MEROMAX for patients with creatinine clearances < 51 mL/min.

Doses Prophylaxis of Mendelson's Syndrome: 150 mg 2 hrs before

Generic Name: Meropenem
PPD Drug Class: Anti-infectives/ Antibiotics/
Carbapenems
Needs a Yes
Prescription:
Indications: Used for the treatment of aerobic &
anaerobic Gr (+) & Gr (-) infections.
Recommended For dosage information of
Dosage: prescription medicine, please consult
with your doctor.
Contraindication: Hypersensitivity.
Precaution: Hypersensitivity to ß-lactam
antibiotics, renal & hepatic
impairment, pregnancy & lactation.
Drug Interaction: Reduces plasma concentration of
valproate & contraceptive effect of
oestrogens. Probenecid prolongs
effect of meropenem.
Side Effect: Nausea, vomiting, diarrhea
(antibiotic-associated colitis
reported), abdominal pain;
disturbance in liver function tests;
thrombocytopenia, positive Coomb's
test, eosinophilia, leucopenia,
neutropenia; headache, paresthesia;
hypersensitivity reactions including
rash, pruritus, urticaria, angioedema,
& anaphylaxis; convulsions, Steven-
Johnson syndrome & toxic epidermal
necrolysis; local reactions including
pain & thrombophlebitis at inj site.
are based on units of 500 mg, 1 g and 2 g, according to the
nature and severity of infection, pathogen sensitivity and
patient immune status.Creatinine clearance 26-50 mL/min:
one unit dose, every 12 hours.Creatinine clearance 10-25
mL/min: one-half unit dose, every 12 hours.Creatinine
clearance <10 mL/min: one-half unit dose, every 24
hours.Impaired hepatic function.Dosage adjustment is not
required.Use in elderly.Dose is guided by creatinine
clearance, as for patients with impaired renal function.
Children (3 months to 12 years).Usual dose: 10-40 mg/kg,
every 8 hours.Exceptions:Febrile neutropenia: 20 mg/kg,
every 8 hours.Meningitis: 40 mg/kg, every 8 hours.(There is
no experience in children with renal impairment)
Mechanism of Action
Meropenem exerts its action by penetrating bacterial cells
readily and interfering with the synthesis of vital cell wall
components, which leads to cell death.
Patient Education
This medication can only be given by infusion. Report
immediately any burning, pain, swelling, or redness at
infusion site. Maintain adequate hydration unless instructed to
restrict fluid intake. May cause nausea or vomiting (small,
frequent meals, frequent mouth care, chewing gum, or
sucking lozenges may help); diarrhea; or headache. Report
persistent GI distress, persistent diarrhea, mouth sores,
respiratory difficulty, headache, or CNS changes (agitation,
delirium). Breast-feeding precaution: Consult prescriber if
breast-feeding.
Geriatric Considerations
Adjust dose based on renal function.
anesthesia, and preferably 150 mg the previous evening. In
obstetric patients in labor, 150 mg every 6 hrs, but if general
anesthesia is required, it is recommended that a nonparticulate
antacid (eg, sodium citrate) be given in addition.
Children: The recommended oral dose for the treatment of
peptic ulcer in children is 2-4 mg/kg twice daily to a
maximum of 300 mg/day.
Renal Impairment: Accumulation of ranitidine with resulting
elevated plasma concentrations will occur in patients with
severe renal impairment (creatinine clearance <50 mL/min). It
is recommended that the daily dose of ranitidine in such
patients should be 150 mg. In patients undergoing chronic
ambulatory peritoneal dialysis or chronic hemodialysis,
ranitidine (150 mg) should be taken immediately after
dialysis.
Special Precautions
Malignancy: The possibility of malignancy should be
excluded before commencement of therapy in patients with
gastric ulcer (and if indications include dyspepsia; patient of
middle age and over with new or recently changed dyspeptic
symptoms) as treatment with ranitidine may mask symptoms
of gastric carcinoma.
Renal Disease: Ranitidine is excreted via the kidney and so
plasma levels of the drug are increased in patients with severe
renal impairment. The dosage should be adjusted as indicated
under Dosage & Administration: Renal Impairment.
Regular supervision of patients who are taking NSAIDs
concomitantly with ranitidine is recommended, especially in
the elderly and in those with a history of peptic ulcer.
Rare clinical reports suggest that ranitidine may precipitate
acute porphyric attacks. Ranitidine should therefore be
avoided in patients with a history of acute porphyria.

Raxide Effects on the Ability to Drive or Operate Machinery: None

Available Forms: Vial 500 mg (P1149.96), 1 g
(P1996.96)
Indication of Merrem IV:
Used for the treatment of infections in adults and children,
caused by bacteria known or suspected to be resistant to
commonly used antibiotics.Including: community and hospital
acquired lower respiratory infections, complicated urinary
tract infections, febrile neutropenia, intra-abdominal and
gynaecological (polymicrobial) infections), complicated skin
and connective tissue infections, meningitis, septicaemia.
Action of Merrem IV:
Microbiology.Meropenem belongs to the carbapenem group
of antibiotics, and acts by killing bacteria. It is active against a
wide variety of bacteria, including many of those which are
often resistant to commonly used
antibiotics.Pharmacokinetics:Elimination half life approaches
one hour, in patients with normal renal function.Close to 70%
of the intravenously administered dose is recovered in the
urine unchanged, within 12 hours. The only metabolite of
meropenem is microbiologically inactive.Meropenem
distributes well to most body fluids and compartments, and is
2% protein bound in the plasma.Meropenem is cleared by
haemodialysis (dose should be given at completion of
haemodialysis procedure to achieve optimal plasma
concentrations). There is no experience with peritoneal
dialysis
Dose advice of Merrem IV:
Usual dose: 500-1000 mg, every 8 hours.Exceptions: Febrile
neutropenia patients: 1 g, every 8 hours.Meningitis: 2 g, every
8 hours.Impaired renal function.Dosage adjustment is advised
Ranitidine HCl
Indications
Treatment of duodenal and gastric ulcer, including that
associated with H. pylori, NSAID-associated peptic ulcer,
postoperative ulcer, acute reflux esophagitis, Zollinger-Ellison
syndrome, chronic episodic dyspepsia, symptomatic relief in
gastroesophageal reflux disease and prophylaxis of
Mendelson's syndrome.
Dosage
Duodenal and Gastric Ulcer: 150 mg twice a day or 300 mg
at bedtime for 4 weeks. Maintenance Dose: 150 mg daily at
bedtime.
Duodenal Ulcer Associated with H. pylori Infection: 300
mg at bedtime or 150 mg twice a day given with amoxicillin
750 mg 3 times a day and metronidazole 3 times a day for 2
weeks. Continue ranitidine for further 2 weeks.
NSAID-Associated Peptic Ulceration: 150 mg twice a day
or 300 mg at bedtime for 8-12 weeks. Prophylaxis: 150 mg
twice a day given concomitantly with NSAID.
Postoperative Ulcer: 150 mg twice a day.
Acute Reflux Esophagitis: 150 mg twice a day or 300 mg at
bedtime.
Zollinger-Ellison Syndrome: 150 mg 3 times a day.
Chronic Episodic Dyspepsia: 150 mg twice a day for 6
weeks.
Symptomatic Relief in Gastroesophageal Reflux Disease:
150 mg twice a day for 2 weeks.
reported.
Use in pregnancy & lactation: Ranitidine crosses the
placenta and is excreted in human breast milk. Like other
drugs, ranitidine should only be used during pregnancy and
nursing if considered essential.
Adverse Drug Reactions
Adverse reactions to ranitidine are generally infrequent and
are reversible following a reduction of dosage or withdrawal
of therapy. The most common adverse effects reported have
been diarrhea, dizziness, tiredness, headache and rashes.
Reversible confusional states, especially in the elderly or in
seriously ill patients eg, those with renal failure, have
occasionally occurred. Other adverse effects which have been
reported rarely are hypersensitivity reactions and fever,
arthralgia and myalgia, blood disorders including
agranulocytosis or neutropenia and thrombocytopenia,
interstitial nephritis, hepatotoxicity, and cardiovascular
disorders.
Carcinogenicity: An association between H2-receptor
antagonists and gastric cancer has been proposed following
individual case reports, the finding of tumors in long-term
high-dose animal studies, and the possibility that nitrites and
nitroso compounds may be produced; but such proposals are
considered to have little clinical relevance. The excess risk of
gastric cancer reported in patients taking ranitidine decreases
with time and there is no evidence of any long-term
persistence of the effect.
Effects on the Blood: Leukopenia, thrombocytopenia and
pancytopenia have all been reported with ranitidine, with
neutropenia and agranulocytosis occurring most often.
Effects on the Cardiovascular System: Bradycardia,
atrioventricular block and cardiac arrest have been reported
rarely during ranitidine therapy; a positive inotropic effect,
without significant changes in heart rate or blood pressure, has A02BA02 - Ranitidine ; Belongs to the class of H2-receptor
also been reported in healthy subjects. antagonists. Used in the treatment of peptic ulcer and gastro-
oesophageal reflux disease (GERD).
Poison Schedule
Effects on the Liver: There have been some case reports of
Rx
ranitidine hepatotoxicity.
Presentation/Packing
Tab 150 mg (white to off-white, round, plain on both sides) x
Effects on the Nervous System: Ranitidine has been 100's. 300 mg x 30's. Amp 25 mg/mL x 2 mL x 5's.
associated with a number of adverse neurological effects
including confusion, loss of color vision, aggressiveness,
hallucinations and severe headache.
Dietary Considerations

Hypersensitivity: Respiratory strider and an urticarial rash.

Click to view ADR Monitoring Website Some products may contain phenylalanine and/or sodium.
Oral dosage forms may be taken with or without food.

Drug Interactions
Ranitidine, at blood levels produced by standard
recommended doses, does not inhibit the hepatic cytochrome
P-450-linked mixed function oxygenase system. Accordingly,
ranitidine in usual therapeutic doses does not potentiate the
actions of drugs which are inactivated by this enzyme; these
include diazepam, lignocaine, phenytoin, propranolol,
theophylline and warfarin. There is no evidence of an
interaction between ranitidine and amoxicillin and
metronidazole. If high doses (2 g) of sucralfate are co-
administered with ranitidine, the absorption of the latter may
be reduced. This effect is not seen if sucralfate is taken after
an interval of 2 hrs.
View more drug interactions for Raxide
Pregnancy Category (US FDA)
Patient Education
Do not take any new prescription or OTC medications or
herbal products during therapy without consulting healthcare
provider. Read Instructions carefully and take exactly as
directed; do not exceed recommended dose. May take several
days before you notice relief. Allow 1 hour between taking
any other antacids (if approved by prescriber) and ranitidine.
Avoid excessive alcohol. Follow diet as prescriber
recommends. May cause drowsiness, dizziness, or fatigue (use
caution when driving or engaging in tasks requiring alertness
until response to drug is known). Report immediately chest
pain or irregular heartbeat; skin rash; CNS changes (mental
confusion, hallucinations, somnolence); unusual persistent
weakness or lethargy; yellowing of skin or eyes; or change in
color of urine or stool. Breast-feeding precaution: Consult
prescriber if breast-feeding.

Category B: Either animal-reproduction studies have not

demonstrated a foetal risk but there are no controlled studies in Geriatric Considerations
pregnant women or animal-reproduction studies have shown an
adverse effect (other than a decrease in fertility) that was not
Ulcer healing rates and incidence of adverse effects are
confirmed in controlled studies in women in the 1st trimester
similar in the elderly, when compared to younger patients;
(and there is no evidence of a risk in later trimesters).
dosing adjustments not necessary based on age alone. Always
adjust dose based upon creatinine clearance. Serum half-life is
Storage increased to 3-4 hours in elderly patients. H2 blockers are the
preferred drugs for treating PUD in the elderly due to cost and
Store at temperatures not exceeding 30°C. Protect from light.
ease of administration. These agents are no less or more
effective than any other therapy. The preferred agents, due to
Shelf-Life: 24 months. side effects and drug interaction profile and pharmacokinetics
are ranitidine, famotidine, and nizatidine. Treatment for PUD
in the elderly is recommended for 12 weeks since their lesions
Mechanism of Action are larger; therefore, take longer to heal. This drug is
Pharmacology: Ranitidine is a rapidly-acting histamine H2- substantially cleared renally, and elderly, having decreased
receptor antagonist used in conditions where inhibition of renal function in general, should be monitored closely for
gastric acid secretion may be beneficial eg, gastric and adverse effects, especially CNS.
duodenal ulcers. It inhibits basal and stimulated secretion of
gastric acid, reducing both the volume and the acid and pepsin
content of the secretion. It has relatively long duration of
action and so a single 150-mg dose effectively suppresses
gastric acid secretion for 12 hrs.

Pharmacokinetics: Ranitidine is readily absorbed from the

GIT with peak concentrations in plasma occurring about 2 hrs
after administration by mouth. The bioavailability of
ranitidine following oral administration is about 50% due to
first-pass metabolism. The elimination t½ from plasma is
around 2-3 hrs and ranitidine is weakly bound, about 15%, to
plasma proteins.

A small proportion of ranitidine is metabolized in the liver to

the N-oxide, S-oxide and desmethylranitidine; the N-oxide is
the major metabolite but accounts for only about 4% of a
dose. Approximately 30% of an oral dose and 70% of an IV
dose is excreted unchanged in the urine in 24 hrs; there is
some excretion in the feces.

Ranitidine crosses the placental barrier and is excreted into

breast milk where concentrations are reported to be higher
than those in plasma. It does not readily cross the blood-brain
barrier but adverse effects on the nervous system have been
reported.

MIMS Class
Antacids, Antireflux Agents & Antiulcerants LOPEP
ATC Classification
Generic Name: Omeprazole
 Rx Presentation/Packing Potentially Fatal: Potentially serious hypokalaemia after
PPD Drug Class: Gastro/ Drugs used in acid-peptic
Form Packing/Price Photo large doses.
disease/ Gastric Antisecretory Drugs/
Proton Pump Inhibitors Lopep capsule Lopep 20 mg x 20's (P640) Drug Interactions
Diuretics, corticosteroids and xanthines may augment
Lopep vial Lopep 40 mg/10 mL x 1's
Needs a Yes hypokalaemia. CV effects potentiated by MAOIs, TCAs,
Prescription: sympathomimetics. Increases absorption of sulfamethoxazole
when used together. May markedly increase heart rate and BP
Indications: Peptic ulcer. Conditions where when used with atomoxetine. Reduces serum levels of
Patient Education
inhibition of gastric acid secretion may digoxin. Hypokalaemia induced by salbutamol increases the
be beneficial, including aspiration risk of digitalis toxicity. BP should be closely monitored if
syndrome, GERD and Zollinger- Consult prescriber before taking any herbal or OTC linezolid is used concurrently with salbutamol.
Ellison syndrome and stress ulcer medications. Take as directed, before eating. Do not crush or Click to view more Drug Interactions
prophylaxis. chew capsules. Delayed release capsule may be opened and Pregnancy Category (US FDA)
contents added to applesauce. Avoid alcohol. You may
Recommended For dosage information of prescription experience anorexia; small frequent meals may help to
Dosage: medicine, please consult with your maintain adequate nutrition. Report severe headache,
doctor. unresolved severe diarrhea, or abdominal pain.
Pregnancy/breast-feeding precautions: Inform prescriber if Category C: Either studies in animals have revealed adverse
Precaution: Possibility of malignancy should be you are or intend to become pregnant. Breast-feeding is not effects on the foetus (teratogenic or embryocidal or other) and
excluded since omeprazole may mask recommended. there are no controlled studies in women or studies in women
symptoms and delay diagnosis. and animals are not available. Drugs should be given only if
the potential benefit justifies the potential risk to the foetus.
Drug Interaction: Diazepam, phenytoin, warfarin. Geriatric Considerations Storage
Side Effect: Nausea, diarrhea, constipation, For special storage condition to ensure optimal shelf-life of
flatulence, skin rashes and headache. In clinical trials, the incidence of side effects in the elderly is medicine... click to view
no different than that of younger adults (?65 years) despite Mechanism of Action
Available Forms: Cap 20 mg (P29.00). Vial 40 mg/10 slight decrease in elimination and increase in bioavailability. For details of the mechanism of action, pharmacology and
mL (P465.00). Bioavailability may be increased in the elderly (?65 years of pharmacokinetics and toxicology ... click to view
age), however, dosage adjustments are not necessary. MIMS Class
Manufacturer: Zynova Pharmaceuticals Antiasthmatic & COPD Preparations / Drugs Acting on the
Uterus
Distributor: RBC-MDC Corporation Mechanism of Action ATC Classification
R03AC02 - salbutamol; Belongs to the class of adrenergic
Proton pump inhibitor; suppresses gastric basal and stimulated inhalants, selective beta-2-adrenoreceptor agonists. Used in
acid secretion by inhibiting the parietal cell H+/K+ ATP the treatment of obstructive airway diseases.
pump R03CC02 - salbutamol; Belongs to the class of adrenergics for
Contents
systemic use, selective beta-2-adrenoreceptor agonists. Used
in the treatment of obstructive airway diseases.
Omeprazole Salbutamol
Indications
Peptic ulcer. Used in conditions where inhibition of gastric Indication ontents
acid secretion may be beneficial, including acid aspiration Listed in Dosage. Per 2.5 mL pulmoneb Ipratropium Br 500 mcg, salbutamol
syndrome, GERD & Zollinger-Ellison syndrome & stress Dosage sulfate 2.5 mg. Per actuation Ipratropium Br 21 mcg,
ulcer prophylaxis. salbutamol sulfate 120 mcg
Adult: PO Acute bronchospasm 2-4 mg (up to 8 mg) 3-4
Dosage times/day. Extended release 8 mg twice daily. IV Severe Indications
Cap Duodenal ulcer 20 mg once a day for 2-4 wk. Gastric bronchospasm 250 mcg via inj or infusion. Higher doses may Management of reversible bronchospasm associated w/
ulcer 20 mg once a day for 4-8 wk. Reflux esophagitis 20 mg be used in respiratory failure. Uncomplicated premature obstructive airway diseases eg bronchial asthma, COPD.
once a day for 4 wk. Peptic ulcer 20 or 40 mg in severe cases labour Arrest of preterm labor between 24 and 33 wk of Dosage
for 4 wk. Zollinger-Ellison syndrome Initially 60-120 mg gestation: Initial: 10 mcg/min via infusion, increase rate Pulmoneb Adult, adolescent >12 yr & elderly Treatment of
daily until complete cure. >80 mg dosage should be divided & gradually at 10 min intervals until there is response; then acute attacks 1-2 pulmoneb. Maintenance: 1 pulmoneb 6-8
given bid. Inj Reflux esophagitis, duodenal & gastric ulcer, increase slowly until contractions cease. Maintain rate for 1 hr hrly. Childn 2-12 yr 3 drops/kg/dose. Max: 2.5 mg of
Zollinger-Ellison syndrome: Patients unable to take oral after contractions have stopped, then gradually reduce rate by salbutamol 6-8 hrly. MDI Adult & childn >12 yr 2 actuations
therapy 40 mg IV once daily up to 5 days. Acid aspiration 50% at 6 hrly intervals. Usual: 10-45 mcg/min. Avoid 6 hrly. Max: 12 actuations in 24 hr.
prophylaxis 40 mg IV 1 hr pre-op. If surgery is delayed for prolonged therapy. IM/SC Severe bronchospasm 500 mcg 4
>2 hr, give additional 40 mg. Impaired hepatic function 10- Overdosage
hrly if needed. Inhalation Acute bronchospasm As aerosol: View Duavent overdosage for action to be taken in the event
20 mg once daily. 100 or 200 mcg 3-4 times/day. 2 puffs may be given prior to of an overdose.
Administration exertion to prevent exercise-induced bronchospasm. Acute
Should be taken with food (Preferably taken in the morning Contraindications
severe asthma As MDI: 4-6 inhalations every 10-20 mins.
just before breakfast.). Hypertrophic obstructive cardiomyopathy or tachyarrythmia.
Severe bronchospasm Via nebuliser: 2.5-5 mg up to 4
Special Precautions Hypersensitivity to soya lecithin or related food products (for
times/day.
MDI).
Possibility of malignancy should be excluded since Click to view Dosage by Indications
Warnings
omeprazole may mask symptoms & delay diagnosis. Administration
For additional cautionary notes to warn of the potential risk of
Adverse Drug Reactions Should be taken on an empty stomach. (Take 1 hr before or 2
using the medicine... click to view
Nausea, diarrhea, constipation, flatulence, skin rash, hr after meals.)
headache. Special Precautions
Overdosage
View ADR Monitoring Website Narrow-angle glaucoma, prostatic hypertrophy or bladder-
For action to be taken in the event of accidental overdose ...
neck obstruction. Convulsive disorders, hyperthyroidism,
Drug Interactions click to view
diabetes mellitus. Patients unusually responsive to
Diazepam, phenytoin, warfarin. Contraindications sympathomimetic amines. Hepatic or renal disease. Pregnancy
View more drug interactions with Lopep Eclampsia and severe pre-eclampsia; intra-uterine infection, & lactation. Paradoxical bronchospasm (for MDI only).
Pregnancy Category (US FDA) intra-uterine foetal death, antepartum haemorrhage, placenta Adverse Drug Reactions
praevia and cord compression, threatened miscarriage, cardiac
Headache,pain, influenza, chest pain; nausea. Bronchitis,
disease.
dyspnea, coughing, pneumonia, bronchospasm, pharyngitis,
Special Precautions sinusitis, rhinitis.
Pregnancy; mild to moderate pre-eclampsia. Arrhythmias, View ADR Monitoring Website
Category C: Either studies in animals have revealed adverse hyperthyroidism, hypertension, DM, myocardial Drug Interactions
effects on the foetus (teratogenic or embryocidal or other) and insufficiency, susceptibility to QT-interval prolongation.
there are no controlled studies in women or studies in women Antagonism w/ β-blockers. MAOIs or TCAs may potentiate
Monitor serum potassium levels. In women treated for
and animals are not available. Drugs should be given only if the effect of salbutamol on CVS. Potential additive effects w/
premature labour, monitor hydration status, cardiac and
the potential benefit justifies the potential risk to the foetus. anticholinergic agents. β-adrenergic agents & diuretics.
respiratory function. Minimise volume of infusion fluid.
View more drug interactions with Duavent
MIMS Class Discontinue treatment if patient develops signs of pulmonary
oedema. Pregnancy Category (US FDA)
Antacids, Antireflux Agents & Antiulcerants
ATC Classification Adverse Drug Reactions
A02BC01 - Omeprazole ; Belongs to the class of proton pump Fine skeletal muscle tremor especially hands, tachycardia,
inhibitors. Used in the treatment of peptic ulcer and gastro- palpitations, muscle cramps, headache, paradoxical
oesophageal reflux disease (GERD). bronchospasm, angioedema, urticaria, hypotension and
Category C: Either studies in animals have revealed adverse
Poison Schedule collapse.
effects on the foetus (teratogenic or embryocidal or other) and
there are no controlled studies in women or studies in women
and animals are not available. Drugs should be given only if
the potential benefit justifies the potential risk to the foetus.
Storage
View Duavent storage conditions for details to ensure optimal
shelf-life.
Description
View Duavent description for details of the chemical structure
and excipients (inactive components).
Mechanism of Action
View Duavent mechanism of action for pharmacodynamics
and pharmacokinetics details.
MIMS Class
Antiasthmatic & COPD Preparations
ATC Classification
R03AK04 - Salbutamol and other drugs for obstructive airway
diseases ; Belongs to the class of adrenergics and other
inhalants used in the treatment of obstructive airway diseases.
Poison Schedule
Rx
Presentation/Packing
Form Packing/Price Photo
Duavent Metered-
Duavent 200 doses
dose inhaler
Duavent Pulmoneb
Duavent 2.5 mL x 20's (P495)
solution