Daftar Obat Generik

Kitab Daftar Nama Obat Generik

by:

Faik Fauzi&Mulachella Genghis Khun

DAFTAR NAMA GENERIK OBAT Klik Cepat ke: Daftar Isi, Index (Sebaiknya baca Panduan dulu) Saluran Cerna Kardiovaskuler Saluran Nafas Neuromuskuler Hormon Antibakteri Saluran Kemih Metabolik Vitamin & Mineral Preparat Mata, Kulit, Telinga, Mulut Imunologi

FaiK Fauzi MuLaCheLLa em@il: [email protected] Blog: faikshare.blogspot.com faik-mulachella.blogspot.com

Nama Generik Obat, Kembali ke: Awal, Daftar Isi, Index

“All high-street pharmacists are obliged by law to dispense whatever the doctor has written on the prescription. If your doctor has prescribed a medicine by its brand name, your pharmacist must dispense that brand. However, if a medicine has been prescribed by its generic name, your pharmacist can dispense whatever version of the medicine they have available, because each version will have the same therapeutic effect…. …There are a few exceptions to this. There are a handful of medicines that your doctor must prescribe by the brand name. These include:  modified-release theophylline & aminophylline  modified-release nifedipine & diltiazem  the immunosuppressant ciclosporin  lithium, which is a mood stabiliser  fentanyl patches  carbamazepine, phenytoin and Na valproate www.netdoctor.co.uk/medicines/brand_generic.htm Genghis Khun ([email protected],nafanakhun.wordpress.com)


Kitab Daftar Nama Obat Generik Ini Dibuat Untuk Kemaslahatan Orang Banyak.

Semua Boleh Mengcopy dan Menyebarluaskannya. Semoga Bermanfaat. Amin.

by:


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DAFTAR NAMA GENERIK OBAT Bisa dibuka di semua sistem operasi: Komputer: - Windows - Linux - Macintosh HP/ PDA: - Symbian - Windows Mobile

FaiK Fauzi MuLaCheLLa em@il: [email protected] Blog: faikshare.blogspot.com faik-mulachella.blogspot.com Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sistem Penulisan Nama Generik berdasarkan nama internasional I: Indikasi BSO: Bentuk sediaan obat D: Dosis dan cara pemberian oral * Qd= 1x Bid=2x Tid=3x Hs= sebelum tidur KI: Kontra Indikasi P: Perhatian ES: Efek Samping IO: Interaksi Obat Preg: (Tingkat Keamanan untuk Ibu Hamil) A, B, C, D, X* Nama Dagang: Nama ini akan langsung diisi bila distribusi di Indonesia.hanya tersedia 1 (satu) macam nama dagang/ paten tersebut Produk®, Rp. /box, Amp) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cara Pemberian Obat Oral Simbol: : Diberikan bersama makanan : Diberikan bersama atau tanpa makanan : Diberikan saat perut kosong (1 jam sebelum makan atau 2 jam sesudah makan) Tingkat Keamanan untuk Ibu Hamil A: Aman pada janin manusia B: Aman pada janin binatang percobaan. C: Efek samping pada janin binatang percobaan, pada manusia belum diketahui. D: Efek samping pada janin manusia, tetapi manfaat obat mungkin lebih besar daripada resikonya. X: Abnormalitas pada janin manusia. Resiko melebihi manfaat yang diperoleh. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cara Pencarian Data 1. Panduan Daftar Isi, atau 2. Mengaktifkan Bookmark disamping halaman PDF viewer atau 3. Melihat Index (Berdasarkan urutan abjad). 4. Fasilitas Search.. (Tekan Ctrl+F) : Tulislah dengan nama generik internasional, misalnya “hydroxide”, jangan ditulis “hidroksida”


Genghis Khun ([email protected],nafanakhun.wordpress.com)


I. SALURAN PENCERNAAN A. ANTASIDA & ANTI ULCERASI B. REGULATOR GIT, ANTI FLATULEN & ANTI INFLAMASI C. ANTI SPASMODIK D. ANTI DIARE E. LAKSATIF & PENCAHAR F. DIGESTAN G. KOLAGOGUM, KOLELITOLITIK & HEPATIK PROTEKTOR H. PREPARAT ANOREKTAL



A. Antasida & anti ulcerasi Aluminium hydroxide/ Antacid Magnesium hydroxide Magnesium trisilicateCimetidine Ranitidine HCl Famotidine Nizatidine Omeprazole Lansoprazole Rabeprazole Pantoprazole Esomeprazole Clebropride Malate Misoprostol Sulpiride Sucralfate Teprenone Rebamipide Polymigel Genghis Khun ([email protected],nafanakhun.wordpress.com)


Aluminium hydroxide/ Antacid I: Hiperasiditas lambung, pengikat fosfat pada kasus hiperfosfatemia pada gagal ginjal. BSO: Tablet Kunyah 300mg D: 1-2 tab/ hr, 1 jam stlh makan & sebelum tidur . KI: Payah ginjal P: Insuffisiensi Ginjal ES: Jarang, konstipasi, diare. Hipofosfatemia (jangka lama, dosis tinggi) IO: Perubahan absorbsi terutama tetrasiklin dan garam Fe Preg:: C Nama Dagang:



Magnesium hydroxide I: Konstipasi & defekasi tdk teratur yg disertai ggn pencernaan. BSO: Syr 400mg/5cc D: Dws 2,4g – 4,8 g sblm tidur/ ssdh bangun tidur. Anak 1,2g2,4 g. KI: P: Kerusakan ginjal ES: Mual muntah, nyeri perut IO: Mengganggu absorpsi Cimetidin/ Tetrasiklin Preg:: B Nama Dagang: Laxasium



Magnesium trisilicate I: Hiperasiditas GI BSO: Tab, Syrup D: Perut Kosong/ menjelang tidur/ timbul gejala. Tdk >7 hr KI: Anak <10th, ggl ginjal, hypophosphataemia P: Insufisiensi ginjal, hypermagnesaemia, nefrolitiasis, ES: Diare, mual, muntah, depresi SSP, osteomalasia pada defisiensi fosfor, osteomalasia, batu ginjal. IO: Mengganggu absorbsi Tetrasiklin Preg:: Nama Dagang:



Cimetidine I: Ulkus duodenum & gaster jinak, ulkus sal GI bag atas,ulkus stoma, ulkus stress, sindroma Zollinger-Ellison, mastositosis sistemik, adenoma endokrin multipel. BSO: Kaplet 200 mg, injeksi 200 mg D: Dws 400 mg pagi & malam, atau 200 mg 3x/hr waktu makan dan 400 mg menjelang tidur. Lama terapi 4 mgg. Anak 20-40 mg/kgBB/hr dlm dosis terbagi. KI: Hipersensitif thd Cimetidine P: Ggn ginjal, hamil, laktasi, keganasan lambung. ES: Diare, pusing, ruam kulit. Ginekomastia, impotensi (pria). Kebingungan reversible. alergi, artralgia, myalgia, kelainan darah, nefritis interstisialis, sakit kepala, hepatotoksik, pankreatitis. IO: Meningkatkan efek Lidocaine, Phenytoin, Theophylline, Warfarin, bbrp antiaritmia, Benzodiazepine, vasodilator Preg:: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ranitidine HCl I: Ulkus duodenum, ulkus gaster jinak,refluks esofagitis BSO: Tab 150 mg. Amp 50 mg/ 2cc D: Ulkus duodenum Dws 150mg 2x/hr selama 4-8mgg. Sindrom Zollinger Ellison 150mg 2x/hr dpt ditingkatkan s/d 6 g/hr. Ulkus Gaster 150 mg 2x/hr selama 2 mgg. Pemeliharaan: 150 mg sblm tidur. Refluks Esofagitis 150mg 2x/hr. KI: Hipersensitif P: Riw. Porfiria akut. Bumil & laktasi. Ggn fungsi hati & ginjal. Lanjut usia ES: Sakit kepala, malaise, insomnia, vertigo IO: Dg Warfarin meningkatkan/menurunkan waktu Protrombin Preg:: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Famotidine I: Ulkus duodenum, ulkus gaster jinak, sindroma Zollinger Ellison, refluks esofagitis BSO: Tab 20 mg D: 40 mg 1x/hr atau 20 mg 2x/hr KI: P: Ggn ginjal berat ES: Trombositopenia IO: Preg:: B Nama Dagang:



Nizatidine I: Tukak duodenal, refluks esofagitis BSO: Kapl 150 mg, Amp 25 mg/cc D: Tab 150-300 mg 2x/hr selama 8-12 mgg. Infus IV kontinu: 150-300 mg dalam 150cc larutan. Rata-rata 10 mg/ jam. Maks: 480 mg/hr. KI: Hipersensitif P: Insufisiensi ginjal, bumil & laktasi ES: IO: Preg:: B Nama Dagang: Axid



Omeprazole proton pump inhibitor I: Hiperasiditas BSO: Kaps 20 mg D: 1x/hr ditelan utuh. Terapi tdk > dr 4 mgg KI: Bumil & Laktasi. P: Umur dibwh 18 th. Gangguan Liver ES: Flatulen, Vertigo IO: Mengurangi efektifitas obat anti HIV & anti fungi. Peningkatan kadar dlm darah: warfarin, phenytoin, benzodiazepines (such as diazepam, triazolam, lorazepam or flurazepam), digoxin, cilostazol, tacrolimus. Preg:: A, B, C, D, X Nama Dagang:



Lansoprazole Proton pump inhibitor I: Ulkus gaster & duoenum BSO: Kaps 30 mg D: Dws 30mg 1x/hr KI: Ggn hati berat P: Anak ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Rabeprazole BSO: Tablet 10 mg, 20 mg D: Dws 1x 20 mg/hr. Tukak Duodenum aktif 1x 10 mg/hr. sembuh dlm 2-4 mgg. Pasien Tukak lambung sembuh dalam 4-6 mgg. Refluks esofagitis 1x 20 mg/hr selama 4-8 mgg. Pagi I: Tukak Duodenum, Tukak lambung, Refluks esofagitis P: Ggn fungsi ginjal, hipersensitif. Usia lanjut. Bumil & Laktasi. Anak. ES: Konstipasi, eksema, sakit kepala, peningkatan GPT, lekosit eosinofilik & GOT IO: Menurunkan kadar Ketokonazole, meningkatkan konsentrasi digoxin dlm darah. Tdk berinteraksi dg obat yg dimetabolisme scr oksidatif: Teofilin, Fenitoin, Warfarin & Diazepam. Preg:: B Nama Dagang:Pariet Genghis Khun ([email protected],nafanakhun.wordpress.com)


Pantoprazole I: Terapi jangka pendek ggn gaster & intestinal yg memerlukan pengurangan sekresi as lambung; ulkus duodenum, ulkus gaster; refluks esofagitis. BSO: Tab 20 mg, 40 mg. Vial 40 mg D: Tab 40 mg/hr slm 2-8 mgg. IV 40 mg/hr slm < 8 mgg. KI: Kerusakan hati. Hamil. P: IV digunakan bila IO tidak memungkinkan. ES: sakit kepala, diare, ruam kulit, pruritus. IO: Mempengaruhi penyerapan Ketokonazole Preg:: B Nama Dagang: Pantozol




Esomeprazole I: Refluks Gastroesofageal, Kombinasi antibakteri utk eradikasi H. pylori BSO: Tab 20 mg, 40 mg. Vial 40 mg/cc D: Tab Refluks Esofagitis Erosif 1x 40 mg/hr slm 4 mgg. Relaps esofagitis & pemeliharaan 1x 20 mg/hr. Vial Dws 40 mg iv pelan/ infus slm 10-30mnt. KI: P: Bumil Laktasi. Intoleransi fruktosa herediter. Malabsorbsi Glukosa Galaktosa. Insufisiensi sukrase isomaltase. ES: Diare, Kembung. Mual, konstipasi, dermatitis, pruritus, mulut kering. IO: Diazepam, Sitalopram, Imipramin, Klomipramin, Fenitoin Preg:: B Nama Dagang: Nexium



Clebropride Malate I: Ulkus peptikum, Gastroduodenitis BSO: Tab 0,5 mg D: Dws 3x/hr KI: Bila stimulasi lambung membahayakan (perdarahan, obstruksi, perforasi). Pasien diskinesia tardiv thd neuroleptik. P: anak, bumil trim 1, laktasi. ES: Mengantuk, pusing. IO: mempotensiasi sfek SSP Fenotiazin & antidopaminergik lain. Preg:: Nama Dagang: Clast



Misoprostol I: Mencegah ulkus krn induksi AINS BSO: Tab 200 mcg D: 4x 200 mcg/hr. KI: Bumil, Laktasi P: ES: Ggn GI: diare, nyeri perut, ggn ginekologi (kram, bercak, menoragi, dismenorre) IO: Preg:: X Nama Dagang:



Sulpiride I: Psikosomatik, ulkus peptikum, colitis ulseratif, peny Crohn, Ggn kolik fungsional, migren abdominal. BSO: Kaps 50 mg, Tab forte 200 mg. Amp 100 mg/ 2cc D: Ggn psikofungsional 2-4 kaps/ hr. Anak 5-10 mg/kgBB/hr dibagi bbrp dosis. Psikiatri pengobatan wkt serangan 3-6 amp/hr (IM). Pemeliharaan 2-4 tab/hr dibagi bbrp dosis. KI: Feokromositoma P: Insufisiensi Ginjal, epilepsy. Bumil & Laktasi. Manula: Parkinson. ES: Galaktore, ginekomastia, impotensi/ frigid, amenore, reaksi extra pyramidal, hipotensi ortostatik, diskinesia tardiv, sedasi & somnolen. IO: Obat Depresan, SSP, alcohol, Levodopa. Preg:: Nama Dagang: Dogmatil Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sucralfate I: Terapi jangka pendek (8 mgg) ulkus duodenum BSO: Tab 500 mg, Susp 500 mg/ 5cc D: 4x 1 g KI: P: GGK, dialysis, Bumil, laktasi, Anak. ES: Konstipasi, mulut kering, ggn GI, ruam kulit, gatal, ggn tidur, nyeri punggung. IO: Menurunkan absorbsi Cimetidine, Fluoroquinolon (Ciprofloxacin, Norfloxacin), Digoxin, Ketokonazol, Fenitoin, Ranitidine, Tetrasiklin, Quinidin, L-tiroksin, Teophylline. Preg:: B Nama Dagang:



Teprenone I: Tukak peptik BSO: Kaps 50 mg D: 3x 50 mg/hr KI: P: Bumil & anak ES: Jarang: konstipasi,rasa penuh pd perut, diare, haus, mual, muntah, ruam kulit, gatal. IO: Preg:: Nama Dagang: Purubex



Rebamipide I: Ulkus gaster, antagonis H2 BSO: Tab 100 mg D: 3x 100 mg/hr KI: P: Hamil,laktasi, lansia ES: abdomen terasa membesar, konstipasi IO: Preg:: Nama Dagang: Mucosta



Polymigel I: Mual, hiperasiditas, nyeri abdomen, kembung BSO: Tab 400 mg D: 1-2 tab 3-4x/hrDosis KI: Hipo/hipertiroidisme,dialisis P: Hiperkalsemia, diet rendah fosfat, disfungsi ginjal pd penggunaan lama ES: Konstipasi, diare, mual, muntah IO: Mengurangi absorbsi bila kombinasi dg Cimetidine, Tetrasiklin Preg:: Nama Dagang: Strocain P



B. Regulator GIT, Anti Flatulen & Anti Inflamasi Metoclopramide HCl Domperidone Cisapride Dimeticone Simeticone Sulfasalazine Mesalazine Ramosetron Otilonium bromide Lactobacillus Tegaserod



Metoclopramide HCl I: GGn GI, mual/ muntah krn obat, kembung, ulkus peptikum, stenosis pylorus (ringan), dyspepsia, epigastralgia. BSO: Tab 5 mg, 10 mg, amp 10 mg/2cc, syrup 5 mg/5cc. Supp 10 mg, 20 mg. Tetes paed. 1 mg/ 10 tts. D: Tab, Amp,Supp: Dws 3x 10 mg/ hr Anak 0,5 mg/kg/hr. KI: Jika stimulasi motilitas GI dpt membahayakan. Ex. Obstruksi intestinal, epilepsy, feokromositoma. P: Anak & remaja, kehamilan, menyusui, DM, depresi, penggunaan obat lain yg menyebabkan reaksi extrapiramidal. ES: Dosis tinggi: pusing, gelisah, lesu, gejala extrapiramidal, sakit kepala, mengantuk, ggn GI, hipertensi. IO: Efek diantagonis oleh antikolinergik & analgesic. Depresan SSP meningkatkan efek sedasi. Absorbsi digoxin & simetidin terganggu. Absorbsi parasetamol, tetrasiklin, levodopa di usus halus akan meningkat. Perubahan kebutuhan insulin. Preg:: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Domperidone I: Dispepsia disertai masa pengosongan lambung yg lambat atau refluks esophagus. Mual & muntah krn: intoleransi sal cerna akibat kemoterapi antikanker, digitalis, levodopa, radioterapi, patologi organ abdomen, GI, hepatobilier, peritoneal, ginjal. BSO: Tab 10 mg, Sirup 5mg/5c D: Dws 10-20 mg 3x/hr perut kosong (bila perlu tambah sblm tidur) , anak 0.25-0.5 mg/kgBB 3x/hr. KI: Pasien dg serangan motilitas lambung dpt membahayakan, missal perdarahan, obstruksi mekanik, perforasi GI. Prolaktinoma tumor hipofise yg mengeluarkan prolaktin. P: Tidak utk mual/ muntah kronik. Bumil laktasi, bayi < 1th. ES: Galaktorea, ginekomastia, kejang usus sementara IO: Antasida, obat anti sekresi. Preg:: Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cisapride I: Ggn motilitas GI spt gastroparesis & Refluks esofagitis. BSO: Tab 5 mg D: Dws 5 mg 3-4x/hr, max 40 mg/hr. Anak 0.2-0.8 mg/kgBB 3-4x/hr,max 40 mg/hr. KI: Stimulasi GI berbahaya, perdarahan GI, obstruksi mekanik/ perforasi. P: Insufisiensi hati/ ginjal. Bumil & laktasi. Prematur dg kehamilan < 34mgg ES: Kram abdomen sementara, borborigmis & diare. IO: Peningkatan absorbsi depresan SSP & alcohol. Efek motilitas GI diturunkan oleh antikolinergik. Preg:: C Nama Dagang:



Dimeticone I: Flatulen & meteorismus. Mengurangi gas sal cerna sblm radiografi. Meringankan distensi abdomen. Dispepsia. BSO: Tab 40 mg D: 40 mg 3x/hr & sblm tidur. 4x/hr sblm pemeriksaan radiografi. KI: P: ES: IO: Preg:: Nama Dagang:



Simeticone I: Kembung & Rasa tidak enak pada perut. Distensi abdomen & dyspepsia. Sbg defoaming agent pd radiografi & endoskopi sal cerna BSO: Tab 125 mg D: 125 mg 3x/hr KI: Neonatus & prematur P: ES: IO: Preg:: C Nama Dagang:



Sulfasalazine I: Kolitis ulseratif, RA, spondilitis ankylosing, spondyloartritis seronegatif. BSO: Kaplet 500 mg D: Kolitis ulseratif: Dws 3-4 g, Anak 40-60mg/kgBB/hr dlm dosis terbagi. AR, spondilitis ankilosa: 500 mg malam hari selama 1 mggu, dilanjutkan 500 mg 2x/hr mggu selanjutnya. KI: Porfiria intermiten akut. Anak < 2th. Obstruksi GIT & UTI. P: Ggn hati/ ginjal, diskrasia darah, defisiensi G6PD. ES: Mual, anoreksia, kenaikan suhu, eritema & pruritus, sakit kepala. IO: Mengurangi absorbsi Folat & Digoxin. Preg:: B, D bila mendekati partus Nama Dagang: Sulcolon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mesalazine I: Radang usus, Colitis ulseratif, pnykt Crohn, Enema. BSO: Tab 250 mg, Enema 4g, Supp 500mg D: Dws: akut 1.5- 3g 3x/hr. Maintenance 500mg 3x/hrDosis. Enema 1x/hr. Supp 2x/hr. KI: Kelainan hati & ginjal berat. Ulkus peptic aktif. Pembekuan darah abnormal.Bayi & Infant. P: manula, bumil & laktasi ES: Eksantema alergi, demam, bronkospasme. IO: Meningkatnya efek hipoglikemik Sulfonilurea. Kumarin, MTX, Probenesid, Sulfinpirazon, Furosemid & Rifampisin. Preg:: B Nama Dagang: Salofalk



Ramosetron I: Mual & muntah karena obat karsinostatik (misal Cisplatin) BSO: Tab 0.1 mg, Amp 0.3 mg/2cc D: Dws Tab 0.1 mg 1x/hr. Amp 0.3 mg 1x/hr. Max 0.6 mg/ hr. KI: P: Sebaiknya diberikan 1 jam sebelum obat karsinostatik. Manula, Bumil & laktasi. ES: syok & reaksi anafilaktik, serangan yg menyerupai epilepsy, ggn tidur, konstipasi, diare, peningkatan BUN, ggn fungsi ginjal, peningkatan SGPT/SGOT/LDH IO: Preg:: Nama Dagang: Nasea



Otilonium bromide I: Irritable Bowel syndrome & pengobatan simtomatis utk nyeri & ggn GI yg berhubungan dg spasme otot polos. BSO: Tab 40 mg D: 40 mg 2-3x/hr. KI: P: Glaukoma, hyperplasia prostate jinak, stenosis pilorik. Hamil & Laktasi. ES: Mual, lelah, nyeri epigastrium, vertigo. IO: Preg:: Nama Dagang: Spasmomen



Lactobacillus I: Pemeliharaan kesehatan fungsi GIT BSO: Tab, Kapsul D: 3x/hr. KI: P: Bumil & Laktasi ES: IO: Preg:: Nama Dagang:



Tegaserod I: ‘Irritable bowel syndrome’, predominan konstipasi, khususnya wanita. Rasa tidak enakpada perut. BSO: Tab 6 mg D: 6mg 2x/hr selama maks 12 minggu KI: Laktasi P: Kerusakan hati berat,hamil. ES: Nyeri abdomen, diare,mual, flatulensi, sakit kepala, pusing, nyeri punggung & sindr seperti flu. IO: Preg:: B Nama Dagang: Zelmac



C. Anti Spasmodik Papaverine HCl Pramiverine Mebeverine Hyoscine butylbromide Butropium Bromide Propantheline bromide Valethamate bromide Timepidium bromide Chlordiazepoxide Tiemonium methylsulphate

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Papaverine HCl I: Kolik sal empedu, ginjal & otot polos lainnya, emboli perifer & mesenteric. BSO: Tab 40 mg, amp 40 mg/cc D: Tab, SC, IM, IV 40-80 mg 3x/hr. KI: P: Pemberian IV, Glaukoma ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Pramiverine I: Kolik & Kejang otot polos: sal cerna, empedu & sal kemih BSO: Tab 2 mg D: 2 mg 3x/hr . Akut 4 mg 2x/hr selama 2 hr. KI: Glaukoma sudut sempit, adenoma prostate dg tendensi terbentuknya sisa urine, takiaritmia, stenosis mekanik sl GIT, megakolon, paska bedah abdomen. P: Hipotensi, bayi, bumil. ES: Rasa kering mulut& kulit, ruam kulit, pandangan kabur, glaucoma, takikardia, ggn kencing. IO: Peningkatan efek antikholinergik dg amantadin atau antidepresan trisiklik. Preg:: Nama Dagang: Systabon Plain



Mebeverine I: Ggn spasme kolon. Sindr ‘Irritable colon’ stadium awal & yg disertai luka pada GIT (divertikulosis & divertikulitis pd kolon, enteritis regional, pnykit kandung empedu, tukak lambung & usus 12 jari, disentri, inflamasi spesifik & non spesifik GIT). BSO: Tab salut gula 135 mg D: 135 mg 3x/hr, 20 menit a.c KI: P: ES: IO: Preg:: BSO: Nama Dagang: Duspatalin



Hyoscine butylbromide I: Spasme GIT & Sal kemih. Pencegahan & terapi dismenore. BSO: Tab 10 mg, ampul 20 mg/cc D: Dws 10-20 mg 4x/hr, anak 10 mg 3x/hr. KI: Hipersensitif, porfiria, glaucoma, hipertrofi prostate dg kecenderungan retensi urine, stenosis mekanis GIT, takikardia, megakolon. P: Bumil, laktasi, lansia, ggn jantung, colitis ulseratif, ileus paralitik, stenosis pilorik. Hindari minuman alcohol. ES: Kering mulut & kulit, konstipasi, palpitasi, aritmia jantung, bradikardi, takikardia, reaksi paradoksikal, ggn penglihatan. IO: Antihistamin, antidepresan, kuinidin, disopiramid, alcohol, antidepresan, analgesic narkotik, sedative/ hipnotik, kalium klorida. Preg:: C Nama Dagang:



Butropium Bromide I: Nyeri, kejang yg berhubungan dengan gastritis, enteritis, tukak peptic, kolesistitis, diskinesia bilier. BSO: Tab 5 mg. D: 10 mg 3x/hr. KI: Glaukoma, Ggn sal kemih krn hipertrofi prostate, ggn jantung berat, ileus paralitik, stenosis pylorus, hipersensitif. P: Hipertrofi prostate, gagal jantung kongestif, aritmia, colitis ulseratif, hipertiroidisme. Bumil. ES: Ggn daya akomodasi mata. Mulut kering. Mual,muntah, konstipasi, ggn miksi, sakit kepala, mengantuk, pusing, takikardia, hipotensi, muka merah, lesu, reaksi hipersensitif. IO: Antidepresan trisiklik, Fenotiazin, MAOI Preg:: C Nama Dagang: Coliopan Genghis Khun ([email protected],nafanakhun.wordpress.com)


Propantheline bromide I: Terapi tambahan ulkus peptic & colitis ulseratif, divertikulitis, divertikulitis, kolesistitis, pankreatitis & prosedur diagnostic GI. Utk pengobatan sindr usus iritabel, kolik ginjal & hiperhidrosis. BSO: Tab 15 mg D: Ulkus peptic 15 mg a.c & 30 mg sblm tidur. Kontras: 30 mg, 45 menit sblm foto. Indikasi lain 15-30 mg 4x/hr. KI: Penyakit obstruktif GI/ Sal kemih. Atoni usus. Colitis ulseratif berat atau toksikmegakolon, hiatal hernia sehubungan dg refluks esofagitis, perdarahan akut, miastenia gravis, glaucoma. P: Panyakit KV berat, lansia, neuropati otonomik, colitis ulseratif, peny hati/ ginjal, hipertiroid, peny jantung kongestif, PJK, hipotensi. ES: Mulut kering, pandangan kabur, midriasi, efek SSP, takikardia, retensi urine, ‘heat stroke’, ggn GI, dermatitis alergi, impotensi, anafilaksis, konstipasi.



IO: Meningkatkan kadar digoksin serum, potensiasi efek kolinergik dari antihistamin, antidepresan, antipsikotik, obat anti Parkinson. Preg:: C Nama Dagang:




Valethamate bromide I: GI spasm (cardiospasm, spastic constipation, ulcerative complaints), spasm of biliary & urinary tract, spasmodic dismenore, delayed dilatation of cervix in parturition. Child: Pylorospsm, spastic bronkhitis BSO: Tab 10 mg, Amp 8 mg/cc. D: Tab 10-20 mg 3x/hr. Amp 8-16 mg IV/ IM/ SC KI: Glaukoma sdt tertutup, obstruksi GIT/ UT, hipertrofi prostate, megakolon, stenosis pylorus. P: ES: Sikloplegia, mydriasis, mulut kering, flushing, takikardi, palpitasi, konstipasi, rash, muntah, fotofobia. IO: Efek antikholinergik bias ditingkatkan oleh parasimpatolitik lain. Preg:: A, B, C, D, X Nama Dagang: Epidosin



Timepidium bromide I: Spasme otot polos. BSO: Kaps 30 mg, Amp 7.5 mg/cc D: Kaps 30 mg 3x/hr Amp 7.5mg SC/IM/IV. KI: Glaukoma, disuria, gagal jantung, ileus paralitik P: hipertrofi prostate, hipertiroidisme, CHF, aritmia, colitis ulseratif idiopatik. ES: Fotofobia, mulut kering, vertigo, palpitasi, konstipasi, disuria. IO: Efek ditingkatkan oleh Trisiklik antidepresan, Phenothiazine, MAOIs Preg:: Nama Dagang: Sesden



Chlordiazepoxide I: Nyeri spastic, dismenore, tukak peptik. BSO: Tab 5 mg D: 1-2 drag 3x/hr KI: Glaukoma sudut sempit akut, miastenia gravis, syok, psikosis berat. P: Ketergantungan, amnesia & serangan grandmal, penyakit otak organic, insufisiensi kardiorespiratoris, penurunan fungsi hati/ ginjal. Gagal nafas/ PPOK. Bumil/ laktasi. Lansia. ES: Lesu, ngantuk, lemah otot. IO: Meningkatkan efek Depresan SSP pada alcohol, barbiturate, antihistamin, fenotiazin, opiate, Fenitoin (potensiasi), meningkatkan efek relaksasi otot dg benzodiazepine & relaksasi otot lainnya. Antasida mengganggu absorbsi di GI Preg:: D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tiemonium methylsulphate I: Spasme sal cerna, sal nafas, sal kemih. BSO: Sir 10 mg/5cc D: Dws 5-15cc 3x/hr Anak 15cc/5cc/kgBB/hr KI: Glaukoma, hyperplasia/ adenoma prostate. P: Bumiltrim 1 ES: IO: Preg:: Nama Dagang: Visceralgine




D. Anti Diare Loperamide HCl Dioctahedral smectite Kaolin, Pectin Attapulgit Racecadotril Furazolidone Charcoal Bismuth salicylate Paromomycin




Loperamide HCl I: Diare akut non spesifik & diare kronis BSO: Tab, Kaps 2 mg D: Awal 4 mg diikuti 2 mg tiap selesai BAB, maks 16 mg/hr. Tidaklebih dari 2 hari. KI: Anak <12 th, colitis akut yg dpt menyebabkan megakolon toksik, kondisi dimana konstipasi hrs dihindari. P: Insufisiensi hati & ginjal. Tidak untuk diare akut krn einfeksi E coli, Salmonella & shigella sp. Tidak untuk diare berdarah & demam tinggi. Bumil laktasi ES: Kembung, konstipasi, mual, muntah, nyeri abdomen, lelah, ngantuk, pusing, megakolon toksik. IO: Tranquilizer, alcohol, penghambat MAO. Preg:: B Nama Dagang:



Dioctahedral smectite I: Diare non spesifik BSO: Sachet 3 g D: Dws & anak >12 thn 3 sachet/hr, 6-12 thn 1-2 sachet/hr. < 6 th sesuai petunjuk dokter. KI: P: Dehidrasi ES: Konstipasi IO: Mengganggu absorbsi Preg:: Nama Dagang: Smecta



Kaolin, Pectin I: Diare non spesifik BSO: Tab (K 550 mg+P 20mg), Susp (K 5.832 g+ P 130 mg) per fl oz, atau (K 700 mg+ P 50 mg) D: Dws & anak >12 thn 2.5 tab/diare maks 15 tab/hr, 6-12 thn 1.5 tab/diare maks 7.5 tab/hr. KI: Obstruksi intestinal, hipersensitifitas P: Anak< 6 th. Jangan digunakan >2 hr & demam. ES: IO: Preg:: Nama Dagang:



Attapulgit I: Diare non spesifik BSO: Tab (600mg), (A 600mg/ 700mg/ 750mg+Pectin 50mg) D: Dws 2 tab/diare maks 12 tab/hr. Anak ½ dosis dws. KI: Obstruksi usus. Anak <6thn. P: Tdk utk diare dg demam tinggi. ES: Konstipasi IO: Digoksin Preg:: Nama Dagang:



Racecadotril I: Bila rehidrasi oral tidak membantu BSO: Kaps 100 mg D: Dws & Anak >15thn 100mg Dosis Tunggal. Terapi selanjutnya 8jam kemudian sampai diare berhenti, maks 400mg/hr. KI: Bumil laktasi. P: Anak <15 thn tidak dianjurkan ES: Ngantuk, mual, muntah, konstipasi, pusing, sakit kepala, ruam kulit. IO: Preg:: Nama Dagang: Hidrasec



Furazolidone Nitrofuran with antiprotozoal activity. I: Diare spesifik & Enteritis krn Salmonella, shigella, Staph aureus, Streptococcus faecalis, E coli, Entamoeba histolitika, Giardia intestinalis. BSO: Sir 50mg/5cc D: Dws & Anak >12th 50-100mg, 5-12th 25-50mg, 3bln-1th 12.5mg. 4x/hr selama maks 7hr. KI: Bayi <3 bln P: Bumil laktasi. ES: Pusing, mual, muntah, bintik merah kulit, hipotensi, demam, artralgia, hemolisis akut pd G6PD. IO: alcohol, Antidepresan guanetidin, metildopa, reserpin, efedrin, amfetamin,fenilefrin, tiramin. Preg:: C Nama Dagang: Neo Prodiar Genghis Khun ([email protected],nafanakhun.wordpress.com)


Charcoal For maximum effect, administer within 30 min after ingesting toxic agents. I: Diare, kembung BSO: Tab 250 mg. D: Dws 750mg-1g 3x/hr. Anak 250-500mg. KI: P: ES: Muntah, konstipasi, feses hitam. IO: antidotum oral spesifik. Menurunkan kerja Ipecacuanha & emetic lain. Dg bbrp obat oral: menimbulkan efek simultan. Preg:: C Nama Dagang: Bekarbon



Bismuth salicylate I: Diare Non spesifik BSO: Tab 375mg D: Dws 375mg tiap 30mnt-1jam maks 8 dosis/hr. KI: Baru sembuh dari Influenza. Alergi thd Acetosal. Bayi, anak <12 thn. Manula. P: Bumil laktasi. Dianjurkan banyak minum. Pasien DM/ Gout/ yg mendapat terapi antikoagulan ES: Lidah & Tinja hitam. IO: Dapat menurunkan kadar Doksisiklin dlm tubuh. Preg:: C Nama Dagang: Scantoma



Paromomycin sulfate Amebicide I: Acute and chronic intestinal amebiasis; preoperatively to suppress intestinal flora; tapeworm infestations; treatment of Cryptosporidium BSO: Capsule: 250 mg D: Oral: Dientamoeba fragilis: 25-30 mg/kg/hr. dlm 3 dosis slm 7 hari. Cryptosporidium: Adults with AIDS: 1.5-2.25 g/hr. Dlm 3-6 dosis for 10-14 days (up to 4-8 weeks may be needed) Tapeworm (fish, dog, bovine, porcine): Children: 11 mg/kg every 15 minutes for 4 doses Adults: 1 g every 15 minutes for 4 doses Hepatic coma: Adults: 4 g/day in 2-4 divided doses for 5-6 days Dwarf tapeworm: Children and Adults: 45 mg/kg/dose every day for 5-7 days KI: Intestinal obstruction, renal failure, hypersensitivity P: Use with caution in patients with impaired renal function or possible or proven ulcerative bowel lesions Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: 1% to 10%: Gastrointestinal: Diarrhea, abdominal cramps, nausea, vomiting, heartburn <1%: Headache, vertigo, exanthema, rash, pruritus, steatorrhea, secondary enterocolitis, eosinophilia, ototoxicity IO: Decreased effect of digoxin, vitamin A, and methotrexate Increased effect of oral anticoagulants, neuromuscular blockers, and polypeptide antibiotics Preg: C BSO: Nama Dagang: Gabbryl



E. Laksatif & Pencahar Bisacodyl Lactulose Sodium Picosulfate Isphagula Docusate sodium Nifuroxazide



Bisacodyl I: Kontipasi. Nyeri saat BAB pd hemoroid. Pre& post operasi. Persiapan Barium Enema. Persiapan Us besar utk Proktosigmoidoskopi. BSO: Tab 5mg Supp 5mg, 10mg D: Dws 10-20mg bedtime. Anak 5-10mg. KI: Obstruksi usus kecil, keadaan yg memerlukan pembedahan abdomen segera, dehidrasi berat. P: Anak, bumil. ES: Rasa tidak enak pada perut, diare. IO: Antasida, susu, obat lain yg , meningkatkan pH lambung. Preg:: B Nama Dagang:



Sorbitol I: Konstipasi, rectal & sigmoid, kehamilan, fekaloma & skibala. Persiapan pra-op (partus, ginekologi, pembedahan anus) BSO : Sacchet 5g Enema 5cc D: Dws 5 g 3x/hr KI: P: ES: IO: Preg:: Nama Dagang:



Lactulose I: Konstipasi kronik BSO: Sirup 66,7%/5cc, 10g/15cc, 3.335g/5cc. D: 10g/hr maks 40g/hr. KI: Pasien galaktosemia yg membutuhkan diet rendah galaktosa. P: DM. Bumil laktasi, manula, anak. ES: Kembung, diare, kram lambung, hipokalemia, hipernatremia, mual, muntah. IO: Neomisin & antibiotic lain. Preg:: B Nama Dagang:



Sodium Picosulfate I: Sembelit BSO: Tetes 7.5 mg/cc D: Dws 8-12tts malam hari. KI: Operasi abdomen akut P: Jangka lama/ dosis tinggi. ES: Hipokalemia IO: Absorbsi diganggu oleh antibiotic spectrum luas Preg:: Nama Dagang: Laxoberon



Isphagula I: Melancarkan regulasi feses pada konstipasi, hemorrhoid, fissure ani,op abdomen/ anus. BSO: Sachet 5 g D: Dws & anak >12th 1 sachet 2-6x/hr KI: IDDM tak terkontrol P: Turunkan dosis insulin pada IDDM ES: kembung IO: Antidiare Preg:: A, B, C, D, X Nama Dagang:



Docusate sodium I: Konstipasi BSO: Tab/ Kaps 100 mg, 250 mg, 50 mg Syr mg/15 ml D: single Dose KI: P: ES: stomach ache, cramping or irritated throat (liquid forms). If these effects continue or become bothersome, inform your doctor. Dehydration and loss of essential nutrients. Symptoms include muscle cramps, muscle weakness or dizziness. IO: Preg:: A, B, C, D, X Nama Dagang: Waxsol



Nifuroxazide I: Diare krn E. Coli, kolopati spesifik & non spesifik BSO: Syr 250 mg/ 5cc D: Dws 1-2 sdt 3x/hr, Anak & Bayi>6 bln 1 sdt 3x/hr. < 6 bln 1 sdt 3x/hr KI: kerusakan fungsi ginjal dan hati. Hipertiroid. Intoleransi Yodium. P: kelainan neurologi ES: Neurotoksisitas berat. Nyeri abdomen, diare, pigmentasi warna hijau pd lidah, urine & feses. Kerusakan serebral IO: Preg:: A, B, C, D, X Nama Dagang: Nifudiar Nifural



F. Digestan Pancreatin



Pancreatin I: Gangguan pencernaan BSO: Tab 150mg, 300mg, 400 mg D: 1x/hr KI: P: Preg:: A, B, C, D, X ES: Diarrhea, constipation, stomach ache, nausea, bloating, gas, loss of appetite, headache, fatigue or dizziness the first few days as your body adjusts to it. Dizziness or drowsiness. IO: Antasid Nama Dagang:



G. Kolagogum, Kolelitolitik & Hepatik Protektor Ornithin Chenodeoxycholic acid Ursodeoxycholic acid Amino acids



Ornithin Indikasi: Ggn fungsi hati, Hiperammonia karena pnykt hepar, sirosis hepatis, ensefalopati Kemasan Dosis Ampul 0,5 mg/cc 4-8 Ampul/ hr, max infus 5g/hr Kaps 250 mg 1-3x/hr ssdh makan Kontra Indikasi: Skizofrenia, insomnia, anak Efek Samping: Mual, muntah Preg:: Nama Dagang:



Chenodeoxycholic acid Indikasi: Batu empedu radiolusen BSO: kaps lunak 250mg D: 15 mg/kg/hr Kontra Indikasi: Pnykit hati kronik, Gagal Ginjal, ulkus peptikum, radang usus halus, hamil, laktasi, puasa P: Monitor fungsi hati Preg:: X Efek Samping: Diare, pruritus, pengingkatan sementara tes fungsi hati IO: Metildopa, kontrasepsi oral & obat hepatotoksik Nama Dagang: Chenofalk



Ursodeoxycholic acid Indikasi:

FaiK Fauzi MuLaCheLLa

em@il: [email protected] Blog: faikshare.blogspot.com faik-mulachella.blogspot.com



Amino acids I:Nutrisi parenteral esensial utk pasien insufisiensi hati kronik berat BSO: Infus 500cc D: 1-1,5 L/hr dg kecep infus 2cc/kg/jam atau 40 tts/mnt KI: Koma hepatik endogen,atrofi hepatik akut, hiperkalemia, syok, dekompensasi kordis, intoleransi fruktosa atau sorbitol, defisiensi fruktosa 1,6-difosfat, keracunan metanol,kelainan metabolisme asam amino P: ES: Preg:: A, B, C, D, X IO: Nama Dagang: Aminofusin Hepar



H. Preparat Anorektal Monoxerutin Diosmin



Monoxerutin I: Varises, hemoroid BSO: Kaps. 300 mg D: Awal 1 kaps 2x/hr. Pemeliharaan: 1 kaps/hr KI: P: Preg:: ES: Keluhan ringan lambung IO: Nama Dagang: Venaron



Diosmin I: Varises, insufisiensi vena, flebitis, hemoroid BSO: Tab 200mg, 500 mg D: Insufisiensi vena kronis 1 g/hr Hemoroid akut: hr 1-4= 3g/hr, hr 5-7= 2g/hr, selanjutnya 1g/hr. Hemoroid kronis: 1g/hr KI: Hipersensitif P: Bumil, Laktasi Preg:: ES: Gangguan GI minor IO: Nama Dagang:

terbagi 1-3 dosis



II. KARDIOVASKULER & SISTEM HEMATOPOIETIKA. A. CARDIAC DRUG B. ANTI ANGINA C. ACE INHIBITOR D. Β BLOCKER E. CA ANTAGONIS F. ANTAGONIS ANGIOTENSIN II & KOMBINASINYA G. DIURETIK H. ANTI HIPERTENSI LAIN I. VASODILATOR PERIFER & CEREBRAL ACTIVATOR J. VASOCONTRICTOR K. ANTI MIGRAIN L. HEMOSTATIK M. ANTI KOAGULAN, ANTI THROMBUS & FIBRINOLITIK N. PREPARAT FLEBITIS & VARISES O. HEMOREOLOGIK P. HAEMATOPOIETIC AGENT Q. ANTI HIPOTENSI R.OBAT KARDIOVASKULER LAIN Genghis Khun ([email protected],nafanakhun.wordpress.com)


A. Cardiac Drug Digoxin Dobutamin Dopamine HCl Isoprenaline HC Milrinone Prajmalium bitartrate Amiodarone lidocaine Propafenone HCl



Digoxin -- + inotropic effect. Effect is achieved via inhibition of the Na+/K+-ATPase pump, leading to increase in intracellular sodium concentration along with concomitant increase in intracellular calcium concentration by means of calcium-sodium exchange mechanism. Net result is augmentation of myocardial contractility. I: Gagal jantung, takikardi supraventrikuler BSO: Tab 0,25 mg D: Dws: Digitalisasi cepat (24-36 jam): 4-6 tab lalu 1 tab pd interval ttt smp kompensasi tercapai. Digitalisasi lambat (3-5 hr): 2-6 tab/hr dlm dosis terbagi. Penunjang: 1-3 tab/hr Anak <10th: Digitalisasi cepat : 25mcg/kg pd interval ttt smp kompensasi tercapai. Penunjang: 10-20 mcg/hr Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: hypersensitivity; beriberi heart disease; idiopathic hypertrophic subaortic stenosis; constrictive pericarditis; carotid sinus syndrome IO: Increase digoxin levels: alprazolam, benzodiazepines, bepridil, captopril, cyclosporine, propafenone, propantheline, quinidine, diltiazem, aminoglycosides, oral amiodarone, anticholinergics, diphenoxylate, erythromycin, felodipine, flecainide, hydroxychloroquine, itraconazole, nifedipine, omeprazole, quinine, ibuprofen, indomethacin, esmolol, tetracycline, tolbutamide, and verapamil. Decrease serum digoxin levels: aminoglutethimide, antihistamines, cholestyramine, neomycin, penicillamine, aminoglycosides, oral colestipol, hydantoins, hypoglycemic agents, antineoplastic treatment combinations (eg, carmustine, bleomycin, methotrexate, cytarabine, doxorubicin, cyclophosphamide, vincristine, procarbazine), aluminum or magnesium antacids, rifampin, sucralfate, sulfasalazine, barbiturates, kaolin/pectin, and aminosalicylic acid Preg:C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Hypokalemia may reduce + inotropic effect of digitalis; IV calcium may produce arrhythmias in digitalized patients; hypercalcemia predisposes patient to digitalis toxicity; hypocalcemia can make digoxin ineffective until serum calcium levels are normal; magnesium replacement therapy must be instituted in patients with hypomagnesemia to prevent digitalis toxicity; patients diagnosed with incomplete AV block may progress to complete block when treated with digoxin; exercise caution in hypothyroidism, hypoxia, and acute myocarditis; adjust dose in renal impairment; highly toxic (overdoses can be fatal) Nama Dagang:



Dobutamin Produces vasodilation and increases inotropic state. At higher dosages may cause increased heart rate, exacerbating myocardial ischemia. I: Penunjang inotropik untuk Gagal Jantung BSO: Amp. 12,5 mg/20cc Vial 250 mg/10cc Vial 50 mg/cc Lar Infus 250 mg/ 5cc D: Awal 100-200 mcg/mnt IV Infus 2,5-10 mcg/kgBB/mnt. Dapat ditingkatkan hingga 40 mcg/ kgBB/mnt. KI: Stenosis subaortik hipertrofik idiopatik, Feokromositoma P: Monitor kecepatan & irama denyut Preg:: B ES: Hipotensi IO: Nitroprussid, b-blocker menghambat efek Dobutamin Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dopamine HCl Stimulates both adrenergic and dopaminergic receptors. I: Syok kardiogenik yng berhub dg infark myokard, septicemia endotoksik, trauma, gagal ginjal. BSO: Amp. 10 mg/cc, 20mg/cc, 40 mg/cc D: 2,5 mcg/kg/mnt dilarutkan dalam infuse IV. Dapat dinaikkan hingga 20-50 mg/kg/mnt. KI: Feokromositoma, takiaritmia atrial/ventrikuler P: Hipovolemia. Preg: C ES: Denyut ektopik, takikardia, nyeri angina, palpitasi. IO: Dipotensiasi oleh MAOI, Fenotiazin Nama Dagang:



Isoprenaline HCl I: Blok jantung, serangan adam-stokes, henti jantung, bronkospasme dalam anestesi, hipoperfusi dan syok BSO: Inj 0,2 mg/cc D: Blok jantung, serangan adam-stokes, henti jantung: Dws: Bolus IV inj awal 0,02-0,06 mg, selanjutnya 0,01-0,2mg. Infus IV 5 mcg/mnt. IM awal 0,2 mg, selanjutnya 0,15-0,2mg. Intrakardiak 0,2mg Bronkospasme dalam anestesi bolus inj: awal 0,01-0,02 mg. Hipoperfusi dan syok Dws: infus 0,5-5 mcg/mnt KI: Takiaritmia, takikardia atau blok jantung krn intoksikasi digitalis, aritmia ventrikuler yg membutuhkan terapi inotropik, angina pektoris P: PJK, insufisiensi koroner, syokkardiogenik, DM, hipertiroid, anestesi halotan. Perbaiki gangguan keseimbangan elektrolit dan hipovolemia sblm pemberian terapi Preg:: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Kecemasan, pusing, sakit kepala, palpitasi, angina, serangan Adam-Stokes, edema pulmonal, hipertensi, hipotensi, aritmia ventrikuler, takiaritmia, flushing, berkeringat IO: Isoproterenol & epinefrin dpt menyebabkan aritmia Nama Dagang: Isuprel



Milrinone + inotropic agent and vasodilator. Results in reduced afterload, reduced preload, and increased cardiac output. Several studies comparing milrinone to dobutamine have demonstrated that milrinone showed greater improvements in preload and afterload and improvements in cardiac output, without significant increases in myocardial oxygen consumption. D: 50 mcg/kg IV loading dose over 10 min, followed by continuous infusion at 0.25-1.0 mcg/kg/min; titrate to maintain adequate systolic blood pressure and cardiac output KI: hypersensitivity; obstructive hypertrophic cardiomyopathy IO: Precipitates in presence of furosemide Preg: C P: Monitor fluids, electrolyte changes, and renal function during therapy; excessive diuresis may increase potassium loss and Genghis Khun ([email protected],nafanakhun.wordpress.com)


predispose digitalized patients to arrhythmias (correct hypokalemia with potassium supplementation prior to treatment); slow rates or stop infusion in patients showing excessive decreases in blood pressure; previous vigorous diuretic therapy has caused significant decreases in cardiac filling pressure; administer cautiously and monitor blood pressure, heart rate, and clinical symptomatology Nama Dagang: Coritrope



Prajmalium bitartrate I: Takiaritmia tanpa gangguan konduksi AV,ekstra sistole yg tak tergantung pada penyebabnya kecuali pada bradikardia, sindrom WPW, pengobatan setelah elektrokonversi, pencegahan pada takikardia paroksismal, kateterisasi jantung. BSO: Tab 20 mg D: Awal 1 tab 3-4x/hr. Penunjang ½ tab 2-4x/hr. Pencegahan 1 tab 2x/hr. BB < 50kg dosisnya 1 mg/kg/hr. KI: Gangguan konduksi AV & stimulus konduksi intraventrikuler, serangan Adam’s-Stokes.Bradiaritmia tmsk ekstrasistole dari denyut jantung yg lambat. P: Dekompensasi kordis. Bumil trim I Preg:: ES: Ikterus kolestatik,ggn penglihatan IO: Nama Dagang:Neo-Gilurytmal Genghis Khun ([email protected],nafanakhun.wordpress.com)


Amiodarone Drug of choice: unstable ventricular arrhythmias. Currently considered a Class IIb intervention by the American Heart Association 2000 Emergency Cardiovascular Care Guidelines. Prehospital studies currently suggest that amiodarone is safe and efficacious for use in out-of-hospital cardiac arrest. Often used for life-threatening ventricular arrhythmias in patients who have relative KI: to its use. BSO: Tab 200 mg, Amp 150 mg/cc D: 150 mg IV infused over 10 min, follow with 1 mg/min constant infusion for 6 h, then maintenance infusion at 0.5 mg/min Oral dosing generally 400 mg/d following load KI: hypersensitivity; sinus node dysfunction; atrioventricular conduction disorders; underlying hepatic, pulmonary, or thyroid disease IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Increases effect and blood levels of theophylline, quinidine, procainamide, phenytoin, methotrexate, flecainide, digoxin, cyclosporine, beta-blockers, and anticoagulants; cardiotoxicity of amiodarone is increased by ritonavir, sparfloxacin, and disopyramide; coadministration with calcium channel blockers may cause an additive effect and decrease myocardial contractility further; cimetidine may increase amiodarone levels Preg: C P: Hypotension, bradycardia, and AV block may occur; hypotension is most common adverse effect during IV administration; acute life-threatening pulmonary or hepatic toxicity may complicate acute or chronic use of this drug; elevation of serum hepatic enzymes and/or TSH requires that patients be monitored carefully during amiodarone therapy; rarely, irreversible blindness from optic neuritis is observed with chronic use Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Lidocaine -- Class IB antiarrhythmic that increases electrical stimulation threshold of the ventricle, suppressing automaticity of conduction through the tissue. Although lidocaine may terminate VT successfully, it may increase the overall mortality in peri-infarction VT. Evidence for effectiveness is considered "Indeterminate" in the 2000 American Heart Association Emergency Cardiovascular Care guidelines. D: 1-1.5 mg/kg IV push, followed by 0.5-0.75 mg/kg IV push to a maximum of 3 mg/kg Continuous 1–4 mg/min infusion should be started after arrhythmia is suppressed Paed. Endotracheal, intraosseous, and IV loading dose: 1 mg/kg, may repeat twice at 10- to 15-min intervals if necessary; follow with continuous IV infusion of 20-50 mcg/kg/min KI: hypersensitivity to amide-type local anesthetics; avoid in Adams-Stokes syndrome and Wolf-Parkinson-White syndrome; Genghis Khun ([email protected],nafanakhun.wordpress.com)


avoid in severe sinoatrial, atrioventricular (AV), or intraventricular block if artificial pacemaker not in place IO: Coadministration with cimetidine or beta-blockers, increases toxicity of lidocaine; coadministration with procainamide and tocainide may result in additive cardiodepressant action; may increase effects of succinylcholine Preg: B P: Do not use a drug solution that contains preservatives; caution in heart failure, hepatic disease, hypoxia, hypovolemia or shock, respiratory-depression, and bradycardia; elderly patients may be at increased risk for CNS and cardiac adverse effects due to increased half-life or decreased clearance of the drug; high plasma concentrations can cause seizures, heart block, and AV conduction abnormalities; has been associated with malignant hyperthermia



Propafenone HCl Possibly works by reducing spontaneous automaticity and prolonging the refractory period. I: Fibrilasi/ Flutter atrium paroksismal, takikardia supraventrikuler paroksismal, aritmia ventrikuler BSO: Tab salut selaput 150 mg D: 150 mg PO q8h and increase at 3- to 4-d intervals up to 300 mg q8h KI: hypersensitivity; bronchospastic disorders; conduction disorders; bradycardia; uncontrolled heart failure IO: Decreases serum levels of rifampin; cimetidine, quinidine, warfarin, and beta-blockers may increase serum levels of propafenone Preg: C P: Should only be used for life-threatening arrhythmias; caution in patients with congestive heart failure, myocardial infarction, or hepatic or renal dysfunction Nama Dagang: Rytmonorm Genghis Khun ([email protected],nafanakhun.wordpress.com)


B. Anti Angina Nitroglycerin/ Glyceryl trinitrate Isosorbide Dipyridamole Trimetazidine




Short-acting nitroglycerins Nitroglycerin/ Glyceryl trinitrate Causes relaxation of vascular smooth muscle by stimulating intracellular cyclic GMP production. Result is decrease in BP. I: Mengontrol hipertensi, angina pectoris BSO: amp 50 mg/10cc D: Jangan langsung IV, tapi larutkan dg NaCl 5% atau Glukosa 5%. Kadar maks 400mcg/cc. Titrasi awal 5 mcg/mnt, dpt dinaikkan 10 sampai 20 mcg/mnt. KI: hypersensitivity; severe anemia; shock; postural hypotension; head trauma; closed-angle glaucoma; cerebral hemorrhage; hypertrophic obstructive cardiomyopathy IO: Concurrent sildenafil (Viagra) may cause severe hypotension and death; aspirin may increase serum concentrations; calcium channel blockers may cause markedly symptomatic orthostatic hypotension (dose adjustment of either agent may be necessary) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preg: C P: Caution in coronary artery disease and low systolic BP; adverse effects include hypotension, flushing, headache, lightheadedness, and tolerance (8- to 12-h nitrate-free interval is most effective method to prevent development of tolerance); high IV doses may cause methemoglobinemia, heparin resistance, and ethanol intoxication; ischemia may worsen upon withdrawal Nama Dagang:



Long-acting nitroglycerins Isosorbide Relaxes vascular smooth muscle by stimulating intracellular cyclic GMP. Decreases LV pressure (ie, preload) and arterial resistance (ie, afterload). Reduces cardiac oxygen demand by decreasing LV pressure and dilating arteries. I: BSO: Isosorbide dinitrate: Tab 5 mg, 10 mg, 20 mg, Tab sublingual 5 mg Tab retard 20 mg IV 1 mg/ cc Isosorbide mononitrate: Tab salut 60 mg D: Isosorbide dinitrate: 2.5-10 mg SL prn IR 10-30 mg PO bid/tid SR 80-120 mg PO qd IR (4x) Isosorbide mononitrate: 10-20 mg PO bid SR 30-120 mg PO qd Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; severe anemia; closed-angle glaucoma; postural hypotension; head trauma; cerebral hemorrhage IO: Alcohol may cause severe hypotension and cardiovascular collapse; aspirin may increase serum concentrations and actions; calcium channel blockers may increase symptomatic orthostatic hypotension (adjust dose of either agent); may decrease effects of heparin Preg: C P: Tolerance to vascular and antianginal effects of nitrates may develop; minimize tolerance by using smallest effective dose or pulse therapy (intermittent dosing) or by alternating with other coronary vasodilators (take last daily dose of short-acting agent no later than 7 pm); caution when administering to patients with glaucoma Nama Dagang:



Dipyridamole I: angina pektoris, ggn sirkulasi darah koroner, pasca infark BSO: Tab 25 mg, 75 mg D: 25-50 mg 2-3x/hr. KI: Hipersensitif P: Jangan utk angina akut, stenosis aorta subvalvular, hemodinamik tak stabik karena MI ES: Ggn GI, sakit kepala IO: Derivat Xantin: teofilin & kafein menurunkan efek vasodilator. Aspirin menginduksi efek antitrombotik Preg:: B Nama Dagang:



Trimetazidine I: Tambahan utk terapi angina BSO: Tab salut selaput 35 mg D: 1 tab 2x/hr KI: Laktasi P: Gagal ginjal, gagal hati berat. Tidak utk serangan akut, angina tak stabil dan IM. Bumil ES: Ggn GI,muntah IO: Preg:: Nama Dagang: Trizedon MR



C. ACE Inhibitor Captopril Quinapril Fosinopril Enalapril Lisinopril Imidapril Trandolapril Benazepril Ramipril Perindopril Comparative studies show ACE inhibitors are more effective than other antihypertensives (ie, beta-blockers, calcium channel blockers) in reducing blood pressure and proteinuria, protecting renal function, and delaying onset of end-stage renal disease.



Captopril Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. I: BSO: Tab 12,5 mg, 25 mg, 50 mg D: Hypertension: 12.5-25 mg PO 2-3x; may increase by 12.5-25 mg/dose at 1- to 2-wk intervals; max 50 mg 3x CrCl 10-50 mL/min: give 75% of starting dose CrCl <10 mL/min: give 50% of starting dose CHF: 6.25-12.5 mg PO bid/tid; may increase by 12.5-25 mg/dose at 1- to 2-wk intervals; max 100 mg tid Paed. Neonates: 0.05-0.1 mg/kg/dose PO q6-24h; titrate dose up to 0.5 mg/kg/dose prn Infants: 0.15-0.3 mg/kg/dose PO q6-24h; titrate dose up; max 6 mg/kg/d in 2-4 divided doses prn Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: 0.3-0.5 mg/kg/dose PO q6-24h; titrate dose up; max of 6 mg/kg/d in 2-4 divided doses prn KI: Hipersensitif; renal impairment IO: NSAIDs may reduce hypotensive effects of captopril; ACE inhibitors may increase digoxin, lithium, and allopurinol levels; rifampin decreases captopril levels; probenecid may increase captopril levels; the hypotensive effects of ACE inhibitors may be enhanced when given concurrently with diuretics Preg: C, D P: Caution in renal impairment, valvular stenosis, or severe congestive heart failure Nama Dagang:



Quinapril Competitive inhibitor of ACE. Reduce angiotensin II levels, decreasing aldosterone secretion. BSO: Tab 5 mg, 10 mg, 20 mg D: Hypertension: 10 mg PO 1-2x; increase to 80 mg/d prn CHF: 10 mg PO 1-2x; target dose is 20 mg PO bid KI: Hipersensitif; angioedema IO: NSAIDs may reduce hypotensive effects of enalapril; ACE inhibitors may increase digoxin, lithium, and allopurinol levels; rifampin decreases enalapril levels; probenecid may increase enalapril levels; the hypotensive effects of ACE inhibitors may be enhanced when given concurrently with diuretics Preg: C, D P: Caution in renal impairment (serum creatinine >3.5), valvular stenosis, or severe congestive heart failure; watch for serum potassium Nama Dagang:Accupril Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fosinopril Competitive inhibitors of ACE. Reduce angiotensin II levels, decreasing aldosterone secretion. BSO: Tab 10 mg D: Hypertension: 10 mg/d PO; increase to 80 mg/d prn CHF: 10 mg/d PO; target dose is 40 mg/d KI: Hipersensitif IO: NSAIDs may reduce hypotensive effects; may increase digoxin, lithium, and allopurinol levels; rifampin decreases levels; probenecid may increase levels; diuretics may exacerbate hypotensive effects Preg: C, D P: Caution in renal impairment, valvular stenosis, severe CHF Nama Dagang: Acenor



Enalapril Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in increased levels of plasma renin and a reduction in aldosterone secretion. Helps control blood pressure and proteinuria. Decreases pulmonary-to-systemic flow ratio in the catheterization laboratory and increases systemic blood flow in patients with relatively low pulmonary vascular resistance. Has favorable clinical effect when administered over a long period. Helps prevent potassium loss in distal tubules. Body conserves potassium; thus, less oral potassium supplementation needed. BSO: Tab 5 mg, D: Hypertension: 2.5-5 mg/d PO; increase prn; dosing range is 10-40 mg/d PO 1-2x; alternatively, 1.25 mg/dose IV over 5 min q6h CHF: 2.5-5 mg/d PO; increase prn; dosing range is 10-40 mg/d PO 1-2x KI: Hipersensitif Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: NSAIDs may reduce hypotensive effects of enalapril; ACE inhibitors may increase digoxin, lithium, and allopurinol levels; rifampin decreases enalapril levels; probenecid may increase enalapril levels; the hypotensive effects of ACE inhibitors may be enhanced when given concurrently with diuretics Preg: C, D P: renal impairment, valvular stenosis, or severe congestive heart failure; IV formulation not recommended in managing neonatal hypertension because of risk of acute renal failure and oliguria Nama Dagang:



Lisinopril Prevents conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. BSO: Tab 5 mg, 10 mg D: Hypertension: 10 mg/d PO; increase 5-10 mg/d at 1- to 2wk intervals; max 40 mg CHF: 10 mg/d PO; increase 5-10 mg/d at 1- to 2-wk intervals; target dose is 40 mg/d KI: Hipersensitif IO: NSAIDs may reduce hypotensive effects of lisinopril; ACE inhibitors may increase digoxin, lithium, and allopurinol levels; rifampin decreases lisinopril levels; probenecid may increase lisinopril levels; the hypotensive effects of ACE inhibitors may be enhanced when given concurrently with diuretics Preg: C, D P: renal impairment, valvular stenosis, or severe congestive heart failure Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Imidapril I: Hipertensi BSO: Tab 5 mg, 10 mg D: Dws 5-10 mg 1x/hr. Pasien dg ggn ginjal, hipertensi berat atau hipertensi parenkim ginjal awal 2,5 mg/hr KI: Hipersensitif, pasien dalam pengobatan apheresi LDL menggunakan dextran selulosa sulfat. Pasien dialisis dengan acrylonitrilic methallyl sulfonat sodium membran (AN 69). Wanita atau wanita yang mungkin hamil. P: Hipertensi berat, hemodialisis, mendapat terapi diuretik, diet pembatasan garam secara ketat. Mengganggu kewaspadaan. Tak dianjurkan penggunaannya 1 jam sebelum operasi. Ggn ginjal berat. Stenosis arteri renal bilateral. ES: Ggn sist hematologi, albuminuria, peningkatan kreatinin BUN, sakit kepala, pusing, hipotensi postural, palpitasi, mual, muntah, nyeri perut, ruam, pruritus, batuk, rasa tidak enak pada faring, malaise, wajah kemerahan, kenaikan serum K, SGOT & SGPT Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Dextran selulosa, AN 69, diuretik hemat K, HCT, triklormetiazid, litium, suplemen Ca, AINS (Indometasin) Preg: Nama Dagang: Tanapress



Trandolapril Prevent conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. BSO: Tab 0.5 mg, 2 mg D: Hypertension: 1 mg/d PO; increase to 8 mg/d prn CHF: 1 mg/d PO; target dose is 4 mg/d KI: Hipersensitif; history of angioedema IO: May increase digoxin, lithium, and allopurinol levels; probenecid may increase levels; diuretics or NSAIDs may increase hypotensive effects Preg: C, D P: Caution in renal impairment, valvular stenosis, or severe CHF Nama Dagang:



Benazepril Prevents conversion of angiotensin I to angiotensin II, which is a potent vasoconstrictor. Also causes lower aldosterone secretion=> reducing systemic & glomerular capillary pressure. BSO: Tab 5 mg, 10 mg D: 10 mg/d PO; increase to 80 mg/d prn KI: Hipersensitif IO: NSAIDs may reduce hypotensive effects of benazepril; ACE inhibitors may increase digoxin, lithium, and allopurinol levels; rifampin decreases benazepril levels; probenecid may increase benazepril levels; the hypotensive effects of ACE inhibitors may be enhanced when given concurrently with diuretics Preg: C, D P: Caution in renal impairment, valvular stenosis, or severe congestive heart failure Nama Dagang: Cibacen



Ramipril Prevent conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in lower aldosterone secretion. BSO: Tab 2,5 mg D: Hypertension: 2.5 mg/d PO; increase to 20 mg/d prn CHF: 2.5 mg/d PO; target dose is 10 mg bid Angina: 2.5-5 mg PO qd; max 20 mg/d KI: Hipersensitif; history of angioedema IO: May increase digoxin, lithium, and allopurinol levels; probenecid may increase levels; diuretics or NSAIDs may increase hypotensive effects Preg: C, D P: Caution in renal impairment, valvular stenosis, or severe CHF Nama Dagang:



Perindopril BSO: Tab 4 mg D: Hypertension: 4 mg/d PO; increase to 8 mg/d prn CHF: 2 mg/d PO; increase to 4 mg dosis tunggal KI: Hipersensitif; hamil,laktasi P: Caution in renal impairment, valvular stenosis, or severe CHF IO: Preg: C, D Nama Dagang: Prexum



D. β Blocker Propranolol Atenolol Metoprolol Carvedilol Carteolol Bisoprolol Sotalol



Propranolol Nonselective beta-blocker that is lipophilic (penetrates CNS). I: Hipertensi, angina pectoris, ansietas takikardia, disaritmia, kardiomiopati obstruktif hipertrofi & tremor esensial. Terapi tambahan pada tirotoksikosis & feokromositoma. Profilaksis setelah IMA, migren & angina. BSO: Tab 10 mg D: Hipertensi , angina pectoris 20 mg 3-4x/hr, titrasi s/d 40 mg 3-4x/hr. IR: 40-160 mg PO bid SR: 60-320 mg PO qd KI: Hipersensitif; history of bronchospasm; uncompensated CHF; bradycardia; cardiogenic shock; AV conduction abnormalities IO: Aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, cholestyramine, and rifampin may decrease effects; calcium channel blockers, cimetidine, loop diuretics, and MAOIs may increase toxicity; may increase toxicity of hydralazine, haloperidol, benzodiazepines, and phenothiazines Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preg: C P: Beta-adrenergic blockade may mask signs of acute hypoglycemia and hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm; withdraw drug slowly and monitor closely; adverse effects include bronchial constriction, Raynaud phenomenon, hypotension, decreased libido, impotence, lethargy, depression, and decreased HDL; caution in Wolff-Parkinson-White syndrome and renal or hepatic dysfunction Nama Dagang:



Atenolol Selectively blocks beta1-receptors, with little/no effect on beta2 BSO: tab 50 mg, 100 mg D: HT= 50 mg PO qd; increase to 100 mg/d, if necessary Angina= 50-200 mg PO qd Paed. 1-2 mg/kg/dose PO qd KI: Hipersensitif; congestive heart failure; pulmonary edema; cardiogenic shock; AV conduction abnormalities; heart block (without a pacemaker) IO: Coadministration with aluminum salts, barbiturates, calcium salts, cholestyramine, NSAIDs, penicillins, and rifampin may decrease effects; haloperidol, hydralazine, loop diuretics, and MAOIs may increase toxicity of atenolol Preg: C P: Beta-adrenergic blockade may reduce symptoms of acute hypoglycemia and mask signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism and cause thyroid storm; monitor patients closely and withdraw drug slowly; during an IV, carefully monitor BP, heart rate, and ECG Genghis Khun ([email protected],nafanakhun.wordpress.com)


Metoprolol Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions. During IV administration, carefully monitor blood pressure, heart rate, and ECG. BSO: Tab 50 mg, 100 mg D: Hypertension= 00 mg/d PO qd or divided bid/tid initially and increase at 1-wk interval prn to a total of 450 mg/d if necessary Angina= 50-200 mg PO bid CHF= 100 mg PO qd; titrate to maximum dose of 400 mg/d PO in 1-2 divided doses. Paed.: 1-5 mg/kg/24h PO divided bid KI: Hipersensitif; uncompensated congestive heart failure; bradycardia; asthma; cardiogenic shock; AV conduction abnormalities IO: Aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, cholestyramine, and rifampin may decrease bioavailability and plasma levels of metoprolol, possibly resulting in decreased Genghis Khun ([email protected],nafanakhun.wordpress.com)


pharmacologic effects; toxicity of metoprolol may increase with coadministration of sparfloxacin, phenothiazines, astemizole, calcium channel blockers, quinidine, flecainide, and contraceptives; metoprolol may increase toxicity of digoxin, flecainide, clonidine, epinephrine, nifedipine, prazosin, verapamil, and lidocaine Preg: B P: Beta-adrenergic blockade may reduce signs and symptoms of acute hypoglycemia and may decrease clinical signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm; monitor patient closely and withdraw the drug slowly; during IV administration, carefully monitor blood pressure, heart rate, and ECG Nama Dagang:



Carvedilol Nonselective beta- and alpha-adrenergic blocker. Does not appear to have intrinsic sympathomimetic activity. May reduce cardiac output and decrease peripheral vascular resistance. BSO: Tab 6.25 mg, 25 mg D: 6.25 mg PO bid; start at 3.125 mg PO bid in heart failure, maintain for 1-2 wk if tolerated, and then increase to 12.5 mg bid; max 25 mg bid KI: Hipersensitif; hypotension; bradycardia; AV/SA node disease; cardiogenic shock; severe uncontrolled cardiac failure IO: Rifampin, barbiturates, cholestyramine, colestipol, NSAIDs, salicylates, and penicillins may decrease effects; may increase effects of antidiabetic agents, digoxin, and calcium channel blockers; clonidine may increase BP and decrease heart rate; may decrease effect of sulfonylureas; cimetidine, fluoxetine, paroxetine, and propafenone may increase levels Preg: C P: CHF and in patients treated with digitalis, diuretics, or ACE inhibitors (AV conduction may be slowed); discontinue if liver Genghis Khun ([email protected],nafanakhun.wordpress.com)


impairment occurs; caution in peripheral vascular disease, hyperthyroidism, and DM Nama Dagang:



Carteolol I: Angina pectoris, takikardia atau aritmia supraventrikuler, hipertensi esensial & neurosis jantung BSO: Tab 5 mg D: Dws awal 10-15 mg/hr terbagi dalam 2-3 dosis. Maks 30 mg dalam dosis terbagi. KI: Asma bronchial, kecenderungan bronkospasme, diabetic ketoasidosis & metabolic asidosis. Sinus bradikardi berat. Blok atrial gr 2 & 3. Blok sinus, koma, syok kardiogenik, gagal ventrikuler kanan sebagai kalanjutan dr hipertensi pulmonal. Ggl jantung kongestif. hamil P: Hipoglikemia idiopatik, DM tak terkontrol. Puasa lama. Ggn hati & ginjal. Ggn sirkulasi perifer. Manula, ibu menyusui. Penghentian terapi 24 jam sblm op, terapi dgn ß-blocker lain pd pasien feokromositoma ES: Jarang, bradikardi, hipotensi, edema pada ekstremitas bawah,sakit kepala,pusing, nyeri ulu hati, mual, muntah, meteorismus, nyeri lambung, konstipasi, diare, erupsi dan gatal pd kulit, lemah, vertigo,lelah. Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Memperkuat obat hipoglikemik, antagonis Ca, simpatolitik, klonidin HCl Preg:: C, D pd trim 2 &3 Nama Dagang: Mikelan



Bisoprolol Selectively blocks beta1 receptors, with little/no effect on beta2 BSO: Tab 2.5 mg, 5 mg D: 2.5-20 mg/d PO; max 40 mg/d KI: Hipersensitif; pulmonary edema; cardiogenic shock; AV conduction abnormalities; heart block (without pacemaker) IO: Aluminum salts, barbiturates, NSAIDs, penicillins, calcium salts, cholestyramine, and rifampin may decrease bioavailability and plasma levels, possibly resulting in decreased pharmacologic effects; sparfloxacin, phenothiazines, astemizole (recalled from US market), calcium channel blockers, quinidine, flecainide, and contraceptives may increase toxicity; may increase toxicity of digoxin, flecainide, clonidine, epinephrine, nifedipine, prazosin, verapamil, and lidocaine Preg: C P: May reduce signs & symptoms of acute hypoglycemia & may decrease clinical signs of hyperthyroidism; abrupt withdrawal may exacerbate symptoms of hyperthyroidism, including thyroid storm; monitor patient closely and withdraw drug slowly Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sotalol Primarily a potassium channel (IKr)–blocking drug, with weak beta-blocker effect. In ESVEM study, sotalol was compared with 6 other drugs (not including amiodarone) in VT patients. Survival was best in the sotalol group. BSO: Tab 80 mg D: 80-120 mg PO q12h initially; occasionally, doses as high as 240 mg q12h are used with careful monitoring for toxicity KI: Hipersensitif; complete AV block; intraventricular conduction defects; patients taking ritonavir or sparfloxacin IO: Increases effect of theophylline, quinidine, procainamide, phenytoin, methotrexate, flecainide, digoxin, cyclosporine, betablockers, and anticoagulants; cardiotoxicity of amiodarone is increased by ritonavir, sparfloxacin, and disopyramide; coadministration with calcium channel blockers may cause an additive effect and decrease myocardial contractility further; cimetidine may increase amiodarone levels Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Risk of proarrhythmia increases with dose; monitor for QT prolongation, dyspnea, fatigue, depression, bradycardia, and syncope due to torsade de pointes Nama Dagang: Sotacor



E. Ca Antagonis Verapamil Diltiazem Amlodipine Nifedipine Felodipine Lacidipine Nicardipine Lercanidipine



Verapamil During depolarization, inhibits calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium. BSO: Tab/Kaps 80 mg, 240 mg D: HT= 240-480 mg/d PO divided tid/qid Angina= IR: 80-120 mg PO tid/qid SR: 120-240 mg PO qd/bid KI: Hipersensitif; severe CHF, sick sinus syndrome or second- or third-degree AV block, and hypotension (<90 mm Hg systolic) IO: Verapamil may increase carbamazepine, digoxin, and cyclosporine levels; coadministration with amiodarone can cause bradycardia and a decrease in cardiac output; may increase cardiac depression when administered concurrently with beta blockers; cimetidine may increase verapamil levels; verapamil may increase theophylline levels Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Depresses impulse formation, AV block, - inotropism, and vasodilation, which can result in hypotension, shock, pulmonary edema, and death; hepatocellular injury may occur; transient elevations of transaminases with or without concomitant elevations in alkaline phosphatase and bilirubin have occurred (elevations have been transient and may disappear with continued verapamil treatment), monitor liver function; IV administration discouraged in neonates and young infants due to severe apnea, bradycardia, hypotension, and cardiac arrest periodically Nama Dagang:



Diltiazem During depolarization, inhibit calcium ions from entering slow channels and voltage-sensitive areas of vascular smooth muscle and myocardium. I: angina pektoris BSO: Tab 30 mg, 60 mg D: 30 mg 4x/hr. titrasi maks 360 mg/hr. ac & hs. KI: Hipersensitif; severe CHF; sick sinus syndrome; second- or third-degree AV block; hypotension (<90 mm Hg systolic); significant LV systolic dysfunction IO: May increase carbamazepine, digoxin, cyclosporine, and theophylline levels; amiodarone may cause bradycardia and decrease in cardiac output; beta-blockers may increase cardiac depression; cimetidine may increase levels Preg: C P: Caution in impaired renal or hepatic function; may increase LFT levels, and hepatic injury may occur Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Amlodipine Relax coronary smooth muscle and produce coronary vasodilation, which, in turn, improves myocardial oxygen delivery. Benefits nonPreg:nant patients with systolic dysfunction, hypertension, or arrhythmias. I: Hipertensi arterial, profilaksis angina pektoris BSO: Tab 5 mg, 10 mg D: HT= 2.5-5 mg PO 1x; max 10 mg/d Angina= 5-10 mg PO qd KI: Hipersensitif IO: Fentanyl may increase hypotensive effects; may increase cyclosporine levels; H2 blockers (eg, cimetidine) may increase toxicity Preg: C P: Adjust dose in renal/hepatic impairment; may cause lower extremity edema; allergic hepatitis has occurred but is rare; caution in patients with severe LV systolic dysfunction Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Nifedipine -- Especially in the sustained-release form, nifedipine is a calcium channel blocker that has proven to be fairly effective in the management of chronic cor pulmonale caused by primary pulmonary hypertension. Modifies the entry of calcium into the cells by blocking the slow or voltage-dependent calcium channels, resulting in vasodilation, which improves myocardial oxygen delivery. Sublingual administration generally is safe, despite theoretical concerns. I: Insufiiensi jantung akut & kronik. Terapi tambahan hipertensi BSO: tab 5 mg, 10 mg D: 3x/d KI: Hipersensitif, pregnancy IO: Monitor oral anticoagulants when used concomitantly; coadministration with any agent that can lower BP, including beta-blockers and opioids, can result in severe hypotension; H2 blockers (cimetidine) may increase toxicity Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Aortic stenosis; angina; congestive heart failure; Preg:; nursing mothers; may cause lower extremity edema; allergic hepatitis has occurred but is rare Nama Dagang:



Felodipine Relaxes coronary smooth muscle and produces coronary vasodilation, which in turn improves myocardial oxygen delivery. Benefits nonPreg:nant patients with systolic dysfunction, hypertension, or arrhythmias. Can be used during Preg: if indicated clinically. Calcium channel blockers potentiate ACE inhibitor effects. Renal protection is not proven, but these agents reduce morbidity and mortality rates in congestive heart failure. Calcium channel blockers are indicated in patients with diastolic dysfunction. Effective as monotherapy in black patients and elderly patients. BSO: tab 5 mg D: 5 mg PO qd; max 20 mg/d KI: Hipersensitif IO: Fentanyl and alcohol may increase hypotensive effects; calcium channel blocker may increase cyclosporine levels; H2 blockers (cimetidine), erythromycin, nafcillin, and azole Genghis Khun ([email protected],nafanakhun.wordpress.com)


antifungals may increase toxicity (avoid combination or monitor closely); carbamazepine may reduce bioavailability (avoid this combination); rifampin may decrease levels (monitor and adjust dose of calcium channel blocker) Preg: C P: Adjust dose in renal/hepatic impairment; may cause lower extremity edema; allergic hepatitis have occurred but is rare Nama Dagang:



Lacidipine I: Hipertensi BSO: Tab 4 mg D: Awal 4 mg 1x/hr. titrasi 6 mg setelah 3-4 minggu. KI: Hipersensitif P: Ggn hati berat. Hamil,laktasi, nodus SA & AV abnormal ES: Sakit kepala, muka kemerahan, edema, pusing, palpitasi, asthenia, ruam kulit, nyeri lambung, mual, poliuria, nyeri dada, hiperplasi ginggiva, alkalin fosfatase meningkat sementara. IO: Diuretik, β-blocker, menambah efek hipotensi. Cimetidin meningkatkatkan kadar obat dlm plasma. Preg:: Nama Dagang: Lacipil



Nicardipine A calcium channel blocker, inhibiting calcium ion influx into vascular smooth muscle and myocardium. BSO: Amp 2 mg, 10 mg D: Start 5 mg/h IV, increase by 2.5 mg/h q5-15min to a maximum of 15 mg/h KI: Hipersensitif; severe CHF; sick sinus syndrome; second- or third-degree AV block; hypotension (<90 mm Hg systolic) IO: May increase carbamazepine, digoxin, cyclosporine, and theophylline levels; when administered with amiodarone, may cause bradycardia and a decrease in cardiac output; when administered with beta-blockers, may increase cardiac depression; cimetidine may increase levels Preg: C P: Caution in impaired renal or hepatic function; may increase LFTs, and hepatic injury may occur. Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Lercanidipine I: Hipertensi esensial ringan-sedang BSO: Tab 10 mg D: 10 mg 1x/d, titrasi 20 mg/d KI: Hamil, laktasi, obstruksi aliran keluar ventrikel kiri. Ggl jantung kongestif, angina pectoris tak stabil, ggn hati/ ginjal berat. Digunakan dg siklosporin atau juz anggur P: sindroma sick sinus (jika tanpa pacu jantung), disfungsi ventrikel kiri,penykit jantung iskemik. Hindari penggunaan bersama inhibitor kuat CYP3A4 (spt ketokonazol) ES: Ruam, edema perifer, palpitasi, takikardi, sakit kepala IO: Hindari penggunaan bersama inhibitor kuat CYP3A4 (spt ketokonazol, itrakonazol, ritonavir, eritromisin, rotreandomisin), siklosposrin, juz anggur. Hati-hati penggunaan dg substansi lain CYP3A4 (spt terfenadin, astemizol, obat anti aritmia kelas III), simetidin dosis tinggi, antikonvulsan dan rifampisin. Pemberian dosis tambahan jika obat bersama β-blocker. Nama Dagang: Zanidip Genghis Khun ([email protected],nafanakhun.wordpress.com)


F. Antagonis Angiotensin II & Kombinasinya Valsartan Irbesartan Losartan Candesartan Telmisartan Olmesartan medoxomil



Valsartan Prodrug that produces direct antagonism of angiotensin II receptors. Displaces angiotensin II from AT1 receptor and may lower blood pressure by antagonizing AT1-induced vasoconstriction, aldosterone release, catecholamine release, arginine vasopressin release, water intake, and hypertrophic responses. May induce more complete inhibition of reninangiotensin system than ACE inhibitors, does not affect response to bradykinin, and is less likely to be associated with cough and angioedema. For use in patients unable to tolerate ACE inhibitors. I: Hipertensi, CHF NYHA II-IV, IMA BSO: Tab 40 mg, 80 mg, 160 mg D: 80 mg PO qd; max 320 mg/d KI: Hipersensitif; severe hepatic insufficiency, biliary cirrhosis or obstruction, primary hyperaldosterism, bilateral renal artery stenosis IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May increase digoxin, lithium, and allopurinol levels; probenecid may increase valsartan levels; coadministration with diuretics, increase hypotensive effects; NSAIDs may reduce hypotensive effects of valsartan; may increase risk of hyperkalemia if taken concurrently with potassium supplements or other potassiumsparing diuretics Preg: C, D P: Caution in hyperkalemia, suspected bilateral renal artery stenosis, or solitary kidney with unilateral RAS Nama Dagang:



Irbesartan Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II at tissue receptor site. May induce more complete inhibition of renin-angiotensin system than ACE inhibitors and do not affect response to bradykinin (less likely to be associated with cough and angioedema). I: Hipertensi esensial BSO: Tab 150 mg, 300 mg D: 150 mg PO 1x qd; max 300 mg/d KI: Hipersensitif; hyperkalemia P: Caution in patients with unilateral or bilateral renal artery stenosis; decrease dose in volume- or salt-depleted patients IO: May increase digoxin, lithium, and allopurinol levels; probenecid may increase irbesartan levels; coadministration with diuretics, increase hypotensive effects; NSAIDs may reduce hypotensive effects of irbesartan; may increase risk of hyperkalemia if taken with potassium -sparing diuretics Preg: C, D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Losartan Nonpeptide angiotensin II receptor antagonists that block vasoconstrictor and aldosterone-secreting effects of angiotensin II at tissue receptor site. May induce more complete inhibition of renin-angiotensin system than ACE inhibitors and do not affect response to bradykinin (less likely to be associated with cough and angioedema). I: Hipertensi BSO: Tab 50 mg D: 25-100 mg PO qd/bid KI: Hipersensitif; hyperkalemia IO: Ketoconazole, sulfaphenazole, and phenobarbital may decrease effects; cimetidine may increase effects Preg: C, D P: Caution in patients with unilateral or bilateral renal artery stenosis; decrease dose in volume- or salt-depleted patients Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Candesartan Blocks vasoconstriction and aldosterone-secreting effects of angiotensin II. May induce more complete inhibition of reninangiotensin system than ACE inhibitors, does not affect response to bradykinin, and is less likely to be associated with cough and angioedema. Use in patients unable to tolerate ACE inhibitors. Angiotensin II receptor blockers reduce blood pressure and proteinuria, protecting renal function, and delaying onset of endstage renal disease. I: Hipertensi BSO: Tab 8 mg, 16 mg D: 8-16 mg/d PO initially; max 32 mg/d KI: Hipersensitif IO: May increase digoxin, lithium, and allopurinol levels; probenecid may increase candesartan levels; coadministration with diuretics, increase hypotensive effects; NSAIDs may reduce hypotensive effects of candesartan; may increase risk of Genghis Khun ([email protected],nafanakhun.wordpress.com)


hyperkalemia if taken concurrently with potassium supplements or other potassium-sparing diuretics Preg: C, D P: Caution in renal impairment (serum creatinine >3.5), valvular stenosis, or severe congestive heart failure; watch for serum potassium Nama Dagang:



Telmisartan I: Hipertensi esensial BSO: tab 40 mg, 80 mg D: Dws 40 mg 1x/hr. Max. 80 mg/hr KI: Hamil, laktasi P: Deplesi vol intravaskuler, ggl jantung kongestif berat, pnykit ginjal tmsk stenosis arteri ginjal, aldosteronisme primer, stenosis aorta atau mitral. ES: sakit kepala, pusing, nyeri, nyeri punggung, lelah, diare, gejala seperti flu, sinusitis, dyspepsia, batuk, nyeri dada, ISK. IO: Diuretik Hemat K, Suplemen K, bahan pengganti garam mengandung K atau obat lain yg dapat meningkatkan kadar K (heparin, digoksin, litium) Preg:: C, D pd trim 2 & 3 Nama Dagang: Micardis



Olmesartan Blocks vasoconstrictor and aldosterone-secreting effects of angiotensin II at tissue receptor site. May induce more complete inhibition of renin-angiotensin system than ACE inhibitors and do not affect response to bradykinin (less likely to be associated with cough and angioedema). BSO: Tab 10 mg, 20 mg, 40 mg D: 20 mg PO qd; max 40 mg/d KI: Hipersensitif IO: Diuretics may enhance hypotensive effect Preg: C, D P: May cause injury or even death to the developing fetus, due to effect on renin-angiotensin system, if given in second or third trimesters of Preg:; serum levels and AUC increase with renal and hepatic insufficiency respectively; may cause oliguria, azotemia, and acute renal failure; facial edema, angioedema, or decreased hemoglobin or hematocrit occur rarely Nama Dagang: Olmetec Genghis Khun ([email protected],nafanakhun.wordpress.com)


G. Diuretik Mannitol Spironolactone Furosemide Acetazolamide Hydrochlorothiazide/ HCT Chlortalidone Indapamide

FaiK Fauzi MuLaCheLLa em@il: [email protected] Blog: faikshare.blogspot.com

Genghis Khun ([email protected]


Mannitol -- Indicated for prophylaxis and treatment of pigment-induced renal failure secondary to rhabdomyolysis in those with cocaine poisoning, among others. Alternative diuretic used when urine output is inadequate despite aggressive fluid therapy. D: 1 g/kg of 20% solution IV over 20-30 min Paed. Initial dose: 0.5-1 g/kg/dose IV Maintenance dose: 0.25-0.5 g/kg/dose IV q4-6h KI: Hipersensitif; anuria; severe pulmonary congestion; progressive renal damage; severe dehydration; active intracranial bleeding; progressive heart failure IO: Effects can be potentiated by other diuretics (eg, furosemide, acetazolamide) Preg: C P: Carefully evaluate cardiovascular status before rapid administration of mannitol because a sudden increase in extracellular fluid may lead to fulminating CHF; avoid pseudoagglutination when blood is administered Genghis Khun ([email protected],nafanakhun.wordpress.com)


simultaneously, add at least 20 mEq of sodium chloride to each liter of mannitol solution; do not administer electrolyte-free mannitol solutions with blood; may crystallize with concentration above 20%; use in-line filter; may cause hypovolemia, headache, and polydipsia



Spironolactone Used for management of hypertension. May block effects of aldosterone on arteriolar smooth muscles. BSO: D: Hypertension: 25-200 mg PO qd or divided bid CHF: 12.5 mg PO qd; max 25 mg/d Paed. 1.5-3.5 mg/kg/d PO divided q6-24h KI: Hipersensitif; anuria; renal failure; hyperkalemia IO: May decrease effect of anticoagulants; potassium and potassium-sparing diuretics may increase toxicity Preg: D P: Caution in renal and hepatic impairment Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Furosemide -- Example of diuretic agents used in the management of chronic cor pulmonale. Furosemide is a powerful loop diuretic that works on thick ascending limb of Henle loop, causing a reversible block in reabsorption of sodium, potassium, and chloride. D: 20-80 mg/d PO/IV/IM; may titrate to maximum dose of 600 mg/d Paed. 1-2 mg/kg/dose PO; max 6 mg/kg/dose; do not administer more frequent than q6h 1 mg/kg IV/IM slowly under close supervision; max 6 mg/kg KI: Hipersensitif; hepatic coma; anuria; concurrent severe electrolyte depletion IO: Metformin decreases furosemide concentrations; furosemide interferes with hypoglycemic effect of antidiabetic agents and antagonizes muscle-relaxing effect of tubocurarine; auditory Genghis Khun ([email protected],nafanakhun.wordpress.com)


toxicity appears to be increased with coadministration of aminoglycosides and furosemide; hearing loss of varying degrees may occur; anticoagulant activity of warfarin may be enhanced when taken concurrently with this medication; increased plasma lithium levels and toxicity are possible when taken concurrently with this medication Preg: C P: Perform frequent serum electrolyte, carbon dioxide, glucose, creatinine, uric acid, calcium, and BUN determinations during first few months of therapy and periodically thereafter Nama Dagang:



Acetazolamide I: Glaukoma, epilepsy, ggl jantung kongestif & edema karena obat BSO: Tab 250 mg D: Glaukoma 250 mg-1 g/d dlm dosis terbagi. Epilepsi 8-30 mg/kg dlm dosis terbagi. Ggl jantung kongestif & edema karena= 250-375 mg 1x/d selama 1-2 hari. KI: Depresi Na &/ K serum, peny hati & ginjal, gagal kelenj suprarenal, asidosis hiperkloremik, sirosis. Penggunaan jangka panjang pd pasien glaucoma sudut tertutup non kongestif P: Obstruksi pulmoner atau emfisema. Hamil & laktasi ES: Parestesia, ggn pendengaran/ tinnitus, perubahan rasa, ggn GI, poliuria, bingung, myopia sementara. IO: Preg: C Nama Dagang: Diamox Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hydrochlorothiazide/ HCT Inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as potassium and hydrogen ions. I: Edema, terapi tambahan hipertensi BSO: Tab 25 mg, 50 mg D: 25-100 mg PO qd; max 200 mg/kg/d Paed. <6 months: 2-3 mg/kg/d PO divided bid >6 months: 2 mg/kg/d PO divided bid KI: Hipersensitif; anuria or renal decompensation IO: May decrease effects of anticoagulants, antigout agents, and sulfonylureas; may increase toxicity of allopurinol, anesthetics, antineoplastics, calcium salts, loop diuretics, lithium, diazoxide, digitalis, amphotericin B, and nondepolarizing muscle relaxants Preg: B P: Caution in renal disease, hepatic disease, gout, DM, and erythematosus Genghis Khun ([email protected],nafanakhun.wordpress.com)


Chlortalidone Inhibits reabsorption of sodium in distal tubules, causing increased excretion of sodium and water as well as potassium and hydrogen ions. I: Hipertensi arterial, esensial, nefrogenik, atau sistolik terisolasi. BSO: Tab 50 mg D: 25-100 mg/d PO KI: Hipersensitif; anuria or renal decompensation IO: May decrease effects of anticoagulants, antigout agents, and sulfonylureas; may increase toxicity of allopurinol, anesthetics, antineoplastics, calcium salts, loop diuretics, lithium, diazoxide, digitalis, amphotericin B, and nondepolarizing muscle relaxants Preg: B, D pd hipertensi yg diinduksi kehamilan P: Caution in renal disease, hepatic disease, gout, DM, and erythematosus Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Indapamide I: Hipertensi esensial BSO: tab lepas lambat 1.5 mg D: 1 tab/d KI: Hipersensitif P: Hamil, laktasi ES: Hipotensi ortostatik, hipokalemia IO: Litium,obat non aritmik menyebabkan ledakan gelombang aritmia (astemizol, bepridil, eritromisin IV, halofantrin, pentamidin, sultoprid, terfenadin, vincamin) Preg:: B, D jika digunakan pd hipertensi yg diinduksi kehamilan Nama Dagang: Natrilix SR



H. Anti Hipertensi Lain Sodium nitroprusside Clonidine Doxazosin Reserpin Bunazosin HCl Methyldopa Terazosin Moxonidine Hydralazine




Sodium nitroprusside I: Hipertensi krisis, control tensi selama anestesi utk mengurangi perdarahan pd op bedah. Terapi jangka pendek ggl jantung BSO: Amp 50 mg/ 5cc D: Administration requires the use of an infusion pump. Average dose: 5 mcg/kg/minute. Adults: I.V. Initial: 0.3-0.5 mcg/kg/minute; increase in increments of 0.5 mcg/kg/minute, titrating to the desired hemodynamic effect or the appearance of headache or nausea; usual dose: 3 mcg/kg/minute; rarely need >4 mcg/kg/minute; maximum: 10 mcg/kg/minute. When administered by prolonged infusion faster than 2 mcg/kg/minute, cyanide is generated faster than an unaided patient can handle. KI: Kondisi lemah, anemi tak terkoreksi,hipovolemi dimana sirkulasi otak tak mencukupi Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Kerusakan ginjal, hati & serebrovaskuler. Kadar kobalamin plasma yg rendah. Leber’s optic atrophy, hipotiroidisme, ggn metabolisme sianida, hipotermia, stress ES: Takikardi, hipotensi postural,mual, diaforesis IO: Efek hipotensif ditingkatkan oleh penghambat ganglion, obat antihipertensi, anestesi cair yg mudah menguap, zat yg mendepresisirkulasi. Preg: C Nama Dagang: Sodium nitroprusside DBL



Clonidine Usually a third-line agent if other medications cannot be tolerated. Stimulates alpha2-adrenoreceptors in brain stem, activating an inhibitory neuron, which in turn results in reduced sympathetic outflow. These effects result in a decrease in vasomotor tone and heart rate. I: Hipertensi dan krisis hipertensi (obat ampul) BSO: Tab 0.075 mg, 0.15 mg. Amp 0.15 mg/cc D: Initial: 0.1 mg PO bid Maintenance: 0.2-1.2 mg/d bid/qid PO; max 2.4 mg/d Amp infuse IV dg kecepatan tak lebih dari 0.5 mcg/kg/mnt. Max 0.15 mcg/infuse, dpt diberikan 4x/d. KI: Hipersensitif IO: TCAs inhibit hypotensive effects of clonidine; coadministration with beta-blockers may potentiate bradycardia; tricyclic antidepressants may enhance hypertensive response Genghis Khun ([email protected],nafanakhun.wordpress.com)


associated with abrupt clonidine withdrawal; narcotic analgesics enhance hypotensive effects of clonidine Preg: C P: Caution in cerebrovascular disease, coronary insufficiency, sinus node dysfunction, and renal impairment; abrupt discontinuation may lead to rebound hypertension Nama Dagang: Catapres



Doxazosin I: Hipertensi, hyperplasia prostate jinak BSO: Tab 1 mg, 2 mg D: Hipertensi: awal 1 mg/hr selama 1-2 minggu. Titrasi 2 mg/hr pd 1-2 minggu selanjutnya, dst 4mg, 8 mg dg interval yg sama. Max 16 mg/hr. Hiperplasia prostat jinak: max 8 mg/hr KI: Hipersensitif P: Hipotensi postural/ sinkop, ggn fungsi hati. Hamil, laktasi. ES: Pusing, sakit kepala, letih, malaise, vertigo, asthenia, somnolen IO: Preg: C Nama Dagang: Cardura



Reserpin I: Hipertensi BSO: Tab 0.1 mg, 0.25 mg D: 0.2-0.5 mg/hr terbagi dlm 2-3 dosis. Max 0.5mg/hr KI: Riwayat depresi, ulkus lambung aktif, colitis ulseratif, hamil, laktasi P: Aritmia jantung, IMA, kerusakan jantung berat, insufisiensi ginjal, batu empedu, epilepsy, asma bronchial, terapi elektrokonvulsi, anestesi ES: Hidung tersumbat, kantuk, depresi, letargi, diare IO: Menghilangkan efek simpatomimetik indirek. Efek hipotensi ditingkatkan oleh tiazid & antihipertensi lain. Meningkatkan efek depresan SSP dr alcohol, analgesic, antihistamin, antidepresan trisiklik. Bersama MAOI menghasilkan eksitasi ringan & hipertensi. Digitalis atau Kuinidin meningkatkan efek aritmia jantung Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bunazosin HCl I: Hipertensi esensial dan hipertensi akibat ggn ginjal BSO: Tab 1 mg D: Dws Awal 1.5 mg/hr terbagi dlm 2-3 dosis. Max 3 mg/hr. KI: Hipersensitif P: Hamil, laktasi, ggn hati ES: Ggn GI, takikardi, sinkop ortostatik, polakisuria, nokturia IO: Diuretik & antihipertensi lain Preg: Nama Dagang: Detantol



Methyldopa I: Hipertensi esensial ringan & berat. Hipertensi nefrogenik, hipertensi pada awal kehamilan BSO: Tab salut selaput 250 mg D: Awal 125 mg/hr. Titrasi tiap 2-3 hari KI: Hepatitis akut, sirosis hepatic atau riwayat penyakit hati P: Riwayat penyakit hati & ggn mental. Disfungsi ginjal berat. ES: Lesu, mulut kering, Ggn GI, peningkatan BB, edema, impotensi. IO: Efek hipotensif dikurangi olehobat simpatomimetik, antidepresan trisiklik, fenotiazin & dipertinggi dg diuretic tiazid, alcohol, l-dopa, vasodilator. Mempotensiasi kerja hipoglikemik dr tolbutamid Preg:: B Nama Dagang: Dopamet



Terazosin I: Hipertensi dan BPH BSO: Tab 1 mg, 2 mg D: Awal 1 mg 1x/hr sebelum tidur.Titrasi max 5 mg/hr. KI: P: Ggn dalam mengoperasikan mesin ES: Ngantuk, mual, asthenia, hipotensi postural IO: Preg:: C Nama Dagang: Hytrin



Moxonidine I: Hipertensi primer ringan sedang BSO: Tab salut selaput 0.2 mg, 0.3 mg D: Awal 0.2 mg tiap pagi. Setelah 3 minggu titrasi 0.4 mg. Max 0.6 mg/hr & 0.4 mg/dosis KI: P: ES: IO: Preg: Nama Dagang: Physiotens



Hydralazine IV form is useful when treating severe hypertension due to preeclampsia/eclampsia. D: 10-20 mg/dose IV q4-6h prn initial; increase to 40 mg per dose prn BP >170/110 mm Hg: 0.1-0.2 mg/kg/dose IV q4-6h prn; max 20 mg or 1.7-3.5 mg/kg/d IV divided q4-6h KI: Hipersensitif; mitral valve rheumatic heart disease IO: MAOIs and beta-blockers may increase hydralazine toxicity; indomethacin may decrease pharmacologic effects of hydralazine Preg: B P: Hydralazine has been implicated in myocardial infarction; caution in suspected coronary artery disease Nama Dagang: Ser-ap-es (Hidralazine 25 mg, Reserpine 0.1 mg, HCT 15 mg) Genghis Khun ([email protected],nafanakhun.wordpress.com)


I. Vasodilator Perifer & Cerebral Activator Citicoline Flunarizine Gingkgo Biloba Co-dergocrine mesylate Cinnarizine Tocopheryl nicotinate Nicergoline Nicotinyl alcohol Buflomedil Bencyclane Isoxsuprine



Citicoline I: Gangguan kesadaran yg menyertai cedera otak. Rehabilitasi ekstremitas inferior pd pasien hemiplegi apopleksi BSO: Tab 500 mg, 1 g Amp 125 mg/cc, 250 mg/2 cc, 500 mg/4 cc, 1 g/8cc D: Cedera Otak: 100-500 mg IV drip/inj IM/IV 1-2x/hr. Infark Serebral: 1 g IV 1x/hr selama 2 minggu . Hemiplegi apopleksi: 250 mg - 1 g IV/IO 1x/hr for 4 wks KI: P: ES: Hipotensi, diplopia, insomnia IO: Preg: Nama Dagang:



Flunarizine I: Migren, pusing vestibuler & serebrovaskuler, Ggn sirkulasi perifer BSO: Tab 5 mg, 10 mg D: 10 mg/hr 1-2x/hr KI: Depresi, parkinsonisme, terapi beta blocker P: Hamil ES: IO: Preg: A, B, C, D, X Nama Dagang:



Gingkgo Biloba I: Ggn peredaran darah otak & perifer dg manifestasi sakit kepala, vertigo, tinnitus, pikun, dementia, penurunan daya ingat, konsentrasi, emosi. BSO: Tab 40 mg, 50 mg D: 1 tab 3x/hr KI: Hipersensitif P: ES: jarang, ggn pencernaan IO: Preg: Nama Dagang:



Co-dergocrine mesylate I: Kemunduran mental krn usia lanjut, pusing, sakit kepala, disorientasi, lupa, depresi BSO: Tab 1 mg, 4.5 mg. Amp 0.3 mg/cc D: 3-6 mg/hr 1-3x/hr Amp. 0.3 mg IV drip/ inj IV lambat/IM/SC 1-2x/hr KI: Psikosis akut & kronik P: Bradikardi berat, Hipotensi ortostatik ES: Hidung tersumbat, ggn GI IO: Preg:: A, B, C, D, X Nama Dagang:



Cinnarizine I: Migren, ggn vestibuler & serebrovaskuler, ggn sirkulasi perifer BSO: Tab 5 mg, 10 mg D: 10 mg/hr dosis tunggal malam hari/ terbagi, lama terapi max 6 bulan KI: Depresi, parkinsonisme, selama terapi β-blocker P: Hamil ES: Somnolen, fatique IO: Galaktorea bila digunakan dg kontrasepsi oral Preg: Nama Dagang:



Tocopheryl nicotinate I: Arteriosklerosis, apopleksi, insufisiensi koroner, ggn peredaran darah lain,kelainan metabolisme lemak. BSO: Kaps 100 mg D: Dws Awal 2 kaps 3x/hr , pemeliharaan 1 kaps 1x/hr KI: P: Nafsu makan hilang, mual, diare ES: IO: Preg: Nama Dagang: Enico



Nicergoline I: Ggn vaskulo-metabolik serebral akut & kronik (trombosis, emboli, ggn sirkulasi). Ggn vaskulo-metabolik perifer akut & kronik (obstruksi vaskuler pd ekstremitas, sindrom raynaud dll) BSO: Tab 10 mg, 30 mg D: 30-60 mg dlm 2-3 dosis terbagi KI: P: ES: Ggn GI ringan, sensasi panas pd wajah, kantuk. IO: Meningkatkan kerja antihipertensi Preg: Nama Dagang: Serolin



Nicotinyl alcohol I: Vasospastik perifer tmsk pnykt Raynaud, gatal pd tangan & kaki, ulkus varikosa BSO: Tab 25 mg D: 1-2 tab 3-4x/hr KI: P: ES: IO: Preg: C Nama Dagang: Cetacol



Buflomedil I: Ggn serebrovaskuler & sirkulasi darah perifer BSO: Tab salut selaput 150 mg D: 2-4 tab/hr KI: Jangan diberikan segera setelah partus atau jika terjadi perdarahan arteri parah P: singkirkan kemungkinan adanya delirium & demensia sekunder krn pnykt sistemik. Pnykt neurology primer, ggn fungsi ginjal ES: Vertigo, sakit kepala, mual, pusing IO: Preg: Nama Dagang: Loftyl



Bencyclane I: Ggn sirkulasi serebral & perifer. Sklerosis vaskuler serebral. Arteriosklerotikal yg menginduksi ggn sirkulasi ekstremitas. Angiopati diabetic, ulkus kruris, pnykt Raynaud, akrosianosis, apopleksi & perdarahan subarakhnoid (setelah hari ke-4), pasca apopleksi. Penurunan pendengaran. BSO: Tab 100 mg D: 1 tab 3x/hr. kasus berat 2 tab 3x/hr. KI: Insufisiensi hati, ginjal & dekompensasi kordis,IMA, blok AV, apopleksi (s/d hari ke-3), kolaps sirkulasi berat, terapi simultan dg β-blocker P: Kejang otak, residu urin krn hipertrofi prostate. ES: Tab Ggn GI, Amp: IV, iritasi dinding pembuluh darah IO: Mempotensiasi aksi antihipertensi, nitrat, α-blocker, obat psikotropik trisiklik Preg: Nama Dagang: Fludilat Genghis Khun ([email protected],nafanakhun.wordpress.com)


Isoxsuprine I: to treat problems resulting from poor blood circulation. BSO: Tablet: 10 mg, 20 mg D: For poor blood circulation: Adults: 10-20 mg 3-4 times/day; start with lower dose in elderly due to potential hypotension KI: Presence of arterial bleeding; do not administer immediately postpartum P: ES: 1% to 10%: Gastrointestinal: Nausea, vomiting IO: May enhance effects of other vasodilators/hypotensive agents; use with caution in elderly Preg: C Nama Dagang:



J. Vasocontrictor Norephinephrine bitartrate



Norepinephrine Naturally occurring catecholamine with potent alpha-receptor and mild beta-receptor activity. Stimulates beta1- and alphaadrenergic receptors, resulting in increased cardiac muscle contractility, heart rate, and vasoconstriction. Increases blood pressure and afterload. Increased afterload may result in decreased cardiac output, increased myocardial oxygen demand, and cardiac ischemia. Generally reserved for use in patients with severe hypotension (eg, systolic blood pressure <70 mm Hg) or hypotension unresponsive to other medication. BSO: Amp 1 mg/cc, 4 mg/4cc, D: 0.5-1 mcg/min IV infusion initially, titrated to effect; max 30 mcg/min KI: Hipersensitif; obstructive hypertrophic cardiomyopathy; peripheral or mesenteric vascular thrombosis because ischemia may be increased and area of infarct extended IO: Enhances pressor response of NE by blocking reflex bradycardia caused by NE Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: May cause tachyarrhythmia (especially sinus tachycardia), increased myocardial oxygen demand, and cardiac ischemia; alkaline solutions may inactivate NE if administered through same IV line; extravasation may cause severe tissue necrosis, (administer into a large vein); if extravasation occurs, immediately infiltrate 5-10 mg of phentolamine (diluted in 10-15 mL of isotonic sodium chloride solution) to prevent necrosis; caution in occlusive vascular disease; if possible, correct bloodvolume depletion before administration



K. Anti Migrain Ergotamine Dihydroergotamine Sumatriptan Pizotifen



Ergotamine I: sakit kepala, migren, mual, vertigo,ggn usus, nyeri haid, hipermenore, ggn menopause BSO: Tab 1 mg D: 1 tab 3x/hr, max 6 tab/hari atau 10 tab/minggu KI: Hamil, laktasi, kerusakan hati & ginjal, pembesaran prostat P: ES: IO: Preg: Nama Dagang:



Dihydroergotamine I: Hipotensi ggn sirkulasi ortostatik, baik primer/ sekunder krn terapi dg obat lainnya & gejala yg diakibatkannya spt pusing & lesu kronis BSO: Tab 2.5 mg D: 2.5 mg 2-3x/hr. Migren & sakit kepala: 2.5 mg 2x/hr KI: Hipersensitif P: ES: Kesemutan pd jari tangan dan kaki. IO: Erytromisin, troleandimisina atau josamisina meningkatkan kadar dihidroergotamin dlm darah Preg:: X Nama Dagang: Dihydergot (DHE)



Sumatriptan I: Migren akut, ‘cluster headache’ akut BSO: Tab 100 mg D: awal 100 mg, max 3 tab/hari, interval + 2 jam KI: Penyakit jantung iskemik, IMA, hipertensi tak terkendali P : Hamil, laktasi ES: IO: Ergotamin, terapi dg MAOI, litium Preg: C Nama Dagang:



Pizotifen I: Migren BSO: Tab 500 mcg D: Awal 0.5 mg/hr, titrasi s/d 1.5 mg/hr. sbg dosis tunggal malam hari atau 3x/hr. Profilaksis migren 0.5-3 mg/hr KI: Glaukoma sudut tertutup, retensi urine P: ES: IO: Meningkatkan efek sentral alcohol. Obat depresan SSP: efek adiktif Preg: Nama Dagang: Lysagor



L. Hemostatik Tranexamic acid Factor VIII Octreotide Carbazochrome Na sulfonate Somatostatin Ethamsylate



Tranexamic acid I: Perdarahan abnormal & gejala pnykt hemoragik spt hemoptisis, perdarahan abnormal selama operasi BSO: Tab 500 mg, Amp 250 mg/5 cc D: 1 tab 3-4x/hr KI: P: Ggn ginjal, trombosis ES: Ggn GI IO: Preg: B Nama Dagang:



Factor VIII I: Hemofilia A klasik BSO: Botol 250 iu D: Perdarahan Ringan & Profilaksis: 10 iu/kg dosis tunggal Perdarahan sedang: 15-25 iu/kg. bisa diulang 10-15 iu/kg 2-3x/hr. Perdarahan Berat: Awal 40-50 iu/kg. Pemeliharaan: 20-25 iu/kg tiap 8-12 jam. Pra-Op: 50 iu/kg. Hemostatik: infus se tiap 6-12 jam selama 10-14 hari sampai sembuh total. KI: Hipersensitif, defisiensi IgA selektif P: monitor tanda anemia progresif. Hamil ES: Alergi, kesemutan pd lengan, telinga & wajah. gemetar IO: Preg:: C Nama Dagang: Koate-DIV Genghis Khun ([email protected],nafanakhun.wordpress.com)


Octreotide I: Mengendalikan gejala pd Karsinoid metastatik & tumor yg sekresi peptide intestinal vasoaktif (VIPomas). Akromegali: Kurangi kadar GH & Somatomedin dlm plasma. Pasien sirosis: stop perdarahan pd Varises gastroesofagus BSO: amp 0.1/cc D: Tumor endokrin gastro-entero-pankreatik: Awal SC 0.05 mg 1-2x/hr, titrasi s/d 0.1-0.2 mg 3x/hr. Perdarahan varises gastro-esofagus: 25 mcg/jam IV selama 5 hari. KI: Hipersensitif P: Insulinoma, diabetes, hamil, laktasi ES: Reaksi local: nyeri, pedas, bengkak & merah. GI: Anoreksia,mual, muntah, nyeri kejang perut, meterismus, flatulensi, diare, steatore. Jarang: obstruksi intestinal akut, distensi abdominal progresif, nyeri epigastrium berat, nyeri tekan perut. Ggn toleransi glukosa Postprandial.Hepatitis akut tanpa kolestasis. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hiperbilirubinemia disertai peningkatan fosfatase alkalin, gama glutamil transferase & transaminase IO: Menurunkan absorbsi intestinal dr siklosporin. Menghambat absorbsi cimetidin Preg: B Nama Dagang: Sandostatin



Carbazochrome Na sulfonate I: Mencegah & menghentikan perdarahan pada post op, pecahnya kapiler Leukopeni & trombositopeni krn radioterapi. BSO: Tab 10 mg, 100 mg D: 1-6 tab/hr dlm dosis terbagi 2-4x Perdarahan serebral krn hipertensi & arteriosclerosis: 90-120 mg/hr selama 3-4 minggu. Pemeliharaan 30 mg/hr. KI: Hipersensitif P: ES: Nafsu makan hilang, dyspepsia. IO: Preg: A, B, C, D, X Nama Dagang:



Somatostatin I: Terapi fistula intestinal & pancreas. Terapi simtomatik utk sekresi berlebihan pd tumor endokrin pd sal GI. Terapi perdarahan GI akut & berat yg diakibatkan oleh ulkus gaster atau duodenum, perdarahan gastritis & varises esophagus, perdarahan yg diketahui dg endoskopi BSO: Vial 250 mcg, 3 mg D: Awal 250 mcg bolus IV lambat > 1 menit. Diikuti infus IV 3.5 mcg/kg/jam (1 amp 3 mg) selama 12 jam. Pemberian terus menerus sebaiknya selama min 48 jam max 5 hari. KI: Hamil, laktasi, pra & post partum P: Hindari pemberian ulang, pantau ketat gula darah ES: panas & kemerahan pd wajah, bradikardi, mual,nyeri abdomen, ggn kadar glukosa darah, hipertensi, hipotensi IO: Pemberian bersama glukosa & fruktosa pantau ketat Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ethamsylate I: Hemostatik-antihemoragik BSO: Tab 500 mg. Amp 250 mg/2cc D: Pencegahan & Terapi: 500 mg 3x/hr Darurat: 500 mg IV DAN IM. Pre-op: 500 mg 3x/hr, 2-3 jam pre-op. 1 jam pre-op 500 mg IV/IM. Selama operasi: 1 g dalam infuse. Post op: 500 mg IV/IM 2x/hr atau 1 tab 3x/hr, selama 4 hari. KI: P: ES: Kadang mual, sakit kepala, ruam kulit, hipotensi IO: Preg: Nama Dagang: Dicynone



M. Anti koagulan, anti thrombus & Fibrinolitik (Trombolitik) Streptokinase Ticlopidine HCl Heparin sodium Warfarin Enoxaparin Aprotinin Acetylsalicyclic acid/ Aspirin Clopidogrel Nadroparin calcium Iloprost Cilostazol Fondaparinux sodium Antithrombin III Anagrelide Alteplase



Streptokinase -- Acts with plasminogen to convert plasminogen to plasmin. Plasmin degrades fibrin clots as well as fibrinogen and other plasma proteins. Increase in fibrinolytic activity that degrades fibrinogen levels for 24-36 h takes place with IV infusion of streptokinase. Absorbed from the pleural space. BSO: Vial 1.500.000 iu D: 250,000 IU IV in 100 mL of isotonic sodium chloride solution qd or bid is instilled into pleural space for 3-5 d KI: Hipersensitif; active internal bleeding; intracranial neoplasm; aneurysm; diathesis; severe uncontrolled arterial hypertension IO: Antifibrinolytic agents may decrease effects of streptokinase; heparin, warfarin, and aspirin may increase risk of bleeding Preg: B P: Caution in severe hypertension, IM administration of medications, trauma, or surgery in the previous 10 d; measure hematocrit, platelet count, aPTT, TT, PT, or fibrinogen levels before therapy is implemented; either TT or aPTT should be Genghis Khun ([email protected],nafanakhun.wordpress.com)


less than twice the reference range value following infusion of streptokinase and before instituting or reinstituting heparin; do not take blood pressure in the lower extremities because it may dislodge a possible deep vein thrombus; PT, aPTT, TT, or fibrinogen should be monitored 4 h after the initiation of therapy Nama Dagang:



Ticlopidine HCl Antiplatelet Agent I: Prevents strokes. Other uses include protection of bypass grafts in the heart, protection of stents in the heart, reduction of graft loss after kidney transplant, and prevention of blood clots. BSO: Tab 250 mg D: 250 mg 1-2x/hr KI: Hipersensitif P: > 65 or older, a blood problem or low blood counts, taking phenytoin, cyclosporine, or theophylline. stomach ulcer or bleeding, bleed easily, Avoid other aspirin-containing products, such as, ibuprofen or like products, other blood thinners (warfarin, ticlopidine, clopidogrel), garlic, ginseng, ginkgo, vitamin E, allergic to any medicine, pregnancy, breast-feeding. ES: Nausea or vomiting. Diarrhea, Belly pain, heartburn, Stomach bleeding or ulceration. Preg:: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Heparin sodium I: Prophylaxis and treatment of thromboembolic disorders Pregnancy Risk Factor BSO: Lock flush injection: Beef lung source: 10 U/mL; 100 U/mL Porcine intestinal mucosa source: 10 U/mL; 100 U/mL Multiple-dose vial injection: Beef lung source, with preservative: 1000 U/mL; 5000 U/mL; 10,000 U/mL; 20,000 U/mL; 40,000 U/mL Porcine intestinal mucosa source, with preservative: 1000 U/mL; 5000 U/mL; 10,000 U/mL; 20,000 U/mL Single-dose vial injection: Beef lung source: 1000 U/mL; 5000 U/mL; 10,000 U/mL; 20,000 U/mL; 40,000 U/mL Porcine intestinal mucosa: 1000 U/mL; 5000 U/mL; 10,000 U/mL; 20,000 U/mL; 40,000 U/mL Unit dose injection: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Porcine intestinal mucosa source, with preservative: 1000 U/dose; 2500 U/dose; 5000 U/dose; 7500 U/dose; 10,000 U/dose; 15,000 U/dose; 20,000 U/dose Heparin sodium infusion, porcine intestinal mucosa source: D5W: 40 U/mL; 50 U/mL; 100 U/mL NaCl 0.45%: 2 U/mL); 50 U/mL; 100 U/mL NaCl 0.9%: 2 U/mL; 5 U/mL; 50 U/mL Heparin calcium: Unit dose injection, porcine intestinal mucosa, preservative free: 5000 U/dose; 12,500 U/dose; 20,000 U/dose D: Line flushing: When using daily flushes of heparin to maintain patency of single and double lumen central catheters, 10 U/mL is commonly used for younger infants (eg, <10 kg) while 100 U/mL is used for older infants, children, and adults. Capped PVC catheters and peripheral heparin locks require flushing more frequently (eg, every 6-8 hours). Volume of heparin flush is usually similar to volume of catheter (or slightly greater). Additional flushes should be given when stagnant Genghis Khun ([email protected],nafanakhun.wordpress.com)


blood is observed in catheter, after catheter is used for drug or blood administration, and after blood withdrawal from catheter. Addition of heparin (0.5-1 unit/mL) to peripheral and central TPN has been shown to increase duration of line patency. The final concentration of heparin used for TPN solutions may need to be decreased to 0.5 U/mL in small infants receiving larger amounts of volume in order to avoid approaching therapeutic amounts. Arterial lines are heparinized with a final concentration of 1 unit/mL. Children: Intermittent I.V.: Initial: 50-100 U/kg, then 50-100 U/kg q4 hours I.V. infusion: Initial: 50 U/kg, then 15-25 U/kg/hour; increase dose by 2-4 U/kg/hour every 6-8 hours as required Adults: Prophylaxis (low-dose heparin): S.C.: 5000 U every 8-12 hours Intermittent IV: 1st 10,000 U, then 50-70 U/kg (5000-10,000 U) every 4-6 hours I.V. infusion: 50 U/kg to start, then 15-25 U/kg/hour as continuous infusion; increase dose by 5 U/kg/hour every 4 Genghis Khun ([email protected],nafanakhun.wordpress.com)


hours as required according to PTT results, usual range: 10-30 U/hour Weight-based protocol: 80 U/kg I.V. push followed by continuous infusion of 18 U/kg/hour. Using a Standard Heparin Solution (25,000 U/500mL D5W), the following infusion rates can be used to achieve the listed doses. KI: Hypersensitivity, severe thrombocytopenia; uncontrolled active bleeding except when due to DIC; suspected intracranial hemorrhage; not for I.M. use; not for use when appropriate monitoring parameters cannot be obtained P: Hipersensitif reaction and only in life-threatening situations. Hemorrhage is the most common complication. Monitor for signs and symptoms of bleeding. Certain patients are at increased risk of bleeding. Risk factors include bacterial endocarditis; congenital or acquired bleeding disorders; active ulcerative or angiodysplastic GI diseases; severe uncontrolled hypertension; hemorrhagic stroke; or use shortly after brain, spinal, or ophthalmology surgery; patient treated concomitantly with platelet inhibitors; conditions associated with increased Genghis Khun ([email protected],nafanakhun.wordpress.com)


bleeding tendencies (hemophilia, vascular purpura); recent GI bleeding; thrombocytopenia or platelet defects; severe liver disease; hypertensive or diabetic retinopathy; or in patients undergoing invasive procedures. A higher incidence of bleeding has been reported in patients >60 years of age, particularly women. They are also more sensitive to the dose. Some preparations contain benzyl alcohol as a preservative. In neonates, large amounts of benzyl alcohol (>100 mg/kg/day) have been associated with fatal toxicity (gasping syndrome). The use of preservative-free heparin is, therefore, recommended in neonates. Some preparations contain sulfite which may cause allergic reactions. Heparin does not possess fibrinolytic activity and, therefore, cannot lyse established thrombi; discontinue heparin if hemorrhage occurs; severe hemorrhage or overdosage may require protamine ES: bleeding is the major adverse effect of heparin. Fever, headache, chills, Unexplained bruising, urticaria, alopecia, dysesthesia pedis, purpura, eczema, Hyperkalemia Genghis Khun ([email protected],nafanakhun.wordpress.com)


(supression of aldosterone), rebound hyperlipidemia on discontinuation, Nausea, vomiting, constipation, hematemesis, Frequent or persistent erection, Hemorrhage, blood in urine, bleeding from gums, epistaxis, adrenal hemorrhage, ovarian hemorrhage, retroperitoneal hemorrhage, thrombocytopenia, Elevated liver enzymes (AST/ALT), Irritation, ulceration, cutaneous necrosis have been rarely reported with deep S.C. injections, I.M. injection (not recommended) is associated with a high incidence of these effects, Peripheral neuropathy, osteoporosis (chronic), Hemoptysis, pulmonary hemorrhage, asthma, rhinitis, Conjunctivitis, anaphylactoid reactions Note: Thrombocytopenia has been reported to occur at an incidence between 0-30%. It is often of no clinical significance. However, immunologically mediated heparin-induced thrombocytopenia has been estimated to occur in 1-2% of patients, and is marked by a progressive fall in platelet counts and, in some cases, thromboembolic complications (skin necrosis, pulmonary embolism, gangrene of the extremities, stroke or myocardial infarction); daily platelet counts for 5-7 Genghis Khun ([email protected],nafanakhun.wordpress.com)


days at initiation of therapy may help detect the onset of this complication. Case reports: Bronchospasm, erythematous plaques IO: increase the risk of hemorrhage: Cephalosporins which contain the MTT side chain, aspirin, NSAIDs, dipyridamole, ticlopidine, clopidogrel. Nitroglycerin (I.V.) may decrease heparin's anticoagulant effect. This interaction has not been validated in some studies, and may only occur at high nitroglycerin dosages. Penicillins (parenteral) may prolong bleeding time via inhibition of platelet aggregation, potentially increasing the risk of hemorrhage. Warfarin: Risk of bleeding may be increased during concurrent therapy. Heparin is commonly continued during the initiation of warfarin therapy to assure anticoagulation and to protect against possible transient hypercoagulability. Other drugs reported to increase heparin's anticoagulant effect include antihistamines, tetracycline, quinine, nicotine, and cardiac glycosides (digoxin). Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


Warfarin Anticoagulant. Prophylaxis and treatment of venous thrombosis, pulmonary embolism, and thromboembolic disorders. D: 2-10 mg/d PO/IV qd; adjust dose to an INR of 1.5:2 or higher depending on the condition requiring anticoagulation Paed. 0.05-0.34 mg/kg/d PO/IV; adjust dose according to desired INR KI: Hipersensitif; severe liver or kidney disease; open wounds; GI ulcers IO: Griseofulvin, carbamazepine, glutethimide, estrogens, nafcillin, phenytoin, rifampin, barbiturates, cholestyramine, colestipol, vitamin K, spironolactone, oral contraceptives, and sucralfate may decrease anticoagulant effects; oral antibiotics, phenylbutazone, salicylates, sulfonamides, chloral hydrate, clofibrate, diazoxide, anabolic steroids, ketoconazole, ethacrynic acid, miconazole, nalidixic acid, sulfonylureas, allopurinol, chloramphenicol, cimetidine, disulfiram, Genghis Khun ([email protected],nafanakhun.wordpress.com)


metronidazole, phenylbutazone, phenytoin, propoxyphene, sulfonamides, gemfibrozil, acetaminophen, and sulindac may increase anticoagulant effects Preg: D P: Dose needs to be adjusted to INR; caution in bleeding tendency and hazardous active hemorrhagic conditions, malignant hypertension, patients at high risk of recurrent trauma, (eg, people with alcoholism or psychosis, unsupervised patients who are senile); warfarin anaphylaxis, hepatic, renal, thyroid, allergic, and hematologic hypocoagulable conditions and disorders; do not switch brands after achieving therapeutic response; caution in active tuberculosis or diabetes; patients with protein C or S deficiency are at risk of developing skin necrosis Nama Dagang:



Enoxaparin I: Prevention of deep vein thrombosis following hip or knee replacement surgery or abdominal surgery in patients at risk for thromboembolic complications; inpatient treatment of acute deep vein thrombosis with and without pulmonary embolism when administered in conjunction with warfarin sodium; outpatient treatment of acute deep vein thrombosis without pulmonary embolism when administered in conjunction with warfarin sodium; prevention of ischemic complications of unstable angina and non-Q wave myocardial infarction (when administered with aspirin) BSO: Injection: Graduated prefilled syringe: 60 mg/0.6 mL, 80 mg/0.8 mL, 100 mg/1.0 mL Ampul: 30 mg/0.3 mL D: S.C.: Adults: DVT prophylaxis in hip replacement: 30 mg twice daily: First dose within 12-24 hours after surgery and every 12 hours until risk of deep vein thrombosis has Genghis Khun ([email protected],nafanakhun.wordpress.com)


diminished or the patient is adequately anticoagulated on warfarin. Average duration of therapy: 7-10 days. 40 mg once daily: First dose within 9-15 hours before surgery and daily until risk of deep vein thrombosis has diminished or the patient is adequately anticoagulated on warfarin. Average duration of therapy: 7-10 days unless warfarin is not given concurrently, then 40 mg S.C. once daily should be continued for 3 more weeks (4 weeks total). DVT prophylaxis in knee replacement: 30 mg twice daily: First dose within 12-24 hours after surgery and every 12 hours until risk of deep vein thrombosis has diminished. Average duration of therapy: 7-10 days; maximum course: 14 days. Patients who weigh <100 lb or are >65 years of age: Some clinicians recommend 0.5 mg/kg/dose every 12 hours to reduce the risk of bleeding. DVT prophylaxis in high-risk patients undergoing abdominal surgery: 40 mg once daily, with initial dose given 2 hours prior Genghis Khun ([email protected],nafanakhun.wordpress.com)


to surgery; usual duration: 7-10 days and up to 12 days has been tolerated in clinical trials. Treatment of acute proximal DVT: Start warfarin within 72 hours and continue enoxaparin until INR is between 2.0 and 3.0 (usually 7 days). Inpatient treatment of DVT with or without pulmonary embolism: Adults: S.C. 1 mg/kg/dose every 12 hours or 1.5 mg/kg once daily. Outpatient treatment of DVT without pulmonary embolism: Adults: S.C.: 1 mg/kg/dose every 12 hours. Prevention of ischemic complications with unstable angina or non-Q-wave myocardial infarction: S.C.: 1 mg/kg twice daily in conjunction with oral aspirin therapy (100-325 mg once daily); treatment should be continued for a minimum of 2 days and continued until clinical stabilization (usually 2-8 days). Dosing adjustment in renal impairment: Total clearance is lower and elimination is delayed in patients with renal failure; adjustment may be necessary in elderly and patients with severe renal impairment. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hemodialysis: Supplemental dose is not necessary. Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics. KI: Hypersensitivity to enoxaparin or thrombocytopenia associated with a + in vitro test for antiplatelet antibodies in the presence of enoxaparin; hypersensitivity to pork products; active major bleeding; not for I.M. or I.V. use P: Patients with recent or anticipated neuraxial anesthesia (epidural or spinal anesthesia) are at risk of spinal or epidural hematoma and subsequent paralysis. Consider risk versus benefit prior to neuraxial anesthesia; risk is increased by concomitant agents which may alter hemostasis, as well as traumatic or repeated epidural or spinal puncture. Patient should be observed closely for bleeding if enoxaparin is administered during or immediately following diagnostic lumbar puncture, epidural anesthesia, or spinal anesthesia. ES: As with all anticoagulants, bleeding is the major adverse effect of enoxaparin. Hemorrhage may occur at virtually any site. Risk is dependent on multiple variables. At the Genghis Khun ([email protected],nafanakhun.wordpress.com)


recommended doses, single injections of enoxaparin do not significantly influence platelet aggregation or affect global clotting time (ie, PT or APTT). Central nervous system: Fever (5% to 8%), confusion, pain Dermatologic: Erythema, bruising Gastrointestinal: Nausea (3%), increased ALT/AST (5.9% to 6.1%) Hematologic: Hemorrhage (5% to 13%), thrombocytopenia (2%), hypochromic anemia (2%) Local: Injection site hematoma (9%), local reactions (irritation, pain, ecchymosis, erythema) IO: Drugs which affect platelet function (eg, aspirin, NSAIDs, dipyridamole, ticlopidine, clopidogrel) may potentiate the risk of hemorrhage. Thrombolytic agents increase the risk of hemorrhage. Warfarin: Risk of bleeding may be increased during concurrent therapy. Enoxaparin is commonly continued during the initiation of warfarin therapy to assure anticoagulation and to protect against possible transient hypercoagulability. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Standard heparin consists of components with molecular weights ranging from 4000-30,000 daltons with a mean of 16,000 daltons. Heparin acts as an anticoagulant by enhancing the inhibition rate of clotting proteases by antithrombin III impairing normal hemostasis and inhibition of factor Xa. Low molecular weight heparins have a small effect on the activated partial thromboplastin time and strongly inhibit factor Xa. Enoxaparin is derived from porcine heparin that undergoes benzylation followed by alkaline depolymerization. The average molecular weight of enoxaparin is 4500 daltons which is distributed as ( less than or equal to 20%) 2000 daltons, ( greater than or equal to 68%) 2000-8000 daltons, and ( less than or equal to 15%) >8000 daltons. Enoxaparin has a higher ratio of antifactor Xa to antifactor IIa activity than unfractionated heparin. Preg: B Nama Dagang: Lovenox Genghis Khun ([email protected],nafanakhun.wordpress.com)


Aprotinin I: Reduction or prevention of blood loss in patients undergoing coronary artery bypass surgery when a high risk of excessive bleeding exists, including open heart reoperation, pre-existing coagulopathies, operations on the great vessels, and when a patient's beliefs prohibit blood transfusions BSO: Injection: 1.4 mg/mL [10,000 U/mL] D: Test dose: All patients should receive a 1 mL I.V. test dose at least 10 minutes prior to the loading dose to assess the potential for allergic reactions Regimen A (standard dose): 2 million U (280 mg) loading dose I.V. over 20-30 minutes 2 million U (280 mg) into pump prime volume 500,000 U/hour (70 mg/hour) I.V. during operation Regimen B (low dose): 1 million U (140 mg) loading dose I.V. over 20-30 minutes 1 million U (140 mg) into pump prime volume 250,000 U/hour (35 mg/hour) I.V. during operation KI: Hypersensitivity to aprotinin or any component Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Anaphylactic reactions are possible. Hypersensitivity reactions are more common with repeated use especially when re-exposure is within 6 months. All patients should receive a test dose at least 10 minutes before loading dose. Patients with a history of allergic reactions to drugs or other agents may be more likely to develop a reaction. ES: 1-10%: Atrial fibrillation, myocardial infarction, heart failure, atrial flutter, ventricular tachycardia, hypotension, supraventricular tachycardia, Fever, mental confusion, Phlebitis, Dyspnea, bronchoconstriction IO: Heparin and aprotinin prolong ACT. The ACT becomes a poor measure of adequate anticoagulation with the concurrent use of these drugs. Fibrinolytic drugs may have poorer activity. Aprotinin blocks this fibrinolytic activity; avoid concurrent use. Captopril's antihypertensive effects may be blocked; avoid concurrent use. Preg:B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Acetylsalicyclic acid/ Aspirin Prevents platelet aggregation by irreversible cyclooxygenase inhibition with subsequent suppression of thromboxane A2. Antiplatelet effect can last as long as 7 d. BSO: D: 81-325 mg PO qd KI: Hipersensitif; liver damage; hypoprothrombinemia; vitamin K deficiency; bleeding disorders; asthma Because of association with Reye syndrome, do not use in children ( <16 y) with flu IO: Antacids and urinary alkalinizers may decrease effects; corticosteroids decrease salicylate serum levels; anticoagulants may cause additive hypoprothrombinemic effects and increased bleeding time; may antagonize uricosuric effects of probenecid and increase toxicity of phenytoin and valproic acid; doses > 2 g/d may potentiate glucose-lowering effect of sulfonylurea drugs Preg: D Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: May cause transient decrease in renal function and aggravate chronic kidney disease; avoid use in patients with severe anemia, history of blood coagulation defects, or taking anticoagulants; adverse effects include prolonged bleeding time, rhinitis, asthma, urticaria, and exacerbation of gout; monitor BP, BUN, and uric acid level; consider discontinuing 7 d before surgery Nama Dagang:



Clopidogrel Selectively inhibits ADP binding to platelet receptor and subsequent ADP-mediated activation of GPIIb/IIIa complex, thereby inhibiting platelet aggregation. Consider in patients with contraindication to aspirin. D: 75 mg PO qd KI: Hipersensitif; active pathological bleeding IO: Naproxen associated with increased occult GI blood loss; prolongs bleeding time; safety of coadministration with warfarin not established Preg: C P: Caution in patients at increased risk of bleeding from trauma, surgery, or other pathological conditions; caution in patients with lesions with propensity to bleed (eg, ulcers); adverse effects include rash, diarrhea, purpura, GI ulcers, neutropenia, and rare cases of agranulocytosis; consider discontinuing 7 d before surgery Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Nadroparin calcium I: Ggn tromboembolik, mencegah pembekuan darah. BSO: Jarum suntik Prefilled 9.500 anti-Xa/cc D: 0.3 cc 1x/hr (7.500 ICU AXa) selama min 7 hari. Pre-op: 2-4 jam sebelum. Bedah ortopedi: 12 jam pre-op & 12 jam post-op BB 50-69 Kg: 0.3 cc pre-op s/d hr ke-3. 0.4 cc harike-4 dst. BB < 50 Kg: 0.2 cc pre-op s/d hr ke-3. 0.3 cc harike-4 dst. Terapi minimal 10 hari. Mencegah pembekuan darah selama hemodialisis: BB 50-69 Kg: 0.4 cc. BB < 50 Kg: 0.3 cc . KI: Trombositopeni P: ES: IO: OAINS, Aspirin, antiplatelet, Dextran Preg: B Nama Dagang: Fraxiparine Genghis Khun ([email protected],nafanakhun.wordpress.com)


Iloprost I: Hipertensi pulmonal primer atau sekunder krn penyakit jaringan ikat atau krn diinduksi obat pd stadium sedang & berat. BSO: Lar inhalasi 2cc D: Dws: 2.5-5 mcg. Jika digunakan dg HaloLite atau Prodose: dosis pd mouthpiece 2.5 mcg, waktu inhalasi 8-10 mnt. Dosis harian 6-9x/hr. Ggn hati: Awal 2.5 mcg dg interval min 3 jam (max 6x/hr) KI: Ulkus peptic aktif, perdarahan intrakranial P: ES: IO: Vasodilator & obat antihipertensi, antikoagulan Preg: C Nama Dagang: Ventavis



Cilostazol I: Symptomatic management of peripheral vascular disease, primarily intermittent claudication; currently being investigated for the treatment of acute coronary syndromes BSO: Tablet: 50 mg, 100 mg D: Adults: Oral: 100 mg 2x/d 1 ½ -2 hours ; dosage should be reduced to 50 mg 2x/d during concurrent therapy with inhibitors of CYP3A4 or CYP2C19 (see Drug Interactions) KI: Hypersensitivity, heart failure (of any severity) P: Use with caution in patients receiving platelet aggregation inhibitors, hepatic impairment. Use with caution in patients receiving inhibitors of CYP3A4 (such as ketoconazole or erythromycin) or inhibitors of CYP2C19 (such as omeprazole); use with caution in severe underlying heart disease; use is not recommended in nursing mothers ES: >10%: Headache, Abnormal stools, diarrhea, Infection.



2-10%: Peripheral edema, palpitation, tachycardia, Dizziness, Dyspepsia, nausea, abdominal pain, flatulence, Back pain, myalgia, Rhinitis, pharyngitis, cough IO: Preg: C Nama Dagang:



Fondaparinux sodium I: Mencegah tomboembolik pd pasien bedah ortopedi tungkai bawah BSO: Jarum Suntik Prefilled 2.5 mg/0.5cc D: 2.5 mg SC 6 jam post op, lalu 2.5mg/hr selama 5-9 hari KI: Perdarahan aktif P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Arixtra



Antithrombin III I: Hereditary antithrombin III deficiency BSO: Powder for injection: 500 U D: Adults: After first dose of antithrombin III, level should increase to 120% of normal; thereafter maintain at levels >80%. Generally, achieved by administration of maintenance doses once every 24 hours. Initially and until patient is stabilized, measure antithrombin III level at least twice daily, thereafter once daily and always immediately before next infusion. 1 unit = quantity of antithrombin III in 1 mL of normal pooled human plasma; administration of 1 unit/1 kg raises AT-III level by 1% to 2%; assume plasma volume of 40 mL/kg. Measure antithrombin III preceding and 30 minutes after dose to calculate in vivo recovery rate; maintain level within normal range for 2-8 days depending on type of surgery or procedure. KI: Hypersensitivity to antithrombin III or any component P: Can potentially transmit infectious diseases since it is a product of human plasma. Discuss risk versus benefits with Genghis Khun ([email protected],nafanakhun.wordpress.com)


patient. Reduce the dose of heparin to avoid bleeding when used concurrently. Administer alone by the I.V. route only. ES: 1% to 10%: Central nervous system: Dizziness (2%) IO: Drugs which affect platelet function (eg, aspirin, NSAIDs, dipyridamole, ticlopidine, clopidogrel) may potentiate the risk of hemorrhage. Heparin's anticoagulant effects are potentiated by antithrombin III. Thrombolytic agents increase the risk of hemorrhage. Warfarin (and other oral anticoagulants) may increase the risk of bleeding with antithrombin III. Preg: C Nama Dagang: Kybernin P



Anagrelide I: Agent for essential thrombocythemia (ET); treatment of thrombocytopenia secondary to myeloproliferative disorders BSO: Capsule: 0.5 mg, 1 mg D: Adults: Oral: 0.5 mg 4 times/day or 1 mg twice daily KI: Hypersensitivity P: Patients with known or suspected heart disease, and only if the potential benefits of therapy outweigh the potential risks. Thrombocytopenia appears to be the main dose-limiting side effect of anagrelide; palpitations, orthostatic hypotension, and headache have also been reported. ES: Palpitations, chest pain, tachycardia, orthostatic hypotension, CHF, cardiomyopathy, Headache, dizziness, bad dreams, impaired concentration ability IO: There is a single case report that suggests sucralfate may interfere with anagrelide absorption Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Alteplase Commercially manufactured recombinant DNA fibrinolytic protein approved for treatment of AMI, AIS, and acute massive pulmonary embolism. BSO: Powder for injection, lyophilized (recombinant): 20 mg [11.6 million U]; 50 mg [29 million U]; 100 mg [58 million U] D: 0.9 mg/kg IV; max 90 mg/dose; infuse over 60 min with 10% of total dose administered as initial IV bolus over 1 min KI: Hipersensitif; active internal bleeding; stroke within last 3 mo; recent intracranial or intraspinal surgery or trauma; intracranial hemorrhage on pretreatment evaluation; suspicion of subarachnoid hemorrhage, intracranial neoplasm, arteriovenous malformation, or aneurysm; bleeding diathesis; severe uncontrolled hypertension IO: Drugs that alter platelet function (eg, aspirin, dipyridamole, clopidogrel, abciximab) may increase risk of bleeding prior to, Genghis Khun ([email protected],nafanakhun.wordpress.com)


during, or after alteplase therapy Note that criteria for use of IV t-PA preclude use of antiplatelet or antithrombotic agents for 24 h following t-PA infusion Preg: C P: Noncompressible arterial punctures and internal jugular and subclavian venous punctures must be avoided to minimize bleeding from noncompressible sites; in event of serious bleeding, immediately discontinue alteplase; monitor patients for allergic-type reactions, such as anaphylactoid reaction, laryngeal edema, rash, and urticaria Nama Dagang: Actilyse



N. Preparat Flebitis & Varises Monoxerutin Heparinoid Diosmin Anagrelide



Monoxerutin Lihat di I. Sal Cerna > Preparat Anorektal



Heparinoid Heparinoid blocks the production of a chemical called prostaglandin which the body produces in response to injury or certain diseases. Prostaglandins are responsible for causing swelling, pain and inflammation, and therefore heparinoid reduces these effects. It is also able to dissolve blood clots and improve the blood supply to the skin. I: Anal itch, Inflammation of the rectum (proctitis), Piles (haemorrhoids), Tear in the lining of the back passage (anal fissure) BSO: D: KI: Children, allergic. P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Hirudoid Genghis Khun ([email protected],nafanakhun.wordpress.com)


O. Hemoreologik Pentoxyfilline Naftidrofuryl Buflomedil Bencyclane



Pentoxyfilline I: Symptomatic management of peripheral vascular disease, mainly intermittent claudication BSO: Tablet, controlled release: 400 mg D: Adults: Oral: 400 mg 3x/hr ; may reduce to 400 mg 2x/d if GI or CNS side effects occur KI: Hypersensitivity; patients with recent cerebral and/or retinal hemorrhage P: Use with caution in patients with renal impairment ES: Dizziness, headache, Dyspepsia, nausea, vomiting IO: Increased effect/toxic potential with cimetidine (increased levels) and other H2-antagonists, warfarin; increased effect of antihypertensives Increased toxicity with theophylline Preg:: C Nama Dagang:



Naftidrofuryl Naftidrofuryl oxalate works in two main ways. Firstly, it causes the blood vessels to widen. Secondly, it increases the ability of cells to remove waste products. Both these properties make it useful in the treatment of disorders caused by decreased blood supply to a particular area of the body. In peripheral vascular diseases, the blood vessels in the extremities are narrowed and the blood and oxygen supply to cells in the hands, feet or legs is reduced. Oxygen is required by cells in order for them to remove waste products, therefore in these conditions waste products can build up. This can cause damage to cells and lead to symptoms such as pain, cramps or ulceration. Similarly, where there is a disorder of blood flow to the brain, a lack of oxygen supply can cause damage to the cells in the brain, resulting in symptoms such as confusion or decreasing mental ability. Naftidrofuryl improves these symptoms by increasing blood and oxygen supply to the affected areas and also increasing the Genghis Khun ([email protected],nafanakhun.wordpress.com)


ability of the cells to remove waste products, even in low oxygen supply. I: Cerebral insufficiency, Narrowing of blood vessels in the extremities (peripheral vascular disease), cerebral atherosclerosis BSO: Tab 100 mg, 200 mg D: 100-200 mg 3x/hr KI: Rash, Nausea, Stomach pain, hepatitis P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



P. Haematopoietic agent Lenograstim Filgrastim Epoetin alfa Epoetin beta Erythropoietin



Lenograstim Lenograstim is a substance that stimulates the production of a type of white blood cell from the bone marrow, known as neutrophils. Neutrophils play a cental role in the body's immune system and defends the body from infections. Therefore a low level of neutrophils in the blood (neutropenia), leaves a person very susceptible to life threatening infections. Neutropenia can be caused by a number of factors, such as cancer chemotherapy and it often occurs in individuals who have recently had a bone marrow transplant or are suffering from AIDS. Lenograstim is commonly used after high dose chemotherapy regimes or bone marrow transplants, to correct low neutrophil levels in the blood and thereby reduces the duration and severity of the neutropenia. As a result, lenograstim minimises the need for antibiotic treatment, the risk of complications due to infections and length of time spent in hospital after bone marrow transplants. Genghis Khun ([email protected],nafanakhun.wordpress.com)


I: To increase production of stem cells (or progenitor cells), To speed up production of neutrophils following bone marrow transplants, chemotherapy induced neutropenia BSO: Vial 33.6 MIU tau 263 mcg/cc D: Dws 150 mcg/m2/hr.1 vial dpt digunakan utk pasien dg BSA s/d 1.6 m2/hr. Transplantasi sumsum tulang (BMT): mulai 24 jam setelah transplantasi, infuse IV dlm saline 100 cc selama 30 menit. Kemoterapi sitotoksik: mulai 24 jam setelah kemoterapi lengkap inj SC, biasanya selama 8-14 hari. KI: Myeloma, Children under 2 years of age P: Severely decreased kidney & liver function ES: Headache, Abdominal pain, Allergic reaction, Bone pain, Reactions at injection site, cutaneous vasculitis, adult respiratory distress syndrome (ARDS) Nama Dagang: Granocyte 34 Genghis Khun ([email protected],nafanakhun.wordpress.com)


Filgrastim I: Patients with nonmyeloid malignancies receiving myelosuppressive anticancer drugs associated with a significant incidence of neutropenia (FDA-approved indication) Cancer patients receiving bone marrow transplant (BMT) (FDAapproved indication) Patients undergoing peripheral blood progenitor cell (PBPC) collection Patients with severe chronic neutropenia (SCN) (FDA-approved indication) Chronic administration in symptomatic patients with congenital neutropenia, cyclic neutropenia, or idiopathic neutropenic; filgrastim should not be started until the diagnosis of SCN is confirmed, as it may interfere with diagnostic efforts Safety and efficacy of G-CSF given simultaneously with cytotoxic chemotherapy have not been established; concurrent treatment may increase myelosuppression; G-CSF should be avoided in patients receiving concomitant chemotherapy and radiation therapy Genghis Khun ([email protected],nafanakhun.wordpress.com)


BSO: Injection, preservative free: 300 mcg/mL D: Children and Adults: Existing clinical data suggest that starting G-CSF between 24 and 72 hours subsequent to chemotherapy may provide optimal neutrophil recover; continue therapy until the occurrence of an absolute neutrophil count of 10,000 L after the neutrophil nadir The available data suggest that rounding the dose to the nearest vial size may enhance patient convenience and reduce costs without clinical detriment Neonates: 5-10 mcg/kg/day once daily for 3-5 days has been administered to neutropenic neonates with sepsis; there was a rapid and significant increase in peripheral neutrophil counts and the neutrophil storage pool Children and Adults: Myelosuppressive chemotherapy infusion: 5 mcg/kg/day IV/SC Doses may be increased in increments of 5 mcg/kg for each chemotherapy cycle, according to the duration and severity of the absolute neutrophil count (ANC) nadir Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bone marrow transplant patients: 5-10 mcg/kg/day as an I.V. infusion of 4 or 24 hours or as continuous 24-hour S.C. infusion; administer first dose at least 24 hours after cytotoxic chemotherapy and at least 24 hours after bone marrow infusion; if ANC decreases <1000/mm3 during the 5 mcg/kg/day dose, increase filgrastim to 10 mcg/kg/day and follow the recommended steps based on neutrophil response: When ANC >1000/mm3 for 3 consecutive days: Reduce Filgrastim dose to 5 mcg/kg/day If ANC remains >1000/mm3 for 3 more consecutive days: Discontinue filgrastim If ANC decreases to <1000/mm3 : Resume at 5 mcg/kg/day If ANC decreases <1000/mm3 during the 5 mcg/kg/day dose, increase filgrastim to 10 mcg/kg/day and follow the above steps Peripheral blood progenitor cell (PBPC) collection: 10 mcg/ kg/day either S.C. or a bolus or continuous I.V. infusion. It is recommended that G-CSF be given for at least 4 days before the first leukapheresis procedure and continued until the last leukapheresis; although the optimal duration of administration Genghis Khun ([email protected],nafanakhun.wordpress.com)


and leukapheresis schedule have not been established, administration of G-CSF for 6-7 days with leukaphereses on days 5,6 and 7 was found to be safe and effective; neutrophil counts should be monitored after 4 days of G-CSF, and G-CSF dose-modification should be considered for those patients who develop a white blood cell count >100,000/mm3 Severe chronic neutropenia: S.C.: Congenital neutropenia: 6 mcg/kg/dose twice daily Idiopathic/cyclic neutropenia: 5 mcg/kg single dose daily Chronic daily administration is required to maintain clinical benefit; adjust dose based on the patients' clinical course as well as ANC; in phase III studies, the target ANC was 1500-10,000/mm3. Reduce the dose if the ANC is persistently >10,000/mm3 Premature discontinuation of G-CSF therapy prior to the time of recovery from the expected neutrophil is generally not recommended; a transient increase in neutrophil counts is typically seen 1-2 days after initiation of therapy Hemodialysis: Supplemental dose is not necessary Genghis Khun ([email protected],nafanakhun.wordpress.com)


Peritoneal dialysis: Supplemental dose is not necessary KI: Hypersensitivity to E. coli-derived proteins or G-CSF P: Complete blood count and platelet count should be obtained prior to chemotherapy. Do not use G-CSF in the period 12-24 hours before to 24 hours after administration of cytotoxic chemotherapy because of the potential sensitivity of rapidly dividing myeloid cells to cytotoxic chemotherapy. Precaution should be exercised in the usage of G-CSF in any malignancy with myeloid characteristics. G-CSF can potentially act as a growth factor for any tumor type, particularly myeloid malignancies. Tumors of nonhematopoietic origin may have surface receptors for G-CSF. ES: Neutropenic fever, fever, Alopecia, Nausea, vomiting, diarrhea, mucositis, This occurs more commonly in patients with cyclic neutropenia/congenital agranulocytosis who received S.C. injections for a prolonged (>14 days) period of time; ~33% of these patients experience subclinical splenomegaly (detected by MRI or CT scan); ~3% of these patients experience clinical splenomegaly, Medullary bone pain (24% incidence): This Genghis Khun ([email protected],nafanakhun.wordpress.com)


occurs most commonly in lower back pain, posterior iliac crest, and sternum and is controlled with non-narcotic analgesics 1-10%: Chest pain, fluid retention, Headache, Skin rash, Anorexia, stomatitis, constipation, Leukocytosis, Pain at injection site, Weakness, Dyspnea, cough, sore throat IO: Drugs which may potentiate the release of neutrophils (eg, lithium) should be used with caution Preg: C Nama Dagang:Neupogen



Epoetin α I: Treatment of anemia associated with chronic renal failure, including patients on dialysis (end-stage renal disease) and patients not on dialysis Treatment of anemia related to zidovudine therapy in HIVinfected patients; in patients when the endogenous erythropoietin level is less than or equal to 500 mU/mL and the dose of zidovudine is less than or equal to 4200 mg/week Treatment of anemia in cancer patients on chemotherapy; in patients with nonmyeloid malignancies where anemia is caused by the effect of the concomitantly administered chemotherapy; to decrease the need for transfusions in patients who will be receiving chemotherapy for a minimum of 2 months Reduction of allogeneic block transfusion in surgery patients scheduled to undergo elective, noncardiac, nonvascular surgery BSO: 1 mL single-dose vials: Preservative-free solution 2000 U/mL, 3000 U/mL, 4000 U/mL, 10,000 U/mL 20,000 U/mL, 40,000 U/mL 2 mL multidose vials: Preserved solution: 10,000 U/mL Genghis Khun ([email protected],nafanakhun.wordpress.com)


D: Chronic renal failure patients: I.V., S.C.: Initial dose: 50-100 U/kg 3 times/week Reduce dose by 25 U/kg when 1) hematocrit approaches 36% or 2) when hematocrit increases >4 points in any 2-week period Increase dose if hematocrit does not increase by 5-6 points after 8 weeks of therapy and hematocrit is below suggested target range Suggested target hematocrit range: 30% to 36% Maintenance dose: Individualize to target range Dialysis patients: Median dose: 75 U/kg 3 times/week Nondialysis patients: Doses of 75-150 U/kg Zidovudine-treated, HIV-infected patients: Patients with erythropoietin levels >500 mU/mL are unlikely to respond Initial dose: I.V., S.C.: 100 U/kg 3 times/week for 8 weeks Increase dose by 50-100 U/kg 3 times/week if response is not satisfactory in terms of reducing transfusion requirements or increasing hematocrit after 8 weeks of therapy Genghis Khun ([email protected],nafanakhun.wordpress.com)


Evaluate response every 4-8 weeks thereafter and adjust the dose accordingly by 50-100 U/kg increments 3 times/week If patients have not responded satisfactorily to a 300 unit/kg dose 3 times/week, it is unlikely that they will respond to higher doses Stop dose if hematocrit exceeds 40% and resume treatment at a 25% dose reduction when hematocrit drops to 36% Cancer patients on chemotherapy: Treatment of patients with erythropoietin levels >200 mU/mL is not recommended Initial dose: S.C.: 150 U/kg 3 times/week Dose adjustment: If response is not satisfactory in terms of reducing transfusion requirement or increasing hematocrit after 8 weeks of therapy, the dose may be increased up to 300 U/kg 3 times/week. If patients do not respond, it is unlikely that they will respond to higher doses. If hematocrit exceeds 40%, hold the dose until it falls to 36% and reduce the dose by 25% when treatment is resumed Genghis Khun ([email protected],nafanakhun.wordpress.com)


Surgery patients: Prior to initiating treatment, obtain a hemoglobin to establish that is is >10 mg/dL or less than or equal to 13 mg/dL Initial dose: S.C.: 300 U/kg/day for 10 days before surgery, on the day of surgery, and for 4 days after surgery Alternative dose: S.C.: 600 U/kg in once weekly doses (21, 14, and 7 days before surgery) plus a fourth dose on the day of surgery KI: Hypersensitivity to albumin (human) or mammalian cellderived products; uncontrolled hypertension P: Blood pressure, platelets in your blood should be regularly monitored during the first eight weeks of treatment with this medicine. # People with kidney failure should have the levels of salts (electrolytes, eg potassium) and haemoglobin in their blood monitored during treatment with this medicine. # People with cancer should have the amount of haemoglobin in their blood monitored while receiving treatment with this medicine. Genghis Khun ([email protected],nafanakhun.wordpress.com)


# If you are receiving dialysis treatment, your dialysis regimen may need adjusting while receiving this medicine. Your doctor will decide this. # All other causes of anaemia, eg iron, vitamin B12 or folate deficiency, should be considered by your doctor and treated if necessary, before you start treatment with this medicine. # People receiving this medicine prior to bone surgery should also receive medication to prevent blood clots, since there is a risk of this occuring following surgery, particularly in people with cardiovascular disease. # All people who receive epoetinum alfa to stimulate blood cell production prior to bone surgery, or prior to donating blood for retransfusion during surgery, should also receive iron supplements. These should ideally be started before the epoetinum treatment, so that the body has adequate iron stores for producing new red blood cells. # Very rarely, this medicine may stop working in people with chronic kidney failure due to the body producing antibodies against the medicine. This causes the production of red blood Genghis Khun ([email protected],nafanakhun.wordpress.com)


cells to stop, a condition known as pure red cell aplasia. For this reason, people with kidney failure must only receive this medicine by injection into a vein (IVly). In the very rare case that pure red cell aplasia develops, this medicine should be stopped and patients should not be switched to any other erythropoietin. # Tell your doctor if you experience sudden stabbing migrainelike headaches while receiving this medicine, as this may be a possible warning sign that your blood pressure is too high. ES: Skin rashes, Cold or flu-like symptoms, hypertensive crisis), thrombosis, thrombocytosis IO: Preg: C Nama Dagang: Hemapo



Epoetin beta Synthetic version of the naturally-occurring hormone erythropoietin. Erythropoietin is produced by healthy kidneys. It stimulates the bone marrow to produce red blood cells, which carry oxygen around the body. Epoetin beta is used to treat anaemia in people with chronic kidney failure who are undergoing dialysis, and in people with impaired kidney function who do not yet need dialysis. These people produce very little erythropoietin as a result of their kidney disease, so the number of red blood cells in their blood is low (anaemia). When epoetin beta is injected, it stimulates the bone marrow to produce more red blood cells, and this corrects the anaemia. Epoetin beta is also used to treat anaemia in people with certain types of cancer. It is used to treat anaemia in adults with solid tumours who are receiving platinum-based chemotherapy. It is also used to treat anaemia in people with non-Hodgkins lymphoma, bone marrow cancer (multiple myeloma) or chronic lymphocytic leukaemia who are receiving anti-tumour therapy. Genghis Khun ([email protected],nafanakhun.wordpress.com)


The increased red blood cell production stimulated by epoetin beta reduces the chances of these people needing a blood transfusion. Premature babies born at less than 34 weeks gestation may also be given epoetin beta to stimulate the production of red blood cells and prevent the development of anaemia. Doctors may also prescribe epoetin beta for anaemic people who are going to donate blood prior to surgery so that their own blood can be given to them during or after surgery. This is called an autologous blood pre-donation programme. Because the epoetin increases blood cell production, it means that a larger volume of blood can be taken from these people, and stored for transfusion during or after the surgery. Your doctor may also prescribe you iron supplements while you are receiving this medicine so that the body has adequate iron stores for producing new red blood cells. I: # Treating anaemia due to kidney disease # Treating anaemia in people with solid tumours being treated with platinum-based chemotherapy Genghis Khun ([email protected],nafanakhun.wordpress.com)


# Treating anaemia in people with bone marrow cancer (multiple myeloma), low-grade non-Hodgkins lymphoma or chronic lymphocytic leukaemia who are receiving chemotherapy # Preventing anaemia in premature babies of less than 34 weeks gestation with a birth weight of 750-1500g # Increasing the volume of blood that can be donated by anaemic patients due to have surgery, so they can receive transfusions of their own blood during or after the surgery BSO: Jarum suntik pre-filled 2.000 iu, 10.000 iu D: Anemia dg gagal ginjal: Fase koreksi: SC: awal 3 x 20 IU/kg/minggu, titrasi tiap 4 minggu. IV: awal 3 x 40 IU/kg/minggu, titrasi tiap 4 mgg 3 x 80 IU/kg/mgg Selanjutnya ditingkatkan 20 iu/kg 3x/mgg, interval per bulan. Max 720 IU/kgBB. Fase pemeliharaan: Awal dikurangi ½ dari pemberian terakhir Anemia pd premature: Genghis Khun ([email protected],nafanakhun.wordpress.com)


3x 250 iu/kg/mgg SC, mulai hari ke-3 kehidupan. Lama 6 minggu. KI: hypertension, pure red cell aplasia, deep vein thrombosis, heart attack or stroke in the last month, unstable angina P: kidney disease, hypertension, thrombocytosis, Malignant disease, Chronic liver failure, Epilepsy, hyperkalaemia, phenylketonuria ES: Headache, Rise in blood pressure, Cold or flu-like symptoms, Reactions at injection site, Skin reactions such as rash and itch, Increased numbers of platelets in the blood, thrombosis, hypertensive crisis IO: Preg: Nama Dagang: Recormon



Erythropoietin I: D: Dosis KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Eprex



Q. Anti Hipotensi Ephedrine HCl



Ephedrine HCl -- Stimulates release of epinephrine stores, producing alphaand beta-adrenergic receptors. D: 5-10 mg PO/IM q6h. 25-mg supp PR q12h Paed.: 2-5 years: 3 mg PO q6-8h >5 years: 6.25 mg PO q6-8h KI: Hipersensitif; angle-closure glaucoma; cardiac arrhythmias IO: Theophylline, atropine, or MAOIs may increase toxicity; alpha- and beta-blockers decrease vasopressor effects of ephedrine; cardiac glycosides and general anesthetics increase cardiac stimulation of ephedrine Preg: B P: Adverse effects (eg, excitation, tremulousness, insomnia, nervousness, palpitation, tachycardia, other symptoms associated with sympathetic activation); bladder sphincter spasm (may cause a transient acute urinary retention); caution in elderly and in patients with DM, hyperthyroidism, hypertension, cardiovascular disease, prostatic hypertrophy, or cerebrovascular insufficiency Genghis Khun ([email protected],nafanakhun.wordpress.com)


R.Obat Kardiovaskuler Lain Adenosine Heptaminol HCl



Adenosine Adenosine is an anti-arrhythmic medicine which acts by slowing the conduction of electrical impulses across the atrioventricular node in the heart. Adenosine is a natural body chemical. In the normal situation electrical impulses start in the sinus node in the heart and spread over the atria (upper chambers of the heart), casuing them to contract. The impulse then passes through the atrio-ventricular node (AV-node) to the ventricles (lower chambers of the heart). The impulse spreads over the ventricles, causing them to contract and pump blood out to the rest of the body. Adenosine is used to treat paroxysmal supraventricular tachycardias, that is, fast, irregular rhythms starting with impulses above the AV node. It quickly causes the heart to return to its normal rhythm. Adenosine is given as a rapid IV bolus. BSO: Diagnostic use: 60 mg/20 mL and 90 mg/30 mL singledose vials Injection, preservative free: 3 mg/mL Genghis Khun ([email protected],nafanakhun.wordpress.com)


I: Abnormal heart rhythms caused by abnormal contractions in the upper part of the heart (supraventricular arrhythmias) D: Rapid I.V. push (over 1-2 seconds) via peripheral line: Neonates: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT Maximum single dose: 12 mg Infants and Children: Pediatric advanced life support (PALS): Treatment of SVT: 0.1 mg/kg; if not effective, administer 0.2 mg/ kg Alternatively: Initial dose: 0.05 mg/kg; if not effective within 2 minutes, increase dose by 0.05 mg/kg increments every 2 minutes to a maximum dose of 0.25 mg/kg or until termination of PSVT; medium dose required: 0.15 mg/kg Maximum single dose: 12 mg Adults: 6 mg; if not effective within 1-2 minutes, 12 mg may be given; may repeat 12 mg bolus if needed Maximum single dose: 12 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Follow each I.V. bolus of adenosine with normal saline flush Note: Preliminary results in adults suggest adenosine may be administered via a central line at lower doses (ie, initial adult dose: 3 mg). Continuous I.V. infusion via peripheral line: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Thallium-201 is injected at midpoint (3 minutes) of infusion. Hemodialysis: Significant drug removal is unlikely based on physiochemical characteristics. Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics. Note: Patients who are receiving concomitant theophylline therapy may be less likely to respond to adenosine therapy. Note: Higher doses may be needed for administration via peripheral versus central vein. KI: Hypersensitivity, second- or third-degree A-V block or sick sinus syndrome (except in patients with a functioning artificial pacemaker), atrial flutter, atrial fibrillation, and ventricular Genghis Khun ([email protected],nafanakhun.wordpress.com)


tachycardia (this drug is not effective in converting these arrhythmias to sinus rhythm). The manufacturer states that Adenoscan® should be avoided in patients with known or suspected bronchoconstrictive or bronchospastic lung disease. P: Patients with pre-existing S-A nodal dysfunction may experience prolonged sinus pauses after adenosine. There have been reports of atrial fibrillation/flutter in patients with PSVT associated with accessory conduction pathways after adenosine. Adenosine decreases conduction through the A-V node and may produce a short-lasting first-, second-, or thirddegree heart block. Because of the very short half-life, the effects are generally self-limiting. Rare, prolonged episodes of asystole have been reported, with fatal outcomes in some cases. At the time of conversion to normal sinus rhythm, a variety of new rhythms may appear on the EKG. A limited number of patients with asthma have received adenosine and have not experienced exacerbation of their asthma. Adenosine may cause bronchoconstriction in patients with asthma, and should be used cautiously in patients with obstructive lung Genghis Khun ([email protected],nafanakhun.wordpress.com)


disease not associated with bronchoconstriction (eg, emphysema, bronchitis). ES: >10%: Facial flushing, palpitations, chest pain, hypotension Headache, Shortness of breath/dyspnea, Sweating 1% to 10%: Dizziness, Nausea (3%), Paresthesia, numbness , Chest pressure (7%) IO: Theophylline and caffeine (methylxanthines) antagonize adenosine's effects; may require increased dose of adenosine. Dipyridamole potentiates effects of adenosine; reduce dose of adenosine. Carbamazepine may increase heart block Preg: C Nama Dagang:



Heptaminol HCl I: Astenia & kelelahan. Hipotensi & defisiensi KV. BSO: Tab 150 mg. amp 250 mg/5cc D: Astenia, Hipotensi & Psikiatri Dws: 300 mg 2x/hari. Anak: 20 mg/kg/hari terbagi dlm 3 dosis Resusitasi dewasa: 2 amp IV sekaligus/IM Neonatus 2 cc ke dalam tali pusat KI: Hipertensi, tiroid P: ES: IO: Preg: A, B, C, D, X* Nama Dagang: Hep-A-Myl



III. SALURAN NAFAS A. ANTI ASTHMA & PPOK B. COUGH & COLD REMEDIA C. DEKONGESTAN & PREPARAT NASAL LAIN D. OBAT PERNAPASAN LAIN



A. Anti Asthma & PPOK Salbutamol/ Albuterol Theophylline/ Aminophylline Orciprenaline sulphate/ Metaproterenol Ipratopium bromide Tiotropium bromide Acefylline piperazine Ephedrine HCl Terbutaline Budesonide Isoproterenol Fenoterol Clenbuterol Ketotifen Zafirlukast Fluticasone Salmeterol Procaterol Beclomethasone Trimetoquinol HCl



Salbutamol/ Albuterol -- Beta-agonist for bronchospasm refractory to epinephrine. Relaxes bronchial smooth muscle by action on beta-2 receptors, with little effect on cardiac muscle contractility. Most patients (even those with no measurable increase in expiratory flow) benefit from treatment. Inhaled beta-agonists initially are prescribed prn. Frequency may be increased; institute regular schedule in patients on anticholinergic drugs who are still symptomatic. Available as a liquid for nebulizer, metered-dose inhalers (MDI), and dry-powder inhalers. D: MDI: 2 puffs q3-4h Nebulizer: 0.2-0.3 mL of 5% solution diluted to 2.5 mL with NS tid/qid Nebulizer Infants and children: 0.01-0.02 mL of 5% solution diluted in 2-3 mL NS q4-6h Adolescents: Administer as in adults Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; preexisting cardiac arrhythmia associated with tachycardia IO: Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation; cardiovascular effects may increase with MAOIs, inhaled anesthetics, TCAs, and sympathomimetic agents Preg: C P: Adverse effects include muscle tremor, nervousness, insomnia, transient hypoxemia, and tachycardia; caution in hyperthyroidism, DM, hypertension, ischemic heart disease, seizures, and pheochromocytoma Nama Dagang:



Theophylline/ Aminophylline -- Mechanism of action is not well defined yet. Was formerly thought that this drug increases intracellular cyclic AMP by causing inhibition of phosphodiesterase; however, current data do not support that. D: 1st 5-8 mg/kg/d, then in the range of 5-15 mcg/mL; 5.6 mg/kg loading dose (based on aminophylline) IV over 20 min, followed by maintenance infusion of 0.1-1.1 mg/kg/h Paed. 6 weeks to 6 months: 0.5 mg/kg/h loading dose IV in first 12 h (based on aminophylline), followed by maintenance infusion of 12 mg/kg/d thereafter; may administer continuous infusion by dividing total daily dose by 24 h 6 months to 1 year: 0.6-0.7 mg/kg/h loading dose IV in first 12 h, followed by maintenance infusion of 15 mg/kg/d; may administer as continuous infusion, as above KI: Hipersensitif; uncontrolled arrhythmias; peptic ulcers; hyperthyroidism; uncontrolled seizure disorders Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Effects may decrease with aminoglutethimide, barbiturates, carbamazepine, ketoconazole, loop diuretics, charcoal, hydantoins, phenobarbital, phenytoin, rifampin, isoniazid, and sympathomimetics; effects may increase with allopurinol, betablockers, ciprofloxacin, corticosteroids, disulfiram, quinolones, thyroid hormones, ephedrine, carbamazepine, cimetidine, erythromycin, macrolides, propranolol, and interferon Preg: C P: Has low serum therapeutic-to-toxicity ratio, and, therefore, serum level monitoring is important; peptic ulcer; hypertension; tachyarrhythmias; hyperthyroidism; compromised cardiac function; do not inject IV solution faster than 25 mg/min; patients diagnosed with pulmonary edema or liver dysfunction are at greater risk of toxicity because of reduced drug clearance Nama Dagang:



Orciprenaline/ Metaproterenol -- Relaxes bronchial smooth muscle by action on beta-2 receptors, with little effect on cardiac muscle contractility. Most patients (even those with no measurable increase in expiratory flow) benefit from treatment. Inhaled beta-agonists initially are prescribed prn. Frequency may be increased; institute regular schedule in patients on anticholinergic drugs who are still symptomatic. D: MDI: 2 puffs q3-4h Nebulizer: 0.2-0.3 mL of 5% sol. diluted to 2.5 mL+ NS tid/qid Nebulizer Infants and children: 0.01-0.02 mL of 5% solution diluted in 2-3 mL of NS q4-6h KI: Hipersensitif; arrhythmia associated with tachycardia IO: Beta-adrenergic blockers antagonize effects; inhaled ipratropium may increase duration of bronchodilatation; Genghis Khun ([email protected],nafanakhun.wordpress.com)


cardiovascular effects may increase with MAOIs, inhaled anesthetics, TCAs, and sympathomimetic agents Preg: C P: Caution in hypertension, cardiovascular disease, congestive heart failure, hyperthyroidism, diabetes, and seizures; not recommended during breastfeeding; adverse reactions include tachycardia, headache, nervousness, dizziness, tremor, GI upset, hypertension, paradoxical bronchospasm, and cough Nama Dagang: Alupent



Ipratopium D: MDI: 2-4 puffs q4-6h Nebulizer: 250 mcg diluted with 2.5 mL NS q4-6h Paed. MDI: 1-2 puffs tid; max 6 puffs per d Nebulizer: 250 mcg tid KI: Hipersensitif IO: Drugs with anticholinergic properties (eg, dronabinol) may increase toxicity; albuterol may increase effects Preg: C P: Caution in narrow-angle glaucoma, prostatic hypertrophy, or bladder neck obstruction Nama Dagang:



Tiotropium -- A quaternary ammonium compound. Elicits anticholinergic/antimuscarinic effects with inhibitory effects on M3 receptors on airway smooth muscles, leading to bronchodilation. Available as a capsule dosage form containing a dry powder for oral inhalation via the HandiHaler inhalation device. Helps patients with COPD by dilating narrowed airways and keeping them open for 24 h. D: Inhale contents of 1 cap (18 mcg) via HandiHaler device qd MDI 1-2 puffs tid; max 6 puffs/d KI: Hipersensitif IO: Coadministration with other anticholinergic containing drugs (eg, ipratropium) may increase toxicity risk Preg: C P: For maintenance treatment only; not effective for acute (rescue) therapy of bronchospasm; discontinue use and consider other treatments if immediate hypersensitivity reactions (including angioedema) or paradoxical bronchospasm Genghis Khun ([email protected],nafanakhun.wordpress.com)


occur; caution with narrow-angle glaucoma, prostatic hyperplasia, or bladder neck obstruction; commonly causes dry mouth; may cause constipation, increased heart rate, blurred vision, glaucoma, and urinary difficulty or retention; monitor patients with moderate-to-severe renal impairment Nama Dagang: Spiriva




Acefylline piperazine I: Asma bronchial, spasme bronkus pd bronchitis, ggn nafas/ sesak scr umum, sesak krn insufisiensi jantung, emfisema & ggn obstruksi Pulmoner kronis. BSO: Tab salut selaput 250 mg. amp 500 mg/5cc D: Tab 2-8 tab/hr dlm dosis terbagi. Amp IM 3-4 amp/hr. IV 1-2 amp/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Etaphylline



Ephedrine HCl I: Treatment of bronchial asthma, nasal congestion, acute bronchospasm, idiopathic orthostatic hypotensionv BSO: Capsule: 25 mg, 50 mg Injection: 25 mg/mL; 50 mg/mL Jelly: 1% Spray: 0.25% D: Children: Oral, S.C.: 3 mg/kg/day or 25-100 mg/m2/day in 4-6 divided doses every 4-6 hours I.M., slow I.V. push: 0.2-0.3 mg/kg/dose every 4-6 hours Adults: Oral: 25-50 mg every 3-4 hours as needed I.M., S.C.: 25-50 mg, parenteral adult dose should not exceed 150 mg in 24 hours I.V.: 5-25 mg/dose slow I.V. push repeated after 5-10 minutes as needed, then every 3-4 hours max 150 mg/24 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hypersensitivity to ephedrine or any component, cardiac arrhythmias, angle-closure glaucoma, patients on other sympathomimetic agents P: Blood volume depletion should be corrected before ephedrine therapy is instituted; use caution in patients with unstable vasomotor symptoms, diabetes, hyperthyroidism, prostatic hypertrophy, or a history of seizures; also use caution in the elderly and those patients with cardiovascular disorders such as coronary artery disease, arrhythmias, and hypertension. Ephedrine may cause hypertension resulting in intracranial hemorrhage. Long-term use may cause anxiety and symptoms of paranoid schizophrenia. Avoid as a bronchodilator; generally not used as a bronchodilator since new beta2 agents are less toxic. Use with caution in the elderly, since it crosses the blood-brain barrier and may cause confusion. ES: >10%: Central nervous system: CNS stimulating effects, nervousness, anxiety, apprehension, fear, tension, agitation, excitation, restlessness, irritability, insomnia, hyperactivity Genghis Khun ([email protected],nafanakhun.wordpress.com)


1% to 10%: Cardiovascular: Hypertension, tachycardia, palpitations, elevation or depression of blood pressure, unusual pallor Central nervous system: Dizziness, headache Gastrointestinal: Xerostomia, nausea, anorexia, GI upset, vomiting Genitourinary: Painful urination Neuromuscular & skeletal: Trembling, tremor (more common in the elderly), weakness Miscellaneous: Diaphoresis (increased) IO: Decreased effect: Alpha- and beta-adrenergic blocking agents decrease ephedrine vasopressor effects Increased toxicity: Additive cardiostimulation with other sympathomimetic agents; theophylline cardiostimulation; MAO inhibitors or atropine may increase blood pressure; cardiac glycosides or general anesthetics may increase cardiac stimulation Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Terbutaline I: Asthma, Chronic obstructive pulmonary disease (COPD) BSO: Aerosol, oral: 0.2 mg/actuation Injection: 1 mg/mL Tablet: 2.5 mg, 5 mg D: Children <12 years: Oral: Initial: 0.05 mg/kg/dose 3x/day, increased; max: 0.15 mg/kg/dose 3-4x/day or a total of 5 mg/24 hours S.C.: 0.005-0.01 mg/kg/dose to a max of 0.3 mg/dose every 15-20 minutes for 3 doses Nebulization: 0.01-0.03 mg/kg/dose q4-6 hours Inhalation: 1-2 inhalations q4-6 hours Children >12 years and Adults: Oral: 12-15 years: 2.5 mg q6h 3 x/day; max 7.5 mg/day >15 years: 5 mg/dose every 6 hours 3 times/day; if side effects occur, reduce dose to 2.5 mg every 6 hours; max 15 mg in 24 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


S.C.: 0.25 mg/dose repeated in 15-30 minutes for one time only; a total dose of 0.5 mg should not be exceeded within a 4hour period Nebulization: 0.01-0.03 mg/kg/dose every 4-6 hours Inhalation: 2 inhalations every 4-6 hours; wait 1 minute between inhalations Dosing adjustment/comments in renal impairment: Clcr 10-50 mL/minute: Administer at 50% of normal dose Clcr <10 mL/minute: Avoid use KI: Allergy P: Diabetes, Heart disease, hypertension, Thyrotoxicosis ES: Tremor, Headache, Nausea, heart palpitations, Muscle cramps, Tense feeling, Sleep disturbances, tachycardia, hypokalaemia, Mouth or throat irritation & paradoxical bronchospasm (with inhaler devices) IO: Decreased effect with beta-blockers Increased toxicity with MAO inhibitors, TCAs Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Budesonide Inhibits bronchoconstriction mechanisms, produces direct smooth muscle relaxation, and may decrease number and activity of inflammatory cells, which, in turn, decreases airway hyperresponsiveness. BSO: Cyclocaps 200 mcg D: 200-400 mcg via PO inhalation 2x initially; increase to 800 mcg bid Paed. 200 mcg via PO inhalation 2x initially; may increase to 400 mcg bid KI: Hipersensitif; bronchospasm, status asthmaticus, and other types of acute episodes of asthma IO: Coadministration with ketoconazole may increase plasma levels but does not appear to be clinically significant Preg: B, C. P: Coughing, upper respiratory tract infection, and bronchitis may occur Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Isoproterenol I: Treatment of reversible airway obstruction as in asthma or COPD; used parenterally in ventricular arrhythmias due to A-V nodal block; hemodynamically compromised bradyarrhythmias or atropine-resistant bradyarrhythmias; temporary use in third degree A-V block until pacemaker insertion; low cardiac output; vasoconstrictive shock states BSO: Inhalation: Aerosol: 0.2% (1:500); 0.25% (1:400) Solution for nebulization: 0.031%; 0.062%; 0.25% ; 0.5%; 1% Injection: 0.2 mg/mL (1:5000) Tablet, sublingual: 10 mg, 15 mg D: Children: Bronchodilation: Inhalation: Metered dose inhaler: 1-2 dose up to 5 times/day Bronchodilation (using 1:200 inhalation solution) 0.01 mL/kg/dose every 4 hours as needed (max: 0.05 mL/dose) diluted with NS to 2 mL Sublingual: 5-10 mg every 3-4 hours, max 30 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cardiac arrhythmias: I.V.: Start 0.1 mcg/kg/minute (usual effective dose 0.2-2 mcg/kg/minute) Adults: Bronchodilation: Inhalation: Metered dose inhaler: 1-2 metered doses 4-6 times/day Bronchodilation: 1-2 inhalations of a 0.25% solution, no more than 2 inhalations at any one time (1-5 minutes between inhalations); no more than 6 inhalations in any hour during a 24hour period; maintenance therapy: 1-2 inhalations 4-6 times/day. Alternatively: 0.5% solution via hand bulb nebulizer is 5-15 deep inhalations repeated once in 5-10 minutes if necessary; treatments may be repeated up to 5 times/day. Sublingual: 10-20 mg every 3-4 hours; max 60 mg/day Cardiac arrhythmias: I.V.: 5 mcg/minute initially, titrate to patient response (2-20 mcg/minute) Shock: I.V.: 0.5-5 mcg/minute; adjust according to response KI: Angina, pre-existing cardiac arrhythmias (ventricular); tachycardia or A-V block caused by cardiac glycoside Genghis Khun ([email protected],nafanakhun.wordpress.com)


intoxication; allergy to sulfites or isoproterenol or other sympathomimetic amines P: Elderly patients, diabetics, renal or cardiovascular disease, hyperthyroidism; excessive or prolonged use may result in decreased effectiveness ES: >10%: Insomnia, restlessness, Dry throat, xerostomia, discoloration of saliva (pinkish-red) 1% to 10%: Flushing of the face or skin, ventricular arrhythmias, tachycardias, profound hypotension, hypertension, Nervousness, anxiety, dizziness, headache, lightheadedness, Vomiting, nausea, Trembling, tremor, weakness, Diaphoresis IO: Increased toxicity: Sympathomimetic agents may cause headaches and elevate blood pressure; general anesthetics may cause arrhythmias Preg: C Nama Dagang:



Fenoterol HBr I: Asma BSO: Inhaler dosis terukur 100 mcg/semprot. 200 mcg/semprot. Larutan inhalasi 0.1% D: Asma akut: 1 semprot. Maks 8 semprot/hr Lar inhalasi, tunggal: 0.2-1 mg 3x/hr dg interval min 3 jam KI: Kardiomiopati obstruksi hipertrofi, takiaritmia P: ES: IO: Preg: B Nama Dagang:



Clenbuterol HCl I: PPOK (asma bronchial, bronchitis kronik & emsifema paru) BSO: Tab 10 mcg. 20 mcg. Sir 5 mcg/5cc D: Tab Dws & >12thn 40 mcg/hr. kasus berat bs 80mcg/hr. pemeliharaan 20 mcg/hr. Anak 1.2 mcg/kg/hr. Sir: 6-12thn 2x 3sdt. 4-6thn 2x 2 sdt. 2-4 thn 3x 1sdt. <2thn 2x 1 sdt KI: Tirotoksikosis, stenosis aorta subvalvular hipertrofik idiopatik, takikardi & takiaritmia. P: IMA, DM, hipertensi ES: Tremor, gelisah,ekstra systole, takikardia IO: β-blocker, efek antagonis Preg: Nama Dagang: Spiropent Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ketotifen Ketotifen prevents the release of histamine from mast cells and also blocks H1 receptors I: Allergic rhinitis (hayfever) or allergic conjunctivitis BSO: Tab 1 mg. Syr 1 mg/5cc D: For asthma: 1 mg 2x/day. Anak: 50 mcg/kg 2x. KI: Pregnancy, Breastfeeding, children < 3 years of age. P: History of epilepsy ES: Drowsiness, Dry mouth, Dizziness, Weight gain, Irritability, insomnia, Nervousness, Excitation, Bladder inflammation, cystitis, hepatitis, Convulsions, Isolated severe skin reactions IO: increased risk of drowsiness: alcohol, other sedating antihistamines, tricyclic antidepressants, MAOI antidepressants, antipsychotics, opioid painkillers, benzodiazepines, barbiturates, sleeping tablets. Preg:: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Zafirlukast Selective and competitive receptor antagonist of leukotriene D4 and E4, components of slow-reacting substance of anaphylaxis. Indicated for treatment of stable, mild, persistent asthma or prophylaxis for EIA. BSO: Tab 20 mg D: 20 mg PO bid; must be taken 30 min prior to breakfast and supper KI: Hipersensitif IO: Increases half-life of warfarin; erythromycin and theophylline decrease serum levels Preg: B P: Elevations of liver enzymes occur rarely, but routine LFT monitoring not required; systemic eosinophilia and vasculitis consistent with Churg-Strauss syndrome also rarely reported; not indicated for treatment of acute asthma exacerbations Nama Dagang: Accolate Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fluticasone Topikal Potensi Ringan Alters level of inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response. I: Topikal: prurigo nodularis, lichen simplex, Eczema, contact dermatitis, seborrhoeic dermatitis, Discoid lupus erythematosus (DLE), Inflammatory skin disorders, Intense and widespread reddening of the skin (generalised erythroderma) in combination with oral or injected corticosteroids, Prickly heat, Psoriasis, Reactions to insect bites& stings, lichen planus, neurodermatitis BSO: Nebule 0.5 mg/2cc. Krim 0.05% D: 44-mcg MDI: 2 puffs bid for mild persistent asthma 110- to 220-mcg MDI: 2 puffs bid for moderate-to-severe persistent asthma Krim: 1X/hr Paed. 44-mcg MDI: 2 puffs bid Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; viral, fungal, and bacterial skin infections Topikal: Acne vulgaris, Broken skin or open wounds, Children less than 1 year of age, acne rosacea, perioral dermatitis, Itching around the back passage and genitals, psoriasis ES: Thinning of the skin, Changes in skin pigmentation, Skin irritation, Stretch marks (striae), telangiectasia, hypertrichosis IO: Preg: C P: Not indicated to treat acute asthma exacerbation or status asthmaticus; prolonged use may increase systemic absorption and may cause Cushing syndrome, reversible HPA-axis suppression, hyperglycemia, and glycosuria; localized infections of the pharynx due to Candida albicans (5%) may occur; rare manifestation of systemic eosinophilic conditions consistent with Churg-Strauss syndrome reported Nama Dagang: Cutivate krim Genghis Khun ([email protected],nafanakhun.wordpress.com)


Salmeterol Can relieve bronchospasm by relaxing smooth muscles of the bronchioles in conditions associated with bronchitis, emphysema, asthma, or bronchiectasis. BSO: Inhaler 25 mcg/aktuasi Rotadisk 50 mcg Diskhaler 1 D: 1 inhalation (50 mcg) bid approximately 12 h apart KI: Hipersensitif; angina, tachycardia, and cardiac arrhythmias associated with tachycardia IO: Concomitant use of beta-blockers may decrease bronchodilating and vasodilating effects of beta-agonists; concurrent administration with methyldopa may increase pressor response; coadministration with oxytocic drugs may result in severe hypotension; ECG changes and hypokalemia resulting from diuretics may worsen when coadministered Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Asthma treatment:[US Boxed Warning] Long-acting beta2agonists may increase the risk of asthma-related deaths. In a large, randomized clinical trial, salmeterol was associated with a small, but statistically significant increase in asthma-related deaths (when added to usual asthma therapy); risk may be greater in African-American patients versus Caucasians. Should only be used as adjuvant therapy in patients not adequately controlled on inhaled corticosteroids or whose disease requires two maintenance therapies; salmeterol is not meant to relieve acute asthmatic symptoms, should not be initiated in patients with significantly worsening or acutely deteriorating asthma, and is not a substitute for inhaled or oral corticosteroids; short-acting beta2-agonist should be used for acute symptoms and symptoms occurring between treatments; corticosteroids should not be stopped or reduced when salmeterol initiated; during initiation of salmeterol watch for signs of worsening asthma Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Procaterol I: Asma, emfisema BSO: Tab 25 mcg, 50 mcg. Syr 5mcg/cc. Inhaler 10 mcg/semprot. D: Dws 2x 1 tab. < 6 thn 1-1.25 mcg/kg diberikan 2x/hr KI: P: ES: Palpitasi, demam, kemerahan, tremor IO: Preg: Nama Dagang: Meptin



Beclomethasone Alters level of inflammation in airways by inhibiting multiple types of inflammatory cells and decreasing production of cytokines and other mediators involved in the asthmatic response. I: BSO: Inhaler 50 mcg/semprot, 100 mcg/smprot, 200 mcg/dosis Rotacap 100 mcg Rotahaler 1 Rotadisk 100 mcg, 200 mcg Diskhaler 1 Topikal : krim 0.025% D: 2 puffs (84 mcg) tid/qid; alternatively, 4 puffs (168 mcg) bid Severe asthma: 12-16 puffs (504-672 mcg)/d; adjust dose downward to response; max 20 puffs (840 mcg)/d QVAR: 80 and 160 mcg/puff Paed. Genghis Khun ([email protected],nafanakhun.wordpress.com)


<6 years: Not established 6-12 years: 1-2 puffs (42-84 mcg) tid/qid to response; alternatively, 4 puffs (168 mcg) bid; max 10 puffs (420 mcg)/d KI: Hipersensitif; bronchospasm, status asthmaticus, and other types of acute episodes of asthma IO: Coadministration with ketoconazole may increase plasma levels but does not appear to be clinically significant Preg: C P: Symptoms of adrenal insufficiency due to suppression of the HPA axis may occur when being withdrawn from systemically active corticosteroids; small number of patients may develop hypercortisolism and adrenal suppression (weight gain, increased bruising, cushingoid features, acneiform lesions, mental disturbances, and cataracts may occur); localized infections of the pharynx due to C albicans (5%) reported Nama Dagang:



Trimetoquinol HCl I: Asma BSO: Tab 3 mg. Tetes Paed 1 mg/cc. Amp 0.1 mg/cc D: Tab 1-4 tab/hr terbagi dlm 2-3x. < 6th 0.1 mg/kg/dosis 3-4x/hr Tetes Paed: 3-4 thn 4-6 cc terbagi dlm 3-4 dosis 1-2 thn 2-4 cc terbagi dlm 3-4 dosis < 1 thn 1-2 cc terbagi dlm 3-4 dosis Inj 1-2 amp SC/IM atau ½-1 amp IV dlm Glukosa 5% atau 20% inj > 3 mnt atau Infuse 1 amp dlm 500cc D5%/ Glukosa-Ringer KI: P: ES: Palpitasi, tremor, pusing IO: Katekolamin menyebabkan aritmia Preg: Nama Dagang: Inolin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Heptaminol acefyllinate I: Asma. BSO: Tab 500 mg. tetes 40%. Amp 500 mg/5cc D: Dws Tts 75-150 tts/hari. Tab 1.5-3 g/hari terbagi dlm 3 dosis. Amp 1-2 amp/hr IM/IV. Tetes Bayi 3 thn 2-3tts/kg/hr. Anak 3-7 thn 2-3 tts/kg/hr max 60 tetes. Anak 7-15 tahun 75-100 tetes/hari terbagi dalam 3 dosis. Lama terapi 1-3 minggu KI: P: ES: IO: Preg: Nama Dagang: Cariamyl



B. Cough & Cold Remedia Acetylcysteine Phenylpropanolamine HCl Guaifenesin/ Glyceryl Guaiacolate & Dextromethorphan Terbutaline Ambroxol HCl Bromhexine HCl Codeine HCl Dextromethorphan Pseudoephedrine Phenylephrine Noscapine Diphenhydramine Carbocisteine Erdosteine Levodropropizine Isoaminile Tipepidine hibenzate Genghis Khun ([email protected],nafanakhun.wordpress.com)


N-acetylcysteine -- Inhalations may be tried to encourage sputum expectoration in patients with tenacious sputum and mucous plugging. BSO: Tab eff 600 mg. Kaps 200 mg. Sachet 200 mg. Sachet paed. Sir kering D: 5-10 mg dissolved in 3 mL NS KI: Hipersensitif IO: None reported Preg: B P: Inhalations may exacerbate bronchospasm; GI distress may occur Nama Dagang:



Phenylpropanolamine HCl I: Anorexiant; nasal decongestant BSO: Capsule: 37.5 mg Tablet & Capsule timed release: 25 mg, 75 mg Tablet Precision release & Timed release: 75 mg D: 2-6 years: 6.25 mg q4h 6-12 years: 12.5 mg q4h max 75 mg/day Decongestant: 25 mg q4h or 50 mg q8h, max 150 mg/day Anorexic: 25 mg 3x/day 30 minutes a.c or 75 mg (timed release) 1x in the morning Precision release: 75 mg after breakfast KI: hypersensitivity P: High blood pressure, tachyarrhythmias, pheochromocytoma, bradycardia, cardiac disease, arteriosclerosis; do not use for more than 3 weeks for weight loss ES: >10%: Hypertension, palpitations 1-10%: Insomnia, restlessness, dizziness, Xerostomia, nausea IO: Decreased effect of antihypertensives Genghis Khun ([email protected],nafanakhun.wordpress.com)


Increased effect/toxicity with MAO inhibitors (hypertensive crisis), beta-blockers (increased pressor effects) Preg: C Nama Dagang:



Guaifenesin/ Glyceryl Guaiacolate & Dextromethorphan Treats minor cough resulting from bronchial and throat irritation. BSO: Caplet, sustained release 300 mg, 600 mg Capsule: 200 mg Liquid: 100 mg/5 mL, 200 mg/5 mL Tablet: 100 mg, 200 mg, 1200 mg Sustained release: 600 mg D: 5 mL PO q4h or 10 mL PO q6-8h; max 40 mL/24h Paed. 1-2 mg/kg/d PO divided tid/qid KI: Hipersensitif IO: Preg: C P: Do not use to treat productive cough or persistent chronic cough resulting from emphysema Nama Dagang:



Ambroxol HCl I: Penyakit sal nafas akut & kronik yg berhubungan dg sekresi abnormal bronkus. BSO: Tab 30 mg, Syr 15 mg/5cc D: D:1 tab 3x/hr atau 10 cc 3x/hr Anak 5-12 th: ½ tab 3x/hr atau 5 cc 3x/hr Anak 2-5 th: 2.5 cc 3x/hr <2th: 2.5cc 2x/hr KI: Hipersensitif P: Hamil ES: Ggn sal cerna. Jarang reaksi alergi IO: Dpt dipakai bersama kortikosteroid, bronkospasmolitik & antibiotik Preg: Nama Dagang:



Bromhexine HCl I: Mukolitik BSO: Tab 8 mg Sir & Elixir 4mg/5cc Lar 8 mg/4cc Amp 4mg/2cc D: 3x/hari KI: Hipersensitif P: Tukak lambung ES: Diare, mual, muntah IO: amoksisilin, sefuroksim, doksisiklin Preg:: A, B, C, D, X Nama Dagang:



Codeine HCl Analgesic, Narcotic; Centrally acting Antitussive I: Manage pain of intercostal muscle strain + cough. BSO: Injection: 30 mg; 60 mg Solution, oral: 15 mg/5 mL Tablet: 15 mg, 30 mg, 60 mg D: 10-20 mg/dose PO q4-6h prn; max 120 mg/d Paed. 2-6 years: 1-1.5 mg/kg/d PO divided q4-6h prn; max 30 mg/d 6-12 years: 1-1.5 mg/kg/d PO divided q4-6h prn; max 60 mg/d KI: Hipersensitif; high-altitude cerebral edema or elevated ICP IO: Toxicity increases with concurrent administration of TCAs, MAOIs, neuromuscular blockers, CNS depressants, phenothiazines, and narcotic analgesics Preg: D P: Sedating; used to treat cough in high-altitude cerebral edema only if absolutely necessary; may depress hypoxic ventilatory rate and respiratory drive during sleep Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dextromethorphan Antitussive I: Symptomatic relief of coughs caused by minor viral upper respiratory tract infections or inhaled irritants; most effective for a chronic nonproductive cough BSO: Syr 10 mg/5cc Capsule: 30 mg Liquid: 10 mg/15 mL, 3.5 mg/5 mL, 7.5 mg/5 mL, 15 mg/5 mL Liquid, sustained release, as polistirex 30 mg/5 mL Lozenges: 2.5 mg, 5 mg, 7.5 mg Syrup: 7.5 mg/mL, 10 mg/5 mL, 15 mg/15 mL D: <2 years: Use only as directed by a physician 2-6 y: 2.5-7.5 mg q4-8h; ext release:15 mg 2x/day, max 30mg/d 6-12 y: 5-10 mg q4h or 15 mg q6-8h; ext release:30 mg 2x/d, max 60 mg/d Adults: 10-20 mg q4h or 30 mg q6-8h; extended release: 60 mg 2x/d; max 120 mg/day KI: Hypersensitivity to dextromethorphan or any component Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Research on chicken embryos exposed to concentrations of dextromethorphan relative to those typically taken by humans has shown to cause birth defects and fetal death; more study is needed, but it is suggested that pregnant women should be advised not to use dextromethorphan-containing medications ES: <1%: Nausea, GI upset, constipation, abdominal discomfort IO: CYP2D6, 2E1, 3A3/4 enzyme substrate Preg: C Nama Dagang:



Pseudoephedrine Stimulates vasoconstriction by directly stimulating alphaadrenergic receptors in respiratory mucosa. Used for symptomatic relief of nasal congestion due to common cold, upper respiratory tract allergies, and sinusitis. Promotes nasal or sinus drainage. BSO: Tab & Capsule: 30 mg, 60 mg Tab & Capsule, timed release: 120 mg Tab Extended release,: 120 mg, 240 mg Drops,: 7.5 mg/0.8 mL Syrup & Liquid,: 15 mg/5 mL; 30 mg/5 mL D: Immediate release: 30-60 mg PO q6h Sustained release: 120 mg PO q12h; max 240 mg/24h Paed. <2 years: 4 mg/kg/d PO divided q6h 2-5 years: 15 mg PO q6h; max 60 mg/24h 6-12 years: 30 mg PO q6h; max 120 mg/24h KI: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hipersensitif; severe anemia; postural hypertension or hypotension; closed-angle glaucoma; head trauma; cerebral hemorrhage IO: Propranolol, MAOIs, and sympathomimetic agents may increase toxicity; methyldopa and reserpine may reduce effects Preg: C P: Cardiovascular disease, DM, prostatic hypertrophy, and increased intraocular pressure Nama Dagang:



Phenylephrine Strong postsynaptic alpha-receptor stimulant with little betaadrenergic activity that produces vasoconstriction of arterioles in the body. BSO: Injection: 1% [10 mg/mL] Nasal solution: Drops: 0.125%, 0.16%, 0.25%, 0.5% Spray: 0.25%, 0.5%, 1% Ophthalmic solution: 0.12%, 2.5%, 10% D: 2-3 gtt or 1-2 sprays 0.25-0.5% solution each nostril or small quantity of 0.5% nasal jelly applied into each nostril q4h prn; 1% solution may be used in adults with severe congestion Paed. Infants >6 months: 1-2 gtt 0.16% solution each nostril q3h <6 years: 2-3 gtt or sprays 0.125% or 0.16% solution each nostril q4h prn 6-12 years: 2-3 gtt 0.25% solution each nostril q4h prn KI: Hipersensitif; severe hypertension or ventricular tachycardia Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Bretylium may potentiate action of vasopressors on adrenergic receptors, possibly resulting in arrhythmias; MAOIs may significantly enhance adrenergic effects of phenylephrine, and pressor response may be increased 2- to 3-fold Guanethidine may increase pressor response of direct-acting vasopressors, possibly resulting in severe hypertension Preg: C P: Caution in elderly patients, hyperthyroidism, myocardial disease, bradycardia, partial heart block, or severe arteriosclerosis; in hypovolemia, use is not a substitute for replacement of blood, fluids and electrolytes, and plasma (promptly restore with loss); dilute IV and administer via large vein; extravasation P: required Nama Dagang:



Noscapine I: Batuk tidak produktif, selesma BSO: Kaps 25 mg, 50 mg.Tetes 10 mg/cc D: 25-50 mg 4x/hr Tetes: Dws 10 tts 3-4x/hr Anak 6-12 thn 5 tts 3-4x/hr Bayi 2 tts 3-4x/hr KI: Asma bronchial, peningkatan TIK, depresi napas, penggunaan bersama MAOI P: Penykt hati & ginjal. Ketergantungan fisik pd penggunaan lama ES: IO: Preg: Nama Dagang:



Diphenhydramine First-generation antihistamine with anticholinergic effects. BSO: Capsule & Tablet: 25 mg, 50 mg Elixir & Syrup: 12.5 mg/5 mL Injection: 10 mg/mL; 50 mg/mL Lotion & Solution, topical spray: 1% Cream: 1%, 2% D: 25-50 mg PO q4-6h prn; max 400 mg/d Paed. <6 years: Not established 6-12 years: 5 mg/kg/d PO divided tid/qid prn; max 300 mg/d KI: Hipersensitif; MAOI use; during asthma attacks, narrow-angle glaucoma, symptomatic prostate hypertrophy, bladder-neck obstruction, and stenosing peptic ulcer; severe hypertension; severe coronary artery disease IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Potentiates CNS effect of depressants; because of alcohol content, do not give syrup form to patient taking drugs that can cause disulfiramlike reactions Preg: C P: Sedation and drowsiness may occur; may exacerbate angleclosure glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction and cause xerostomia Nama Dagang:



Carbocisteine Mucolytic I: Tracheostomy, Chronic obstructive pulmonary disease (COPD), Cystic fibrosis, Glue ear (suppurative otitis media) BSO: Kapl 375 mg, 500 mg Susp forte 500 mg/5cc Sir 250 mg/5cc D: Dws 1 sdm 3x/hr Anak 5-12thn: 1 sdt 3x/hr 2-5 thn: ½ sdt 4x/hr KI: Allergy, Peptic ulcers P: ES: Rash, Bleeding from the stomach or intestine, Diarrhoea, Nausea and vomiting IO: Preg: Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Erdosteine I: D: KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Vectrine



Levodropropizine I: Terapi simtomatik batuk non produktif BSO: Syr 60 mg/5cc D: Dws & anak > 12 thn 3x 2 sdt. Interval min 6 jam KI: Hamil, laktasi, lender bronkus berlebihan P: ES: Mual, muntah IO: Sedatif Preg: Nama Dagang: Levopront



Isoaminile I: D: KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Peracon



Tipepidine hibenzate I: Batuk, mukolitik BSO: Tab 33.21 mg D: Dws 3x 1 tab . Kasus berat tambah 1 tab bedtime. Anak >6th ½ dosis dws Anak < 6th 2.2 mg/kg/hr terbagi dlm 3 dosis. KI: P: ES: Kantuk, pusing, anoreksia, haus IO: Preg: Nama Dagang: Asvex



C. Dekongestan & Preparat Nasal Lain Oxymetazoline Xylometazoline Fexofenadine HCl Beclomethasone Fluticasone Triamcinolone acetonide Mometasone furoate Budesonide



Oxymetazoline Stimulates alpha-adrenergic receptors and causes vasoconstriction when applied directly to mucous membranes. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation. BSO: Solution, nasal: Drops, pediatric: 0.025%. Spray: 0.05% D: 2-3 sprays or 2-3 gtt of 0.05% solution in each nostril bid, qam and qhs or q10-12h Paed. 2-6 years: 2-3 gtt of 0.025% solution in each nostril bid, qam and qhs KI: Hipersensitif; MAOI therapy IO: Hypotensive action of guanethidine may be reversed; concurrent methyldopa may increase vasopressor response; concurrent MAOIs and ephedrine may result in hypertensive crisis; pressor sensitivity to mixed-acting agents (eg, ephedrine) Genghis Khun ([email protected],nafanakhun.wordpress.com)


may be increased; guanethidine potentiates effects of epinephrine and inhibits effects of ephedrine; phenothiazines may reverse action of nasal decongestants (eg, oxymetazoline); TCAs potentiate vasopressor response and may result in dysrhythmias Preg: C P: Caution in hyperthyroidism, coronary artery and ischemic heart disease, DM, and increased intraocular pressure or prostatic hypertrophy; because of increase in vasoconstriction, hypertensive patients may have change in blood pressure; do not use topical decongestants for >3-5 d to avoid rebound phenomenon Nama Dagang:



Xylometazoline Ophthalmic Agent, Vasoconstrictor I: Symptomatic relief of nasal and nasopharyngeal mucosal congestion BSO: Solution, nasal: 0.05% [0.5 mg/mL]; 0.1% [1 mg/mL] D 2-12 years: Instill 2-3 drops (0.05%) in each nostril q8-10h Adults: Instill 2-3 drops or sprays (0.1%) in each nostril q8-10h KI: P: ES: 1% to 10%: Drowsiness, dizziness, seizures, headache, Blurred vision, ocular irritation, photophobia Miscellaneous: Sweating IO: Preg: C BSO: Nama Dagang:



Fexofenadine Nonsedating Antihistamine I: Seasonal allergic rhinitis and chronic idiopathic urticaria BSO: Capsule: 60 mg Tablet: 30 mg, 60 mg, 180 mg D: Adults: 60 mg 2x/day or 180 mg 1x/day Anak 6-11 thn: 30 mg 2x/hari. Suspension: Anak 2-11 thn: 30 mg 2x/hari, or 5 cc 2x/hari. Anak 6bln-2thn: 15 mg or 2.5 cc 2x/hari. KI: Hypersensitivity P: preg: & lactation ES: Headache, Nausea, Dizziness, Fatigue, Drowsiness (rare) IO: Levels may increase with coadministration of erythromycin and ketoconazole Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Triamcinolone acetonide Corticosteroid, Topical Potensi Sedang I: Inhalation: Control of bronchial asthma and related bronchospastic conditions. Intranasal: Management of seasonal and perennial allergic rhinitis in patients greater than or equal to 12 years of age Systemic: Adrenocortical insufficiency, rheumatic disorders, allergic states, respiratory diseases, systemic lupus erythematosus, and other diseases requiring anti-inflammatory or immunosuppressive effects Topical: Inflammatory dermatoses responsive to steroids BSO: Semprot hidung 55 mcg/semprot. krim 0.1% D: 220 mcg (2 semprot tiap lubang hidung) 1x/hr Topikal: Oles 2-3x/hr KI: Known hypersensitivity to triamcinolone; systemic fungal infections; serious infections (except septic shock or tuberculous meningitis); primary treatment of status asthmaticus Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Glaucoma, bronchospasm, epistaxis, Smell and taste disturbances, Irritation of the tissues in the nose, Dryness of the nose and throat, Stinging or burning at the area of application IO: Decreased effect: Barbiturates, phenytoin, rifampin metabolism of triamcinolone; vaccine and toxoid effects may be reduced Increased toxicity: Salicylates may increase risk of GI ulceration Preg: C Nama Dagang: Nasacort AQ



Mometasone furoate Medium potency topical corticosteroid I: Hayfever & perennial allergic rhinitis. Nasal polyps in adults >18 years of age. Atopic dermatitis, Psoriasis BSO: Semprot hidung 50 mcg/dosis. Cream: 0.1% D: 100 mcg (2 semprot) 1x/hr each nostril. maxl 200 mcg/hr Topikal Oles 1x/hr KI: Nasal infections. < 6 years of age. Topikal: Acne vulgaris, acne rosacea. P: Active or inactive tuberculosis infection, Herpes simplex virus infection of the eye ES: Headache, epistaxis, pharyngitis, Nasal irritation, Nasal burning, Nasal ulceration, Smell or taste disturbances Topikal: Thinning of the skin, Changes in skin pigmentation, paraesthesia, Acne, contact dermatitis, striae, hypertrichosis, folliculitis, Temporary burning and stinging on application Preg: C Nama Dagang: Nasonex Genghis Khun ([email protected],nafanakhun.wordpress.com)


D. Obat Pernapasan Lain Beractant



Beractant Lung Surfactant I: Prevention and treatment of respiratory distress syndrome (RDS) in premature infants Rescue therapy: Treatment of infants with RDS confirmed by xray and requiring mechanical ventilation (administer as soon as possible - within 8 hours of age) BSO: Suspension: 200 mg D: Prophylactic treatment: Administer 100 mg phospholipids (4 mL/kg) intratracheal as soon as possible; as many as 4 doses may be administered during the first 48 hours of life, no more frequently than 6 hours apart. The need for additional doses is determined by evidence of continuing respiratory distress; if the infant is still intubated and requiring at least 30% inspired oxygen to maintain a PaO2 less than or equal to 80 torr. Rescue treatment: Administer 100 mg phospholipids (4 mL/kg) as soon as the diagnosis of RDS is made; may repeat if needed, no more frequently than every 6 hours to a maximum of 4 doses Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: P: Rapidly affects oxygenation and lung compliance and should be restricted to a highly supervised use in a clinical setting with immediate availability of clinicians experienced with intubation and ventilatory management of premature infants. If transient episodes of bradycardia and decreased oxygen saturation occur, discontinue the dosing procedure and initiate measures to alleviate the condition; produces rapid improvements in lung oxygenation and compliance that may require immediate reductions in ventilator settings and FiO2. ES: 1% to 10%: Respiratory: Oxygen desaturation IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Survanta



IV. NEURO MUSKULER A. ANALGESIK & ANTIPIRETIK B. ANTI RHEUMATIK & ANALGESIK ANTI INFLAMASI C. PREPARAT GOUT D. ANTI KONVULSAN & ANTI EPILEPSY E. MINOR TRANSQUILIZER, ANXIETAS & RELAXAN F. MAJOR TRANSQUILIZER G. HIPNOTIC & SEDATIF H. ANTI DEPRESSAN I. STIMULAN SSP & OBAT ADHD J. NOOTROPIK & NEUROTONIK K. ANTI EMETIK & ANTI VERTIGO L. PENYAKIT NEURODEGENERATIF M. PENYAKIT NEUROMUSKULAR N. PREPARAT PARKINSON O. RELAKSAN OTOT



A. Analgesik & Antipiretik Morphine Pethidine Codeine HCl Meperidine Mefenamic acid Acetaminophen/ Paracetamol Acetylsalicyclic acid/ Aspirin/ ASA Metamizole sodium/ Methampyrone Ketorolac Tramadol Naproxen



Analgesik Narcotic Morphine I: Relief of moderate to severe acute and chronic pain; pain of myocardial infarction; relieves dyspnea of acute left ventricular failure and pulmonary edema; preanesthetic medication BSO: Capsule: 15 mg, 30 mg Capsule,: 20 mg, 50 mg, 100 mg Injection: 0.5 mg/mL; 1 mg/mL; 2 mg/mL; 3 mg/mL; 4 mg/mL; 5 mg/mL; 8 mg/mL; 10 mg/mL; 15 mg/mL; 25 mg/mL; 50 mg/mL Injection: Preservative free: 0.5 mg/mL; 1 mg/mL; 10 mg/mL; 25 mg/mL I.V. via PCA pump: 1 mg/mL; 5 mg/mL I.V. infusion preparation: 25 mg/mL Solution, oral: 10 mg/5 mL; 20 mg/5 mL, 20 mg/mL, 100 mg/5 mL, 10 mg/2.5 mL Suppository, rectal: 5 mg, 10 mg, 20 mg, 30 mg Tablet: 15 mg, 30 mg Controlled release: 15 mg, 30 mg, 60 mg, 100 mg, 200 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sustained release: 30 mg, 60 mg, 100 mg D: Doses should be titrated to appropriate effect; when changing routes of administration in chronically treated patients, please note that oral doses are approximately one-half as effective as parenteral dose Oral: Tablet and solution (prompt release): 0.2-0.5 mg/kg/dose every 4-6 hours as needed; tablet (controlled release): 0.3-0.6 mg/kg/dose every 12 hours I.M., I.V., S.C.: 0.1-0.2 mg/kg/dose every 2-4 hours as needed; usual maximum: 15 mg/dose; may initiate at 0.05 mg/kg/dose I.V., S.C. continuous infusion: Sickle cell or cancer pain: 0.025-2 mg/kg/hour; postoperative pain: 0.01-0.04 mg/kg/hour Sedation/analgesia for procedures: I.V.: 0.05-0.1 mg/kg 5 minutes before the procedure Adolescents >12 years: Sedation/analgesia for procedures: I.V.: 3-4 mg and repeat in 5 minutes if necessary Adults: Oral: Prompt release: 10-30 mg every 4 hours as needed; controlled release: 15-30 mg every 8-12 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.M., I.V., S.C.: 2.5-20 mg/dose every 2-6 hours as needed; usual: 10 mg/dose every 4 hours as needed I.V., S.C. continuous infusion: 0.8-10 mg/hour; may increase depending on pain relief/adverse effects; usual range: up to 80 mg/hour Epidural: Initial: 5 mg in lumbar region; if inadequate pain relief within 1 hour, administer 1-2 mg, maximum dose: 10 mg/24 hours Intrathecal (1/10 of epidural dose): 0.2-1 mg/dose; repeat doses not recommended Rectal: 10-20 mg every 4 hours Dosing adjustment in renal impairment: Clcr 10-50 mL/minute: Administer at 75% of normal dose Clcr <10 mL/minute: Administer at 50% of normal dose Dosing adjustment/comments in hepatic disease: Unchanged in mild liver disease; substantial extrahepatic metabolism may occur; excessive sedation may occur in cirrhosis Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: hypersensitivity; increased intracranial pressure; severe respiratory depression P: Some preparations contain sulfites which may cause allergic reactions; infants <3 months of age are more susceptible to respiratory depression, use with caution and generally in reduced doses in this age group; use with caution in patients with impaired respiratory function or severe hepatic dysfunction and in patients with hypersensitivity reactions to other phenanthrene derivative opioid agonists (codeine, hydrocodone, hydromorphone, levorphanol, oxycodone, oxymorphone). Morphine shares the toxic potential of opiate agonists and usual precautions of opiate agonist therapy should be observed; may cause hypotension in patients with acute myocardial infarction. Tolerance or drug dependence may result from extended use. ES: Percentage unknown: Flushing, CNS depression, drowsiness, sedation, increased intracranial pressure, antidiuretic hormone release, physical and psychological dependence, diaphoresis Genghis Khun ([email protected],nafanakhun.wordpress.com)


>10%: Palpitations, hypotension, bradycardia, Dizziness, Nausea, vomiting, constipation, xerostomia, Pain at injection site, Weakness, Histamine release IO: CYP2D6 enzyme substrate Increased toxicity: CNS depressants, tricyclic antidepressants may potentiate the effects of morphine and other opiate agonists; dextroamphetamine may enhance the analgesic effect of morphine and other opiate agonists Preg: B, D Nama Dagang: MST Continus



Pethidine opioid analgesics Opioids mimic the effects of naturally occurring pain relieving chemicals (endorphins). They bind to specific receptors in the brain and spinal cord called opioid receptors, which results in the blocking of transmission of pain signals. I: Moderate-severe pain. Pain relief during childbirth & surgery BSO: D: KI: COPD, Convulsions, respiratory depression, comatose states P: Neonates, Breathing problems, Convulsions, Diseases of the bile ducts, Elderly people, prostatic hypertrophy, Head injury, Hypothyroidism, tachycardia, raised intracranial pressure, acute alcoholism, adrenocortical insufficiency, Premature infants, shock, Severely decreased liver & kidney function, Weak or debilitated people Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Changes in mood, Drowsiness, respiratory depression, dependence, Skin rashes, hypotension, hallucinations, Constipation, Nausea and vomiting IO: Opioids should not be taken concurrently with all MAOI antidepressants (e.g. tranylcypromine and selegiline) and for two weeks after the MAOI antidepressant has been stopped. When taken together with other medicines that have a sedative effect on the central nervous system, for example alcohol, medicines that induce sleep (hypnotics), antidepressant and antihistamines, drowsiness is likely to be increased . Preg: A, B, C, D, X Nama Dagang:



Meperidine Analgesic, Narcotic I: Dental: Adjunct in preoperative IV conscious sedation in patients undergoing dental surgery; alternate oral narcotic in patients allergic to codeine to treat moderate to moderatesevere pain Medical: Management of moderate to severe pain; adjunct to anesthesia and preoperative sedation BSO: Injection,: Multiple-dose vials: 50 mg/mL; 100 mg/mL Injection, Single-dose: 10 mg/mL; 25 mg/dose; 50 mg/dose; 75 mg/dose; 100 mg/dose Syrup,: 50 mg/5 mL Tablet,: 50 mg, 100 mg D: Doses should be titrated to appropriate analgesic effect; when changing route of administration, note that oral doses are about half as effective as parenteral dose Adults: Oral, I.M., I.V.: S.C.: 50-150 mg/dose every 3-4 hours as needed Elderly: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral: 50 mg every 4 hours I.M.: 25 mg every 4 hours Dosing adjustment in renal impairment: Clcr 10-50 mL/minute: Administer at 75% of normal dose Clcr <10 mL/minute: Administer at 50% of normal dose Dosing adjustment/comments in hepatic disease: Increased narcotic effect in cirrhosis; reduction in dose more important for oral than I.V. route KI: Hypersensitivity to meperidine or any component; patients receiving MAO inhibitors presently or in the past 14 days P: Use with caution in patients with pulmonary, hepatic, renal disorders, or increased intracranial pressure; use with caution in patients with renal failure or seizure disorders or those receiving high-dose meperidine; normeperidine (an active metabolite and CNS stimulant) may accumulate and precipitate twitches, tremors, or seizures; some preparations contain sulfites which may cause allergic reaction; not recommended as a drug of first choice for the treatment of chronic pain in the elderly due to the accumulation of normeperidine; for acute pain, its use should be Genghis Khun ([email protected],nafanakhun.wordpress.com)


limited to 1-2 doses; tolerance or drug dependence may result from extended use ES: >10%: Hypotension, Fatigue, drowsiness, dizziness, Nausea, vomiting, constipation, Weakness, Histamine release 1-10%: Nervousness, headache, restlessness, malaise, confusion, Anorexia, stomach cramps, xerostomia, biliary spasm, Ureteral spasms, decreased urination, Pain at injection site, Dyspnea, shortness of breath IO: CYP2D6 enzyme substrate Increased toxicity: May aggravate the adverse effects of isoniazid; MAO inhibitors, fluoxetine, and other serotonin uptake inhibitors greatly potentiate the effects of meperidine; acute opioid overdosage symptoms can be seen, including severe toxic reactions; CNS depressants, tricyclic antidepressants, phenothiazines may potentiate the effects of meperidine Preg: B, D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mefenamic acid NSAID I: Short-term relief of mild-moderate pain including primary dysmenorrhea BSO: Capsule: 250 mg D: 500 mg to start then 250 mg q4 hours; max therapy: 1 week KI: Hypersensitivity P: May have adverse effects on fetus ES: Diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, Dizziness, Drowsiness, Skin rashes, Visual disturbances, fluid retention, oedema, palpitations, Ulceration of the stomach or intestines, pancreatitis, angioedema, bronchospasm, Kidney, liver or blood disorders IO: CYP2C9 enzyme substrate Increased effect/toxicity with oral anticoagulants, methotrexate Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Acetaminophen/ Paracetamol Acting directly on hypothalamic heat-regulating centers, which increases dissipation of body heat via vasodilation and sweating. D: 325-650 mg PO/PR q4-6h or 1000 mg tid/qid; max 4 g/d Paed.: 15 mg/kg PO/PR q4h prn; max 2.6 g/d KI: Hipersensitif IO:Rifampin can reduce analgesic effects; coadministration with barbiturates, carbamazepine, hydantoins, and isoniazid may increase hepatotoxicity; chronic use may potentiate effects of warfarin Preg: B P: Hepatotoxicity possible in those with chronic alcoholism following various dose levels; severe or recurrent pain or high or continued fever may indicate a serious illness; APAP is contained in many OTC products, and combined use with these products may result in cumulative APAP doses that exceed recommended maximum dose Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Aspirin/ Acetylsalicylic Acid/ ASA I: Treatment of mild to moderate pain, inflammation, and fever; prophylaxis for myocardial infarction and transient ischemic episodes; management of rheumatoid arthritis, rheumatic fever, osteoarthritis, and gout (high dose) BSO: Suppository, rectal: 60 mg, 120 mg, 125 mg, 130 mg, 195 mg, 200 mg, 300 mg, 325 mg, 600 mg, 650 mg, 1.2 g Tablet: 65 mg, 75 mg, 81 mg, 325 mg, 500 mg D: Children: Analgesic and antipyretic: Oral, rectal: 10-15 mg/kg/dose q4-6h, max 60-80 mg/kg/day Anti-inflammatory: Oral: Initial: 60-90 mg/kg/day in divided doses; maintenance: 80-100 mg/kg/day divided q6-8h, maximum dose: 3.6 g/day; monitor serum concentrations Kawasaki disease: Oral: 80-100 mg/kg/day divided every 6 hours; after fever resolves: 8-10 mg/kg/day once daily; monitor serum concentrations Antirheumatic: Oral: 60-100 mg/kg/day in divided doses q4h Adults: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Analgesic and antipyretic: Oral, rectal: 325-650 mg every 4-6 hours up to 4 g/day Anti-inflammatory: Oral: Initial: 2.4-3.6 g/day in divided doses; usual maintenance: 3.6-5.4 g/day; monitor serum concentrations TIA: Oral: 1.3 g/day in 2-4 divided doses Myocardial infarction prophylaxis: 160-325 mg/day; a lower aspirin dosage has been recommended in patients receiving ACE inhibitors KI: Hypersensitivity to salicylates or other NSAIDs; asthma; rhinitis; nasal polyps; inherited or acquired bleeding disorders (including factor VII and factor IX deficiency); pregnancy (in 3rd trimester especially); do not use in children (<16 years of age) for viral infections (chickenpox or flu symptoms), with or without fever, due to a potential association with Reye's syndrome P: Use with caution in patients with platelet and bleeding disorders, renal dysfunction, dehydration, erosive gastritis, or peptic ulcer disease. Heavy alcohol use (>3 drinks/day) can increase bleeding risks. Avoid use in severe renal failure or in Genghis Khun ([email protected],nafanakhun.wordpress.com)


severe hepatic failure. Discontinue use if tinnitus or impaired hearing occurs. Caution in mild-moderate renal failure (only at high dosages). Patients with sensitivity to tartrazine dyes, nasal polyps and asthma may have an increased risk of salicylate sensitivity. Surgical patients should avoid ASA if possible, for 1-2 weeks prior to surgery, to reduce the risk of excessive bleeding. ES: Hemorrhage, idiosyncratic, allergy, Hypotension, tachycardia, dysrhythmias, edema, Rash, angioedema, urticaria , Acidosis, hyperkalemia, dehydration, hypoglycemia (children), hyperglycemia, hypernatremia (buffered forms), Nausea, vomiting, dyspepsia, epigastric discomfort, heartburn, stomach pains, gastrointestinal ulceration (6% to 31%), gastric erosions, gastric erythema, duodenal ulcers, Anemia, D.I.C , prolongation of prothrombin times, coagulopathy, thrombocytopenia, hemolytic anemia, bleeding, iron deficiency anemia , Hepatotoxicity, increased transaminases, hepatitis (reversible) Neuromuscular and skeletal: Rhabdomyolysis, weakness, acetabular bone destruction (OA) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Otic: Hearing loss, tinnitus Renal: Interstitial nephritis, papillary necrosis, proteinuria, renal impairment, renal failure (including cases caused by rhabdomyolysis), increased BUN, increased serum creatinine Respiratory: Asthma, bronchospasm, dyspnea, laryngeal edema, hyperpnea, tachypnea, respiratory alkalosis, noncardiogenic pulmonary edema Miscellaneous: Anaphylaxis, prolonged pregnancy and labor, stillbirths, low birth weight, peripartum bleeding, Reye's syndrome Case reports: Colonic ulceration, esophageal stricture, esophagitis with esophageal ulcer, esophageal hematoma, oral mucosal ulcers (aspirin-containing chewing gum), coronary artery spasm, conduction defect and atrial fibrillation (toxicity), delirium, ischemic brain infarction, colitis, rectal stenosis (suppository), cholestatic jaundice, periorbital edema, rhinosinusitis IO: ACE inhibitors: The effects of ace inhibitors may be blunted by aspirin administration, particularly at higher dosages. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Buspirone increases aspirin's free % in vitro. Carbonic anhydrase inhibitors and corticosteroids have been associated with alteration in salicylate serum concentrations. Heparin and low molecular weight heparins: Concurrent use may increase the risk of bleeding. Methotrexate serum levels may be increased; consider discontinuing aspirin 2-3 days before high-dose methotrexate treatment or avoid concurrent use. NSAIDs may increase the risk of gastrointestinal adverse effects and bleeding. Serum concentrations of some NSAIDs may be decreased by aspirin. Platelet inhibitors (IIb/IIa antagonists): Risk of bleeding may be increased. Probenecid effects may be antagonized by aspirin. Sulfonylureas: The effects of older sulfonylurea agents (tolazamide, tolbutamide) may be potentiated due to displacement from plasma proteins. This effect does not appear to be clinically significant for newer sulfonylurea agents (glyburide, glipizide, glimepiride). Genghis Khun ([email protected],nafanakhun.wordpress.com)


Valproic acid may be displaced from its binding sites which can result in toxicity. Verapamil may potentiate the prolongation of bleeding time associated with aspirin. Warfarin and oral anticoagulants may increase the risk of bleeding. Preg: C Nama Dagang:



Metamizole sodium/ Methampyrone I: Neuralgia, sakit kepala, berbagai nyeri BSO: Kapl & Tab 500 mg Amp 1g/2cc D: Tab 500 mg- 1g 3-4x/hr. max 2 g/hr Inj 500 mg 3-4x/hr IM/IV KI: Perdarahan, porfiria, psikosis berat P: ES: Kantuk, ketergantungan, ggn penglihatan, hipotensi, agranulositosis IO: Klorpromazin Preg: Nama Dagang:



Ketorolac NSAID I: Short-term (<5 days) management of pain; first parenteral NSAID for analgesia; 30 mg provides the analgesia comparable to 12 mg of morphine or 100 mg of meperidine BSO: Injection: 10 mg/cc, 30 mg/mL Solution, ophthalmic: 0.5% Tablet: 10 mg D: Note: The use of ketorolac in children <16 years of age is outside of product labeling Single-dose treatment: I.M., I.V.: 0.4-1 mg/kg as a single dose; Note: Limited information exists. Single I.V. doses of 0.5 mg/kg, 0.75 mg/kg, 0.9 mg/kg and 1 mg/kg have been studied in children 2-16 years of age for postoperative analgesia. One study (Maunuksela, 1992) used a titrating dose starting with 0.2 mg/kg up to a total of 0.5 mg/kg (median dose required: 0.4 mg/ kg). Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral: One study used 1 mg/kg as a single dose for analgesia in 30 children (mean ± SD age: 3 ± 2.5 years) undergoing bilateral myringotomy Multiple-dose treatment: I.M., I.V., Oral: No pediatric studies exist; one report (Buck, 1994) of the clinical experience with ketorolac in 112 children, 6 months to 19 years of age (mean: 9 years), described usual I.V. maintenance doses of 0.5 mg/kg every 6 hours (mean dose: 0.52 mg/kg; range: 0.17-1 mg/kg) Adults (pain relief usually begins within 10 minutes with parenteral forms): Oral: 10 mg every 4-6 hours as needed for a maximum of 40 mg/day; on day of transition from I.M. to oral: maximum oral dose: 40 mg (or 120 mg combined oral and I.M.); maximum 5 days administration I.M.: Initial: 30-60 mg, then 15-30 mg every 6 hours as needed for up to 5 days maximum; maximum dose in the first 24 hours: 150 mg with 120 mg/24 hours for up to 5 days total Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.V.: Initial: 30 mg, then 15-30 mg every 6 hours as needed for up to 5 days maximum; maximum daily dose: 120 mg for up to 5 days total Ophthalmic: Instill 1 drop in eye(s) 4 times/day for up to 7 days Elderly >65 years: Renal insufficiency or weight <50 kg: I.M.: 30 mg, then 15 mg every 6 hours I.V.: 15 mg every 6 hours as needed for up to 5 days total; maximum daily dose: 60 mg KI: In patients who have developed nasal polyps, angioedema, or bronchospastic reactions to other NSAIDs, active peptic ulcer disease, recent GI bleeding or perforation, patients with advanced renal disease or risk of renal failure, labor and delivery, nursing mothers, patients with hypersensitivity to ketorolac, aspirin, or other NSAIDs, prophylaxis before major surgery, suspected or confirmed cerebrovascular bleeding, hemorrhagic diathesis, concurrent ASA or other NSAIDs, epidural or intrathecal administration, concomitant probenecid P: Use extra caution and reduce dosages in the elderly because it is cleared renally somewhat slower, and the elderly are also Genghis Khun ([email protected],nafanakhun.wordpress.com)


more sensitive to the renal effects of NSAIDs; use with caution in patients with congestive heart failure, hypertension, decreased renal or hepatic function, history of GI disease (bleeding or ulcers), or those receiving anticoagulants ES: Renal impairment, wound bleeding (with I.M.), postoperative hematomas 1- 10%: Edema, Drowsiness, dizziness, headache, pain, Nausea, dyspepsia, diarrhea, gastric ulcers, indigestion, Pain at injection site, Diaphoresis (increased) IO: Decreased effect of diuretics Increased toxicity: Lithium, methotrexate increased drug level; increased effect/toxicity with salicylates, probenecid, anticoagulants Preg: B, D hamil trim 3 Nama Dagang:



Tramadol Analgesic, Non-narcotic I:Inhibits ascending pain pathways, altering perception of and response to pain. Also inhibits reuptake of norepinephrine and serotonin. BSO: Tab: 50 mg, 100 mg D: 50-100 mg PO q4-6h; max 400 mg/d KI: Hipersensitif; opioid-dependency; concurrent use of MAOIs or within 14 d; use of SSRIs, TCAs, or opioids or acute alcohol intoxication IO: Decreases carbamazepine effects; cimetidine increases toxicity, risk of serotonin syndrome with coadministration of antidepressants Preg: C P: Dizziness, nausea, constipation, sweating, or pruritus; additive sedation with alcohol and TCAs; abrupt discontinuation can precipitate opioid withdrawal symptoms; adjust dose in liver disease, myxedema, hypothyroidism, or hypoadrenalism; Preg: Genghis Khun ([email protected],nafanakhun.wordpress.com)


and breastfeeding; seizure; development of tolerance or dependency with extended use Nama Dagang:



Naproxen Na NSAID I: Management of inflammatory disease and rheumatoid disorders (including juvenile rheumatoid arthritis); acute gout; mild to moderate pain; dysmenorrhea; fever, migraine headache BSO: Suspension, oral: 125 mg/5 mL Tablet: 220 mg;275 mg;550 mg,200 mg,250 mg,375mg,500mg Tablet, controlled release: 375 mg, 500 mg D: Oral: Fever: 2.5-10 mg/kg/dose; maximum: 10 mg/kg/day Juvenile arthritis: 10 mg/kg/day in 2 divided doses Adults: RA, OA and ankylosing spondylitis: 500-1000 mg/day in 2 divided doses; may increase to 1.5 g/day of naproxen base for limited time period Mild to moderate pain or dysmenorrhea: Initial: 500 mg, then 250 mg every 6-8 hours; maximum: 1250 mg/day naproxen base Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dosing adjustment in hepatic impairment: Reduce dose to 50% KI: Hypersensitivity to naproxen, aspirin, or other nonsteroidal anti-inflammatory drugs (NSAIDs) P: Use with caution in patients with GI disease (bleeding or ulcers), cardiovascular disease (CHF, hypertension), dehydration, renal or hepatic impairment, and patients receiving anticoagulants; perform ophthalmologic evaluation for those who develop eye complaints during therapy (blurred vision, diminished vision, changes in color vision, retinal changes); NSAIDs may mask signs/symptoms of infections; photosensitivity reported; elderly are at especially high-risk for adverse effects ES: Diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, Dizziness, insomnia, vertigo, tinnitus, Skin reactions such as rash or itching, Ulceration or bleeding of the stomach or intestines, fluid retention, oedema, Increase in blood pressure, Visual disturbances, Drowsiness, Concentration Genghis Khun ([email protected],nafanakhun.wordpress.com)


difficulties, Depression, Seizures (convulsions), bronchospasm, angioedema, itchy blistering rash or anaphylactic shock, photosensitivity, Kidney, liver or blood disorders IO: CYP2C8, 2C9, and 2C18 enzyme substrate Increased toxicity: Naproxen could displace other highly protein bound drugs, such as oral anticoagulants, hydantoins, salicylates, sulfonamides, and sulfonylureas Naproxen and warfarin may cause a slight increase in free warfarin Naproxen and probenecid may cause increased plasma half-life of naproxen Naproxen and methotrexate may significantly increase and prolong blood methotrexate concentration, which may be severe or fatal Preg: B, D hamil trim 3 Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


B. Anti Rheumatik & Analgesik Anti Inflamasi Piroxicam Meloxicam Tenoxicam Naproxen Ibuprofen Diclofenac Ketoprofen Etodolac Sulfasalazine Indometacin Loxoprofen Phenylbutazone Oxyphenbutazone Dexketoprofen Fenbufen Nabumetone Celecoxib Valdecoxib Etoricoxib Etanercept Parecoxib Tinoridine Sodium hyaluronate/ Hyaluronic acid Nimesulide Infliximab Rituximab Glucosamine, Chondroitin sulphate Diacerein Leflunomide Genghis Khun ([email protected],nafanakhun.wordpress.com)


Piroxicam NSAID I: Management of inflammatory disorders; symptomatic treatment of acute and chronic rheumatoid arthritis, osteoarthritis, and ankylosing spondylitis; also used to treat sunburn BSO: Tab 10 mg, 20 mg. Vial IM 20 mg. Supp 20 mg Gel 0.5 % D: 10-20 mg/d PO. 0.2-0.3 mg/kg/d PO; max 15 mg/d Gel: oles 3-4x/hr KI: Hypersensitivity; active GI bleeding P: Use with caution in patients with impaired cardiac function, dehydration, hypertension, impaired renal function, GI disease (bleeding or ulcers) and patients receiving anticoagulants; elderly have increased risk for adverse reactions to NSAIDs ES: Indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, Loss of appetite, flatulence, Skin reactions such as rash or itching, photosensitivity, Ulceration of the Genghis Khun ([email protected],nafanakhun.wordpress.com)


stomach or intestines, Bleeding from the stomach or intestines, fluid retention), resulting in swelling (oedema), Dizziness, Headache, Sleepiness, Difficulty sleeping, Depression, Confusion, vertigo, tinnitus, Blurred vision, angioedema, bronchospasm, Kidney, liver or blood disorders. IO: Preg: C, D Hamil trim 3 Nama Dagang:



Meloxicam To some extent, more selective for COX-2 receptors, compared to traditional NSAIDs. Decreases activity of cyclooxygenase, which in turn inhibits prostaglandin synthesis. These effects decrease formation of inflammatory mediators. I: Relief of signs and symptoms of osteoarthritis BSO: Tablet: 7.5 mg, 15 mg. Supp 15 mg Amp 15 mg/1.5 cc D: 7.5 mg PO qd prn (1x/hr); may increase to 15 mg PO qd prn KI: Hipersensitif; active GI bleeding IO: Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate Genghis Khun ([email protected],nafanakhun.wordpress.com)


toxicity; phenytoin levels may be increased when administered concurrently Preg: C, D hamil trim 3 P: Category D in third trimester of Preg:; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur, (discontinue if there is persistent leukopenia, granulocytopenia, or thrombocytopenia) NSAID labeling carries a warning about increased risk of hypertension, stroke, and cardiovascular events, including myocardial infarction Nama Dagang:



Tenoxicam NSAID. Blocking the production of prostaglandin which the body produces in response to injury or certain diseases. prostaglandin go on to cause swelling, pain and inflammation. I: Arthritis, myalgia, Pain BSO: Tab salut selaput 20 mg D: 20 mg 1x/hr Gout akut: Hr 1-2: 40 mg 1x/hr. 5 hr berikutnya 20 mg/hr KI: Allergy, Peptic ulcers, Ulcer caused by NSAID P: Asthma, Children, Elderly, Heart, Kidney & liver disease ES: Rash, Abdominal pain, Diarrhoea, Nausea, dyspepsia, Ulceration & Bleeding of the stomach or intestine, fluid retention, Dizziness, Blood disorders, Kidney disease, pancreatitis, photosensitivity, toxic epidermal necrolysis, bronchospasm, Damage to the liver Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Naproxen NSAID I: For relief of mild to moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclooxygenase, which results in decrease of prostaglandin synthesis. BSO: Tab 250 mg. Kapl 500 mg. supp 500 mg Suspension, oral: 125 mg/5 mL Gel 0.1 g/g D: 500 mg PO followed by 250 mg PO q6-8h; max 1.25 g/d Paed. >2 years: 2.5 mg/kg/dose PO; max 10 mg/kg/d Gel: Oles 2x/hr max6x/hr KI: Hipersensitif; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency IO: Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may Genghis Khun ([email protected],nafanakhun.wordpress.com)


decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently Preg: B, D hamil trim 3 P: Category D in third trimester of Preg:; acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of drug Nama Dagang:



Ibuprofen DOC for patients with mild-moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. BSO: Caplet: 100 mg Drops, oral: 40 mg/mL Suspension, oral: 100 mg/5 mL Suspension, oral, drops: 40 mg/mL; 50 mg/1.25 mL Tablet: 100 mg, 200 mg, 300 mg, 400 mg, 600 mg, 800 mg Tablet, chewable: 50 mg, 100 mg D: 400 mg PO q4-6h; max 3.2 g/d KI: Hipersensitif; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding IO: Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may Genghis Khun ([email protected],nafanakhun.wordpress.com)


increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently Preg: B, D pd trim III atau menjelang partus P: Category D in third trimester of Preg:; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy Nama Dagang:



Diclofenac Inhibits prostaglandin synthesis by decreasing activity of enzyme cyclooxygenase, which in turn decreases formation of prostaglandin precursors. BSO: Solution, ophthalmic,: 0.1% Tablet, enteric coated: 25 mg, 50 mg, 75 mg Tablet, delayed release: 25 mg, 50 mg, 75 mg Tablet, extended release: 100 mg Gel D: 50 mg PO tid; max 150 mg/d KI: Hipersensitif; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency; high risk of bleeding IO: Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may Genghis Khun ([email protected],nafanakhun.wordpress.com)


increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently Preg: B P: Category D in third trimester of Preg:; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; low WBC counts occur rarely and usually return to normal in ongoing therapy; discontinuation of therapy may be necessary if persistent leukopenia, granulocytopenia, or thrombocytopenia Nama Dagang:



Ketoprofen Relief of mild to moderate pain and inflammation. BSO: Tab salut enteric 50 mg, 100 mg Tab OD 200 mg Supp 100 mg Amp: 50 mg/cc, 100 mg/ 2cc Gel 2.5 % D: 25-50 mg PO q6-8h prn; max 300 mg/d Gel: oles 2-3x/hr max 7 hari KI: Hipersensitif IO: Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effects of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; may increase PT when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase risk of methotrexate Genghis Khun ([email protected],nafanakhun.wordpress.com)


toxicity; phenytoin levels may be increased when administered concurrently Preg: B - Usually safe but benefits must outweigh the risks. D Hamil trim 3 P: Category D in third trimester of Preg:; caution in congestive heart failure, hypertension, and decreased renal and hepatic function; caution in coagulation abnormalities or during anticoagulant therapy Nama Dagang:



Etodolac NSAID I: Rheumatoid arthritis, Osteoarthritis. BSO: Capsule: 200 mg, 300 mg Tablet: 400 mg, 500 mg D: Single dose of 76-100 mg is comparable to the analgesic effect of aspirin 650 mg; in patients greater than or equal to 65 years, no substantial differences in the pharmacokinetics or side-effects profile were seen compared with the general population Acute pain: 200-400 mg every 6-8 hours, as needed, max total daily doses of 1200 mg; for patients weighing <60 kg, total daily dose should not exceed 20 mg/kg/day Osteoarthritis: Initial: 800-1200 mg/day given in divided doses: 400 mg 2 or 3 times/day; 300 mg 2, 3 or 4 times/day; 200 mg 3 or 4 times/day; total daily dose should not exceed 1200 mg; for patients weighing <60 kg, total daily dose should not exceed 20 mg/kg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Allergic reactions, peptic ulcer or bleeding from the gut, Severe heart failure, Pregnancy, Breastfeeding, children. P: Elderly people, History of disorders affecting the stomach or intestines, Inflammatory bowel disease such as Crohn's disease or ulcerative colitis, Kidney & Liver disease, Heart failure, ischaemic heart disease, cerebrovascular disease, Poor circulation in the arteries of the legs or feet (peripheral arterial disease), hypertension, hyperlipidaemia, Diabetes, Smokers, History of asthma, People taking anticoagulant medicines ES: Indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, flatulence, stomatitis, Headache, Dizziness, Visual disturbances, Skin reactions such as rash and itch, photosensitivity, insomnia, Drowsiness, Confusion, Depression, fluid retention, oedema, tinnitus, dyspnoea, Ulceration or bleeding in the stomach or intestines, angioedema, bronchospasm, Kidney, liver or blood disorders. IO: Decreased effect with aspirin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Increased effect/toxicity with aspirin (GI irritation), probenecid; increased effect/toxicity of lithium, methotrexate, digoxin, cyclosporin (nephrotoxicity), warfarin (bleeding) Preg: C, D hamil trim 3 Nama Dagang: Lonene



Indomethacin NSAID I: RA, OA, ankylosing spondylitis, Acute gout, tendinitis, bursitis, tenosynovitis, capsulitis, Painful disorders of the muscles and skeleton, Lower back pain, Pain and inflammation following orthopaedic (bone) surgery or other orthopaedic procedures, Dysmenorrhea) BSO: Kaps 100 mg D: 200 mg 2x/hr KI: Children, allergic reactions, Active peptic ulcer or bleeding from the gut, Severe heart failure, Pregnancy, Breastfeeding. P: Elderly people, History of disorders affecting the stomach or intestines, Inflammatory bowel disease such as Crohn's disease or ulcerative colitis, Decreased kidney & liver function, Heart failure, hypertension, History of asthma & allergies, People with blood clotting disorders or taking anticoagulants, Epilepsy, Parkinson's disease, Psychiatric disorders Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Headache, Dizziness, indigestion, nausea, vomiting, diarrhoea or abdominal pain, Ulceration or bleeding in the stomach or intestines, fluid retention, oedema, Rise in blood pressure, Change in heart rate or rhythm, Hair loss, vertigo, tinnitus, Confusion, Depression, Anxiety, Fatigue, insomnia, Pins and needles sensations, Eye pain, Blurred vision, Allergy, Kidney, liver or blood disorders IO: CYP2C9 enzyme substrate Increased toxicity: May increase serum potassium with potassium-sparing diuretics; probenecid may increase indomethacin serum concentrations; other NSAIDs may increase GI adverse effects; may increase nephrotoxicity of cyclosporin Indomethacin may increase serum concentrations of digoxin, methotrexate, lithium, and aminoglycosides (reported with I.V. use in neonates) Preg: B, D if used >48 hours or after 34-week gestation Nama Dagang: Dialon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Loxoprofen I: AR, OA, nyeri punggung, periartritis skapulo-humoral & sindroma leher-bahu & lengan BSO: Tab 60 mg D: Dws 60 mg 3x/hr atau dosis tunggal 60-120 mg tgt umur & beratnya gejala. KI: Tukak peptik, ggn hematologi berat. Hamil trim akhir, laktasi P: Usia lanjut, hamil ES: syok, anemia hemolitik, sindr mukokutaneus okular, ggl ginjal akut, sindr nefrotik IO: Antikoagulan kumarin, kuinolon, antimikroba Preg:: A, B, C, D, X Nama Dagang: Loxonin



Phenylbutazone I: AR, Demam rematik, tendonitis, bursitis, sinovitis, gout akut, tromboflebitis superfisial BSO: Kapl & Kaps 100 mg, 200 mg D: Awal 300-600 mg/hr terbagi dlm 3-4 dosis KI: Edema,dekompensasi kordis, tukak lambung, riwayat diskrasia darah, anak < 14 thn, ggn hati & ginjal P: Usia lanjut, hamil & laktasi ES: Mual, muntah, ggn epigastrium, hematuria, penglihatan kabur IO: antikoagulan, insulin, hipoglikemik oral Preg: C, D hamil trim 3 Nama Dagang:



Oxyphenbutazone NSAID I: Management of inflammatory disorders, as an analgesic in the treatment of mild to moderate pain; acute gouty arthritis BSO: Tablet: 100 mg, 200 mg D: Acute gout: 1st 400 mg then 100 mg q4h. max 7day KI: Active GI bleeding; ulcer disease; hypersensitivity to oxyphenbutazone or any component P: ES: >10%: Dizziness, Skin rash, Abdominal cramps, heartburn, indigestion, nausea 1% to 10%: Headache, nervousness, Itching, Fluid retention, Vomiting, Tinnitus IO: Preg: D BSO: Nama Dagang: Reozon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dexketoprofen NSAID I: Pain in muscles, bones/ joints, dysmenorrhea, Toothache BSO: Tab salut selaput 25 mg D: 12.5 mg 3-4x/hr atau 25 mg 3x/hr. Maks 75 mg. KI: Children, allergic, asthma, peptic ulcer, Crohn's disease, Ulcerative colitis, Pregnancy, Breastfeeding. P: Elderly people, Dehydration, History of disorders affecting the stomach or intestines, hypertension, History of allergies ES: Indigestion, nausea, vomiting, constipation, diarrhoea, heartburn, abdominal pain, Headache, Dizziness, insomnia, vertigo, Palpitations, Fatigue, Flushing, Dry mouth, fluid retention, oedema, Changes in blood pressure, Ulceration of the stomach or intestine, bronchospasm, photosensitivity, Visual disturbances, tinnitus Preg:: A, B, C, D, X Nama Dagang: Ketesse Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fenbufen NSAID I: Rheumatoid arthritis, ankylosing spondylitis, Osteoarthritis, Painful disorders of the muscles and skeleton, such as tendinitis, sprains, strains, dislocations, fractures, back pain BSO: Kaps 300 mg D: Rematik: 600-900 mg 2-3x/hr. Max 1200 mg/hr Analgesik: 400 mg 2x/hr atau 300 mg 3x/hr KI: Allergic reactions, Active peptic ulcer or bleeding from the gut, Severe heart failure, children < 14 years of age. P: Elderly people, Inflammatory bowel disease such as Crohn's disease or ulcerative colitis, Heart failure, hypertension, History of asthma & allergies, People with blood clotting disorders or taking anticoagulant medicines, Diseases affecting connective tissue, eg SLE ES: Indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, Rash, Headache, Dizziness, insomnia, tinnitus, Genghis Khun ([email protected],nafanakhun.wordpress.com)


vertigo, Visual disturbances, Ulceration of the stomach or intestines, Bleeding from the stomach or intestines, fluid retention, oedema, photosensitivity, Hypersensitivity reactions, Kidney, liver or blood disorders, Lung disorders IO: Preg:: A, B, C, D, X Nama Dagang: Cybufen



Nabumetone NSAID I: Inflammation of joints (arthritis) BSO: Tablet: 500 mg, 750 mg D: 500-1000 mg 1-2x/day Max 1 g/hr KI: Allergy, Peptic ulcers, Severe liver disease P: Asthma, Children, Elderly people, Heart disease, hypertension, Kidney disease, Liver disease ES: Abdominal pain, Diarrhoea, Nausea, dyspepsia, Ulceration of the stomach or intestine, Rash (allergic reaction), fluid retention, Dizziness or loss of balance, Kidney disease, pancreatitis, photosensitivity, toxic epidermal necrolysis, bronchospasm, angioedema IO: Aspirin decreases serum concentrations probably by protein-binding displacement; there is an increased bleeding potential with concomitant warfarin therapy; may increase lithium and methotrexate concentrations by decreasing renal clearance; may decrease diuretic and hypotensive effects of Genghis Khun ([email protected],nafanakhun.wordpress.com)


thiazides, loop diuretics, ACE inhibitors, and beta-blockers; may increase nephrotoxicity of cyclosporine Preg: C, D hamil trim 3 Nama Dagang: Goflex



Celecoxib Primarily inhibits COX-2. COX-2 is considered an inducible isoenzyme, induced by pain and inflammatory stimuli. Inhibition of COX-1 may contribute to NSAID GI toxicity. At therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased. Seek lowest dose of celecoxib for each patient. Celecoxib has the same general class labeling as conventional NSAIDs. BSO: Kaps 100 mg, 200 mg D: 100 mg PO qd/bid (1-2x/hr) KI: Hipersensitif IO: Coadministration with fluconazole may cause increase in celecoxib plasma concentrations because of inhibition of celecoxib metabolism; coadministration of celecoxib with rifampin may decrease celecoxib plasma concentrations Preg: B P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May cause fluid retention and peripheral edema; caution in compromised cardiac function, hypertension, and conditions predisposing to fluid retention; severe heart failure and hyponatremia may occur because celecoxib may deteriorate circulatory hemodynamics; NSAIDs may mask usual signs of infection; caution in the presence of existing controlled infections; evaluate symptoms and signs suggesting liver dysfunction Nama Dagang: Celebrex



Valdecoxib NSAID I: RA, OA, dysmenorrhoea BSO: Tab salut selaput 10 mg D: OA &RA 10-20 mg 1x/hr. Max 20 mg Dismenore primer 40 mg 1x/hr. Tambahan 40 mg dpt diberikan pd hari I . KI: Allergy, Active peptic ulcer, Bleeding from the stomach or intestines, Inflammatory bowel disease such as ulcerative colitis or Crohn's disease, People who have had coronary artery bypass graft (CABG) surgery, Moderate to severe heart failure, ischaemic heart disease, cerebrovascular disease, Severely decreased liver function, Third trimester of pregnancy, Breastfeeding, P: Elderly people, Moderately decreased liver function, Decreased kidney function, fluid retention, Dehydration, History of diseases of the stomach or intestines, History of ulceration or bleeding in the stomach or intestines, hypertension, Genghis Khun ([email protected],nafanakhun.wordpress.com)


hyperlipidaemia, Diabetes, Smokers, Narrowing of the arteries in the extremities (peripheral arterial disease) ES: Abdominal pain and bloating, diarrhoea, nausea, indigestion, Dry mouth, insomnia, somnolence, hypertension, Cough, pharyngitis, sinusitis, Urinary tract infection, peripheral oedema, Rash or itching, anaemia, Dry socket following a tooth extraction, Blurred vision, Pins and needles or numb sensations, Anxiety, Confusion, Ulceration or bleeding of the stomach or intestines, heart failure, Severe skin reactions IO: If you are taking anti-blood-clotting medicines (anticoagulants) such as warfarin, you should have your blood clotting time (INR) monitored if you start or stop treatment with valdecoxib, or if your dose is changed. Valdecoxib may be taken with low-dose (75mg daily) aspirin. However, this combination may carry an increased risk of ulceration or bleeding in the stomach or intestines compared to taking valdecoxib on its own. Valdecoxib should not be taken with higher daily doses of aspirin. For more information and advice ask your doctor or pharmacist. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Valdecoxib should not be taken with other non-steroidal antiinflammatory drugs (NSAIDs), eg ibuprofen, diclofenac, as using more than one NSAID together may also increase the risk of side effects on the gut. Valdecoxib may potentially decrease the effectiveness of medicines used for lowering high blood pressure (antihypertensives). There may be an increased risk of side effects on the kidney if valdecoxib is taken with any of the following medicines, and your kidney function should be monitored if you are taking any of these medicines with valdecoxib: * ACE inhibitors, eg enalapril * ciclosporin * diuretics, eg bendroflumethiazide, furosemide * tacrolimus. The following medicines may increase the blood level of valdecoxib, and your doctor may prescribe a lower dose of valdecoxib if you are taking one of these medicines: Genghis Khun ([email protected],nafanakhun.wordpress.com)


* fluconazole * ketoconazole. The following medicines may decrease the blood level of valdecoxib: * antiepileptics, eg carbamazepine, phenytoin * dexamethasone * rifampicin. Valdecoxib may increase the blood levels of the following medicines: * flecainide * propafenone * metoprolol * omeprazole * phenytoin * diazepam * imipramine * lithium (your lithium blood level should be monitored if you are starting, changing dose, or stopping valdecoxib while taking lithium). Genghis Khun ([email protected],nafanakhun.wordpress.com)


Valdecoxib may also increase the blood levels of hormones (oestrogens and progestogens) contained in combined oral contraceptive pills, and this may increase the risk of side effects from these pills. Discuss this with your doctor. Other NSAIDs can reduce the removal of the medicine methotrexate from the body. This has not been reported with valdecoxib, but people taking methotrexate should be well monitored for any side effects of methotrexate while taking valdecoxib. Preg: C Nama Dagang: Bextra



Etoricoxib NSAID I: Acute gout, RA, OA BSO: Tab salut selaput 60 mg, 90 mg, 120 mg D: 60 -120 mg 1x/hr KI: < 16 years of age, allergic reactions, Severely decreased liver function, Moderate to severely decreased kidney function, Active peptic ulcer or bleeding from the gut, Inflammatory bowel disease such as Crohn's disease or ulcerative colitis, hypertension, Heart failure, ischaemic heart disease, cerebrovascular disease, peripheral arterial disease, Pregnancy, Breastfeeding, Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucosegalactose malsorption (Arcoxia tablets contain lactose). P: Elderly people, History of disorders affecting the stomach or intestines, such as ulceration or bleeding, Decreased liver & kidney function, Liver cirrhosis, Dehydration, History of heart Genghis Khun ([email protected],nafanakhun.wordpress.com)


failure, oedema, hypertension, hyperlipidaemia, Diabetes, Smokers ES: Headache, Dizziness, diarrhoea, constipation, nausea, vomiting, indigestion, flatulence or abdominal pain, oedema, hypertension, asthenia, Fatigue, Cold or flu-like symptoms, Skin reactions such as rash and itch, Blurred vision, insomnia, Muscle cramps, Weight gain, Anxiety, Depression, epistaxis, dyspnoea, Chest pain, Heart attack or stroke, Ulceration or bleeding of the stomach or intestine, Liver or kidney disorders IO: Preg:: A, B, C, D, X Nama Dagang: Arcoxia



Etanercept Soluble p75 TNF receptor fusion protein (sTNFR-Ig). Inhibits TNF binding to cell surface receptors, which, in turn, decreases inflammatory and immune responses. BSO: Vial 25 mg D: 25 mg SC 2x/wk with or without concomitant administration of MTX KI: Hipersensitif, sepsis, concurrent live vaccination IO: Preg: B P: Caution in impaired renal function and asthma; discontinue administration if serious infection develops; adverse effects may include injection site pain, localized erythema, rash, URI symptomology, GI upset, nausea, vomiting, rhinitis, cough, and drug-induced lupus Nama Dagang: Enbrel Genghis Khun ([email protected],nafanakhun.wordpress.com)


Parecoxib I: Terapi jangka pendek utk nyeri pasca operasi BSO: Vial 20 mg D: 40 mg IV/IM diikuti 20-40 mg 2-4x/hr. Max 80 mg/hr Lansia > 65 th: BB < 50 Kg ½ dosis lazim. Max 40 mg/hr KI: Hipersensitif, hamil (tirm 1 & 2), laktasi, tukak peptic aktif P: ES: Hipoestesi, nyeri punggung, edema perifer, osteitis alveolar, dispepsia, kembung, peningkatan kreatinin, hipokalemia,agitasi, insomnia. IO: Warfarin, diuretik, antihipertensi, siklosporin, takrolimus, flukonazol, rifampisin, fenitoin Preg:: A, B, C, D, X Nama Dagang: Dynastat



Tinoridine I: Radang pasca bedah, cedera sal. Kemih, radang akut sal nafas atas, otitis, artritis, uretritis, epididimitis, lumbago, nyeri punggung, artralgia, nyeri setelah cabut gigi, rematik BSO: Kaps 50 mg D: 50-100 mg 2x/hr KI: P: ES: Jarang, ggn GI, vertigo, mulut kering IO: Preg:: A, B, C, D, X Nama Dagang: Nonflamin



Sodium hyaluronate/ Hyaluronic acid I: Surgical aid in cataract extraction, intraocular implantation, corneal transplant, glaucoma filtration, and retinal attachment surgery BSO: Jarum suntik 10 mg/mL, 12 mg/mL, 14 mg/mL, 16 mg/mL 20 mg/cc, 30 mg/mL D: 3 cc/ sendi lutut atau pinggang sebagai dosis tunggal KI: Hypersensitivity to hyaluronate P: Do not overfill the anterior chamber; carefully monitor intraocular pressure; risk of hypersensitivity exists ES: 1% to 10%: Ocular: Postoperative inflammatory reactions (iritis, hypopyon), corneal edema, corneal decompensation, transient postoperative increase in IOP IO: Preg: C Nama Dagang:



Nimesulide I: OA, RA, pnykit Rematik ekstra artikuler, nyeri & peradangan sesudah intervensi bedah & akibat trauma akut, dismenore. BSO: Tab 100 mg D: 100 mg 2x/hr KI: Hipersensitifitas, tukak lambung, Anak, Hamil P: Ggn fungsi ginjal dan jantung ES: Anoreksia, urin gelap,perforasi, vertigo. IO: AINS lain: meningkatkan resiko perdarahan Preg: X Nama Dagang:



Infliximab Chimeric IgG1k monoclonal antibody that neutralizes cytokine TNF-alpha and inhibits its binding to TNF-alpha receptor. Reduces infiltration of inflammatory cells and TNF-alpha production in inflamed areas. Used with MTX in patients who have inadequate response to MTX monotherapy. BSO: Vial 100 mg D: 3 mg/kg IV at weeks 0, 2, and 6; then q4-8wk, usually with MTX; some patients require higher doses (4-5 mg/kg) KI: Hipersensitif Preg: B P: TNF-alpha modulates cellular immune responses; anti–TNF therapies, such as infliximab, may adversely affect normal immune responses and allow development of superinfections; may increase risk of reactivation of TB in patients with certain granulomatous infections; PPD-+ patients require TB prophylaxis; may cause anti-DNA antibodies and drug-induced lupus Nama Dagang: Remicade Genghis Khun ([email protected],nafanakhun.wordpress.com)


Rituximab Chimeric IgG1-kappa monoclonal antibody directed against the CD20 antigen found on the surface of normal and malignant B lymphocytes. The Fab domain of rituximab binds to CD20 antigen on B lymphocytes, and Fc domain recruits immune effector functions to mediate B-cell lysis in vitro. Possible mechanisms of cell lysis include complement-dependent cytotoxicity (CDC) and antibody-dependent cell-mediated cytotoxicity (ADCC). Rituximab in combination with methotrexate is indicated to reduce signs and symptoms in adult patients with moderately to severely active RA who have had an inadequate response to one or more TNF antagonist therapies. BSO: Injection, preservative free: 100 mg/ 10cc; 500 mg/50cc D: Give two 1-g IV infusions 2 wk apart Glucocorticoids administered as methylprednisolone 100 mg IV or equivalent 30 min prior to each infusion are recommended to reduce incidence and severity of infusion reactions Genghis Khun ([email protected],nafanakhun.wordpress.com)


Adults: I.V. (refer to individual protocols): Do not administer I.V. push or bolus (hypersensitivity reactions may occur). Consider premedication (consisting of acetaminophen and diphenhydramine) before each infusion of rituximab. Premedication may attenuate infusion-related events. Because transient hypotension may occur during infusion, give consideration to withholding antihypertensive medications 12 hours prior to rituximab infusion. KI: Known anaphylaxis or IgE-mediated hypersensitivity to murine proteins or any component of product IO: renal toxicity reported with drug in combination with cisplatin in clinical trials (in clinical trials involving patients with RA, concomitant administration of MTX or cyclophosphamide did not alter pharmacokinetics of rituximab) Preg: C P: Safety and efficacy of re-treatment not established in controlled trials; not recommended in patients with RA and no prior inadequate response to one or more TNF antagonists; has caused severe infusion reactions (in some cases, reactions Genghis Khun ([email protected],nafanakhun.wordpress.com)


were fatal); hepatitis B virus (HBV) reactivation with fulminant hepatitis, hepatic failure, and death has been reported in some patients with hematologic malignancies treated with rituximab; hypersensitivity reactions (non–IgE-mediated reactions reported); mucocutaneous reactions, some with fatal outcome, have been reported in patients treated with rituximab; vaccination with live-virus vaccines not recommended Nama Dagang: MabThera



Glucosamine HCl, Chondroitin sulphate I: OA, membantu melindungi kerusakan rawan sendi BSO: Krim D: 2-3x/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Diacerein I: Terapi oral jangka panjang spesifik utk penykt sendi degeneratif (OA & penyakit lain yg berkaitan) BSO: Kapl 50 mg D: 1 kapl 2x/hr KI: Hipersensitif P: Hamil & laktasi ES: Mual, muntah, diare, nyeri epigastrik IO: Obat yg menyebabkan perubahan transit intestinal & atau kualitas kandungan intestinal (misalnya kelebihan serat atau filtrate), Al hidroksida, Mg hidroksida Preg: B Nama Dagang: Artrodar



Leflunomide Antimetabolite First new DMARD approved in more than 10 years. Blocks autoimmune antibodies and reduces inflammation. Inhibits dihydroorotate dehydrogenase, an enzyme in the de novo pyrimidine synthesis pathway. Studies indicate that it reduces symptoms, possibly better than MTX, and may even slow progression of RA. Use with caution in renal insufficiency I: Treatment of active rheumatoid arthritis to reduce signs and symptoms and to retard structural damage as evidenced by xray erosions and joint space narrowing BSO: Tablet: 10 mg, 20 mg, 100 mg D: Initial: 100 mg/d PO for 3 d Maintenance dose: 10-20 mg/d PO KI: Hipersensitif IO: Cholestyramine and charcoal reduce effects; concomitant rifampin increases toxicity Preg: X P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Serious adverse reactions include hepatotoxicity and immunosuppression; other reactions include nausea, diarrhea, abdominal pain, rash, bronchitis, headache, hypertension, dizziness, and alopecia; caution if impaired liver or renal function or if immunodeficient; leflunomide is a prodrug and active metabolite has a very long plasma half-life (approximately 15 d); with serious toxicity, can be cleared more quickly using cholestyramine 8 mg tid. Nama Dagang: Arava



C. Preparat Gout Colchicine Allopurinol Indometacin Phenylbutazone Probenecid



Colchicine -- Inhibits microtubules and thereby may inhibit phagocytosis, neutrophil mobility, and chemotaxis. Also may inhibit generation of prostaglandins. BSO: Injection: 0.5 mg/mL Tablet: 0.5 mg, 0.6 mg D: PO for acute flares: 0.5 mg or 0.6 mg q1h until significant pain relief, adverse GI effects, or a total dose of 6 mg IV acute flares: 1 mg in 20 mL of isotonic sodium chloride solution without glucose pushed through a secure IV line over 10-20 min Can be repeated in 6 h, but no more than 4 mg in 24 h and no further colchicine by any route for a week Prophylaxis: 0.5 mg or 0.6 mg bid PO; adjust dose for renal insufficiency KI: Hipersensitif; severe renal, hepatic, GI, or cardiac disorders; blood dyscrasias IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sympathomimetic agent toxicity and effect of CNS depressants are significantly increased Preg: X P: Risk of renal failure, hepatic failure, permanent hair loss, bone marrow suppression, numbness or tingling in hands and feet, disseminated intravascular coagulopathy, and decreased sperm count; dose-dependent GI upset is common; rarely myopathy and neuropathy, especially with long-term treatment in the setting of renal insufficiency Nama Dagang: Recolfar



Allopurinol -- Reduces production of uric acid, thereby allowing body to dispose of excess uric acid stores. Most effective therapy to lower serum uric acid. Most patients achieve the target uric acid level of 5 mg/dL at 300-400 mg/d, less if renal insufficiency is present. I: Hiperurikemia BSO: Injection: 500 mg Tablet: 100 mg, 300 mg D: Initial: 100 mg/d PO; titrate monthly according to serum uric acid level Maintenance: 300-400 mg/d PO Effective doses based on GFR: 400 mg PO qd for 140 mL/min creatinine clearance; 300 mg for 100 mL/min creatinine clearance; 200 mg for 60 mL/min creatinine clearance; 150 mg for 40 mL/min creatinine clearance; 100 mg for 20 mL/min or less KI: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hipersensitif (if reaction not severe, can try a desensitization regimen [Fam, 2001] [Walz-LeBlanc, 1991]) IO: Alcohol decreases effects; increases incidence of skin rash when used concurrently with ampicillin and amoxicillin; large amounts of vitamin C acidifies urine and may cause renal stone formation; inhibits metabolism of azathioprine and 6mercaptopurine Preg: C P: Not for use in asymptomatic hyperuricemia; reduce dose in renal insufficiency; monitor liver function and perform CBC count before initiating therapy and periodically thereafter, discontinue medication if rash occurs and evaluate Nama Dagang:



Probenecid -- Designed to lower tissue stores of uric acid by increasing net renal excretion of uric acid by inhibiting tubular reabsorption. D: 250 mg PO bid for 1 wk, then 500 mg bid; can increase up to 3 g/d KI: Hipersensitif; children <2 y; high urinary uric acid excretion, renal insufficiency (GFR <50 mL/min), renal stones; known blood dyscrasia; coadministration of ketorolac because levels/toxicity of ketorolac are significantly increased IO: Salicylates at high dosages and nitrofurantoin may decrease effects; increases levels/toxicity of methotrexate, beta-lactam antibiotics, acyclovir, thiopental, clofibrate, dyphylline, pantothenic acid, ketorolac, benzodiazepines, rifampin, sulfonamide, dapsone, zidovudine, and sulfonylureas Preg: B P: crosses placental barrier; use of any drug in women of childbearing potential requires anticipated benefit be weighed against possible hazards; caution in history of peptic ulcer; can provoke attacks of acute gouty arthritis and renal stones Genghis Khun ([email protected],nafanakhun.wordpress.com)


D. Anti Konvulsan & Anti epilepsy Diazepam Clonazepam Phenobarbital Carbamazepine Oxcarbazepine Phenytoin Gabapentin Valproic acid Lamotrigine Levetiracetam Topiramate Magnesium sulphate



Diazepam -- Effective in treating vertigo. Depresses all levels of CNS, including limbic and reticular formation, possibly by increasing activity of GABA, major inhibitory neurotransmitter. Individualize dosage and cautiously increase to avoid adverse effects. Effective for acute episodes. Discontinue as quickly as possible to maximize cerebellar vestibular compensation process. BSO: Gel, rectal delivery system: Pediatric rectal tip (4.4 cm): 5 mg/mL Adult rectal tip (6 cm): 5 mg/mL Injection: 5 mg/mL Injection, emulsified: 5 mg/mL Solution, oral (wintergreen-spice flavor): 5 mg/5 mL Solution, oral concentrate: 5 mg/mL Tablet: 2 mg, 5 mg, 10 mg D: 5-10 mg PO/IV/IM q4-6h Paed. <6 months: Not recommended >6 months: Genghis Khun ([email protected],nafanakhun.wordpress.com)


0.05-0.3 mg/kg/dose IV/IM over 2-3 min, repeat in 2-4 h prn 0.12-0.8 mg/kg/d PO divided q6-8h; max 10 mg/dose KI: Hipersensitif IO: Increases toxicity of benzodiazepines in CNS with coadministration of phenothiazines, barbiturates, alcohols, and monoamine oxidase inhibitor (MAOIs) Preg: D P: Caution with other CNS depressants, low albumin levels, or hepatic disease (may increase toxicity) Nama Dagang:



Clonazepam -- Suppresses muscle contractions by facilitating neurotransmission of GABA and other inhibitory transmitters. BSO: Tablet: 0.5 mg, 1 mg, 2 mg D: Based on equivalent doses of other benzodiazepines (eg, 1 mg PO of clonazepam for 1-2 mg of alprazolam) KI: Hipersensitif; severe liver disease; acute narrow-angle glaucoma IO: Phenytoin and barbiturates may reduce effects; coadministration of CNS depressants increase toxicity Preg: D P: Caution in chronic respiratory disease or impaired renal function; withdrawal symptoms can result from abrupt discontinuation of the medication Other P: include history of drug and alcohol abuse; monitor blood counts and liver function tests Nama Dagang: Rivotril Genghis Khun ([email protected],nafanakhun.wordpress.com)


Phenobarbital -- Best studied barbiturate in treatment of SE. Can be administered 20 mg/min IV. If patient has received benzodiazepine, potential for respiratory suppression significantly increased. I: Management of generalized tonic-clonic (grand mal) and partial seizures; sedative BSO: Capsule: 16 mg Elixir: 15 mg/5 mL; 20 mg/5 mL Injection: 30 mg/mL; 60 mg/mL; 65 mg/mL; 130 mg/mL Powder for injection: 120 mg Tab: 8mg, 15mg, 16mg, 30 mg, 32 mg, 60 mg, 65 mg, 100 mg D: Children: Sedation: Oral: 2 mg/kg 3x/day Hypnotic: I.M., I.V., S.C.: 3-5 mg/kg at bedtime Preoperative: Oral, I.M., I.V.: 1-3 mg/kg 1-1.5 hours pre-op Adults: Sedation: Oral, I.M.: 30-120 mg/day in 2-3 divided doses Hypnotic: Oral, I.M., I.V., S.C.: 100-320 mg at bedtime Preoperative: I.M.: 100-200 mg 1-1.5 hours pre-op Genghis Khun ([email protected],nafanakhun.wordpress.com)


Anticonvulsant: Status epilepticus: Loading dose: I.V.: Infants and Children: 10-20 mg/kg 1-2x/day; in select patients may administer additional 5 mg/kg/dose every 15-30 minutes until seizure is controlled or a total dose of 40 mg/kg is reached Adults: 1st 300-800 mg, then 120-240 mg/dose at 20-minute intervals until seizures are controlled or a total dose of 1-2 g Anticonvulsant maintenance dose: Oral, I.V.: Infants: 5-8 mg/kg/day in 1-2 divided doses Children: 1-5 years: 6-8 mg/kg/day in 1-2 divided doses 5-12 years: 4-6 mg/kg/day in 1-2 divided doses Children >12 years and Adults: 1-3 mg/kg/day in divided doses or 50-100 mg 2-3 times/day Withdrawal: Initial daily requirement is determined by substituting phenobarbital 30 mg for every 100 mg pentobarbital used during tolerance testing; then daily requirement is decreased by 10% of initial dose Dosing interval in renal impairment: Clcr <10 mL/minute: Administer every 12-16 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hemodialysis: Moderately dialyzable (20% to 50%) Dosing adjustment/comments in hepatic disease: Increased side effects may occur in severe liver disease; monitor plasma levels and adjust dose accordingly 20 mg/kg IV q20min until seizures controlled or total 1-2 g administered Paed. 20 mg/kg IV over 10-15 min in single or divided dose until seizure controlled or 40 mg/kg administered KI: Hipersensitif IO: Combination with benzodiazepines causes significant respiratory depression; strongly consider elective intubation before combination given Preg: B P: Nama Dagang:



Carbamazepine Effective in patients who have not responded to lithium therapy. Also can act to inhibit seizures induced through the kindling effect, which is thought to occur by way of repeated limbic stimulation. Has been effective in treating patients who have rapid-cycling bipolar disorder or those who have not been responsive to lithium therapy. BSO: Capsule, extended release: 200 mg, 300 mg Suspension, oral: 100 mg/5 mL Tablet: 200 mg Tablet, chewable: 100 mg Tablet, extended release: 100 mg, 200 mg, 400 mg D: 1st 200 mg PO qd in divided doses with increments of 100 mg 2 times/wk; if adverse effects occur, decrease 200 mg Dose range: 300-1600 mg PO qd Serum level range: 17-50 mmol/L (4-12 mcg/mL) Manic episode: 200-1800 mg PO qd Plasma level: 4-12 mcg/mL Paed. Genghis Khun ([email protected],nafanakhun.wordpress.com)


6-12 years: 100 mg PO bid or 10 mg/kg/d divided bid initially, then increase to 100 mg/d every wk Maintenance: 20-30 mg/kg/d PO bid/qid; max 1 g/d KI: Hipersensitif; administration of MAOIs within last 14 d; history of liver disease, cardiovascular disease, and blood dyscrasias IO: Halothane coadministration may cause hepatocellular damage; grapefruit juice, influenza vaccine, isoniazid, cimetidine, erythromycin, and phenelzine increase plasma levels; phenytoin, alprazolam, clonazepam, primidone, and phenobarbital decrease both CBZ level and levels of interacting agents; fluoxetine increases level; decreases levels of imipramine, phenothiazines, haloperidol, theophylline, thyroid hormones, ritonavir, saquinavir, contraceptives, risperidone, thiothixene, cyclosporine, corticosteroids, doxycycline, trazodone, doxepin, and amitriptyline; increases plasma levels of diltiazem and verapamil; can reduce its own level by "autoinduction;" coadministration with lithium or loxapine Genghis Khun ([email protected],nafanakhun.wordpress.com)


increases toxicity of both CBZ and the interacting agents; coadministration with clozapine further increases bone marrow toxicity and resulting agranulocytosis Preg: D P: A very small, but significant, risk of causing agranulocytosis or aplastic anemia exists. During drug initiation, avoid using hazardous equipment or driving; other depressants and alcohol may lead to increased dizziness and sleepiness; keep in a dry place; drinking grapefruit juice while taking CBZ elevates blood levels; report any indications of blood dyscrasias (eg, easy bruising, sore throats, fever, rash) Nama Dagang:



Oxcarbazepine I: Epilepsy to control partial seizures. This medicine cannot cure epilepsy and will only work to control seizures for as long as you continue to take it . BSO: Tablet: 150 mg, 300 mg, 600 mg D: Adults > 17 —At first, 300 mg 2x/d.max 2.4 g a day. Children 2-16—8-10 mg/kg/day, divided into 2 doses. KI: Allergy, children < 6 years P: Elderly people, Decreased kidney & liver function, heart block, Heart failure, arrhythmias, hyponatraemia, porphyrias. ES: Somnolence, Headache, Dizziness, Visual disturbances, Fatigue, diarrhoea, constipation, nausea, vomiting or abdominal pain, hyponatraemia, Agitation, Confusion, Depression, emotional lability, ataxia, Concentration or memory difficulties, Skin reactions such as rash and itch, Acne, alopecia, asthenia, leucopenia, hepatitis, Irregular heart beats, SLE. Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Phenytoin -- Mainstay in treatment of SE. Must be administered slowly and therefore takes longer to enter brain than benzodiazepines. Has advantage of being long-term anticonvulsant and can be administered PO after acute illness. Not water soluble, and must be solubilized in propylene glycol carrier with pH 12 to prepare IV form; therefore, cannot be given >50 mg/min without risk of significant hypotension and cardiac arrhythmias. Also major risk of potential irritation at IV site and vascular compromise of infused limb. Therefore, use in SE should be avoided if possible. BSO: Capsule: Extended: 30 mg, 100 mg Prompt: 100 mg Injection: 50 mg/mL Suspension, oral: 30 mg/5 mL; 125 mg/5 mL Tablet, chewable: 50 mg D: Genghis Khun ([email protected],nafanakhun.wordpress.com)


15-20 mg/kg IV, max 50 mg/min; intubate if necessary and control hyperthermia; if seizures continue after 20 min, give additional 10 mg/kg; target levels after correction of hypoalbuminemia should be 20-30 mcg/mL in SE KI: Hipersensitif IO: None reported as contraindicated for this indication Preg: C P: Risk of hypotension and cardiac arrhythmias (perform cardiac monitoring during infusion); infusion rate should be <50 mg/min Nama Dagang:



Gabapentin I: Epilepsy - used for partial seizures with or without secondary generalisation. This medicine may be used on its own to treat adults and children aged 12 years and over, or as an add-on therapy for adults and children aged six years and over who are already taking other antiepileptics. # Nerve pain (neuropathic pain) in adults, for example due to diabetic neuropathy or following shingles (post-herpetic neuralgia). # Trigeminal neuralgia, which is severe pain in the lips, gums, cheek, chin or eye caused by a disorder of the nerves in the face (unlicensed use) BSO: Capsule: 100 mg, 300 mg, 400 mg, 600 mg, 800 mg D: If gabapentin is discontinued or if another anticonvulsant is added to therapy, it should be done slowly over a minimum of 1 week Initial: 300 mg 3 times/day, if necessary the dose may be increased using 300 or 400 mg capsules 3 times/day up to 1800 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Total daily dosage range: 900-1800 mg/day administered in 3 divided doses at 8-hour intervals Pain: 300-1800 mg/day given in 3 divided doses has been the most common dosage range Bipolar disorder: 300-3000 mg/day given in 3 divided doses Dosing adjustment in renal impairment: Clcr >60 mL/minute: Administer 1200 mg/day Clcr 30-60 mL/minute: Administer 600 mg/day Clcr 15-30 mL/minute: Administer 300 mg/day Clcr <15 mL/minute: Administer 150 mg/day Hemodialysis: 200-300 mg after each 4-hour dialysis following a loading dose of 300-400 mg KI: Allergy # Neurontin capsules contain lactose and should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. Neurontin tablets do not contain lactose. P: Elderly people, Decreased kidney function, Diabetes. Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Dizziness, somnolence, ataxia, indigestion, nausea, vomiting, constipation, diarrhoea or abdominal pain, Changes in appetite, Weight gain, oedema, rash or itching, purpura, Visual disturbances, paraesthesia, Tremor or twitching, insomnia, Headache, Anxiety or nervousness, emotional lability, amnesia, Depression, leucopenia, Impotence, Incontinence. IO: Gabapentin does not modify plasma concentrations of standard anticonvulsant medications (ie, valproic acid, carbamazepine, phenytoin, or phenobarbital) Antacids reduce the bioavailability of gabapentin by 20% Cimetidine may decrease clearance (by 14%) of gabapentin; gabapentin may increase Cmax of norethindrone by 13% Preg: C Nama Dagang:



Valproic acid/ Valproate sodium Has proven effectiveness in treating and preventing mania. Classified as a mood stabilizer and can be used alone or in combination with lithium. Useful in treating patients with rapidcycling bipolar disorders and has been used to treat aggressive or behavioral disorders. A combination of valproic acid and valproate has been effective in treating persons in manic phase, with a success rate of 49%. BSO: Capsule, sprinkle,: 125 mg Injection,: 100 mg/mL Syrup: 250 mg/5 mL Tablet, delayed release,: 125 mg, 250 mg, 500 mg D: 250 mg PO tid, initially in increments until a serum level of 350-700 mmol/L (50-100 mcg/mL) has been achieved Maintenance: 750-3000 mg PO qd in divided doses Manic episode: Loading dose of 20 mg/kg/d PO Stat dose: 20 mg/kg PO, with next dose in 12 h; then 10 mg/kg bid Genghis Khun ([email protected],nafanakhun.wordpress.com)


Maintenance: 500-3500 mg PO qd to achieve plasma level of 50-125 mcg/mL Paed. 10-15 mg/kg/d PO initially in 1-3 divided doses; increase by 5-10 mg/kg/d PO qwk until therapeutic plasma level achieved. Maintenance: 30-60 mg/kg/d PO divided bid/tid KI: Hipersensitif, hepatic disease/dysfunction IO: Coadministration with cimetidine, salicylates, felbamate, and erythromycin may increase toxicity; rifampin may significantly reduce valproate levels; in pediatric patients, protein binding and metabolism of valproate decrease when taken concomitantly with salicylates; coadministration with carbamazepine may result in variable changes of carbamazepine concentrations, with possible loss of seizure control; valproate may increase diazepam and ethosuximide toxicity (monitor closely); valproate may increase phenobarbital and phenytoin levels, while either one may decrease valproate levels; valproate may displace warfarin from protein binding sites (monitor coagulation tests); may increase zidovudine levels in patient sero+ for HIV; valproate inhibits the metabolism Genghis Khun ([email protected],nafanakhun.wordpress.com)


of lamotrigine and increases the risk of Stevens-Johnson syndrome (a lamotrigine dose has to be titrated up more slowly when used with valproate) Preg: D P: Monitor for hepatic toxicity (obtain liver function tests prior to initiating therapy and thereafter); serum ammonia levels may increase independently of other liver functions and may cause altered mental status; check platelet count and bleeding times prior to therapy and during treatment; valproic acid inhibits cytochrome P-450 metabolism system (pay attention to any drugs that use this system); monitor for symptoms of pancreatitis and pancreatic enzymes because hemorrhagic pancreatitis has been reported Nama Dagang: Depakene



Valproate semisodium Nama Dagang:depakote



Lamotrigine Anticonvulsant that appears to be effective in the treatment of the depressed-phase in bipolar disorders. BSO: Tablet: 50 mg, 100 mg D: 12.5-37.5 mg/d PO, initially, gradually titrated in 25-mg increments not more often than weekly; effective dose usually 100-400 mg/d qd or divided bid Paed. 2-15 mg/kg/d PO divided bid initially KI: Hipersensitif; lactation; renal impairment; hepatic and cardiac problems IO: Acetaminophen increases renal clearance and decreases effects; similarly, phenobarbital and phenytoin increase metabolism, causing a decrease in levels; concurrent administration with valproic acid increases lamotrigine levels Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Can cause adverse CNS effects, including dizziness, sedation, ataxia, nystagmus, and diplopia; dermatological problems include hypersensitivity rash, Stevens-Johnson syndrome, and angioedema; renal involvement can produce hematuria; caution in impaired renal or hepatic function; fatal hypersensitivity reactions to lamotrigine are more likely to occur with rapid dose increments (caution when coadministered with valproate) Nama Dagang: Lamictal



Levetiracetam I: Indicated as adjunctive therapy in the treatment of partial onset seizures in adults with epilepsy BSO: Tab 250 mg, 500 mg, 750 mg D: Adults: Initial: 500 mg 2x daily; additional dosing increments may be given (1 g/day additional q2wk). max 3 g Dosing adjustment in renal impairment: Clcr 50-80 mL/min: 500-1000 mg every 12 hours Clcr 30-50 mL/min: 250-750 mg every 12 hours KI: Children < 4 years of age. P: Decreased kidney & liver function. ES: Dizziness or loss of balance, somnolence, Headache, asthenia, emotional lability, Hostility, Nervousness, Loss of appetite, amnesia, ataxia, Hyperactivity, Shaking, tremor, insomnia, Depression, Personality disorders, Abnormal thinking or behaviour, diarrhoea, nausea, indigestion, Double vision, Rash, Hair loss. Preg: C Nama Dagang:Keppra Genghis Khun ([email protected],nafanakhun.wordpress.com)


Topiramate Anticonvulsant, Miscellaneous I: Adjunctive therapy for partial onset seizures in adults and pediatric patients (ages 2-16 years) Orphan drug: Topiramate has also been granted orphan drug status for the treatment of Lennox-Gastaut syndrome BSO: Capsule: 15 mg, 25 mg Tablet: 25 mg, 100 mg, 200 mg D: Seizures: Adults—25-50 mg/hari for first week. Max 400 mg/day. Children (2-16): 25 mg nightly for 1wk. increase q1 or 2 weeks, 2x/hari. Prevent seizures: 50 mg/day 2x/day for 1wk. Max. 400 mg/day 2x/day. Prevent migraine headaches: Adults—25 mg/day for 1wk. Max. 100 mg/day. KI: Epilepsy in children < 2 years of age, Migraine in children < 16 years of age, Breastfeeding, Rare hereditary problems of Genghis Khun ([email protected],nafanakhun.wordpress.com)


galactose intolerance, the Lapp lactase deficiency or glucosegalactose malabsorption. P: Decreased liver & kidney function, history of kidney stones, hypercalciuria, History of depression or suicidal thoughts, Adolescents and young adults, Severe lung/breathing disorders, Hereditary blood disorders called porphyrias. ES: Paraesthesia, Headache, Fatigue, Dizziness, Drowsiness, Decreased appetite and weight loss, Nausea, insomnia, Depression, Concentration or memory difficulties, Abdominal pain, Nervousness, Decreased sense of touch, Confusion, Agitation, Visual disturbances. # Speech disturbances, ataxia, asthenia, Alteration in taste, Behaviour problems in children, metabolic acidosis. IO: CYP2C19 enzyme substrate; CYP2C19 enzyme inhibitor Digoxin levels and ethinyl estradiol blood levels are decreased when coadministered with topiramate Concomitant administration with other CNS depressants will increase its sedative effects; coadministration with other Genghis Khun ([email protected],nafanakhun.wordpress.com)


carbonic anhydrase inhibitors may increase the chance of nephrolithiasis Topiramate may increase phenytoin concentration by 25% Topiramate may decrease valproic acid concentration by 11% Preg: C Nama Dagang: Topamax



Magnesium sulphate Magnesium has been demonstrated to be superior to phenytoin for preventing and treating eclamptic seizures. BSO: Granules: ~40 mEq magnesium/5 g Injection: 100 mg/mL; 125 mg/mL; 250 mg/mL; 500 mg/mL Solution, oral: 50% [500 mg/mL] D: The recommended dietary allowance (RDA) of magnesium is 4.5 mg/kg which is a total daily allowance of 350-400 mg for adult men and 280-300 mg for adult women. During pregnancy the RDA is 300 mg and during lactation the RDA is 355 mg. Average daily intakes of dietary magnesium have declined in recent years due to processing of food. The latest estimate of the average American dietary intake was 349 mg/day. Dose represented as MgSO4 unless stated otherwise. Hypomagnesemia: Neonates: I.V.: 25-50 mg/kg/dose (0.2-0.4 mEq/kg/dose) every 8-12 hours for 2-3 doses Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: I.M., I.V.: 25-50 mg/kg/dose (0.2-0.4 mEq/kg/dose) every 4-6 hours for 3-4 doses, maximum single dose: 2000 mg (16 mEq), may repeat if hypomagnesemia persists (higher dosage up to 100 mg/kg/dose MgSO4 I.V. has been used); maintenance: I.V.: 30-60 mg/kg/day (0.25-0.5 mEq/kg/day) Adults: Oral: 3 g every 6 hours for 4 doses as needed I.M., I.V.: 1 g every 6 hours for 4 doses; for severe hypomagnesemia: 8-12 g MgSO4/day in divided doses has been used Management of seizures and hypertension: Children: I.M., I.V.: 20-100 mg/kg/dose every 4-6 hours as needed; in severe cases doses as high as 200 mg/kg/dose have been used Eclampsia, pre-eclampsia: Adults: I.M.: 1-4 g every 4 hours I.V.: Initial: 4 g, then switch to I.M. or 1-4 g/hour by continuous infusion Maximum dose should not exceed 30-40 g/day; maximum rate of infusion: 1-2 g/hour Genghis Khun ([email protected],nafanakhun.wordpress.com)


Maintenance electrolyte requirements: Daily requirements: 0.2-0.5 mEq/kg/24 hours or 3-10 mEq/1000 kcal/24 hours Maximum: 8-16 mEq/24 hours Cathartic: Oral: Children: 0.25 g/kg every 4-6 hours Adults: 10-15 g in a glass of water Dosing adjustment/comments in renal impairment: Clcr <25 mL/minute: Do not administer or monitor serum magnesium levels carefully Paed. 20-100 mg/kg/dose IV q4-6h prn; in severe cases, may use doses as high as 200 mg/kg/dose IV KI: Hipersensitif; heart block, myocardial damage; Addison disease; severe hepatitis IO: Concurrent use of magnesium sulfate with nifedipine may cause hypotension and neuromuscular blockade; may increase neuromuscular blockade observed with aminoglycosides and potentiate neuromuscular blockade produced by tubocurarine, Genghis Khun ([email protected],nafanakhun.wordpress.com)


vecuronium, and succinylcholine; may increase CNS effects and toxicity of CNS depressants, betamethasone, and cardiotoxicity of ritodrine Preg: A P: Levels of 8-12 mg/dL may cause loss of reflexes, diplopia, flushing, or slurring of speech; levels >12 mg/dL may cause muscular paralysis, ventilatory failure, and circulatory collapse; patients should have frequent neurological evaluations; loss of deep tendon reflex indicates that the magnesium level may be toxic; some clinicians follow serum magnesium levels q6h along with neurological examination; magnesium may alter cardiac conduction, leading to heart block in digitalized patients; in overdose, calcium gluconate 10-20 mL IV of 10% solution can be administered as antidote for clinically significant hypermagnesemia Nama Dagang:



E. Minor Transquilizer, Anxietas & Relaxan Diazepam Midazolam



Midazolam -- Onset of action 35 s after IV injection and is well absorbed when injected IM. Duration of action is 15 min, and elimination half-life is 2-5 h. No active metabolites exist and have greater affinity for benzodiazepine receptors than diazepam. D: 0.01-0.05 mg/kg IV over 2 min; may repeat q15min; max 10 mg. Paed. 0.05-0.2 mg/kg IV over 2-3 min KI: Hipersensitif; preexisting hypotension; narrow-angle glaucoma; sensitivity to propylene glycol (the diluent) IO: Metabolism of midazolam may be reduced in the presence of medications that share same metabolic pathway; sedative effects of midazolam may be antagonized by theophyllines; narcotics and erythromycin may accentuate sedative effects of midazolam because of decreased clearance Preg: D P: Caution in congestive heart failure, pulmonary disease, renal impairment, and hepatic failure Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


F. Major Transquilizer Chlorpromazine Perphenazine Trifluoperazine Haloperidol Sulpiride Prochlorpherazine Olanzapine



Chlorpromazine Mechanisms responsible for relieving nausea and vomiting include blocking postsynaptic mesolimbic dopamine receptors, anticholinergic effects, and depression of RAS. Blocks alphaadrenergic receptors and depresses release of hypophyseal and hypothalamic hormones. BSO: Capsule, sustained action: 30 mg, 75 mg, 150 mg, 200 mg, 300 mg Concentrate, oral: 30 mg/mL; 100 mg/mL Injection: 25 mg/mL Suppository, rectal: 25 mg, 100 mg Syrup: 10 mg/5 mL Tablet: 10 mg, 25 mg, 50 mg, 100 mg, 200 mg D: Children >6 months: Psychosis: Oral: 0.5-1 mg/kg/dose q4-6 hours; I.M., I.V.: 0.5-1 mg/kg/dose q6-8 hours; max for <5 y: 40 mg/day; max for 5-12 years: 75 mg/day Nausea and vomiting: Oral: 0.5-1 mg/kg/dose q4-6 hours as needed Genghis Khun ([email protected],nafanakhun.wordpress.com)


IM/IV: 0.5-1 mg/kg/dose q6-8 hours; max for <5 y: 40 mg/day; max for 5-12 y: 75 mg/day Rectal: 1 mg/kg/dose q6-8 hours as needed Adults: Psychosis: Oral: Range: 30-2000 mg/day in 1-4 divided doses, initiate at lower doses and titrate as needed; usual dose: 400-600 mg/day; some patients may require 1-2 g/day I.M., I.V.: Initial: 25 mg, may repeat (25-50 mg) in 1-4 hours, gradually increase to a max. of 400 mg/dose q4-6 hours until patient is controlled; usual dose: 300-800 mg/day Intractable hiccups: Oral, I.M.: 25-50 mg 3-4 times/day Nausea and vomiting: Oral: 10-25 mg every 4-6 hours I.M., I.V.: 25-50 mg every 4-6 hours Rectal: 50-100 mg every 6-8 hours Elderly (nonpsychotic patient; dementia behavior): Initial: 10-25 mg 1-2 times/day; increase at 4- to 7-day intervals by 10-25 mg/ day. Increase dose intervals (bid, tid, etc) as necessary to control behavior response or side effects; maximum daily dose: Genghis Khun ([email protected],nafanakhun.wordpress.com)


800 mg; gradual increases (titration) may prevent some side effects or decrease their severity. KI: Hipersensitif; bone marrow suppression, narrow-angle glaucoma, severe liver or cardiac disease IO: Other CNS depressants, anticholinergics, or anticonvulsants; antihypertensives may cause additive effect; coadministration with epinephrine may cause hypotension Preg: C P: May cause pseudoparkinsonism; akathisia is a common extrapyramidal reaction in elderly patients; lowers seizure threshold and increases risk of seizures in patient with history of seizures Nama Dagang:



Perphenazine I: Hypomania, Agitated and excited states, Anxiety (short term use), Mania, Nausea and vomiting, Persistant hiccups, Psychotic illness, Schizophrenia, Violent and dangerous behaviour BSO: Concentrate, oral: 16 mg/5 mL Injection: 5 mg/mL Tablet: 2 mg, 4 mg, 8 mg, 16 mg D: Psychoses: Oral: 1-6 years: 4-6 mg/day in divided doses 6-12 years: 6 mg/day in divided doses >12 years: 4-16 mg 2-4 times/day I.M.: 5 mg every 6 hours Nausea/vomiting: I.M.: 5 mg every 6 hours Adults: Psychoses: Oral: 4-16 mg 2-4 times/day max 64 mg/day I.M.: 5 mg every 6 hours up to 15 mg/day in ambulatory patients and 30 mg/day in hospitalized patients Nausea/vomiting: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral: 8-16 mg/day in divided doses up to 24 mg/day I.M.: 5-10 mg every 6 hours as necessary up to 15 mg/day in ambulatory patients and 30 mg/day in hospitalized patients I.V. (severe): 1 mg at 1- to 2-minute intervals max 5 mg Hemodialysis: Not dialyzable (0% to 5%) KI: Breastfeeding, Children < 14 years, policitemia, leucopenia P: 'prolonged QT interval', myasthenia gravis, Agitation and restlessness, Alcohol withdrawal, Brain damage, Closed angle glaucoma, Coronary heart disease, cardiovascular disease, Elderly people, Epilepsy, Heart failure, Hypothyroidism, arrhythmias, Kidney failure, Liver disease, Parkinson's disease, brain damage, Pregnancy, Severe disease affecting the airways or lungs, phaeochromocytoma ES: Dry mouth, postural hypotension, Blood disorders, Weight gain, convulsions, arrhythmias, urinary retention, extrapyramidal effects, tardive dyskinesia, Sexual problems, oculogyric crisis, Requires immediate treatment, Drowsiness Preg:C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Trifluoperazine I: Schizophrenia, Short-term treatment of severe anxiety, severely agitated behaviour and violent or dangerously impulsive behaviour, Nausea and vomiting. BSO: Concentrate, oral: 10 mg/mL Injection: 2 mg/mL Tablet: 1 mg, 2 mg, 5 mg, 10 mg D: Children 6-12 years: Psychoses: Oral: Hospitalized or well supervised patients: Initial: 1 mg 1-2 times/day, gradually increase until symptoms are controlled or adverse effects become troublesome; maximum: 15 mg/day I.M.: 1 mg 2x/day Adults: Psychoses: Outpatients: Oral: 1-2 mg twice daily Hospitalized or well supervised patients: 1st : 2-5 mg 2x/day with optimum response in the 15-20 mg/day range; max 40 mg/day I.M.: 1-2 mg every 4-6 hours max 10 mg/24 hours Nonpsychotic anxiety: Oral: 1-2 mg 2x/day; max 6 mg/day; therapy for anxiety should not exceed 12 weeks; max 6 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


for longer than 12 weeks when treating anxiety; agitation, jitteriness, or insomnia may be confused with original neurotic or psychotic symptoms KI: Allergy, Disturbance in the normal numbers of blood cells in the blood, Heart failure, Liver disease, comatose states. P: Elderly people, Decreased kidney function, Heart disease, Angina pectoris, arrhythmias, Epilepsy, myasthenia gravis, Parkinson's disease, Closed angle glaucoma, prostatic hypertrophy ES: Drowsiness, Dizziness, insomnia, Dry mouth, Constipation, Blurred vision, Muscle weakness, Loss of appetite, Skin rashes, Interference with the body's temperature regulation, Weight gain, Confusion, Abnormal movements of the hands, legs, face, neck and tongue, eg shakiness, twitching, rigidity, Anxiety, restlessness and agitation (akathisia), arrhythmias, jaundice, hyperprolactinaemia, Changes in menstrual periods, Disturbances in the normal numbers of blood cells in the blood. Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Haloperidol -- Controls psychosis and provides rapid tranquilization. Administer with a benzodiazepine to protect against lowered seizure threshold. BSO: Concentrate, oral: 2 mg/mL Injection: 50 mg/mL; 100 mg/mL Injection: 5 mg/mL Tablet: 0.5 mg, 1 mg, 2 mg, 5 mg, 10 mg, 20 mg D: Tab: Adults: 500 mcg-5 mg 2-3x/day. Max. 100 mg/day. Children 3-12= 15-40 kg: 25-150 mcg/kg/day, 2-3x/day. Children <3 Older adults: 500 mcg-2 mg 2-3x/day. For short-acting injection dosage form: Adults: 2-5 mg. For long-acting or depot injection dosage form: Adults: 10-15x dosis oral perhari, IM per bulan. KI: Hipersensitif; extrapyramidal symptoms; Parkinson disease IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Serum plasma levels decreased by rifampin; potentiates effects of CNS depressants (eg, alcohol, opiates, anesthetics); lithium has induced an encephalopathic syndrome Preg: C P: Severe neurotoxicity manifesting as rigidity or inability to walk or talk may occur in patients with thyrotoxicosis also receiving antipsychotics; if administered IV/IM, watch for hypotension; caution in diagnosed CNS depression or cardiac disease; if history of seizures, benefits must outweigh risks; significant increase in body temperature may indicate intolerance to antipsychotics (discontinue if occurs) Ventricular arrhythmias such as torsade de pointes have been reported in patients, especially those with cardiac disease and in those given high doses of IV haloperidol Nama Dagang:



Sulpiride I: Schizophrenia, anti emetik BSO: Kaps 50 mg. Tab forte 200 mg. amp 100 mg/2cc D: KI: Children < 14 years, Severe liver & kidney disease, blood disorders, porphyries, phaeochromocytoma, pituitary prolactinoma, Breast cancer, Alcohol intoxication. # Reduced awareness, slow reactions or drowsiness due to illnesses that reduce activity in the central nervous system. P: Elderly people, Decreased kidney function, hypomania, History of epilepsy, Parkinson's disease, cardiovascular disease, 'prolonged QT interval', bradycardia, hypokalaemia, People at risk of stroke. ES: Restlessness and agitation, extrapyramidal effects, tardive dyskinesia, insomnia, Drowsiness, Dizziness, Weight gain, hyperprolactinaemia, Sexual problems, Convulsions, jaundice or hepatitis, arrhythmias. Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prochlorpherazine -- Antidopaminergic drug that blocks postsynaptic mesolimbic dopamine receptors. Has anticholinergic effect and can depress reticular activating system. I : nausea and vomiting; psychosis; anxiety BSO : Capsule, sustained action: 10 mg, 15 mg, 30 mg Injection: 5 mg/mL Suppository, rectal: 2.5 mg, 5 mg, 25 mg Syrup: 5 mg/5 mL Tablet: 5 mg, 10 mg, 25 mg D: 5-10 mg PO/IM q6h 25-mg supp PR q12h Paed. 2.5 mg PO/PR q8h or 5 mg PO/PR q12h prn; max 15 mg/d 0.1-0.15 mg/kg/dose IM; change to PO when possible KI: Hipersensitif; bone marrow suppression; narrow-angle glaucoma; severe liver or cardiac disease IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Coadministration with other CNS depressants or anticonvulsants may cause additive effects; administration with epinephrine may cause hypotension Preg: D P: Drug-induced Parkinson syndrome or pseudoparkinsonism frequent; akathisia most common extrapyramidal reaction in elderly; lowers seizure threshold; caution in history of seizures Nama Dagang:



Olanzapine -- May inhibit serotonin, muscarinic, and dopamine effects. I: Manifestations of psychotic disorders; short-term treatment of acute manic episodes associated with bipolar I disorder BSO: Tablet: 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg Tablet, orally-disintegrating: 5 mg, 10 mg, 15 mg, 20 mg D: Adults: 5-10 mg 1x/hr.; increase to 10 mg 1x/day within 5-7 days, thereafter adjust by 5 mg/day at 1-week intervals, max 20 mg/day; doses of 30-50 mg/day have been used KI: Hipersensitif IO: Fluvoxamine may increase effects; antihypertensives may increase risk of hypotension and orthostatic hypotension; levodopa, pergolide, bromocriptine, charcoal, carbamazepine, omeprazole, rifampin, and cigarette smoking may decrease effects Preg: C P: Caution in narrow-angle glaucoma, cardiovascular disease, cerebrovascular disease, prostatic hypertrophy, seizure disorders, hypovolemia, and dehydration Genghis Khun ([email protected],nafanakhun.wordpress.com)


G. Hipnotic & Sedatif Nitrazepam Midazolam Estazolam Triazolam



Nitrazepam benzodiazepines I: Insomnia BSO: D: KI: Children, acute pulmonary insufficiency, myasthenia gravis, Phobias or obsessional states, Severe liver disease, respiratory depression, sleep apnoea syndrome, single medication for depression or chronic psychosis P: Breastfeeding, respiratory disease, Elderly people, History of alcoholism or drug abuse, Kidney disease, porphyries, Liver disease, Muscle weakness, Personality disorders, Pregnancy ES: Confusion, Addiction to the medicine, Muscle weakness, amnesia, Drowsiness and lightheadedness the next day, ataxia IO: Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Midazolam Benzodiazepine I: Dental: Sedation component in I.V. conscious sedation in oral surgery patients; syrup formulation is used for children to help alleviate anxiety before a dental procedure Medical: Preoperative sedation and provides conscious sedation prior to diagnostic or radiographic procedures Unlabeled use: Anxiety, status epilepticus BSO: Injection: 1 mg/mL; 5 mg/mL Syrup: 2 mg/mL D: Personnel and equipment needed for standard respiratory resuscitation should be immediately available during midazolam administration. Infants <2 months and Children: Status epilepticus refractory to standard therapy: I.V.: Loading dose: 0.15 mg/kg followed by a continuous infusion of 1 mcg/kg/minute; titrate dose upward every 5 minutes until clinical seizure activity is controlled; mean infusion rate required in 24 children was 2.3 mcg/kg/minute with a range of 1-18 mcg/kg/minute Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: Preoperative sedation: I.M.: 0.07-0.08 mg/kg 30-60 minutes presurgery I.V.: 0.035 mg/kg/dose, repeat over several minutes as required to achieve the desired sedative effect max of 0.1-0.2 mg/kg Conscious sedation during mechanical ventilation: I.V.: Loading dose: 0.05-0.2 mg/kg then follow with initial continuous infusion: 1-2 mcg/kg/minute; titrate to the desired effect; usual range: 0.4-6 mcg/kg/minute Conscious sedation for procedures: Oral, Intranasal: 0.2-0.4 mg/kg (max 15 mg) 30-45’ pre-op I.V.: 0.05 mg/kg 3 minutes pre-op >12 years: I.V.: 0.5 mg q3-4’ until effect achieved Adults: Preoperative sedation: I.M.: 0.07-0.08 mg/kg 30-60 minutes presurgery; usual dose: 5 mg Conscious sedation: I.V.: Initial: 0.5-2 mg slow I.V. over at least 2 minutes; slowly titrate to effect by repeating doses every 2-3 Genghis Khun ([email protected],nafanakhun.wordpress.com)


minutes if needed; usual total dose: 2.5-5 mg; use decreased doses in elderly Healthy Adults <60 years: Some patients respond to doses as low as 1 mg; no more than 2.5 mg should be administered over a period of 2 minutes. Additional doses of midazolam may be administered after a 2-minute waiting period and evaluation of sedation after each dose increment. A total dose >5 mg is generally not needed. If narcotics or other CNS depressants are administered concomitantly, the midazolam dose should be reduced by 30%. Elderly: I.V.: Conscious sedation: Initial: 0.5 mg slow I.V.; give no more than 1.5 mg in a 2-minute period; if additional titration is needed, give no more than 1 mg over 2 minutes, waiting another 2 or more minutes to evaluate sedative effect; a total dose >3.5 mg is rarely necessary Sedation in mechanically intubated patients: I.V. continuous infusion: 100 mg in 250 mL D5W or NS, (if patient is fluidrestricted, may concentrate up to a maximum of 0.5 mg/mL); initial dose: 1 mg/hour; titrate to reach desired level of sedation Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hemodialysis: Supplemental dose is not necessary Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics KI: Hypersensitivity to this drug or any component of its formulation, including benzyl alcohol (cross-sensitivity with other benzodiazepines may exist); parenteral form is not for intrathecal or epidural injection; narrow-angle glaucoma (not in product labeling, however, benzodiazepines are contraindicated); pregnancy; concurrent use with protease inhibitors like amprenavir and ritonavir P: May cause severe respiratory depression, respiratory arrest, or apnea. Use with extreme caution, particularly in noncritical care settings. Appropriate resuscitative equipment and qualified personnel must be available for administration and monitoring. Initial dosing must be cautiously titrated and individualized, particularly in elderly or debilitated patients, patients with hepatic impairment (including alcoholics), or in renal impairment, particularly if other CNS depressants (including opiates) are used concurrently. Initial doses in elderly or Genghis Khun ([email protected],nafanakhun.wordpress.com)


debilitated patients should not exceed 2.5 mg. Use with caution in patients with respiratory disease or impaired gag reflex. Use during upper airway procedures may increase risk of hypoventilation. Prolonged responses have been noted following extended administration by continuous infusion (possibly due to metabolite accumulation) or in the presence of drugs which inhibit midazolam metabolism. Causes CNS depression (dose-related) resulting in sedation, dizziness, confusion, or ataxia which may impair physical and mental capabilities. Patients must be cautioned about performing tasks which require mental alertness (ie, operating machinery or driving). A minimum of 1 day should elapse after midazolam administration before attempting these tasks. Use with caution in patients receiving other CNS depressants or psychoactive agents. Effects with other sedative drugs or ethanol may be potentiated. Benzodiazepines have been associated with falls and traumatic injury and should be used with extreme caution in patients who are at risk of these events (especially the elderly). Genghis Khun ([email protected],nafanakhun.wordpress.com)


Midazolam causes anterograde amnesia. Paradoxical reactions, including hyperactive or aggressive behavior have been reported with benzodiazepines, particularly in adolescent/ pediatric or psychiatric patients. Does not have analgesic, antidepressant, or antipsychotic properties. Benzodiazepines have been associated with dependence and acute withdrawal symptoms on discontinuation or reduction in dose. Acute withdrawal, including seizures, may be precipitated after administration of flumazenil to patients receiving long-term benzodiazepine therapy. ES: >10%: Decreased tidal volume and/or respiratory rate decrease, apnea 1-10%: Drowsiness, oversedation, headache, Nausea, vomiting, local reactions at injection site (severity less than diazepam), Coughing, Physical and psychological dependence with prolonged use, hiccups IO: CYP3A3/4 enzyme substrate Verapamil, troleandomycin, miconazole, itraconazole, nifedipine, grapefruit juice, diltiazem, fluconazole, ketoconazole, Genghis Khun ([email protected],nafanakhun.wordpress.com)


clarithromycin, and erythromycin, protease inhibitors like amprenavir and ritonavir may increase the serum concentrations and effects of midazolam via CYP3A4 inhibition If narcotics or other CNS depressants are administered concomitantly, the midazolam dose should be reduced by 30% if <65 years of age, or by at least 50% if >65 years of age Preg: D Nama Dagang:



Estazolam Intermediate-acting benzodiazepine Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Half-life is 10-24 h, and peak action is 2 h. I: Short-term management of insomnia BSO: Tablet: 1 mg, 2 mg D: 1 mg PO hs; may require 2 mg Start with 0.5 mg PO hs in debilitated or small elderly patients Elderly: 0.5-1 mg PO qhs KI: Hipersensitif; narrow-angle glaucoma; untreated obstructive sleep apnea; history of substance abuse IO: Increases toxicity with coadministration of phenothiazines, barbiturates, alcohols, and MAOIs Preg: X P: Hepatic disease, low albumin levels, or renal or pulmonary disease; causes residual daytime sedation, impairs cognition, and increases risk of falls Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Triazolam Benzodiazepine I: Short-term treatment of insomnia BSO: Tablet: 0.125 mg, 0.25 mg D: Onset of action is rapid, patient should be in bed when taking medication: Adults: 0.125-0.25 mg at bedtime KI: Hypersensitivity to this drug or any component of its formulation (cross-sensitivity with other benzodiazepines may exist); concurrent therapy with CYP3A4 inhibitors (such as ketoconazole, itraconazole, protease inhibitors and nefazodone); pregnancy P: Should be used only after evaluation of potential causes of sleep disturbance. Failure of sleep disturbance to resolve after 7-10 days may indicate psychiatric or medical illness. A worsening of insomnia or the emergence of new abnormalities of thought or behavior may represent unrecognized psychiatric or medical illness and requires immediate and careful evaluation. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Causes CNS depression (dose-related) resulting in sedation, dizziness, confusion, or ataxia which may impair physical and mental capabilities. Patients must be cautioned about performing tasks which require mental alertness (ie, operating machinery or driving). Use with caution in patients receiving other CNS depressants or psychoactive agents. Effects with other sedative drugs or ethanol may be potentiated. Benzodiazepines have been associated with falls and traumatic injury and should be used with extreme caution in patients who are at risk of these events (especially the elderly). Use caution in patients with depression, particularly if suicidal risk may be present. Use with caution in patients with a history of drug dependence. Benzodiazepines have been associated with dependence and acute withdrawal symptoms on discontinuation or reduction in dose. Acute withdrawal, including seizures, may be precipitated after administration of flumazenil to patients receiving long-term benzodiazepine therapy. Paradoxical reactions, including hyperactive or aggressive behavior have been reported with benzodiazepines, particularly Genghis Khun ([email protected],nafanakhun.wordpress.com)


in adolescent/pediatric or psychiatric patients. Does not have analgesic, antidepressant, or antipsychotic properties. ES: >10%: Drowsiness 1- 10%: Headache, dizziness, nervousness, lightheadedness, ataxia, Nausea, vomiting IO: CYP3A3/4 and 3A5-7 enzyme substrate Cimetidine, ciprofloxacin, clarithromycin, clozapine, CNS depressants, diltiazem, disulfiram, digoxin, erythromycin, ethanol, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, isoniazid, itraconazole, ketoconazole, labetalol, levodopa, loxapine, metoprolol, metronidazole, miconazole, nefazodone, omeprazole, phenytoin, rifabutin, rifampin, troleandomycin, valproic acid, protease inhibitors like amprenavir and ritonavir, verapamil may increase the serum level and/or toxicity of triazolam; monitor for altered benzodiazepine response Preg: X BSO: Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


H. Anti Depressan Amitriptyline Fluoxetine Paroxetine Sertraline Moclobemide Venlafaxine Imipramine Clomipramine Fluvoxamine Mirtazapine Mianserin Duloxetine Tianeptine Maprotiline Citalopram Lithium carbonate Amoxapine Genghis Khun ([email protected],nafanakhun.wordpress.com)


Amitriptyline Blocks reuptake of norepinephrine and serotonin. Decreases pain by inhibiting spinal neurons involved in pain perception. I: Depressive illness, nocturnal enuresis in children > 7 years, Nerve pain & Preventing migraine (unlicensed use). BSO: Injection: 10 mg/mL Tablet: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg D: 10-150 mg PO hs; initially administer as smaller divided increments and gradually titrate up to an effective level with a max 150 mg PO qhs KI: Hipersensitif; administration of MAOIs in past 14 d; history of seizures; cardiac arrhythmias; glaucoma; urinary retention IO: Phenobarbital may decrease effects; coadministration with CYP2D6 enzyme system inhibitors (eg, cimetidine, quinidine) may increase amitriptyline levels; amitriptyline inhibits hypotensive effects of guanethidine; may interact with thyroid medications, alcohol, CNS depressants, barbiturates, and disulfiram Preg: D Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Caution in cardiac conduction disturbances, history of hyperthyroidism, and renal or hepatic impairment; avoid using in elderly patients Nama Dagang:



Fluoxetine FDA-approved for OCD and panic disorder. I: Depressive illness, obsessive-compulsive disorder, bulimia nervosa, Premature ejaculation BSO: Capsule: 10 mg, 20 mg, 40 mg Liquid: 20 mg/5 mL Tablet: 10 mg, 20 mg D: Kaps: Depression: Adults— 20 mg 1x/hr pagi hari. Max 80 mg/hr. Children > 8= 10-20 mg 1x pagi hari. Bulimia nervosa: Adults—60 mg 1x pagi hari. Max 80 mg/hr. Obsessive-compulsive disorder: Adults—20 mg 1x pagi hari. Max 80 mg/hr. Children > 7= 10 mg 1x pagi hari. Max 60 mg/hr Panic disorder: Adults— 10 mg 1x/hr pagi hari. Max 60 mg/hr. For premenstrual dysphoric disorder: Adults=20 mg 1x/hr pagi hari selama 14 hari. Max 80 mg/hr. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children > 8= 10-20 mg 1x pagi hari. KI: Hipersensitif; concurrently taking MAOIs or took them in the last 2 wk IO: Increases toxicity of diazepam and trazodone by decreasing clearance; increases toxicity of MAOIs and highly protein-bound drugs Preg: C P: Caution in hepatic impairment and history of seizures; MAOIs should be discontinued at least 14 d before initiating therapy Nama Dagang:



Paroxetine FDA-approved for panic disorder, depression, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and OCD. I: Depressive illness, Generalised anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, Post-traumatic stress disorder, social phobia. BSO: Tab 20 mg D: Adults= 20 mg 1x pagi hari. Max 50 mg/hr. KI: Hipersensitif; concurrent administration with MAOIs or administering within 14 days of discontinuing an MAOI IO: Phenobarbital and phenytoin decrease effects; alcohol, cimetidine, sertraline, phenothiazines, and warfarin increase toxicity Preg: C P: Caution in history of seizures, mania, renal disease, and cardiac disease Nama Dagang: Seroxat Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sertraline I: Depression in adults, obsessive-compulsive disorder, Posttraumatic stress disorder in adult women BSO: Concentrate, oral: 20 mg/mL Tablet: 25 mg, 50 mg, 100 mg D: Oral: Elderly: 1st 25 mg/day in the morning, increase by 25 mg/day increments every 2-3 days if tolerated to 50-100 mg/day; additional increases may be necessary; max: 200 mg/day KI: Hipersensitif; within 14 d of taking an MAOI IO: Increases toxicity of MAOIs, diazepam, tolbutamide, and warfarin Preg: C P: Caution in preexisting seizure disorders and those who have experienced a recent myocardial infarction, have unstable heart disease, and hepatic or renal impairment Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Moclobemide I: Major depression, social phobia. BSO: Tab 150 mg D: 150 mg 2x/hr. Max 600 mg/hr. KI: Children, Schizophrenia and schizo-affective disorders, Acute states of confusion, phaeochromocytoma. P: Severely decreased liver function, manic depression, Agitated and excited states, Thyrotoxicosis. ES: Disturbed sleep, Dizziness, diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, Anxiety and restlessness, Agitation, paraesthesia, Dry mouth, Visual disturbances, oedema, Skin reactions such as rash and itch, Confusion IO: Preg:: A, B, C, D, X Nama Dagang: Aurorix Genghis Khun ([email protected],nafanakhun.wordpress.com)


Venlafaxine Selectively inhibits presynaptic serotonin reuptake, norepinephrine (at doses of approximately 150 mg PO qam), and dopamine (at doses of approximately 150-225 mg qam). I: Depressive illness, depression associated with anxiety. BSO: Kaps 75 mg D: * For mental depression & anxiety: 75 mg 1x/hari. Max 225 mg/hr. * For panic disorder: 37.5 mg 1x/hr for 7 hari. Max 225 mg/hr. KI: Hipersensitif; MAOIs in past 2 wk IO: Cimetidine, MAOIs, sertraline, fluoxetine class IC antiarrhythmics, TCAs, and phenothiazine may increase effects; serotonin syndrome Preg: C P: Anxiety, anorexia, sedation, dry mouth, nervousness, dizziness, insomnia, headaches, nausea, increased BP, and sexual dysfunction may occur; taper over 1-2 wk upon discontinuation Nama Dagang: Efexor XR Genghis Khun ([email protected],nafanakhun.wordpress.com)


Imipramine Tricyclic antidepressant that has norepinephrine and serotonin reuptake-inhibition properties. I: Depression, enuresis BSO: Tab salut selaput 25 mg D: Maximum antidepressant effect may not be seen for 2 or more weeks after initiation of therapy. Depression: 1.5 mg/kg/day with dosage increments of 1 mg/kg every 3-4 days, max 5 mg/kg/day in 1-4 divided doses; monitor carefully especially with doses > 3.5 mg/kg/day Enuresis: > 6 years: 1st 10-25 mg at bedtime, increase by 25 mg/day; max 2.5 mg/kg/day 6-12 y: 50 mg at bedtime > 12 y: 75 mg at bedtime Adjunct in the treatment of cancer pain: Initial: 0.2-0.4 mg/kg at bedtime; increased by 50% every 2-3 days up to 1-3 mg/kg/dose at bedtime Adolescents: Oral: Initial: 25-50 mg/day; increase gradually; maximum: 100 mg/day in single or divided doses Genghis Khun ([email protected],nafanakhun.wordpress.com)


Adults: Oral: Initial: 25 mg 3-4 times/day, max 300 mg/day I.M.: Initial: Up to 100 mg/day in divided doses; change to oral as soon as possible Elderly: Initial: 10-25 mg at bedtime; increase by 10-25 mg every 3 days for inpatients and weekly for outpatients if tolerated; average daily dose to achieve a therapeutic concentration: 100 mg/day; range: 50-150 mg/day KI: Hipersensitif; narrow-angle glaucoma; acute recovery phase following myocardial infarction; history of bipolar disorders; patients taking MAOIs or fluoxetine or those who took them in the previous 2 wk IO: Increases toxicity of sympathomimetic agents such as isoproterenol and epinephrine by potentiating effects and inhibiting antihypertensive effects of clonidine Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May impair mental or physical abilities required for performance of potentially hazardous tasks; caution in cardiovascular disease, conduction disturbances, seizure disorders, urinary retention, hyperthyroidism, or those receiving thyroid replacement; an ECG may be warranted prior to initiation of therapy with imipramine, repeat after dose stabilized to monitor any potential widening of QRS Nama Dagang: Tofranil



Clomipramine Tricyclic antidepressant with potent NE and 5-HT reuptake inhibition. I: Depressive illness, Phobic or obsessional disorders, cataplexy, narcolepsy. BSO: Capsule: 25 mg, 50 mg, 75 mg D: Oral: Initial: Adults: 25 mg/day. Increase to 100 mg/day the first 2 weeks, max 250 mg/day KI: Hipersensitif; concurrent use of MAOI or other TCA IO: Potentiates CNS depressants, anticholinergics, sympathomimetics, and other protein-bound drugs; potentiated by CYP2D6 inhibitors; SSRIs Preg: C P: Suicidal tendencies or risk of overdose; seizure disorder; cardiac disease; glaucoma; urinary retention Nama Dagang:



Fluvoxamine FDA approved for OCD in children (8-17 y) and adults. I: Depressive illness, obsessive-compulsive disorder. BSO: Tab salut selaput 50 mg D: Obsessive-compulsive disorder or social phobia: 100 mg 1x at bedtime. Max 300 mg/hari. Paed.: 25-200 mg PO qd KI: Hipersensitif; patients currently receiving MAOIs or those who took them in previous 2 wk IO: Risk of a hypertensive crisis increases with coadministration with MAOIs; potentiates effect of triazolam and alprazolam and thus, when taking them concurrently, dose should be reduced by at least 50%; also reduce dose of theophylline by one third and monitor plasma levels if taking it concurrently with fluvoxamine; alcohol, cimetidine, sertraline, phenothiazines, and warfarin increase toxicity Preg: C P: liver disease, history of seizures or suicidal tendencies Nama Dagang: Luvox Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mirtazapine Exhibits both noradrenergic and serotonergic activity. In cases of depression associated with severe insomnia and anxiety, shown to be superior to other SSRI drugs. I: Depressive illness. BSO: Tab 30 mg D: 15 mg PO hs initially; may increase in 15-mg increments q1-2wk, max 45 mg hs KI: Hipersensitif; MAOI within 14 d IO: May increase effect of CNS depressants; concurrent administration with MAOI may trigger hypertensive crisis Preg: C P: May cause drowsiness; discontinue use if patient develops sore throat, fever, or other signs of infection; suicidal ideation is inherent in depression and may persist until significant remission occurs; severe neutropenia reported in clinical trials Nama Dagang: Remeron Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mianserin I: Depressive illness. BSO: Tab 10 mg D: Awal 30-40 mg malam atau dg dosis terbagi. Durasi 30-90 mg/hr. Usia lanjut < 30 mg/hr KI: Children < 18 years, Severe liver disease, Breastfeeding, Mania, People who have taken a monoamine oxidase inhibitor antidepressant (MAOI) in the last two weeks. P: Elderly, Decreased liver & kidney function, Heart disease, heart block, arrhythmias, prostatic hypertrophy, Closed angle glaucoma, History of epilepsy, People at risk of seizures, Diabetes, Psychotic illness, manic depression, porphyrias. ES: Drowsiness, Dizziness, postural hypotension, arthralgia, oedema, Skin rash, Sweating, Tremor, Disturbances of liver function, jaundice, Disturbances in the normal numbers of blood cells in the blood, convulsions, Breast enlargement and tenderness, Production of breast milk, Sexual problems Preg:: A, B, C, D, X Nama Dagang: Tolvon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Duloxetine -- Potent inhibitor of neuronal serotonin and norepinephrine reuptake. Antidepressive action is theorized to be due to serotonergic and noradrenergic potentiation in CNS. I: Depressive illness, diabetic peripheral neuropathic pain. BSO: Kaps salut enteric 30mg, 60mg D: Depression: 40 mg/hari terbagi dalam 1-2 dosis. Diabetic peripheral neuropathy pain: 60 mg 1x/hr. KI: Hipersensitif; uncontrolled narrow-angle glaucoma; do not administer within 14 d after stopping MAOIs; do not initiate MAOIs within 5 d of stopping duloxetine IO: Metabolized by CYP1A2 and CYP2D6; coadministration with drugs that inhibit CYP1A2 (eg, fluvoxamine, cimetidine, ciprofloxacin, enoxacin) may increase blood levels and toxicity; coadministration with drugs that inhibit CYP2D6 (eg, paroxetine, fluoxetine, quinidine) may increase blood levels and toxicity; moderately inhibits CYP2D6 and may decrease elimination of Genghis Khun ([email protected],nafanakhun.wordpress.com)


CYP2D6 substrates (eg, tricyclic antidepressants, phenothiazines [eg, thioridazine], type 1C antiarrhythmics [eg, propafenone, flecainide]); coadministration with MAOIs may cause serious, sometimes fatal, reactions that include hyperthermia, rigidity, myoclonus, autonomic instability, mental status changes, including extreme agitation, delirium, and coma Preg: C P: Observe closely for clinical worsening and suicidality when initiating treatment or following dosage change; gradually decrease dose when discontinuing, do not abruptly discontinue; caution with hepatic impairment or end-stage renal disease; may cause slight blood pressure increase; may activate mania or hypomania; common adverse effects include nausea, dry mouth, constipation, decreased appetite, fatigue, somnolence, and increased sweating Nama Dagang: Cymbalta Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tianeptine I: Episode depresi mayor BSO: Tab 12.5 mg D: 12.5 mg 3x/hr KI: Anak 15 th. Ada jarak 2 minggu setelah penghentian terapi MAOI. Penghentian Tianeptine 24 jam bila akan diganti MAOI P: Hamil, menyusui. Pengawasan thd pasien resiko bunuh diri. ES: Jarang IO: MAOI Preg:: A, B, C, D, X Nama Dagang: Stablon



Maprotiline I: Depression and anxiety associated with depression Chronic neurogenic pain BSO: Tablet: 10 mg, 25 mg, 50 mg, 75 mg D: 25 mg 1-3x/hr. Max 150 mg/hr. KI: Hypersensitivity to maprotiline; use of monoamine oxidase inhibitors within 14 days; use in a patient during the acute recovery phase of MI ES: Skin rash, redness, swelling, or itching, Constipation (severe), Nausea or vomiting, Shakiness or trembling, convulsions, Unusual excitement, Weight loss Rare: Breast enlargement (males/females), Confusion (especially in the elderly), Difficulty in urinating, Fainting, Hallucinations, Inappropriate secretion of milk—in females, Irregular heartbeat, Sore throat and fever, Swelling of testicles, Yellow eyes or skin Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Citalopram Enhances serotonin activity due to selective reuptake inhibition at the neuronal membrane. Also has the advantage of fewer potential drug IO:. Citalopram is a 50:50 racemate of r- and scitalopram. I: Depressive illness, Panic disorder with/without agoraphobia. BSO : Tab 20 mg D: 20 mg 1x/hr. Max 60 mg/hr. KI: Hipersensitif; concurrent MAOI therapy IO: May be potentiated by azole antifungals, omeprazole, and macrolides; serotonin syndrome may be induced by buspirone, tramadol, MAOIs, and nefazodone Preg: C P: Cirrhosis; suicidal tendencies; SIADH; DM; breastfeeding; common adverse effects include fatigue and sexual dysfunction Nama Dagang: Cipram Genghis Khun ([email protected],nafanakhun.wordpress.com)


Lithium carbonate I: Mania and hypomania, 'mood stabiliser', recurrent depression, Aggressive or self-harming behaviour BSO: Tab 200 mg, 400 mg D: Capsules, tablets, syrup: Dws: 300-600 mg 3x/hr. Children <12: 15-20 mg/kg/hr, terbagi 2-3 dosis Slow-release capsules, extended-release tablets): Adults: 300-600 mg 3x/hr or 450-900 mg 2x/hr. Maintenance, preventive use: 400-1200 mg PO qd Acute manic episode: 600-2400 mg PO qd Paed. 6-12 years: 15-60 mg/kg/d PO divided tid/qid; max D: KI: Hipersensitif; renal disease or damage (renal function and clearance are critical in maintaining proper levels); history or evidence of brain damage; cardiovascular disease; generalized severe debilitation IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Increases toxicity of thiazide diuretics, haloperidol, phenothiazines, neuromuscular blockers, carbamazepine, fluoxetine, and ACE inhibitors Preg: D P: Patient should have adequate renal function as evidenced by elevated creatinine levels or BUN levels, and they should drink plenty of fluids to prevent dehydration; excessive sodium loss can produce lithium toxicity (avoid excessive sweating); use lower doses in elderly individuals; do not perform ECT when being administered; avoid rapid increases in dosing Anything causing hyponatremia increases levels and could cause toxicity; toxicity is closely related to serum levels and can occur at therapeutic doses; serum lithium determinations are required to monitor therapy Nama Dagang: Frimania Genghis Khun ([email protected],nafanakhun.wordpress.com)


Amoxapine I: Neurotic or reactive depressive disorder as well as endogenous and psychotic depression; depression accompanied by anxiety or agitation BSO: Tablet: 25 mg, 50 mg, 100 mg, 150 mg D: Once symptoms are controlled, decrease gradually to lowest effective dose. Maintenance dose is usually given at bedtime to reduce daytime sedation. Oral: Adolescents: Initial: 25-50 mg/day; increase to 100 mg/day; divided/ single dose at bedtime Adults: Initial: 25 mg 2-3 times/day, increased to 100 mg 2-3 times/day; Elderly: Initial: 25 mg at bedtime increased by 25 mg weekly for outpatients and every 3 days for inpatients if tolerated; usual dose: 50-150 mg/day, but doses up to 300 mg may be necessary Maximum daily dose: Inpatient: 600 mg, Outpatient: 400 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hypersensitivity to amoxapine; use of monoamine oxidase inhibitors within past 14 days; recovery from acute myocardial infarction P: May cause sedation, resulting in impaired performance of tasks requiring alertness (ie, operating machinery or driving). Sedative effects may be additive with other CNS depressants and/or ethanol. The degree of sedation is moderate relative to other antidepressants. May worsen psychosis in some patients or precipitate a shift to mania or hypomania in patients with bipolar disease. May increase the risks associated with electroconvulsive therapy. This agent should be discontinued, when possible, prior to elective surgery. Therapy should not be abruptly discontinued in patients receiving high doses for prolonged periods. May cause orthostatic hypotension (risk is moderate relative to other antidepressants) - use with caution in patients at risk of hypotension or in patients where transient hypotensive episodes would be poorly tolerated (cardiovascular disease or cerebrovascular disease). The degree of anticholinergic Genghis Khun ([email protected],nafanakhun.wordpress.com)


blockade produced by this agent is moderate relative to other cyclic antidepressants - use caution in patients with urinary retention, benign prostatic hypertrophy, narrow-angle glaucoma, xerostomia, visual problems, constipation, or history of bowel obstruction. Use caution in patients with depression, particularly if suicidal risk may be present. Use with caution in patients with a history of cardiovascular disease (including previous MI, stroke, tachycardia, or conduction abnormalities). The risk of conduction abnormalities with this agent is moderate relative to other antidepressants. May lower seizure threshold - use caution in patients with a previous seizure disorder or condition predisposing to seizures such as brain damage, alcoholism, or concurrent therapy with other drugs which lower the seizure threshold. Use with caution in hyperthyroid patients or those receiving thyroid supplementation. Use with caution in patients with hepatic or renal dysfunction and in elderly patients. ES: >10%: Drowsiness, Xerostomia, constipation Genghis Khun ([email protected],nafanakhun.wordpress.com)


1-10%: Dizziness, headache, confusion, nervousness, restlessness, insomnia, ataxia, excitement, anxiety, Edema, skin rash, Elevated prolactin levels, Nausea, Tremor, weakness, Blurred vision, Diaphoresis IO: CYP1A2, 2C9, 2C19, 2D6, and 3A3/4 enzyme substrate Amoxapine inhibits the antihypertensive response to bethanidine, clonidine, debrisoquin, guanadrel, guanethidine, guanabenz, guanfacine; monitor BP; consider alternate antihypertensive agent Abrupt discontinuation of clonidine may cause hypertensive crisis, amoxapine may enhance the response Use with altretamine may cause orthostatic hypertension Amoxapine may be additive with or may potentiate the action of other CNS depressants (sedatives, hypnotics, or ethanol) With MAO inhibitors, hyperpyrexia, hypertension, tachycardia, confusion, seizures, and deaths have been reported (serotonin syndrome); this combination should be avoided Amoxapine may increase the prothrombin time in patients stabilized on warfarin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cimetidine and methylphenidate may decrease the metabolism of amoxapine; additive anticholinergic effects seen with other anticholinergic agents The SSRIs, to varying degrees, inhibit the metabolism of TCAs and clinical toxicity may result Use of lithium with a TCA may increase the risk for neurotoxicity Phenothiazines may increase concentration of some TCAs and TCAs may increase concentration of phenothiazines; monitor for altered clinical response TCAs may enhance the hypoglycemic effects of tolazamide, chlorpropamide, or insulin; monitor for changes in blood glucose levels Cholestyramine and colestipol may bind TCAs and reduce their absorption; monitor for altered response TCAs may enhance the effect of amphetamines; monitor for adverse CV effects Verapamil and diltiazem appear to decrease the metabolism of imipramine and potentially other TCAs; monitor for increased TCA concentrations. The pressor response to I.V. epinephrine, Genghis Khun ([email protected],nafanakhun.wordpress.com)


norepinephrine, and phenylephrine may be enhanced in patients receiving TCAs; this combination is best avoided. Grapefruit juice,amprenavir, indinavir, ritonavir may inhibit the metabolism of clomipramine and potentially other TCAs; monitor for altered effects; a decrease in TCA dosage may be required Quinidine may inhibit the metabolism of TCAs; monitor for altered effect Combined use of anticholinergics with TCAs may produce additive anticholinergic effects; combined use of beta-agonists with TCAs may predispose patients to cardiac arrhythmias Preg: C BSO: Nama Dagang: Asendin



I. Stimulan SSP & Obat ADHD Methylphenidate



Methylphenidate I: Attention deficit hyperactivity disorder (ADHD). BSO: Tablet: 10 mg, 20 mg Kaps 20 mg, 30 mg, 40 mg D: Deficit hyperactivity disorder (ADHD): Tab: + Adults= 5-20 mg 2-3x/hr a.c + Anak 6th= 5 mg 2x/hr. Titrasi per minggu. Max 60 mg/hr. Etended -release tablets: + Dws & anak > 6th=10-20 mg 1x pagi hr a.c. Max 60 mg/hr Narcolepsy: Tab: + Adults= 5-20 mg 2-3x/hr a.c if unable to sleep because of taking medication late in day, take last dose before noon or 6 pm KI: Hipersensitif; psychosis; agitation; hyperthyroidism; uncontrolled hypertension; cardiac disease; glaucoma; current MAOI or within past 2 wk; substance abuse IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Reduces effects of guanethidine and bretylium; toxicity of phenytoin, TCAs, warfarin, primidone, and phenobarbital may increase when administered concurrently with methylphenidate; MAOIs increase toxicity of methylphenidate Preg: C P: Caution in dementia, seizures, and hypertension Nama Dagang: Ritalin/ Ritalin SR/ Ritalin LA



J. Nootropik & Neurotonik Piracetam Mecobalamin Pyritinol Sulbutiamine Citrulline Nimodipine



Piracetam I: Gejala involusi yg berhub dg proses penuaan, misal: lupa, asthenia, ggn adaptasi, ggn reaksi psikomotor, alkoholisme kronik & ketergantungan, Sindrom pasca trauma, myoclonus. BSO: Kaps 400 mg, 800 mg, 1.2 g Sir 500 mg/5cc Amp 200 mg/cc, 1 g/5cc D: 2.4 g/hr terbagi dalam 3 dosis Amp 1 g 3x/hr IM/IV KI: Breastfeeding, Children < 16 years, Moderate to severely decreased liver & kidney function, Pregnancy. P: Decreased kidney function, Elderly people ES: Diarrhoea, insomnia, Depression, Skin rashes, Weight gain, somnolence, Nervousness, Hyperkinesia IO: Jangan diberikan bersama ekstrak tiroid Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mecobalamin I: Neuropati perifer, tinnitus, vertigo, anemia megaloblastik krn defisiensi vit B12. BSO: Kapl 250 mcg, 500 mcg. Amp 500 mcg D: 500 mcg 3x/mggu IO/IV/IM KI: P: Neonatus, bayi premature, anak ES: Anoreksia, mual, diare, ruam kulit IO: Preg:: A, B, C, D, X Nama Dagang:



Pyritinol I: Pasca trauma otak, perdarahan otak, keracunan & radang otak, gejala degenerasi otak sehubungan dg ggn metabolisme & sirkulasi otak. Daya pikir menurun, pelupa, sukar konsentrasi BSO: Drag 100 mg, forte 200 mg Lar 100 cc Amp 20 mg D: Dws 200 mg 3x/hr. terapi minimal 6-8 mgg. Amp min 3 pasang/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Sulbutiamine I: Terapi simtomatik asthenia fungsional BSO: Drag 200 mg D: 200-600 mg 1x/hari atau dlm dosis terbagi. Umumnya 2 tab/ hari pd waktu sarapan KI: P: ES: Agitasi ringan pd usia lanjut. Reaksi alergi kulit IO: Preg: A, B, C, D, X Nama Dagang: Arcalion 200



Citrulline I: Membantu & memperbaiki metabolisme tubuh.Menjaga kebugaran tubuh saat kerja keras,olahraga & masa pemulihan. BSO: Sachet D: 1 sachet 3x/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Stimol



Nimodipine I: Bleeding into the space between the skull and the brain (subarachnoid haemorrhage) BSO: Tab 30 mg, Lar Infus 10 mg/50cc D: Adults: 60 mg q4 hours for 21 days. Infus 1-2 mg/jam selama 5-14 hari. Lalu selama 7 hari berikutnya 2 tab 6x/hr. KI: Hypersensitivity P: Kidney disease, cerebral oedema ES: Headache, tachycardia, bradycardia, facial flushing, hypotension, Nausea, diarrhoea, constipation, nausea, vomiting or abdominal pain, Feeling of warmth IO: Preg: C Nama Dagang: Nimotop



K. Anti Emetik & Anti Vertigo Dimenhydrinate Domperidone Promethazine theoclate Betahistine Metoclopramide HCl Cinnarizine Chlorpromazine Perphenazine Diphenhydramine Clebropride Malate Sulpiride Ondansetron Tropisetron Granisetron



Dimenhydrinate Antihistamine -- A 1:1 salt of 8-chlorotheophylline and diphenhydramine believed to be particularly useful in treatment of vertigo. Diminishes vestibular stimulation and depresses labyrinthine function by means of central anticholinergic activity. I: nausea, vertigo, and vomiting associated with motion sickness BSO: Tab/ Caps: 50 mg Injection: 50 mg/mL Liquid: 12.5 mg/4 mL D: 50 mg PO/IM q4-6h or 100-mg supp q8h Paed. 2-6 years: Up to 12.5-25 mg PO/IM q6-8h; max 75 mg/d 6-12 years: 25-50 mg PO q6-8h; max 150 mg/d KI: Hipersensitif; administration to neonates (IV products may contain benzyl alcohol, which has been associated with fatal Genghis Khun ([email protected],nafanakhun.wordpress.com)


gasping syndrome in premature infants and low-birth-weight infants) IO: Alcohol or other CNS depressants may have additive effect; caution with concurrent antibiotics that may cause ototoxicity; may mask ototoxic symptoms caused by certain antibiotics (irreversible damage may result) Preg: B P: Do not treat severe emesis with antiemetic drugs alone; may contain either sulfites or tartrazine, which may cause allergictype reactions in susceptible persons; may impede diagnosis of conditions such as brain tumors, intestinal obstruction, and appendicitis; may obscure signs of toxicity from overdosage of other drugs Nama Dagang:



Promethazine theoclate Antihistamines I: Vertigo, Nausea and vomiting, Preventing travel sickness BSO: Tab 25 mg D: 25 mg 1x/hr tiap malam KI: Allergy, neonates, People who have taken MAOIs in the last 14 days, Reduced awareness, slow reactions or drowsiness, comatose states P: Asthma, Breastfeeding, Bronchitis, Closed angle glaucoma, Decreased kidney function, Epilepsy, Liver disease, Obstruction of the bladder or intestine, Pregnancy, bronchiectasis ES: Headache, Blurred vision, urinary retention, Confusion, Nightmares, Restlessness, photosensitivity, palpitations, Dizziness, Disorientation, paradoxical hyperexcitability, Dry mouth, Drowsiness IO: alcohol, nalgesik narkotik, hipnotik sedative, trankuilizer, barbiturat Preg: C Nama Dagang:Nufapreg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Betahistine I: Vertigo, tinnitus and hearing problems associated with Ménière's disease BSO: Tab 8 mg D: 8 mg 3x/hr Max 6 tab/hr dlm dosis terbagi KI: Tumour of the adrenal gland (phaeochromocytoma) P: Peptic ulcer, Asthma ES: Itching (pruritus), indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, Rash IO: Preg:: A, B, C, D, X Nama Dagang:



Diphenhydramine hydrochloride Antihistamine I: Symptomatic relief of allergic symptoms caused by histamine release which include nasal allergies and allergic dermatosis; can be used for mild nighttime sedation; prevention of motion sickness and as an antitussive; has antinauseant and topical anesthetic properties; treatment of antipsychotic-induced extrapyramidal reactions BSO: Vial 10 mg/cc, 50 mg/mL Tablet & Capsule: 25 mg, 50 mg Cream, Lotion & Solution, topical spray:1%, 2% Syrup & Elixir: 12.5 mg/5 mL D: Adults: Oral: 25-50 mg q6-8 hours Nighttime sleep aid: 50 mg at bedtime I.M., I.V.: 10-50 mg 1x q2-4 hours, max 400 mg/day Topical: max 7 days Children: Oral: (>10 kg): 12.5-25 mg 3-4x/day; max 300 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


IM/IV: 5 mg/kg/day or 150 mg/m2/day in divided doses q6-8 hours, max 300 mg/day KI: Hipersensitif; MAOIs IO: Potentiates effect of CNS depressants; due to alcohol content, do not administer syrup dosage form to patient taking medications that can cause disulfiramlike reactions Preg: C P: May exacerbate glaucoma, hyperthyroidism, peptic ulcer, or urinary tract obstruction; xerostomia may occur Nama Dagang:



Ondansetron Selective 5-HT3-receptor antagonist, blocking serotonin, both peripherally on vagal nerve terminals and centrally in the chemoreceptor trigger zone. I: Nausea and vomiting caused by chemotherapy or radiotherapy for cancer & following surgery. BSO: Injection: 2 mg/mL; 32 mg Solution: 4 mg/5 mL Tablet: 4 mg, 8 mg, 24 mg Tablet, orally disintegrating: 4 mg, 8 mg D: 4-8 mg PO q12h Alternatively, 8 mg administered IV over 15 min q12h or 1 mg/h infused continuously for up to 24 h Solution, oral disintegrating tablets, and tablets: Anticancer medicine: Adults: 8 mg 2-3x/day 30’ before the anticancer medicine. 4-11 years: 4 mg More severe nausea and vomiting: Adults: 24 mg 30’ before the anticancer medicine After surgery: Adults: 16 mg 1h before anesthesia. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Radiation treatment: Adults: 8 mg 1-2h before radiation. the anticancer medicine. 4-11 years: 4 mg Injection: Anticancer medicine: Adults: 32 mg IV slow > 15‘. 150 mcg/kg 30’ before anticancer. Prevention of nausea and vomiting after surgery: Adults: 4 mg IV slow > 30’’-4‘. 100 mcg/kg 30’ before anesthesi KI: Hipersensitif IO: Food increases extent of absorption; Cmax and Tmax do not change much; St John's wort may decrease ondansetron levels; due to reports of profound hypotension during concomitant therapy, manufacturer of apomorphine contraindicates use with ondansetron; CYP3A4 inducers may decrease levels/effects of ondansetron Preg: B P: May mask progressive ileus and/or gastric distension; anaphylactoid reactions may occur Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tropisetron I: Prevention of cancer chemotherapy-induced nausea and vomiting in children, Prevention of post-surgical nausea and vomiting in adults who are at high risk of post-surgical nausea and vomiting, post-surgical nausea and vomiting in adults BSO: Kaps 5 mg. Amp 5 mg/5cc D: Hari 1: Infus IV 5 mg atau Inj IV pelan Hari 2-6 dst: Tab pagi a.c KI: Pregnancy P: Disturbed heart rhythm or nerve conduction within the heart # People taking and anti-arrhythmia or beta-blocking medicines ES: Headache, Fatigue, diarrhoea, constipation, nausea, vomiting or abdominal pain, Dizziness, Allergy IO: Preg:: A, B, C, D, X Nama Dagang: Navoban



Granisetron I: Preventing and treating nausea and vomiting caused by chemotherapy or radiotherapy for cancer & following surgery in adults and children. BSO: Amp: 1 mg/mL Tablet: 1 mg D: Anticancer medicine: Tab: 1 mg 1h before anticancer medicine 2x/day Injection: 10 mcg IV slow > 5’. 30’ before anticancer medicine Radiation therapy: 2 mg 1h before radiation KI: Hypersensitivity, tablets contain lactose -> should not be taken by people with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption. P: Intestinal obstruction. ES: Headache, Constipation, Skin rash, Alteration in results of liver function tests, hypersensitivity. Preg: B Nama Dagang: Kytril Genghis Khun ([email protected],nafanakhun.wordpress.com)


L. Penyakit NeuroDegeneratif Rivastigmine Donepezil Galantamine



Rivastigmine I: Mild to moderately dementia in Alzheimer & Parkinson BSO: Capsule: 1.5 mg, 3 mg, 4.5 mg, 6 mg Solution, oral: 2 mg/mL D: Adults: 1.5 mg 2x/day. Max 6 mg 2x/day. KI: Decreased liver function, Breastfeeding, children P: Sick sinus syndrome, heart conduction defects, peptic ulcer, asthma, COPD, History of urinary obstruction, seizures ES: Nausea, vomiting, diarrhoea, indigestion or abdominal pain, Decreased appetite and weight loss, Dizziness, Increased sweating, Fatigue, asthenia, Agitation, Headache, somnolence, tremor, Confusion, insomnia, Depression, syncope, Ulceration of the stomach or intestine, Seizures, angina, Rash, hallucinations, Worsening of Parkinson's symptoms, Abnormal heart beats Preg: B Nama Dagang: Exelon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Donepezil HCl I: Mild to moderately severe Alzheimer's dementia. BSO: Tab 5 mg, 10 mg D: Mild-moderate Alzheimer: 5 mg hs. Max 10 mg/day Severe Alzheimer' :10 mg hs (at bedtime). KI: Children, Breastfeeding P: Decreased liver function, sick sinus syndrome, heart conduction defects, peptic ulcer, People taking long-term NSAIDs, urinary obstruction, Parkinson's disease, Epilepsy, Asthma, Chronic obstructive pulmonary disease (COPD). ES: Nausea and vomiting, Loss of appetite, Diarrhoea, Fatigue, insomnia, Headache, Dizziness, Fainting, Hallucinations, Agitation, Aggressive behaviour, Muscle cramps, Urinary incontinence, Rash or itching, bradycardia, Seizure, Liver disorders, extrapyramidal effects. IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Galantamine I: Mild to moderately severe Alzheimer's disease BSO: Tab 4 mg D: 4 mg 2x/day KI: Severely decreased kidney & liver function, Breastfeeding. P: Moderately reduced liver function, cardiovascular disease, atrial fibrillation, Unstable angina pectoris, Disturbances in the level of potassium in the blood, cerebrovascular disease, Epilepsy, Parkinson's disease, COPD, severe asthma, Active lung infections, peptic ulcers ES: Nausea, vomiting, diarrhoea, constipation, indigestion or abdominal pain, Loss of appetite and weight loss, Fatigue, Dizziness, Headache, Fever, Confusion, Depression, Falls, insomnia, Tremor, Abnormal heart beats, bradycardia, Seizures, Hallucinations, Aggression, hypokalaemia Preg: B Nama Dagang:Reminyl Genghis Khun ([email protected],nafanakhun.wordpress.com)


M. Penyakit Neuromuskular Neostigmine Pyridostigmine



Neostigmine I: Myasthenia gravis, urinary retention, paralytic ileus BSO: Injection: 0.25 mg/mL; 0.5 mg/mL; 1 mg/mL Tablet: 15 mg D: Myasthenia gravis: Diagnosis: I.M.: Children: 0.04 mg/kg as a single dose Adults: 0.02 mg/kg as a single dose Myasthenia gravis: Treatment: Children: Oral: 2 mg/kg/day divided every 3-4 hours I.M., I.V., S.C.: 0.01-0.04 mg/kg q2-4 hours Adults: Oral: 15 mg/dose q3-4 hours max 375 mg/day IM/IV/SC: 0.5-2.5 mg q1-3 hours max 10 mg/24 hours Reversal of nondepolarizing neuromuscular blockade after surgery in conjunction with atropine: I.V.: Infants: 0.025-0.1 mg/kg/dose Children: 0.025-0.08 mg/kg/dose Adults: 0.5-2.5 mg; total dose max 5 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bladder atony: Adults: I.M., S.C.: Prevention: 0.25 mg every 4-6 hours for 2-3 days Treatment: 0.5-1 mg every 3 hours for 5 doses after bladder has emptied Dosing adjustment in renal impairment: Clcr 10-50 mL/minute: Administer 50% of normal dose Clcr <10 mL/minute: Administer 25% of normal dose KI: Intestinal obstruction, allergy, Obstruction of the urinary tract P: Asthma, Decreased kidney function, Epilepsy, hypotension, Parkinson's disease, People who have recently had a heart attack, Peptic ulcer, bradycardia ES: Abdominal cramps, Diarrhoea, Nausea and vomiting, Increased salivation IO: Preg: C Nama Dagang:



Pyridostigmine I: Myasthenia gravis, urinary retention, paralytic ileus BSO: Tab: 60 mg D: Normally, sustained release dosage form is used at bedtime for patients who complain of morning weakness Oral: Children: 7 mg/kg/day in 5-6 divided doses Adults: Initial: 60 mg 3 times/day with maintenance dose ranging from 60 mg to 1.5 g/day; sustained release formulation should be dosed at least every 6 hours (usually 12-24 hours) IM/IV: Children: 0.05-0.15 mg/kg/dose (max single dose: 10 mg) Adults: 2 mg q2-3 hours or 1/30th of oral dose Reversal of nondepolarizing neuromuscular blocker: IM/IV: Children: 0.1-0.25 mg/kg/dose preceded by atropine Adults: 10-20 mg preceded by atropine KI: Intestinal obstruction, Obstruction of the urinary tract P: Asthma, Decreased kidney function, Epilepsy, hypotension, Parkinson's disease, People who have recently had a heart attack, Peptic ulcer, bradycardia Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Abdominal cramps, Diarrhoea, Nausea and vomiting, Increased salivation IO: Preg:: A, B, C, D, X Nama Dagang: Mestinon



N. Preparat Parkinson Levodopa Estazolam Trihexyphenidyl



Levodopa I: Parkinson BSO: Capsule: 100 mg, 250 mg, 500 mg Tablet: 100 mg, 250 mg, 500 mg D: 250 mg 2-4x/day. Max 8 g/day KI: < 25 years, Severe liver, kidney & heart disease, endocrine disease, Closed angle glaucoma, malignant melanoma, Suspicious skin lesions of unknown cause, Severe psychotic illness, Pregnancy, Breastfeeding, People who have taken MAOI in the last 14 days. P: Liver, Kidney & Lung disease, Asthma, cardiovascular disease, heart attack, arrhythmias, endocrine disorders, Diabetes, convulsions, peptic ulcers, psychiatric illness, Open angle glaucoma, osteomalacia. ES: Dyskinesia, diarrhoea, constipation, nausea, vomiting or abdominal pain, Mood changes, strange or abnormal thoughts or depression, Confusion, palpitations, Irregular heart beats, postural hypotension, Loss of appetite, Dry mouth, asthenia, insomnia, somnolence, Suddenly falling asleep, hallucinations, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bleeding or ulceration in the stomach or intestines, Disturbances in the normal numbers of blood cells in the blood, pathological gambling, hypersexuality, Visual disturbances, dyspnoea IO: Preg: C Nama Dagang:



Estazolam I: Short-term management of insomnia BSO: Tablet: 1 mg, 2 mg D: Adults: Oral: 1 mg at bedtime, some patients may require 2 mg; start at doses of 0.5 mg in debilitated or small elderly patients KI: Hypersensitivity, pregnancy P: Use with caution in elderly or debilitated patients, patients with hepatic disease (including alcoholics), or renal impairment. Use with caution in patients with respiratory disease or impaired gag reflex. Avoid use in patients with sleep apnea. As a hypnotic, should be used only after evaluation of potential causes of sleep disturbance. Failure of sleep disturbance to resolve after 7-10 days may indicate psychiatric or medical illness. A worsening of insomnia or the emergence of new abnormalities of thought or behavior may represent unrecognized psychiatric or medical illness and requires immediate and careful evaluation. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Benzodiazepines have been associated with anterograde amnesia. Paradoxical reactions, including hyperactive or aggressive behavior, have been reported with benzodiazepines, particularly in adolescent/pediatric or psychiatric patients. Does not have analgesic, antidepressant, or antipsychotic properties. Use caution in patients with depression, particularly if suicidal risk may be present. Use with caution in patients with a history of drug dependence. Benzodiazepines have been associated with dependence and acute withdrawal symptoms on discontinuation or reduction in dose. Acute withdrawal, including seizures, may be precipitated in patients after administration of flumazenil to patients receiving long-term benzodiazepine therapy. ES: >10%: Somnolence, Weakness 1-10%: Flushing, palpitations, Anxiety, confusion, dizziness, hypokinesia, abnormal coordination, hangover, agitation, amnesia, apathy, emotional lability, euphoria, hostility, seizure, sleep disorder, stupor, twitch , Dermatitis, pruritus, rash, urticaria, Xerostomia, constipation, decreased appetite, Genghis Khun ([email protected],nafanakhun.wordpress.com)


flatulence, gastritis, increased appetite, perverse taste, Frequent urination, menstrual cramps, urinary hesitancy, urinary frequency, vaginal discharge/itching, Paresthesia, Photophobia, eye pain, eye swelling, Cough, dyspnea, asthma, rhinitis, sinusitis, Diaphoresis IO: Carbamazepine, rifampin, rifabutin may enhance the metabolism of estazolam and decrease its therapeutic effect; consider using an alternative sedative/hypnotic agent Cimetidine, ciprofloxacin, clarithromycin, clozapine, CNS depressants, diltiazem, disulfiram, digoxin, erythromycin, ethanol, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, isoniazid, itraconazole, ketoconazole, labetalol, levodopa, loxapine, metoprolol, metronidazole, miconazole, nefazodone, omeprazole, phenytoin, rifabutin, rifampin, troleandomycin, valproic acid, verapamil may increase the serum level and/or toxicity of estazolam Preg: X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Trihexyphenidyl (THP) I: Parkinson's disease, extrapyramidal symptoms which are side effects of another medicine. BSO: Elixir: 2 mg/5 mL Tablet: 2 mg, 5 mg D: Initial: 1-2 mg/day, increase by 2 mg increments at intervals of 3-5 days; usual dose: 5-15 mg/day in 3-4 divided doses KI: Children, tardive dyskinesia, rare hereditary problems of fructose intolerance, glucose-galactose malabsoprtion or sucrase-maltase insufficiency. P: Elderly people, Decreased kidney, liver &heart function, hypertension, Glaucoma, prostatic hypertrophy, obstruction in the genitourinary tract, obstruction in the stomach or intestines, myaesthenia gravis. ES: Dry mouth, Constipation, Blurred vision, insomnia, Confusion, Agitation, Restlessness, hallucinations, euphoria, Memory problems. Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Decreased effect: May increase gastric degradation of levodopa and decrease the amount of levodopa absorbed by delaying gastric emptying; the opposite may be true for digoxin Therapeutic effects of cholinergic agents (tacrine, donepezil) and neuroleptics may be antagonized Increased toxicity: Central and/or peripheral anticholinergic syndrome can occur when administered with amantadine, rimantadine, narcotic analgesics, phenothiazines and other antipsychotics (especially with high anticholinergic activity), tricyclic antidepressants, quinidine and some other antiarrhythmics, and antihistamines Preg: C BSO: Nama Dagang:



O. Relaksan Otot Botulinum Toxin type A, Clostridium botulinum A Succinylcholine Cl/ Suxamethonium chloride Pancuronium Br Vecuronium Br Rocuronium Br Atracurium besilate Eperisone Chlorzoxazone Baclofen Tizanidine



Botulinum Toxin type A, Clostridium botulinum type A Ophthalmic Agent, Toxin I: Blepharospasm, hemifacial spasm, spasmodic torticollis/idiopathic cervical dystonia, Wrist and hand disability in adults due to spasm of the muscle in the upper arm as a result of a stroke, dynamic equinus foot deformity, hyperhidrosis BSO: Vial 100 u D: Awal 2.5 u/0.1 cc Eye conditions: IM into the muscles around the eyes 1/> times. cervical dystonia: IM into the muscles of the neck Severe sweating of the armpits (primary axillary hyperhidrosis): IM below the skin in the armpit KI: Infection at the proposed injection site, myasthenia gravis, Eaton Lambert syndrome P: Inflammation in the area to be injected, Excessive weakness or wasting in the muscle to be injected, dysphagia, seizures, cardiovascular disease, amyotrophic lateral sclerosis, People who have recently had surgery or are due to have surgery in the Genghis Khun ([email protected],nafanakhun.wordpress.com)


near future, People at risk of closed angle glaucoma, People who have had previous eye surgery ES: Pain at the injection site, Misplaced injections may paralyse nearby muscles and excessive doses may paralyse muscles that are not near the injection site, Fever, Flu-like symptoms, dysphagia, Rash or itching IO: The muscle paralysing effect of botulinum toxin type A may be increased by the following medicines: * aminoglycoside antibiotics, eg neomycin, gentamicin * spectinomycin * muscle relaxants, particularly those used in anaesthesia * antibiotics such as polymixins, tetracyclines or lincomycin. Preg: C Nama Dagang: BTXA



Succinylcholine Cl/ Suxamethonium chloride Neuromuscular Blocker Agent, Depolarizing I: Produces skeletal muscle relaxation in procedures of short duration such as endotracheal intubation or endoscopic exams BSO: Injection: 20 mg/mL; 50 mg/mL; 100 mg/mL Powder for injection: 100 mg, 500 mg, 1 g D: I.M., I.V.: Older Children and Adolescents: Intermittent: Initial: 1 mg/kg/dose one time; maintenance: 0.3-0.6 mg/kg every 5-10 minutes as needed Adults: 0.6 mg/kg (range: 0.3-1.1 mg/kg) over 10-30 seconds, up to 150 mg total dose Maintenance: 0.04-0.07 mg/kg every 5-10 minutes as needed Continuous infusion: 2.5 mg/minute (or 0.5-10 mg/minute); dilute to concentration of 1-2 mg/mL in D5W or NS Note: Pretreatment with atropine may reduce occurrence of bradycardia Dosing adjustment in hepatic impairment: Dose should be decreased in patients with severe liver disease Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Malignant hyperthermia, myopathies associated with elevated serum creatine phosphokinase (CPK) values, narrowangle glaucoma, hyperkalemia, penetrating eye injuries, disorders of plasma pseudocholinesterase, hypersensitivity to succinylcholine or any component P: Use in pediatrics and adolescents; use with caution in patients with pre-existing hyperkalemia, paraplegia, extensive or severe burns, extensive denervation of skeletal muscle because of disease or injury to the CNS or with degenerative or dystrophic neuromuscular disease; may increase vagal tone ES: >10%: glaukoma, Postoperative stiffness 1-10%: Bradycardia, hypotension, cardiac arrhythmias, tachycardia, Intragastric pressure, salivation IO: Increased toxicity: Anticholinesterase drugs (neostigmine, physostigmine, or pyridostigmine) in combination with succinylcholine can cause cardiorespiratory collapse; cyclophosphamide, oral contraceptives, lidocaine, thiotepa, pancuronium, lithium, magnesium salts, aprotinin, chloroquine, Genghis Khun ([email protected],nafanakhun.wordpress.com)


metoclopramide, terbutaline, and procaine enhance and prolong the effects of succinylcholine Prolonged neuromuscular blockade: Inhaled anesthetics Local anesthetics Calcium channel blockers Antiarrhythmics (eg, quinidine or procainamide) Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin) Immunosuppressants (eg, cyclosporine) Preg: C Nama Dagang: Quelicin



Pancuronium Br Neuromuscular Blocker Agent, Nondepolarizing I: Drug of choice for neuromuscular blockade except in patients with renal failure, hepatic failure, or cardiovascular instability; produce skeletal muscle relaxation during surgery after induction of general anesthesia, increase pulmonary compliance during assisted respiration, facilitate endotracheal intubation, preferred muscle relaxant for neonatal cardiac patients, must provide artificial ventilation BSO: Injection: 1 mg/mL; 2 mg/mL D: Based on ideal body weight in obese patients. I.V.: Continuous I.V. infusions are not recommended due to case reports of prolonged paralysis Dosing adjustment in renal impairment: Elimination half-life is doubled, plasma clearance is reduced and rate of recovery is sometimes much slower Clcr 10-50 mL/minute: Administer 50% of normal dose Clcr <10 mL/minute: Do not use Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dosing adjustment/comments in hepatic disease: Elimination half-life is doubled, plasma clearance is doubled, recovery time is prolonged, volume of distribution is increased (50%) and results in a slower onset, higher total dosage and prolongation of neuromuscular blockade Patients with liver disease may develop slow resistance to nondepolarizing muscle relaxant; large doses may be required and problems may arise in antagonism KI: Hypersensitivity P: Ventilation must be supported during neuromuscular blockade. Electrolyte imbalance alters blockade. Use with caution in patients with myasthenia gravis or other neuromuscular diseases, pre-existing pulmonary, hepatic, renal disease, and in the elderly ES: 1-10%: Elevation in pulse rate, elevated blood pressure, tachycardia, hypertension, Rash, itching, Excessive salivation IO: Increased toxicity: Magnesium sulfate, furosemide can increase or decrease neuromuscular blockade (dosedependent) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prolonged neuromuscular blockade: Inhaled anesthetics Local anesthetics Calcium channel blockers Antiarrhythmics (eg, quinidine or procainamide) Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin) Immunosuppressants (eg, cyclosporine) Preg: C Nama Dagang: Pavulon



Vecuronium Br Neuromuscular Blocker Agent, Nondepolarizing I: Adjunct to anesthesia, to facilitate intubation, and provide skeletal muscle relaxation during surgery or mechanical ventilation BSO: Powder for injection: 10 mg D: I.V. (do not administer I.M.): Children >1 year and Adults: Initial: 0.08-0.1 mg/kg/dose; maintenance: 0.05-0.1 mg/kg/every hour as needed; may be administered with caution as a continuous infusion at 0.075 mg/ kg/hour (concern has been raised of drug-induced myopathies in ICU setting) Note: Children (1-10 years) may require slightly higher initial doses and slightly more frequent supplementation KI: hypersensitivity P: Use with caution in patients with hepatic impairment, neuromuscular disease, myasthenia gravis, and the elderly; ventilation must be supported during neuromuscular blockade Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: <1%: Tachycardia, flushing, edema, hypotension, circulatory collapse, bradycardia, rash, itching, hypersensitivity reaction IO: Increased toxicity/effect with aminoglycosides, ketamine, magnesium sulfate, verapamil, quinidine, clindamycin, furosemide Preg: C Nama Dagang: Norcuron



Rocuronium bromide Neuromuscular Blocker Agent, Nondepolarizing I: Inpatient and outpatient use as an adjunct to general anesthesia to facilitate both rapid-sequence and routine tracheal intubation, and to provide skeletal muscle relaxation during surgery or mechanical ventilation BSO: Injection: 10 mg/mL D: Children: Initial: 0.6 mg/kg under halothane anesthesia produce excellent to good intubating conditions within 1 minute and will provide a median time of 41 minutes of clinical relaxation in children 3 months to 1 year of age, and 27 minutes in children 1-12 years Maintenance: 0.075-0.125 mg/kg administered upon return of T1 to 25% of control provides clinical relaxation for 7-10 minutes Adults: Tracheal intubation: I.V.: Initial: 0.6 mg/kg is expected to provide approximately 31 minutes of clinical relaxation under opioid/nitrous oxide/oxygen anesthesia with neuromuscular block sufficient for intubation Genghis Khun ([email protected],nafanakhun.wordpress.com)


attained in 1-2 minutes; lower doses (0.45 mg/kg) may be used to provide 22 minutes of clinical relaxation with median time to neuromuscular block of 1-3 minutes; maximum blockade is achieved in <4 minutes Maximum: 0.9-1.2 mg/kg may be given during surgery under opioid/nitrous oxide/oxygen anesthesia without adverse cardiovascular effects and is expected to provide 58-67 minutes of clinical relaxation; neuromuscular blockade sufficient for intubation is achieved in <2 minutes with maximum blockade in <3 minutes Maintenance: 0.1, 0.15, and 0.2 mg/kg administered at 25% recovery of control T1 (defined as 3 twitches of train-of-four) provides a median of 12, 17, and 24 minutes of clinical duration under anesthesia Rapid sequence intubation: 0.6-1.2 mg/kg in appropriately premedicated and anesthetized patients with excellent or good intubating conditions within 2 minutes Genghis Khun ([email protected],nafanakhun.wordpress.com)


Continuous infusion: Initial: 0.01-0.012 mg/kg/minute only after early evidence of spontaneous recovery of neuromuscular function is evident Dosing adjustment in hepatic impairment: Reductions are necessary in patients with liver disease KI: hypersensitivity P: Use with caution in patients with cardiovascular or pulmonary disease, hepatic impairment, neuromuscular disease, myasthenia gravis, dehydration (may alter neuromuscular blocking effects); respiratory acidosis, hypomagnesemia, hypokalemia, or hypocalcemia (may enhance actions) and the elderly; ventilation must be supported during neuromuscular blockade ES: >1%: Transient hypotension and hypertension <1%: Arrhythmias, abnormal EKG, tachycardia, edema, rash, injection site pruritus, nausea, vomiting, bronchospasm, wheezing, rhonchi, hiccups Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Decreased effect: Chronic carbamazepine or phenytoin can shorten the duration of neuromuscular blockade; phenylephrine can severely inhibit neuromuscular blockade Increased effect: Infusion requirements are reduced 35% to 40% during anesthesia with enflurane or isoflurane Increased toxicity: Aminoglycosides, vancomycin, tetracyclines, bacitracin Preg: B Nama Dagang: Esmeron



Atracurium besilate Neuromuscular Blocker Agent, Nondepolarizing I: Drug of choice for neuromuscular blockade in patients with renal and/or hepatic failure; eases endotracheal intubation as an adjunct to general anesthesia and relaxes skeletal muscle during surgery or mechanical ventilation; does not relieve pain BSO: Injection: 10 mg/mL Injection, preservative-free: 10 mg/mL D: I.V. (not to be used I.M.): Children >2 years to Adults: 0.4-0.5 mg/kg, then 0.08-0.1 mg/kg 20-45 minutes after initial dose to maintain neuromuscular block Infusions (require use of an infusion pump): 0.2 mg/mL or 0.5 mg/mL in D5W or NS Continuous infusion: Initial: 9-10 mcg/kg/minute followed by 5-9 mcg/kg/minute maintenance KI: Hypersensitivity P: Reduce initial dosage in patients in whom substantial histamine release would be potentially hazardous (eg, patients Genghis Khun ([email protected],nafanakhun.wordpress.com)


with clinically important cardiovascular disease); maintenance of an adequate airway and respiratory support is critical ES: Mild, rare, and generally suggestive of histamine release <1%: Cardiovascular effects are minimal and transient, erythema, itching, urticaria, wheezing, bronchial secretions Causes of prolonged neuromuscular blockade: Excessive drug administration Cumulative drug effect, decreased metabolism/excretion (hepatic and/or renal impairment) Accumulation of active metabolites Electrolyte imbalance (hypokalemia, hypocalcemia, hypermagnesemia, hypernatremia) Hypothermia Drug interactions Increased sensitivity to muscle relaxants (eg, neuromuscular disorders such as myasthenia gravis or polymyositis) IO: Prolonged neuromuscular blockade: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Halothane has only a marginal effect, enflurane and isoflurane increases the potency and prolong duration of neuromuscular blockade induced by atracurium by 35% to 50% Dosage should be reduced by 33% in patients receiving isoflurane or enflurane and by 20% in patients receiving halothane Local anesthetics Calcium channel blockers Corticosteroids Antiarrhythmics (eg, quinidine or procainamide) Antibiotics (eg, aminoglycosides, tetracyclines, vancomycin, clindamycin) Immunosuppressants (eg, cyclosporine) Preg: C Nama Dagang:



Eperisone I: spasme muskuloskeletal BSO: Tab salut selaput 50 mg D: 50 mg 3x/hr KI: P: Ggn hati ES: Ggn hati, lemas, insomnia IO: Preg:: A, B, C, D, X Nama Dagang:



Chlorzoxazone Skeletal Muscle Relaxant I: Dental: Treatment of muscle spasm with acute temporomandibular joint pain Medical: Symptomatic treatment of muscle spasm and pain associated with acute musculoskeletal conditions BSO: Tab 200 mg D: 500 mg 3-4x/day KI: hypersensitivity P: ES: Bloody or black, tarry stools, Clay-colored stools, Constipation, Cough, Dark urine, Decreased appetite, Difficulty swallowing, Dizziness, Fast heartbeat, Fever, Headache, Hives, Itching, Large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, Loss of appetite, Nausea and vomiting, Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue, Severe stomach pain, Shortness of breath, Skin rash * Swelling of the feet or lower legs Genghis Khun ([email protected],nafanakhun.wordpress.com)


* Tightness in the chest * Unusual tiredness or weakness * Vomiting of blood or material that looks like coffee grounds * Wheezing * Yellow eyes or skin IO: CYP2E1 enzyme substrate Preg: C Nama Dagang: Solaxin



Baclofen Skeletal Muscle Relaxant I: Multiple sclerosism, Tumours in the spinal cord, Motor neurone disease, traumatic partial section, Stroke, Cerebral palsy, Head injury BSO: Tab 10 mg D: 5mg 3x/day, increase 5 mg q3 day. Max 80 mg/day KI: Peptic ulcer P: Elderly people, Decreased kidney & liver function, respiratory disease, Diabetes, Epilepsy, Stroke, People who have previously had peptic ulcer disease, Psychotic disorders, Parkinson's disease ES: Drowsiness, nausea, vomiting, constipation or diarrhoea, Lightheadedness, respiratory depression, Confusion, Headache, insomnia, Mood changes, Muscle weakness, ataxia, Tremor, hallucinations, Nightmares, nystagmus, Dry mouth, Increased need to pass urine, hypertension, convulsions Preg: C Nama Dagang: Lioresal Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tizanidine Alpha2 Agonist I: Multiple sclerosis, Spinal cord injury or disease BSO: Tablet: 4 mg D: 8 mg 3-4x/day. Max 36 mg/day. KI: Allergy, Severe liver disease P: Children, Decreased kidney function, Elderly people ES: Dry mouth, insomnia, Drowsiness, Nausea, Fatigue, diarrhoea, constipation, nausea, vomiting or abdominal pain, hypotension, hallucinations, Dizziness, bradycardia, hepatitis IO: Tizanidine increases the effects of alcohol and sedatives medicines. Tizanidine may increase the blood pressurelowering efects of anti-hypertensive medicines. When taken together with beta blockers or digoxin there is an increased risk of low blood pressure or a slow heart rate. Oral contraceptives reduce the turnover of tizanidine and may increase the likelihood of tizanidine side effects. Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


V. HORMON A. ANDROGEN SINTETIS B. ESTROGEN & PREPARAT SINTETIS C. PROGESTERON SINTETIS D. PROTEKSI KEHAMILAN E. KESUBURAN/ STIMULASI FOLIKEL F. HORMON TROPIK SINTETIS G. HORMON LAIN H. KORTIKOSTEROID I. HORMON REPLACEMENT J. KONTRASEPSI



A. Androgen Sintetis Testosterone Danazol Mesterolone



Testosterone I : treatment of hypogonadism with low BMD BSO : Kaps 40 mg D: Adults—30 mg applied to your upper gum above the left or right incisor 2x/hr KI: hypersensitivity; women with breast cancer; men with breast or prostate cancer IO: Preg: X P: Renal impairment and elderly patients; may increase risk of prostatic hyperplasia; monitor PSA; may increase growth of subclinical prostate carcinoma; discontinue if edema or jaundice occurs; monitor liver function, hemoglobin, hematocrit, and cholesterol; ensure adequate calcium and vitamin D intake Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Danazol -- Synthetic steroid analog with strong antigonadotropic activity (inhibits LH and FSH) and weak androgenic action. Competes with androgen and progesterone at receptor level, resulting in amenorrhea within 3 mo. I: Endometriosis, benign breast disease, hereditary angioedema - that can cause nettle rash and swelling around the eyes, mouth and hands (this is an unlicensed use of this medicine). BSO: Kaps 100 mg, 200 mg D: Endometriosis: 100-400 mg 2x/hari selama 3-6 bulan. Fibrocystic breast disease: 50-200 mg 2x/hari selama 6 bulan. Prevention of attacks of hereditary angioedema: 200 mg 2-3x/ hari. KI: Hipersensitif; breastfeeding; seizure disorders; markedly impaired hepatic function or porphyria IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prolongation of PT occurs in patients who are on warfarin; carbamazepine levels might rise with concurrent use; might interfere with laboratory determinations of DHEA, androstenedione, and testosterone Preg: X P: Caution in renal, hepatic (may elevate serum transaminase levels), or cardiac insufficiency and in seizure disorders; androgen effects may cause hirsutism, acne, lowering of voice, or decreased breast size Nama Dagang:



Mesterolone I: # Low testosterone levels in men # Male infertility caused by low testosterone levels BSO: Tab 25 mg D: Defisiensi androgen awal 25 mg 3-4x/hr selama bbrp bulan. Pemeliharaan 50-75 mg/hr. Infertilitas pria: 100 mg/hr selama bbrp bulan KI: # History of or current liver tumours # Prostate cancer # Women P: Pemeriksaan prostat secara teratur. Hanya utkpria, tumor hati ganas ES: Excessive frequency and duration of erections IO: Preg:: A, B, C, D, X Nama Dagang: Proviron



B. Estrogen & Preparat Sintetis Esterified estrogen Conjugated estrogen Estradiol Ethinylestradiol Estriol Estropipate Tibolone Estradiol valerate Estrone



Esterified estrogen Oral: Breast cancer in women after menopause and in men: 10 mg 3x/day for 3 mo Vulvar atrophy or Atrophic vaginitis, or osteoporosis: 0.3-1.25 mg/day Ovary problems (failure or removal of both ovaries): 1.25 mg/day each day or only on certain days of the month. Ovary problems (female hypogonadism): 2.5-7.5 mg/day Symptoms of menopause: 0.625-1.25 mg/day Prostate cancer: 1.25-2.5 mg 3x/day.



Conjugated Estrogen -- Reduces bone resorption and may increase osteoblast activity. Multiple studies have shown bone loss prevention at the spine and hip when started within 10 y of menopause (but initiate as soon as possible) and continued for life if tolerated. Although due to safety concerns, many now advocate stopping hormones when menopausal symptoms abate and then using other treatments. I: # Hormone replacement therapy to relieve symptoms of the menopause # Second-line option for preventing osteoporosis in postmenopausal women who are at high risk of fractures and cannot take other medicines licensed for preventing osteoporosis. D: Oral: Breast cancer in women after menopause and in men: 10 mg 3x/day for 3 mo Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vulvar atrophy, atrophic vaginitis, symptoms of menopause: 0.3 mg/day each day or only on certain days of the month. Osteoporosis: 0.3 mg/day Ovary problems (female hypogonadism or for starting puberty): 0.3-0.625 mg/day Ovary problems (failure or removal of both ovaries): 1.25 mg/day Prostate cancer: 1.25-2.5 mg 3x/day. Injection: Controlling abnormal bleeding of the uterus: 25 mg IM/IV 2-4x/day KI: Hipersensitif; known or suspected Preg:; breast cancer; undiagnosed abnormal genital bleeding; active thrombophlebitis or thromboembolic disorders; history of thrombophlebitis, thrombosis, or thromboembolic disorders associated with previous estrogen use (except when used in treatment of breast or prostatic malignancy) IO: May reduce hypoprothrombinemic effect of anticoagulants; coadministration of barbiturates, rifampin, and other agents that Genghis Khun ([email protected],nafanakhun.wordpress.com)


induce hepatic microsomal enzymes may reduce levels; pharmacologic and toxicologic effects of corticosteroids may occur as a result of estrogen-induced inactivation of hepatic P-450 enzyme; loss of seizure control has been noted when administered concurrently with hydantoins Preg: X P: Certain patients may develop undesirable manifestations of excessive estrogenic stimulation (eg, abnormal or excessive uterine bleeding, mastodynia); may cause some degree of fluid retention (exercise caution); prolonged unopposed estrogen therapy may increase risk of endometrial hyperplasia (combine with progesterone in women with uterus); caution in hepatic dysfunction, women who breastfeed, gallbladder disease, bone disease associated with hypercalcemia, and uterine leiomyomata; perform initial complete physical examination with blood pressure, PAP smear, and mammogram and repeat annually; discontinue if jaundice or severe uncontrollable hypertension develops; discontinue 2 wk before surgery associated with thromboembolism Genghis Khun ([email protected],nafanakhun.wordpress.com)


Estradiol -- Reduces bone resorption and may increase osteoblast activity. Multiple studies have shown it prevents bone loss at spine and hip when started within 10 y of menopause (initiate as soon as possible after start of menopause) and continued for life if tolerated. D: Oral: Breast cancer in women after menopause and in men: 10 mg/day 3x/day Vulvar atrophy, atrophic vaginitis, female hypogonadism or failure or removal of both ovaries, or symptoms of menopause: 1-2 mg 1x/day fo 3mo Prostate cancer: 1-2 mg 3x/day Osteoporosis: 0.5 mg/day Skin lotion: Symptoms of menopause: 1.74 1x (morning) Transdermal: vulvar atrophy, atrophic vaginitis, symptoms of menopause, ovary problems (female hypogonadism or failure or removal of both ovaries), or osteoporosis: Genghis Khun ([email protected],nafanakhun.wordpress.com)


0.025-0.1mg q1wk for 3 wk KI: Hipersensitif; Preg:; breast cancer; thrombophlebitis; undiagnosed vaginal bleeding IO: May reduce hypoprothrombinemic effects of anticoagulants; levels may be reduced with coadministration of barbiturates, rifampin, and other agents that induce hepatic microsomal enzymes; an increase in corticosteroid levels may occur when administered concurrently with ethinyl estradiol; use of ethinyl estradiol with hydantoins may cause spotting, breakthrough bleeding, and Preg:; increase in fluid retention caused by estrogen intake may reduce seizure control Preg: X P: Unopposed estrogen is associated with endometrial hyperplasia and endometrial carcinoma in women with a uterus (combine estrogen with progesterone in these patients); hepatic dysfunction; conditions aggravated by fluid retention; gallbladder disease; bone disease associated with hypercalcemia; uterine leiomyomata; perform initial complete Genghis Khun ([email protected],nafanakhun.wordpress.com)


physical examination with blood pressure, PAP smear, and mammogram (repeat annually); discontinue if jaundice or severe, uncontrollable hypertension develops; discontinue 2 wk before surgery associated with thromboembolism; caution in women who breastfeed Nama Dagang: Premarin



Ethinylestradiol D: Oral: Breast cancer in women after menopause and in men: 1 mg 3x/day Ovary problems (female hypogonadism or failure or removal of both ovaries): 0.05 mg 3x/day for 3-6 mo Prostate cancer: 0.15-3mg/day Symptoms of menopause: 0.02-0.05 mg/day KI: Hipersensitif, endometrial and hepatic cancer; thromboembolic disorders; undiagnosed vaginal bleeding; smoking in those >35 y; cardiovascular disease IO: Phenobarbital, phenytoin, paramethadione, carbamazepine, troglitazone, rifampicin, and griseofulvin induce enzymes that reduce levels of contraceptive steroids; oral anticoagulants may increase thromboembolic potential Preg: X P: Caution in patients diagnosed with hepatic impairment, migraine, seizure disorders, cerebrovascular disorders, breast cancer, or thromboembolic disease Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Estriol I: # Vaginal and urinary symptoms of the menopause # Female infertility caused by 'cervical hostility' BSO: Tab 1 mg D: 0.5-1 mg/hr pd harike-6 s/d15 KI: Breast cancer, endometrial cancer, endometrial hyperplasia, Vaginal bleeding of unknown cause, deep vein thrombosis, pulmonary embolism, or a past history of these conditions where the cause is unknown, SNH, heart attack, Angina pectoris, Active liver disease, History of liver disease when liver function has not returned to normal, porphyrias, Pregnancy, Breastfeeding, Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Ovestin tablets contain lactose). P: Close family history of breast cancer, fibrocystic breast disease, fibroids in the womb, endometriosis, endometrial hyperplasia, venous thromboembolism, Blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome, factor V Leiden, taking anticoagulants, SLE, Severe Genghis Khun ([email protected],nafanakhun.wordpress.com)


obesity, Varicose veins, Smokers, hypertension, hypertriglyceridaemia, History of liver disease, Decreased kidney function, Heart failure, History of diabetes, gallstones, migraines or severe headaches, epilepsy, asthma, otosclerosis # History of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of hormone preparations such as contraceptive pills (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while taking HRT. ES: Nausea and vomiting, Breast tenderness or pain, Breakthrough bleeding or spotting, Headache, Excessive production of cervical mucus, nausea, abdominal pain, bloating, flatulence, indigestion, Vaginal thrush, Depression, Dizziness, Changes in sex drive, Rise in blood pressure, Gall bladder disease, peripheral oedema, Skin reactions such as rash and itch, Steepening of corneal curvature which may make contact lenses uncomfortable, Premenstrual-like symptoms, Disturbance in liver function, chloasma, Blood clots in the blood Genghis Khun ([email protected],nafanakhun.wordpress.com)


vessels (eg, DVT, pulmonary embolism, heart attack, stroke see warnings above) IO: The following medicines may potentially reduce the blood levels and effect of this medicine, which could result in recurrence of symptoms or irregular bleeding: * antiepileptic medicines, ex carbamazepine, phenytoin * barbiturates such as amobarbital * nevirapine and efavirenz for HIV infection * protease inhibitors for HIV infection such as ritonavir * rifamycin antibiotics such as rifabutin and rifampicin * the herbal remedy St John's wort (Hypericum perforatum). Oestrogens may increase the blood level of ropinirole used to treat Parkinson's disease. Preg:: A, B, C, D, X Nama Dagang: Ovestin



Estropipate I: Hormone replacement therapy to relieve symptoms of the menopause # Second-line option for preventing osteoporosis in postmenopausal women who are at high risk of fractures and cannot take other medicines licensed for preventing osteoporosis. BSO: Cream, vaginal: 0.15% [estropipate 1.5 mg/g] Tablet: 0.625 mg [estropipate 0.75 mg]; 1.25 mg [estropipate 1.5 mg]; 2.5 mg [estropipate 3 mg]; 5 mg [estropipate 6 mg] D: Oral: Vulvar atrophy, atrophic vaginitis, or symptoms of menopause: 0.75-6 mg/day Ovary problems (female hypogonadism or failure or removal of both ovaries): 1.5-9 mg/day Osteoporosis: 0.75 mg/day KI: Breast cancer, endometrial cancer, endometrial hyperplasia, Vaginal bleeding of unknown cause, deep vein thrombosis, pulmonary embolism, or a past history of these conditions where the cause is unknown, SNH, heart attack, Angina Genghis Khun ([email protected],nafanakhun.wordpress.com)


pectoris, Active liver disease, History of liver disease when liver function has not returned to normal, porphyrias, Pregnancy, Breastfeeding, Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Ovestin tablets contain lactose). P: Close family history of breast cancer, fibrocystic breast disease, fibroids in the womb, endometriosis, endometrial hyperplasia, venous thromboembolism, Blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome, factor V Leiden, taking anticoagulants, SLE, Severe obesity, Varicose veins, Smokers, hypertension, hypertriglyceridaemia, History of liver disease, Decreased kidney function, Heart failure, History of diabetes, gallstones, migraines or severe headaches, epilepsy, asthma, otosclerosis # History of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of hormone preparations such as contraceptive pills (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while taking HRT. Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Nausea and vomiting, Breast tenderness or pain, Breakthrough bleeding or spotting, Headache, Excessive production of cervical mucus, nausea, abdominal pain, bloating, flatulence, indigestion, Vaginal thrush, Depression, Dizziness, Changes in sex drive, Rise in blood pressure, Gall bladder disease, peripheral oedema, Skin reactions such as rash and itch, Steepening of corneal curvature which may make contact lenses uncomfortable, Premenstrual-like symptoms, Disturbance in liver function, chloasma, DVT, pulmonary embolism, heart attack, stroke IO: Decreased effect: Rifampin decreases estrogen serum concentrations. Increased toxicity: Hydrocortisone increases corticosteroid toxic potential, Anticoagulants: Increases potential for thromboembolic events with anticoagulants Carbamazepine, tricyclic antidepressants, and corticosteroids; increased thromboembolic potential with oral anticoagulants Preg: X Nama Dagang: Ogen Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tibolone I: # Relieving the symptoms of oestrogen deficiency (eg hot flushes, decreased sex drive, depression) in women who have gone through the menopause. # Prevention of osteoporosis in women who have gone through the menopause and are at high risk of fractures, but cannot take other medicines used to prevent osteoporosis. BSO: Tab 2.5 mg D: 2.5 mg/hr KI: Breast cancer, endometrial cancer, endometrial hyperplasia, Vaginal bleeding of unknown cause, deep vein thrombosis, pulmonary embolism, or a past history of these conditions where the cause is unknown, SNH, heart attack, Angina pectoris, Active liver disease, History of liver disease when liver function has not returned to normal, porphyrias, Pregnancy, Breastfeeding, Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Ovestin tablets contain lactose). Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Close family history of breast cancer, fibrocystic breast disease, fibroids in the womb, endometriosis, endometrial hyperplasia, venous thromboembolism, Blood disorders that increase the risk of blood clots in the veins, eg antiphospholipid syndrome, factor V Leiden, taking anticoagulants, SLE, Severe obesity, Varicose veins, Smokers, hypertension, hypertriglyceridaemia, History of liver disease, Decreased kidney function, Heart failure, History of diabetes, gallstones, migraines or severe headaches, epilepsy, asthma, otosclerosis # History of irregular brown patches appearing on the skin, usually of the face, during pregnancy or previous use of hormone preparations such as contraceptive pills (chloasma). Women with a tendency to this condition should minimise their exposure to the sun or UV light while taking HRT. ES: Nausea and vomiting, Breast tenderness or pain, Breakthrough bleeding or spotting, Headache, Excessive production of cervical mucus, nausea, abdominal pain, bloating, flatulence, indigestion, Vaginal thrush, Depression, Dizziness, Changes in sex drive, Rise in blood pressure, Gall bladder Genghis Khun ([email protected],nafanakhun.wordpress.com)


disease, peripheral oedema, Skin reactions such as rash and itch, Steepening of corneal curvature which may make contact lenses uncomfortable, Premenstrual-like symptoms, Disturbance in liver function, chloasma, Blood clots in the blood vessels (eg, DVT, pulmonary embolism, heart attack, stroke see warnings above) IO: The following medicines may potentially reduce the blood levels and effect of this medicine, which could result in recurrence of symptoms or irregular bleeding: * antiepileptic medicines such as carbamazepine, phenytoin * barbiturates such as amobarbital * rifamycin antibiotics such as rifabutin and rifampicin. Some women with diabetes may need small adjustments in their dose of insulin or antidiabetic tablets while taking this medicine. You should monitor your blood sugar and seek advice from your doctor or pharmacist if your blood sugar control seems to be altered after starting this medicine. Preg:: A, B, C, D, X Nama Dagang: Livial Genghis Khun ([email protected],nafanakhun.wordpress.com)


Estradiol valerate Injection: vulvar atrophy, atrophic vaginitis, symptoms of menopause, or ovary problems (female hypogonadism or failure or removal of both ovaries): 10-20 mg IM q4wk Prostate cancer: 30 mg IM q1-2wk



Estrone Injection: Abnormal bleeding of the uterus: 2-5 mg/day IM Vulvar atrophy, Atrophic vaginitis, or symptoms of menopause: 0.1-0.5 mg IM 2-3x/wk Ovary problems (female hypogonadism or failure or removal of both ovaries): 0.1-1 mg/wk IM Prostate cancer: 2-4 mg IM 2-3x/wk



C. Progesteron sintetis Medroxyprogesterone Norethisterone Dydrogesterone Progesterone Norgestrel Lynestrenol Gestrinone



Medroxyprogesterone I: Irregular menstrual bleeding (without ovulation), secondary amenorrhoea, Mild to moderate endometriosis BSO: Injection, suspension: 100 mg/mL; 150 mg/mL; 400 mg/mL. Tablet: 2.5 mg, 5 mg, 10 mg D: Oral: Dysfunctional uterine bleeding or amenorrhea: 5-10 mg.day for 5-10 days Menstrual period: 10 mg for 5-10 days Endometrial hyperplasia: Estrogen Days 1-25: medroxyprogesterone oral, 5-10 mg/day for 10-14 Or, 2.5- 5 mg/day without stopping. IM: Treating cancer of the kidneys or uterus: 400-100 mg IM single dose 1x/wk SC: Pain related to endometriosis: 104mg SC (anterior thigh or abdomen) q3months (12-14 weeks). Max 2 years. KI: Hipersensitif; cerebral apoplexy; undiagnosed vaginal bleeding; thrombophlebitis; liver dysfunction; missed abortion; known or Genghis Khun ([email protected],nafanakhun.wordpress.com)


suspected malignancy of breast or genital tract; active or past history of thrombophlebitis, thromboembolic disorders, or cerebral apoplexy (based on past experience with combination oral contraceptive medications; little data suggest that progestin therapy used without estrogen is associated with an increased risk of thrombotic events) IO: Decreases aminoglutethimide efficacy Preg: X P: Caution in asthma, depression, renal or cardiac dysfunction, or thromboembolic disorders; perform complete physical examination, document recent Papanicolaou smear, and take family history before therapy; give special attention to blood pressure, breasts, abdomen, and pelvic organs; repeat physical examination annually; progestins can cause fluid retention (address any condition aggravated by this factor); monitor patients with epilepsy, migraine, asthma, renal or cardiac dysfunction, and history of psychic depression Genghis Khun ([email protected],nafanakhun.wordpress.com)


Norethisterone I: Contraception BSO: Tab 5 mg D: 5 mg 3x/hr selama 10 hari KI: Pregnancy, Abnormal vaginal bleeding of unknown cause, stroke or heart attack, deep vein thrombosis, pulmonary embolism, Breast cancer, Active liver disease, Liver cancer, History of severe liver disease if liver function has not returned to normal, porphyrias. P: Heart disease, Cancers dependent on sex hormones for growth, Women who have previously had an ectopic pregnancy, ovarian cysts, jaundice during a previous pregnancy. ES: Changes in menstrual bleeding, Nausea and vomiting, Dizziness, Headache/migraine, Changes in sex drive, Weight gain, Breast tenderness, Skin problems, Depression, Cysts on the ovaries IO: Preg: X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dydrogesterone I: Abortion, habitual abortion, dysmenorrhoea, Absence of menstrual periods when taking oestrogens, Endometriosis, Female infertility, Irregular menstrual bleeding when taking oestrogens, Irregular menstrual cycles, Premenstrual syndrome BSO: Tab 10 mg D: Infertilitas: 5 mg 2x/hr muai hr ke-14 s/d 25. Tx min 6 siklus Abortus imminen: Awal 20 mg, lanjut 5-10 mg 3x/hr Abortus habitualis & Dismenore & Endometriosis: 5-10 mg 2x/hr mulai hr ke-5 s/d 25 KI: allergic reaction P: ES: Headache, Nausea, Dizziness, Bloating, Skin reactions such as rash and itch, Breast tenderness, Menstrual spotting between periods IO: Preg:: A, B, C, D, X Nama Dagang: Duphaston Genghis Khun ([email protected],nafanakhun.wordpress.com)


Progesterone I: Abnormal uterine bleeding (without ovulation) before the menopause, Disorders of the menstrual cycle, In vitro fertilisation where there is infertility due to defects of the fallopian tubes, endometriosis or unknown causes but with normal ovulatory cycles, Infertility due to inadequate luteal phase, Premenstrual syndrome, Symptoms of the menopause BSO: Capsule: 100 mg Gel: 4%, 8% Injection, in oil: 50 mg/mL Intrauterine system, reservoir: 38 mg in silicone fluid D: For women with a uterus receiving estrogen therapy: 200 mg/d PO for 2 d sequentially per 28-d cycle KI: Hipersensitif; caps contain peanut oil and should never be used by patients allergic to peanuts; known or suspected Preg:; thrombophlebitis thromboembolic disorders, cerebral apoplexy, or patient with a history of these conditions; severe liver dysfunction or disease; known or suspected malignancy of Genghis Khun ([email protected],nafanakhun.wordpress.com)


breast and genital organs; undiagnosed vaginal bleeding; missed abortion; as a diagnostic test for Preg: IO: Ketoconazole inhibits metabolism by human liver microsomes (clinical relevance unknown) Preg: B P: May cause some degree of fluid retention; thus, conditions that might be influenced by this factor (eg, epilepsy, migraine, asthma, cardiac or renal dysfunction) require careful observation Patients with history of depression should be carefully observed Transient dizziness may occur in some patients; caution when driving a motor vehicle or operating machinery; small percentage of women may experience extreme dizziness and/or drowsiness during initial therapy; for these women, bedtime dosing is advised Nama Dagang: Crinone Genghis Khun ([email protected],nafanakhun.wordpress.com)


Norgestrel I: Prevention of pregnancy; progestin only products have higher risk of failure in contraceptive use BSO: Tablet: 0.075 mg D: first day of menstruation: 1 tab/day. If one dose is missed, take as soon as remembered, then next tablet at regular time; if two doses are missed, take 1 tablet and discard the other, then take daily at usual time; if three doses are missed, use an additional form of birth control until menses or pregnancy is ruled out. KI: Known hypersensitivity to norgestrel; thromboembolic disorders, severe hepatic disease, breast cancer, undiagnosed vaginal bleeding, pregnancy P: Discontinue if sudden loss of vision or if diplopia or proptosis occur; use with caution in patients with a history of mental depression; use of any progestin during the first 4 months of pregnancy is not recommended ES: >10%: Edema, Breakthrough bleeding, spotting, changes in menstrual flow, amenorrhea, Anorexia, Weakness Genghis Khun ([email protected],nafanakhun.wordpress.com)


1-10%: Embolism, central thrombosis, Mental depression, fever, insomnia, Melasma or chloasma, allergic rash with or without pruritus, Changes in cervical erosion and secretions, increased breast tenderness, Weight gain or loss, Cholestatic jaundice, Local: Thrombophlebitis IO: Decreased effect: Aminoglutethimide may decrease effects by increasing hepatic metabolism Preg:: A, B, C, D, X Nama Dagang:



Lynestrenol I: BSO: Tab 5 mg D: 5 mg/ hr pd hari ke-16 s/d 25 KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Nomegestrol Acetate I: defisiensi Progesteron BSO: Kapl 5 mg D: 5 mg/hr selama 10 hari pd hari ke-16 s/d 25 KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Lutenyl



Gestrinone I: Endometriosis. BSO: D: KI: Adult males, Breastfeeding, Children, Elderly people, Metabolic or blood flow disorders during previous sex hormone (oestrogen or progesterone) therapy, Pregnancy, severe cardiac insufficiency, Severely decreased kidney & liver function P: Decreased heart&kidney function, Diabetes, hyperlipidaemia ES: Headache, Depression, Weight gain, Alteration in results of liver function tests, fluid retention, Acne, Voice changes, hirsutism, Nervousness, Changes in sex drive, Menstrual spotting between periods, Reduction in breast size IO: Preg:: A, B, C, D, X Nama Dagang:



D. Proteksi Kehamilan Allylestrenol



Allylestrenol I: Abortus habitualis BSO: Tab 5 mg D: 5 mg 3x/hr selama 5 s/d 7 hari. Max 40 mg/hr KI: Ggn fungsi hati P: DM ES: Mual, muntah IO: Preg:: A, B, C, D, X Nama Dagang:



E. Kesuburan/ Stimulasi Folikel: Chorionic Gonadotrophin



Chorionic Gonadotrophin I: Delayed puberty in boys (when boys do not develop secondary sexual characteristics at 12 - 14 years old). Female infertility, Oligospermia, Undescended testes BSO: Powder for injection (human origin): 200 U/mL; 500 U/mL; 1000 U/mL; 2000 U/mL D: Low levels of male hormones:1000-4000 U IM 2-3x/day Pregnancy occur in women: 5000-10,000 U IM/day Cryptorchidism: 1000-5000 U IM 2-3x/wk for 10 doses KI: Tumours whose growth is affected by certain hormones P: Asthma, Boys who have not yet reached puberty, Decreased kidney function, Epilepsy, Heart failure, Treatment of migraine ES: Headache, Tiredness, Changes in mood, Irritation in area of use, gynaecomastia, Over stimulation of the ovaries causing production of many ova (eggs) in the woman, oedema, Pregnancy with two or more foetuses IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


F. Hormon Tropik Sintetis Clomifene citrate Cetrorelix acetate Bromocriptine Lutropin alfa Follitropin alfa Follitropin beta



Clomiphene citrate Stimulates release of pituitary gonadotropins. Acts as an antiestrogen to decrease - estrogen feedback on hypothalamus. In addition, may have effects on pituitary gland and ovaries and can induce ovulation in women with hypothalamic amenorrhea. Improves folliculogenesis and, therefore, ovarian function during luteal phase. I: Infertility in women caused by failure of ovulation BSO: Tablet: 50 mg D: 50 mg/day Hari ke-5-10 siklus mens,increase max 250 mg/d 50-100 mg PO qd for 5 d; max 6 mo KI: Hipersensitif; liver disease; abnormal uterine bleeding; uncontrolled thyroid or adrenal dysfunction P: Polycystic ovary syndrome, Fibroids of the uterus, Endometriosis, History of seizures ES: Enlargement of the ovaries, mittelschmerz, Over production of many eggs, Hot flushes, Abdominal discomfort (swelling or bloating), Nausea and vomiting, Breast discomfort, Visual disturbances, Headache, Spotting of blood between menstrual Genghis Khun ([email protected],nafanakhun.wordpress.com)


periods, Heavy or painful menstrual periods, Endometriosis, Dizziness, Nervous tension, Insomnia, Fatigue, Skin reactions such as rash and itch, psychosis, Stroke, Depression, Seizures IO: Danazol may reduce response Preg: X P: Visual symptoms and abdominal pain may occur Nama Dagang:



Cetrorelix acetate I: Female infertility BSO: Vial 0.25 mg, 7.3 mg D: 3 mg SC 1x on day 7 of menstrual cycle, or 0.25 mg on Day 5-6 of menstrual cycle. Continue ‘til HCG administration occurs KI: Allergic reaction to mannitol, Breastfeeding, Moderate to severely decreased kidney & liver function, Post-menopausal women, Pregnancy P: ES: Headache, Rash, Nausea, hypotension, Reactions at injection site, Itching (pruritis), Redness around injection site, Cough IO: Preg: X Nama Dagang: Cetrotide



Bromocriptine I: # High prolactin levels that leading to infertility and/or abnormal milk production in men or women. # Preventing or stopping milk production (lactation) for medical reasons following childbirth, miscarriage or abortion. # Benign breast disease or breast pain that occurs at certain times of the menstrual cycle. # Menstrual cycle disorders and premenstrual symptoms, eg headaches, breast pain, mood changes or bloating. # Infertility. # Benign tumours in the pituitary gland that release the hormone prolactin (prolactinomas). # acromegaly, Parkinson's disease. BSO: Tab 2.5 mg D: 2.5 mg Dosis tunggal selama 6 s/d 12 hari KI: Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Parlodel tablets contain lactose), Children < 5 years, Allergy to ergot Genghis Khun ([email protected],nafanakhun.wordpress.com)


alkaloids, eg ergotamine, hypertension, eclampsia, abortion, cardiovascular disease, psychiatric illness. P: Decreased liver function, cardiovascular disease, Raynaud's disease, psychiatric illness & peptic ulcers, porphyrias. ES: Headache, Constipation, Drowsiness, Nausea and vomiting, Nasal congestion, Dry mouth, Dizziness, dyskinesia, Confusion, Hallucinations, Leg cramps, Hair loss, postural hypotension, retroperitoneal fibrosis, pericardial fibrosis, pulmonary fibrosis, Bleeding or ulceration of the stomach or intestine, Suddenly falling asleep, pathological gambling, hypersexuality. IO: Preg: B Nama Dagang: Parlodel



Somatropin



Lutropin alfa I: Lutropin alfa is a drug whose actions are almost the same as those of luteinizing hormone (LH), which is produced by the pituitary gland. It is a hormone also normally produced by the placenta in pregnancy. Lutropin alfa is used to help conception occur. It is usually given in combination with follitropin alfa. Many women being treated with these drugs usually have not been able to conceive yet. BSO: Amp 75 iu D: 75 IU SC 1x for 2wk, together with 75-150 IU of follitropin alfa as two separate injections. After last dose of lutropin alfa, then injection of hCG twenty-four hours later. If abdominal pain occurs with the use of lutropin alfa, discontinue treatment, do not receive the dose of hCG, and avoid coitus. ES: Bleeding, blistering, burning, coldness, hives, itching, lumps, numbness, Bloating, Stomach or pelvic discomfort, aching, or heaviness, Diarrhea Preg: X Nama Dagang: Luveris Genghis Khun ([email protected],nafanakhun.wordpress.com)


Follitropin alfa I: Anovulation, Assisted reproduction - including IVF, GIFT, ZIFT. BSO: Urofollitropin & Follitropin alpha Powder for injection: 75 IU, 150 IU Follitropin beta: Powder for injection: 75 IU D: Female infertility: 75 IU SC 1x/day for 2wk, increased at weekly intervals by 37.5 IU, max 300 IU 1x/day. injection of hCG twenty-four hours later. If abdominal pain occurs, discontinue treatment, do not receive the dose of hCG, and avoid coitus. Assisted reproductive technology (ART) procedures: 150 IU SC 1x/day for 5 days beginning on Day 2-3 of menstrual cycle. increased 75-150 IU q3-5 days, max 450 IU 1x/day, for 5 more days. injection of hCG twenty-four hours later. Male infertility: 150 IU SC 3x/week, in conjunction with 1000 USP U of hCG . increased up to 300 IU 3x/wk Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Breast cancer, Cancer of the hypothalamus & ovaries, allergy, Ovarian cysts, Pregnancy, Tumour of the pituitary gland in the brain, Uterine cancer, Vaginal bleeding of unknown cause P: Diseases of the adrenal gland, Hyperprolactinaemia, Hypothyroidism ES: Irritation in area of use, Over stimulation of the ovaries causing production of many ova (eggs) in the woman, thromboembolism, Pregnancy with two or more foetuses IO: Preg: X Nama Dagang: Gonal-F



Follicle-stimulating hormone/ Follitropin beta I: Female infertility, failure of ovulation BSO: Vial 50 iu, 100 iu D: Female infertility: 75 IU SC/IM 1x/day for 2wk, increased at weekly intervals by 37.5 IU, max 300 IU/day. If abdominal pain occurs with the use of follitropin beta, discontinue treatment, do not receive the dose of hCG, and avoid coitus. Assisted reproductive technology (ART) procedures: 150 IU SC/IM 1x/day for 4 days beginning on Day 2-3 of menstrual cycle. increased by 75-150 IU max 600 IU/day. KI: Breast cancer, Breastfeeding, Ca of hypothalamus, ovaries, Uterine & pituitary gland, Fibroids of the uterus, Malformation of sex organs, Ovarian cysts, Pregnancy, Vaginal bleeding of unknown cause P: Endocrine disorders ES: Over production of many ova (eggs), thromboembolism, Pregnancy with two/ > fetuses, Pain at the injection site Preg: X Nama Dagang:Puregon Genghis Khun ([email protected],nafanakhun.wordpress.com)


G. Hormon Lain Cyproterone acetate Octreotide



Cyproterone acetate anti-androgen I: Prostate cancer BSO: Tab 50 mg D: 50 mg 2x/hr. Ca prostate: 100 mg 2-3x/hr KI: Women, Children. P: Venous thromboembolism, pulmonary embolism, TIA, sickle cell anaemia, Diabetes, Advanced cancers, Liver disease, Long-term severe depression. ES: Fatigue, Weakness, Shortness of breath, Dry skin, Weight changes, Reduced growth of body hair and increased growth of scalp hair, Lightening of hair colour, Decreased sex drive, Reduced volume of ejaculation, Decreased sperm count & Impotence (reversible on stopping treatment), gynaecomastia, galactorrhoea, osteoporosis, Depressive moods, Liver disorders, thromboembolism Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


H. Kortikosteroid Dexamethasone Prednisone Methylprednisolone Prednisolone Hydrocortisone



Dexamethasone Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reducing capillary permeability. Prednisone in equivalent doses may be substituted if administered over 5 d. I: Myeloma, Certain types of tuberculosis (fulminating or disseminated) along with anti-tuberculosis therapy, Complication following a heart attack involving fever, chest pain, pneumonitis, pericarditis, haemolytic anaemia, cerebral oedema, Inflammatory disorders, adrenal insufficiency, Leukaemia, anaphylactic reaction, angioneurotic oedema, Tests to determine the underlying cause of Cushing's syndrome (dexamethasone suppression test) BSO: Aerosol Oral & Nasal: 84 mcg dexamethasone/ spray Topical: 0.01%; 0.04% Cream: 0.1% Elixir & Oral solution: 0.5 mg/5 mL Solution, oral, Concentrate: 0.5 mg/0.5 mL (30% alcohol) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Injection: 4 mg/mL, 8 mg/mL; 10 mg/mL, 16 mg/mL, 20 mg/mL; 24 mg/mL Ointment, ophthalmic: 0.05% Suspension, ophthalmic: 0.1% with methylcellulose 0.5% Tablet: 0.25 mg, 0.5 mg, 0.75 mg, 1 mg, 1.5 mg, 2 mg, 4 mg, 6 mg Tablet, therapeutic pack: 6 x 1.5 mg; 8 x 0.75 mg D: 0.6 mg/kg PO/IV/IM as 1 dose Paed. Extubation or airway edema: 0.5-2 mg/kg/d PO/IV/IM in divided doses q6h before extubation and 4-6 doses after Neonates: Airway edema or extubation: IV: 0.25 mg/kg/dose given 4 hours prior to scheduled extubation and then q8 hours for 3 doses total; range: 0.25-1 mg/kg/dose for 1-3 doses; max: 1 mg/kg/day. Bronchopulmonary dysplasia (to facilitate ventilator weaning): IO/IV: range: 0.5-0.6 mg/kg/day given in divided doses q12 hours for 3-7 days, then taper over 1-6 weeks Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: Antiemetic (prior to chemotherapy): I.V. (should be given as sodium phosphate): 10 mg/m2/dose (maximum: 20 mg) for first dose then 5 mg/m2/dose every 6 hours as needed Anti-inflammatory immunosuppressant: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.08-0.3 mg/ kg/day or 2.5-10 mg/m2/day in divided doses every 6-12 hours Extubation or airway edema: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.5-2 mg/kg/day in divided doses every 6 hours beginning 24 hours prior to extubation and continuing for 4-6 doses afterwards Cerebral edema: I.V. (should be given as sodium phosphate): Loading dose: 1-2 mg/kg/dose as a single dose; maintenance: 1-1.5 mg/kg/day (maximum: 16 mg/day) in divided doses every 4-6 hours for 5 days then taper for 5 days, then discontinue Bacterial meningitis in infants and children >2 months: I.V. (should be given as sodium phosphate): 0.6 mg/kg/day in 4 divided doses every 6 hours for the first 4 days of antibiotic Genghis Khun ([email protected],nafanakhun.wordpress.com)


treatment; start dexamethasone at the time of the first dose of antibiotic Physiologic replacement: Oral, I.M., I.V.: 0.03-0.15 mg/kg/day or 0.6-0.75 mg/m2/day in divided doses every 6-12 hours Adults: Acute nonlymphoblastic leukemia (ANLL) protocol: I.V.: 2 mg/m2/dose every 8 hours for 12 doses Antiemetic (prior to chemotherapy): Oral/I.V. (should be given as sodium phosphate): 10 mg/m2/dose (usually 20 mg) for first dose then 5 mg/m2/dose every 6 hours as needed Anti-inflammatory: Oral, I.M., I.V. (injections should be given as sodium phosphate): 0.75-9 mg/day in divided doses every 6-12 hours I.M. (as acetate): 8-16 mg; may repeat in 1-3 weeks Intralesional (as acetate): 0.8-1.6 mg Intra-articular/soft tissue (as acetate): 4-16 mg; may repeat in 1-3 weeks Intra-articular, intralesional, or soft tissue (as sodium phosphate): 0.4-6 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cerebral edema: I.V. 10 mg stat, 4 mg I.M./I.V. (should be given as sodium phosphate) every 6 hours until response is maximized, then switch to oral regimen, then taper off if appropriate; dosage may be reduced after 24 days and gradually discontinued over 5-7 days Diagnosis for Cushing's syndrome: Oral: 1 mg at 11 PM, draw blood at 8 AM the following day for plasma cortisol determination Physiological replacement: Oral, I.M., I.V. (should be given as sodium phosphate): 0.03-0.15 mg/kg/day OR 0.6-0.75 mg/ m2/day in divided doses every 6-12 hours Shock therapy: Addisonian crisis/shock (ie, adrenal insufficiency/responsive to steroid therapy): I.V. (given as sodium phosphate): 4-10 mg as a single dose, which may be repeated if necessary Unresponsive shock (ie, unresponsive to steroid therapy): I.V. (given as sodium phosphate): 1-6 mg/kg as a single I.V. dose or up to 40 mg initially followed by repeat doses every 2-6 hours while shock persists Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hemodialysis: Supplemental dose is not necessary Peritoneal dialysis: Supplemental dose is not necessary Ophthalmic: Ointment: Apply thin coating into conjunctival sac 3-4 times/day; gradually taper dose to discontinue Suspension: Instill 2 drops into conjunctival sac every hour during the day and every other hour during the night; gradually reduce dose to every 3-4 hours, then to 3-4 times/day Topical: Apply 1-4 times/day. Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary. KI: Hipersensitif; active bacterial or fungal infection IO: Effects decrease with coadministration of barbiturates, phenytoin, and rifampin; decreases effect of salicylates and vaccines ES: Thinning of the skin, glaucoma, Weight gain, Irregular menstrual cycle, adrenal suppression, osteoporosis, Ulceration of the stomach or intestine, Increased susceptibility to infections, Increased risk of fractures of the bones, hirsutism, Genghis Khun ([email protected],nafanakhun.wordpress.com)


candidiasis, Supression of growth in children and adolescents, Alterations in number and motility of sperm, Changes in mood, Muscle weakness, Acne Preg: C P: Increases risk of several complications, including severe infections; monitor adrenal insufficiency when tapering; abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections are possible complications of glucocorticoid use Nama Dagang:



Prednisone -- Glucocorticoid absorbed readily from GI tract. It has antiinflammatory and immune-modulating effects, and profound and varied metabolic effects. I: Treatment of a variety of diseases including adrenocortical insufficiency, hypercalcemia, rheumatic, and collagen disorders; dermatologic, ocular, respiratory, gastrointestinal, and neoplastic diseases; organ transplantation and a variety of diseases including those of hematologic, allergic, inflammatory, and autoimmune in origin; not available in injectable form, prednisolone must be used BSO: Solution, oral: Concentrate (30% alcohol): 5 mg/mL; Nonconcentrate (5% alcohol): 5 mg/5 mL Syrup: 5 mg/5 mL Tablet: 1 mg, 2.5 mg, 5 mg, 10 mg, 20 mg, 50 mg D: 1 mg/kg or 60 mg PO qd for 7 d followed by taper for total of 10 d Paed. 1 mg/kg PO qd for 6 d followed by taper for total of 10 d === Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral: Dose depends upon condition being treated and response of patient; dosage for infants and children should be based on severity of the disease and response of the patient rather than on strict adherence to dosage indicated by age, weight, or body surface area. Consider alternate day therapy for long-term therapy. Discontinuation of long-term therapy requires gradual withdrawal by tapering the dose. Anti-inflammatory or immunosuppressive dose: 0.05-2 mg/kg/day divided 1-4 times/day Acute asthma: 1-2 mg/kg/day in divided doses 1-2 times/day for 3-5 days Alternatively (for 3- to 5-day "burst"): <1 year: 10 mg every 12 hours 1-4 years: 20 mg every 12 hours 5-13 years: 30 mg every 12 hours >13 years: 40 mg every 12 hours Asthma long-term therapy (alternative dosing by age): <1 year: 10 mg every other day 1-4 years: 20 mg every other day Genghis Khun ([email protected],nafanakhun.wordpress.com)


5-13 years: 30 mg every other day >13 years: 40 mg every other day Nephrotic syndrome: Initial (first 3 episodes): 2 mg/kg/day or 60 mg/m2/day (maximum: 80 mg/day) in divided doses 3-4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1-1.5 mg/kg/dose or 40 mg/ m2/dose given every other day for 4 weeks Maintenance dose (long-term maintenance dose for frequent relapses): 0.5-1 mg/kg/dose given every other day for 3-6 months Children and Adults: Physiologic replacement: 4-5 mg/m2/day Adults: 5-60 mg/day in divided doses 1-4 times/day Elderly: Use the lowest effective dose Dosing adjustment in hepatic impairment: Prednisone is inactive and must be metabolized by the liver to prednisolone. This conversion may be impaired in patients with liver disease, however, prednisolone levels are observed to be higher in patients with severe liver failure than in normal patients. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Therefore, compensation for the inadequate conversion of prednisone to prednisolone occurs. Dosing adjustment in hyperthyroidism: Prednisone dose may need to be increased to achieve adequate therapeutic effects KI: Hipersensitif; severe uncontrolled diabetes; systemic fungal infections; peptic ulcer disease; tuberculosis; severe osteoporosis; severe adverse reactions to corticosteroids IO: Drugs that induce hepatic enzymes may increase clearance —these include phenobarbital, phenytoin, and rifampin; patients on aspirin or Coumadin must be monitored closely for GI bleeding Preg: B P: Patients are at risk for hyperglycemia, electrolyte abnormalities (especially hypokalemia in patients taking diuretics), osteoporosis, avascular necrosis, psychosis, and myopathy or worsening weakness in patients with myasthenia gravis; abrupt discontinuation of prednisone without taper puts patient at risk for adrenal crisis Genghis Khun ([email protected],nafanakhun.wordpress.com)


Methylprednisolone Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Topikal : Potensi Kuat I: Primarily as an anti-inflammatory or immunosuppressant agent in the treatment of a variety of diseases including those of hematologic, allergic, inflammatory, neoplastic, and autoimmune origin. Prevention and treatment of graft-versushost disease following allogeneic bone marrow transplantation. Topikal: Dermatitis atopik, neurodermatitis, ekzema, degeneratif dishidrotik, ekzema vulgaris, ekzema pada anak,psoriasis === 100 mg IV or equivalent 30 min prior to each infusion recommended to reduce incidence and severity of infusion reactions BSO : Injection: 20 mg/mL; 40 mg/mL; 80 mg/mL Genghis Khun ([email protected],nafanakhun.wordpress.com)


Injection: 40 mg; 125 mg; 500 mg; 1000 mg; 2000 mg Tablet: 2 mg, 4 mg, 8 mg, 16 mg, 24 mg, 32 mg Tablet, dose pack: 4 mg Krim, salep 0.1 % D: Topikal: 1x/hr.Lama terapi Dws: 3 bulan. Anak 1 bulan === Dosing should be based on the lesser of ideal body weight or actual body weight Children: Anti-inflammatory or immunosuppressive: Oral, I.M., I.V. (sodium succinate): 0.5-1.7 mg/kg/day or 5-25 mg/m2/day in divided doses every 6-12 hours; "Pulse" therapy: 15-30 mg/kg/dose over greater than or equal to 30 minutes given once daily for 3 days Status asthmaticus: I.V. (sodium succinate): Loading dose: 2 mg/kg/dose, then 0.5-1 mg/kg/dose every 6 hours for up to 5 days Genghis Khun ([email protected],nafanakhun.wordpress.com)


Acute spinal cord injury: I.V. (sodium succinate): 30 mg/kg over 15 minutes, followed in 45 minutes by a continuous infusion of 5.4 mg/kg/hour for 23 hours Lupus nephritis: I.V. (sodium succinate): 30 mg/kg over greater than or equal to 30 minutes every other day for 6 doses High-dose therapy for acute spinal cord injury: I.V. bolus: 30 mg/kg over 15 minutes, followed 45 minutes later by an infusion of 5.4 mg/kg/hour for 23 hours Adults: Anti-inflammatory or immunosuppressive: Oral: 2-60 mg/day in 1-4 divided doses to start, followed by gradual reduction in dosage to the lowest possible level consistent with maintaining an adequate clinical response I.M. (sodium succinate): 10-80 mg/day once daily I.M. (acetate): 10-80 mg every 1-2 weeks I.V. (sodium succinate): 10-40 mg over a period of several minutes and repeated I.V. or I.M. at intervals depending on clinical response; when high dosages are needed, administer Genghis Khun ([email protected],nafanakhun.wordpress.com)


30 mg/kg over a period of greater than or equal to 30 minutes and may be repeated every 4-6 hours for 48 hours Status asthmaticus: I.V. (sodium succinate): Loading dose: 2 mg/kg/dose, then 0.5-1 mg/kg/dose every 6 hours for up to 5 days High-dose therapy for acute spinal cord injury: I.V. bolus: 30 mg/kg over 15 minutes, followed 45 minutes later by an infusion of 5.4 mg/kg/hour for 23 hours Lupus nephritis: High-dose "pulse" therapy: I.V. (sodium succinate): 1 g/day for 3 days Aplastic anemia: I.V. (sodium succinate): 1 mg/kg/day or 40 mg/ day (whichever dose is higher), for 4 days. After 4 days, change to oral and continue until day 10 or until symptoms of serum sickness resolve, then rapidly reduce over approximately 2 weeks. Hemodialysis: Slightly dialyzable (5% to 20%); administer dose posthemodialysis Intra-articular (acetate): Administer every 1-5 weeks Large joints: 20-80 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Small joints: 4-10 mg Intralesional (acetate): 20-60 mg every 1-5 weeks KI: Hipersensitif; viral, fungal, or tubercular skin infections IO: Coadministration with digoxin may increase digitalis toxicity secondary to hypokalemia; estrogens may increase levels of methylprednisolone; phenobarbital, phenytoin, and rifampin may decrease levels of methylprednisolone (adjust dose); monitor patients for hypokalemia when administered concurrently with diuretics; grapefruit juice increases prednisolone concentrations; methylprednisolone and cyclosporine mutually inhibit one another, resulting in increased plasma levels of each drug Preg: C P: Hyperglycemia, edema, osteonecrosis, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, growth suppression, myopathy, and infections are possible complications of glucocorticoid use; Depo-Medrol contains benzyl alcohol, which is potentially toxic when administered locally to neural tissue; administration of Genghis Khun ([email protected],nafanakhun.wordpress.com)


Depo-Medrol by other than indicated routes, including the epidural route, has been associated with reports of serious medical events such as arachnoiditis, meningitis, paraparesis/paraplegia, sensory disturbances, bowel/bladder dysfunction, seizures, visual impairment (eg, blindness, ocular, and periocular inflammation), and residue or slough at injection site



Prednisolone I: BSO: Injection: (for I.M., intralesional, intra-articular, or soft tissue administration only): 25 mg/mL; 50 mg/mL (for I.M., I.V., intra-articular, intralesional, or soft tissue administration): 20 mg/mL For intra-articular, intralesional, soft tissue administration only): 20 mg/mL Liquid, oral: 5 mg/5 mL Solution & Suspension, ophthalmic: 0.125%; 1% Syrup: 15 mg/5 mL Tablet: 5 mg D: Acute asthma: Oral: 1-2 mg/kg/day in divided doses 1-2 times/day for 3-5 days I.V.: 2-4 mg/kg/day divided 3-4 times/day Anti-inflammatory or immunosuppressive dose: Oral, I.V., I.M.: 0.1-2 mg/kg/day in divided doses 1-4 times/day Nephrotic syndrome: Oral: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Initial (first 3 episodes): 2 mg/kg/day or 60 mg/m2/day (maximum: 80 mg/day) in divided doses 3-4 times/day until urine is protein free for 3 consecutive days (maximum: 28 days); followed by 1-1.5 mg/kg/dose or 40 mg/m2/dose given every other day for 4 weeks Maintenance (long-term maintenance dose for frequent relapses): 0.5-1 mg/kg/dose given every other day for 3-6 months Adults: Oral, I.V., I.M. (sodium phosphate salt): 5-60 mg/day Multiple sclerosis (sodium phosphate): Oral: 200 mg/day for 1 week followed by 80 mg every other day for 1 month Rheumatoid arthritis: Oral: Initial: 5-7.5 mg/day; adjust dose as necessary Elderly: Use lowest effective dose Dosing adjustment in hyperthyroidism: Prednisolone dose may need to be increased to achieve adequate therapeutic effects Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hemodialysis: Slightly dialyzable (5% to 20%); administer dose posthemodialysis Peritoneal dialysis: Supplemental dose is not necessary Intra-articular, intralesional, soft-tissue administration: Tebutate salt: 4-40 mg/dose Sodium phosphate salt: 2-30 mg/dose Ophthalmic suspension/solution: Children and Adults: Instill 1-2 drops into conjunctival sac every hour during day, every 2 hours at night until favorable response is obtained, then use 1 drop every 4 hours KI: Acute superficial herpes simplex keratitis; systemic fungal infections; varicella; hypersensitivity to prednisolone or any component P: ES: Spreading and worsening of infection, Visual disturbances, Irritation in area of use, Local sensitivity reactions, Stinging or burning, Itching & Skin rash at the area of application, Tear of the eye covering due to the presence of another eye disease (eye preparations only), glaucoma Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: CYP3A enzyme substrate; inducer of cytochrome P-450 enzymes Barbiturates, phenytoin, rifampin decrease corticosteroid effectiveness Decreases salicylates Decreases vaccines Decreases toxoids effectiveness Preg: C Nama Dagang:



Hydrocortisone I: Insufficient production of natural steroid hormones by the adrenal glands (adrenal insufficiency) Topikal; Potensi Ringan BSO: Hydrocortisone acetate: Aerosol, rectal: 10% (20 g) Cream & Ointment, topical: 0.5%; 1% Injection, suspension: 25 mg/mL; 50 mg/mL Suppositories, rectal: 10 mg, 25 mg Hydrocortisone base: Aerosol, Paste & Gel, topical: 0.5%; 1% Cream, rectal & topical: 1%; 2.5% Lotion, topical: 0.25%; 0.5%; 1%; 2%; 2.5% Solution, topical & Ointment, rectal: 1% Ointment, topical: 0.2%; 0.5%; 1%; 2.5% Suspension, rectal: 100 mg/60 Tablet, oral: 5 mg, 10 mg, 20 mg Hydrocortisone buteprate: Cream: 1% Hydrocortisone butyrate: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cream, Ointment & Solution, topical: 0.1% Hydrocortisone cypionate: Suspension, oral: 10 mg/5 mL Hydrocortisone sodium phosphate: Injection, I.M./I.V./S.C.: 50 mg/mL Hydrocortisone sodium succinate: Injection, IM/I.V.: 100 mg, 250 mg, 500 mg, 1000 mg Hydrocortisone valerate: Cream & Ointment, topical: 0.2% D: Infants and young Children: Succinate: 1-2 mg/kg/dose bolus, then 25-150 mg/day in divided doses every 6-8 hours Older Children: Succinate: 1-2 mg/kg bolus then 150-250 mg/day in divided doses every 6-8 hours Adults: Succinate: 100 mg I.V. bolus, then 300 mg/day in divided doses every 8 hours or as a continuous infusion for 48 hours; once patient is stable change to oral, 50 mg every 8 hours for 6 doses, then taper to 30-50 mg/day in divided doses Chronic adrenal corticoid insufficiency: Adults: Oral: 20-30 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Anti-inflammatory or immunosuppressive: Infants and Children: Oral: 2.5-10 mg/kg/day or 75-300 mg/m2/day every 6-8 hours I.M., I.V.: Succinate: 1-5 mg/kg/day or 30-150 mg/m2/day divided every 12-24 hours Adolescents and Adults: Oral, I.M., I.V.: Succinate: 15-240 mg every 12 hours Congenital adrenal hyperplasia: Oral: Initial: 30-36 mg/m2/day with 1/3 of dose every morning and 2/3 every evening or 1/4 every morning and mid-day and 1/2 every evening; maintenance: 20-25 mg/m2/day in divided doses Physiologic replacement: Children: Oral: 0.5-0.75 mg/kg/day or 20-25 mg/m2/day every 8 hours I.M.: Succinate: 0.25-0.35 mg/kg/day or 12-15 mg/m2/day once daily Shock: I.M., I.V.: Succinate: Children: Initial: 50 mg/kg, then repeated in 4 hours and/or every 24 hours as needed Adolescents and Adults: 500 mg to 2 g every 2-6 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


Status asthmaticus: Children and Adults: I.V.: Succinate: 1-2 mg/kg/dose every 6 hours for 24 hours, then maintenance of 0.5-1 mg/kg every 6 hours Rheumatic diseases: Adults: Intralesional, intra-articular, soft tissue injection: Acetate: Large joints: 25 mg (up to 37.5 mg) Small joints: 10-25 mg Tendon sheaths: 5-12.5 mg Soft tissue infiltration: 25-50 mg (up to 75 mg) Bursae: 25-37.5 mg Ganglia: 12.5-25 mg Dermatosis: Children >2 years and Adults: Topical: Apply to affected area 3-4 times/day (Buteprate: Apply once or twice daily). Therapy should be discontinued when control is achieved; if no improvement is seen, reassessment of diagnosis may be necessary. Ulcerative colitis: Adults: Rectal: 10-100 mg 1-2 times/day for 2-3 weeks Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: systemic fungal infection, amoebiasis P: Myasthenia gravis, Adolescents, Children, Decreased kidney function, Diabetes, Elderly people, Family history of diabetes & glaucoma, Heart failure, Herpes simplex virus infection of the eye, hypertension, Hypothyroidism, diverticulitis, ulcerative colitis, Inflammatory bowel disease such as ulcerative colitis or Crohn's disease, cirrhosis, Osteoporosis, heart attack, Peptic ulcer, Post-menopausal women, myopathy, intestinal anastomosis, Tuberculosis ES: Seizures, osteoporosis, hirsutism, Skin thinning, Supression of growth in children and adolescents, Alterations in number and motility of sperm, Weight gain, Acne, Muscle weakness, Irregular menstrual cycle, adrenal suppression, Ulceration of the stomach or intestine, glaucoma Preg:: A, B, C, D, X Nama Dagang:



I. Hormon Replacement Estradiol, Drosperinone Estradiol, Dydrogesterone Estradiol, Estriol, Estrone Estradiol, Levonorgestrel Estradiol, Medroxyprogesterone Estradiol, Norethisterone 17 beta-estradiol and norgestimate: 1 mg for 3 days, then 1 mg of estradiol+ 0.09 mg of norgestimate for 3 days. Ethinyl estradiol and norethindrone: 2.5 mcg ethinyl estradiol+ 0.5 mg norethindrone 1x/day. Estradiol and norethindrone: 1 mg estradiol and 0.5 mg norethindrone 1x/day. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Estradiol, Drosperinone Estradiol D: 1 tab (drospirenone 0.5 mg/ estradiol 1 mg) 1x/day



Estradiol, Dydrogesterone Estradiol, Dydrogesterone D: Nama Dagang:



Estradiol, Estriol, Estrone Estradiol Nama Dagang:



Estradiol, Levonorgestrel Estradiol, Nama Dagang:



Estradiol, Medroxyprogesterone Estradiol, Medroxyprogesterone



Estradiol, Norethisterone Estradiol, Norethisterone



J. KONTRASEPSI Estrogen and Progestin Oral Contraceptives Etonogestrel Desogestrel



Estrogen and Progestin Oral Contraceptives Ethinyl estradiol and a progestin derivative -- Reduce secretion of LH and FSH from the pituitary by decreasing amount of GnRH. Reduce pituitary production of gonadotropins and result in reduced LH and FSH with no ovulation. D: Monophasic, biphasic, or triphasic tablets: Contraception: 1 tab daily for 21 day cycle or 28 day cycle Norethindrone acetate and ethinyl estradiol triphasic tablets and norgestimate and ethinyl estradiol triphasic tablets: Treat acne: 1 tab daily for 21 day cycle or 28 day cycle KI: Hipersensitif; Preg:; active or inactive thrombophlebitis or thromboembolic disorders, cerebral vascular disease, myocardial infarction, coronary artery disease, or a past history of these disorders; known or suspected breast cancer; known or suspected genital cancer; history of cholestatic jaundice in Preg: or jaundice with prior pill use; past or present liver tumors IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hepatotoxicity might occur with concurrent administration of cyclosporine; concomitant use of rifampin, barbiturates, phenylbutazone, phenytoin sodium, and, possibly, griseofulvin, ampicillin, and tetracyclines might influence efficacy of oral contraceptives and increase amount of breakthrough bleeding and menstrual irregularity Preg: X P: Complete physical examination, documentation of recent Pap smear test, and family history recommended; pay special attention to blood pressure, breasts, abdomen, and pelvic organs; repeat physical examination annually as long as patient is on hormonal therapy Oral contraceptives can cause fluid retention (address any condition aggravated by this factor) Monitor patients with epilepsy, migraine, asthma, or renal or cardiac dysfunction History of psychic depression might be aggravated (observe patient closely) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Progestin compounds might elevate LDL levels, making control of hyperlipidemia more difficult (observe closely); certain forms of congenital hypertriglyceridemia might be aggravated by oral contraceptives, with resultant pancreatitis Discontinue if jaundice develops Contact lens wearers with visual changes should be examined by ophthalmologist Patients might develop hypertension secondary to increase in angiotensinogen production (reevaluate blood pressure approximately 3 mo after initiating therapy in all patients)



Etonogestrel I: Contraception in women aged 18 to 40 years. KI: Deep vein thrombosis, pulmonary embolism, Progestogen dependent cancer, Severe liver disease or history of severe liver disease if liver function has not returned to normal, Vaginal bleeding of unknown cause, Pregnancy, porphyrias. P: History of breast cancer, thromboembolism, hypertension, Decreased liver function, Diabetes, Women with a tendency to suffer from brown patches on the skin, particularly the face (chloasma) often due to pregnancy or oral contraceptives ES: Headache, Acne, Weight gain, Breast tenderness or pain, Irregular menstrual bleeding, Vaginal infections, Depressed mood, Decreased sex drive & appetite, Nervousness, Dizziness, Hot flushes, Hair loss or growth, abdominal pain, nausea, vomiting, constipation, diarrhea, Bruising, Irritation, pain or itching, Scarring or abscess at site of implant, Vaginal discharge, Migraine, Rise in blood pressure, Ovarian cysts Nama Dagang: Implanon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Desogestrel I: Contraception. KI: Known or suspected pregnancy, Abnormal vaginal bleeding of unknown cause, stroke or heart attack, deep vein thrombosis, pulmonary embolism, Breast cancer or history of this (though this pill may be considered for women who have had no evidence of the disease for five years), Active liver disease, Liver cancer, History of severe liver disease if liver function has not returned to normal, porphyrias. P: Heart disease, Cancers dependent on sex hormones for growth, Women who have previously had an ectopic pregnancy, History of ovarian cysts, History of jaundice ES: Irregular bleeding, Nausea, Acne, Mood changes, Decreased sex drive, Breast tenderness, Headache, Vomiting, Fatigue, Hair loss, Cysts on the ovaries, vaginitis. Nama Dagang: Cerazette



VI. ANTIBAKTERI, ANTI AMUBA & ANTI HELMINTIK A. AMINO GLIKOSIDA B. CEPHALOSPORIN C. CHLORAMPHENICOL D. MAKROLIDA E. PENICILLIN F. QUINOLON G. TETRASIKLIN H. BETA LAKTAM GOL LAIN I. ANTIBIOTIKA GOL LAIN J. FUNGISIDA K. ANTI AMOEBA L. ANTI LEPRA & TBC M. ANTI HELMINTICS N. SCABICID & PEDICULOCID O.ANTI FILARIA & MALARIA P. ANTI VIRUS Q. ANTI NEOPLASMA Genghis Khun ([email protected],nafanakhun.wordpress.com)


A. Amino Glikosida Gentamicin Kanamycin Amikacin Streptomycin Dibekacin Tobramycin Netilmicin Dosing interval in renal impairment: Clcr > 60 mL/minute: Administer every 8 hours Clcr 40-60 mL/minute: Administer every 12 hours Clcr 20-40 mL/minute: Administer every 24 hours Clcr 10-20 mL/minute: Administer every 48 hours Clcr <10 mL/minute: Administer every 72 hours



Gentamicin Acts by inhibiting normal protein synthesis; active against variety of pathogenic organisms, including P aeruginosa. When treating Pseudomonas species I: Septicaemia or blood poisoning, Pyelonephritis, Infections of the bile duct or gall bladder, endocarditis, prostatitis, pneumonia BSO: Infusion, in D5W: 60 mg, 80 mg, 100 mg Infusion, in NS: 40 mg, 60 mg, 80 mg, 90 mg, 100 mg, 120 mg Injection: 40 mg/mL Pediatric: 10 mg/mL Intrathecal, preservative free: 2 mg/mL Ointment: Topical: 0.1% Ophthalmic: 0.3% [3 mg/g] D: Newborns: Intrathecal: 1 mg every day Anak >3 bln: Intrathecal: 1-2 mg/day Anak <5 thn: I.M., I.V.: 2.5 mg/kg/dose 3x/hari Cystic fibrosis: 2.5 mg/kg/dose every 6 hours Anak >5 thn: I.M., I.V.: 1.5-2.5 mg/kg/dose 3x/hari Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prevention of bacterial endocarditis: 2 mg/kg with ampicillin (50 mg/kg) 30 minutes prior to procedure Adults: I.M., I.V.: Severe life-threatening infections: 2-2.5 mg/kg/dose ISK: 1.5 mg/kg/dose Synergy (for gram-+ infections): 1 mg/kg/dose Prevention of bacterial endocarditis: 1.5 mg/kg (max 80 mg) with ampicillin (1-2 g) 30 minutes prior to procedure GI/GU surgery: 1.5 mg/kg (max 80 mg) with ampicillin 2 g 30 minutes prior to procedure Children and Adults: Intrathecal: 4-8 mg/day Ophthalmic: Ointment: Instill 1/2 " (1.25 cm) 2-3x/day to every 3-4 hours Solution: Instill 1-2 drops every 2-4 hours, up to 2 drops every hour for severe infections Topical: Apply 3-4 times/day to affected area Some clinicians suggest a daily dose of 4-7 mg/kg for all patients with normal renal function. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preg: C P: Narrow therapeutic index (not intended for long-term therapy); caution in impaired renal function and neuromuscular disorders because may aggravate muscle weakness; serious adverse effects of vestibular and auditory branches of eighth cranial nerve may occur Nama Dagang:



Kanamycin I: Oral: Preoperative bowel preparation in the prophylaxis of infections and adjunctive treatment of hepatic coma (oral kanamycin is not indicated in the treatment of systemic infections); treatment of susceptible bacterial infection including gram-- aerobes, gram-+ Bacillus as well as some mycobacteria Parenteral: Rarely used in antibiotic irrigations during surgery BSO: Capsule: 500 mg. Injection: Pediatric: 75 mg, Adults: 500 mg; 1 g D: Children: Infections: I.M., I.V.: 15 mg/kg/day terbagi 2-3 dose Adults: Infections: IM, IV: 5-7.5 mg/kg/dose terbagi 2-3 dose (<15 mg/kg/day) Preoperative intestinal antisepsis: Oral: 1 g every 4-6 hours for 36-72 hours Hepatic coma: Oral: 8-12 g/day in divided doses Intraperitoneal: After contamination in surgery: 500 mg diluted in 20 mL distilled water; other irrigations: 0.25% solutions Aerosol: 250 mg 2-4 times/day (250 mg diluted with 3 mL of NS and nebulized) Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hypersensitivity P: Pre-existing renal insufficiency, vestibular or cochlear impairment, myasthenia gravis, conditions which depress neuromuscular transmission ES: Edema, neurotoxicity, drowsiness, headache, pseudomotor cerebri, skin itching, redness, rash, photosensitivity, erythema, nausea, vomiting, diarrhea (most common with oral form), malabsorption syndrome with prolonged and high-dose therapy of hepatic coma; anorexia, weight loss, increased salivation, enterocolitis, granulocytopenia, agranulocytosis, thrombocytopenia, burning, stinging, weakness, tremors, muscle cramps, ototoxicity (auditory& vestibular), nephrotoxicity, dyspnea IO: Increased toxicity: Penicillins, cephalosporins, amphotericin B, diuretics may increase nephrotoxicity; polypeptide antibiotics may increase risk of respiratory paralysis and renal dysfunction Genghis Khun ([email protected],nafanakhun.wordpress.com)


Neuromuscular blocking agents with oral kanamycin may increase neuromuscular blockade; a small increase in warfarin's effect may occur due to decreased absorption of vitamin K Decreased toxicity: Methotrexate with kanamycin (oral) may be less well absorbed as may digoxin (minor) and vitamin A Preg: D Nama Dagang:



Amikacin Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. For gram-- bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against P aeruginosa. I: Short-term treatment of serious bacterial infections BSO: Injection: 50 mg/mL; 250 mg/mL D: Low therapeutic index I.M., I.V.: 5-7.5 mg/kg/dose every 8 hours Daily dose: 15-20 mg/kg for all patients with normal renal. KI: Hipersensitif IO: Coadministration with other aminoglycosides, penicillins, cephalosporins, and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular-blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics Preg: D Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Not intended for long-term therapy; caution in patients with renal failure (not on dialysis), hypocalcemia, myasthenia gravis, and conditions that depress neuromuscular transmission ES: Rash, Nausea and vomiting, Headache, Pins and needles, Damage to the kidneys, hearing & vestibular function within the ear. Symptoms include giddiness or dizziness, vertigo, unsteadiness or loss of balance. Nama Dagang:



Streptomycin sulfate I: Brucellosis, Tuberculosis BSO: Injection: 400 mg/mL D: Daily: 20-30 mg/kg/day (max: 1 g/day) DOT: 2x/wk: 25-30 mg/kg (max: 1.5 g) DOT: 3x/week: 25-30 mg/kg (max: 1 g) Enterococcal endocarditis: 1 g 2x/day for 2 wk, 500 mg 2x/day for 4 wks in combination with penicillin Streptococcal endocarditis: 1 g 2x/day for 2 wk, 500 mg 2x/day for 1 wk Tularemia: 1-2 g/day in divided doses for 7-10 days or until patient is afebrile for 5-7 days Plague: 2-4 g/day in divided doses until the patient is afebrile for at least 3 days Elderly: 10 mg/kg/day, max 750 mg/day; dosing interval should be adjusted for renal function; some authors suggest not to give more than 5 days/week or give as 20-25 mg/kg/dose twice weekly KI: Hipersensitif; non–dialysis-dependent renal insufficiency Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Nephrotoxicity may be increased with aminoglycosides, cephalosporins, penicillins, amphotericin B, and loop diuretics ES: Rash, Allergic reaction to active ingredient, Fever (pyrexia), Nausea and vomiting, Damage to hearing & vestibular function within the ear, tinnitus, Damage to the kidneys, Tingling in and around the mouth. Symptoms include giddiness or dizziness, vertigo, unsteady or loss of balance. Preg: D P: Narrow therapeutic index; not intended for long-term therapy; caution in renal failure not on dialysis; caution with myasthenia gravis, hypocalcemia, and conditions that depress neuromuscular transmission



Dibekacin I: Septikemia, abses, furunkel, furunkolosis, flegmon, tonsilitis, bronkitis, pneumonia, peritonitis, pielonefritis, sistitis, uretritis, otitismedia, otitispasca op BSO: Vial 50 mg, 100 mg. Amp 50 mg/cc D: IM Dws 100 mg/hr. Anak 1-2 mg/kg/hr dibagi dlm 1-2 dosis. Drip infus IV Dws: 100 mg/hr terbagi dlm 2 dosis. Lama infus 30 mnt-1jam. KI: Hipersensitif P: Hamil. Kerusakan fungsi ginjal & hati. Nutrisi oral & parenteral buruk. Usia lanjut. ES: syok. Ototoksisitas, nefrotoksisitas. Jarang: kerusakan hati, def Vit K & Vit B. Ggn GI. Sakit kepala. IO: Zat substitusi darah, obat anestesi, relaksan otot, diuretik, karbenisilin, sulbenisilin, tikarsilin, piperasilin. Preg:: A, B, C, D, X Nama Dagang: Dibekacin Meiji Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tobramycin I: Bacterial infections of the central nervous system, peritonitis, the bile duct or gall bladder, cystitis, pyelonephritis, prostatitis, pneumonia, bronchopneumonia or acute bronchitis, burns, Bacterial infections of bone. BSO: Injection: 10 mg/mL; 40 mg/mL Ointment,Solution ophthalmic: 0.3% Powder for injection: 40 mg/mL Solution, inhalation: 60 mg/mL D: Low therapeutic index, Children <5 years: I.M., I.V.: 2.5 mg/kg/dose every 8 hours Children >5 years: 1.5-2.5 mg/kg/dose every 8 hours Adults: I.M., I.V.: Severe life-threatening infections: 2-2.5 mg/kg/dose Urinary tract infection: 1.5 mg/kg/dose Synergy (for gram-+ infections): 1 mg/kg/dose Children and Adults: Ophthalmic: Instill 1-2 drops of solution every 4 hours; apply ointment 2-3 times/day; for severe Genghis Khun ([email protected],nafanakhun.wordpress.com)


infections apply ointment every 3-4 hours, or solution 2 drops q30-60 minutes initially, then reduce to less frequent intervals Inhalation: Standard aerosolized tobramycin: Children: 40-80 mg 2-3 times/day Adults: 60-80 mg 3 times/day High-dose regimen: > 6 years and Adults: 300 mg every 12 hours (do not administer doses less than 6 hours apart); administer in repeated cycles of 28 days on drug followed by 28 days off drug KI: allergy, myasthenia gravis. P: newborn babies and infants, elderly people, decreased kidney function, obesity, dehydration, disorders involving muscle weakness, such as Parkinson's disease. ES: Changes in kidney function, Damage to hearing & vestibular function within the ear. Symptoms include dizziness, sensations of ringing or other noise in the ears (tinnitus), vertigo, unsteadiness or loss of balance, Rash or itching, Headache, Nausea and vomiting, Decrease in the levels of magnesium, sodium, calcium or potassium in the blood, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Disturbances in the normal levels of blood cells in the blood, Fever, Confusion, Lethargy, Pain at the injection site, Inflammation of the large intestine (colitis) IO: Increased effect: Extended spectrum penicillins (synergistic) Increased toxicity: Neuromuscular blockers increase neuromuscular blockade Amphotericin B, cephalosporins, loop diuretics, and vancomycin may increase risk of nephrotoxicity Preg: C Nama Dagang:



Netilmicin I: Septicemia, peritonitis, intra-abdominal abscess, lower respiratory tract infections, urinary tract infections; skin, bone, and joint infections caused by susceptible organisms; active against Pseudomonas aeruginosa, E. coli, Proteus, Klebsiella, Serratia, Enterobacter, Citrobacter, and other gram-- bacilli BSO: Injection: 100 mg/mL D: Neonates <6 weeks: 2-3.25 mg/kg/dose 2x/hari Children 6 weeks to 12 years: 1-2.5 mg/kg/dose 3x/hari Children >12 years & Adults: 1.5-2 mg/kg/dose 2-3x/day Some clinicians suggest a daily dose of 4-7 mg/kg for all patients with normal renal function. KI: hypersensitivity P: Use with caution in patients with pre-existing renal insufficiency, vestibular or cochlear impairment, myasthenia gravis, hypocalcemia, conditions which depress neuromuscular transmission. Parenteral aminoglycosides are associated with nephrotoxicity or ototoxicity; the ototoxicity may be proportional to the amount of drug given and the duration of treatment; Genghis Khun ([email protected],nafanakhun.wordpress.com)


tinnitus or vertigo are indications of vestibular injury and impending hearing loss; renal damage is usually reversible. ES: >10%: Central nervous system: Neurotoxicity Otic: Ototoxicity (auditory), ototoxicity (vestibular) Renal: Nephrotoxicity, decreased creatinine clearance 1% to 10%: Dermatologic: Skin itching, redness, rash, swelling IO:Increased/prolonged effect of depolarizing and nondepolarizing neuromuscular blocking agents Increased toxicity: Concurrent use of amphotericin, vancomycin, ethacrynic acid, furosemide and other nephrotoxic agents may increase nephrotoxicity Preg: D Nama Dagang: Netromycin



B. Cephalosporin Cefadroxil Cefazolin Cefradine/ Cephradine Cefamandole Cefprozil Ceftriaxone Cefotaxime Ceftazidime Ceftizoxime Cefopherazone Cefpodoxime Cefpirome Cefotiam Cefepime Cefditoren

Cephalotin/ Cefalotin Cephalexin/ Cefalexin Cefaclor Cefuroxime Cefmetazole Cefixime



Cefadroxil Cephalosporin (First Generation) I: Used for epiglottitis and for resistant rhinosinusitis. BSO: Capsule: 500 mg, Tablet: 1 g Suspension, oral: 125 mg/5 mL, 250 mg/5 mL, 500 mg/5 mL D: 1-2 g/d PO divided bid Paed.: 30 mg/kg/d PO divided bid KI: Hipersensitif; hyperbilirubinemic neonates, particularly if premature IO: Alcoholic beverages consumed <72 h after dosing may produce disulfiramlike reactions; may increase hypoprothrombinemic effects of anticoagulants; coadministration with potent diuretics and aminoglycosides (eg, loop diuretics) may increase nephrotoxicity Preg: B P: Reduce dosage by half if CrCl is 10-30 mL/min and by three fourths if CrCl is <10 mL/min (high doses may cause CNS toxicity); bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cephalotin/ Cefalotin Cephalosporin (First Generation) I: Infections caused by susceptible strains in respiratory, genitourinary, gastrointestinal, skin and soft tissue, bone and joint infections; septicemia; treatment of susceptible gram-+ bacilli and cocci (never enterococcus); some gram-- bacilli including E. coli, Proteus, and Klebsiella may be susceptible BSO: Powder for injection: 0.5 g, 1 g, 2 g D: Adults= 500 mg-2 g IM/ IV tiap 4-6 jam. Children—13.3-26.6 mg/kg/ 4 jam IM/IV. KI: Hypersensitivity P: Use with caution in patients with a history of penicillin allergy, especially IgE-mediated reactions (eg, anaphylaxis); may cause antibiotic-associated colitis or colitis secondary to C. difficile ES: 1% to 10%: Gastrointestinal: Diarrhea, nausea, vomiting IO: Probenecid decreases renal clearance of cephalothin; aminoglycosides may increase risk of nephrotoxicity Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefazolin Antibiotic, Cephalosporin (First Generation) I: Alternate antibiotic in patients allergic to penicillin. Infection of gram-+ bacilli and cocci (except enterococcus); some gram-bacilli including E. coli, Proteus, and Klebsiella may be susceptible BSO: Vial 1 g D: 2 g IV q8h for 4-6 wk. Paed.: 25 mg/kg IV q6h KI: Hipersensitif IO: Probenecid prolongs effects; coadministration with aminoglycosides may increase renal toxicity; may yield false-+ urine-dip test results for glucose Preg: B P: Adjust dose in renal impairment; superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy Nama Dagang: Biozolin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cephalexin/ Cefalexin Antibiotic, Cephalosporin (First Generation) I: Bacterial infections of respiratory tract, otitis media, infections of the skin or soft tissue, bones and joints, urinary tract, including chronic prostatitis, genitals, teeth or gums. BSO: Tablet & Capsule: 250 mg, 500 mg Powder for oral suspension: 125 mg/5 mL; 250 mg/5 mL Suspension, oral, pediatric: 100 mg/mL [5 mg/drop] D: 500 mg PO q6h for 10 d Paed.: 25-50 mg/kg/d PO q6h for 10 d; max 3 g qd KI: Hipersensitif IO: Coadministration with aminoglycosides increases nephrotoxic potential Preg: B P: Adjust dose in renal impairment Nama Dagang:



Cefradine/ Cephradine Cephalosporin (First Generation) I: sinusitis, bronchitis, pneumonia, Bacterial infections of the urinary tract, kidney (pyelonephritis), the ears, nose or throat, eg otitis media, pharyngitis, tonsillitis, skin or soft tissue, eg abscesses, cellulitis, impetigo. Preventing infection following surgery BSO: Capsule: 250 mg, 500 mg Powder for injection: 250 mg, 500 mg, 1 g, 2 g, (in ready-to-use infusion bottles) Powder for oral suspension: 125 mg/5 mL; 250 mg/5 mL D: Adults= 250 mg-1 g tiap 6-12 jam. Infants and children 9 months= 6.25 mg-1 g/kg/ 6 jam, or 12.5-50 mg/kg/ 12 jam. KI: Allergy to cephalosporin-type antibiotics P: Hipersensitif, Decreased kidney function ES: Nausea, vomiting, heartburn, diarrhoea or abdominal pain, Dizziness, Inflammation of the tongue (glossitis), Wheezing or difficulty in breathing, Headache, Overgrowth of the yeast Genghis Khun ([email protected],nafanakhun.wordpress.com)


Candida, which may cause infection such as thrush, Skin reactions such as rash and itch, Fever, Pain in the joints (arthralgia), Swelling due to fluid retention (oedema), Disturbance in the levels of blood cells in the blood, Severe allergic skin rashes, Bowel infection resulting in inflammation of the bowel lining (pseudomembranous colitis), Liver or kidney disorders IO: Increased effect: High-dose probenecid decreases clearance Increased toxicity: Aminoglycosides increase nephrotoxic potential Preg: B Nama Dagang:



Cefaclor -- Second-generation cephalosporin I: Pyelonephritis, Infections of the ears, nose or throat, respiratory tract, urinary tract, skin or soft tissue infections BSO: Capsule: 250 mg, 500 mg Powder for oral suspension: 125 mg/5 mL; 187 mg/5 mL; 250 mg/5 mL; 375 mg/5 mL Tablet, extended release: 375 mg, 500 mg D: Bacterial infections: Tab: Adults= 250-500 mg tiap 8 jam. Infants and children 1 month=6.7-13.4 mg/kg/ 8 jam. Extended-release tablets: Adults= 375-500 mg tiap 12 jam for 7-10 days. Chewable tab: Children Pharyngitis: 20 mg/ kg tiap 12 jam. Otitis media: 40 mg/ kg tiap 8-12 jam. KI: Hipersensitif IO: Alcoholic beverages consumed <72 h after taking may produce disulfiramlike reactions; may increase hypoprothrombinemic effects of anticoagulants; Genghis Khun ([email protected],nafanakhun.wordpress.com)


coadministration with potent diuretics (eg, loop diuretics) and aminoglycosides may increase nephrotoxicity; monitor renal function closely ES: Headache, Rash, Itching (pruritus), Abdominal pain, Diarrhoea, Vomiting, Nausea, Allergic reaction to active ingredient, Fever (pyrexia), Dizziness, Inflammation of the large intestine (colitis) Preg: B P: Reduce dosage by half if CrCl is 10-30 mL/min and by one fourth if CrCl <10 mL/min; bacterial or fungal overgrowth of nonsusceptible organisms may occur with prolonged or repeated therapy Nama Dagang:



Cefamandole Cephalosporin (Second Generation) I: Bacterial infection; mainly respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic, septicemia; surgical prophylaxis. Active against methicillinsensitive staphylococci, many streptococci, and various gram-bacilli including E. coli, some Klebsiella, P. mirabilis, H. influenzae, and Moraxella. BSO: Powder for injection: 500 mg; 1 g; 2 g; 10 g D: Adults= 500 mg-2 g IM/IV tiap 4-8 jam. Infants and children 1 month= 8.3- 50 mg/ kg IM/IV tiap4-8 jam. KI: Hypersensitivity P: Modify dosage in patients with severe renal impairment; prolonged use may result in superinfection; although rare, cefamandole may interfere with hemostasis via destruction of vitamin K producing intestinal bacteria, prevention of activation of prothrombin by the attachment of a methyltetrazolethiol side chain, and by an immune-mediated thrombocytopenia. Use with caution in patients with a history of penicillin allergy especially Genghis Khun ([email protected],nafanakhun.wordpress.com)


IgE-mediated reactions (eg, anaphylaxis, urticaria); may cause antibiotic-associated colitis or colitis secondary to C. difficile. ES: Contains MTT side chain which may lead to increased risk of hypoprothrombinemia and bleeding. Gastrointestinal: Diarrhea Local: Thrombophlebitis IO: Disulfiram-like reaction has been reported when taken within 72 hours of alcohol consumption Increased cefamandole plasma levels: Probenecid Increased nephrotoxicity: Aminoglycosides, furosemide Hypoprothrombinemic effect increased: Warfarin and heparin Preg: B Nama Dagang: Dardokef



Cefuroxime Cephalosporin (Second Generation) I: Bacterial infections of respiratory tract, ears, nose or throat, urinary tract, Gonorrhoea, Pelvic inflammatory disease, meningitis, septicaemia. Preventing infections following abdominal, pelvic, bone (orthopaedic), heart (cardiac), lung (pulmonary), oesophageal and blood vessel (vascular) surgery. BSO: Infusion, premixed (frozen): 750 mg; 1.5 g Powder for injection: 750 mg, 1.5 g, 7.5 g Powder for oral suspension: 125 mg/5 mL; 250 mg/5 mL Tablet: 125 mg, 250 mg, 500 mg D: 2 g IV q6-8h Pediatric: 80-160 mg/kg/d IV divided q4-6h D: For bacterial infections: Oral suspension: Anak 3 bln-1 thn= 10-15 mg/kg 2x/hr for 10 days. Tab: Dws= 250-500 mg 2x/hr Gö: 1 g single dose. Anak= 30 mg/kg/d PO divided bid for 5 d 250 mg tiap 12 jam for 10 days. For injection dosage form: Adults= 750 mg- 3 g IM/IV tiap 6-8 jam for 5-14 days. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Gö: 1.5 g IM single dose/ terbagi 2 dosis (+ probenecid oral 1 g) Anak > 1 bln= 12.5-150 mg/kg IM/IV tiap 6-8 jam. Newborns= 10-100 mg/kg IV tiap 8-12 jam. KI: Hipersensitif ES: Inflammation at the injection site, Temporary rise in liver enzymes, diarrhoea, nausea, vomiting, abdominal pain, Overgrowth of the yeast Candida, jaundice, nephritis, anaphylaxis IO: Alcoholic beverages consumed <72 h after taking may produce disulfiramlike reactions; may increase hypoprothrombinemic effects of anticoagulants; may increase nephrotoxicity in patients receiving potent diuretics (eg, loop diuretics); coadministration with aminoglycosides increases nephrotoxic potential Preg: B P: Administer half dose if CrCl is 10-30 mL/min and quarter dose if CrCl <10 mL/min; fungal and microorganism overgrowth may occur with prolonged therapy Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefprozil Cephalosporin (Second Generation) I: Treatment of otitis media and infections involving the respiratory tract and skin and skin structure; Active against methicillin-sensitive staphylococci, many streptococci, and various gram-- bacilli including E. coli, some Klebsiella, P. mirabilis, H. influenzae, and Moraxella. BSO: Powder for oral suspension: 125 mg/5 mL; 250 mg/5 mL Tablet: 250 mg, 500 mg D: Adults= 250-500 mg tiap 12-24 jam for 10 days. Children 2-12thn= 7.5-20 mg/kg tiap 12-24 jam for 10 days. KI: Hipersensitif IO: Probenecid increases effect of cefprozil; coadministration with furosemide and aminoglycosides increases nephrotoxic effects of cefprozil Preg: B P: Adjust dosage in renal impairment Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefmetazole Cephalosporin (Second Generation) I: Aerobic and anaerobic gram-+ and gram-- bacteria; surgical prophylaxis, specifically colorectal and OB-GYN BSO: Vial 1 g, 2 g D: Adults: I.V.: Prophylaxis: 2 g 30-90’ pre-op or 1 g 30-90’ preop; repeat 8 and 16 hours later KI: Hypersensitivity P: Severe renal impairment; history of penicillin allergy especially IgE-mediated reactions (eg, anaphylaxis); may cause antibiotic-associated colitis or colitis secondary to C. difficile ES: Contains MTT side chain which may lead to increased risk of hypoprothrombinemia and bleeding. Rash, Diarrhea IO: Increased effect: Probenecid may decrease cephalosporin elimination. Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity Preg: B Nama Dagang: Cefmetazon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ceftriaxone Cephalosporin (Third Generation) I: Gonorrhoea, septicaemia, respiratory tract, Meningitis, Preventing infection following surgery BSO: Vial 1 g D: 2 g IV/IM q12-24h; max 4 g/d Gonococcal pharyngitis: 250 mg IM for 1 dose Paed. Neonates >7 d: 25-50 mg/kg/d IV/IM; max 125 mg/d Infants and children: 100 mg/kg/d IV/IM divided q12h; max 2 g/d Gonococcal pharyngitis: 125 mg IM for 1 dose KI: Hipersensitif IO: Probenecid increase levels; coadministration with ethacrynic acid, furosemide, & aminoglycosides increase nephrotoxicity Preg: B P: Adjust dose in renal impairment; caution in breastfeeding women, allergy to penicillin, pseudo-biliary lithiasis, and non—C difficilediarrhea Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefixime Cephalosporin (Third Generation) I: Infection of the kidney, ears, nose or throat, respiratory tract, urinary tract BSO: Powder for oral suspension: 100 mg/5 mL Tablet, film coated: 200 mg, 400 mg D: 400 mg PO once Paed. <45 kg: 8 mg/kg PO once; max 400 mg. KI: Hipersensitif IO: Coadministration of aminoglycosides increases nephrotoxicity; probenecid may increase effects Preg: B P: Adjust dose in patients with renal impairment, continuous ambulatory peritoneal dialysis, and hemodialysis Nama Dagang:



Cefotaxime Antibiotic, Cephalosporin (Third Generation) I: Gonorrhoea, pyelonephritis, respiratory tract, urinary tract, skin or soft tissue infections. Meningitis, Preventing infection following surgery, BSO: Infusion, as sodium, premixed, in D5W (frozen): 1 g; 2 g Powder for injection: 500 mg, 1 g, 2 g, 10 g D: 1-2 g IV q6-8h; max 12 g/d Paed. 100-200 mg/kg/d IV divided q8h KI: Hipersensitif IO: Probenecid may increase levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity Preg: B P: Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy; has been associated with severe colitis Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ceftazidime Cephalosporin (Third Generation) I: Abdominal& urinary tract infections, Infections caused by the bacterium pseudomonas aeruginosa. Infections of respiratory tract BSO: Infusion, premixed (frozen): 1 g; 2 g Powder for injection: 500 mg, 1 g, 2 g, 6 g D: Adults= 250 mg- 2 g IM/IV tiap 8-12 jam. Cystic fibrosis may receive 30-50 mg/kg IV tiap 8 jam. Anak 1-12 thn= 30-50 mg/kg IV tiap 8 jam. Newborns up to 4 weeks of age= 30 mg/kg IV tiap 12 jam. KI: Hipersensitif IO: Nephrotoxicity may increase with aminoglycosides, furosemide, and ethacrynic acid; probenecid may increase ceftazidime levels Preg: B P: Adjust dose in renal impairment Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ceftizoxime Cephalosporin (Third Generation) I: Bacterial infection of respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic, septicemia; active against many gram-- bacilli (not Pseudomonas), some gram-+ cocci (not Enterococcus), and some anaerobes BSO: Injection in D5W (frozen): 1 g; 2 g Powder for injection: 500 mg, 1 g, 2 g, 10 g D: 500 mg- 4 g IM/IV tiap 8-12 jam. Go: 1g single doseIM. Anak > 6 bln= 50 mg/kg IM/IV tiap 6-8 jam. KI: Hypersensitivity P: Renal impairment, history of penicillin allergy, may cause antibiotic-associated colitis or colitis secondary to C. difficile ES: 1% to 10%: Fever, Rash, pruritus, Eosinophilia, thrombocytosis, Elevated transaminases, alkaline phosphatase. IO: Increased effect: Probenecid may decrease cephalosporin elimination. Increased toxicity: Furosemide, aminoglycosides may be a possible additive to nephrotoxicity Preg: B Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefopherazone -- Third-generation cephalosporin I: Bacterial infection; respiratory tract, skin and skin structure, bone and joint, urinary tract and gynecologic as well as septicemia. Active against a variety of gram-- bacilli, some gram-+ cocci, and has some activity against Pseudomonas aeruginosa. BSO: Injection: 1 g; 2 g D: Adults= IM/IV 1-6g tiap 12 j,or 2-4 g tiap 8 j. max 12 g/d Pediatric: Not established; 100-150 mg/kg/d IV/IM divided q8-12h; max 12 g/d (suggested) KI: Hipersensitif IO: Probenecid may increase levels; coadministration with furosemide and aminoglycosides may increase nephrotoxicity Preg: B P: Adjust dose in severe renal impairment; has been associated with severe colitis Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefpodoxime Cephalosporin (Third Generation) I: Gonorrhoea, Infections of respiratory tract, urinary tract, Skin or soft tissue BSO: Tab 100 mg D: Acute cystitis: 100 mg PO q12h Acute pyelonephritis: 200 mg PO q12h Paed. 10 mg/kg PO divided bid; max 400 mg/d KI: Hipersensitif IO: Decreased effect with antacids and H2-receptor antagonists; increased effect with probenecid Preg: B P: Adjust dose in severe renal insufficiency (high doses may cause CNS toxicity); superinfections and promotion of nonsusceptible organisms may occur with prolonged use or repeated therapy Nama Dagang: Banan Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cefpirome I: Septikemia, neutropenia febril, pneumonia nosokomial, infeksi pd ICU, infeksi berat BSO: Vial 1 g D: 2-4 g 2x/hr KI: Hipersensitif P: Hipersensitif ES: Gatal IO: Preg:: A, B, C, D, X Nama Dagang:



Cefotiam I: Bronkitis, peritonitis, osteomielitis, profilaksis pra op BSO: Tab 200 mg, Vial 1 g D: Dws IM/IV 0.5-2 g 2-4x/hr. Septikemia s/d 4 g KI: Hipersensitif P: Hamil, laktasi, ggn transportasi esofagus, alergi penisilin. ES: Sakit kepala, nyeri dada, syok, kolitis pseudomembran, ikterus, hipoprotrombinemia, sindr steven-Johnson IO: Aminoglikosida, diuretik Preg:: A, B, C, D, X Nama Dagang:



Cefepime Cephalosporin (Fourth Generation) I: Urinary tract infections; monotherapy for febrile neutropenia; skin and skin structure infections caused by Streptococcus pyogenes; pneumonia caused by pneumococcus, Pseudomonas aeruginosa, and other gram-- organisms; complicated intra-abdominal infections (+ metronidazole). Also active against methicillin-susceptible staphylococci, Enterobacter sp, and many other gram-- bacilli. BSO: Infusion, piggy-back: 1 g; 2 g Injection: 500 mg, 1 g, 2 g D: 500 mg- 2 g IM/IV tiap jam for 7-10 days. Anak 2 bln-16 thn= 50 mg/kg IM/IV tiap 8-12 jam, for 7-10 days. KI: Hypersensitivity P: Renal impairment; history of penicillin/ cephalosporin allergy, especially IgE-mediated reactions (eg, anaphylaxis); may cause antibiotic-associated colitis or colitis secondary to C. difficile ES: >10%: + Coombs' test without hemolysis Genghis Khun ([email protected],nafanakhun.wordpress.com)


1% to 10%: Rash, pruritus, Diarrhea, nausea, vomiting, Fever (1%), headache (1%), Local: Pain, erythema at injection site IO: Increased effect: High-dose probenecid decreases clearance Increased toxicity: Aminoglycosides increase nephrotoxic potential Preg:: A, B, C, D, X Nama Dagang:



Cefditoren I: BSO: Tab salut selaput D: Adults & > 12 thn Bronchitis= 400 mg 2x/hari for 10 days Tonsillitis: 200 mg KI: Hypersensitivity P: ES: IO: Preg: B Nama Dagang: Meiact



C. Chloramphenicol Chloramphenicol Thiamphenicol



Chloramphenicol I: Haemophilus influenzae infection, Severe infections, Typhoid BSO: Capsule: 250 mg Ointment, ophthalmic: 1% [10 mg/g] Powder for injection: 1 g Powder for ophthalmic solution: 25 mg/vial Solution Otic:& Ophthalmic:: 0.5% [5 mg/mL] D: Capsules and suspension: Adults= 500 mg PO/IV q6h 12.5 mg/kg tiap 6 jam, or 25 mg/kg tiap 12 jam. Anak= 6.25 mg/kg tiap 6 jam. Injection: Adults= 12.5 mg/kg tiap 6 jam. Anak= 6.25 mg/kg tiap 6 jam. KI: Hipersensitif IO: When administered concurrently with barbiturates, chloramphenicol serum levels may decrease while barbiturate levels may increase, causing toxicity; manifestations of hypoglycemia may occur with sulfonylureas; rifampin may reduce serum chloramphenicol levels, presumably through Genghis Khun ([email protected],nafanakhun.wordpress.com)


hepatic enzyme induction; may increase effects of anticoagulants; may increase serum hydantoin levels, possibly resulting in toxicity; chloramphenicol levels may be increased or decreased Preg: C P: Use only for indicated infections or as prophylaxis for bacterial infections; serious and fatal blood dyscrasias (aplastic anemia, hypoplastic anemia, thrombocytopenia, granulocytopenia) can occur; evaluate baseline and perform periodic blood studies approximately every 2 d while in therapy; discontinue upon appearance of reticulocytopenia, leukopenia, thrombocytopenia, anemia, or findings attributable to chloramphenicol; adjust dose in liver or kidney dysfunction; caution in Preg: at term or during labor because of potential toxic effects on fetus (gray syndrome) Nama Dagang:



Thiamphenicol I: Infeksi sal napas, urogenital, hepatobilier, sal cerna, demam tifoid & paratifoid & salmonellosis lain. Bruselosis. Gonorre BSO: Kaps 500 mg D: 500 mg 3x/hr. Anak 30-50 mg/kg/hr dlm dosis terbagi KI: Hipersensitif, anemia, hamil trim 3. Laktasi P: Jangka panjang. Defisiensi G6PD. Bayi. Kerusakan hati &ginjal ES: depresi ssm. Tulang, anemia aplastik, sindr pd bayi IO: PCT meningkatkan kadar serum. Preg:: A, B, C, D, X Nama Dagang:



D. Makrolida Erythromycin Roxithromycin Azithromycin Spiramycin Clarithromycin Lincomycin



Erythromycin I: Bronchitis, bronchiectasis, pneumonia, Legionnaires' disease, sinusitis, pharyngitis, laryngitis, tonsillitis, Whooping cough, otitis externa, gum disease (gingivitis), Vincent's angina, blepharitis, boils, abscesses, cellulitis, impetigo, erysipelas, Urethritis, prostatitis, Gonorrhoea, Syphilis, Diphtheria, Scarlet fever, Prevention of bacterial infection following surgery, burns, trauma or dental procedures Acne, acne rosacea. BSO: Erythromycin base: Capsule, delayed release: 250 mg Ointment, ophthalmic: 0.55 mg (3.5 g) Tablet: 250 mg, 333 mg, 500 mg Erythromycin estolate: Capsule: 250 mg Suspension, oral: 125 mg/5 mL; 250 mg/5 mL Tablet: 500 mg Erythromycin ethylsuccinate: Granules for oral suspension: 400 mg/5 mL Powder for oral suspension: 200 mg/5 mL Genghis Khun ([email protected],nafanakhun.wordpress.com)


Suspension, oral: 200 mg/5 mL; 400 mg/5 mL Suspension, oral [drops]: 100 mg/2.5 mL Tablet: 400 mg Tablet, chewable: 200 mg Erythromycin gluceptate: Injection: 1000 mg Erythromycin lactobionate: injection: 500 mg, 1000 mg Erythromycin stearate: Tablet, film coated: 250 mg, 500 mg D: Infections: Dws= 250-500 mg 2-4x/hari. Anak= 7.5-12.5 mg/kg 4x/hari, or 15-25 mg/ kg 2x/hari. Prevention of heart infections: Dws= 1 g 2 jam sblm op. then 500 mg 6 jam after first dose. Anak= 20 mg/kg 2 jam sblm op, then 10 mg/kg after first dose.. KI: Hipersensitif; hepatic impairment IO: Coadministration may increase toxicity of theophylline, digoxin, carbamazepine, and cyclosporine; may potentiate anticoagulant effects of warfarin; coadministration with lovastatin and simvastatin increases risk of rhabdomyolysis Preg: B Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Caution in liver disease; estolate formulation may cause cholestatic jaundice; adverse GI tract effects are common (give doses pc); discontinue use if nausea, vomiting, malaise, abdominal colic, or fever occur Nama Dagang:



Roxithromycin I: Pneumonia, bronchitis, sinusitis, tonsillitis, pharyngitis, otitis media, Chlamydia BSO: Tab 150 mg D: Dws 150 mg 2x/hr . Anak > 4th 5-8 mg/kg/hr terbagi dlm 2 dosis KI: Hipersensitif P: Hamil, laktasi, disfungsi liver ES: Ggn GI IO: Teofilin, digoxin, terfenadin Preg:: A, B, C, D, X BSO: Nama Dagang:



Azithromycin I: pneumonia, bronchitis, sinusitis, tonsillitis, pharyngitis, otitis media, Chlamydia. Bacterial infections of the skin or soft tissue. BSO: Powder for injection: 500 mg Powder for oral suspension: 100 mg/5 mL; 200 mg/5 mL; 1 g (single-dose packet) Tablet: 250 mg, 600 mg D: Oral: Chancroid in men and chlamydia infections: 1g single dose. Gonococcal: 2 g single dose Otitis media and pneumonia: Anak 6 bln-12 thn= Hr I=10 mg/kg 1x Hr 2-5= 5 mg/kg 1x Strep throat: Anak 2-12 thn= 12 mg/kg 1x for 5 days. Tab: Bronchitis, strep throat, pneumonia, and skin infections: Dws= Hr I. 500 mg. Hr 2-5. 250 mg. Chlamydia infections: Dws= 1 g single dose. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prevention of Mycobacterium avium complex (MAC) disease: Dws = 1.2 g 1x/minggu. sinusitis: 500 mg a day for 3 days Injection: Pelvic inflammatory disease, Pneumonia: 500 mg 1x/hr IV for 1-2 hari. KI: Hipersensitif; hepatic impairment; coadministration with pimozide IO: May increase toxicity of theophylline, warfarin, and digoxin; effects are reduced with coadministration of aluminum and/or magnesium antacids; nephrotoxicity and neurotoxicity may occur when coadministered with cyclosporine Preg: B P: Site reactions can occur with IV route; bacterial or fungal overgrowth may result from prolonged antibiotic use; may increase hepatic enzymes and cholestatic jaundice; caution in patients with impaired hepatic function or prolonged QT intervals Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Spiramycin -- DOC for maternal or fetal toxoplasmosis. Alternative therapy in other patient populations when unable to use pyrimethamine and sulfadiazine. I: Toxoplasmosis in pregnant women since this medicine decreases the chance that the unborn baby will get the infection. It will not work for colds, flu, or other virus infections. BSO: Tab 250 mg, 500 mg (1.5 MIU), 1 g (3 MIU), Sir 125 mg/5cc D: Capsules or tab: Infections: Dws= 1-2 g (3,000,000-6,000,000 IU) 2x/hari 2x/hr or 500 mg-1 g (1,500,000-3,000,000 IU) 3x/hari. Severe infections: 2-2.5 g(6,000,000-7,500,000 IU) 2x/hari. Anak >20 kg= 25 mg (75,000 IU)/ kg 2x/hari or 17 mg (51,000 IU)/ kg 3x/hari. Injection: Infections: Dws= 500 mg (1,500,000 IU) IV pelan tiap 8 jam. Severe infections: 1 g (3,000,000 IU) slowly IV tiap 8 jam. Suppository: Infections: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dws= 2-3x 750 mg (1,950,000 IU) suppositories per day. Anak= 2-3x 500 mg (1,300,000 IU) suppositories per day. Newborns= 250 mg (650,000 IU) supp/5 kgBB 1x/hari. KI: Hipersensitif IO: Decreases bioavailability of carbidopa, leading to decrease of levodopa levels ES: Less common, Skin rash, itching, Unusual bleeding or bruising. Preg: C P: Cross-resistance between microorganism resistant to erythromycin and carbomycin; acute colitis is experienced in 1% of patients; GI toxicity most common adverse effect; IV administration associated with peripheral paresthesias, irritation at injection site, dysesthesia, giddiness, pain, stiffness, burning sensation, and hot flashes; long-term use may result in superinfection; caution in cardiovascular disease because may prolong QT; may elevate LFTs Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Clarithromycin -- Binds to 50S ribosomal subunit of bacteria. Inhibits protein synthesis by interfering with tRNA translocation and inhibiting formation of initiation complex. I: Bronchitis, pneumonia, tonsillitis, sinusitis, pharyngitis, otitis media. Bacterial infections of the skin or soft tissue. Eradicating Helicobacter pylori (in people with peptic ulcers.) BSO: Granules for oral suspension: 125 mg/5 mL; 250 mg/5 mL Tablet, film coated: 250 mg, 500 mg Tablet, film-coated, extended release: 500 mg D: Tab: Dws 250-500 mg 2x/day for 7-14 days. Anak 7.5 mg/kg 2x/day for 10 days Eradicating Helicobacter pylori: Dws 500 mg 3x/day for 14 days (+ Omeprazole/ Ranitidine) or 500 mg 2x/day for 14 days (+ amoxicillin/ Lanzoprazole) Extended release tab: Dws 1000 mg 1x/day for 7-14 days. KI: Hipersensitif; coadministration of pimozide Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Toxicity increases with coadministration of fluconazole and pimozide; effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, carbamazepine, ergot alkaloids, triazolam, HMG-CoA reductase inhibitors; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increases in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents; decreases metabolism of repaglinide, thus increasing serum levels and effects Preg: C P: Nausea, diarrhea, glossitis, stomatitis, skin rashes, pruritus, urticaria, anaphylaxis, Stevens-Johnson syndrome, eosinophilia, headache, transient CNS symptoms (eg, anxiety, dizziness, insomnia, confusion, bad dreams); coadministration with ranitidine or bismuth citrate not recommended if CrCl <25 mL/min; give half dose or increase dosing interval if CrCl <30 mL/min Genghis Khun ([email protected],nafanakhun.wordpress.com)


Lyncomycin Macrolide I: Bacterial infections, mainly those caused by streptococci and staphylococci resistant to other agents BSO: Kaps 500 mg. Sir 250 mg/5cc. Injection: 300 mg/mL D: Capsules: Dws 500 mg 3-4x/day. Anak 7.5-15 mg/kg 4x or 10-20 mg/kg 3x/day Injection: Dws 600 mg-1g IV pelan >1 jam 2-3x/day or 600 mg IM 1-2x/day Anak: 10 mg/kg IM 1-2x/day or 3.3-6.7 mg/kg IV pelan 3x/day or 5-10 mg/kg IV 2x/day KI: Minor bacterial infections or viral infections; hypersensitivity to lincomycin or any component or clindamycin P: ES: 1% to 10%: Gastrointestinal: Nausea, vomiting, diarrhea IO: Decreased effect with erythromycin Increased activity/toxicity of neuromuscular blocking agents Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


E. Penicillin Penicillin G Benzathine/ Benzathine Penicillin G Penicillin G Procaine/ Procaine Benzylpenicillin Penicillin V K/ Phenoxymethylpenicillin Amoxicillin Amoxicillin/Clavulanic acid Ampicillin Piperacillin, Tazobactam Sultamicillin Sulbenicillin Flucloxacillin Cloxacillin



Penicillin G benzathine/ Benzathine Penicillin G I: Active against some gram-+ organisms, few gram-organisms such as Neisseria gonorrhoeae, and some anaerobes and spirochetes; used in the treatment of syphilis; used only for the treatment of mild to moderately severe infections caused by organisms susceptible to low concentrations of penicillin G or for prophylaxis of infections caused by these organisms BSO: Injection: 300,000 U/mL; 600,000 U/mL D: Injection: Dws: 1,200,000-2,400,000 U IM single dose Primary/secondary syphilis: 2.4 million U IM in a single dose Latent/unknown duration/tertiary syphilis (excluding neurosyphilis): 2.4 million U IM qwk x 3 wk Anak: 300,000-1,200,000 U IM singledose Primary/secondary syphilis: 50,000 U/kg IM single dose; max 2.4 million U Latent/unknown duration/tertiary syphilis (excluding neurosyphilis): 50,000 U/kg IM qwk x 3 wk KI: Hipersensitif Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Probenecid can increase effectiveness by decreasing clearance; coadministration with tetracyclines can decrease effectiveness Preg: B P: Impaired renal function or seizure disorders Nama Dagang:



Penicillin G Procaine/ Procaine Benzylpenicillin DOC for treatment of actinomycosis. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. I: Moderately severe infections due to Treponema pallidum and other penicillin G-sensitive microorganisms that are susceptible to low but prolonged serum penicillin concentrations BSO: Injection, suspension: 300,000 U/mL; 500,000 U/mL; 600,000 U/mL D: Injection: Dws: 600,000-1,200,000 U IM single dose Neurosyphilis: Add probenecid 500 mg PO qid x 17-21 d Anak: 50,000 U IM singledose KI: Hipersensitif IO: Probenecid can increase effects; coadministration of tetracyclines can decrease effects Preg: B P: Caution in impaired renal function Nama Dagang: Procaine Penicillin G Meiji Genghis Khun ([email protected],nafanakhun.wordpress.com)


Penicillin V K/ Phenoxymethyl Penicillin -- DOC for treatment of actinomycosis. Interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms. I: Ear infections, tonsillitis, Skin infections caused by the streptococcus bacteria Prevention against recurrence of rheumatic fever or prevention of pneumococcal infection BSO: Tab 125mg, 250mg, 500mg, 625mg (250 mg=400,000U) Sir 250 mg/5cc D: Dws 125-500 mg 3-4x/day. Anak 2.5-16.7 mg/kg 3-6x/day. KI: Hipersensitif IO: Probenecid can increase effects; coadministration of tetracyclines can decrease effects ES: Rash, Itching (pruritus), Diarrhoea, Allergic reaction to active ingredient, Fever (pyrexia), colitis Preg: B P: Caution in impaired renal function Nama Dagang: Ospen, Fenocin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Amoxicillin I: Otitis media, Infections of respiratory tract, Bronchitis, Pneumonia, Skin or soft tissue infections, Infections of the urinary tract, Gynaecological infections, Gonorrhoea, peritonitis, bacterial endocarditis, Dental abscess, septicaemia, Typhoid and paratyphoid fever, Eradicating Helicobacteria pylori. BSO: Capsule: 250 mg, 500 mg Powder for oral suspension: 125 mg/5 mL; 250 mg/5 mL Powder for oral suspension, drops: 50 mg/mL Suspension, oral: 200 mg/5 mL; 400 mg/5 mL Tablet, chewable: 125 mg, 200 mg, 250 mg, 400 mg Tablet, film coated: 500 mg, 875 mg D: Dws: 250-500 mg 3x/day or 500-875mg 2x/day Anak: 15 mg/kg 2x/day. Bayi: 6.7-13.3 mg/kg 3x/day, or 12.5-22.5 mg/kg 2x/day Helicobacter pylori bacterial infection: 1 g 2x/day for 14 hari (+ clarithromycin and lansoprazole) or 1 g 3x/day for 14 hari (+ lansoprazole) KI: Hipersensitif; concomitant use of disulfiram Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Coadministration with warfarin or heparin increases risk of bleeding; may act synergistically against selected microorganisms when coadministered with aminoglycosides; coadministration with allopurinol may increase incidence of amoxicillin rash; may decrease efficacy of oral contraceptives when administered concomitantly Preg: B P: Hepatic impairment may occur with prolonged treatment in elderly persons; diarrhea may occur; adjust dose in renal impairment; cross-allergy may occur with other beta-lactams and cephalosporins; administer for >10 d to eliminate organism and prevent sequelae (eg, endocarditis, rheumatic fever); many patients with infectious mononucleosis develop rash during therapy with amoxicillin; urticarial rash that appears after a few days of therapy may indicate hypersensitivity Nama Dagang:



Amoxicillin/ Clavulanic acid I: Abdominal infections, Animal bites, Infections of respiratory tract, genito-urinary infections, cellulitis BSO: Suspension, oral: per 5 cc: Amox 125 mg+clav 31.25 mg, Amox 200 mg+clav 28.5 mg, Amox 250 mg+clav 62.5 mg, Amox 400 mg+clav 57 mg Tab: Amox 250 mg+clav 125 mg, Amox 500 mg+clav 125 mg Amox 875 mg+clav 125 mg Tablet, chewable: Amox 125 mg+clav 31.25 mg Amox 200 mg+clav 28.5 mg, Amox 250 mg+clav 62.5 mg Amox 400 mg+clav 57 mg D: Oral: Dws: 250-500 mg 3x/day or 875 mg 2x/day Paed.: 20-40 mg/kg/d PO divided bid KI: Hipersensitif IO: +Warfarin or heparin increases risk of bleeding ES: Headache, Rash, Itching (pruritus), Diarrhoea, Vomiting, Nausea, Allergic, jaundice, Dizziness, colitis Preg: B P: Renal impairment, adjust dosage when CrCl <30 mL/min Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ampicillin I: Otitis media, sinusitis, Bronchitis, Pneumonia, gonorrhoea, septicaemia, peritonitis, bacterial endocarditis, meningitis, Typhoid and paratyphoid fever. BSO: Capsule: 250 mg, 500 mg. Drops: 100 mg/mL. Oral susp: 125 mg/5 mL; 250 mg/5 mL; 500 mg/5 mL Powder for injection: 125 mg, 250 mg, 500 mg, 1 g, 2 g, 10 g D: Oral Dws 250-500 mg 4x/day. Anak: 12.5-25 mg/kg 4x/day or 16.7-33.3 mg/kg 3x/day Injection: Dws: 250-500 mg IM/IV 4-8x/day. Anak 12.5 mg/kg KI: Hipersensitif IO: Probenecid & disulfiram elevate levels; allopurinol decreases effects and has additive effects on ampicillin rash; may decrease effects of oral contraceptives ES: Rash, Itching (pruritus), Diarrhoea, Nausea, Vomiting, colitis, Liver or kidney disorders, Blood disorders. Preg: B P: Renal failure; evaluate rash & differentiate from allergy Genghis Khun ([email protected],nafanakhun.wordpress.com)


Piperacillin, Tazobactam. I: D: KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: 1. Tazocin



Sultamicillin I: Infeksi saluran nafas BSO: Tab 375 mg. Vial 0.75 g. 1.5 g D: Dws & Anak 375-750 mg 2x/hr. Anak < 30 kg= 25-50 mg/kg/hr terbagi dlm 2 dosis. Go: 2.25 g dosis tunggal + Probenecid 1 g KI: Hipersensitif P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Bactesyn



Sulbenicillin I: Infeksi Sal Kencing, kandung empedu, sal napas, BSO: Vial 1 g, 2 g D: Dws 2-4 g/hr. Anak 40-80 mg/kg/hr IV terbagi dlm 2-4 dosis. KI: Hipersensitif P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Kedacillin



Flucloxacillin I: Infected ulcers, wounds or burns, abscesses, cellulitis, impetigo, boils, pneumonia, lung abscess, sinusitis, tonsillitis, pharyngitis, Osteomyelitis, quinsy, otitis media and otitis externa. # Bacterial infections of the urinary tract, meningitis, septicaemia, endocarditis, enteritis, heart or bone surgery. BSO: Kaps 250 mg. 500 mg D: Oral: Dws 250-500 mg 4x/day Anak: 125-250 mg 4x/day or 6.25-12.5 mg/kg 4x/day KI: Allergy, liver problems or jaundice P: Decreased liver & function, > 50 years of age. ES: Diarrhoea, Nausea and vomiting, Rash, Allergic reaction, colitis, jaundice, hepatitis. IO: Preg:: A, B, C, D, X Nama Dagang: Floxapen



Cloxacillin I: Bacterial infections, notably penicillinase-producing staphylococci causing respiratory tract, skin and skin structure, bone and joint, urinary tract infections BSO: Kaps 250 mg, 500 mg. Vial 250 mg, 500 mg, 1 g Powder for oral suspension: 125 mg/5 mL D: Dws 250-500 mg IO/IV 4x/day. Anak: 6.25-12.5 mg/kg 4x/d KI: Hypersensitivity P: Monitor PT if patient concurrently on warfarin, elimination of drug is slow in renally impaired; use with caution in patients allergic to cephalosporins due to a low incidence of crosshypersensitivity ES: 1-10%: Gastrointestinal: Nausea, diarrhea, abdominal pain IO: Decreased effect: Efficacy of oral contraceptives may be reduced Increased effect: Disulfiram, probenecid may increase penicillin levels, increased effect of anticoagulants Preg: B Nama Dagang: Meixam Genghis Khun ([email protected],nafanakhun.wordpress.com)


F. Quinolon Ciprofloxacin Ofloxacin Moxifloxacin Levofloxacin Norfloxacin Sparfloxacin Pefloxacin Gatifloxacin Not included in product labeling: • Chancroid • Pulmonary exacerbations (airway infections) in cystic fibrosis



Ciprofloxacin Against pseudomonads, streptococci, MRSA, Staphylococcus epidermidis, & most gram-- organisms. Does not have activity against anaerobes. Inhibits bacterial DNA synthesis and growth. I: Pneumonia (but not pneumococcal pneumonia), bronchitis, bronchiectasis and lung infections in cystic fibrosis, sinusitis, otitis media & externa, conjunctivitis, cystitis, pyelonephritis, urethritis, prostatitis, infected ulcers, wounds or burns, abscesses, cellulitis, erysipelas, osteomyelitis & septic arthritis, peritonitis or abdominal abscesses, typhoid, diarrhea, PID, gonorrhoea, septicaemia, intestinal surgery or endoscopic procedures. Anthrax affecting the lungs, anthrax spores I: Infusion, in D5W: 400 mg, in NS or D5W: 200 mg Injection: 200 mg; 400 mg Solution, ophthalmic: 3.5 mg/mL Suspension, oral: 250 mg/5 mL; 500 mg/5 mL Tablet: 100 mg, 250 mg, 500 mg, 750 mg D: Extended-release tab: Dws 500 mg-1g 1x/day for 3-14 days Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral susp or tab: Dws 100-750 mg 2x/day for 3-28 days. Anak: Inhalational anthrax: 15 mg/kg 2x/day Injection:Dws 200-400 mg 2-3x/day. Anak: not recommended except Inhalational anthrax: 10 mg/kg 2x/day KI: Hipersensitif, Anak IO: Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before/ after taking fluoroquinolones; cimetidine may interfere with metabolism; reduces therapeutic effects of phenytoin; probenecid increase serum concentrations; increase toxicity of theophylline, caffeine, cyclosporine, and digoxin; may increase effects of anticoagulants (monitor PT) ES: Nausea and vomiting, Diarrhoea, Rash or itching, Headache, Restlessness, Dizziness, dyspepsia, Depression, Sleepiness, Tremor, Confusion, Convulsions, Disturbances in vision, taste, hearing or smell. Preg: C P: In prolonged therapy, Renal function impairment; Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ofloxacin Interferes with DNA synthesis by binding to topoisomerases II and IV to cause bacterial lysis. Elimination through kidneys by active tubular secretion, which probenecid can block. I: Gonorrhoea, urinary tract infection, septicaemia, chest or lower respiratory tract infection, genito-urinary infections, Skin or soft tissue infections BSO: Injection: 200 mg; 400 mg Ophthalmic & Otic: 0.3% Tablet: 200 mg, 300 mg, 400 mg D: Dws IO/IV 200-400 mg 2x/day for 3-14days. Prostatitis: for 6wk. Gö: 400 mg single dose. KI: Hipersensitif; lactation, Epilepsy, Lack of the enzyme G6PD in the blood (G6PD deficiency), Children, adolescents. IO: Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before/ after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; ciprofloxacin reduces therapeutic effects of phenytoin; Genghis Khun ([email protected],nafanakhun.wordpress.com)


probenecid may increase ciprofloxacin serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT) ES: Headache, Rash, Itching (pruritus), Abdominal pain, Diarrhoea, Disturbed sleep, Restlessness, Loss of contact with reality (psychosis), Dizziness, Nausea and vomiting, Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects), Numbness Preg: C P: Adverse effects include nausea, vomiting, abdominal pain and diarrhea, headache, dizziness; rare reports of seizures, hallucinations, pseudomembranous colitis, skin rash, bone marrow depression, abnormal liver function tests, tendonitis, and photosensitivity; with prolonged therapy, periodically evaluate organ (eg, renal, hepatic, hematopoietic) function; adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Moxifloxacin Inhibits the A subU of DNA gyrase, resulting in inhibition of bacterial DNA replication and transcription. I: Bacterial sinusitis, bronchitis, pneumonia BSO: Tablet: 400 mg. Infus 400 mg/250 cc D: Dws: 400 mg IO/IV 1x/day for 5-14 days KI: Hipersensitif; pediatrics, unless benefits outweigh risks (as in cystic fibrosis) IO: Antacids and electrolyte supplements reduce absorption; loop diuretics, probenecid, and cimetidine increase serum levels; NSAIDs enhance CNS-stimulating effect; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); may increase effects of anticoagulants (monitor PT) ES: Headache, insomnia, Confusion, diarrhoea, constipation, nausea, vomiting or abdominal pain, arrhythmias, dyspepsia, convulsions, Alteration in results of liver function tests, vertigo, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dizziness, Alteration in taste, somnolence, asthenia, Chest pain, candidiasis, Anxiety, Pain in the muscles and joints, Rash or itching Preg: C P: In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy; prolonged QT interval on ECG, and ventricular arrhythmias may occur Nama Dagang: Avelox



Levofloxacin Rapidly becoming a popular choice in pneumonia. This is the L stereoisomer of the D/L parent compound ofloxacin, the D form being inactive. Good monotherapy with extended coverage against Pseudomonas species, as well as excellent activity against pneumococcus. Agent acts by inhibition of DNA gyrase activity. PO form has bioavailability that reportedly is 99%. I: Sinusitis, bronchitis, pneumonia, cystitis and pyelonephritis, prostatitis. Bacterial infections of the skin or soft tissue BSO: Infusion, in D5W: 5 mg/mL Injection: 25 mg/mL Tablet: 250 mg, 500 mg D: 250-750 mg IO/IV slow 1x/day KI: Hipersensitif IO: Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before or after taking fluoroquinolones; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of Genghis Khun ([email protected],nafanakhun.wordpress.com)


phenytoin; probenecid may increase levofloxacin serum concentrations ES: Nausea, diarrhoea, vomiting, abdominal pain, indigestion, Alteration in results of liver function tests, Loss of appetite, Rash or itching, Headache, Dizziness, Drowsiness, insomnia, asthenia, thrush, Pins and needles sensations, Anxiety, Depression, Tremor, Confusion, Convulsions, Pain in the muscles and joints, Blood disorders, Increased heart rate, Low blood pressure Preg: C P: In prolonged therapy, perform periodic evaluations of organ system functions (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Norfloxacin Against pseudomonads, streptococci, MRSA, S epidermidis, and most gram-- organisms. Not anaerobes. Inhibits bacterial DNA synthesis and growth. I: Urinary tract infection BSO: Tab & Kapl 400 mg. Ophthalmic sol.: 0.3% [3 mg/mL] D: 400 mg 2x/day for 3-28 day. Gö: 800 mg single dose. KI: Hipersensitif. Children and growing adolescents. IO: Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2-4 h before/after taking fluoroquinolones; cimetidine may interfere with metabolism; reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations; may increase toxicity of theophylline, caffeine, cyclosporine, and digoxin (monitor digoxin levels); increase effects of anticoagulants (monitor PT) ES: Headache, Rash, pruritus, Abdominal pain, Diarrhoea, dyspepsia, psychosis, Dizziness, Nausea and vomiting Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: In prolonged therapy, perform periodic evaluations of organ system function (eg, renal, hepatic, hematopoietic); adjust dose in renal function impairment; superinfections may occur with prolonged or repeated antibiotic therapy Nama Dagang: Pyrflox



Sparfloxacin I: Treatment of adults with community-acquired pneumonia caused by C. pneumoniae, H. influenzae, H. parainfluenzae, M. catarrhalis, M. pneumoniae or S. pneumoniae; treatment of acute bacterial exacerbations of chronic bronchitis caused by C. pneumoniae, E. cloacae, H. influenzae, H. parainfluenzae, K. pneumoniae, M. catarrhalis, S. aureus or S. pneumoniae BSO: Tablet: 200 mg D: Adults: Oral: 200 mg/day for 10 days. Dosing adjustment in renal impairment: Clcr <50 mL/minute: Day I: 400 mg, then 200 mg/ 48 hours for 9 days (total 6 tab) KI: Hypersensitivity, children <18 years of age, a concurrent administration with drugs which increase the Q-T interval including: amiodarone, bepridil, bretylium,cisapride, disopyramide, furosemide, procainamide, quinidine, sotalol, albuterol, astemizole, chloroquine, cisapride, halofantrine, phenothiazines, prednisone, terfenadine, and tricyclic antidepressants Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Other quinolones have caused transient arthropathy in children; CNS stimulation may occur (tremor, restlessness, confusion, and very rarely hallucinations or seizures); use with caution in patients with known or suspected CNS disorder or renal dysfunction; prolonged use may result in superinfection; if an allergic reaction (itching, urticaria, dyspnea, pharyngeal or facial edema, loss of consciousness, tingling, cardiovascular collapse) occurs, discontinue the drug immediately; use caution to avoid possible photosensitivity reactions during and for several days following fluoroquinolone therapy; pseudomembranous colitis may occur and should be considered in patients who present with diarrhea ES: >1%: Insomnia, agitation, sleep disorders, anxiety, delirium Diarrhea, abdominal pain, vomiting, Leukopenia, eosinophilia, anemia, Increased LFTs IO: Decreased effect: Decreased absorption with antacids containing aluminum, magnesium, and/or calcium, sucralfate, didanosine and by products containing zinc and iron salts when administered concurrently. Take > 4 hours after sparfloxacin. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Phenytoin serum levels may be reduced by quinolones; antineoplastic agents may also decrease serum levels of fluoroquinolones Increased toxicity/serum levels: Quinolones cause increased levels of caffeine, warfarin, cyclosporine, and theophylline (although one study indicates that sparfloxacin may not affect theophylline metabolism), cimetidine and probenecid increase quinolone levels; an increased incidence of seizures may occur with foscarnet. Avoid use with drugs which increase Q-T interval as significant risk of cardiotoxicity may occur. Concurrent use with cisapride is contraindicated. Preg: C Nama Dagang:



Pefloxacin I: Infeksi berat bakteri gram (+) dan (-). GO. BSO: Tab 400 mg. Amp 400 mg/ 5cc. Lar infus 400 mg/125 cc D: 400 mg 2x/hr. Amp 400 mg 2x/hr dlm Infus IV pelan > 1 jam. KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Gatifloxacin Good activity against pneumococci. BSO: Infusion: 2 mg/mL Injection: 10 mg/mL Tablet: 200 mg, 400 mg D: 200-400 mg IO/IV ix/day for 7-14 days Dosage adjustment in renal impairment: Cr clearance <40 mL/minute (or patients on hemodialysis/CAPD): initial dose 400 mg, then 200 mg/day. KI: Hipersensitif; pediatrics, unless benefits outweigh risks (as in cystic fibrosis) IO: Antacids, iron salts, and zinc salts may reduce serum levels; administer antacids 2 h before or after; cimetidine may interfere with metabolism of fluoroquinolones; levofloxacin reduces therapeutic effects of phenytoin; probenecid may increase serum concentrations Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


G. Tetrasiklin Tetracycline Oxytetracycline Doxycycline Minocycline



Tetracycline Treats gram+ and gram- organisms and mycoplasmal, chlamydial, and rickettsial infections. Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). I: Acne vulgaris, acne rosacea, Chlamydia infections, chronic bronchitis, brucellosis, Infections caused by Mycoplasma organisms & Rickettsiae micro-organisms transmitted by lice, fleas, ticks and mites BSO: Tab & Caps: 100 mg, 250 mg, 500 mg Ophthalmic oint & susp: 1% [10 mg/mL] Topical oint: 3% [30 mg/mL] Solution, topical: 2.2 mg/mL Oral susp: 125 mg/5 mL D: 250-500 mg 4x/day or 500 mg-1g 2x/day. Gö: First: 1.5 g, then 500 mg 4x/day for 4 days. Anak >8thn: 6.25-12.5 mg/kg 4x/day or 12.5-25 mg/kg 2x/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; severe hepatic dysfunction, Breastfeeding, Children <12 years of age, SLE, Moderate to severely decreased kidney function, Pregnancy IO: Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of Preg:; can increase hypoprothrombinemic effects of anticoagulants ES: Headache, Diarrhoea, Visual disturbances, pancreatitis, Dizziness, Nausea and vomiting, Skin reactions such as rash and itch, Liver disorders, dysphagia, photosensitivity Preg: D P: Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last half of Preg: through 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oxytetracycline I: Acne vulgaris, acne rosacea, Chronic bronchitis, Dental infections, Weil's Disease/leptospirosis, brucellosis, Infections caused by Rickettsiae micro-organisms transmitted by lice, fleas, ticks and mites, genito-urinary infections, Lyme disease BSO: Capsule: 250 mg Injection,+ lidocaine 2%: 5% [50 mg/mL]; 12.5% [125 mg/mL] D: 250-500 mg 4x/day. Anak >8 thn: 6.25-12.5 mg/kg 4x/day Injection IM: Dws 100 mg 3x/day, or 150 mg 2x/day, or 250 mg Anak: IM 5-8.3 mg/kg 3x/day, or 7.5-12.5 mg/kg 2x/day KI: Children <12 years of age, porphyrias, SLE P: Kidney & Liver disease ES: Headache, Rash, Diarrhoea, Visual disturbances, IO: Decreased effect: antacids containing Al, Ca or Mg. Preg: D Nama Dagang:



Doxycycline Inhibits protein synthesis &, thus, bacterial growth by binding to 30S & possibly 50S ribosomal subU of susceptible bacteria. I: Acne vulgaris, Bubonic plague, Chlamydia, Cholera, Chronic bronchitis, gas gangrene, Weil's Disease/leptospirosis, tularaemia, Eye infections, Gonorrhoea, brucellosis, chest or lower respiratory tract infection, Infections caused by Rickettsiae micro-organisms transmitted by lice, fleas, ticks and mites, Infections of the urinary tract, parrot fever/psittacosis, melioidosis, Sinusitis, granuloma inguinale, Louse and tickbourne relapsing fever, Pneumonia, Scrub typhus, leptospirosis, malaria, enterotoxigenic E coli, amoebiasis, chancroid, Syphilis, Tetanus, malaria caused by chloroquine-resistant Plasmodium falciparum BSO: Tablet & Capsule: 20 mg, 50 mg, 100 mg Capsule, coated pellets: 100 mg Gel, for subgingival application: 50 mg in each 500 mg of blended formulation; 2-syringe system contains doxycycline Genghis Khun ([email protected],nafanakhun.wordpress.com)


syringe (50 mg) and delivery system syringe (450 mg) along with a blunt cannula Powder for injection: 100 mg, 200 mg Powder for oral suspension: 25 mg/5 mL Syrup: 50 mg/5 mL D: 100 mg PO/IV slow q12h. 300 mg PO once Anak: >8 years: 1 mg/kg PO/IV q12h; max 200 mg/d Prevention of malaria: 100 mg 1x. 1-2 days before travel, 1x/day throughout travel, for 4wk after leave the malarious area. Anak >8th: 2mg/kg 1x. KI: Hipersensitif; severe hepatic dysfunction, Allergy to other tetracycline antibiotics, Children <12 years, Preg: & lactation IO: Minimal decrease in bioavailability with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate ES: Blood disorders, photosensitivity, Loss of appetite, Disturbances of liver function, oesophagitis, dysphagia, enterocolitis, benign intracranial hypertension, Rash, Diarrhoea, Nausea and vomiting Preg: D Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; if used during tooth development (last half of Preg: through age 8 y), can cause permanent discoloration of teeth; Fanconilike syndrome may occur with tetracyclines past expiration date Nama Dagang:



Minocycline Inhibits protein synthesis by binding to 30S ribosomal subunit at site that blocks binding of amino acid–charged tRNA to acceptor site of the ribosomal mRNA complex. Drug accumulates in cells of susceptible organisms by mean of an energy-dependent mechanism. Passes through enterohepatic circulation and primarily excreted in urine I: Acne vulgaris, Bronchitis, Eye infections, Gonorrhoea, Infections of the ears, nose or throat, Infections of the urinary tract, prostatitis, urethritis, Pelvic inflammatory disease, Pneumonia, Prevention of infections following surgery # Skin or soft tissue infections BSO: Kaps 50 mg, 100 mg D: 1st IO/IV slow 100 mg, then 50 mg 2-4x/day. Anak >8 years: 4 mg/kg PO initially, then 2 mg/kg q12h. KI: Hipersensitif, SLE, Breastfeeding, Children <12 years, Kidney failure, Pregnancy IO: Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; Genghis Khun ([email protected],nafanakhun.wordpress.com)


can decrease effects of oral contraceptives, causing breakthrough bleeding and increasing risk of Preg:; tetracyclines can increase hypoprothrombinemic effects of anticoagulants ES: Diarrhoea, pancreatitis, photosensitivity, vertigo, Dizziness, Nausea and vomiting, tinnitus, Loss of appetite, skin reactions such as rash and itch, pseudomembranous colitis, Liver disorders, dysphagia, benign intracranial hypertension, Overgrowth of the yeast Candida, Staining of skin, nails, teeth, sweat, tears, eyes, breast milk Preg: D P: Photosensitivity possibly with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations with prolonged therapy; tetracycline use during tooth development (last half of Preg: to age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupus-like syndromes may occur Nama Dagang: Minocin Genghis Khun ([email protected],nafanakhun.wordpress.com)


H. Beta Laktam Gol Lain Imipenem + Cilastatin Meropenem



Imipenem + Cilastatin -- Covers both pathogenic actinomycetes and companion bacteria, which frequently are resistant to penicillin. I: Abdominal infections, septicaemia, chest or lower respiratory tract infection, genito-urinary infections. Pre-op. BSO: Powder for injection IV: Imipenem & cilastatin: 250 mg, 500 mg, 750 mg D: 250 mg- 1g IV slow 3-4x/d, or 500-750 IM 2x/d. max 4 g/d Paed. Not established; 15-25 mg/kg/dose IV q6h for >3 mo KI: Hipersensitif IO: Coadministration with cyclosporine may increase CNS adverse effects of both agents; coadministration with ganciclovir may result in generalized seizures ES: Rash, Abdominal pain, Diarrhoea, Blood disorders, colitis, Seizures, Nausea and vomiting, Alteration in taste Preg: C P: Adjust dose in renal insufficiency; avoid use in children <12. Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Meropenem Bactericidal broad-spectrum carbapenem antibiotic that inhibits cell wall synthesis. Effective against most gram-+ and gram-bacteria. Has slightly increased activity against gram-- bacteria and slightly decreased activity against staphylococci and streptococci compared with imipenem. I: Abdominal infections, septicaemia, chest or lower respiratory tract infection, Infections of the urinary tract, Meningitis # Skin or soft tissue infections BSO: Infusion: 500 mg; 1 g Injection: 25 mg/mL; 33.3 mg/mL D: I.V.: Preterm: 20 mg/kg/dose 2x/d, Full-term (<3 mo) 20 mg/kg/dose 3x/d Children >3 mo (<50 kg): Intra-abdominal infections: 20 mg/kg 3x/d (max 1 g 3x/d) Meningitis: 40 mg/kg 3x/d (max. 2 g 3x/d) Adults: 1 g 3x/d Meningitis: 2 g 3x/d Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dosing adjustment in renal impairment: Adults: Clcr 26-50 mL/minute: 1 g/ 12 jam Clcr 10-25 mL/minute: 500 mg/ 12 jam Clcr <10 mL/minute: 500 mg/day KI: Hipersensitif; first trimester of Preg: IO: Probenecid: inhibit renal excretion of meropenem, increasing meropenem levels ES: Headache, Rash, Abdominal pain, Diarrhoea, Blood disorders, colitis, convulsions, Pain and inflammation of the blood vessel at the site of injection, Nausea and vomiting Preg: B P: Adjust dose in renal impairment; pseudomembranous colitis and thrombocytopenia may occur, which require immediate discontinuation Nama Dagang:



I. Antibiotika Gol Lain Co-trimoxazole Colistin sulphate Clindamycin Vancomycin Linezolid Fosfomycin Teicoplanin



Co-trimoxazole I: Peumonia caused by the bacterium pneumocystis carinii (PCP) due to HIV or AIDS, toxoplasmosis, nocardiosis, urinary tract infection, chronic bronchitis, otitis media BSO: The 5:1 ratio (SMZ to TMP) remains constant: Suspension, oral: SMZ 200 mg and TMP 40 mg/ 5 mL Tab:SMZ 400mg+TMP 80mg, Forte: SMZ 800 mg+TMP 160mg D: 160 mg TMP/800 mg SMZ PO bid for 3 d Paed. >2 months: 8 mg TMP/40 mg SMZ PO divided bid for 3 d KI: Premature babies, allergy, Severely decreased kidney function or kidney failure, porphyrias IO: May increase PT when used with warfarin (perform coagulation tests and adjust dose accordingly); coadministration with dapsone may increase blood levels of both drugs; coadministration of diuretics increases incidence of thrombocytopenia purpura in elderly patients; phenytoin levels may increase with coadministration; may potentiate effects of methotrexate in bone marrow depression; hypoglycemic Genghis Khun ([email protected],nafanakhun.wordpress.com)


response to sulfonylureas may increase with coadministration; may increase levels of zidovudine ES: Headache, Rash, Diarrhoea, Nausea and vomiting, Overgrowth of the yeast Candida, hyperkalaemia, Disturbances in the normal numbers of blood cells in the blood, hyponatraemia, hypoglycaemia, Loss of appetite, stomatitis, Dizziness, Depression, Hallucinations. Cough, Shortness of breath, myalgia, convulsions, Liver or kidney disorders, Severe blistering skin reactions, eg Stevens-Johnson Syndrome, toxic epidermal necrolysis Preg: C P: Elderly people, Decreased liver & kidney function, People at risk of folic acid deficiency, hyperkalaemia, Asthma, Severe allergies, Blood disorders, G6PD deficiency Nama Dagang:



Colistin sulphate Polymyxin E It works by disrupting the structure of part of the bacterial cell membrane, causing the vital contents of the bacteria to leak out. This ultimately leads to the death of the bacteria. I: Sterilisation of the bowel prior to surgery BSO: Tab 250.000 iu. Powder for oral suspension: 25 mg/5 mL D: Diarrhea: Children: 5-15 mg/kg/day terbagi 3 dosis. KI: hypersensitivity P: Impaired renal function; some systemic absorption may occur; potential for renal toxicity exists; prolonged use may lead to superinfection ES: Confusion, Muscle weakness, Visual disturbances, Balance problems involving the inner ear (vertigo), Pins and needles (paraesthesia), Damage to the nerves, Kidney damage. IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Clindamycin Lincosamide agent that inhibits bacterial growth, possibly by blocking dissociation of peptidyl t-RNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Drawback is lack of coverage against some companion bacteria. I: Abdominal, Bone and joint infections, bacterial endocarditis. Acne BSO: Capsule: 75 mg, 150 mg, 300 mg Cream, vaginal: 2% Gel, topical, Lotion, Pledgets, Solution, topical: 1% [10 mg/g] Granules for oral solution: 75 mg/5 mL Infusion, in D5W: 300 mg; 600 mg Injection: 150 mg/mL Suppository, vaginal: 2.5 g (clindamycin 100 mg) D: Caps & sol: 150-300 mg 3x/d. Anak 2-5 mg/kg 3-4x/d, Injection: 300-600 mg IM/IV 3-4x/d. Anak 3.75-10 IM/IV mg/kg 3-4x/d KI: Hipersensitif; regional enteritis; ulcerative colitis; hepatic impairment; antibiotic-associated colitis Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Increases duration of neuromuscular blockade induced by tubocurarine and pancuronium; erythromycin may antagonize effects; antidiarrheals may delay absorption ES: Rash, Abdominal pain, Diarrhoea, colitis, jaundice, Disturbance in the components of the blood, Pain and inflammation of the blood vessel at the site of injection, Nausea and vomiting Preg: B P: Adjust dose in severe hepatic dysfunction; no adjustment necessary in renal insufficiency; associated with severe and possibly fatal colitis Nama Dagang:



Vancomycin I: Pseudomembranous colitis BSO: Capsule: 125 mg, 250 mg Powder for oral solution: 1 g, 10 g Powder for injection: 500 mg, 1 g, 2 g, 5 g, 10 g D: 125-500 mg 4x/d for 7-10 days. Anak 10 mg/kg injection: 7.5-15 mg/kg IV 2-4x/d Paed.: Infants (1 mo) & children: 20 mg/kg IV q12h KI: Hipersensitif IO: Erythema, histaminelike flushing, and anaphylactic reactions may occur when administered with anesthetic agents; taken concurrently with aminoglycosides, risk of nephrotoxicity may increase above that with aminoglycoside monotherapy; effects in neuromuscular blockade may be enhanced when coadministered with nondepolarizing muscle relaxants ES: Rash, pruritus, Nausea, Blood disorders, Fever (pyrexia), Kidney damage, anaphylaxis, ototoxicity, Kidney failure Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Caution in renal failure and neutropenia; red man syndrome is caused by an IV infusion that is too rapid (dose given over a few min) but rarely happens when dose given as 2-h administration, PO, or with intraperitoneal administration; red man syndrome is not an allergic reaction; monitor blood levels, with a goal of 30-40 mcg/mL 1 h after completion of IV dose Administer slowly; rapid administration is associated with hypotension and histamine release, ie, red man syndrome Nama Dagang: Vancomycin Abbot



Linezolid I: Complicated skin and soft tissue infections, Pneumonia BSO: Infusion: 200 mg; 400 mg; 600 mg Suspension, oral: 20 mg/mL Tablet: 400 mg, 600 mg D: IO/Infus 400-600 mg 2x/d. Anak 10 mg/kg 2-3x/d KI: Taken a MAOI in the last 14 days, Breastfeeding, Children < 18 years of age P: Decreased kidney & liver function, haemodialysis, hypertension, phaeochromocytoma, a carcinoid tumour, Thyrotoxicosis, manic depression, schizoaffective disorder, Acute states of confusion, Anaemia, lekopenia, thrombocytopenia ES: Headache, diarrhoea, constipation, nausea, vomiting or abdominal pain, candidiasis, Metallic taste, Decreased numbers of red blood cells, haemoglobin, white blood cells or platelets in the blood, Alteration in results of liver function tests, Fatigue, Fever, Dizziness, Pins and needles sensations (paraesthesia) or numbness, insomnia, Blurred vision, tinnitus, hypertension, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Rash or itching, pancreatitis, kidney failure, transient ischaemic attack IO: Linezolid is a reversible, nonselective inhibitor of MAO. Serotonergic agents (eg, TCAs, venlafaxine, trazodone, sibutramine, meperidine, dextromethorphan, and SSRIs) may cause a serotonin syndrome (eg, hyperpyrexia, cognitive dysfunction) when used concomitantly. Adrenergic agents (eg, phenylpropanolamine, pseudoephedrine, sympathomimetic agents, vasopressor or dopaminergic agents) may cause hypertension. Preg:: A, B, C, D, X Nama Dagang: Zyvox



Fosfomycin I: Bladder infection in women. BSO: Powder: 3 g, to be mixed in 4 oz of water. Vial 1 g D: Powder IO 3 g 1x. IV infus 100-200 mg/kg 2x/hr. KI: P: ES: >1%: Headache, Rash, Diarrhea (2% to 8%), nausea, vomiting, epigastric discomfort, anorexia IO: Decreased effect: Antacids or calcium salts may cause precipitate formation and decrease fosfomycin absorption Metoclopramide: Increased gastrointestinal motility may lower fosfomycin tromethamine serum concentrations and urinary excretion. This drug interaction possibly could be extrapolated to other medications which increase gastrointestinal motility. Preg: B Nama Dagang: Fosmicin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Teicoplanin I: Endocarditis, post-op. serious staphylococcal bact. infections BSO: Vial 400 mg D: Dws: Awal 400 mg IV. Maint. : 200 mg/hr IV/IM Anak: 10 mg/kg/12 jam terbagi dlm 3 dosis. Pemeliharaan 10 mg/kg/hr IV/IM Neonatus: Single dose 16 mg/kg. Maint 8 mg/kg 1x/hr KI: Hipersensitif P: Decreased kidney function, History of allergies ES: Rash, itching (pruritus), Diarrhoea, Blood disorders, Alteration in results of liver function tests, Fever (pyrexia), Hearing disturbances, Pain and inflammation of the blood vessel at the site of injection, Dizziness, Nausea and vomiting, Kidney damage, An extreme allergic reaction (anaphylaxis) IO: Preg:: A, B, C, D, X Nama Dagang: Targocid Genghis Khun ([email protected],nafanakhun.wordpress.com)


J. Fungisida Griseofulvin Ketoconazole Miconazole Itraconazole Voriconazole Tioconazole Terbinafin Fluconazole Nystatin Clotrimazole



Griseofulvin I: Fungal infections of the skin, nails, scalp or hair. BSO: Microsize: Caps & Tab: 125 mg, 250 mg, 500 mg Suspension, oral: 125 mg/5 mL with alcohol 0.2% Ultramicrosize: Tab: 165 mg, 330 mg, 125 mg, 250 mg, 330 mg D: Microsize caps, tab, and susp: 250-500 mg 1-2x/d Anak 5-10 mg/kg 1-2x/d Ultramicrosize: 125-375 mg 1-2x/d. Anak 2.75-7.3 mg/kg KI: Severe liver disease, systemic lupus erythematosus, porphyries, Pregnancy, Breastfeeding P: ES: Nausea and vomiting, Diarrhoea, Headache, Dizziness, Confusion, Fatigue, Sleep disturbance, Impaired co-ordination, Liver problems, peripheral neuropathy, Rash, leucopenia, photosensitivity IO: Decreased effect: Barbiturates may decrease levels of griseofulvin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Decreased warfarin, cyclosporine, and salicylate activity with griseofulvin Griseofulvin decreases oral contraceptive effectiveness Increased toxicity: With alcohol tachycardia and flushing Preg: C Nama Dagang:



Ketoconazole Inhibits synthesis of ergosterol, causing cellular components to leak, resulting in fungal cell death. I: Candidiasis, pityrosporum folliculitis, dermatophytosis. BSO: Cream & Shampoo: 2% Tablet: 200 mg D: Tab 200 mg 1x/d . Cream, Gel 1-2x/d. Shampoo: every 3-4 days for 8wk KI: Hipersensitif; fungal meningitis IO: Isoniazid may decrease bioavailability of ketoconazole; coadministration decreases effects of either rifampin or ketoconazole; may increase effect of anticoagulants; may increase toxicity of corticosteroids and cyclosporine; may decrease theophylline levels ES: Nausea and vomiting, Itching (pruritus), Abdominal pain, Diarrhoea, Headache, Dizziness, Sleepiness, Rash. Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hepatotoxicity may occur; may reversibly decrease corticosteroid serum levels (adverse effects are avoided with dose of 200-400 mg/d); administer antacid, anticholinergics, or H2-blockers at least 2 h after taking ketoconazole Nama Dagang:



Miconazole -- Damages fungal cell wall membrane by inhibiting biosynthesis of ergosterol. Membrane permeability is increased, causing nutrients to leak out, which results in fungal cell death. I: Fungal infections of the skin, eg ringworm, candidiasis, athlete's foot, fungal nappy rash, groin infections BSO: Lotion, Powder, Spray, Cream Topical & Vaginal: 2% Suppository, vaginal: 100 mg; 200 mg Injection: 1% [10 mg/mL] Tincture: 2% with alcohol D: Topical 2x/d 200-mg vaginal supp: Insert 1 qhs for 3 d. 100 mg for 7 d 2% cream: Insert 1 applicator full (5 g) intravaginally qhs for 7 d Monistat Dual PaBSO: 1200 mg vaginal insert once plus 2% cream for external use KI: Hipersensitif IO: May impair barrier contraceptives Preg: C P: Avoid contact with eyes; burning, irritation, and dyspareunia Genghis Khun ([email protected],nafanakhun.wordpress.com)


Itraconazole -- Has fungistatic activity. Synthetic triazole antifungal agent that slows fungal cell growth by inhibiting cytochrome P450dependent synthesis of ergosterol, a vital component of fungal cell membranes. I: Tinea pedis, ringworm (tinea corporis), jock itch (tinea cruris), or pityriasis versicolor, vulvovaginal candidiasis, oropharyngeal candidiasis, Fungal nail infections, histoplasmosis, cryptococcosis, aspergillosis, candidiasis, neutropenia. BSO: Capsule: 100 mg Injection kit: 10 mg/mL - 25 mL ampul, one 50 mL (100 mL capacity) bag 0.9% sodium chloride, one filtered infusion set Solution, oral: 100 mg/10 mL D: 200-400 mg PO qd Cutaneous candidiasis & onychomycosis: 200 mg PO/IV bid for 7 d/mo for 3-6 mo OPC and esophageal candidiasis: 200 mg/d PO/IV for 7-14 d Genghis Khun ([email protected],nafanakhun.wordpress.com)


Candidemia and invasive candidiasis: 200 mg tid for 3 d, followed by 200 mg PO/IV bid for 14-21 d Paed. Cutaneous candidiasis: 3-5 mg/kg/d PO/IV for 30 d KI: Hipersensitif IO: Antacids may reduce absorption of itraconazole; edema may occur with coadministration of calcium channel blockers (eg, amlodipine, nifedipine); rhabdomyolysis may occur with coadministration of HMG-CoA reductase inhibitors (lovastatin or simvastatin); inhibits cytochrome P450 hepatic enzymes to cause increased levels of atovaquone, AZT, benzodiazepines, clarithromycin, cyclosporine, digoxin, oral hypoglycemics, midazolam phenytoin, rifabutin, saquinavir, tacrolimus, theophylline, triazolam, and warfarin Levels may decrease with long-term coadministration of rifampin, rifabutin, phenytoin, phenobarbital, carbamazepine, and isoniazid; increases levels of indinavir, saquinavir, and ritonavir; indinavir, ritonavir, and fixed-dose combination of lopinavir/ritonavir increase levels Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, Dizziness, hypokalaemia, Alteration in results of liver function tests, hepatitis, Jaundice, rash or itching, oedema, pulmonary oedema, Pain in the muscles or joints, Visual disturbances, hyperglycaemia, Pins and needles or numb sensations, peripheral neuropathy, Liver & Heart failure, Menstrual disorders, impotence, alopecia. Preg: C P: Caution in hepatic insufficiencies; nausea, vomiting, diarrhea, and abdominal discomfort may occur; high doses may produce hypertension, hypokalemia, or edema; may have - inotropic effect; exacerbations of congestive heart failure reported, especially with IV administration Nama Dagang:



Voriconazole I: Serious fungal infections, primarily in people with progressive and possibly life-threatening infections. D: Oral suspension or tablets: 1 h ac or pc Loading dose: 6 mg/kg IV q12h infused over 2 h for 2 doses Maintenance: 4 mg/kg IV q12h infused over 2 h; switch to 200 mg PO q12h when able to tolerate; may increase to 300 mg PO q12h if inadequate response <40 kg: Average maintenance dose is 100 mg PO q12h (may increase to 150 mg PO q12h) KI: Hipersensitif; CrCl <50 mL/min (decreased excretion of IV vehicle) if administering IV; coadministration with rifampin, rifabutin, carbamazepine, barbiturates, sirolimus, pimozide, quinidine, cisapride, or ergot alkaloids IO: CYP450 2C19 (highest affinity), 2C9, and 3A4 (minor) substrate and inhibitor; CYP450 inducers (eg, rifampin) have shown to decrease steady-state peak plasma levels by up to 93%; may increase serum levels of drugs metabolized by CYP450 2C19 or 2C9, of which some are contraindicated (eg, Genghis Khun ([email protected],nafanakhun.wordpress.com)


sirolimus, pimozide, quinidine, cisapride, ergot alkaloids) and others may mandate more frequent monitoring (eg, cyclosporine, tacrolimus, warfarin, HMG-CoA inhibitors, benzodiazepines, calcium channel blockers) ES: Visual disturbances, Fever, diarrhoea, constipation, nausea, vomiting or abdominal pain, Headache, peripheral oedema, Weakness, Chest or back pain, RDS, Hair loss, Low blood pressure, Dizziness, Hallucinations, Confusion, Depression, Anxiety. Preg: C P: Decrease maintenance dose in hepatic dysfunction; common adverse effects include visual disturbances, fever, rash, vomiting, nausea, diarrhea, headache, sepsis, peripheral edema, abdominal pain, rash (including Stevens-Johnson syndrome and phototoxicity), and respiratory disorders; rare cases of severe hepatotoxicity reported; administer PO dose 1 h ac or pc Nama Dagang: Vfend Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tioconazole I: Treatment of fungal nail infections BSO: Krim 1% D: 1-2x/hr KI: Hipersensitif, Pregnancy P: ES: hypersensitivity IO: Preg: C Nama Dagang:



Terbinafin I: Tinea corporis, tinea cruris, tinea pedis, nails BSO: Cream,Gel, topical: 1% . Tablet: 250 mg D: 250 mg 1x/d. Anak 125-187.5 mg Tinea capitis: for 6wk. Onychomycosis: for 6-12wk. Tinea cruris & corporis: for 2-4wk. Tinea pedis: for 2-6wk KI: Breastfeeding P: Decreased liver & kidney function, Psoriasis ES: Dyspepsia, nausea, vomiting, diarrhoea or abdominal pain, Loss of appetite, Headache, Allergic skin reactions such as rash and itch, Pain in the muscles and joints, Fatigue IO: Decreased effect: Cyclosporine clearance is increased (~15%) with concomitant terbinafine; rifampin increases terbinafine clearance (100%) Increased effect: Terbinafine clearance is decreased by cimetidine (33%) and terfenadine (16%); caffeine clearance is decreased by terfenadine (19%) Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fluconazole -- Triazole with less effect on human sterol metabolism. Does not decrease cortisol and testosterone levels, as occurs with ketoconazole. Has fewer adverse effects and better tissue distribution than older systemic imidazoles. I: vaginitis (vaginal thrush), candidal balanitis. BSO: Injection: 2 mg/mL Powder for oral suspension: 10 mg/mL; 40 mg/mL Tablet: 50 mg, 100 mg, 150 mg, 200 mg D: 1st 200-400mg then 100-200 mg 1x/d for 2-12wk. Paed. <2 weeks: Administer q72h IV >4 weeks: 3 mg/kg/d PO/IV for superficial infections and 6-12 mg/kg/d for systemic infections KI: Hipersensitif, Children <16 years, Hamil, laktasi. IO: Inhibits cytochrome P450 hepatic enzymes to cause increased levels of atovaquone, AZT, benzodiazepines, clarithromycin, cyclosporine, oral hypoglycemics, phenytoin, rifabutin, Genghis Khun ([email protected],nafanakhun.wordpress.com)


saquinavir, tacrolimus, theophylline, terfenadine, and warfarin; levels may increase with hydrochlorothiazide; levels may decrease with long-term coadministration of rifampin, rifabutin, and phenytoin ES: Nausea, Abdominal discomfort, Diarrhoea, flatulence, Headache, Rash (you should not use this medicine again if you get a rash after taking it). Preg: C P: Renal insufficiency; monitor closely if rash develops and discontinue drug if lesions progress; may cause clinical hepatitis, cholestasis, and fulminant hepatic failure (including death) with underlying medical conditions (eg, AIDS, malignancy) and while taking multiple concomitant medications; not recommended during breastfeeding Nama Dagang:



Nystatin Fungicidal and fungistatic antibiotic obtained from Streptomyces noursei. Changes permeability of fungal cell membrane after binding to cell membrane sterols, causing cellular contents to leak. Membrane channel activity is increased at lower doses, and pores are formed at higher concentrations. I: Candidosis, Preventing overgrowth of Candida in the intestines, eg in people having chemotherapy, or taking high doses or prolonged courses of antibiotics or corticosteroids. BSO: Cream, Ointment, Powder topical: 100,000 U/g Powder, for preparation of oral suspension: 50 million U, 1 billion U, 2 billion U, 5 billion U Suspension, oral: 100,000 U/mL Tablet: 100.000 iu/cc, 500,000 U Vaginal tab: 100,000 U Troche: 200,000 U D: 1-2 tab 3-5x/day for 14 days. Topical 2-3x/day Vag cream & tab: 100,000 U 1-2x/day for 2wk or 500,000 U1x Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif IO: Preg: A ES: # Nausea # Mouth irritation # Diarrhoea # Vomiting # Rash P: Do not use to treat systemic mycoses; adverse GI effects include nausea, vomiting, and diarrhea Nama Dagang:



Clotrimazole I: BSO: Topical, Vaginal cr, Lotion, Solution, topical: 1% Tablet, vaginal: 100 mg; 500 mg Troche: 10 mg Twin pack: Vaginal tablet 500 mg and vaginal cream 1% D: Troche & topical 2x/day for 7 days Vaginal Cream: for 7 consecutive days Vag Tablet: Insert 100 mg/day for 7 days or 500 mg single dose KI: Hipersensitif IO: May impair barrier contraceptives Preg: B P: Not for treatment of systemic fungal infections; avoid contact with the eyes; if irritation or sensitivity develops, discontinue use and institute appropriate therapy



K. Anti Amoeba Metronidazole Tinidazole Secnidazole Paromomycin



Metronidazole -- Active against various anaerobic bacteria and protozoa. Appears to be absorbed into cells. Intermediate metabolized compounds are formed and bind DNA and inhibit protein synthesis, causing cell death. Antimicrobial effect may be due to production of free radicals. Indicated for invasive E histolytic. I: septicaemia, sepsis, necrotising pneumonia, osteomyelitis, peritonitis, Abscess, pelvic cellulites, ulcerative gingivitis, bacterial vaginosis, urogenital trichomoniasis, amoebiasis or amoebic dysentery, giardiasis BSO: Capsule: 375 mg Gel, topical & vaginal: 0.75% [7.5 mg/mL] Injection, ready to use: 5 mg/mL Powder for injection: 500 mg Tablet: 250 mg, 500 mg Tablet, extended release: 750 mg D: 500-750 mg 3x/d for 10 d

Anak: 7.5 mg/kg, max 1g



For trichomoniasis infections: 2 g single dose, or 1 g 2x for 1 day, or 250 mg 3x for 1wk. Anak 5 mg/kg Extended release tab: Bacterial vaginosis: 750 mg 1x for 1wk Injection: 15 mg/kg IV 2-4x for 1wk KI: Hipersensitif IO: Cimetidine may increase toxicity of metronidazole; may increase effects of anticoagulants; may increase toxicity of lithium and phenytoin; ingestion of ethanol during therapy may induce a disulfiramlike reaction with abdominal cramps, nausea, and emesis ES: Diarrhoea, constipation, nausea, vomiting, Loss of appetite, urticaria, angioedema, Drowsiness, Dizziness, Headache, ataxia, Skin rashes, Pain in the muscles or joints, Darkening of the urine, Visual disturbances, Confusion, Liver disorders, peripheral neuropathy, leucopenia, Seizures Preg: B P: Hepatic disease; monitor for seizures and development of peripheral neuropathy; alcoholic beverages should be avoided during administration and for 3 d after Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tinidazole I: Amoebic infection of the liver, Helicobacter pylori, anaerobic bacteria, vaginitis, ulcerative gingivitis, giardiasis, after surgery, urogenital trichomoniasis, acute amoebic dysentry BSO: Tab 500 mg D: 2g 1x/day for 3 days. Anak: 50 mg/kg For giardiasis & trichomoniasis: 2 g single dose. KI: Hipersensitif; first trimester of Preg: IO: Limited data exist; interaction information based on experience with other nitroimidazole derivatives (ie, metronidazole); may prolong PT when coadministered with warfarin; avoid alcoholic beverages and preparations that contain ethanol or propylene glycol during and 3 d following administration (may cause disulfiramlike reaction); may increase serum levels of lithium, phenytoin, cyclosporine, tacrolimus, and fluorouracil; CYP450 inducers (eg, phenobarbital, rifampin, phenytoin) may increase elimination; CYP450 inhibitors (eg, cimetidine, ketoconazole) Genghis Khun ([email protected],nafanakhun.wordpress.com)


may decrease elimination; concurrent administration with cholestyramine may decrease oral bioavailability; oxytetracycline may antagonize effect ES: Abdominal pain, Fits (convulsions), peripheral neuropathy, Nausea and vomiting, Bitter or metallic taste, Sensation of a furry tongue, Darkening of the urine, Headache, Skin rashes, Allergic reaction to active ingredient, Dizziness Preg: C P: Carcinogenicity has been observed in mice and rats treated long-term with metronidazole (another nitroimidazole), although not observed with tinidazole, use cautiously; seizures and peripheral neuropathy have been reported; caution with history of blood dyscrasia; may cause metallic/bitter taste, nausea, anorexia, vomiting, weakness, fatigue, dizziness, or headache; if administered on day of hemodialysis, administer additional dose equivalent to one-half of recommended dose following dialysis Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Secnidazole I: amubiasis intestinalis BSO: Kapl 500 mg D: 2 g single dose. Anak 2-30 mg/kg/hr single dose KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Sentyl



L. Anti Lepra & TBc Dapsone Clofazimine Rifampicin/Rifampin Isoniazid Pyrazinamide Ethambutol



Dapsone I: An itchy blistering rash due to gluten allergy (dermatitis herpetiformis), Leprosy, Prevention of Plasmod. Falcip. malaria BSO: Tablet: 25 mg, 100 mg D: IO 100 mg 1x/day, or 1.4 mg/kg (with other drugs) Paucibacillary: WHO: for 6 mo, US: for 1 y Multibacillary: WHO: for 1 y, US: for 2 y Dermatitis herpetiformis: 1st 50 mg 1x, titrate 300 mg 1x Paed. 2 mg/kg PO qd. Paucibacillary: for 6mo, Multibacillary: for 1y KI: Hipersensitif; G-6-PD deficiency; porphyria; severe anemia IO: May inhibit anti-inflammatory effects of clofazimine; hematologic reactions may increase with folic acid antagonists, eg, pyrimethamine (monitor for agranulocytosis during second and third months of therapy); probenecid increases toxicity; trimethoprim may increase toxicity of both drugs; because of increased renal clearance, rifampin may significantly decrease levels Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Headache, insomnia, hepatitis, psychosis, peripheral neuropathy, Nausea and vomiting, Loss of appetite, haemolysis, Rash with a fever and a decrease in numbers of certain immune cells (Dapsone syndrome), methaemoglobinaemia, agranulocytosis, Allergic dermatitis Preg: B P: Perform weekly blood counts first month, then monthly for 6 months, then semiannually; discontinue if platelets or leukocytes substantially reduced or if hematopoiesis occurs; caution with 200-300 mg/d, which may cause hemolysis, or in methemoglobin reductase deficiency, methoglobinemia, G-6-PD deficiency, or hemoglobin M due to high risk for hemolysis and Heinz-body formation; caution in patients exposed to other agents or conditions (eg, infection, diabetic ketosis) that can cause hemolysis Anorexia, nausea, vomiting may occur; adverse neurologic effects such headache, nervousness, insomnia, blurred vision, paresthesia, and reversible peripheral neuropathy (rare) thought to be due to axonal degeneration; drug fever, hematuria, Genghis Khun ([email protected],nafanakhun.wordpress.com)


pruritus, psychosis, and skin rashes may occur; infectious mononucleosis-like syndrome, which may be fatal, occurs occasionally; exacerbation of LL leprosy thought to be analogous to Jarisch-Herxheimer reaction; sulfone syndrome may develop 5-6 wk after initiation of treatment in malnourished people; syndrome characterized by fever, malaise, exfoliative dermatitis, jaundice with hepatic necrosis, lymphadenopathy, methemoglobinemia, and anemia; phototoxicity may occur when patient exposed to UV light Nama Dagang:



Clofazimine I: Leprosy BSO: Capsule: 50 mg D: 50 mg PO qd,self-administered,& 300 mg 1x/mo(supervised) Multibacillary WHO: PO 300 mg qmo (supervised) and 50 mg qd for 1 y ENL: PO 100 mg tid for 12 wk, tapering to 100 mg bid for 12 wk, then 100 mg qd for 12-24 wk Paed. 6 mg/kg PO 1x/mo and 1 mg/kg/d self-administered Multibacillary 10-14 y: PO 150 mg qmo (supervised) & 50 mg qod for 1 y >14 y: PO 300 mg qmo (supervised) & 50 mg qd for 1 y KI: Hipersensitif; Preg:; persistent GI symptoms IO: Dapsone may inhibit anti-inflammatory activity ES: Rash, Abdominal pain, Diarrhoea, Dryness of the skin and eyes, Nausea and vomiting, Brownish-black discoloration of the lesions and skin, Change in colour of faeces and body fluids/secretions, Dimming of vision, Discoloration of the hair Genghis Khun ([email protected],nafanakhun.wordpress.com)


which is reversible, Discoloration of the conjunctiva, cornea and tears. Preg: C P: Intestinal toxicity (dose related) may result in diarrhea, cramping, and abdominal pain; intestinal symptoms may be progressive and potentially life threatening; severe abdominal symptoms may mimic surgical emergencies, resulting in exploratory laparotomy; caution in patients with GI problems (eg, abdominal pain, diarrhea) May cause discoloration of skin (may be distressing to light-skinned individuals and may result in depression or suicide); dry skin, itching, acneform eruption and photosensitivity may occur; apply oil to skin for dryness and ichthyosis Nama Dagang: Lamprene



Rifampicin/ Rifampin I: Brucellosis, Legionnaires' disease, Leprosy, serious staphylococcal bacterial infections, tuberculosis in combination with other drugs, Prevention of infection from the bacterium H. influenzae, meningococcal meningitis BSO: D: TB: 600 mg 1x, or 2x/wk or 3x/wk (with other med) Meningitis bacteria: 600 mg 1x for 4 days Leprosy: 600 mg PO once per mo Paucibacillary: WHO: for 6 mo, for 1 y Multibacillary: WHO: for 1 y, US: for 2 y Paed. 10 mg/kg PO once per mo 10-20 mg/kg PO/IV; max 600 mg qd Single skin lesion, paucibacillary: 5-14 years: 300 mg PO once Paucibacillary & Multibacillary 10-14 years: 450 mg once a mo (supervised) <10 years: 300 mg PO once a mo (supervised) Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; liver disease; jaundice; Preg:; lactation, Life long inherited blood diseases which can cause a variety of symptoms, including mental health problems (porphyrias) IO: Induces microsomal enzymes, which may decrease effects of acetaminophen, oral anticoagulants, barbiturates, benzodiazepines, beta-blockers, chloramphenicol, oral contraceptives, corticosteroids, mexiletine, cyclosporine, digitoxin, disopyramide, estrogens, hydantoins, methadone, clofibrate, quinidine, dapsone, tazobactam, sulfonylureas, theophyllines, tocainide, and digoxin; enalapril may cause increase in blood pressure; isoniazid may increase rate of hepatotoxicity with either agent alone (discontinue 1 or both LFTs altered); food delays absorption ES: Rash, Diarrhoea, Red colouration of urine, colitis, jaundice, Alteration in results of liver function tests, haemolytic anaemia, Cold or flu-like symptoms, Nausea and vomiting, Loss of appetite, Shortness of breath, thrombocytopenia, Kidney failure Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Important adverse effects include GI symptoms (eg, nausea, vomiting, diarrhea, hepatic toxicity), hematologic effects (eg,) hemolytic anemia and thrombocytopenia, and flulike symptoms (especially with intermittent therapy); saliva, urine, and sweat may be reddish orange and may stain soft contact lenses; obtain CBCs and baseline clinical chemistry before and throughout therapy; in liver disease, weigh benefits vs risk of further liver damage; interrupted and high-dose intermittent therapy associated with thrombocytopenia (reversible if therapy discontinued as soon as purpura occurs); if treatment continued or resumed after appearance of purpura, cerebral hemorrhage or death may occur Nama Dagang:



Isoniazid I: Treatment of tuberculosis in combination with other drugs BSO: Injection: 100 mg/mL Syrup: 50 mg/5 mL Tablet: 50 mg, 100 mg, 300 mg D: PO: Preventing: 300 mg 1x/d . Anak 10 mg/kg 1x Treatment of tuberculosis: 300-900 mg 1x/d, or 2x/wk, or 3x/wk Paed. 10 mg/kg/d PO qd; max 300 mg/d KI: Hipersensitif; previous isoniazid-associated hepatic injury; other severe adverse reactions IO: Higher incidence of isoniazid-related hepatitis can occur with daily alcohol ingestion; aluminum salts may decrease isoniazid serum levels (administer 1-2 h before taking aluminum salts); may increase effects of anticoagulants with coadministration; may inhibit metabolic clearance of benzodiazepines Carbamazepine toxicity or isoniazid hepatotoxicity may result from concurrent use (monitor carbamazepine concentrations Genghis Khun ([email protected],nafanakhun.wordpress.com)


and liver function); coadministration with cycloserine may increase adverse CNS effects (eg, dizziness); acute behavioral and coordination changes may occur with coadministration of disulfiram Coadministration with rifampin after halothane anesthesia may result in hepatotoxicity and hepatic encephalopathy; may inhibit hepatic microsomal enzymes and increase toxicity of hydantoin ES: Hypersensitivity, Seizures, psychosis, Nausea and vomiting, hepatitis, peripheral neuritis, agranulocytosis, optic neuritis Preg: C P: Active chronic liver disease or severe renal dysfunction; periodic ophthalmologic examinations during isoniazid therapy are recommended even when visual symptoms do not occur # Alcoholism, Decreased liver & kidney function, Epilepsy, History of psychotic illness, Slow liver metabolism. Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Pyrazinamide I: Tuberculosis (in combination with other anti-Tb agents) BSO: Tablet: 500 mg D: <50 kilograms: 1.5 g PO qd 50-75 kilograms: 2 g PO qd >75 kilograms: 2.5 g PO qd Paed. 15-30 mg/kg/d PO qd; max 2 g/d 50-70 mg/kg 2x/wk or 3x/wk KI: Hipersensitif; severe hepatic damage; acute gout ES: 1-10%: Malaise, Nausea, vomiting, Arthralgia, myalgia Preg: C P: Use only in combination with other effective antituberculous agents; inhibits renal excretion of urates; may result in hyperuricemia (usually asymptomatic); perform baseline serum uric acid determinations; discontinue drug if signs of hyperuricemia with acute gouty arthritis occur; perform baseline LFTs (closely monitor in liver disease); discontinue pyrazinamide if signs of hepatocellular damage appear; caution in history of DM Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ethambutol I: Treatment of tuberculosis in combination with other drugs BSO: Tablet: 100 mg, 400 mg D: 15-25 mg/kg PO qd KI: Hipersensitif; optic neuritis (unless clinically indicated), Children under 5 years of age, Poor vision, optic neuritis IO: Aluminum salts may delay and reduce absorption (administered several hours before or after ethambutol dose) ES: Rash, Itching (pruritus), Visual disturbances, peripheral neuritis, thrombocytopenia, optic neuritis, Colour blindness Preg: B P: Reduce dose in impaired renal function; may have reversible adverse visual effects if promptly discontinued Nama Dagang:



M. Anti Helmintics Pyrantel Pamoate Mebendazole Levamisole Piperazine



Pyrantel Pamoate -- Neuromuscular blocking agent used to slowly paralyze worm to be eliminated from GI tract. I: Treatment of pinworms ( Enterobius vermicularis), whipworms ( Trichuris trichiura), roundworms ( Ascaris lumbricoides), and hookworms ( Ancylostoma duodenale) BSO: Capsule: 180 mg Liquid & Suspension, oral : 50 mg/mL: 50 mg/mL; 144 mg/mL D: 11 mg/kg PO to maximum of 1 g KI: Hipersensitif; hepatic disease IO: In ascariasis, pyrantel and piperazine are mutually antagonistic and should not be used concomitantly; theophylline serum levels may increase in pediatric patients following pyrantel pamoate administration ES: Anorexia, nausea, vomiting, abdominal cramps, diarrhea Preg: C P: Caution in liver impairment, anemia, and malnutrition Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mebendazole I: Threadworm (pinworm), Roundworm (ascariasis), Hookworm, Whipworm infections (trichuriasis). BSO: Tablet, chewable: 100 mg D: 500 mg PO once or 100 mg PO bid for 3 d, repeat 2-3 mo KI: Hipersensitif, Children under 2 years of age, Pregnancy. IO: Coadministration with carbamazepine may decrease efficacy; dexamethasone, cimetidine, and praziquantel may increase toxicity Preg: C P: Discontinue use if LFTs increase significantly (resume when levels decrease to pretest values); abdominal pain, nausea, vomiting, diarrhea, dizziness, vertigo, fever, increased intracranial pressure, and alopecia may occur Nama Dagang:



Levamisole I: BSO: Tablet: 50 mg D: Adults: Oral: 1st : 50 mg 3x/d for 3 days, then 50 mg 3x for 3 days every 2 weeks (fluorouracil is always given concomitantly) KI: hypersensitivity P: Agranulocytosis can occur asymptomatically and flu-like symptoms can occur without hematologic adverse effects; frequent hematologic monitoring is necessary ES: >10%: Nausea, diarrhea 1% to 10%: Edema, Fatigue, fever, dizziness, headache, somnolence, depression, nervousness, insomnia, Dermatitis, alopecia, Stomatitis, vomiting, anorexia, abdominal pain, constipation, taste perversion, Leukopenia, Rigors, arthralgia, myalgia, paresthesia, Infection IO: Increased toxicity/serum levels of phenytoin Disulfiram-like reaction with alcohol Preg: C Nama Dagang: Askamex Genghis Khun ([email protected],nafanakhun.wordpress.com)


Piperazine I: Infection with threadworms & roundworms (ascariasis). BSO: Syrup: 500 mg/5 mL. Tablet: 250 mg D: For granules for oral solution dosage form: For roundworms or pinworms: 2 g 3x/d for 1 d, repeated 2wk. # 2-8 y: 2 g 1x, 8-14 y: 2g 2x for 1 d For oral suspension dosage form: Roundworms or pinworms: 1.8g 3x for 1d # < 2 y: 600 mg 3x. # 2-8 y: 1.2 g 2x, # 8-14 y: 1.2g 3x For tablet dosage form: Roundworms: 3.5 g 1x for 2d. Anak 75 mg/kg Pinworms: 65 mg/kg 1x for 1wk KI: Children < 3 months, intestinal obstruction, Epilepsy ES: Urticaria, Diarrhoea, Nausea and vomiting, bronchospasm, Dizziness, Inability to coordinate muscles, Drowsiness, Confusion, Blurred vision Preg: B Genghis Khun ([email protected],nafanakhun.wordpress.com)


N. Scabicid & Pediculocid Permethrin Lindane Malathion



Permethrin 5% I: Scabies BSO: Cream: 5%, Liquid, topical: 1% D: Oles 1x KI: Hipersensitif IO: None reported Preg: B P: Adverse effects include pruritus, burning, stinging, numbness, erythema, and edema of the scalp; discontinue use upon irritation or hypersensitivity Nama Dagang: Scabimite



Lindane Stimulates nervous system of parasite, causing seizures and death. I: Treatment of scabies ( Sarcoptes scabiei), Pediculus capitis (head lice), and Pediculus pubis (crab lice); FDA recommends reserving lindane as a second-line agent or with inadequate response to other therapies BSO: Cream, Lotion, Shampoo: 1% D: 1x/d Shampoo: Apply to dry head/ pubic hair, allow to set for 4 min, then lather for 4 min and rinse; repeat in 7 d prn Lotion: Apply to affected skin/hair; put on clean clothing; rinse off in 8-12 h Paed. Infants and children: Apply thin film topically over entire body, including hairline, neck, scalp, temple, and forehead; leave on 6-8 h before washing off with water; may repeat in 1 wk if necessary; max 30 g/application KI: Hipersensitif; neonates; acutely swollen skin or Norwegian scabies Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Oil-based hairdressings may increase toxicity of lindane ES: Seizures, Dizziness, clumsiness, or unsteadiness, Fast heartbeat, Muscle cramps, Nervousness, restlessness, or irritability, Vomiting, Skin irritation not present before use of lindane, Skin rash Preg: B P: Caution if history of seizures; do not apply to eyes, face, or mucous membranes; caution in Preg:; adverse reactions have been reported (eg, DIC, aplastic anemia)



Malathion Recently approved (1999) by US FDA to treat head lice. Irreversible cholinesterase inhibitor that is hydrolyzed and therefore detoxified rapidly by mammals but not by insects; ovicidal and pediculicidal. Binds to hair and provides some residual protection after therapy. I: Head lice and their ova BSO: Lotion: 0.5% D: Apply to dry hair; leave on 8-12 h, rinse; repeat in 7 d prn KI: Hipersensitif IO: None reported; however, potential for interaction with aminoglycosides and antimyasthenics Preg: B P: Contains flammable alcohol; do not expose lotion or wet hair to open flame or electric heat (eg, hair dryers); allow hair to dry naturally and uncovered following application; avoid contact with eyes; flush eyes immediately with water if contact occurs Genghis Khun ([email protected],nafanakhun.wordpress.com)


O.Anti Filaria & Malaria Chloroquine Quinine sulfat Primaquine Sulfadoxine-Pyrimethamine



Chloroquine Effective for P vivax, P ovale, P malariae, and drug-sensitive P falciparum. I: Prevention & Treatment of malaria, hepatic amoebiasis or amoebic hepatitis, rheumatoid arthritis, Systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE) BSO: Injection: 50 mg [40 mg base]/mL Tablet: 250 mg [150 mg base]; 500 mg [300 mg base] D: Malaria:Oral, prevention: 500 mg [300 mg base] 1x per wk. 5 mg/kg base (starting 1-2 wk prior to travel, once qwk in the endemic area, & continuing weekly for 4 wk after returning from endemic area) Treatment: 1st day: 1g, 6-8 j kemudian 500 mg. Day 2-3: 500 mg 1x (4-2-2-2) Anak: 10 mg/kg base PO (max 600 mg), then 5 mg/kg base at 6 h, 24 h, and 48 h Protozoa: 250 mg 4x/d for 2 days, then 250 mg 2x fo 2-3wk Anak: 10 mg/kg Injection: Malaria Genghis Khun ([email protected],nafanakhun.wordpress.com)


250-500 mg IM, repeat q6h bila perlu. Anak 4.4 mg/kg IM/SC Severe malaria: 10 mg/kg base IV at constant rate over 8 h, followed by 15 mg/kg base over 24 h Protozoa: 200-500 mg IM for 10-12days. Anak 7.5 mg/kg KI: Hipersensitif; psoriasis; retinal changes; visual field changes attributable to 4-aminoquinolones IO: Cimetidine may increase serum levels of chloroquine (possibly other 4-aminoquinolones); magnesium trisilicate may decrease absorption of 4-aminoquinolones ES: Diarrhoea, nausea, vomiting or abdominal pain, Headache, Skin rashes, Itching (pruritus), hypotension, Visual disturbances, Loss of hair colour, alopecia, convulsions, Disturbance in the normal numbers of blood cells in the blood, Damage to the retina of the eye (long-term use), Discolouration of skin, nails, or mucous membranes, eg inside of mouth, tinnitus or hearing loss, Anxiety, confusion, hallucinations or strange or abnormal thoughts, Weakening of muscles, Weakening of the heart muscle (long-term use at high doses), Changes in the electrical signals in the heart (seen on an ECG) Genghis Khun ([email protected],nafanakhun.wordpress.com)


# Liver disorders Preg: C P: Nausea, headache, blood dyscrasias, and retinopathy (rare) may occur with daily use; risk of retinopathy may increase with prophylactic cumulative doses >100 g (ie, 5 y), perform regular ophthalmologic examinations after taking drug for prolonged period or after any visual disturbance Nama Dagang:



Quinine sulfate I: Cramp in the legs at night, Treatment of malaria BSO: Capsule: 200 mg, 260 mg, 325 mg Tablet: 260 mg D: Treatment: 650 mg PO q8h for 3-7 d with second agent if drug-resistant P falciparum Severe malaria: Quinine dihydrochloride 20 mg/kg IV over 4 h, followed by 10 mg/kg IV q8-12h; switch to PO antimalarial when patient has improved and can take PO medications, reduce dose by one third if used parenterally for more than 72 h Maintenance: 10 mg/kg salt infused over 2-8 h at 8- to 12-h intervals Paed. 25 mg/kg/d PO divided tid, for 3-7 d with second agent Prophylaxis: Not indicated Treatment with quinine sulfate: 10 mg/kg/d PO tid for 3-7 d Treatment with quinine dihydrochloride: 20 mg/kg IV over 4 h, followed by 10 mg/kg IV q8-12h; switch to PO antimalarial when Genghis Khun ([email protected],nafanakhun.wordpress.com)


patient has improved and can take PO medications, reduce dose by one third if used parenterally for more than 72 h KI: Hipersensitif; optic neuritis; tinnitus; G-6-PD deficiency; history of blackwater fever IO: Aluminum-containing antacids may delay or decrease quinine bioavailability when administered concurrently; cimetidine increases quinine blood levels and creates the potential for toxicity; rifamycins decrease quinine concentrations by increasing hepatic clearance of quinine (effect can persist for several days after discontinuing rifamycins); concurrent administration of acetazolamide or sodium bicarbonate may increase toxicity by increasing quinine blood levels; quinine may enhance action of warfarin and other PO anticoagulants by decreasing synthesis of vitamin K–dependent clotting factors; digoxin serum concentrations may increase when digoxin is administered concurrently with quinine; important to monitor digoxin levels periodically; quinidine may decrease plasma cholinesterase activity, causing a decrease in the metabolism of succinylcholine Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Rash, Nausea, hypoglycaemia, angioedema, tinnitus, Flushing, Kidney failure, Headache, Abdominal pain, Confusion, Blood disorders, Visual disturbances, Abnormal heart rhythms (arrhythmias) Preg: X P: Caution in G-6-PD deficiency and tendency to develop granulocytopenia; prolonged treatment or overdosing with quinine may cause cinchonism; quinine has quinidinelike activity and thus can cause cardiac arrhythmias; monitor blood pressure and glucose levels



Primaquine I: Treatment to eliminate the liver stages of the life cycle of Plasmdium vivax or Plasmodium ovale malaria parasite after treatment with chloroquine. BSO: Tablet: 26.3 mg [15 mg base] D: Prophylaxis & Treatment: 15 mg base (26.3 mg salt) PO qd for 14 d after departure from malaria-risk area Paed. 0.3 mg/kg base (0.5 mg/kg salt) KI: Hipersensitif; drugs that suppress bone marrow IO: Coadministration with quinacrine may increase toxicity ES: Methaemoglobinaemia, Abdominal pain, Vomiting, Nausea, haemolytic anaemia Preg: C P: Caution in G-6-PD deficiency and those with tendency to develop granulocytopenia Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sulfadoxine-Pyrimethamine I: Treatment of Plasmodium falciparum malaria BSO: Tablet: Sulfadoxine 500 mg and pyrimethamine 25 mg D:Prophylaxis: Not indicated. Treatment: 3 tab single dose Paed.. Treatment: <1 y: 0.25 tab PO once 1-3 y: 0.5 tab PO once 4-8 y: 1 tab PO once 9-14 y: 2 tab PO once KI: Allergy, Blood disorders, porphyrias, Liver & kidney failure, Premature babies and during the first two months of life IO: Do not use antifolic drugs (eg, sulfonamides, trimethoprimsulfamethoxazole combinations) while patient is receiving sulfadoxine and pyrimethamine tab for antimalarial prophylaxis ES: Headache, pruritus, insomnia, myalgia, convulsions, Nausea and vomiting, Shortness of breath, Cough, Rash, Diarrhoea, Blood disorders Preg: C P: Asthma, Liver & Kidney disease, G6PD deficiency) Genghis Khun ([email protected],nafanakhun.wordpress.com)


P. Anti Virus Aciclovir Ganciclovir Valganciclovir Valaciclovir Ritonavir Entecavir Atazanavir Adefovir dipivoxil Interferon alfa-2b Interferon beta-1a Peginterferon alfa-2a Peginterferon alfa-2b Ribavirin Zidovudine Stavudine Lamivudine Nevirapine Didanosine Oseltamivir Inosine dimepranol acedoben/ Methisoprinol



Acyclovir/ Aciclovir Synthetic purine nucleoside analogue with inhibitory activity against HSV types 1 and 2 and VZV. I: Varicella zoster infection, herpes simplex infection, cold sores, Preventing herpes simplex infections in people whose immune systems are impaired, eg due to disease or treatment, recurrent cold sores or genital herpes, herpes zoster BSO: Capsule: 200 mg Powder for Injection: 500 mg; 1000 mg Ointment, topical: 5% [50 mg/g] Salep Mata 3% Suspension, oral: 200 mg/5 mL Tablet: 400 mg, 800 mg D: Oral, Genital herpes: 200 mg PO 5x/d for 10days Prevention of recurrent of genital herpes infections: 200-400 mg PO 2-5x/d for 5 days- 1y Chickenpox: 800 mg PO 4x/d for 5 days. Anak 20mg/kg Shingles: 800 mg PO 5x/d for 7-10 days. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Injection: Herpes of the brain, genitals, or mucous membranes, or for the treatment of shingles: 5-10 mg/kg IV slow >1h, 3x/d for 5-10 days. Anak 10-20 mg/kg Widespread herpes virus infection in newborns: 10 mg/kg IV slow > 1h 3x/d for 10 days KI: Hipersensitif IO: Concomitant use of probenecid or zidovudine prolongs halflife and increases CNS toxicity of acyclovir Preg: B ES: Headache, Abdominal pain, Diarrhoea, Confusion, Fatigue, photosensitivity, Alteration in results of liver function tests, Disturbance in the components of the blood, hallucinations, Dizziness, Nausea and vomiting, hepatitis, Decreased kidney function, Skin reactions such as rash and itch P: Exercise caution in renal failure or when using nephrotoxic drugs Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ganciclovir An acyclic nucleoside analog of 2'-deoxyguanosine that inhibits replication of herpes viruses both in vitro and in vivo. Levels of ganciclovir-triphosphate are as much as 100-fold greater in CMV-infected cells than in uninfected cells, possibly because of preferential phosphorylation of ganciclovir in virusinfected cells. I: Parenteral: Treatment of CMV retinitis in immunocompromised individuals, including patients with acquired immunodeficiency syndrome; prophylaxis of CMV infection in transplant patients; may be given in combination with foscarnet in patients who relapse after monotherapy with either drug Oral: Alternative to the I.V. formulation for maintenance treatment of CMV retinitis in immunocompromised patients, including patients with AIDS, in whom retinitis is stable following appropriate induction therapy and for whom the risk of more rapid progression is balanced by the benefit associated with avoiding daily I.V. infusions. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Implant: Treatment of CMV retinitis BSO: Capsule: 250 mg Implant, intravitreal: 4.5 mg released gradually over 5-8 months Powder for injection, lyophilized: 500 mg D: CMV retinitis Induction: 5 mg/kg IV over 1 h q12h for 14-21 d (do not use PO ganciclovir for induction treatment) Maintenance: 1 g PO tid 5 mg/kg IV qd for 5-7 d/wk CMV pneumonia Induction: 5 mg/kg IV bid plus Ig 500 mg/kg 3 times per wk for the first 2 wk Maintenance: 5 mg/kg/d IV for 1 mo plus Ig 500 mg/kg qwk for 1 mo KI: Hipersensitif IO: Concomitant administration with dapsone, vinblastine, Adriamycin, pentamidine, flucytosine, vincristine, amphotericin B, and trimethoprim and sulfamethoxazole combinations or Genghis Khun ([email protected],nafanakhun.wordpress.com)


other nucleoside analogs may result in additive toxicity in bone marrow, spermatogonia, and germinal layers of skin and GI mucosa (coadminister only if potential benefits outweigh risks); coadministration with imipenem and cilastatin may cause generalized seizures (use only if potential benefits outweigh risks); serum creatinine may increase following concurrent use of ganciclovir with either cyclosporine or amphotericin B; renal clearance is reduced in the presence of probenecid; bioavailability may increase when didanosine is administered either 2 h prior to or simultaneously with ganciclovir; bioavailability may decrease in the presence of zidovudine, while the bioavailability of zidovudine is increased in the presence of ganciclovir Preg: C P: Clinical toxicity includes granulocytopenia, anemia, and thrombocytopenia; because PO formulation is associated with a higher rate of CMV retinitis progression compared to IV use, use PO only when benefits outweigh risks (eg, advanced HIV Genghis Khun ([email protected],nafanakhun.wordpress.com)


disease); half-life and plasma and/or serum concentrations may be increased as a result of reduced renal clearance; dosages >6 mg/kg IV may result in increased toxicity; rapid infusions may result in increased toxicity; initially, reconstituted solutions of IV ganciclovir have a high pH (ie, 11); phlebitis or pain may occur at the site of IV infusion despite further dilution in IV fluids; administration should be accompanied by adequate hydration; photosensitization (ie, photoallergy, phototoxicity) may occur; should not be administered if the neutrophil count is <500 cells/mL or platelet counts <25,000 cells/mL; monitor CBC count and electrolytes qwk (if stable on long-term therapy, frequency can be extended) Nama Dagang: Cymevene



Valganciclovir I: CMV retinitis in people with AIDS, organ transplant BSO: Tab 450 mg D: 900 mg 2x KI: Allergy, Breastfeeding, People undergoing haemodialysis P: Anaemia, Decreased kidney function, blood disorders, neutropenia, leucopenia, radiotherapy treatment, thrombocytopenia ES: Headache, insomnia, Depression, Blood disorders, oral thrush, Diarrhoea, constipation, nausea, vomiting or abdominal pain, convulsions, Fever (pyrexia), peripheral neuropathy, Dizziness, Alteration in taste, Loss of appetite, dyspnoea, Eye pain, Cough, Retinal detachment, Sepsis, Anxiety, Pain in the muscles and joints, Liver or kidney disorders, Rash or itching, Swelling of the area at the back of the eye responsible for seeing fine detail (macular oedema), Abnormal thinking Preg: C Nama Dagang: Valcyte Genghis Khun ([email protected],nafanakhun.wordpress.com)


Valacyclovir I: Genital herpes, cold sores, recurrent cold sores or genital herpes, Reducing the risk of spreading genital herpes to a sexual partner (when used with safe sex practices such as using condoms), Prevention of cytomegalovirus (CMV) infection in people who have had a kidney transplant, Shingles (herpes zoster) BSO: D: Genital herpes, first outbreak: 1g 2x for 10 d Genital herpes, recurrent outbreaks: 500mg 2x for 3d Cold sores: 2g 2x for 1day Prevent recurrent outbreaks of genital herpes: 0.5-1g 1x Shingles: 1 g 3x for 1wk Chickenpox: 20 mg/kg 3x for 5d, max 1g 3x KI: Hipersensitif IO: Probenecid, zidovudine, or cimetidine coadministration prolongs half-life and increases CNS toxicity of valacyclovir ES: Headache, Abdominal pain, Diarrhoea, Drowsiness, Confusion, photosensitivity, Decreased kidney function, Genghis Khun ([email protected],nafanakhun.wordpress.com)


hallucinations, Dizziness, Nausea and vomiting, thrombocytopenia, Skin reactions such as rash and itch, Disturbances of liver function Preg: B P: Requires dosage adjustment in renal failure; caution in renal failure and coadministration of nephrotoxic drugs; associated with onset of hemolytic uremic syndrome; allogenic bone marrow transplant recipients and renal transplant recipients Nama Dagang: Valtrex



Ritonavir I: HIV infection. Low doses used to boost the effect of other protease inhibitors, eg saquinavir, amprenavir, indinavir. BSO: Capsule: 100 mg. Solution: 80 mg/mL D: HIV: 600 mg 2x KI: Decompensated liver disease, children < 2 years, P: Decreased liver & kidney function, Hepatitis, esp. chronic hepatitis B or C, haemophilia, Diabetes, porphyrias. ES: Nausea, vomiting, diarrhoea or abdominal pain, Headache, asthenia, A tingling sensation or numbness in the hands, feet or around the lips or mouth, Dizziness, somnolence, insomnia, Anxiety, Throat irritation, vasodilatation, Loss of appetite, Mouth ulcers, Rash, itching or sweating, myalgia, Low blood pressure and fainting, Blood disorders. Preg: B Nama Dagang: Norvir Genghis Khun ([email protected],nafanakhun.wordpress.com)


Entecavir I: chronic hepatitis B infection BSO: Tab 0.5 mg. 1 mg. Lar 0.05 mg/cc D: 0.5-1 mg 1x KI: P: ES: Abdominal discomfort, Decreased appetite, Diarrhea, Fast, shallow breathing, General feeling of discomfort, Muscle pain or cramping, Nausea, Right upper abdominal pain and fullness, Shortness of breath, Sleepiness, Unusual tiredness or weakness IO: Preg: C BSO: Nama Dagang: Baraclude



Atazanavir I: HIV infection. BSO: Kaps 100 mg, 150 mg. 200 mg D: 300-400 mg 1x KI: Moderate to severely decreased liver function, Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption (Reyataz capsules contain lactose) P: haemophilia, Diabetes, Decreased liver function, History of hepatitis, heart conduction defects, 'prolonged QT interval', bradycardia, electrolytes. ES: Headache, insomnia, pancreatitis, dyspepsia, jaundice, palpitations, Dizziness, hepatitis, haematuria, amnesia, somnolence, asthenia, Chest pain, Appetite and weight changes, Skin reactions such as rash and itch, Abnormal dreams, syncope, Anxious or depressed mood, Pain in the muscles and joints, nausea, vomiting, diarrhoea or abdominal pain Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Preg: B Nama Dagang: Reyataz



Adefovir I: Chronic hepatitis B BSO: Tab 10 mg D: 10 mg 1x KI: Children or adolescents under 18 years of age P: Elderly people, Decreased kidney function, Liver disease including other hepatitis infections, hepatomegaly, Obese women, HIV infection ES: Feeling of weakness, Nausea, Flatulence, Indigestion, Diarrhoea, Abdominal pain, Headache, Kidney disorders, Rash, Itching, Elevated levels of lactic acid in the blood (lactic acidosis) IO: Preg:: A, B, C, D, X Nama Dagang: Hepsera



Peginterferon alfa-2a I: D: KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Pegasys



Peginterferon alfa-2b I: D: KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Peg Intron



Interferon alfa-2b I: Chronic hepatitis B, Chronic hepatitis C (preferably in combination with ribavirin), Hairy cell leukaemia, Cancer of the blood, characterised by an increased number of blood cells called granulocytes in the blood (chronic myeloid leukaemia or CML), multiple myeloma, follicular lymphoma, A type of tumour mostly found in the intestine or appendix, which secretes excessive amounts of the hormone serotonin (carcinoid tumour) that has spread to the liver or lymph nodes, malignant melanoma BSO: Injection, albumin free: 3 million U; 5 million U; 10 million U; 25 million U Powder for injection, lyophilized: 18 million U, 50 million U D: Interferon alfa-n3: 0.05 mL (250,000 IU) per wart 2x/wk for up to 8 wk; max recommended dose per treatment session is 0.5 mL (2.5 million IU) Interferon alfa-2b: 1 million IU injected into each lesion 3 times/ wk on alternate d for 3 wk; maximum recommended dose per treatment session is 5 million IU Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif to mouse IgG, egg protein, or neomycin IO: Potential risk of renal failure when administered concurrently with IL-2; theophylline may increase toxicity by reducing clearance; cimetidine may increase antitumor effects; zidovudine and vinblastine may increase toxicity ES: Cold or flu-like symptoms, Loss of appetite, Fatigue, Weakness, Headache, Local pain and swelling at the site of injection, Depression, Irritability, insomnia, Anxiety, diarrhoea, constipation, nausea, vomiting or abdominal pain, alopecia, Skin reactions such as rash and itch, Pain in the muscles or joints, Dizziness, Menstrual disturbances, Pins and needles sensations, Numbness, Liver, kidney or lung disorders Preg: C P: Depression and suicidal ideation may be adverse effects of treatment; infrequently, severe or fatal GI hemorrhage has been reported; prior to initiation of therapy, perform tests to quantitate peripheral blood hemoglobin, platelets, granulocytes, hairy cells, and bone marrow hairy cells; monitor periodically (eg, monthly) during treatment to determine response to treatment; if Genghis Khun ([email protected],nafanakhun.wordpress.com)


no response within 6 mo, discontinue treatment; if a response occurs, continue treatment until no further improvement is observed and laboratory parameters have been stable for about 3 mo; not known whether continued treatment after that time is beneficial; because the manufacturing process, strength, and type of interferon (eg, natural human leukocyte interferon versus single-species recombinant interferon) may vary for different interferon formulations, changing brands may require a change in dosage (do not change interferon product without considering these factors); fever and other flulike symptoms associated with this product; caution in debilitating medical conditions (eg, unstable angina, uncontrolled congestive heart failure, chronic obstructive pulmonary disease, DM with ketoacidosis, coagulation disorders, severe myelosuppression, seizure disorders) Nama Dagang: Intron A Genghis Khun ([email protected],nafanakhun.wordpress.com)


Peginterferon alfa-2a I: chronic hepatitis C BSO: Suntik 135 mcg/0.5cc. 180 mcg/0.5cc D: 180 mcg 1x/wk for 6-12 mo KI: P: may cause some people to become drowsy, dizzy, or less alert than they are normally. Make sure you know how you react to this medicine before you drive, use machines, or do anything else that could be dangerous if you are dizzy and not alert. ES: Black, tarry, stools, Chills, Cough, Discouragement, Feeling sad or empty, Fever, Irritability, Lack of appetite, Loss of interest or pleasure, Lower back or side pain, Painful or difficult urination, Pale skin, Shortness of breath, Sore throat, Tiredness, Trouble concentrating, Trouble sleeping, Ulcers, sores, or white spots in mouth, Unusual bleeding or bruising, Unusual tiredness or weakness IO: Preg: C Nama Dagang: Pegasys Genghis Khun ([email protected],nafanakhun.wordpress.com)


Peginterferon alfa-2b I: chronic hepatitis C BSO: Vial 50 mcg. 100 mcg D: 40-150 mcg SC 1x/wk for 1year KI: P: You may have feelings of anxiety or depression while taking peginterferon alfa-2b. ES: Abdominal pain, Anxiety, Black, tarry stools, Blood in urine or stools, Bloody diarrhea, Chills, Cough or hoarseness, Depression, Fever, Infection, Irritability, Lower back or side pain, Mood swings, Nausea, Painful or difficult urination, Pinpoint red spots on skin, Trouble in sleeping, Unusual bleeding or bruising, Vomiting IO: Preg: C Nama Dagang: Peg Intron Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ribavirin Inhibits viral replication by inhibiting DNA and RNA synthesis. I: Severe viral respiratory infection (respiratory syncytial virus (RSV) bronchiolitis) in infants and young children BSO: Capsule: 200 mg, Powder for aerosol: 6 g D: IV ribavirin is available on a compassionate use and investigational basis from US Centers for Disease Control and Prevention (CDC); suggested dosing based on available literature follows; however, dose may be altered based on individual circumstance or further research; consultation with CDC and an infectious diseases clinician recommended 30 mg/kg IV (max 2 g) loading dose, followed by 16 mg/kg IV (max 1 g) q6h for 4 d, followed by 8 mg/kg IV (max 500 mg) for 3-6 d KI: Hipersensitif IO: Decreases effects of zidovudine ES: Anaemia, reticulocytosis, Worsening lung function, Bacterial pneumonia, Pneumothorax Preg: X Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Caution in hemolytic anemia (monitor hemoglobin during therapy); be aware of teratogenicity, teratogenic in all animal species in which adequate studies are available, and, although clinical studies are not available, may harm human fetus; concentrates in red blood cells and persists for life of the cell; terminal half-life for systemic elimination is expected to be that of circulating red blood cells; after exposure, minimum safe interval for which conception must be avoided is not known; as appropriate, screening for Preg: is recommended prior to administration, as is counseling both men and women regarding avoidance of conception for a reasonable interval after exposure; patient should be encouraged to seek preconception counseling prior to attempting to conceive Nama Dagang: Rebetol



Zidovudine I: HIV infection; pregnant women and their newborn infants. BSO: Capsule: 100 mg Injection: 10 mg/mL Syrup: 50 mg/5 mL Tablet: 300 mg D: HIV: 600 mg Inj: 1-2 mg/kg IV slow 5-6x/day Prevent pregnant women (after 14 weeks of pregnancy): 100 mg 5x/d, or 200 mg 3x, or 300 mg 2x until the start of labor Newborn: 2 mg/kg 4x 8-12h post partum s/d umur 6wk Injection: 2 mg/kg IV infus> 1 jam, then 1 mg/kg until the umbilical cord is clamped. Newborn infants: 1.5 mg/kg 4x KI: # People with low haemoglobin levels # People with low levels of a type of white blood cell (neutrophil) in the blood # New born infants with jaundice requiring light therapy or whose liver transaminase enzymes are 5x greater than normal. Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Elderly people, Decreased liver & kidney function, hepatomegaly, Liver disease, Hepatitis, especially chronic hepatitis B or C, History of alcohol abuse, Obese women, Vitamin B12 deficiency. ES: Headache, Dizziness, diarrhoea, constipation, nausea, vomiting or abdominal pain, anaemia, leucopenia, neutropenia, malaise, asthenia, pyrexia, myalgia, Shortness of breath, Rash or itching, Liver disorders, pancreatitis, paraesthesia, Alteration in taste, somnolence, insomnia, Loss of appetite, lactic acidosis, Anxiety and depression IO: Decreased effect: Acetaminophen may decrease AUC of zidovudine as can the rifamycins Increased toxicity: Coadministration with drugs that are nephrotoxic (amphotericin B), cytotoxic (flucytosine, Adriamycin®, vincristine, vinblastine, doxorubicin, interferon), inhibit glucuronidation or excretion (acetaminophen, cimetidine, indomethacin, lorazepam, probenecid, aspirin), or interfere with RBC/WBC number or function (acyclovir, ganciclovir, pentamidine, dapsone); although the AUC was unaffected, the Genghis Khun ([email protected],nafanakhun.wordpress.com)


rate of absorption and peak plasma concentrations were increased significantly when zidovudine was administered with clarithromycin (n=18); valproic acid increased AZT's AUC by 80% and decreased clearance by 38% (believed due to inhibition first pass metabolism); fluconazole may increase zidovudine's AUC and half-life, concomitant interferon alfa may increase hematologic toxicities and phenytoin, trimethoprim, and interferon beta-1b may increase zidovudine levels Preg:: A, B, C, D, X BSO: Nama Dagang:



Stavudine I: HIV infection. BSO: Capsule: 15 mg, 20 mg, 30 mg, 40 mg Powder for oral solution: 1 mg/mL D: caps, oral solution: 40 mg/kg 2x. Anak 1 mg/kg Extended-release caps: 100 mg/kg 1x. KI: Allergy, glucose-galactose malabsorption, children < 3mo P: Decreased liver & kidney function, hepatomegaly, Hepatitis, History of alcohol abuse, Obese women, pancreatitis, peripheral neuropathy. ES: Nausea, vomiting, diarrhoea or abdominal pain, Fatigue, Headache, insomnia, Abnormal dreams, Abnormal thinking, Dizziness, Pins and needles sensations, peripheral neuropathy, Depression, Rash or itching, Anxiety, Pain in the muscles and joints, asthenia, Loss of appetite, lactic acidosis, Liver disorders, pancreatitis, gynaecomastia, hyperglycaemia, Raised cholesterol levels IO: Drugs associated with peripheral neuropathy (chloramphenicol, cisplatin, dapsone, ethionamide, gold, Genghis Khun ([email protected],nafanakhun.wordpress.com)


hydralazine, iodoquinol, isoniazid, lithium, metronidazole, nitrofurantoin, pentamidine, phenytoin, ribavirin, vincristine) may increase risk for stavudine peripheral neuropathy Preg: C Nama Dagang: Zerit



Lamivudine I: HIV infection, hepatitis B infection. BSO: Solution, oral: 5 mg/mL; 10 mg/mL Tablet: 100 mg, 150 mg D: Hepatitis B infection: 100 mg 1x HIV infection or AIDS: 150 mg 2x. Anak 2-4 mg/kg KI: Allergy, children < 3 months of age. P: Decreased kidney function, hepatomegaly, Liver disease, History of alcohol abuse, Obese women. ES: Headache, insomnia, Cough, nausea, vomiting, diarrhoea or abdominal pain, Rash, alopecia, Fatigue, malaise, pyrexia, neutropenia, anaemia, Liver disorders, pancreatitis, peripheral neuropathy, lactic acidosis IO: Increased effect: Zidovudine concentrations increase (~39%) with coadministration with lamivudine; trimethoprim/sulfamethoxazole increases lamivudine's AUC and decreases its renal clearance by 44% and 29%, respectively; although the AUC was not significantly affected, absorption of Genghis Khun ([email protected],nafanakhun.wordpress.com)


lamivudine was slowed and Cmax was 40% lower when administered to patients in the fed versus the fasted state Preg: C Nama Dagang: 3TC, 3TC-HBV



Nevirapine I: HIV infection. BSO: Suspension, oral: 50 mg/5 mL. Tablet: 200 mg D: 200 mg 1x for 2wk, then 200 mg 2x KI: Allergy, Severely decreased liver function, People needing post-exposure prevention of HIV (for example following needlestick injuries). P: Decreased liver &kidney function, Hepatitis, Women, People with high CD4 cell counts. ES: Rash, Nausea and vomiting, Fatigue, Headache, pyrexia, Diarrhoea, Abdominal pain, myalgia, Jaundice, hepatitis, Severe, potentially life-threatening skin reactions, eg StevensJohnson syndrome, toxic epidermal necrolysis IO: CYP3A3/4 enzyme substrate; CYP3A3/4 enzyme inducer; CYP3A3/4 enzyme inhibitor. Increased effect/toxicity with cimetidine, macrolides, ketoconazole Methadone's plasma concentrations may decrease. Preg: B Nama Dagang: Viramune Genghis Khun ([email protected],nafanakhun.wordpress.com)


Didanosine I: HIV infection. BSO: Powder for oral solution: Buffered: 100 mg, 167 mg, 250 mg, 375 mg Pediatric: 2 g, 4 g Tablet, buffered, chewable: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg D: Dosis KI: allergy, children < 3 months of age. P: Decreased liver & kidney function, Hepatitis, History of alcohol abuse, Obese women, hyperuricaemia, pancreatitis, hypertriglyceridaemia, phenylketonuria, Intolerance to fructose. ES: Nausea, vomiting, diarrhoea or abdominal pain, Headache, Rash, Fatigue, peripheral neuropathy, Dry mouth, asthenia, Loss of appetite, Pain in the muscles and joints, lactic acidosis, Raised cholesterol levels, Diabetes, pancreatitis, hyperuricaemia, alopecia, Changes to the retina and optic nerve of the eye, Dry eyes, Liver disorders, Blood disorders Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Drugs whose absorption depends on the level of acidity in the stomach such as ketoconazole, itraconazole, and dapsone should be administered at least 2 hours prior to didanosine Increased toxicity: Concomitant administration of other drugs which have the potential to cause peripheral neuropathy or pancreatitis may increase the risk of these toxicities Preg: B Nama Dagang: Videx



Oseltamivir Inhibits neuraminidase, which is a glycoprotein on the surface of influenza virus that destroys an infected cell's receptor for viral hemagglutinin. By inhibiting viral neuraminidase, decreases release of viruses from infected cells and thus, viral spread. Effective to treat influenza A or B. Must administer within 48 h of symptom onset. The best effect occurs the sooner it is taken after symptom onset. Reduces the length of illness by an average of 1.5 d. (In a subgroup of high-risk patients, illness was reduced by 2.5 d.) In addition, the severity of symptoms is also reduced. I: Flu (influenza) BSO: Capsule: 75 mg D: Acute illness: 75 mg PO bid (2x)for 5 d Prophylaxis: 75 mg PO qd (1x) Paed.: Acute illness >1 year and <15 kg: 30 mg PO bid 15-23 kg: 45 mg PO bid 23-40 kg: 60 mg PO bid Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif ES: Nausea, Vomiting, Abdominal pain, Diarrhoea, Indigestion, Headache, Tiredness, Dizziness, insomnia, Conjunctivitis, Nosebleeds, Rash, hepatitis, Severe skin reactions. IO: Preg: C P: Caution in renal impairment, chronic cardiac or respiratory disease, and breastfeeding Nama Dagang: Tamiflu



Inosine dimepranol acedoben/ Methisoprinol I: BSO: Tab 500 mg. Sir 250 mg/5cc D: 50 mg/kg/hr terbagi dlm 3-4 dosis. Infeksi berat/ akut: 100 mg/kg/hr terbagi dlm 4-6 dosis. Lama terapi 7-10 hari KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Isoprinosine



Q. Anti Neoplasma Cyclosporine Doxorubicin Epirubicin Bleomycin Dacarbazine Daunorubicin Cyproterone acetate Cyclophosphamide Etoposide Methotrexate Tamoxifen Vinorelbine Vincristine Vinblastine Cytarabine Gemcitabine Fludarabine Capecitabine Trastuzumab Temozolomide Bicalutamide Tegafur Rituximab Paclitaxel Docetaxel Oxaliplatin Carboplatin Cisplatin Exemestane Mitomycin Megestrol Medroxyprogesterone Letrozole Leuprorelin Anastrozole Irinotecan Imatinib Gefitinib Ifosfamide Hydroxyurea/ Hydroxycarbamide Mitoxantrone Goserelin Flutamide 5-Fluorouracil/ Fluorouracil Asparaginase Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cyclosporine cyclosporine binds to macrophilin and then inhibits calcineurin, a calcium-dependent enzyme, which, in turn, inhibits phosphorylation of nuclear factor of activated T cells and inhibits transcription of cytokines, particularly IL-4. BSO: D: 2 mg/kg/d PO divided bid; if no improvement within 1 mo, may be increased gradually; max 5 mg/kg/d As skin lesions improve, reduce dose by 0.5-1 mg/kg/d/mo; lowest effective dose for maintenance Paed. 3-5 mg/kg/d PO KI: Hipersensitif; uncontrolled hypertension or malignancies; do not administer concomitantly with PUVA or UV-B radiation in psoriasis because may increase risk of cancer IO: Carbamazepine, phenytoin, isoniazid, rifampin, and phenobarbital may decrease concentrations; azithromycin, itraconazole, nicardipine, ketoconazole, fluconazole, erythromycin, verapamil, grapefruit juice, diltiazem, aminoglycosides, acyclovir, amphotericin B, and clarithromycin Genghis Khun ([email protected],nafanakhun.wordpress.com)


may increase toxicity; acute renal failure, rhabdomyolysis, myositis, and myalgias increase when taken concurrently with lovastatin Preg: C P: Evaluate renal and liver functions often by measuring BUN, serum creatinine, serum bilirubin, and liver enzyme levels; may increase risk of infection and lymphoma; reserve IV use only for patients who cannot take PO; development of malignancies (particularly skin) has been reported; perform biopsy on skin suggestive of malignancy or premalignancy and, if malignant, discontinue



Doxorubicin I: Advanced ovarian cancer when platinum-based chemotherapy has been unsuccessful, AIDS-related Kaposi's sarcoma (a form of skin cancer), Breast cancer that has spread to other areas of the body BSO: Injection: Aqueous, with NS & Preservative free: 2 mg/mL Powder for injection, lyophilized: 10 mg, 20 mg, 50 mg, 100 mg D: Refer to individual protocols: 40-50 mg/m2 IV q4wk Children: 35-75 mg/m2 as a single dose, repeat every 21 days; or 20-30 mg/m2 once weekly; or 60-90 mg/m2 given as a continuous infusion over 96 hours every 3-4 weeks Adults: 60-75 mg/m2 as a single dose, repeat every 21 days or other dosage regimens like 20-30 mg/m2/day for 2-3 days, repeat in 4 weeks or 20 mg/m2 once weekly The lower dose regimen should be given to patients with decreased bone marrow reserve, prior therapy or marrow infiltration with malignant cells Currently the maximum cumulative dose is 550 mg/m2 or 450 mg/m2 in patients who have received RT to the mediastinal Genghis Khun ([email protected],nafanakhun.wordpress.com)


areas; a baseline MUGA should be performed prior to initiating treatment. If the LVEF is <30% to 40%, therapy should not be instituted; LVEF should be monitored during therapy. Doxorubicin has also been administered intraperitoneal (phase I in refractory ovarian cancer patients) and intra-arterially. Dosing adjustment in renal impairment: Adjustments not required in mild to moderate renal failure Clcr <10 mL/minute: Reduce dose to 75% of normal dose in severe renal failure Hemodialysis: Supplemental dose is not necessary Dosing adjustment in hepatic impairment: Bilirubin 1.2-3 mg/dL: Administer 50% of dose Bilirubin 3.1-5 mg/dL: Administer 25% of dose Bilirubin >5 mg/dL: Avoid use KI: Breastfeeding, Pregnancy P: Radiotherapy treatment in the area of the chest cavity, treatment with other medicines that may have side effects on the heart, eg other anthracycline chemotherapy medicines, Decreased liver & heart function, Heart disease, Diabetes Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Skin reactions such as rash and itch, diarrhoea, constipation, nausea, vomiting or abdominal pain, Allergic reaction, alopecia, pyrexia, anaemia, Loss of appetite, leucopenia, stomatitis, cardiotoxicity, asthenia, thrombocytopenia, palmar-plantar erythrodysesthesia IO: May decrease phenytoin and digoxin plasma levels; phenobarbital may decrease plasma levels; cyclosporine may induce coma or seizures; mercaptopurine increases toxicity; cyclophosphamide increases cardiac toxicity Preg: D P: Irreversible cardiac toxicity and myelosuppression may occur; extravasation may result in severe local tissue necrosis; reduce dose in patients with impaired hepatic function; adverse effects include infusion reactions, mucositis, and skin toxicity (palmar-plantar erythrodysesthesia); nausea and vomiting are mild; alopecia and cardiac toxicity are uncommon Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Epirubicin I: myeloma, Breast cancer, lymphoma, Cancer of the ovaries, Colorectal cancer, Gastrointestinal cancer, Leukaemia, Lung cancer, Superficial bladder cancer BSO: Injection: 2 mg/mL D: KI: Allergy, heart failure, Max doses of other anthracycline type anticancer medicines has been given, myelosuppression P: Radiotherapy treatment in the area of the chest cavity, Decreased liver function ES: Diarrhoea, Red urine, pyrexia, Chills, Nausea and vomiting, anaemia, leucopenia, stomatitis, cardiotoxicity, Reversible hair loss, thrombocytopenia, urticaria, immunosuppression IO: No systematic evaluation of the potential for interaction with inhibitors or inducers of cytochrome P-450 isoenzymes has been performed. However, cimetidine increased the AUC of epirubicin by 50%. Preg: D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bleomycin I: Bladder cancer, lymphoma, malignant effusions, Lung cancer, Metastatic cancerous melanoma, Squamous cell carcinoma, Testicular cancer, Thyroid cancer BSO: Powder for injection: 15 U, 30 U D: Refer to individual protocols; 1 unit = 1 mg Children and Adults: Test dose for lymphoma patients: I.M., I.V., S.C.: Because of the possibility of an anaphylactoid reaction, less than or equal to 2 U of bleomycin for the first 2 doses; monitor vital signs every 15 minutes; wait a minimum of 1 hour before administering remainder of dose; if no acute reaction occurs, then the regular dosage schedule may be followed Single-agent therapy: I.M./I.V./S.C.: Squamous cell carcinoma, lymphoma, testicular carcinoma: 0.25-0.5 U/kg (10-20 U/m2) 1-2 times/week CIV: 15 U/m2 over 24 hours daily for 4 days Combination-agent therapy: I.M./I.V.: 3-4 U/m2 Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.V.: ABVD: 10 U/m2 on days 1 and 15 Maximum cumulative lifetime dose: 400 U KI: Impaired breathing ability, pneumonia P: Decreased kidney function ES: Rash, Tiredness, Allergic, pyrexia, Chills, pulmonary fibrosis, erythema, Loss of appetite, striae, stomatitis, pneumonitis, Ridging of the nails, Hardening, reddening, tenderness and swelling of the tips of the fingers Preg: D Nama Dagang:



Dacarbazine I: Breast cancer, Cancer of the colon (large bowel), Cancer of the ovaries, soft tissue sarcoma, Lung cancer, Hodgkin's disease, Metastatic cancerous melanoma, Testicular cancer BSO: Injection: 100 mg; 200 mg; 500 mg D: Dosis KI: Allergy, Severe myelosuppression P: Decreased kidney & liver function ES: Headache, Diarrhoea, facial flushing, Allergic reaction, photosensitivity, Alteration in results of liver function tests, anaemia, leucopenia, thrombocytopenia, liver damage, Nausea & vomiting, Loss of appetite, alopecia, Cold or flu-like symptoms IO: Metabolism may be increased by drugs that induce hepatic enzymes. Patients may experience impaired immune response to vaccines. Possible infection after administration of live vaccines in patients receiving immunosuppressants Preg: C Nama Dagang: Dacarbazine DBL Genghis Khun ([email protected],nafanakhun.wordpress.com)


Daunorubicin I: Acute lymphocytic leukaemia, Acute myeloid leukaemia BSO: Powder for injection, lyophilized: 20 mg/20cc D: Dosis KI: Allergy, herpes & varicella zoster infection, Decreased blood cell production by the bone marrow P: Current or previous radiotherapy treatment in the area of the chest cavity, Decreased liver & heart function, Previous therapy with other anthracycline type anticancer medicines or other medicines potentially toxic to the heart ES: Rash, Diarrhoea, facial flushing, heart failure, Red colouration of urine, phlebitis, pyrexia, anaemia, leucopenia, stomatitis, Reversible hair loss, thrombocytopenia, immunosuppression, mucositis, Nausea and vomiting IO: Patients may experience impaired immune response to vaccines; possible infection after administration of live vaccines in patients receiving immunosuppressants Preg: D Nama Dagang: Daunorubicin DBL Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cyclophosphamide I: Cancer of the lymph nodes (lymphoma), Other cancers BSO: Powder for injection: 100 mg, 200 mg, 500 mg, 1 g, 2 g Tablet: 25 mg, 50 mg D: Children: SLE: I.V.: 500-750 mg/m2 every month; maximum dose: 1 g/m2 JRA/vasculitis: I.V.: 10 mg/kg every 2 weeks Children and Adults: Oral: 50-100 mg/m2/day as continuous therapy or 400-1000 mg/ m2 in divided doses over 4-5 days as intermittent therapy I.V.: Single Doses: 400-1800 mg/m2 (30-50 mg/kg) per treatment course (1-5 days) which can be repeated at 2-4 week intervals MAXIMUM SINGLE DOSE WITHOUT BMT is 7 g/m2 (190 mg/ kg) SINGLE AGENT THERAPY Continuous daily doses: 60-120 mg/m2 (1-2.5 mg/kg) per day Autologous BMT: IVPB: 50 mg/kg/dose x 4 days or 60 mg/kg/dose for 2 days; total dose is usually divided over 2-4 days Genghis Khun ([email protected],nafanakhun.wordpress.com)


Nephrotic syndrome: Oral: 2-3 mg/kg/day every day for up to 12 weeks when corticosteroids are unsuccessful KI: Decreased blood cell production by the bone marrow, Infection, Inflammation of the bladder causing damage and bleeding, often as a result of certain anti-cancer treatments, allergy, Severely decreased liver & kidney function P: Decreased kidney & liver function, porphyrias, leucopenia, impaired immune response, thrombocytopenia ES: Bone marrow suppression, fluid retention, Dizziness, Nausea and vomiting, haemorrhagic cystitis, hyponatraemia IO: CYP2B6, 2D6, and 3A3/4 enzyme substrate Increased toxicity: Allopurinol may cause increase in bone marrow depression and may result in significant elevations of cyclophosphamide cytotoxic metabolites Anesthetic agents: Cyclophosphamide reduces serum pseudocholinesterase concentrations and may prolong the neuromuscular blocking activity of succinylcholine; use with caution with halothane, nitrous oxide, and succinylcholine Genghis Khun ([email protected],nafanakhun.wordpress.com)


Chloramphenicol results in prolonged cyclophosphamide halflife to increase toxicity Cimetidine inhibits hepatic metabolism of drugs and may decrease or increase the activation of cyclophosphamide Doxorubicin: Cyclophosphamide may enhance cardiac toxicity of anthracyclines Phenobarbital and phenytoin induce hepatic enzymes and cause a more rapid production of cyclophosphamide metabolites with a concurrent decrease in the serum half-life of the parent compound Tetrahydrocannabinol results in enhanced immunosuppression in animal studies Thiazide diuretics: Leukopenia may be prolonged Preg: D Nama Dagang:



Etoposide I: Small cell lung cancer, Testicular cancer, In addition to these licensed uses, etoposide may also be used by specialists to treat other types of cancer, including leukaemia and lymphoma. BSO: Capsule: 50 mg Injection: 20 mg/mL D: Refer to individual protocols: Children: I.V.: 60-120 mg/m2/day for 3-5 days every 3-6 weeks AML: Remission induction: 150 mg/m2/day for 2-3 days for 2-3 cycles Intensification or consolidation: 250 mg/m2/day for 3 days, courses 2-5 Brain tumor: 150 mg/m2/day on days 2 and 3 of treatment course Neuroblastoma: 100 mg/m2/day over 1 hour on days 1-5 of cycle; repeat cycle every 4 weeks BMT conditioning regimen used in patients with rhabdomyosarcoma or neuroblastoma: I.V. continuous infusion: 160 mg/m2/day for 4 days Genghis Khun ([email protected],nafanakhun.wordpress.com)


Conditioning regimen for allogenic BMT: 60 mg/kg/dose as a single dose Adults: Small cell lung cancer: Oral: Twice the I.V. dose rounded to the nearest 50 mg given once daily if tolerated I.V.: 35 mg/m2/day for 4 days or 50 mg/m2/day for 5 days every 3-4 weeks total dose less than or equal to 400 mg/day or in divided doses if >400 mg/day IVPB: 60-100 mg/m2/day for 3 days (with cisplatin) CIV: 500 mg/m2 over 24 hours every 3 weeks Testicular cancer: IVPB: 50-100 mg/m2/day for 5 days repeated every 3-4 weeks I.V.: 100 mg/m2 every other day for 3 doses repeated every 3-4 weeks BMT/relapsed leukemia: I.V.: 2.4-3.5 g/m2 or 25-70 mg/kg administered over 4-36 hours KI: Decreased liver function, Pregnancy, Breastfeeding P: Decreased kidney & liver function Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Leucopenia, thrombocytopenia, Reversible hair loss, Nausea and vomiting, anaemia, Abdominal pain, Loss of appetite, Diarrhoea or constipation, Sore mouth or throat, Changes in blood pressure, bronchospasm, peripheral neuropathy, somnolence, Fatigue, Fever, Difficulty swallowing # Alteration in results of liver function tests IO: CYP3A3/4 enzyme substrate Warfarin may elevate prothrombin time with concurrent use Methotrexate: Alteration of MTX transport has been found as a slow efflux of MTX and its polyglutamated form out of the cell, leading to intercellular accumulation of MTX Calcium antagonists: Increases the rate of VP-16-induced DNA damage and cytotoxicity in vitro Carmustine: Reports of frequent hepatic dysfunction with hyperbilirubinemia, ascites, and thrombocytopenia Cyclosporine: Additive cytotoxic effects on tumor cells Preg: D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Methotrexate Antimetabolite that inhibits dihydrofolate reductase, thereby hindering DNA synthesis and cell reproduction. I: Cancer, rheumatoid arthritis, Severe psoriasis BSO: Injection: 2.5 mg/mL; 25 mg/mL Injection, preservative free: 25 mg Powder injection: 20 mg, 25 mg, 50 mg, 100 mg, 250 mg, 1 g Tablet: 2.5 mg D: 10-25 mg/wk PO/IM or 2.5-7.5 mg PO q12h for 3 doses/wk Refer to individual protocols. May be administered orally, I.M., intra-arterially, intrathecally, or I.V. Children: Dermatomyositis: Oral: 15-20 mg/m2/week as a single dose once weekly or 0.3-1 mg/kg/dose once weekly Juvenile rheumatoid arthritis: Oral, I.M.: 5-15 mg/m2/week as a single dose or as 3 divided doses given 12 hours apart Antineoplastic dosage range: Oral, I.M.: 7.5-30 mg/m2/week or every 2 weeks Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.V.: 10-18,000 mg/m2 bolus dosing or continuous infusion over 6-42 hours Dosing schedules listed below: Conventional Dose: 15-20 mg/m2 oral twice weekly 30-50 mg/m2 oral, I.V. weekly 15 mg/day for 5 days oral, I.M. every 2-3 weeks Intermediate Dose: 50-150 mg/m2 I.V. push every 2-3 weeks 240 mg/m2* I.V. infusion every 4-7 days 0.5-1 g/m2* I.V. infusion every 2-3 weeks High Dose: 1-12 g/m2* I.V. infusion every 1-3 weeks *Followed with leucovorin rescue - refer to leucovorin monograph for details. Pediatric solid tumors (high-dose): I.V.: <12 years: 12 g/m2 (dosage range: 12-18 g) greater than or equal to 12 years: 8 g/m2 (maximum: 18 g) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Acute lymphocytic leukemia (intermediate-dose): I.V.: Loading: 100 mg/m2 over 1 hour, followed by a 35-hour infusion of 900 mg/m2/day Meningeal leukemia: I.T.: 10-15 mg/m2 (maximum dose: 15 mg) or less than or equal to 3 months: 3 mg/dose 4-11 months: 6 mg/dose 1 year: 8 mg/dose 2 years: 10 mg/dose greater than or equal to 3 years: 12 mg/dose I.T. doses are prepared with preservative-free MTX only. Hydrocortisone may be added to the I.T. preparation; total volume should range from 3-6 mL. Doses should be repeated at 2- to 5-day intervals until CSF counts return to normal followed by a dose once weekly for 2 weeks then monthly thereafter. Adults: I.V.: Range is wide from 30-40 mg/m2/week to 100-12,000 mg/m2 with leucovorin rescue Genghis Khun ([email protected],nafanakhun.wordpress.com)


Doses not requiring leucovorin rescue range from 30-40 mg/m2 I.V. or I.M. repeated weekly, or oral regimens of 10 mg/m2 twice weekly High-dose MTX is considered to be >100 mg/m2 and can be as high as 1500-7500 mg/m2. These doses require leucovorin rescue. Patients receiving doses greater than or equal to 1000 mg/m2 should have their urine alkalinized with bicarbonate or Bicitra® prior to and following MTX therapy. Trophoblastic neoplasms: Oral, I.M.: 15-30 mg/day for 5 days; repeat in 7 days for 3-5 courses Head and neck cancer: Oral, I.M., I.V.: 25-50 mg/m2 once weekly Rheumatoid arthritis: Oral: 7.5 mg once weekly OR 2.5 mg every 12 hours for 3 doses/week; max 20 mg/week Psoriasis: Oral: 2.5-5 mg/dose every 12 hours for 3 doses given weekly or Oral, I.M.: 10-25 mg/dose given once weekly Ectopic pregnancy: I.M./I.V.: 50 mg/m2 single-dose without leucovorin rescue Genghis Khun ([email protected],nafanakhun.wordpress.com)


Elderly: Rheumatoid arthritis/psoriasis: Oral: Initial: 5 mg once weekly; if nausea occurs, split dose to 2.5 mg every 12 hours for the day of administration; dose may be increased to 7.5 mg/ week based on response, max 20 mg/week KI: Hipersensitif; alcoholism; hepatic insufficiency; documented immunodeficiency syndromes; preexisting blood dyscrasias (eg, bone marrow hypoplasia, leukopenia, thrombocytopenia, significant anemia); renal insufficiency IO: Oral aminoglycosides may decrease absorption and blood levels of concurrent oral MTX; charcoal lowers MTX levels; coadministration with etretinate may increase hepatotoxicity of MTX; folic acid or its derivatives contained in some vitamins may decrease response to MTX; probenecid, NSAIDs, salicylates, procarbazine, and sulfonamides, including TMPSMZ, can increase MTX plasma levels; may decrease phenytoin plasma levels; may increase plasma levels of thiopurines Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preg: D P: Monitor CBC counts monthly and liver and renal function q1-3mo during therapy (monitor more frequently during initial dosing, dose adjustments, or when risk of elevated MTX levels, eg, dehydration); has toxic effects on hematologic, renal, GI, pulmonary, and neurologic systems; discontinue if significant drop in blood counts occurs; fatal reactions reported when administered concurrently with NSAIDs Nama Dagang:



Tamoxifen I: Breast cancer, Infertility in women caused by failure of ovulation BSO: Tablet: 10 mg, 20 mg D: Breast cancer in women/ men: 20-40 mg 1x Reducing the risk of developing breast cancer in high-risk women: 20 mg 1x for 5years KI: Infertility with risk of abnormal blood clots in the veins, Pregnancy, Breastfeeding P: Breast cancer, Severe obesity, Smokers, porphyrias ES: Hot flushes, Vaginal bleeding or discharge, pruritus vulva, Headache, Light-headedness, diarrhoea, constipation, nausea, vomiting or abdominal pain, Fluid retention, alopecia, Blood & Liver disorders, Visual disturbances, thromboembolic disorders, endometriosis, Cancerous changes in the endometrium, Fibroids in uterus, Stevens-Johnson Syndrome, angioedema IO: CYP1A2, 2A6, 2B6, 2C, 2D6, 2E1,& 3A3/4 enzyme substrate Preg: D Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vinorelbine I: # Advanced breast cancer that has not responded to, or has relapsed following, treatment with a chemotherapy regimen containing an anthracycline, eg epirubicin. # Advanced non-small cell lung cancer. BSO: Injection: 10 mg/mL (1 mL, 5 mL) D: Dosage adjustment in hematological toxicity: Granulocyte counts should be greater than or equal to 1000 cells/mm3 prior to the administration of vinorelbine. Adjustments in the dosage of vinorelbine should be based on granulocyte counts obtained on the day of treatment as follows: Granulocytes greater than or equal to 1500 cells/mm3 on day of treatment: Administer 30 mg/m2 Granulocytes 1000-1499 cells/mm3 on day of treatment: Administer 15 mg/m2 Granulocytes <1000 cells/mm3 on day of treatment: Do not administer. Repeat granulocyte count in one week; if 3 consecutive doses are held because granulocyte count is <1000 cells/mm3, discontinue vinorelbine Genghis Khun ([email protected],nafanakhun.wordpress.com)


For patients who, during treatment, have experienced fever and/or sepsis while granulocytopenic or had 2 consecutive weekly doses held due to granulocytopenia, subsequent doses of vinorelbine should be: 22.5 mg/m2 for granulocytes greater than or equal to 1500 cells/ mm3 11.25 mg/m2 for granulocytes 1000-1499 cells/mm3 Dosing adjustment in hepatic impairment: Vinorelbine should be administered with caution in patients with hepatic insufficiency. In patients who develop hyperbilirubinemia during treatment with vinorelbine, the dose should be adjusted for total bilirubin as follows: Serum bilirubin less than or equal to 2 mg/dL: Administer 30 mg/m2 Serum bilirubin 2.1-3 mg/dL: Administer 15 mg/m2 Serum bilirubin >3 mg/dL: Administer 7.5 mg/m2 Dosing adjustment in patients with concurrent hematologic toxicity and hepatic impairment: Administer the lower doses determined from the above recommendations Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Neutropenia, thrombocytopenia, current infection, Pregnancy, Breastfeeding, fructose intolerance. # Vinorelbine should not be used to treat people who are currently having radiotherapy treatment to the liver. P: Decreased liver function, heart disease. ES: Neutropenia, anaemia, thrombocytopenia, Constipation, Nausea and vomiting, Diarrhoea, Loss of appetite, Inflammation of the mouth, paraesthesia, peripheral neuropathy, phlebitis, Fatigue, Hair loss, Jaw pain. IO: Preg: D Nama Dagang: Navelbine



Vincristine I: myeloma, Acute lymphocytic leukaemia, Acute myeloid leukaemia, Breast cancer, chronic myeloid leukaemia – CML, Osteosarcoma, Ewing's sarcoma, Cancer of the brain, soft tissue sarcoma, Wilms' tumour, Chronic lymphocytic leukaemia, Head and neck cancer, Lung cancer, Hodgkin's disease, NonHodgkin's lymphoma, Retinoblastoma, neuroblastoma BSO: Injection: 1 mg/mL D: Refer to individual protocols as dosages vary with protocol used; adjustments are made depending upon clinical and hematological response and upon adverse reactions Children >10 kg or BSA greater than or equal to 1 m2: 1-2 mg/ m2, may repeat once weekly for 3-6 weeks; maximum single dose: 2 mg Neuroblastoma: I.V. continuous infusion with doxorubicin: 1 mg/ m2/day for 72 hours Adults: I.V.: 0.4-1.4 mg/m2 (up to 2 mg maximum in most patients); may repeat every week Dosing adjustment in hepatic impairment: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Serum bilirubin 1.5-3.0 mg/dL or AST 60-180 U: Administer 50% of normal dose Serum bilirubin 3.0-5.0 mg/dL: Administer 25% of dose Serum bilirubin >5.0 mg/dL or AST >180 U: Omit dose The average total dose per course of treatment should be around 2-2.5 mg; some recommend capping the dose at 2 mg maximum to reduce toxicity; however, it is felt that this measure can reduce the efficacy of the drug KI: Injection into the spinal cord (intrathecal injection) P: Liver disease ES: Abdominal pain, Constipation, urinary retention, peripheral neuritis, Loss of appetite, Damage to the nerves, Reversible hair loss, Jaw pain, paralytic ileus, Pain IO: CYP3A3/4 and 3A5-7 enzyme substrate; CYP2D6 enzyme inhibitor Increased toxicity: Digoxin plasma levels and renal excretion may decrease with combination chemotherapy including vincristine Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vincristine should be given 12-24 hours before asparaginase to minimize toxicity (may decrease the hepatic clearance of vincristine) Acute pulmonary reactions may occur with mitomycin-C. Previous or simultaneous use with mitomycin-C has resulted in acute shortness of breath and severe bronchospasm within minutes or several hours after vinca alkaloid injection and may occur up to 2 weeks after the dose of mitomycin. Preg: D Nama Dagang:



Vinblastine I: A group of disorders where there is an overgrowth of cells called histiocytes which normally have the ability to engulf foreign matter or bacteria. The overgrowth of these cells can occur in the skin, bone, lungs, lymph nodes, liver or spleen. Breast cancer, choriocarcinoma, Kaposi's sarcoma, Kidney cancer, Hodgkin's disease, Non-Hodgkin's lymphoma, Testicular cancer BSO: Injection: 1 mg/mL Powder for injection: 10 mg D: Refer to individual protocols. Varies depending upon clinical and hematological response. Give at intervals of at least 14 days and only after leukocyte count has returned to at least 4000/mm3; maintenance therapy should be titrated according to leukocyte count. Dosage should be reduced in patients with recent exposure to radiation therapy or chemotherapy; single doses in these patients should not exceed 5.5 mg/m2. Dosing adjustment in hepatic impairment: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Serum bilirubin 1.5-3.0 mg/dL or AST 60-180 U: Administer 50% of normal dose Serum bilirubin 3.0-5.0 mg/dL: Administer 25% of dose Serum bilirubin >5.0 mg/dL or AST >180 U: Omit dose KI: Injection into the spinal cord (intrathecal injection) P: Decreased liver function ES: Constipation, Depression, Nausea and vomiting, anaemia, peripheral neuritis, Loss of appetite, leucopenia, stomatitis, Damage to the nerves, Reversible hair loss, Jaw pain, paralytic ileus, thrombocytopenia. IO: CYP3A3/4 and 3A5-7 enzyme substrate; CYP2D6 enzyme inhibitor. Phenytoin plasma levels may be reduced with concomitant combination chemotherapy with vinblastine Alpha-interferon enhances interferon toxicity; phenytoin may decrease plasma levels Increased toxicity: Previous or simultaneous use with mitomycin-C has resulted in acute shortness of breath and severe bronchospasm within Genghis Khun ([email protected],nafanakhun.wordpress.com)


minutes or several hours after vinca alkaloid injection and may occur up to 2 weeks after the dose of mitomycin Mitomycin-C in combination with administration of VLB may cause acute shortness of breath and severe bronchospasm, onset may be within minutes or several hours after VLB injection Preg: D Nama Dagang:



Cytarabine I: Leukaemia BSO: Powder for injection: 100 mg, 500 mg, 1 g, 2 g Powder for injection, as hydrochloride (Cytosar-U®): 100 mg, 500 mg, 1 g, 2 g D: I.V. bolus, IVPB, and CIV doses of cytarabine are very different. Bolus doses are relatively well tolerated since the drug is rapidly metabolized; bolus doses are associated with greater gastrointestinal and neurotoxicity; continuous infusion uniformly results in myelosuppression. Refer to individual protocols. Induction remission: I.V.: 200 mg/m2/day for 5 days at 2-week intervals 100-200 mg/m2/day for 5- to 10-day therapy course or every day until remission I.T.: 5-75 mg/m2 every 4 days until CNS findings normalize or <1 year: 20 mg 1-2 years: 30 mg Genghis Khun ([email protected],nafanakhun.wordpress.com)


2-3 years: 50 mg >3 years: 70 mg Maintenance remission: I.V.: 70-200 mg/m2/day for 2-5 days at monthly intervals I.M., S.C.: 1-1.5 mg/kg single dose for maintenance at 1- to 4week intervals High-dose therapies: Doses as high as 1-3 g/m2 have been used for refractory or secondary leukemias or refractory non-Hodgkin's lymphoma Doses of 3 g/m2 every 12 hours for up to 12 doses have been used Bone marrow transplant: 1.5 g/m2 continuous infusion over 48 hours Dosage adjustment of high-dose therapy in patients with renal insufficiency: In one study, 76% of patients with a Clcr <60 mL/minute experienced neurotoxicity; dosage adjustment should be considered in these patients Hemodialysis: Supplemental dose is not necessary Peritoneal dialysis: Supplemental dose is not necessary Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dose may need to be adjusted in patients with liver failure since cytarabine is partially detoxified in the liver KI:Allergy, Decreased blood cell production by the bone marrow P:Decreased kidney& liver function, leucopenia, thrombocytopenia ES: Mouth ulcers, Nausea and vomiting, bone marrow suppresion, Liver problems IO: Preg: D Nama Dagang:



Gemcitabine Cytidine analog. Metabolized intracellularly to active nucleotide. Inhibits ribonucleotide reductase and competes with deoxycytidine triphosphate for incorporation into DNA. Cellcycle specific for S phase. Indicated for advanced ovarian cancer (that has relapsed at least 6-months after completion of platinum-based therapy. Used in combination with carboplatin. I: BSO: Vial 200 mg D: 1000 mg/m2 IV infused over 30 min on days 1 and 8 of each 21-day cycle; administer carboplatin on day 1 after gemcitabine Adults: I.V. (refer to individual protocols): 1000 mg/m2 once weekly for up to 7 weeks (or until toxicity necessitates reducing or holding a dose), followed by a week of rest from treatment; subsequent cycles should consist of infusions once weekly for 3 consecutive weeks out of every 4 weeks For patients who tolerate the subsequent course, at a dose of 1250 mg/m2, the dose for the next cycle can be increased to Genghis Khun ([email protected],nafanakhun.wordpress.com)


1500 mg/m2, provided again that the AGC and platelet nadirs exceed 1500 x 106/L and 100,000 x 106/L, respectively, and again, if nonhematologic toxicity has not been greater than WHO Grade 1 Dosing adjustment in renal/hepatic impairment: Use with caution; gemcitabine has not been studied in patients with significant renal or hepatic dysfunction KI: Hipersensitif IO: Preg: D P: May cause myelosuppression (particularly thrombocytopenia); toxicities include flu like syndrome, LFT abnormality, maculopapular rash, pruritus, nausea, vomiting, dyspnea, hematuria, proteinuria, and hemolytic uremic syndrome; clearance reduced in women and elderly individuals Nama Dagang: Gemsar Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fludarabine I: Chronic lymphocytic leukaemia BSO: Powder for injection, lyophilized: 50 mg D: I.V.: Acute leukemia: 10 mg/m2 bolus over 15 minutes followed by continuous infusion of 30.5 mg/m2/day over 5 days or 10.5 mg/m2 bolus over 15 minutes followed by 30.5 mg/ m2/day over 48 hours followed by cytarabine has been used in clinical trials Solid tumors: 9 mg/m2 bolus followed by 27 mg/m2/day continuous infusion over 5 days Adults: Chronic lymphocytic leukemia: 25 mg/m2/day over a 30-minute period for 5 days; 5-day courses are repeated every 28 days days Non-Hodgkin's lymphoma: Loading dose: 20 mg/m2 followed by 30 mg/m2/day for 48 hours KI: Moderate to severely decreased kidney function, haemolytic anaemia, Pregnancy, Breastfeeding Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: > 75 years, Decreased liver & kidney function, Anaemia, thrombocytopenia, granulocytopenia, HIV infection or immunodeficiency syndr, opportunistic infections, Skin cancer ES: Neutropenia, thrombocytopenia, anaemia, Infections, Pneumonia, Nausea and vomiting, Diarrhoea, pyrexia, stomatitis, Fatigue, Weakness, Loss of appetite, oedema, Visual disturbances, peripheral neuropathy, Skin rashes, Tumour lysis syndrome, heart failure, arrhythmias IO: Increased toxicity: Cytarabine when administered with or prior to a fludarabine dose competes for deoxycytidine kinase decreasing the metabolism of F-ara-A to the active F-ara-ATP (inhibits fludarabine); however, administering fludarabine prior to cytarabine may stimulate activation of cytarabine Preg: D Nama Dagang: Fludara



Capecitabine I: Metastatic colorectal cancer, surgery for stage III colon cancer, Advanced stomach cancer (in combination with platinum-based chemotherapy), metastatic breast cancer. BSO: Tablet: 150 mg, 500 mg D: 2.5g/ m2/day q12h taken about twelve hours apart within 30 minutes after the end of a meal. (with/witout docetaxel 75 mg/m2/day Infus IV >1jam every 3wk) KI: Deficiency of an DPD enzyme, Allergy, Severely decreased kidney & liver function, thrombocytopenia, leucopenia, neutropenia, Pregnancy, Breastfeeding, glucose-galactose malabsorption. P: Decreased kidney & liver function, DM, Disease affecting the brain or nervous system, heart disease, electrolyte imbalance, hypercalcaemia, hypocalcaemia, > 60 years of age, Severe diarrhoea, hand-foot syndrome. ES: hand-foot syndrome or palmar-plantar erythrodysesthesia, diarrhoea, nausea, vomiting, constipation or abdominal pain, Genghis Khun ([email protected],nafanakhun.wordpress.com)


stomatitis, Fatigue, asthenia, Loss of appetite, Skin reactions, alopecia, pyrexia, Headache, Dizziness, paraesthesia, Change in taste, Watery eyes, Swollen ankles due to fluid retention, dyspnoea, Dehydration, bone marrow suppression, Pain in the muscles or joints, angina. IO: Increased effect: Taking capecitabine immediately before an aluminum hydroxide/magnesium hydroxide antacid, or a meal, increases the absorption of capecitabine. Phenytoin levels may be increased by capecitabine. Increased toxicity: The concentration of 5-fluorouracil is increased and its toxicity may be enhanced by leucovorin. Deaths from severe enterocolitis, diarrhea, and dehydration have been reported in elderly patients receiving weekly leucovorin and fluorouracil. Warfarin: Altered coagulation parameters have been noted in cancer patients receiving coumarin derivatives concomitantly with capecitabine. Preg:: A, B, C, D, X Nama Dagang: Xeloda Genghis Khun ([email protected],nafanakhun.wordpress.com)


Trastuzumab I: # Early HER2-+ breast cancer, following surgery, chemotherapy and radiotherapy (if applicable). # HER2-+ breast cancer that has spread to other parts of the body (metastatic breast cancer). For people who have not previously received chemotherapy for their disease, this medicine may be given in combination with the chemotherapy medicines paclitaxel or docetaxel. For people who have already received at least two courses of chemotherapy, this medicine may be given on its own. BSO: Injection: Vial, 440 mg, with vial of bacteriostatic water for injection D: I.V. infusion: Initial loading dose: 4 mg/kg IV infusion >90 minutes Maintenance dose: 2 mg/kg IV infusion > 90 minutes (can be administered over 30 minutes if prior infusions are well tolerated) weekly until disease progression Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Allergy, severe breathing difficulties at rest due to complications of advanced cancer, People who need oxygen treatment, children < 18 years of age. P: Heart failure, Coronary artery disease, hypertension ES: Pyrexia, Chills, diarrhoea, constipation, indigestion, nausea, vomiting or abdominal pain, Headache, Chest pain, Weakness or loss of strength, Pain in the muscles and joints, Rash, Flulike symptoms, Infection, Weight loss, Breast inflammation, tachycardia, heart failure, Dizziness, paraesthesia, oedema, Dry mouth, Nosebleeds, Skin reactions, Depression, Anxiety, Difficulties with breathing, Lung, Blood & liver disorders Preg: D Nama Dagang: Herceptin



Temozolomide I: Certain types of brain tumours (glioblastoma multiforme, anaplastic astrocytoma) BSO: Capsule: 5 mg, 20 mg, 100 mg, 250 mg D: Dosage is adjusted according to nadir neutrophil and platelet counts of previous cycle and counts at the time of the next cycle Measure day 22 ANC and platelets. Measure day 29 ANC and platelets. Based on lowest counts at either day 22 or day 29: On day 22 or day 29, if ANC <1,000/L or the platelet count is <50,000/L, postpone therapy until ANC >1,500/L and platelet count >100,000/L. Reduce dose by 50 mg/m2 for subsequent cycle. If ANC 1,000-1,500/L or platelets 50,000-100,000/L, postpone therapy until ANC >1,500/L and platelet count >100,000/L; maintain initial dose. If ANC >1,500/L (on day 22 and day 29) and platelet count >100,000/L, increase dose to, or maintain dose at 200 mg/ m2/day for 5 for subsequent cycle. Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Allergy, Severe myelosuppression, Pregnancy, lactation P: Elderly people, People with other severely debilitating diseases or infection, Severely decreased kidney & liver function, glucose-galactose malabsorption ES: Headache, Loss of appetite, Weight loss, Fatigue, alopecia, diarrhoea, constipation, nausea, vomiting or abdominal pain, Sore mouth, Decrease in the number of blood cells in the blood, Anxiety, Mood swings, insomnia, Dizziness, Confusion, Convulsions, Memory loss, paraesthesia, Visual disturbances, Hearing impairment, Fluid retention causing swelling of the legs or ankles, Skin reactions, Cough, dyspnoea, Pain in the muscles or joints, asthenia IO: Although valproic acid reduces the clearance of temozolomide by 5%, the clinical significance of this is unknown Preg: D Nama Dagang: 1. Temodal Genghis Khun ([email protected],nafanakhun.wordpress.com)


Bicalutamide I: Prostate cancer BSO: Tablet: 50 mg D: 1 tablet 1x, with or without food. KI: Children, Women P: Moderate to severely decreased liver function ES: Depression, Impotence, Weight gain, gynaecomastia, Dry skin, Hot flushes, angina, alopecia, Itching (pruritis), asthenia, thrombocytopenia, Decreased sex drive, Breast tenderness, Liver disorders, Nausea, vomiting, diarrhoea or abdominal pain, arrhythmias IO: In vitro displacement of warfarin by bicalutamide Preg: X Nama Dagang: Casodex



Tegafur I: Metastatic colorectal cancer, in combination with calcium folinate BSO: Kaps 200 mg D: 800-1600 mg/hr terbagi dlm 2-4 dosis KI: Allergy, Children and adolescents, Severely decreased liver function, low levels of red or white blood cells or platelets due to previous radiotherapy or chemotherapy treatment, Deficiency of cytochrome P450 2A6, Pregnancy, Breastfeeding P: Elderly people, Decreased liver & kidney function, Deficiency of an DPD enzyme, Heart disease, Severe diarrhoea ES: Diarrhoea, constipation, nausea, vomiting, asthenia, thrush, alopecia, Skin reactions, Watery and sore eyes, Loss of appetite, Headache, Dehydration, Sleepiness, Dizziness, insomnia, Depression, Confusion, Pins and needles sensations, peripheral oedema, dyspnoea, Preg:: A, B, C, D, X Nama Dagang: Futraful Genghis Khun ([email protected],nafanakhun.wordpress.com)


Paclitaxel Mechanisms of action are tubulin polymerization and microtubule stabilization. I: Metastatic carcinoma of the ovary in combination with cisplatin; treatment of metastatic breast cancer BSO: Injection: 6 mg/mL (5 mL, 16.7 mL) D: 175 mg/m2 IV over 3 h q3wk; alternatively, 135 mg/m2 IV over 24 h q3wk === Premedication with dexamethasone (20 mg orally or I.V. at 12 and 6 hours or 14 and 7 hours before the dose), diphenhydramine (50 mg I.V. 30-60 minutes prior to the dose), and cimetidine, famotidine or ranitidine (I.V. 30-60 minutes prior to the dose) is recommended Ovarian carcinoma: 135-175 mg/m2 over 1-24 hours administered every 3 weeks Metastatic breast cancer: Treatment is still undergoing investigation; most protocols have used doses of 175-250 mg/ m2 over 1-24 hours every 3 weeks Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif, peripheral neuropathy; bone marrow suppression; liver failure; severe cardiac disease IO: With cisplatin may further increase myelosuppression Preg: D P: Premedicate with steroids, H1 blockers, and H2 blockers to decrease risk of hypersensitivity reactions; myelosuppression, alopecia, arthralgia/myalgias, and cardiac arrhythmia may occur Nama Dagang:



Docetaxel I: Breast cancer. BSO: Injection: 20 mg/0.5 mL, 80 mg/ 2 mL D: Corticosteroids (oral dexamethasone 8 mg twice daily for 3 days or 5 days starting 1 day prior to docetaxel administration) are necessary to reduce the potential for hypersensitivity and severe fluid retention Locally advanced or metastatic carcinoma of the breast: 60-100 mg/m2 over 1 hour every 3 weeks Dosage adjustment in patients who are initially started at 100 mg/m2 (>1 week), cumulative cutaneous reactions, or severe peripheral neuropathy: 75 mg/m2 Note: If the patient continues to experience these adverse reactions, the dosage should be reduced to 55 mg/m2 or therapy should be discontinued Dosing adjustment in hepatic impairment: Total bilirubin greater than or equal to the upper limit of normal (ULN), or AST/ALT >1.5 times the ULN concomitant with alkaline phosphatase >2.5 times the ULN: Docetaxel should Genghis Khun ([email protected],nafanakhun.wordpress.com)


not be administered secondary to increased incidence of treatment-related mortality KI: Neutropenia, decreased liver function, Pregnancy, Breastfeeding. P: Decreased liver function, Severe fluid retention. ES: Bone marrow suppression, neutropenia, pyrexia, Increased susceptibility to infections, thrombocytopenia, anaemia, diarrhoea, constipation, nausea, vomiting or abdominal pain, stomatitis, Loss of appetite, hand-foot or palmar-plantar syndrome, Change in the colour of nails, alopecia, fluid retention, arrhythmias, peripheral neuropathy, asthenia, Pain in the muscles and joints. IO: CYP3A3/4 enzyme substrate Preg: D Nama Dagang: Taxotere



Oxaliplatin I: Stage III (Duke's C) colon cancer, metastatic colorectal ca BSO: Vial 5 mg/cc D: KI: Children, myelosuppression, People with numbness, weakness or tingling sensations in the extremities and difficulty in performing delicate tasks, eg buttoning clothes, before treatment starts, Severely decreased kidney function # Pregnancy, Breastfeeding P: Allergy, Moderately decreased kidney function ES: Pyrexia, bone marrow suppression, Increased susceptibilty to infections, abdominal pain, diarrhoea, constipation, nausea, vomiting, indigestion, stomatitis, abnormal tingling or numb sensations in fingers or toes, difficulty performing delicate tasks, Allergic skin reactions, conjunctivitis, rhinitis, Fatigue, Weakness, Headache, Loss of appetite, alopecia, ototoxicity, Lung disorders Preg: D Nama Dagang: Eloxatin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Carboplatin I: # Cancer of the ovaries, # Lung cancer BSO: Powder for injection, lyophilized: 50 mg, 150 mg, 450 mg D: Dose is based on the following formula: total dose (mg) = (target AUC) X (GFR = 25) where AUC (area under plasma concentration-time curve) is expressed in mg/mL/min and GFR (glomerular filtration rate) is expressed in mL/min.Target AUC of 4-7.5 IV q3-4wk recommended KI: Hipersensitif; bone marrow suppression IO: Nephrotoxicity increases with aminoglycosides and other nephrotoxic drugs Preg: D P: Produces significantly less nephrotoxicity, peripheral neuropathy, nausea, and vomiting compared to cisplatin; IV hydration not required; produces more myelosuppression than cisplatin Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cisplatin Intrastrand cross-linking of DNA and inhibition of DNA precursors are among proposed mechanisms of action. Used in combination with radiation therapy. I: Bladder cancer, Cancer of the ovaries, Cervical cancer, Head and neck cancer, Lung cancer, Testicular cancer BSO: Injection, aqueous: 1 mg/mL (50 mL, 100 mL) Powder for injection: 10 mg, 50 mg D: 50-100 mg/m2 IV q3wk, 40 mg/m2 IV qwk for 5 wk. I.V. (refer to individual protocols): The manufacturer recommends that subsequent cycles should only be given when serum creatinine <1.5 mg%, WBC greater than or equal to 4,000/mm3, platelets greater than or equal to 100,000/mm3, and BUN <25. It is recommended that a 24-hour urine creatinine clearance be checked prior to a patient's first dose of cisplatin and periodically thereafter (ie, after every 2-3 cycles of cisplatin) Pretreatment hydration with 1-2 L of chloride-containing fluid is recommended prior to cisplatin administration; adequate Genghis Khun ([email protected],nafanakhun.wordpress.com)


hydration and urinary output (>100 mL/hour) should be maintained for 24 hours after administration If the dose prescribed is a reduced dose, then this should be indicated on the chemotherapy order Children: Various dosage schedules range from 30-100 mg/m2 once every 2-3 weeks; may also dose similar to adult dosing Recurrent brain tumors: 60 mg/m2 once daily for 2 consecutive days every 3-4 weeks Adults: Advanced bladder cancer: 50-70 mg/m2 every 3-4 weeks Head and neck cancer: 100-120 mg/m2 every 3-4 weeks Testicular cancer: 10-20 mg/m2/day for 5 days repeated every 3-4 weeks Metastatic ovarian cancer: 75-100 mg/m2 every 3 weeks Intraperitoneal: cisplatin has been administered intraperitoneal with systemic sodium thiosulfate for ovarian cancer; doses up to 90-270 mg/m2 have been administered and retained for 4 hours before draining Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; renal failure; peripheral neuropathy; bone marrow suppression IO: Decreases elimination of bleomycin ES: hyperuricaemia, hypocalcaemia, hypokalaemia, peripheral neuropathy, anaemia, hypomagnesaemia, leucopenia, thrombocytopenia, immunosuppression, Nausea and vomiting, a metallic taste, Kidney damage, anaphylaxis, ototoxicity Preg: D P: Peripheral neuropathy and myelosuppression may occur; IV hydration decreases risk of nephrotoxicity; selective serotonin antagonists and steroids can be used for prophylaxis against nausea/vomiting Nama Dagang:



Exemestane I: # Early invasive breast cancer in postmenopausal women who have had two to three years of treatment with tamoxifen # Advanced breast cancer in postmenopausal women where other anti-oestrogen medicines have not been effective BSO: Tablet: 25 mg D: Breast cancer: 25 mg 1x/day after a meal. KI: Pre-menopausal women, Pregnancy, Breastfeeding, Rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency P: Decreased liver & kidney function, Osteoporosis ES: Hot flushes, Fatigue, Joint pain, insomnia, Headache, Increased sweating, nausea, vomiting, constipation, diarrhoea, indigestion or abdominal pain, Loss of appetite, Dizziness, Depression, Carpal tunnel syndrome, alopecia, peripheral oedema, Pain, Weakness, Sleepiness, Disturbances in the normal levels of blood cells in the blood Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: CYP3A4 substrate; however, ketoconazole, a CYP3A4 inhibitor, did not change the pharmacokinetics of exemestane. No other potential drug interactions have been evaluated. Preg: D Nama Dagang: Aromasin



Mitomycin I: Metastatic breast cancer, Cancer of the pancreas, Cancers of the mouth, throat and stomach, Liver cancer, Lung cancer, Superficial bladder cancer BSO: Vial 2 mg, 10 mg D: Refer to individual protocols Single-agent therapy: 20 mg/m2 every 6-8 weeks Note: Doses >20 mg/m2 have not been shown to be more effective, and are more toxic. Combination therapy: 10 mg/m2 every 6-8 weeks Bone marrow transplant: 40-50 mg/m2 2-40 mg/m2/day for 3 days Total cumulative dose should not exceed 50 mg/m2; see below: ( nadir after prior dose per mm3) Leukocytes 4000; platelets >100,000: 100% of prior dose to be given L 3000-3999; T 75,000-99,999: 100% L 2000-2999; T 25,000-74,999: 70% Genghis Khun ([email protected],nafanakhun.wordpress.com)


L 2000; T <25,000: 50% KI: P: Allergy, Bleeding disorders, Mildly decreased kidney function Severe myelosuppression ES: Pruritus, Diarrhoea, Drowsiness, Weakness, phlebitis, alopecia, Nausea and vomiting, Kidney damage, lethargy, anaemia, leucopenia, stomatitis, thrombocytopenia # Thickening and scarring of tissue in the lung IO: Increased toxicity: Vinca alkaloids acute shortness of breath or bronchospasm Doxorubicin may enhance cardiac toxicity Preg: D Nama Dagang: Mitomycin-C Kyowa



Megestrol I: Breast cancer, Endometrial cancer BSO: Suspension, oral: 40 mg/mL with alcohol 0.06% Tablet: 20 mg, 40 mg D: Adults: Oral (refer to individual protocols): Breast carcinoma& Uterine bleeding 40 mg 4 times/day Endometrial: 40-320 mg/day in divided doses; use for 2 months to determine efficacy; max 800 mg/day Male/Female: HIV-related cachexia: Initial dose: 800 mg/day; daily doses of 400-800 mg/day KI: Allergy, Breastfeeding, Children, Pregnancy P: Thrombophlebitis, Severely decreased liver function ES: Heart failure, Changes in mood, hyperglycaemia, fluid retention, Nausea and vomiting, Hot flushes, dyspnoea, Stimulation of tumour growth, alopecia, hypertension, urticaria, uterine bleeding, Weight gain IO: Preg: X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Letrozole I: # Pre-operative treatment of localised hormone receptor + breast cancer in postmenopausal women, to shrink the cancer and allow breast-conserving surgery # Immediately following surgery for hormone receptor + early invasive breast cancer in postmenopausal women, to reduce chances of the cancer returning # Following five years standard treatment with tamoxifen for early invasive breast cancer in postmenopausal women, to reduce chances of the cancer returning # Advanced breast cancer in postmenopausal women, either as first-line treatment or where other anti-oestrogen medicines have not been effective BSO: Tablet: 2.5 mg D: 2.5 mg 1x/day KI: Pre-menopausal women, Pregnancy, Breastfeeding, Severely decreased liver function, Pre-operative treatment for localised breast cancer if the breast cancer is not responsive to oestrogen, or this is unknown Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Severely decreased kidney function, Osteoporosis ES: Hot flushes, diarrhoea, constipation, nausea, vomiting or abdominal pain, Fatigue, Hair loss, Pain in muscles or joints, Change in appetite, Headache, Dizziness, Rash, dry skin or itching, Increased sweating, peripheral oedema, Weight gain, Vaginal bleeding, discharge or dryness, Urinary tract infection, Tumour pain, Depression or anxiety, Memory impairment, dyspnoea, palpitations, Raised cholesterol levels, insomnia IO: CYP3A3/4 and 2A6 enzyme substrate; CYP2A6 and 2C19 enzyme inhibitor Preg: D Nama Dagang: Femara



Leuprorelin I: Advanced prostate cancer, Endometriosis BSO: Vial 3.75 mg D: Ca prostat: 3.75 mg Dosis tunggal SC/ IM per bulan Endometriosis: dosis sama, dimulai 5 hari pertama mens selama 6 bulan KI: Pregnancy, Breastfeeding, Vaginal bleeding (unknown) P: Depression, Diabetes, tumour symptoms (tumour flare), cancer has spread to the spine, urinary obstruction, Osteoporosis, long-term treatment with corticosteroids, or antiepileptic, history of heavy drinking or smoking ES: Headache, insomnia, Hot flushes, Dizziness, Decreased sex drive, Fatigue, nausea, vomiting, diarrhoea or abdominal pain, Visual disturbances, paraesthesia, palpitations, Worsening of depression, leucopenia, pulmonary embolism Men: Impotence, gynaecomastia, Sweating Women: Vaginal dryness, osteoporosis, Hair loss, Breast tenderness, Change in breast size Preg: X Genghis Khun ([email protected],nafanakhun.wordpress.com)


Anastrozole I: Advanced breast cancer in postmenopausal women # Treating postmenopausal women who have had surgery to remove early hormone receptor + breast cancer. It can be used for 5 years immediately following the surgery, or after 2-3years of taking tamoxifen. BSO: Tablet: 1 mg D: 1 mg 1x/day KI: liver & kidney disease, Pre-menopausal women, Pregnancy, Breastfeeding, glucose-galactose malabsorption P: Osteoporosis, risk factors for osteoporosis ES: Hot flushes, asthenia, Joint pain or stiffness, Mood disturbances, Rash, Headache, Diarrhoea, Nausea, vomiting, Loss of appetite, Vaginal bleeding, somnolence, Raised cholesterol levels, osteopororsis IO: CYP3A3/4 enzyme substrate; CYP1A2, 2C8, 2C9, and 3A3/4 enzyme inhibitor Preg: D Nama Dagang: Arimidex Genghis Khun ([email protected],nafanakhun.wordpress.com)


Irinotecan I: Colorectal cancer BSO: Injection: 20 mg/mL D: Adults: I.V.: Weekly regimen: 125 mg/m2 over 90 minutes on days 1, 8, 15, and 22, followed by a 2-week rest Once-every-3-week regimen: 350 mg/m2 over 90 minutes, once every 3 weeks A reduction in the starting dose by one dose level may be considered for patients greater than or equal to 65 years of age, prior pelvic/abdominal radiotherapy, performance status of 2, or increased bilirubin (dosing for patients with a bilirubin >2 mg/dL cannot be recommended based on lack of data per manufacturer) Depending on the patient's ability to tolerate therapy, doses should be adjusted in increments of 25-50 mg/m2. Irinotecan doses may range 50-150 mg/m2. Combination therapy with 5-FU and leucovorin: Six-week (42-day) cycle (next cycle beginning on day 45): Genghis Khun ([email protected],nafanakhun.wordpress.com)


125 mg/m2 over 90 minutes on days 1, 8, 15, and 22; to be given in combination with bolus leucovorin and 5-FU (leucovorin administered immediately following irinotecan; 5-FU immediately following leucovorin) 180 mg/m2 over 90 minutes on days 1, 15, and 22; to be given in combination with infusional leucovorin and bolus/infusion 5FU (leucovorin administered immediately following irinotecan; 5FU immediately following leucovorin) Note: For all regimens: It is recommended that new courses begin only after the granulocyte count recovers to greater than or equal to 1500/mm3, the platelet count recovers to greater than or equal to 100,000/mm3, and treatment-related diarrhea has fully resolved. Treatment should be delayed 1-2 weeks to allow for recovery from treatment-related toxicities. If the patient has not recovered after a 2-week delay, consideration should be given to discontinuing irinotecan. Dosing adjustment for toxicities: A decrease in dose level corresponds to a decrease in irinotecan dosage by 25-50 mg/ Genghis Khun ([email protected],nafanakhun.wordpress.com)


m2; specific dose levels corresponding to individual protocols should be consulted. KI: Children, bowel obstruction, Chronic inflammatory bowel disease such as ulcerative colitis or Crohn's disease, hiperbilirubinemia, Severe reduction in blood cell production in the bone marrow, Pregnancy, Breastfeeding. P: Elderly people, hyperbilirubinaemia, Campto infusion contains sorbitol and may be unsuitable for people with hereditary fructose intolerance. ES: Diarrhoea, Nausea and vomiting, Dehydration, Abdominal pain, Constipation, Loss of appetite, stomatitis, Reversible hair loss, neutropenia, anaemia, thrombocytopenia, Increased susceptibility to infections, Fever, asthenia, Fatigue, Acute cholinergic syndrome, Muscle cramps, Skin reactions such as rash and itch IO: Preg: D Nama Dagang: Campto Genghis Khun ([email protected],nafanakhun.wordpress.com)


Imatinib I: cancer called Philadelphia chromosome + chronic myeloid leukemia (Ph+ CML) or gastrointestinal stromal tumors (GIST) BSO: Kaps/ Tab 100 mg D: ASM, HES or CEL, MDS or MPD: 400 mg 1x/d CML & GIST: 400-600 mg1x/d ALL: 600 mg 1x/d DFSP: 800 mg 1x/d KI: P: ES: IO: not recommended with: Aprepitant, Carbamazepine, Dexamethasone, Fosaprepitant, Phenobarbital, Phenytoin, Rifampin, St John's Wort, Warfarin Preg:D Nama Dagang: Glivec



Gefitinib I: non-small cell lung cancer after the failure of other chemotherapy treatment. BSO: Tab 250 mg D: 250 mg 1x/d KI: P: Check if diarrhea, nausea or anorexia, problems breathing, new eye problems. ES: Bloating/swelling of face, arms, hands, lower legs or feet, Burning, dry or itching eyes, Change in vision, Difficult/ labored breathing, Eye discharge or excessive tearing, Redness, pain, swelling of eye, eyelid, or inner lining of eyelid, Shortness of breath IO: Combination drug is not recommended, but may be required in some cases. Preg: D Nama Dagang: Iressa Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ifosfamide Forms DNA interstrand and intrastrand bonds that interfere with protein synthesis. I: Lymphoma, Other cancers BSO: Powder for injection: 1 g, 3 g D: 5 g/m2 IV over 24 h q3wk I.V. (refer to individual protocols): Adults: 50 mg/kg/day or 700-2000 mg/m2/day for 5 days Alternatives include 2400 mg/m2/day for 3 days or 5000 mg/m2 as a single dose Doses of 700-900 mg/m2/day for 5 days may be given IVP; courses may be repeated every 3-4 weeks To prevent bladder toxicity, ifosfamide should be given with extensive hydration consisting of at least 2 L of oral or I.V. fluid per day. A protector, such as mesna, should also be used to prevent hemorrhagic cystitis. The dose-limiting toxicity is hemorrhagic cystitis and ifosfamide should be used in conjunction with a uroprotective agent. Dosing adjustment in renal impairment: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Scr >3.0 mg/dL: Withhold drug Scr 2.1-3.0 mg/dL: Reduce dose by 25% to 50% KI: Hipersensitif; renal/hepatic failure; bone marrow suppression IO: Phenobarbital, phenytoin, chloral hydrate, and other drugs that interfere with cytochrome P-450 activity may alter effects Preg: D P: May cause hemorrhagic cystitis and severe myelosuppression; caution in renal function impairment or compromised bone marrow reserve Nama Dagang: Holoxan



Hydroxyurea/ Hydroxycarbamide I: cancer and to prevent painful episodes associated with sickle cell anemia. BSO: Capsule: 200 mg, 300 mg, 400 mg, 500 mg D: pediatric astrocytoma, medulloblastoma, and primitive neuroectodermal tumors: 1500-3000 mg/m2 as a single dose in combination with other agents every 4-6 weeks CML: Initial: 10-20 mg/kg/day once daily; adjust dose according to hematologic response Adults: Dose should always be titrated to patient response and WBC counts; usual oral doses range from 10-30 mg/kg/day or 500-3000 mg/day; if WBC count falls to <2500 cells/mm3, or the platelet count to <100,000/mm3, therapy should be stopped for at least 3 days and resumed when values rise toward normal Solid tumors: Intermittent therapy: 80 mg/kg 1x every third day Continuous therapy: 20-30 mg/kg/day 1x/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Concomitant therapy with irradiation: 80 mg/kg as a single dose every third day starting at least 7 days before initiation of irradiation Resistant chronic myelocytic leukemia: 20-30 mg/kg/day divided daily HIV: 1000-1500 mg daily in a single dose or divided doses Sickle cell anemia (moderate/severe disease): Initial: 15 mg/kg/ day, increased by 5 mg/kg every 12 weeks if blood counts are in an acceptable range until the maximum tolerated dose of 35 mg/kg/day is achieved or the dose that does not produce toxic effects Acceptable range: Neutrophils greater than or equal to 2500 cells/mm3 Platelets greater than or equal to 95,000/mm3 Hemoglobin >5.3 g/dL, and Reticulocytes greater than or equal to 95,000/mm3 if the hemoglobin concentration is <9 g/dL Toxic range: Neutrophils <2000 cells/mm3 Genghis Khun ([email protected],nafanakhun.wordpress.com)


Platelets <80,000/mm3 Hemoglobin <4.5 g/dL Reticulocytes <80,000/mm3 if the hemoglobin concentration is <9 g/dL Monitor for toxicity every 2 weeks; if toxicity occurs, stop treatment until the bone marrow recovers; restart at 2.5 mg/kg/day less than the dose at which toxicity occurs; if no toxicity occurs over the next 12 weeks, then the subsequent dose should be increased by 2.5 mg/kg/day; reduced dosage of hydroxyurea alternating with erythropoietin may decrease myelotoxicity and increase levels of fetal hemoglobin in patients who have not been helped by hydroxyurea alone KI: Severe anemia, severe bone marrow suppression; WBC <2500/mm3 or platelet count <100,000/mm3; hypersensitivity P: Renal impairment, in patients who have received prior irradiation therapy, and in the elderly. ES: >10%: Drowsiness, nausea and vomiting may occur, as well as diarrhea, constipation, mucositis, ulceration of the GI tract, anorexia, and stomatitis, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hematologic: Myelosuppression: Dose-limiting toxicity, causes a rapid drop in leukocyte count (seen in 4-5 days in nonhematologic malignancy and more rapidly in leukemia); thrombocytopenia and anemia occur less often; reversal of WBC count occurs rapidly, but the platelet count may take 7-10 days to recover WBC & Platelets: Moderate. Onset (days): 7, Nadir (days): 10 Recovery (days): 21 1-10%: Dermatologic changes (hyperpigmentation, erythema of the hands and face, maculopapular rash, or dry skin), alopecia Miscellaneous: Carcinogenic potential IO: Increased effect: Zidovudine, zalcitabine, didanosine: Synergy. Increased toxicity: Fluorouracil: The potential for neurotoxicity may increase with concomitant administration Cytarabine: Modulation of its metabolism and cytotoxicity reduction of cytarabine dose Preg: D Nama Dagang: Hydrea Genghis Khun ([email protected],nafanakhun.wordpress.com)


Mitoxantrone I: Metastatic breast cancer, Non-Hodgkin's lymphoma, Acute non-lymphocytic leukaemia in adults, Primary liver cancer that cannot be treated with surgery. BSO: Injection: 2 mg/mL D: Refer to individual protocols. I.V. (may dilute in D5W or NS): Children less than or equal to 2 years: 0.4 mg/kg/day once daily for 3-5 days Children >2 years and Adults: 12 mg/m2/day once daily for 3 days; acute leukemia in relapse: 8-12 mg/m2/day once daily for 4-5 days Solid tumors: Children: 18-20 mg/m2 every 3-4 weeks OR 5-8 mg/m2 1x/wk Adults: 12-14 mg/m2 every 3-4 weeks OR 2-4 mg/m2/day for 5d Max: 80-120 mg/m2 in patients with predisposing factor and <160 mg in patients with no predisposing factor Dosing adjustment in hepatic impairment: Official dosage adjustment recommendations have not been established Genghis Khun ([email protected],nafanakhun.wordpress.com)


Moderate dysfunction (bilirubin 1.5-3 mg/dL): Some clinicians recommend a 50% dosage reduction Severe dysfunction (bilirubin >3.0 mg/dL) have a lower total body clearance and may require a dosage adjustment to 8 mg/ m2; some clinicians recommend a dosage reduction to 25% of dose Dose modifications based on degree of leukopenia or thrombocytopenia: Granulocyte count nadir >2000 cells/mm2; platelet count nadir >150,000 cells/mm2; total bilirubin <1.5 mg/dL: Increase dose by 1 mg/m2 Granulocyte count nadir 1000-2000 cells/mm2; platelet count nadir 75,000-150,000 cells/mm2; total bilirubin <1.5 mg/dL: Maintain same dose Granulocyte count nadir <1000 cells/mm2; platelet count nadir <75,000 cells/mm2; total bilirubin 1.5-3 mg/dL: Decrease dose by 1 mg/m2 KI: Pregnancy, Breastfeeding, Allergy. Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Decreased blood cell production by the bone marrow, Decreased liver function, Heart disease, People who have previously had radiotherapy to the chest area, People who have had previous therapy with other anthracycline type anticancer medicines or other medicines that can have side effects on the heart. ES: Blue/green coloration of urine, leucopenia, anaemia, thrombocytopenia, diarrhoea, constipation, nausea, vomiting or abdominal pain, Loss of appetite, stomatitis, Alteration in taste, Hair loss (reversible on stopping treatment), Fatigue and weakness, phlebitis, Confusion, Anxiety, pyrexia, amenorrhoea # Blue discoloration of the skin, nails or whites of the eyes (this is temporary and due to the colour of the medicine), Rash, Shortness of breath, Changes in liver function, Bleeding in the stomach or intestines, Heart failure, arrhythmias IPreg: D Nama Dagang: Norexan Genghis Khun ([email protected],nafanakhun.wordpress.com)


Goserelin I: Breast cancer, Endometriosis, Fibroids of the uterus, Preparing the pituitary gland prior to infertility treatment, Preparing the uterus lining (endometrium) prior to surgery, Prostate cancer BSO: Injection, implant: 3.6 mg single dose disposable syringe with 16-gauge hypodermic needle; 10.8 mg single dose disposable syringe with 14-gauge hypodermic needle D: Breast Cancer, Cancer of the prostate, endometriosis, Thinning the uterus before surgery of the uterus: 3.6 mg SC (upper abdomen) per mo KI: Allergy, Children, Pregnancy P: Polycystic ovary syndrome, osteoporosis ES: Headache, gynaecomastia, paraesthesia, Hot flushes, arthralgia, Decrease in the density of bone, Changes in blood pressure, Development of fluid filled sacks (cysts) in the ovaries # Vaginal dryness, Decreased sex drive, pituitary apoplexy Preg: X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Flutamide I: Advanced prostate cancer BSO: Capsule: 125 mg, 250 mg D: Adults: Oral: 250 mg 3x KI: Women P: Decreased liver function, Heart disease ES: insomnia, Tiredness, diarrhoea, constipation, nausea, vomiting or abdominal pain, photosensitivity, gynaecomastia, Increased appetite, galactorrhoea, haemolytic anaemia, Decrease in production of sperm, Decreased sex drive, Breast tenderness, Liver disorders IO: CYP3A3/4 enzyme substrate reg: D Nama Dagang:



5-Fluorouracil/ Fluorouracil Pyrimidine antagonist. Inhibition of thymidylate synthase and inhibition of RNA synthesis. Also is a potent radiosensitizer. I: Breast cancer, Colorectal cancer BSO: Cream, topical: 5%, 1% Injection: 50 mg/mL Solution, topical: 2%; 5% D: 225 mg/m2/d continuous IV for 5 wk Children and Adults: IV 1st : 400-500 mg/m2/day (12 mg/kg/day; max: 800 mg/day) for 4-5 days either as a single daily I.V. push or 4-day CIV I.V.: Maintenance: 200-250 mg/m2 (6 mg/kg) every other day for 4 days repeated in 4 weeks 500-600 mg/m2 (15 mg/kg) weekly as a CIV or I.V. push I.V.: Concomitant with leucovorin: 370 mg/m2/day x 5 days 500-1000 mg/m2 every 2 weeks 600 mg/m2 weekly for 6 weeks Genghis Khun ([email protected],nafanakhun.wordpress.com)


Although the manufacturer recommends no daily dose >800 mg, higher doses of up to 2 g/day are routinely administered by CIV; higher daily doses have been successfully used Hemodialysis: Administer dose posthemodialysis Dosing adjustment/comments in hepatic impairment: Bilirubin >5 mg/dL: Omit use Topical: Actinic or solar keratosis: Apply twice daily for 2-6 weeks Superficial basal cell carcinomas: Apply 5% twice daily for at least 3-6 weeks and up to 10-12 weeks KI: Hipersensitif; myelosuppression; acute active infection IO: Increase effects of anticoagulants, immunosuppressives, NSAIDs, platelet inhibitors, and thrombolytics Preg: X P: Inflammatory reactions may occur with occlusive dressings; porous gauze dressing may be applied for cosmetic reasons, without increase in reaction Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Asparaginase I: acute lymphocytic leukemia, lymphoma; used for induction therapy BSO: Injection: 10,000 U/vial D: Refer to individual protocols; Asparaginase is available from two different microbiological sources: One is from Escherichia coli and the other is from Erwinia carotovora; the Erwinia is restricted to patients who have sustained allergic reactions to the E. coli preparation I.M., I.V.: 6000 U/m2 every other day for 3-4 weeks or daily doses of 1000-20,000 U/m2 for 10-20 days; other induction regimens have been utilized Hemodialysis: Significant drug removal is unlikely based on physiochemical characteristics Peritoneal dialysis: Significant drug removal is unlikely based on physiochemical characteristics Desensitization should be performed before administering the first dose of asparaginase to patients who developed a + reaction to the intradermal skin test or who are being retreated; Genghis Khun ([email protected],nafanakhun.wordpress.com)


one schedule begins with a total of 1 unit given I.V. and doubles the dose every 10 minutes until the total amount given in the planned dose for that day Asparaginase Desensitization: Inj No. 1: 1 IU; Accumulated total dose = 1 Inj No. 2: 2 IU; Accumulated total dose = 3 Inj No. 3: 4 IU; Accumulated total dose = 7 Inj No. 4: 8 IU; Accumulated total dose = 15 Inj No. 5: 16 IU; Accumulated total dose = 31 Inj No. 6: 32 IU; Accumulated total dose = 63 Inj No. 7: 64 IU; Accumulated total dose = 127 Inj No. 8: 128 IU; Accumulated total dose = 255 Inj No. 9: 256 IU; Accumulated total dose = 511 Inj No. 10: 512 IU; Accumulated total dose = 1023 Inj No. 11: 1024 IU; Accumulated total dose = 2047 Inj No. 12: 2048 IU; Accumulated total dose = 4095 Inj No. 13: 4096 IU; Accumulated total dose = 8191 Inj No.14 8192 IU; Accumulated total dose= 16,383 Inj No15: 16,384 IU;Accumulated total dose= 32,767 Genghis Khun ([email protected],nafanakhun.wordpress.com)


Injection No.16: 32,768 IU; Accumulated total dose = 65,535 Injection No. 17: 65,536 IU; Accumulated total dose = 131,071 Injection No. 18: 131,072 IU; Accumulated total dose = 262,143 For example, if a patient was to receive a total dose of 4000 U, he/she would receive injections 1-12 during the desensitization KI: Pancreatitis (active or any history of), hypersensitivity; P: ES: Joint pain, Puffy face, Skin rash or itching, Stomach pain (severe) with nausea and vomiting, Trouble in breathing Less: Confusion, Convulsions, Frequent urination, Headache, Loss of bladder control, Muscle spasm or jerking of all extremities, Numbness or tingling in hands, arms, or legs, Severe weakness, Sudden loss of consciousness, Swelling of feet or lower legs, Unusual bleeding or bruising, Unusual thirst IO: Decreased effect: Methotrexate: Asparaginase terminates methotrexate action by inhibition of protein synthesis and prevention of cell entry into the S phase Increased toxicity: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vincristine and prednisone: An increase in toxicity has been noticed when asparaginase is administered with VCR and prednisone Cyclophosphamide (decreases metabolism) Mercaptopurine (increases hepatotoxicity) Vincristine (increases neuropathy) Prednisone (increases hyperglycemia) Preg: C Nama Dagang: Leunase



VII. SALURAN KEMIH A. ANTISEPTIK SALURAN KEMIH B. HIPERTROFI PROSTAT C. PREPARAT VAGINA D. BEKERJA PADA UTERUS E. INKONTINENSIA & FREKUEN F. DISFUNGSI EREKSI



A. Antiseptik saluran Kemih Pipemidic Acid Phenazopyridine



Pipemidic Acid I: ISK BSO: Kaps 400 mg D: 400 mg 2x/hr selama min 10 hari KI: Hipersensitif, bayi P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Phenazopyridine I: to relieve the pain, burning, and discomfort caused by infection or irritation of the urinary tract. It is not an antibiotic and will not cure the infection itself. BSO: Tab: 100 mg, 200 mg D: 200 mg 3x/hari. Children= 4 mg/kg 3x/hari. KI: Hypersensitivity; kidney or liver disease P: Does not treat infection, acts only as an analgesic; drug should be discontinued if skin or sclera develop a yellow color; use with caution in patients with renal impairment. Use of this agent in the elderly is limited since accumulation of phenazopyridine can occur in patients with renal insufficiency. It should not be used in patients with a Clcr <50 mL/minute. ES: 1-10%: Headache, dizziness, Stomach cramps IO: Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


B. Hipertrofi Prostat Doxazosin Terazosin Finasteride Dutasteride Alfuzosin



Tamsulosin I: Benign prostatic hyperplasia. BSO: Kaps 0.2 mg D: Adults= 0.4 mg ax/hari KI: postural hypotension, Severely decreased liver function. P: Severely decreased kidney function. ES: Dizziness, Headache, asthenia, Abnormal ejaculation, postural hypotension, syncope, palpitations, diarrhoea, constipation, nausea or vomiting, rhinitis, Drowsiness, Blurred vision, Dry mouth, oedema, Persistent painful erection of the penis (priapism) IO: Preg: B Nama Dagang: Harnal



Finasteride Blocks conversion of testosterone to its more active metabolite, dihydrotestosterone. More effective when used in combination with OCPs. I: Enlarged prostate gland (benign prostatic hyperplasia). BSO: Tablet, film coated: 1 mg, 5 mg D: BPH: Adults= 5 mg 1x/hari. Hair growth: Adults—1 mg 1x/hari. KI: Hipersensitif; lactation; childhood IO: ES: Impotence, Allergy to active ingredients (hypersensitivity), Rash (allergic reaction), Breast tenderness/swelling, Ejaculation disorders, Decreased sex drive. Preg: X P: Minimum of 6 mo treatment necessary to determine response; caution in liver function abnormalities; monitor patients with severely diminished urinary flow for obstructive uropathy (may not be candidates for this therapy) Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dutasteride I: Enlarged prostate gland (benign prostatic hyperplasia) BSO: Kaps 0.5 mg D: Benign prostatic hyperplasia (BPH): 0.5 mg 1x/hari. KI: # Women # Children or adolescents under 18 years of age # Allergy to other 5-alpha reductase inhibitors, eg finasteride # Severely decreased liver function P: Mild to moderately decreased liver function ES: Impotence, Decreased sex drive # Ejaculation disorders, such as decreased amount of semen produced or decreased sperm count # Breast enlargement or tenderness # Allergic reactions such as rash, itching or localised swelling IO: Preg: X Nama Dagang: Avodart Genghis Khun ([email protected],nafanakhun.wordpress.com)


Alfuzosin I: Benign prostatic hyperplasia in men > 65 years of age. This medicine is taken for 2-3 days while a catheter is in place and for one day after the catheter has been removed. BSO: Tab 10 mg D: Adults—10 mg 1x/hari KI: People taking other alpha-blocker medicines, Decreased liver function, postural hypotension, micturition syncope. P: Elderly people, Decreased kidney function, Allergy to alphablocker medicines, Coronary artery disease or angina pectoris. # People taking blood pressure lowering medication. ES: Feeling faint, Dizziness, Headache, Nausea, Abdominal pain, asthenia, malaise, vertigo, Drowsiness, Dry mouth, Diarrhoea, postural hypotension, syncope, tachycardia, palpitations, Chest pain, Flushing, oedema, Rash or itching. IO: Preg: B Nama Dagang: Xatral Genghis Khun ([email protected],nafanakhun.wordpress.com)


C. Preparat Vagina Povidone Iodine Clotrimazole Tinidazole Metronidazole Nystatin Estriol



Povidone Iodine I: External antiseptic with broad microbicidal spectrum against bacteria, fungi, viruses, protozoa, and yeasts BSO: Aerosol, Lubricating gel, Cream & Ophthalmic sterile prep: 5% Antiseptic gauze pads, Douche, Foam, Vaginal & Ointment, topical, vaginal(Topical & Suppositories): 10% Scrub, surgical, Shampoo, Cleanser Skin & Skin foam: 7.5% Mouthwash (0.5%) Swab aid & Perineal wash concentrate: 1% Swabsticks: 4" D: Shampoo: Apply 2 Cth, 2x/week, then shampoo weekly. Topical: Apply as needed KI: Hypersensitivity, pre-pubertal children, taking lithium, Thyroid disorders (do not use regularly) ES: Irritation in area of use, Interference with thyroid function. Preg: D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


D. Bekerja Pada Uterus Oxytocin Methylergometrine/ Methylergonovine Isoxsuprine Ritodrine Dinoprostone



Oxytocin -- Nine–amino acid peptide produced in hypothalamus and secreted by posterior pituitary in pulsatile fashion. Uterine receptors for oxytocin increase during the weeks before onset of labor, with sharpest increase just before labor. I: Inducing) labour, Stimulating labour when the contractions are considered too weak, post-partum haemorrhage, During caesarian section, Management of certain types of miscarriage BSO: Injection: 10 U/mL Solution, nasal: 40 U/mL D: Injection: Start or continue labor: 0.5-2 miu/ menit IV pelan. Titrasi dosis tiap 15-60 menit. Incomplete abortion, causing abortion, or controlling bleeding after an abortion: 10 U IV pelan. Control bleeding after delivery: 10 U IV pelan/ IM KI: Hipersensitif; unfavorable fetal position and a contracting uterus with hypertonic or hyperactive patterns; nonreassuring fetal status and remote from delivery; labor in which vaginal delivery should be avoided (eg, invasive cervical carcinoma, Genghis Khun ([email protected],nafanakhun.wordpress.com)


cord presentation or prolapse, active herpes genitalis, total placenta previa, vasa previa) IO: Pressor effect of sympathomimetics may increase when used concomitantly, causing postpartum hypertension ES: Nausea and vomiting, Spasms of the uterus, Bleeding, arrhythmias, Skin rashes, Fall in blood pressure (causing dizziness, lightheadedness, feeling faint), Difficulty in breathing, Shock, High doses may cause very strong contractions of the womb, resulting in tearing of the womb, tissue damage or distress to the baby, Water intoxication and hiponatremia. Preg: X P: An overstimulated uterus can be hazardous to mother and fetus; hypertonic contractions can occur in patients with uteruses hypersensitive to oxytocin, regardless of whether administered appropriately; has intrinsic antidiuretic effect that can cause water intoxication when administered by continuous infusion and patient is receiving fluids PO Genghis Khun ([email protected],nafanakhun.wordpress.com)


Methylergometrine/ Methylergonovine I: Prevention and treatment of postpartum and postabortion hemorrhage caused by uterine atony or subinvolution BSO: Injection: 0.2 mg/mL, Tablet: 0.2 mg D: Dosis KI: Induction of labor, threatened spontaneous abortion, hypertension, toxemia, hypersensitivity to methylergonovine or any component, pregnancy P: Use caution in patients with sepsis, obliterative vascular disease, hepatic, or renal involvement, hypertension; administer with extreme caution if using I.V. ES: >10%: Cardiovascular: Hypertension 1% to 10%: Gastrointestinal: Nausea, vomiting IO: Augmented effects may occur with concurrent use of methylergonovine and vasoconstrictors or ergot alkaloids Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ritodrine I: The management of pre-term labour BSO: Infusion, in D5W: 0.3 mL. Amp: 10 mg/mL. Tab 10 mg D: Extended-release capsules: 1st 40 mg/8 hours until 37th week of pregnancy. Tablets: 10 mg/2 hours after stops IV ritodrine. After that, 10- 20 mg/ 4-6 hours. until your 37th week of pregnancy. For injection: 50-350 mcg/ minute IV KI: Antepartum haemorrhage, Chorioamnionitis, Cord compression, IUFD, Maternal cardiac disease, eclampsia P: pulmonary oedema, hypertension, Hyperthyroidism, Mildmoderate pre-eclampsia ES: Antepartum haemorrhage, Chorioamnionitis, Cord compression, Intra uterine foetal death, Maternal cardiac disease, eclampsia, tremor, Sweating, pulmonary oedema, palpitations, Nausea and vomiting, Flushing, Inflammation of parotid glands, tachycardia, Wheezing Preg: B Nama Dagang: Yutopar Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dinoprostone I: Starting (inducing) labour (childbirth) BSO: Insert, vaginal: 10 mg Gel, endocervical: 0.5 mg in 3 g syringes Suppository, vaginal: 20 mg D: To thin and widen the opening of the cervix just before labor: * Cervical Gel: 0.5 mg into the canal of cervix. * Vaginal gel: 1 mg into vagina. 1-2 mg 6hours after first dose. * Supp: 20 mg into vagina q3-5 hours as needed. * System: 10 mg into vagina. KI: Current heart, lung, liver or kidney disease, labour has already started, history of major surgery on the uterus & cervix. had more than three full term pregnancies, pelvic inflammatory disease, IUFD, there may be a problem in delivery, placenta praevia, unexplained vaginal bleeding P: more than one baby, KPD, abnormally strong contractions of the womb in a previous pregnancy, History of asthma & glaucoma, hypertension, Gestational diabetes, hypothyroidism, Women > 35 years, over 40 weeks pregnant Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Nausea and vomiting, Diarrhoea, Abnormally strong contractions of the womb, Problems with the baby's heart rate, Foetal distress, Tearing of the womb wall if the contractions are very strong or prolonged, disseminated intravascular coagulation – DIC, Vaginal swelling (oedema) IO: Increased effect of oxytocics Preg: C Nama Dagang: Prostin E2



E. Inkontinensia & Frekuen Flavoxate Tolterodine



Flavoxate I: Incontinence, nocturia, Pain in the bladder/above the pubic bone, dysuria, urinary frequency, Spasms of the bladder or urethra due to catheters, cystoscopy or urinary tract surgery, urinary urgency BSO: Tablet, film coated: 100 mg D: Adults and > 12 years= 100-200 mg 3-4x/hr. KI: Bleeding from the stomach or intestines, intestinal obstruction, achalasia, ileus, Obstruction of the urinary tract P: Elderly people, Glaucoma ES: Headache, tachycardia, Diarrhoea, Drowsiness, Confusion, vertigo, palpitations, Nausea and vomiting, dysuria, Nervousness, urticaria, hyperpyrexia, Blurred vision, Dry mouth IO: Preg: B Nama Dagang: Uroxal Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tolterodine I: Urinary frequency, urinary urgency, urinary incontinence BSO: Tab salut selaput 2 mg D: 2 mg 2x/hari. Extended-release capsules: 4 mg 1x/hr. KI: Urinary retention, Closed angle glaucoma, myasthenia gravis, ulcerative colitis, toxic megacolon, Pregnancy, Breastfeeding, glucose-galactose malabsorption P: Elderly people, Decreased liver & kidney function, Obstruction of the outflow of urine from the bladder, autonomic neuropathy, Hiatus hernia, 'prolonged QT interval', Heart diseases, bradycardia, hypokalaemia, hypomagnesaemia, hypocalcaemia ES: Dry mouth, Dryness of the skin and eyes, dyspepsia, Constipation, Vomiting, Blurred vision, Nervousness, somnolence, paraesthesia, Fatigue, Headache, urinary retention, peripheral oedema, tachycardia, Hallucinations, arrhythmias Preg: C Nama Dagang: Detrusitol Genghis Khun ([email protected],nafanakhun.wordpress.com)


F. Disfungsi Ereksi Sildenafil Vardenafil Tadalafil



Sildenafil I: Impotence (erectile dysfunction) BSO: Tablet: 25 mg, 50 mg, 100 mg D: Erectile dysfunction: Adults-< 65 = 50 mg single dose, 1 h before coitus. Alternatively 30'-4 hours before coitus. daily dose 25-100 mg. Adults > 65 = 25 mg If taking protease inhibitors, such as for the treatment of HIV: 25 mg dose, max single dose of 25 mg of Viagra in a 48 hour period. Pulmonary arterial hypertension: 20 mg 3x/hari. KI: Women, Children < 18 years of age, severe heart disorders, hypotension, taking any form of nitrate medications, eg glyceryl trinitrate, Severely decreased liver function, Hereditary degeneration of the back of the eyeball (retina), such as retinitis pigmentosa, Rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption. Genghis Khun ([email protected],nafanakhun.wordpress.com)


# This medicine is not recommended for people who have ever experienced an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). This condition causes a sudden, partial decrease or loss of vision in one or both eyes due to damage to the optic nerve. It can be temporary or permanent. P: Elderly people, Decreased liver & kidney function, cardiovascular disease, aortic stenosis, Bleeding disorders, eg haemophilia, Active peptic ulcer, Physical abnormality of the penis, such as severe curvature, scarring or Peyronie's disease ES: Headache, Flushing, Dizziness, Visual disturbances, Nasal congestion, palpitations, Indigestion, Eye pain, Red eyes, arrhythmias, hypotension, hypertension, Fainting, Nosebleeds, Rash, Persistent painful erection of the penis (priapism), angina pectoris, cerebrovascular haemorrhage, transient ischaemic attack Preg: B Nama Dagang: Viagra Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vardenafil I: Impotence (erectile dysfunction) BSO: Tab 5 mg. 10 mg. 20 mg D: Erectile dysfunction: < 65 years: 10 mg as a single dose. 1 hour before coitus. > 65 years: 5 mg. KI: Women, Children < 18 years, heart disorders, unstable angina, history of stroke & stroke, hypotension, Hereditary degeneration of retina, such as retinitis pigmentosa, Severe kidney & liver failure, taking any form of nitrate medications, eg glyceryl trinitrate, taking protease inhibitors to treat HIV infection, eg ritonavir, indinavir. # This medicine is not recommended for people who have ever experienced an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). This condition causes a sudden, partial decrease or loss of vision in one or both eyes due to damage to the optic nerve. It can be temporary or permanent. Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Elderly men, cardiovascular disease, aortic stenosis, 'prolonged QT interval', hypokalaemia, Bleeding disorders, eg haemophilia, Active peptic ulcer, Physical abnormality of the penis, such as severe curvature, scarring or Peyronie's disease Conditions such as sickle cell disease, bone cancer or leukaemia in which there is an increased risk of prolonged erections (priapism), Decreased kidney & liver function ES: Headache, Flushing, Dizziness, rhinitis, dyspepsia, Nausea, Visual disturbances, such as blurred vision, blue/green tinge to vision, watery eyes, Sleepiness, Increased heart rate, palpitations, hypertension, hypotension, syncope, Shortness of breath, Nosebleeds, photosensitivity, Pain or increased tension in the muscles, Prolonged or painful erections, Anxiety. IO: Preg: B Nama Dagang: Levitra



Tadalafil I: Impotence (erectile dysfunction) BSO: Tab salut selaput 10 mg D: Erectile dysfunction: 10 mg single dose, 30 minutes before coitus. Erectile dysfunction (daily use): 2.5 mg 1x/day, without coitus. KI: Women, Children < 18 years, heart disorders, heart attack or stroke in the last three months, arrhythmias, hypertension, hypotension, glucose-galactose malabsorption, taking any form of nitrate medications, eg glyceryl trinitrate. # This medicine is not recommended for people who have ever experienced an eye condition called non-arteritic anterior ischemic optic neuropathy (NAION). This condition causes a sudden, partial decrease or loss of vision in one or both eyes due to damage to the optic nerve. It can be temporary or permanent. P: Decreased liver & kidney function, cardiovascular disease, Conditions such as sickle cell disease, bone cancer or leukaemia in which there is an increased risk of prolonged Genghis Khun ([email protected],nafanakhun.wordpress.com)


erections (priapism), Physical abnormality of the penis, such as severe curvature, scarring or Peyronie's disease ES: Headache, dyspepsia, Dizziness, Flushing, Nasal congestion, Back pain, myalgia, Eye pain, hyperaemia, Swelling of the eyelids, Visual disturbances, hypertension, hypotension, syncope, Chest pain, palpitations, tachycardia, Sweating, Prolonged or painful erections IO: Preg: B Nama Dagang: 1. Cialis



VIII. METABOLIK A. INSULIN B. ORAL DIABETIK AGENT C. ANTI HIPERLIPIDEMIA D. PREPARAT TIROID E. ANTI TIROID F. ANTI OSTEOPOROSIS & METABOLISME TULANG



A. Insulin Insulin



Insulin Stimulates cellular uptake of potassium within 20-30 min. Administer glucose along with insulin to prevent hypoglycemia. Monitor blood sugar levels frequently. I: IDDM BSO: Vial 40 mg/cc, 100 mg/cc Penfill 100 U/mL D: Inj SC 15-30 menit sblm makan &atau sblm tidur. 10 U IV and either 50 mL D50W bolus or 500 mL D10W >1 h Paed. 0.5-1 g/kg IV followed by 1 U of regular insulin per 3 g glucose KI: Hipersensitif; hypoglycemia ES: hypoglycaemia, Cough, Shortness of breath, Throat irritation, Dry throat, Nosebleeds, pharyngitis, Wheezing, bronchospasm, Alteration in your voice, Pain at the back of the throat, Dry mouth, Tonsil disorder, Chest pain, Allergy. IO: Medications that may decrease hypoglycemic effects of insulin include acetazolamide, AIDS antivirals, asparaginase, Genghis Khun ([email protected],nafanakhun.wordpress.com)


phenytoin, nicotine isoniazid, diltiazem, diuretics, corticosteroids, thiazide diuretics, thyroid estrogens, ethacrynic acid, calcitonin, oral contraceptives, diazoxide, dobutamine, phenothiazines, cyclophosphamide, dextrothyroxine, lithium carbonate, epinephrine, morphine sulfate, and niacin; medications that may increase hypoglycemic effects of insulin include calcium, ACE inhibitors, alcohol, tetracyclines, betablockers, lithium carbonate, anabolic steroids, pyridoxine, salicylates, MAOIs, mebendazole, sulfonamides, phenylbutazone, chloroquine, clofibrate, fenfluramine, guanethidine, octreotide, pentamidine, and sulfinpyrazone Preg: B P: Hyperthyroidism may increase renal clearance of insulin and may need more insulin to treat hyperkalemia; hypothyroidism may delay insulin turnover, requiring less insulin to treat hyperkalemia; monitor glucose carefully; dose adjustments of insulin may be necessary in patients diagnosed with renal and hepatic dysfunction Nama Dagang: Lantus Genghis Khun ([email protected],nafanakhun.wordpress.com)


B. Oral Diabetik agent Glibenclamide Metformin Gliclazide Glipizide Glimepiride Chlorpropamide Nateglinide Acarbose Rosiglitazone Gliquidone Pioglitazone



Glibenclamide I: Type 2 (non-insulin dependent) diabetes, when diet has failed to fully control blood sugar BSO: Tab 2.5 mg. 5 mg D: 2.5-5 mg 1x/hari pagi sebelum makan KI: IDDM, Diabetic keto-acidosis, coma or precoma, Severely decreased liver & kidney function, Severe problems with the production of natural steroid hormones by the adrenal glands # Pregnancy, Breastfeeding, porphyrias P: Elderly people, Decreased kliver & idney function ES: Diarrhoea, constipation, nausea, vomiting or abdominal pain, hypoglycaemia, Temporary visual disturbances at start of treatment, Weight gain, Allergic skin rashes, Disturbance in liver function, hepatitis, Cholestatic jaundice, Disturbances in the normal numbers of blood cells in the blood Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Metformin Reduces hepatic glucose output, decreases intestinal absorption of glucose, and increases glucose uptake in the peripheral tissues (muscle and adipocytes). Major drug used in obese patients who have type 2 DM. I: NIDDM, Polycystic ovary syndrome (unlicensed use). BSO: Tablet: 500 mg, 625 mg, 750 mg, 850 mg, 1000 mg D: Tab: Metformin alone: Dws: 500 mg 2-3x/hari,or 850 mg 1x pagi d.c . Increase per week, max 2550 mg/hari. Metformin with insulin: 500 mg/hari, increase 500 mg/mgg Anak max 2 g/hari. Extended-release tab: Dws: Metformin alone: 500 mg 1x/hari sore, max 2 g/hr. Metformin with insulin: 500 mg/hari, increase 500 mg/mgg KI: Hipersensitif; acute myocardial infarction; septicemia; renal disease



IO: Diuretics, thyroid products, PO contraceptives, phenytoin, calcium channel–blocking drugs; phenothiazines may decrease effects; cimetidine may increase levels Preg: B P: Caution in renal insufficiency; discontinue therapy before performing any surgical procedures; impaired liver function Nama Dagang:



Gliclazide I: NIDDM BSO: Tab 30 mg D: 30-120 mg dosis tunggal KI: Children < 12 years, Allergy, IDDM, Diabetic ketoacidosis, Coma or pre-coma, Severely decreased liver & kidney function, porphyrias, Pregnancy, Breastfeeding. P: Elderly people, Decreased liver & kidney function, hypothyroidism, pituitary insufficiency, adrenal insufficiency, Malnutrition, Severe vascular disease (coronary heart dis). ES: Diarrhoea, constipation, indigestion, nausea, vomiting or abdominal pain, Temporary visual disturbances at start of treatment, hypoglycaemia, Skin reactions, Disturbances in the normal levels of blood cells in the blood, jaundice, hepatitis IO: Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Glipizide I: Diabetes BSO: Tablet: 5 mg, 10 mg Tablet, extended release: 5 mg, 10 mg D: 1st line: Dws: glipizide 2.5 mg (+ Metformin 250 mg) 1x/hr . 2nd line: glipizide 2.5 mg (+ Metformin 500 mg) 2x/hr KI: Life long inherited blood diseases which can cause a variety of symptoms, including mental health problems (porphyrias) P: Elderly people, Kidney & liver disease ES: Drowsiness, Diarrhoea, constipation, nausea, vomiting or abdominal pain, hypoglycaemia, Dizziness, Weight gain, Skin rashes IO: Preg: C Nama Dagang:



Glimepiride I: NIDDM BSO: Tablet: 1 mg, 2 mg, 4 mg D: Dws Rosiglitazone 4 mg (glimepiride 1 mg), or Rosiglitazone 4 mg (glimepiride 2 mg) 1x/hari. KI: IDDM, Diabetic keto-acidosis, coma or precoma, Severely decreased liver & kidney function, porphyrias, Pregnancy, Breastfeeding, Allergy. P: Elderly people, Decreased kidney & liver function, Problems with the adrenal glands production ES: Diarrhoea, constipation, nausea, vomiting or abdominal pain, Temporary visual disturbances at start of treatment, Weight gain, hypoglycaemia, Allergic, Disturbance in liver function, hepatitis, Cholestatic jaundice O: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Chlorpropamide Sulfonylurea I: NIDDM BSO: Tablet: 100 mg, 250 mg D: Adults: 250 mg/day in, 100-125 mg/day in older patients Increased/ decreased by 50-125 mg/day at 3- to 5-day intervals Maintenance dose: 100-250 mg/day; avoid doses >750 mg/day At higher dosages, sulfonylureas may block the ATP-sensitive potassium channels, which may correspond to an increased risk of cardiovascular events. In May, 2000, the National Diabetes Center issued a warning to avoid the use of sulfonylureas at higher dosages (chlorpropamide daily doses >100 mg). KI: Porphyrias P: Elderly people, Liver & Kidney disease, hypoglycaemia ES: Allergic, hypoglycaemia, facial flushing, Weight gain, Headache, Increased sensitivity to sunlight, Blood disorders, Skin rashes, Diarrhoea, constipation, nausea, vomiting or abdominal pain Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Decreased effect: Thiazides and hydantoins (eg, phenytoin) decrease chlorpropamide effectiveness may increase blood glucose Increased toxicity: Increases alcohol-associated disulfiram reactions Increases oral anticoagulant effects Salicylates may increase chlorpropamide effects may decrease blood glucose Sulfonamides may decrease sulfonylureas clearance Preg: C Nama Dagang:



Nateglinide I: Additional treatment of type 2 diabetes that is poorly controlled by metformin alone BSO: Tab salut selaput 120 mg D: Dws: 60-120 mg 3x/hari KI: Breastfeeding, Diabetic keto-acidosis, Pregnancy, Severely decreased liver function, Type 1 (insulin dependent) diabetes P: Elderly people, pituitary insufficiency, adrenal insufficiency, Malnutrition, Moderate to severely decreased kidney function, Moderately decreased liver function, Weak or debilitated people ES: Headache, Abdominal pain, Diarrhoea, Hypoglycaemia, Indigestion (dyspepsia), Alteration in results of liver function tests, Allergic skin reactions IO: Preg: C Nama Dagang: Starlix Genghis Khun ([email protected],nafanakhun.wordpress.com)


Acarbose I: NIDDM BSO: Tablet: 50 mg, 100 mg. D: Dws: 25 mg 3x/hari. KI: Breastfeeding, Children < 12 years P: Increased gas formation in the gut, Decreased liver function, Inflammatory bowel disease such as ulcerative colitis or Crohn's disease, decreased kidney function, partial intestinal obstruction, Pregnancy, Ulceration of the colon ES: Abdominal distension, hepatitis, borborygmi, flatulence, Rash, Abdominal pain, Diarrhoea, Alteration in results of liver function tests IO: Preg: B Nama Dagang: Glucobay 50/ Glucobay 100



Rosiglitazone I: NIDDM BSO: Tablet: 2 mg, 4 mg, 8 mg D: Dws: 4 mg 1x/hari, or 2 mg 2x/hr. increase setelah 2-3 bln, 8 mg 1x/hari atau 4 mg 2x/hari. KI: Heart failure, Decreased liver function, Diabetic ketoacidosis & pre-coma, Pregnancy, Breastfeeding, glucose-galactose malabsorption, children < 18 years of age. P: Elderly people, Decreased kidney function, Heart disease, low haemoglobin levels, macular oedema. ES: Hypoglycaemia, oedema, Constipation, anaemia, hyperlipidaemia, Weight gain, Increased appetite, Headache, Fatigue, Dizziness, Pain in the muscles, paraesthesia, dyspnoea, Heart failure, thrombocytopenia, Abnormal liver function, pulmonary oedema, macular oedema. IO: Substrate for cytochrome P-450 isoenzyme 2C8 (CYP2C8); minor metabolism by CYP2C9 Preg: C Nama Dagang: Avandia Genghis Khun ([email protected],nafanakhun.wordpress.com)


Gliquidone I: NIDDM BSO: Tab 30 mg D: Awal 15 mg 1x/hr pagi sebelum makan pagi. Titrasi sampai 45-60 mg/hari 2-3x/hr. Maks dosis tunggal 60 mg. Maks dosis harian 120 mg, KI: Porphyrias P: Elderly people, Liver disease ES: Headache, diarrhoea, constipation, nausea, vomiting or abdominal pain, hypoglycaemia, Weight gain, Blood disorders, Skin rashes IO: Preg:: A, B, C, D, X Nama Dagang:



Pioglitazone I: NIDDM BSO: Tablet: 15 mg, 30 mg, 45 mg D: 15-30 mg 1x/hari. KI: Heart failure, Diabetic ketoacidosis, Decreased liver function # People having kidney dialysis, Pregnancy, Breastfeeding, glucose-galactose malabsorption, children < 18 years of age. P: People > 75 years of age, Heart disease, low haemoglobin levels, macular oedema. ES: Visual disturbances, Weight gain, Decreased sense of touch, Upper airway infections, anaemia, arthralgia, Headache, oedema, haematuria, Impotence, Dizziness, flatulence, insomnia, hypoglycaemia (particularly if taken in combination with a sulphonylurea medicine, eg gliclazide, or insulin), glycosuria, proteinuria, Sweating IO: Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


C. Anti Hiperlipidemia Simvastatin Pravastatin Fluvastatin Lovastatin Atorvastatin Rosuvastatin Colestyramine Fenofibrate Gemfibrozil Ciprofibrate Tocopheryl nicotinate Ezetimibe



HMG-CoA reductase inhibitors: Simvastatin Inhibits cholesterol synthesis and increases cholesterol metabolism. I: Hypercholesterolaemia, High levels of triglycerides and lipoproteins. BSO: Tablet: 5 mg, 10 mg, 20 mg, 40 mg, 80 mg D: Dws: 20-40 mg 1x/hari. Anak 10-17 thn: 10 mg 1x/hari, max 40 mg/hari KI: Hipersensitif; active liver disease; unexplained elevation of liver enzymes; Preg:; breastfeeding IO: Mibefradil, cyclosporine, itraconazole, ketoconazole, gemfibrozil, niacin, erythromycin, clarithromycin, and nefazodone increase toxicity; coadministration with warfarin may increase PT; rifampin and nicotinic acid may decrease effects; coadministration with either niacin or erythromycin has been associated with rhabdomyolysis Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: abdominal pain, constipation, flatulence, feeling of weakness, headache, dizziness, paraesthesia, indigestion, nausea and vomiting, diarrhoea, anaemia, liver disorders, rash or itching, hair loss, muscle disorders, depression, sleep disturbances, memory loss, sexual problems. Preg: X P: May elevate creatine kinase and transaminase levels; discontinue therapy if symptoms of myopathy or renal failure develop; caution in patients with a history of liver disease and in those who consume excessive amounts of alcohol Nama Dagang:



Pravastatin I: Hypercholesterolaemia, High levels of triglycerides and lipoproteins. BSO: Tablet: 10 mg, 20 mg, 40 mg D: Dws: 40 mg 1x/hari. Anak 8-13 thn: 20 mg 1x/hari. KI: Hipersensitif; active liver disease; unexplained elevations in liver function tests; Preg:; breast-feeding IO: Immunosuppressive agents, gemfibrozil, clofibrate, cholestyramine, niacin, and erythromycin increase toxicity; may increase the PT when coadministered with warfarin; coadministration with either niacin or erythromycin has been associated with rhabdomyolysis ES: Dizziness, Headache, Visual disturbances, indigestion, nausea and vomiting, diarrhoea, constipation, abdominal pain, flatulence, Skin reactions such as rash and itch, Increased urination, Fatigue, myalgia or arthralgia, Muscle weakness & Genghis Khun ([email protected],nafanakhun.wordpress.com)


cramps, Alteration in results of liver function tests, paraesthesia, Liver disorders, rhabdomyolysis, Depression, insomniac, Memory loss, Sexual problems. Preg: X P: May elevate creatine kinase and transaminase levels; caution in liver disease and ethanol abuse Nama Dagang:



Fluvastatin I: Hypercholesterolaemia, High levels of triglycerides and lipoproteins. BSO: Capsule: 20 mg, 40 mg D: Dws: Tab: 20-40 mg 1x sore hari. Extended-release tab: 80 mg 1x/hari KI: Hipersensitif; active liver disease; unexplained elevations in liver function tests; Preg:; breastfeeding IO: Toxicity increases when coadministered with triazole antifungals, CNS depressants, macrolide antibiotics, mibefradil, immunosuppressive agents, gemfibrozil, and niacin; coadministration with warfarin may increase PT; rifampin, nicotinic acid, bile acid sequestrants, and propranolol may decrease effects Preg: X P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May elevate creatine kinase and transaminase levels; photosensitivity may occur with prolonged exposure to sunlight or tanning equipment Nama Dagang: Lescol/ Lescol XL



Lovastatin I: Adjunct to dietary therapy to decrease elevated serum total and LDL cholesterol concentrations in primary hypercholesterolemia; primary prevention of coronary artery disease (patients without symptomatic disease with average to moderately elevated total and LDL cholesterol and below average HDL cholesterol) BSO: Tablet: 10 mg, 20 mg, 40 mg D: Tab: Dws: 20 mg 1x/hari sore hari , increase dose q4wk, max 80 mg/hari. Anak: setengah dosis dewasa. Extended-release tab: max 60 mg/hr. KI: Hipersensitif; active liver disease; unexplained elevations in liver function tests; Preg:; breastfeeding IO: Mibefradil, cyclosporine, itraconazole, ketoconazole, gemfibrozil, niacin, erythromycin, clarithromycin, and nefazodone increase toxicity; coadministration with warfarin Genghis Khun ([email protected],nafanakhun.wordpress.com)


may increase PT; increases effects of levothyroxine; rifampin, nicotinic acid, bile acid sequestrants, and propranolol may decrease effects Preg: X P: May elevate creatine kinase and transaminase levels; discontinue therapy if symptoms of myopathy or renal failure develop; caution in patients with a history of liver disease and in those who consume excessive amounts of alcohol Nama Dagang:



Atorvastatin I: Hypercholesterolaemia, High levels of triglycerides and lipoproteins. Reducing the risk of cardiovascular events. BSO: Tablet: 10 mg, 20 mg, 40 mg D: 10-20 mg 1x/hari, titrate to max 80 mg/hari KI: Hipersensitif; significant hepatic impairment; Preg:; breastfeeding IO: Toxicity increases when coadministered with triazole antifungals, CNS depressants, macrolide antibiotics, mibefradil, cyclosporine, fibric acid derivatives, and niacin; increases toxicity of levothyroxine; coadministration with warfarin may increase the PT ES: Headache, insomnia, diarrhoea, constipation, nausea, vomiting or abdominal pain, flatulence, Muscle pain, .Feeling of weakness, Dizziness, angina, Back pain, joint pain, alopecia, Loss of appetite, Muscle cramps, Skin reactions, thrombocytopenia, Weight gain, Memory loss, Depression, Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sexual problems, Liver disorders, .Muscle disorders, Changes in blood sugar levels. Preg: X P: May elevate creatine kinase and transaminase levels; caution in patients receiving drugs that prolong QRS or QT interval; discontinue therapy if symptoms of myopathy or renal failure develop; caution in patients with a history of liver disease and in those who consume excessive amounts of alcohol Nama Dagang: Lipitor



Rosuvastatin HMG-CoA reductase inhibitor that in turn decreases cholesterol synthesis and increases cholesterol metabolism. Reduces totalC, LDL-C, and TG levels and increases HDL-C level. Used adjunctively with diet and exercise to treat hypercholesterolemia. I: Primary, familial & mixed hyperlipidaemia BSO: Tab salut selaput 10 mg. 20 mg D: 5-10 mg PO qd initially; may increase dose if needed, max 40 mg/d; for marked hypercholesterolemia (ie, LDL-C >190 mg/ dL), initiate with 20 mg/d PO KI: Hipersensitif; active liver disease; unexplained serum transaminase elevation IO: Cyclosporine or gemfibrozil significantly increase Cmax and AUC, thereby increasing myopathy and rhabdomyolysis risk; limit dose to 5 mg/d when coadministered with cyclosporine and 10 mg/d when coadministered with gemfibrozil; coadministration Genghis Khun ([email protected],nafanakhun.wordpress.com)


with aluminum and magnesium hydroxide antacids decreases plasma concentrations (administer antacids 2 h after rosuvastatin); may increase oral contraceptive plasma concentrations; alcohol may increase hepatotoxic risk ES: Headache, Dizziness, Abdominal pain, Constipation, Nausea, myalgia, asthenia, Skin reactions, myopathy, rhabdomyolysis, arthralgia, Alteration in results of liver function tests, proteinuria, hepatitis, Depression, Sleep disturbances, Memory loss, Sexual problems. Preg: X P: Common adverse effects include muscle aches, stomach pain, constipation, nausea, and weakness; may cause myopathy, rhabdomyolysis, and kidney failure; monitor LFTs (ie, baseline, 12 wk after drug initiation and any dose elevation, and semiannually), discontinue if elevation persists; decrease dose with CrCl <30 mL/min; doses 40 mg or greater associated with hematuria and proteinuria Nama Dagang: Crestor Genghis Khun ([email protected],nafanakhun.wordpress.com)


Colestyramine I: Adjunct in the management of primary hypercholesterolemia; pruritus associated with elevated levels of bile acids; diarrhea associated with excess fecal bile acids; binding toxicologic agents; pseudomembraneous colitis BSO: Bubuk 4 g D: High cholesterol or pruritus (itching) related to biliary obstruction: 4 g 1-2x/hari , increase to 8-24 g 2-6x/hari Paed. Not established; suggested dosing is 240 mg/kg/d PO divided bid/tid; max 8 g/d KI: Hipersensitif; biliary obstruction IO: Inhibits absorption of many drugs, including warfarin, thyroid hormone, amiodarone, NSAIDs, methotrexate, digitalis glycosides, glipizide, phenytoin, imipramine, niacin, methyldopa, tetracyclines, clofibrate, hydrocortisone, and penicillin G ES: >10%: Constipation, heartburn, nausea, vomiting 1% to 10%: Headache, Belching, bloating, diarrhea Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preg: C P: Patients may require fat-soluble vitamins and folic acid replacement with long-term therapy; caution in constipation and phenylketonuria; administer 1-2 h before or 4-6 h after bile acid sequestrant Nama Dagang: Questran



Fibric acid derivatives Fenofibrate Adjunct to dietary therapy in treating hyperlipidemias associated with hypertriglyceridemia, including type IV and type V. Not proven to be of use in prevention of coronary artery disease. I: High levels of cholesterol and triglycerides in the blood (hyperlipidaemia). BSO: Capsule: 67 mg, 200 mg D: Hypertriglyceridemia 43 mg 1x/hari Hypercholesteremia: 130-200 mg 1x/hari. Tablets: Hypertriglyceridemia 48-160 mg 1x/hari Hypercholesteremia: 130-200 mg 1x/hari. KI: Hipersensitif; hepatic or renal dysfunction, including primary biliary cirrhosis; unexplained persistent liver function abnormalities; gallbladder disease; caution in hypothyroidism IO: May increase effects of warfarin; the benefits and risks of administration with immunosuppressants and other nephrotoxic Genghis Khun ([email protected],nafanakhun.wordpress.com)


drugs should be considered carefully and the lowest possible dose used; a theoretical risk of severe myositis, rhabdomyolysis, and renal failure exists if combined with the HMG-CoA reductase inhibitors, and close monitoring of serum creatine kinase is appropriate ES: Diarrhoea, flatulence, nausea, vomiting or abdominal pain, Headache, Fatigue, vertigo, Skin reactions, photosensitivity, pancreatitis, deep vein thrombosism, pulmonary embolism, alopecia, Sexual problems, Alteration in results of liver function tests, Gallstones, Muscle pain, inflammation, cramps or weakness, rhabdomyolysis, hepatitis. Preg: C P: May cause cholelithiasis or cholecystitis; associated with myositis and elevated creatine kinase levels, particularly when used with HMG-CoA reductase inhibitors; increased incidence of malignancy Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Gemfibrozil Adjunct to dietary therapy in adult patients with type IV and V hyperlipidemias presenting at risk for pancreatitis. Adjunctive therapy in coronary heart disease prevention in patients with type IIb hyperlipidemia (low HDL, elevated LDL and triglycerides) not responding to other agents or diet modifications. I: Hyperlipidaemia, Prevention of coronary heart disease. BSO: Capsule: 300 mg Tablet, film coated: 600 mg D: Adults: 600 mg 2x/hari KI: Hipersensitif; gallbladder disease; renal or hepatic insufficiencies IO: May potentiate effects of warfarin; closely monitor if coadministered with lovastatin Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Headache, Rash, pruritus, Blurred vision, flatulence, Impotence, diarrhoea, constipation, nausea, vomiting or abdominal pain, pancreatitis, photosensitivity, jaundice, angioedema, Dizziness, atrial fibrillation, rhabdomyolysis, myalgia, myasthenia Preg: B P: Discontinue if reduction in triglyceride levels is not observed after 3 mo of therapy; monitor for abnormal elevation of ALT, AST, LDH, bilirubin, and alkaline phosphatase serum levels; may increase cholesterol excretion into bile, leading to cholelithiasis; incidence of myositis is higher among patients with renal impairment; caution in diabetes and hypothyroidism Nama Dagang:



Ciprofibrate I: Primary dyslipoproteinaemias BSO: Kapl 100 mg D: Dws 100 mg/hr KI: Severely decreased kidney & liver function, Pregnancy, Breastfeeding, glucose-galactose malabsorption, children. P: Elderly people, Decreased liver & kidney function nephrotic syndrome, hypoalbuminaemia, hypothyroidism, alcoholism. ES: Headache, vertigo, Nausea and vomiting, Diarrhoea, dyspepsia, Abdominal pain, Alteration in results of liver function tests, Skin reactions, myalgia, myositis, alopecia, Dizziness, Drowsiness, Impotence, rhabdomyolysis IO: Preg: A, B, C, D, X Nama Dagang: Modalim Genghis Khun ([email protected],nafanakhun.wordpress.com)


Ezetimibe I: Primary, familial hypercholesterolaemia # A rare inherited disease with raised levels of plant sterols similar to cholesterol in the blood (homozygous sitosterolaemia or phytosterolaemia) BSO: Tab 10 mg D: High cholesterol: Adults & >10 tahun: 10 mg 1x/hr. KI: Active liver disease & unexplained raised results in liver function tests, Pregnancy (if taken with a statin) # Breastfeeding, glucose-galactose malabsorption P: ES: Headache, Abdominal pain, Diarrhoea, Constipation, flatulence, Nausea, Fatigue, Allergic skin rash, Liver disorders, myalgia or arthralgia, myopathy or rhabdomyolysis, pancreatitis IO: Preg: C Nama Dagang: Ezetrol Genghis Khun ([email protected],nafanakhun.wordpress.com)


D. Preparat Tiroid Levothyroxine



Levothyroxine I: Hypothyroidism. BSO: Powder for injection, lyophilized: 200 mcg/vial; 500 mcg/vial Tablet: 25 mcg, 50 mcg, 75 mcg, 88 mcg, 100 mcg, 112 mcg, 125 mcg, 150 mcg, 175 mcg, 200 mcg, 300 mcg D: Children: Congenital hypothyroidism: Oral: 0-6 months: 8-10 mcg/kg/day or 25-50 mcg/day 6-12 months: 6-8 mcg/kg/day or 50-75 mcg/day 1-5 years: 5-6 mcg/kg/day or 75-100 mcg/day 6-12 years: 4-5 mcg/kg/day or 100-150 mcg/day >12 years: 2-3 mcg/kg/day or greater than or equal to 150 mcg/ day I.M., I.V.: 50% to 75% of the oral dose Adults: Oral: Initial: 0.05 mg/day, then increase by increments of 25 mcg/day at intervals of 2-3 weeks; average adult dose: 100-200 mcg/day; maximum dose: 200 mcg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.M., I.V.: 50% of the oral dose Myxedema coma or stupor: I.V.: 200-500 mcg one time, then 100-300 mcg the next day if necessary Thyroid suppression therapy: Oral: 2-6 mcg/kg/day for 7-10 days KI: Thyrotoxicosis. P: Elderly people, Heart disease decreased function of the adrenal glands, panhypopituitarism, DM, diabetes insipidus. ES: Angina, heart palpitations, arrhythmias, tachycardia, muscle cramps, diarrhoea, vomiting, tremor, restlessness, excitability, insomnia, headache, flushing, sweating, fever, intolerance to heat, muscle weakness, weight loss. IO: Preg: A Nama Dagang:



E. Anti Tiroid Propylthiouracil



Propylthiouracil (PTU) I: Hyperthyroidism BSO: Tablet: 50 mg D: 3x 1 tab. Adjust dosage to maintain T3, T4, and TSH levels in normal range; elevated T3 may be sole indicator of inadequate treatment. Elevated TSH indicates excessive antithyroid treatment. or 6-10 years: 50-150 mg/day >10 years: 150-300 mg/day Maintenance: Determined by patient response or1/3 to 2/3 of the initial dose in divided doses every 8-12 hours. This usually begins after 2 months on an effective initial dose. Adults: Initial: 300 mg/day in divided doses every 8 hours. In patients with severe hyperthyroidism, very large goiters, or both, the initial dosage is usually 450 mg/day; an occasional patient will require 600-900 mg/day; maintenance: 100-150 mg/day in divided doses every 8-12 hours Genghis Khun ([email protected],nafanakhun.wordpress.com)


Elderly: Use lower dose recommendations; Initial: 150-300 mg/day Withdrawal of therapy: Therapy should be withdrawn gradually with evaluation of the patient every 4-6 weeks for the first 3 months then every 3 months for the first year after discontinuation of therapy to detect any reoccurrence of a hyperthyroid state. KI: Children < 6 years, severe allergic reaction. P: Kidney & liver disease ES: Blood disorders, Skin rashes, arthralgia, jaundice, alopecia, pyrexia, hepatitis, pruritis, urticaria, Allergic skin reactions IO: Preg: D Nama Dagang:



F. Anti Osteoporosis & Metabolisme Tulang Alendronate/ Sodium alendronate Risedronate Zoledronic acid Disodium clodronate Raloxifene Calcitriol Calcitonin Alfacalcidol Pamidronate



Alendronic acid/ Sodium alendronate I: # Prevention and treatment of osteoporosis in women who have passed the menopause, men & caused by long-term treatment with corticosteroids such as prednisolone. BSO: Tablet: 5 mg, 10 mg, 40 mg D: Prevention: 5 mg PO qd or 35 mg/wk. Treatment: 10 mg PO qd or 70 mg PO qwk Treatment of osteoporosis caused by glucocorticoid treatment: 5 mg 1x/hr, In postmenopausal women not receiving estrogen, the dose is 10 mg/d. Paget's disease of bone: 40 mg 1x/hari for 6 bln. KI: Hipersensitif; inability to stand or sit upright for at least 30 min; hypocalcemia; esophageal abnormalities (eg, stricture, achalasia) that might delay esophageal emptying IO: Coadministration with calcium-containing products and other multivalent cations decreases absorption (separate dosing by Genghis Khun ([email protected],nafanakhun.wordpress.com)


30 min); increased GI distress with aspirin, NSAIDs, or other GI irritants Preg: C P: Upper GI disease; renal insufficiency (CrCl <35 mL/min); treat disturbances of mineral metabolism; ensure adequate vitamin D and calcium intake; discontinue if esophageal reaction (eg, dysphagia, odynophagia, retrosternal pain, worsening heartburn) occurs; not for use in women who breastfeed Nama Dagang:



Risedronate I: Paget's disease, in which there is excessive breakdown of bone and increased and irregular formation of bone, causing the bones to become enlarged, deformed, painful, weak and prone to breaking. BSO: Tablet: 5 mg, 30 mg D: 5 mg/ hr or 35 mg/wk Paget's disease: 30 mg/d for 2 months KI: Hipersensitif; hypocalcemia; inability to stand or sit upright for at least 30 min IO: Coadministration with calcium-containing products and other multivalent cations decreases absorption (separate dosing by 30 min); caution with aspirin, NSAIDs, or other GI irritants ES: Diarrhoea, constipation, nausea, indigestion or abdominal pain, Headache, musculoskeletal pain, dysphagia, gastritis, duodenitis, oesophagitis, Ulceration of oesophagus, iritis, Genghis Khun ([email protected],nafanakhun.wordpress.com)


glossitis, Leg cramps, Dizziness, Flu-like symptoms, Dry eyes, hypocalcaemia, peripheral oedema, Weight loss, tinnitus, Muscle weakness, Skin reactions, eg rash Preg: C P: Upper GI disease; renal insufficiency (CrCl <30 mL/min); correct any preexisting hypocalcemia or other mineral or bone disturbances prior to starting therapy; ensure adequate vitamin D and calcium intake; discontinue if esophageal reaction (eg, dysphagia, odynophagia, retrosternal pain, worsening heartburn) occurs; not for use in women who breastfeed Nama Dagang:



Zoledronic acid I: Managing bone complications (such as bone pain, bone damage or hypercalcaemia) in multiple myeloma or breast cancer that has spread to the bone # Reducing hypercalcaemia caused by tumours. BSO: Vial 4 mg/5cc D: 4 mg infuse iv tiap 3-4 mgg KI: Hypocalcaemia, Allergy, Children, Pregnancy, Breastfeeding, decreased kidney function. P: Decreased kidney function, Dehydration. ES: Flu-like symptoms, fever, Fatigue, Headache, nausea, vomiting, diarrhoea, constipation, Loss of appetite, conjunctivitis, Anaemia, Bone pain, hypocalcaemia or hypophosphataemia, Dizziness, Blurred vision, insomnia, Shortness of breath, Kidney problems, Rash or itching. Preg: D Nama Dagang: Zometa Genghis Khun ([email protected],nafanakhun.wordpress.com)


Disodium Clodronate/ Clodronic acid I: Managing bone complications (such as bone pain, bone damage or hypercalcaemia) in multiple myeloma or breast cancer that has spread to the bone # Reducing hypercalcaemia caused by tumours. BSO: Kaps 400 mg. Kons Infus 60 mg/cc D: 1.6-3.2 g/hr . Konsentrat infuse KI: Children, Allergy, taking other bisphosphonate medicines, Severely decreased kidney function, Pregnancy, Breastfeeding. P: Decreased kidney function. ES: Nausea and vomiting, Diarrhoea, Skin reactions such as rash or itching, Kidney problems, bronchospasm IO: Preg:: A, B, C, D, X Nama Dagang: Bonefos



Raloxifene Nonsteroidal benzothiophene that acts as estrogen agonist on bone, decreasing bone resorption. Shown to increase BMD at spine and hip but to a lesser extent than estrogen therapy. Recommended for use in women at moderate risk for osteoporosis who are unwilling or unable to take estrogen, who have infrequent vasomotor symptoms of menopause (eg, hot flashes), and who are at low risk for cardiovascular disease and moderate-to-high risk for breast cancer. Studies demonstrate 40-50% risk reduction in vertebral fracture. I: Prevention and treatment of osteoporosis in post-menopausal BSO: Tablet: 60 mg D: 60 mg 1x/d, KI: Hipersensitif; thrombophlebitis IO: May antagonize warfarin; avoid with anion exchange resins (eg, cholestyramine); caution with other drugs that are highly protein bound (eg, diazepam, diazoxide, lidocaine) Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Hot flushes, Flu-like symptoms, Leg cramps, peripheral oedema, DVT, trombocytopenia, dyspepsia, Nausea and vomiting, Migraine, Headache, Rash, hypertension, Breast pain, englargement or tenderness, SNH Preg: X P: Not for use in premenopausal women; not recommended for use with concomitant estrogen replacement therapy; discontinue 72 h before prolonged immobilization or surgery associated with thromboembolism and resume once fully ambulatory; hepatic dysfunction; not recommended for use in women who breastfeed Nama Dagang: Evista



Calcitriol I: # Osteoporosis in postmenopausal women # The correction of abnormalities of calcium and phosphate metabolism in renal osteodystrophy. BSO: Capsule: 0.25 mcg, 0.5 mcg Injection: 1 mcg/mL; 2 mcg/mL Solution, oral: 1 mcg/mL D: Maintain calcium levels of 9-10 mg/dL Children: Oral: 0.25-2 mcg/day have been used (with hemodialysis); 0.014-0.041 mcg/kg/day (not receiving hemodialysis); increases should be made at 4- to 8-week intervals I.V.: 0.01-0.05 mcg/kg 3 times/week if undergoing hemodialysis Adults: Oral: 0.25 mcg/day or every other day (may require 0.5-1 mcg/day); increases should be made at 4- to 8-week intervals I.V.: 0.5 mcg/day 3 times/week (may require from 0.5-3 mcg/day given 3 times/week) if undergoing hemodialysis Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hypoparathyroidism/pseudohypoparathyroidism: Oral (evaluate dosage at 2- to 4-week intervals): Children: <1 year: 0.04-0.08 mcg/kg once daily 1-5 years: 0.25-0.75 mcg once daily Children >6 years and Adults: 0.5-2 mcg once daily Vitamin D-dependent rickets: Children and Adults: Oral: 1 mcg once daily Vitamin D-resistant rickets (familial hypophosphatemia): Children and Adults: Oral: Initial: 0.015-0.02 mcg/kg once daily; maintenance: 0.03-0.06 mcg/kg once daily; maximum dose: 2 mcg once daily Hypocalcemia in premature infants: Oral: 1 mcg once daily for 5 days Hypocalcemic tetany in premature infants: I.V.: 0.05 mcg/kg once daily for 5-12 days KI: Hypercalcaemia, allergy, Vitamin D toxicity P: Children, Decreased kidney function, Monitor blood Ca levels Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Headache, Abdominal pain, Thirst, hypersensitivity, Sweating, diarrhoea, constipation, nausea, vomiting or abdominal pain, Weakness, arrhythmias, vertigo, hypercalcaemia, hyperphosphateaemia, Loss of appetite, somnolence, paralytic ileus, Dehydration, polyuria, Indifference/ apathy, High calcium levels in the urine IO: Preg: C Nama Dagang:



Calcitonin Inhibits osteoclast activity, thereby slowing bone loss. I: Preventing bone loss due to sudden immobilisation, for example as a result of fractures in people with osteoporosis Paget's disease, hypercalcaemia caused by tumours BSO: Parenteral and intranasal forms; however, intranasal form is more convenient and better tolerated. Diminution of benefit may occur after 20 mo with parenteral form. Injection: Human: 0.5 mg/vial Salmon: 200 U/mL Spray, nasal: Salmon: 200 U/activation (0.09 mL/dose) (2 mL glass bottle with pump) D: Injection: Paget's disease, postmenopausal osteoporosis: 100 u IM/SC 1x/d or 3x/wk Hypercalcemia: 4 U/kg IM/SC tiap 12 jam. 200 IU (1 puff) into 1 nostril 1x/d. It is best to spray into the nostril on one side one day and the other side the next day. KI: Hipersensitif IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May potentiate oral anticoagulants and oxyphenbutazone; may alter insulin effects ES: Nausea and vomiting, Flushing, Diarrhoea, Inflammation at site of injection, Dizziness, Skin rash, Metallic taste in mouth # Increased production of urine Preg: B P: Perform periodic nasal examinations and discontinue if severe ulceration occurs with nasal spray use; monitor for hypocalcemic tetany initially and urine sediments over long term with injectable use; hypocalcemia may occur (supplement with calcium and vitamin D); examine urine sediment during prolonged therapy; caution in women who breastfeed Nama Dagang:



Alfacalcidol I: # Hypocalcaemia in the neonate, hypoparathyroidism, hyperparathyroidism, osteomalacia, correction of abnormalities of calcium and phosphate metabolism in renal osteodystrophy. BSO: Tab 0.25 mcg. 0.5 mcg. 1 mcg D: 0.5-1 mcg 1x/hr. anak 0.01-0.03 mcg/kg/hr KI: P: ES: Thirst, Sweating, Diarrhoea, constipation, nausea, vomiting or abdominal pain, Hypercalcaemia, Hyperphosphateaemia, Loss of appetitea IO: Preg:: A, B, C, D, X Nama Dagang:



Pamidronate I: Hypercalcemia +malignancy; osteolytic bone lesions+multiple myeloma or metastatic breast cancer; Paget's disease of bone BSO: Vial 30 mg D: Hypercalcemia: 60-90 mg IV infuse over 2-24 hours for 3d Paget's disease: 30 mg IV infuse over 2-24 hours for 3d Bone metast.: 90 mg IV infuse over 2-24 hours, per 3-4wk or 1x/month. KI: Previous hypersensitivity to pamidronate or other biphosphonates P: Use caution in patients with renal impairment as nephropathy was seen in animal studies. However, in contrast to reports of renal failure with other biphosphonates, impairment of renal function has not been reported with pamidronate in studies to date. However, further experience is needed to assess the nephrotoxic potential with higher doses and prolonged administration. Use caution in patients who are pregnant or in the breast-feeding period; leukopenia has been observed with oral pamidronate and monitoring of white blood cell counts is Genghis Khun ([email protected],nafanakhun.wordpress.com)


suggested. Vein irritation and thrombophlebitis may occur with infusions. Has not been studied exclusively in the elderly; monitor serum electrolytes periodically since elderly are often receiving diuretics which can result in decreases in serum calcium, potassium, and magnesium. ES: 1% to 10%: Central nervous system: Malaise, fever, convulsions Endocrine & metabolic: Hypomagnesemia, hypocalcemia, hypokalemia, fluid overload, hypophosphatemia Gastrointestinal: GI symptoms, nausea, diarrhea, constipation, anorexia Hepatic: Abnormal hepatic function Neuromuscular & skeletal: Bone pain Respiratory: Dyspnea IO: Preg: C Nama Dagang: Aredia Genghis Khun ([email protected],nafanakhun.wordpress.com)


IX. VITAMIN & MINERAL A. VITAMIN B ANTI OBESITAS



A. Vitamin Vitamin A (Retinol) Vitamin B1(Thiamine) Vitamin B12 (Cyanocobalamin) Vitamin B2 (Riboflavin) Vitamin B6 (Pyridoxine) Vitamin B Complex Vitamin C (ascorbic acid) Vitamin D2 (Ergocalciferol) Vitamin D3 (Cholecalciferol) Vitamin E Vitamin H (Biotin) Vitamin K Niacin (Nicotinic acid)



Vitamin A (Retinol) I: Some conditions may increase your need for vitamin A. These include: Diarrhea, Eye diseases, Intestine diseases, Infections, Measles, Pancreas disease, Stomach removal, Stress BSO: Capsule: 10,000 U [OTC], 25,000 U, 50,000 U Drops, oral (water miscible) [OTC]: 5000 U/0.1 mL Injection: 50,000 U/mL Tablet [OTC]: 5000 U D: * To treat deficiency: 25,000- 50,000 U/d + Measles= Anak 6-12bln= 100,000 U as a single dose. Anak > 1 thn= 200,000 U as a single dose. RDA: <1 year: 375 mcg 1-3 years: 400 mcg 4-6 years: 500 mcg* 7-10 years: 700 mcg* >10 years: 800-1000 mcg* Male: 1000 mcg Genghis Khun ([email protected],nafanakhun.wordpress.com)


Female: 800 mcg * mcg retinol equivalent (0.3 mcg retinol = 1 unit vitamin A) Note: Use of vitamin A in measles is recommended only for patients 6 months to 2 years of age hospitalized with measles and its complications or patients >6 months of age who have any of the following risk factors and who are not already receiving vitamin A: immunodeficiency, ophthalmologic evidence of vitamin A deficiency including night blindness, Bitot's spots or evidence of xerophthalmia, impaired intestinal absorption, moderate to severe malnutrition including that associated with eating disorders, or recent immigration from areas where high mortality rates from measles have been observed Note: Monitor patients closely; dosages >25,000 U/kg have been associated with toxicity + Xerophthalmia (eye disease) Anak 6-12bln= 100,000 U as a single dose. Hari ke 1, II dan 4 minggu kemudian. Anak > 1 thn= 200,000 U as a single dose. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hari ke 1, II dan 4 minggu kemudian. Severe deficiency with xerophthalmia: Oral: Anak 1-8thn= 5000-10,000 U/kg/day for 5 days/until recovery. Dws & Anak >8thn: 500,000 U/day for 3 days, then 50,000 U/day for 14 days, then 10,000-20,000 U/day for 2 months Deficiency (without corneal changes): Oral: Infants <1 year: 100,000 U every 4-6 months Children 1-8 years: 200,000 U every 4-6 months Children >8 years and Adults: 100,000 U/day for 3 days then 50,000 U/day for 14 days Malabsorption syndrome (prophylaxis): Children >8 years and Adults: Oral: 10,000-50,000 U/day of water miscible product Dietary supplement: Oral: Infants up to 6 months: 1500 U/day Children: 6 months to 3 years: 1500-2000 U/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


4-6 years: 2500 U/day 7-10 years: 3300-3500 U/day Children >10 years and Adults: 4000-5000 U/day KI: Hypervitaminosis A, hypersensitivity to vitamin A or any component; pregnancy if dose exceeds RDA recommendations P: Evaluate other sources of vitamin A while receiving this product; patients receiving >25,000 U/day should be closely monitored for toxicity ES: 1-10%: Drying or cracking of skin, Hypercalcemia, Weight loss , Visual changes, Hypervitaminosis A IO: Decreased effect: Cholestyramine decreases absorption of vitamin A; neomycin and mineral oil may also interfere with vitamin A absorption Increased toxicity: Retinoids may have additive adverse effects Preg: A, X (if dose exceeds RDA recommendation) Nama Dagang:



Vitamin B complex I: Supportive nutritional supplementation in conditions in which water-soluble vitamins are required like GI disorders, chronic alcoholism, pregnancy, severe burns, and recovery from surgery BSO: Capsule Solution: 5 mL, 360 mL D: 1 tab/caps per day KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Vitamin B1 (Thiamine) I: Beriberi, Wernicke's encephalopathy syndrome, and peripheral neuritis associated with pellagra, alcoholic patients with altered sensorium; various genetic metabolic disorders BSO: Injection: 100 mg/mL; 200 mg/mL Tablet: 50 mg, 100 mg, 250 mg, 500 mg Tablet, enteric coated: 20 mg D: US normal daily recommended intakes: Dws L=1.2-1.5 mg/d. P= 1-1.1 mg/d. Hamil= 1.5 mg/d Laktasi= 1.6 mg/d Anak 7-10 thn= 1 mg/d Anak 4-6 thn= 0.9 mg/d Anak < 3 thn= 0.3-0.7 mg/d Deficiency: Beriberi Dws:Oral, 5-10 mg 3x/d. Anak: 10 mg/d. KI: Hypersensitivity to thiamine or any component P: Use with caution with parenteral route (especially I.V.) of administration Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: <1%: Cardiovascular collapse and death, warmth, rash, angioedema, paresthesia IO: Neuromuscular blocking agents; high carbohydrate diets or I.V. dextrose solutions increase thiamine requirement Preg:: A, C (if dose exceeds RDA recommendation) Nama Dagang:



Vitamin B2 (Riboflavin) I: Prevent riboflavin deficiency and treat ariboflavinosis BSO: Tablet: 25 mg, 50 mg, 100 mg D: US normal daily recommended intakes: Dws L=1.4-1.8 mg/d. P= 1.2-1.3 mg/d. Hamil= 1.6 mg/d Laktasi= 1.7-1.8 mg/d Anak 7-10 thn= 1.2 mg/d Anak 4-6 thn= 1.1 mg/d Anak < 3 thn= 0.4-0.8 mg/d KI: P: Riboflavin deficiency often occurs in the presence of other B vitamin deficiencies ES: Genitourinary: Discoloration of urine (yellow-orange) IO: Decreased absorption with probenecid Preg:: A, B, C, D, X A/C (if dose exceeds RDA recommendation) Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vitamin B6 (Pyridoxine) I: Vitamin B6 deficiency, pyridoxine-dependent seizures in infants, adjunct to treatment of acute toxicity from isoniazid, cycloserine, or hydralazine overdose BSO: Injection: 100 mg/mL Tablet: 25 mg, 50 mg, 100 mg Tablet, extended release: 100 mg D: US normal daily recommended intakes: Dws L=1.7-2 mg/d. P= 1.4-1.6 mg/d. Hamil= 2.2 mg/d Laktasi= 2.1 mg/d Anak 7-10 thn= 1.4 mg/d Anak 4-6 thn= 1.1 mg/d Anak < 3 thn= 0.3-1 mg/d Deficiency: 10-50 mg PO bid/qid (often 30-100 mg/d) KI: Hipersensitif IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May decrease levodopa, phenytoin, and phenobarbital serum levels ES: <1%: Sensory neuropathy, seizures have occurred following I.V. administration of very large doses, headache, nausea, decreased serum folic acid secretions, increased AST, paresthesia, allergic reactions have been reported Preg: A P: >200 mg/d may precipitate withdrawal effects when medication is discontinued Nama Dagang:



Vitamin B12 (Cyanocobalamin) I: Alcoholism, hemolytic Anemia, Fever (continuing), Genetic disorders such as homocystinuria and/or methylmalonic aciduria, Intestine diseases, Infections (continuing or chronic), Kidney, Liver, Pancreas, Stomach & Thyroid disease * Worm infections BSO: D: Intranasal gel: Dws 500 mcg 1 nostril per wk. Tablets or extended-release tab. US normal daily recommended intakes: Dws L=2 mcg/d. Hamil= 2.2 mcg/d Laktasi= 2.6 mcg/d Anak 7-10 thn= 1.4 mcg/d Anak 4-6 thn= 1 mcg/d Anak < 3 thn= 0.3-0.7 mcg/d Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Folic acid I: Megaloblastic and macrocytic anemias due to folate deficiency; dietary supplement to prevent neural tube defects BSO: Injection: 5 mg/mL; 10 mg/mL Tablet: 0.1 mg, 0.4 mg, 0.8 mg, 1 mg D: Infants: 0.1 mg/day Children <4 years: Up to 0.3 mg/day Children >4 years and Adults: 0.4 mg/day Pregnant and lactating women: 0.8 mg/day RDA: Adult male: 0.15-0.2 mg/day Adult female: 0.15-0.18 mg/day KI: Pernicious, aplastic, or normocytic anemias P: Doses >0.1 mg/day may obscure pernicious anemia with continuing irreversible nerve damage progression. Resistance to treatment may occur with depressed hematopoiesis, alcoholism, deficiencies of other vitamins. Injection contains benzyl alcohol (1.5%) as preservative (use care in administration to neonates). Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: <1%: Slight flushing, general malaise, pruritus, rash, bronchospasm, allergic reaction IO: Decreased effect: In folate-deficient patients, folic acid therapy may increase phenytoin metabolism. Phenytoin, primidone, para-aminosalicylic acid, and sulfasalazine may decrease serum folate concentrations and cause deficiency. Oral contraceptives may also impair folate metabolism producing depletion, but the effect is unlikely to cause anemia or megaloblastic changes. Concurrent administration of chloramphenicol and folic acid may result in antagonism of the hematopoietic response to folic acid; dihydrofolate reductase inhibitors (eg, methotrexate, trimethoprim) may interfere with folic acid utilization. Preg: A, C (if dose exceeds RDA recommendation) Nama Dagang:



Vitamin C (ascorbic acid) I: Scurvy =muscle weakness, swollen and bleeding gums, loss of teeth, and bleeding under the skin, as well as tiredness and depression. Wounds also do not heal easily. BSO: Crystals & Powder: 4 g/teaspoonful; 5 g/teaspoonful Injection: 250 mg/mL; 500 mg/mL Liquid, oral: 35 mg/0.6 mL Lozenges: 60 mg Solution & Syrup, oral: 100 mg/mL Tablet: 25 mg, 50 mg, 100 mg, 250 mg, 500 mg, 1000 mg I: Oral, I.M., I.V., S.C.: <6 months: 30 mg 6 bln-1 thn= 35 mg 1-3 years: 15 mg; max 400 mg/day 4-8 years: 25 mg; max 650 mg/day 9-13 years: 45 mg; max 1200 mg/day 14-18 years: max 1800 mg/day Males: 75 mg Females: 65 mg Adults: max 2000 mg/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Males: 90 mg Females: 75 mg; Pregnant female: less than or equal to 18 years: 80 mg; max 1800 mg/day 19-50 years: 85 mg; max 2000 mg/day Lactating female: less than or equal to 18 years: 15 mg; max 1800 mg/day 19-50 years: 20 mg; max 2000 mg/day Adult smoker: Add an additional 35 mg/day Children: Scurvy: 100-300 mg/day in divided doses for at least 2 weeks Urinary acidification: 500 mg every 6-8 hours Dietary supplement: 35-100 mg/day Adults: Scurvy: 100-250 mg 1-2 times/day for at least 2 weeks Urinary acidification: 4-12 g/day in 3-4 divided doses Prevention and treatment of colds: 1-3 g/day Dietary supplement: 50-200 mg/day D: US normal daily recommended intakes: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dws L/P= 50-60 mg/d. Hamil= 70 mg/d Laktasi= 90-95 mg/d Smoker= 100 mg/d Anak 4-10 thn= 45 mg/d Anak < 3 thn= 30-40 mg/d Deficiency: Dws: Scurvy: 100-300 mg/d for 2 weeks. KI: Large doses during pregnancy P: Diabetics and patients prone to recurrent renal calculi (eg, dialysis patients) should not take excessive doses for extended periods of time ES: 1% to 10%: Renal: Hyperoxaluria with large doses <1%: Flushing, faintness, dizziness, headache, fatigue, nausea, vomiting, heartburn, diarrhea, flank pain IO: Aspirin (decreases ascorbate levels, increases aspirin) Fluphenazine (decreases fluphenazine levels) Warfarin (decreased effect), Iron (absorption enhanced) Oral contraceptives (increased contraceptive effect) Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vitamin D2 (Ergocalciferol) I: Refractory rickets, hypophosphatemia, hypoparathyroidism BSO: Capsule: 50,000 U [1.25 mg] Injection: 500,000 U/mL [12.5 mg/mL] Liquid: 8000 U/mL [200 mcg/mL] Tablet: 50,000 U [1.25 mg] D: Oral dosing is preferred; I.M. therapy required with GI, liver, or biliary disease associated with malabsorption Premature infants: 10-20 mcg/day (400-800 U), up to 750 mcg/ day (30,000 U) Infants and healthy Children: 10 mcg/day (400 U) Adults: 10 mcg/day (400 U) Renal failure: Children: 100-1000 mcg/day (4000-40,000 U) Adults: 500 mcg/day (20,000 U) Hypoparathyroidism: Children: 1.25-5 mg/day (50,000-200,000 U) & Ca supplements Adults: 625 mcg to 5 mg/day (25,000-200,000 U) + Ca Vitamin D-dependent rickets: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: 75-125 mcg/day (3000-5000 U); max: 1500 mcg/day Adults: 250 mcg to 1.5 mg/day (10,000-60,000 U) Nutritional rickets and osteomalacia: Children and Adults (with normal absorption): 25-125 mcg/day (1000-5000 U) Children +malabsorption: 250-625 mcg/day (10,000-25,000 U) Adults +malabsorption: 250-7500 mcg (10,000-300,000 U) Vitamin D-resistant rickets: Children: Initial: 1000-2000 mcg/day (40,000-80,000 U) with phosphate supplements; daily dosage is increased at 3- to 4month intervals in 250-500 mcg (10,000-20,000 U) increments Adults: 250-1500 mcg/day (10,000-60,000 U) with phosphate supplements Familial hypophosphatemia: 10,000-80,000 U daily plus 1-2 g/day elemental phosphorus Osteoporosis prophylaxis: Adults: 51-70 years of age: 400 U/day >70 years of age: 600 U/day Maximum daily dose: 2000 U/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hypercalcemia, hypersensitivity to ergocalciferol or any component; malabsorption syndrome; evidence of vitamin D toxicity P: Administer with extreme caution in patients with impaired renal function, heart disease, renal stones, or arteriosclerosis; must administer concomitant calcium supplementation; maintain adequate fluid intake; avoid hypercalcemia; renal function impairment with secondary hyperparathyroidism ES: Generally well tolerated IO: Decreased effect: Cholestyramine, colestipol, mineral oil may decrease oral absorption Increased effect: Thiazide diuretics may increase vitamin D effects Increased toxicity: Cardiac glycosides may increase toxicity Preg: A, C (if dose exceeds RDA recommendation) Nama Dagang:



Vitamin D3 (Cholecalciferol) I: Dietary supplement, treatment of vitamin D deficiency or prophylaxis of deficiency BSO: Tablet: 400 U, 1000 U D: Adults: Oral: 400-1000 U/day KI: Hypercalcemia; hypersensitivity to cholecalciferol or any component; malabsorption syndrome; evidence of vitamin D toxicity P: ES: 1-10%: Irritability, headache, Pruritus, Polydipsia, Nausea, vomiting, anorexia, pancreatitis, metallic taste, Bone pain, myalgia, Conjunctivitis, photophobia, Polyuria IO: Thiazide diuretics, cholestyramine, colestipol, corticosteroids, mineral oil, phenytoin, barbiturates, digitalis glycosides, antacids (magnesium) Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Vitamin H (Biotin) I: Genetic disorder of biotin deficiency, Seborrheic dermatitis in infants, Surgical removal of the stomach BSO: D: Prevent deficiency: o Adults: 30-100 mcg/day. o Children 7-10 years of age: 30 mcg/day. o Children 4-6 years of age—25 mcg/ day. o Children < 3 years of age—10 -20 mcg/day. KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Vitamin E Protects polyunsaturated fatty acids in membranes from attack by free radicals. I: Hemolytic anemia secondary to vitamin E deficiency, dietary supplement BSO: Tab & Caps: 100U, 200U, 400U, 500 U, 600 U, 1000 U Caps, water miscible: 73.5 mg, 147 mg, 165 mg, 330 mg, 400 U Cream: 50 mg/g Drops, oral: 50 mg/mL Oil & Liquid, topical: 10 mL, 15 mL, 30 mL, 60 mL Lotion: 120 mL Ointment, topical: 30 mg/g D: 1 U vitamin E = 1 mg dl-alpha-tocopherol acetate. 60-75 IU/d PO/IM; study doses for the prevention of coronary artery disease have ranged from 400-800 IU/d PO ===== Premature infants <3 months: 17 mg (25 U) Infants < 6 months: 3 mg (4.5 U) 7-12 months: 4 mg (6 U) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Children: 1-3 years: 6 mg (9 U); max 200 mg/day 4-8 years: 7 mg (10.5 U); max 300 mg/day 9-13 years: 11 mg (16.5 U); max 600 mg/day 14-18 years: 15 mg (22.5 U); max 800 mg/day Adults: 15 mg (22.5 U); max 1 g/day Pregnant female: <18 years: 15 mg (22.5 U); max 800 mg/day 19-50 years: 15 mg (22.5 U); max 1 g/day Lactating female: <18 years: 19 mg (28.5 U); max 800 mg/day 19-50 years: 19 mg (28.5 U); max 1 g/day Vitamin E deficiency: Children (with malabsorption syndrome): 1 unit/kg/day of water miscible vitamin E (to raise plasma tocopherol concentrations to the normal range within 2 months and to maintain normal plasma concentrations) Adults: 60-75 U/day Prevention of vitamin E deficiency: Adults: 30 U/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prevention of retinopathy of prematurity or BPD secondary to O2 therapy: (American Academy of Pediatrics considers this use investigational and routine use is not recommended): Retinopathy prophylaxis: 15-30 U/kg/day to maintain plasma levels between 1.5-2 g/mL (may need as high as 100 U/kg/day) Cystic fibrosis, beta-thalassemia, sickle cell anemia may require higher daily maintenance doses: Cystic fibrosis: 100-400 U/day Beta-thalassemia: 750 U/day Sickle cell: 450 U/day Alzheimer's disease: 1000 U twice daily Tardive dyskinesia: 1600 U/day Topical: Apply a thin layer over affected area KI: Hipersensitif; iron deficiency anemia IO: Mineral oil decreases absorption of vitamin E; vitamin E delays absorption of iron and increases effects of anticoagulants Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: <1%: Headache, fatigue, contact dermatitis with topical preparation, nausea, diarrhea, intestinal cramps, weakness, blurred vision, gonadal dysfunction Preg: B P: Large doses of vitamin E may result in vitamin K deficiency, enhancing the anticoagulant activity of warfarin and increasing the risk of major and minor bleeding complications, especially in patients who are also taking antiplatelet medication; necrotizing enterocolitis may occur



Vitamin K I: As an antidote to coumarin-type anticoagulants, eg warfarin Prevention &treatment of bleeding due to vitamin K deficiency BSO: Inj:Aqueous colloidal & IM only: 2 mg/mL; 10 mg/mL Tablet: 5 mg D: Blood clotting, increased bleeding, dietary supplementation: Menadiol oral: 5-10 mg/day injection: 5-15 mg IM/SC 1-2x/day Phytonadione PO/IM/SC: 2.5-25 mg, rarely up to 50 mg. Prevention of bleeding in newborns: 0.5-1 mg IM/SC, right after delivery. q6-8 hours, if needed. KI: Allergy, glucose-galactose malabsorption P: Elderly people ES: Decreased appetite, Decreased movement, Difficulty in breathing, hepatomegali, General body swelling, Irritability, Muscle stiffness, Paleness, Yellow eyes or skin Preg: C Nama Dagang: Vit K Kimia Farma Genghis Khun ([email protected],nafanakhun.wordpress.com)


Niacin (Nicotinic acid) Used in tissue respiration, lipid metabolism, and glycogenolysis. I: Some conditions: Cancer, DM, Diarrhea (prolonged), Fever (prolonged), Hartnup disease, Infection (prolonged), Intestinal problems, Liver disease, Mouth or throat sores, Overactive thyroid, Pancreas disease, Stomach ulcer, Stress (prolonged), Surgical removal of stomach BSO: Extended-release formulation may reduce flushing, an unpleasant adverse effect that causes 30-40% of patients to discontinue therapy. D: Niacin oral: Prevent deficiency: 15-20 mg/day Adult males: 15-20 mg/ day. females: 13-15 mg/ day. Pregnant: 17 mg/day, Breast-feeding: 20 mg/day Children 7 -10 years of age: 13 mg/day Children 4-6 years of age: 12 mg/day Infants birth <3 years of age—5-9 mg/ day. KI: Hipersensitif; active liver disease or unexplained significant increases in AST and ALT; substantial alcohol consumption; active peptic ulcer disease; active gout; hyperuricemia Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: HMG-CoA reductase inhibitors increase the risk of rhabdomyolysis; cutaneous vasodilation may be a problem if high dose is used with peripheral dilators such as nitroglycerine; taking aspirin 30-60 min before first dose of the day may help alleviate prostaglandin-mediated adverse effects (eg, flushing, itching); clonidine may inhibit niacin-induced flushing; separate dosing of bile acid sequestrants by at least 4-6 h; may increase PT when coadministered with warfarin ES: Injection: Skin rash or itching, Wheezing Prolonged use of extended-release niacin: Darkening of urine, Light gray-colored stools, Loss of appetite, stomach pain Preg: A P: Caution in patients with gallbladder disease or diabetes in those predisposed to gout; monitor blood glucose; may elevate uric acid levels and lower blood phosphate levels; Preg: category C when used at doses greater than RDA Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


B. Anti Obesitas Diethylpropion HCl Phaseolus vulgaris Sibutramine Orlistat Mazindol



Diethylpropion HCl Anorexiant, Mengontrol BB dg menurunkan nafsu makan BSO: Tablet: 25 mg. Tablet, controlled release: 75 mg D: 1 tab/hr KI: Hipersensitif, arteriosklerosis lanjut, hipertensi berat, hipertiroidisme, glaukoma, agitasi/ psikosis akut, riwayat penylahgunaan obat, ggn afektif & psikiatrik, terapi MAOI. Anak < 12 th. P: Hipertensi, pnykt KV, epilepsi, DM, dpt menyebabkan ketergantungan. ES: Palpitasi, takikardi, peningkatan TD, nyeri prekordial, aritmia, stimulasi SSP, pusing, mengantuk, depresi, diskrasia darah, ggn GI IO: Antagonisme dg guanetidin & bretilium. Potensiasi dg zat yg mempengaruhi TD. Meningkatkan insiden aritmia jika digunakan dg anestesia umum. Preg:: Nama Dagang: Apisate (diethylpropion HCl 75 mg, Vit B1 5 mg, B2 4 mg, B6 2 mg, nicotinamide 30 mg) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Phaseolus vulgaris I: Menurunkan BB BSO: Tab 30 D: 1-2 tab 2x/hr, 10-20 mnt sebelum mengonsumsi karbohidrat. Ditelan bersama segelas air. P: Hipersensitif thd kromium & Tanin. Kerusakan hati & ginjal berat. Hamil & Laktasi ES: Mual, kembung, konstipasi, diare,. Dpt menyebabkan rasa tidak nyaman pd GI jika dikonsumsi pd saat perut kosong IO: Kodein, Efedrin, ß-blocker. Kolkisin sebaiknya diberikan sesudah 2 jam.Simetidin, kuinolon, Ca karbonat, antasid, kortikosteroid menurunkan absorbsi kromium. Aspirin & Vit C meningkatkan absorbsi Kromium. Preg:: Nama Dagang: F-Slim (Phaseolus vulgaris 500 mg green tea extr (setara dg EGCG) 90 mg, chromium polynicotinate 100mcg) Genghis Khun ([email protected],nafanakhun.wordpress.com)


Sibutramine I: Pasien obesitas dg Indeks Massa Tubuh ≥ 30 kg/m2, atau > 27 kg/m2 pd psien dg factor resiko lai yg berhub. Dg obesitas (DM, dislipidemia, hipertensi) yg tdk mencapai penurunan BB scr adekuat hanya melalui diet & atau olahraga saja. BSO: Kaps 10 mg, 15 mg D: 10 mg 1x/hr . Jika tdk tercapai penurunan BB ≥ 2 kg/ 4 mgg. Dosis dinaikkan 15 mg 1x/hr. KI: Hipersensitif thd Sibutramine HCl, obesitas organic, riwayat ggn makan, ggn psikiatrik, sindr. Gilles de la tourette, penggunaan MAOI atau triptofan atau obat yg bekerja scr sentral, riw pnykt arteri koroner, ggl jntung kongestif, takikardia, pnykt oklusi arteri perifer, aritmia, pnykt serebrovaskuler, hipertensi tdk terkontrol (>145/90 mmHg), hipertiroidisme, ggn hati/ginjal berat, hiperplasia prostate jinak, feokromositoma, glaucoma sudut sempit, riw penyalahgunaan obat, narkoba atau alcohol, hamilo, laktasi, anak < 18 th, usia lanjut > 65 th. Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Cek TD & Denyut nadi selama 3 bln pertama terapi. Ggn hati/ ginjal, kejang, batu empedu. Dpt mengganggu kemampuan mengemudi atau menjalankan mesin. Pasien dg kecenderungan pendarahan & mendapat obat yg mempengaruhi hemostasis atau fungsi trombosit. Glaukoma sudut terbuka, punya risiko peningkatan TIO ES: Kehilangan nafsu makan, konstipasi, mulut kering, insomnia IO: MAOI, obat SSP & serotonergik. Obat yg meningkatkan TD atau denyut jantung atau mempengaruhi metabolisme sitokrom P450. Preg:: C Nama Dagang: Reductil



Orlistat I: Obesity BSO: Kaps 120 mg D: Dws 120 mg 3x/d . KI: Chronic malabsorption syndrome, cholestasis, laktasi P: Diabetes ES: Headache, Oily spotting from the rectum, Abdominal pain or discomfort, Flatulence (wind) with discharge, Oily or fatty stools, Urgent or increased need to open the bowels, Diarrhoea Infections of the airways, hypoglycaemia in diabetes, Faecal incontinence, Fatigue, Urinary tract infection, Irregular menstrual cycle, Anxiety, Tooth or gum disorders, Diverticulitis, Gall stones, Raised liver enzymes, hepatitis IO: Preg: B Nama Dagang:Xenical



Mazindol I: Short-term adjunct in exogenous obesity BSO: Tablet: 1 mg, 2 mg D: 1st: 1 mg 1x/d; usual dose= 1 mg 3x/d or 2 mg 1x/d 1 h a.c , take with meals to avoid GI discomfort KI: Hypersensitivity, severe hypertension/cardiovascular dis. P: discontinue drug if Tolerance ES: Palpitation, tachycardia, edema, Insomnia, dizziness, dysphoria, drowsiness, depression, headache, restlessness, Rash, clamminess, Changes in libido, Nausea, constipation, vomiting, xerostomia, polyuria, impotence, Tremor, weakness, Blurred vision, corneal opacities, Diaphoresis (excessive) IO: Mazindol may decrease the hypotensive effect of guanethidine; monitor. Mazindol enhances the pressor effect of exogenous catecholamines (norepinephrine) and potential blood pressure increases in patients taking sympathomimetic medications Preg: C Nama Dagang: Teronac Genghis Khun ([email protected],nafanakhun.wordpress.com)


X. PREPARAT MATA A. ANTIINFEKSI & ANTISEPTIK B. ANTI INFLAMASI C. ANTIBIOTIK & ANTIINFLAMASI D. ANTI ALERGI E. OKULAR DEKONGESTAN F. MIDRIATIKUM G. MIOTIKUM H. GLUKOMA SUDUT TERBUKA & TERTUTUP KRONIK I. KATARAK J. KESEHATAN MATA K. PREPARAT MATA LAIN



A. Antiinfeksi & Antiseptik Sulfacetamide Ciprofloxacin Ofloxacin Chloramphenicol Levofloxacin Dibekacin Fusidic acid Gentamicin Tobramycin Tetracycline Oxytetracycline Neomycin Neomycin, Polymyxin B, and Gramicidin Aciclovir Idoxuridine



Sulfacetamide I: Treatment and prophylaxis of conjunctivitis due to susceptible organisms; corneal ulcers; adjunctive treatment with systemic sulfonamides for therapy of trachoma; topical application in scaling dermatosis (seborrheic); bacterial infections of the skin BSO: Lotion & Ointment, ophthalmic: 10% Solution, ophthalmic: 10%; 15% D: Children >2 months and Adults: Ophthalmic: Ointment: Apply 1-4 x/day and at bedtime Solution: Instill 1-3 drops several times daily up to every 2-3 hours in lower conjunctival sac during waking hours and less frequently at night Children >12 years and Adults: Topical: Seborrheic dermatitis: Apply at bedtime and allow to remain overnight; in severe cases, may apply twice daily Secondary cutaneous bacterial infections: Apply 2-4 times/day until infection clears KI: Hypersensitivity to sulfacetamide or any component, sulfonamides; infants <2 months of age Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Inactivated by purulent exudates containing PABA; use with caution in severe dry eye; ointment may retard corneal epithelial healing; sulfite in some products may cause hypersensitivity reactions; cross-sensitivity may occur with previous exposure to other sulfonamides given by other routes ES: 1% to 10%: Local: Irritation, stinging, burning IO: Decreased effect: Silver, gentamicin (antagonism) Preg: C Nama Dagang:



Fusidic acid I: Konjungtivitis, Impetigo kontagiosum, folikulitis superfisialis, furunkolosis, sikosis barbae, hidradenitis aksilaris, abses, paronikia, eritrasma. BSO: Tetes mata 1% Krim, salep 2% D: 1 tts tiap 4 jam, kemudian Krim/ Salep: tanpa pembalut/ kasa steril: 3-4x/hr. Dg pembalut gunakan lebih sering. Lama terapi 7 hari KI: allergy P: ES: # Skin rashes # Skin irritation # Stinging on application IO: Preg:: A, B, C, D, X Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Neomycin I: Orally to prepare GI tract for surgery; topically to treat minor skin infections; treat diarrhea caused by E. coli; adjunct in the treatment of hepatic encephalopathy BSO: Cream & Ointment, topical: 0.5% Injection: 500 mg Solution, oral, as sulfate: 125 mg/5 mL Tablet, as sulfate: 500 mg [base 300 mg] D: Topical: Use in the eye every eight to twenty-four hours. KI: Hypersensitivity P: Use with caution in patients with renal impairment, preexisting hearing impairment, neuromuscular disorders; neomycin is more toxic than other aminoglycosides when given parenterally; do not administer parenterally; topical neomycin is a contact sensitizer with sensitivity occurring in 5% to 15% of patients treated with the drug; symptoms include itching, reddening, edema, and failure to heal; do not use as peritoneal lavage due to significant systemic adsorption of the drug Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: 1% to 10%: Dermatologic: Dermatitis, rash, urticaria, erythema Local: Burning Ocular: Contact conjunctivitis IO: Decreased effect: May decrease GI absorption of digoxin and methotrexate Increased effect: Synergistic effects with penicillins Increased toxicity: Oral neomycin may potentiate the effects of oral anticoagulants Increased adverse effects with other neurotoxic, ototoxic, or nephrotoxic drugs Preg: C Nama Dagang:



Neomycin, Polymyxin B, and Gramicidin I: infections of the eye BSO: Solution, ophthalmic: Neomycin sulfate 1.75 mg, polymyxin B sulfate 10,000 U, and gramicidin 0.025 mg per mL D: 1 drop in the eye 2-4x/day for 7-10 days serious infection: 1 drop every 15-30 minutes at first. KI: Hypersensitivity P: Symptoms of neomycin sensitization include itching, reddening, edema, failure to heal; prolonged use may result in glaucoma, defects in visual acuity, posterior subcapsular cataract formation, and secondary ocular infections ES: 1-10%: Dermatologic: Itching Local: Reddening, failure to heal Ocular: Low grade conjunctivitis IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Idoxuridine -- Analog of thymidine. Blocks reproduction of herpes simplex virus by producing incorrect DNA copies that prevent the virus from infecting or destroying tissue. A 15-40% resistance rate has been reported. Has not been studied for smallpox infections and for treatment of orthopoxviruses in humans. Benefit is theoretical. I: virus infections of the eye BSO: Tetes mata 0.1% D: 1 gtt q1h during the day and q2h at night initially for 7 d; then, reduce 1 gtt q2h during the day and q4h at night; for 3-7 d maximum treatment period is approximately 21 d Alternatively, instill 1 gtt q1min for 5 min and repeat q4h (day and night); KI: Hipersensitif IO: Coadministration with solutions that contain boric acid may result in precipitate formation, which may cause irritation Preg: C P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


May cause clouding of the cornea, blurred vision, or lacrimal punctal occlusions; some strains of herpes simplex appear to be resistant; use alternate therapy if no lessening of fluorescein staining in 14 d; do not exceed recommended frequency and duration of administration Nama Dagang: Isotic Ixodine



B. Anti Inflamasi Fluorometholone Betamethasone Diclofenac



Fluorometholone I: Inflammation of the eye and conjunctiva BSO: Ophthalmic Suspension: 0.1% D: Ophthalmic ointment: 1-3x/hari Ophthalmic suspension (eye drops): 1-2 drops 2-4x/d KI: Fungal eye infection, ocular tuberculosis, Untreated bacterial eye infection, Viral infections of the eye P: Any disease causing thinning of the outer layers of the eye (cornea and sclera), Inflammation of the front of the eye (cornea) caused by infection with the herpes simplex virus (herpes simplex keratitis), Recent cataract surgery ES: cataracts, Visual disturbances, Perforation of the eye ball, Skin thinning and development of visible veins and/or skin stripes around the eye, Spreading and worsening of infection, glaucoma IO: Preg:: A, B, C, D, X Nama Dagang: Flumetholon Genghis Khun ([email protected],nafanakhun.wordpress.com)


Betamethasone Medium-strength topical corticosteroid Suppressing migration of PMN, leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells. I: Seborrheic or atopic dermatitis, neurodermatitis, anogenital pruritus, psoriasis, inflammatory phase of xerosis BSO: 0.05-0.1% oint for adults and 0.05% for pediatrics.Tetes mata 0.1%. Krim 0.1% D: 1-2 tetes 12x/hr KI: Glaucoma, Herpes simplex virus infection of the eye, allergy, Perforated ear drum, Red eye due to unknown causes, Tuberculosis, Viral, bacterial or fungal infections in the area P: ES: Spreading of infection, glaucoma, Visual disturbances, bronchospasm, epistaxis, Local sensitivity reactions, IO: Preg: C, D pada trim 1 Nama Dagang: Celestone Genghis Khun ([email protected],nafanakhun.wordpress.com)


C. Antibiotik & Antiinflamasi



D. Anti Alergi Lodoxamide Pemirolast



Lodoxamide 0,1% I: Allergic conjunctivitis BSO: Solution, ophthalmic: 0.1% D: 1 drop 4x/day for 3 mo KI: Known sensitivity or allergy to any ingredient P: Safety and efficacy in children <2 years of age have not been established; not for injection; not for use in patients wearing soft contact lenses during treatment ES: Headache, Blurred vision, Flushing, Itchiness of the eye, Dry eyes, lacrimation, Dizziness and nausea, Formation of crust on the margin of eyelid, Red eye due to excess blood supply (hyperaemia), Burning and stinging on instillation IO: Preg: B Nama Dagang: Alomide



Pemirolast K I: Prevent itching of the eye due to allergic conjunctivitis BSO: Solution, ophthalmic: 0.1% D: 1-2 drops 4x/day KI: Hypersensitivity P: Safety and efficacy in children <3 years of age have not been established; not for injection or oral use; ophthalmic use only; not indicated to treat contact lens irritation; do not wear contact lens if eye is red. In non-red eyes, soft contact lenses should not be applied for 10 minutes after the instillation of pemirolast potassium to avoid absorption of lauralkonium chloride (a preservative in Alamast™). ES: >10%: Headache, Rhinitis, Cold/flu symptoms, <5%: Fever, Dysmenorrhea, Burning eyes, dry eyes, foreign body sensation, ocular discomfort, Back pain, Bronchitis, cough, sinusitis, sneezing/nasal congestion IO: Preg: C Nama Dagang: Alegysal Genghis Khun ([email protected],nafanakhun.wordpress.com)


E. OKULAR DEKONGESTAN Naphazoline Tetrahydrozoline Olopatadine



Naphazoline HCl I: Topical ocular vasoconstrictor; will temporarily relieve congestion, itching, and minor irritation, and to control hyperemia in patients with superficial corneal vascularity; treatment of nasal congestion; adjunct for sinusitis BSO: Solution: Drops & Spray: 0.05% Ophthalmic: 0.012%; 0.02%; 0.03%; 0.1% D: 1 drop 3x/day Rebound congestion may occur with extended use; use with caution in the presence of hypertension, diabetes, hyperthyroidism, heart disease, coronary artery disease, cerebral arteriosclerosis, or long-standing bronchial asthma KI: Hypersensitivity to naphazoline or any component, narrowangle glaucoma, prior to peripheral iridectomy (in patients susceptible to angle block) P: Rebound congestion may occur with extended use; use with caution in the presence of hypertension, diabetes, hyperthyroidism, heart disease, coronary artery disease, cerebral arteriosclerosis, or long-standing bronchial asthma Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: 1% to 10%: Central nervous system: Dizziness, headache, nervousness Gastrointestinal: Nausea Local: Transient stinging, nasal mucosa irritation, dryness, rebound congestion Ocular: Mydriasis, increased intraocular pressure, blurring of vision Respiratory: Sneezing IO: Preg: C Nama Dagang:



Tetrahidrozoline HCl 0,5% Adrenergic Agonist Agent; Ophthalmic Agent, Vasoconstrictor I: Nasal congestion and conjunctival congestion BSO: Ophthalmic: 0.05% D: Nasal congestion: Intranasal: Children 2-6 years: 2-3 drops of 0.05% solution q4-6 hours. Adults: 2-4 drops 0.1% sol q3-4 hours. no more frequent than every 3 hours Conjunctival congestion: Ophthalmic: 1-2 drops 2-4 times/day ES: >10%: Transient stinging, Sneezing 1% to 10%: Tachycardia, palpitations, hypertension, heart rate, Headache, Tremor, Blurred vision IO: Increased toxicity: MAO inhibitors can cause an exaggerated adrenergic response if taken concurrently or within 21 days of discontinuing MAO inhibitor; beta-blockers can cause hypertensive episodes and increased risk of intracranial hemorrhage; anesthetics Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Phenylephrine hydrochloride Alpha/Beta Agonist; Ophthalmic Agent, Antiglaucoma; Ophthalmic Agent, Mydriatic I: Hypotension, vascular failure in shock; as a vasoconstrictor in regional analgesia; symptomatic relief of nasal and nasopharyngeal mucosal congestion; as a mydriatic in ophthalmic procedures and treatment of wide-angle glaucoma; supraventricular tachycardia BSO: Injection: 1% [10 mg/mL] Nasal solution: Drops: 0.125%: 0.16%: 0.25%: 0.5% Spray: 0.25%: 0.5% , 1% Ophthalmic solution: 0.12%: 2.5%: 10% D: Ophthalmic procedures: Infants <1 year: 1 drop of 2.5% 15-30 minutes pre-op Adults: 1 drop of 2.5-10% solution, q10-60 minutes. Nasal decongestant: (should not exceed 5 continuous days) 2-6 years: 1 drop q2-4 hours of 0.125% solution 6-12 years: 1-2 sprays/ drops q4 hours of 0.25% solution Adults: 1-2 sprays/ drops q4 hours of 0.25% to 0.5% Genghis Khun ([email protected],nafanakhun.wordpress.com)


; 1% solution may be used in adult in cases of extreme nasal congestion; do not use nasal solutions more than 3 days Hypotension/shock: Children: I.M., S.C.: 0.1 mg/kg/dose q1-2 hours (max 5 mg) I.V. bolus: 5-20 mcg/kg/dose q10-15 minutes I.V. infusion: 0.1-0.5 mcg/kg/minute Adults: I.M., S.C.: 2-5 mg/dose q1-2 hours (max 5 mg) I.V. bolus: 0.1-0.5 mg/dose q10-15 minutes (max 0.5 mg) I.V. infusion: 10 mg in 250 mL D5W or NS (1:25,000 dilution) (40 mcg/mL); start at 100-180 mcg/minute (2-5 mL/minute; 50-90 drops/minute) initially; when blood pressure is stabilized, maintenance rate: 40-60 mcg/minute (20-30 drops/minute) Paroxysmal supraventricular tachycardia: I.V.: Children: 5-10 mcg/kg/dose over 20-30 seconds Adults: 0.25-0.5 mg/dose over 20-30 seconds Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hypersensitivity to phenylephrine, bisulfite (some products contain metabisulfite), or any component; hypertension; ventricular tachycardia P: Use with caution in the elderly, patients with hyperthyroidism, bradycardia, partial heart block, myocardial disease, or severe CAD. Not a substitute for volume replacement. Avoid hypertension; monitor blood pressure closely and adjust infusion rate. Infuse into a large vein if possible. Watch I.V. site closely. Avoid extravasation. The elderly can be more sensitive to side effects from the nasal decongestant form. Rebound congestion can occur when the drug is discontinued after chronic use. ES: Headache, anxiety, weakness, dizziness, tremor, paresthesia, Metabolic acidosis, blanching of skin, Pilomotor response, Decreased renal perfusion, reduced urine output, reduced urine output, Respiratory distress IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Olopatadine Antihistamine; Ophthalmic Agent, Miscellaneous I: Seasonal allergic conjunctivitis BSO: Solution, ophthalmic: 0.1% D: 0.1% solution: 1 drop 2x/day. 0.2% solution: 1x/day KI: Allergy to any ingredient P: Disorders of the back of the eye (cornea), Dry eyes ES: Headache, Blurred vision, Dry mouth, photophobia, Dizziness, Itchiness of the eye, Dry eyes, asthenia, Dry nose, keratitis, hyperaemia, Sensation of something in the eye, Discharge from the eye, Fluid retention and swelling of the eyelid, Eye discomfort IO: Preg: C Nama Dagang: Patanol



F. MIDRIATIKUM Atropine



Atropine sulfate 0,5-1% Anticholinergic; Antidote; Antispasmodic; Mydriatic I: Preoperative medication to inhibit salivation and secretions; treatment of sinus bradycardia; treatment of exercise-induced bronchospasm; antidote for organophosphate pesticide poisoning; to produce mydriasis and cycloplegia for examination of the retina and optic disc and accurate measurement of refractive errors; uveitis == Topical: Dilating the pupil, uveitis BSO: Injection: 0.1 mg/mL; 0.3 mg/mL; 0.4 mg/mL; 0.5 mg/mL; 0.8 mg/mL; 1 mg/mL Ointment & Solution, ophthalmic: 0.5%, 1% Tablet: 0.4 mg D: Note: Doses <0.1 mg have been associated with paradoxical bradycardia. Preanesthetic: Oral, I.M., I.V., S.C.: <5 kg: 0.02 mg/kg/dose 30-60 minutes preop then every 4-6 hours as needed. Use of a minimum dosage of 0.1 mg in Genghis Khun ([email protected],nafanakhun.wordpress.com)


neonates <5 kg will result in dosages >0.02 mg/kg. There is no documented minimum dosage in this age group. >5 kg: 0.01-0.02 mg/kg/dose to a maximum 0.4 mg/dose 30-60 minutes preop; minimum dose: 0.1 mg Bradycardia: I.V., intratracheal: 0.02 mg/kg, minimum dose 0.1 mg, maximum single dose: 0.5 mg in children and 1 mg in adolescents; may repeat in 5-minute intervals to a maximum total dose of 1 mg in children or 2 mg in adolescents. ( Note: For intratracheal administration, the dosage must be diluted with normal saline to a total volume of 1-2 mL). When treating bradycardia in neonates, reserve use for those patients unresponsive to improved oxygenation and epinephrine. Children: Bronchospasm: Inhalation: 0.03-0.05 mg/kg/dose 3-4 times/day Preprocedure: Ophthalmic: 0.5% solution: Instill 1-2 drops twice daily for 1-3 days before the procedure Uveitis: Ophthalmic: 0.5% solution: Instill 1-2 drops up to 3 times/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Adults (doses <0.5 mg have been associated with paradoxical bradycardia): Asystole: I.V.: 1 mg; may repeat every 3-5 minutes as needed Preanesthetic: I.M., I.V., S.C.: 0.4-0.6 mg 30-60 minutes preop and repeat every 4-6 hours as needed Bradycardia: I.V.: 0.5-1 mg every 5 minutes, max a total of 2 mg or 0.04 mg/kg; may give intratracheal in 1 mg/10 mL dilution only, intratracheal dose should be 2-2.5 times the I.V. dose Neuromuscular blockade reversal: I.V.: 25-30 mcg/kg 30 seconds before neostigmine or 10 mcg/kg 30 seconds before edrophonium Organophosphate or carbamate poisoning: I.V.: 1-2 mg/dose every 10-20 minutes until atropine effect (dry flushed skin, tachycardia, mydriasis, fever) is observed, then every 1-4 hours for at least 24 hours; up to 50 mg in first 24 hours and 2 g over several days may be given in cases of severe intoxication Bronchospasm: Inhalation: 0.025-0.05 mg/kg/dose every 4-6 hours as needed (maximum: 5 mg/dose) Ophthalmic solution: 1%: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Preprocedure: Instill 1-2 drops 1 hour before the procedure. Uveitis: Instill 1-2 drops 4 times/day. Ophthalmic ointment: Apply a small amount in the conjunctival sac up to 3 times/day. Compress the lacrimal sac by digital pressure for 1-3 minutes after instillation. KI: Hypersensitivity; narrow-angle glaucoma; adhesions between the iris and lens; tachycardia; unstable cardiovascular status in acute hemorrhage; obstructive GI disease; paralytic ileus; intestinal atony of the elderly or debilitated patient; severe UC; toxic megacolon complicating UC; hepatic disease; obstructive uropathy; renal disease; myasthenia gravis; asthma; thyrotoxicosis P: Heat prostration can occur in the presence of a high environmental temperature. Rule out intestinal obstruction before treating diarrhea. Psychosis can occur in sensitive individuals. The elderly may be sensitive to side effects. Use caution in patients with myocardial ischemia. Use caution in hyperthyroidism, autonomic neuropathy, BPH, CHF, tachyarrhythmias, hypertension, and hiatal hernia associated Genghis Khun ([email protected],nafanakhun.wordpress.com)


with reflux esophagitis. Use with caution in children with spastic paralysis. ES: >10%: Dry, hot skin, Impaired GI motility, constipation, dry throat, dry mouth, Irritation at injection site, Dry nose, Sweating (decreased) 1% to 10%: Increased sensitivity to light, Decreased flow of breast milk, Dysphagia IO: Phenothiazine and TCAs may increase anticholinergic effects when used concurrently. Sympathomimetic amines may cause tachyarrhythmias; avoid concurrent use. Preg: C Nama Dagang: Isotic cycloma Tetes mata 10 mg/cc



G. MIOTIKUM Betaxolol Acetylcholine



Betaxolol I: Treatment of chronic open-angle glaucoma and ocular hypertension; management of hypertension BSO: Solution, ophthalmic: 0.5% D: Adults: Oral: 10 mg/day; increase 20 mg/day after 7-14d. Initial dose in elderly & renal impairment: 5 mg/day. Can increase every 2 weeks up to a maximum of 20 mg/day. Clcr <10 mL/minute: Administer 50% of usual dose. KI: Hypersensitivity to betaxolol or any component; sinus bradycardia; heart block greater than first-degree (except in patients with a functioning artificial pacemaker); cardiogenic shock; uncompensated cardiac failure; pulmonary edema; pregnancy (2nd and 3rd trimester) P: Administer cautiously in compensated heart failure and monitor for a worsening of the condition. Avoid abrupt discontinuation in patients with a history of CAD; slowly wean while monitoring for signs and symptoms of ischemia. Use caution with concurrent use of beta-blockers and either verapamil or diltiazem; bradycardia or heart block can occur. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Use caution in patients with PVD (can aggravate arterial insufficiency). In general, beta-blockers should be avoided in patients with bronchospastic disease. Betaxolol, with B1 selectivity, should be used cautiously in bronchospastic disease with close monitoring. Use cautiously in diabetics because it can mask prominent hypoglycemic symptoms. Can mask signs of thyrotoxicosis. Can cause fetal harm when administered in pregnancy. Dosage adjustment required in severe renal impairment and those on dialysis. Use care with anesthetic agents which decreases myocardial function. ES: Ophthalmic: >10%: Ocular: Conjunctival hyperemia 1% to 10%: Ocular: Anisocoria, corneal punctate keratitis, keratitis, corneal staining, decreased corneal sensitivity, eye pain, vision disturbances Systemic:>10%: Central nervous system: Drowsiness, insomnia Endocrine & metabolic: Decreased sexual ability 1% to 10%: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cardiovascular: Bradycardia, palpitations, edema, congestive heart failure, reduced peripheral circulation Central nervous system: Mental depression Gastrointestinal: Diarrhea or constipation, nausea, vomiting, stomach discomfort Respiratory: Bronchospasm Miscellaneous: Cold extremities IO: CYP1A2 and 2D6 enzyme substrate Clonidine; Hypertensive crisis after or during withdrawal of either agent. Drugs which slow AV conduction (digoxin): Effects may be additive with beta-blockers. Glucagon: Betaxolol may blunt the hyperglycemic action of glucagon. Insulin and oral hypoglycemics: May mask tachycardia from hypoglycemia. NSAIDs (ibuprofen, indomethacin, naproxen, piroxicam) may reduce the antihypertensive effects of beta-blockers. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Salicylates may reduce the antihypertensive effects of betablockers. Sulfonylureas: Beta-blockers may alter response to hypoglycemic agents. Verapamil or diltiazem may have synergistic or additive pharmacological effects when taken concurrently with betablockers. Preg: C Nama Dagang:Betoptima



Acetylcholine I: To obtain rapid and complete constriction of the pupil during eye surgery (lens delivery in cataract surgery, corneal transplant (keratoplasty), removal of part of the iris (iridectomy) or other surgery on the front of the eye). BSO: Powder, intraocular: 1:100 [10 mg/mL] D: Adults: Intraocular: 0.5-2 mL of 1% injection instilled into anterior chamber before or after securing one or more sutures KI: Breastfeeding, Pregnancy P: ES: Difficulties with breathing, Sweating, hypotension, Flushing, bradycardia IO: Preg: C Nama Dagang: Miochol-E Genghis Khun ([email protected],nafanakhun.wordpress.com)


H. GLUKOMA Sudut Terbuka & Tertutup Kronik Acetazolamide Latanoprost Timolol Betaxolol Brinzolamide Travoprost Pilocarpine



Acetazolamide I: Epilepsy, oedema, secondary glaucoma, Open angle glaucoma, Prior to surgery for suddenly severe closed angle glaucoma BSO: Capsule, sustained release: 500 mg (not recommended for treatment of epilepsy) Injection: 500 mg Tablet: 125 mg, 250 mg D: Note: I.M. administration is not recommended because of pain secondary to the alkaline pH Children: Glaucoma: Oral: 8-30 mg/kg/day or 300-900 mg/m2/day q8 hours I.M., I.V.: 20-40 mg/kg/24 hours q6 hours, max 1 g/day Edema: Oral, I.M., I.V.: 5 mg/kg or 150 mg/m2 once every day Epilepsy: Oral: 8-30 mg/kg/day in 1-4 divided doses, max 1 g/day Adults: Glaucoma: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Chronic simple (open-angle): Oral: 250 mg 1-4 x/day or 500 mg sustained release capsule 2x/daily Secondary, acute (closed-angle): I.M., I.V.: 250-500 mg, may repeat in 2-4 hours to a max of 1 g/day Edema: Oral, I.M., I.V.: 250-375 mg once daily Epilepsy: Oral: 8-30 mg/kg/day in 1-4 divided doses Altitude sickness: Oral: 250 mg every 8-12 hours (or 500 mg extended release capsules q12-24 hours) Therapy should begin 24-48 hours before and continue during ascent and for at least 48 hours after arrival at the high altitude Urine alkalinization: Oral: 5 mg/kg/dose repeated 2-3 times over 24 hours Elderly: Oral: Initial: 250 mg 2x/day; use lowest effective dose Dosing adjustment in renal impairment: Clcr 10-50 mL/minute: Administer every 12 hours Clcr <10 mL/minute: Avoid use ineffective Hemodialysis: Moderately dialyzable (20% to 50%) Peritoneal dialysis: Supplemental dose is not necessary Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Allergy, Chronic non-congestive glaucoma, Failure of the adrenal glands, hyperchloraemic acidosis, hypokalaemia, hyponatraemia, Severe kidney & liver disease P: Pulmonary obstruction, Decreased liver function, Elderly people, Emphysema, nephrolithiasis, Potential blockage of the urinary tract, Unstable balance of salts in the body ES: Headache, Thirst, Changes in mood, Fatigue, Decreased appetite, paraesthesia, Dizziness, Flushing, polyuria IO: Preg: C Nama Dagang: Diamox



Latanoprost I: Open angle glaucoma, ocular hypertension BSO: Solution, ophthalmic: 0.005% D: 1 drop 1x/d in the evening. KI: Pregnancy, Breastfeeding, children. P: Closed angle glaucoma, pigmentary glaucoma, inflammatory glaucoma, neovascular glaucoma, congenital glaucoma, conjunctivitis, pseudophakia, aphakia, Closed or blocked retinal vein, diabetic retinopathy, Asthma. ES: Temporary blurred vision, Change in colour of the iris, Eye irritation, hyperaemia, blepharitis, Eye pain, Rash, oedema, iritis, uveitis, macular oedema, Swelling or erosions of the cornea, Darkening of the eyelid(s), dyspnoea, Worsening of asthma, Chest pain, Headache, Dizziness. IO: Decreased effect: In vitro studies have shown that precipitation occurs when eye drops containing thimerosal are mixed with latanoprost. If such drugs are used, administer with an interval of at least 5 minutes between applications Preg: C Genghis Khun ([email protected],nafanakhun.wordpress.com)


Timolol I: Ocular hypertension, Open angle glaucoma, 2nd glaucoma BSO: Solution, ophthalmic: 0.25%; 0.5% D: 1 drop 2x/d KI: Allergy, asthma, COPD, sinus bradycardia, 2nd or 3rd degree heart block, Heart failure, cardiogenic shock, Prinzmetal's angina, hypotension, Raynaud's disease, phaeochromocytoma, children. P: Sick sinus syndrome, 1st degree heart block, History of severe heart disease, metabolic acidosis, Hyperthyroidism, Diabetes, History of allergies, anaphylaxis, Psoriasis, myaesthenia gravis ES: Blurred vision, conjunctivitis, blepharitis, keratitis, Dry eyes, Double vision, ptosis, Headache, Fatigue, Chest pain, Allergic skin reactions, Disturbed sleep, Depression, hypotension, Dizziness, Cold hands and feet, bradycardia, nausea, vomiting, diarrhoea, indigestion, Heart block or heart failure, dyspnoea Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Brinzolamide I: Open angle glaucoma, ocular hypertension BSO: Suspension, ophthalmic: 1% D: 1drop 3x/day KI: Allergy, hyperchloraemic acidosis, Severely decreased kidney function P: Closed angle glaucoma, Contact lens wearers, Diabetes, Dry eyes, Elderly people, ciliary body, pigmentary glaucoma ES: Headache, Blurred vision, Bitter taste, conjunctivitis, Itchiness of the eye, blepharitis, Disorders of the front layer of the eye (cornea), keratitis, Dry eyes, Formation of crust on the margin of eyelid, hyperaemia, Temporary burning and stinging on application, Sensation of something in the eye, Tiredness of the eye, Discharge from the eye IO: Concurrent use of oral carbonic anhydrase inhibitors (CAIs) - additive effects and toxicity. High-dose salicylates may result in toxicity from CAIs Preg: C Nama Dagang: Azopt Genghis Khun ([email protected],nafanakhun.wordpress.com)


Travoprost I: Open angle glaucoma, ocular hypertension. BSO: Lar mata 0.004% D: 1 drop 1x in the evening. KI: Pregnancy, Breastfeeding, children < 18 years, P: Closed angle glaucoma, neovascular glaucoma, pigmentary glaucoma, pseudoexfoliative glaucoma, congenital glaucoma, Thyroid eye disease, conjunctivitis, pseudophakia, aphakia, Closed or blocked retinal vein, diabetic retinopathy, Disorders of cornea, Dry eyes, Severe or poorly controlled asthma. ES: Conjunctival Hyperaemia, Darkening, thickening and lengthening of the eyelashes, Change in colour of the iris, sensation, Itchiness, dry & pain of the eye(s), photophobia, conjunctivitis, oedema, blepharitis, iritis, uveitis, Headache, Darkening of the eyelid(s) or skin around the eye(s), hypotension, bradycardia, Worsening of asthma, macular oedema Preg: C Nama Dagang: Travatan Genghis Khun ([email protected],nafanakhun.wordpress.com)


Pilocarpine Cholinergic Agonist, Antiglaucoma, Miotic I: glaucoma BSO: Gel: 4%, Tablet: 5 mg Solution: 0.25%; 0.5%; 1%; 2%; 3%; 4%; 6%; 8%; 10% D: Solution: Chronic glaucoma: 1 drop 4x/day Acute angle-closure glaucoma: 1 drop q5-10’ for 3-6 doses Then 1 drop q1-3h Gel: 1x bedtime, Eye insert: 1x q1wk KI: Children, secondary glaucoma, allergy, acute iritis P: Asthma, Certain diseases of the eye, Dark coloured eyes Heart disease, hypertension, Obstruction of the urinary tract, Parkinson's disease, Peptic ulcer ES: Headache, Blurred vision, browache, Congestion of conjunctiva, myopia, vitreous haemorrhage, pupillary block, Burning, itching and painful sensations in the eye, Constriction of the pupils, Retinal detachment Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


I. KATARAK Pirenoxine Azapentacene



Pirenoxine I: Permulaan katarak senilis BSO: Tetes 0.05 mg/cc. Larutan mata 750 mcg/tab D: 1-2 tts 3-5x/hr KI: P: ES: keratitis superfisialis, blefaritis marginalis, gatal, pruritus IO: Preg:: A, B, C, D, X Nama Dagang:



Azapentacene I: Katarak senilis, traumatic, congenital & katarak sekunder BSO: Tetes mata 0.15 mg/cc D: 2 tts 3-5x/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Pentacin



J. KESEHATAN MATA Billberry dry extract



Bilberry dry extract I: Memelihara kesehatan mata BSO: Kaps 80 mg D: 80 mg/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



K. Preparat Mata Lain Verteporfin Polyvinyl alcohol Pemirolast



Verteporfin I: Predominantly classical subfoveal choroidal neovascularisation OR occult subfoveal choroidal neovascularisation with disease progression due to wet agerelated macular degeneration Subfoveal choroidal neovascularisation secondary to progessive short-sightedness (pathological myopia) Pathologic myopia, Ocular histoplasmosis BSO: D: KI: Breastfeeding, porphyrias, Severely decreased liver function P: Biliary obstruction, Moderately decreased liver function ES: Blurred vision, Nausea, Sweating, photosensitivity, Back pain, Dizziness, vitreous haemorrhage, pruritis, asthenia, Chest pain, Retinal detachment, syncope, sub-retinal haemorrhage, hypercholesterolemia, Abnormal vision such as dark haloes, flashes of light, black spots, decreased vision Nama Dagang: Visudyne Genghis Khun ([email protected],nafanakhun.wordpress.com)


Polyvinyl alcohol I: Dry eye conditions BSO: Tetes Mata 1.4% D: 1-2 tts KI: # Known sensitivity or allergy to any ingredient # Soft contact lens wearers P: ES: # Blurred vision after application # Eye burning/stinging IO: Preg:: A, B, C, D, X Nama Dagang: Optifresh



Pemirolast Mast Cell Stabilizer; Ophthalmic Agent, Miscellaneous I: Prevent itching of the eye due to allergic conjunctivitis BSO: Solution, ophthalmic: 0.1% D: Children >3 years and Adults: 1-2 drops 4 times/day KI: Hypersensitivity P: Safety and efficacy in children <3 years of age have not been established; not for injection or oral use; not indicated to treat contact lens irritation; do not wear contact lens if eye is red. In non-red eyes, soft contact lenses should not be applied for 10 minutes after the instillation of pemirolast potassium to avoid absorption of lauralkonium chloride. ES: >10%: Headache, Rhinitis, Cold/flu symptoms <5%: Fever, Dysmenorrhea, Burning eyes, dry eyes, foreign body sensation, ocular discomfort, Back pain, Bronchitis, cough, sinusitis, sneezing/nasal congestion IO: Preg: C Nama Dagang:Alegysal Genghis Khun ([email protected],nafanakhun.wordpress.com)


XI. PREPARAT KULIT A. ANTISEPTIK & DESINFEKTAN B. KORTIKOSTEROID C. ANTIBIOTIKA D. FUNGISIDA E. SCABICID E. ANTIVIRUS F. ANALGESIC & ANTI INFLAMASI G. PELINDUNG KULIT H. ANTIHISTAMIN & PRURITUS I. ANTI AKNE J. PEMUTIH K. KERATOLITIK L. SUN BLOCK/ TABIR SURYA M. ANTI ALOPESIA N. PREPARAT PSORIASIS, SEBOROIK & IKTIOSIS O. LAIN Genghis Khun ([email protected],nafanakhun.wordpress.com)


A. Antiseptik & Desinfektan Povidone Iodine Chlorhexidine gluconate Policresulen Feracrylum



Chlorhexidine Gluconate I: active against gram-+ and gram-- organisms, facultative anaerobes, aerobes, and yeast BSO: Chip, for periodontal pocket insertion: 2.5 mg Foam & Liquid, topical, with isopropyl alcohol 4%: 2%; 4% Skin Cleanser: 4% Rinse: Oral : 0.12% with alcohol 11.6% Topical: 0.5% with isopropyl alcohol 70% Sponge/Brush: 4% with isopropyl alcohol 4% Wipes : 0.5% D: Adults: Precede use of solution by flossing and brushing teeth; completely rinse toothpaste from mouth. Swish 15 mL undiluted oral rinse around in mouth for 30 seconds, then expectorate. Avoid eating for 2-3 hours after treatment. Ginggivitis: 2x q6 months. Cleanser: Wash for 15 seconds and rinse Hand rinse: Rub 15 seconds and rinse Genghis Khun ([email protected],nafanakhun.wordpress.com)


Periodontal chip: Adults: inserted into a periodontal pocket with a probing pocket depth greater than or equal to 5 mm. Up to 8 chips may be inserted in a single visit q3 months in pockets with a remaining depth greater than or equal to 5 mm. If dislodgment occurs 7 days or more after placement, the subject is considered to have had the full course of treatment. If dislodgment occurs within 48 hours, a new chip should be inserted. KI: Hypersensitivity P: Staining of oral surfaces, tooth restorations, and dorsum of tongue may occur; keep out of eyes and ears; for topical use only; there have been case reports of anaphylaxis following chlorhexidine disinfection ES: >10%: Increase of tartar on teeth, changes in taste. Staining of oral surfaces, Stain does not have a clinically adverse effect but because removal may not be possible, patient with frontal restoration should be advised of the potential permanency of the stain. Preg: B Genghis Khun ([email protected],nafanakhun.wordpress.com)


Policresulen I: Hemostatik. Pembersihan & regenerasi jaringan pd luka baker, luka,proses inflamasi kronik, lesi dekubitus, ulkus kruris, kondiloma akuminata, stomatitis aftosa, vaginosis bacterial, kandidiasis vaginal, trikomoniasis D: Hemostasis local: gunakan langsung Luka bakar: larutan 1:3 s/d 1:8 KI: P: ES: IO: Preg:: A, B, C, D, X BSO: Nama Dagang: Albothyl



Feracrylum I: Mengurangi perdrahan pada luka, membersihkan luka luar & luka sesuadh operasi. Antiseptik pd luka bakar BSO: Lar 1 % D: Kompres 1-3 menit KI: Tidak boleh digunakan bersama asam aminokaproat P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Hemolok



B. Kortikosteroid Hydrocortisone Beclomethasone Triamcinolone acetonide Desonide Alclometasone Fluticasone Fluprednidene Mometasone furoate Prednicarbate Fluocinolone acetonide Diflucortolone Desoximetasone Betamethasone Methylprednisolone Clobetasol propionate Halcinonide Genghis Khun ([email protected],nafanakhun.wordpress.com)


Desonide Potensi Sedang (low potency corticosteroid) I: Dermatitisatopik & kontak, ekzema terutama pd anak, psoriasis, pruritus pd anus & vulva, eritema akibat terbakar sinar matahari & dermatitislain BSO: Krim 0.5 mg/g D: Oles 2-3x/hr KI: Known hypersensitivity to desonide, fungal infections, tuberculosis of skin, herpes simplex P: Use with caution in patients with impaired circulation, skin infections ES: <1%: Itching, dry skin, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin maceration, skin atrophy, striae; local burning, irritation, miliaria; secondary infection IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Alclometasone Potensi Sedang (low potency topical corticosteroid) I: Eczema, Inflammation of the skin (dermatitis), Inflammatory skin disorders BSO: Cream, Ointment, topical: 0.05% D: Topical: Apply a thin film to the affected area 2-3 times/day. KI: Acne vulgaris, acne rosacea, Herpes simplex, chickenpox, fungi (eg thrush, ringworm, athlete's foot) or bacteria (eg impetigo), perioral dermatitis, Tuberculosis infection of the skin P: Children ES: Changes in skin pigmentation, Stretch marks (striae), Groupings of fine blood vessels becoming prominent under the skin (telangiectasia), Thinning of the skin IO: Preg: C Nama Dagang:



Fluprednidene Potensi Sedang I: BSO: Krim 0.1% D: 1x/hr sesudah mandi KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Prednicarbate Potensi Kuat, medium potency topical corticosteroid I: Relief of the inflammatory and pruritic manifestations of corticosteroid-responsive dermatoses BSO: Krim 2.5 mg/g D: Oles 1-2x/hr selama 4 mggu KI: Hypersensitivity to prednicarbate or any component; fungal, viral, or tubercular skin lesions, herpes simplex or zoster P: Systemic absorption of topical corticosteroids has produced reversible HPA axis suppression. This is more likely to occur when the preparation is used on large surface or denuded areas for prolonged periods of time or with an occlusive dressing. ES: <1%: Pruritus, edema, urticaria, burning, allergic contact dermatitis and rash, folliculitis, acneiform eruptions, hypopigmentation, perioral dermatitis IO: Preg: C Nama Dagang: Dermatop Genghis Khun ([email protected],nafanakhun.wordpress.com)


Fluocinolone acetonide Potensi Kuat [low, medium, high potency topical corticosteroid] I: prurigo, Eczema, otitis externa, contact dermatitis, seborrhoeic dermatitis, discoid lupus erythematosus (DLE), Inflammatory skin disorders, Psoriasis, lichen planus, neurodermatitis BSO: Krim 0.25 mg/g.Salep 0.25 mg/g. Gel 0.025% D: 3-4x/hr. Gel: malam hari KI: Acne vulgaris, Children less than 1 year of age, acne rosacea, Herpes simplex, chickenpox, fungi (eg thrush, ringworm, athlete's foot) or bacteria (eg impetigo), perioral dermatitis, Itching around the back passage and genitals, Nappy rash, Widespread plaque psoriasis P: ES: IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Diflucortolone Potensi Kuat I: Discoid lupus erythematosus (DLE), Psoriasis, Severe eczema, Severe inflammatory skin disorders, lichen planus, neurodermatitis BSO: Krim 0.1% D: Oles 2-3x/hr KI Acne rosacea, Acne vulgaris, Children under four years of age, Infections of the skin, perioral dermatitis, Itching around the back passage and genitals, Nappy rash: P: Children, Psoriasis ES: Thinning of the skin, Acne, Stretch marks (striae), telangiectasia, hypertrichosis) IO: Preg:: A, B, C, D, X Nama Dagang:



Desoximetasone Potensi Kuat [medium to high potency topical corticosteroid] I: BSO: Krim 0.25% D: Oles 1-2x/hr KI: Known hypersensitivity to desoximetasone, topical fungal infections, tuberculosis of skin herpes simplex P: Use with caution in patients with impaired circulation; skin infections ES: <1%: Itching, dry skin, folliculitis, hypertrichosis, acneiform eruptions, allergic contact dermatitis, skin maceration, skin atrophy, striae, perioral dermatitis, hypopigmentation; local burning, irritation, miliaria; secondary infection IO: Preg: C Nama Dagang:



Clobetasol propionate Potensi sangat Tinggi (very high potency topical corticosteroid) I: Eczema unresponsive to weak steroid creams, Psoriasis, Severe inflammatory skin disorders D: 1-2x/hr KI: Acne vulgaris, Children less than 1 year of age, acne rosacea, Infections of the skin, perioral dermatitis, Itching around the back passage and genitals, Widespread plaque psoriasis P: Children, Psoriasis ES: Thinning of the skin, Changes in skin pigmentation, Stretch marks (striae), telangiectasia, hypertrichosis IO: Preg: C BSO: 0,05% krim, salep, aplikasi kulit kepala Nama Dagang:



Halcinonide Potensi Kuat [high potency topical corticosteroid] I: Inflammation of corticosteroid-responsive dermatoses BSO: 0,1% krim, solution, Tinkt D: Oles 2-3x/hr KI: Viral, fungal, or tubercular skin lesions, known hypersensitivity to halcinonide or any component P: Adverse systemic effects may occur when used on large areas of the body, denuded areas, for prolonged periods of time, with an occlusive dressing, and/or in infants or small children ES: <1%: Itching, dry skin, folliculitis, hypertrichosis, acneiform eruptions, hypopigmentation, perioral dermatitis, allergic contact dermatitis, skin maceration, skin atrophy, striae; local burning, irritation, miliaria; secondary infectionroid] IO: Preg: C Nama Dagang: Halog Genghis Khun ([email protected],nafanakhun.wordpress.com)


C. Antibiotika Silver Sulfadiazine Gentamicin Chloramphenicol Neomycin Tetracycline Erythromycin Mupirocin Fusidic acid Framycetin



Silver sulfadiazine I: Abrasions, burns, leg ulcers and pressure sores BSO: Cream, topical: 1% [10 mg/g] D: Apply 1-2x/d KI: neonates, Heavily weeping (exudative) leg or pressure ulcers, Premature infants, Term or near term pregnancy P: # Allergy, Decreased kidney & liver function # Lack of the enzyme G6PD in the blood (G6PD deficiency) ES: # Itching (pruritus) # Burning sensation # Rash # hypersensitivity # leucopenia IO: Preg: B Nama Dagang:



Mupirocin I: Bacterial skin infections, Eradication of Staphylococcal bacteria from the nostrils to prevent and treat infection BSO: Salep 2%. Krim 20 mg/g D: apply 3x/day KI: Known sensitivity or allergy to any ingredient P: ES: Skin irritation, Stinging on application, Itching (pruritis) IO: Preg:: A, B, C, D, X Nama Dagang:



Framycetin I: Luka bakar, laserasi, abrasi. Luka gigit, luka tusuk, koyak. Ulkus: varikosa, diabetik, decubitus. BSO: Kasa balut D: Tutup luka KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



D. Fungisida Clotrimazole Miconazole Tioconazole Sertaconazole Undecylenic acid Terbinafin Nystatin Naftifine Ketoconazole Isoconazole Bifonazole Ciclopirox Olamin Selenium sulfide



Sertaconazole I: Mikosis superfisial: dermatofitosis, tinea pedis, tinea cruris, tinea corporis, tinea manus, kandidiasis, ptiriasis versikolor BSO: Krim 2 % D: Apply to cover the affected and surrounding skin areas and rub in gently KI: P: Hamil, laktasi ES: Reaksi lokal IO: Preg: C Nama Dagang: Dermofix



Undecylenic Acid I: Treatment of athlete's foot (tinea pedis), ringworm (except nails and scalp), prickly heat, jock itch (tinea cruris), diaper rash and other minor skin irritations due to superficial dermatophytes BSO: Cream: 20% Foam & Liquid, topical: 10% Ointment, topical: 22%; 25% Powder, topical: 10%; 22% Solution, topical: 25% D: apply 2x/d KI: P: ES: 1% to 10%: Dermatologic: Skin irritation, sensitization IO: Preg:: A, B, C, D, X Nama Dagang:



Naftifine I: athlete's foot (ringworm of the foot; tinea pedis); jock itch (ringworm of the groin; tinea cruris); and, tinea corporis. BSO: Cream & Gel: 1% D: apply 1-2x/day KI: P: ES: Burning or stinging feeling on treated area(s) Less common: Dry skin, Itching, redness, or other sign of skin irritation not present before use of this medicine IO: Preg: B Nama Dagang: Exoderil



Isoconazole I: Jamur superfisial BSO: Krim 1 % D: Oles 2x/hr KI: P: Hindari kontak dg mata ES: IO: Preg:: A, B, C, D, X Nama Dagang: Travogen



Bifonazole I: Dermatomikosis krn dermatofita, ragi, lumu & jamur lain BSO: Krim 1 % D: Oles 1x/hr KI: P: ES: reaksi kulit (jarang) IO: Preg:: A, B, C, D, X Nama Dagang: Mycospor



Ciclopirox Olamin I: Tinea pedis (athlete's foot), tinea cruris (jock itch), tinea corporis, cutaneous candidiasis, and tinea versicolor (pityriasis) BSO: Cream & Lotion topical: 1% Lacquer, nail, topical solution: 8% D: Apply 2x/d For shampoo dosage form: 2x/wk for 4wk For topical solution dosage form: KI: Known hypersensitivity to ciclopirox or any of its components; avoid occlusive wrappings or dressings P: For external use only; avoid contact with eyes ES: 1% to 10%: Local: Irritation, redness, burning, or pain IO: Preg: B Nama Dagang:



Selenium Sulfide I: Dandruff, seborrhoeic dermatitis BSO: Lot 2.5 % Shampoo: 1%; 2.5% D: Dandruff or seborrheic dermatitis: 2x/wk Tinea versicolor: 1x/d for 1wk KI: Broken skin or open wounds, Children under 5 years of age, Inflamed skin P: ES: Hair loss (alopecia), Irritation in area of use, Sensitisation or allergic reaction, Hair discolouration, Oiliness or dryness of scalp and hair IO: Preg: C Nama Dagang:



E. Scabicid Lindane Permethrin



E. Antivirus Aciclovir Tromantadine HCl



Tromantadine HCl I: Herpes simpleks & zooster di kulit & mukosa BSO: Gel 1 % D: 3x/hr KI: P: ES: Hipersensitif IO: Preg:: A, B, C, D, X Nama Dagang: Viru-Merz



F. Analgesic & Anti Inflamasi Methylsalicylate Capsaicin Piroxicam Diclofenac Ketoprofen Naproxen lidocaine Glucosamine Benzydamine



Methylsalicylate I: Nyeri otot, nyeri sendi, Terkilir. Tidak untuk luka terbuka BSO: Krim, balsam, Gel 1 % D: 1-3x/hr KI: P: ES: Hipersensitif IO: Preg:: A, B, C, D, X Nama Dagang:



Capsaicin May render skin and joints insensitive to pain by depleting substance P in peripheral sensory neurons. I: BSO: Krim 0.075 % D: Oles 3-4x/hr. KI: Hipersensitif; broken or irritated skin IO: Preg: C P: For external use only; avoid contact with eyes, mucous membranes, wounds, or damaged skin; do not use tight bandage; discontinue use if condition worsens or symptoms persist for 14-28 d Nama Dagang: Capzacin cream



G. Pelindung Kulit Panthenol Collagenase Urea Vitamin E Oilatum



Panthenol I: Penyembuhan luka & epitelisasi setiap tjd luka BSO: Salep, Krim 5 % D: 1-3x/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang: Bepanthen



Collagenase Enzyme, Topical Debridement I: Promotes debridement of necrotic tissue in dermal ulcers and severe burns BSO: Ointment, topical: 250 U/g D: Apply 1x/d KI: Known hypersensitivity to collagenase P: For external use only; avoid contact with eyes; monitor debilitated patients for systemic bacterial infections because debriding enzymes may increase the risk of bacteremia ES: 1% to 10%: Local: Irritation IO: Decreased effect: Enzymatic activity is inhibited by detergents, benzalkonium chloride, hexachlorophene, nitrofurazone, tincture of iodine, and heavy metal ions (silver and mercury) Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oilatum Sabun



H. Antihistamin & Pruritus Doxepin Tripelennamine



Doxepin hydrochloride Antidepressant, Tricyclic (Tertiary Amine); Topical Skin Product I: Pruritus pd exzema BSO: Capsule: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg, 150 mg Concentrate, oral: 10 mg/mL Cream: 5% D: 4x/day KI: Known sensitivity or allergy to any ingredient P: Children under 12 years of age, urinary retention, Glaucoma, Mania, Severe liver disease ES: Rash, Dry mouth, Drowsiness, Stinging and redness, Burning sensation, Irritation of the skin IO: Preg: B Nama Dagang: Sagalon



Tripelennamine Antihistamine I: Perennial and seasonal allergic rhinitis and other allergic symptoms including urticaria BSO: Krim 2 % D: Bila perlu KI: Hypersensitivity to tripelennamine or any component P: Use with caution in patients with narrow-angle glaucoma, bladder neck obstruction, symptomatic prostate hypertrophy, asthmatic attacks, and stenosing peptic ulcer ES: >10%: Central nervous system: Slight to moderate drowsiness, Respiratory: Thickening of bronchial secretions 1% to 10%: Headache, fatigue, nervousness, dizziness, Appetite increase, weight gain, nausea, diarrhea, abdominal pain, xerostomia, Arthralgia, Pharyngitis IO: Increased effect/toxicity with alcohol, CNS depressants, MAO inhibitors Preg: B Nama Dagang: Tripel Genghis Khun ([email protected],nafanakhun.wordpress.com)


I. Anti Akne Sulfur Tretinoin Benzoyl peroxide Clindamycin Erythromycin Azelaic acid Nicotinamide Retinoic Acid



Sulfur I: Acne, seborrheic dermatitis and scabies. (hypertrichosis) BSO: Lot 6.6% D: Acne: 2-3x/d Seborrheic dermatitis: ointment 5-10%: 1-2x/d. Scabies: ointment 6% each night for three nights. KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Tretinoin -- Inhibits microcomedo formation and eliminates lesions. Makes keratinocytes in sebaceous follicles less adherent and easier to remove. I: Acne vulgaris BSO: Cream: 0.025%; 0.05%; 0.1% Gel, topical: 0.01% ; 0.025%, 0.1%. Liquid, topical: 0.05% D: Acne, fine wrinkles, dark spots, or rough skin caused by the sun: 1x/d at bedtime KI: Pregnancy, cutaneous epithelioma, Areas of skin affected by eczema, Acne rosacea, perioral dermatitis. P: Sensitive areas of skin such as the neck. ES: Dry skin, Skin peeling, Burning/stinging/warmth on application, Skin redness, Itching, Rash, Temporary changes in skin pigmentation, photosensitivity, Skin blistering/crusting, Eye irritation, Oedema IO: Preg: D Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Benzoyl peroxide I: Mild to moderate acne vulgaris and acne rosacea BSO: Bar & Cream: 5%; 10% Gel: 2.5%; 5%; 10%; 20% Liquid: 5%; 10% Lotion: 5%; 5.5%; 10% Mask: 5% D: For acne: 1-4x/d Facial mask: 1x/wk KI: P: ES: Less common or rare: Painful irritation of skin, including burning, blistering, crusting, itching, severe redness, or swelling, Skin rash IO: Increased toxicity: Benzoyl peroxide potentiates adverse reactions seen with tretinoin Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Azelaic acid I: Acne vulgaris: Topical treatment of mild to moderate inflammatory acne vulgaris BSO: Krim 20 % D: 2x/hr KI: Known hypersensitivity to any of components P: For external use only; not for ophthalmic use; there have been isolated reports of hypopigmentation after use. If sensitivity or severe irritation develops, discontinue treatment and institute appropriate therapy. ES: 1% to 10%: Dermatologic: Pruritus, stinging Local: Burning Neuromuscular & skeletal: Paresthesia IO: Preg: B Nama Dagang:



Nicotinamide I: Mild to moderate inflammatory acne. BSO: Gel 4 % D: 2x/hr KI: Allergy to any ingredient. P: ES: Skin dryness, Itching, Redness, Burning sensation, Skin irritation IO: Preg:: A, B, C, D, X Nama Dagang:



Retinoic acid I: BSO: Krim 0.025 %. 0.05 %. 0.1 %. Gel 0.025 %. Lar 0.05 % D: Oles 1x/hr sebelum tidur KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



J. Pemutih Urea Hydroquinone



Urea/ Carbamide Diuretic, Osmotic; Keratolytic Agent; Topical Skin Product I: Reduces intracranial pressure and intraocular pressure; topically promotes hydration and removal of excess keratin in hyperkeratotic conditions and dry skin; mild cervicitis Chronic dry skin conditions such as eczema. Inherited, non-inflammatory dryness and scaling of the skin (ichthyosis, xeroderma). Overgrowth of the outer layer of skin causing it to become thickened and scaly (hyperkeratosis). BSO: Cream: Topical: 2% [20 mg/mL]; 10%; 20%; 30%; 40% Vaginal: 8.34% [83.4 mg/g] Injection: 40 g/150 mL Lotion: 2%; 10%; 15%; 25% D: Children: I.V. slow infusion: <2 years: 0.1-0.5 g/kg >2 years: 0.5-1.5 g/kg Adults: Genghis Khun ([email protected],nafanakhun.wordpress.com)


I.V. infusion: 1-1.5 g/kg by slow infusion (1-21/2 hours); maximum: 120 g/24 hours Topical: Apply 1-3 times/day Vaginal: Insert in vagina at bedtime for 2-4 weeks KI: Severely impaired renal function, hepatic failure; active intracranial bleeding, sickle cell anemia, topical use in viral skin disease P: Urea should not be used near the eyes; use with caution if applied to face, broken, or inflamed skin; use with caution in patients with mild hepatic or renal impairment ES: 1% to 10%: Electrolyte imbalance, Nausea, vomiting, Local: Transient stinging, local irritation, tissue necrosis from extravasation of I.V. preparation, Skin irritation, Stinging IO: Decreased effect/toxicity/levels of lithium Preg: C Nama Dagang:



Hydroquinone Depigmenting Agent I: Gradual bleaching of hyperpigmented skin conditions BSO: Cream, topical:: 1.5%: 2%: 4% Cream & Gel, topical, with sunscreen: 2%: 4% Solution, topical: 3% D: apply 2x/d KI: Sunburn, depilatory usage, known hypersensitivity to hydroquinone P: Limit application to area no larger than face and neck or hands and arms ES: 1% to 10%: Local: Irritation IO: Preg: C Nama Dagang:



K. Keratolitik Salicylic acid Tretinoin



Salicylic acid By dissolving the intercellular cement substance, salicylic acid produces desquamation of the horny layer of skin, while not affecting structure of viable epidermis. For removal of nongenital cutaneous warts, particularly common or plantar warts. Prior to application, wash affected area. May soak wart in warm water for 5 min. Dry area thoroughly. BSO: D: 17% by weight solution or gel: Apply to wart and let dry bid/tid prn until wart removed for up to 12 wk 40% by weight solution adsorbed to medicated discs: Apply over wart and cover for 48 h, replace prn until wart removed for up to 12 wk KI: Hipersensitif IO: Use of this medication with other topical drying agents (eg, tretinoin, sulfur, resorcinol, benzoyl peroxide) or topical medicated or alcohol-containing preparations (eg, aftershave, toiletries, skin cleansers, cosmetics) may have a cumulative Genghis Khun ([email protected],nafanakhun.wordpress.com)


drying or irritating effect, leading to desquamation and skin erosion Preg: C P: Avoid contact with mucous membranes, normal skin surrounding warts, and eyes; immediately flush with water for 15 min if contact with eyes or mucous membranes occurs; avoid inhaling vapors; prolonged use in infants, people with diabetes, and patients with impaired circulation is contraindicated; not for use on moles, birthmarks, warts with hair growing from them, genital or facial warts, warts on mucous membranes, irritated skin, or any area that is infected or reddened Nama Dagang:



L. Sun block/ Tabir Surya



M. Anti alopesia Minoxidil



Minoxidil Topical Skin Product; Vasodilator I: Management of severe hypertension (usually in combination with a diuretic and beta-blocker); treatment of male pattern baldness (alopecia androgenetica) BSO: Solution, topical: 2% [20 mg/metered dose]; 5% Tablet: 2.5 mg, 10 mg D: Topical: 2x/day KI: Women (a lower strength product is available for women see end of factsheet), Allergy to minoxidil, ethanol or propylene glycol, Treated or untreated high blood pressure (hypertension), Any scalp abnormality, eg psoriasis, eczema, sunburn or broken skin, Men with a shaved scalp, Men who are using other medicines or occlusive dressings applied to the scalp, This medicine is not recommended for men under 18 or over 65 years of age, as there is no information available regarding its safety in these age groups. Genghis Khun ([email protected],nafanakhun.wordpress.com)


P: Heart disease or an irregular heart beat. If you have a heart condition you should consult your doctor before using this medicine. ES: Itching, Skin irritation, Dry skin, Flushing of the scalp skin due to widening of the small blood vessels (erythema), Flaking scalp, Unwanted growth of hair on other parts of the body, Worsening of hair loss IO: Preg: C Nama Dagang:



N. Preparat Psoriasis, Seboroik & Iktiosis Povidone Iodine Selenium sulfide Dithranol Calcipotriol/ Calcipotriene Urea



Dithranol I: Psoriasis BSO: Krim 0.02 % D: Oles 2x/hr KI: Infants and young children, Pustular psoriasis, Inflamed, broken, blistered, raw or oozing areas of skin, Skin on the face, genitals, flexures or in skin folds. P: ES: Redness or burning sensation of the treated skin or the surrounding skin, Brownish staining of the treated skin or the surrounding skin (this will disappear within one to two weeks after finishing treatment), Temporary staining of fingernails or hair, Allergic skin rash. IO: Preg:: A, B, C, D, X Nama Dagang: Anthramed



Calcipotriol/ Calcipotriene I: Plaque psoriasis (psoriasis vulgaris)dtime for 2-4 weeks BSO: Cream, Solution & Ointment: 0.005% D: Psoriasis: 2x/day for 6-8wk KI: Hypersensitivity to any components of the preparation; patients with demonstrated hypercalcemia or evidence of vitamin D toxicity; use on the face P: Use may cause irritations of lesions and surrounding uninvolved skin. If irritation develops, discontinue use. Transient, rapidly reversible elevation of serum calcium has occurred during use. If elevation in serum calcium occurs above the normal range, discontinue treatment until calcium levels are normal. For external use only; not for ophthalmic, oral or intravaginal use. ES: Itching (pruritus), photosensitivity, erythema, Worsening of the skin condition psoriasis, dermatitis, Irritation in area of use IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


O. Lain Methoxalen Tacrolimus Pimecrolimus



Methoxalen I: vitiligo, a disease in which skin color is lost. Oral: Symptomatic control of severe, recalcitrant disabling psoriasis, not responsive to other therapy when diagnosis has been supported by biopsy. Administer only in conjunction with a schedule of controlled doses of long wave ultraviolet (UV) radiation; also used with long wave ultraviolet (UV) radiation for repigmentation of idiopathic vitiligo. Topical: Repigmenting agent in vitiligo, used in conjunction with controlled doses of UVA or sunlight BSO: Capsule: 10 mg Lotion: 1% Solution: 20 mcg/mL D: Psoriasis: Adults: Oral: 10-70 mg 11/2 -2 hours before exposure to ultraviolet light, 2-3 times at least 48 hours apart; dosage is based upon patient's body weight and skin type Vitiligo: Children >12 years and Adults: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Oral: 20 mg 2-4 hours before exposure to UVA light or sunlight; limit exposure to 15-40 minutes based on skin basic color and exposure Topical: Apply lotion 1-2 hours before exposure to UVA light, no more than once weekly KI: Diseases associated with photosensitivity, cataract, invasive squamous cell cancer, known hypersensitivity to methoxsalen (psoralens), and children <12 years of age P: Family history of sunlight allergy or chronic infections; lotion should only be applied under direct supervision of a physician and should not be dispensed to the patient; for use only if inadequate response to other forms of therapy, serious burns may occur from UVA or sunlight even through glass if dose and or exposure schedule is not maintained; some products may contain tartrazine; use caution in patients with hepatic or cardiac disease ES: >10%: Itching, Nausea 1% to 10%: Severe edema, hypotension, Nervousness, vertigo, depression, Painful blistering, burning, and peeling of skin; Genghis Khun ([email protected],nafanakhun.wordpress.com)


pruritus, freckling, hypopigmentation, rash, cheilitis, erythema, Loss of muscle coordination IO: Increased toxicity: Concomitant therapy with other photosensitizing agents such as anthralin, coal tar, griseofulvin, phenothiazines, nalidixic acid, sulfanilamides, tetracyclines, thiazides Preg: C Nama Dagang: Oxsoralen



Tacrolimus I: Atopic dermatitis BSO: salep 0.03% (children), 0.1% (adult) Capsule: 1 mg, 5 mg Injection, with alcohol and surfactant: 5 mg/mL (1 mL) D: Topikal: apply 2x/day Do not cover the area KI: Allergy, Atopic dermatitis that is infected, Areas of skin affected by cancerous or potentially cancerous growths, People with an underactive immune system, for example due to a condition present from birth, certain diseases, or treatment with certain medicines (eg immunosuppressants, chemotherapy), genetic skin defects such as Netherton's syndrome, or people with intense widespread reddening of the skin (erythroderma), where there may be increased absorption of the medicine into the bloodstream. P: People with enlarged lymph glands, Liver failure. ES: Burning sensation at application site, Redness, itching or irritation at application site, Sensation of warmth, pins and needles or pain at application site, Rash, folliculitis, Herpes Genghis Khun ([email protected],nafanakhun.wordpress.com)


simplex infections, such as cold sores, eczema herpeticum, Facial flushing or skin irritation after drinking alcohol, Increased skin sensitivity, especially to hot and cold, Acne, Cases of malignancies, including cases of skin cancer and lymphoma have been reported in a very small number of people using this medicine. IO: Preg: C Nama Dagang: 1. Protopic salep



Pimecrolimus I: Atopic dermatitis in adults and children aged two years and over, who are not responsive to, or intolerant of, conventional treatments such as topical corticosteroids. BSO: Krim 1 % D: 2x/day KI: Children <2 years of age, Allergy, Infected eczema or dermatitis, Areas of skin affected by viral infections, such as cold sores (herpes simplex) or chicken pox (herpes zoster), Areas of skin affected by cancerous or potentially cancerous growths, underactive immune system, Pregnancy, genetic skin defects such as Netherton's syndrome, or people with intense widespread reddening of the skin (erythroderma), where there may be increased absorption of the medicine into the bloodstream. P: ES: Burning sensation at application site, Redness, itching or irritation at application site, Inflammation of the hair follicles (folliculitis), Skin infections, eg impetigo, herpes simplex, herpes Genghis Khun ([email protected],nafanakhun.wordpress.com)


zoster, molluscum contagiosum, warts, eczema herpeticum, Boils (furuncles), Worsening of symptoms, Rash, pain, pins and needles, swelling, dryness, or shedding of surface skin at application site, Skin flushing, rash, burning, itching or swelling after drinking alcohol. IO: Preg: C Nama Dagang: Elidel



XII. PREPARAT TELINGA Docusate sodium



XIII. PREPARAT MULUT Hexetidine Povidone Iodine Miconazole Dequalinium Fradiomycin & Gramicidin Triamcinolone acetonide Benzydamine



Hexetidine I: Ginggivitis, stomatitis, periodontitis, sariawan, angina vincent BSO: Lar 0.1% D: 15cc dikumur selama 30 detik, 2x/hari KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Povidon iodine I: Faringitis, moniliasis oral, Ginggivitis, stomatitis, periodontitis, sariawan, angina vincent BSO: Obat kumur 1% D: 15cc dikumur selama 30 detik, ulangi tiap 2-4 jam KI: P: ES: IO: Preg: D Nama Dagang:



Dequalinium I: Sakit tenggorokan, faringitis, tonsillitis, infeksi gusi & selaput lender rongga mulut BSO: Tab/ Loz 250 mcg. D: Tab: Awal 250 mcg/ 2 jam. Setelah gejala reda 250 mcg/ 4-5jam Loz: 250 mcg di atas lidah, 3-4x/hr. max 8 tab/hr KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Fradiomycin sulfate & Gramicidin I: Ginggivitis, stomatitis, periodontitis, sariawan, angina vincent BSO: Tab hisap Fradiomycin sulfate 2.5 mg, Gramicidin 1mg D: Dws 1-2 tab. Anak 1 tab. 4-5x/hr KI: P: ES: Anoreksia, mual & ggn GI IO: Preg:: A, B, C, D, X Nama Dagang:



Benzydamine I: Inflammation and pain following dental surgery, Mouth ulcers BSO: Obat kumur 1.5mg/cc. Loz 3 mg Gel 5 % D: Kumur 2-3x/hr dg interval 3-4 jam. Bila perlu s/d 5x/hr. Loz: 1 loz tiap 3 jam. Max 12 loz/hr, tidak lebih dari 7 hari. Jangan dikunyah. KI: Children aged 12 years and under P: Hamil, gangguan hati/ ginjal berat. Topikal: jangan digunakan pd daerah basah, sekitar mata/ permukaan mukosa ES: Stinging or numbness of the throat and mouth IO: Preg:: A, B, C, D, X Nama Dagang:



XIV. IMUNOLOGI A. ANTI HISTAMIN & ANTI ALERGI B. VAKSIN, ANTI SERUM & IMUNOLOGIKAL C. IMUNOSUPRESAN



A. Anti Histamin & Anti Alergi Chlorphenamine Diphenhydramine Doxepin Cyproheptadine Hydroxyzine Dimethindene Clemastine Astemizole Terfenadine Triamcinolone acetonide Oxatomide Mebhydrolin Homochlorcyclizine Fexofenadine HCl Loratadine Desloratadine Cetirizine Levocetirizine Genghis Khun ([email protected],nafanakhun.wordpress.com)


Chlorpheniramine I: Perennial and seasonal allergic rhinitis and other allergic symptoms including urticaria BSO: Capsule: 12 mg Capsule, timed release: 8 mg, 12 mg Injection: 10 mg/mL; 100 mg/mL Syrup: 2 mg/5 mL Tablet: 4 mg, 8 mg, 12 mg Tablet: Chewable: 2 mg Timed release: 8 mg, 12 mg D: 4 mg PO q4-6h 10-20 mg per dose IV/IM/SC; max 40 mg/d Paed. 2-6 years: 1 mg PO q4-6h; max 4 mg/d 6-12 years: 2 mg PO q4-6h; max 12 mg/d KI: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hipersensitif; asthma attacks; narrow-angle glaucoma; symptomatic prostate hypertrophy; bladder neck obstruction; pyloroduodenal obstruction ES: Urinary retention, Diplopia, Polyuria >10%: drowsiness, Thickening of bronchial secretions 1-10%: Headache, excitability, fatigue, nervousness, dizziness, Nausea, xerostomia, diarrhea, abdominal pain, appetite increase, weight increase, Arthralgia, weakness, Pharyngitis IO: CNS toxicity increases with coadministration of other CNS depressants, tricyclic antidepressants, MAOIs, and phenothiazines Preg: B P: May cause significant confusional symptoms; not for administration to premature or full-term neonates Nama Dagang:



Cyproheptadine antihistamines I: Anaphylactic reaction, Migraine, allergy (e.g. itchy rash or nasal congestion), itch (e.g allergy or chickenpox virus) BSO: Syrup: 2 mg/5 mL with alcohol 5% Tablet: 4 mg D: Oral: Paed. 0.25 mg/kg/d PO divided bid/tid 2-6 years: 2 mg 2-3x/d (max 12 mg/day) 7-14 years: 4 mg 2-3x/d (max 16 mg/day) Adults: 4-20 mg/day 3x/d (max 0.5 mg/kg/day) KI: Hipersensitif; glaucoma; symptomatic prostatic hypertrophy; bladder neck obstruction; pyloroduodenal obstruction; severe lower respiratory tract symptoms ES: Blurred vision, urinary retention, Dry mouth, Drowsiness, Confusion, Blood disorders, diarrhoea, constipation, nausea, vomiting or abdominal pain, heart palpitations, hypotension, Dizziness, somnolence, Irritability, Wheezing IO: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Potentiates effects of CNS depressants; MAOIs may prolong and intensify anticholinergic and sedative effects of antihistamines Preg: B P: Caution in patients with a predisposition to urinary retention, poorly controlled asthma, increased intraocular pressure, hyperthyroidism, cardiovascular disease, or hypertension; may thicken bronchial secretions caused by anticholinergic properties and may inhibit expectoration and sinus drainage Nama Dagang:



Hydroxyzine Antiemetic; Sedating antihistamine A drug of choice for primary acquired cold urticaria. SC and IV are not recommended administration routes. I: Treatment of anxiety, as a preoperative sedative in pediatric dentistry, Unlabeled uses: Antiemetic; alcohol withdrawal symptoms BSO: Injection: 25 mg/mL; 50 mg/mL Syrup: 10 mg/5 mL, 25 mg/5 mL Tablet, Capsule: 10 mg, 25 mg, 50 mg, 100 mg D: Children: Oral: 0.6 mg/kg/dose 4x/d I.M.: 0.5-1 mg/kg/dose 4-6x/d (q4-6h) Adults: Antiemetic: I.M.: 25-100 mg/dose 4-6x/day Anxiety: Oral: 25-100 mg 4 times/day; max: 600 mg/day Preoperative sedation: Oral: 50-100 mg I.M.: 25-100 mg Management of pruritus: Oral: 25 mg 3-4 times/day Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif ES: Central nervous system: Drowsiness, headache, fatigue, nervousness, dizziness Respiratory: Thickening of bronchial secretions Gastrointestinal: Xerostomia Neuromuscular & skeletal: Tremor, paresthesia, seizure Ocular: Blurred vision IO: CNS depression may increase with alcohol or other CNS depressants Preg: C P: Associated with clinical exacerbations of porphyria (may not be safe for porphyric patients); ECG abnormalities (alterations in T waves) may occur; may cause drowsiness Nama Dagang: Bestalin Genghis Khun ([email protected],nafanakhun.wordpress.com)


Dimethindene maleate I: Alergi BSO: Tetes 0.1 % D: Dws 20-40 tts 3x/hr atau 1 tab 2x/hr KI: P: ES: Kantuk IO: Preg: B Nama Dagang: Fenistil



Clemastine sedating antihistamine I: Allergic conditions such as hayfever, nettle rash (urticaria) and reactions to insect bites. BSO: Syrup: 0.67 mg/5 mL with alcohol 5.5% Tablet: 1.34 mg, 2.68 mg D: Oral: 1.34 mg 2x/d to 2.68 mg 3x/d, max 8.04 mg/day. KI: # Children under one year of age # Hereditary blood disorders called porphyrias. P: Elderly people, Liver & Kidney disease, Epilepsy, Glaucoma, Prostatic hypertrophy, urinary retention, Obstruction of the gut. ES: Drowsiness, Headache, Blurred vision, Dry mouth, Diarrhoea, constipation, nausea, vomiting or abdominal pain, Difficulty passing urine, Dizziness, Palpitations, Confusion, Tremor, Disturbed sleep, Depression IO: Preg:: A, B, C, D, X Nama Dagang: Tavegyl Genghis Khun ([email protected],nafanakhun.wordpress.com)


Astemizole I: Alergi: Rinitis, konjungtivitis, urtikaria BSO: Tab 10 mg. syr 5 mg/cc D: Dws 10 mg. KI: P: Hamil, ggn hati, sindroma QT kongenital, hipokalemia tak terkoreksi. ES: Peningkatan BB IO: Derivat azol, makrolida Preg: C Nama Dagang: Proalert



Terfenadine I: Rinitis alergi, alergi kulit BSO: Tab 60 mg D: Dws 60 mg 2x/hr KI: Hipersensitif P: Hamil, laktasi ES: IO: Preg: C Nama Dagang:



Oxatomide I: Alergi: rinitis, asma ekstrinsik, urtikaria kronik, konjungtivitis folikuler, dermatitis atopi BSO: Tab 30 mg D: 30 mg 2x/hr. Anak 0.5 mg/kg dosis tunggal KI: P: ES: IO: Preg:: A, B, C, D, X Nama Dagang:



Mebhydrolin I: Alergi, Rinitis vasomotor, insect bite, urtikaria BSO: Kaps 50 mg D: Dws 75-100 mg 3x/hr KI: P: Hamil, laktasi. Jangan mengemudi ES: agranulositosis, kantuk, mual, muntah, diare, kolik, ggn GI, anoreksia IO: Preg:: A, B, C, D, X Nama Dagang:



Homochlorcyclizine I: BSO: Tab 10 mg D: 10-20 mg 2x/hr KI: Glaukoma, obstruksi sal. Kemih bawah P: ES: Kantuk IO: Preg:: A, B, C, D, X Nama Dagang: Homoclomin



Loratadine non-sedating antihistamine I: Nasal and non-nasal symptoms of seasonal allergic rhinitis BSO: Syrup: 1 mg/mL, Tablet: 10 mg D: Dws & anak > 6thn: 10 mg/day KI: Hipersensitif ES: Drowsiness, Dizziness, Blurred vision, Difficulty concentrating, Indigestion, diarrhoea, constipation, nausea, vomiting or abdominal pain, Dry mouth, Urinary retention, Headache, Loss of appetite, Palpitations, Arrhythmias, Hepatitis, Wheezing or difficulty in breathing, Muscle weakness, Tinnitus, Irritability, Nightmares IO: Ketoconazole, erythromycin, procarbazine, and alcohol may increase loratadine levels Preg: B P: Initiate therapy at lower dose in liver impairment; caution in Preg: and lactation Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Desloratadine Non-sedating antihistamine I: Allergic rhinitis, chronic idiopathic urticaria BSO: Tab 5 mg, Syr 2.5mg/ 5 cc D: Dws 5 mg 1x/hr. Anak 6-11 thn: 2.5 mg 1x/day. KI: Hipersensitif, Pregnancy, Breastfeeding ES: Fatigue, Dry mouth, Headache, Diarrhoea, Fever (in infants and toddlers), Difficulty sleeping, Dizziness, Somnolence, nausea, vomiting, indigestion or abdominal pain, Tchycardia, Palpitations, Muscle pain, Hyperactivity, Seizures IO: Limited data exist; erythromycin and ketoconazole increase desloratadine and 3-hydroxydesloratadine plasma concentrations, but no increase in clinically relevant adverse effects, including QTc, was observed Preg: C P: Decrease dose in hepatic impairment; rarely causes pharyngitis or dry mouth Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Cetirizine HCl non-sedating antihistamine Sedation occurs in approximately 10% of patients. Dosing qhs may be useful if sedation is a problem. Although the standard dose is 5-10 mg qd. I: Hayfever, perennial allergic rhinitis, chronic idiopathic urticaria. BSO: Syrup: 5 mg/5 mL Tablet: 5 mg, 10 mg D: 5-10 mg 1x/day KI: Hipersensitif ES: Headache, Dry mouth, Dizziness, Agitation, Stomach or intestinal discomfort, Drowsiness IO: Increases CNS toxicity of depressants; theophylline decreases clearance of cetirizine Preg: B P: Caution in hepatic or renal dysfunction; 10 mg/d may cause drowsiness in approximately 10% of patients Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Levocetirizine non-sedating antihistamine Histamine1-receptor antagonist. Active enantiomer of cetirizine. Peak plasma levels reached within 1 h and half-life is about 8 h. I: Seasonal allergic rhinitis & perennial allergic rhinitis, chronic idiopathic urticaria. BSO: D: 5 mg 1x/day in the evening KI: Hipersensitif; CrCl <10 mL/min or hemodialysis; children aged 6-11 y with renal impairment ES: Headache, Dry mouth, Fatigue, Sleepiness, asthenia, Abdominal pain, Shortness of breath, Nausea, Weight gain. IO: Coadministration with CNS depressants (eg, alcohol, sedative-hypnotics) may increase somnolence; ritonavir increased plasma AUC of measurable cetirizine by 42% and half-life by 53% Preg: B P: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Common adverse effects include somnolence, nasopharyngitis, fatigue, xerostomia, and pharyngitis in adults and children >12 y; pyrexia, somnolence, cough, and epistaxis commonly observed in children 6-12 y; caution with activities requiring mental alertness Nama Dagang: Xyzal



B. Vaksin, Anti Serum & Imunologikal Influenza vaccine Diphtheria, Tetanus Toxoids, and Acellular Pertussis Vacc Diphtheria, Tetanus, Acellular Pertussis, Polio, HiB Vacc Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B Vacc Measles, mumps, rubella vaccine (live) Haemophilus b Conjugate Vaccine Poliovirus Vaccine Rabies immune globulin-Human Human diploid cell vaccine Rabies vaccine Meningococcal Polysaccharide Vaccine; A, C, Y, and W-135 Pneumococcal Vaccine Varicella Virus Vaccine Tetanus Immune Globulin Interferon alfa-2b Interferon beta-1a Immunoglobulin Hepatitis A vaccine Hepatitis B vaccine Rho(D) Immune Globulin Thymalfasin/ Thymosin alpha-1



Influenza vaccine Indicated for active immunization to prevent influenza A and B viruses. Induces antibodies specific to virus strains contained in vaccine following administration. The US Public Health Service determines influenza vaccine contents annually. Typically, 3 live attenuated virus strains, which antigenically represent the influenza strains likely to circulate the next flu season, are included in the formulation each year. I: BSO: D: 0.5 mL IM for 1 dose each year prior to flu season Paed. <6 months: Not established 6-35mo: 0.25 mL IM then 4wk after 1st dose 3-8 y: 0.5 mL IM then 4wk after first dose >8 y: 0.5 mL IM for 1 dose each year prior to flu season KI: Hipersensitif to vaccine contents including thimerosal, eggs, egg products, or chicken protein; history of Guillain-Barré syndrome; history of neurologic symptoms following vaccination Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Immunosuppressive therapy (eg, high-dose corticosteroids, chemotherapy) may reduce antibody response Preg: C P: Defer vaccination with acute febrile illnesses or neurological findings until symptoms have abated; may cause soreness at injection site, fever, malaise, and myalgia Nama Dagang: Vaxigrip



Diphtheria, Tetanus Toxoids, & Acellular Pertussis Vaccine Toxoid I: As fourth and fifth dose in primary immunization series against diphtheria, tetanus, and pertussis from age 15 months or 17 months through 7th birthday (recipients must have previously received 3 doses of whole-cell DTP (DTwP)) BSO: Injection: Diph 6.7 Lf U, tet 5 Lf U, acel. pert vacc 46.8 mcg/ 0.5 mL Diph 25 Lf U, tet 10 Lf U, acel. pert vacc 25 mcg/ 0.5 mL Diph 15 Lf U, tet 6 Lf U, acel. pert vacc 40 mcg/ 0.5 mL D: Before administration, ensure that at least 3 doses of wholecell DTP vaccine have been given. Give the fourth dose of DTaP at ~18 months of age, at least 6 months after the third DTwP. Give a fifth 0.5 mL dose at 4-6 years of age. Tetanus and diphtheria toxoids for adult use (Td) is the preferred agent for adults and older children. KI: Patients >7 years of age, patients with cancer, immunodeficiencies, an acute respiratory infection, or any other active infection; children with a history of neurologic disorders Genghis Khun ([email protected],nafanakhun.wordpress.com)


should not receive the pertussis or any component; history of any of the following effects from previous administration of pertussis vaccine precludes further use: >103°F fever (39.4°C), convulsions, focal neurologic signs, screaming episodes, shock, collapse, sleepiness or encephalopathy; known hypersensitivity to diphtheria and tetanus toxoids or pertussis vaccine; do not use for treatment of actual tetanus, diphtheria, or whooping cough infections P: DTaP should not be used in children <15 months of age and should not be used in children who have received fewer than 3 doses of DTP ES: All serious adverse reactions must be reported to the U.S. Department of Health and Human Services (DDHS) Vaccine Adverse Event Reporting System (VAERS) 1-800-822-7967. IO: Decreased effect with immunosuppressive agents, corticosteroids within 1 month Preg: B Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Diphtheria, Tetanus, Acellular Pertussis, Polio, HiB Vaccine I: # Vaccination of infants against diphtheria, tetanus, whooping cough, polio and infection with Haemophilus influenzae type B (Hib) bacteria, which can cause serious diseases such as meningitis, pneumonia and blood poisoning. BSO: Jarum suntik pra isi 0.5 cc D: 0.5 cc IM pd bulan ke 2, 4, 6, 18 pd anterolateral paha atas atau otot deltoid KI: >4years, allergy, encephalopathy, Progressive or unstable disease affecting the brain and nervous system, eg epilepsy (in this case the vaccine should be postponed until the condition is corrected or stable), Fever or sudden severe illness (in this case the vaccine should be postponed until after the child has recovered). P: # Children who had a temperature of 40ºC or higher within 48 hours of a previous dose of whooping cough vaccine # Children who collapsed or were unresponsive following a previous dose of whooping cough vaccine Genghis Khun ([email protected],nafanakhun.wordpress.com)


# Children who cried persistantly and inconsolably for more than three hours within 48 hours of a previous dose of whooping cough vaccine # Children who had convulsions within three days of a previous dose of whooping cough vaccine # Bleeding disorders # Reduced platelet count in the blood (thrombocytopenia). ES: Pain, redness and swelling at the injection site, Fever (pyrexia), Headache, malaise, Sleepiness, Irritability, Loss of appetite, Restlessness, Unusual crying, Diarrhoea, Nausea and vomiting, Weakness, Swelling of injected limb, Swollen glands, Rash, Difficulty sleeping, Stuffy nose, Coughing, Stomache ache, Backache IO: Preg: C BSO: Nama Dagang: Pediacel Genghis Khun ([email protected],nafanakhun.wordpress.com)


Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B Vaccine I: BSO: Vial 0.5 cc D: Imunisasi Primer: 0.5 cc IM dalam, tiap 4 minggu selama 3x Booster: 1x sebelum akhir tahun ke-2 KI: Pnykit febris akut berat, ensefalopati yg tak diketahui sebabnya P: Trombositopenia atau ggn perdarahan ES: IO: Preg:: A, B, C, D, X Nama Dagang: Tritanrix HB



Measles, mumps, rubella vaccine (live) BSO: Vial 0.5 cc Injection: 1000 TCID50 each of measles virus vaccine and rubella virus vaccine, 5000 TCID50 mumps virus vaccine D: > 12 mo: 1x SC Infants <12 months of age: If there is risk of exposure to measles, single-antigen measles vaccine should be administered at 6-11 months of age with a second dose (of MMR) at >12 months of age Administer S.C. in outer aspect of the upper arm to children greater than or equal to 15 months of age: 0.5 mL at 15 months of age and then repeated at 4-6 years* of age In some areas, MMR vaccine may be given at 12 months *Many experts recommend that this dose of MMR be given at entry to middle school or junior high school KI: Blood dyscrasias, Active, untreated tuberculosis, impaired immune response due to disease or treatment, Pregnancy, Genghis Khun ([email protected],nafanakhun.wordpress.com)


anaphylaxis, Sudden feverish illness, Untreated malignant or cancerous disease P: Allergy, Conditions in which fever should be avoided, History of brain damage, HIV infection, convulsions & epilepsy ES: Headache, Rash, Diarrhoea, Allergic, Seizures, Fever, paraesthesia, Dizziness, Nausea and vomiting, Sore throat, Swollen glands (lymph nodes), parotitis, ataxia, thrombocytopenia, Irritability, febrile convulsions, malaise, Pain in the muscles and joints, Pain, swelling, redness and hardening of the skin at the injection site IO: Preg: C Nama Dagang: M-M-R® II



Haemophilus b Conjugate Vaccine I: Prevent infection by Haemophilus influenza type b (Hib) bact. BSO: Vial dosis tunggal 0.5 cc D: HbOC or PRP-T injection & PRP-OMP injection: Children 15-59 mo: One dose IM Children 12-14 mo: 1x, then a booster dose at 15months of age. Children 7-11 mo: 2 doses, 2mo apart, booster at 15 mo. Infants 2-6 mo: 3 doses, 2 months apart, booster at 15 months PRP-D injection: Children 15-59 mo: 1 dose IM. < 15 mo: not recommended. ES: allergic: Hives, Itching, Reddening of skin (especially around ears), Swelling of eyes, face, or inside of nose, Unusual tiredness or weakness (sudden and severe) More common: Fever of up to 102 °F (39 °C) (usually < 48h), Irritability, Loss of appetite, Lack of interest, Redness at place of injection, Reduced physical activity, Tenderness at place of injection, Tiredness Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Poliovirus Vaccine I: prevent poliomyelitis (polio). BSO: Injection: Suspension poliovirus (1, 2 and 3) grown in human diploid cell cultures Solution, oral: type 1, 2, and 3 viruses in monkey kidney tissue D: Poliovirus vaccine live oral (OPV) & Poliovirus vaccine inactivated enhanced potency (eIPV) IM/SC: 6 wk-18 years:I: 1x, II: 6-8wk later, III: 8-12 mo after the second dose. A booster: at 4-6 years of age only if the 3rd dose was given before the child's fourth birthday. Poliovirus vaccine inactivated (IPV): injection IM/SC: I,II,III: q4-8wk IV: 6-12 mo after the third dose. KI: Oral: Leukemia, lymphoma, or other generalized malignancies; diseases in which cellular immunity is absent or suppressed (hypogammaglobulinemia, agammaglobulinemia); immunosuppressive therapy; diarrhea; parenteral administration Genghis Khun ([email protected],nafanakhun.wordpress.com)


Parenteral: Hypersensitivity to any component including neomycin, streptomycin, or polymyxin B; defer vaccination for persons with acute febrile illness until recovery P: Although there is no convincing evidence documenting adverse effects of either OPV or E-IPV on the pregnant woman or developing fetus, it is prudent on theoretical grounds to avoid vaccinating pregnant women. However, if immediate protection against poliomyelitis is needed, OPV is recommended. OPV should not be given to immunocompromised individuals or to persons with known or possibly immunocompromised family members; E-IPV is recommended in such situations. ES: Fever (>101.3°F), Rash, pain at injection site IO: Decreased effect with immunosuppressive agents, immune globulin, cholera vaccine; separate by 1 month if possible; may temporarily suppress tuberculin skin test sensitivity (4-6 weeks); DTP, MMR, Hib, and hepatitis B vaccines may be given concurrently if at different sites Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Rabies immune globulin-Human (BayRab, Imogam) -- Has been licensed since 1975, and, unlike its predecessor, ERIG, is not associated with significant adverse reactions, anaphylaxis, or serum sickness. Purified ERIG is still used in some developing nations because of cost or availability and is associated with an adverse effect rate of 0.8-6%, which usually involves minor reactions. HRIG is not associated with transmission of viral hepatitis or HIV. Experimentally, infiltration of HRIG at site of exposure is more protective than IM administration. Previously, half the dose was administered at the site and half IM; however, current recommendation is that the entire dose be infiltrated, if possible, in and around the site, with any remaining solution administered IM in the gluteus. D: 20 IU/kg; most or all of solution is infiltrated around the wound; any remaining solution should be administered IM in the gluteus; max 20 IU/kg Paed. Administer as in adults, except inject into anterolateral thigh Genghis Khun ([email protected],nafanakhun.wordpress.com)


KI: Hipersensitif; to prevent interference with a maximum active immunity from rabies vaccine, do not administer in repeated doses once rabies vaccine treatment initiated; >20 IU/kg is associated with reduced antibody response to HDCV and should not be used IO: Through an antigen-antibody antagonism, RIG may diminish antibody response to MMR vaccine; should administer live virus vaccines 14-30 d before or 6-12 wk after immune globulin administration; antibody response to rabies vaccine may be delayed if administered simultaneously with RIG Preg: B P: Caution in thrombocytopenia or bleeding disorders; do not administer immunoglobulin and vaccine using same syringe or in same site Genghis Khun ([email protected],nafanakhun.wordpress.com)


Human diploid cell vaccine Inactivated forms of virus inducing an active immune response. D: Preexposure Primary: 1 mL IM deltoid on days 0, 7, and 21 or 28 Booster: 1 mL IM deltoid Postexposure No prior vaccination with HDCV or RVA: 1 mL IM deltoid on days 0, 3, 7, 14, and 28 Prior vaccination: 1 mL IM deltoid on days 0 and 3 Alternatives 2-1-1 IM regimen: 1 mL IM bid (1 dose in each deltoid) on day 0, then 1 mL IM deltoid on days 7 and 21 8-site ID regimen (WHO regimen, 1998; may be considered for use in resource-poor areas, but not FDA approved for this use in United States): 0.1 mL ID in each of 8 sites (each deltoid, each lateral thigh, each suprascapular region, and right and left lower quadrants of abdomen) on day 0, 0.1 mL ID in each of 4 sites (each deltoid, each lateral thigh) on day 7, 0.1 mL ID deltoid (1 site only) on days 28 and 90 Genghis Khun ([email protected],nafanakhun.wordpress.com)


Paed. inject into anterolateral thigh KI: Life-threatening hypersensitivity reactions; if reaction occurs, carefully consider patient risk of developing rabies before deciding to discontinue immunization IO: High-dose corticosteroids, antimalarials, and radiation therapy may inhibit immunization, and patients may remain susceptible despite vaccination; use of immunosuppressants should be avoided during postexposure therapy; persons receiving immunosuppressive therapy should receive RIG (3 doses/mL each IM) Preg: B P: Administer IM only in deltoid area; vaccination may fail if injected into gluteal area (because of higher likelihood of injecting into fat rather than muscle) To prevent failure with Imovax Rabies ID, inject ID and not IM; use IM route for Imovax Rabies Vaccine; in Hipersensitif, may pretreat with antihistamines; epinephrine injection (1:1000), volume replacement, oxygen, and corticosteroids must be immediately available to counteract anaphylactic reactions that Genghis Khun ([email protected],nafanakhun.wordpress.com)


may occur Preg: is not a contraindication to postexposure use of this vaccine because risks of inadequately treated rabies exposure clearly outweigh risks of fetal abnormalities based on limited data; preexposure prophylaxis may also be indicated in Preg:; however, if risk of rabies is substantial and removal of Preg:nant woman from high-risk area is feasible, this may be preferred



Rabies vaccine I: Vaccination against rabies BSO: Injection: Rabies antigen 0.25 U/0.1 mL D: Preexposure Primary : 1 mL IM deltoid on days 0, 7, and 21 or 28 Booster : 1 mL IM deltoid Postexposure No prior vaccination with HDCV or RVA: 1 mL IM deltoid on days 0, 3, 7, 14, and 28 1st day: + Rabies immune globulin. Prior vaccination with HDCV or RVA: 1 mL on days 0 and 3 KI: None reported for postexposure immunization; if alternative products are not available, exercise caution in persons known to be sensitive to neomycin, amphotericin B, chlortetracycline, processed bovine gelatin, and chicken protein because trace amounts of these products may be present in vaccine IO: High-dose corticosteroids, antimalarials, and radiation therapy may inhibit immunization, and patients may remain susceptible Genghis Khun ([email protected],nafanakhun.wordpress.com)


despite vaccination; use of immunosuppressants should be avoided during postexposure therapy; persons receiving immunosuppressive therapy should receive RIG (3 doses/mL each IM) ES: Cold or flu-like symptoms, Fever, malaise Preg: C P: Administer IM only in deltoid area; vaccination may fail if injected into gluteal area (because of higher likelihood of injecting into fat rather than muscle); epinephrine injection (1:1000), volume replacement, oxygen, and corticosteroids must be immediately available to counteract anaphylactic reactions that may occur; Preg: is not a contraindication to postexposure use of this vaccine because risks of inadequately treated rabies exposure clearly outweigh risks of fetal abnormalities based on limited data; preexposure prophylaxis may also be indicated in Preg:; however, if risk of rabies is substantial and removal of the Preg:nant woman from the highrisk area is feasible, this may be preferred Genghis Khun ([email protected],nafanakhun.wordpress.com)


Meningococcal Polysaccharide Vaccine, Groups A, C, Y, and W-135 quadrivalent vaccine Visitors who are travelling to Saudi Arabia for the Hajj and Umrah pilgrimages to Mecca will need to produce a certificate of vaccination with this quadrivalent meningitis vaccine, before they can be issued with a visa. I: Against meningitis caused by groups A, C, W135 and Y BSO: Injection: 10 dose, 50 dose. Vial 0.5 cc D: One dose: 0.5 mL S.C; the need for booster is unknown KI: Babies <2 mo of age, People with a severe feverish illness. P: ES: Pain, swelling, redness or hardening of the skin at the injection site, Headache, Fatigue, Fever, Sleepiness (somnolence), Very rarely, allergic reactions such as anaphylaxis IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Pneumococcal Vaccine I: Risk of pneumococcal disease for Children >2 years of age and adults, including all those > 65 years of age BSO: Injection: 25 mcg each of 23 polysaccharide isolates/0.5 mL dose D: 1x SC/IM KI: Sudden feverish illness, Children < 2 years of age (because it does not stimulate sufficient numbers of antibodies to be produced in this age group. The Prevenar pneumococcal vaccine should be used to vaccinate children under two.) P: Blood clotting disorders, eg haemophilia, thrombocytopenia ES: Fever, Nausea and vomiting, Headache, asthenia, malaise, Pain in the muscles and joints, paraesthesia, Swollen glands (lymph nodes), urticaria IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Varicella Virus Vaccine I: prevent infection by the varicella-zoster virus (VZV). The American Association of Pediatrics recommends that the chickenpox vaccine should be given to all healthy children 12 mo-18 years; children between 12 months and 13 years who have not been immunized or who have not had chickenpox should receive 1 vaccination. While children 13-18 years of age require 2 vaccinations 4-8 weeks apart; the vaccine has been added to the childhood immunization schedule for infants 12-28 months of age and children 11-12 years of age who have not been vaccinated previously or who have not had the disease; it is recommended to be given with the measles, mumps, and rubella (MMR) vaccine BSO: Powder for injection, lyophilized powder, preservative free: 1350 plaque forming U (PFU)/0.5 mL D: Prevention of Varicella: > 13 years: 1 dose SC/IM, then 4-8wks later. 12 months-12 years of age: a second dose is 3 months later. Genghis Khun ([email protected],nafanakhun.wordpress.com)


Prevention of herpes zoster: 1 dose SC KI: Hypersensitivity, blood dyscrasias, leukemia, lymphomas, or other malignant neoplasms affecting the bone marrow or lymphatic systems; receiving immunosuppressive therapy; primary and acquired immunodeficiency states; congenital or hereditary immunodeficiency; active untreated tuberculosis; febrile illness; pregnancy; I.V. injection P: Acute lymphoblastic leukemia in remission can receive the vaccine under an investigational protocol (215-283-0897); Immediate treatment for anaphylactoid reaction should be available during vaccine use; defer vaccination for at least 5 months following blood or plasma transfusions, immune globulin (IgG), or VZIG (avoid IgG or IVIG use for 2 months following vaccination); salicylates should be avoided for 5 weeks after vaccination; vaccinated individuals should not have close association with susceptible high risk individuals (newborns, pregnant women, immunocompromised persons) following vaccination ES: Fever over 39 °C (102 °F), Varicella-like skin rash Genghis Khun ([email protected],nafanakhun.wordpress.com)


Tetanus Immune Globulin I: Passive immunization against tetanus; tetanus immune globulin is preferred over tetanus antitoxin for treatment of active tetanus; part of the management of an unclean, wound in a person whose history of previous receipt of tetanus toxoid is unknown or who has received <3 doses of tetanus toxoid; elderly may require TIG more often than younger patients with tetanus infection due to declining antibody titers with age BSO: Injection: 250 U/mL D: Prevention: 250 U IM. Children: 4 U/kg; or 250 U. Treatment of tetanus: Children: 500-3000 U; some infiltrate locally around the wound Adults: 3000-6000 U KI: Hypersensitivity; patients with IgA deficiency; I.V. administration P: Have epinephrine 1:1000 available for anaphylactic reactions; do not administer I.V. ES: >10%: Pain, tenderness, erythema at injection site 1% to 10%: Fever, Urticaria, angioedema, Muscle stiffness Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: Never administer tetanus toxoid and TIG in same syringe (toxoid will be neutralized); toxoid may be given at a separate site; concomitant administration with Td may decrease its immune response, especially in individuals with low prevaccination antibody titers Preg:: A, B, C, D, X Nama Dagang:



Typhoid Vi Polysaccharide vaccine I: Parenteral: Promotes active immunity to typhoid fever for patients intimately exposed to a typhoid carrier or foreign travel to a typhoid fever endemic area Oral: For immunization of children >6 years and adults who expect intimate exposure of or household contact with typhoid fever, travelers to areas of world with risk of exposure to typhoid fever, and workers in microbiology laboratories with expected frequent contact with S. typhi Typhoid vaccine: Live, attenuated Ty21a typhoid vaccine should not be administered to immunocompromised persons, including those known to be infected with HIV. Parenteral inactivated vaccine is a theoretically safer alternative for this group. BSO: Capsule, enteric coated: Viable S. typhi Ty21a Colony-forming U 2-6 x 109 and nonviable S. typhi Ty21a Colony-forming U 50 x 109 with sucrose, ascorbic acid, amino acid mixture, lactose and magnesium stearate Genghis Khun ([email protected],nafanakhun.wordpress.com)


Injection, suspension (H-P): Heat- and phenol-inactivated, killed Ty-2 strain of S. typhi organisms; provides 8 U/mL, less than or equal to 1 billion/mL and less than or equal to 35 mcg nitrogen/mL Injection : Purified Vi capsular polysaccharide 25 mcg/0.5 mL Powder for suspension (AKD): 8 U/mL < 1 billion/mL, acetone inactivated dried (50 doses) D: S.C. (AKD and H-P): I: 0.25 cc; II: > 4 weeks later Booster: Children 6 mo-10 years: 0.25 mL q3 years >10 years & adults: 0.5 mL Oral: Adults: Primary: 1 caps (day 1, 3, 5, and 7) Booster : every 5 years KI: Allergy, Sudden feverish illness P: Bleeding disorders, Children <2 years, thrombocytopenia ES: Headache, Fever, Pain & Redness around injection site Preg: C Nama Dagang: Typherix Genghis Khun ([email protected],nafanakhun.wordpress.com)


Interferon beta-1a Immunomodulator I: Relapsing/remitting multiple sclerosis (characterised by at least 2 relapses over the previous two years, without evidence of progression of the disease between relapses) in people who are able to walk unaided. BSO: Powder for injection, lyophilized: 33 mcg [6.6 million U] D: Multiple sclerosis (MS): Rebif: 22-44 mcg 3x/wk SC Genital warts: Rebif: 3.67 mcg per lesion 3x/wk for 3 weeks KI: <16 years of age, History of severe depression or thoughts of suicide, Uncontrolled epilepsy, Pregnancy, Breastfeeding. P: Seizure, mood disorders, arrhythmias, decreased kidney & liver function, History of liver disease & alcohol abuse ES: Flu-like symptoms, Flushing, Diarrhoea, insomnia, Depression, alopecia, irregular menstrual bleeding, Dizziness, Under or overactive thyroid, Confusion, Seizures, hepatitis IO: Decreases clearance of zidovudine->increasing toxicity Preg: C Nama Dagang: Rebif Genghis Khun ([email protected],nafanakhun.wordpress.com)


Immunoglobulin I: Primary humoral immunodeficiency (PI), ITP, and chronic inflammatory demyelinating polyneuropathy (CIDP). BSO: Injection: 5% [50 mg/mL] ; 10% [100 mg/mL] D: Children and Adults: I.V.: Primary immunodeficiency disorders: 200-400 mg/kg q4 weeks or as per monitored serum IgG concentrations Chronic lymphocytic leukemia (CLL): 400 mg/kg/dose q3wks Idiopathic thrombocytopenic purpura (ITP): Maintenance dose: 400 mg/kg/day for 2-5 consecutive days; or 1000 mg/kg every other day for 3 doses, if needed or 1000 mg/kg/day for 2 consecutive days; or up to 2000 mg/kg/day over 2-7 consecutive days Chronic ITP: 400-2000 mg/kg/dose as needed to maintain appropriate platelet counts Kawasaki disease: 400 mg/kg/day for 4 days within 10 days of onset of fever 800 mg/kg/day for 1-2 days within 10 days of onset of fever 2 g/kg for one dose only Genghis Khun ([email protected],nafanakhun.wordpress.com)


AIDS: 200-250 mg/kg/dose every 2 weeks 400-500 mg/kg/dose every month or every 4 weeks Pediatric HIV: 400 mg/kg every 28 days Autoimmune hemolytic anemia and neutropenia: 1000 mg/kg/dose for 2-3 days Autoimmune diseases: 400 mg/kg/day for 4 days Bone marrow transplant: 500 mg/kg beginning on days 7 and 2 pretransplant, then 500 mg/kg/week for 90 days posttransplant Adjuvant to severe cytomegalovirus infections: 500 mg/kg/dose every other day for 7 doses Severe systemic viral and bacterial infections: Children: 500-1000 mg/kg/week Prevention of gastroenteritis: Infants and Children: Oral: 50 mg/kg/day divided every 6 hours Guillain-Barré syndrome: 400 mg/kg/day for 4 days 1000 mg/kg/day for 2 days 2000 mg/kg/day for one day Genghis Khun ([email protected],nafanakhun.wordpress.com)


Refractory dermatomyositis: 2 g/kg/dose every month x 3-4 doses Refractory polymyositis: 1 g/kg/day x 2 days every month x 4 doses Chronic inflammatory demyelinating polyneuropathy: 400 mg/kg/day for 5 doses once each month 800 mg/kg/day for 3 doses once each month 1000 mg/kg/day for 2 days once each month Dosing adjustment/comments in renal impairment: Clcr <10 mL/ minute: Avoid use KI: Hypersensitivity P: Anaphylactic hypersensitivity reactions can occur, especially in IgA-deficient patients; studies indicate that the currently available products have no discernible risk of transmitting HIV or hepatitis B; aseptic meningitis may occur with high doses ( greater than or equal to 2 g/kg). Acute renal dysfunction (increased serum creatinine, oliguria, acute renal failure) can rarely occur; usually within 7 days of use. Genghis Khun ([email protected],nafanakhun.wordpress.com)


ES: Fast or pounding heartbeat, Troubled breathing. Bluish coloring of the lips or nailbeds, Burning sensation in the head, Faintness or lightheadedness, weakness, Wheezing IO: Increased toxicity: Live virus, vaccines (measles, mumps, rubella); do not administer within 3 months after administration of these vaccines Preg: C Nama Dagang:



Hepatitis A vaccine I: Vaccination against hepatitis A in > 16 years & adults. BSO: Injection: 360 ELISA U/0.5 mL ; 1440 ELISA U/mL Injection, pediatric: 720 ELISA U/0.5 mL D: I.M. deltoid: Children 2-18 years: 720 ELISA U (2x360 ELISA U) 15-30 days prior to travel, with a booster 6-12 months after Adults: 1440 ELISA U KI: <15 years, Allergy, Sudden feverish illness. P: Liver disease, risk of bleeding or thrombocytopenia (- these given SC rather than IM). ES: Asthenia, myalgia, arthralgia, Headache, diarrhoea, nausea, vomiting or abdominal pain, Loss of appetite, Fever, Redness around injection site, Skin reactions such as rash and itch IO: Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Hepatitis B vaccine I: Prevention of hepatitis B BSO: Injection: Hepatitis B surface antigen 20 mcg/mL Recombinant DNA: Pediatric: Hepatitis B surface antigen 2.5 mg/0.5 mL Adolescent/high-risk infant/Adult: 5 mcg/0.5 mL Dialysis , 40 mcg/mL D: 2.5-20 mcg IM deltoid/ thigh, 3 doses: 0, 1, 6 month later. Newborn babies: 3 doses: at birth/ within 7 days of birth, then 1 & 6 months after the first dose, OR 4 doses: 7 day, then 1, 2 & 7 later. + blood dialysis: 40 mcg 3 doses: 0, 1, 6 month later, OR 4 doses: 0, 1, 2, 6 months. KI: Sudden feverish illness ES: diarrhoea, nausea, vomiting or abdominal pain, Headache, Dizziness, paraesthesia, Fatigue, Fever, flu-like symptoms. IO: Decreased effect: Immunosuppressive agents Preg: C Nama Dagang: Genghis Khun ([email protected],nafanakhun.wordpress.com)


Rho(D) Immune Globulin Immune Globulin I: prevent from interacting with any of baby's blood that may get into mother's blood system while pregnant or during delivery. If mother blood type is Rh o(D) - & baby is Rh o(D) +; mother's body may produce a defense (antibodies) against Rh o(D) + blood. These antibodies will not cause a problem if this is your first pregnancy, unless you have had a blood transfusion in the past and have already developed these antibodies. However, if you have other Rh o(D) + babies in the future, these antibodies may try to destroy the blood of the future babies. Rh o(D) immune globulin can be used to treat ITP, to prevent excessive bleeding. Rh o(D) immune globulin may also be used if you have recently received a transfusion that contained Rh o(D) + blood and your blood type is Rh o(D) -. BSO: Injection: one single dose 300 mcg of Rho (D) immune globulin Genghis Khun ([email protected],nafanakhun.wordpress.com)


D : Prevent your body from producing antibodies against Rh o(D) + blood: 1/> IM/IV during pregnancy, within 72 hours after partus, at the end of an abortion, or after a transfusion. Prevent excessive bleeding in ITP: IV KI: P: ES: Bloody urine, Decreased frequency of urination or amount of urine, hypertension, thirst, Lower back pain, Nausea or vomiting, Pale skin, Swelling of face, fingers, or lower legs, Troubled breathing, Unusual bleeding or bruising, weakness, Weight gain IO: Preg: C Nama Dagang:



Thymalfasin/ Thymosin alpha-1 I: primary humoral Zadaxin



C. Imunosupresan Mycophenolate Ciclosporin Azathioprine



Mycophenolate I: Preventing the body rejecting a transplanted kidney (in combination with ciclosporin and corticosteroids). BSO: Capsule 250 mg Injection: 500 mg Tablet, film coated: 500 mg D: PO/Injection: Prevention of rejection of transplanted heart/ liver: 1.5 g 2x/d Prevention of rejection of transplanted kidney: 1 g 2x/d KI: Allergy, Breastfeeding, glucose-galactose malabsorption P: Serious digestive system disease, Rare hereditary diseases where there is a deficiency of an enzyme called HGPRT, eg Lesch-Nyhan or Keelley-Seegmiller syndrome. ES: Diarrhoea, constipation, nausea, vomiting or abdominal pain, leucopenia, thrombocytopenia or anaemia, Increased susceptibility to infections, Disturbances in the levels of electrolytes, Ulceration or bleeding in the stomach or intestines, Headache, Depression, anxiety, Confusion, Seizures, Dizziness, paraesthesia, insomnia, loss of appetite, dyspnoea, Genghis Khun ([email protected],nafanakhun.wordpress.com)


flu-like symptoms, oedema, hepatitis, jaundice, tachycardia, Increased risk of developing lymphomas and other cancers, particularly skin cancer. IO: Decreased effect: Antacids decrease Cmax and AUC, do not administer together; cholestyramine decreases AUC, do not administer together Increased toxicity: Acyclovir and ganciclovir levels may increase due to competition for tubular secretion of these drugs; probenecid may increase mycophenolate levels due to inhibition of tubular secretion; salicylates: high doses may increase free fraction of mycophenolic acid Preg: D Nama Dagang:



Cyclosporine I: Transplantasi organ/ sumsum tulang. Uveitis endogen. Psoriasis, AR, sindroma Nefrotik, dermatitis atopik (eczema) Immunosuppressant which may be used with azathioprine and/ or corticosteroids to prolong organ and patient survival in kidney, liver, and heart transplants; used in allogeneic bone marrow transplants for prevention and treatment of graft-versushost disease; also used in some cases of severe autoimmune disease that are resistant to corticosteroids and other therapy. BSO: Capsule : 25 mg, 50 mg, 100 mg Injection : 50 mg/mL Solution, oral : 100 mg/mL D: Oral: Transplant rejection: 12-15 mg/kg/day Maintenance: 5-10 mg/kg/day Rheumatoid arthritis, Psoriasis: 2.5-4 mg/kg/day Injection: Transplant rejection: 2-6 mg/kg/day KI: Hipersensitif P: Laktasi. Awasi kadar Kalium darah. ES: Hiperkalemia, kerusakan hati & ginjal, hipertensi. Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: CYP3A3/4 enzyme substrate Increased toxicity: Drugs that increase cyclosporine concentrations: Azithromycin, clarithromycin, diltiazem, erythromycin, fluconazole, itraconazole, ketoconazole, nicardipine, verapamil, grapefruit juice Drugs that enhance nephrotoxicity of cyclosporine: Aminoglycosides, amphotericin B, acyclovir Lovastatin - myositis, myalgias, rhabdomyolysis, acute renal failure Nifedipine - increases risk of gingival hyperplasia Preg: C Nama Dagang: Sandimmun/ Sandimmun Neoral



Azathioprine Kerja: Menghambat produksi WBC I: Active chronic autoimmune hepatitis, autoimmune haemolytic anaemia, pemphigus vulgaris, ITP, dermatomyositis, polymyositis, systemic lupus erythematosus, polyarteritis nodosa, Preventing the body from rejecting transplanted organs, eg heart, liver, kidney transplants, severe rheumatoid arthritis BSO: Tab 50 mg, Injection: 100 mg D: Transplantasi organ awal 3-5 mg/kgBB/hr mulai saat dilakukan transplantasi. Hepatitis kronik aktif 1-1,5 mg/kgBB/hr KI: Bumil, Allergy to mercaptopurine, Pregnancy P: Laktasi, Decreased kidney & liver function, Elderly people, Inherited deficiency of an enzyme called thiopurine methyltransferase (TPMT) ES: Toksisitas hematology & GI. Rentan infeksi. Genghis Khun ([email protected],nafanakhun.wordpress.com)


IO: allopurinol, oksipurinol, tiopurinol. Obat penghambat neuromuskuler, Warfarin, obat sitotoksik/mielosupresan, Vaksin Preg:: D Nama Dagang:



PUSTAKA ✔ MIMS Indonesia, Petunjuk Konsultasi Edisi 6 2006/2007 ✔ Http://www.netdoctor.co.uk ✔ http://redpoll.pharmacy.ualberta.ca/drugbank/index.ht ml ✔ Medical Drug Reference Version 2, Parson Technology, Inc ✔ Http://www.emedicine.com ✔ Integrative Medicine Access, www.onemedicine.com. ✔ Http://www.mayoclinic.com



DAFTAR ISI PANDUAN PENGGUNAAN I. SALURAN PENCERNAAN II. KARDIOVASKULER & SISTEM HEMATOPOIETIK III. SALURAN NAFAS IV.NEURO MUSKULER V. HORMON VI. ANTIBAKTERI, ANTI AMUBA & ANTI HELMINTIK VII. SALURAN KEMIH VIII. METABOLIK IX. VITAMIN & MINERAL X. PREPARAT MATA XI. PREPARAT KULIT XII. PREPARAT TELINGA XIII. PREPARAT MULUT XIV. IMUNOLOGI PUSTAKA INDEX Genghis Khun ([email protected],nafanakhun.wordpress.com)


INDEX A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



A Acarbose Acefylline piperazine Acetaminophen Acetazolamide Acetylcysteine Acetylsalicyclic acid Acetylcholine Aciclovir Adefovir dipivoxil Adenosine Alclometasone Alendronate Alfacalcidol Alfuzosin Allopurinol Allylestrenol Alteplase Aluminium hydroxide

Ambroxol HCl Amikacin Amino acids Aminophylline Amiodarone Amitriptyline Amlodipine Amoxapine Amoxicillin Ampicillin Anagrelide Anastrozole Antithrombin III Aprotinin Ascorbic acid Asparaginase Aspirin Astemizole



Atazanavir Atenolol Atorvastatin Atracurium besilate Atropine

Attapulgit Azapentacene Azathioprine Azelaic acid Azithromycin



B Baclofen Beclomethasone Benazepril Bencyclane Benzoyl peroxide Benzydamine Benzathine Penicillin Beractant Betahistine Betamethasone Betaxolol Bicalutamide Bifonazole Billberry dry extract

Biotin Bisacodyl Bismuth salicylate Bisoprolol Bleomycin Botulinum Toxin type A Brinzolamide Bromhexine HCl Bromocriptine Budesonide Buflomedil Bunazosin HCl Butropium Bromide



C Calcipotriol Calcipotriene Calcitonin Calcitriol Candesartan Capecitabine Capsaicin Captopril Carbamazepine Carbazochrome Na sulfonate Carbocisteine Carboplatin Carteolol Carvedilol Cefaclor Cefadroxil Cefalexin Cefalotin

Cefamandole Cefazolin Cefditoren Cefepime Cefixime Cefmetazole Cefopherazone Cefotaxime Cefotiam Cefpirome Cefpodoxime Cefprozil Cefradine Ceftazidime Ceftizoxime Ceftriaxone Cefuroxime Celecoxib



Cephalexin Cephalotin Cephradine Cetirizine Cetrorelix acetate Charcoal Chenodeoxycholic acid Chloramphenicol Chlordiazepoxide Chlorhexidine gluconate Chloroquine Chlorphenamine Chlorpromazine Chlorpropamide Chlortalidone Chlorzoxazone Cholecalciferol Chondroitin sulphate Chorionic Gonadotrophin

Ciclopirox Olamin Ciclosporin Cilastatin Cilostazol Cimetidine Cinnarizine Ciprofibrate Ciprofloxacin Cisapride Cisplatin Citalopram Citicoline Citrulline Clarithromycin Clavulanic acid Clebropride Malate Clemastine Clenbuterol Clindamycin



Clobetasol propionate Clodronic acid Clofazimine Clomifene citrate Clomipramine Clonazepam Clonidine Clopidogrel Clostridium botulinum A Clotrimazole Cloxacillin Co-dergocrine mesylate Co-trimoxazole

Codeine HCl Colchicine Colestyramine Colistin sulphate Collagenase Conjugated estrogen Cyanocobalamin Cyclophosphamide Cyclosporine Cyproheptadine Cyproterone acetate Cytarabine



D Dacarbazine Danazol Dapsone Daunorubicin Dequalinium Desloratadine Desogestrel Desonide Desoximetasone Dexamethasone Dexketoprofen Dextromethorphan Diacerein Diazepam Dibekacin Diclofenac Didanosine Diethylpropion HCl

Diflucortolone Digoxin Dihydroergotamine Diltiazem Dimenhydrinate Dimethindene Dimeticone Dinoprostone Dioctahedral smectite Diosmin Diphenhydramine Diphtheria, Tetanus Toxoids, and Acellular Pertussis Vaccine Diphtheria, Tetanus, Acellular Pertussis, Polio, HiB Vaccine Diphtheria, Tetanus, Acellular Pertussis, Hepatitis B Vaccine Dipyridamole Disodium clodronate



Dithranol Dobutamin Docetaxel Docusate sodium Domperidone Donepezil Dopamine HCl Doxazosin Doxepin Doxorubicin Doxycycline Duloxetine Dutasteride Dydrogesterone



E Enalapril Enoxaparin Entecavir Eperisone Ephedrine HCl Epirubicin Epoetin alfa Epoetin beta Erdosteine Ergocalciferol Ergotamine Erythromycin Erythropoietin Esomeprazole Estazolam Esterified estrogen Estradiol Estradiol valerate

Estrone Estriol Estrone Estropipate Etanercept Ethambutol Ethamsylate Ethinylestradiol Etodolac Etonogestrel Etoposide Etoricoxib Exemestane Ezetimibe



F Factor VIII Famotidine Felodipine Fenbufen Fenofibrate Fenoterol Feracrylum Fexofenadine HCl Filgrastim Finasteride Flavoxate Flucloxacillin Fluconazole Fludarabine Flunarizine Fluocinolone acetonide Fluorometholone Fluorouracil

Fluoxetine Fluprednidene Flutamide Fluticasone Fluvastatin Fluvoxamine Folic acid FSH Follitropin alfa Follitropin beta Fondaparinux sodium Fosfomycin Fosinopril Fradiomycin Framycetin Furazolidone Furosemide Fusidic acid



G Gabapentin Galantamine Ganciclovir Gatifloxacin Gefitinib Gemcitabine Gemfibrozil Gentamicin Gestrinone Gingkgo Biloba Glibenclamide

Gliclazide Glimepiride Glipizide Gliquidone Glucosamine Glyceryl Guaiacolate Glyceryl trinitrate Goserelin Gramicidin Granisetron Griseofulvin Guaifenesin



H Haemophilus b Conjugate Vaccine Haloperidol Halcinonide HCT Heparin sodium Heparinoid Hepatitis A vaccine Hepatitis B vaccine Heptaminol acefyllinate Heptaminol HCl Hexetidine Homochlorcyclizine Human diploid cell vaccine Hyaluronic acid Hydralazine Hydrochlorothiazide Hydrocortisone

Hydroquinone Hydroxycarbamide Hydroxyurea Hydroxyzine Hyoscine butylbromide



I Ibuprofen Idoxuridine Ifosfamide Iloprost Imatinib Imidapril Imipenem Imipramine Immunoglobulin Indapamide Indometacin Infliximab Influenza vaccine Inosine dimepranol acedoben

Insulin Interferon alfa-2b Interferon beta-1a Ipratopium bromide Irbesartan Irinotecan Isoaminile Isoconazole Isoniazid Isoprenaline HC Isoproterenol Isosorbide Isoxsuprine Isphagula Itraconazole



K Kanamycin Kaolin, Pectin Ketoconazole Ketoprofen Ketorolac Ketotifen



L Lacidipine Lactobacillus Lactulose Lamivudine Lamotrigine Lansoprazole Latanoprost Leflunomide Lenograstim Lercanidipine Letrozole Leuprorelin Levamisole Levetiracetam Levocetirizine Levodopa Levodropropizine Levofloxacin

Levonorgestrel Levothyroxine lidocaine Linezolid Lindane Lincomycin Lisinopril Lithium carbonate Lodoxamide Loperamide HCl Loratadine Losartan Lovastatin Loxoprofen Lutropin alfa Lynestrenol



M Magnesium hydroxide Magnesium sulphate Magnesium trisilicate Malathion Mannitol Maprotiline Mazindol Measles, mumps, rubella vaccine (live) Mebendazole Mebeverine Mebhydrolin Mecobalamin Medroxyprogesterone Mefenamic acid Megestrol Meloxicam Menadione

Meningococcal Polysaccharide Vaccine, Groups A, C, Y, and W-135 Meperidine Meropenem Mesalazine Mesterolone Metamizole sodium Metformin Methampyrone Methisoprinol Methotrexate Methoxalen Methyldopa Methylergometrine Methylergonovine Methylphenidate Methylprednisolone Methylsalicylate



Metoclopramide HCl Metoprolol Metronidazole Mianserin Miconazole Midazolam Milrinone Minocycline Minoxidil Mirtazapine Misoprostol Mitomycin Mitoxantrone Moclobemide Mometasone furoate Monoxerutin Morphine Moxifloxacin Moxonidine

Mupirocin Mycophenolate



N N-acetylcysteine Nabumetone Nadroparin calcium Naftidrofuryl Naftifine Naphazoline Naproxen Nateglinide Neomycin Neostigmine Netilmicin Nevirapine Niacin Nicardipine Nicergoline Nicotinic acid Nicotinamide Nicotinyl alcohol

Nifedipine Nifuroxazide Nimesulide Nimodipine Nitrazepam Nitroglycerin Nizatidine Nomegestrol acetate Norephinephrine bitartrate Norethisterone Norfloxacin Norgestrel Noscapine Nystatin



O Octreotide Ofloxacin Oilatum Olanzapine Olmesartan medoxomil Olopatadine Omeprazole Ondansetron Orciprenaline sulphate Orlistat Ornithin Oseltamivir Otilonium bromide Oxaliplatin Oxatomide Oxcarbazepine Oxymetazoline Oxyphenbutazone

Oxytetracycline Oxytocin



P Paclitaxel Pamidronate Pancreatin Pancuronium Br Panthenol Pantoprazole Papaverine HCl Paracetamol Parecoxib Paromomycin Paroxetine Pefloxacin Peginterferon alfa-2a Peginterferon alfa-2b Pemirolast Penicillin G Benzathine Penicillin G Procaine Pentoxyfilline

Perindopril Permethrin Perphenazine Pethidine Phaseolus vulgaris Phenazopyridine Phenobarbital Phenoxymethylpenicillin Phenylbutazone Phenylephrine Phenylpropanolamine HCl Phenytoin Pilocarpine Pimecrolimus Pioglitazone Pipemidic Acid Piperacillin Piperazine Piracetam



Pirenoxine Piroxicam Pizotifen Pneumococcal Vaccine Policresulen Poliovirus Vaccine Polymigel Polymyxin B Polyvinyl alcohol Potassium chloride Povidone Iodine Prajmalium bitartrate Pramiverine Pravastatin Prednicarbate Prednisolone Prednisone Primaquine

Probenecid Procaine benzylpenicillin Procaterol Prochlorpherazine Progesterone Promethazine theoclate Propafenone HCl Propantheline bromide Propranolol Propylthiouracil Pseudoephedrine Pyrantel Pamoate Pyrazinamide Pyridostigmine Pyridoxine Pyrimethamine Pyritinol



Q Quinapril Quinine sulfat



R Rabeprazole Rabies immune globulinHuman Rabies vaccine Racecadotril Raloxifene Ramipril Ramosetron Ranitidine HCl Rebamipide Reserpin Retinol Retinoic Acid Rho(D) Immune Globulin Ribavirin Riboflavin Rifampicin Rifampin

Risedronate Ritodrine Ritonavir Rituximab Rivastigmine Rocuronium Br Rosiglitazone Rosuvastatin Roxithromycin



S Salbutamol Salicylic acid Salmeterol Salmonella Typhii Secnidazole Selenium sulfide Sertaconazole Sertraline Sibutramine Sildenafil Silver Sulfadiazine Simeticone Simvastatin Sodium hyaluronate Sodium nitroprusside Sodium Picosulfate Somatostatin Somatropin

Sotalol Sparfloxacin Spiramycin Spironolactone Stavudine Streptokinase Streptomycin Succinylcholine Cl Sucralfate Sulbenicillin Sulbutiamine Sulfacetamide Sulfadoxine Sulfasalazine Sulfur Sulpiride Sultamicillin Sumatriptan Suxamethonium chloride



T Tacrolimus Tadalafil Tamoxifen Tamsulosin Tazobactam Tegafur Tegaserod Teicoplanin Telmisartan Temozolomide Tenoxicam Teprenone Terazosin Terbinafin Terbutaline Terfenadine Testosterone Tetanus Immune Globulin

Tetracycline Tetrahydrozoline Theophylline Thiamine Thiamphenicol Thymalfasin Thymosin alpha-1 Tianeptine Tibolone Ticlopidine HCl Tiemonium methylsulphate Timepidium bromide Timolol Tinidazole Tinoridine Tioconazole Tiotropium bromide Tipepidine hibenzate Tizanidine



Tobramycin Tocopheryl nicotinate Tolterodine Topiramate Tramadol Trandolapril Tranexamic acid Trastuzumab Travoprost Tretinoin

Triamcinolone acetonide Triazolam Trifluoperazine Trihexyphenidyl Trimetazidine Trimetoquinol HCl Tripelennamine Tromantadine HCl Tropisetron



U Undecylenic acid Urea Ursodeoxycholic acid



V Valaciclovir Valdecoxib Valethamate bromide Valganciclovir Valproate semisodium Valproic acid Valsartan Vancomycin Vardenafil Varicella Virus Vaccine Vecuronium Br Venlafaxine Verapamil Verteporfin Vinblastine

Vincristine Vinorelbine Vitamin A Vitamin B1 Vitamin B12 Vitamin B2 Vitamin B6 Vitamin B Complex Vitamin C Vitamin D2 Vitamin D3 Vitamin E Vitamin H Vitamin K Voriconazole



W Warfarin



X Xylometazoline



Z Zafirlukast Zidovudine Zoledronic acid


Kitab Daftar Nama Obat Generik

by:

Faik Fauzi&Mulachella Genghis Khun

Daftar Obat Generik

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