnancy": "Pregnancy\u00a0\n(From Benzodiazepines: British National Formulary)\nPregnancy\u00a0There is a risk of neonatal withdrawal symptoms when benzodiazepines are used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression." }, "ESOMEPRAZOLE": { "indications": "Indications\u00a0see under Dose", "name": "ESOMEPRAZOLE", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "1 Gastro-intestinal system", "1.3 Antisecretory drugs and mucosal protectants", "1.3.5 Proton pump inhibitors", "ESOMEPRAZOLE" ], "cautions": "Cautions\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nCautions\u00a0Proton pump inhibitors may mask the symptoms of gastric cancer; particular care is required in those presenting with \u2018alarm features\u2019 (see Dyspepsia), in such cases gastric malignancy should be ruled out before treatment. A proton pump inhibitor should be prescribed for appropriate indications at the lowest effective dose for the shortest period; the need for long-term treatment should be reviewed periodically.; interactions: Appendix 1 (proton pump inhibitors)", "side-effects": "Side-effects\u00a0\n(From 1.3.5 Proton pump inhibitors: British National Formulary)\nSide-effects\u00a0Side-effects of the proton pump inhibitors include gastro-intestinal disturbances (including nausea, vomiting, abdominal pain, flatulence, diarrhoea, constipation), and headache. Less frequent side-effects include dry mouth, peripheral oedema, dizziness, sleep disturbances, fatigue, paraesthesia, arthralgia, myalgia, rash, and pruritus. Other side-effects reported rarely or very rarely include taste disturbance, stomatitis, hepatitis, jaundice, hypersensitivity reactions (including anaphylaxis, bronchospasm), fever, depression, hallucinations, confusion, gynaecomastia, interstitial nephritis, hyponatraemia, hypomagnesaemia (with long-term treatment), blood disorders (including leucopenia, leucocytosis, pancytopenia, thrombocytopenia), visual disturbances, sweating, photosensitivity, alopecia, Stevens-Johnson syndrome, and toxic epidermal necrolysis. By decreasing gastric acidity, proton pump inhibitors may increase the risk of gastro-intestinal infections (including Clostridium difficile infection).Rebound acid hypersecretion and protracted dyspepsia may occur after stopping prolonged treatment with a proton pump inhibitor.", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88869.htm", "doses": [ "By mouth duodenal ulcer associated\r\nwith Helicobacter pylori, see Recommended Regimens for Helicobacter pylori Eradication", "NSAID-associated gastric ulcer, adult over 18 years, 20\u00a0mg once daily for 4\u20138 weeks; prophylaxis in patients\r\nwith an increased risk of gastroduodenal complications who require\r\ncontinued NSAID treatment, 20\u00a0mg daily", "Gastro-oesophageal reflux disease (in the presence of erosive\r\nreflux oesophagitis), adult and child over 12 years, 40\u00a0mg once daily for 4 weeks,\r\ncontinued for further 4 weeks if not fully healed or symptoms persist;\r\nmaintenance 20\u00a0mg daily; child 1\u201312\r\nyears, body-weight 10\u201320\u00a0kg, 10\u00a0mg once daily for 8 weeks; body-weight\r\nover 20\u00a0kg, 10\u201320\u00a0mg once daily for 8 weeks", "Symptomatic treatment of gastro-oesophageal reflux disease (in\r\nthe absence of oesophagitis), adult and child over 12 years, 20\u00a0mg once\r\ndaily for up to 4 weeks, then 20\u00a0mg daily when required; child 1\u201312 years, body-weight over 10\u00a0kg, 10\u00a0mg once\r\ndaily for up to 8 weeks", "Zollinger\u2013Ellison syndrome, adult over 18 years, initially 40\u00a0mg twice daily, adjusted according to\r\nresponse; usual range 80\u2013160\u00a0mg daily (above 80\u00a0mg in 2 divided doses)", "By intravenous injection over at\r\nleast 3 minutes or by intravenous infusion, adult over 18 years, gastro-oesophageal\r\nreflux disease, 40\u00a0mg once daily; symptomatic reflux disease without\r\noesophagitis, treatment of NSAID-associated gastric ulcer, prevention\r\nof NSAID-associated gastric or duodenal ulcer, 20\u00a0mg daily; continue\r\nuntil oral administration possible", "Severe peptic ulcer bleeding (following endoscopic\r\ntreatment), adult over 18 years, initial intravenous infusion of 80\u00a0mg over 30 minutes, then by continuous intravenous infusion 8\u00a0mg/hour for 72 hours,\r\nthen by mouth 40\u00a0mg once daily for 4 weeks" ], "pregnancy": "Pregnancy\u00a0manufacturer advises caution\u2014no information available" }, "TRASTUZUMAB": { "indications": "Indications\u00a0\n(From Trastuzumab: British National Formulary)\nTrastuzumab and product literature", "name": "TRASTUZUMAB", "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "8 Malignant disease and immunosuppression", "8.1 Cytotoxic drugs", "8.1.5 Other antineoplastic drugs", "Trastuzumab" ], "cautions": "Cautions\u00a0see section 8.1 and notes above; symptomatic heart\r\nfailure, history of hypertension, coronary artery disease, uncontrolled arrhythmiasCardiotoxicity\u00a0Monitor cardiac function\r\nbefore and during treatment\u2014for details of monitoring\r\nand managing cardiotoxicity, consult product literature", "side-effects": "Side-effects\u00a0see section 8.1; also\r\ninfusion-related side-effects (possibly delayed onset), including\r\nchills, fever, hypersensitivity reactions such as anaphylaxis, urticaria,\r\nand angioedema; gastro-intestinal symptoms, hepatitis; cardiotoxicity\r\n(see also above), chest pain, hypertension, hypotension; pulmonary\r\nevents (possibly delayed onset); headache, taste disturbance, anxiety,\r\nmalaise, depression, insomnia, drowsiness, dizziness, paraesthesia,\r\ntremor, asthenia, peripheral neuropathy, hypertonia, paresis; mastitis,\r\nurinary-tract infection; ecchymosis, oedema, weight loss; arthralgia,\r\nmyalgia, arthritis, bone pain, leg cramps; dry eye, increased lacrimation;\r\nrash, pruritus, sweating, dry skin, alopecia, acne, nail disorders", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/88513.htm", "doses": [ "See Doses" ], "pregnancy": "Pregnancy\u00a0manufacturer advises avoid\u2014oligohydramnios reported;\r\neffective contraception must be used during treatment and for 6 months\r\nafter stopping" }, "3.8 Aromatic inhalations": { "breadcrumbs": [ "Home", "BNF No. 63 (March 2012)", "3 Respiratory system" ], "name": "3.8 Aromatic inhalations", "fname": "/home/david/src/nhshackday/bnf-html/www.medicinescomplete.com/mc/bnf/current/3070.htm", "doses": [ "add one teaspoonful to a pint of hot, not boiling, water and inhale the vapour" ] } }