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BDNF

BANGLADESH
NATIONAL
FORMULARY
2019

5
Published by
Directorate General of Drug Administration
Health Services Division
Ministry of Health and Family Welfare (MOHFW)
In Association with
Bangladesh Medical Association
Bangladesh Pharmaceutical Society
Bangladesh National Formulary
(BDNF)
2019

Published by
Directorate General of Drug Administration
Health Services Division
Ministry of Health and Family Welfare (MOHFW)
In Association with
Bangladesh Medical Association
Bangladesh Pharmaceutical Society
BDNF 2019

An official publication about drugs and related items officially used in Bangladesh
for rapid reference and includes all the available information for prescribing and
dispensing.

Published by
Directorate General of Drug Administration
Aushadh Bhaban, Mohakhali, Dhaka-1212, Bangladesh

In Association with
Bangladesh Medical Association
and
Bangladesh Pharmaceutical Society

ISSN 1683-1314

5th
Edition
July, 2019

Computer Composed by
Md. Shahidul Islam Khan

Cover Design by
Md. Mehedi Hasan,
National Consultant, Essential Drugs and Medicines,
WHO Bangladesh

Printed by
--------------------

Caution
Bangladesh National Formulary (BDNF) is meant for academic and
professional use only. Any part of this book may not be used for any form of
advertisement, sales, publicity or business related to drug(s) mentioned in
the Formulary without the prior written permission of the publisher.

Acknowledgement
World Health Organization (WHO), Bangladesh
• Directorate General of Drug Administration
Aushadh Bhaban, Mohakhali,
Dhaka-1212, Bangladesh
Tel : 880-2-9880854, 9880964, 9880897, 9880803
E-mail : dgda.gov@gmail.com
Web : www.dgda.gov.bd

• Bangladesh Medical Association


• Bangladesh Pharmaceutical Society

Supported by:
CONTENTS
Preface i-ii
Committees iii-iv
Contributors v-vii
User’s Guide viii
Guidance on Prescribing ix-xv

Notes on drugs and preparations


1. Anti-Infective 1-90
2. Gastro-Intestinal System 91-121
3. Cardiovascular System 122-175
4. Respiratory System 176-194
5. Endocrine System 195-235
6. Obstetrics, Gynaecology and Genito Urinary-Tract Disorders 236-264
7. Central Nervous System 265-314
8. Anaesthesia 315-328
9. Musculoskeletal and Joint Diseases 329-353
10. Eye 354-386
11. Ear, Nose and Throat 387-402
12. Skin 403-442
13. Immunological Products and Vaccines 443-463
14. Malignant Diseases and Immunosuppression 464-493
15. Anaemias and Other Blood Disorders 494-508
16. Nutrition 509-534
17. Contrast Media 535-541

Appendices and Indices


Appendix-1 Treatment Guidelines 542-568
Appendix-1a Treatment Guidelines for Acute Watery Diarrhoea 542-545
Appendix-1b Treatment Guidelines for Tuberculosis 546-548
Appendix-1c Treatment Guidelines for Leprosy 549-550
Appendix-1d Treatment Guidelines for Dengue Infection 551-554
Appendix-1e Treatment Guidelines for Acute Respiratory Tract Infection 555-555
Appendix-1f Treatment Guidelines for Drug Addicts 555-558
Appendix-1g Treatment Guidelines for Burn Injury 559-561
Appendix-1h Treatment Guidelines for Malaria 562-562
Appendix-1i Treatment Guideline for Kala-azar 563-565
Appendix-1j Treatment Guidelines for Chikungunya 566-568
Appendix-2 Drug Interactions 569-643
Appendix-3 Liver Diseases 644-650
Appendix-4 Renal Impairment 651-659
Appendix-5 Pregnancy 660-699
Appendix-6 Breast-Feeding 700-705
Appendix-7 Poisoning 706-714
Appendix-8 Immunization Schedule 715-722
Appendix-9 Essential Drug List 723-734
Appendix-10 List of Over the Counter (OTC) Drugs 735
Appendix-11 List of Controlled Drugs 736
Appendix-12 Adverse Drug Reactions Monitoring (ADRM) and 737-747
Pharmacovigillance
Appendix-13 Pharmaceutical Abbreviations 748-751
Appendix-14 Medicinal Gases 752-757
Appendix-15 Nuclear Medicine and Radiopharmaceuticals 758-766
Appendix-16 Nuclear Parenteral Doses (for Adults and Children) of 767-770
Drugs for Medical Emergencies
Appendix-17 Drug and Food Interaction 771-772
Appendix-18 Side Effect of some common drugs 773-777
Appendix-19 Clinical Pathology and other Biomedical tablet 778-791
Appendix-20 List of thermolabile products with recommended 792-794
Storage Condition
Appendix-21 Access, Watch and Reserve groups of antibiotics 795-798

Dental Practitioners’ Formulary 799-824


Index of Pharmaceutical Manufacturers in Bangladesh 825-832
Abbreviations & Symbols Used in the Formulary 833-834
General Index 835-900
Reporting Form of Suspected Adverse Drug Reactions
COMMITTEES

Committees
CHIEF PATRON NATIONAL FORMULARY COMMITTEE
Mr. Zahid Maleque, MP
Honorable Minister Chairman
Ministry of Health & Family Welfare Professor Kanak Kanti Barua
Government of the People’s Republic Vice-chancellor, BSMMU, Dhaka
of Bangladesh
Member-Secretary
PATRONS Nayer Sultana
Md. Asadul Islam Director (cc)
Honorable Secretary Directorate General of Drug Administration
Health Services Division
Ministry of Health & Family Welfare Members
Government of the People’s Republic Major General (Rtd.) Md. Abdul Ali Mia
of Bangladesh Ex-Consultant Physician General
Bangladesh Armed Forces Medical Services
ADVISORY COMMITTEE Dhaka

Chairman Additional Secretary


(Drugs Admin & Law)
Major General Md. Mustafizur Rahman Health Services Division
Exe-Director General Ministry of Health & Family Welfare
Directorate General of Drug Administration Bangladesh Secretariat, Dhaka
Dhaka
Professor A. K. M. Nurul Anwar
Co-Chairman Ex-Director General
Professor Md. Ismail Khan Directorate General of Health Services (DGHS)
Vice Chancellor
Chittagong Medical University Professor A.B.M Faruque
Chittagong Department of Pharmaceutical Technology
University of Dhaka
Members
Additional Secretary Dr. Mustafa Jalal Mohiuddin
(Drugs Admin & Law) President
Health Services Division Bangladesh Medical Association
Ministry of Health & Family Welfare
Bangladesh Secretariat, Dhaka Professor Rashid–E-Mahbub
Ex-President
Professor Nazmun Nahar Bangladesh Medical Association
EX-Director General
BIRDEM Hospital, Dhaka Professor Md. Zulfiqur Rahman Khan
Dean
President Faculty of Surgery, BSMMU, Dhaka
Bangladesh Medical & dental Council Professor A.F.M Saiful Islam
Ex-Director
President Center for Medical education, Dhaka
Bangladesh Private Practitioners Association
Professor Md. Abdur Rahman
Dean
M. Musaddek Hossain Faculty of Pharmacy
Vice-President University of Dhaka
Bangladesh Pharmacy Council
Professor Sania Tahmina
Director, CDC
Directorate General of Health Services (DGHS)
Dr. Firdausi Qadri
Emeritus Scientist & Acting Senior Director(IDD)
ICDDRB, Mohakhali, Dhaka

President
Bangladesh Pharmaceutical society
iii
COMMITTEES

EDITORIAL BOARD WORKING COMMITTEE


Adviser Chairperson
Professor DR. Md. Zohurul Haque Professor Dr. Afsana Karim
Professor of Pharmacology
Department of Pharmacology
Ex-Director
BIRDEM, Dhaka
Directorate of Drug Administration
Member-Secretary
Chief Editor
Mahbub Hossain
Professor Dr. Afsana Karim Superintendent of Drugs
Department of Pharmacology
Directorate General of Drug Administration
BIRDEM, Dhaka
Members
Executive Editor
Sr. Assistant Secretary (Drug Admin)
Professor Sitesh Chandra Bachar Ministry of Health & Family Welfare
Professor of Pharmaceutical Technology
Bangladesh Secretariat, Dhaka
Faculty of Pharmacy
University of Dhaka
Professor Sitesh Chandra Bachar
Professor of Pharmaceutical Technology
Assistant Editor Faculty of Pharmacy
Dr. Mohammad Asaduzzaman University of Dhaka
Associate Professor
Clinical Pharmacy & Pharmacology Dept. Dr. A. K. Lutful Kabir
University of Dhaka
Associate Professor
Pharmaceutical Technology Dept.
Members University of Dhaka
Deputy Secretary (Drug Admin)
Health Services Division Nayer Sultana
Ministry of Health & Family Welfare Director (cc)
Bangladesh Secretariat, Dhaka Directorate General of Drug Administration

Brigadier General Dipak Kumar Paul Md. Razibul Habib


Chowdhury Superintendent of Drugs
Pharmacology Department Directorate General of Drug Administration
Dean
Medical Studies Faculty
BUP, Mirpur Cantonment, Dhaka
Professor A.K.M. Mosarrof Hossain
Pharmacology Department
Sylhet M A G Osmani Medical College, Sylhet

Professor Sultana Ferdousi


Chairman
Physiology Department
BSMMU, Dhaka

Professor Eliza Omar Eva


Pharmacology Department
Shahid Shohrawardi Medical College, Dhaka

Member-Secretary
Nayer Sultana
Director (cc)
Directorate General of Drug Administration

iv
CONTRIBUTORS

Contributors
Ahmad Istiaque, Advisor, Aristopharma Ltd.
Ahmed Md. Jamal Uddin, Dr. Associate Professor, Department of Internal Medicine,
BIRDEM
Allo Akhtarun Nahar (Retd.) Chief Nutrition Officer, BIRDEM.
Amin Md. Ruhul, Director (C.C), Directorate General of Drug Administration
AraGulshan, Dr., Professor of Pharmacology, Medical College for Women, Uttara
Ara Iffat, Dr., Professor of Obstetrics & Gynecology, Dhaka Medical College
Azad Khan AbulKalam, Dr., Professor of Internal Medicine, Dhaka Medical College
Azam Md. Golam, Dr. Associate Professor, Department of GHPD, BIRDEM.
BacharSitesh Chandra, PhD, Professor of Pharmacy, University of Dhaka
Banu Layla Afroza, Dr., Professor of Pharmacology, Shikdar Medical College
BanuParvin Akhter, Dr., Chief Oncologist, Delta Medical College & Hospital
Barami A A Salim, Ex-Director, Directorate General of Drug Administration
Bari Tajul Islam Abdul, Dr.Infectious Disease Division, icddrb& Former Program
Manner, EPI, Bangladesh.
BasakSanchay, Sanofi Pasteur, Sanofi Bangladesh Limited.
Basher M Abul, Dr., Professor of Radiology & Imaging, BSMMU
Begum Bilkis, Professor & Chairman of Clinical Pharmacy and Pharmacology,
University of Dhaka
Begum Fatima, Dr., Associate Professor, National Institute of Nuclear Medicine &
Allied Science, Atomic Energy Commission
BegumFerdousi, Dr., Professor of Gynaecology& Obstetrics, BIRDEM
Begum Hosne Ara, Dr. Associate Professor, Department of Skin and VD, BIRDEM.
Begum Kohinur, Dr., Professor, Pharmacy Department, Asha University
Begum Masuda, Dr., Professor of Hematology, BSMMU
Begum Samsad, Dr., Assistant Professor of Dermatologist, Shaheed Suhrawardy
Medical College
Bhattacharya Pinaki, Dr., D16 Pharma & Biotech Ltd.
Bhuiyan M M Rahman, Dr., Professor of Gastroenterology
Chowdhury Ashesh Kumar, Prof. Immunology,BIRDEM.
Chowdhury Mohiul Islam, Dr. Infectious Disease Division, icddrb, Dhaka,
Bangladesh
Chowdhury Shah Abdur Rahman, Professor, Pharmacology.
Chowdhury ShameemMatin, Dr., Psychiatrist, Private Practitioner
Chowdhury Sk. Ferozuddin, Professor, Pharmacy Department, Jahangirnagar
University
DiptaTashmimFarhana, Prof. Transfusion Medicine &Clinical Haemato logy,
BIRDEM.
Faroque A.B.M., Professor of Pharmaceutical Technology, University of Dhaka
FatemaKaniz, Dr. Associate Professor, Department of Critical Care Medicine,
BIRDEM.
Ferdousi Sultana, Dr.Professor of Physiology, BSMMU
Ghani Abdul,Dr., Professor, Ex-Director, Directorate of Drug Administration
Habib Mansur, Dr., Professor of Neuromedicine, Dhaka Medical College
Haque Md. Zahurul, Dr., Professor of Pharmacology, Ex-Director, Directorate of Drug
Administration
Hasan Md. Mehedi, National Consultant - Essential Drug and Medicines, (WHO),
Bangladesh.
Hasnat Abul, Dr., Professor of Clinical Pharmacy & Pharmacology, University of
Dhaka
Hawlader Md. Mujibur Rahman, Dr., Professor of Conservative Dentistry and
Endodontics, BSMMU
Hossain Istiaque, Healthcare Pharmaceuticals Ltd.
Hossain Mahbub, Superintendent of Drugs, Directorate General of Drug
Administration
Hossain Md. Akter, Assistant Director, Directorate General of Drug Administration,
DGDA
Hossain Mohammad Delwar, Dr. Associate Professor Internal Medicine, BIRDEM.
Hossain Sayed Mashoor, Dr., RPGLC

v
CONTRIBUTORS

Hossain Sheikh Mohammed, Dr., Ophthalmologist, National Institute of Ophthalmology &


Hospital
Hossain Syed Emamul, Dr., Central Drug Addiction Treatment Center, Department of Narcotics
Control
Hossain Touhid Mohammad Saiful, Dr., Assistant Professor of Urology, BSMMU
Huq M Azizul, Glaxo Smithkline Bangladesh Ltd.
HyeHumayun K. M. A., Dr., Ex-Director, Directorate General of Health Services
Hye M. A., Dr., Professor, Ahsania Mission Cancer Hospital
Hye Md. Abdul, Dr., Professor of Anesthesiology, BSMMU
Iqbal Rowshan, Dr., BIRDEM
Islam AFM Saiful, Dr.,Professor,Department Pharmacology, Anwar Khan Modern Medical College
IslamK M H S Sirajul, Dr., Professor of Cardiology, BSMMU
Islam Md Mohid, Superintendent of Drug, Directorate General of Drug Administration
Islam Shahidul Professor, Microbiology, BIRDEM.
Jahan Mina Hoor, Ex. Assistant Director, Directorate of Drug Administration, DGDA.
Jaigirdar Md. Quamrul Hasan, Dr., Professor Dermatology, BSMMU
Jalil, Reza-ul,Dr., Professor of Pharmaceutical Technology, University of Dhaka
Kabir Abul Kamal Lutful, Assistant Professor of Pharmaceutical Technology, University of Dhaka
Kabir Enamul, Dr., Pathology Department, Sir Salimullah Medical College
Kabir Md. Zhangir, Dr., Professor of Urology, Lab Aid Hospital
Kalam Abul, Dr., Navana Pharmaceuticals Ltd.
Kalimuddin Md., Dr., Registrar, National Heart Foundation & Research Institute
Karim Afsana, Dr., Professor of Pharmacology, BIRDEM
Klara Tisocki, Dr., Regional Advisor, Essential Drugs and other Medicines (EDM), World Health
Organization (WHO), Regional Office for South East Asia, New Delhi, India
Kutubi Afroza, Dr., Assistant Professor of Obstetrics & Gynecology, Dhaka Medical College
Mazid M A, Dr., Professor of Pharmaceutical Chemistry, University of Dhaka
Misbahuddin Mir, Dr., Professor of Pharmacology, BSMMU
Mohamed Ramzy Ismail, Technical Officer, Essential Drugs and Medicines, WHO Bangladesh
MomtazAzmeri, Dr., Assistant Professor of Pharmacology, Delta Medical College
Moyeenuzzaman M., Dr., Professor of Physical Medicine, BSMMU
Muquit A. N. M. Abdul, ACI Ltd.
Noor Farah, Dr., Professor of Pharmacology, Dhaka Dental College
PodderUjjwal Kumar, Business Development & Regulatory Affairs, Novartis (BD) Ltd.
Qadri Firdausi, Dr., Director, Centre for Vaccine Science, ICDDR’B
Rahat-Uzzaman, Healthcare Pharmaceuticals Ltd.
Rahman Mafuzar, Dr., Ex. Professor of Radiology & Imaging, BIRDEM Hospital
Rahman Md. Habibur, Dr., Professor of Pharmaceutical Technology & Ex- Director, Directorate of
Drug Administration
Rahman Md. Mahbubur, Dr., Resident Psychiatrist, Central Drug Addiction Treatment Center,
Department of Narcotics Control
Rahman Md. Mojibur,Dr., Professor of Epidemiology
Rahman Md. Mostafizur, Novartis (Bd) Ltd.
Rahman Md. Sayedur, Dr., Professor of Pharmacology, BSMMU
Rahman S M Abdur, Dr. PhD,Professor of Clinical Pharmacy & Pharmacology, University of
Dhaka
Rahman Shah Ataur, Dr., Professor of Dermatology
Rahman Syed Mizanur, Dr., Radiology & Imaging Department, BSMMU
Rashid Harun-Al, Dr., Professor of Anaesthesiology, Holly Family & Red Crescent Hospital
Rashid K. M. Mahbubur, Marketing Manager, Glaxo SmithKline Bangladesh Ltd.
Rashid Md. Abdur, Dr., Professor of Pharmaceutical Chemistry, University of Dhaka
Reza Md. Selim, Dr., Professor of Pharmaceutical Technology, University of Dhaka
Rizvi Shahriar, Dr., Medical CDC, DGHS
Rouf Abu SharaShamsur, PhD, Professor of Pharmaceutical Technology, University of Dhaka
Roy Bhupati Kumar, Healthcare Pharmaceuticals Ltd.
Sattar Humayun, Dr., Professor of Microbiology, BSMMU
Sayeed Ashraf, Dr. Prof. Opthalmology, BIRDEM.
Shaheen Md. Shafiul Alam, Dr. Assistant Professor, Department of Anaesthesiology, BIRDEM.
Shaheen Nazma, Dr., Professor,Institute of Nutrition and Food Science, University of Dhaka
Siddiqi Umme Ruman, Dr, Zoonotic Disease Control Program, Communicable Disease Control
Unit, DGHS.
Siddiqua Aysha, Dr. Pharmacologist, Directorate General of Drug Administration

vi
CONTRIBUTORS

Sultana Nashid, Dr., Associate Professor of Pharmacology, Delta medical College


Sultana Nayer, Director (C.C), Directorate General of Drug Administration
Tahmeed Syed A B, Sanofi Pasteur
Uddin Md. Saleh, Dr., Professor of Ophthalmology
Umma Hani Kajol, UHFPO (C.C), Patnitala, Naogaon
Yusuf Abdullah Md, Dr., Assistant Professor, Department of Microbiology,
National Institute of Neurosciences Hospital.
Shafiullah Rajib hassan IBN, Dr., Medical Officer, Directorate General of Drug Administration

vii
User’s Guide

While compiling the Bangladesh National Formulary (BDNF), the Editorial Board has
tried to follow the style in which the British National Formulary (BNF) has been
arranged. This is because of the fact that the target users of the BDNF, i.e., the
physicians, pharmacists, dentists and other interested groups of Bangladesh, are
already used to making use of the BNF.

All the drugs (both locally manufactured and imported), which are registered with the
Directorate of Drug Administration up to 30th June, 2019 and are in current use in
Bangladesh, are included in the BDNF. Each of them is described individually. They
are first grouped into Chapters according to their pharmacological or physiological or
other medical category. This edition of the BDNF has such 17 Chapters. Each Chapter
is again sub-divided into Sections using numerical proceeds according to more distinct
co-relations between the items included in each Section. Each of these Sections
begins with a brief description of the subject matter, i.e., the drug or its group, which is
expected to be useful for the target users. Description of the drug is followed by brief
notes on its indications, side-effects, cautions, contra-indications, warnings, drug
interactions, doses, names of the proprietary preparations containing the said drug,
names of the manufacturers, the available dosage forms of the drug and their
strengths.

The opening Chapter of the BDNF includes a Guideline on Prescriptions, which


highlights various aspects of prescription writing, prescribing for children and the
elderly and prescribing in terminal illness. It also includes notes on the concept of
essential drugs and control of narcotics.

This issue of the BDNF also includes Chapters on Abbreviations used in the
Formulary, Dental Practitioners Formulary, Index of Manufacturers, Adverse Drug
Reactions Monitoring, a General Index and 21 Appendices.

For readers convenience the body of the text and index is composed in double
columns with no colours in the main captions, but the sub-heads and sub-sub-heads
in the body are printed in colours. Rulers are used above all sub-heads, thickness of
which are varied using black colour depending on the importance of the heads.
Separate superscript symbols are used to denote essential drugs (ED), controlled drugs
(CD)
, and imported drugs (I). Names of the microorganisms are printed in Italics. Names
of the generic drugs are printed in bold letters. Proprietary names are kept in bold
regular but the Company names are in Italics.

Indications, Cautions, Contra-indications, Side-effects, Interactions and Doses are


printed in regular and bold types. Generic items are printed in capital and bold letter.

It should be noted here that the price of the individual drug, which is sold and used in
Bangladesh is also mentioned in this issue.

viii
GUIDANCE ON PRESCRIBING

Guidance on Prescribing
GENERAL GUIDANCE

Appropriate prescribing implies the choice of medicines based on efficacy, safety,


suitability and cost relative to other drugs or treatments that may be available.
Medicines should be prescribed only when they are necessary. Taking time to explain
to patient (and relatives) the treatment options, as well as the rationale and potential
risks ofchosen treatment regimen encourages the patient to take the medicines as
prescribed. Successful therapy comprises much more than choosing an appropriate
drug; it requires knowledge, judgment, skill, wisdom, responsibility, and above all,
patient and doctor compliance.

COMPLIANCE

Patient compliance means adherence to a prescribedtreatment schedule. Patient


non-compliance is a major factor in therapeutic failure.

Reasons for patient non-compliance include: (a) poor patient-doctor relationship with
resultant failure to follow the instructions; (b) lack of adequate information about the
medications; (c) frequency and complexity of drug regimen; (d) forgetfulness; and (e)
fear or anxiety about drug reactions.

Discussing the rationale and possible adverse effects of treatment to the patient or
relatives improves compliance. Simplifying the regimen may also help. The patient
should know the nature of the disease and reasons for drug therapy including
expected benefits; how and when to take the medicine(s) with special instructions, if
any; how long a drug needs to be taken; what to do if a dose is missed; how to
recognize possible adverse effects; and when to report back to the doctor.

Doctor compliance is no less important and relates to his/her professional obligations


and responsibilities. A doctor should have full knowledge about the drugs he/she
prescribes, and be very careful and accurate in prescribing and telling the patients
what they need to know.

DRUG INFORMATION: ROLE OF BDNF

Most physicians recognize that they need unbiased drug information to choose from
the various medicines available in the market, which are often seductively promoted to
them by pharmaceutical companies.
Bangladesh National Formulary (BDNF) aims to provide prescribers, pharmacists, and
other healthcare professionals with up-to- date information about use of medicines.
It provides key information necessary for the selection, prescribing, dispensing and
administration of medicines, registered and approved by the Directorate General of
Drug Administration, Bangladesh.
Information on medicines provided in BDNF has been drawn from manufacturer’s
product literature, verified by professional experts with standard medical and
pharmaceutical literature like BNF, BP, USP, Martindale, and national guidelines.
Generic and International Non-proprietary Names (INN) where applicable have been
provided. Proprietary or brand names are as registered by the Drug Administration.
The doses mentioned areintended for general guidance only. The BDNF advocates

ix
GUIDANCE ON PRESCRIBING

caution that ‘prescription-only drugs’ and ‘controlled drugs’ need to be prescribed only
by a qualified and registered physician or dental surgeon.

ESSENTIAL DRUG CONCEPT: IMPORTANCE IN PRESCRIBING

The essential drugs (EDs) concept was first promoted in 1977 by World Health
Organization (WHO);encouraged each of the member countriesthe need to compile
and regularly update a list of a minimal number of appropriate (effective, safe, suitable
and least costly) drugs that will satisfy the healthcare needs of its majority population.
The Govt. should then ensure that the listed essential drugsbe available at all times, in
adequate amounts, in appropriate dosage forms and in affordable prices; and doctors
be encouraged to prescribe from the list of essential drugs. In 1977 WHO compiled its
first model list of essential drugs, updated regularlysince then, the most recent list
contains about 560 items.

The National Drug Policy (NDP) of 1982 was thefirst determined effort to implement
WHO concept of essential drugs in Bangladesh. Essential drugs have been marked by
symbol (ED) in BDNF. The essential drug list following NDP of 1982 have been revised
and updated in 2016 which contain 285 items (see Appendix-9).

Prescribing fromthe list of essential drugs is considered to be relatively effective and


safe and of acceptable quality and most cost-effective. .

PRESCRIPTION WRITING

Prescription shouldbe legible and dated containing the name, age and address of the
patient, and should be signed in ink by the prescriber.
The age of the patient should always be mentioned in cases of ‘prescription-only
drugs’ for children under 12 years.
A prescription ordering ‘controlled drugs’ must in addition specify the prescriber’s
address, the formulation and strength of the preparation, and the total quality of the
preparation to be supplied (or the number of dose units) in both words and figures. A
prescription ordering a ‘controlled drug’ should clearly mention that it can be
dispensed only once and it’s refilling is not permitted.

DRUG NAMES IN PRESCRIPTION

Names of drugs or medicinal products should be written clearly and not abbreviated.
Drugs prescribed may be either in non-proprietary (generic) or in proprietary (brand)
names.

There are growing awareness for using generic names in prescribing for obvious
advantages—uniformity, convenience, economy, and better comprehension.
Prescribing in non-proprietary (generic) names is also less taxing on the memory of
the prescriber.

However, when it is considered important to ensure consistency of a product in


respect of its quality or bioavailability, and when it is thought that the control over the
quality relative to other manufactured products may not be as rigorous as one would
expect, a doctor may opt to prescribe by proprietary names.

x
GUIDANCE ON PRESCRIBING

In the prescription, unit dose strength should be clearly stated

• Avoid unnecessary use of decimal point; e.g. 5 mg and not 5.0 mg.
• Quantities in grams should be written as 1 g or 1.2 g etc.
• Quantities less than 1 gram should always be written in milligrams; e.g. 500 mg
and not 0.5 g.
• Quantities less than 1 mg should be written in micrograms; e.g. 100 micrograms
and not as 0.1 mg
• Micrograms or nanograms should not generally be abbreviated, because it may
create confusion with milligrams.
• ml (for milliliter) should only be written and not cc (for cubic centimeter).
• When decimals are unavoidable for quantities less than one, a zero should be
written before the decimal; e.g. 0.5 g and not .5 g.

The quantity to be supplied may be specified in numbers or volume; it may also be


stated by indicating the number of days of treatment required.
The directions for use should preferably be in a language that is understood by the
patient and should be without any abbreviations.

PRESCRIBING FOR THE ELDERLY

Prescribing for elderly patients especially very old requires special consideration.They
are usually more vulnerable to adverse effects.Factors responsible include multiple
therapy (poly pharmacy) and alteration of pharmacokinetic or dynamic parameters.
Elderly patients often receive multiple drugs for their multiple diseases or symptoms,
which greatly increasethe risk of adverse effects and/or drug interactions. Elderly
patients’ medicines should be reviewed regularly and those that are not of benefit
should be stopped. Prophylactic medicines are inappropriate if they complicate
treatment or produce side-effects Non-pharmacological means are more appropriate
for symptoms like headache, sleeplessness, light-headedness particularly when
associated with social stress.
In the very old, manifestations of normal ageing may be mistaken for diseases,
leading to inappropriate prescribing. Age related muscle weakness, difficulty in
maintaining balance etc. are often confused with neurological diseases. Nervous
system of the elderly patients is more sensitive to many commonly used drugs like
opioids, benzodiazepines, anti-psychotics, anti-Parkinsondrugs which when used
need caution and regular monitoring.
Pharmacokinetic changes in the elderly can greatly reduce renal clearance and
markedly increase tissue concentration, resulting in slow excretion of drugs
particularly of nephrotoxic drugs. Acute illness can lead to rapid reduction in renal
clearance especially if accompanied by dehydration. Bleeding associated with aspirin
and other NSAIDs are more likely to have serious outcomes in elderly patients with
renal impairment or cardiac diseases.
Hepatic metabolism of lipid soluble drugs particularly with narrow therapeutic window
is reduced in elderly patients because of reduction in liver volume.
Very old patients may have difficulty in swallowing tablets or capsules and in case of
drugs like NSAIDs if left in the mouth may lead to ulceration Elderly patients should
therefore be advised to take tablets/capsules with enough fluid, and in upright position.
Liquid formulation if available may be preferable
Simple treatment regimen is always better for the elderly patients. Once or twice daily
preparation is preferable. Full instructions must be written on the prescription. It is also

xi
GUIDANCE ON PRESCRIBING

important to check the patient’s compliance by counting the remaining tablets or


capsules. Stopping a drug at the right time is as important as starting it.

PRESCRIBING FOR CHILDREN

Responses to drugs in neonates (first 1m), infants (up to1yr) and children(upto12yrs)
are not the same as in adults. The risk of adverse effects are more due to relative
deficiency of drug metabolizing enzymes, differing sensitivity of target organs,
inefficient renal filtration, and inadequate detoxifying systems. Special care should be
taken while prescribing for children and neonates.
Liquid preparations are particularly suitable for infants. Sugar-free liquid preparations
are preferable for long term treatment to avoid risk of dental caries. Many children are
able to swallow tablets or capsules and may prefer a solid dosage form. Whenever
possible, painful intramuscular injections should be avoided. Strength of the tablet or
capsule should be clearly mentioned in the prescription.
Inclusion of age of the child or infant in the prescription is a legal requirement while
ordering ‘prescription-only drugs’ for them; in fact it is advisable to mention the age
while prescribing any drug for children or infants

PRESCRIIBING IN PALLIATIVE CARE

Palliative care is the ‘total care’ needed for a terminally ill patient whose disease is not
responsive to any curative treatment. Aim of the ‘total care’ is to provide the best
quality of life for the patient and family. Control of pain and other symptoms,
management of complications, maintenance of nutrition, and psychological support of
the patient and familyare the main stay of the palliative care
For a total care plan, it is important to make careful assessment of symptoms and the
needs of the patient preferably by multidisciplinary team. Many patients wish to remain
and managed at home with their families, butshould be admitted in specialized
palliative care hospital if the family cannot cope.
While prescribing drugs, the number should be as few as possible. Oral administration
is the route of choice unless the symptoms are severe enough, in which case drugs
may be administered parentally.

Control of Common symptoms:

Pain: Non-opioids (paracetamol, NSAIDs) opioids (codeine, morphine) analgesics;


and adjuvant (antidepressants, antiepileptics) are used alone or in combination
according to type of pain and response.In mild cases, paracetamol may be enough.
Moderate pain may be treated by aspirin or other NSAIDs. In some cases, codeine
may be added for better relief. NSAIDs’ induced gastric upset may be relieved by PPIs
(ranitidine150 mg twice daily). If these measures fail, morphine (orally or parentally) is
the most useful analgesic. The dose should be adjusted carefully with assessment of
the pain.Laxatives should be prescribed to prevent morphine-induced constipation.
Bowel colic may be relieved by loperamide or hyoscinehydrobromide.Pain due to
muscle spasm usually responds toDiazepam. Pain due to nerve compression may be
reduced by dexamethasone.Patients with neuropathic pain may benefit from a trial of
a tricyclic antidepressant. An antiepileptic (gabapentine or pregabaline) may be added
or substituted if pain persists.

xii
GUIDANCE ON PRESCRIBING

Nausea and vomiting: may be due to disease itself, its treatment or concurrent
medical or surgical conditions. The cause should be identified before prescribing any
anti-emetic. Metoclopramide, anti-emetic with pro-kinetic action is the drug of choice.
Anti-emetic therapy should be reviewed every 24hrs and if necessary, a substitute
anti-emetic (haloperidol, cyclizine,levomepromazine) may be prescribed.

Hiccup: An antacid with an anti-flatulent may be prescribed. If this does not work
well, metoclopramide orally or i.m can be added. Alternately chlorpromazine may be
tried.

Dyspnea: Breathlessness at rest may be relieved by carefully titrated doses of


morphine, starting at 5mg every 4 hours. Diazepam 5-10 mg daily may be helpful. If
there is bronchospasm or partial obstruction, dexamethasone 4-8 mg daily may be
tried.

Anorexia: Anorexia may be due to a tumor or its complication, treatment by


radiotherapy or chemotherapy, oral ulceration, depression or anxiety. The approach
to treatment is by removing the cause if possible, alteration of diet and the use of
appetite stimulants. Prednisolone 10-30 mg daily or dexamethasone 2-4 mg daily
may improve appetite.

Dysphagia: Dysphagia may be due to a tumor itself, treatment, neurological damage


or concurrent illness or a combination of these factors. If patient cannot swallow a
solid diet, a liquid diet is advised. If liquid diet also cannot be taken, endo-esophageal
tube may be needed. Dexamethasone 8 mg daily may help. Dry mouth associated
with candidiasis can be treated with oral preparation of Nystatin or miconazole.

Convulsions: Convulsions are common in patients with cerebral tumor or uraemia.


Phenytoin or carbamazepine may be prescribed as prophylaxis. If oral medication is
not possible, Diazepamgiven as suppository (10-20 mg every 4-8 hours) or
Phenobarbitone injection (50-200 mg twice daily) is continued as prophylaxis.

PRESCRIBING CONTROLLED DRUGS

Narcotic and psychotropic drugs, which are under dual control of Directorate of Drug
Administration and Department of Narcotics Control (under The Narcotics Control Act,
1990; Act no. XX of 1990) and are permissible for use as medicinal products in
Bangladesh, are included as monographs in the BDNF. Such drugs are distinguished
throughout in the BDNF by the symbol [CD], meaning “Controlled Drugs”. A list of
controlled drugs is shown in Appendix-11.

Prescription requirements in respect of controlled drugs are as follows:

1. A registered medical practitioner or a dentist as per clause (m) and (e) of


section 2 of the Bangladesh Medical and Dental Council Act, 1980 (XVI of
1980) only shall prescribe any of the controlled drugs.
2. Prescription for controlled drugs must be written, signed and dated in
prescriber’s own handwriting; and specifies prescriber’s full address.
3. The prescription must state patient’s name and address, the total quantity
prescribed and the number of dose units in both words and figures.
4. It should be stated that the prescription is not refillable, and shall not be
dispensed more than once.

xiii
GUIDANCE ON PRESCRIBING

5. If a patient under care of a physicianbecomes an addict requiring treatment,


shall be referred to a narcotics addiction treatment/rehabilitation centre, and
as per section 17(2) of the Narcotics Control Act, 1990 shall inform the
Director General, Department of Narcotics Control, President’s Secretariat,
1 Segun Bagicha, GPO Box No. 3169, Dhaka-1000.

STORAGE AND DISPENSING OF CONTROLLED DRUGS

1. Controlled Drugs, especially A-Class and B-Class narcotics and psychotropic


drugs (see Appendix-11), should be stored in pharmacies and in hospitals or
health centers or clinics in a secured place under lock and key.
2. The name and address of the seller/dispenser and the date on which the
prescription is dispensed must be recorded on the prescription by the
pharmacist/dispenser.
3. The prescription for a controlled drug shall not be dispensed more than once
(see Section 13(3) of Narcotics Control Act, 1990).
4. It is recommended that pharmacies maintain a separate register for dispensing of
all A-Class and B-Class narcotics and psychotropic drugs (see Appendix-11),
wherein the name and address of both the prescriber and the patient, and name
and quantity of the drug dispensed along with the date of dispensing are
recorded.
5. A pharmacist is not allowed to dispense a controlled drug unless all the required
information is given on the prescription.

ADVERSE REACTIONS TO DRUGS

Any drug may produce unwanted or unexpected adverse reactions. Rapid detection,
management and reporting of adverse drug reaction is of utmost importance. Some
reactions like nausea, vomiting, headache, allergic rashes, convulsions etc. may
appear soon enough after the administration of a drug. Some other reactions like
malignancy, agranulocytosis, retinopathy, retroperitoneal fibrosis, etc. may appear
months or years after the exposure. Any suspicion of such an association should be
carefully investigated and reported.
When an infant is born with some congenital abnormality or there is an abortion of a
malformed fetus, doctors should consider whether this might be an adverse reaction to
a drug taken by the mother during pregnancy. Doctors should be particularly careful
and alert about adverse reactions to drugs in the elderly and in infants.

To prevent adverse drug reactions—

1. Do not prescribe a drug unless there is a good indication. If the patient is an


infant or an elderly or a pregnant woman, do not use a drug unless the need for it
is imperative.
2. Specially be careful in prescribing drugs for a person with previous history of
allergy or any adverse drug reactions.
3. Find out whether the patient is already taking some other medicines and avoid
possible drug interactions (see Appendix-2) while prescribing.
4. Age and hepatic or renal disease may alter metabolism and excretion of drugs,
so that much smaller doses may be needed to avoid adverse side effects.

xiv
GUIDANCE ON PRESCRIBING

5. Prescribe as few drugs as possible. Simplify the drug regimen and provide clear
instructions so that the patient (especially the elderly) has no difficulty in
understanding.
6. Whenever possible, use a familiar or established drug which is already included
in an official pharmacopoeia. Be especially careful in prescribing ‘new drugs’.
7. If serious adverse reactions are known to be associated with a drug, warn the
patient while prescribing it.

Reporting Adverse Drug Reactions:

Doctors working in public hospitals or health complexes or in private hospitals/clinics


or engaged in private practice have a special responsibility of reporting suspected
adverse reactions to any therapeutic agents including drugs, blood products, vaccines,
contrast medias, herbal products; and all cases of adverse reactions that were fatal,
life-threatening, hospitalization or prolongation of hospitalization, disability or
permanent damage, congenital anomaly/birth defect or any other serious issues.

Detection, management and reporting of adverse drug events (ADE), especially those
in respect of ‘new drugs’, is of vital importance.

There is an Adverse Drug Reactions Monitoring (ADRM) cell in the office of the
Directorate General of Drug Administration, which works in collaboration with WHO.
Details about the ADRM cell and a Yellow Card for ADE reporting to ADRM cell are
included at the end of the BDNF.

xv
Chapter 1
ANTI-INFECTIVES
Anti-infective Drug Therapyp 1

1.1 Antibacterial drugsp.3


1.1.1 Penicillins p.3
1.1.2 Cephalosporinsp.13
1.1.3 Other beta-lactamsp.29
1.1.3.1 Carbapenemsp.29
1.1.3.2 Monobactamp. 32
1.1.4 Aminoglycosidesp.32
1.1.5 Macrolidesp.35
1.1.6 Tetracyclinesp.40
1.1.7 Quinolones and fluoroquinolonesp.42
1.1.8 Sulfonamides and trimethoprimp.49
1.1.9 Metronidazole tinidazole and ornidazolep.50
1.1.10 Antimycobacterial drugsp.50
1.1.10.1 Anti-tuberculosis drugs p.51
1.1.10.2 Anti-leprosis drugsp.55
1.1.11 Drugs used in sexually transmitted diseases p.56
1.1.12 Other antibacterials p.57
1.2 Antifungal drugs p.62
1.2.1 Systemic antifungals for systemic fungal infectionsp.62
1.2.2 Systemic antifungals for mucocutaneous infectionsp.64
1.2.3 Topical antifungalsp.64
1.3 Antiprotozoal drugs p.66
1.3.1 Antimalarialsp.66
1.3.2 Amebicidesp.73
1.3.3 Trichommonocidesp.77
1.3.4 Antigiardial drugsp.77
1.3.5 Leishmeniacidesp.78
1.4 Antiviral drugs p.79
1.4.1 Drugs for herpes virus infectionsp.80
1.4.2 Drugs for viral hepatitisp.82
1.4.3 Drugs for influenza an respiratory syncytial virusp.84
1.4.4 Drugs for HIV infectionp.86
1.5 Anthelminticsp.94
1.5.1 Drugs for nematode infectionsp.94
1.5.2 Drugs for cestode infectionsp.99
1.6 Antimicrobial option for medically important organismp….

1. ANTI-INFECTIVE DRUGS ANTI-INFECTIVE DRUG THERAPY:


1.1 ANTIBACTERIALS Anti-infective (antimicrobial) drugs are
1.2 ANTIFUNGALS used for the treatment and prophylaxis of
1.3 ANTIPROTOZOALS infections. Nowadays, healthcare
1.4 ANTIVIRALS professionals are increasingly more
1.5 ANTHELMINTICS presented with scenarios in which
infecting microbes that are resistant to all
but a handful of antimicrobials Infections
secondary to drug-resistant pathogens
1. ANTI-INFECTIVES

continue to present therapeutic whether pregnant or breast-feeding or


challenges to clinicians. A number of the taking oral contraceptives.
historically most active antimicrobials Choice of appropriate route of
have undergone widespread administration, dosage formulation, and
susceptibility diminution. Particularly duration of therapy will depend on ability
problematic pathogens include gram- to tolerate drugs orally, site, type and
positive microbes such as severity of infection and kinetic
Staphylococcus aureus and consideration of drugs. Life threatening
Enterococcus species; extended- infections often require intravenous
spectrum, and metallobetalactamase- therapy. Painful intramuscular injections
producing Enterobacteriaceae; and should better be avoided in children. The
nonfermentative gram-negative species dose of an antibacterial will vary on such
such as Acinetobacter species and factors such as age, weight, renal and
Pseudomonas aeruginosa. hepatic functions and the severity of
SELECTING AN ANTIMICROBIAL: infection. Duration of therapy depends on
Ideally, the selection should base on nature of infection and the response to
identification of the causative organism(s) treatment. In most cases a 5-7 days
and their susceptibility to antimicrobials course is sufficient, and should not be
(Definitive therapy). In practice, however, unduly prolonged as the drugs are costly,
the choice often follows from clinical encourage resistance and may lead to
diagnosis defining as precisely as side-effects. In certain infections like
possible, the sites and nature of infection, chronic, it is necessary to continue
responsible pathogen(s) and known treatment for longer periods.
sensitivity to drugs (Empiric therapy). CHEMOPROPHYLAXIS: The basis of
Samples (blood, pus, urine, sputum, chemoprophylaxis is use of an
CSF, etc.) should be collected before antimicrobial agent in a healthy person to
starting any ‘blind’ antimicrobial therapy prevent infection but in practice it also
to confirm clinical diagnosis and drug includes suppression of existing infection.
sensitivity. Removing barriers such as The main categories of
draining an abscess, obstruction in chemoprophylaxis are: (i) prevention of
urinary or respiratory tract, etc. is infections like rheumatic fever, recurrent
important to facilitate entry of urinary tract infections, etc.; (ii)
antimicrobials to site(s) of infection. prevention of opportunistic infections like
Patients who receive Empiric bacterial endocarditis after dentistry or
antimicrobial therapy, to which the peritonitis after bowel surgery; (iii)
causative pathogen is resistant, suffer suppression of existing infection before
significantly. This underscores the overt diseases result e.g. tuberculosis,
importance of selecting an empiric malaria, animal bites, trauma; and (iv)
antimicrobial that possesses activity prevention of exacerbation of a chronic
against the range of suspected infection like bronchitis.
pathogens. One or more antimicrobials, Chemoprophylaxis in surgery is justified
suggested by knowledge of likely when risk of infection is high (such as
organism and its sensitivity pattern, is presence of large number of organisms
then judged by the drug’s specificity, in organs being operated or in colorectal
safety (risk-benefit ratio), kinetic and gynecological surgery); when risk of
considerations and cost effectiveness in infection is low but consequence of
respect to the patient factors to make the infection could be disastrous (e.g.
final choice. Factors related to patient insertion of prosthetic joints or valves
include history of drug allergy, renal and etc.); or when patient is
hepatic function, susceptibility to infection immunocompromised and is especially
(i.e. whether immunoco-mpromised), susceptible to infection. Antimicrobials
severity of illness, ability to tolerate should be selected on the basis of the
drugs, concomitant use of other drugs, knowledge of the likely pathogens at the
ethnic origin, age and sex; and if female,
2
1. ANTI-INFECTIVES

sites of surgery and their prevailing * - Watch group antibiotics


antimicrobial susceptibility. included in the EML/EMLc only
Antimicrobials should preferably be given for specific, limited indications
intravenously (IV) or intramuscularly (IM)
at the beginning of surgery and for no [W] - Watch group antibiotics
more than 72 hours.
COMBINATION THERAPY: In most [R] - Reserve group antibiotics
cases treatment with a single drug is [C] - Complementary list -
sufficient. But in some special cases, two
or more antimicrobials are indicated, for
signifies that the medicine(s)
example: (i) to prevent development of require(s) specialist diagnostic or
resistance in tuberculosis or leprosy; (ii) monitoring facilities, [Appendix-21]
to broaden antibacterial spectrum in case
of mixed infection e.g. peritonitis; (iii) to [OTC] - Over The Counter
obtain potentiation e.g. penicillin with
gentamicin.
1.1. ANTIBACTERIAL DRUGS
CONTROL OF ANTI MICROBIAL 1.1.1 PENICILLINS
RESISTANCE: Development of 1.1.2 CEPHALOSPORINS
resistance may be limited by avoidance 1.1.3 OTHER BETA-LACTAMS
of indiscriminate use of antimicrobial 1.1.3.1 CARBAPENEMS
drugs, controlling Access, Watch and 1.1.3.2 MONOBACTAM
Reserve classess antibiotics for rational 1.1.4 AMINOGLYCOSIDES
use, ensuring proper quality of 1.1.5 MACROLIDES
antimicrobial drugs, appropriate selection 1.1.6 TETRACYCLINES
of such drugs, constant monitoring of 1.1.7 QUINOLONES AND
resistance pattern in community, and FLUOROQUINOLONES
restricting use of newer antimicrobial 1.1.8 SULFONAMIDES AND
drugs as long as currently used drugs are TRIMETHOPRIM
effective. To assist in the development of 1.1.9 METRONIDAZOLE
tools for antibiotic stewardship at local, TINIDAZOLE AND ORNIDAZOLE
national and global levels and to reduce 1.1.10 ANTIMYCOBACTERIAL DRUGS
antimicrobial resistance, three different 1.1.10.1 ANTI-TUBERCULOSIS
categories were developed by WHO– DRUGS
ACCESS, WATCH and RESERVE 1.1.10.2 ANTI-LEPROSIS
groups. A publicly sponsored DRUGS
antimicrobial policy should incorporate 1.1.11 DRUGS USED IN SEXUALLY
prevention of indiscriminate use; TRANSMITTED DISEASES
appropriate combination to be used only 1.1.12 OTHER ANTIBACTERIALS
when essential; sensitivity pattern to be
monitored at the community level; 1.1.1. PENICILLINS
indiscriminate use of newer antimicrobial 1.1.1.1 NARROW-SPECTRUM
drugs to be restricted. ACCESS, WATCH PENICILLINS
and RESERVE groups classification is 1.1.1.2 BROAD-SPECTRUM
available in Appendix-21. PENICILLINS
1.1.1.3 EXTENDED SPECTRUM
Note: (ANTIPSEUDOMONAL)
[ED] - Essential Drug PENICILLINS
1.1.1.4 MECILLINAMS
[A] - Key Access Antibiotics
1.1.1.1 NARROW SPECTRUM
PENICILLINS
1.1.1.1.1 PENICILLINASE-SENSITIVE
3
1. ANTI-INFECTIVES

NARROW SPECTRUM necessary increase to 2.4 g daily or more


PENICILLINS according to severity of infections
1.1.1.1.2 PENICILLINASE-RESISTANT (single dose over 1.2 gIV route only);
NARROW SPECTRUM PREMATURE INFANT AND NEONATE,
PENICILLINS 50 mg/kg body weight daily in 2 divided
1.1.1.1.1 PENICILLINASE-SENSITIVE doses; in meningococcal meningitis, 100
NARROW SPECTRUM mg/kg daily in 2 divided doses; INFANT,
PENICILLINS 1-4 weeks, 75 mg/kg daily in 3 divided
doses. CHILD, 1 month to 12-years, 100
These penicillins are effective against mg/kg daily in 4 divided doses;
non-betalactamase (penicillinase) bacterial endocarditis, 7.2 g daily in 4-6
producing streptococci, meningococci, divided doses; meningococcal meningitis,
enterococci, pneumococci, staphylo- 2.4 g every 4-6 hours; CHILD, 1 month to
cocci, treponema pellidum, bacillus 12 years, 180-300 mg/kg daily in 4-6
anthracis, clostridium species, divided doses;
actinomyces and other gram positive
rods and non-betalactamase producing Proprietary Preparation
Pen G(Opsonin), Inj., 10 Lac IU, Tk. 16.74/vial.,
gram negative anaerobic organisms.
5 Lac IU, Tk. 11.29/vial

BENZYLPENICILLIN[A] BENZATHINE PENICILLIN[ED] [A]


(Penicillin G)
Benzathine penicillin has a very long
Indications:Streptococcal pharyngitis, duration of action (2-3 weeks). It is used
arthritis, meningitis, endocarditis; to provide a prolonged coverage of
meningococcal diseases; pneumococcal penicillin in rheumatic fever and is
pneumonia, meningitis; anthrax, syphilis, especially suitable for the treatment of
gonorrhea, actinomycosis, gas gangrene, all stages of syphilis.
carbuncle, to eliminate carrier state in Indications: Rheumatic fever, upper
diphtheria, with or without gentamicin for respiratory tract infections, gonococcal
listeria; surgical prophylaxis in limb infections and syphilis
amputation; intrapartum prophylaxis Contra-indications: Penicillin hyper
against group B streptococcal infection; sensitivity
prophylaxis against recurrence of Interactions: See Appendix -2
rheumatic fever and streptococcal Side-effects: See under Penicillins
infections Dose: Deep IM inj. (in the buttock):
Cautions:Dose reduction in renal rheumatic fever, ADULT, 600,000 units
impairment, (estimated GFR 10– per week or 12,00,000 units monthly;
50 ml/min/1.73 m2, use normal dose CHILD, 3 lac to 6 lac units;primary or
every 8–12 hours; estimated GFR less secondary syphilis, a total of 24 lac units
than 10 ml/min/1.73 m2 use normal dose (12 lac units in each buttock) once; larger
every 12 hours); doses and longer courses may be
Contraindications: Penicillin needed for late syphilis or neurosyphilis
hypersensitivity
Interactions:See Appendix-2 Proprietary Preparations
Side-effects:Urticaria, fever, joint pain, Benzapen(Square), Inj., 12 Lac Units/Vial, Tk.
rashes, angioedema, serum sickness like 28.04/vial.
reactions, neutropenia, hemolytic anemia G-Benzathine Penicillin (Gonoshasthaya),
and nephritis; diarrhea and antibiotic- Inj., 12 Lac Units / Vial, Tk. 22.00/Amp.; Inj., 6
associated colitis, neutropenia, Lac Units/Vial, Tk. 15.00/Amp.
thrombocytopenia, coagulation disorders
and CNS toxicity.
Dose: IM inj. or slow IV inj. or Infusion:
ADULT, 1.2 g daily in 4 divided doses, if

4
1. ANTI-INFECTIVES

PHENOXYMETHYL PENICILLIN [ED] [A] Procaine penicillin NOT suitable for


(Penicillin V) intravenous (IV) route
Dose: IM inj., 300,000 units with 100,000
Indications: Tonsillitis, otitis media, units of benzylpenicillin once every 12-24
erysipelas; prophylaxis in rheumatic fever hours;
and pneumococcal infection Primary syphilis, IM inj., procaine
Cautions, Contraindications: See penicillin 900 mg with benzylpenicillin
under benzylpenicillin sodium 180 mg daily for 10 days (14
Interactions: See Appendix -2 days for secondary or latent syphilis)
Dose :oral: ADULT, 500mg every 6
hours; CHILD, up to 1 year 62.5 mg Proprietary Preparations
Combipen(Acme), Inj., 4 LacTk. 14.05/Vial; 8
every 6 hours, 1-5 years 125 mg every
Lac Tk. 13.55/Vial
6 hours, 6-12 years 250 mg every 6 Pronapen(Renata), Inj.,8 Lac Tk. 9.10/Vial;Inj.,
hours 4 Lac, Tk. 14.05/Vial
Prophylaxis in rheumatic fever or
pneumococcal infection, 250 mg twice 1.1.1.1.2 PENICILLINASE-RESISTANT
daily; CHILD under 5 years 125 mg twice NARROW SPECTRUM PENICILLINS
daily
Cloxacillin, Dicloxacillin, Fucloxacillin,
Proprietary Preparations
Biopen(Biopharma), 125 mg/5 ml, Tk.
Nafcillin, Oxacillin comprise this group
18.28/50ml, Tk. 28.91/100ml.;Tab., 250 mg, Tk. of penicillins that are resistant to
2.28/Tab. inactivating activity of penicillinases and
G-Penicillin V(Gonoshasthaya), Susp., 125 exhibit antibacterial spectrum, similar to
mg/5 ml, Tk. 19.76/50 ml;Tab., 500 mg, Tk. those of narrow spectrum drugs.
2.00/Tab. Antibacterial activity against
Open(Opsonin),125 mg/5ml, Tk. betalactamases producing organisms
24.73/50ml.;Tab. , 250 mg , Tk. 2.28/Tab., 500
mg , Tk. 4.59/Tab.
also is achieved by combining enzyme
Oracyn-K(Sanofi), Suspn., 125 mg/5ml, Tk. inhibitors like clavulanic acid,
18.46/50 ml.,Tab. , 250mg, Tk. 2.30/Tab. tazobactam, sulbactam with penicillins
Pacin(Zenith), Tab. 2,50 mg, Tk. 2.16/Tab. not resistant to betalactamases.
Penco(Supreme), Tab. , 250 mg, Tk. As they are acid stable, they can be
1.45/Tab. given orally as well as by injection.
Penvik(Square), Suspn.,250 mg/5 ml, Tk. Flucloxacillin is better and well absorbed
58.64/100ml.;Tab.,250 mg, Tk. 2.30/Tab., 500
mg, Tk. 4.44/Tab.
from the gut than cloxacillin.
. Staphylococcus aureus strains resistant
PROCAINE PENICILLIN[ED] [A] to flucoxacillin have also arisen, and may
be treated by vancomycin or by
(Procaine benzylpenicillin) teicoplnin. Other alternatives may include
rifampicin and solium fusidate.
Procaine penicillin is a salt of procaine
and benzylpenicillin, which is poorly
soluble in water. It is used as CLOXACILLIN[ED] [A]
intramuscular (IM) depot injections, which
provide therapeutic tissue concentrations Indications: Same as that of
of penicillin for up to 24 hours. Flucloxacillin
Indications: Preferred choice for the Cautions: See under Flucloxacillin.
treatment of yaws and syphilis; Contraindications: See under Benzyl-
neurosyphilis requires special penicillin
consideration, penicillin sensitive all other Interactions:See underBenzylpenicillin.
infections (See under Benzylpenicillin) Side-effects: Seeunder Benzylpenicillin.
Caution, Contraindication and Side- Dose: oral:500 mg every 6 hours, at
effects: Same as in Benzylpenicillin; least 30 minutes before food; CHILD

5
1. ANTI-INFECTIVES

under 2 years, quarter of adult dose; 2- Cholestatic Jaundice may occur up to


10 years, half of adult dose several weeks after treatment with
By IM injection, 250 mg every 4-6 hours; flucloxacillin; in that case treatment with
CHILD under 2 years quarter of adult flucloxacillin should be stopped.
dose; 2-10 years half of adult dose Contraindications: See under Benzyl-
By slow IV injection or by intravenous penicillin
infusion, 500 mg over 3 to 4 minutes Side-effects: See under Benzyl-
every 4 to 6 hours; CHILD under 2 years penicillin; also hepatitis and cholestatic
quarter of adult dose; 2-10 years half of jaundice reported
adult dose Dose: By mouth, 250–500 mg every 6
All systemic doses may be doubled in hours, at least 30 minutes before food;
severe infections CHILD under 2 years, quarter of adult
dose; 2-10 years, half of adult dose
Proprietary Preparations By IM injection, 250-500 mg every 6
Clobex(Beximco), Cap., 500 mg, Tk. hours; CHILD under 2 years quarter adult
5.98/Cap.; Susp 125 mg/5ml, Tk.43.98/100 ml dose; 2-10 years half of adult dose
Cloxin(Opsonin), Suspn., 125 mg /5 ml, Tk. By slow IV injection or by IV infusion,
44.84/100 ml.;Cap., 500 mg , Tk. 5.92/Cap.;Inj.,
500 mg , Tk. 25.31/Vial
0.25-1 g every 6 hours; doses may be
Ficlox(Sanofi), Cap., 500mg, Tk. 5.98/Cap. doubled in severe infections. CHILD:
G-Cloxacillin(Gonoshasthaya), Suspn.,125 under 2 years 1/4th the adult dose; 2-10
mg/5 ml, Tk. 42.25/100 ml;Cap., 500 mg, Tk. years 1/2 of adult dose
4.50/Cap.;Inj., 500 mg/Vial, Tk. 20/Vial Endocarditis: 12 g daily in 6 divided
Loxa(Albion), Susp., 125 mg/5 ml, Tk. doses for 4 weeks
43.00/100 ml; Cap. 500 mg, Tk. 5.94/Cap. Osteomyelitis: up to 8 g daily in 3-4
Navaclo (Navana), Cap., 500 mg, Tk.
6.76/Cap.;Susp.,125 mg/5 ml,Tk. 43.33/100ml
divided doses
Sinaclox(Ibn Sina), Cap. , 500 mg, Tk.
5.75/Cap.; Suspn., 125 mg/5 ml, Tk. 43/100ml Proprietary Preparations
Tyclox(Astra Bio), Cap.,500 mg, Tk. 5.95/Cap.; Adflox(Team), Cap., 500 mg, Tk. 9/Cap.
Suspn.,125 mg/5 ml, Tk. 40/100 ml A-Flox(Acme), Cap.,250.00 mg,
Tk.5.66/Cap.,500.00 mg, Tk. 10.58/Cap.; Inj.,
250 mg/Vial, Tk. 35.25/Vial,; 500 mg/Vial, Tk.
DICLOXACILLIN[A] 45.30/Vial ,; suspn., 125 mg/5 ml, Tk.
Indications: Treatment of staphylococcal 61.61/100ml
infection resistant to benzylpenicillin Clox-F(Asiatic), Cap., 250 mg, Tk. 5/Cap.;
Side-effect and Cautions:Same as that 500mg, Tk. 10/Cap.;Suspn.,125 mg/5 ml, Tk.
of flucloxacillin 60/100ml,250 mg/5 ml, Tk. 110/100ml
FCX(G.A.Co), Suspn, 125 mg/5ml,
Dose: 125 to 250 mg every 6
Tk.60.00/100 ml
hours,CHILD: 12.5 to 25mg/kg daily Floxapen(General), Cap., 250mg,
individed doses. Doses may be Tk.5.78/Cap.; Tk. 10.57/Cap.; Suspn., 125
increased in severe infections mg/5 ml, Tk. 61.41/100ml
Dicloxacillin sodium has also been given Flubac(Popular), Cap. , 250 mg, Tk.5.77/Cap.;
parenterally 500 mg, Tk. 10.04/Cap.; Suspn., 250 mg/5 ml,
Tk. 110.42/100 ml.,125 mg/5 ml, Tk. 61.23/60
ml
GenericPreparation
Flubex(Beximco), Cap., 250 mg, Tk.5.50/Cap.;
Capsule, 500mg; 250 mg 500 mg, Tk. 10.50/Cap.; Suspn, 250 mg/5 ml,
Tk. 110/100 ml.,125mg/5 ml, Tk. 60.00/100 ml
FLUCLOXACILLIN[ED] [A] Fluc(Astra ), Cap. , 250 mg, Tk. 5.50/Cap.; 500
mg, Tk. 10.00/Cap.; Suspn., 125 mg/5 ml, Tk.
60.00/100ml
Indications: Beta-lactamase-producing Fluclox(ACI), Cap., 250mg, Tk.
staphylococci infections including otitis 5.79/Cap.,500mg, Tk. 10.57/Cap.; Inj.,
externa; adjunct in pneumonia, impetigo, 250mg/Vial, Tk. 35.24/Vial,500mg/Vial, Tk.
cellulitis, osteomyelitis and in 45.28/Vial,; Susp. , 125mg/5ml, Tk.
staphylococcal endocarditis 61.41/100ml,250mg/5ml, Tk. 110.74/100ml
Cautions: See under Benzylpenicillin Flucloxin(Eskayef), Cap, 250mg , Tk.
5.77/Cap.; 500mg , Tk. 10.50/Cap.;Inj,

6
1. ANTI-INFECTIVES

500mg/vial, Tk. 45.28/Vial,; Susp.;125 mg/5 Staflu(Alco), Cap.,250 mg,Tk. 5.79/Cap.; 500
ml, Tk. 61.00/100ml mg, Tk. 10.57/Cap.;Suspn.,125 mg / 5ml, Tk.
Flucocin(Euro), Cap., 500 mg, Tk. 10.52/Cap. 65.20/100ml.; 250 mg / 5ml, Tk. 110.75/100ml
Flucopen(Somatec), Cap., 250 mg, Tk. Stafoxin(Aristo), Cap., 250 mg, Tk. 5.50/Cap.;
5.53/Cap.; 500 mg, Tk. 10.03/Cap.; Suspn., 500 mg, Tk. 10.00/Tab.; suspn.,125 mg/5 ml,
125 mg/5 ml, Tk. 60.23/100ml Tk. 60.00/100ml
FLU-K(Kemiko), Cap., 250 mg, Tk. 6.65/Cap.; Stapkil(Pacific), Suspn.,125mg/5ml, Tk.
500 mg, Tk. 10.53/Cap. 46/100ml.; Cap.,250 mg,Tk. 5.50/Cap.,500 mg,
Flupen(Drug Intl), Cap., 250mg, Tk. 5.05/Cap., Tk. 10.00/Cap.
500mg, Tk. 10.55/Cap.;Suspn, 125mg/5ml, Tk.
60.20/100ml,; 1.1.1.2 BROAD SPECTRUM
Flurif, (Sharif), Cap.,500 mg, Tk. 10.52/Cap.
Flustar(Renata), suspn., 125 mg/5 ml, Tk. PENICILLINS
60.00/100ml 1.1.1.2.1 PENICILLINASE-SENSITIVE
Flux(Opsonin), Cap., 250 mg , Tk. 5.77/Cap.; BROAD SPECTRUM
500 mg, Tk. 10.57/Cap.; Suspn., 125 mg/5 ml, PENICILLINS
Tk. 61.42/100 ml , Tk. 110.42/100 ml ,; Inj., 500 1.1.1.2.2 PENICILLINASE-RESISTANT
mg/Vial , Tk. 45.30/Vial
BROAD SPECTRUM
Fluxi(Ziska), Suspn., 125 mg/5 ml, Tk.
60.00/100ml PENICILLINS
Fluxicap(Ziska), Cap. , 250 mg, Tk. 4.60/Cap.;
500 mg, Tk. 10.00/Cap Broad-spectrum penicillins (Ampicillin,
Flxzen(Zenith), Cap, 250 mg, Tk. 5.02/Cap.; Amoxicillin, Bacampicillin) retain the
500 mg , Tk. 8.03/Cap .; Suspn., 125 mg/5 ml, antibacterial activity of narrow spectrum
Tk. 60.23/100ml
Fucil(Nipa), Cap, 500 mg , Tk. 10.00/Cap.;
with additional bactericidal activity
Susp., 125 mg/5ml , Tk. 60.00/100ml against E. coli, H. influenzae, Salmonella
Fulcin(Supreme), Cap, 250 mg, Tk. 5.50/Cap.; species, Listeria monocytogenes
500 mg, Tk. 10.50/Cap.; suspn., 125 mg/5 ml, andHelicobacter pylori.
Tk. 60.00/100ml
Halopen(Nipro JMI), Susp., 125 mg/5 ml, Tk. 1.1.1.2.1 PENICILLINASE-SENSITIVE
60.41 Tk /100 ml; Cap., 250 mg, Tk. 5.55 Tk
BROAD SPECTRUM
/Cap.; 500 mg, Tk.10.03/Ta
Inclox(Incepta), Cap,250 mg, Tk. 5.50/Cap.; PENICILLINS
500 mg, Tk. 10.00/Cap. These drugs are subjected to the
Isoclox(Globe), Cap., 250 mg,Tk. 5.50/Cap.; destruction by the penicillinase produced
500 mg, Tk. 10.00/Cap.;Suspn.,125 mg /5 ml, by organisms Ampicillinis particularly
Tk. 60.00/100ml valuable for the treatment of respiratory
Monaclox-F(Amico), Cap., 250mg , TK.
tract infections (RTI) by mixed organisms
5.50/Cap.; 500mg , TK. 10.00/Cap.; Suspn.,
125mg/5ml, TK. 65.00/100ml that include Haemophilus influenzae.
Murein(One Pharma), Cap.,500 mg ,Tk. Amoxicillin It is a derivative of ampicillin
10.00/Cap. and has the same antibacterial spectrum.
Orgaflu (Organic), Cap.,250 mg,Tk. 5.58/Cap. Orally given it is better absorbed than
; 500 mg, Tk. 10.53/Cap. ampicillin and produces higher plasma
Phylopen(Square), Cap.,250 mg, Tk. and tissue concentrations. Besides, its
5.54/Cap.,500 mg, Tk. 10.57/Cap.; Inj., 500
absorption is not affected by the
mg, Tk. 45.30/Vial ; Suspn.,125 mg/5 ml, Tk.
60.4/100ml,; 250 mg/5 ml, Tk. 110.75/100ml presence of food in the stomach.
Revistar(Biopharma), Cap., 250 mg, Tk.
5.52/Cap; 500 mg, Tk. 10.04/Cap.; suspn., 125 AMOXICILLIN[A]
mg/5 ml, Tk. 60.23/100ml
Silox(Silva), Cap., 250mg,Tk. 5.77/Cap.
(Amoxycillin)
,500mg, Tk. 10.03/Cap.
Sinaflox(Ibn Sina), Cap., 250mg, Tk. 5.60/Cap. Indications: As under Ampicillin; also
,500mg, Tk. 10.50/Cap.; suspn., 125 mg/5 ml, endocarditis prophylaxis, meningococcal
Tk. 65.00/100ml disease and adjunct in listeria meningitis
Skilox(Healthcare), Cap., 250mg , Tk. Cautions, Contra-indications, Side-
10.00/Cap.; 500mg ,Tk. 16.66/Cap.; suspn., effects: See under Ampicillin.
125 mg/5 ml, Tk. 62.00/100 ml

7
1. ANTI-INFECTIVES

Dose: oral: ADULT 250 mg every 8 Fimoxyl(Sanofi), Cap., 250mg, Tk. 3.61/Cap.;
hours, doubled in severe infections; 500mg, Tk. 6.76/Cap.; Inj., 250mg, Tk.
CHILD up to 10 years, 125 mg every 8 19.19/Vial; 500mg, Tk. 26.29/Vial; Paed. drop,
125mg/1.25ml, Tk. 30.20/15ml; Susp.,
hours, doubled in severe infections 125mg/5ml, Tk. 47.46/100ml; 250mg/5ml, Tk.
Severe or recurrent purulent respiratory 68.26/100ml; Tab., 250 mg, Tk. 3.48/Tab.;
infection, 3 g every 12 hours 500mg, Tk. 6.02/Tab.
Short course oral therapy Genamox(General), Cap., 250mg, Tk.
Dental abscess, 3 g repeated after 8 3.61/Cap. ; 500mg, Tk. 6.76/Cap,; Pead. drop.,
hours. UTI 3 g repeated after 10-12 125 mg/1.25 ml, Tk. 30.11/15ml.; Suspn., 125
hours. Otitis media: CHILD 3-10 years, mg/5 ml , Tk. 47.45/100ml
Hi-mox(Hudson), Cap., 250mg, Tk.3.50/Cap.
750 mg twice daily for two days Kamoxy(Kemiko), Cap., 250 mg, Tk.
IM inj.: 500 mg every 8 hours; CHILD, 3.60/Cap. ,500 mg, Tk. 6.78/Cap. ;Suspn. ;125
50-100 mg/kg daily in divided doses mg / 5ml.; Tk. 47.60/100ml,;
IV inj. or infusion; 500 mg every 8 hours Loxyl(Asiatic), Cap., 250mg ,
increased to 1 g every 6 hours; CHILD, Tk.3.61/Cap.;Suspn.;125gm/5ml, Tk.
50-100 mg/kg daily in divided doses 47.46/100ml
Meningitis (if necessary, in combination Loxyl(Asiatic), Cap.; 500 mg , Tk. 6.76/Cap.
Monamox(Amico), Cap., 250mg , TK.
with another antibiotic), by IV infusion, 2g 3.00/Cap.; 500mg , TK. 6.00/Cap.; Paed.drop.
every 4 hours for 5 days in 125mg/1.25ml, TK. 28.00/15ml,;
meningococcal disease or for 10-14 days Mox(Astra Bio), Cap. , 250 mg, Tk. 3.60
in listerial meningitis /Cap.,500 mg, Tk. 6.00/Cap. ; Suspn., 125
mg/5 ml, Tk. 47.00/100ml,; Paed. drop, 125
Proprietary Preparations mg/1.25 ml, Tk. 30.00/15ml
Admox(Team), Cap.,500 mg, Tk. 6.79/Cap.; Moxacil(Square), Cap., 250 mg, Tk.
Suspn., 125mg/5ml, Tk. 47.60/100ml, ; 3.61/Cap., 500 mg, Tk. 6.79/Cap. ; Tab. , 250
Amocin(Pacific), Cap., 250 mg, Tk. 3.30/Cap. mg, Tk. 3.50/Tab. ;Inj., 500 mg/vial, Tk.
; 500 mg, Tk. 6.70/Cap. ; Suspn., 125mg/5ml, 32.88/Vial,; Paed. drop, 125 mg/1.25 ml, Tk.
Tk. 40.00/100ml 30.2/15ml,; Suspn. , 125 mg/5 ml, Tk.
Amotid(Biopharma), Cap., 250mg , Tk. 47.61/100ml,; 250 mg/5 ml, Tk. 65.45/100ml,;
3.61/Cap.; 500mg , Tk. 6.02/Cap.; Paed. Moxapen(Nipa), Cap. , 500 mg, Tk. 6.00/Cap.
drop, 125 mg/1.25 ml, Tk. 30.11/15ml.; Suspn., Moxarif(Sharif), Cap. , 500 mg, Tk. 6.00/Cap.
125 mg/5 ml, Tk. 46.17/100ml,; Moxico(Supreme), Cap, 500 mg, Tk.
Amoxizen(Zenith), Cap, 250 mg,Tk. 3.52/Cap. 6.00/Cap.,250 mg, Tk. 3.60/Cap.;Suspn,
;500 mg, Tk. 6.11/Cap. 250g/5ml, Tk. 65.00/100ml., 125 mg/5ml, Tk.
Amx(Nipro JMI), Cap., 250mg, Tk. 3.60/Cap.; 47.00/100ml
500mg, Tk. 6.78 /Cap.; Susp., 125mg/5ml, Tk. Mimox(Albion), Cap. , 250 mg, Tk. 3.54; Susp.,
47.61 /100 ml ; 250mg/5ml 78.0 125 mg/5 ml, Tk. 46.00/100ml
Aristomox(Aristo), Cap., 250mg , TK. Moxin(Opsonin),Tab. , 250 mg , Tk. 3.48/Tab.;
3.50/Cap, 500mg , Tk. 6.75/Cap.; Suspn., Cap., 500 mg , Tk. 6.74/Cap.; Inj.,250 mg ,
125mg/5ml Tk. 45.00/100ml Tk. 19.07/Vial., 500 mg, Tk. 26.17/Vial.;
Avlomox(ACI),Cap,250mg , TK. 3.45/Cap.; Suspn., 125mg/5ml , Tk. 47.61/100ml,;
500mg , TK. 6.12/Cap. ; Inj, 500mg , TK. Paed.drop 125mg /1.25 ml, Tk. 30.20/15
32.10/Vial,;Suspn TK. 125 mg/5 ml, Orgamox(Organic), Cap., 250 mg, Tk.
TK.46.18/100ml.;250mg/5ml, TK. 3.54/Cap.; 500mg , Tk. 6.76/Cap.
65.45/100ml.;Tk.49.73/60ml .; Paed. drop, Sapox(Alco), Cap., 500 mg, Tk. 6.78/Cap.;
125mg/1.25ml, TK. 30.29/15ml Paed drop., 125 mg / 1.25ml, Tk. 30.29/15ml,;
Bactamox(Renata), Tab., 250 mg, Tk. Suspn.; 125 mg / 5ml, Tk. 47.61/100ml , 250
3.38/Tab.; 500 mg, Tk. 5.81/Tab.; paed. drop. mg / 5ml, Tk. 69.21/100ml
125 mg/1.25 ml, Tk. 28.32/15ml,; Suspn. , 125 Sinamox(Ibn Sina), Cap., 250 mg, Tk.
mg/5 ml, Tk. 45.52/100ml 3.60/Cap.; 500 mg, Tk. 6.75Cap. ; Pead.
Demoxil(Drug Intl), Tab , 250mg, Tk. drops. 125 mg/1.25 ml.;Tk.30.00/15ml.;
3.52/Tab. , 500mg, Tk. 6.27/Tab. Suspn., Suspn., 125 mg/5 ml, Tk. 47.46/100ml.;
250mg/5ml, Tk. 65.20/100ml,125mg/5ml, Tk. 250mg/5ml, Tk. 69.00/100ml
47.15/100ml SK-Mox(Eskayef), Cap, 250 mg, Tk. 3.55/Cap.;
Fimox(Popular), Cap., 250,Tk. 3.62/Cap. ; 500 mg, Tk. 6.09/Cap. ; Suspn., 250 mg/5 ml,
500mg, Tk. 6.78/Cap. ; Suspn.;125mg/5ml, Tk. Tk. 68.20/100ml.; Suspn.,125 mg/5 ml, Tk.
47.60/60 ml.; Paed. drops,125 mg/1.25 ml,Tk. 47.60/100ml,; paed drop., 125 mg/1.25 ml, Tk.
30.28/10 ml 30.20/15ml

8
1. ANTI-INFECTIVES

Tycil(Beximco), Cap., 500 mg, Tk.


6.79/Cap.,250 mg, Tk. 3.62/Cap; Suspn., 250
1.1.1.2.2 PENICILLINASE-RESISTANT
mg/5 ml, Tk. 65.45/100 ml
Tymox(Somatec),Suspn.,125 mg/5 ml, Tk. BROAD SPECTRUM
47.14/100ml,; Paed. drop, 125 mg/1.25 ml, PENICILLINS
Tk. 30.20/15ml,;Cap., 500 mg, Tk. 6.04/Cap.
Ultramox(Globe), Cap., 250 mg, Tk. 3.50/Cap., CO-AMOXICLAV[A]
500 mg, Tk. 6.07/Cap.; Suspn., 125 mg /5 ml,
Tk. 47.29/100 ml
Co-amoxiclav is a combined preparation
AMPICILLIN[ED] [A] of Amoxicillin (as the trihydrate or as the
sodium salt) and betalactamase inhibitor
Clavulanic acid (as potassium
Indications: UTI, otitis media, sinusitis,
clavulanate).
chronic bronchitis, Haemophilus
Indications: Infections due to beta-
influenzae infections, invasive
lactamase producing strains including
salmonellosis, meningococcal disease,
RTI, genitourinary and abdominal
listerial meningitis, H pylori infection,
infections, cellulitis, animal bites, severe
prophylaxis and treatment of endocarditis
dental infection with spreading cellulitis.
Cautions: Allergy to penicillin, renal
Cautions: See under Ampicillin; in
impairment requires dose reduction,
hepatic impairment and in pregnancy.
erythematous rashes common in
CHOLESTATIC JAUNDICE has been
glandular fever and chronic lymphatic
identified as an adverse reaction
leukemia
occurring either during, or shortly after,
Contra-indications: Penicillin
the use of co-amoxiclav. An
hypersensitivity
epidemiological study has shown that the
Interactions: See Appendix-2
risk of acute liver toxicity was about 6
Side-effects: Nausea, vomiting,
times greater with co-amoxiclav than with
diarrhea; rarely rashes (discontinue
amoxicillin
treatment), antibiotic-associated colitis
Contraindications: Hypersensitivity,
Dose: ORAL: 0.25-1g every 6 hours, at
history of penicillin or co-amoxiclav
least 30 minutes before food; CHILD
associated jaundice; hepatic dysfunction
under 10 years, ½ ADULT dose
Side-effects: See under Ampicillin,
By IM or IV injection or infusion, 500 mg
alsohepatitis, cholestatic jaundice,
every 4-6 hours; CHILD under 10 years,
erythema multiforme, toxic epidermal
½ of adult dose.
necrolysis, exfoliative dermatitis,
UTI 500 mg every 8 hours
vasculitis, dizziness, headache,
Meningitis (if necessary, in combination
convulsions (particularly with high doses
with another antibiotic), by intravenous
or in renal impairment); superficial
infusion 2 g every 4 hours for 5 days in
staining of teeth with suspension,
meningococcal disease or for 10-14 days
phlebitis at injection site; see also
in listerial meningitis
cautions above.
Dose: oral: Amoxicillin, 250mg every 8
Proprietary Preparations
hours, doubled in severe infections;
Ampexin(Opsonin), Inj., 250 mg/vial,
Tk.17.89/Vial; 500 mg/vial, Tk. 24.00/Vial CHILD up to 10 years, 125 mg every 8
Pen-A(Reneta), Inj., 500 mg/vial, Tk. 20.43/Vial hours, doubled in severe infections;
Acmecilin(Acme), Cap., 250 mg, Tk. severe or recurrent purulent respiratory
3.34/Cap.; Susp., 125 gm/5 ml, Tk. 39.71/100 infection, 3 g every 12 hours
ml; Inj., 250mg/Vial, Tk. 19.43 /Vial; 500 Severe dental infections, expressed as
mg/vial, Tk. 27.32 /Vial amoxicillin, 250 mg every 8 hours for 5
Ampexin(Opsonin), Inj., 250 mg/vial,
days.
Tk.17.89/Vial; 500 mg/vial, Tk. 24.00/Vial
Ampirex(Jayson), Cap., 250 mg, Tk 2.04.;Inj., By IV injection over 3-4 minutes or by IV
500 mg/vial, Tk. 22.49/Vial.; Susp., 125mg/5ml, infusion, expressed as amoxicillin, 1 g
Tk.33.89/100 ml every 8 hours increased to 1 g every 6
9
1. ANTI-INFECTIVES

hours in more serious infections; Ultraclav(Globe), Tab., 500 mg + 125 mg, Tk.
INFANTS up to 3 months 25 mg/kg every 25.00Tab.
8 hours (every 12 hours in the perinatal
period and in premature infants); CHILD 1.1.1.3 EXTENDED SPECTRUM
3 months-12 years, 25 mg/kg every 8 (ANTIPSEUDOMONAL) PENICILLINS
hours increased to 25 mg/kg every 6 This group consists of extended-
hours in more serious infections; surgical spectrum drugs that exhibit the
prophylaxis, 1 g at induction; for high risk antimicrobial activity of broad-spectrum
procedures (e.g. colorectal surgery) a penicillins and also are effective against
further 2-3 doses may be given every 8 Psuedomonus aeruginosa,Klebsiella
hours in first 24 hours (longer if pneumonia, Proteus sp. and Bacteroids
significantly increased risk of infection) fragilis. The Carboxypenicillin,
Ticarcillin, is principally indicated for
Proprietary Preparations serious infections due to P aeruginosa
Augment(Eskayef), Inj.,1 gm + 200 mg,Tk. and also has activity against certain other
275.00/vial.; suspn 125 mg + 31.25 mg/5 ml, Gram-negative bacilli including Proteus
Tk. 175.00/100ml.; Tab, 875 mg + 125 mg, Tk.
spp. and B fragilis. The ureidopenicillin,
30.00/Tab.,250 mg + 125 mg, Tk.
20.00/Tab.,500 mg + 125 mg, Tk. 25.00/Tab piperacillin is more active than ticarcillin
Avloclav(ACI), Tab., 250mg +125mg, TK. against Ps. aeruginosa.
25.00/Tab.; 875mg + 125mg , TK. 45/Tab.;
500mg + 125mg , TK. 32.00/Tab. ; Suspn.,
125mg + 31.25mg / 5ml , TK.220.00/100ml ,
400mg + 57.5mg /5ml , TK. 195.00/50ml. ;Inj.,
1gm + 200mg , TK. 300.00/vial; 500mg
PIPERICILLIN WITH TAZOBACTAM[A*]
+100mg , Tk.150/vial
Clamox(Opsonin), Inj.1 gm + 200 mg, Tk. Indications: P. aeruginosa infections,
276.05/ vial;500 mg + 100 mg ,Tk. 140.53/ surgical prophylaxis, also see under
vial,;Suspn,125 mg + 31.25 mg /5 ml, Tk. Dose
151.02/100 ml.;Tab. 250 mg + 125 mg Tk.
Cautions: See under Benzyl penicillin
16.56/Tab., 875 mg + 125 mg, Tk.
25.10/Tab.,500 mg + 125 mg , Tk. 20.14/Tab
Contra-indications:See under Benzyl
Demoxiclave(Drug Intl), Suspn.,125mg+ penicillin
31.25mg/5ml, Tk. 150.45/100ml., 400mg+ Side-effects: See under Benzyl
57.5mg/5ml, Tk. 90.30/35ml,; Tab., 250mg+ penicillin; also nausea, vomiting,
125mg, Tk. 16.05/Tab. ; 500mg+ 125mg, Tk. diarrhea, less commonly stomatitis,
24.10/Tab.;Inj., 1gm+ 200mg, Tk. dyspepsia, constipation, jaundice,
300.90/vial.,500mg+ 100mg, Tk. 150.45/Vial,
hypotension, headache, insomnia; rarely
Fimoxyclav(Sanofi), Inj., 500mg+100mg/Vial,
Tk. 150.45/Vial; 1gm+200mg, Tk. 300.90 /Vial; abdominal pain, hepatitis, edema; very
Tab., 250mg + 125mg, Tk. 25.08 Tk/Tab.; rarely hypoglycemia, hypokalemia,
500mg+125mg,Tk. 32.10 Tk/Tab.; pancytopenia, Stevens-Johnson
875mg+125mg, Tk. 45.13Tab.; Susp., syndrome, toxic epidermal necrolysis.
400mg+57.5mg/5ml, Tk. 245.74/50 ml; Dose: Lower respiratory tract,urinary
125mg+31.25mg/5ml, Tk.245.74/100 ml tract, intra-abdominal, and skin
Moxaclav (Square), Inj.,1gm + 200 mg, Tk.
infections, and septicemia: ADULT and
300.00/vial., 500 mg + 100 mg , Tk.
150.00/vial.; Suspn. ,125 mg + 31.25 mg/5 ml,
CHILD over 12 years, byIV inj. over 3-5
Tk. 175.53/100ml., Tk. 135.92/60ml,400 mg + minutes or byIV infusion: 100-150 mg/kg
57.5 mg/5 ml , Tk. 90.61/35ml.; Tab. , 250 mg daily in divided doses, or increased to
+ 125 mg, Tk. 25.00/Tab., 500 mg + 125 mg, 200-300 mg/kg daily in severe infections
Tk. 32.00/Tab. ,875 mg + 125 mg, Tk. and at least 16 g daily in life-threatening
45.00/Tab. infections. NEONATES IV injection over
Tyclav(Beximco), Inj., 1g + 200mg, Tk.
3-5 minutes or IV infusion, aged up to 7
300.00/vial, 500mg + 100mg, Tk. 150.00/vial,;
Suspn., 125mg + 31.25mg/5ml, Tk. days or over 7 days but under 20 kg, 150
220.00/100ml., 400mg + 57.5mg/5ml, Tk. mg/kg daily in 3 divided doses, aged over
230.00/50ml,;Tab. 500mg + 125mg, Tk. 7 days and over 20 kg, 300 mg/kg/d in 3-
32.00/Tab., 250mg + 125mg, Tk. 25.00/Tab., 4 divided doses; CHILD 1 month-12
875mg + 125mg, Tk. 45.00/Tab.; years: 100-200 mg/kg daily in 3-4 divided
10
1. ANTI-INFECTIVES

doses, increased to 200-300 mg/kg daily ADULT and CHILD over 40 kg, 400 mg
in 3-4 divided doses for severe infections; every 6-8 hours; UTI, CHILD under 40
surgical prophylaxis: 2 g just before kg, 20-40 mg/kg daily in 3-4 divided
surgery followed by at least 2 doses of 2 doses
g at 4/6 hours intervals within 24 hours of Note: Tablets should be swallowed
surgery. whole with plenty of fluid during meals
while sitting or standing
Proprietary Preparations
Brodactam(Sanofi), IV., Infusion., 4g + Proprietary Preparations
0.5g,/vial Tk. 1003.01/Vial Alexid(Aristo), Tab., 200mg, Tk. 15/Tab.
Megacilin(Popular), IV., Infusion4 gm + 0.5 Emcil(Square), Tab., 200 mg, Tk.15.05/Tab.
gm/vial, Tk. 1003.77Vial Pivicil(General), Tab.,200 mg, Tk.12.09/Tab.,
Tazocilin(Square), IV., Infusion4 gm + 0.5 V-cillin(Asiatic), Tab., 200mg, Tk. 12/Tab
gm/vial, Tk. 1003.01/Vial
Tazopen(Renata), IV., Infusion 2gm +
0.25gm/vial, Tk. 550.00/Vial; 4 gm + 0.5 1.1.2 CEPHALOSPORINS
gm/vial, Tk. 1000.00/Vial 1.1.2.1 FIRST-GENERATION DRUGS
Tazosyn(ACI), IV., Infusion4 gm + 0.5 gm/vial, 1.1.2.2 SECOND-GENERATION
Tk. 1003.01/Vial; 2gm + 0.25gm/vial , Tk. DRUGS
601.80/Vial 1.1.2.3 THIRD-GENERATION DRUGS
1.1.2.4 FOURTH-GENERATION
1.1.1.4 MECILLINAMS[A] DRUGS

PIVMECILLINAM HYDROCHLORIDE[A] Cephalosporins are broad-spectrum,


bactericidal antibiotics and are classified
Pivmecillinam has significant activity into "generations" on the basis of general
against many Gram-negative bacteria features of antimicrobial activity.
including E. coli,Klebsiella, Enterobacter Of the first generation, Cefazolin is more
and Salmonellae. It is not active against susceptible to hydrolysis by
Pseudomonas aeruginosa or betalactamase from S. aureus than is
Enterococci. Pivmecillinam is hydrolyzed cephalothin. Second generation
to mecillinam, which is the active drug. Cefoxitin and cefuroxime and third
Indications: Acute uncomplicated generation drugs are more resistant than
cystitis, chronic or recurrent bacteriuria, first generation agents to betalactamases
UTI produced by gram-negative bacteria.
Cautions: See under Benzylpenicillin; Third generation drugs are susceptible to
liver and renal function tests required in hydrolysis by chromosomally encoded
long term use; pregnancy; avoid in acute type 1 beta-lactamases induced by
porphyria treatment of infections due to aerobic
Contraindications: See under gram-negative bacilli with second- or
Benzylpenicillin: also carnitine deficiency, third-generation drugs and/or imipenem.
esophageal strictures, gastrointestinal Fourth generation agents such as
obstruction; not recommended for infants cefipime, are poor inducers of type 1
under 3 months beta-lactamases and are less susceptible
Interactions: See Appendix-2 than third generation drugs to hydrolysis
Side-effects: See under Benzyl- by type 1 beta-lactamases.
penicillin; also nausea, vomiting, Cautions:. Great caution should be
dyspepsia; and reduced serum and total taken before administration of a
body carnitine (during repeated or long cephalosporin in patients who have had a
term use) recent severe, immediate reaction to
Dose : oral:acute uncomplicated cystitis, penicillin, impaired renal function,
ADULT and CHILD over 40 kg, initially pregnancy and breast-feeding.
400 mg then 200 mg every 8 hours for 3 Side-effects: Anaphylaxis,
days; chronic or recurrent bacteriuria, bronchospasm, and urticaria are seen.
11
1. ANTI-INFECTIVES

Cephalosporins are potentially Adora(Incepta), Paed. drops, 125 mg/1.25 ml,


nephrotoxic drugs. Gastrointestinal upset Tk. 50.00/15ml; Suspn. 125 mg/5 ml, Tk.
in the form of diarrhea can result after 90.00/100m, 5gm/100ml, Tk. 120.00/100ml;
Tk.60/60ml; Cap., 500mg, Tk. 18/Cap.
cephalosporins and may be more Arocef(Eskayef), Cap, 500mg , Tk. 15.00/Cap.;
frequent with cefoperazone and 500mg , Tk. 15.00/Cap.; Suspn. , 125 mg/5
cefpiramide because of their greater ml, Tk. 70.00/100ml,; Paed. drops, 125
biliary excretion. mg/1.25 ml, Tk. 50.00/15ml
Bexen(Nipro JMI), Cap. 500 mg, Tk.
12.07/Cap.; Suspn. 125 mg/5 ml Tk. 70.26/100
1.1.2.1.1 FIRST-GENERATION
ml
CEPHALOSPORINS Cedril(ACI), Suspn., 125 mg/5 ml, TK.
70.47/100ml,; Cap., 500mg, TK. 12.09/Tab.
First generation drugs (cefadroxil, Ficef(UniMed) Cap. 500 mg Tk. 12.00/Cap;
cephalexin, cphradine etc.) are very Paed. drops 125 mg/5 ml, Tk. 50.00/15 ml;
active against gram-positive cocci Suspn. 125 mg/5 ml Tk. 70.20/100 ml
Fodexil(Square), Cap., 500 mg, Tk.
including pneumococci, streptococci and
15.05/Cap. ; Tab. , 1 gm, Tk. 25.00/Tab.
staphylococci and have modest activity Licef(Asiatic), Suspn, 125 mg/5 ml, Tk.
against gram-negative microorganisms. 82.00/100ml,
Most oral cavity microbes, except Sefanid(Drug Intl), Suspn., 125mg/5ml, Tk.
B.fragilis group are sensitive. Activity 70.25/100ml,; Cap., 500mg, Tk. 12.05/Cap.
against Moraxella catarrhalis, E. coli, K. Trubid(Opsonin), Suspn., 125 mg/5 ml, Tk.
pneumonia and P. mirabilis is good. They 70.26/ 100 ml,; Tk. 50.19/ 60 ml,; Cap, 500
mg, Tk. 15.00/Cap.
are not effective against enterococci,
Twicef(Acme), Suspn.,250mg/5ml , Tk.
methicillin-resistant S. aureus and S. 120.82/100ml,; ., 125 mg/5 ml, Tk.
epidermidis, P.aeruginosa. 70.47/100ml,; Cap., 500 mg , Tk. 12.09/Cap.;
Paed. drops, 125 mg/1.25 ml, Tk. 50.20/15ml
CEFADROXIL[A]
CEFOPERAZONE[A]
Indications: Urinary tract infections,
minor polymicrobial infections, i.e. Indication: Used in the treatment of
cellulites, soft tissue abscess, ottitis susceptible infection especially those due
media, sinusitis to Pseudomonus spp. It is slightly less
Cautions:See notes above active against some Entrobactecae.
Contra-indications: Hypersensitivity, Cautions:See notes above; not
porphyria recommended for the treatment of
Interactions:See Appendix-2 meningitis because of its poor
Side-effects: Diarrhea, nausea and penetration into the C. S. F.
vomiting, abdominal discomfort, Contraindications and Side-effects:
headache, rashes, pruritus, urticaria, See under Cefadroxil
serum-sickness like reactions with rash, Interaction:See Appendix -2
fever and arthalgia and anaphylaxis, Dose and Administration: The usual
erythema multiforme, toxic epidermal dose is 2 to 4 g daily in two divided dose.
necrolysis, hepatic enzymes In severe infections up to 12g daily in two
disturbances, transient hepatitis and to four divided dose may be given. In
cholestatic jaundice; general the dose should not exceed 4g
Dose: : Oral l: patients weighing > 40 kg: daily in patient with liver disease or biliary
0.5-1 g twice daily; CHILD < 1 year 25 obstruction or 1 to 2g daily in those both
mg/kg daily in 2-3 divided doses; 1-6 liver and kidney impairments; if higher
years 250 mg twice daily; > 6 years 500 dose are used plasma concentration of
mg twice daily cefoperazone should be monitored

Proprietary Preparations Proprietary Preparations


Adocil(Kemiko), Suspn., 125 mg / 5ml, Tk. Cefopen(Square), Inj., 1 gm, Tk. 250.00/Vial,;
80.24/100ml; Cap. 500 mg, Tk. 12.00/Cap. 500mg, Tk.150.00/Vial

12
1. ANTI-INFECTIVES

CEPHALEXIN [ED][A] minutes orIV infusion 0.5-1 g every 6


(Cefalexin) hours for mild to moderate infections; for
severe infections increased to 8 g daily;
Indications: Prophylaxis of recurrent CHILD 50-100 mg/kg daily in 4 divided
UTI; also see under cefadroxil doses; in surgical prophylaxis: 1-2 g by
Cautions, Contraindications and Side- deep IM inj. or byIV inj. over 5 minutes.
effects: See notes above and under
cefadroxil Proprietary Preparations
Adecef(Supreme), Cap, 500mg, Tk.
Interactions: See Appendix-2
12.50/Cap. ; Paed. drops, 125 mg/1.25 ml, Tk.
Dose: oral: ADULT 250-500 mg every 8- 50.00/15ml,; Suspn, 125mg / 5ml, Tk.
12 hours for mild to moderate infections; 80.25/100ml.; 250 mg/5 ml, Tk. 120.00/100ml
for severe infections increased to 1-1.5 g Ancef(UniMed), Cap,250mg, Tk. 6.50/Cap. ;
every 6-8 hours, as prophylactic in 500mg, Tk. 12.50/Cap. ; Paed. drops, 125
recurrent urinary tract infections, 125 mg mg/1.25 ml, Tk. 50.00/15ml,; Suspn,
at night; CHILD 25 mg/kg daily in 2-3 250mg/5ml, Tk. 120.00/100ml.; 125mg/5ml,
Tk. 85.00/100ml
divided doses, doubled for severe
Avlosef(ACI), Cap., 250mg , TK. 8.02/Cap. ;
infections, max. 100 mg/kg daily in 500mg , TK. 15.05/Cap.;Inj, 1gm/vial,TK.
divided doses;under 1 year, 125 mg 95.29/Vial,; 500mg/vial , TK. 65.20/ Vial,;
every 12 hours; 1-5 years, 125 mg every Paed. drops, 125mg/1.25ml, TK. 65.20/15ml ,;
8 hours; 6-12 years, 250mg every 8 Suspn, 125mg / 5ml , TK. 90.27/100ml
hours ,250mg/5ml TK. 135.41/100ml ,TK. 80.54/60ml
Bactokil(Virgo), Cap., 250 mg, Tk.
156.00/Cap. ; 500 mg, Tk. 262.50/Cap. ;
Proprietary Preparations
Suspn., 125mg / 5ml, Tk. 80.00/100ml
Acelex(Acme), Cap., 250.00 mg, Tk.
Belocef(Amico), Cap., 250mg , Tki. 6.50/Cap.;
6.65/Cap.; 500.00 mg , Tk. 12.58/Cap. ;
500mg , TK. 12.50/Cap.; Paed. drops,
Paed.drop., 125mg/1.25 ml, Tk. 42.66/15ml.;
125mg/1.25ml, Tk. 50.00/15ml,; Suspn,
Suspn., 125 mg/5 ml, Tk. 77.52/100ml
125mg/5ml, TK. 80.00/100ml
Avloxin(ACI), Susp. , 125mg/5ml, Tk..
Betasef(Alco), Cap., 250 mg, Tk. 8.00/Cap. ;
69.47/100ml,; Cap., 500mg , TK. 10.57/Cap
500 mg, Tk. 15.00/Cap.; Paeed.drops 125
Ceporex(GSK), Cap., 500 mg, Tk. 12.73/Cap.;
mg/1.25 ml, Tk. 65.00/15ml,; Suspn250mg/5ml
Suspn., 125 mg/5 ml, Tk. 84.27/100ml
Tk. 90.00/100ml ,250 mg / 5 ml, Tk.
Lexin(Astra Bio), Cap. , 250 mg, Tk.
120.35/100ml
6.60/Cap.; 500 mg, Tk. 12.73/Cap.; Suspn.,
Cefadin(Ziska), Cap. , 500 mg, Tk. 12.00/Cap.;
125 mg/5 ml, Tk. 77.52/100 ml
Inj., 1g/vial, Tk. 80.00/ Vial,; 500 mg, Tk.
Neorex(Eskayef), Cap, 500mg, Tk. 12.50/Cap.;
50.00/ Vial ,; Suspn, 125 mg/5 ml, Tk.
250mg, Tk. 6.60/Cap.; 500mg, Tk.12.50/Cap.;
80.00/100ml
Suspn, 125mg/5ml, Tk. 83.50/100ml
Ceflin(Nipa), Cap., 500 mg, Tk. 12.66/Cap.;
Nufex(General), Suspn, 125 mg/5 ml, Tk.
Suspn, 125 mg/5ml, Tk. 80.00/100ml
78.52/100ml; Cap., 500mg, Tk. 9.06/Cap.
Cephid(Zenith), Cap., 250mg, Tk. 6.52/Cap. ;
500 mg, Tk. 12.55/Cap.; Suspn, 125 mg/5 ml,
CEPHRADINE CILASTATIN[W] Tk. 80.30/100ml
Cephracap(Euro), Cap., 500mg, Tk.
Indications: Surgical prophylaxis, also 15.00/Cap.
Cephran (Opsonin), Cap. , 500 mg , Tk.
see under cefadroxil 15.05/Cap. ; Inj, 500 mg/vial , Tk. 54.20/Via,; 1
Cautions, Contraindications and Side- gm/vial, Tk. 80.30/Vial,; Paed. drops, 125
effects: See notes above and under mg/1.25 ml, Tk. 65.00/15ml
cefadroxil Dicef(Drug Intl), Cap., 250mg, Tk. 7.05/Cap. ;
Interactions: See Appendix-2 500mg, Tk. 13.05/Cap.; Paed. drops,
Dose: oral: ADULT 250-500 mg every 6 125mg/1.25ml, Tk. 50.20/15ml,; Suspn,
125mg/5ml, Tk. 81.25/100ml,; 250mg/5ml, Tk.
hours or 0.5-1 g every 12 hours for mild
120.40/100ml
to moderate infections; for severe Eusef(Globe), Cap., 500 mg, Tk. 12.00/Cap. ;
infections increased to 1 g every 6 hours; Inj, 1 gm/vial, Tk. 80.00/ Vial,500 mg/vial, Tk.
CHILD 25-50 mg/kg daily in 2-4 divided 50.00/ Vial.; Paed. drop, 125 mg/1.25 ml, Tk.
doses; deep IM inj. orIV inj. over 3-5
13
1. ANTI-INFECTIVES

50.00/15ml,; Suspn, 125 mg /5 ml, Tk. mg/1.25 ml, Suspn, 125 mg/5 ml, Tk.
80.00/100ml,; 250 mg /5 ml, Tk. 140.00/100ml 80.00/100 ml
Extracef(Aristo), Cap., 250mg , Tk. 6.50/Cap.; Sicef(Silva), Cap.,500mg, Tk. 12.55/Cap. ;
500mg , TK. 15.00/Cap. ; Paed. drops, 125 Suspn.,125 mg/5 ml, Tk. 80.30/100ml
mg/1.25 ml, Tk. 62.00/15ml,Suspn, 125mg / Sinaceph(Ibn Sina), Cap., 250 mg, Tk.
5ml , Tk. 90.00/100ml,; 250 mg/5 ml, Tk. 6.80/Cap. ;500 mg, Tk. 15.00/Cap. ; Inj., 500
125.00/60ml, mg/vial, Tk. 55.00/ Vial,; 1 gm/vial, Tk. 85.00/
Gigacef(Pacific), Cap.,500 mg, Tk. 15.00/Cap. Vial,; Paed. drops, 125 mg/1.25
; Paed. drops, 125 mg/1.25 ml, Tk. 46.00/15ml ml,Tk.55.00/15ml,;Suspn, 125 mg/5 ml, Tk.
,; Suspn, 125mg/5ml, Tk. 64.00/100ml 95.00/100ml,
Intracef(Beximco), Cap., 250mg , Tk. SK Cef(Eskayef), Inj, 1gm/vial, Tk. 80.00/
6.50/Cap.; 500mg, Tk.12.50/cap ,;Paed. drop, Vial,; 500mg/vial, Tk. 50.00/ Vial,; Cap,
125 mg/1.25 ml, Tk., 50.00/15ml,; Suspn, 250mg , Tk. 8.00/Cap. ,500mg , Tk. 15.00/Cap.
125mg/5ml, Tk. 80.00/100ml,; 250mg/5ml, Tk. ,Paed. drops, 125 mg/1.25 ml, Tk. 65.00/15ml
120.00/100ml ,; Suspn, 250 mg/5 ml, Tk. 140.00/100ml,; 125
Lebac(Square), Cap.,250 mg, Tk. 8.03/Cap. ; mg/5 ml, Tk. 90.00/100ml,Tk. 80.00/60ml
500 mg, Tk. 15.05/Cap. ; Inj, 1 gm/vial, Tk. Supracef(Biopharma), Cap., 250mg , Tk.
95.29/Vial ,; Inj, 500 mg/vial, Tk. 65.19/Vial,; 6.52/Cap.; 500mg , Tk. 12.05/Cap. ; Paed.
Paed. drop, 125 mg/1.25 ml, Tk. 65.19/15ml,; drops, 125 mg/1.25 ml, Tk. 50.19/15ml,;
Suspn, 125 mg/5 ml, Tk. 90.27/100ml,; 250 Suspn, 250 mg/ 5ml, Tk. 120.45/100ml; 125
mg/5 ml, Tk. 135.4/100ml mg/5 ml, Tk. 80.30/100ml
Polycef(Renata), Cap., 250 mg, Tk. 6.52/Cap. Tydin(Somatec), Cap., 500 mg, Tk. 14.68/cap.
; 500 mg, Tk. 12.54/Cap. ; Inj,1 gm/vial,Tk.; ; Paed. drops, 125 mg/1.25 ml, Tk.
90.00/ Vial.;250mg/vial, Tk. 38.10/ Vial,500 50.00/15ml.; Suspn., 125mg/5 ml, Tk.
mg/vial, Tk. 65.00/ Vial.; Paed. drop, 125 82.00/100ml; 250 mg/5 ml, Tk. 120.46/100ml
mg/1.25 ml, Tk. 62.00/15ml.; Suspn, 125 mg/5 Vecef(Asiatic), Cap., 500mg , Tk. 12.50/Cap. ;
ml, Tk. 90.00/100ml,; 250 mg/5 ml, Tk. Inj., 1gm/vial , Tk. 80.00/Vial,; 500mg/vial , Tk.
132.00/100ml 50.00/ Vial,; Paed. drops, 125 mg/1.25 ml, Tk.
Procef(Incepta), Cap. , 500 mg, Tk. 50.00/15ml.; Suspn, 125 mg/5 ml, Tk.
12.50/Cap. ; 250 mg, Tk. 6.50/Cap. ; Inj, 1 80.00/100ml; 250mg/5ml, Tk. 120.00/100ml
gm/vial, Tk. 80.00/ Vial,; 500 mg/vial, Tk. 50.00/ Velogen(General), Cap. , 250mg, Tk.
Vial ,; Paed. drops, 125 mg/1.25 ml, Tk. 6.54/Cap.;500mg, Tk. 12.59/Cap. ; Paed.
50.00/15ml,; Suspn, 250 mg/5 ml, Tk. drops, 125 mg/1.25 ml, Tk. 50.34/15ml,;
120.00/100ml,; 125 mg/5 ml, Tk. 80.00/100ml Suspn, 125 mg/5 ml, Tk. 82.56/100ml
Rocef(Healthcare), Cap.,250mg , Tk. Velox(Kemiko), Cap., 250 mg, Tk. 7.02/Cap.;
6,50/Cap. ; 500mg , Tk. 12.50/Cap. ; Suspn, 500 mg, Tk. 13.04/Cap.;Paed.drop,125
125mg/5ml , Tk. 95.00/100 ml,; 250mg/5ml , mg/1.25 ml,Tk. 50.15/15ml;125 mg / 5 ml,Tk.
Tk. 140.00/100 ml 80.24/100ml
Roxicef(Popular), Cap., 500 mg, Tk. Zecef(GACO), Cap.,500 mg,Tk. 12.54/Cap.;
12.55/Cap. ;Suspn, 250 mg/5 ml, Tk. Suspn.,125 mg/5ml, Tk. 80.24/100 ml
120.45/200 ml,; 125mg / 5ml, Tk. 80.30/100 ml
Sefin(Orion), Cap., 250 mg, Tk. 6.55/Cap. ;
1.1.2.1.2 SECOND-GENERATION
500 mg, Tk. 12.59/Cap. ; Inj, 1 gm/vial, Tk.
80.55/ Vial,; 500 mg/vial, Tk. 35.23/ Vial,; CEPHALOSPORINS
Paed. drop, 125 mg/1.25 ml, Tk. 50.35/15ml,;
Suspn, 250 mg/5ml, Tk. 120.81/100ml, Tk. Compared to first generation, second
60.42/50ml,; 125mg / 5ml , Tk. 80.55/100ml,; generation cephalosporins are more
Cap., 250mg, Tk. 6.50/Cap. 500mg , Tk. active against gram-negative
12.50/Cap.
microorganisms but such activity is less
Sefrad(Sanofi), Cap., 250mg, Tk. 10.03/Cap. ;
500mg, Tk. 16.05/Cap. ; Inj., 500mg/vial, Tk. than third generation agents. A subset of
60.18/Vial,; Paed. drops, 100mg/ml, Tk. second generation i.e. Cefoxitin,
65.20/15 ml,; Suspn, 125 mg/ 5 ml, Tk. Cefotetan and Cefmetazole also is active
95.29/100 ml.,250 mg/5 ml, Tk.130.39/100 ml,; against B. fragilis.
Sefril(Acme), Cap. , 250mg., Tk. 8.03/Cap.
,500 mg., Tk. 15.04/Cap. ; Inj.,1 gm/vial, Tk.
90.27/ Vial ,500mg/vial, Tk. 65.19/ Vial.; Paed.
drops, 125 mg/1.25 ml, Tk. 62.19/15ml.,
Suspn, 125mg / 5ml , Tk. 90.27/100ml,; 250
mg/5 ml, Tk. 120.82/100ml
Sefty(Astra Bio), Cap. , 250 mg, Tk. 6.50/Cap.,
500 mg, Tk. 15.00/Cap. ; Paed.drop, 125
14
1. ANTI-INFECTIVES

CEFACLOR [A] 125.00/15ml,; Suspn., 125 mg/5 ml, Tk.


180.00/100ml
Xclor(Orion), Suspn., 125 mg/5ml , Tk.
Indications: Sinusitis, otitis and lower 190.57/100ml
respiratory infections caused by beta-
lactamase producing H. influenza or B. CEFOXITIN[A]
catarrhalis, also see under cefadroxil
Cautions: Penicillin hypersensitivity,
Indications: As prophylactic against
pregnancy, breast-feeding, renal
intestinal anerobes in colorectal surgery,
impairment; false positive urinary glucose
mixed anerobic infections, i.e. peritonitis,
test and false positive Coombs’ test
diverculitis, infections due to facultative
Contraindications and Side-effects:
gram-negative bacteria, i.e. pelvic
See under cefadroxil
inflammatory disease, diabetic foot
Interactions: See appendix-2
infection; also see under Cefadroxil
Dose: oral:ADULT 250 mg every 8 hour
Cautions, Contra-indications, Side-
for mild to moderate infections; for severe
effects:See notes above and under
infections increased to 500 mg every 8
cefadroxil
hour up to a max. of 4 g daily in 3 divided
Interactions:See Appendix-2
doses; CHILD > 1 month, 20 mg/kg daily
(probenecid reduces the renal clearance
in 3 divided doses for mild to moderate
of Cefoxitin)
infections; for severe infections increased
Dose :By deep IM or slow IV inj. or IV
to 40 mg/kg every 8 hour up to a max. of
infusion 1-2 g every 6-8 hours for mild to
1 g daily in 3 divided doses
moderate infections; increased up to 12 g
daily in 3-4 divided doses for severe
Proprietary Preparations
Abaclor(ACI), Cap.;250 mg, Tk.
infections; CHILD recommended routeIV;
21.14/Cap.;500 mg, TK. 40.27/Tab. ;375 mg, up to 1 week, 20-40 mg/kg every 12
Tk. 30.09/Tab.; Paed. drops, 125mg/1.25ml, hours, 1-4 weeks 20-40 mg/kg every 8
Tk. 125.85/15 ml,; Susp., 125 mg/5 ml, TK. hours in mild to moderate infections,
201.35/100 ml increased to 200 mg/kg daily in 3-4
Alclor(Acme), Paed. drop, 100mg/ ml, Tk. divided doses up to a max.of 12 g daily in
125.37/15ml.; Suspn.,125 mg/5 ml, Tk. severe infections; surgical prophylaxis:
190.58/100ml;Cap.,500 mg, Tk. 40.12/Cap.
Ceflon(Eskayef), Cap.,250mg, Tk. 16.00/Cap. ;
by deep IM or slowIV inj. orIV infusion 2
500 mg , Tk. 30.00/Cap.; Suspn.,125 mg/5 ml, g, 30-60 minutes before surgery,
Tk. 200.00/100ml,; Paed. drop, 125 mg/1.25 repeated every 6 hours for 24 hours;
ml, Tk. 125.00/15ml CHILD 30-40 mg/kg 30-60 minutes
Cfl(Sharif), Paed. drops, 125 mg/1.25 ml, Tk. before surgery, repeated every 6 hours
125.37/15ml ,;Suspn.,125 mg/5 ml, Tk. for 24 hours (second and third doses
190.58/100ml every 8-12 hours in neonates);
Clobac(Opsonin), Suspn.,125 mg /5 ml, Tk.
180.68/100 ml,; 500 mg /5 m, Tk.
inuncomplicated UTI, Cefoxitin 1 g twice
125.47/15ml,; 125mg/5ml, Tk. 175/100ml daily has been given intramuscularly
Clocef(Amico), Cap., 500mg, Tk. 22/Cap.
Clorocef(Ibn Sina), Suspn., 125mg/5ml, Tk. Proprietary Preparations
205.00/100ml,; Pead. drop, 125 mg/1.25 ml, Cefot(ACI), Inj., 1gm /vial, Tk. 132.40/ Vial,
Tk. 130.00/15ml 500mg/vial, Tk. 76.23/ Vial, 250mg/vial, Tk.
Efaclor(Astra Bio), Suspn., 125 mg/5 ml, Tk. 50.15/ Vial,2gm/vial,Tk. 250.75/ Vial
180.00/100 ml Cefotax(Renata), Inj., 250 mg/vial,Tk. 75.00/
Loracef(Square), Cap., 500 mg,Tk. Vial,500 mg/vial, Tk. 180.00/ Vial,1 gm/vial, Tk.
38.26/Cap.; Paed. drops, 125 mg/1.25 ml, Tk. 100.00/Vial
125.85/15ml,;Suspn., 125 mg/5 ml, Tk. Cefotime(Incepta), Inj., 1 gm/vial, Tk. 132.00/
191.3/100ml Vial,; 250 mg/vial, Tk. 50.00/ Vial,; 500 mg/vial,
Oticef(Alco), Paed. drops, 125 mg / 1.25 ml, Tk. 76.00/ Vial
Tk. 125.38/15ml ,; Suspn., Tk. 200.60/100ml Ceftax(Opsonin), Inj.,
Cap., 500 mg, Tk. 40.12/Cap. 1 gm/vial, Tk. 132.50/ Vial,250 mg/vial , Tk.
Oticlor(Incepta), Cap., 500 mg, Tk. 40.00/Cap. 50.19/ Vial,500 mg/vial , Tk. 76.29/ Vial
; Paed. drops, 125 mg/1.25 ml, Tk.
15
1. ANTI-INFECTIVES

Maxcef(Square), Inj., 1 gm/vial, Tk. 140.42/ single dose; CHILD > 3 months, 125 mg
Vial,250 mg/vial, Tk. 70.21/ Vial,500 mg/vial, twice daily, can be doubled in CHILD > 2
Tk. 90.27/ Vial years with otitis media; Lyme disease:
Taxceph(Ibn Sina), Inj.,1 gm/vial, Tk. 140.00/
Vial,250mg/vial, Tk. 52.00/ Vial,500mg/vial, Tk.
ADULT and CHILD > 12 years, 500 mg
76.00/ Vial twice daily for 20 days; by IM inj. orIV inj.
Taxim(Acme), Inj., 1 gm/vial, Tk. 150.44/ Vial or infusion, 750 mg every 6-8 hours for
,250 mg/vial, Tk. 75.22/ Vial.,500 mg/Vial, Tk. mild to moderate infections;increased to
100.30/ Vial 1.5 g every 6-8 hours for severe
Torped(Orion), Inj., 1 gm/vial, Tk. 130.88/ infections, single doses over 750 mgIV
Vial, 250 mg/vial, Tk. 50.35/ Vial , 500 mg/vial, only; CHILD 60-mg/kg daily (range 30-
Tk. 75.50/ Vial
100 mg/kg daily) in 3-4 divided doses; for
gonorrhea, 1.5 g as a single dose by IM
CEFPROZIL[A] inj; surgical prophylaxis, 1.5 g byIV inj. at
induction of anesthesia, may be
Indications: Upper Respiratory tract supplemented with 750 mg IM inj. 8 and
infection, Skin and Soft tissue infections 16 hours later in abdominal, pelvic and
Cautions: See notes above orthopedic operations or followed by 750
Contra-indications, Side-effects: See mg by IM inj. every 8 hours for further 24-
under Cefadroxil 48 hours in cardiac, pulmonary,
Dose: URTI and Skin and Soft tissue esophageal and vascular surgery
infections, 500 mg once daily usually for
10 days; CHILD 6 months – 12 years; 20 Proprietary Preparations
mg/kg (Max 500 mg) once daily. Acute Adetil(Supreme), suspn, 125mg/5ml,
exacerbations of chronic bronchitis, 500 Tk.198.00/70ml,;Tab.,250mg, Tk. 25.00/Tab.;
mg every 12 hours usually for 10 days. 500mg, Tk. 45.00/Tab.
Otitis media, CHILD 6 months-12 years, Axet(Orion), Inj , 750mg/vial, Tk. 125.85/Vial
,;250 mg/vial, Tk. 60.41/Vial,;Tab.,125mg, Tk.
20 mg/kg (max 500 mg) every 12 hours
15.10/Tab., 250 mg, Tk. 25.18/Tab.,500 mg,
Tk. 45.30/Tab. ;suspn., 125mg/5ml, Tk.
Proprietary Preparations 216.46/70ml
Cefozil(Popular), Tab., 250mg, Tk. 30.11/Tab.; Axetil(Alco), suspn., 125mg/5ml, Tk.
500mg, Tk. 55.21/Tab.; Susp., 125 mg/5 ml, 190.57/70ml ,;Tab.,125 mg, Tk.
Tk.230.87/50 ml 12.04/Tab.,500 mg, Tk. 45.14/Tab,250 mg,Tk.
25.08/Tab.
Axicef(UniMed), suspn, 125mg/5ml, Tk.
CEFUROXIME[A*] 200.00/70ml,;Inj.,500mg/vial, Tk.
45.00/Vial,;Tab , 250mg, Tk. 25.00/Tab.
Axim(Aristo), Inj., 750mg/vial , Tk. 125.00/Vial,
Indications: Surgical prophylaxis, Lyme 1.5g/vial, Tk. 200.00/vial,; Tab., 125mg ,Tk.
disease, community acquired pneumonia 15.00/Tab.; 250mg , Tk. 25.00/Tab,; 500mg ,
especially where beta-lactamase Tk. 45.00/Tab. Susp., 125 mg/5 ml, Tk.
producing H influenza or K pneumonia is 225.00/70 ml;
a consideration, gonorrhea, also see C-2(Astra Bio), Tab. , 250 mg, Tk. 25.00/Tab. ;
under cefadroxil 500 mg, Tk. 45.00/Tab. ;suspn, 125mg/5ml, Tk.
198.00/5ml
Cautions: See notes above; also Cefobac(Popular), Tab. , 250mg, Tk.
pregnancy, breast-feeding and renal 25.09/Tab.,500mg, Tk. 45.17/Tab.;Inj.,750
impairment (Appendix-4) mg/vial, Tk. 125.47/Vial,1.5 gm/vial, Tk.
Interactions: See Appendix-2 200.75/Vial
Contraindications and Side-effects: Cefotil(Square), Inj.,750 mg/vial, Tk.
See under cefadroxil 125.85/Vial .,1.5 gm/vial, Tk. 201.35/vial
.;Tab.,500 mg, Tk. 45.29/Tab,250 mg, Tk.
Dose: Oral :as cefuroxime axetil, 250 mg
25.17/Tab. ; suspn, 125mg/5ml, Tk.
twice daily for mild to moderate 199.34/70ml,;
infections, increased to 500 mg twice Cefunix(Virgo), Tab. , 250mg, Tk.
daily for severe infections and for 25.00/Tab.,500mg , Tk. 40.00/Tab.
pneumonia; for urinary tract infections Cefurim(Somatec), suspn, 125mg/5ml, Tk.,
125 mg twice daily, doubled in 200.00/70ml,;Tab.,500 mg , Tk. 45.17/Tab.,250
pyelonephritis; for gonorrhea, 1 g as a mg, Tk. 25.10/Tab.
16
1. ANTI-INFECTIVES

Cerox(ACI), Inj., 1.5gm, TK. 201.35/vial,; 250 250.94/50ml.;Inj.,750mg/vial ,Tk. 125.00/Vial,;


mg, TK. 55.38/vial,; 750mg,TK. Tab., 500 mg, Tk. 45.17/Tab.
126.12/vial,;suspn, 125mg/5ml, TK. Orextil(Monico), Tab., 500mg, Tk.
199.35/70ml .;250mg/5ml , 45.00/Tab.;250 mg, Tk. 25.00/Tab.
Tk.250.75/50mlTab., 250mg, TK. 25.17/Tab. , Primocef(Novo ), Inj.,1.5 gm/vial, Tk.
500mg, TK. 45.31/Tab. 125mg, TK. 200.00/vial,;750 mg/vial, Tk. 125.00/vial,;Tab.,
15.11/Tab. 250 mg, Tk. 25.00/Tab.; 500 mg, Tk.
Ceroxime(Asiatic), Tab., 125mg , Tk. 45.00/Tab.; suspn, 125mg/5ml, Tk.
15.00/Tab.; Inj., 750mg/vial , Tk. 125.00/vial,; 198.00/70ml
suspn, 125mg/5ml, Tk. 198.00/70ml,; Probac(Silva),suspn, 125mg/5ml, Tk.
Tab.,250mg , Tk. 25.00/Tab.,; 500mg , Tk. 198.74/70ml ,;Tab.,250mg,Tk. 25.10/Tab.
45.00/Tab. Rofurox(Radiant), Tab., 250mg, Tk.
Famicef(Acme),Tab. , 250 mg , Tk. 25.17/Tab. 40.00/Tab., 500mg , Tk. 60.00/Tab.;suspn,
,500 mg , Tk. 45.29/Tab.; Inj1.5 gm/vial, Tk. 125mg/5ml, Tk. 325.00/70
201.35/vial ,750 mg/vial, Tk. 120.82/vial,; Roxicil(Pharmacil), Inj.,750mg/vial ,Tk.
suspn, 250 mg/5 ml , Tk. 186.25/35ml,Tk. 170.51/Vial ,;Tab, 250mg ,Tk.
199.34/70ml. 30.09/Tab.;500mg , Tk. 50.15/Tab.
Furex(Drug Intl), Inj.,1.5gm/vial, Tk. Roxcef(Nipro JMI), Tab., 250 mg, Tk.
200.65/vial, 750mg/vial, Tk. 125.40/vial,; 25.08/Tab.; 500mg, Tk. 45.14/Tab.
Suspn.,125mg/5ml, Tk. 225.75/70ml,; Tab., Inj.,750 mg/vial,Tk.125.00/vial ,1gm/viai
250mg, Tk. 25.10/Tab. ; 500mg, Tk. 45.15/Tab. Tk.200.00/vial
Furocef(Renata), Inj.,1.5 gm,/vial Tk. Secomax(General),Tab., 250mg, Tk.
200.75/vial,; 750mg/vial, Tk. 125.47/vial, 25.16/Tab., 500mg, Tk. 45.31/Tab.; suspn.,
250mg/vial, Tk. 55.21/vial 250mg/5ml, Tk. 201.35/70ml
;Suspn, 125mg/5ml, Tk. 198.75/70ml. ; Sefur(Opsonin), suspn, 250mg/5ml, Tk.
250mg/5ml ,Tk,250.00/50ml.;Tab.,125 mg, Tk. 250.94/ 50 ml.,
15.06/Tab., 250 mg, Tk. 25.09/Tab. 500mg, Inj., 1.5 gm /vial, Tk. 200.75/vial, Inj.,750
Tk. 45.17/Tab. , mg/vial, Tk. 125.47/Vial,; Tab. , 125 mg , Tk.
Furoget(Getwell), Suspn., 125mg/5ml, Tk. 15.06/Tab. ,250 mg , Tk. 25.16/Tab. ,500 mg ,
195.00/70ml ,; Tab. ,500mg,Tk. 44.00/Tab. Tk. 45.30/Tab.
;250mg, Tk. 24.00/Tab. Sefurox(Sanofi), Inj.,1.5g/vial, Tk. 200.60/Vial,
Furotil(Healthcare), Inj.,1.5gm/vial, Tk. Inj., 750mg/vial, Tk. 125.85/Vial.;suspn,
275.00/vial, 750mg/vial, Tk. 175.00/vial.; suspn, 125mg/5ml, Tk. 199.34/Vial,; Tab.,500mg, Tk.
125mg/5ml, Tk. 200.00/70ml. ;Tab., 125mg , 45.31/Tab.,250mg, Tk. 25.17/Tab.;
Tk. 15.00/Tab.,250mg , Tk. 25.00/Tab., 500mg Segorin(Pacific), Tab. , 250 mg,Tk. 25.00/Tab.
, Tk. 45.00/Tab. , 125 mg, Tk. 15.00/Tab. , 500 mg, Tk.
Furotixol(Sharif), suspn, 125 mg /5 ml , Tk. 45.00/Tab. ;suspn,125mg/5ml, Tk.
198.59/70ml ,;Tab.,250 mg, Tk. 25.09/Tab. 150.00/70ml .
500 mg, Tk. 45.13/Tab. Sharpkil(One Pharma),Tab., 250 mg, Tk.
Kfore(Kemiko), Tab., 250 mg, Tk. 25.07/Tab. 25.00/Tab.,500 mg, Tk. 45.00/Tab.
, 500 mg, Tk. 45.13/Tab. Turbocef(Beximco), Inj., 750mg/vial, Tk.
Kilbac(Incepta), suspn., 125mg/5ml, Tk. 125.00/vial,; 1.5gm/vial, Tk. 200.00/vial,; suspn,
198.00/70ml.; ;250mg/5ml, Tk250.00/50ml 250mg/5ml, Tk. 240.00/Susp.;Tab., 250mg, Tk.
Inj.,1.5 gm/vial, Tk. 200.00/vial,; 250 mg/vial, 25.00/Tab.; 500mg, Tk. 45.00/Tab.
Tk. 55.00/vial,; 750 mg/vial, Tk. 125.00/vial Uroxime(Euro), suspn, 125mg/5ml,
,;Tab., 125 mg, Tk. 15.00/Tab.;250 mg, Tk. Tk.198.00/70ml ,;Tab., 301.25mg, Tk.
25.00/Tab. , 500 mg, Tk. 45.00/Tab. 25.00/Tab.;500mg,Tk. 45.00/Tab.
Kilmax(Eskayef), Inj., 750mg/vial, Tk. Vexotil(Organic), Tab.,250 mg, Tk.
125.00/Vial,; 1.5gm/vial ,Tk. 200.00/vial, 250mg 25.08/Tab.,500 mg,Tk. 45.13/Tab.
/vial, Tk. 55.00/vial.; ;suspn,125mg/5ml, Tk. ;suspn,125mg/5ml, Tk. 198.60/70ml
198.00/70ml,;250mg/5ml Tk.250.00/50mlTab, Xefrim(Beacon), suspn, 125mg/5ml, Tk.
125mg , Tk. 15.00/Tab.,250mg , Tk. 199.35/70ml,; Tab. , 250mg , Tk. 25.08/Tab.
25.00/Tab.,500mg, Tk. 45.00/Tab Ximetil(Globe), Inj. ,1.5 gm/vial, Tk.
Lepath(Amico), Tab., 250mg , TK. 22.00/Tab. 200.00/vial,; 750 mg,/vial Tk. 125.00/Vial,;
Merocef(Ibn Sina), suspn, 125mg/5ml, Tk. Tab. , 250 mg, Tk. 25.00/Tab.;500 mg, Tk.
200.00/70ml,; Inj., 750 mg/vial, Tk. 45.00/Tab.; suspn., 125mg/5ml,
130.00/vial,; Tab.,500 mg, Tk. 46.00/Tab. ; Tk.198.00/70ml
250mg, Tk. 26.00/Tab. Xitil(Ziska), suspn, 125mg/5ml, Tk.
Mextil(Biopharma), suspn, 125mg/5ml, Tk. 198.00/70ml,;Tab.250 mg, Tk. 25.00/Tab.,500
200.75/70ml,;250mg/5ml mg, Tk. 45.00/Tab.

17
1. ANTI-INFECTIVES

Zenifor(Zenith), suspn, 125mg/5ml, Tk. 48.00/Tab.;Suspn., 125 mg + 31.25 mg/5 ml,


198.00/50ml,;Tab., 500 mg, Tk. 45.00/Tab. Tk. 250.00/70ml
Zinnat(GSK), Tab. , 250 mg, Tk. 30.00/Tab., Kefuclav(Eskayef), Suspn., 125 mg + 31.25
500 mg, Tk. 55.00/Tab mg/5 ml, Tk. 250.00/70ml,; Tab, 500 mg +
125 mg, Tk. 50.00/Tab.; 250 mg +62.5 mg, Tk.
Cefuroxime + Clavulanic Acid 30.00/Tab.; 250mg+ 62.50mg, Tk. 30.00/Tab.;
Axeclav(Alco), Suspn. 125 mg + 31.25 mg/5 500mg + 125mg, Tk. 50.00/Tab.; 500mg +
ml, Tk. 250.00/70ml ,; Tab., 500 mg + 125 125mg, Tk. 50.00/Tab.; 250mg+ 62.50mg, Tk.
mg, Tk. 50.00/Tab. ,250 mg +62.5 mg, Tk. 30.00/Tab.
30.00/Tab. Mexclav(Biopharma), Tab., 250mg+ 62.50mg,
Axim(Aristo), Suspn., 125 mg + 31.25 Tk. 30.00/Tab.; 500mg + 125mg, Tk.
mg/5ml,Tk.250.00/70ml,; 125 mg + 31.25 mg/5 50.00/Tab.
ml, Tk. 225.00/70mlTab., 250 mg +62.5 mg, Rofuclav(Radiant), Tab. , 250mg+ 62.50mg,
Tk. 30.00/Tab. ; 500 mg + 125 mg, Tk. Tk., 50.00/Tab.; 500 mg + 125 mg, Tk.
50.00/Tab. 0.00/Tab.; 500 mg + 125 mg, Tk. 50.00/Tab.
Ceclav(Sharif), Tab., 500 mg+ 125mg, Tk. Secoclav(General), Tab. , 500mg + 125mg,
50.00/Tab. ; 250 mg+ 62.5 mg, Tk.30.00/Tab. Tk. 50.00/Tab.; 250mg + 62.50mg, Tk.
Cefaclav(Incepta), Suspn. , 125 mg + 31.25 30.00/Tab.
mg/5 ml, Tk. 250.00/70ml,; Tab.,500 mg+ Sefur(Opsonin),Suspn.,125 mg + 31.25 mg/5
125mg, Tk. 50.00/Tab.,250 mg+ 62.5 mg, Tk. ml, Tk.198.75/70 ml
18.00/Tab.; 250 mg+ 62.5 mg, Tk. Sharpkil(One Pharma), Tab., 250 mg + 62.5
30.00/Tab.,500 mg+ 125mg, Tk. 50.00/Tab. mg, Tk. 30.00/Tab.; 500 mg+ 125 mg, Tk.
Cefobac(Popular), Suspn. 125 mg + 31.25 50.00/Tab.
mg/5 ml, Tk. 198.75/70 ml Xiclav(Ziska), Suspn., 125 mg + 31.25 mg/5
Cefotil(Square), Suspn.,125 mg + 31.25 mg/5 ml, Tk. 250.00/70 ml,; Tab, 250 mg + 62.5 mg,
ml, Tk. 250.00/70ml,;Tab. , 250 mg + 62.5 mg Tk. 300.00/Tab.; 500 mg + 125 mg, Tk.
, Tk. 30.10/Tab. ; 500 mg + 125 mg , Tk. 400.00/Tab.
50.15/Tab. Ximeclav(Globe), Suspn. 125 mg + 31.25
Cefurim(Somatec), Tab., 250 mg + 62.50 mg , mg/5 ml, Tk. 250.00/Vial,; Tab. , 250 mg +
Tk. 30.00/Tab.; Suspn. , 125 mg + 31.25 62.5 mg, Tk. 30.00/Tab.; 500 mg + 125 mg,
mg/5 ml, Tk. 250.00/70ml,; Tab., 500 mg + Tk. 50.00/Tab.
125 mg, Tk. 50.00/Tab.
Cerox(ACI), Tab., 125mg + 31.25mg , Tk.
1.1.2.3 THIRD-GENERATION
21.06/Tab. ; 500mg + 125mg, TK. 50.15/Tab.
; 125 mg + 31.25 mg/5 ml, Tk. CEPHALOSPORINS
225.00/70ml,;Suspn., 125 mg + 31.25 mg/5 ml,
TK. 250.75/70ml Third generation agents (Cefotaxime,
Clavurox(Popular), Tab., 500mg + 125mg, Tk. Ceftriaxone, Ceftibuten etc.) generally
50.00/Tab.; suspn.,125 mg + 31.25 mg/5 ml, are less active than first generation drugs
Tk. 250.00/70 ml
against gram-positive cocci, but they are
Clavusef(Opsonin), Suspn., 125 mg + 31.25
mg/5 ml, Tk. 252.75/70 ml,; Tab. , 125 mg + much more active against the
31.25 mg , Tk. 18.05/Tab.; 250 mg + 62.5 Enterobacteriaceae, including beta-
mg ,Tk. 30.10/Tab.,; 500 mg + 125 mg , Tk. lactamase producing strains. Among third
50.15/Tab. generation drugs ceftazidime and
Cloavurox(Popular), Tab.,250 mg + 62.5 mg cefoperazone also are effective in P.
, Tk. 30.00/Tab. aeruginosa infection but are less active
Co-Axet(Orion), Tab.,250 mg+ 62.5 mg, Tk.
than other third generation agents
30.09/Tab.; 500 mg +125 mg,Tk. 50.15/Tab.
Famiclav(Acme), Suspn. , 125 mg + 31.25 against gram-positive cocci.
mg/5 ml, Tk. 252.00/70ml,; Tab. , 250 mg +
62.50 mg , Tk. 30.00/Tab. ; 500 mg + 125 mg CEFDINIR[W]
, Tk. 50.00/Tab.
Fuclav, (Drug Intl), Suspn. 125 mg + 31.25
mg/5 ml, Tk. 250.75/70ml,; 125mg+ 31.25mg, Indications: Gonorrhea, otitis media,
Tk. 18.10/Tab. ; 250mg+ 62.50mg, Tk. pharyngitis, lower RTI such as bronchitis
30.10/Tab. ; 500mg+ 125mg, Tk. 50.20/Tab. and UTI
Furoclav(Renata), Tab. , 250mg+ 62.50mg, Caution: Renal Impairment
Tk. 30.00/Tab. ; 500 mg + 125 mg , Tk. Side effects:See under Cefadroxil
50.00/Tab. Interactions:See Appendix-2
Furoget(Getwell), Tab. , 250mg +2.50 mg, Dose: Oral:ADULT, 600 mg daily as a
Tk. 28.00/Tab. ; 500mg + 125mg, Tk.
single dose on in two divided doses
18
1. ANTI-INFECTIVES

CHILD may be given 14 mg/kg body CEFIXIME [A*][W]

weight daily
Indications:Sinusitis, otitis media, skin
Proprietary Preparations and soft tissue infections caused by
Cednir(Eskayef), Cap, 300mg , Tk.
Enterobacteriaceae and betalactamase
40.00/Cap.;Suspn., 125 mg/5 ml, Tk.
160.00/30ml producing H. influenzae, Morexella
Cefexta(UniMed),Suspn., 125 mg/5 ml, Tk. catarrhalis and N. gonorrhea
225.00/60ml,;Cap., 300mg, Tk. 57.00/Cap.; Cautions, Contra-indicationsandSide-
Suspn., 250 mg/5 ml, Tk. 210.00/30ml effects: See notes above and under
Efdinir(Incepta), Cap.,300 mg, Tk. cefadroxil
45.00/Cap.;Suspn.,125 mg/5 ml, Tk. Interactions: See Appendix -2
175.00/60ml
Dose: Oral: ADULT and CHILD > 10
years: 200-400 mg twice/once daily;
CEFDITOREN[W] CHILD > 6 months: 8 mg/kg daily in 1-2
divided doses
Indications: Sinusitis, otitis media, skin
and soft tissue infections caused by Proprietary Preparations
Enterobacteriaceae and betalactamase Adexim(Supreme), Cap, 200mg,
producing H. influenzae, Morexella Tk.30.00/Cap.; Suspn., 100 mg/5 ml,
catarrhalis and N. gonorrhea Tk.160.00/50ml
Cautions: See notes above; also Afix(Aristo), Suspn., 200 mg/5 ml,
Tk.195.00/30ml, Tk. 280.00/50ml,;100 mg/5 ml,
carnitine deficiency Tk. 195.00/50ml,Tk.120.00/30ml Tk. Cap.,
Contra-indications: See under 400mg , Tk. 50.00/Cap. ; 200mg , Tk.
Cefadroxil 3.00/Cap. ; Tab. , 200mg , Tk.
Interactions:See Appendix -2 35.00/Tab.;400mg , Tk. 50.00/Tab.
Side-effects:See under Cefadroxil Afixime(Asiatic), Cap., 200mg , Tk. 30.00/Cap.
Dose: Oral: ADULT and CHILD > 10 , 400mg , Tk. 50.00/Cap.; Suspn., 100 mg/5
years: 200-400 mg twice daily; in patients ml, 130.00/37.5ml,Tk. 210.00/50ml
Bestcef(Biopharma), Cap., 200mg , Tk.
with renal insufficiency: creatinine 35.00/Cap. ;400mg , Tk. 50.19/Cap. ;Suspn,
clearance (CC) < 30ml/min, 200 mg once 100mg /5ml, Tk. 130.49/37.5ml,Tk.
daily, CC 30-49 ml/min, 200 mg twice 210.00/50ml
daily Bioxim(Sharif), Cap. , 400 mg, Tk.
50.14/Cap.,200 mg, Tk. 30.10/Cap. Suspn.,
Proprietary Preparations 100 mg/5 ml, Tk. 120.37/30ml, Tk.
Cefditor(Orion), Tab., 200mg, Tk.100.30/Tab. 175.00/50ml , Tk. 280.00/50ml ,;
Ceftoren(ACI), Tab., 200mg, Tk. 150.00/Tab. C-3(Astra Bio), Cap., 400 mg, Tk. 50.00/Cap. ;
200 mg, Tk. 35.00/Cap. , Tk. 30.00/Cap. ;
Suspn., 100 mg/5 ml, Tk. 195.00/5ml
CEFETAMET PIVOXIL HCl[W] Cebex(Novo), Suspn., 100 mg/5 ml, Tk.
195.00/50ml,; Cap., 200 mg, Tk. 35.00/Cap.,
This member of third-generation 400 mg, Tk. 50.00/Cap.
cephalosporins has therapeutic profile Cef-3(Square), Cap., 200 mg, Tk. 35.11/Cap.,
400 mg, Tk. 50.35/Cap.;paed.drop, 125
similar to that of cefixime. However, it
mg/1.25ml, Tk. 100.3/21ml,; Suspn., 100 mg/5
may precipitate carnitine deficiency. ml, Tk. 135.4/30ml,Tk. 210.63/50ml,Tk.
The usual administration is per oral in a 250/75ml,; 200 mg/5 ml, Tk. 280.85/50ml,;
dose of 500 mg twice daily. Tab., 200 mg, Tk. 35.11/Tab.
Cefcil(Pharmacil), Cap., 200mg , Tk.
Proprietary Preparation 34.10/Cap.; Suspn., 100 mg/5 ml, Tk.
Tenafet(Incepta),Tab.,250mg,Tk.20/Tab;500m 200.60/50ml
g,Tk.35/Tab.;Susp.,250mg/5ml,Tk.120/50 ml Ceficap(Euro), Suspn., 100 mg/5 ml, Tk.
195/50ml. ; Cap., 224mg, Tk. 35.00/Cap.
,400mg, Tk. 50.00/Cap.
Cefiget(Getwell), Suspn., 100 mg/5 ml, Tk.
205.00/50ml,Tk. 245.00/100ml ,Tk.

19
1. ANTI-INFECTIVES

90.00/20ml,; Cap., 400mg, Tk. 49.00/Cap., 135.51/30ml, Tk. 155.58/40ml,Tk.


200mg, Tk. 34.00/Cap 195.74/50ml,Tk. 225.00/70ml ,; Tab. , 400 mg,
Cefim, (ACI), Cap., 200mg, TK. 35.11/Cap. , Tk. 50.00/Tab. ; 200 mg, Tk. 35.00/Tab. ;
400mg, TK. 50.34/Cap. ; Paed. drops, 125 Cap., 200 mg, Tk. 35.00/Cap.; 400 mg, Tk.
mg/1.25ml, TK. 100.00/21ml; Suspn., 200 mg/5 50.00/Cap
ml, TK. 300.90/50ml ,;Suspn.,100 mg/5 ml, Orgaxim(Organic), Cap., 200mg, Tk.
TK. 241.62/75ml ,; TK. 130.39/30ml ,TK. 30.10/Cap. ;500mg , Tk. 50.15/Cap. ; Suspn.,
210.63/50ml ,; Tab., 200 mg, TK. 30.90/Tab. ; 100 mg/50ml, Tk. 195.59/5ml, Tk. 240.72/75ml
400mg, TK. 50.15/Tab. Prexim(Ziska), Cap. , 400 mg, Tk. 45.00/Cap.
Cefix(Globe), Cap., 200 mg, Tk. 35.00/Cap.; 200 mg, Tk. 30.00/Cap. ,; Suspn., 100 mg/5 ml,
400 mg, Tk. 50.00/Cap. ; Suspn., 100 mg /5 ml, Tk. 120.00/30ml,Tk. 195.00/50ml,;
Tk. 195.00/50ml, Rofixim(Radiant), Cap. , 500mg, Tk.
Cefixim(Ibn Sina), Cap., 200 mg, Tk. 45.00/Cap. ,400mg, Tk. 65.00/Cap. ;
35.00/Cap. ; Paed.drop, 125mg/1.25ml, Tk. Suspn.,100 mg/5 ml, Tk. 250.00/50ml,
100.00/21ml,; Suspn, 100mg /5ml, Tk. 200mg/5 ml, Tk. 395.00/50ml,
180.00/40ml,Tk. 130.00/30ml,Tk. 210.00/50ml,; Roxim(Eskayef), Cap 200mg , Tk. 30.00/Cap.
200mg /5ml, Tk. 280.00/50ml,; Cap., 400 mg, ,400mg , Tk. 50.00/Cap. Suspn, 200 mg/5 ml,
Tk. 55.00/Cap. ; Tk. 320.00/37.5ml, Tk.320/60ml; 100 mg/5 ml,
Ceftid(Opsonin), Cap. , 400 mg. Tk. Tk. 135.00/30ml,Tk.195.00/50ml
50.35/Cap.,200 mg , Tk. 35.11/Cap. ;; Paed Paed. drop, 125 mg/1.25ml, Tk. 85.00/15ml,;
drops, 125mg/1.25ml, Tk. 98.00/21ml,;Suspn., Tab., 200mg, Tk. 30.00/Tab., 400mg , Tk.
100 mg/5 ml, Tk. 210.63/50 ml ,Tk.130.49/ 37.5 50.00/Tab.
ml.,Tk. 321.21/ 50 ml; Tab. , 400 mg , Tk. Saver(Alco), Suspn., 100 mg / 5 ml, Tk.
50.19/Tab.; 200 mg , Tk. 35.00/Tab.; 120.36/30ml , Tk. 150.45/40ml ,Tk.
Cexime(GSK), Cap. , 200 mg, Tk. 35.11/Cap. 195.59/50ml ,; Cap., 200 mg, Tk. 30.09/Cap.
; 400 mg, Tk . 50.15/Cap. ;100 mg/5 ml, Tk. ; 400 mg, Tk. 50.15/Cap.
200.00/50ml Starcef(Beacon), Cap., 400mg , Tk.
Denvar(Healthcare), Cap., 200mg , Tk. 50.00/Cap. ; 200mg , Tk. 35.11/Cap. ;
35.00/Cap. ,400mg, Tk. 50.00/Cap. ;Suspn., Suspn., 100 mg/5 ml, Tk. 196.33/50ml
200mg/5ml , Tk. 320.00/50 ml,; 225.00/37.5 ml Supraxim(Silva), Cap. , 200mg, Tk.
,; 100mg/5ml, Tk. 145.00/30 ml ,Tk. 210.00/50 35.00/Cap.; Suspn., 100 mg/5 ml, Tk.
ml 200.00/50ml ,Tk. 140.00/30ml
Emixef(Incepta), Suspn., 200 mg/5 ml, Tk. T-cef(Drug Intl), Cap , 400mg, Tk. 50.20/Cap.;
280.00/50ml,; Suspn., 100 mg/5 ml, Tk. 200mg, Tk. 30.10/Cap. ; Suspn., 200mg/5ml,
130.00/30ml, Tk. 170.00/40ml, Tk. Tk. 280.85/50ml,; 100mg/5ml, Tk.
195.00/50ml.; Cap, 200 mg, Tk. 35.00/Cap. 135.45/30ml,; 195.60/50ml,; Paed.drops,
; 400 mg, Tk. 50.00/Cap. 125mg/1.25ml, Tk. 100.30/21ml
Erafix(Virgo), Cap. , 200 mg, Tk. 36.00/Cap. Tgocef(Somatec), Suspn., 100 mg/5 ml, Tk.
Fix-A(Acme), Cap., 200 mg, Tk. 35.00/Cap. ; 130.00/30ml,;Tk. 195.00/50ml,; Cap., 200 mg,
400 mg, Tk. 50.35/Cap.; Suspn., 100 mg/5 ml, Tk. 35.00/Cap. ; 400 mg, Tk. 50.00/Cap.
Tk. 210.63/50ml ,Tk. 130.88/37.5ml ,Tk. Tocef(General), Suspn., 100 mg/5 ml, Tk.
240.72/75ml ,.;200mg/5ml,Tk. 280.84/50ml,; 130.88/37.5ml, 196.33/50ml,; 200 mg/5 ml, Tk.
Paed.drops, 125 mg/1.25ml, Tk.100.30/21ml 280.00/50ml,; Cap., 200mg, Tk. 35.00/Cap. ;
Gen-3(Amico), Cap., 200mg , 30.00/Cap.; 400mg, Tk. 50.34/Cap.
Suspn., 100mg/5ml , TK. 175.00/50ml Trifix(Pacific), Suspn., 200 mg/5 ml, Tk.
G-FIX(G.A.Co), Cap., 200 mg, Tk. 35.11/Cap.; 240.00/50ml ,; Cap., 200 mg, Tk. 35.00/Cap. ;
400 mg, Tk. 48.00/Cap., Suspn., 100 mg/5ml, 400 mg, Tk. 50.00/Cap.
Tk. 195.59/50 ml Triocef(Nipa), Cap., 200 mg, Tk. 30.00/Cap. ;
Kefim(Kemiko), Cap., 400 mg, Tk. 55.16/Cap. Suspn., 100 mg/5 ml, Tk. 135.00/37.5ml, Tk.
; 200 mg, Tk. 30.09/Cap.,Suspn., 100 mg/5 ml, 195.00/50ml
Tk. 130.39/37.5ml , Tk. 195.59/50ml Triocim(Beximco), Cap., 200mg, Tk.
Kuracef(Sanofi), Suspn., 100 mg/5 ml, Tk. 35.00/Cap.; 400mg, Tk. 50.00/Cap. ; Suspn.,
135.00/30 ml,Tk. 215.00/50 ml,; Tab., 200mg, 100mg/5ml, Tk. 210.00/50ml,; 200 mg/5 ml, Tk.
Tk. 40.00/Tab.; 400mg, Tk. 55.00/Tab. 320.00/50ml
Odacef(UniMed), Cap., 200mg, Tk. Truso(Orion), Cap., Tk. 35.11/Cap. ; Suspn.,
30.00/Cap. ;400mg, Tk. 50.00/Cap. ; Suspn., 200 mg/5 ml, Tk. 280.84/50ml,; 100 mg/5 ml,
100 mg/5 ml, Tk. 195.00/50ml,Tk. 120.00/30ml Tk. 130.89/37.5ml,; Tk. 195.59/50ml Paed.
Onefix(One Pharma), Cap. , 200 mg, Tk. drops, 125 mg/1.25ml, Tk. 80.24/15ml
34.99/Cap. ; 400 mg , Tk. 49.99/Cap. ; Suspn., Zemicef(Popular), Cap. , 200mg, Tk.
100 mg/5 ml, Tk. 135.00/30ml,Tk. 195.00/50ml 35/Cap.;Suspn, 200 mg/5 ml, 100mg/5 ml, Tk.
Orcef(Renata), Suspn., 200 mg/5 ml, Tk. 120.45/30ml, Tk.150.57/40ml, Tk.195.74/50ml
280.00/50 ml,;Suspn., 100 mg/5 ml, Tk.
20
1. ANTI-INFECTIVES

[W] [W]
CEFOTAXIME CEFPODOXIME

Indications: As part of 3-drug Indications: Upper respiratory-tract


combination with vancomycin and infections, particularly those that are
Ampicillin in meningitis due to H. recurrent and resistant to other
influenzae,penicillin-sensitiveS. antibiotics; lower respiratory-tract
pneumonia, N. meningitidisand gram- infections including bronchitis and
negative enteric bacteria, gonorrhea, pneumonia; skin and soft tissue
Hemophilus epiglottitis; also see under infections; uncomplicated UTI and
cefadroxil gonorrhea; also effective against
Cautions, Contraindications: Side- penicillin-resistant strains of
effects: Streptococcus pneumonia
Interactions: See Appendix-2 Caution, Contraindications and Side-
Side-effects: Rare events of cardiac effects: See notes above and under
arrhythmias after rapid inj. also see under cefadroxil
cefadroxil Interactions:See Appendix -2
Dose :By IM or slow IV inj. or IV infusion Dose: Oral:as cefpodoxime proxetil:
1 g every 12 hours for mild to moderate upper respiratory-tract infections (in
infections; increased to 8 g daily in 4 pharyngitis and tonsillitis only in
divided doses for severe meningitis, up to infections which are recurrent, chronic, or
a max. of 12 g daily in 3-4 divided doses; resistant to other antibacterial), 100 mg
CHILD 100-150 mg/kg/day in 2 to 4 twice daily, 200 mg twice daily in
divided doses in mild to moderate sinusitis; lower respiratory tract infections
infections, increased to 200 mg/kg daily including bronchitis and pneumonia, 100-
in severe infections; NEONATES 50 200 mg twice daily; skin and soft tissue
mg/kg/day in 2 to 4 divided doses for mild infections, 200 mg twice daily;
to moderate infections; increased to 150- uncomplicated urinary-tract infections,
200 mg/kg/day 4 divided doses for 100-200 mg twice daily; uncomplicated
severe infections; for gonorrhea, a single gonorrhea, 200 mg as a single dose;
dose of 500 mg CHILD 15 days-6 months 4 mg/kg every
12 hours; 6 months-2 years 40 mg every
Proprietary Preparations 12 hours; 3-8 years 80 mg every 12
Cefot(ACI), Inj.,1gm/vial,Tk. 132.40/ Vial, 500 hours; > 9 years 100 mg every 12 hours
mg/vial, Tk. 76.23/ Vial, 250mg, Tk. 50.15/
Vial, 2gm, Tk. 250.75/Vial Proprietary Preparations
Cefotax(Renata), Inj., 250 mg/vial, Tk. 75.00/
Cefdox(ACI), Suspn, 40 mg/5 ml, Tk.
Vial, 500 mg, Tk. 180.00/Vial, 1 gm/vial, Tk.
98.67/50ml,80 mg/5 ml, Tk. 176.19/50ml;
100.00/Vial, Tab., 200mg, TK. 42.29/Tab. ; Cap., 100mg ,
Cefotime(Incepta), Inj., 1 gm/vial, Tk. 132.00/ Tk. 22.13/Cap.,200mg, Tk. 25.00/Cap. ; Paed.
Vial, 250 mg/vial, Tk. 50.00/ Vial,500 mg/vial, drops20 mg/ml, Tk. 60.41/15ml
Tk. 76.00/ Vial Cefipod(Asiatic), Suspn, 40 mg/5 ml, Tk.
Ceftax(Opsonin), Inj., 1 gm/vial, Tk. 132.50/
195.00/100ml,80 mg/5 ml, Tk. 175.00/50ml,;
Vial,250 mg/vial , Tk. 50.19/Vial, 500 mg/vial ,
Cap., 100mg , Tk. 14.00/Cap. ; Paed. drops,
Tk. 76.29/ Vial 20 mg/ml, Tk. 60.00/15ml
Maxcef(Square), Inj., 1 gm/vial, Tk.
Cefobid(UniMed), Cap.,200mg, Tk.
140.42/Vial. ,250 mg/vial,Tk. 70.21/Vial,500
42.00/Cap.; Suspn, 40mg/5ml, Tk. 98.00/50ml
mg/vial, Tk. 90.27/ Vial
Cefodim(Pacific), Cap. , 100 mg, Tk.
Taxceph(Ibn Sina), Inj.,1 gm/vial, Tk.
22.00/Cap. ; 200 mg, Tk. 40.00/Cap. ; Suspn,
140.00/Vial, 250mg/vial, Tk. 52.00/ Vial,500mg,
40mg/5ml, Tk. 80.00/50ml
Tk. 76.00/ Vial Cefokid(Euro), Suspn, 80 mg/5 ml, Tk.
Taxim(Acme), Inj., 1 gm/vial, Tk. 150.44/Vial , 98.00/50ml
250 mg/vial, Tk. 75.22/ Vial,500 mg/Vial, Tk. Cefomin(Popular), Tab. , 100mg, Tk.
100.30/ Vial 20.08/Tab.; 200.00mg, Tk. 38.14/Tab. Suspn,
Torped(Orion), Inj.,1 gm/vial, Tk. 130.88/
40mg/5 ml, Tk. 96.36/50ml
Vial, 250 mg/vial, Tk. 50.35/ Vial ,; 500 mg/vial,
Tk. 75.50/ Vial
21
1. ANTI-INFECTIVES

Ceforan(Drug Intl), Tab., 200mg, Tk. Vanprox(Square), Paed. drops, 20 mg/ml, Tk.
28.10/Tab. ; 100mg, Tk. 17.05/Tab. ; Suspn, 60.4/15ml,; Suspn, 40 mg/5 ml, Tk.
40mg/5ml, Tk. 120.40/100ml, Tk. 98.65/50ml,; Cap., 200 mg, Tk. 42.29/Cap.
75.25/50ml,80mg/5ml, Tk. 175.55/50ml Vercef(Beximco), Paed. drops, 20 mg/ml, Tk.
Cefpod(Zenith), Tab., 100 mg , Tk. 22.00/Tab. 60.00/15ml,; Suspn, 40mg/5ml, Tk.
Cepdoxim(Alco), Cap., 100 mg, Tk. 98.00/50ml,; 80mg/5ml, Tk. 175.00/50ml
20.06/Cap.; 200 mg, Tk. 30.09/Cap. Susp., Victorin(Novo Health), Cap., 200 mg, Tk.
40 mg/ 5ml, Tk. 175.53/100ml ,; Tk. 40.00/Cap. ; Paed. drops, 20 mg/ml, Tk.
90.27/50ml ,; 60.00/15ml,:Suspn, 40mg/5ml, Tk. 98.00/50ml
CP(Acme), Tab., 200 mg, Tk. 42.29/Tab. ; Ximeprox(Incepta), Paed. drops, 20 mg/ml,
Suspn, 40 mg/5 ml, Tk. 98.65/50ml,; 80mg/5 Tk. 60.00/15ml,: Suspn, 40 mg/ 5ml, Tk.
ml, Tk. 175.52/50ml,; Paed. drops, 120 175.00/50ml,; Tk. 195.00/100ml,; 80 mg/5 ml,
mg/1.25ml, Tk. 60.40/15ml Tk. 98.00/50ml,; Tab., 100 mg, Tk. 17.00/Tab.
Desbac(General), Cap., 100mg, Tk. ; 200 mg, Tk. 28.00/Tab.
22.13/Cap.; Suspn, 40 mg/5ml, Tk. 98.67/50ml Zedoxim(Globe), Cap., 100 mg, Tk.
Dofixim(Ibn Sina), Cap.,100mg, Tk. 20.00/Cap. , 200 mg, Tk. 40.00/Cap. ;
168.00/Cap.; Suspn, 40 mg/ 5ml, Tk. Paed.drop , 20 mg/ml, Tk. 60.00/Vial,; Suspn,
100.00/50ml 40 mg/5 ml, Tk. 95.00/50 ml;
DxProxil(Monico), Suspn, 40mg/5ml, Tk.
98.00/50ml Cefpodoxime + Clavulanic Acid
Emiprox(Virgo), Suspn., 40 mg/5 ml, Tk. Clavuran(Drug Intl), Tab., 100mg+ 62.5mg, Tk.
90.00/50ml, 80 mg/5 ml, Tk. 170.00/50ml 22.10/Tab.; 200mg+ 125mg, Tk. 35.15/Tab.
Instina(Ziska), Suspn., 40 mg/5 ml, Tk. Combocef(ACI), Tab., 200mg +125mg Tk.
98.00/50ml 50.15/Tab.; 100mg + 62.5mg, Tk. 30.09/Tab.
Kidcef(Beacon),Suspn., 40mg/5ml, Tk. Duo(Incepta), Tab, 100mg+ 62.5mg, Tk.
98.67/50ml 25.00/Tab.; 200 mg + 125 mg, Tk. 40.00/Tab.
Leprox(Amico), Suspn., 40mg/5ml, TK. Xtabac(Opsonin), Tab. , 200 mg + 125 mg ,
98.00/50ml,; 80mg/5ml, TK. 175.00/50ml Tk. 35.00/Tab.; 100 mg + 62.50 mg, Tk.
Neoprox(Somatec), Suspn., 40 mg/5 ml, Tk. 20.00/Tab.
98.37/50ml,; Paed. drops, 20 mg/ml, Tk.
60.23/15ml
CEFTAZIDIME[W]
Pedicef(Orion), Paed. drops , 20mg/ml, Tk.
60.39/15ml,; Suspn., 40mg/5ml, Tk.
98.66/50ml,;80mg/5ml, Tk. 176.19/50ml Indications: With an aminoglycoside
Podo(Kemiko)Suspn., 40 mg / 5ml, Tk. treatment of choice for Pseudomonus
98.29/50ml meningitis, surgical prophylaxis, also see
Rovantin(Opsonin), Suspn, 40 mg /5 ml, Tk. under Cefixime
98.66/50ml,80 mg /5 ml, Tk. 175.66/50ml,20
Cautions, Contra-indications, Side-
mg /5 ml, Tk. 60.42/5ml,; Tab., 100 mg , Tk.
14.05/Tab., 200 mg , Tk. 25.09/Tab. effects:See notes above and under
Roxetil(Healthcare), Cap., 100mg , Tk. cefadroxil
352.00/Cap. , 200mg, Tk. 504.00/Cap. ; Interactions:See Appendix-2
Suspn, 40mg/5ml, Tk. 95.00/50 ml Dose:IM or slow IV inj. or IV infusion: 1 g
Sarelox(Sanofi), Suspn., 80mg/ml, Tk. every 8 hours for mild to moderate
98.67/50 ml infections, increased to 2 g every 8-12
Starin(Eskayef), Suspn., 40 mg/ 5ml, Tk.
hours for severe infections, single dose
98.00/50ml, 80 mg/5 ml, Tk. 150/50ml,; Cap,
100mg , Tk. 22.00/Cap. , 200mg , Tk. over 1 gIV route only, up to a max. of 3 g
40.00/Cap.; Paed. drops , 20mg/ml, Tk. daily; CHILD up to 2 months 25-60 mg/kg
60.00/15ml daily in 2 divided doses, > 2 months 30-
Taxetil(Aristo), Suspn, 80 mg/5 ml, Tk. 100 mg/kg daily in 2-3 divided doses; up
175.00/50ml,; 40 mg/5 ml, Tk. 99.00/50ml, Tk. to 150 mg/kg daily in 3 divided doses
195.00/100ml,; Cap., 100mg , Tk. 22.00/Cap.; (max. 6 g daily ) if immunocompromised
200mg , Tk. 40.00/Cap.; Paed. drops, 20
or meningitis;IV route recommended for
mg/ml, Tk. 62.00/15ml
Trioclav(Eskayef), Tab, 200mg, Tk. children; urinary tract and less serious
40.00/Tab.; 200mg , Tk. 40.00/Tab. infections: 0.5-1 g every 12 hours;
Trucef(Renata), Paed. drops, 20 mg/ml, Tk. Pseudomonal lung infection in cystic
60.23/15ml,; Suspn, 40 mg/ 5ml, Tk. fibrosis: ADULT with normal renal
98.37/50ml,; 80 mg/ 5ml, Tk. 175.66/50ml function 100-150 mg/kg daily in 3 divided
doses; CHILD up to 150 mg/kg daily
(max. 6 g daily) in 3 divided doses;IV
22
1. ANTI-INFECTIVES

route recommended for children; surgical CEFTIBUTEN [W]

prophylaxis, prostatic surgery, 1 g at


induction of anesthesia repeated if Ceftibuten is an oral 3rd generation
necessary when catheter removed cephalosporin used similarly to cefixime
in the treatment of urinary tract infection
Proprietary Preparations and respiratory tract infection.
Asizime(Asiatic), Inj , 1gm/vial, Tk.
Indications:See under Cefixime
240.00/Vial, Inj , 250mg/vial , Tk. 85.00/
Vial,500mg/vial , Tk. 130.00/ Vial Cautions, Contra-indications, Side-
Cefazid(Renata), Inj, 1 gm/vial, Tk. effects: See notes above and under
240.00/Vial,250 mg/vial, Tk. 85.00/ Vial,500 cefadroxil
mg/vial, Tk. 130.00/ Vial Interactions: See Appendix-2
Ceftazim(Aristo), Inj , 1g/vial, Tk. Dose: Oral: ADULT and CHILD > 10
240.00/Vial,250mg/vial , Tk. 85.00/ years: 400 mg once daily; CHILD > 6
Vial,500mg/vial , Tk. 130.00/Vial
months: 8 mg/kg once daily
Lesero(Ziska), Inj , 1g/vial, Tk. 215.00/
Vial,500 mg/vial, Tk. 115.00/Vial ,250 mg/vial,
Tk. 70.00/ Vial Proprietary Preparations
Maxidim(Beximco), Inj , 250mg/vial, Tk. 85.00/ Butibac(Drug Intl), Cap., 400 mg, Tk.
Vial,; 500mg/vial, Tk. 130.00/ Vial,1gm/vial, Tk. 120.00/Cap. ; Suspn., 90 mg/5 ml, Tk.
240.00/ Vial 480.00/60ml
Serozid(Opsonin), Inj , 500 mg/vial , Tk. Buticef(Ibn Sina), Suspn., 90 mg/5 ml, Tk.
130.39/ Vial,1 gm/vial, Tk. 240.00/ Vial ,250 480.00/60ml ,; Cap., 400 mg, Tk. 1200.00/Cap.
mg/vial , Tk. 85.00/ Vial Cebumax(General), Cap. , 400 mg, Tk.
Sidobac(Incepta), Inj , 1 gm/vial, Tk. 215.00/ 120.00/Cap.;Suspn., 90 mg/5 ml, Tk.
Vial , 250 mg/vial, Tk. 70.00/ Vial,500 mg/vial, 480.00/60ml
Tk. 115.00/ Vial Cebuten(Renata), Cap., 400 mg, Tk.
Tazicef(Novo Health), Inj , 250 mg/vial, Tk. 120.00/Cap. ; 400 mg, Tk. 120.00/Cap.
70.00/ Vial ,1.0 gm/vial, Tk. 215.00/ Vial,500 Cefamax(Incepta), Suspn., 90 mg/5 ml, Tk.
mg/vial, Tk. 115.00/ Vial 480.00/60ml,; Cap. , 400 mg, Tk. 120.00/Cap.
Tazid(Square), Inj , 1 gm/vial, Tk. 240.72/ Cefaten(Eskayef), Cap. , 400 mg, Tk.
Vial,; 250 mg/vial, Tk. 85.26/ Vial,500 mg/vial, 120.00/Cap., 400 mg, Suspn., 90 mg/5 ml, Tk.l
Tk. 130.39/ Vial 465.00/60ml., 90 mg/5 ml, Tk. 775.00/100ml
Tazimax(Eskayef), Inj, 1gm, Tk. 240.00/ Vial,; Cefteria(ACI), Suspn., 90 mg/5 ml, TK.
250mg , Tk. 85.00/ Vial,1gm/vial, Tk. 481.00/60ml ,90 mg/5 ml, TK. 802.00/120ml
240.00/Vial,250mg/vial, Tk. 85.00/ Vial ,;Cap., 400 mg, TK. 120.00/Cap.
Tizime(Globe), Inj , 1 gm/vial, Tk. 210.00/Vial,; Ceftiben(Square), Cap., 400 mg, Tk.
250 mg/vial,Tk. 70.00/Vial,500 mg/vial, Tk. 120.00/Cap. ; Suspn., 90 mg/5 ml, Tk.
115.00/Vial 480.00/60ml
Trizidim(Acme), Inj , 250 mg/vial, Tk. 70.47/ Inbuten(Pharmacil), Cap. , 400 mg, Tk.
Vial,; 1 gm, Tk. 216.45/ Vial,500 mg, Tk. 120.00/Cap,; Suspn., 90 mg/5 ml, Tk.
115.78/ Vial 480.00/60 ml
Trum(Drug Intl), Inj , 1gm, Tk. 225.70/ Vial,; Logibac(Acme), Suspn., 90 mg/5 ml, Tk.
250mg/vial, Tk. 70.25/ Vial,; 500mg/vial, Tk. 480.00/60ml,; Cap., 400 mg, Tk. 120.00/Cap.
120.40/ Vial Maxbuten(Sanofi), Suspn., 180mg/ml, Tk.
Zidicef(Popular), Inj , 1 gm/vial, Tk. 215.81/ 800.00/60ml,90 mg/5 ml, Tk. 480.00/60ml,;
Vial,; 250mg/vial, Tk. 70.26/ Vial,; 500 mg/vial, Tab., 400mg, Tk. 120.00/Tab.;
Tk.115.43/ Vial,2 gm, Tk. 361.36/ Vial Oditen(Opsonin), Cap., 400 mg, Tk.
Zidim(Orion), Inj, 500 mg, Tk. 115.78/ Vial , 1 120.37/Cap.;Suspn., 90 mg/5 ml, Tk. 481.44/60
gm/vial, Tk. 216.45/Vial,250 mg/vial, Tk. 70.48/ ml ,Tk. 800.00/120 ml
Vial Roin(Ziska), Cap. , 400 mg, Tk. 120.00/Cap. ;
Zidimax(Biopharma), Inj , 250mg/vial , Tk. Suspn., 90 mg/5 ml, Tk. 400.00/60ml
70.00/ Vial,500mg/vial ,Tk. 115.00/ Vial Tibucef(Globe), Suspn., 90 mg/5 ml, Tk.
Zitum(ACI), Inj , 250mg/vial,Tk. 70.47/ 465.00/60 ml,; Cap., 400 mg, Tk. 120.00/Cap.
Vial,500mg/vial, Tk. 115.78/ Vial,1gm/vial,Tk. Zoventa(Healthcare),Suspn.,180mg/5ml, Tk.
226.53/ Vial 800.00/60 ml ,90mg/5ml ,Tk. 480.00/60
ml,Cap.,200 mg ;Cap Tk. 70.00/Cap.,400
mg,Tk. 120.00/Cap.

23
1. ANTI-INFECTIVES

CEFTRIAXONE[W] , Tk. 100.00/vial,Inj., IV 2g/vial, Tk.


300.00/vial,1g/vial, Tk. 200.00/vial,500mg/vial ,
Tk. 130.00/vial, 250mg/vial , Tk. 100.00/vial
Indications: Surgical prophylaxis; also Axosin(Ibn Sina), Inj., IM 1g/vial, Tk.
see under Cefotaxime 180.00/vial,; 500mg/vial, Tk.
Cautions: See notes above ; also 120.46/vial,250mg/vial , Tk. 90.00/vial,; Inj., IV
hepatic impairment, in premature 2g/vial, Tk. 290.00/vial,; 1g/vial, Tk.
neonates may displace bilirubin from 180.00/vial,; 500mg/vial , Tk. 120.46/vial,
250mg/vial , Tk. 90.00/vial
binding sites of albumin
Cefaz(Astra Bio), Inj., IM 1g/vial,
Contra-indications: Neonates with 250mg/vial,Tk. 100.00/vial,; Inj., IV 2g/vial, Tk.
jaundice, hypoalbuminemia, acidosis or 300.00/vial, 1g/vial, Tk. 190.00/vial,;
impaired bilirubin binding; also see under Cefone(Sharif), Inj., IM
Cefadroxil 500mg/vial,Tk.120.37/vial,;250mg/vial , Tk.
Interactions:See Appendix -2 90.28/vial,; Inj., IV 2g/vial, Tk.
Side-effects:See under Cefadroxil; also 200.79/vial,1g/vial, Tk. 180.58/vial,;
Ceftizone(Renata),Inj., IM 1g/vial, Tk.
pancreatitis, rarely prolongation of
200.75/vial,; 500mg/vial , Tk. 140.53/vial,;
prothrombin time 250mg/vial , Tk. 100.38/vial,; Inj., IV 2g,Tk.
Dose: By IM or slow IV inj. over at least 341.28/vial,; Tk. 500mg/vial , Tk. 140.53/vial,;
2-4 minutes orIV infusion 1 g daily for 250mg/vial , Tk. 100.38/vial,;
mild to moderate infections, increased to Ceftobac(Organic), Inj., IM 1g/vial, Tk.
2-4 g daily for severe infections; INFANT 160.00/vial,; 500mg/vial , Tk. 120.00/vial,; Inj.,
and CHILD 20-50 mg/kg daily in mild to IV 2g/vial, Tk. 300.00/vial,;
Ceftrix(Novo Healthcare), Inj., IM 1g/vial, TK.
moderate infections, up to 80 mg/kg daily
191.29/Vial,;500mg/vial ,Tk.
in severe infections; doses of 50 mg/kg 130.39/vial,;250mg/vial, Tk. 100.30/vial; Inj., IV
and over byIV infusion only; NEONATES 2gm/vial, Tk. 302.04/Vial,;1g/vial, Tk.
byIV infusion over 60 minutes, 20-50 191.29/Vial,Inj., 500mg/vial, Tk. 130.39/vial.;
mg/kg daily up to a max. of 50 mg/kg 250mg/vial, Tk. 100.30/Vial,;
daily; uncomplicated gonorrhea: by deep Ceftron(Square), Inj., IM., 1g/100vial, Tk.
IM inj. of 250 mg as a single dose; 190.58/Vial,; 500mg/vial, Tk. 130.39/vial,;
250mg/vial , Tk. 100.30/vial; Inj., IV 2gm/vial,
surgical prophylaxis: by deep IM inj. orIV
Tk. 302.04/Vial,; 1g/vial, Tk. 190.58/Vial,;
inj. over at least 2-4 minutes, 1 g a single 500mg/vial, Tk. 130.39/vial.,250mg/vial,TK.
dose; colorectal surgery deep IM inj. or 100.30/Vial,;
inj. over at least 2-4 minutes or by IV Cetaxone(Euro), Inj., IM 1g/vial, TK.
infusion, 2 g as a single dose; IM doses 190.00/Vial,; 500mg , TK. 130.00/vial,; 250mg
over 1 g should be divided between more , TK. 100.30/vial
than one site Inj., IV 2gm/vial,TK. 300.00/Vial,; 1g/vial, TK.
190.00/Vial,; 500mg/vial, TK.
130.00/vial,250mg/via, TK. 100.30/Vial,;
Proprietary Preparations Dicephin(Drug Intl),Inj., IM,; 1g/vial, TK.
Aciphin(ACI), Inj., IM 1g/vial, Tk. 191.29/Vial, 190.60/Vial,; 500mg/vial , Tk. 130.45/vial,;
500mg/vial , Tk. 130.39/vial, 250mg , Tk. 250mg/vial , Tk. 100.30/vial ,; Inj., IV
100.30/vial ,Inj., IV 2gm/vial, TK. 302.04/Vial, 2gm/vial,Tk. 301.00/Vial,; 1g/vial, Tk.
1g/vial, Tk. 191.29/Vial,; 500mg/vial, Tk. 190.60/Vial,; 500mg/vial, Tk.
130.39/vial, 250mg/vial, Tk. 100.30/Vial,; 130.45/vial.,250mg/vial, Tk. 100.30/Vial,;
Arixon(Beximco), Inj., IM Enocef(Sanofi),
1g/vial,Tk.190.00/vial,500mg/vial, Tk. Inj., IM 1g/vial, Tk. 201.35/Vial,
130.00/vial; 250mg/vial, Tk. 100.00/vial,;Inj.,IV Exephin(Incepta), IM Inj. , 1 gm/vial, Tk.
2g/vial, Tk. 300.00/vial, 1g/vial,; Tk. 190.00/vial,; 250 mg/vial, Tk. 100.00/vial,; 500
190.00/vial,;500mg/vial, Tk. mg/vial, Tk. 130.00/vial.;Inj.,IV.,2 gm/vial, Tk.
300.00/vial.;250mg/vial , Tk. 100.00/vial 300.00/vial,; 1 gm/vial, Tk. 190.00/Vial,; 250
Asixone(Asiatic), Inj., IM 1g/vial, Tk. mg/vial, Tk. 100/vial ; 500 mg/vial, Tk.
190.00/vial,; 500mg/vial , Tk. 130.00/vial
130.00/vial.;250mg/vial , Tk. 100.00/vial,; Inj., Imacef(General),Inj., IM 1g/vial, Tk.
IV 2g/vial, Tk. 300.00/vial,; 1g/vial, Tk. 190.00/Vial,; 500mg , Tk. 130.00/vial,; Inj., IV
190.00/vial,; 500mg/vial , Tk. 130.00/vial,; 2gm, Tk. 302.04/Vial,;1g/vial, Tk. 161.08/Vial,;
250mg/vial , Tk. 100.00/vial,; 500mg/vial, Tk.130.00/vial
Axon(Aristo),Inj., IM 1g/vial, Tk. Infecef(Alco), Inj.,IM 1g, Tk. 190.57/Vial,;
200/vial,500mg/vial , Tk. 130.00/vial,250mg/vial 500mg , Tk. 130.39/vial,;250mg, Tk.
24
1. ANTI-INFECTIVES

100.39/vial; Inj., IV 2gm,Tk. , 300.90/Vial,; Trizon(Acme), IM Inj., 1 g/Vial,Tk. 190.58/vial;


1g/vial, Tk. 190.57/Vial,; 500mg/vial, Tk. 250 mg/Vial, Tk. 100.30/vial,; 500 mg/Vial, Tk.
130.39/vial.,250mg/vial, TK. 100.30/Vial,; 130.39/vial,; 1 g/Vial, Tk.
Maxzon(One Pharma), IM Inj. , 250 mg/vial, 190.58/vial,;IV.Inj.,2gm/vial, Tk. 300.90/vial,;
Tk. 100.00/vial,; 500 mg/vial , Tk. 130.00/vial,; 250 mg/vial, Tk. 100.30/vial ; 500 mg/vial, Tk.
Inj.,IV., 1 gm/vial, Tk.1190.00/vial,; 2 gm/vial , 130.39/vial
Tk. 300.00/vial Vertex(Orion), IM Inj , 1 gm/vial, Tk.
Odatrix(UniMed), Inj.,IM 1g/vial, TK. 190.21/Vial,; 250 mg/vial, Tk. 100.3/Vial,;
160.00/Vial,; 500mg/vial , TK. 120.00/vial,; 500 mg/vial, Tk. 130.39/Vial,; IV.Inj.,2
Inj., IV 2gm/vial,TK. 300.00/Vial,; 1g/vial, TK. gm/vial, Tk. 302.04/Vial ,; 1 gm/vial, Tk.
160.00/Vial,; 190.21/Vial,; 250 mg/vial, Tk. 100.30/Vial.
Oricef(Healthcare), IM Inj. , 1gm/vial , Tk. 500 mg/vial, Tk. 130.39/Vial
320.00/vial,; 250mg/vial , Tk. 130.00/vial,; Winner(Biopharma), IM Inj. , 1 gm/vial, Tk.
500mg/vial , Tk. 200.00/vial; IVInj., 1gm/vial , 180.68/vial,; 500mg/vial , Tk. 120.45/vial,;
Tk. 320.00/vial,; 250mg/vial, Tk. 130.00/vial,; IV.Inj.,500mg/vial , Tk.120.45/vial,; 1 gm/vial,
2gm/vial, Tk. 490.00/vial,; 500mg/vial , Tk. Tk. 180.68/vial,; 2gm/vial, Tk. 300.00/vial
200.00/vial
Orizone(Pharmacil), IV Inj. , 1 gm/vial, Tk.
1.1.2.2 FOURTH-GENERATION
290.87/Vial ,; 2gm/vial, Tk. 501.05/Vial ,;
500mg , Tk. 200.60/Vial CEPHALOSPORINS[R]
Perix(Monico),
Inj., IM 250mg/vial, TK. 90.00/Vial,; Fourth generation drugs have an
Rit(Kemiko), Inj., IM 1g/vial, TK. 190.58/Vial,; extended spectrum of activity compared
500mg/vial, TK. 120.35/vial ,250mg/vial, TK. to third generation and have increased
95.29/vial,Inj., IVInj.,2g/vial, TK. 300.00/Vial,;
stability against betalactamases. They
Inj., 1g/vial, TK. 190.58/Vial,; Inj., 500mg/vial,
TK. 120.35/vial., 250mg/vial, TK. 95.29/vial are considered to be particularly useful in
Rofecin(Radiant), IM Inj. 250mg, Tk. infections caused by aerobic gram-
150.45/vial,; 1 gm/vial, Tk. 361.08/vial,; negative organisms resistant to third
500mg, Tk. 220.66/vial,; Inj.,IV. 500mg/vial, Tk. generation cephalosporins.
220.66/vial,; 2.0g/vial , Tk. 682.05/vial,; 1
gm/vial, Tk. 361.08/vial,; 250mg, Tk.
150.45/vial
CEFEPIME[R]
Traxef(Beacon), Inj., 1gm , Tk. 320.96/vial
Traxon(Opsonin), IM. Inj. , 1gm/vial , Tk. Indications: Drug of choice for the
190.00/vial,; 250 mg/vial , Tk. 100.00/vial,; empirical treatment of nosocomial
500 mg/vial, Tk. 130.00/vial,; IV.Inj., 500 infections, i.e. nosocomial isolates of
mg/Vial , Tk. 130.00/vial ,; 1gm/Vial , Tk. enterobacter, citrobacter and serratia;
190.58/vil,; 250 mg/Vial , Tk. 100.00/vial2
gm/vial , Tk. 302.03/vial,;
also see under Cefixime
Tribac(Globe), IM Inj. , 1 gm/vial, Tk. Cautions, Contra-indications, Side-
180.00/Vial,; 250 mg/vial, Tk. 90.00/Vial,; 500 effects:See notes above and under
mg/Vial, Tk. 120.00/Vial,;IV.Inj., 2 gm/vial, Tk. cefadroxil
300.00/Vial,; 1 gm/vial, Tk. 180.00/Vial,; 250 Interactions:See Appendix-2
mg/vial, Tk. 90.00/Vial,; 500 mg/vial, Tk. Dose:By slow IV inj. over at least 2-4
120.00/Vial
minutes orIV infusion 0.5-1 g 12 hourly
Triject(Eskayef), IM.,Inj, 1 gm/vial, Tk.
190.00/Vial,; 500mg/vial, Tk. 130.00/Vial ,;
for mild to moderate infections; increased
250mg/vial, Tk. 100.00/Vial,; 500mg/vial, Tk. to 2 g daily every 12 hours for severe
130.00/Vial,; IV .Inj., 2 gm/vial, Tk. infections; INFANT and CHILD 75-120
300.00/Vial,; 250mg/vial, Tk. 100.00/Vial,; 1 mg/kg/day in 2-3 divided doses
gm/vial, Tk. 190.00/Vial,; 500mg/vial, Tk.
130.00/Vial,; 250mg/vial, Tk. 100.00/vial Proprietary Preparations
Triphin(Ziska), IM Inj. , 1 gm/Vial, Tk. Ceftipime(Renata), Inj, 1 gm/vial, Tk. 552.08/
160.00/vial,; 250 mg/Vial, Tk. 80.00/vial,; 500 Vial; 2 gm/vial, Tk. 1104.15/ Vial, 500 mg, Tk.
mg/Vial, Tk. 120.00/vial.;IV, Inj. , 2 gm/vial, Tk. 301.13/ Vial
250.00/vial,; 1 gm/vial, Tk. 160.00/vial,; 250 Efepime(Ziska), Inj, 1 g/vial, Tk. 550.00/Vial, 2
mg/vial, Tk. 80.00/vial,; 500 mg/vial, Tk. g/vial, Tk. 1100.00/Vial, 500 mg/vial, Tk.
120.00/vial 300.00/ Vial

25
1. ANTI-INFECTIVES

Forgen(Aristo), Inj, 1 gm/vial, Tk. 550.00/ Vial, Proprietary Preparation


2gm/vial , Tk. 1100.00/ Vial,500mg/vial , Tk. Force(Square), IV Inj. 1 gm/Vial, Tk.
300.00/ Vial 401.51/Vial
Gen-4(Ibn Sina), Inj, 500 mg/vial, Tk. 555.00/
Vial,2gm/vial, Tk. 1010.00/ Vial,500mg, Tk.
305.00/Vial 1.1.3 OTHER BETA-LACTUMS
Magnova , (Orion), Inj, 1mg/vial , Tk. 551.65/ 1.1.3.1 CARBAPENEMS[W]
Vial,2 gm/vial , Tk. 1103.31/ Vial ,500mg , Tk. 1.1.3.2 MONOBACTAM[W]
300.90/ Vial
Maxpime(Square), Inj, 1 gm/vial, Tk. 551.65/
Vial,500 mg, Tk. 300.90/ Vial,2gm/vial , Tk. Besides Penicillins and
1100.00/ Vial Cephalosporins, Carbapenems
Pime(ACI), Inj, 1gm/vial, Tk. 553.73/ Vial,; (Doripenem, Ertapenem, Imipenem,
2gm/vial, Tk. 1107.47/ Vial,; 500mg, Tk. Meropenem) and monobactam
302.04/ Vial (Aztreonam) are important therapeutic
Superpime(Acme), Inj, 1 gm/vial, Tk. 551.64/
agents with a beta lactam structure. They
Vial, 2 gm/vial, Tk. 1103.31/ Vial, 500 mg/vial ,
Tk. 300.90/ Vial are bactericidal and act by inhibiting cell
Tetracef(Beximco), Inj, 1gm/vial, Tk. 550.00/ wall synthesis of susceptible organisms.
Vial, 500mg, Tk. 300/Vial
Tupime(Kemiko), Inj, 1 gm/vial, Tk. 551.65/Vial 1.1.3.1. CARBAPENEMS[W]
Ultrapime(Incepta), Inj, 1 gm/vial, Tk. 550.00/
Vial, 500 mg, Tk. 300.00/ Vial
Unipim(Drug Intl), Inj, 1gm/vial, Tk. 501.50/ The carbapenems have wide spectrum of
Vial, 500mg, Tk. 301.10/ Vial activity, being active against many
Winnipime(Sanofi), Inj, 1g/vial, Tk. 551.65/ aerobic and anaerobic gram-positive and
Vial ,2g/vial, Tk. 1103.31/ Vial gram-negative organisms, including
Xenim(Opsonin), Inj., 1 gm/vial, Tk. 552.08/ Listeria,Pseudomonas and most
Vial,; 500 mg/vial , Tk. 301.13/ Vial Enterobacteriaceae.Carbapenems are
Ximepime(Globe), Inj., 1 gm/vial, 550.00/ Vial,;
2 gm/vial, 1100.00/ Vial,; 500 mg/vial ,
resistant to wide spectrum of
300.00/Vial,; 1gm/vial , Tk. 550.00/ Vial, betalactamases.
2gm/vial , Tk. 1100.00/ Vial, 500mg , Tk.
300.00/ Vial DORIPENEM[W]
Zopime(Healthcare), Inj., 1gm/vial , Tk.
550.00/ Vial, 500mg/vial, Tk. 300.00/ Vial
Doripenem is the newest of the
carbapenems with a broad spectrum and
CEFPIROME[R]
enhanced gram-negative antimicrobial
activity particularly against P aeruginosa.
Indications: infections due to sensitive institutional susceptibility patterns and
Gram positive and Gram-negative cost may be the 2 factors that will carry
bacteria the most weight in prescribing decisions.
Cautions, Contra-indications, Side- Indications: Treatment of complicated
effects: See notes above and under intra-abdominal infections and
cefadroxil complicated urinary tract infections,
Interactions:See Appendix -2 including pyelonephritis;
Dose:IV inj. or infusion: complicated Cautions: Hypersensitivity to beta
upper and lower UTI, Skin and Soft lactams, pregnancy, CNS disorders,
tissue infections, 1 g every 12 hours, renal impairment
increased to 2 g every 12 hours in very Contra-indications: Hypersensitivity;
severe infections; Interactions: See Appendix-2
Lower Respiratory Tract Infection, 1-2 g Side-effects:See under Cefadroxil, also
every 12 hours; seizures, convulsions, confusion and
Severe infections including bacteremia mental disturbances
and septicemia and infections in Dose: Complicated Intra-abdominal
neutropenic patients, 2 g every 12 hours Infection:500 mg IV infusion over 1 hour
CHILD less than 12 years not 8 hourly x 5-14 days,at least 3 days IV,
recommended may switch to an appropriate oral
26
1. ANTI-INFECTIVES

treatment if clinical improvement Noted; Cautions: Hypersensitivity to other beta-


Complicated UTI lactams, pregnancy, CNS disorders,
500 mg IV infusion over 1 hour 8 hourly x renal impairment
10 days can be extended up to 14 days if Contra-indications: Hypersensitivity to
concurrent bacteremia; treatment of imipenem or cilastatin, breast-feeding
bronchopulmonary infection in patients Interactions: See Appendix -2
with cystic fibrosis who are colonized with Side-effects:See under Cefadroxil, also
P aeruginosa seizures, convulsions, confusion and
mental disturbances, increases in serum
Proprietary Preparations creatinine and blood urea, tooth or
Dionem(Opsonin), Inj., 500 mg , Tk. tongue discoloration, red coloration of
2000.00/Vial urine in children
Doriject(Popular), Inj., 500 mg Tk. Dose:Deep IM inj.: 500-750 mg 12
2000.00/Vial
Dorinem(ACI), Inj., 500 mg, Tk. 2006.02/Vial
hourly; gonococcal urethritis or cervicitis,
Doripen(Eskayef), Inj., 500 mg, Tk. 500 mg a single dose;IV infusion, 1-2 g
2000.00/Vial, 250 mg, Tk. 1300.00/Vial, daily in 3-4 divided doses, may be
Perinem(Drug Intl), Inj., 500 mg, Tk. increased to 50 mg/kg up to a max. of 4 g
2000.00/Vial daily; CHILD > 3 months, 60 mg/kg/day
in 4 divided doses; surgical
ERTAPENEM[W] prophylaxis:IV infusion: 1 g at induction
Ertapenem is considered a narrower of anesthesia repeated after 3 hours,
spectrum agent, as it has limited activity supplemented in colorectal, cardiac
against certain pathogens of concern surgery by doses of 500 mg 8 and 16
such as P aeruginosa. hours after induction
Indications:Infection againstP
aeruginosa. Proprietary Preparations
Cautions: Hypersensitivity to other beta- Cispenam(Incepta), Inj., 250 mg+250 mg, Tk.
650.00/Vial, 500 mg+ 500 mg , Tk. 1195/Vial.
lactams, pregnancy, CNS disorders,
Imbac(Popular), Inj. , 500 mg + 500 mg , Tk.
renal impairment 1199.51/Vial
Interactions: See Appendix-2 Iminem(ACI), Inj., 500 mg + 500 mg , Tk.
Side-effects:See under Cefadroxil 1203.12/Vial ,; 250 mg + 250 mg , Tk.
Dose :1 gram IV or IM once daily for 5 to 650.00/Vial
14 days Iropen(Renata),Inj., 500 mg + 500 mg , Tk.
1295.00/Vial
Maxipen(Opsonin), Inj., 500 mg + 500 mg ,
Proprietary Preparation
Tk. 1295.00/Vial
Etropen(Techno)Inj.,1 gm/vial,Tk.3400/vial

MEROPENEM[W]
IMIPENEM WITH CILASTATIN[W]
Indications: Aerobic and anaerobic
Indications: Drug of choice for infections
Gram-positive and Gram-negative
caused by cephalosporin-resistant
infections, septicemia; see also notes
nosocomial bacteria, such as Citrobacter
above
freundii and Enterobacter spp; good
Cautions: Hypersensitivity to beta-
choice for empiric treatment of serious
lactam antibiotics; hepatic impairment
infections in hospitalized patients who
(Appendix-3); renal impairment
have recently received other beta-lactam
(appendix-4); pregnancy (appendix-5);
drugs, urinary tract and lower respiratory
and breast-feeding(appendix-6);
infections, septicemia particularly of renal
Interactions: See Appendix-2
origin, intraabdominal and gynecological
Contra indications: Hypersensitivity to
infections, skin, soft-tissue, bone and
meropenem.
joint infections, surgical prophylaxis; also
Side-effects: Gastrointestinal
see Notes above
disturbances such as nausea, vomiting,
27
1. ANTI-INFECTIVES

diarrhoea, abdominal pain; disturbance of Merocon(Beacon), Inj. , 1 gm/vial , Tk.


liver function tests; hypersensitivity 1303.91/Vial ,; 500 mg, Tk. 702.11/Vial
reaction such as skin rash, pruritus, Meroject(Eskayef), Inj, 500mg, Tk.
700.00/Vial,; 1 gm/vial, Tk. 1300.00/Vial. ;
urticaria, thrombocytopenia, positive 500mg/vial, Tk. 700.00/Vial,; 1gm/vial , Tk.
Coombs test; eosinophilia, neutropenia, 1300.00/Vial.
leucopenia; headache, paraesthesia; Meromax(Orion), Inj. , 500 mg/vial, Tk.
also reported convulsion, Steven- 654.41/Vial,; 1 gm/vial, Tk. 1208.07/Vial
Johnson syndrome and toxic epidermal Meronix(Novo Health), Inj. , 1gm/vial, Tk.
necrolysis; local reactions including pain 1300.00/Vial ,; 500 mg/vial, Tk. 700.00/Vial
and thrombophlebitis at injection site Meropen(Renata), Inj. , 1 gm/vial, Tk.
1300.00/Vial. ,; 250 mg/Vial, Tk. 400.00/Vial,;
Dose:By intravenous injection over 3 to 500 mg/vial, Tk. 700.00/Vial
5minutes or by intravenousinfusion over Merotrax(Ibn Sina), Inj. , 1gm/vial, Tk.
15 to 30minutes in a usual dose of 0.5 to 1300.00/Vial,; 500mg, Tk. 700.00/Vial
1g every 8 hours; dose may be doubled Neopenem(Healthcare), Inj, 1gm/vial, Tk.
in hospital-acquired pneumonia, 1350.00/Vial,; 250mg/vial , Tk. 450.00/Vial,;
peritonitis, septicemia and infections in 500mg/vial, Tk. 750.00/Vial
neutropenic patients. 2g every 8 hours Penomer(Beximco), Inj. , 500mg/vial, Tk.
700.00/Vial,; 1gm/vial, Tk. 1300.00/Vial
for meningitis; dose of up to2 g every Ronem(Opsonin), Inj. , 500 mg/vial , Tk.
8hours also been used in cystic fibrosis. 700.00/Vial,; 1 gm/vial, Tk. 1300.00/Vial
Dose should be reduced in patients with Ropenem(Drug Intl), Inj. , 1gm/vial, Tk.
renal impairment; CHILD over 3 months 1003.00/Vial,; 500mg, Tk. 503.15/Vial
of age and weighing less than of 50kg, Specbac(Square), Inj. , 1 gm/vial, Tk.
10-20mg/kg every 8 hours (not 1300.00/Vial. ; 250 mg/vial, Tk. 400.00/Vial;
recommended for infection in 500 mg/vial, Tk. 700.00/Vial
Merocil(Pharmacil), IV Inj.,1 gm/Vial, Tk.
neutropenia) 1594.78/Vial ; 500mg/Vial, Tk. 852.56/Vial
For meningitis, 2g every 8 hours; CHILD
3 months to 12 years 40mg/kg every 8
1.1.3.2 MONOBACTAM[W]
hours; over 50 kg body weight adult dose
Exacerbations of chronic lower
respiratory-tract infection in cystic AZTREONAM[W]
fibrosis, up to 2g every 8 hours; CHILD 4-
18 years 25-40mg/kg every 8 hours Indications: Gram negative infections
caused by Pseudomonas
Proprietary Preparations aeruginosa,Hemophilus influenzae,
Aronem(ACI), Inj. , 1gm, Tk. 1208.14/Vial,; Neisseria meningitides and N. gonorrhea
500mg, TK. 654.41/Vial Cautions: Hepatic impairment, breast-
Aropen(Aristo), Inj. , 1gm, Tk. 1200.00/Vial
feeding; penicillins- and/or
Betanem (Kemiko), Inj. , 1 gm/vial, Tk.
1250.00/Vial,; 500 mg/vial, Tk. 700.00/Vial
cephalosporins-allergic patients tolerate
Carbanem(Sanofi), Inj. , 1gm/vial, Tk. aztreonam without reaction
1303.91/Vial,; 500mg, Tk. 702.11/Vial Contra-indications: Aztreonam
Fulspec(Acme), Inj. , 250 mg/vial, Tk. hypersensitivity; pregnancy
400.00/Vial,; 1 gm/vial, Tk. 1208.15/Vial,; Interactions:See Appendix-2
500.00 mg/vial, Tk. 654.42/Vial Side-effects: Nausea, vomiting,
Intrapen(General), Inj., 1 gm/vial, Tk.
diarrhea, abdominal cramps, mouth
1303.90/Vial,; 500 mg, Tk. 702.11/Vial
I-Penam(Incepta), Inj. , 1gm/vial, Tk. ulcers, altered taste, jaundice and
1300.00/Vial ,; 500 mg, Tk. 700.00/Vial hepatitis, blood disorders including
Menem(Astra Bio), Inj. , 1 gm/vial, Tk. thrombocytopenia and neutropenia,
1300.00/Vial,; 500 mg/vial, Tk. 700.00/Vial urticaria and rashes
Mepen(Biopharma), Inj. , 1gm/vial, Tk. Dose:Deep IM or slow IV inj. over at
1200.00/Vial,; 500mg/vial , Tk. 650.00/Vial least 2-4 minutes or IV infusion: 1 g every
Merobac(Popular), Inj. , 1gm/vial, Tk.
8 hours for mild to moderate infections;
1204.53/Vial,; 750 mg, Tk. 652.45/Vial
Merocar(Globe), Inj. , 1 gm/vial, Tk.
increased to 2 g every 6-8 hours for
1200.00/Vial,; 500 mg, Tk. 650.00/Vial severe infections; CHILD > 1 week, IV inj.
or infusion: 30 mg/kg every 6-8 hours,
28
1. ANTI-INFECTIVES

increased for severe infections in child > essential (if given, serum concentration
2 years, to 50 mg/kg every 6-8 hours up must be monitored).
to a max. of 8 g/day; for urinary tract Side-effects: All aminoglycosides are
infections, 0.5-1 g 8-12 hourly; for ototoxic and nephrotoxic. Ototoxicity is
gonorrhea or cystitis, 1 g by IM inj. as a largely irreversible Concurrent use of
single dose frusemide, ethacrynic acidpotentiates
ototoxicity. Cochlear toxicity initiates as a
Proprietary Preparations high-pitched tinnitus followed by auditory
Atreon(Square), Inj., 500 mg/Vial, Tk. impairment. Vestibular toxicity starts as
300/Vial;2 gm/Vial, Tk. 650/Vial;1 gm/vial, Tk. moderately intense headache which is
450/Vial rapidly followed by an acute stage of
Azonam(Incepta), Inj., 1 gm/Vial, Tk. 400/Vial
nausea, vomiting and difficulty with
equilibrium. All aminoglycosides are
1.1.4. AMINOGLYCOSIDES[A] capable of affecting both cochlear and
(See also section 12 and 10) vestibular function. Tobramycin affects
both functions, whereas Amikacin,
These drugs are primarily active against Neomycin and kanamycin primarily
aerobic, gram-negative bacilli. Because affect auditory function and streptomycin
of limited spectrum compared with other and gentamicin are primarily
aminoglycosides, Kanamycin and vestibulotoxic. Nephrotoxicity of
Streptomycin are not recommended for aminoglycosides is almost always
infections caused by P. aeruginosa and reversible and starts as a defect in renal
Serratia. Streptomycin is active against concentrating ability, mild proteinuria and
Mycobacterium tuberculosis, for which it appearance of hyaline and granular casts
is now entirely reserved. Gentamicin in urine. Most common significant finding
and Tobramycin exhibit similar activity is mild rise in serum creatinine. The most
but against P. aeruginosa and some important result of nephrotoxicity is the
strains of Proteus species Tobramycin is reduced excretion of drug which, in turn,
considered to be superior. predisposes to ototoxicity. Other
Aminoglycosides have limited activity potentially nephrotoxic drugs such as
against gram-positive bacteria. S. aureus Amphotericin B, Vancomycin,
and Strep. viridans appear to be sensitive Cisplatin, Cyclosporine, Cephalothin
while other gram-positive organisms and aggravate aminoglycosides induced
anaerobes are resistant. nephrotoxicity. In very high doses, these
Cautions:Patients with renal impairment drugs can produce curare-like
may require earlier and more frequent neuromuscular blockade and may cause
concentration measurement. Patients respiratory paralysis.
with creatinine clearance value less than
80-100 ml/min. needs dose adjustment. AMIKACIN[A] [C]
Monitoring for ototoxicity by careful
audiometric examination also is required
Indications: Preferred choice for initial
in patients receiving high dosed and/or
treatment of serious nosocomial gram-
prolonged courses of aminogly-
negative bacillary infections resistant to
cosides.Cautions are also required in
gentamicin and tobramycin; also see
pregnancy and in nursing mothers.
under Gentamicin
Use of aminoglycosides in second and
Cautions, Contra-indications, Side-
third trimesters of pregnancy carries the
effects:See notes above
risk of auditory or vestibular nerve
Dose:IM or slow IV inj. or IV infusion, 15
damage. Streptomycin has the
mg/kg daily divided doses every 12 hours
greatestrisk and with Gentamicin and
Tobramycin the risk is probably very
Proprietary Preparations
small but should not be used unless Amibac(Popular), Inj., 100 mg/2 ml, Tk.
16.06/2 ml,; 500 mg/2ml, Tk. 48.18/2 ml
29
1. ANTI-INFECTIVES

Amikin(Incepta), Inj., 100 mg/2 ml, Tk. Gentabac(Popular), Inj., 80 mg /2 ml, Tk.
16.00/2m l,500 mg/2 ml, Tk. 48.00/2 ml 10.15/Amp; 20 mg /2 ml, Tk. 6.07/Amp
Amistar(Square), Inj.,100 mg/2 ml, Tk. Gentanix(Novo Health), Inj.,80 mg/2 ml, Tk.
16.05/2 ml, 500 mg/2 ml, Tk. 48.14/2 ml 10.00/Amp
Kacin(ACI), Inj., 100mg/2ml, Tk. 16.11/2 ml,; Gentin(Opsonin), Inj. 20 mg /2 ml, Tk. 6.08/ 2
500mg/2ml, Tk. 48.32/2ml ml /Amp,; Inj., 80 mg/2 ml, Tk. 14/2ml amp
Mikacin(Aristo), Inj., 500mg/2ml, Tk. 45.00/2 Intamycin (Incepta), Inj. , 80 mg/2 ml, Tk.
ml,; 100mg/2ml Tk. 15.00/2 ml 10.00/Amp., 20 mg /2 ml, Tk. 6.00/Amp
Psudonil(Drug Intl), Inj.,100mg/2ml, Tk. Optimycin (Aristo) Inj. , 80 mg/2 ml, Tk.
16.05/2 ml,; 250mg/2ml, Tk. 30.10/2 ml,; 14.00/Amp.
500mg/2ml, Tk. 45.15/2 ml Invigen (Beximco), Inj. (IV. infusion).
80mg/100ml
GENTAMICIN[ED] [A] Tk.47.22/100ml
G-Gentamycin(Gonoshasthaya) Inj. , 80
Indications: Urinary tract infections, mg/2 ml, Tk. 12.00/Amp.,
bacteremia, infected burns, osteomyelitis,
sepsis, pneumonia, peritonitis, biliary
tract infections, acute pyelonephritis or NEOMYCIN SULPHATE[ED] [A]
prostatitis, otitis, meningitis, ocular
infections caused by susceptible Indications: Bowel sterilization before
organisms (see notes above); with an surgery, with polymyxins for bladder
antipseudomonal penicillin for sepsis in irrigation to prevent bacteremia and
granulocytopenic patients, concurrently bacteriuria associated with the use of
with penicillin G for bacterial endocarditis indwelling catheters, infections
due to viridans streptococci or associated with burns, wounds, ulcers,
enterococci; in combination with nafcillin dermatoses caused by susceptible
in selected cases of staphylococcal organisms, as an adjunct to the therapy
endocarditis; in combination with a of hepatic coma
penicillin and/or metronidazole for Cautions:Too toxic for systemic use;
surgical chemoprophylaxis, and in because severe renal insufficiency may
undiagnosed serious infections develop in the late stages of hepatic
Cautions: See notes above coma, great cautions should be taken
Contra-indications: Myasthenia gravis; when neomycin is utilized as an adjunct
also see notes above and should be stopped if there is
Side-effects See notes above;also ototoxicity or evidence of renal injury;
hypomagnesaemia on prolonged therapy also see notes above
Dose:IM or slow IV inj. over at least 3 Contra-indications:Intestinal
minutes, initially 2 mg/kg, then 3-5 mg/kg obstruction; also see notes above
daily in divided doses every 8 hours, or Side-effects: See notes above; also
as once-daily dose by IV infusion, 5 increased salivation, stomatitis
mg/kg given over 30-60 minutes; CHILD Interactions: See Appendix-2
up to 2 weeks 3 mg/kg every 12 hours; 2 Dose:Oral: Preoperative bowel
weeks-12 years 2 mg/kg every 8 hours; sterilization, 1 g every 4 hours, for 2-3
by intrathecal inj.1-10 mg daily; ear and days; hepatic coma, up to 4 g daily in
eye infections, 3-4 drops 3-4 times daily divided doses usually for max.14 days
Note: one-hour (“peak”) concentration Side-effects: Increased salivation,
should not exceed 10 mg/litre (5 mg/litre stomatitis; see also under
in endocarditis); pre-dose (“trough”) Aminoglycosides
concentration should be less than 2
mg/litre (less than 1mg /litre in Proprietary Preparations
endocarditis) See section 12.2.&10.2.(for skin and eye
preparation)
Proprietary Preparations
Genacyn(Square), Inj., 80 mg /2 ml, Tk.
10.18/Amp; 20 mg /2 ml, Tk. 6.11/Amp

30
1. ANTI-INFECTIVES

[ED] [A]
STREPTOMYCIN
Proprietary Preparation
Indications: Tuberculosis in combination See section10.2.1(For Eye preparation
with other drugs; plague, tularemia, only)
adjunct to doxycycline in brucellosis,
enterococci endocarditis 1.1.5 MACROLIDES
Cautions, Contra-indications, Side-
effects: See notes above AZITHROMYCIN[W]
Interactions: See Appendix-2
Dose:Deep IM inj. or IV inj. ADULT Indications:Same as that of
tuberculosis, 15 mg/kg/d, CHILD 20-40 Clarithromycin
mg/kg/d, not to exceed 1-1.5 g/d; for Cautions, Contra-indications, Side-
intermittent supervised therapy 1-1.5 g effects:See under Erythromycin;also
twice or thrice weekly; bacterial anorexia, dyspepsia, photosensitivity,
endocarditis, 0.5 g twice daily; the dose interstitial nephritis, acute renal failure,
is reduced in those under 50kg or those asthenia, paraesthesia, convulsions,
over 40 years or those with renal Stevens-Johnson syndrome, toxic
impairment epidermal necrolysis and taste
Note: one-hour (“peak”) concentration disturbances
should not exceed 40mg/litre; pre-dose Interactions: See Appendix -2
(“trough”) concentration should be less Dose: Oral &IV: ADULT should be given
than 5 mg/litre (less than 1 mg/litre in 1 hour before or 2 hours after meal when
renal impairment or in those over 50 administered orally, 500 mg on first day,
years of age) then 250 mg/d for days 2 through 5;
uncomplicated genital chlamydial
Generic Preparation infections and non-gonococcal urethritis:
Injection,1gm/vial 1 g as a single dose; M. avium-
intracellulare infection in AIDSpatients,
TOBRAMYCIN[A] for treatment 500 mg daily and for
prevention 1200 mg once weekly;CHILD
Indications: See under Gentamicin 10 mg/kg (max. 500 mg) on first day,
Cautions: See notes above; For then 5 mg/kg (max. 250 mg) for days 2
inhalation treatment: other inhaled drugs through 5
should be given before,
Contraindications, Side- effects: See Proprietary Preparations
notes above Acos(Radiant), Suspn., 200ml/5ml, Tk.
Interactions: See Appendix-2 175.53/30ml,; Tab.,500mg, Tk. 55.17/Tab.
Dose:IM or slow IV inj. over 3-5 minutes Adiz(Euro), Cap., 250 mg, Tk. 25.00/Cap. ,
500 mg, Tk. 35.00/Cap.
or IV infusion, 5-6 mg/kg daily in divided Asizith(Asiatic), Suspn., 200ml/5ml,, Tk.
doses every 8 hours; NEONATES 2 130.00/30ml,Tk. 85.00/15ml,; Tab., 250mg ,
mg/kg every 12 hours; CHILD > 1 week Tk. 20.00/Tab., 500mg , Tk. 35.00/Tab.
2-2.5 mg/kg every 8 hours; for chronic AZ(Aristo), Suspn., 200ml/5ml, Tk.
pulmonary Pseudomonas aeruginosa 100.00/15ml, Cap., 500mg , Tk. 35.00/Cap.;
infection in cystic fibrosis patients, by Tab. , 250mg , Tk. 25.00/Tab. ,500mg , Tk.
inhalation of nebulized solution, ADULT 35.00/Tab.
Azalid(Orion), Tab. ,500 mg, Tk. 35.11/Tab. ;
& CHILD over 6 years, 300 mg every 12 Cap., 500 mg, Tk. 25.00/Cap. ; Susp,
hours for 28 days, courses repeated after 200ml/5ml, Tk. 85.58/15ml,, Tk. 130.88/35ml
28-day interval Azaltic(Nipro JMI), Susp., 200mg/5ml , Tk.
Note: one-hour (“peak”) concentration 85.00/15ml; Tk. 130.39/35 ml; Tab., 500 mg,
should not exceed 10 mg/litre; pre-dose Tk. 35.00/Tab.
(“trough”) concentration should be less Azasite(Sharif), Suspn., 200 mg/5 ml, Tk.
than 2 mg/litre 85.26/20ml , Tk. 130.39/35ml , Tk. 185.56/50ml
,; Tab. 500 mg, Tk. 35.11/Tab.
31
1. ANTI-INFECTIVES

Azicin(Opsonin), Cap.,500 mg,Tk. 135.00/35ml , Tk. 90.00/15ml ,; Tk.


30.00/Cap.,250 mg ,Tk. 20.08/Cap. ; Suspn., 115.78/25ml,; Tab. , 500mg, Tk. 34.00/Tab.
200 mg /5 ml, Tk. 100.00/20 ml , Tk. 140.00/35 Maczith(Biopharma), Cap., 250mg, Tk.
ml ,; Tab. , 250 mg , Tk. 25.00/Tab., 500 mg, 25.00/Cap.; Suspn., 200gm/5ml, Tk.
Tk. 35.11/Tab.; Sachet1 gm, Tk. 80.00/sachet 160.00/35ml,Tk. 95.00/15ml,Tk.
Aziget(Getwell), Suspn, 200 mg/5 ml, Tk. 180.00/50ml,Tab., 500mg , Tk. 35.00/Tab.
140.00/35ml , Tk. 185.00/50ml , Tk. 85.00/15ml ,250mg Tk. 25.09/Tab.
, Tab., 500mg, Tk. 34.00/Tab.; Odaz(UniMed), Suspn, 200mg/5m, Tk.
Azikil(One Pharma), Suspn., 200 mg/5ml, Tk. 100.00/15ml,Tk. 150.00/30ml
100.00/20ml,Tk. 140.00/35ml, Tk. Odazyth(ACI), Inj.,500mg/vial. Tk. 251.69/vial,
185.00/50ml,Tab., 500 mg, Tk. 35.00/Tab. Suspn.,200mg/5ml, Tk.250.75/75ml ,Tk.
Azimex(Drug Intl), Suspn., 200mg/5ml, Tk. 186.26/50ml,Tk. 85.58/15ml , Tk. 130.88/30ml
130.45/30ml,Tk. 185.55/50ml, Tk. 90.30/15ml,; Tab., 500mg, Tk. 35.11/Tab. ; Cap., 250mg,
Tab., 250mg, Tk. 25.10/Tab. ;500mg, Tk. Tk. 25.08/Cap
35.15/Tab. Orgazith(Organic), Cap., 250 mg, Tk.
Azimon(Monico), Suspn., 200mg/5ml, Tk. 20.06/Cap.,Susp.,200 mg / 5ml,Tk. 85.26/20ml,
90.0015ml.; Tab., 500mg, Tk. 35.00/Tab. Tk. 130.39/35ml , Tk. 185.56/50ml,
Azin(Acme), Cap , 250.00 mg, Tk. 25.08/Cap.; Respazit(Somatec), Suspn., 200 mg / 5 ml, Tk.
Tab. , 500.00 mg, Tk. 35.11/Tab.;Suspn., 200 140.00/35ml,Tk. 185.00/50ml,; Cap., 250 mg,
mg/5ml,, Tk. 140.42/30ml,Tk. 185.56/50ml, Tk. Tk. 25.00/Cap.; Tab., 500 mg, Tk. 35.00/Tab.
95.29/15ml Romycin(Ibn Sina), Suspn., 200 mg / 5 ml, Tk.
Azinaaf(Naafco), Suspn., 200mg/5ml, Tk. 140.00/35ml,Tk. 190.00/50ml,Tk.
130.00/35ml,; Tab.,500 mg, 33.00/Tab. 90.00/15ml,;Cap., 500mgTk. 35.00/Cap.; Tab.,
Azithral(Globex), Tab., 500mg,Tk. 12.00/Tab.; 250mgTk. 2500/Tab.
Cap, 250 mg, Tk. 20.00/Cap. Rozith(Healthcare), Inj.,, 500 mg/vial,, Tk.
Azithro(Astra Bio), Tab. ,250 mg, Tk. 460.00/Ivial.; Suspn.,200mg /5ml ,Tk. 95.00/
20.00/Tab. ; 500 mg, Tk. 15ml, Tk. 185.00/50ml.; Tab., 250mg , Tk.
30.00/Tab.,Tk.35.00/Tab .; Suspn., 200 mg/5 25.00/Tab.,500mg , Tk. 35.00/Tab.
ml, Tk. 140.00/25ml SB-Azit(Sunman-Bardem), Tab., 500 mg, Tk.
Azithrocin(Beximco), Inj., 500 mg/vial,. 35.00/Tab.
460.00/vial ; Suspn., 200mg / 5ml, Tk. Simpli(Beacon), Inj.,, 500 mg/vial, Tk.
185.00/50,Tk. 85.00/15ml,Tk. 130.00/30mlTab., 461.38/vial. ;Suspn., 200 mg / 5 ml,Tk.
250mg , Tk. 25.00/Tab., 500mg, Tk. 85.57/20ml; Tab, 500mg , Tk. 35.11/Tab.
30.00/Tab.; Cap., 250mg , Tk. 25.00/Cap Telide(Team), Suspn., 200mg/5ml, Tk.
Azithrogen(Biogen), Tab.,500mg, Tk. 135.00/35ml, Tk. 180.00/50ml, Tk. 83.00/15ml
30.00/Tab. ,:Tab., 500 mg, Tk. 33.00/Tab.
Azithromax(Ziska), Suspn., 200 mg/5 ml, Tk. Thromax(Novo Health), Suspn., 200mg/5ml
130.00/35ml,Tk. 185.00/50ml, Tk. 85.00/15ml,; Tk. 120.00/25ml,; Tab., 250 mg, Tk.
Tab. , 500 mg, Tk. 300.00/Tab. 20.00/Tab.; 500 mg, Tk. 35.00/Tab.
Azix(Amico), Suspn., 200gm/5ml, TK. 85.00/ Virzith(Virgo), Suspn., 200mg/5ml, Tk.
15ml ,; Tab., 500mg, TK. 30.00 /Tab. 130.00/30ml, Tk. 180.00/50ml,Tk. 90.00/15ml,;
Azmin(Modern), Suspn., 200gm/5ml Tk. Tab. , 500mg, Tk. 36.00/Tab.
130.00/35ml,Tk. 85.00/15ml,Tab., 524.05 mg , Xolide(Radiant), Cap. , 250mg , Tk.
Tk. 35.00/Tab. 27.08/Cap. ; 500mg , Tk . 40.12/Cap.
Azomac(General), Pead. drop,Tk. 85.57/15ml Zemycin(GACO), Suspn., 200mg/5ml, Tk.
,; Susp., 200gm/5ml,, Tk. 100.30/20ml,Tk. 85.26/15 ml,Tk. 128.00/35 ml,Tk. 172.00/50
185.55/50ml,; Tk. 130.88/35ml, Tk. ml,; Tab., 500 mg, Tk. 30.09/Tab.
140.43/35ml,Tab., 500mg, Tk. 35.00/Tab. Zenicin(Zenith), Suspn., 200mg/5ml, Tk.
Azro(Nipa), Suspn, 200 mg/5ml, Tk. 126.00/30ml, Tk. 180.00/50ml, Tk.
85.00/15ml,Tk. 130.00/30ml, Tk. 180.00/50ml, 80.00/15ml,Tab., 500 mg , Tk. 30.00/Tab.
Tab., 500 mg, Tk. 30.00/Tab. Zibac(Popular), Tab. , 500mg, Tk. 35.00/Tab.;
Curazith(Sanofi), Suspn., 200gm/5ml, Tk. 250mg, Tk. 20.08/Tab.,Inj.,, 500 mg/vial, Tk.
85.26/15ml,Tab., 500mg,Tk. 35.11/Tab.; 250.94/vial, ; Suspn., 200mg/5ml, Tk.
250mg, Tk. 20.06/Tab. 100.00/20ml,
Demacro(Decent), Suspn., 200gm/5ml,, Tk. Zimax(Square), Suspn., 200mg/5ml, Tk.
85.00/15ml,; Tab., 500mg, Tk. 30.00/Tab. 85.58/15ml,; Tab. , 500 mg, Tk. 35.11/Tab.;
Macazi(Pacific), Tab., 500 mg, Tk. 35.00/Tab. 500 mg, Tk. 35.11/Tab.; Cap. , 250 mg, Tk.
;Suspn.,200mg/5ml, Tk. 118.00/35ml , Tk. 25.08/Cap. ; Inj., 500 mg/vial, Tk. 461.38/vial
64.00/15ml Zinex(Alco), Suspn., 200 mg / 5ml, Tk.
Macrozith(Silva), Cap., 250mg, Tk. 130.39/30ml ; Tk. 185.56/50ml , Tk.
20.08/Cap. ; Suspn., 200gm/5ml Tk. 85.26/15ml ;Tab., 250 mg, Tk. 20.06/Tab.;
500 mg, Tk. 35.00/Tab.
32
1. ANTI-INFECTIVES

Zita(Kemiko), Suspn., 200 mg / 5 ml, Tk. proximal vein, 500 mg twice daily, CHILD
130.39/30ml , Tk. 185.56/50ml , Tk. 85.26/15ml not recommended.
,Tab., 500 mg, Tk. 35.00/Tab.
Zithracin(Supreme), Tab., 500mg, Tk.
35.00/Tab.; Suspn., 200 mg / 5 ml, Tk.
Proprietary Preparations
85.25/15ml , Claricin(Acme), Tab. , 250 mg., Tk.
Zithrin(Renata), Cap., 250mg , Tk. 25.17/Tab.; 500 mg., Tk. 40.27/Tab.; Suspn.,
20.00/Cap.; Suspn., 200 mg / 5 ml, Tk. 125 mg/5 ml, Tk. 395.00/60ml
Clarin(Drug Intl), Tab., 250mg, Tk. 25.10/Tab.;
125.00/30ml,Tk. 130.00/35ml,Tk.
500mg, Tk. 40.15/Tab.
80.30/15ml,Tk. 85.32/20ml,Tk.
Clarith(Ibn Sina), Suspn., 125 mg/5 ml, Tk.
185.00/50ml,:Tab., 250mg , Tk. 25.00/Tab.,
350.00/70ml,; Tab., 250 mg, Tk. 30.00/Tab.
500mg, Tk. 35.00/Tab.; Inj.,, 500 mg/vial, Tk.
460.00/vial. Clarox(Renata), Tab. 250mg, Tk. 25.00/Tab.;
500mg Tk. 40.00/Tab.
Zithrox(Eskayef), Suspn., 200 mg / 5 ml, Tk.
96.00/15ml,Tk. 90.00/20ml,Tk. Klabex(Opsonin), Tab. , 500 mg , Tk.
40.00/Tab.
186.00/50ml,130.00/30ml,Tk. 140.00/35ml;
Klabid(UniMed), Tab , 250mg, Tk. 30.00/Tab.;
Tab, 250mg , Tk. 25.00/Tab.; 500mg, Tk.
35.00/Tab.; Suspn., 200 mg / 5 ml,Tk. 500mg, Tk. 50.00/Tab.; ER Tab., 500 mg, Tk.
140.00/35ml,; Tk. 186.00/50ml,; 65.00/Tab.
Zycin(Globe), Suspn., 200 mg/5 ml, Tk. Klaricid(I)(Abbott), Inj.500mg/vial Tk.623.73
130.00/30ml,; Tk. 185.00/50ml, 85.00/15ml,; Klarix(Incepta), Suspn, 125 mg/5 ml, Tk.
340.00/60ml,; Tab., 250mgTk. 25.00/Tab.,
Tab. , 500 mg, Tk. 35.00/Tab
500mg Tk. 40.00/Tab.
Macrobid(General), Tab. , 500mg, Tk.
CLARITHROMYCIN[W] 50.34/Tab.
Remac(Square), Suspn.,125 mg/5 ml, Tk.
Indications: Eradication of H. pylori, first- 395/60ml,;Tab 500 mg, Tk. 40.27/Tab.
line therapy for prophylaxis and treatment
of disseminated infection caused by M. ERYTHROMYCIN[ED] [W]
avium-intracellulare in AIDS patients and
for treatment of pulmonary infections in Indications: Mycoplasma pneumonia
non-HIV-infected patients, toxoplasmosis infections, campylobacter enteritis, first
encephalitis; also see under line drug for chlamydial urogenital
Erythromycin infections in pregnant women, chlamydial
Cautions: See under Erythromycin; dose pneumonia, diphtheria, pertussis,
reduction required in renal impairment legionnaires’ disease, acne vulgaris
Contra-indications:See under (topical erythromycin preparations are
Erythromycin used to treat acne); effective alternative
Interactions: See Appendix-2 to penicillins in hypersensitive patients for
Side-effects: See under Erythromycin, pharyngitis, scarlet fever, erysipelas and
also reported headache, taste cellulitis due to S. pyogenes, for tetanus
disturbances, tooth and tongue and for prophylaxis against recurrences
discoloration, stomatitis, glossitis, of rheumatic fever
hepatitis and Stevens-Johnson Cautions: Hepatic and renal impairment;
syndrome; on IV infusion, local concomitant therapy with pimozide or
tenderness, phlebitis; less commonly , terfenadine should be avoided; porphyria;
arthralgia and myalgia; rarely tinnitus; in patients with a predisposition to QT
very rarely, dizziness, insomnia, interval prolongation; small amount
nightmare, paraesthesia, convulsions, secreted into breast milk, potential
hypoglycemia, renal failure problems for nursing infant: modification
Dose: Oral : ADULT & CHILD > 12 of bowel flora,
years, 250 mg every 12 hours, increased Contra-indications: Liver disease
in severe infections to 500 mg every 12 hypersensitivity
hours; CHILD < 12 years, 7.5 mg/kg Interactions: See Appendix-2
twice daily; by IV infusion into larger Side-effects: Nausea, vomiting,
abdominal discomfort, diarrhea, antibiotic
33
1. ANTI-INFECTIVES

associated colitis, hypersensitivity Erymex(Ibn Sina), Suspn, 125 mg/5 ml, Tk.
reactions including urticaria, rashes, 84.50/100ml,; Tab.,500mg, Tk. 10.25/Tab.
cholestatic jaundice and other reactions, Erythin(ACI), Suspn., 125 mg /5 ml, Tk.
60.41/60ml,Tk. 61.47/100ml.;Tab., 500mg, Tk.
reversible hearing loss after large doses, 8.06/Tab.
chest pain and arrhythmias including Ertyhrox(Renata), Suspn., 125 mg /5 ml, Tk.
prolongation of QT interval and 69.32/100ml,; Tab. , 250 mg, Tk.
ventricular tachycardia 5.15/Tab., 500 mg, Tk. 10.30/Tab.
Dose Oral ADULT & CHILD > 8 years, Eryzen(Zenith), Suspn., 125 mg /5 ml, Tk.
250-500 mg every 6 hours or 0.5-1 g 57.02/100ml,; Tab., 250 mg, Tk. 4.38/Tab.,500
every 12 hours, up to 4 g daily in severe mg, Tk. 8.66/Tab.
Etrocin(Beximco), Suspn., 125 mg /5 ml, Tk.
infections; CHILD up to 2 years, 125 mg 84.75/100ml,; Tab., 500mg, Tk. 9.03/Tab.
every 6 hours, 2-8 years, 250 mg every 6 Firmac(Incepta), Suspn., 125 mg /5 ml, Tk.
hours, doses doubled for severe 60.00/100ml
infections; early syphilis, 500 mg 4 times Mac(Orion), Suspn., 125 mg /5 ml, Tk.
daily for 14 days; uncomplicated genital 60.46/100ml,Tk. 103.71/100ml,Tk. 74.49/70ml
chlamydia, non-gonococcal urethritis, Macas(Asiatic), Suspn., 125 mg /5 ml, Tk.
500 mg twice daily for 14 days; by 56.85/100ml,; Tab., 500mg , Tk. 8.12/Tab.
Macery(Pacific), Suspn., 125 mg /5 ml, Tk.
IVinfusion: ADULT & CHILD in severe 46.00/100ml .; Tab., 250 mg, Tk. 5.00/Tab.,500
infections, 50 mg/kg daily by continuous mg, Tk. 10.00/Tab.
infusion or in divided doses every 6 Macro(Astra Bio), Suspn., 125 mg /5 ml, Tk.
hours; for mild infections when oral 60.00/100ml
therapy not possible, 25 mg/kg daily Priocin(Eskayef), Suspn., 125 mg/5 ml , Tk.
61.42/100ml.; Tab., 500mg , Tk. 7.00/Tab.
Proprietary Preparations Throcin(Globe), Tab. , 500 mg, Tk. 8.00/Tab.;
Acryth(Monico), Suspn., 125 mg /5 ml, Tk. Suspn., 125 mg /5 ml, Tk. 56.00/100 ml
60.00/100ml G-Erythromycin(Gonoshasthaya), Tab., 500
mg, Tk.15.00/Tab.
Adethro(Supreme), Suspn., 125 mg /5 ml, Tk.
Ero(Hudson), Susp., 125mg/5ml, Tk.60.00/100
60.00/100ml,; Tab., 500gm, Tk. 8.00/Tab.
ml
A-Mycin(Aristo), Paed. drops, 50 mg/1.25 ml,
Tk. 60.00/25ml,; Suspn., 125 mg /5 ml, Tk. Erocin(Acme), Susp., 125 mg/5 ml, Tk.
84.75/100ml,; 125 mg /5 ml, Tk. 69.32/100 ml ; Tab., 250 mg, Tk. 5.16/Tab.
100.00/50ml,Tab., 250mg , Tk. 5.15/Tab. ; ;500 mg, Tk. 10.32/Tab.
500mg , Tk. 9.00/Tab. Erom(Kemiko), Susp., 125 mg/5 ml, Tk.
Azmin(Modern), Tab., 500 mg, Tk. 35.00/Tab.; 60/100 ml ;Tab., 250 mg, Tk. 4.85/Tab. ; 500
Suspn., 250 mg /5 ml, Tk. mg, Tk. 8.60/Tab.
Eromac(General), Susp.,125 mg/5 ml,Tk.
130.00/35mi.,Tk.85.00/15ml
61.23/100 ml
Erixin(Amico), Suspn., 125 mg /5 ml, TK.
Eryrox DS(Navana), Susp, 125 mg/5 ml, Tk.
60.00/100ml
Ermac(Opsonin), Suspn., 125 mg /5 ml, Tk. 60.22/100 ml
84.74/100 ml Erythromycin DS(Albion), Susp., 125 mg/5 ml,
Tk. 60.00/100 ml; DSTab., 500 mg, Tk.
Eromycin(Square), Paed. drops, 200 mg/5 ml,
7.50/Tab.
Tk. 60.4/60ml,; Suspn., 125 mg /5 ml, Tk.
Macrocin(Sanofi), Tab., 250 mg, Tk. 4.88/Tab.;
69.53/100ml,; Tab. , 250 mg, Tk. 5.18/Tab.500
mg, Tk. 10.35/Tab. Tab., 500 mg, Tk. 8.66/Tab.; Susp., 125 mg/5
Eronix(Ziska), Suspn., 125 mg /5 ml, Tk. ml, Tk. 61.00/100 ml ;
60.00/100ml
Erosa(Biopharma), Suspn., 125 mg /5 ml, Tk. ROXITHROMYCIN[W]
67.00/100ml,; Tab., 250mg , Tk. 4.52/Tab.;
500mg , Tk. 8.03/Tab.
Indications: As for erythromycin
Erosite(Sharif), Suspn., 125 mg /5 ml, Tk.
69.32/100ml Cautions: As for erythromycin
Errin(Radiant), Suspn., 125 mg /5 ml, Tk. Interactions: See Appendix -2
60.18/100 ml Contra indication: Liver disease
Ery(Alco), Suspn., 125 mg /5 ml, Tk. Side-effects: Gastrointestinal distur-
69.53/100ml,; Tab., 250 mg, Tk. 5.17/Tab. bances, Increase in liver enzyme values
; 500 mg, Tk. 10.33/Tab. and hepatitis; rashes and other
Erybac(Drug Intl), Suspn., 125 mg /5 ml, Tk.
hypersensitivity reactions; headache,
60.20/100 ml,; Tab., 250mg, Tk.
4.05/Tab.;500mg, Tk. 8.05/Tab.
34
1. ANTI-INFECTIVES

dizziness, weakness, reversible 1.1.6 TETRACYCLINES[A]


pancreatitis, eosinophilia (See also section 12.2,10)
Dose:By mouth, ADULT 150mg twice
daily, or sometimes 300mg once daily, They are broad-spectrum bacteriostatic
before meals, in the treatment of antibiotics with activity against wide
susceptible infections. CHILD up to 40kg range of aerobic and anaerobic gram-
bodyweight, a dose of 5-8mg per kg daily positive and gram-negative bacteria,
before meals may be used rickettsiae, chlamydia, legionella,
mycoplasma, atypical mycobacteria, and
Proprietary Preparations spirochaetes and against some protozoa.
A-Rox(Ambee), Susp., 50 mg/5 ml, Tk. But their use has decreased because of
45.17/50ml; Tab., 150 mg, Tk. 6.53/Tab; 300
mg, Tk. 11.04/Tab
increasing emergence of resistance. In
Pedilid(Incepta), Susp., 50mg/5 ml, Tk. general, they are more active against
50.00/50 ml; Tab., 150 mg, Tk. 7.00/Tab.; 300 gram-positive than gram-negative
mg, Tk. 14.00/Tab. organisms.
Rocky(Amico ), Susp., 50 mg/5 ml , Tk. These drugs distribute widely into
40.00/50 ml; Tab. 150 mg, Tk. 7.00/Tab.; 300 prostate, bone marrow, bone, dentine,
mg, Tk. 12.00/Tab. enamel of unerupted teeth and
Rolid(Globe), Tab., 300 mg, Tk. 14.00/Tab;
150 mg, Tk. 7.00/Tab.; Susp., 50 mg/5 ml, Tk.
reticuloendothelial cells of liver.
45.00/50 ml Penetration into CSF, synovial fluid,
Rotomycin(Kemiko), Tab. , 300 mg, Tk. mucosa of maxillary sinus, and fetal
14.00/Tab. circulation is excellent. Relatively high
Roxcin(Alco), Tab. , 150 mg, Tk. 7.00/Tab. ; concentrations also are found in breast
300 mg, Tk. 14.00/Tab.; Susp., 50 mg/5 ml Tk. milk. Primary route of elimination of these
50.00/50 ml drugs except that of doxycycline, is the
Ryth(Navana), Tab., 150 mg, Tk. 7.03/Tab.;
300 mg, Tk. 14.05/Tab.;Susp., 50 mg/5 ml ,
kidney.
Tk. 50.19/50 ml;Tk. 100.38/100 ml Cautions: Gastrointestinal distress,
nausea and vomiting can be minimized
by giving these drugs with food but
SPIRAMYCIN[W]
should not be ingested with dairy
products, antacids containing Calcium,
Spiramycin is a macrolide antibiotic with Aluminum, Zinc, Magnesium or
actions similar to those of erythromycin. Silicate, Vitamins with iron, Sucralfate,
Indications: Respiratory tract infections, Bismuth subsalicylate,
genital infections, skin and soft tissue Cholestyramine and Colestipol;
infections caused by streptococci, unused supplies of these antibiotics
pneumococci and meningococci, should be discarded.
diphtheria, prophylaxis of fetus against Contra-indications: Preganant patients
transmission of maternal toxoplasmosis and to patients with renal insufficiency
in pregnancy (doxycycline may be given). Neither they
Caution: Breast-feeding are recommended for lactating mother
Contra-indications: known hypersen- and for treatment of common infections in
sitivity to macrolides children under the age of 8 years.
Side-effects: Nausea, vomiting, Side-effects: Epigastric burning and
diarrhea, allergic skin reactions distress, abdominal discomfort, nausea,
Dose: Oral: ADULTS 6 to 9 million vomiting and diarrhea may occur.
IU/day in 2 to 3 divided doses. CHILD Esophagitis, esophageal ulcers and
weighing more than 20kg, 0.15 million IU pancreatitis have been reported.
per kg body weight per day, to be divided Photosensitivity particularly with
into 2 to 3 doses. demeclocycline and doxycycline also is
seen. Children may develop permanent
Proprietary Preparation brown discoloration of teeth. This risk is
Rovamycin(Sanofi),Tab.,Tk.20.00/Tab.
highest when tetracycline is given to
35
1. ANTI-INFECTIVES

neonates, babies prior to first dentition Impedox(ACI), Cap, 100mg, Tk. 2.17/Cap.
and to pregnant mothers. Fanconi Monadox(Amico), Cap., 100 mg, Tk. 2.50/Cap.
syndrome, has been Therapy with Oriodox(Orion), Cap., 100 mg, Tk. 2.12/Cap.
Unidox(Globe), Cap., 100 mg, Tk. 2.50/Cap.
tetracyclines may lead to the
superinfections that result in intestinal
functional disturbances, anal pruritus, OXYTETRACYCLINE[ED] [A]
vaginal or oral candidiasis or enterocolitis
with shock and death. Indications: See under Tetracycline
Pseudomembranous colitis due to an Cautions: See notes above; also
overgrowth of toxin producing C. difficile porphyria
is particularly relevant. Contra-indications, Side-effects:See
notes above
DOXYCYCLINE[ED] [A] Dose: Oral: 250-500 mg every 6 hours;
acne, 500 mg twice daily for 4-6 months,
up to 2 years or longer in severe cases
Indications: Chronic prostatitis, sinusitis,
malaria treatment and prophylaxis, pelvic
Proprietary Preparations
inflammatory disease (with metroni- Oxecylin(Acme), Cap., 250 mg, Tk. 2/Cap.
dazole); brucellosis (with rifampicin), Renamycin(Renata), Cap., 250mg,Tk. 2/Cap.
adjunct to gingival scaling and root Teramycin(Ziska), Tab. , 500 mg, Tk. 3/Tab.
planning for periodonititis; also see under
tetracycline (except eye infections) TETRACYCLINE[ED] [A]
Cautions, Contra-indications: See
notes above
Indications:Mycoplasma pneumonia,
Interactions: See Appendix-2
chlamydial pneumonia,
Side-effects: See notes above; also
lymphogranuloma venereum, trachoma,
vestibular reactions including anorexia,
rickettsial infections (epidemic typhus,
dizziness, tinnitus and vertigo
Dose :Oral : 200 mg on first day, then scrub typhus, rickettsial pox, Q fever),
uncomplicated gonococcal infections,
100 mg daily; severe infections including
syphilis, brucellosis, exacerbations of
refractory urinary tract infections, 200 mg
daily; early syphilis, 200 mg daily in 1-2 chronic bronchitis, acne, actinomycosis,
lyme disease, tularemia, cholera, eye
divided doses for 14 days; late latent
infections (conjunctivitis, blepharitis)
syphilis, 100-200 mg twice daily for 28
days; uncomplicated genital chlamydia, Cautions, Contra-indications: See
notes above; also hepatic impairment
non-gonococcal urethritis, 100 mg twice
Side-effects: See notesabove
daily for 7 days; by IV infusion: 200 mg in
one or two infusions on first day followed Interactions: See Appendix-2
Dose:Oral: 250 mg every 6 hours for
by 100-200 mg on subsequent days
mild to moderate infections, increased in
Proprietary Preparations severe infections to 500 mg every 6-8
Asidox(Asiatic), Cap., 100mg, Tk. 2/Cap. hours; primary, secondary, or early latent
Dopac(Pacific), Cap., 100 mg, Tk. 2/Cap. syphilis, 500 mg every 6 hours for 14
Dox P(Astra Bio), Cap., 100mg,Tk.2/Cap. days; non-gonococcal urethritis, 500 mg
Doxicap(Renata), Cap. , 100 mg, Tk. every 6 hours for 7-14 days (21 days if
2.20/Cap. ; 50 mg, Tk. 1.42/Cap. failure or relapse after first course); acne,
Doxicline(Ziska), Cap.,100 mg, Tk.2.00/Cap. 500 mg twice daily for 4-6 months, up to
Doxico(Supreme), Cap.,100mg, Tk.2.15/Cap.
2 years or longer in severe cases;
Doxigen(General),Cap.,100 mg, Tk.2.16/Cap.
Doxin(Opsonin), Cap. , 100 mg, Tk. topical: 1% solution, 2-4 drops 4-6 hourly,
2.21/Cap.; 50 mg, Tk. 1.43/Cap. every hourly in severe cases
Doxizen(Zenith), Cap., 100 mg, Tk. 2.16/Cap.
Doxy(Acme), Cap. , 100 mg, Tk. 2.20/Cap. Proprietary Preparations
Doxycycline(Popular), Cap., 100 mg, Tk. Tetclin(Pacific), Cap. , 250 mg, Tk. 1.00/Cap.
2.00/Cap. Tetramycin(Asiatic), Cap., 250mg, Tk.
Doxysina(Ibn Sina), Cap., 100 mg, Tk. 1.30/Cap.
2.03/Cap.
36
1. ANTI-INFECTIVES

Tetrasina(Ibn Sina), Cap. , 250mg, Tk. are contra-indicated in patients with


1.75/Cap. ; 500 mg, Tk. 3.30/Cap. history of tendon disorders related to
Tetrax(Square), Cap., 500 mg, Tk. 2.29/Cap. quinolones. In presence of epilepsy and
Titacin(Supreme),Cap, 500mg, Tk. 2.00/Cap.;
Tab., 250 mg, Tk. 1.30/ Tab
myasthenia gravis cautious
A-Tetra(Acme),Tab.,500 mg, Tk. administration is required. These drugs
2.29/Tab.;Cap., 500mg, Tk. 2.03/Cap. should be withdrawn if psychiatric,
G-Tetracycline(Gonoshasthaya), Cap., 250 neurological, tendinitis or hypersensitivity
mg, Tk.1.00/Cap.; reactions occur.
Jmycin(Jayson), Cap., 250 mg, Tk. 1.31/Cap. Side-effects: Gastrointestinal upset in
Monatrex(Amico), Cap., 250 mg, Tk. the form of mild nausea, vomiting, and/or
1.20/Cap.; DS Cap., 500 mg, Tk. 2.00/Cap.
Tetracycline-H(Hudson), Cap. 250 mg, Tk.
abdominal discomfort, rarely diarrhea
1.00/Cap. and antibiotic-associated colitis. Central
nervous system side effects including
1.1.7.1. QUINOLONES AND headache, dizziness have been reported,
FLUOROQUINOLONES(See photosensitivity with lomefloxacin and
section 10.2,11.1) pefloxacin. Reversible arthopathy and
joint swelling have developed in children
receiving fluoroquinolones. Tendinitis, a
The older agents are 4-quinolones rare complication seen in adults. Risk of
(Nalidixic acid, Cinoxacin) with retinal detachment.
narrower spectrum of antimicrobial
activity and the newer drugs are
fluorinated analogs with broad spectrum CIPROFLOXACIN[ED] [A*][W]
of activity and much wider tissue
distribution.The quinolones are effective Indications: Urinary tract infections,
against enteric gram-negative bacilli; P. pseudomonal lower respiratory infections
aeruginosa is resistant. Fluorinated except pneumococcal pneumonia,
analogs have greatly improved enteric fever, shigellosis, gonorrhea,
antibacterial activity against many gram- chancroid, prostatitis, septicemia, bone,
positive and gram-negative organisms. joints and soft tissue infections, traveler's
Fluoroquinolones also are active against diarrhea, superficial bacterial infections of
agents of atypical pneumonia like eye caused by sensitive organisms,
mycoplasmas, Chlamydia and second line drug for legionellosis, with an
intracellular pathogens, such as anti-anaerobic (clindamycin or
legionella and some mycobacteria. metronidazole) for pelvic inflammatory
Resistance to one fluoroquinolone disease, part of multidrug therapy for
usually confers cross-resistance to all multidrug-resistant tuberculosis, with
other members of this class. amoxicillin-clavulanate as an oral empiric
Cautions and Contra-indications: Dose therapy for fever in low-risk patients with
adjustment in patients with creatinine granulocytopenia secondary to cancer
clearance less than 50 ml/min. is chemotherapy, eradication of
required for cinoxacin, norfloxacin, meningococci from carriers, surgical
ciprofloxacin, ofloxacin, enoxacin and prophylaxis and prophylaxis of infection
lomefloxacin but not for nalidixic acid, in neutropenic patients
trovafloxacin and pefloxacin. Cautions Cautions and Contra-indications:
are required in pregnancy, nursing Excessive alkalinity of urine should be
mother and the non-renally cleared avoided, adequate fluid intake required to
fluoroquinolones in patients with hepatic avoid crystalluria, performance of skilled
failure. These drugs are not generally tasks like driving may be impaired
recommended for use in prepubertal (effects enhanced by alcohol); also see
children, although in some cases the notes above
benefits may outweigh the risks and Side-effects: See notes above; also
requires careful assessment. Quinolones flatulence, dysphagia, hyperglycemia,
alerted prothrombin concentration,
37
1. ANTI-INFECTIVES

vasculitis, erythema nodosum, petechiae, Cilocin(Pacific), Suspn, 250mg/5ml, Tk.


hemorrhagic bullae, tinnitus, 100.00/60ml,; Tab., 500 mg, Tk. 12.00/Tab. ,;
tenosynovitis, tachycardia, edema, 500 mg, Tk. 8.00/Tab.
CIP(Asiatic), Tab., 500mg , Tk. 14.00/Tab.,
syncope, hot flushes and sweating; pain 750mg , Tk. 18.00/Tab.
and phlebitis at injection site Cipcin(Biopharma), Inj.,(IV.Infusion),
Interactions: See Appendix-2 0.20%,, Tk. 140.00/100ml,; Suspn, 250 mg/5
Dose: Oral: Urinary-tract infections, 250- ml, Tk. 100.00/60ml,; Tab., 750 mg , Tk.
500 mg twice daily; 100 mg twice daily 18.07/Tab., 250 mg , Tk. 8.53/Tab., 500 mg ,
for 3 days in acute uncomplicated cystitis Tk. 15.06/Tab.
in women; chronic prostatitis, 500 mg Ciprin(Nipa), Tab. , 500 mg, Tk. 12.00/Tab.
Cipro(Acme), Inj.,(IV.Infusion), 0.20%,,, Tk.
twice daily for 28 days; gonorrhea, 500 146.94/100ml,; Suspn, 250 mg/5 ml, Tk.
mg as a single dose; pseudomonal lower 100.30/60ml,; Tab, 250 mg., Tk. 8.56/Tab.;
respiratory-tract infection in cystic 500.00 mg , Tk. 14.06/Tab.; 750 mg, Tk.
fibrosis, 750 mg twice daily; most other 18.11/Tab
infections, 500-750 mg twice daily; Ciprobey(Sharif), Suspn, 250 mg/5 ml, Tk.
surgical prophylaxis, 750 mg 60-90 90.28/60ml,; Tab., 500 mg, Tk. 14.04/Tab.
minutes before procedure; CHILD (not Ciprocin(Square), Inj.,(IV.Infusion), , 0.20%,,
Tk. 146/100ml,; Suspn, 250 mg/5 ml, Tk.
recommended but where benefit 100.3/60ml,; Tab, 250 mg, Tk. 8.56/Tab.; 500
outweighs risk), 5-17 years, up to 20 mg, Tk. 15.05/Tab.; 750 mg, Tk. 18.12/Tab.
mg/kg twice daily, max. 1.5 g daily; IV Cipronaaf(Naafco), Tab. , 500 mg, Tk.
infusion, over 30-60 minutes; 200-400 14.00/Tab.
mg twice daily; pseudomonal lower Cipronil(Silva), Suspn, 250 mg/5 ml, Tk.
respiratory tract infection in cystic 95.00/60ml,; Tab., 500mg, Tk. 14.05/Tab.
fibrosis, 400 mg twice daily; CHILD 5-17 Ciprox(Opsonin), Suspn, 125 mg/5 ml, Tk.
90.34/60 ml; 250 mg/5 ml, Tk. 100.00/60ml,;
years, up to 10 mg/kg 3 times daily, max. Tab.XR,1 gm , Tk. 20.14/Tab.,; 250 mg , Tk.
1.2 g daily; urinary-tract infections, 100 8.53/Tab.; 500 mg , Tk. 15.05/Tab.; 750 mg ,
mg twice daily; gonorrhea, 100 mg as a Tk. 18.13/Tab.
single dose; Ciproxy (Opso Saline), Inj., (IV Infusion),
IV infusion: over 30-60 minutes, 200– 0.20%,Tk. 52.83/100 ml
400mg twice daily. Ciprozen(Zenith), Suspn, 250 mg/5 ml, Tk.
75.25/60ml,;Tab., 250 mg, Tk. 8.03/Tab.; 500
mg, Tk. 14.06/Tab.
Proprietary Preparations Ciprozid(Drug Intl), Suspn, 250mg/5ml, Tk.
Adecin(Supreme), Suspn, 250 mg/5 ml, Tk.
90.30/60ml,; Tab., 250mg, Tk. 8.05/Tab.;
90.25/100ml,; Tab. , 500 mg, Tk. 14.00/Tab. 500mg, Tk. 15.05/Tab.; 1000mg, Tk.
Amiflox(Amico), Tab., 250 mg, Tk. 6.00/Tab.;
20.10/Tab.; 750mg, Tk. 16.05/Tab.
Tab., 500 mg, TK. 14.00/Tab.; Suspn, 250
Cipwell(Getwell), Suspn, 250 mg/5 ml, Tk.
mg/5 ml, TK. 85.00/60ml
95.00/60ml,; Tab., 500mg, Tk. 14.00/Tab.
Ancipro(UniMed), Tab , 250mg, Tk. 8.50/Tab. Civox(Popular), Tab. , 500mg, Tk. 14.05/Tab.;
, 500mg, Tk. 14.00/Tab. ; 750mg, Tk. Inj.,(IV.Infusion), , 0.20%,, Tk.
18.00/Tab. 100.38/100ml,; Suspn, 250 mg/5 ml, Tk.
Aprocin(Aristo), Suspn.,250mg/5ml,Tk. 90.34/60 ml,; Tk. 90.34/60 ml
100/60ml; Tab., 500mg , Tk. 14.00/Tab. ;
Dumaflox(Alco), Suspn, 250 mg/5 ml, Tk.
750mg , Tk. 18.00/Tab.
100.00/60ml,; Tab., 250 mg, Tk. 7.52/Tab.;
Bactin(Ibn Sina), Inj.,(IV.Infusion), 0.20%,, 500 mg, Tk. 10.03/Tab. ; 750 mg, Tk.
Tk. 145.00/100ml,; Suspn, 250 mg/5 ml, Tk.
12.04/Tab.
110.00/60ml,; Tab.,250 mg, Tk. 8.54/Tab. ;
Fiprox(Sanofi), Tab. , 500mg, Tk. 14.09/Tab.
500 mg, Tk. 15.00/Tab. ; 750 mg, Tk.
Flontin(Renata), Inj.,(IV.Infusion), 0.20%,,
18.06/Tab.
Tk. 145.54/100ml,; Suspn, 250 mg/5 ml, Tk.
Beuflox(Incepta), Inj.,(IV.Infusion), , 0.20%,,,
100.00/60ml; 250 mg, Tk. 8.53/Tab.; 750 mg,
Tk. 47.85/100ml,; Tab., 250 mg, Tk. 8.00/Tab. Tk. 18.06/Tab.; 500 mg, Tk. 15.00/Tab.
,250 mg, Tk. 8.50/Tab.; 500 mg, Tk. Floxabid(ACI), Inj.,(IV.Infusion), , 0.20%, Tk.
15.00/Tab.; 750 mg, Tk. 18.00/Tab.; Suspn, 146.44/100ml; Tab., 100mg, Tk. 20.13/Tab.;
250 mg/5 ml , Tk. 100.00/60ml,; 250mg, Tk. 8.56/Tab.; 500mg, Tk. 15.05/Tab.;
Cero(G.A.Co), Tab., 500 mg, Tk. 14.05/Tab.
750mg, Tk. 18.12/Tab.; Suspn, 250 mg/5 ml,
Cibact(Euro), Suspn, 250 mg/5 ml, Tk.
Tk. 100.30/60ml
100.00/60ml,; Tab., 500 mg, Tk. 14.00/Tab.
Floxy(Team), Tab., 500 mg, Tk. 13.00/Tab.
Ciflocin(Astra Bio), Tab. , 500 mg, Tk.
12.00/Tab.;
38
1. ANTI-INFECTIVES

Geflox(General), Inj.,(IV.Infusion), , 0.20%, history of prolongation of the QT interval,


Tk. 70.21/100ml,; Suspn, 250 mg/5 ml, Tk. patients with uncorrected electrolyte
100.00/60ml,; Tab., 500mg , Tk. 14.09/Tab.; disorders, and patients receiving Class IA
250mg, Tk. 8.52/Tab.
Glaxipro(GSK), Tab. , 500 mg, Tk. 15.00/Tab
or III antiarrhythmic agents;safety and
Kapron(Globe), Inj.,(IV.Infusion), , 0.20%,Tk. efficacy has not been evaluated in
90.00/100ml; Suspn, 250 mg/5 ml, Tk. pregnant or lactating women or in
90.00/60ml,; Tab., 250 mg, Tk. 8.00/Tab.; 500 individuals <18 years of age
mg, Tk. 15.00/Tab.; 750 mg, Tk. 18.00/Tab.; Side-effects: See notes above
Libracin(Libra ), Inj.,(IV.Infusion), , 0.20%,, Interactions: See Appendix-2
Tk. 70.48/100ml Dose: Oral: Treatment of mild-to-
Maprocin(Orion), Suspn, 250 mg/5 ml, Tk.
90.61/60ml,; Tab., 500 mg, Tk. 15.00/Tab.;
moderate Cap, 320 mg once daily for 7
750mg, Tk. 18.16/Tab. days
Monipro(Monico), Suspn, 250 mg/5 ml, Tk. Note: For patients with creatinine
90.00/60ml; Tab., 500mg, Tk. 14.00/Tab. clearance <40 mL/min, the dose should
Neofloxin(Beximco), Inj.,(IV.Infusion), , be adjusted to 160 mg daily.
0.20%,,, Tk. 146.50/100ml,; Suspn, 250 mg/5 Gemifloxacin can be taken with or
ml, 100.0027/60ml,; sachet.,Tk. without food and should be swallowed
11.9966/Schet,; 250 mg/5 ml, Tk. Tab.,
250mg, Tk. 8.50/Tab.; 500mg, Tk. 15.00/Tab.;
whole with a liberal amount of liquid.
750mg, Tk. 18.00/Tab.
Ocimax(One Pharma), Suspn, 250 mg/5ml, Proprietary Preparations
Tk.99.99/60ml,; Tab., 500 mg, Tk. 13.99/Tab. Asiflocin(Asiatic), Tab., 320 mg, Tk.
Orcipro(Organic),Tab., 500 mg,Tk. 14.05/Tab 65.00/Tab.
Procin(Kemiko), Suspn, 250 mg/5 ml, Tk. Facticin(Square), Tab., 320 mg, Tk.
90.27/60ml,; Tab., 250 mg, Tk. 8.52/Tab.; 500 65.19/Tab.
mg, Tk. 14.05/Tab.; 750 mg, Tk. 18.00/Tab. Factiq(Monico), Tab., 320 mg, Tk. 65.00/Tab.
Q-Nol(Decent), Tab., 500mg, Tk. 11.00/Tab. Flogem(Opsonin), Tab., 320 mg, Tk.
Quinox(Eskayef), Suspn, 250 mg/5 ml, Tk. 65.25/Tab.
100.00/100ml,; Tab, 500 ng, Tk. 15.00/Tab.; Gefcin(Biopharma), Tab., 320 mg, Tk.
250mg, Tk. 8.50/Tab.; 750mg , Tk. 18.00/Tab 65.20/Tab.
Quintor(Ziska), Suspn, 250 mg/5 ml, Tk. Geloxin(Euro), Tab., 320 mg, Tk. 65.00/Tab.
60.00/60ml,; 500 mg, Tk. 10.00/Tab. Gemicin(Healthcare), Cap, 320 mg, Tk.
Rocipro(Healthcare), Tab., 500mg, Tk. 65.00/Cap.
14.00/Tab. Gemif(Beacon), Tab., 320 mg, Tk. 65.20/Tab.
Tyflox(Somatec), Suspn, 250 mg/5 ml, Tk. Gemiflox(Popular), Tab., 320 mg, Tk.
100.00/60ml; Tab., 500 mg, Tk. 14.00/Tab. 65.25/Tab.
Virflox(Virgo), Suspn, 250 mg/5 ml, Tk. Geminox(Eskayef), Tab., 320 mg, Tk.
90.00/60ml; Tab., 500 mg, Tk. 700.00/Tab. 65.00/Tab.; 320 mg, Tk. 65.00/Tab.
Winbac(Radiant), Tab. , 500mg, Tk. Gemitab(Ibn Sina), Tab. ,320 mg, Tk.
16.05/Tab. 350.00/Tab.
Xbac(Beacon), Inj.,(IV.Infusion), 200 mg/100 Geoflox(Sharif), Tab., 320 mg, Tk. 65.19/Tab.
ml, Tk. 145.99/Infusion,; Suspn, 250 mg/5 ml, Kmi(kemiko), Tab., 320 mg, Tk. 65.00/Tab.
Tk. 90.60/60ml,; Tab., 500mg , Tk. 14.09/Tab.; Orasquin(Incepta), Tab. , 320 mg, Tk.
750mg , Tk. 18.11/Tab. 65.00/Tab.
Xirocip(Novo Healthcare), IVInfusion,0.2%, Tk. Toplon(Renata), Tab., 320 mg, Tk. 65.00/Tab.
70.00/100ml,; 0.4%, Tk. 120.00/100ml; Suspn, Xemi(Orion), Tab., 320 mg, Tk. 50.15/Tab.
250 mg/5 ml, Tk. 90.00/60ml; Tab., 1000 mg,
Tk. 25.00/Tab.; 500 mg, Tk. 14.00/Tab. LEVOFLOXACIN[W]

GEMIFLOXACIN[W] Indications: See under dose


Cautions: See notes above; renal
Indications:Treatment of community- impairment; may impair performance of
acquired pneumonia (CAP) due to skilled tasks, history of psychiatric illness
multidrug-resistant Streptococcus Interactions : See Appendix-2
pneumoniae Side-effects: See notes above; also
Cautions and Contra-indications: asthenia, anxiety, tachycardia,
Should be avoided in patients with a hypotension, hypoglycemia, pneumonitis,
39
1. ANTI-INFECTIVES

local reactions and transient hypotension Levora(Somatec), Tab., 500 mg, Tk.
reported with infusion 14.05/Tab.
Dose:Oral :acute sinusitis, 500mg daily Levosina(Ibn Sina)Tab. ,500mg, Tk.
15.50/Tab.; 750 mg, Tk. 21.00/Tab.
for 10-14 days Levox(Opsonin), Suspn, 125 mg/5 ml, Tk.
Exacerbation of chronic bronchitis, 250- 75.28/100 ml; Tab., 250 mg, Tk. 8.03/Tab. ;
500mg daily for 7-10 days 750 mg , Tk. 20.08/Tab.; 500 mg , Tk.
Community-acquired pneumonia, 500mg 15.10/Tab.; Inj.,(IV.Infusion), 0.5%,
once or twice daily for 7-14 days Tk.100.38/100 ml;
Complicated UTIs, 250mg daily for 7-10 Levoxin(Incepta), Suspn., 125 mg/5 ml, Tk.
days 80.00/100ml,; Tab., 250 mg, Tk. 8.00/Tab.
; 500 mg, Tk. 15.00/Tab. ; 750 mg, Tk.
Skin and soft tissue infections, 250 mg 20.00/Tab. ; IV.Infusion 0.5%,,Tk.
daily or 500mg once or twice daily for 7- 100.00/100ml
14 daysby intravenous infusion (over at .Lexazen(Zenith), Tab. , 250 mg, Tk.
least 60 minutes for 500mg), community- 8.03/Tab.; 500 mg, Tk. 14.06/Tab.
acquired pneumonia, 500mg once or Lexvo(Modern), Tab. , 500 mg, Tk. 15.00/Tab.
twice daily Lezon(Euro), Tab., 500 mg, Tk. 15.00/Tab.
Complicated UTIs, 250mg daily, Lifcin(Biopharma), Inj.,(IV.Infusion),
0.5%,,Tk. 100.00/100ml,: Suspn., 125 mg/5 ml,
increased in severe infections Tk. 75.28/100ml,; Tab., 500 mg, Tk.
Skin and soft tissue infections, 500mg 15.06/Tab.
twice daily Lin(Kemiko), Tab., 250 mg, Tk. 10.00/Tab. ;
500 mg, Tk. 15.05/Tab.
Proprietary Preparations Livacin(G.A.Co), Tab., 500 mg, Tk.15.00/Tab.
Adelev(Supreme), Tab. , 250mg, Tk. Locin(Globe), Tab., 250 mg, Tk. 11.00/Tab. ;
8.00/Tab.; 500mg, Tk. 15.00/Tab. 500 mg, Tk. 14.00/Tab.
Asilee(Asiatic),Tab., 500mg , Tk. 15.00/Tab. Lovicin(Nipa), Tab., 500 mg , Tk. 15.00/Tab.
Corbic(Novo Health), Tab. , 500 mg, Tk. Orgalev, (Organic), Tab. , 500 mg, Tk.
15.00/Tab. 15.05/Tab.
Evo(Beximco), Inj.,(IV.Infusion), 0.5%, Tk. Orlev(Orion), Tab, 500 mg, Tk. 15.10/Tab.
100.00/100ml,; Tab., 500mg, Tk. 16.00/Tab.; Ovel(Aristo), Tab., 500mg, Tk. 15.00/Tab.
750mg, Tk. 20.00/Tab.; 250mg , Tk. 9.00/Tab. Quilev(Monico), Tab., 500mg, Tk. 15.00/Tab.
Flovo(Decent), Tab., 500mg, Tk. 15.00/Tab. Quixin(Beacon), Tab. , 500mg , Tk. 15.10/Tab.
Floxaget(Getwell), Tab. , 500mg, Tk. Resquin(Healthcare), Tab., 250mg , Tk.
15.00/Tab. 8.00/Tab.; 500mg, Tk.15.00/Tab.; 750mg, Tk.
Genolev(General), Tab., 250mg, Tk. 20.00/Tab.
8.05/Tab.; 500mg, Tk. 15.11/Tab. Trevox(Square), Suspn., 125 mg/5 ml, Tk.
Leflox(ACI), Tab., 500mg, Tk. 15.11/Tab. ; 80.24/100ml,; Inj.,(IV.Infusion), 0.5%,Tk.
750mg, Tk. 20.13/Tab. 100.3/100ml,; Tab. , 500 mg, Tk. 15.10/Tab. ;
Leo(Acme), Inj.,(IV.Infusion), 0.5%, Tk. 750 mg, Tk. 20.13/Tab.
100.30/100ml,; Tab. , 250.00 mg , Tk. Xenolev(Virgo), Tab. , 500mg , Tk. 15.00/Tab.
8.07/Tab. ; 500 mg, Tk. 15.10/Tab. ; 750 mg ,
Tk. 20.13/Tab. LOMEFLOXACIN HYDROCHLORIDE[W]
Leoflox(Alco), Tab. , 500 mg, Tk. 15.05/Tab. ;
250 mg, Tk. 7.02/Tab.
Levin(Amico), Tab., 500mg , TK. 14.00/Tab. Indications: See under Ciprofloxacin
Levo(Astra Bio), Tab. , 500 mg, Tk. 15.00/Tab. Cautions: See under Ciprofloxacin
Levobac(Popular), Tab. , 500 mg, Tk. Contra-indications: See under
15.06/Tab.; 750 mg, Tk. 20.08/Tab.; I Ciprofloxacin
Inj.,(IV.Infusion), 0.5%,, Tk. 100.38/100ml,; Side-effects: See notes above
Levoflox(Drug Intl), Tab., 500mg, Tk.
Dose:Oral: 400 mg once/twice daily;
15.05/Tab.; 750mg, Tk. 20.10/Tab.
Levoking(Renata), Tab. , 250 mg, Tk. topical for Eye infections: see under
8.03/Tab. ; 500 mg, Tk. 15.06/Tab. ; 750 mg, Ciprofloxacin
Tk. 20.07/Tab. Note. evening administration may
Levolo(Pacific), Tab., 500 mg, Tk. 15.00/Tab. minimize the phototoxicity reactions
Levomax(Eskayef), Suspn, 125 mg/5 ml, Tk.
90.00/5ml, 250mg/5ml, Tk. 130.00/5ml ; Tab, Proprietary Preparations
750mg , Tk. 20.00/Tab.; 500mg, Tk. Lomeflox(Aristo), Tab., 400mg, Tk. 15/Tab.
15.00/Tab.; 750mg, Tk. 20.00/Tab.; Mexlo(Square), Tab., 400 mg, Tk. 15.10/Tab.
Levonix(Ziska), Tab. , 500 mg, Tk. 14.00/Tab. Omeflox(ACI)Tab., 400 mg, Tk. 15.11/Tab.
40
1. ANTI-INFECTIVES

MOXIFLOXACIN [W] [C] 2 weeks, false positive urinary glucose


test
Indications: Sinusitis, community- Side-effects:See notes above; also
acquired pneumonia, complicated skin reported weakness, increased
and soft-tissue infections not responding intracranial pressure, cranial nerve palsy,
to other antibacterials toxic psychosis, metabolic acidosis
Cautions: See notes above; also Dose:oral: 1 g every 6 hours for 7 days,
conditions predisposing to arrhythmias reduced to 500 mg every 6 hours in
including myocardial ischemia chronic therapy; CHILD > 3 months max.
Contra-indications: See notes 50 mg/kg daily in divided doses, reduced
above;also electrolyte disturbances, in prolonged therapy to 30 mg/kg daily
heart failure with reduced left ventricular
ejection fraction Proprietary Preparations
Dixicon(Jayson), Susp., 300 mg/5 ml, Tk.
Interactions:See Appendix-2
30.45/50 ml
Side effect: See notes above;; also Nalid(Square), Susp., 300 mg/5 ml, Tk.
flatulence, gastritis; amnesia; very rarely, 41.74/50 ml; Tab. 500 mg, Tk. 4.87/Tab.
rhabdomyolysis, potentially life- Naligram(Acme), Susp., 300 mg/5 ml, Tk.
threatening hepatic failure 41.73/50 ml; 300 mg/5 ml, Tk. 86.10/100
Dose: Oral, IV infusion, over 60 minutes, ml;Tab., 500 mg, Tk.4.87/Tab.
400mg once daily Nalidex (Ambee), Susp., 300mg/5ml, Tk.
30.46/50 ml; Tab., 500 mg, Tk. 4.07/Tab.
Proprietary Preparations
Cubimox(Acme), Tab. , 400 mg, Tk. OFLOXACIN[W]
40.00/Tab
Flomox(Opso Saline), Inj.(IV Infusion), 400 Indications:See under Ciprofloxacin
mg/250 ml, Tk. 90.23/250 ml Cautions:See under Ciprofloxacin
Iventi(Square), Inj.(IV Infusion), 400
mg/250ml, Tk. 350/250ml Vial,; Tab. , 400 mg,
Contra-indications: See under
Tk. 40.00/Tab. Ciprofloxacin
Lomeflox (Aristo), Tab., 400 mg, Interactions:See Appendix-2
Tk.15.00/Tab. Side-effects:See notes above; also eye
Maxiflox(ACI), Tab., 400 mg, Tk. 40.00/Tab. irritation; hot flushes; change in blood
Mexlo (Square), Tk. 70.21/5ml,; Tab. , 400 mg sugar; myopathy, rhabdomyolysis
, Tk. 15.10/Tab. Dose:Oral: for mild to moderate
Moxibac(Popular), Inj.(IV Infusion), 400
mg/250ml, Tk. 350.00/250 ml Vial,; Tab. ,
infections, 200-400 mg twice daily for 7-
400mg, Tk. 70.00/Tab. 10 days, may be increased to 400-800
Moxiflox(Alco), Tab. , 400 mg, Tk. 50.15/Tab. mg twice daily in severe cases; for
Moxilocin(Opsonin), Tab. 400 mg, Tk.40/Tab. uncomplicated gonorrhea, 400 mg as a
Moxquin(Incepta), Tab. 400 mg, Tk. 40/Tab. single dose; for PID & chronic prostatitis
Omeflox(ACI), Tab., 400 mg, Tk. 15.11/Tab. therapy with ofloxacin needs to be
Optimox(Aristo), Tab., 400 mg, Tk. 40.00/Tab.; continued for 14 & 28 days respectively;
Respamox(Somatec), Tab. 400mg, Tk.
40.00/Tab.
IV infusion: over at least 30 minutes 200-
(For Eye preparation see section 10.2) 400 mg twice daily in mild to moderate
infections, for severe or complicated
infections, dose may be increased to 400
NALIDIXIC ACID[ED] [W]
mg twice daily
Indications: urinary tract infections, Proprietary Preparations
shigellosis Flocet(Opsonin), Tab. , 200 mg, Tk.
Cautions & Contra-indications:See 12.05/Tab.; 400 mg, Tk. 22.08/Tab.;
notes above; also porphyria; monitoring Inj.(IVInfusion)0.2%, Tk. 120.37/100ml
of blood count, renal and hepatic Oflacin(Drug Intl), Tab., 200mg, Tk.
functions required if given for more than 12.05/Tab.; 400mg, Tk. 20.10/Tab.
Rutix(Square), Tab. , 200 mg, Tk. 12.09/Tab. ;
400 mg, Tk. 22.14/Tab.
41
1. ANTI-INFECTIVES

Cautions: All sulfonamides and their


PEFLOXACIN MESYLATE[W] derivatives, including carbonic anhydrase
inhibitors, thiazides, frusemide,
Indications: See under Ciprofloxacin bumetanide, torsemide, diazoxide, and
Cautions, Contra-indications:See sulfonylurea hypoglycemic drugs, are
under Ciprofloxacin; also hepatic cross-allergic. Plenty of fluid is to be
impairment taken and monitoring of blood count is
Side-effects: See notes above; required in prolonged therapy. Hepatic
Dose:Oral & IV infusion 400 mg twice function monitoring also is required in
daily AIDS patients receiving co-trimoxazole.
Interactions: See Appendix -2 Dose adjustment is needed in renal
insufficiency and therapy with
Proprietary Preparations sulfonamides and/or trimethoprim in
Nobac(Ibn Sina), Tab., 400mg, Tk.12/Tab. pregnancy and in breast-feeding requires
Peflox(Drug Intl), Tab., 400mg, Tk.11.05/Tab. careful assessment of risks in the baby.
Sulfonamides and cotrimoxazole are not
SPARFLOXACIN[W] recommended for use in infants below 6
weeks except for treatment or
Indications: See under Ciprofloxacin; prophylaxis of pneumocystis pneumonia.
also for respiratory infections caused by Side-effects: Fever, skin rashes,
S. pneumonia exfoliative dermatitis, photosensitivity,
Cautions, Contra-indications:See urticaria, nausea, vomiting, diarrhea,
under Ciprofloxacin; also hepatic crystalluria, various types of nephrosis
impairment and allergic nephritis. Stevens-Johnson
Interactions:See Appendix-2 syndrome and toxic epidermal necrolysis,
Side-effects: See notes above;also although rare, is a particularly serious
cardiac rhythm disturbances and and potentially fatal type of reaction
prolongation of QT interval are in reports associated with use of sulfonamides.
Dose: Oral 200-400 mg once daily Hemolytic anemia, particularly in
glucose-6-phosphate-dehydrogenase
Proprietary Preparations deficient patients, aplastic anemia,
Aciflox(ACI), Tab., 200mg, TK. 12.00/Tab. granulocytopenia, thrombocytopenia, or
Asaf(Asiatic), Tab., 200mg , Tk. 18.75/Tab. leukemoid reactions also are reported
Floxipar(Acme), Tab., 200.00 mg., Tk. after sulfonamides therapy; risk of
15.61/Tab. kernicterus in newborns if taken near the
Omniflox(Aristo), Tab., 200mg , Tk. 18/Tab. end of pregnancy.
Parlox(Eskayef), Tab., 200 mg, Tk. 15/Tab. Trimethoprim may produce megalo-
Quinoflox(Healthcare), Tab., 200mg, Tk.
150.00/Tab.
blastic anemia, leucopenia and
Saga(Square), Tab. , 200 mg, Tk. 15.05/Tab. granulocytopenia. Nausea and vomiting,
Salocin(Kemiko), Tab., 200 mg, Tk. 17/Tab. drug fever, vasculitis, renal damage and
Spar(Globe), Tab. , 200 mg, Tk. 20.00/Tab. central nervous system disturbances
Sparflox(Alco), Tab. , 200 mg, Tk. 16.05/Tab. occasionally occur.
Sparlin(Beximco),Tab.,200mg, Tk. 15.06/Tab.
Sparonex(Drug Intl), Tab., 200mg, Tk.
18.10/Tab.
CO-TRIMOXAZOLE[ED] [A]

1.1.8 SULPHONAMIDES Indications: Urinary tract infections,


ANDTRIMETHOPRIM [A] acute exacerbation of chronic bronchitis,
typhoid fever, shigellosis, pneumocystis
carinii pneumonia, acute otitis media in
A few of them are used topically such as
children, toxoplasmosis, nocardiasis
in eye infections and in infected wound
Cautions: Monitoring of blood counts is
and burn injury. In combination with
required in prolonged therapy; adequate
trimethoprim as Co-trimoxazole,
fluid intake is to be maintained; also see
notes above
42
1. ANTI-INFECTIVES

Contra-indication: Porphyria Tk.19.60/50ml; Tab., 400 mg + 80 mg, Tk.


Interactions: See Appendix-2 1.20/Tab.
Side-effects:See notes above; Megatrim(Beximco), Suspn., 200 mg+ 40 mg
/5 ml., Tk. 22.17/60ml,; Tab., 800mg + 160mg,
Dose Oral: ADULT 480-960 mg every 12 Tk. 2.65.00/Tab.
hours; CHILD 6 weeks-5 months 120 mg M-Trim(Modern), Suspn., 200 mg+ 40 mg /5
every 12 hours; 6 months-5 years 240 ml., Tk. 23.96/60ml,; Tab., 800 mg+160 mg. ,
mg every 12 hours; 6-12 years, 480 mg Tk. 2.65/Tab.
every 12 hours; Octrim(Orion), Suspn., 200 mg+ 40 mg /5 ml.,
By IV infusion: ADULT 960 mg every 12 Tk. 21.08/60ml
hours increased to 1.44 g every 12 hours Ptrim(Astra Bio), Suspn., 200 mg+ 40 mg /5
ml., Tk. 22.00/60ml,; Tab., 80 mg + 160 mg,
in severe infections; CHILD 36 mg/kg Tk. 2.50/Tab.
daily in 2 divided doses increased to 54 Septra(Asiatic), Suspn., 200 mg+ 40 mg /5 ml.,
mg/kg daily in severe infections; Tk., 21.57/60ml,; Tab., 400mg + 80mg , Tk.
pneumocystis carinii infections: for 1.49/Tab. ; 800mg+160mg, Tk. 2.03/Tab.
treatment oral or IV infusion, ADULT & Sinatrim(Ibn Sina), Suspn., 200 mg+ 40 mg /5
CHILD over 4 weeks 120 mg/kg daily in ml., Tk. 22.00/60ml,; Tab., 800mg + 160mg,
2-4 divided doses for 14 days, for Tk. 210.00/Tab.
Sulphatrim(Amico), Suspn., 200 mg+ 40 mg/5
prophylaxis: Oral: ADULT 960 mg once ml., TK. 22.10/60ml,; Tab., 400 mg + 80mg ,
daily or 960 mg on alternate days or 960 TK. 1.49/Tab. ; 800mg + 160mg , TK.
mg twice daily on alternate days; CHILD 2.50/Tab.; 100 mg + 20mg , TK. 0.58/Tab.
6 weeks-5 months 120 mg twice daily on Triprim(Supreme), Cap. , 400mg +80mg, Tk.
3 consecutive days or 7 days/week; 6 1.48/Cap. ; Suspn., 200 mg+ 40 mg /5 ml., Tk.
months-5 years 240 mg 6-12 years 480 21.00/60ml,; Tab., 800mg + 160mg , Tk.
mg 2.00/Tab.
Jasotrim(Jayson), Susp., 200 mg + 40 mg/5
ml , Tk. 21.61/60 ml; Tab., 400 mg + 80 mg,
Proprietary Preparations Tk. 1.49/Tab.
Actrim(Globe), Suspn., 200 mg+ 40 mg /5 ml.,
Tk.22.00/60ml
Actrim-DS(Globe),Tab., 800 mg + 160 mg, Tk. 1.1.9 METRONIDAZOLE, TINIDAZOLE
2.00/Tab. AND ORDINAZOLE
Alcot(Pacific), Suspn., 200 mg+ 40 mg /5 ml., See section 1.3.2
Tk. 20.00/60ml ,; Tab., 400 mg + 80 mg, Tk.
1.00/Tab. ; 400 mg + 80 mg, Tk. 2.00/Tab.
1.1.10ANTI-MYCOBACTERIAL DRUGS
Avlotrin(ACI), Suspn., 200 mg+ 40 mg /5 ml., 1.1.10.1 ANTI-TUBERCULOSIS DRUGS
TK. 22.21/60ml ,; Tab., 400mg +80mg , TK. 1.1.10.2ANTI-LEPROSY DRUGS
1.5/Tab. ; 800mg + 160mg , TK. 2.01/Tab.
Biotrim(Biopharma), Suspn., 200 mg+ 40 mg
/5 ml., Tk. 21.56/60ml,; Tab., 800mg + 160mg 1.1.10.1ANTI-TUBERCULOSIS DRUGS
, Tk. 2.01/Tab. FIRST LINE DRUGS
Cosat(Eskayef), Suspn., 200 mg+ 40 mg /5 ETHAMBUTOL HYDROCHLORIDE[ED]
ml., Tk. 22.07/60ml, Tab., 800 mg + 160 mg ,
Tk. 2.55/
Cotrazen(Zenith), Suspn., 200 mg+ 40 mg /5 Ethambutol is effective against most
ml., Tk. 21.36/60ml,; Tab., 400 mg + 80 mg, strains of M tuberculosis and M kansasii
Tk. 1.40/Tab.; 800 mg + 160 mg, Tk. 2.02/Tab. and good number of strains of M. avium
Cotrim(Square), Suspn., 200 mg+ 40 mg /5 complex. No other bacteria are sensitive
ml., Tk. 21.64/60ml,; Tab. , 400 mg + 80 mg, to ethambutol. Cleared by both renal and
Tk. 1.49/Tab. ,Tab, 800 mg + 160 mg, Tk.
2.04/Tab.
nonrenal routes, renal being more
Co-trimoxazole(Popular), Tab. , 400mg + prominent.
80mg , Tk. 1.48/Tab. Indications: Tuberculosis in combination
Cots (Opsonin), Suspn., 200 mg+40mg/5 ml., with other drug (see under chemotherapy
Tk. 22.14./60 ml for tuberculosis)
Gentrim(General), Tab. , 400mg + 80mg, Tk. Cautions: Dose reduction required in
1.49/Tab. renal impairment, also monitoring of
G-Cotrimoxazole(Gonoshasthaya), Susp, 200
mg+40 mg/5 ml, Tk. 28.00/100 ml;
plasma concentration if creatinine
43
1. ANTI-INFECTIVES

clearance less than 30 ml/min; tests of Contra-indications: Drug induced liver


visual acquity and red-green disease
discrimination prior to therapy and routine Interactions: See Appendix-2
ophthalmological monitoring during Side-effects: Rash, fever, jaundice,
therapy recommended, patients should peripheral neuritis leading to numbness,
be warned to report any visual change; tingling of the feet particularly in slow
cautions for elderly, young children and acetylators, diabetic, HIV infected and
pregnant patients malnourished or anemic patients; allergic
Contra-indications: Optic neuritis, poor reactions including hepatitis, skin
vision eruptions and morbilliform eruptions,
Interactions: See Appendix-2 maculopapular, purpuric and urticarial
Side-effects: Optic neuritis leading to rashes; hematological reactions like
loss of red/green discrimination ability, agranulocytosis, eosinophilia,
pruritus, joint pain, GIT upset, abdominal thrombocytopenia, hemolytic anemia;
pain, malaise, headache, dizziness, convulsions, insomnia, muscle twitching,
mental confusion, disorientation, ataxia, paraesthesia, stupor, toxic
hallucination; numbness and tingling of encephalopathy; optic neuritis and
fingers due to peripheral neuritis atrophy
infrequently; rarely anaphylaxis, Dose: Oral or IM inj: treatment and
thrombocytopenia and leucopenia prophylaxis, ADULT 300 mg once daily;
Dose: Oral: ADULT & CHILD > 12 years CHILD 10-20 mg/kg (max. 300 mg) once
15 mg/kg once daily; for recurrent cases, daily; for intermittent supervised therapy,
25 mg/kg/d for 60 days then 15 mg/kg/d; 10 mg/kg thrice or 15 mg twice weekly;
CHILD 6-12 years, 10-15 mg/kg/d; for pyridoxine, 15-50 mg/d particularly in
intermittent supervised therapy, ADULT high risk patients for peripheral
& CHILD > 12 years, 30 mg/kg thrice neuropathy
weekly or 50 mg/kg twice weekly (not
recommended for children under 5 years) Proprietary Preparations
Rifampicin + Isoniazid
Proprietary Preparations Rimactazid(Novartis), Tab. , 300 mg + 150
(For Combined Preparations of mg, Tk. 8.37/Tab. ;150 mg+ 75 mg, Tk.
4.00/Tab.;, 450 mg + 300 mg, Tk. 11.71/Tab.
Ethambutol, see under Isoniazid) Isoniazid + Thiacetazone
Rifampicin+Isoniazid+Pyrazinamide
ISONIAZID[ED]
Rifampicin+Isoniazid+Pyrazinamide+
Ethambutol HCl
Isoniazid is effective selectively against
Rimstar 4-FDC(Novartis), Tab. , 150 mg +75
M. tuberculosis and M. kansasii. Hepatic mg + 400 mg + 275 mg, Tk. 10.00/Tab.
clearance by genetically determined
acetylation is the principal mode of
RIFAMPICIN[ED]
isoniazid elimination.
Indications: Tuberculosis in combination
with other drug (see under Rifampicin exerts broad-spectrum
chemotherapy for tuberculosis) antibacterial effect and is effective
Cautions: Monthly evaluation of patients against most gram-positive as well as
for symptoms of hepatitis has been many gram-negative organisms. S.
advised, one-third to one-half of normal aureus, coagulase-negative
dose is recommended in moderate to staphylococci, E. coli, Pseudomonus,
severe hepatic insufficiency; other indole-positive and indole-negative
conditions that require cautious therapy Proteus, and Klebsiella, N. meningitidis,
with isoniazid are epilepsy, history of H. influenzae are particularly susceptible.
psychosis, alcohol dependence, Of the mycobacteria, M. tuberculosis, M.
malnutrition, diabetes mellitus, slow kansasii, M. scrofulaceum, M.
acetylator status, porphyria, pregnancy, intracellulare are sensitive, while M.
breast-feeding and HIV infection fortuitum is highly resistant.

44
1. ANTI-INFECTIVES

After absorption from gastrointestinal supervised therapy, 600 mg twice or


tract, it is eliminated rapidly in the bile thrice weekly;
and exhibits an entrohepatic recycling. Leprosy, supervised therapy of 600 mg
Rifampicin is a potent inducer of hepatic once in a month, 450 mg for patients
drug metabolizing enzymes and weighing less than 35 kg; Brucellosis,
eliminates principally in feces. legionnaires disease and serious
Indications: Treatment of tuberculosis in staphylococcal infections, in combination
combination with other drug (see under with other drugs, orally or by IV infusion,
chemotherapy for tuberculosis), an 0.6-1.2g daily in 2-4 divided dose
alternative to isoniazid as prophylactic in
close contacts to a case of isoniazid- Proprietary Preparations
resistant tuberculosis provided that the (For Combined Preparations of
index case is susceptible to this drug; Rifampicin, see under Isoniazid)
Leprosy, brucellosis, hemophilus
influenzae infection, legionnaires PYRAZINAMIDE[ED]
disease, prophylaxis of meningococcal
meningitis; in combination with This is an important front-line anti-
ceftriaxone or vancomycin for treatment tuberculosis drug and is used in
of meningitis caused by penicillin- combination with isoniazid and rifampicin
resistant strains of pneumococci, in in short-course, 6 months regimen as a
combined therapy against serious 'sterilizing' agent active against residual
staphylococcal infections such as intracellular organisms responsible for
osteomyelitis and prosthetic valve relapse. Pyrazinamide produces
endocarditis selective bactericidal effect against M.
Cautions: Patients with hepatic tuberculosis, but not effective against M.
impairment need hepatic function and bovis.
blood counts monitoring, alcoholism, The drug is taken up by macrophages
during concomitant use of oral and is converted to active pyrazinoic acid
contraceptives, patients should be by mycobacterial pyrazinamidase. The
advised to useadditional means of drug eliminates principally by renal route.
contraception, pregnancy, breast- Indications: Treatment of tuberculosis in
feeding, porphyria; patients should be combination with other drugsin
warned about harmless orange-red color combinationwith ciprofloxacin or ofloxacin
to urine, feces, saliva, sputum, tears, and as prophylactic in close contacts to a
sweat case of multidrug-resistant tuberculosis
Contra-indications: Jaundice, liver provided that the index case is
damage susceptible to these drugs
Interactions: See Appendix-2 Cautions: Hepatic insufficiency,
Side-effects: Gastrointestinal symptoms monitoring of liver function is advised;
including anorexia, nausea, vomiting, therapy should be stopped if there is
diarrhea; cholestatic jaundice and evidence of hepatotoxicity (elevation of
occasionally hepatitis; light-chain plasma alanine and aspartate
proteinuria commonly and acute renal aminotransferases are the earliest
failure rarely, thrombocytopenic purpura, features of drug hepatotoxicity); diabetes,
urticaria, rashes; a flu-like syndrome gout
characterized by fever, chills, myalgias, Contra-indications: Liver damage,
anemia, and sometimes associated with porphyria
acute tubular necrosis Interactions: See Appendix-2
Dose: Tuberculosis treatment and Side-effects: Most serious is the
prophylaxis, ADULT < 50 kg, 450 mg hepatotoxicity; liver tenderness,
once daily, 50 kg and over 600mg once hepatomegaly, jaundice and fulminating
daily or as 10 mg/kg/d; CHILD 10 mg/kg liver failure that can be fatal;
(max. 600 mg) daily; for intermittent hyperuricemia and gouty arthritis occur
45
1. ANTI-INFECTIVES

uniformly and not considered to be a Side-effects: Hearing loss, tinnitus,


reason to halt therapy; also anorexia, transient proteinuria, cylindruria,
nausea and vomiting, dysuria, occasional electrolyte disturbances and nitrogen
mild fever, malaise retention, severe renal failure,urticaria
Dose Oral: Treatment and prophylaxis, and rashes; leukocytosis or leucopenia
ADULT & CHILD 15-30 mg/kg daily as a rarely thrombocytopenia; change in liver
single dose, max. 2 g/d; for intermittent function tests, neuromuscular block after
supervised therapy, 35-40 mg/kg twice or large doses, pain and induration at
thrice weekly, max. 3 g/occasion injection site
Dose:Deep IM inj. 15-30 mg/kg/d or up
Proprietary Preparations to 1 g daily for 2-4 months then 1 g, 2-3
(For Combined Preparations of times weekly
Pyrazinamide, see under Isoniazid)
Generic Preparation
STREPTOMYCIN[ED] [C] Capsule, 250mg
See section 1.1.4
THIACETAZONE CYCLOSERINE

Thiacetazone is bacteriostatic against This drug is inhibitory to many gram-


many strains of M tuberculosis and M positive and gram-negative organisms
leprae. Thiacetazone containing but is used exclusively to treat
regimens are less effective than the tuberculosis caused by strains of M.
short-course regimens recommended by tuberculosis resistant to first-line drugs.
WHO, but are used with isoniazid in long- The drug has adequate oral
term regimens principally because of its bioavailability and achieves antibacterial
low cost. WHO does not recommend its concentrations in many tissues including
use in leprosy. central nervous system and CSF.
Dose:See standard treatment Indications: In combination with other,
Guidelines(Appendix-1) drugs, tuberculosis resistant to first-line
Cautions: Dose reduction is necessary
Generic Preparation in renal impairment; monitoring of blood
Isoniazid 300 mg + Thiacetazone 150 mg counts, renal and hepatic function;
Tablet pregnancy and breast-feeding;
neurological toxicities are common above
SECOND LINE ANTI-TUBERCULOSIS the dose of 0.75 g/d
DRUGS: Contra-indications: Severe renal
impairment, epilepsy, depression,
porphyria
AMIKACIN[C] Interactions: See Appendix-2
See under Aminoglycosides (Sec1.1.4. ) Side-effects: Most serious toxicities are
peripheral neuropathy and central
CAPREOMYCIN nervous system dysfunction including
headache, dizziness, vertigo,
Indications: In combination with other drowsiness, tremor, convulsions,
drugs for tuberculosis resistant to first- confusion, depression, and psychotic
line drugs reactions, (dose reduction & pyridoxine
Cautions: Renal, hepatic, or auditory 150 mg/d are recommended); rashes,
impairment, monitoring of renal, hepatic, allergic dermatitis megaloblastic anemia;
auditory, vestibular function and changes in liver function tests; heart
electrolytes are advised; pregnancy failure at high doses reported
(teratogenic in animals) and breast- Dose: Oral: Initially 250 mg every 12
feeding hours for 2 weeks, then increased to
Interactions: See Appendix-2 maximum 500 mg every 12 hours; CHILD

46
1. ANTI-INFECTIVES

initially 10 mg/kg daily adjusted according impairment); gastric ulcer; G6PD


to blood concentration and response deficiency; pregnancy, breast-feeding
Interactions: See Appendix-2
Generic Preparation Side-effects: GI disturbances including
Capsule,250 mg nausea, vomiting, abdominal pain, gastric
irritation and ulcer; hypersensitivity
ETHIONAMIDE reactions including skin rashes, arthalgia,
lymphadenopathy, syndrome like
Ethionamide has selective infectious mononucleosis; hemolytic
antimycobacterial activity including M anemia
tuberculosis, M kansasii, M leprae and Dose: Oral tuberculosis: ADULT, 12 g
some strains of M avium complex. daily in 3 divided doses; ulcerative colitis:
Indications: In combination with other 2 g once daily
drugs for tuberculosis resistant to first-
line drugs or when first line drugs cannot RIFABUTIN
be given because of toxicity; alternative
to Clofazimine in regimens for leprosy It exerts antibacterial activity similar to
Cautions: Hepatic impairment (should that of rifampicin. It is both a substrate
not be used in severe impairment), and inducer of cytochrome P 450
monitoring of hepatic function before and enzymes.
during treatment; unsafe in porphyria; Indications: See under Dose
psychiatric disorders; monitoring of blood Cautions: See under rifampicin
glucose, thyroid function and of visual Contra-indications: jaundice, liver
acquity damage (not recommended for use in
Interactions: See Appendix-2 children)
Side-effects: GI disturbances, mental Interactions: See Appendix -2
disturbances including anxiety, Side-effects:Nausea, vomiting;
depression, psychotic disorders; leucopenia, thrombocytopenia, anemia,
headache, dizziness, postural raised liver enzymes, jaundice, uveitis
hypotension; hepatotoxicity; following high doses or administration
hypersensitivity reactions including with drugs which raise plasma
thrombocytopenia, purpura, alopecia, concentration; arthalgia, myalgia,
dermatitis influenzae-like syndrome, dyspnea; also
Dose: Oral resistant tuberculosis: hypersensitivity reactions including fever,
ADULT, 15-20 mg/kg daily (max. 1 g rash, eosinophilia, bronchospasm; urine,
daily); CHILD, 10-20 mg/kg (max. 750 saliva and other body secretions colored
mg) daily; in single or divided doses orange-red;
Dose: Oral: prophylaxis of
Generic Preparation mycobacterium avium complex infections
Tablet,250mg in HIV-infected patients, 300 mg daily as
a single dose; treatment of non-
PARA-AMINOSALICYLIC ACID tuberculous mycobacterial disease, in
combination with clarithromycin and
This is bacteriostatic against M ethambutol, 450-600 mg daily as a single
tuberculosis, while other mycobacteria dose;
are usually resistant. alternative to rifampicin for treatment of
Indications: in combination with other tuberculosis in HIV-infected patients (as it
drugs for tuberculosis resistant to first- as less interactions than rifampicin with
line drugs or when first line drugs cannot indinavir and nelfinavir), 150-450 mg
be given; ulcerative colitis daily as a single dose for at least 6
Cautions: Renal and hepatic impairment months; for preventive therapy of
(should not be used in severe tuberculosis, either alone, in a 6-month
regimen or with pyrazinamide in a 2-
47
1. ANTI-INFECTIVES

month regimen, 150-450 mg daily as a portion of drug is excreted in feces.


single dose; treatment of pulmonary Clofazimine is stored widely in
tuberculosis, 150-450 mg daily as a reticuloendothelial tissues and skin.
single dose for 6 months Indications: Leprosy in combination with
other drug, chronic skin ulcers (Buruli
Generic Preparation ulcer) produced by M. ulcerans,
Capsule, 150 mg prophylaxis against erythema nodosum
leprosum
CHEMOTHERAPY OF TUBERCULOSIS Cautions: Hepatic and renal impairment;
Mycobacteria are slowly growing pregnancy and breast-feeding; may
organisms, can remain dormant for long discolor soft lenses; best to avoid if
time and a substantial proportion reside persistent abdominal pain and diarrhea
within macrophages inaccessible to Interactions: See Appendix-2
many drugs and can rapidly develop Side-effects: Nausea, vomiting
resistance to any single drug. As such, (hospitalize if persistent), abdominal pain;
combinations of drugs are employed to headache; tiredness; brownish-black
overcome these obstacles and to prevent discoloration of lesions and skin including
emergence of resistance. Another areas exposed to light, reversible hair
problem, to prevent disease relapse, discoloration; dry skin; red discoloration
required therapy is of long duration which of feces, urine and other body fluids; also
most patients fail to comply. To rash; pruritus, acne-like eruptions,
overcome this problem, supervised short- anorexia, eosinophilic enteritis, bowel
course therapy with intermittent obstruction, dry eyes, dimmed vision,
administration of drugs has been macular and subepithelial corneal
formulated and adopted by many national pigmentation; elevated blood sugar,
anti-tuberculosis programmes. weight loss, spinal infarction,
Followings are recommended regimens lymphadenopathy
for treatment and prophylaxis of Dose: Oral: leprosy, 50-100 mg daily, in
tuberculosis: lepromatous lepra reactions, dose
increased to 300 mg daily for maximum
of 3 months
1.1.10.2 DRUGS FOR LEPROSY
(See Appendix-1c) Generic Preparation
Capsule, 50mg
Leprosy is a slowly progressive chronic
infectious granulomatous disease caused
DAPSONE[ED]
by Mycobacterium leprae affecting mostly
the skin and peripheral nerves resulting Like sulfonamides, it acts by inhibiting
in anaesthetic hypopigmented patches in microbial folate synthesis; well absorbed
skin, and sometimes trophic changes after oral administration and widely
producing deformities in certain other distributed throughout body fluids and
tissues notably oral/nasal mucosa, the tissues and tends to accumulate in skin,
eye, muscle and bone. Multidrug muscle, liver, and kidney. Dapsone is
treatment (MDT) for leprosy as principally cleared through kidney after
recommended by the Bangladesh acetylation.
National TB and Leprosy Control Indications: Leprosy, treatment and
Programme is shown in Appendix-1 prophylaxis of pneumocystis carinii
pneumonia, dermatitis herpetiformis
Cautions: Dose adjustment required in
CLOFAZIMINE[ED]
renal failure, cardiac or pulmonary
disease; anemia; hemolysis in G-6PD
Clofazimine is active against both deficient patients, during long-term
dapsone-sensitive and dapsone-resistant treatment, patients and their attendants
bacilli and against M. intracellulare. should be told how to recognize signs of
Variable absorption from gut and a major blood disorders; they should be advised
48
1. ANTI-INFECTIVES

to get admission into hospitals if gonorrhoea, Haemophilus ducreyi and


symptoms such as fever, sore throat, Chlamydia trachomatis; though AIDS
rash, mouth ulcers, purpura, bruising or caused by the human immunodeficiency
bleeding develop; breast-feeding, virus (HIV) is not yet a very common STD
pregnancy; best to avoid in porphyria; in Bangladesh, there are special reasons
Contraindications: Blood dyscrasia, for awareness against this new global
hypersensitivity to dapsone menace. Syphilis and gonorrhoea being
Interactions: See Appendix-2 the two most prevalent STDs, the drug
Side-effects: Dose-related and not treatments regimens for these two
common at dose used for leprosy, diseases are described.
hemolysis in G-6PD deficient patients,
methemoglobinemias rather common; 1.1.12 OTHER ANTIBACTERIALS
neuropathy, allergic dermatitis anorexia,
nausea, vomiting, pruritus, tachycardia,
CHLORAMPHENICOL[ED] [OTC] [A]
headache, insomnia, psychosis during
therapy of lepromatous leprosy; (See section 10.2 & 11.1.1)
erythema nodosum leprosum often
develops Chloramphenicol was found to have a
Dose: Oral: leprosy, 100 mg daily or 1-2 serious (often fatal) bone marrow
mg/kg daily, depression However, it is still the drug of
choice for enteric fever when other
Generic Preparation antibiotics are resistant. For H. influenzae
Tablet, 100mg infections, especially meningitis,
emergence of ampicillin resistant strains
led to a reappraisal of the use of
RIFAMPICIN[ED]
chloramphenicol.
see under Drugs for tuberculosis Indications: Severe rickettsial infections
such as typhus or rocky mountain fever
1.1.11 DRUGS USED IN SEXUALLY in children, alternative to a beta-lactam
TRANSMITTED DISEASES for bacterial meningitis due to penicillin-
resistant strain of pneumo- or meningo-
Sexually transmitted diseases (STDs) are coccus and in penicillin-allergic patients,
a group of communicable diseases that alternative to tetracyclines for acute and
are transmitted predominantly by sexual chronic brucellosis, eye and ear
contact and caused by a wide range of infections caused by susceptible
bacterial, viral, protozoal and fungal organisms
agents, and also by different Cautions: Dose must be reduced in
ectoparasites. hepatic impairment, in newborns less
The highest incidence of STDs is than a week old and in premature infants;
observed in 2024 years age group. repeated courses & prolonged treatment
Certain socio-demographic factors such are not recommended; periodic blood
as population explosion, rapid counts and monitoring of plasma
urbanization and industrialization, rural to concentration (in neonates) are required
urban migration, prostitution, broken Contra-indications: Pregnancy, breast-
homes, sexual disharmony, social feeding, porphyria
disruption and alcoholism undoubtedly Interactions: See Appendix-2
contribute towards the increase of STDs Side-effects: Blood dyscrasia such as
in a developing country like Bangladesh. leucopenia, thrombocytopenia, dose-
Over 20 pathogens have been found to related reversible suppression of red-cell
spread commonly by sexual contact. The production, idiosyncratic irreversible
most common of these pathogens with aplastic anemia; also peripheral neuritis,
usual clinical manifestations are optic neuritis; erythema multiforme;
Treponema pallidum, Neisseria nausea, vomiting, diarrhea, grey baby
49
1. ANTI-INFECTIVES

syndrome (abdominal distension, pallid 4 divided doses; severe infections, at


cyanosis, circulatory collapse) usually least 300 mg daily regardless of weight
after excessive doses in neonates with
immature hepatic function Proprietary Preparations
Dose: Oral IV inj. or infusion: ADULT & Anobac(Globe), Cap., 300 mg, Tk. 15.00/Cap.
CHILD, 50-100 mg/kg/d in 4 divided Asiclin(Asiatic), Cap., 150mg , Tk. 8.00/Cap.
doses; INFANTS < 2 weeks, 25 mg/kg/d ,300mg , Tk. 15.00/Cap.; Inj., 300mg /2ml, Tk.
39.00/2ml, 600mg/4ml, Tk. 69.00/4ml
in 4 divided doses; topical (as 0.5% Cinamycin(Ibn Sina), Cap. , 150mg, Tk.
solution and 1% ointment); 2-3 drops/in 8/Cap.; 300mg, Tk. 15/Cap.;Inj., 300mg/2ml,
thin layer 2-3 times or more Tk. 200.00/2ml.; 600mg/4ml , Tk. 350.00/4ml
Cleocin(Healthcare), Cap., 150mg, Tk.
Proprietary Preparation 300.00/Cap.; 300mg , Tk;. 448.00/Cap.
Chloramphenicol(Hudson), Cap., 250mg, Cleodin(General), Cap., 150mg, Tk.
Tk.2.50/Cap. 6.00/Cap.; 300mg, Tk. 15.04/Cap.; Inj.,
300mg/2ml, Tk. 40.12/2ml,600mg/4ml, Tk.
(See also section 10.2&11.1., For skin 70.21/4ml
Climycin(Square), Cap, 150 mg, Tk.
and ENT preparation) 8.06/Cap.300 mg, Tk. 15.10/Cap.
Clinacyn(Beximco), Cap., 150mg, Tk.
CLINDAMYCIN 8.00/Cap.; 300mg, Tk. 15.00/Cap.
Clincin (Navana), Cap., 150 mg, Tk.
8.00/Cap.; 300mg, Tk. 15.00/Cap.;Syrup, 75
Indications: Severe anaerobic infection
mg/5 ml, Tk. 250/100 ml
caused by bacteroids and other Clinda(Astra Bio), Cap. , 150 mg, Tk.
anaerobes, septic abortion, pelvic 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
abscesses, with an aminoglycosides or Clindabac(Popular), Cap.,150 mg, Tk.
cephalosporin to treat penetrating wound 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
of gut, with primaquine as an alternative Clindacin(Incepta), Cap. ,150 mg, Tk.
to co-trimoxazole in pneumocystis 8.00/Cap., 300 mg, Tk. 15.00/Cap.;
Inj.,300mg/2ml, Tk. 40.00/2ml. ; 600mg/4ml,
pneumonia in AIDS patients and with
TK.. 70.00/4ml.; Suspn., 75 mg /5 ml, Tk.
pyrimethamine in AIDS-related 280.00/100 ml
toxoplasma encephalitis; topically in Clindamet(Somatec), Cap., 150 mg, Tk.
acne. 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
Cautions: Should be discontinued if Clindaver (Veritas), Cap., 300 mg, Tk.
there is diarrhea or colitis, requires 15.00/Cap.
monitoring of renal and hepatic functions Clindax(Opsonin), Inj., 300 mg/2 ml, Tk. 40.15/
2 ml, 600 mg/4 ml, Tk.70.26/4ml,;Cap.,150 mg,
in prolonged therapy and in neonates
Tk. 8.03/ Cap., 300 mg , Tk. 15.06/Cap.;
and infants; renal or hepatic impairment, Suspn., 75 mg /5 ml, Tk. 250.94/ 100 ml
pregnancy and breast-feeding Clinex(Aristo), Cap., 150mg , Tk. 8.00/Cap.;
Contra-indications: Diarrheal states 300mg, Tk.15.00/cap
Interactions: See Appendix-2 Daclin(ACI), Cap.,150mg, Tk.
Side-effects: Diarrhea, nausea, 8.02/Cap.,300mg, Tk.15.05/Cap
vomiting, pseudomembranous colitis, Dalacin(Drug Intl), Cap.,300mg, Tk.
15.05/Cap.; Inj.,300mg/2ml, Tk. 40.15/2ml. ;
impaired liver function, jaundice,
600mg/4ml, Tk. 70.25/4ml.
neutropenia, eosinophilia, Endamycin(Euro), Cap., 150mg, Tk.
agranulocytosis, thrombocytopenia, rash, 15.00/Cap.; 300mg, Tk. 8.00/Cap.
urticaria, erythema multiforme, exfoliative Fortior(Pharmacil), Cap.,300mg, Tk.
and vesiculobullous dermatitis 22.00/cap.
Dose: Oral: 150-300 mg every 6 hours; Linacin(Sharif), Cap. , 150 mg , Tk. 8.03/Cap.;
up to 500 mg every 6 hours in severe 300 mg , Tk. 15.04/Cap.
Lincocin(Acme), Cap. ,300 mg , Tk.
infections; CHILD 10-20 mg/kg/d in 4
15.04/Cap.
divided doses; deep IM inj. or IV infusion: Lindamax(Eskayef), Cap, 150mg, Tk.
0.6-2.7 g daily in 2-4 divided doses; life- 8.00/Cap.; 300mg , Tk. 15.00/Cap. ;
threatening infection, up to 4.8 g daily; Maxclin(Alco), Tab., 150 mg, Tk. 8.00/Tab.;
CHILD > 1 month, 15-40 mg/kg daily in 3- 300 mg,Tk. 15.00/Tab.

50
1. ANTI-INFECTIVES

Qcin (Renata), Inj., 300 mg/2 ml, Tk. 40.00/2 FOSFOMYCIN [R][C]
ml; 600 mg/4 ml, Tk. 70.00/4 ml;Cap. 150 mg,
Tk. 8.00/Cap.; 300 mg, Tk. 15.00/Cap.
Xindal (Orion), Cap., 150 mg, Tk. 8.00/Cap.; Indications: Uncomplicated urinary tract
300 mg, Tk. 15.00/Cap. infections (acute cystitis) in women due
to susceptible strains of Escherichia coli
LINEZOLID[C] and Enterococcus faecalis
Cautions:Breast
Indications: Pneumonia, complicated feeding,Pregnancy,Renal Impairmen
skin and soft tissue infections caused by Contra-indications: Patients with severe
Gram- positive bacteria including those renal insufficiency (CLcr<10ml/min),
due to vancomycin-resistant enterococci patients undergoing haemodialysis
and methicillin resistant S aureus Interactions:Concomitant administration
Cautions: Blood count including platelet of metoclopramide has been shown to
count requires weekly monitoring; if lower serum and urinary concentrations
significant myelosuppression, treatment and should be avoided.
should be stopped; visual function Side-effects: Headache dizziness
monitoring is required in long dyspepsia vulvovaginitisdizziness
therapy(more than 28 days), patients Dose: Oral: ADULT: Uncomplicated
should be warned to report symptoms of lower urinary tract infections: one sachet
visual impairment immediately; history of (3g)
seizures, hepatic impairment, renal Child:not recomeded under the age of12
impairment, pregnancy; tyramine–rich Year
foods Note: Fosfomycin is for oral
Interactions: See Appendix -2 administration and should be taken on an
Contra-indications: Breast-feeding; empty stomach, either 1 hour before or at
patients using MAO-inhibitor drugs least 2 hours after meals and preferably
Side-effects: Diarrhea, nausea, and before bedtime after emptying the
vomiting, metallic taste, dizziness and bladder. The contents of a sachet should
abnormal liver function test; reversible be dissolved in a glass of water and
myelosuppression including anemia; taken immediately after its preparation.
leucopenia, pancytopenia, and in
particular, thrombocytopenia has been Proprietary Preparation
Fosamin(Beximco), Granules for Oral Solution,
reported 3mg, Tk. 350.00/sachet
Dose: Oral or IV infusion over 30-120
minutes: ADULTover 18 years600mg
NITROFURANTOIN[ED] [A] [C]
every 12 hours for 10-14 days

Proprietary Preparations Indications: For long-term suppression


Arlin(Beximco), Inj., 600 mg/300 ml, Tk. and treatment of uncomplicated lower
450.00/ Vial,; Suspn., 100mg/5ml, Tk. urinary tract infections
280.00/100ml,; Tab., 400mg , Tk. 60.00/Tab.; Cautions: Hepatic insufficiency; elderly
600mg , Tk. 85.0003/Tab. patients (risk of acute pulmonary
Ezolid(ACI), Tab., 400mg, Tk. 60.00/Tab. ; reactions); anemia; diabetes mellitus;
600mg, Tk. 85.00/Tab.
electrolyte imbalance; vitamin B and
Linexil(Opsonin), Inj., 600 mg/300 ml, Tk.
451.36/ Vial,; Suspn., 100 mg /5 ml, Tk. folate deficiency; pulmonary disease;
280.00/100 ml. urine may be colored yellow or brown;
Linzolid(Incepta), Inj., 600 mg/300 ml, Tk. Contra-indications: Known
450.00/ Vial,; Suspn. 100 mg/5 ml, Tk. hypersensitivity, renal impairment,
280.00/100 ml; Tab., 400 mg, Tk. 60.00/Tab.; pregnancy (at term) and breast-feeding;
600 mg, Tk. 85.00/Tab. infants less than 3 months old, G6PD
deficiency; acute porphyria
Interactions: See Appendix-2

51
1. ANTI-INFECTIVES

Side-effects: Diarrhea, nausea, and dyspnea, headache, depression,


vomiting; neurological disturbances dizziness, muscle spasm, rash,
including dizziness, headache, vertigo, pruritus;less commonly anorexia, taste
nystagmus, benign intracranial disturbances, dry mouth, peripheral
hypertension, severe and sometimes edema, sleep disturbances, anxiety,
irreversible peripheral polyneuropathy; memory impairment, convulsions,
hypersensitivity reactions including skin hypoesthesia, paraesthesia, antibiotic-
rashes, urticaria, pruritus, fever, associated colitis, influenza-like
erythema multiforme, Steven-Johnson symptoms, dysuria, polyuria, glycosuria,
syndrome, exfoliative dermatitis, polymenorrhoea, blood disorders,
pancreatitis, blood disorders (including hyperkalemia; rarely blood pressure
agranulocytosis, thrombocytopenia, and changes, constipation
aplastic anemia); acute pulmonary Dose: Oral: travellers' diarrhea not
sensitivity reactions characterized by associated with fever, bloody diarrhea,
sudden onset of fever, chills, blood or leucocytes in the stool, or 8 or
eosinophilia, cough, chest pain , more unformed stools in the previous 24
dyspnea, pleural effusion, chronic hours: ADULT over 18 years, 200 mg
symptoms include interstitial pneumonitis every 8 hours for 3 days; reduction in
and pulmonary fibrosis recurrence of hepatic encephalopathy,
Dose: Oral: acute uncomplicated ADULT over 18 years, 550 mg twice daily
infection, ADULT, 50 mg every 6 hours
with food for 7 days (3 days usually Proprietary Preparations
adequate in women); CHILD, over 3 Aximin(Acme), Tab., 200 mg , Tk. 20.07/Tab.,
months, 750 micrograms/kg every 6 550 mg , Tk. 45.13/Tab.
hours; severe chronic recurrent infection, Efaxim(Square), Tab., 200 mg, Tk.
20.00/Tab., 550 mg, Tk. 45.00/Tab.
100 mg every 6 hours with food for 7 Faxan(Drug Intl), Tab., 200mg, Tk. 20.10/Tab.,
days (dose reduced or discontinued if 550mg, Tk. 40.15/Tab.
severe nausea); prophylaxis, 50–100 mg Henlix(ACI), Tab., 200mg, Tk. 25.00/Tab.,
at night; CHILD over 3 months, 1 mg/kg 550mg, Tk. 45.00/Tab.
at night Hepatab(Ibn Sina), Tab., 200mg, Tk.
20.00/Tab., 550mg, Tk. 50.00/Tab.
Proprietary Preparations Hepaximin(Aristo), Tab., 200mg , Tk.
20.00/Tab., 550mg , Tk. 45.00/Tab.
Nintoin(Incepta), Suspn., 25 mg/5 ml, Tk.
Rifabac(Popular), Tab. , 200mg, Tk.
80.00/100ml.; Cap., 100 mg, Tk. 20.00/Cap. ;
100 mg, Tk. 4.00/Cap. ; Tab. , 100 mg, Tk. 25.00/Tab., 550mg, Tk. 65.00/Tab.
6.00/Tab. Rifacol(Sharif), Tab. , 200 mg, Tk.
Nitrofur, (ACI), Suspn, 25mg/5ml, Tk. 20.07/Tab., 550 mg, Tk. 45.13/Tab.
80.00/100ml Rifagut(Opsonin), Tab. , 200 mg, Tk.
Ofuran(Pacific), Tab. , 100 mg, Tk. 20/Tab. 20.06/Tab., 550 mg, Tk. 45.00/Tab., 200 mg,
Tk. 20.00/Tab.
Rantoin(Drug Intl), Tab., 100mg, Tk. 6/Tab.
Rifagyl(Globe), Tab. , 550 mg, Tk. 45.00/Tab.
Urobak(Opsonin), suspn.,, 25 mg/5 ml, Tk.
Rifamax(Incepta), Tab. , 200 mg, Tk.
60.00/ 100 ml ,; Tab, 100 mg , Tk. 6.00/Tab.
Urocure(Square), Cap. , 100 mg, Tk. 25.00/Tab., 550 mg, Tk. 65.00/Tab.
Rifaxin(Ziska), Tab. , 200 mg, Tk. 20.00/Tab.,
20.06/Cap. ; Suspn. , 25 mg/5 ml, Tk.
550 mg, Tk. 45.00/Tab.
80.24/100ml
Rixmin(Astra Bio), Tab. , 200 mg, Tk. 20/Tab.
Xifamin(Nipro JMI), Tab., 200 mg, Tk.20/Tab.
RIFAXIMIN
SODIUM FUSIDATE
Indications: See under Dose
Caution: Hepatic impairment Fusidic acid and its salts are effective
Contra-indications: hypersen-sitivity; against Staphylococci, notably Staph.
intestinal obstruction; pregnancy and aureus and Staph. epidermidis including
breast-feeding methicillin-resistant strains. Neisseria B.
Interactions: See Appendix -2 fragilis and many clostridialare used
Side-effects: Nausea, vomiting, mainly in the treatment of staphylococcal
abdominal pain, flatulence, diarrhea,
52
1. ANTI-INFECTIVES

infection They have been used in the prophylaxis in orthopedic surgery at risk
treatment of abscess including brain of infection with Gram-positive organisms
abscess, in bones and joint infections, Cautions: Blood count, kidney and liver
and topically in the treatment of in eye function tests required; vancomycin
infections and infections of the skin (see sensitivity; monitoring of auditory function
also section 10.2&12.2) if other nephrotoxic or neurotoxic drugs
Indications: See notes above given; pregnancy
Cautions: Liver function tests required Interactions: See Appendix -2
Side-effects: Nausea, vomiting, Side-effects: Rush, pruritus; rarely,
abdominal pain, reversible jaundice, nausea, vomiting, diarrhea, dizziness,
especially after rapid intravenous bronchospasm, mild hearing loss,
injection or infusion; altered liver function vestibular disorders; renal failure,
tests; neutropenia, eosinophilia, urticaria, Stevens-Johnson syndrome, toxic
rash, thrombophlebitis epidermal necrolysis
Interactions: See Appendix-2 Dose: Loading dose of 6mg/kg IV 12hrly
Dose: See section 10.2.&12.2 for 3doses, them maintenance dose of
6mg/kg IV once daily. Insevere
Proprietary Preparations infections, higher doses have been used;
Facid (Eskayef),Tab, 250mg, Tk. 65.00/Tab 12mg/kg IV 12hrly for 3 doses, then
Fusidin Leo(I) (Leo),Tab.111.02/Tab 12mg/kg daily.
(See section 10.2. for Eye and12.2 for Skin IV inj. or infusion, ADULT > 70 kg body
preparation)
weight, initially 400 mg 12 hourly for 3
doses, then (may be given by IM inj.) 400
SPECTINOMYCIN[A] mg once daily; CHILD over 2 months, IV
inj. or infusion, initially 10 mg/kg (max.
This is a narrow-spectrum bacteriostatic 400 mg) 12 hourly for 3 doses, then 6
antibiotic structurally related to mg/kg (max. 200 mg) once daily
aminoglycosides and is effective against
a number of gram-negative organisms Proprietary Preparations
but is inferior to other drugs to which Targocid(I) (Gruppo), Inj., 200 mg/Vial, Tk.
such organisms are susceptible. 872.08/Vial; 400 mg/Vial, Tk. 1568.62/Vial
Indications: Recommended as Tergocin (Incepta),Inj.,200mg/vial,Tk.1600/vial
alternative treatment for uncomplicated
gonococcal infection in patients who are TIGECYCLINE[R]
intolerant or allergic to beta-lactam drugs
and fluoroquinolones Tigecycline should be reserved for the
Cautions: Renal and hepatic impairment treatment of complicated skin and soft-
Interactions: See Appendix-2 tissue infections and complicated
Side-effects: Nausea, dizziness, abdominal infections caused by multiple-
urticaria, fever; rarely nephrotoxicity and antibacterial resistant organisms when
anemia other antibacterials cannot be used; it is
Dose: deep IM inj. a single dose of 2 g or not recommended for the treatment of
40 mg/kg foot infections in patients with diabetes.
Indications: See notes above
Proprietary Preparation Cautions: Cholestasis; dose reduction in
Tinobac (Incepta), Inj., 2 gm/vial, Tk. hepatic impairment; also see under
250.00/Vial tetracyclines
Contra-indications: hypersensitivity to
TEICOPLANIN[W] Tetracyclines
Interactions: See Appendix -2
Indications: Treatment of serious Gram- Side-effects: Nausea, vomiting,
positive infection including endocarditis, abdominal pain, dyspepsia, diarrhea,
dialysis-associated peritonitis; anorexia, bilirubinaemia, dizziness,
53
1. ANTI-INFECTIVES

headache, hypoglycaemia, prolonged interstitial nephritis; blood disorders


prothrombin time, prolonged activated including neutropenia (usually after
partial thromboplastin time, rash, pruritus, receiving dose of 25g); rarely
and injection-site reactions; less agranulocytosis; and thrombocytopenia;
commonly pancreatitis, cholestatic nausea; eosinophilia; anaphylaxis,
jaundice, and hypoproteinaemia; also rashes including, exfoliative dermatitis;
reported, antibiotic-associated colitis, and toxic epidermal necrolysis; phlebitis;
hepatic failure, thrombocytopenia, on rapid infusion, severe hypotension
Stevens-Johnson syndrome (including shock and cardiac arrest);
Dose: IV infusion:ADULT, over 18 years, wheezing, dyspnea; urticaria, pruritus
initially 100 mg, then 50 mg every 12 Dose: Oral: in antibiotic associated
hours for 5–14 days; initially 100 mg colitis, 125mg every 6 hours for 7 to
then 25 mg every 12 hours in 10days; dose may be increased if
severehepatic impairment infection is severe or fails to respond.
CHILD, 5mg/kg every 6 hours, over 5
Proprietary Preparations years half adult dose; By intravenous
Widebac(Incepta),IV. Infusion, 50 mg/vial, Tk. infusion, 500mg over at least 60 minutes
600.00/vial every 12 hours, ELDERLY, over 65
Tygacil(I)(Wyeth) ,IV. Infusion 50 mg/Vial, Tk. years, IV. Infusion 500mg every 12 hours
4120/Vial
or 1g once daily; NEONATE up to
1week,15mg/kg initially then 10mg/kg
VANCOMYCIN[W] every 12 hours; INFANT 1-4weeks,
15mg/kg initially then 10mg/kg every 8
Indications: For the treatment of serious hours; CHILD over 1month, 10mg/kg
Staphylococcal or other Gram-positive every 6 hours
infections where other drugs such as the
pencillins cannot be used because of Note: plasma concentration monitoring
resistance or patient intolerance. It is required; pre-dose concentration should
used in the prophylaxis and treatment of be 5-10mg/L
endocarditis by intravenous route; (added
to dialysis fluid and used for the Proprietary Preparations
treatment of peritonitis associated with Covan(Renata),IV. Infusion, 1 gm/Vial, Tk.
continuous ambulatory, peritoneal 480.00/vial; 500 mg/vial, Tk. 250.00/vial
dialysis, antibiotic associated colitis Vancard(Techno), IV. Infusion., 1 gm/Vial, Tk.
Cautions: Hypersensitive to it; should 850.00/Vial; 500 mg/Vial, Tk. 470.00/Vial
Vancobac(Popular), IV. Infusion 1 gm/vial, Tk.
not be given intramuscularly; avoid rapid
552.08/vial; 500mg/vial, Tk. 321.21/vial
infusion; rotate infusion site; renal Vancomin(Opsonin), IV. Infusion Vial, 500
impairment; elderly; avoid if history of mg/Vial , Tk. 250.94/vial; 1 gm/Vial, Tk.
deafness; all patients require plasma 481.81/vial
vancomycin measurement (after 3 or 4 Vanmycin(Incepta), IV. Infusion 1 gm/Vial, Tk.
doses if renal function normal, earlier if 480.00/vial; 500 mg/vial, Tk. 250.00/vial
renal impair-ment), blood counts,
urinalysis, and renal functions test; 1.2 ANTIFUNGALS
monitor auditory function in elderly or if (See section 12.2&10.2)
renal impairment; pregnancy and breast 1.2.1 FOR SYSTEMIC FUNGAL
feeding; systemic absorption may follow INFECTIONS
oral administration especially in 1.2.2 FOR MUCOCUTANEOUS
inflammatory bowel disorders or INFECTIONS
following multiple doses 1.2.3 TOPICAL ANTIFUNGALS
Interactions: See Appendix-2
Side-effects: Ototoxicity (discontinue if
tinnitus occurs); flushing of the upper
body (“red man” syndrome); nephro-
toxicity including renal failure and

54
1. ANTI-INFECTIVES

1.2.1 FOR SYSTEMICFUNGAL thrombophlebitis at injection site;


INFECTIONS encephalopathy rarely

AMPHOTERICIN B(See section 1.3.5) Dose:By slow IV infusion, 0.5-1 mg/kg/d,


is an amphoteric polyene macrolide continued to a total dose of 1-2 g;
nearly insoluble lele in water and exhibits Oral: intestinal candidiasis, 100-200 mg
broad-spectrum fungicidal activity. The every 6 hours; INFANT and CHILD 100
drug is effective against clinically mg 4 times daily, oral and perioral
significant yeasts, including C. albicans infections, Amphotericin 10 mg lozenges,
and Cryptococcus neoformans, the 1 lozenge to dissolve slowly in the mouth
organisms causing endemic mycoses 4 times daily for 10-15 days or 100 mg
including Histoplasma capsulatum, suspension placed in the mouth after
Blastomyces dermatitidis and food and retain near lesions 4 times daily
Coccidioides immitis and the pathogenic for 14 days, therapy should be continued
molds, such as Aspergillus fumigatus and for 48 hours after lesions have resolved.
mucor. It has limited activity against the
protozoa L. braziliensis and Naegleria Proprietary Preparation
Tericin(Beacon), Inj., 50mg, Tk. 15045.11/Vial
fowleri.
Indications: Drug of choice for initial
induction regiment for life-threatening FLUCONAZOLE[ED]
mycotic infections such as severe fungal
pneumonia, cryptococcal meningitis, Indications: See under Dose
sepsis syndrome, for empiric therapy Cautions: Renal insufficiency, in
incancer patients with neutropenia, severeform dose interval should be
mycotic corneal ulcers and keratitis, increased from 24 to 48 or 72 hours;
fungal arthritis, candiduria. breast-feeding; monitoring of liver
Cautions: Renal impairment; hepatic function is required in prolonged and or
and renal-function tests, blood counts, high dose therapy, drug should be
and plasma electrolyte monitoring stopped if evidence of hepatic necrosis
required, if any abnormality therapy Contra-indications: Pregnancy, severe
should be discontinued; pregnancy and liver disease, acute porphyria
breast-feeding; when given parenterally, Interactions: See Appendix-2
toxicity common (close supervision Side-effects: Nausea, abdominal
necessary and test dose required); rapid discomfort, diarrhea, and flatulence,
infusion (risk of arrhythmias) and occasionally abnormalities of liver
concurrent corticosteroids therapy need enzymes, rarely rash, angioedema,
to be avoided anaphylaxis, Stevens-Johnson syndrome
Contra-indications: Hypersensitivity and fixed drug eruption; skeletal and
Interactions: See Appendix -2 cardiac deformities in infants born to
Side-effects: when given parenterally, women taking high doses during
anorexia, nausea and vomiting, diarrhea, pregnancy has also been reported
epigastric pain; febrile reactions, Dose: Candidiasis: oropharyngeal
headache, muscle and joint pain; candidiasis, orally, 200 mg on the first
anemia; disturbances in renal function day then 100 mg daily for 2 weeks;
with renal tubular acidosis, hypokalemia esophageal candidiasis, orally, 100-200
and hypomagnesemia; cardiovascular mg daily; vaginal candidiasis and
toxicity including arrhythmias; blood candidial balantitis, orally, 150 mg as a
disorders; neurological disorders single dose; deep candidiasis in allogenic
including hearing loss, diplopia, bone marrow transplant recipients and
convulsions, peripheral neuropathy, candidemia in non-immunocompromised
abnormal liver function; rash, patients, orally, 400 mg daily; CHILD oral
anaphylactoid reactions; pain and or IV infusion, 3-6 mg/kg on first day then
3 mg/kg daily, every 72 hours in
55
1. ANTI-INFECTIVES

NEONATE up to 2 weeks old, every 48 and hair loss; rhabdomyolysis is also


hours in NEONATE 2-4 weeks old; Tinea reported
pedis, corporis, cruris, pityriasis Dose: Oral : oropharyngeal candidiasis,
versicolor, and dermal candidiasis, orally, 100 mg daily, 200 mg daily in AIDS or
50 mg daily for 2-4 weeks for up to 6 neutropenia for 15 days; vulvovaginal
weeks in tinea pedis; cryptococcosis candidiasis, 200 mg twice daily for 1 day;
including meningitis, oral or IV infusion, pityriasis versicolor, 200 mg daily for 7
400 mg daily for initial 8 weeks, then 200 days; tinea corporis and tinea cruris, 100
mg daily; CHILD 6-12 mg/kg daily, every mg/d for 15 days or 200 mg/d for 7 days;
72 hours in NEONATE up to 2 weeks old, tinea pedis and manuum, 100 mg daily
every 48 hours in NEOANTE 2-4 weeks for 30 days or 200 mg twice daily for 7
old, max. 400 mg daily; prevention of days; onychomycosis, 200 mg daily for 3
relapse of cryptococcal meningitis in months; histoplasmosis, 200 mg 1-2
AIDS patients after completion of primary times daily; systemic aspergillosis,
therapy, 100-200 mg daily; candidiasis and cryptococcosis including
coccidioidomycosis including meningitis, cryptococcal meningitis, histoplasmosis
oral or by IV infusion, 200-400 mg daily; where other antifungal drugs
prevention offungalinfections in inappropriate or ineffective, 200 mg once
immunocompromised patients following daily, IV infusion: 200 mg every 12 hours
cytotoxic chemotherapy or radiotherapy, for 2 days, then 200 mg once daily for
oral or by IV infusion, 50-400 mg daily max. 12 days; maintenance in AIDS
adjusted according to risk; CHILD patients to prevent relapse of underlying
according to extent and duration of fungal infection and prophylaxis in
neutropenia, 3-12 mg/kg daily, every 72 neutropenia when standard therapy
hours in NEONATE up to 2 weeks old, inappropriate, 200 mg once daily
every 48 hours in NEONATE 2-4 weeks
old, max. 400 mg daily Proprietary Preparations
Itra(Square), Cap., 100 mg, Tk. 15.10/Cap.
Proprietary Preparations Trec(Team), Cap., 100 mg, Tk. 14/Cap.
See section 12.2 Iconal(Kemiko), Cap., 100mg, Tk. 15.04/Cap.

ITRACONAZOLE KETOCONAZOLE

This is a synthetic triazole having Indications: Systemic mycoses, serious


mechanism and antifungal spectrum of chronic resistant mucocutaneous
activity similar to those of fluconazole. candidiasis, serious mycoses of gut not
Indications: See under Dose responsive to other therapy, chronic
Cautions: Absorption is impaired in vaginal candidiasis not responsive to
AIDS patients, neutropenia and when other therapy, dermatophytes infections
gastric acidity is reduced; the drug should not responsive to other therapy excluding
be administered at least two hours after infection of the toe nails, prophylaxis of
antacid or a full meal; monitoring of liver mycoses in patients with reduced
function in prolonged therapy, dose immune responses
adjustment in renal impairment, liver Cautions: See notes above;liver function
disease, risk of heart failure with high tests before, during and after treatment;
dose, drug should be discontinued if porphyria
peripheral neuropathy; Contra-indications: Hepatic impairment,
Contra-indications: Severe hepatic pregnancy, breast-feeding
impairment, acute porphyria; pregnancy Interactions: See Appendix-2
Interactions: See Appendix-2 Side-effects: Nausea, anorexia,
Side- effects: See under fluconazole; vomiting, rashes, pruritus, hepatitis;
also heart failure, hypertriglyceridemia, gynaecomastia, decreased libido in
hypertension, peripheral neuropathy; in males, at high doses azospermia has
prolonged therapy hypokalemia, edema, been reported; also hypertension, fluid

56
1. ANTI-INFECTIVES

retention, asymptomatic elevation of ECHINOCANDINS


aminotransferase
Dose: Oral: ADULT 200 mg once daily, The echinocandin antifungals include
increased to 400 mg if required; CHILD Anidulafungin,Caspofungin and
3.3-6.6 mg/kg daily; duration of therapy: Micafungin. They are only active against
5 days for candida vulvovaginitis, 2 Aspergillus spp. and Candida spp.;
weeks for candida esophagitis and 6-12 however, anidulafungin and micafungin
months for deep mycoses; prophylaxis are not used for the treatment of
and maintenance treatment in aspergillosis. Echinocandins are not
immunosuppressed patients, 200 mg effective against fungal infections of the
daily CNS. For the role of echinocandin
antifungals in the prevention and
Proprietary Preparations systemic treatment of fungal infections
Ketocon(Opsonin), Tab., Tk. 8.06/Tab.
KetofunAmico), Tab., TK. 8.30/Tab.
(See section12.2.for skin preparation) ANIDULAFUNGIN

VORICONAZOLE Indications: Oesophageal candidiasis,


Candidemia and other complicated
Indications: Invasive aspergillosis, Candida infections.
invasive fluconazole-resistant Candida Side-effects: Nausea, Vomiting,
spp. Including C krusei, serious infection Hypomagnesaemia, Hypokalemia and
caused by Scedosporium spp., Fusarium Headche.
spp. Dose: For candidemia, 200mg IV on day
Cautions: Monitoring of hepatic and 1, followed by 100mg IV daily. For
renal function and skin cancer oesophageal candidiasis, 100mg IV on
surveillance required; also see notes day 1, followed by 50mg IV daily.
above CHILDREN: Age> 28 days, 1.5-3mg/kg
Contraindications: Acute porphyria loading dose, then 0.75-1.5mg/kg/ day
Interactions: See Appendix-2 (once daily).
Side-effects: Nausea, vomiting,
diarrhea, jaundice, edema, hypotension, Proprietary Preparations
Eraxis(I)(Pharmacia&Upjohn),Inj.,100ml/vial Tk.
chest pain, respiratory distress 11245.25/vial.
syndrome, headache, dizziness, anxiety,
hallucination, paraesthesia, tremor,
CAPSOFUNGIN
hypoglycemia, hematuria, blood
disorders, acute renal failure,
hypokalemia, visual disturbances; less Indications: 1st line of drug for
commonly, hepatitis, cholecystitis, candidemia, candidal intra-abdominal
pancreatitis, arrhythmias, ataxia, abscesses, peritonitis and pleural spaces
nystagmus, adrenocortical insufficiency; infections; Oesophageal candidiasis;
Dose: Oral: ADULT and CHILD over 12 Empiric therapy for febrile, neutropenic
years, body-weight over 40 kg, 400 mg patients; Invasive aspergillosis in patients
12 hourly for 2 doses then reduced to refractory to or intolerant of other
200 mg; body-weight under 40 kg, 200 therapics.
mg 12 hourly for 2 doses then reduced to Cautions: As it is metabolized in liver, so
100 mg; IV infusion: 6 mg/kg 12 hourly reduce dose to 35mg/day IV in moderate
for 2 doses then reduced to 4 mg/kg hepatic insufficiency. Interactions include
Cyclosporine (Hepatic toxicity) and
Generic Preparation tacrolimus (Drug level Monitoring)
Tablet, 200mg; 50mg; Syrup, 200mg/5ml Side-effects: Pruritus at infusion site;
and headache, Fever, Chills, Vomiting
and Diarrhoea associated with infusion.
57
1. ANTI-INFECTIVES

Dose: 70mg IV on 1st day, followed by


50mg IV daily. TERBINAFINE
CHILD: 70mg/m2 IV on 1stday, followed
by 50mg/m2 IV daily (max dose Indications: Fungal infections of the skin
70mg/day) and nails; ringworm infections including
tinea pedis, cruris and corporis
Proprietary Preparations Cautions: Pregnant and breast-feeding
Cancidas(I)(MSD), IV. Infusion, 50mg/Vial Tk.
women; hepatic and renal impairment;
16640.48/vial, 70mg/vial Tk.16640.48/vial
psoriasis, autoimmune disease
Contra-indications: Hypersensitivity
1.2.2FOR MUCOCUTANEOUS Interactions:See Appendix-2
INFECTIONS Side-effects: Gastrointestinal distress,
(see section 12.2.2) mild abdominal pain, skin reactions (rash,
GRISEOFULVIN[ED] urticaria), headache; rarely
hepatotoxicity, severe neutropenia,
This is a narrow-spectrum fungistatic Stevens-Johnson syndrome or toxic
drug given orally and is the choice of epidermal necrolysis may occur; very
treatment for extensive and intractable rarely, psychiatric disturbance, blood
fungal infections disorders
Indications: Fungal infections of skin, Dose: Oral: onychomycosis of nails, 250
hair, nails and scalp where topical mg daily for 3 months; duration of oral
therapy is inappropriate or failed therapy for ringworm infections is 2-6
Cautions: May impair performance of weeks with local application of cream
skilled tasks, aggravation of systemic twice daily
lupus erythematosus; breast-feeding,
pregnancy should be avoided during Proprietary Preparations
therapy and for 1 month after treatment, Infud(General), Tab.250mg, Tk. 50.00/Tab.
men should not father children within 6 Mycofin(Eskayef), Tab, 250mg, Tk. 40/Tab.
months of treatment Mycofree(Drug Intl), Tab., 250mg, Tk. 25/Tab.
Skinabin(ACI), Tab., 250mg, Tk. 40.27/Tab.
Contra-indications: Severe liver
Telfin(UniMed), Tab., 250mg, Tk. 50.00/Tab.
disease, lupus erythematosus rashes,
(See section12.2 for skin preparation)
mental confusion, peripheral neutritis,
headache, nausea, vomiting, vertigo,
gastric discomfort, augmentation of 1.2.3 TOPICAL ANTIFUNGALS
alcohol effects, transient macular edema (See section12.2)
Interactions: See Appendix-2
Side-effects: Hepatotoxicity, Superficial fungal infections including
photosensitivity, urticaria, erythematous dermatophytosis (ringworm), candidiasis,
rashes, mental confusion, peripheral tinea versicolor, piedra, tinea nigra and
neuritis, headache, nausea, vomiting, fungal keratitis are treated successfully
vertigo, gastric discomfort, augmentation by topical antifungals with or without
of alcohol effects, transient macular concomitant administration of systemic
edema antifungal drugs. Topical administration
Dose: Oral: 500 mg daily, in divided of antifungal is usually not successful for
doses or as a single dose, in severe mycoses of the nails (onychomycosis)
infection dose may be doubled; CHILD and hair (tinea capitis) and not
10 mg/kg daily in divided doses or as a recommended for subcutaneous
single dose mycoses (sporotrichosis and
chromomycosis). Besides the type of
Proprietary Preparations lesion and mechanism of drug’s action,
Fulcinex(ACI), Suspn, 2.5gm/100ml, Tk. viscosity, hydrophobicity and acidity of
23.49/60ml; Tab., 500mg, Tk. 5.60/Tab. the formulation are important
Grisovin FP(GSK), Tab., 500mg, Tk. 5.88/Tab determinants of the efficacy of topical
Grisozen(Zenith),Tab., 500 mg, Tk. 6.68/Tab. agents in superficial mycoses. Because
58
1. ANTI-INFECTIVES

of thepoor penetration of the topical 1.3 ANTIPROTOZOAL DRUGS


drugs into hyperkeratotic lesions, 1.3.1 ANTIMALARIALS
removal of the thick keratin is a useful 1.3.2 AMEBICIDES
adjunct to therapy. 1.3.3 TRICHOMMONOCIDES
(See section 12.2.2) 1.3.4 ANTIGIARDIAL DRUGS
1.3.5 LEISHMENIACIDES
CLOTRIMAZOLE[ED]
(See section 12.2.2& 6.2.2) 1.3.1 ANTIMALARIA DRUGS

ECONAZOLE CHEMOTHERAPY OF MALARIA


(See section 12.2.2& 6.2.2) (see also Appendix-1h)

MICONAZOLE[ED] Chemoprophylaxis: As no antimalarial


drug kills sporozoites, which initiate
(See section 12.2.2) infection in humans, it is not truly
possible to prevent infection. Drugs can
NYSTATIN[ED] only prevent the development of
(See section 12.2.2 & 6.2.2) symptomatic malaria either by clinical
suppression (keeping the parasite count
Indications: Candidiasis of mouth, in blood below threshold level of clinical
esophagus or intestinal tract, vaginal attack) or by causal prophylaxis
candidiasis, skin infection, perineal (destroying pre-erythrocytic intrahepatic
pruritus forms of parasites).
Cautions: If irritation or sensitization Prophylaxis for infections with
develops, treatment should be chloroquine-sensitive P. falciparum P.
discontinued, pregnancy vivax. P. malariae, and P. ovale.
Contra-indications: Hypersensitivity
Interactions: See Appendix-2 ADULT 500 mg of chloroquine phosphate
Side-effects: Nausea, vomiting, (300 mg of base) weekly starting one
diarrhea, local irritation or burning week before entering an endemic area
sensation may occur and continuing until 4 weeks after
Dose:oral: Intestinal candidiasis 500,000 leaving; CHILD, 8.3 mg/kg of chloroquine
units every 6 hours, doubled in severe phosphate (5 mg base per kg) taken
infections; CHILD 100,000 units every 6 orally by the same schedule; in pregnant
hour; prophylaxis, 1 million units once women chloroquine be maintained in
daily; NEONATE 100,000 units once adult dose until delivery;
daily Prophylaxis for infections with
chloroquine-resistant or multidrug-
Proprietary Preparations resistant strains ofP.
See section 12.2.2 & 6.2.2 falciparum:Regimens:
ADULT & CHILD > 45 kg body weight:
TIOCONAZOLE mefloquine 250 mg tablet weekly starting
1 week before entering an endemic area
(See section 12.2.2 & 6.2.2) and ending 4 weeks after leaving;
Tioconazole, an imidazole, is used for the pediatric doses taken by the same
treatment of Candida vulvovaginitis. A schedule are, CHILD weighing 5-9 kg
single 4.6 g dose of ointment containing 31.25 mg, 10-19 kg 62.5 mg, 20-30 kg
6.5% drug is given at bedtime. 125 mg; and for those weighing 31-45 kg
187.5 mg; OR
ADULT doxycycline 100 mg daily; CHILD
over 8 years of age, the dosage is 2
mg/kg given once daily, increasing up to
59
1. ANTI-INFECTIVES

the daily adult dose. Prophylaxis with mefloquine 15 mg/kg (or 25 mg/kg) to
doxycycline should begin 1 day before affect a radical cure
travel to an endemic area and end 4
weeks after leaving. Generic Preparation
Note: doxycycline use for malaria Injection 80 mg/ml
prophylaxis should not exceed 4 months;
it should not be given to children less ARTEMETHER PLUS LUMEFANTRINE
than 8 years of age or to pregnant (Tablet, artemether 20 mg with
women lumefantrine 120 mg)

ARTEMISININS Indications: Treatment of acute


uncomplicated malaria due to
Artemisinin has three major Plasmodium falciparum mixed infections
semisynthetic derivatives in clinical use, including P. falciparum in areas with
Dihydroartemisinin, Artemether and significant drug resistance.
Artesunate.The short plasma t1/2 of Cautions: ECG required before and
these drugs often leads to treatment during treatment in cardiac disorder
failure when artimisinins are used as including bradycardia, heart failure,
monotherapy. Combining an artemisinin history of arrhythmias, QT interval
derivative with a longer–lasting partner prolongation, electrolyte disturbances,
drug ensures sustained antimalarial concomitant administration of drugs that
activity. prolonged QT interval; patients unable to
take food require monitoring (greater risk
ARTEMETHER[ED] of recrudescence); severe renal
impairment or hepatic impairment, avoid
This lipid soluble analog of artemisinin is in acute porphyria; dizziness may affect
a potent blood schizontocides against all performance of skilled tasks (e.g.
human malaria parasites but not effective driving); pregnancy, breast-feeding.
against dormant hepatic forms. Contra-indications: Family history of
Artemether also exhibit antiparasitic sudden death, congenital prolongation of
activity against several other protozoa QT interval,history of arrhythmias, of
including Leishmania major and clinically relevant bradycardia, and of
Toxoplasma gondii and against congestive heart failure accompanied by
schistosomes, but not used clinically to reduced left ventricular ejection fraction
treat these infections Interactions: See Appendix-2
Indications: Treatment of severe malaria Side-effects: Abdominal pain, anorexia,
including infections due to chloroquine diarrhea, nausea and vomiting,
and multidrug-resistant strains of P. headache, dizziness, sleep disorders;
falciparum. palpitations, arthralgia, myalgia; cough,
Cautions: Cardiac diseases asthenia, fatigue; pruritus,
Contra-indications: First trimester of rash.Dose:oral: treatment of
pregnancy uncomplicated falciparum malaria,
Interactions: See Appendix -2 ADULT & CHILD > 12 years and body
Side-effects: Headache, nausea, weight > 35 kg, initially 4 tablets followed
vomiting, abdominal pain, dizziness, by 5 doses of 4 tablets each after 8, 24,
tinnitus, neutropenia, elevated liver 36, 48 and 60 hours (total 24 tablets over
enzyme values; cardiotoxicity (after high 60 hours); CHILD body-weight 10-14 kg
dose). initially 1 tablet followed by 5 doses of 1
Dose: Treatment of P.falciparum malaria tablet each after 8, 24, 36, 48 and 60
(in areas of quinine resistance), by IM inj. hours (total 6 tablets over 60 hours);
ADULT & CHILD > 6 month, loading body-weight 15-24 kg initially 2 tablets
dose of 3.2 mg/kg daily until patient can followed by 5 doses of 2 tablet each after
tolerate oral medication or to maximum 7 8, 24, 36, 48 and 60 hours (total 12
days; this is followed by a single dose of tablets over 60 hours); body-weight 25-
60
1. ANTI-INFECTIVES

34 kg, initially 3 tablets followed by 5 CHLOROQUINE [ED]

doses of 3 tablet each after 8, 24, 36, 48


and 60 hours (total 18 tablets over 60 Indications: Chemoprophylaxis and
hours) treatment of malariarheumatoid arthritis,
lupus erythematosus, adjunct to
Proprietary Preparations metronidazole in extra-intestinal
Artemet(Incepta),Tab. , 20 mg +120 mg, Tk.
amebiasis
20.00/Tab.
Lumertam(Square), Tab, 20 mg + 120 mg, Tk. Cautions: Impaired renal and hepatic
20.13/Tab. functions(avoid concurrent therapy with
Coavlon(ACI), Tab., 20mg+120mg, Tk. hepatotoxic drugs); neurologic or
20.14/Tab. hepatologic disorders, G6PD deficiency;
Arexel(Jayson), Tab. 20 mg + 120 mg, Tk. may aggravate myasthenia gravis,
17.06/Tab. psoriasis.
Contra-indications: Psoriasis,
ARTESUNATE[ED] porphyria, retinal or visual field
abnormalities, myopathy
This water-soluble analog of artemisinin Interactions: See Appendix -2
is useful for oral, IV, IM and rectal Side-effects: Pruritus, anorexia, malaise,
administration. The drug exhibits similar headache, nausea, vomiting, abdominal
pharmacological profile like that of pain, diarrhea, blurring of vision, rashes,
artemether (see above). urticaria; rarely psychotic episodes,
Indications: Treatment of uncomplicated convulsions, depigmentation and loss of
P. falciparum malaria in areas of multiple- hair, impaired hearing, hemolysis in G-
drug resistance 6PD deficient patients, agranulocytosis,
Cautions: Risk of recurrence if used exfoliative dermatitis, hypotension, QRS
alone in non-immune patients; also see widening and T wave abnormalities in
under artemether ECG; long-term administration of high
Contra-indications: First trimester of doses for rheumatologic diseases can
pregnancy. result in irreversible ototoxicity,
Interactions: See Appendix-2 retinopathy, myopathy and peripheral
Side-effects: Headache, nausea, neuropathy; large IM inj. or rapid IV
vomiting, abdominal pain, diarrhea, infusion can cause severe hypotension
dizziness, tinnitus, neutropenia, elevated and respiratory and cardiac arrest
liver enzyme values; ECG abnormalities, Dose: Oral: Treatment of non-falciparum
including prolongation of QT interval; malaria, ADULT initialdose of 620 mg of
temporary suppression of reticulocyte base thena single dose of 310 mg of
response.and induction of black-water base after 6 to 8 hours then a single dose
fever, of 310 mg of base daily for 2
Dose:Oral: treatment of uncomplicated days(approximate total cumulative dose
P. falciparum malaria (in an areas of of 25 mg/kg of base);
multiple-drug resistance), ADULT & CHILD initial dose of 10 mg base/kg then
CHILD > 6 months, 4 mg/kg daily for 3 a single dose of 5 mg base /kg after 6-8
days; a single dose of mefloquine 15 hours followed by single dose of 5 mg
mg/kg (or 25 mg/kg,) is given on day 2 or base/kg daily for 2 days; rheumatic
3 to affect a radical cure; if artesunate disease, 150 mg base daily, max. 2.5 mg
used alone, treatment should be base/kg daily; CHILD up to 3 mg base/kg
continued for 7 days daily; Prophylaxis of malaria, started 1
week before entering endemic area and
Proprietary Preparation continued for 4 weeks after leaving,
Artex(Jayson), Tab. 50 mg, Tk. 12.05/Tab. 310 mg once weekly; child up to 6 weeks
body-weight under 4.5 kg, 25 mg once
weekly; 6 weeks–6 months body-weight
4.5–8 kg, 50 mg once weekly; 6 months–
61
1. ANTI-INFECTIVES

1 year body-weight 8–11 kg, 75 mg once sleep disorders; neuropsychiatric


weekly; 1–3 years body-weight 11–15 kg, reactions like depression, (suicidal
100 mg once weekly; 3–4 years body- ideation and suicide reported), confusion,
weight 15–16.5 kg, 125 mg once weekly; acute psychosis or seizures; tinnitus,
4–8 years body-weight 16.5–25 kg, vestibular disorders, visual disturbances,
150 mg once weekly (or 155 mg once circulatory disorders, bradycardia,
weekly if tablets used); 8–13 years body- cardiac conduction disorders, muscle
weight 25–45 kg, 225 mg once weekly weakness, myalgia, arthralgia, rash,
(or 232.5 mg once weekly if tablets urticaria, pruritus, alopecia, asthenia,
used); over 13 years, body-weight over malaise, fatigue, fever, loss of appetite,
45 kg, adult dose leucopenia or leukocytosis,
thrombocytopenia. Side effects may
Proprietary Preparations occur and persist up to several months
Avloquin(ACI), Syrup 80mg/5mlml, Tk. after discontinuation
14.91/60ml; Tab., 250mg, Tk. 1.22/Tab Dose : Oral: prophylaxis starting 2–3
Clit(Hudson), Syrup, 125mg/5ml, Tk.12.00/60 weeks before entering endemic area and
ml; Tab., 250mg, Tk.1.20/Tab.
Jasochlor(Jayson), Tab. , 250 mg, Tk.
continued for 4 weeks after leaving:
1.21/Tab.; Syrup, 80 mg/5 ml, Tk.14.87/60ml ADULT and CHILD body-weight over
Quinolex(Globe), Syrup, 80 mg / 5 ml, Tk. 45 kg, 250 mg once weekly; body-weight
20/60 ml,; Tab. , 250 mg, Tk. 1/Tab. 5–16 kg, 62.5 mg once weekly; body-
Supraquin(Supreme), Syrup, 80mg/5ml,, Tk. weight 16–25 kg, 125 mg once weekly;
14.00/60ml,; Tab., 250 mg, Tk. 14.40/Tab. body-weight 25–45 kg, 187.5 mg once
Zenoquine(Zenith), Syrup, 80mg/5ml, , Tk. weekly; for treatment, ADULT & CHILD
14.65/60ml,; Tab., 150 mg+ 250mg, Tk.
1.30/Tab.
20 mg base/kg (max. 1.5 g) as a single or
preferably in 2 divided doses 6-8 hours
apart daily for 3 days; also see Notes
MEFLOQUINE[ED]
above
Indications: Prophylaxis of malaria in Proprietary Preparations
areas where there is a high risk of Meflon(ACI), Tab., 250 mg, Tk. 39.61/Tab.
chloroquine-resistant falciparum malaria; Larimef(Healthcare), Tab., 250 mg , Tk.
Cautions: Severe hepatic and renal 39.60/Tab.
impairment; traumatic brain injury; may
impair fine motor skills like airplane PRIMAQUINE[ED]
piloting or car driving ( may occur and
persist up to several months after Indications:Radical cure of P. vivax and
stopping the drug); patient counseling to P. ovale malaria; with clindamycin an
discontinue mefloquine and to seek alternative to co-trimoxazole for
immediate medical attention if pneumocystis carinii infection.
neuropsychiatric symptoms appear Cautions:Pregnancy (risk of neonatal
Contra-indications: Should not be used hemolysis and methemoglobinemias in
for treatment if it has been used for third trimester); breast-feeding, G-6PD
prophylaxis; epilepsy, psychiatric deficiency (See notes above), diseases
disorders and history thereof including associated with granulocytopenia i.e.
depression or convulsions (for rheumatoid arthritis, lupus erythematosus
prophylaxis); cardiac arrhythmia and Contra-indications:Hemolytic anemia
conduction defects; hypersensitivity to Interactions:See Appendix-2
quinine; also not recommended for use in Side-effects:Anorexia, nausea, vomiting,
first trimester of pregnancy and in jaundice, less commonly, mild diarrhea,
children weighing less than 5 kg and / or methemoglobinemias, hemolytic anemia
< 3 months especially in G6PD deficiency,
Interactions: See Appendix -2 agranulocytosis, cardiac arrhythmia
Side-effects:: Nausea, vomiting, Dose: Oral: ADULT 15 mg daily for 14-
diarrhea, abdominal pain, dizziness, loss 21 days following a course of
of balance, headache, somnolence,
62
1. ANTI-INFECTIVES

chloroquine; CHILD, over 6 months of Cautions: See under Pyrimethamine and


age: (specialist advice should be sought under Co-trimoxazole; not recommended
for children under 6 months of age); in P. for prophylaxis because of severe side-
vivax infection, 500 micrograms/kg (max. effects on long-term use; possible
30 mg) daily for 14 days, and for P. teratogenic risk in first
ovale, 250 micrograms/kg (max. 15 mg) trimester (pyrimethamine a folate
daily for 14 days; antagonist); in third trimester risk of
PREGNENCY: the radical cure with neonatal hemolysis and
primaquine should be postponed until the methemoglobinemias; discontinue if
pregnancy is over; instead chloroquine cough or shortness of breath
should be continued at a dose of 310 mg Contra-indications: See under Co-
each week during the pregnancy trimoxazole; sulfonamide allergy
Interactions: See Appendix -2
Proprietary Preparations Side-effects: See under Pyrimethamine
Jasoprim (Jayson), Tab.,15mg, Tk.1.26/Tab and under Co-trimoxazole (section
Kanaprim(Globe), Tab. , 15 mg, Tk. 0.62/Tab. 1.1.8.); pulmonary infiltrates (e.g.
P-Phos, (Hudson), Tab., 15mg, Tk. 0.62/Tab. eosinophilic or allergic alveolitis) reported
Remaquin(ACI), Tab., 15mg, Tk. 1.51/Tab.
Dose: Oral:ADULT, pyrimethamine
75 mg with sulfadoxine 1.5 g as a single
PYRIMETHAMINE[ED] dose together with, or after, a course of
quinine: CHILD, up to 4 years and body-
Indications: with sulfadoxine for weight over 5 kg, pyrimethamine 12.5 mg
treatment of Falciparum malaria with (or with sulfadoxine 250 mg; 5–6 years,
following) quinine; with sulfadiazine for pyrimethamine 25 mg with sulfadoxine
treatment of toxoplasmosis in 500 mg; 7–9 years, pyrimethamine
immunocompromised patients; 37.5 mg with sulfadoxine 750 mg; 10–14
Cautions: Renal or hepatic insufficiency, years, pyrimethamine 50 mg with
folate supplements required in sulfadoxine 1 g; 14–18 years,
pregnancy, breast-feeding blood count pyrimethamine 75mg with sulfadoxine
monitoring required in prolonged therapy; 1.5g
history of seizures (avoid large loading
doses) Proprietary Preparations
Interactions: See Appendix-2 Malacide(Square), Tab., 500 mg+25 mg, Tk.
Side-effects: Depression of 4.43/Tab.
hematopoiesis with prolonged treatment; Sulfamin(Jayson), Tab., 500 mg+25 mg, Tk.
nausea, vomiting, diarrhea; headache, 4.43/Tab.
dizziness, rashes; less commonly fever,
abnormal skin pigmentation; very QUININE[ED]
rarely colic, buccal ulceration,
convulsions Indications: First-line drug for treatment
Dose: See Pyrimethamine with of severe, uncomplicated falciparum
Sulfadoxine below malaria in an area with documented
chloroquine-resistant malaria, with
Proprietary Preparations clindamycin first-line therapy for babesial
See under Pyrimethamine with infections; nocturnal leg cramps
Sulfadoxinebelow Cautions: Great cautions required in
patients with underlying cardiac
PYRIMETHAMINE WITH abnormalities (including atrial fibrillation,
SULFADOXINE[ED] conduction defects, heart block), elderly,
monitor ECG during parenteral treatment;
Indications: Adjunct to quinine in the monitor blood glucose and electrolyte
treatment of P.falciparum malaria during parenteral treatment; G6PD
deficiency; renal and hepatic insufficiency
63
1. ANTI-INFECTIVES

require dose adjustment, therapy should pyrimethamine 75 mg with sulfadoxine


be discontinued if signs of cinchonism, 1.5 g; IVquinine 20 mg/kg infuse over 4
hemolysis or hypersensitivity; high doses hours, then10 mg/kg infuse over 4 hours,
are teratogenic in first trimester; but in every 8-12 hourly followed by oral
malaria benefit of treatment considered quinine;
to outweighs risk In nocturnal leg cramps: 200–300 mg
Contra-indications: Visual and auditory of quinine salt at bedtime for at least 4
problems; hemoglobinuria; myasthenia weeks, if improvement, continue
gravis
Interactions: See Appendix-2 Proprietary Preparations
Side-effects: Cinchonism, including Albiquin(Albion), Tab., 300 mg, Tk. 6.40/Tab.
tinnitus, headache, nausea, dizziness, Aloquin(Alco), Tab., 300 mg, Tk.3.40/Tab.
flushing and visual disturbances, Jasoquin(Jayson), Inj., 300 mg/5 ml, Tk.
20.59/Amp. Tab., 300 mg, Tk.6.42/Tab.
abdominal pain, blindness;
hypersensitivity reactions including
rashes, angioneurotic edema, 1.3.2 ANTIAMEBIC DRUGS
bronchospasm; hematologic
abnormalities like hemolysis particularly METRONIDAZOLE[ED] [OTC] [A]
in G-6PD deficient patients, leucopenia,
agranulocytosis, thrombocytopenia; may Metronidazole is effective against
cause hypoglycemia, severe hypotension tropozoites of E. histolytica, G. lamblia,T.
and ECG abnormalities like QT vaginalis, all anaerobic cocci and both
prolongation after rapid IV infusion, rarely anaerobic gram-negative bacilli, including
black water fever that includes marked Bacteroides species, and anaerobic
hemolysis and hemoglobinuria spore-forming gram-positive bacilli. Non-
Dose:treatment of falciparum malaria: sporulating gram-positive bacilli, aerobic
Oral: ADULT,600 mg of quinine salt and facultative anaerobic bacteria as well
every 8 hours for 5–7 days together with as the cysts of E. histolytica are not
or followed by either doxycycline 200 mg sensitive. The drug is completely and
once daily for 7 daysor clindamycin 450 promptly absorbed after oral intake and
mg every 8 hours for 7 days;if the with the exception of placenta,
parasite is likely to be sensitive, penetrates well into body tissues and
pyrimethamine 75 mg with sulfadoxine fluids, including CSF, vaginal secretions,
1.5 g as a single dose (instead of either seminal fluids, and saliva and breast
clindamycin or doxycycline) together milk. It is eliminated in the urine largely
with, or after, a course of quinine 600 mg as metabolites.
every 8 hours for 7 days; CHILD, Indications: See under Dose
10 mg/kg (of quinine salt, max. 600 mg) Cautions: Disulfiram-like reaction with
every 8 hours for 7 days together with or alcohol, repeated therapy requires
followed by leukocyte count before, during and after
Clindamycin 7–13 mg/kg (max. 450 mg) each course of treatment; pregnancy,
every 8 hours for 7 days or in children lactation; great caution in patients with
over 12 years, doxycycline 200 mg once central nervous system disease, drug
daily for 7 days should be withdrawn if numbness or
or if the parasite is likely to be paraesthesia of the extremities occur
sensitive, pyrimethamine with sulfadoxine Contra-indications: First trimester
as a single dose: up to 4 years and pregnancy
body-weight over 5 kg, pyrimethamine Interactions: See Appendix-2
12.5 mg with sulfadoxine 250 mg; 5–6 Side-effects: Dry mouth, metallic taste,
years, pyrimethamine 25 mg with furred tongue, stomatitis, nausea,
sulfadoxine 500 mg; 7–9 years, diarrhea, rashes; headache, dizziness,
pyrimethamine 37.5 mg with sulfadoxine ataxia, erythema multiforme, darkening of
750 mg; 10–14 years, pyrimethamine urine, pruritus, urticaria, angioedema,
50 mg with sulfadoxine 1 g; 14–18 years, anaphylaxis, abnormal liver function
64
1. ANTI-INFECTIVES

tests, hepatitis, jaundice, Proprietary Preparations


thrombocytopenia, aplastic anemia, Amodis(Square), Suspn, 200 mg/5ml, Tk.
myalgia, arthralgia, peripheral 29.89/60ml,; Tab. , 500 mg, Tk. 1.91/Tab. ;
neuropathy in prolonged treatment, 400 mg, Tk. 1.27/Tab. Inj.,( IV Infusion), 500
mg/100 ml, Tk. 53.56/Vial,;
ataxia and transient epileptic seizures Amotrex(ACI), Inj.,( IV Infusion),, 500 mg/100
with high doses; dysuria, cystitis and a ml, TK. 85.26/ Vial;Suspn, 200 mg/5ml, TK.
sense of pelvic pressure also have been 29.9/60ml ,; Tab., 200mg, TK. 0.69/Tab. ;
reported 400mg, TK. 1.27/Tab. ; 800mg, TK. 2.02/Tab.
Dose:Urogenital trichomoniasis, oral: Anzole(Monico), Suspn, 200 mg/5ml, Tk.
ADULT 2 g as a single dose or 250 mg 25.00/60ml,; Tab., 400mg, Tk. 1.14/Tab.
thrice daily or 375 mg twice daily for 7 Benmet(Pacific), Tab.,400 mg, Tk. 1.26/Tab.
Biozyl(Biopharma), Inj.,( IV Infusion),, 500
days; CHILD 1-3 years 50 mg every 8 mg/100 ml, Tk. 75.00/100ml Vial,; Suspen, 200
hours; 3-7 years 100 mg twice daily, 7-10 mg/5ml, Tk. 25.09/60ml,; Tab., 400mg , Tk.
years 100 mg thrice daily; amebiasis, 1.00/Tab.
oral: ADULT 500-750 mg thrice daily for Decagyl(Decent), Tab., 400mg, Tk. 1.00/Tab.
10 days; CHILD 35-50 mg/kg/d in three Dirozyl(Acme), Supp., 500mg., Tk.
divided doses for 10 days; giardiasis, 12.09/Supp,
oral: ADULT 250 mg thrice daily for 5 Filmet(Beximco), Suspn, 200 mg/5ml, Tk.
29.89/60ml,; Tab., 400mg, Tk. 1.52/Tab.;
days; CHILD, 15 mg/kg thrice daily for 5 200mg, Tk. 0.68/Tab.; 800mg, Tk. 2.01/Tab.;
days; anaerobic infections, IV infusion: Inj.,( IV Infusion),, 500 mg/100 ml, Tk.
ADULT 15 mg/ kg followed 6 hours later 54.00/Vial
by 7.5 mg/kg every 6 hours for 7-10 Flagyl(Sanofi), Suspn. , 40mg/ml, Tk.
days; CHILD 7.5 mg/kg every 8 hours; 29.89/Suspn. ; Tab., 200mg, Tk. 0.67/Tab.;
orally, ADULT 800 mg initially then 400- 400mg, Tk. 1.58/Tab.
500 mg every 8 hours; CHILD 7.5 mg/kg Flamyd(Incepta), Suspn, 200 mg/5ml, Tk.
29.50/60ml,; Tab, 400 mg, Tk.
every 8 hours;rectally, 1g every 8 hours 1.05/Tab.; 500mg, Tk. 1.92/Tab.; Vaginal Gel,
for 3 days, then 1g every 12 hours for 7- 750mg/100gm, Tk. 50.00/30gm,; Inj.,( IV
10 days; leg ulcers and pressure sores, Infusion), 500 mg/100 ml, Tk. 53.40/100ml Vial
orally: 400 mg every 8 hours for 7 days; Gly(Astra Bio), Suspn, 200 mg/5ml, Tk.
bacterial vaginosis, orally: 400-500 mg 25.00/5ml
twice daily for 5-7 days or 2 g as a single Kemet(Kemiko), Tab., 400 mg, Tk. 1.26/Tab.
dose: pelvic inflammatory disease, orally, Librazol(Libra), Inj.,( IV Infusion),, 500 mg/100
ml, Tk. 49.90/100ml Vial
400 mg twice daily for 14 days; acute M-Dazole(Modern), Tab., 400 mg, Tk.
ulcerative gingivitis, orally: ADULT 200- 1.20/Tab.
250 mg every 8 hours for 3 days; CHILD Mecozol(Amico), Suspn, 200 mg/5ml, TK.
1-3 years, 50 mg every 8 hours for 3 25.00/60ml,; Tab., 400mg, TK. 1.50/Tab.
days; 3-7 years, 100 mg every 12 hours; Menilet(Alco), Tab. , 400 mg, Tk. 1.57/Tab.
7-10 years, 100 mg every 8 hours; acute Menol(Supreme), Suspn, 200 mg/5ml, Tk.
dental infections, oral: 200 mg every 8 25.75/60ml,; Tab., 400 mg, Tk. 1.14/Tab.
Metco(Eskayef), Inj.,( IV Infusion),, 500 mg/100
hours for 3-7 days; Helicobacter pylori ml, Tk. 60.18/ 100ml Vial,; , Suspn, 200
eradication, oral: 400 mg twice/thrice mg/5ml, Tk. 29.89/60ml,; Tab., 400mg, Tk.
daily; 1.26/Tab.;
surgical prophylaxis, oral: 400 mg every Metfil(Bristol), Tab. , 400mg , Tk. 1.00/Tab.
8 hours started 24 hours before surgery, Metonid(Popular), Tab. , 400mg, Tk.
then continued postoperatively by IV 1.14/Tab.; Inj.,( IV Infusion), 500 mg/100 ml,
infusion or by rectum until oral Tk. 52.95/100ml Vial
Metrion(General), Inj.,( IV Infusion),, 500
administration can be resumed; CHILD mg/100 ml, Tk. 80.24/100ml Vial,; Tab. ,
7.5 mg/kg every 8 hours; through rectum: 400mg, Tk. 1.14/Tab.; Suspn, 200 mg/5ml,
1 g every 8 hours; CHILD 5-10 years, Tk.25.76/60ml
500 mg every 8 hours; IV infusion: 500 Metro(Ziska), Suspn, 200 mg/5ml, Tk.
mg shortly before surgery then every 8 25.00/60ml,; Tab, 400 mg, Tk. 1.05/Tab.
hours until oral administration can be Metrobac(Ziska), Inj.,( IV Infusion), 500
started; CHILD 7.5 mg/kg every 8 hours mg/100 ml, Tk. 53.00/100 ml Vial

65
1. ANTI-INFECTIVES

Metromax(Novo ), Tab. , 250 mg, Tk. Xynor(Beximco), Tab., 500 mg, Tk. 6.50/Tab.
0.78/Tab.; 500 mg, Tk. 1.35/Tab.;IVInfusion,
500 mg/100 ml, Tk. 52.00/100ml Val SECNIDAZOLE
Metrozen(Zenith), Suspn, 200 mg/5ml, Tk.
21.44/60 ml,; Tab., 400 mg, Tk. 1.07/Tab. Indications: Amebiasis, and has also
Metryl(Opsonin), Inj.,( IV Infusion),, 500 mg , been tried in giardiasis, and
Tk. 53.57/100 ml Vial,; Tab., 200 mg , trichomoniasis.
Tk.0.67/Tab. ; 400 mg , Tk. 1.27/Tab. ; 500 mg Cautions, Contraindications & Side-
, Tk. 1.91/Tab. ; Suspen, 200 mg/5ml, Tk. effect: See under Metronidazole
29.59/ 60 ml,; Dose: Oral: Giardiasis: ADULT, single
Metsina(Ibn Sina), Inj.,( IV Infusion),, 500
dose of 2g; CHILD, 30mg/kg; invasive
mg/100 ml, Tk. 75.00/100ml Vial,; Tab., 400
mg, Tk. 155.00/Tab. hepatic amebiasis ADULT, 1.5g single
Mez iv(Renata), Inj.,( IV Infusion),, 500 dose or in divided doses for 5 days
mg/100 ml, Tk. 70.00/100 ml Vial
Micogyl(Globe), Tab. , 400 mg, Tk. 1.20/Tab.; Proprietary Preparations
IVInfusion, 500 mg/100 ml, Tk. 53.41/100 ml Pronil(Acme), Tab., 1 gm., Tk. 16.11/Tab., 500
Vial mg., Tk. 8.66/Tab.
Nidazyl(Orion), Suspn, 200 mg/5ml, Tk. Secnid(Square), Tab., 1 gm, Tk. 20.06/Tab.
29.89/60ml,; Tab. , 400 mg, Tk. 1.05/Tab. Secnidal(Sanofi), Tab., 1 gm, Tk. 25.46/Tab.
Strazyl(Asiatic), Suspn., 4gm/100ml, Tk. Secnizol(Incepta), Tab., 1 gm, Tk. 16.00/Tab.
24.84/60ml,; Tab., 200mg, Tk. 0.66/Tab. ; Sezol (ACI), Tab., 1 gm, Tk. 17.05/Tab.
400mg , Tk. 1.02/Tab.
TINIDAZOLE
ORNIDAZOLE Indications: See under Dose
Cautions: See under Metronidazole;
Indications: Treatment of susceptible also avoid breast-feeding during and for
protozoal infections and treatment and 3 days after stopping treatment
prophylaxis of anaerobic bacterial Contra-indications: Acute porphyria;
infections also see under Metronidazole
Cautions: See under metronidazole; Interactions: See Appendix-2
also blood dyscrasia; doses should be Side-effects: See under Metronidazole
reduced in patients with severe liver Dose: Oral: intestinal amebiasis: ADULT
disease and CHILD 12-18 years, 2 g daily in a
Interactions: See Appendix-2 single dose for 3 days, CHILD, 1 month-
Side-effects: See under metronidazole 12 years, 50-60 mg/kg (max. 2 g) once
Dose: IV infusion:severe amoebic daily for 3 days; hepatic amebiasis:
dysentery and amoebic liver abscess: 0.5 ADULT and CHILD 12-18 years, 1.5-2 g
to 1 gm initially, followed by 500mg every once daily for 3-6 days, CHILD, 1 month-
12 hours for 3 to 6 days; 12 years, 50–60 mg/kg (max. 2 g) once
Oral:amebiasis: ADULT: 500mg twice daily for 5 days; giardiasis and
daily for 5-10 days; CHILD :25 mg/kg trichomoniasis, , ADULT and CHILD 12-
daily 500mg as a single dose 5-10 18 years, 2 g as a single dose (repeat
days;giardiasis, ADULT:1 or 1.5 g as a once if required) , CHILD 1 month–12
single daily dose for 1 or 2 days; CHILD years single dose of 50–75 mg/kg (max.
:500mg as a single dose;trichomoniasis, 2 g) (repeat once if necessary)
a single dose of 1.5 g or 1 gm together anaerobic infections, oral: treatment, 2 g
with 500 mg vaginally; 5 day course of initially then 1 g daily for minimum 5-6
500 mg twice daily are also used, (sexual days; prophylaxis 2 g as a single dose;
partners should be treated concomitantly) by slow IV infusion: treatment, 800 mg
daily, prophylaxis, 1600 mg as a single
Proprietary Preparations dose;
OR-500(Zenith), Tab. 500 mg, Tk. 6.52/Tab. bacterial vaginosis and acute ulcerative
Ornid(Drug Intl), Tab., 500 mg, Tk. 7.05/Tab. gingivitis, 2 g as a single dose;
Ornil(Opsonin), Tab., 500 mg, Tk. 7.00/Tab.
Ornizol(Alco), Tab., 500 mg, Tk. 6.02/Tab.
abdominal surgery prophylaxis, a single 2
Robic(Square), Tab., 500 mg, Tk. 7.02/Tab. g dose approximately 12 hours before
Troniz(UniMed), Tab , 500 mg, Tk. 6.50/Tab. surgery; CHILD 50-60 mg/kg/d.
66
1. ANTI-INFECTIVES

Proprietary Preparations Nidor(Pharmasia), Susp., 100 mg/ 5 ml, Tk.


Tinizol DS(Beacon), Tab. , 1 gm, Tk. 5.72/Tab. 50.00/60 ml; Tab., 500 mg, Tk. 10.04/Tab.
T-Zol(Popular), Tab. , 500 mg, Tk. 2.77/Tab.; 1 Nidozox(Acme), Suspn, 100 mg/5 ml, Tk.
gm, Tk. 5.75/Tab. 40.12/30ml,; Tab., 500.00 mg, Tk. 10.07/Tab.
Nitalet(Amulet), Tab., 500 mg, Tk. 10.00/Tab.
Nitanid(Drug Intl), Suspn, 100 mg/5 ml, Tk.
1.3.3.DRUGS FOR TRICHOMONIASIS 50.20/60ml,; Tab., 500mg, Tk. 10.05/Tab.
Nitasis(Navana), Susp., 100 mg/ 5 ml, Tk.
1.3.4 ANTIGIARDIAL DRUGS 35.00/30 ml, Tk. 10.00/Tab.
Nitasol(Ibn Sina), Suspn, 100 mg/5 ml, Tk.
36.00/30ml,; Tk. 50.00/60ml,; Tab.,500mg, Tk.
Giardiasis, caused by the flagellated 132.00/Tab.
protozoan Giardia lamblia, can be Nitax(Delta), Tab., 500 mg, Tk. 8.00/Tab.
successfully treated by metronidazole Nitaxen(Leon), Susp., 100 mg/ 5 ml, Tk.
and related nitroimidazoles like tinidazole 35.00/30 ml; 500 mg, Tk. 10.00/Tab.
and scenidazole. Other than these, Nitaxide(Beximco), Tab., 500mg, Tk.
10.00/Tab.;Suspn, 100 mg/5 ml, Tk.
paromomycin and nitazoxanide are also
35.00/30ml,;Tk. 50.00/60ml
used for clinical cure. Nitazet(Organic), Tab. , 500 mg, Tk.
10.03/Tab. ; Suspn, 100 mg/5 ml, Tk.
NITAZOXANIDE 35.11/30ml , 100 mg/5 ml, Tk. 50.15/60ml
Nitazox(Incepta), Suspn, 100 mg/5 ml, Tk.
50.00/60ml,; Tk. 1.167/30ml,; Tab.,Tk.
Indications: Treatment of G intestinalis 10.00/Tab.
infections and treatment of diarrhea Nitide(Nipro JMI), Susp., 100 mg/ 5 ml, Tk.
caused by cryptosporidia 35.00/30 ml; Tk. 50.00/60 ml; Tab., 500mg , Tk.
Cautions:Pregnancy, breast-feeding; 10.00/Tab.
greenish discoloration of urine Nitoxin(Aristo), Suspn, 100 mg/5 ml, Tk.
Interactions:See Appendix-2 36.00/30ml, Tk. 50.00/60ml,; Tab., 500mg , Tk.
Side-effects: GI disturbances: 10.00/Tab.
Nixar(Sharif), Susp., 100 mg/ 5 ml, Tk.
abdominal pain, nausea, vomiting, 35.00/30 ml; Tab. 500 mg, Tk. 10.00/Tab.
iarrhea; headache; rarely, fever, malaise, Nizox(Somatec), Suspn, 100 mg/5 ml, Tk.
pruritus, dizziness, rhinitis 35.00/30ml,; Tab., 500 mg, Tk. 10.03/Tab.
Dose: Oral: ADULT, 500 mg twice daily Ntz(Asiatic), Suspn, 100 mg/5 ml, Tk.
for 3 days; CHILD, 12-47 months, 100 35.00/30ml,Tk. 50.00/60ml
mg twice daily for 3 days; 4-11 years, Proxa-A(Ad-din), Tab., 500 mg, Tk. 9.00/Tab.;
200 mg twice daily for 3 days Susp. , 100 mg/5 ml, Tk. 35/30 ml
Tazonid(Popular), Suspn, 100 mg/5 ml, Tk.
32.12/30mll
Proprietary Preparations Tazox(Novo Health), Suspn, 100 mg/5 ml, Tk.
Adnix(Alco), Suspn, 100 mg/5 ml, Tk. 35.00/30ml,; Tab. , 500 mg, Tk. 10.00/Tab.
35.11/30ml ,; Tab. , 500 mg, Tk. 10.03/Tab. Toza(Eskayef), Suspn, 100 mg/5 ml, Tk.
Albizox(Albion), Susp., 100 mg/ 5 ml, Tk. 35.00/30ml,; Tk. 50.00/60ml,; Tab, 500mg, Tk.
50.00/60 ml 10.00/Tab.; Tk. 10.00/Tab.
Alinix(Healthcare), Suspn, 100 mg/5 ml, Tk. Xanide(Globe), Suspn, 100 mg/5 ml, Tk.
35.00/30 ml,; Tk. 50.00/60 ml ,; Tab., 500mg , 35.00/30 ml,; Tk. 50.00/60 ml,; Tab. , 500 mg,
Tk. 300.00/Tab. 10.00/Tab
Antizoa(RAK), Susp., 100 mg/ 5 ml, Tk. Xanita(Renata), Suspn, 100 mg/5 ml, Tk.
35.00/30 ml; Tab. 500 mg, Tk. 10.00/Tab. 40.00/30ml,; Tk. 58.00/60ml,; Tab. , 500mg,
Atinid(Biopharma), Suspn, 100 mg/5 ml, Tk. Tk. 10.04/Tab.
35.13/30ml,; Tk. 50.19/60 ml,; Tab., 500 mg, Zoana(Orion),Suspn, 100 mg/5 ml, Tk.
Tk. 10.04/Tab. 50.24/62ml,; Tk. 35.24/32ml,; Tab. , 500mg,
Dianide(General), Tab. 500mg, Tk. Tk. 10.07/Tab.
10.07/Tab.; Suspn, 100 mg/5 ml, Tk. Zonan(MST), Susp. , 100 mg/5 ml, Tk. 35/30
50.34/60ml,; Tk. 35.25/30ml ml; Tk.50/60 ml ; Tab., 500 mg, Tk. 10/Tab.
Diar(ACI), Suspn, 100 mg/5 ml, Tk. Zox(Square), Tab. , 500 mg, Tk. 10.07/Tab.;
35.24/30ml ,; Tk. 50.34/60ml ,; Tab., 500mg, Suspn, 100 mg/5 ml, Tk.35.24/30gm; Tk. .
Tk. 10.07/Tab. 50.35/60 ml
Nicud, (Monico), Suspn, 100 mg/5 ml, Tk.
35.00/30ml
67
1. ANTI-INFECTIVES

Zoxan(Opsonin), Suspn, 100 mg/5 ml, Tk. treatment; predisposition to QT interval


50.19/ 60 ml ,; Tk. 35.13/30 ml,; Tab., 500 mg, prolongation, concomitant use with drugs
Tk. 10.07/Tab. that prolong the QT interval
Zoxanid(Silva), Tab., 500mg, Tk. 10.04/Tab.;
Suspn, 100 mg/5 ml, Tk. 35.13/ 30 ml; Tk.
Contra-indication: Significant renal
50.19/60ml impairment
Interactions: See Appendix-2
1.3.5 DRUGS FOR LEISHMANIASIS Side-effects: Anorexia, nausea,
vomiting, abdominal pain; ECG changes;
(See section 1.2) headache, lethargy, myalgia; raised liver
The classic therapy for all species of enzymes; coughing and substernal pain;
Leishmania is pentavalent antimony rarely anaphylaxis; and also reported,
(sodium antimony gluconate, sodium fever, sweating, flashing, vertigo,
stibogluconate). As an alternative, bleeding from nose and gum, jaundice,
Liposomal amphotericin B is a highly rash; pain and thrombosis on IV
effective agent for visceral leishmaniasis administration, intramuscular injection
and currently drug of choice in antimony- also painful
resistant disease. Pentamidine isetionate Dose:Visceral leishmaniasis: IM or IV inj.
can be also used in antimony-resistant (injection should be filtered immediately
leishmaniasis. Other drugs include before administration using a filter of
Paromomycin, parenterally for visceral 5 microns or less), ADULT and CHILD,
disease and topical formulation for 20 mg/kg/d for 28 days; cutaneous
cutaneous form, and the orally active leishmaniasis: except L. aethiopica, L.
agent Miltefosine, both for visceral and braziliensis, L. amazonensis, by
cutaneous diseases. intralesional inj. ADULT and CHILD 100-
300 mg into base of lesion, repeated if
SODIUM STIBOGLUCONATE[ED] required, once or twice at intervals of 1-2
days; by IM inj. ADULT and CHILD 10-20
This pentavalent antimonial is effective mg/kg daily until a few days after clinical
against cutaneous as well as visceral cure and negative slit-skin smear; in
leishmaniasis (kala-azar). It is rapidly cutaneous lesion due to, L. braziliensis
absorbed after parenteral (IM or IV inj.) and L. amazonensis, dose is 20 mg/kg
administration and exhibits two phase- daily; mucocutaneous leishmaniasis due
elimination, i.e. with short (about 2 hours) to L. braziliensis: IM inj. ADULT and
and long (> 24 hours) half-life. CHILD 20 mg/kg daily until negative slit-
Indications: Leishmaniasis skin smear or for at least 4 weeks; if
Cautions: Renal and hepatic relapse or unresponsive treatment with
impairment, pregnancy; protein-rich diet pentamidine isetionate or amphotericin-B
should be provided through out treatment
period, iron and other nutritional Generic Preparation
deficiencies and intercurrent infections Injection, 100mg/ml
required to be corrected; monitoring of
cardiac, renal and hepatic functions, MILTEFOSIN
dose reduction or withdrawal of therapy if Indications: Visceral and cutaneous
any abnormality; IV injections must be leishmaniasis
given slowly over 5 minutes (to reduce Cautions: Pregnancy and breastfeeding
the risk of local thrombosis) and stopped Side-effects:Nausea and vomiting,
if coughing or substernal pain; treatment Contra-indication: Pregnancy
of mucocutaneous leishmaniasis may Dose: ADULT- >25kg: 100mg/day, twice
induce severe inflammation around the a day, for 28days;<25kg: 50mg/day,
lesions (may be life-threatening if twice a day, for 28 days.
pharyngeal or tracheal involvement, may
require corticosteroid); heart disease Proprietary Preparation
(withdraw if conduction disturbance- Miltefos(Popular), Cap., 10mg, Tk. 60.23/Tab.;
occurs); monitor ECG before and during 50mg , Tk. 160.60/Tab.

68
1. ANTI-INFECTIVES

primary or recurrent genital herpes


1.4 ANTIVIRAL DRUGS infection requires administration of
1.4.1 DRUGS FOR HERPES VIRUS systemic antiviral drug. Treatment should
INFECTIONS start as early as possible and usually
1.4.2 DRUGS FOR VIRAL HEPATITIS within 5 days of the appearance.
1.4.3 DRUGS FOR INFLUENZA AND Varicella-zoster infection (chicken pox) in
RESPIRATORY SYNCTIAL healthy children between 1 month and 12
VIRUS years is usually mild and does not require
1.4.4 DRUGS FOR HIV INFECTION treatment.

Antiviral agents, similar to the ACICLOVIR


antibacterials, are most active when (Acyclovir)
viruses are replicating.Antiviral drugs
inhibit virus replication in different ways: Indications: Herpes simplex
by directly acting on virus-specific encephalitis, primary and recurrent
proteins and by modulating host genital herpes, herpes simplex skin
immune system. The first category infections, including initial and recurrent
drugs are: Aciclovir, Cidofovir, labial and genital herpes (as a cream),
Famciclovir, Idoxuridine, Valaciclovir, disseminated varicella-zoster in
Adefovir Dipivoxil, Entecavir, immunocompromised patients, neonatal
Telbivudine, Tenofovir Disoproxil, herpes simplex infection
Amantadine, Rimantadine, Cautions: Maintain adequate hydration;
Oseltamivir, zanamavir, Lamivudine, renal impairment requires dose
Zidovudine, Didanosine, Zalcitabine, reduction; pregnancy, breast-feeding,the
Stavudine, Ganciclovir, Tribavirine. ophthalmic ointment causes a mild
The second category includes transient stinging sensation and a diffuse
Interferons and Inosinepranobex. superficial punctate keratopathy which
clears when the drug is stopped
Contra-indications: Hypersensitivity
1.4.1 DRUGS FOR HERPES Interactions: See Appendix-2
VIRUSINFECTIONS Side-effects: Rashes, gastrointestinal
1.4.1.1 DRUGS FOR HERPES disturbances; rises in bilirubin and liver
enzymes, increases in blood urea and
SIMPLEXAND VARICELLA-
ZOSTER creatinine, decreases in hematological
1.4.1.2 DRUGS FOR indices, headache, neurological
reactions, dizziness; also confusion,
CYTOMEGALOVIRUS
hallucinations, agitation, tremors,
1.4.1.1 DRUGS FOR HERPES somnolence, psychosis, convulsions and
SIMPLEX AND coma; extravasation of intravenous
VARICELLA-ZOSTER infusion fluid may cause severe local
INFECTIONS inflammation sometimes leading to
ulceration
Herpes Infection of the mouth, lips and Dose:By mouth Herpes simplex
eye is generally associated with herpes (treatment) 200 mg (400 mg in the
virus serotype 1 (HSV-1) and genital immunocompromised or if absorption is
infection is most often associated with impaired) 5 times daily, usually for 5
HSV-2 and also with HSV-1. Mild days; CHILD under 2 years, half of adult
infection of the eye (ocular herpes) and dose, over 2 years, adult dose
of the lips (herpes labialis) in Herpes simplex (prevention or
immunocompetent individuals is treated recurrence) 200mg 4 times daily or
with a topical antiviral whereas severe 400mg twice daily possibly reduced to
infection, neonatal herpes, infection in 200 mg 2 or 3 times daily and interrupted
immunocompromised individuals, and every 6-12 months
69
1. ANTI-INFECTIVES

Herpes simplex (prophylaxis) in the Xovir(Beacon), Inj.( IV, Infusion),


immunocompromised, 200-400mg 4 250mg/100mlml ,Tk. 401.2/vial.; 500mg/100ml ,
times daily; CHILD under 2 years, half of Tk. 702.11/vial.
adult dose, over 2 years, adult dose;
VALACICLOVIR
Varicella and herpes zoster (treatment)
ADULTS 800mg 5 times daily for 7 days;
CHILD 20 mg/kg (max. 800 mg) 4 times Indications:See under acyclovir; also
daily; 2-5 years 400mg 4 times daily over prevention of cytomegalovirus (CMV)
6 years, 800 mg 4 times daily disease following solid organ
By intravenous infusion (treatment of transplantation when valganciclovir or
herpes simplex in the immunocom- ganciclovir cannot be used
promised, severe initial genital herpes, Cautions, Contra-indications:See
and varicella-zoster) 5mg/kg every 8 under acyclovir
hours usually for 5 days, doubled to 10 Interactions:See Appendix-2
mg/kg every 8 hours in varicella-zoster in Side-effects: See under acyclovir;
the immunocompromised and in simplex neurological reactions more frequent in
encephalitis (usually given for 10 days in high doses
encephalitis); prophylaxis of herpes Dose: Oral:Herpes simplex (treatment)
simplex in the immunocompromised, 500 mg twice daily for 5 days (1 g twice
5mg/kg every 8 hours daily in immunocompromised or HIV
NEONATE: up to 3 months, herpes patients); CHILD under 2 years, half of
simplex, 10mg/kg every 8 hours usually adult dose, over 2 years, adult dose
for ten days; CHILD 3 months-12 years; Herpes labialis, treatment, ADULT and
herpes simplex or varicella-zoster, 250 CHILD over 12 years, 2 g 12 hourly
mg/m2 every 8 hours usually for 5 days, Herpes simplex, suppression, 500 mg
doubled to 500 mg/m2 every 8 hours for daily in 1-2 divided doses in
varicella-zoster in the immunocom- immunocompromised or HIV
promised and in simplex encephalitis patients,500mg twice daily; herpes zoster
(given for 10 days in encephalitis) treatment, 1 g three times daily for 7 days
(See sec.10.2.3&12.2.3.) Prevention of CMV disease following
solid organ transplantation, 2 g 4 times
Proprietary Preparations daily usually for 90 days
Acerux(Opsonin),;Inj.( IV, Infusion), 250
mg/100 ml, Tk. 400.00/100 ml; 500 mg/100 ml, Proprietary Preparations
Tk. 700.00/100 ml;Suspn 200 mg /5ml, Tk. Alaclov(ACI), Tab., 500mg , Tk. 40.15/Tab.
125.47/70 ml; Tab. , 200 mg, Tk. 14.05/Tab.; Revira(Square), Tab., 1 gm, Tk.75.00/Tab.,
400 mg , Tk. 22.00/Tab. 500 mg , Tk. 40.15/Tab.
Acyvir(Aristo), Inj.( IV, Infusion), 250mg/100 Valovir(Incepta), Tab., 1 mg, Tk. 75.00/Tab;
ml, Tk. 400.00/Vial, 500 mg/100 ml, Tk. 500 mg, Tk. 40.00/Tab.
700.00/Vial
Novirax(Drug Intl), Tk. 40.15/Tab.; 200mg, Tk. 1.4.1.2 DRUGS FOR
14.05/Tab.; 400mg, Tk. 22.10/Tab.
.
CYTOMEGALOVIRUS
Simplovir(Incepta), Inj.( IV, Infusion),, (CMV) INFECTIONS
250mg/100 mlTk. 400.00/vial;500 mg/100 ml, GANCICLOVIR
Tk. 700.00/Vial;Tk. 1000.00/100ml;Tab. Tk. (See section 10.2.3)
22.00/Tab. ,Tk. 14.00/Tab.
Viroxi(Eskayef), Tab., 200mg, Tk. 14.00/Tab.
Virunil(Globe), Inj.( IV, Infusion), 250 Indications: life-threatening or sight-
mg/100ml,Tk. 400.00/Vial; 500 mg/100ml, Tk. threatening CMV infections in
700.00/Vial immunocompromised patients only;
Virux(Square), Inj.( IV, Infusion), 250 prevention of CMV disease during
mg/100ml, Tk. 401.20/vial.; 500 mg/100ml, immunosuppressive therapy following
Tk.702.11/vial.;Suspn, 200 mg/5 ml, organ transplantation; local treatment of
Tk.125.85/70ml;Tab., 200
CMV retinitis; congenital cytomegalovirus
mg,Tk.14.1/Tab.;Tab. , 400 mg, Tk. 22.14/Tab.
infection of the CNS

70
1. ANTI-INFECTIVES

Cautions: history of cytopenia; (See section 10.2.3 for Eye preparation)


radiotherapy; ensure adequate hydration
during intravenous administration; infuse 1.4.2.1 DRUGS FOR VIRAL
into vein with adequate flow preferably HEPATITIS
using plastic cannula; children, renal Use of drugs for treatment and/or
insufficiency,potential carcinogen and prophylaxis of viral heapatitis demands
teratogen advice of a specialist. The management
Contra-indications: Hypersensitivity to of acute viral hepatitis is largely
valganciclovir, ganciclovir, aciclovir, or symptomatic. Chronic hepatitis is maily
valaciclovir; abnormally low hemoglobin, due to infections caused by hepatitis B
neutrophil, or platelet counts; pregnancy, (HVB) and hepatitis C (HCV) viruses and
breast-feeding (until 72 hours after last a number of drugs are available for
dose) treating those infections.
Interactions: See Appendix -2 Treatment of Chronic hepatitis: In
Side-effects: Leucopenia, contrast to hepatitis C which is supposed
thrombocytopenia; GI disturbances, to be curable in all affected individual,
hepatic dysfunction, peripheral hepatitis B is capable of establishing
neuropathy, depression, anxiety, lifelong chronic infection in ~10% of
confusion, anorexia, night sweats; patients. Blood is the main source of
myalgia, arthralgia; macular edema, infection and spread may follow
retinal detachment, vitreous floaters, transfusion of infected blood or blood
pruritus,disturbances in hearing and products or result from injections with
vision, and alopecia contaminated needle (most common
Dose: IV infusion: initially 5 mg/kg every among parenteral drug abusers who
12 hours for 14–21 days for treatment or share needles). Products such as
for 7–14 days for prevention; albumin solution and gammaglobulins,
maintenance (for patients at risk of which are pasteurized, are wholly free of
relapse of retinitis) 6 mg/kg daily on 5 risk.Patients with chronic HBV may
days per week or 5 mg/kg daily until develop active hepatitis that can lead to
adequate recovery of immunity; if retinitis fibrosis and cirrhosis and all such
progresses initial induction treatment individuals have a greatly increased
may be repeated; Maintenance treatment incidence of hepatocellular carcinoma.
in AIDS patients where retinitis stable Interferon (IFN) alone or in combination
(following at least 3 weeks of intravenous with ribavirin can cure patients with
ganciclovir), oral: 1g 3 times daily with chronic infection but is associated with
food or 500mg 6 times daily with food in high rates of side effects, often leading to
renal impairment; CHILD, 1 month–18 premature treatment withdrawal. Drugs
years initially (induction) 5 mg/kg every like entecavir, adefovir dipivoxil,
12 hours for 14–21 days for treatment or lamivudine, and telbivudine and tenofovir
for 7–14 days for prevention; disoproxil with potent anti-HBV activity
maintenance (for patients at risk of are much better tolerated than IFN-
relapse of retinitis), 6 mg/kg daily on 5 containing regimens but are not usually
days per weekor 5 mg/kg daily until curative. Tenofovir disoproxil or its
adequate recovery of immunity; if retinitis combination with either emtricitabine or
progresses initial induction treatment lamivudine may be used with other
may be repeated; antiretrovirals in patients who require
Congenital cytomegalovirus infection of treatment for both HIV and chronic
the CNS:IV infusion: NEONATE, 6 mg/kg hepatitis B.
every 12 hours for 6 weeks

Proprietary Preparation
Cymevene(I) (Roche), IV infusion) 500mg/Vial,
Tk. 3,981.00/Vial
71
1. ANTI-INFECTIVES

ADEFOVIR DIPIVOXIL
Proprietary Preparations
Indication: Chronic hepatitis B infection Virodacla (Incepta), Tab., 60 mg, Tk.400/Tab.
Dakovir(Beximco), Tab., 60mg, Tk. 300/Tab.
with either compensated liver disease Dakla (Healthcare), Tab., 60mg, Tk. 400/Tab.
with evidence of viral replication and Daclavir (Beacon),Tab., 60mg, Tk.400/Tab.
histologically documented active liver
inflammation and fibrosis or decomposed
ENTECAVIR
liver disease
Cautions: Monitor renal function in every Indications: Treatment of chronic HBV
3 months, more frequently in renal infection with active viral replication and
Impairment and in patient receiving either evidence of persistence elevations
nephrotoxic drugs ; monitor liver function in serum aminotransferases or
and viral and serological markers for histologically active disease
hepatitis B every 6 months; discontinue if Caution: Monitoring of hepatic function
deterioration in liver function, hepatic every 3 months and viral and serological
steatosis, progressive hepatomegaly or markers for HBV infection every 3-6
unexplained lactic acidosis; pregnancy months during treatment (monitoring
Contraindication: Breast feeding continued for at least 1 year after
Side-effects: Abdominal pain, nausea, discontinuation), therapy discontinue if
vomiting, dyspepsia, flatulence, detoriation in liver function, hepatic
diarrhoea, asthenia, headache, renal steatosis, progressive hepatomegaly or
failure; hypophosphatemia unexplained lactic acidosis; dose
Dose: ADULT over 18 years, 10mg/day reduction if GFR < 50 ml/min/1.732;
pregnancy and breast-feeding
Proprietary Preparations Interactions: See Appendix-2
Antiva(Square), Tab. 10 mg, Tk. 35.14/Tab. Side-effects: headache, fatigue,
Adfovir(Sun), Tab. 10 mg, Tk. 25.17/Tab. dizziness, nausea, vomiting, dyspepsia,
Infovir(Incepta), Tab. 10 mg, Tk. 35.00/Tab. diarrhea, raised serum amylase and
Rezoven(Beximco),Tab.,10mg, Tk. 35.00/Tab lipase; less commonly,
thrombocytopenia, rash, alopecia
DACLATASVIR Dose: Oral: adult over 18 years: not
Indications: In combination with previously treated with nucleoside
Sofosbuvir for the treatment of chronic analogue, 500 micrograms once daily,
hepatitis C virus (HCV) infection in lamivudine-resistant chronic hepatitis B,
adults. 1 mg once daily
Caution
&Contraindications:Hypersensitivity to Proprietary Preparations
the active substance or to any of the Barcavir(Incepta), Tab., 1mg, Tk.90/Tab.;500
excipients,should not be used during mcg, Tk. 48.00/Tab.
Cavir(Square), Tab., 1 mg, Tk. 90.27/Tab.; 500
pregnancy or in women of childbearing mcg,Tk. 48.14/Tab.
,breast feeding Contraindicated in Caviral(Beacon), Tab., 500 mcg, Tk.
combination with medicinal products that 60.18/Tab.
strongly induce CYP3A4 and P-gp, Encavir(Popular), Tab., 0.5 mg, Tk.
Side-effects: Weakness, tiredness, 65.25/Tab.; 1 mg Tk. 120.45/Tab.
headache, nausea, skin rash, Entavir(Drug Intl), Tab. , 500 mcg , Tk.
diarrhea.Sleep disturbances, anemian 45.15/Tab.; 1mg, Tk. 90.30/Tab.
Entavir(Opsonin), Tab., 1 mg, Tk.
combination with sofosbuvir- fatigue, 79.47/Tab.; 0.5 mg, Tk. 42.38/Tab.
headache, and nausea Enteca(Renata), Tab, 500 mcg , Tk.
Dosage :The recommended dose of 48.00/Tab.
Daclatasvir is 60 mg once daily, to be Enviral(Opsonin), Tab., 500 mcg, Tk.
taken orally with or without meals. 48.18/Tab.; 1 mg , Tk. 90.34/Tab.
Daclatasvir must be administered in Genevir(General), Tab., 1mg, Tk. 90.27/Tab.;
combination with other medicinal 500 mcg, Tk. 48.14/Tab.
Tecavir(Aristo), Tab., 1mg, Tk. 90.00/Tab.; 500
products.Consult product literature
mcg, Tk. 3.00/Tab.
72
1. ANTI-INFECTIVES

Tecavir(Aristo), Tab., 0.5 mg, Tk. 48.00/Tab.; 1 Proprietary Preparations


mg, Tk. 90.00/Tab. Buviren(Renata), Tab. , 400mg, Tk. 600/Tab.
Teviral(ACI), Tab., 500 mcg , Tk. 3.00/Tab.; Hopetavir(Incepta), Tab., 400mg, Tk.
1mg , Tk. 100.30/Tab .; Syrup, 5mg/100ml, 600.00/Tab.
Tk. 220.00/70ml,; Hopso(Drug Intl), Tab. , 400mg, Tk.
Teviral(ACI), Tab., 5mg, Tk. 48.18/Tab.; 1 450.00/Tab.
mg,Tk. 90/Tab. Sofo(Aristopharma), Tab., 400mg , Tk.
Vir(Acme), Tab. , 500 mcg, Tk. 48.14/Tab. 600.00/Tab.
Virenta(Eskayef), Tab, 500 mcg, Tk. Sofomax(ACI), Tab., 400mg , Tk. 700.00/Tab.
48.00/Tab. Soforal(Beacon), Tab. , 400mg , Tk.
600.00/Tab.
SOFOSBUVIR Sofovir(Beximco), Tab., 400mg, Tk.
350.00/Tab.
Indications: For the treatment of
Sovalvir(Healthcare), Tab., 400mg, Tk.
chronichepatitis C (CHC) infection as a 6031.97/Tab.
component of a combination antiviral Soventa(Eskayef), Tab, 400mg, Tk.
treatment regimen 600.00/Tab.
Caution: Not recommended for Suvirux(Square), Tab. , 400 mg, Tk.
administration as monotherapy; special 600.00/Tab.
monitoring required in liver problems
Sofosbuvir400mg and Velpatasvir100mg
,current or previous infection with the
Fixvel(Beacon), Tab., Tk.1000.00/Tab.
hepatitis B virus,kidney problems ,blood Panovir(Incepta), Tab., Tk.1000.00/Tab.
tests is must before, during and after
your treatment with Sofosbuvir
INTERFERONS (IFNs)
Contra-indications: When used in
combination with peginterferon
alfa/ribavirin or ribavirin alone, all INTERFERON ALFA
contraindications to peginterferon alfa
and/or ribavirin also apply to its Indications: IFN alfa-2a and alfa 2b:
combination therapy.Because ribavirin chronic hepatitis B and chronic hepatitis
may cause birth defects and fetal death, C ideally in combination with ribavirin;
Sofosbuvir 400mg tablet in combination chronic myelogenous and hairy cell
with peginterferon alfa/ribavirin or leukemia, follicular lymphoma, adjunct to
ribavirin is contraindicated in pregnancey surgery in malignant melanoma;
and in men whose female partners are IFN alfa-2a: AIDS-related Kaposi’s
pregnant.avoid inbreast feeding. sarcoma, progressive cutaneous T-cell
Side-effects: Most common adverse lymphoma
events observed with it in in combination IFN alfa-2b: lymph or liver metastases of
with peginterferon alfa and ribavirin were carcinoid tumor, maintenance of
fatigue, headache, nausea, insomnia and remission in multiple myeloma
anemia;anxiety,blurred vision , memory Cautions: See notes above; monitoring
loss, loss of concentration,weight loss , of lipid profile
stomach discomfort, constipation, dry Contra-indications: Avoid injections
mouth, indigestion, acid reflux ,hair loss containing benzyl alcohol in neonates
andryskin,back pain, muscle spasms , Interactions: See Appendix-2
chest pain, feelingweak,nasopharyngitis. Side-effects: Influenza like syndrome
Dose: For Adults and Paediatric fatigue and depression which disappear
Population is one 400 mg tablet, taken on lowering the dose; other effects are
orally, once daily with food. anorexia, convulsions, hypotension,
Consideration should be given to hypertension, cardiac dysrhythmias and
potentially extending the duration of bone marrow depression; also reported
therapy according to different genotypes nephrotoxicity, hepatotoxicity and severe
of CHC beyond 12 weeks and up to 24 hypertriglyceridemia
weeks ; Dose: See section 14.2.4.

73
1. ANTI-INFECTIVES

Hepatitis B: IFN-2b, 5-10 mU in Caution: Dose adjustment required in


ADULTand 6 mU/m2 in CHILD thrice renal insufficiency; pregnancy, breast-
weekly for 4-6 weeks,Hepatitis C: 3 mU feeding; also see notes above
thrice weekly Interactions:See Appendix-2
Dose: prevention of influenza (should be
Proprietary Preparations started within 48 hours of exposure):
See section14.2.4 ADULT and CHILD over 13 years, 75 mg
once daily for 10 days for post-exposure
1.4.2.2 DRUGS FOR INFLUENZA prophylaxis and for upto 6 weeks during
AND RESPIRATORY an endemic;
SYNCYTIAL VIRUS Treatment of influenza: ADULT and
CHILD over 13 years, 75 mg 12 hourly
for 5 days
AMANTADINE HYDROCHLORIDE
Proprietary Preparations
Indications: Prevention and treatment of G-Oseltamivir(Gonoshasthaya), Susp, 30
influenza A virus infections, Parkinson's mg/25ml, Tk. 350.00/25 ml; Cap. 75 mg,
disease Tk.75.00/Cap.
Cautions: Renal and hepatic Oselta(Popular), Cap., 75 mg, Tk. 150.57/Cap.
insufficiency, congestive heart failure, Pandeflu(ACI), Cap., 75 mg, Tk. 151.02/Cap.
Tamiflu(I)(Roche)Cap., 75 mg, Tk.
confused or hallucinatory states, elderly,
199.85/Cap.
gradual withdrawal required in
Parkinson's disease
Contra-indications: Pregnancy, breast- RIBAVIRIN
feeding, epilepsy, gastric ulceration, and
severe renal impairment Indications: Sever respiratory syncytial
Side-effects: anorexia, nausea, virus bronchiolitis in infants and children;
nervousness, difficulty in concentrating, in combination with peginterferon alfa or
light headedness, hallucination, interferon alfa for chronic hepatitis B and
dizziness, convulsions, blurred vision, C in patients without liver dcompensation
edema and who have fibrosis or high
Dose: Oral: Influenza A, ADULT & inflammatory activity or for relapse
CHILD > 10 years, treatment 100 mg following previous response to interferon
daily for 4-5 days; prophylaxis, 100 mg alfa
daily usually for 6 weeks or with influenza Cautions: For inhalation therapy:
vaccination for 2-3 weeks after pregnancy should be excluded before
vaccination; Parkinson's disease, 100 treatment, effective contraception
mg/d initially then increased after 1 week essential during treatment and for 6
to 100 mg twice daily (max. 400 mg/d), months after treatment in women and in
ELDERLY 100 mg daily men;
Contra-indications: Pregnancy, breast-
Proprietary Preparation feeding; Specific contraindications for
Amantril (ACI), Cap., 100mg, Tk.10.00/Cap. oral treatment: Severe cardiac disease,
Altrip (NIPRO JMI), Tab., 6.25 mg, Tk. haemoglobinopathies; severe debilitating
35.08/Tab. medical conditions; severe hepatic
dysfunction or decompensated cirrhosis;
OSELTAMIVIR[ED autoimmune disease ,history of severe
psychiatric condition
Because of the need of metabolism into Interactions: See Appendix -2
active form, which may not be proper in Side-effects: Specific for inhalation
children particularly in neonates, this therapy: Worsening respiration, bacterial
drug is not recommended for use under 1 pneumonia and pneumothorax reported;
year of age unless there is a pandemic. rarely non-specific anemia and hemolysis
Indications: See under Dose. Dose:Respiratory syncytial virus
bronchitis in infants and children: by
74
1. ANTI-INFECTIVES

aerosol inhalation or nebulization of a usual risk factors for cardiovascular


solution containing 20mg/ml for 12-18 disease should be taken into account
hours for at least 3 days, maximum 7 before starting antiretroviral therapy and
days; chronic hepatitis C (in combination patients should be advised about lifestyle
with interferon alfa or peginterferon alfa): changes to reduce their cardiovascular
ADULT over 18 years body weight under risk; plasma lipids and blood glucose
75 kg,400mg in morning and 600mg in should be measured before starting
the evening;body-weight 75 kg and antiretroviral therapy, after 3–6 months of
over,600mg twice daily treatment, and then annually; reports of
osteonecrosis in patients with advanced
Proprietary Preparations HIV disease or following long-term
Celbarin(Incepta), Cap., 200 mg, Tk. 35/Cap. exposure to combination ART;
Chrocee(ACI), Cap., 200 mg, TK. 35.00/Cap. improvement in immune function as a
Copeg(Beacon), Cap., 200 mg, Tk. 35/Cap. result of antiretroviral treatment may
Opegus(Drug Intl), Cap., 200 mg, Tk. 25/Cap.
Rivarin(Healthcare),Cap.,200 mg,Tk. 35/Cap.
provoke a marked inflammatory reaction
Viracin(Beximco), Cap., 200 mg, Tk. against residual opportunistic organisms;
35.00/Cap. these reactions may occur within the first
few weeks or months of initiating
1.4.4 DRUGS FOR HUMAN treatment; reports of autoimmune
IMMUNODEFICIENCY VIRUS disorders (such as Graves’ disease)
(HIV) INFECTION many months after initiation of treatment.
1.4.4.1 NUCLEOSIDE AND
NUCLEOTIDE REVERSE 1.4.4.1 NUCLEOSIDE AND
TRANSCRIPTASE INHIBITORS NUCLEOTIDE REVERSE
1.4.4.2 NON-NUCLEOSIDE REVERSE TRANSCRIPTASE
TRANSCRIPTASE INHIBITORS INHIBITORS
1.4.4.3 PROTEASE INHIBITOR
1.4.4.4 INTEGRASE INHIBITORS ABACAVIR[ED]
1.4.4.5 ENTRY INHIBITORS
Indications: Treatment of HIV-infection
Currently available drugs provide in combination with other antiretroviral
suppressive therapy for HIV infection drugs
rather than a curative one. The goal of Cautions: Potentially fatal
therapy is to reduce plasma viral load hypersensitivity syndrome mostly linked
through suppression of replication as with HLA-B*5701 allele; test for that allele
much as possible for as long as possible before use; counsel patient about how to
and expected outcome of initial therapy recognize hypersensitivity and to seek
in a previously untreated patient is an immediate medical attention if symptoms
undetectable viral load (plasma HIV RNA develop ; heavily loaded HIV-infection (>
<50 copies /ml) within 24 weeks of 100 000 copies/ml); patients with chronic
treatment initiation. hepatic B and C, hepatic impairment,
Cautions: Metabolic effects associated lactic acidosis; patients at high risk of
with antiretroviral treatment include fat cardiovascular disease; alcoholic
redistribution, insulin resistance, and patients;
dyslipidemia; (collectively termed Contraindications: History of
lipodystrophy syndrome); fat hypersensitivity
redistribution (with loss of subcutaneous Interactions: See Appendix-2
fat, increased abdominal fat, ‘buffalo Side-effects: Fatal hypersensitivity
hump’ and breast enlargement) is characterized by fever, rash, abdominal
associated with regimens containing pain and other GI complaints, cough,
protease inhibitors and nucleoside phengitis, dyspnea, sore throat, acute
reverse transcriptase inhibitors; the respiratory distress syndrome, myalgia,
75
1. ANTI-INFECTIVES

headache, paraesthesia, mouth TENOFOVIR DISOPROXIL[ED


ulceration, edema, hypotension, renal
failure; rarely myolysis Indications: HIV infection in combination
Dose: Oral: ADULT, 600 mg in 1-2 with other antiretroviral drugs; chronic
doses; CHILD, 3 months-12 years, 8 hepatitis B infection with either
mg/kg 12 hourly adjusted to body weight compensated liver disease or
(max. 600 mg ) decompensated liver disease
Cautions : See notes above; also test
Generic Preparations renal function and serum phosphate
(Tablet, Abacavir 300 mg+ Lamivudine 150 mg
before treatment, then every 4 weeks
+ Zidovudine 300 mg)
(more frequently if at increased risk of
renal impairment) for 1 year and then
LAMIVUDINE[ED] every 3 months, interrupt treatment if
renal function deteriorates or serum
Indications: HIV infection in combination phosphate decreases; concomitant or
with at least two other antiretroviral recent use of nephrotoxic drugs; for use
drugs, chronic hepatitis B infection in chronic hepatitis B, monitor liver
Cautions: Pregnancy, breast-feeding, function tests every 3 months and viral
renal and hepatic impairment; monitoring markers for hepatitis B every 3–6 months
of hepatic function is required, drug during treatment (continue monitoring for
should be discontinued if deterioration, at least 1 year after discontinuation,
hepatic steatosis, hepatomegaly or recurrent hepatitis may occur on
unexplained lactic acidosis discontinuation): If a dose is more than
Contraindications: Breast-feeding 12 hours late, the missed dose should
Side-effects: Tiredness, respiratory tract not be taken and the next dose should be
infections, throat discomfort, headache, taken at the normal time
abdominal discomfort, nausea, vomiting, Interactions: See Appendix -2
diarrhea, hypersensitivity reactions, Side-effects: See notes above; also
peripheral neuropathy, lactic acidosis, hypophosphatemia; rarely renal failure,
raised liver enzymes and serum amylase proximal renal tubulopathy, nephrogenic
Dose:oral: HIV infection in combination diabetes insipidus; reduced bone density
with other antiretroviral drugs, 150 mg Dose: Oral: ADULT, over 18 years,
every 12 hours or 300 mg once daily; 245 mg once daily; CHILD 2–18 years:HIV
INFANT < 1 month 2 mg/kg twice daily; infection in combination with other ARDs
CHILD 3 months-12 years 4 mg/kg every when first-line NRTIs cannot be used
12 hours; max. 300 mg daily; chronic because of resistance or contra-
hepatitis B, ADULT 100 mg daily indications,
CHILD 2–18 years, 6.5 mg/kg (max.
Proprietary Preparations 245 mg) oncedaily or Body-weight 17–22
Lamivudine kg 123 mg once dailybody-weight 22–28
Hepavir(Square), Tab.,100 mg, Tk. 25.17/Tab.
Lamidin(Eskayef), Tab.,100mg, Tk. 25.30/Tab.
kg 163 mg once daily; body- weight 28–
Lamivir(Incepta), Tab.,100 mg, Tk. 25.00/Tab. 35 kg 204 mg once daily; body-
Viradin(Healthcare), Tab., 100mg, Tk. weightover 35 kg 245 mg once
25.00/Tab. dailyChronic hepatitis B infection with
Lamivudine + Zidovudine compensatedliver disease (with evidence
Diavix(Beximco), Tab.150 mg + 300 mg, Tk. of viral replication,and histology of active
45.00/Tab. liver inflammation or fibrosis): Child 12–
Lamivudine + Zidovudine + Nevirapine
Triovix(Beximco), Tab.150 mg + 300 mg + 200
18 years, body-weight > 35kg 245 mg
mg, Tk. 70.00/Tab. once daily

Proprietary Preparations
Becovir(Beacon), Tab., 300mg, Tk 85.26/Tab.
Foviral(ACI), Tab., 300mg, Tk. 85.26/Tab.
Proxivir(Square), Tab., 300mg, Tk. 85.26/Tab.

76
1. ANTI-INFECTIVES

Tenoviral(Opsonin), Tab., 300mg, Tk. hypersensitivity reactions, pigmentation


85.26/Tab. of nails, skin and mucosa
Tenvira(Aristo), Tab., 300mg, Tk. 85.00/Tab. Dose: Oral: ADULT 500-600 mg daily in
T-fovir(Drug Intl), Tab., 300mg, Tk. 85.30/Tab.
Vironil(UniMed), Tab., 300mg, Tk. 95.00/Tab.
2-3 divided doses; INFANT < 4 weeks 4
Xynovir(Incepta), Tab., 300mg, Tk. 85.00/Tab. mg/kg twice daily; CHILD > 3 months
180-360 mg/m2 daily in 3-4 divided
TENOFOVIR ALAFENAMIDE doses; max. 200 mg every 6 hours;
patients temporarily unable to take
zidovudine by mouth, by IV infusion over
Hepatitis B virus (HBV) nucleoside
1 hour 1-2 mg/kg every 4 hours
analog reverse transcriptase inhibitor.
(approximating to 1.5-3 mg/kg every 4
Indications: Chronic hepatitis B virus
hours by mouth) usually for not more
infection in adults with compensated liver
than 2 weeks; CHILD 80-160 mg/m2
disease.
every 6 hours (120 mg/m2 every 6 hours
Cautions & Side-effect: See under
approximates to 180 mg/m2 every 6
Tenofovir disoproxil
hours by mouth); prevention of maternal-
Dose: 25 mg (one tablet) taken orally
fetal HIV transmission, oral, between 14
once with food
and 34 weeks of gestation, 100 mg 5
times daily, IV during labor, 2 mg/kg over
Proprietary Preparation
Tafecta (Beacon), Tab. 25mg, Tk. 160.00/Tab. 1 hour, then 1 mg/kg/h by continuous
infusion, followed by syrup to neonate
from birth through 6 weeks of age, 2
ZIDOVUDINE[ED]
mg/kg every 6 hours
Indications: HIV infection in combination Proprietary Preparation
with other antiretroviral drugs, alone for (For co-formulation with abacavir and
prevention of maternal-fetal HIV lamivudine see under abacavir and that with
transmission; AIDS or AIDS-related lamivudine see under lamivudine)
complex, to reduce the frequency of
opportunistic infections and for ZALCITABINE
prolonging survival
Cautions: See under lamivudine; also Indications: Advanced HIV infection in
hematological disorders, vitamin B12 combination with other antiretroviral
deficiency; associated with higher risk of drugs
lipoatrophy Cautions: Peripheral neuropathy
Contra-indications: Abnormally low pancreatitis (monitor serum amylase in
neutrophil counts or hemoglobin those with history of elevated serum
concentration, neonates with amylase); cardiomyopathy, history of
hyperbilirubinemia requiring treatment congestive cardiac failure; hepatotoxicity
other than phototherapy, or with raised (potentially life threatening lactic acidosis
transaminase with hepatomegaly reported); pregnancy
Interactions: See Appendix-2 (women of childbearing age should use
Side-effects: Anemia, leucopenia, effective contraception during treatment);
neutropenia, nausea, vomiting, abdomi- renal impairment
nal discomfort, diarrhea, taste PERIPHERAL NEUROPATHY:
disturbance, pancreatitis, liver disorders discontinue immediately if peripheral
including fatty change and raised bilirubin neuropathy develops characterized by
and liver enzyme, chest pain, dyspnea, numbness and burning dysaesthesia
cough, influenza-like symptoms, possibly followed by sharp shooting pains
headache, fever, neuropathy, or severe continuous burning and
convulsions, dizziness, anxiety, potentially irreversible pain; extreme
depression, asthenia, myopathy, caution and close monitoring required in
pancytopenia, thrombocytopenia, those at risk of peripheral neuropathy
77
1. ANTI-INFECTIVES

(especially those with low CD4 cell count Side-effects: Rash, usually in the first 2
for whom risk is greater) weeks; Stevens-Johnson syndrome;
PANCREATITIS: discontinue headache, dizziness, insomnia, abnormal
permanently if clinical pancreatitis dreams, fatigue, impaired concentration
develops; suspend if raised serum (administration at bed time in the first 2-4
amylase associated with glucose weeks reduces CNS effects); nausea,
intolerance rising triglyceride, decreasing less frequently vomiting, diarrhea,
serum calcium or other signs of hepatitis, depression, anxiety, psychosis,
impending pancreatitis until pancreatitis amnesia, ataxia, stupor, vertigo, also
excluded reported raised serum cholesterol,
Contraindications: Peripheral elevated liver enzymes (especially if
neuropathy; breast-feeding seropositive for hepatitis B and C),
Interactions: See Appendix-2 pancreatitis
Side-effects: Peripheral neuropathy Dose: Oral: HIV infection in combination
(discontinue immediately); oral ulcers, with other antiretroviral drugs, ADULT
nausea, vomiting, dysphagia, anorexia, 600 mg once daily; CHILD, 3-18 years:
diarrhoea, abdominal pain, constipation; body weight 13-15 kg 200 mg once daily;
pharyngitis; headache, dizziness; body weight 15-20 kg 250 mg once daily;
myalgia, arthralgia; rash, pruritus, body weight 20-25 kg 300 mg once daily;
sweating, weight loss, fatigue, fever, body weight 25-32 kg 350 mg once daily;
rigors, chest pain, anemia, leucopenia, body weight 33-40 kg 400 mg once daily;
neutropenia, thrombocytopenia, body weight 40 kg and over adult dose
disorders of liver function; less frequently
pancreatitis, esophageal jaundice and Proprietary Preparations
hepatocellular damage; Avifanz(Beximco), Tab. 600 mg, Tk. 140/Tab.
Dose: 750 micrograms 3 times daily; Delfavir(Delta), Tab. 600 mg, Tk. 50 /Tab
ELDERLY and CHILD under 13 years, Adiva(Sqaure), Tab. 600 mg Tk.201.35/Tab.
not recommended (safety and efficacy
not established) NEVIRAPINE[ED

Generic Preparation Indications: HIV infection in combination


Tablet, 75 micrograms; 750 microgarms with other antiretroviral drugs; prevention
of maternal-fetal HIV transmission
1.4.4.2 NON-NUCLEOSIDE Cautions: Hepatic impairment (chronic
REVERSETRANSCRIPTASE hepatitis B or C); severe renal
INHIBITORS impairment; pregnancy and breast-
feeding; high CD4 cell count;close liver
EFAVIRENZ[ED] function monitoring required during first
18 weeks; monitor before treatment then
every 2 weeks for 2 months then after 1
Indications: HIV infection in combination month and then regularly; monitor closely
with other antiretroviral drugs for skin reactions during first 18 weeks
Cautions: See notes above; also hepatic discontinue permanently if abnormalities
impairment; severe renal impairment; in liver function tests accompanied by
pregnancy and breast-feeding; elderly; hypersensitivity reaction;
history of mental illness or substance Counseling:Patients should be told how
abuse; patient on other hepatotoxic drug to recognize hypersensitivity reactions
needs monitoring of liver function; and advised to discontinue treatment and
discontinue if severe rash with blistering, seek immediate medical attention if
desquamation, mucosal involvement or severe skin reaction, hypersensitivity
fever; reactions, or symptoms of hepatitis
Contra-indications: Porphyria, develop
pregnancy Contra-indications: Acute porphyria;
Interactions: See Appendix-2 post-exposure prophylaxis

78
1. ANTI-INFECTIVES

Interactions: See Appendix-2 1.4.4.3 PROTEASE INHIBITORS


Side-effects: Rash including Stevens-
Johnson syndrome and rarely, toxic
INDINAVIR[ED]
epidermal necrolysis; hepatitis and
jaundice reported; nausea, vomiting,
abdominal pain, diarrhea, headache, Indications: HIV infection in combination
drowsiness, fatigue, fever; with nucleoside reverse transcriptase
hypersensitivity reactions (may involve inhibitors and usually with low-dose
hepatic reactions and rash) anaphylaxis, ritonavir
angioedema, urticaria, also reported Cautions: Hepatic impairment; adequate
Dose: Oral: HIV infection in combination hydration, at least 2 L daily to reduce risk
with other antiretroviral drugs, ADULT, of nephrolithiasis (more frequent in
200 mg once daily of ‘immediate-release’ children; may require interruption or
preparation for first 14 days then (if no discontinuation) ; solubility decreases at
rash present) 200 mg twice daily of higher pH, antacids or other buffering
‘immediate-release’ preparation or agents should not be taken at the same
400 mg once daily of modified-release time;
preparation; CHILD, 1 month–3 hemophilia; pregnancy and breast-
years 150–200 mg/m2 (max. 200 mg) feeding;
once daily of ‘immediate-release’ Interactions: See Appendix-2
preparation for first 14 days, then (if no Side-effects: Nausea, vomiting,
rash present) 150–200 mg/m2 (max. diarrhea, abdominal discomfort,
200 mg) twice daily or 300– dyspepsia, flatulence pancreatitis, dry
400 mg/m2 (max. 400 mg) once daily of mouth, taste disturbances; headache,
‘immediate-release’ preparation; 3–18 dizziness, insomnia; myalgia, myositis,
years 150–200 mg/m2 (max. 200 mg) rhabdomyolysis, asthenia, paraesthesia;
once daily of ‘immediate-release’ hyperglycemia: anaphylactoid reactions,
preparation for first 14 days, then (if no rash (including Stevens-Johnson
rash present after initial dose syndrome), pruritus, dry skin,
titration)150–200 mg/m2 (max. 200 mg) hyperpigmentation, alopecia, paronychia;
twice daily of ‘immediate-release’ interstitial nephritis, nephrolithiasis,
preparationprevention of maternal-fetal dysuria, hematuria, crystalluria,
HIV transmission, 200 mg orally as a proteinuria, pyuria (in children), hepatitis,
single dose to the woman at onset of transient hyperbilirubinemia; blood
labor followed by a 2 mg/kg oral dose to disorders including neutropenia,
the neonate within 3 days after delivery hemolytic anemia; lipodystrophy
Note: Initial dose titration using Dose: Oral: HIV infection, in combination
‘immediate-release’ preparation should with two NRTIs and low-dose ritonavir
not exceed 28 days; if rash not resolved booster, ADULT, indinavir 800 mg and
within 28 days, alternative treatment ritonavir 100 mg both twice daily; in
should be sought; If a dose is more than combination with two NRTIs but without
8 hours late with the ‘immediate-release’ ritonavir booster ADULT, 800 mg every 8
preparation (or more than 12 hours late hours; CHILD & ADOLESCENT 4-17
with the modified-release preparation), years 500 mg/m2 every 8 hours
the missed dose should not be taken and (maximum 800 mg every 8 hours);
the next dose should be taken at the CHILD < 4 years safety and efficacy not
usual time established

Proprietary Preparation Generic Preparation


(For co-formulation with lamivudine and Capsule, 200 mg,
zidovudine see under lamivudine)

79
1. ANTI-INFECTIVES

NELFINAVIR[ED] fraction, electrolyte disturbances,


concomitant use of drugs that prolong QT
Indications: HIV infection in combination or PR interval);
with other antiretroviral drugs Interactions: See Appendix-2
Cautions: See notes above; also hepatic Side-effects: Diarrhea, buccal and
and renal impairment, diabetes mellitus, mucosal ulceration, abdominal
hemophilia, pregnancy and breast- discomfort, nausea, vomiting, headache,
feeding peripheral neuropathy, paraesthesia,
Interactions: See Appendix -2 dizziness, insomnia, mood changes,
Side-effects: Diarrhea, nausea, ataxia, musculoskeletal pain, asthenia;
vomiting, flatulence, abdominal pain; fever, pruritus, rash and other skin
rash; reports of elevated creatinine eruptions, rarely Stevens-Johnson
kinase, hepatitis and pancreatitis, syndrome; other rare adverse effects
neutropenia, hypersensitivity reactions include thrombocytopenia and blood
including bronchospasm, fever, pruritus disorders, seizures, liver damage,
and facial edema, lipodystrophy and pancreatitis and nephrolithiasis, elevated
metabolic effects creatinine kinase, raised liver enzymes
Dose : Oral: HIV infection in combination and neutropenia, when used in
with other antiretroviral drugs, ADULT combination therapy, lipodystrophy and
1.25 g twice daily or 750 mg 3 times metabolic effects
daily; CHILD, 3-13 years, initially 50- Dose: Oral:HIV infection in combination
55mg/kg twice daily (max 1.25g twice with nucleoside reverse transcriptase
daily) or 25-30mg/kg 3 times daily inhibitors and with low-dose ritonavir
(max.750 mg 3 times daily) booster, ADULT, previously treated with
ART, saquinavir 1 g and ritonavir 100 mg
Proprietary Preparation both twice daily and not previously
Avifix(Beximco), Tab. 250 mg, Tk. 45.00/Tab treated with ART, 500 mg 12 hourly for 7
days then 1 g 12 hourly ; without
SAQUINAVIR ritonavir booster, ADULT 1.2 g every 8
hours after meal; CHILD < 16 years
safety and efficacy not established
Indications: HIV infection in combination
with other antiretroviral drugs and usually
Generic Preparation
with low-dose ritonavir Tablet, 500 mg
Cautions: See notes above; also monitor
ECG before starting treatment and then
1.4.4.4 INTEGRASE INHIBITORS
on day 3 or 4 of treatment, discontinue if
QT interval over 480 milliseconds, if QT HIV-retrovirus DNA remains in the host
interval more than 20 milliseconds above cell nucleus for a prolonged period of
baseline, or if prolongation of PR interval, inactivity or latency because of its ability
patients should be told how to recognize of chromosomal integration through
signs of arrhythmia and advised to seek activity of the viral integrase enzyme.
medical attention if symptoms such as Raltegravir inhibits this enzyme and
palpitation or syncope develop; prevents the formation of covalent bonds
concomitant use of garlic reduces between host and virus DNA.
plasma concentration; hepatic and renal
impairment; diabetes mellitus; RALTEGRAVIR
hemophilia; pregnancy and breast-
feeding; Indications: HIV infection in combination
Contra-indications: Severe hepatic with other antiretroviral drugs
impairment; predisposition to cardiac Cautions: Myopathy or rhabdomyolysis;
arrhythmias (including congenital QT chronic hepatitis B or C; psychiatric
prolongation, bradycardia, history of illness; discontinue if severe rash or rash
symptomatic arrhythmias, heart failure with fever, malaise, arthralgia, myalgia,
with reduced left ventricular ejection blistering, mouth ulceration,
80
1. ANTI-INFECTIVES

conjunctivitis, angioedema, hepatitis, or


eosinophilia; severe hepatic impairment, ENFUVIRTIDE
pregnancy, breast-feeding
Interactions: See Appendix -2 Indications: HIV infection in combination
Side-effects: GI disturbances, with other antiretroviral drugs for resistant
abdominal pain, flatulence, hypertrigly- infection or for patients intolerant to other
ceridemia, dizziness, headache, antiretroviral regimens
depression, insomnia, abnormal dreams, Cautions: Discontinue immediately if any
hyperactivity, asthenia, rash (including signs or symptoms of systemic
Stevens-Johnson syndrome); less hypersensitivity develop and do not
commonly, gastritis, hepatitis, rechallenge; patients should be told how
pancreatitis, dry mouth, taste to recognize signs of hypersensitivity,
disturbances, pain on swallowing, peptic and advised to discontinue treatment and
ulcer, constipation, rectal bleeding, seek immediate medical attention if
lipodystrophy, palpitation, ventricular symptoms develop; hepatic impairment,
extrasystoles, bradycardia, hypertension, chronic hepatitis B or C; pregnancy and
flushing, chest pain, edema, dysphonia, breast-feeding
epistaxis, nasal congestion, drowsiness, Interactions: See Appendix-2
anxiety, appetite changes, confusion, Side-effects Injection-site reactions;
impaired memory and attention, suicidal pancreatitis, gastro-esophageal reflux
ideation, pyrexia, chills, carpal tunnel disease, anorexia, weight loss;
syndrome, tremor, peripheral neuropathy, hypertriglyceridemia; peripheral
erectile dysfunction, gynaecomastia, neuropathy, asthenia, tremor, anxiety,
menopausal symptoms, osteopenia, nightmares, impaired concentration,
renal failure, nocturia, polydipsia, vertigo; pneumonia, sinusitis, influenza-
anemia, thrombocytopenia, neutropenia, like illness; diabetes mellitus; hematuria;
arthralgia, myalgia, rhabdomyolysis, renal calculi, lymphadenopathy; myalgia;
visual disturbances, tinnitus, gingivitis, conjunctivitis; dry skin, acne, erythema,
glossitis, acne, pruritus, hyperhidrosis, skin papilloma; less
dry skin, skin papilloma, alopecia; commonly hypersensitivity reactions,
Dose: Oral: ADULT, 400 mg twice including rash, fever, nausea, vomiting,
daily; CHILD, 2–18 years:(in combination chills, rigors, low blood pressure,
with other antiretroviral drugs for HIV respiratory distress, glomerulonephritis,
infection resistant to multiple and raised liver enzymes reported;
antiretrovirals): body-weight 12– Dose: Subcutaneous injection:
14 kg 75 mg twice daily; body-weight 14– reconstitute with 1.1 mL water for
20 kg 100 mg twice daily; body-weight Injections and allow to stand (for up to 45
20–28 kg 150 mg twice daily; body- minutes) to dissolve; do not shake or
weight 28–40 kg 200 mg twice daily; invert vial;
body-weight over 40 kg 300 mg twice ADULT, 90 mg twice daily; CHILD, 6–16
daily years 2 mg/kg (max. 90 mg) twice daily,
16–18 years 90 mg twice daily
Generic Preparation
Tablet, 400 mg
Generic Preparation
Injection, 90 mg/ml
1.4.4.5 ENTRY INHIBITORS
Entry inhibitor drugs prevent entry into MARAVIROC
host cell of the retrovirus in two different
ways: inhibiting fusion of viral cell Indications: HIV infected adults in
membranes mediated by gp41 and CD4 combination with other antiretroviral
interactions (enfuvirtide) and blocking drugs previously treated with
host cell CCR5 receptor to block binding antiretrovirals who have base line
of viral gp 120 (maraviroc).
81
1. ANTI-INFECTIVES

evidence of predominantly CCR5-tropic 1.5.1.2 DRUGS FOR HOOKWORMS


virus (ANCYLOSTOMIASIS,
Cautions: Cardiovascular disease; NECATORIASIS)
hepatic impairment, chronic hepatitis B or
C; pregnancy, breast-feeding Hookworms (Ancylostomiasis) are
Interactions: See Appendix -2 located in the upper small intestine and
Side-effects: GI disturbances; suck blood from their point of attachment;
depression, insomnia, malaise, anemia may thereby be produced.
headache, anemia, rash; less commonly, Effective treatment needs not only
seizures, renal failure, proteinuria, expulsion of the worms but treatment of
myositis; rarely hepatitis, angina, the anemia. Albendazole is the drug of
pancytopenia, granulocytopenia, first choice against both species and
Stevens-Johnson syndrome, toxic mebendazole is the next.Dog and cat
epidermal necrolysis; also reported hookworm larvae may enter human skin
hypersensitivity reactions including rash, where they produce slowly extending
fever, eosinophilia, and hepatic reactions; itching tracks usually on the foot
Dose: Oral: ADULT,over 18 years, (cutaneous larva migrans or creeping
300 mg twice daily eruption). Single tracks can be treated
with topical thiabendazole andmultiple
GenericPreparation infections respond to oral
Tablet, 150 mg, ivermectin,albendazole or thiabendazole

1.5 ANTHELMINTICS 1.5.1.3 DRUGS FOR THREADWORMS/


1.5.1 DRUGS FOR NEMATODE PINWORMS
INFECTIONS
1.5.2 DRUGS FOR CESTODE The adult threadworms do not live for
INFECTIONS longer than 6 weeks. Adult female worms
1.5.1 DRUGS FOR NEMATODE lay ova on the perianal skin which causes
INFECTIONS pruritus; scratching the area then leads to
1.5.1.1 ASCARICIDES : DRUGS FOR ova being transmitted on fingers to the
COMMON ROUNDWORMS mouth, often via food eaten with
1.5.1.2 DRUGS FOR HOOKWORMS unwashed hands. Pruritus in the perianal,
(ANCYLOSTOMIASIS, perineal region can be severe, scratching
NECATORIASIS) may cause secondary infection.
1.5.1.3 DRUGS FOR Mebendazoleis the drug of choice.
THREADWORMS/ Albendazole and pyrantel pamoate also
PINWORMS(ENTEROBIASIS) are highly effective.
1.5.1.4 DRUGS FOR DWARF
THREAD-WORMS 1.5.1.4DRUGS FOR DWARF
(STRONGYLOIDIASIS) THREAD-WORMS
1.5.1.5 DRUGS FOR WHIPWORMS (STRONGYLOIDIASIS)
(TRICHURIASIS)
1.5.1.6 DRUGS FOR LYMPHATIC Strongyloides stercoralis also called
FILARIASIS(WUCHERIA Drawf threadworm is capable to complete
INFECTIONS) its life-cycle within human host. It lives in
1.5.1.1 ASCARICIDES: DRUGS FOR the gut and produce larvae, which
COMMON ROUNDWORMS penetrate the gut wall and invade the
tissues, setting up a cycle of auto-
The preferred agents are the infection. Ivermectin is the treatment of
benzimidazoles, mebendazole and choice for chronic Strongyloides
albendazole and the board-spectrum infection. Albendazoleis an alternative.
drug pyrantel pamoate. Levamisol is an
alternate choice.
82
1. ANTI-INFECTIVES

1.5.1.5 DRUGS FOR WHIPWORMS treatment in inoperable cases, ADULT >


(TRICHURIASIS) 60 kg, 800 mg daily in divided doses for
28 days followed by 14 tablet-free days,
Although rarely causes serious may be given up to 3 cycles; for alveolar
complication heavy Trichuris burdens in echinococcosiscaused by E
children can lead to colitis, dysentery multilocularis, above drug treatment
syndrome and rectal prolapse. needs to be continued for months or
Mebendazole and albendazole are the years; neurocysticercosis , ADULT > 60
most effective drugs. kg 800 mg daily in 2 divided doses for 8-
30 days, ADULT < 60 kg 15 mg/kg, max.
800 mg/d in 2 divided doses for 8-30
ALBENDAZOLE[ED] [OTC]
days; cutaneous larva migrans, 400 mg
as a single dose; intestinal capillariasis,
Albendazole, a broad-spectrum 200-400 mg twice daily for 10 days;
benzimidazole carbamate has trichinosis, 200-400 mg twice daily for 15
antihelminthic activity similar to that of days; Strongyloides stercoralis, as an
mebendazole (see also under alternative to ivermectin, 400 mg twice
mebendazole) and is more effective daily for 3 days, repeated after 3 weeks if
against strongyloidiasis, cystic hydatid necessary
disease caused by Echinococcus
granulosus and neurocysticercosis Proprietary Preparations
caused by larval forms of Taenia solium. Aben(Team), 400 mg, Tab. Tk. 4.50/Tab.
Certain microsporidial species that cause Abentel(Aristo), Tab., 400mg , Tk. 5.00/Tab.
intestinal infections in AIDS patients Adze(Kemiko), Tab., 400 mg, Tk. 4.01/Tab.
respond partially or completely. The drug AH(Drug Intl),Suspn.,200mg/5ml, 20.10/10ml ,;
also has some efficacy against anaerobic Tab., 400mg, Tk. 5.05/Tab.
Alarm(Decent), Tab., 400mg, Tk. 4.00/Tab.
protozoa such as Trichomonus vaginalis
AlbamaxDS(Ziska), Tab., 400 mg, Tk.
and Giardia lamblia 4.00/Tab.
Indications: See under Dose Alben (Eskayef), Suspn, 200mg/5
Cautions: liver disease; monitoring of ml,Tk.20.00/10ml.;Tab.,400 mg, Tk. 5.00/Tab.;
liver function and for bone marrow Albendol(Globex), Suspn., 200mg/ 5 ml,
toxicities required in prolong use; in Tk.15.00/10mlTab., 400mg, Tk. 3.50/Tab
neurocysticercosis sought neurologist / Albezen(Zenith), 400 mg , Tab. , Tk. 3.01/Tab.
neurosurgeon advice Alda(Supreme), Suspn., 200mg/ 5 ml,
Tk.15.00/10ml,; Tab., 400 mg, Tk. 4.00/Tab.
Contra-indications: pregnancy Aldex(G.A co), Suspn., 200 mg/5ml, Tk.
Interactions: See Appendix-2 15.05/10 ml .; Tab., 400 mg, Tk. 4.02/Tab.
Side-effects: Gastrointestinal AL-DS(Globe), Tab., 400 mg, Tk. 5.00/Tab.
disturbances, headache, dizziness, Almex(Square), Suspn., 200 mg/5 ml , Tk.
changes in liver enzymes 20/10ml.; Tab., 400 mg, Tk. 5.02/Tab.
Dose: Oral: roundworm & hookworm Alphin(Beximco), Tab., 400mg , Tk. 5.00/Tab.
Alzed(General), Tab, 400mg, Tk. 3.32/Tab.
infections: ADULT & CHILD > 2 years
Anbendazole(Popular), Tab., 400mg, Tk.
400 mg as a single dose; threadworm 4.01/Tab.
infections 400 mg as a single dose for 3 Asiben(Asiatic), Suspn., 200mg/5ml, Tk.
days, repeated after 3 weeks if 14.00/10ml .;Tab., 400mg , Tk. 3.80/Tab.
necessary; echinococcus granulosus Azole(Biopharma), Tab., 400mg, Tk. 4.02/Tab.;
(cystic hydatid disease): adjunct in Suspn., 200mg/5ml, Tk. 18.00/10ml
surgical treatment:pre-surgery, 800 mg Ben-A(Acme),Tab. , 400.00 mg., Tk. 5.01/Tab.;
Suspn., 200mg/5ml, Tk. 20.07/10ml
daily in divided doses for 28 days
Benda(Bristol), Tab. , 400mg , Tk. 175.00/Tab.
followed by 14 tablet-free days, cycle Benfast(Novo Healthcare), Tab., 200 mg, Tk.
repeated once before surgery; post- 2.00/Tab.; , 400 mg, Tk. 4.00/Tab.
surgery, 800 mg daily in divided doses Chuben(Alco), Tab., 400 mg, Tk. 3.86/Tab.
for 28 days followed by 14 tablet-free Estazol(Ibn Sina), Suspn., 200mg/5ml, Tk.
days, cycle repeated once; as primary 20.00/10ml,; Tab.,Tk. 200.00/Tab.

83
1. ANTI-INFECTIVES

Helben(Modern), Tab. , 400 mg., Tk. 5.00/Tab. Johnson syndrome and toxic epidermal
Parnil DS(Euro), Tab., 400mg, Tk. 5.00/Tab. necrolysis
Sintel(ACI), Tab., 400mg, Tk. 5.02/Tab. ; Dose: Oral:pinworms/ threadworms
Tab.,(dispersible) 400mg, Tk. 6.02/Tab.;
Suspn., 200mg/5ml, Tk. 20.06/10ml ,
(enterobiasis), ADULT & CHILD >6
Verben(Astra Bio), Suspn., 200 mg/5 ml, Tk. months, 100 mg as a single dose; repeat
15.00 /5ml .; Tab. , 400 mg, Tk. 4.00/Tab. dose at 2 and 4 weeks if necessary ;
Vermid(Somatec), Tab., 400 mg, Tk. 5.00/Tab. roundworm (Ascaris lumbricoides),
Vermin DS(Nipa), Tab., 400 mg, Tk. 4.50/Tab. hookworm (Ankylostoma duodenale,
Zoben(Amico), Tab., 400mg , TK. 4.50/Tab.; Necator americanus), whipworm
Suspn., 200 mg/5 ml,, TK. 20.00/10ml (Trichuris trichiura) and Trichostrogylus
infections, ADULT & CHILD > 2 years,
LEVAMISOLE[ED] 100 mg twice daily for 3 days or 500 mg
as a single dose, may be repeated in 2-3
Indications: Ascariasis, hookworm and weeks, CHILD<< 2 years single dose
mixed ascariasis with hookworm administration not allowed; intestinal
infections, as an adjunct with fluorouracil capillariasis, 400 mg/d in divided doses
after surgical resection in patients with for 21 or more days; trichinosis, 600 mg
Dukes stage C colon cancer initially, increasing stepwise over 3 days
Cautions: Pregnancy, concomitant to 1200-1500 mg daily in 3 divided doses
alcohol for 10 days
Contra-indications: Severe liver and
kidney disease, breast-feeding Proprietary Preparations
Interactions: See Appendix-2 Bendex(G.A.Co), Tab., 100 mg, Tk. 1.15/Tab.;
Side-effects: Abdominal pain, nausea, 500 mg, Tk. 3.50/Tab.
vomiting, headache, dizziness, Misole(Albion), Susp., 100 mg/5 ml, Tk.
14.83/30ml
disulfiram-like adverse effects when
Panamox(Jayson), Tab., 100 mg, Tk. 0.74/
taken concomitantly with alcohol Tab.; Susp., 100 mg/5 ml, Tk.14.75/30 ml
Dose: Oral: ADULT & CHILD > 12 years Solas(Opsonin), Tab. 100 mg, Tk. 1.15/Tab. ;
2.5 mg/kg, CHILD 5-12 years 80 mg and Suspn 100 mg/5ml, Tk. 18.25/ 30 ml
1-4 years 40 mg as a single dose, in Vermizol(Zenith), Tab. 100 mg, Tk. 0.74/Tab.
severe hookworm infection second dose
in 3-7 day PYRANTEL PAMOATE
Indications: Roundworm (Ascaris
Proprietary Preparations lumbricoides), pinworm (Enterobius
Asitrax(Asiatic), Syrup, 40 mg/5ml, Tk. vermicularis), hookworm (Ankylostoma
12.00/30ml,; Tk. 8.00/15ml
Biotrex(Biopharma), Syrup, 40 mg/5ml, Tk.
duodenale), trichostrongyliasis and
15.00/30ml trichinosis infections
Etrax(ACI), Syrup, 40mg/5ml, Tk. 24.07/30ml ,; Cautions: Impaired liver function,
Tab., 40mg, Tk. 1.00/Tab. pregnancy, lactation
Helmisole(G.A.Co), Syrup, 40 mg/5ml, Tk. Interactions: See Appendix -2
15.05/30 ml,; Tab., 40 mg, Tk. 0.41/Tab. Side-effects: Anorexia, nausea,
Neotrax(Acme), Syrup, 40 mg/5ml, Tk. vomiting, abdominal pain, headache,
24.00/30ml,; Tk. 70.47/460ml,; Tab.;40mg ,
Tk. 0.43/Tab.
dizziness, drowsiness, insomnia, rashes
Vermicom(Opsonin), Syrup, Tk. 9.28/ 30 ml and raised SGOT levels
Dose: Oral: 10 mg/kg in a single dose(for
MEBENDAZOLE[ED] [OTC] hookworm same dose is repeated on 3
successive days and for trichinosis
Indications: See under Dose treatment for 5 days)
Cautions: Pregnancy, lactation
Interactions: See Appendix -2 Proprietary Preparations
Side-effects: Rarely abdominal pain, Delentin(Renata), Suspn., 50mg/ml, Tk.
diarrhea; rarelyhepatitis, convulsions, 16.05/10 ml
dizziness, neutropenia, urticaria, Melphin(Beximco), Suspn., 50mg/ml, Tk.
alopecia, rash including Stevens- 16.00/10 ml

84
1. ANTI-INFECTIVES

Minisol(Albion), Susp., 50 mg/ml, Tk. 12.00/30 Proprietory Preparation


ml Carbamazine(Amico), Tab., 100mg , Tk.
1.30/Tab.
1.5.1.6 DRUGS FOR LYMPHATIC Filazine(Hudson), Tab. 100 mg, Tk. 1.30/Tab.
Lafil(Supreme), Tab, 100mg, Tk. 1.00/Tab.
FILARIASIS
(WUCHERIA INFECTIONS)
IVERMECTIN
In lymphatic filariasis (LF) host reaction
to the adult worm initially causes It has efficacy in ascariasis,
lymphatic inflammation that can progress strogyloidosis, cutaneous larva migrans
through stages of lymphatic obstruction and lymphatic filariasis. Pinworm and
and secondary attacks of bacterial whipworm infections are variably
cellulitis leading to lymphedema responsive and hookworm infection is
manifested by hydrocele and unresponsive.
elephantiasis. Global program Indications: See under Dose
recommends that all at-risk individuals be Cautions, Contra-indications:
treated once yearly orally with two drug Pregnancy; mass treatment withheld
combination: Diethylcarbamazine (DEC) from pregnant women, children < 15 kg
and Albendazole (most countries) or body weight and in the seriously ill
DEC and ivermectin (parts of sub- Interactions: See Appendix -2
Saharan Africa, Yemen). Side-effects:In LF therapy, Mazzotti-like
reaction to dying microfilariae: usually
DIETHYL CARBAMAZINE[ED] mild itching and swollen, tender lymph
nodes; rarely, rarely abdominal pain,
diarrhea; rarelysevere reactions including
Indications: Lymphatic filariasis, high fever, tachycardia, hypotension,
treatment and prophylaxis of loiasis in prostration, dizziness, headache,
temporary residents in endemic areas, arthralgia, myalgia, diarrhea, edema and
visceral larva migrans in patients with high parasite burdens,
Cautions: in heavy infections there may encephalopathies; mild ocular irritation,
be febrile reaction, and in heavy Loa loa somnolence, transient eosinophilia,
infection there is a small risk of raised liver enzymes also are reported
encephalopathy, in such case treatment Dose: Oral: control of LF( in combination
must be given under careful in-patient with albendazole 400 mg), 200
supervision and stopped at the first sign micrograms/kg as a single annual dose
of cerebral involvement; renal impairment for at least 5 years; treatment
requires dose reduction, cardiac of:onchocerciasi (O volvulus), ascariasis,
disorders trichuriasis,enterobiasis, strogyloidiasis,
Contra-indications: Pregnancy, infants, ADULT & CHILD ≥ 5 years, 150-
elderly, debilitated patients 200microgm/kg, single dose; cutaneous
Interactions: See Appendix -2 larva migrans, 200 micrograms/kg single
Side-effects: Fever, headache, dose; treatment of hyperkeratotic
anorexia, malaise, urticaria, vomiting, scabies,200 micrograms/kg in
asthmatic attacks following the first dose combination with topical drugs
are due to products of destruction of the
parasite, microencephalitis, reversible ProprietaryPreparations
proteinuria Ivactin(Aristo), Tab., 3mg, Tk. 6.00/Tab.
Dose: Oral:1 mg/kg on the first day, then Scabo(Delta), Tab., 6 mg, Tk. 5.00/Tab.
increased gradually > 3 days to 6 mg/kg
daily in divided doses and maintained for
21 days; loiasis prophylaxis, 300 mg
weekly for as long as exposure occurs
1.5.2 DRUGS FOR CESTODE
INFECTIONS
85
1. ANTI-INFECTIVES

1.5.2.1 DRUGS FOR TAPEWORMS 1.5.2.2 DRUGS FOR HYDATID


(TAENIASIS: BEEF AND DISEASE (ECHINOCOCCOSIS)
PORKTAPEWORMS)
1.5.2.2 DRUGS FOR HYDATID Echinococcus granulosus produces
DISEASE unilocular, slowly growing cyst usually in
1.5.2.1 DRUGS FOR TAPEWORMS liver and lung whereas E multilocularis
causes multilocular invasive cysts also in
Beef tapeworm (Taenia saginata) rarely the same organs. The disease may
produces serious infection and is remain asymptomatic: cysts are
preventable by cooking beef at 600 C for frequently found on routine chest X-rays.
> 5 minutes. Praziquantel is the first Rupture of a cyst is associated with
choice whereas niclosomide stands next. formation of localized or generalized
Taenia solium or pork tapeworm causes secondary echinococcosis.
two types of infections: the intestinal form Asymptomatic patients do not always
caused by the adult worm and the far require treatment. Surgical treatment
more dangerous systemic form of remains the method of choice in many
cysticercosis, which usually co-exist, situations. Albendazole is used in
caused by the invasive larval form of the conjunction with surgery to reduce the
parasite. Invasion of the brain is common risk of recurrence or as primary treatment
and dangerous: epilepsy, meningitis and in inoperable cases. Alveolar
raised intracranial pressure may ensue. echinococcosis due to E. multilocularis is
Albendazole is choice of treatment for usually fatal if untreated. Surgical
cysticercosis (treatment of removal with albendazole cover is the
neurocysticercosis demands supports of treatment of choice, but where effective
neurologist/neurosurgeon), and surgery is impossible, repeated cycles of
niclosomide is preferred for intestinal albendazole (for a year or more) may
infection. help. Careful monitoring of liver function
is particularly important during drug
treatment

1.6 ANTIMICROBIAL OPTIONS FOR MEDICALLY IMPORTANT ORGANISMS


Organism Category of isolates Name of antibiotic

Staphylococcus aureus Penicillin sensitive isolates Penicillin G


Amoxicillin
Cephalexin
Penicillin resistant isolates Cloxacillin
Flucloxacillin
Clindamycin
Erythromycin
MRSA Clindamycin
Vancomycin
Linezolid
Daptomycin
Tetracycline
Cotrimoxazole
D test positive (clindamycin Cloxacillin
resistance) Flucloxacillin
Vancomycin
(according to c/s)
86
1. ANTI-INFECTIVES

Staphylococcus Penicillin sensitive isolates Penicillin G


epidermidis Amoxicillin
Cephalexin
MRSE Vancomycin plus
aminoglyside
Streptococcus pyogenes All isolates are penicillin Penicillin G
(Group A) sensitive Amoxicillin
Ampicillin
Streptococcus agalactiae Penicillin G
(Group B) Ampicillin
Enterococcus faecalis Penicillin sensitive Penicillin
Ampicillin
High level gentamycin Penicillin plus
resistant (HLGRE) aminoglycoside or
Vancomycin plus
aminoglycoside
Vancomycin resistant Linezolid
Quinopristin-dalfopristin
daptomycin
Streptococcus Penicillin sensitive strain Penicillin G
pneumoniae Erythromycin
Penicillin resistant strain Ceftriaxone
Levofloxacin
Vancomycin
Streptococci viridians Penicillin G with or
group without aminoglycosides
Neisseria meningitidis Penicillin G
Ceftriaxone/cefotaxime
Chloramphenical
Neisseria gonorrhoeae Penicillin sensitive Cefixime
Ceftriaxone
Spectinomycin

Neisseria gonorrhoeae Penicillin resistant (PPNG) Ciprofloxacin


Quinolone resistant Spectinomycin
Bacillus anthracis Penicillin G
Corynebacterium Penicillin G
diphtheriae Erythromycin
Listeria monocytogenes Cotrimoxazole
Ampicillin with or without
gentamycin
Escherichia coli Non beta lactamase Ampicillin
Amoxyclav
Cephalosporin
Cotrimoxazole

87
1. ANTI-INFECTIVES

ESBLs Aminoglycoside
Carbapenem
Cotrimoxazole
Nitrofurantoin (UTI)
Ciprofloxacine
Tigecycline
Piperacillin-Tazobactum
(choice according to c/s
report)
Salmonella typhi Nalidixic acid sensitive Quinolone
Ampicillin
Azithromycin
Nalidixic acid resistant Ceftriaxone
Cefixime
Azithromycin
(choice according to c/s)
Shigella sp. Ciprofloxacin
Vibrio cholerae Tetracycline
Haemophilus spp Amoxicillin, Co-
amoxiclav
Cephalosporin,
Ciprofloxacin, Macrolid
Helicobacter pylori Amoxicillin
Metronidazole
Bismuth
Campylobacter jejuni Erythromycin
Klebsiella spp Non beta lactamase Cephalosporins
Enterobacter spp Aminoglycosides
Serratia spp Quinolones
Proteus spp
Morganella spp
Providenciaspp
Klebsiella spp ESBLs Aminoglycoside
Enterobacter spp Carbapenem
Serratia spp Cotrimoxazole
Proteus sp Nitrofurantoin (UTI)
Morganella spp Quinolones
Providenciaspp (choice according to c/s
report)
Pseudomonas Piperacillin-tazobactam
aeruginosa Ceftazidime, cefepime
Quinolones
Carbapenem
Aztreonam
(choice according to c/s
report)
Burkholderia Ceftazidime
pseudomallei Carbapenem
Cotrimoxazole
Amoxyclav
Leginella Azithromycin,
Levofloxacin,
doxycycline

88
1. ANTI-INFECTIVES

Chlamydia trachomatis Azythromycin,


doxycycline
Rickettsia Tetracycline
Treponema pallidum Penicillin, Doxycyclin
Nocardia Cotrimoxazole
Mycoplasma Erythromycin,
Tetracyclin
Bacteroides Metronidazole,
Coamoxyclav
Clindamycin
Carbapenem
Clostridium tetani Penicillin
Clostidium difficile Metronidazole
Vancomycin
Actinomyces PenicillinG
Herpes Simplex Virus Acyclovir
Varicella Zoster Virus No antiviral therapy
needed
Cytomegalovirus Gancyclovir
Human papilloma virus Podophyllin
Liquid Nitrogen
Alpha interferon
Influenza virus Oseltamivir
Zanamivir
Hepatitis B virus Pegylated α-IFN
Lumivudin
Hepatitis C virus Pegylated α-IFN
Plus ribavirin
HIV virus Zidovudin
Lamivudin
Nevirapine
Indinavir
Dermatophytes Miconazole
Clotrimazole
Histoplasma capsulatum Itraconazole
Amphotericin B
Coccidioides immitis Itraconazole
Amphotericin B
Blastomyces dermatitidis Itraconazole
Candida albicans Topical nystatin or
clotrimazole
Fluconazole
Ketoconazole
Amphotericin B
Cryptococcus Amphotericin B plus
neoformans flucytosine
Aspergillus sp Amphotericin B
Mucor &Rhizopus sp Amphotericin B
Entamoeba histolytica Metronidazole
Tinidazole
Ornidazole

89
1. ANTI-INFECTIVES

Secnidazole
Diloxanide furate
Giardia lamblia Metronidazole
Nitozoxanide
Trichomonas vaginalis Metronidazole
Plasmodium sp. Chloroqine sensitive strain Chloroquine phosphate

Chloroqine resistant strain Artemether


Artemether with
lumefantrine
Artesunate
Quinine
Mefloquine
Toxoplasma gondii Sulfadiazine plus
pyrimethamine
Pneumocystis jiroveci Cotrimoxazole
Leishmania donvani Sodium stibogluconate
Liposomal Amphotericin
B
Miltefosin
Echinococcus Albendazole
Taenia sp Praziquantel
Schistosoma Praziquantel
Ascaris lumbricoides Mebendazole
Pyrantel pamoat
Hook worm Mebendazole
Pyrantel pamoat
Pinworm Mebendazole
Pyrantel pamoat
Strongyloides stercoralis Ivermectin
Trichuris trichiura Mebendazole
Wuchereria bancrofti Diethylcarbamazine
Dracunculus medinensis Thiabendazole
Metronidazole
Onchocerca volvulus Ivermectin

90
Chapter 2

GASTRO-INTESTINAL SYSTEM
2.1 Drugs for Dyspepsia and gastrooesophegal refluxp.91
2.1.1 Aluminium and magnesium containing antacids p.92
2.1.2 Compound antacid preparations p.93
2.2 Antispasmodics and other drugs altering gut motility p.94
2.3 Ulcer-healing drugs p.100
2.3.1 H2 receptor antagonistsp.100
2.3.2 Selective antimuscarinics p.103
2.3.3 Proton pump inhibitors p. 103
2.3.4 Chelates and complexes p.110
2.3.5 Prostaglandin analogues p.110
2.3.6 Drugs for eradication of H. pylori p. 111
2.4 Drugs for acute diarrhoea p. 111
2.5 Drugs for chronic diarrhoeap.113
2.6 Laxatives p. 115
2.6.1 Bulk forming laxatives p. 115
2.6.2 Stimulant laxatives p. 116
2.6.3 Faecal softeners p. 116
2.6.4 Osmotic laxatives p. 117
2.7 Preparations for haemorrhoids p. 119
2.7.1 Soothing haemorrhoidal preparations p. 119
2.7.2. Compound haemorrhoidal preparations with corticosteroids p. 119
2.7.3 Rectal sclerosants p. 120
2.7.4 Other Preparations p. 120
2.8 Drugs affecting intestinal secretions p. 120
2.8.1 Drugs acting on gall bladder p. 120
2.8.2 Pancreatin p. 121

2.1 DRUGS FOR DISPEPSIA AND without complications can bemanaged


GASTRO-OESOPHEGAL initially by changing the frequency
REFLUX andvolume of feed. A thickened
formulafeed can be used upon advice of
Pregnant woman with gastro- a dietitian. If necessary, a
oesophageal reflux is managed by suitablealginate-containing preparation
dietary and lifestyle changes; if no can be used instead ofthickened feeds.
improvement of symptoms, an antacid Older children with reflux may be
(section 2.1.1) or an alginatemay be managed by life-style changes; if
given. If this is ineffective, necessary by treatment with an
ranitidine(section 2.3.1)may be advised. alginatecontainingpreparation.
However, omeprazole (section2.3.3) is Non-resposive children to the above
reserved for women with severe or measures or whohave problems such as
complicatedreflux disease.Domperidone respiratory disorders or
can be added with caution suspectedoesophagitis need to be
Children withgastro-oesophageal reflux referred to hospital; anH2-receptor
disease is commonin infancy. However, antagonist (section 2.3.1) may be tried
most symptoms resolve withouttreatment toreduce acid secretion. If the
between 12 and 18 months of age. oesophagitis is resistant toH2-receptor
Infants withmild or moderate reflux antagonists, the proton pump inhibitor

91
2. GASTRO-INTESTINAL SYSTEM

omeprazole(section 2.3.3) can be salts cause constipation; so mixtures of


advised. these two preserve normal bowel
Hepatic and renal impairment: function. Some of these preparations
Patients with fluid retention should avoid contain high concentration of sodium
antacids containing large amounts of and should not be given to patients on
sodium. sodium restricted diet.
Interactions: Antacids should preferably
not be taken at the same time as other PREPARATIONS CONTAINING
drugs since they may impair absorption. MIXUTURES OF ALUMINIUM
It may also damage enteric coatings HYDROXIDE AND MAGNESIUM
designed to prevent dissolution in the HYDROXIDE[ED][OTC]
stomach.
Proprietary Preparations
2.1.1 ALUMINIUM-AND MAGNESIUM- Alimag(Asiatic), Tab. Tk. 0.52/Tab.
CONTAINING ANTACIDS Alucil-S(Opsonin),Susp.Tk.
2.1.2 COMPOUND ANTACID 56.39/200mlTab.Tk. 1.50/Tab.
PREPARATIONS Antacid(Popular), Tab. Tk. 0.53/Tab.
Antameal(Alco), Tab. Tk. 0.50/Tab.
Antanil(Ibn Sina), Susp.Tk. 33/200 ml Tab.
Antacids are basic compounds, which Tk. 0.52/Tab.
neutralize hydrochloric acid in the gastric Apcocid(Supreme), Tab. Tk. 0.50/Tab.
secretions; they often relieve symptoms Apedrox(APC), Susp. Tk. 30/200ml
of gastrointestinal disorders associated Biocid(Biopharma), Tab. Tk. 0.50/Tab.
with gastric hyperacidity such as ulcer Biocid MH(Biopharma),Susp.Tk.32.42/200 ml
Cytocid(Central), Susp. Tk.32/200 ml
dyspepsia, non-erosive gastro- Entacyd(Square), Susp. Tk. 55/200 ml Tab.
oesophegal reflux disease and peptic Tk. 0.80/Tab.
ulcer Antacids, sometimes also used in G-Antacid MH(Gonoshasthaya), Tab.
functional (non-ulcer) dyspepsia but the Tk.0.53/Tab
evidence of benefit is uncertain. They Gascon(Popular), Tab. Tk. 1.20/Tab.
are best given usually between meals Jpdrox(Jayson), Susp. Tk. 57/200 ml;
and at bedtime when symptoms occur or Tab. Tk. 0.73/Tab.
Lactameal(Beximco), Tab. Tk.
are expected. Liquid preparations are 0.53/Tab.;Susp. Tk. 33.00/200 ml
more effective than solids and relatively Magnogel(Amico ), Tab. Tk. 0.52/Tab.; Susp.
insoluble antacids are longer acting. Tk.32.00/200 ml
Presence of foods in the stomach can Oxecone(Acme), Susp.Tk. 57.33/200 ml;Tab.
prolong the neutralizing activity. Antacids Tk. 0.73/Tab.
may interact with many other drugs Sugel(Pacific), Susp. Tk. 24.06/200 ml; Tab.
affecting the rate and extent of their Tk. 0.38/Tab.
absorption (see Appendix-2). For this
reason, antacids should preferably not MAGNESIUM TRISILICATE
be taken at the same time with other
drugs. Indications: used as an antacid in dose
upto 2 g by mouth; usually in combi-
2.1.1 ALUMINIUM AND MAGNESIUM nation with aluminium-containing
CONTAINING ANTACIDS antacids.
Cautions:see notes above; patients with
Salts of Aluminium (Aluminium impaired renal functions.
hydroxide gel) and Magnesium Contraindications:see notes above
(Magnesium hydroxide, Magnesium Interactions: see Appendix-2
trisilicate and Magnesium carbonate), Side-effects:diarrhea.
being relatively insoluble in water, are
long-acting and are suitable for use as Proprietary Preparation
Mixtures of 250mg of Dried
antacid. Magnesium-containing antacids Aluminium Hydroxide Gel and
tend to cause diarrhoea and aluminium 500mg of Magnesium Trisilicate

92
2. GASTRO-INTESTINAL SYSTEM

G-Antacid(Gonoshasthaya), Susp. Marlox Plus(Incepta), Tab.Tk. 3.00/Tab.;


Tk.32.00/200ml;Tab. Tk. 0.53/Tab. Susp., Tk. 100.00/200 ml
Novelta(Orion), Tab.Tk. 3.00/Tab.; Tk.
65.00/100 ml; Tk. 100.00/200 ml
2.1.2 COMPOUND ANTACID,
Oxecone-MS(Acme), Susp.Tk.100.00/200 ml
SIMETHICONEAND ALGINATE
PREPARATIONS
ALUMINIUM -AND MAGNESIUM-
CONTAINING ANTACIDS WITH
Compound preparations have no clear ADDITIONAL INGREDIENTS
advantages over simpler preparations;
their neutralising capacity may be the
Simethicone whichacts as a defoaming
same. Complexes containing both
agent has been combined with an
aluminium and magnesium such as
antacid formulation to relieve flatulence.
magaldratehydrotalcite and almasilate
have been used.
ALGINATES
MAGALDRATE
Alginate an anionic polysaccharide is
obtained from brown algae.
Magaldrate (Aluminium Magnesium
Alginatescontaining antacids form a
Hydroxide Sulfate) is a synthetic
viscous gel (raft) that floats on the
combination of aluminium and
surface of stomach contents which
magnesium hydroxides and sulphates. It
impedes reflux and protects
reacts initially rapidly with acid and
oesophageal mucosa from acid attack.
releases aluminium hydroxide, which
Compound antacid preparations contain
then reacts more slowly to provide
alginic acid or sodium alginates with
sustained neutralizing action. Magaldrate
sodium bicarbonate/potassium
may be given in doses of up to 2 g by
bicarbonate, calcium carbonate. Some
mouth.
compounds preparations also contain
alginate/alginic acid with dried aluminium
Proprietary Preparations
Marlox(Incepta), Tab. , 400 mg, Tk.
hydroxide, magnesium trisilicate and
1.00/Tab.; Susp. 400 mg/5 ml,Tk. 50.00/200 sodium bicarbonate.
ml
Oxecone(Acme), Suspn. 400 mg/5 ml, Tk. Proprietary Preparations
54.36/200ml; Tab. , 400 mg , Tk. 1.00/Tab. Sodium Alginate + Potassium Bicarbonate
Magacil(Opsonin), Tab., 400 mg, Tk. Algicid(Incepta), Susp., 500 mg + 100 mg
0.75/Tab.; Susp., 400 mg/5 ml , Tk. /5ml, Tk. 125.00/200 ml ;Tab. , 500 mg + 100
37.74/200ml mg, Tk. 3.50/Tab.
Magaplus(Kemiko), Susp., 400 mg/5 ml, Tk. Algicon(Leon), Tab. , 500 mg + 100 mg, Tk.
54.20/200 ml 3.00/Tab. ;Susp., 500 mg + 100 mg /5ml,Tk.
125.00/200 ml
Magaldrate 480mg + Simethicone20mg/Tab Asynta(Square), Susp., 500 mg + 100 mg/5
Magaldrate 480mg + Simethicone20mg/5ml ml, Tk. 125.00/200 ml
suspension Gastrocon(Unimed), Tab., 500 mg+100 mg,
Avlocid MS(ACI), Tab., , Tk. 3.00/Tab.; Tk. 4.50/Tab.;Susp., 500mg+100 mg/5ml, Tk.
Susp., Tk. 100.00/200 ml 155.00/200 ml
Digecid Plus(Beximco), Tk. 2.00/Tab.; Susp., Viscocid(Beximco), Susp. 500 mg+100 mg
Tk. 110.00/200 ml /5ml, Tk. 150.00/200 ml
Gastid(Eskayef), Tab., Tk. 3.00/Tab.; Susp.,
Tk. 100.00/200 ml SIMETHICONE
Magacil Plus(Opsonin), Susp.Tk.75.19/200ml
Magalrat Plus(Ibn Sina), Tab., Tk. 3.00/Tab.; (Activated Dimethicone)
Susp., Tk. 100.00/200 ml
Maganta Plus(Square), Tab., Tk. 3.00/Tab.; Simethicone which is also known as
Susp., Tk. 100.00/200 ml Activated Dimethicone has been used
Magaplus-X(Kemiko),Susp.Tk. 55.00/100 ml; for the relief of the painful symptomos of
Tk. 100.00/200 ml excess gas in the digestive tract. Such
gas is frequently caused by excessive
93
2. GASTRO-INTESTINAL SYSTEM

swallowing of air while eating foods that


disagree, and this may also lead to 2.2 ANTISPASMODICS AND
indigestion. It has also been used in OTHER DRUGS ALTERING
infantile colic but evidence of benefit is GUT MOTILITY
uncertain.
Indications: flatulence, Abdominal Gastrointestinal pain and discomfort may
distension, gas and windy colic. be due to spasm of the smooth muscles
Simethicone drops are particularly indi- which may be associated with dyspepsia
cated in infantile colic irritable bowel syndrome or diverticular
Cautions; Contraindications; Side- disease. Antispasmodic drugs may be
effects: Simethicone is an inert subst- useful as adjunctive treatment and are of
ance and no adverse effects have been two types: a) antimuscarinics; and b)
reported after oral administration direct smooth muscle relaxant.

Proprietary Preparations ANTIMUSCARINICS


Aeropac(Amico), Paed. drops, 67 mg/ml, Tk.
25.00/15 ml (See also section 8.1.2)
Bloatstop(Acme), Emulsion, 1 gm/100 ml, Tk. The antimuscarinics reduce intestinal
70.00/100 ml spasm, motility and gastric secretions,
Flacol(Square), Paed. drops, 67 mg/ml,, Tk. and may be useful in some forms of
30.11/15 ml ;Tab. , 40mg, Tk.1.50/Tab. dyspepsia, irritable bowel syndrome and
Flatulex(Opsonin), Paed. drops, 67 mg/ml,, 67
diverticular disease. Antimuscarinics
mg/ml, Tk. 22.64/15 ml
Flatunil(Acme), Paed. drops, 67 mg/ml, 67 used in gastrointestinal muscle spasm
mg/ml, Tk. 30.00/15 ml include the tertiary amines Atropine
Gasnil(Eskayef), Paed. drops 67 mg/ml, Tk. sulphate,Dicycloverine hydrochloride
30.00/15 ml and Oxyphencyclimine hydrochloride
Lefoam(Incepta), Paed. drops, 67 mg/ml, Tk. Trimebutine is a drug with
30.00/15 ml antimuscarinic and opioid agonist effects
Neodrop(Beximco), Paed. drops, 67 mg/ml,
quarternary ammonium compounds
Tk. 30.00/15 ml
Pedicon(Orion), Paed. drops, 67 mg/ml, Tk. Hyoscine butylbromide Propantheline
25.09/10 ml;Paed. drops, 67 mg/ml, Tk. bromide,oxyphenonium bromide,and
30.11/15 ml Tiemonium methylsulphate.
Semecon(Drug Int.), Paed.drops, 67 mg/ml, Dicycloverine hydrochloride has much
Tk. 35.00/15 ml less antimuscarinic action than atropine
Simecol(Alco), Paed. drops, 67 mg/ml, Tk. and may also have some direct action on
28.00/15 ml
smooth muscle. Hyoscine butylbromide
Simet(ACI), Paed. drops, 67 mg/ml, Tk.
30.11/15 ml is advised as a gastro-intestinal
antispasmodic, but it is poorly absorbed.
Aluminium hydroxide and magnesium Quaternary ammonium compounds are
hydroxide with simethicone less lipid soluble and so are less likely to
Antacid MAX(Beximco), Tab. Tk. 2/Tab. cross the blood-brain barrier; they are
Antanil Plus(Ibn Sina), Susp.Tk. 65/200 ml; also less well absorbed. Although central
Tab., Tk. 1.50/Tab.
atropine like side-effects, such as
Avlocid Plus(ACI), Tab. Tk. 2/Tab. ;Susp.,
Tk. 75/200 ml confusion, are thereby reduced,
BIocid Plus(Biopharma), Susp. Tk. peripheral atropine-like side-effects still
75/200ml;Tab. Tk. 2/Tab. remain common. The elderly are
Entacyd Plus(Square), Susp.Tk. 75/200 ml; particularly susceptible to glaucoma and
Tab. Tk. 2.00/Tab. urinary retention.
Flatameal DS(Beximco), Susp. Tk. 75/200 ml Antimuscarinics are contraindicated in
Kdrox Plus(Kemiko), Tab. Tk. 2/Tab.
myasthenia gravis (but may be used to
Makcid Plus(Maks), Susp. Tk. 64/200 ml
Oxecone-S(Acme), Susp.Tk. 75/200 ml;Tab., decrease muscarinic side-effects of
Tk. 2.00/Tab. anticholinesterases), pyloric stenosis,
Peptacid(Amico),Tab.,Tk.1/Tab.;Tk.55/200 ml paralytic ileus, toxic megacolon,and
Recocid Plus(Rephco), Susp., Tk. 75/200 ml; prostatic enlargement. It should be used
Tab. Tk. 2/Tab.
94
2. GASTRO-INTESTINAL SYSTEM

with caution in children and in the Dose: 10–20 mg 3 times daily; INFANT
elderly; in Down’s syndrome, reflux 6–24 months 5–10mg3–4 times daily, 15
oesophagitis, diarrhoea, conditions minutes before feeds;
associated with cardiac insufficiency and CHILD 2–12years 10mg 3 times daily
tachycardia, hypertension,ulcerative
colitis,autonomic neuropathy, acute Proprietary Preparations
myocardial infarction, pyrexia, individuals Abdorin(Opsonin), Syrup, 10 mg /5 ml, Tk.
susceptible toangle-closure glaucoma. 30.11/50 ml,; Tab. , 10 mg, Tk. 2.01/Tab.
Side-effects of antimuscarinic drug Colicon(Square), Syrup, 10 mg/5 ml, Tk.
30.2/50ml,; Tab., 10 mg, Tk. 2.01/Tab.
(especially with high doses) include Cyclopan(Incepta), Inj. , 20 mg/2 ml, Tk.
constipation, transient bradycardia 8.00/2ml,; Syrup, 10 mg/5 ml, Tk. 30.00/50ml,;
(followed by tachycardia, palpitations Tab, 10 mg, Tk. 2.00/Tab.
and arrhythmias), reduced bronchial Dirin(Alco), Tab. , 10 mg, Tk. 2.01/Tab.;
secretions, urinary retention, dilatation of Syrup, 10 mg / 5ml, Tk. 40.12/50ml
the pupils with loss of accommodation, Diverin(ACI), Syrup, 10mg/5ml, Tk. 30.2/50ml
photophobia, dryness of the mouth and ,; Tab., 10mg, Tk. 2.02/Tab.; 20mg, Tk.
3.52/Tab.
skin, occasional confusion (particularly in Ibspa(Pacific), Tab., 10mg/5 ml, Tk.
the elderly), nausea, vomiting and 25.00/50ml,; 10 mg, Tk. 2.00/Tab.
giddiness. Loverin(Beximco), Tab., 10mg, Tk. 2.01/Tab.
Robentyl(Healthcare), Syrup, 50ml , Tk.
ATROPINE SULPHATE[ED] 40.00/Syrup,; 10mg , Tk. 200.00/Tab.
Cyclovin(Somatec), Tab. , 10 mg, Tk.
2.01/Tab.; 10 mg/5 ml, Tk. 30.11/50 ml
Indications: Aid in peptic ulcer Eraspa(MST), Tab. 10 mg, Tk. 2/Tab.
treatment, gastrointestinal spasm, renal Spalax(Navana), Syrup, 10 mg/5 ml, Tk.
and biliary coilc, pre-medication (see 30.11/50 ml
sec. 8.1.3)
Cautions; Contraindications; Side- HYOSCINE BUTYLBROMIDE[ED]
effects:See notes above
Interactions: See Appendix-2 Indications: symptomatic relief of
Dose: See section 8.1.2 gastro-intestinal, biliary or genitourinary
colic (spasmodic pain) and irritable
Proprietary Preparations bowel syndrome; dysmenorrhoea; as
Atropine(Chemist), Inj.,1mg/ml, Tk. 2.52/1ml antispasmodic in endoscopy and
Amp
Atropine-Jayson(Jayson), Inj. 0.6 mg/1ml, Tk.
radiological procedures of gut; as an
5.00/1 ml Amp. adjunct in the treatment of peptic ulcer..
G-Atropine(Gonoshasthaya), Inj.0.6 mg/1ml, Cautions; Contraindications; Side-
Tk. 3.01/1ml Amp. effects:see notes above
Interactions: see Appendix-2
DICYCLOVERINE HYDROCHLORIDE Dose:by mouth, 10-20 mg 4 times daily;
(Dicyclomine hydrochloride) CHILD 6-12 years, 10 mg 3 times daily.
By intramuscular or intravenous injection
Indications: Symptomatic relief of (acute spasm), 20 mg, repeated after 30
gastro-intestinal disorders characterised minutes if necessary. CHILD not
by smooth muscle spasm recommended
Side effects: See notes above
Cautions:See notes above Proprietary Preparations
Asipan(Asiatic), Tab., 20mg , Tk. 3.00/Tab.
Contra-indications:See notes above;
Buscon(Ibn Sina), Tab., 10 mg, Tk.
also infants under 6 months 3.00/Tab.; Inj., 20mg/ml, Tk. 29.50/ml Amp
Pregnancy:Use only if essential Butapan(Sanofi), Tab., 10mg, Tk. 6.90/Tab.;
Breast-feeding: Should be avoided, 20mg, Tk. 13.64/Tab.
present in milk; apnoeareported in infant Colik(ACI), Tab., 10mg, Tk.6.90/Tab.; 20mg,
Tk. 6.72/Tab., Inj., 20 mg/ml, Tk. 29.90/Amp,
Eziride(Opsonin), Tab. 150 mcg , Tk.
5.00/Tab.
95
2. GASTRO-INTESTINAL SYSTEM

Hybucin(Supreme), Tab. 10 mg, Tk. 3.40/Tab. TIEMONIUM METHYLSULPHATE


Hybut(Amico), Tab., 10mg, Tk. 3.43/Tab.
Hysomide(Opsonin), Inj., 20 mg/ml, Tk.
29.90/Amp,; Tab. , 10 mg, Tk. 6.90/Tab.; 20 Indications: symptomatic relief of
mg , Tk. 13.64/Tab. gastrointestinal, biliary, renal and
Spanil(Beximco), Tab., 10mg, Tk. 6.90/Tab. genitourinary colic
Spasmozen (Zenith), Tab. 10 mg , Tk. Cautions;Contraindications; Side-
3.44/Tab. effects: see notes above.
Typan(Astra Biopharma), Tab. , 10 mg, Tk.
Interactions: see Appendix-2
3.43/Tab.
Altapan(Albion), Tab., 10 mg, Tk.1.80/Tab. Dose:by mouth 100-300 mg daily in
Asipan(Asiatic), Tab., 20 mg, Tk. 3.00/Tab. divided doses; by intramuscular or slow
Butapan(Sanofi), Tab., 10 mg, Tk. 3.42/Tab.; intravenous injection, 10 mg 2-3 times
20 mg, Tk. 6.00/Tab.;Inj., 20 mg/ml , daily
Tk.7.89/Amp.
Butason(Hudson), Tab., 10mg, Tk.1.75/Tab. Proprietary Preparations
Colipan(Medimet), Inj., 1 mg/ml, Tk.7.85/1 ml Algin(Renata), Inj., 5 mg/2 ml, Tk. 25.00/2 ml
Amp.; Tab., 10mg, Tk.3.00/Tab.; 20mg, Amp., Tab. , 50 mg, Tk. 6.00/Tab., Syrup,
Tk.5.65/Tab. 10mg/5 ml, Tk. 90.00/100ml
G-Hyoscine(Gonoshasthaya), Tab. 10 mg, Aspasom (Kemiko), Tab., 50 mg, Tk.
Tk.3.35/Tab.; Inj., 20 mg/ml, Tk.7.75/Amp. 5.00/Tab., Syrup, 10mg/5 ml, Tk. 90.00/100ml
Spasmoson(Jayson), Tab., 10 mg, Tk. Dysma(Rangs), Tab., 50 mg, Tk. 5/Tab.
3.40/Tab.; Inj., 20 mg/ml, Tk. 7.88/Amp. Emogin(Somatec), Tab., 50 mg, Tk.
5.00/Tab.
OXYPHENONIUM BROMIDE Emonium(Beximco), Inj., 5 mg/2 ml, Tk.
75.00/2ml Amp., Tab., 50mg, Tk. 5.00/Tab.
Monivis(Organic), Tab. , 50 mg, Tk.
Indications: symptomatic relief of 6.02/Tab.
gastro-intestinal, biliary or genitourinary Norvis(Square), Inj., 5 mg/2 ml, Tk. 25.00/2
colic; as an adjunct in the treatment of ml Amp., Syrup, 10mg/5 ml, Tk. 87.26/100ml;
peptic ulcer. Tab. , 50 mg, Tk. 6.02/Tab.
Cautions; Contraindications; Side- Onium(Orion), Syrup, 10mg/5 ml, Tk.
effects:see notes above 50.15/50ml; 10mg/5 ml, Tk. 85.26/100ml; Tab.
, 50 mg, Tk. 6.02/Tab., Inj, 5 mg/2 ml, Tk.
Interactions: see Appendix-2 25.08/2 ml Amp.
Dose:by mouth, 5-10 mg 3 times daily Panium(Navana), Tab., 50 mg, Tk.
5.00/Tab.;Inj., 5 mg/2 ml, Tk. 20.00/amp.
Proprietary Preparations Previp(Genera), Tab. , 50 mg, Tk. 4.02/Tab.
Antrenex(Opsonin), Tab., 5 mg, Tk. 1.25/Tab. Relvis(Biopharma), Inj. , 5 mg/2 ml, Tk.
Antrenyl(Novartis), Tab., 5 mg, Tk. 4.00/Tab. 15.00/2 ml Amp., Tab., 50mg, Tk. 5.00/Tab.
A-Spasm(Acme), Tab., 5 mg, Tk. 1.44/Tab. Spadyl(SMC Enterprise), Tab., 50 mg, Tk.
Isonil(Amico), Tab., 5 mg, Tk. 1.41/Tab. 5.00/Tab.
Spanium(Ziska), Inj., 5 mg/2 ml, Tk. 15/2ml
Amp.; 50 mg, Tk. 4/Tab.
PROPANTHELINE BROMIDE
Spason(Astra Biopharma), Tab. , 50 mg,
Spazin (Euro), Tab., 50mg, Tk. 5.00/Tab.
Indications: symptomatic relief of Tiemo (Alco), Tab. , 50 mg, Tk. 4.01/Tab.
gastrointestinal colic, as an adjunct in Tienum(Chemist), Inj. , 2 ml, Tk. 15/2 ml Amp;
the treatment of peptic ulcer; adult Tab. , 50 mg, Tk. 4/Tab.
enuresis and urinary incontinence Timem(Silva), Tab. , 50mg, Tk. 4.02/Tab.
Timoben(Benham), Tab., 50 mg, Tk. 5/Tab.
Cautions; Contra indications; Side-
Timonac(Julpher), Inj., 5 mg/2 ml , Tk.
effects: see notes above 20.00/amp.;Tab., 50 mg, Tk. 6.00/Tab.
Interactions: see Appendix-2 Timonate(Pacific), Inj. , 5 mg/2 ml, Tk. 25.00/2
Dose: 15 mg 3 times daily 1 hour before ml Amp; Tab., 50 mg, Tk. 6.00/Tab.
meals and 30 mg at night, max. 120mg Timonil(Popular), Tab. , 50 mg, Tk.
daily CHILD not recommended 4.02/Tab., Inj, 5 mg/2 ml, Tk. 15.06/2 ml amp.
Timothy(Eskayef), Inj. , 5 mg/2 ml, Tk. 15.00/2
ml Amp., Tab, 50 mg, Tk. 4.00/Tab., 50 mg,
Proprietary Preparation
Tk. 4.00/Tab.
Prokind(Beacon), Tab. 15 mg, Tk. 8.02/Tab.

96
2. GASTRO-INTESTINAL SYSTEM

Timozin(Incepta), Tab. , 50 mg, Tk. Dose:200 mg 3 times daily before


6.00/Tab., Inj., 5 mg/2 ml, Tk. 15.00/2 ml Amp. meals.
Tinilux(Sharif), Tab. 50mg, Tk. 6.00/Tab.,
50mg, Tk. 6.00/Tab.
Tinimet (Rephco), Inj.,5 mg/2 ml,Tk.20/amp.;
Proprietary Preparations
5mg/2ml, Tk. 25/amp.;Tab., 50 mg, Tk. 5/Tab. Timotor(Square), Tab.,100 mg, Tk. 5.01/Tab.
Tinium(Acme), Inj., 5 mg/2 ml, Tk. 20.07/2 ml Trimotil(Incepta), Tab.,100 mg, Tk. 5.00/Tab.
Amp., Tab., 50 mg, Tk. 6.00/Tab.
Tino(Delta), Tab. , 50 mg, Tk. 4.00/Tab. OTHER ANTISPASMODICS
Tispa(Concord), Tab. , 50 mg, Tk. 5.00/Tab.
Titos(Novo Health), Tab. , 50 mg, Tk.
Alverine, drotaverine, Mebeverine,
5.00/Tab.
Tium(Ad-din), Tab., 50 mg, Tk. 3.50/Tab. and peppermint oil are believed to
Tivis(Beacon), Tab. , 50 mg, Tk. 5.00/Tab.; directly relax intestinal smooth muscle
Inj., 5 mg/2 ml, Tk. 16.00/amp. and may relieve spasm and pain in
Tivis(Beacon), Tab. , 50mg , Tk. 5.04/Tab., irritable bowel syndrome and diverticular
Inj., 5 mg/2 ml, Tk. 16.05/2 ml Amp. disease. They have no serious adverse
Tynium(ACI), Tab., 50mg , Tk. 6.02/Tab., Inj., effects but like all antispasmodics should
5 mg/2 ml, Tk. 15.11/2ml amp., Syrup,
be avoided in paralytic ileus.
10mg/5 ml, Tk. 56.17/50ml; 10mg/5 ml, Tk.
85.26/100ml
Veralgin(Aristo), Inj. , 5 mg/2 ml, Tk. 25.00/2 ALVERINE CITRATE
ml Amp., 50mg , Tk. 6.00/Tab.
Visarin(Pharmasia), Tab., 50 mg, Tk. 4/Tab.
Indications:as an adjunct in gastro-
Viscer(Techno), Inj., 5 mg/2 ml, Tk. 12/amp.
Visceral(Ibn Sina), Tab., 50mg, Tk. 8.00/Tab., intestinal disorderscharacterised by
Inj. , 5 mg/2 ml, Tk. 160.00/2 ml Amp. smooth muscle spasm; dysmenorrhoea
Visegin(UniMed), Tab.,50mg,Tk. 5/Tab. Contra-indications: paralytic
Viset(Healthcare), Syrup, 10mg/5 ml, Tk. ileus,breast-feeding
55.00/Syrup., 10mg/5 ml, Tk. 90.00/Syrup; Caution: pregnancy,
Tab., 50mg, Tk. 7.00/Tab., Inj. , 5 mg/2 ml, Tk. Side-effects: nausea; dyspnoea;
250.00/2 ml Amp
headache, dizziness;pruritus, rash;
Visnil(Nipro JMI),Tab., 50 mg, Tk. 4/Tab.
Visnor(Apex), Inj., 5 mg/2 ml, Tk. 15.00/amp;
hepatitis also reported
Tab., 50 mg, Tk. 4.00/Tab. Dose:ADULT and CHILD over 12 years,
Visonium(Drug Intl), Inj., 5 mg/2 ml, Tk. 60–120mg 1–3 timesdaily.
25.02/2 ml Amp.; Tab., 50mg, Tk. 5.00/Tab.
Vispazin(Globe), Suspn., 10mg/5 ml, Tk. Proprietary Preparations
90.00/100ml; Inj. , 5 mg/2 ml, Tk. 15.00/2 ml Alve(Orion), Tab., 60 mg, Tk. 5.01/Tab.
Amp.; Tab. , 50 mg, Tk. 5.00/Tab. Alverate(Ibn Sina), Tab., 60mg, Tk. 5.02/Tab.
Visral(Opsonin), Supp, 20 mg , Tk. Dismonal(Opsonin), Tab., 60 mg, Tk.
8.00/Supp., Syrup, 10mg/5 ml, Tk. 5.00/Tab.
80.00/100ml; Tab. , 50 mg , Tk. 6.00/Tab., Pelverin(Popular), Tab., 60mg, Tk. 5.02/Tab.
Inj., 5 mg /2 ml, Tk. 15.10/2ml Amp. Spasverin(Beacon), Tab. , 60mg , Tk.
Xelcom(Radiant), Tab. , 50mg, Tk. 5.02/Tab.
8.00/Tab., Inj, 5 mg/2 ml, Tk. 35.00/2 ml Amp
Zeum(Novartis), Tab., 50 mg, Tk. 6.50/Tab.
DROTAVERINE HYDROCHLORIDE
TRIMEBUTINE MALEATE
Indications: as an antispasmodic in
gastro-intestinal colic,biliary and
Indication: Irritable bowel Syndrome genitourinary colic; tenesmus in
Cautions:Pregnancy,breast dysentery; dysmenorrhoea
feeding,children Cautions and Contraindications:
Contraindication: Should not be taken pregnancy and lactation; impairment of
by anyone who is allergic to trimebutine liver or kidney (Appendix 3 & 4)
Side effects: Abdominal Interactions: see Appendix-2
pain,constipation,diarrhoea,dry Side-effects: flushing, perspiration,
mouth,fatigue, foul taste, headaches, hot palpitation and vertigo are reported
or cold sensations,indigestion nausea, Dose:by mouth 40-80 mg 3 times daily.
rash
97
2. GASTRO-INTESTINAL SYSTEM

by subcutaneous or intramuscular Mevin(Square), Tab., 135 mg, Tk. 6.02/Tab.;


injection, 40-80 mg up to three times Cap., 200 mg, Tk.10.03/Cap.
daily Rostil(Beximco), SR Cap., 200 mg, Tk.
10.00/Cap.; Tab., 135 mg, Tk. 7.00/Tab.
by slow intravenous injection in acute Veripel(Beacon), Cap., 200mg , Tk. 9.03/Cap.
renal colic, 40-80 mg Veron(Eskayef), Tab., 135 mg, Tk. 6.00/Tab.;
135 mg, Tk. 6.08/Tab.
Proprietary Preparations
Dot(Acme), Tab. , 40 mg, Tk. 1.76/Tab.; Inj.,
OTHER DRUGS ALTERING GUT
40 mg./2 ml, Tk. 7.04/2ml
Dotarin(Popular), Tab., 40 mg, Tk. 1.76/Tab.; MOTILITY
Inj., 40mg/2ml, Tk. 7.03/Amp. (See sectio section 7.8)
Dover(Nipa), Tab. 40 mg, Tk. 1.75/Tab. Gut smooth muscle exhibits intrinsic
Drotapan(Incepta), Tab. 40 mg, Tk. 1.75/Tab. motor activity which is modified by
Drovin(ACI), Inj., 40mg/2ml, Tk.10.07/2ml; autonomic innervation, local reflexes and
Tab., 40 mg, Tk. 1.77/Tab.
gut hormones to produce peristalsis.
Espa(Square), Inj., 40 mg/2 ml, Tk. 7.02/Amp.,
40 mg, Tk.1.75/Tab. Prokinetic drugs which include
N-Aspa(Albion), Tab., 40 mg, Tk. 1.81/Tab. domperidone and metoclopramide
No-Spa(Ambee), Tab., 40 mg, Tk. 1.82/Tab., stimulate the motility of the gut by acting
Inj. 40 mg/2 ml, Tk. 7.98/2 ml amp. at various points within this complex
Rova(Kemiko), Tab., 40 mg, Tk. 2.00/Tab. system to enhance gut movement.
Span(Opsonin), Tab. , 40 mg, Tk. 1.76/Tab.
Tav(Organic), Tab., 40 mg, Tk. 1.76/Tab.
Taverin(Beximco), Tab.,40 mg, Tk. 2.20/Tab. APREPITANT

MEBEVERINE HYDROCHLORIDE It is an antiemetic drug mediates its


effect by blocking the neurokinin 1 (NK1)
Indications: as an adjunct in the receptor.
treatment of symptomatic relief of Indications:as an adjunct to
gastrointestinal colic, irritable bowel dexamethasone and a 5HT3-receptor
syndrome antagonist in preventing nausea and
Cautions; Contraindications :paralytic vomitingassociated with moderately and
ileus, pregnancy and breast-feeding, highly emetogenicchemotherapy
porphyria; should be used with care in Cautions:should not be used
patients with cardiac disorder, hepatic or concurrently with pimozide, terfenadine,
renal insufficiency astemizole, or cisapride. Taking
Interactions: see Appendix-2 aprepitant with these medications could
Side-effects: anorexia, dizziness, result in serious or life-threatening
headache, insomnia, tachycardia have problems
been reported Contra-indications: acute porphyria ,
Dose: ADULT and CHILD above 12 hepatic impairment;pregnancy;breast-
years 135 mg 3 times daily, prefeably 20 feeding, child under 18 years of age.
mins before meals Side-effects: hiccups, dyspepsia,
diarrhoea, constipation, anorexia;
Proprietary Preparations asthenia, headache, dizziness; less
A-Meb(Acme),Tab. 135 mg., Tk. 6.01/Tab. commonly weight changes, dry mouth,
Evarin(Delta),Tab. 135 mg, Tk. 6.00/Tab. colitis, flatulence, stomatitis, abdominal
Iriban(Incepta), Tab., 200 mg, Tk. pain, duodenal ulcer, taste disturbance,
10.00/Tab.; 135 mg, Tk. 6.00/Tab. oedema, bradycardia, palpitations,
Irisyn(Ibn Sina), Tab., 135 mg, Tk. 7.00/Tab. cough, euphoria, anxiety, confusion,
Mave(Opsonin), Cap. , 200 mg , Tk. drowsiness, thirst, abnormal dreams,
10.07/Cap.; Tab., 135 mg, Tk. 7.00/Tab.
chills, hyperglycaemia, polyuria,
Mebeverine(Albion), Tab.,135 mg,Tk. 6/Tab.
Mebiz(Sun), SR Cap., 200 mg, Tk.10/Cap. anaemia, dysuria, haematuria,
Mespa (Ambee), Tab. 135 mg, Tk. 6.02/Tab. hyponatraemia,neutropenia, myalgia,
Meverine(Drug Intl), Tab., 135 mg, Tk. conjunctivitis, pharyngitis, sneezing,
6.05/Tab.; Cap., 200 mg, Tk. 10.05/Cap. tinnitus, sweating, pruritus,rash, acne,
98
2. GASTRO-INTESTINAL SYSTEM

photosensitivity, and flushing; dyspnoea, Dedom(Decent), Suspn. , 5mg/5ml, Tk.


insomnia, visual disturbances, 28.00/60 ml,; Tab., 10mg, Tk. 1.90/Tab.
dysarthria, urticaria, and Stevens- Deflux(Beximco), Dispersible Tab., 10mg, Tk.
2.50/Tab.; Paed Drops, 5mg/5ml,; Suspn.,
Johnson syndrome also reported. 5mg/5ml, Tk. 38.00/100ml,; Tab., 10mg, Tk.
Dose: ADULT over 18 years 125 mg 1 2.50/Tab.
hour before chemotherapy, then 80mg Doma(Pacific), Suspn. , 5 mg/5 ml, Tk.
daily as a single dose for the next 2 40/100ml ,; 5 mg/5 ml, Tk. 25/60ml ,; Tab., 10
days; consult product literature for dose mg, Tk. 3.00/Tab.
of concomitant corticosteroid and 5HT3- Dometic(One Pharma), Tab., 10 mg , Tk.
receptor antagonist. 2.00/Tab.
Domidon(Ziska), Suspn., 5 mg/5 ml, Tk.
28/60ml,; Tab., 10 mg, Tk. 2/Tab.
Proprietary Preparations Domilin(General), Suspn, 5mg/5ml, Tk.
Emend(Opsonin), Cap., 40 mg , Tk. 40.27/100ml,; Tab., 10mg, Tk. 2.01/Tab.
45.13/Cap. Domilux(Popular), Tab., 10 mg, Tk. 2.00/Tab.;
Emestop (Incepta), Cap., 40 mg, Tk. Suspn., 5mg/5ml,Tk. 35/ 60ml
50.00/Cap. ; 125 mg, Tk. 150.00/Cap. Domin(Opsonin), Supp, 15 mg , Tk.
5.02/15gm,; Suspn., 5mg/5ml, Tk. 28.11/60
DOMPERIDONE ml; Tab., 10 mg, Tk. 2.50/Tab.; Supp, 30 mg ,
Tk. 8.03/ 30 mg ,; Suspn., 5mg/5ml, Tk.
20.08/15 ml
Indications:nausea and vomiting Dominaaf(Naafco), Sunpn., 5 mg/5 ml, Tk.
associated with Levodopa therapy and 30.00/60ml,; Tab., 10 mg, Tk. 2/Tab.
Bromocriptine, functional dyspepsia, Dominat(Nipa), Tab., 10 mg, Tk.2/Tab.
acute Migraine attack Domiren(Renata), Paed. Drops, 5mg/5ml, Tk.
Cautions:renal impairment, pregnancy 25.00/15 ml; Suspn., 5mg/5ml, Tk.
and breast-feeding; not recommended 35.00/Suspn; 5mg/5ml, Tk. 38.00/Suspn.;
Tab., 10 mg, Tk. 2/Tab.
for routine prophylaxis of postoperative
Domperon(Astra Bio, Suspn., 5 mg/5 ml, Tk.
vomiting or for chronic administration 28.00/60 ml,; Tab, 10 mg, Tk. 2.00/Tab.
Interactions:see Appendix-2 Dompi(Alco), Suspn., 5mg / 5ml, Tk.
Side-effects:raised prolactin concen- 40.12/60ml ,; Tab. , 10 mg, Tk. 2.01/Tab.;
trations (possible galactorrhoea and 10mg, Tk. 2.25/Tab.
gynaecomastia), reduced libido reported; Don-A(Acme), Paed Drops, 5mg/5ml, Tk.
rashes and other allergic reactions; 20.13/15ml,; 5mg/5ml, Tk. 25.17/30ml,; Supp,
15 mg., Tk. 5.03/Supp,; 30 mg., Tk.
acute dystonic reactions reported
8.07/Supp,; 5mg/5ml, Tk. 35.11/60ml,; Tab. ,
Dose: 10-20 mg 3 times daily according 10 mg, Tk. 2.01/Tab.
to the requirement. CHILD: Not recomm- Dopadon(Ibn Sina), Paed. Drops, 5mg/5ml,
ended except nausea and vomiting after Tk. 25.00/15ml,; Suspn., 5mg/5ml, Tk.
cytotoxic therapy, 200-400 micrograms/ 30.00/60ml,; Tab., 10mg, Tk. 2.50/Tab.
kg every 4-8 hours Dysnov(UniMed), Tab , 10mg, Tk. 2.50/Tab.;
Paed Drop, 5mg/5ml, Tk. 20.00/15ml,; Suspn.,
5mg/5ml, Tk. 38.00/100ml
Proprietary Preparations
Edone(Zenith), Suspn.; 5mg/5ml, Tk.
Adegut(Supreme), Suspn.,100mg/100ml, Tk.
28.11/60ml,; 5mg/5ml, Tk. 38.14/100ml,; Tab.,
28/60ml,; Tab., 10mg, Tk. 2.00/Tab.
10 mg, Tk. 2.01/Tab.; 10 mg, Tk. 5.00/Tab.
Anet (Kemiko), Tab.,10 mg, Tk. 2/Tab.
Efodio(Radiant), Tab. , 10mg, Tk. 4.00/Tab.
Apidone(Team), Suspn., 5mg/5 ml, Tk.
Egut(Euro), Syrup, 5mg/5ml, Tk.
33.00/60ml,; Tab., 10 mg, Tk. 2.20/Tab.
35.00/100ml; Tab., 10 mg, Tk. 2.5/Tab.
Apuldon(Aristo), Paed Drops, 5mg/5ml, Tk.
Emidom(Somatec), Suspn., 5mg/5ml, Tk.
25.00/15ml,30ml,; Supp, 15mg , Tk.
28.11/60ml,; Tab., 10 mg, Tk. 2.50/Tab.
6.00/Supp,; 30mg, Tk. 9.00/Supp,; Suspn.,
Esogut(Biopharma), Paed Drops, 5mg/5ml,
5mg/5ml, Tk. 35.00/60ml,; Tab. , 10mg, Tk.
Tk. 25.00/15ml,; Suspn., 5mg/5ml, Tk.
2.50/Tab.
28.11/60ml,; Tab., 10mg, Tk. 2.50/Tab.
Atidon(Asiatic), Suspn., 5mg/5ml, Tk.
Loridon(Modern), Suspn., 5mg/5ml, Tk.
28.00/60ml,; Tab., 10 mg, Tk. 2.00/Tab.
20.00/15ml,; 5mg/5ml, Tk. 28.00/60ml,; Tab. ,
Bpdon(Bristol), Tab.,10mg, Tk.100/Tab
10 mg , Tk. 2.50/Tab.
Cosy(Orion), Tab., 10 mg, Tk. 2.50/Tab.;
Motifast(Square), Dispersible Tab., 10mg, Tk.
Syrup, 5mg/5ml, Tk. 28.19/60ml,; Syrup,
2.51/Tab.
5mg/5ml, Tk. 38.26/100ml

99
2. GASTRO-INTESTINAL SYSTEM

Motigen(Novo Health), Tab. ,10mg, Tk. Metocol(Opsonin), Syrup, 5mg/5ml,


2.00/Tab.; Suspn, 5mg/5ml, Tk. 38.00/100ml Tk.15.83/100 ml; 5mg/5ml,
Motigut(Square), Paed. Drops, 5mg/5ml, Tk. Tk.10.65/15 ml
25.08/15ml,; Suspn. , 5 mg/5 ml, Tk. Migen(Albion), Syrup, 100 mg/100 ml, Tk.
35.11/60ml,; Tab., 10 mg, Tk. 2.51/Tab. 13.70/100 ml
Motinorm(Sharif), Tab., 10 mg, Tk.2.00/Tab. Motilon(Sanofi), Tab. 10mg,
Motistat(Globex), Suspn.,5mg/5ml, Tk. Tk. 0.34/Tab.
40.12/60ml,; Tab., 10 mg, Tk. 2.00/Tab. Nutramid(Acme), Tab., 10 mg,
Noburn(Beacon), Tab.,10mg, Tk. 2.01/Tab. Tk. 0.34/Tab.; Syrup, 100 mg/100 ml, Tk.
Nudon (Organic), Tab., 10 mg, Tk. 2.00/Tab. 10.65/60 ml
Omidon(Incepta), Paed. Drops, 5mg/5ml, Tk.
25.00/15ml,; Suspn., 5mg/5ml, Tk.
2.3 ULCER HEALING DURGS
35.00/60ml,; Tab. , 10mg, Tk. 2.00/Tab.;
Suspn., 5mg/5ml, Tk. 38.00/100ml,; Tab., 10
mg, Tk. 2.00/Tab. 2.3.1 H2 RECEPTOR ANTAGONISTS
Paridon(Drug Intl), Tab., 10mg, Tk. 2.05/Tab.; 2.3.2 SELECTIVE ANTIMUSCARINICS
Suspn, 5mg/5ml, Tk. 32.10/100ml 2.3.3 PROTON PUMP INHIBITORS
Perion(Globe), Suspn., 5 mg /5 ml, Tk.
2.3.4 CHELATES AND COMPLEXES
30.00/60 ml,; 5 mg /5 ml, Tk. 38.00/100 ml,;
Tab, 10 mg, Tk. 2.00/Tab. 2.3.5 PROSTAGLAND INALOGUES
Ridon(Eskayef), Sachet, 10mg , Tk. 2.3.6 DRUGS FOR ERADICATION OF
6.00/Sachet,; Syrup, 5mg/5ml, Tk. HELICOBACTER PYLORI
20.00/15ml,; 5mg/5ml, Tk. 30.00/60ml,; Tab,
10 mg, Tk. 2.50/Tab.
Sagdon(Nuvista), Tab., 10 mg, Tk. 2.00/Tab. 2.3.1 H2 -RECEPTOR ANTAGONISTS
Sandom(Sanofi), Suspn., 5mg/5ml, Tk.
28.18/Vial.; Tab,10mg, Tk. 2.02/Tab.; Paed H2-receptor antagonists reduce gastric
Drop, 5mg/ml, Tk. 20.13/Vial. acid (both basal and food stimulated)
Vave(ACI), Suspn., 5mg/5ml, Tk. 35.11/60ml
,; 5mg/5ml, Tk. 40.12/100ml,; Tab., 10mg , and pepsin output as a result of H2-
Tk. 5.02/Tab.; Paed Drops, 5mg /ml, Tk. receptor blockade. They have been used
25.08/15ml ,; Tab., 10mg , Tk. 2.50/Tab. in peptic ulcer, gastrointestinal reflux
Virdon(Virgo), Paed Drops, 5mg/5ml, Tk. diseases and in selected cases of
20.00/15ml,; Suspn. , 5mg/5ml, Tk. persistent dyspepsia. High doses of H2-
28.00/60ml,; Tab., 10 mg, Tk.200/Tab. receptor antagonists have been used in
Vomino(Monico), Tab., 10mg, Tk. 2.00/Tab.; the Zollinger-Ellison syndrome, though a
Suspn., 5mg/5ml, Tk. 28.00/60ml
Xepadon(Amico), Paed Drop, 5mg/ml,
proton pump inhibitor (see sec 2.3.3) is
Tk.18.00/15ml,; Suspn., 5mg/5ml, Tk. now preferred.
25.00/60ml,; Tab., 10mg , Tk. 2.00/Tab.
FAMOTIDINE
METOCLOPRAMIDE
HYDROCHLORIDE[ED) Indications:see under Dose
(See section 7.8) Cautions:see under ranitidine; does not
inhibit hepatic microsomal drug
Indications: See notes above and see metabolism
section7.8 Side-effects:see under ranitidine; dry
Cautions andSide-effects: See mouth and anorexia also reported
section7.8 Dose: benign gastric and duodenal
Interactions: See Appendix-2 ulceration; 20 mg twice daily or 40 mg at
Dose:By mouth 10 mg 3 times daily; night for 4-8 weeks; maintenance 20 mg
IM/IV10 mg 3 times daily over 1-2 at night. In Zollinger-Ellison syndrome,
minutes. CHILD 1-5 mg 3 times daily. 20 mg every 6 hours (higher dose in
those who have previously been
Proprietary Preparations receiving another H2-antagonist)
Maxocol(Medimet), Syrup, 5mg/5ml,
Tk.15.77/100ml; Tab.,10mg, Tk.0.34/Tab. Proprietary Preparations
Meclid(Jayson), Inj., 10 mg/2 ml,Tk. 3.55/2 ml Famodin(Acme), Tab. 20.00 mg., Tk.
Amp. 2.00/Tab.; 40 mg., Tk. 4.01/Tab.
100
2. GASTRO-INTESTINAL SYSTEM

Famotack(Square), Tab. 20 mg, Tk. arrhythmias) and in cardiovascular


2.00/Tab.; 20mg, Tk. 2.05/Tab. impairment, does not significantly inhibit
Famotid(Drug Intl), Tab., 40mg, Tk. 4.05/Tab. hepatic micro-somal drug metabolism.
Famotidine(Albion), Tab., 20 mg,
Tk.1.50/Tab.; 40 mg, Tk. 3/Tab.
Side-effects:altered bowel habit,
Novatac(ACI), Tab.,40mg, Tk. 4.13/Tab.; dizziness, rash, tiredness; occasionally,
20mg, Tk. 2.27/Tab. gynaecomastia (cimetidine only, and
Servipep(Novartis), Tab., 20 mg, Tk. 4/Tab.; usually only in high dosage), reversible
40 mg, Tk. 6/Tab. confusional states, reversible liver
Yamadin(Beximco), Tab., 20 mg, Tk. damage, headache; rare reports of
1.90/Tab.; Tab., 40 mg, Tk. 3.82/Tab. breast swelling and tenderness in men;
bradycardia, AV block and asystole.
NIZATIDINE Dose:by mouth, 150 mg twice daily
(morning and night), or for patients with
Indications:see under Dose gastric and duodenal ulceration; 300 mg
Cautions: also avoid rapid intravenous as a single daily dose at night for 4 to 8
injection (risk of arrhythmias and weeks, up to 6 weeks in chronic episodic
postural hypotension); dyspepsia, and up to 8 to 12 weeks in
hepatic impairment reflux oesophagitis and NSAID
Interactions:see Appendix-2(histamine associated ulceration; Zollinger-Ellison
H2-antagonists) and notes above synd-rome, 150 mg 3 times daily,
Pregnancy: avoid unless essential increased if necessary to 6 g daily in
Breast-feeding: amount too small to be divided doses.
harmful For maintenance, 150 mg at
Side-effects:see notes above; also night.CHILD, 8-18 years, up to 150 mg
sweating; rarely nausea, fever, twice daily. Gastric acid reduction
vasculitis, hyperuricaemia (prophylaxis of acid aspiration) in
Dose: benign gastric, duodenal or obstetrics, by mouth, 150 mg at onset of
NSAID-associated ulceration, treatment, labour, then every 6 hours.
300 mg in the evening or 150 mg twice By intramuscular injection, 50 mg every
daily for 4–8 weeks; maintenance, 6-8 hours.
150mg at night By slow intravenous injection, 50 mg
Gastro-oesophageal reflux disease, diluted to 20 ml and given over at least 2
150–300 mg twice daily for up to 12 minutes; may be repeated every 6-8
weeks. CHILD not recommended hours.
Renal impairment: use half normal By intravenous injection, 25 mg/hour for
dose if eGFR 20–50 mL/minute/1.73m2; 2 hours; may be repeated every 6-8
use one-quarter normal dose if eGFR hours.
less than 20 mL/minute/1.73m2 Surgical procedures, by intramuscular or
slow intravenous injection, 50 mg 45-60
Generic Preparation minutes before induction (intravenous
Capsule, 150mg injection diluted to 20 ml and given over
at least 2 minutes), or by mouth, 150 mg
RANITIDINE[ED][OTC] 2 hours before induction, and also, when
possible on the preceding evening.
Indications: benign gastric and
duodenal ulceration stomal ulcer, reflux Proprietary Preparations
Aceptin-R(Asiatic), Inj., 50 mg/2 ml, Tk.
oesophagitis, Zollinger-Ellison synd-
10.00/2 ml Amp; Tab., 150 mg, Tk. 2.00/Tab.
rome, other conditions where reduction Acin(Biopharma), Syrup, 75 mg/5 ml, Tk.
of gastric acidity is beneficial.(see notes 45.17/100ml; Tab., 150 mg, Tk. 2.50/Tab.
above) Alin(Rephco), Tab.,150 mg, Tk. 2.50/Tab.
Cautions:renal and hapatic impairment Amurun (Amulet),Tab.,150 mg, Tk. 2/Tab.
(reduce dose); pregnancy and breast- Anitid(Team), Tab., 150 mg, Tk. 2.00/Tab.
feeding. Avoid intravenous injection in
high dosage (may rarely cause
101
2. GASTRO-INTESTINAL SYSTEM

Antac(Ambee), Syrup, 75mg/5ml, Tk Ranidin(Acme), Inj., 50 mg/2 ml, Tk. 10.03/2


40.15/100 ml; Tab., 150 mg, Tk. 1.81/Tab.; ml Amp; Syrup, 75 mg/5 ml, Tk. 45.29/100ml;
Inj. , 50 mg / 2 ml , Tk. 5.32/2ml Amp Tab., 300 mg , Tk. 4.03/Tab., 50 mg , Tk.
Asinar(Sanofi), Tab., 150mg, Tk. 2.51/Tab. 2.51/Tab.
Astac(Astra Bio), Tab. , 150 mg, Tk. 2.00/Tab. Ranison(Jayson), Inj., 50 mg/1 ml , Tk.
Bentid(Benham), Tab.,150 mg, 10.00/Amp.;Tab. ,150 mg, Tk.1.73/Tab.
Tk.2.00/Tab.;150 mg, Tk.2.00/Tab. Ranisyn(MST), Tab., 150 mg, Tk. 2.10/Tab.
Bristol Neoset(Bristol), Tab. , 150mg , Tk. Ranitid(Opsonin), Syrup, 75 mg/5 ml, Tk.
1.500/Tab. 50.15/100 ml; Inj., 50 mg/2 ml, Tk. 10.00/2 ml
Duran(Techno), Tab., 300 mg , Tk.4.00/Tab.; Amp; Tab. , 150 mg , Tk. 2.51/Tab., 150 mg ,
Syrup, 75 mg/5 ml, Tk. 40/100 ml.; IVInfusion, Tk. 2.51/Tab., 300 mg , Tk. 4.02/Tab.
50 mg/100 ml, Tk. 60.00/100 ml Ranitidine(Albion), Syrup, 75 mg/5 ml, Tk.
Eucon(Pacific), Inj., 50 mg/2 ml, Tk. 10.00/2 40.00/100ml; Tk. 70.00/200ml .;Tab., 150 mg,
ml Amp.; Tab., 150 mg, Tk. 1.90/Tab. Tk.2.00/Tab.
Gastab(Nipro JMI), Syrup, 75 mg/5 ml, Tk. Ranitidine-R(Doctor TIMS), Tab. , 150 mg,
45.17/100 ml; Tab., 150 mg, Tk. 2.00/Tab. Tk.2.50/Tab.
Gastroloc(Beacon), Tab. , 150mg , Tk. Ranitor(Popular), Tab. , 150 mg, Tk. 2.00/Tab.
2.00/Tab. Ranix(Chemist), Inj.,50mg/ 2 ml, Tk. 25.00/2
Gepin(General), Tab. , 150mg, Tk. 2.01/Tab., ml Amp.
Syrup, 75 mg/5 ml, Tk. 50.00/100ml; 75 mg/5 Rantec(Medimet), Tab., 150mg, Tk.2.00/Tab.;
ml, Tk. 95.00/200ml; Inj., 50 mg/2 ml, Tk. 300mg, Tk.3.50/Tab.
10.00/2ml Amp Ranul(Apex), Tab., 150 mg, Tk. 1.00/Tab.
G-Ranitidine(Gonoshasthaya), Tab.,150 mg, Ravia(Pharmasia), Tab.,150 mg, Tk.1.00/Tab.
Tk. 1.40/Tab. Recodin(Concord),Tab.,150 mg, Tk.1.50/Tab.
Hi-Tac(Hudson), Tab., 150mg, Tk.2.00/Tab. Reetac-R(Navana),Tab.,150 mg, Tk.1.50/Tab.
Inran(Monico), Inj., 50 mg/2 ml, Tk. 6.00/2 ml Renete(Euro), Tab., 150 mg, Tk. 2.50/Tab.
Amp; Tab., 150mg, Tk. 2.00/Tab. Resectin(SMC Enterprise), Tab. , 150 mg,
Inseac(Ibn Sina), Syrup, 75 mg/5 ml, Tk. Tk. 2.50/Tab.
55.00/100ml; Tab., 300 mg, Tk. 4.00/Tab, 100 Rhine(Healthcare), Tab., 150mg , Tk.
mg, Tk. 2.50/Tab. 3.00/Tab.
Libret(Libra),Inj.,(IV Infusion), 50 mg/100 ml, Sutac(Supreme), Tab. , 150 mg, Tk.
Tk. 55.21/100 ml 2.00/Tab.
Lumeran(Aristo), Tab., 150mg, Tk. 2.00/Tab. Tinadin(Delta),Tab.150mg,Tk.2.00 /Tab.
Neoceptin(Beximco), Inj., 50 mg/2 ml, Tk. Ulcar(Drug Intl), Tab., 150mg, Tk. 2.55/Tab.,
10.00/2 ml Amp; Infusion, 0.05%, Tk. 300mg, Tk. 8.05/Tab.
101.00/100 ml; Syrup, 75 mg/5 ml, Tk. Ultradin(Globe), Tab. , 150 mg, Tk. 2.50/Tab.
50.00/100ml; Tab., 150mg, Tk. 2.50/Tab. Unitac(G.A.Co), Tab., 150 mg, Tk. 1.81/Tab.
Neotack(Square), Inj., 50 mg/2 ml, Tk. Veridin(Veritas), Tab., 150 mg, Tk.2.50/Tab.
10.03/2ml Amp; Syrup, 75 mg/5 ml, Virdin(Virgo), Tab. , 150 mg , Tk. 2.00/Tab.
Tk.50.15/100ml; 150 mg, Tk.2.51/Tab. Wintack(White Horse), Tab., 150 mg,
Neotin(Nipa), Tab., 150mg, Tk. 2.50/Tab. Tk.2.00/Tab.
Normacid(Kemiko), Tab., 150 mg, Tk. Xantid(ACI), Inj., 50 mg/2 ml, Tk. 7.55/2ml
2.51/Tab., Inj., 50 mg/2 ml, Tk. 6.02/2 ml Amp; Tab., 150mg, Tk. 2.51/Tab., 300mg, Tk.
Amp., Syrup, 75 mg/5 ml, Tk. 45.13/100ml 4.03/Tab., 150 mg, Tk. 1.51/Tab.
Norma-H(Renata), Tab.,150 mg, Tk.2.50/Tab. Zantac(GSK), Tab.,150 mg, Tk.4.07/Tab
Off-H(Organic), Tab.,150mg, Tk.2.51/Tab. Zenidine(Zenith), Tab.,150mg,Tk. 2/Tab.
Ortac(Orion), Inj., 50 mg/2 ml, Tk. 6.04/2ml Zenil(Rangs), Tab., 150mg, Tk. 2/Tab.
Amp; Tab., Tk. 2.01/Tab. Zodin(Somatec), Syrup, 75 mg/5 ml, Tk.
Peptil H(Eskayef), Inj., 50 mg/2 ml, Tk. 6.00/2 40.15/100ml; Tab., 150mg, Tk. 2.01/Tab.
ml Amp; 50 mg/2 ml, Tk. 6.00/2 ml Amp; Liq, Zorep(Amico), Tab., 150mg, Tk. 2/Tab.
100ml, Tk. 45.00/100ml; Tab., 150mg , Tk.
1.80/Tab., 150mg , Tk. 2.00/Tab., 150mg, Tk.
2.00/Tab., Liq, 100ml, Tk. 45.00/100ml
Peptosol(Opso Saline), IV Infusion, 50
mg/100 ml, Tk. 26.41/100 ml 2.3.2 SELECTIVE
Protec-R(Globex),Tab.,150mg,Tk.1/Tab. ANTIMUSCARINICS
Ranbex(Novo),Tab.,150mg,Tk. 1.25/Tab.
Rani (Alco), Tab., 150 mg, Tk. 2.01/Tab. M1 selective antimuscarinic pirenzepine
Ranid(Ziska),Tab.,150mg, Tk. 1.20/Tab.
blocks cholinergic stimulation of gastric
Ranidin(Acme), Inj., 50 mg/1 ml , Tk. 10/Amp.;
Syrup, 75 mg/5 ml, Tk. 45.16/100 ml.; Tab., acid secretion but has some anticholi-
150 mg, Tk.2.01/Tab.; 300 mg , Tk.4.01/Tab. nergic adverse effects. It had been tried
102
2. GASTRO-INTESTINAL SYSTEM

in the treatment of peptic ulcer but has Proprietary Preparation


now been discontinued. Delanix(Incepta), Cap., 30 mg, Tk. 9.00/Tab.;
60 mg, Tk. 16.00/Cap.
Desopra(Alco), Cap. , 30 mg, Tk. 10.00/cap.
2.3.3 PROTON PUMP INHIBITORS Dexilant(Ziska), Cap. 30 mg, Tk. 9/Cap.;
60mg, Tk. 16/Cap.
These include Omeprazole, Dexlan(Ibn Sina), Cap. , 60 mg, Tk.
Lansoprazole, Pantoprazole, 18.00/Cap.; 30 mg, Tk. 10.00/Cap.
Rabeprazole and Esmoprazole. They Dexogut(Popular), Cap. , 31.500mg, Tk.
10.00/Cap.; 63.00mg, Tk. 18.00/Cap.
produce profound and sustained
inhibition of gastric acid secretion by
blocking the hydrogen-potassium- LANSOPRAZOLE
adenosine triphosphate enzyme system
(the ‘proton pump’) of the gastric parietal Indications: Gastric ulcer, duodenal
cell. They are effective short-term ulcer, reflux oesophagitis Zollinger-
treatments for gastric and duodenal Ellison syndrome; also used in
ulcers. The response is rapid and conjunction with other drugs in triple
sustained (a single daily dose of therapy for eradication of H. pylori
omeprazole is sufficient to provide Cautions:See notes above;avoid in
effective suppression of gastric acid for a pregnancy and breast-feeding
24 hour period), and thus promotes Interactions:See Appendix-2
better compliance than with other anti Side-effects:See notes above
ulcer drugs. Lansoprazole and Dose: Benign gastric ulcer 30 mg daily
pantoprazole appear to be comparable in the morning before breakfast for a
with omeprazole in efficacy. period of 4 to 8 weeks. For gastric or
Cautions: Proton pump inhibitors should duodenal ulcer associated with H. pyloroi
be used with caution in patients with liver in triple therapy for eradication of H.
disease, in pregancy and in breast- pylori, see section 2.3.6
feeding; they may musk the symptoms of
gastric cancer. Proprietary Preparations
Side-effects: These include Enso(Kemiko), Cap. , 15 mg, Tk. 3.01/Cap. ;
gastrointestinal disturbances (nausea, 30 mg, Tk. 5.02/Cap.
Lanozole(Medimet), Cap., 30 mg,
vomiting, diarrhoea flatulence, abdomi- Tk.5.00/Cap.; 5 mg, Tk.3.00/Cap.
nal pain), hypersensitivity reactions Lansec(Drug Intl), Cap., 30mg, Tk. 6.05/Cap.;
(rash, urticaria, pruritus, angiooedema); 15 mg, Tk. 3.55/Cap.
occasional headache, malaise, muscle Lansina(Ibn Sina), Cap. , 30 mg, Tk.
and joint pain, blurred vision and dry 6.00/Cap.
mouth. Lanso(Square), Cap. , 30 mg, Tk.6.04/Cap.
Lansocon(Biopharma), Cap. , 30 mg, Tk.
6.00/Cap.
DEXLANSOPRAZOLE Lansodin(Acme), Cap. , 15 mg , Tk.
3.52/Cap. ; 30 mg, Tk. 6.04/Cap.
Indications: acid reflux, heartburn, Lansoprazole(Albion), Cap. , 15 mg, Tk.
difficulty swallowing, persistent cough, 3.50/Cap. ;30 mg, Tk. 6.00/Cap.
Lansopril(Amico), Cap. , 30 mg, TK.
stomach ulcers(occasional use)
5.00/Cap.
Cautions :See notes above;liver Lansoprol(Ziska), Cap. , 30 mg, Tk.
disease, bone fracture, shoulder pain, 80.00/Cap.
elderly Lantid(Opsonin), Cap. , 15 mg, Tk. 3.01/Cap.
Side effects: See notes above; diarrhea, ; 30 mg , Tk. 5.02/Cap.
a low magnesium level, persistent Lanz(ACI), Cap., 15mg, Tk.3.03/Cap.; 30mg,
muscle spasms, seizures, abdominal or Tk. 5.04/Cap.
Lap(Ambee), Cap. , 30 mg, Tk. 5.01/Cap
stomach pain, cramping, fever
Lasocon(Biopharma), Cap. , 30 mg, Tk.
Dose: 30 mg/60 mg once daily with or 6.00/Cap.
without food Protolon(Beximco), Cap. , 30mg, Tk.
6.00/Cap.

103
2. GASTRO-INTESTINAL SYSTEM

Zoton(General), Cap. , 30mg, Tk. 6.04/Cap. Esmosec(Techno), Tab., 20 mg, Tk. 5/Tab.;
40 mg, Tk. 8/Tab.
Esmotac(G.A.Co), Tab., 20 mg , Tk.
ESOMEPRAZOLE
4.02/Tab.; 40 mg , Tk. 7.03/Tab.
ESO(Asiatic), Tab., 40 mg, TK. 8.00/Tab.; 20
Indications: listed in dosage mg , Tk. 5.00/Tab.
Caution:see notes above; exclude Esobest(Sharif), Tab. , 40 mg, Tk.
gastric malignancy before treatment; 8.00/Tab.; 20 mg, Tk. 10.00/Tab.; Cap, 20
severe hepatic impairment mg , Tk. 7.00/Cap.; 40 mg , Tk. 10.00/Cap.
Esocon(Biopharma), Cap., 40 mg, Tk.
Interactions:see Appendix-2
9.50/Cap.; 20 mg, Tk. 7.00/Cap.; Inj,
Side-effects: headache, abdominal 40mg/Vial, Tk. 65.00/Vial
pain, diarrhoea, nausea, vomiting, Esofour(Albion), Cap., 20 mg, Tk. 6/Cap.;
pruritus, dizziness 20mg, Tk. 6/Cap. Tab., 20 mg, Tk. 5/Tab.;
Dose: erosive reflux esophagitis: 20-40 40mg, Tk. 7/Tab.
mg once daily for 4-8 weeks; mainte- Esogap(Euro), Inj. , 40 mg/Vial, Tk.
nance, 20 mg once daily 100.00/Vial,; Tab., 20 mg, Tk. 5.00/Tab.; 450
mg, Tk. 8.00/Tab.
Symptomatic gastro-esophageal reflux:
Esoge(Organic), Cap. , 20 mg, Tk.
20 mg once daily for 4 weeks 6.50/Cap. ; 40 mg, Tk. 8.03/Cap.
Triple therapy for eradication of H. pylori Esoking(Globex), Cap., 20 mg, Tk. 6.00/Cap.
20 mg twice daily (with 1 g amoxycillin Esolin(Rephco), Tab. 40 mg, Tk. 8.00/Tab. ;
twice daily and 500mg calrithromycin 20 mg, Tk. 4.00/Tab.
twice daily for 7 days Esolok(Ibn Sina), Inj. , 40 mg/vial, Tk.
100.00/Inj.; Cap., 20 mg, Tk. 7.00/Cap.; 40
mg, Tk. 8.00/Cap. Tab., 20 mg, Tk. 5.00/Tab.
Proprietary Preparations
; 40 mg, Tk. 8.00/Tab.
Alton(General), Tab. , 20 mg, Tk. 5.01/Tab;
Esomenta(Julpher), Cap., 20 mg, Tk.
40 mg, Tk. 8.03/Tab.Inj., 40mg/Vial, Tk.
7.00/Cap.;Cap., 40 mg, Tk. 10.0/Cap.
100.30/Vial,;
Esomep(ACI), Inj., 40mg, Tk. 90.27/40mg,;
Asector(Novo Healthcare), Cap., 20 mg, Tk.
Cap., 20 mg, Tk. 7.02/Cap.; 40mg, Tk.
7.00/cap.; 40 mg, Tk. 9.00/Cap.; Inj. , 40
9.03/Cap.; Tab., 20mg, Tk. 5.02/Tab.; 40mg,
mg/Vial, Tk. 90.00/Vial
Tk. 8.02/Tab.
Asozit(White Horse), Cap., 20 mg, Tk. 7/Cap.
Esomium(SMC Enterprise), Cap., 40 mg, Tk.
Curacid(Rangs), Cap., 20mg, Tk. 6.00/Cap.;
9.00/Cap.; 20 mg, Tk. 6.00/Cap.
40mg, Tk. 9.00/Cap.
Esomo(Amulet), Cap., 20 mg, Tk. 6.00/Cap.;
Ema(Globe), Cap., 20 mg, Tk. 7.00/Cap.; 40
40 mg, Tk. 8.00/Cap.
mg, Tk. 3.00/Cap.; Inj. , 40 mg/vial, Tk.
Esonaaf(Naafco), Cap., 20 mg, Tk. 2.00/Cap.
3.00/Inj.; Tab. , 20 mg, Tk. 4.75/Tab.; 40 mg,
Esonix(Incepta), Cap., 20 mg, Tk.
Tk. 8.00/Tab.
7.00/Cap.; 40 mg, Tk. 9.00/Cap.; Inj., 40
Emep(Aristopharma), Cap. , 20 mg, Tk.
mg/Vial, Tk. 70.00/Vial,; 40 mg/Vial, Tk.
7.00/Cap.; 40 mg, Tk. 9.00/Cap.; Injection, 40
90.00/Vial,; Powder for Suspn. , 20
mg/Vial, Tk. 90.00/Vial,; Tab., 20mg , Tk.
mg/Sachet, Tk. 7.00/Sachet,; Tab, 20 mg, Tk.
5.00/Tab.
5.00/Tab.; 40 mg, Tk. 8.00/Tab.
Epa(Zenith), Tab., 20 mg, Tk. 4.01/Tab.
Esopra(Alco), Cap., 20 mg, Tk. 6.02/Cap.;
Epizol(Nipa), Cap. , 20 mg, Tk. 7.00/Cap.; 40
40 mg, Tk. 9.03/Cap.; Tab, 20 mg, Tk.
mg, Tk. 9.00/Cap.
4.01/Tab.; 40 mg, Tk. 7.02/Tab.
Eprazol(Labaid), Cap., 20 mg, Tk. 7/Cap.
Esoprex(Beacon), Cap., 40mg , Tk.
E-Proton(Doctor TIMS), Cap., 20 mg, Tk.
9.03/Cap.; 20mg , Tk. 7.02/Cap.; Inj.,
7.00/Cap.
40mg/Vial;, Tk. 100.30/Vial,;
Erazole(Kemiko), Cap. , 40 mg, Tk.
. Esoprol(Ziska), Cap., 20mg, Tk. 5.00/Cap;
10.03/Cap.; 20 mg, Tk. 7.02/Cap .; Tab., 20
40mg, Tk. 8.00/Cap.
mg, Tk. 5.02/Tab.; 40 mg, Tk. 8.03/Tab.
Esoral(Eskayef), Cap. , 20mg , Tk. 7.00/Cap.;
Escap(Sanofi), Cap., 40mg, Tk. 12.00/Cap.;
Inj. , 40mg , Tk. 90.00/Inj. ; Tab, 20mg, Tk.
20mg, Tk. 8.00/Cap.
10.00/Tab.; 20mg , Tk. 5.00/Tab.; 20mg, Tk.
Eslo(Bristol), Cap., 20mg , Tk. 390.00/Cap .;
5.00/Tab.; 20mg, Tk. 5.00/Tab.; 20mg , Tk.
Tab, 40mg , Tk. 335.00/Tab.; 20mg , Tk.
10.00/Tab.; 20mg , Tk. 4.01/Tab.; 20mg , Tk.
225.00/Tab.; 20mg , Tk. 450.00/Tab.
5.00/Tab.; 40mg , Tk. 14.00/Tab.; 40mg, Tk.
Esmax(Concord), Cap., 20 mg, Tk. 6/Cap.;
7.00/Tab.; 40mg , Tk. 8.00/Tab.;
40mg, Tk. 8/Cap; Tab., 20 mg, Tk. 5/Tab.
Esorant(Supreme), Cap, 20mg, Tk.
Esmogel(Biogen), Cap., 20mg , Tk. 6.50/Cap.
6.00/Cap.; 40mg, Tk. 8.00/Cap.

104
2. GASTRO-INTESTINAL SYSTEM

Esotac(Navana), Tab., 40 mg, Tk. Prazia(Amico), Cap., 20mg , TK. 7.00/Cap.;


7.03/Tab.;Cap., 20 mg, Tk. 6.00/Cap. 40 mg, 40mg , TK. 10.00/Cap.; Tab., 20mg, TK.
Tk. 8.00/Cap. 5.00/Tab.; 40mg , TK. 8.00/Tab.
Esotem(Team), Cap., 40 mg, Tk. 9.00/Cap. ; Progut(Popular), Cap. , 20mg , Tk. 7.00/Cap.
20 mg, Tk. 6.50/cap. ; , 40 mg, Tk. 9.00/Cap.; Powder for Suspn.,
Esotid(Opsonin), Cap. , 20 mg , Tk. 20 mg/Sachet,; Tab. , 20 mg, Tk. 5.00/Tab.;
6.04/Cap.; Tab, 20 mg , Tk. 5.03/Tab.; Cap., Inj., (Popular), Inj. , 40 mg/Vial, Tk. 90.00/Vial
40 mg , Tk. 9.06/Cap. Tab. , 40 mg , Tk. Pronex(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.;
8.00/Tab.; Vial, 40 mg , Tk. 90.27/ 40 mg 40mg, Tk. 8.05/Tab.; Cap., 20mg, Tk.
Esotor(Nipro JMI), Tab. , 20 mg, Tk. 5.00/Tab. 6.00/Cap.; 40mg, Tk. 8.00/Cap.; Inj., 40mg,
; 40 mg, Tk. 8.00/Tab. Tk. 90.30/Inj.;
Esover(Veritas), Cap. , 20 mg, Tk. SB-Emec(Sunman-Bardem), Cap., 20 mg,
7.00/Cap.;40 mg, Tk. 9.00/Cap. Tk. 7.00/Cap.; 40 mg, Tk. 9.00/Cap.
Esovir(Virgo), Cap., 20 mg, Tk. 700.00/Cap. Sergel(Healthcare), Cap., 20mg , Tk.
Esoz(Astra Biopharma), Cap. , 20 mg, Tk. 700.00/Cap.; 40mg , Tk. 500.00/Cap.; Tab.,
7.00/Cap.; 40 mg, Tk. 8.00/Cap.; Tab. , 20 20mg, Tk. 210.00/Tab.; Inj, 40mg , Tk.
mg, Tk. 5.00/Tab. 40 mg, Tk. 8.03/Tab.. 100.00/Inj. ; 40mg/Vial, Tk. 100.00/Vial,; Tab.,
Esprazo(Pacific), Cap., 20 mg, Tk. 7.00/Cap. 40mg , Tk. 270.00/Tab.
Exium(Radiant), Cap., 20mg , Tk. 10.00/Cap.; Sompraz(Sun), Tab. , 20 mg, Tk. 6.00/Tab;40
40mg , Tk. 14.00/Cap.; 20mg , Tk. 8.50/Cap.; mg, Tk. 9.00/Tab..;
40 mg, Tk. 12.00/Cap. ; Inj., 40mg/Vial, Tk. Somprazol(Sharif), Cap. , 20 mg, Tk.
120.00/Vial. 6.00/Cap. ; 40 mg, Tk. 9.00/Cap.
Exmart(MST), Tab., 20 mg, Tk. 5/Cap.; 40
mg, TK. 8/Tab. Esomeprazole + Naproxen
Exome(Chemist), Tab., 20 mg, Tk. 5.00/Tab. Anaflex(ACI), Tab., 20mg+375mg, TK.
Exor(Orion), Inj, 40 mg, Tk. 100.30/Inj.; Cap., 8.02/Tab.; 20 mg + 500 mg, TK. 10.03/Tab.
20 mg, Tk. 7.00/Cap.; 40 mg, Tk. 10.00/Cap. Demovo(Delta), Tab. , 20 mg + 375 mg, Tk.
EZ(Modern), Cap. , 20 mg, Tk. 7.00/Cap. 8.00/Tab. ; 20 mg + 500 mg, Tk. 10/Tab.
Gerdo(Nuvista), Cap., 20 mg, Tk. 7.02/Cap. Dinovo(Beximco), Tab., 375mg + 20mg, Tk.
iMAX(Delta), Cap. , 20 mg, Tk. 5.00/Cap. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Maxima(Acme), Cap., 40 mg , Tk. Emaprox(Globe), Tab. , 375 mg + 20 mg, Tk.
10.00/Cap.; 20 mg , Tk. 7.00/Cap.; Inj., 40 mg, 3.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
Tk. 90.27/Inj.; Tab., 20 mg, Tk. 5.00/Tab.; 40 Emaprox(Globe), Tab.,20 mg + 375 mg, Tk.
mg, Tk. 8.00/Tab. 8.00/Tab.; 20 mg + 500 mg , Tk. 10.00/Tab.
Maxpro(Renata), Cap., 20 mg, Tk. Esona(Navana), Tab., 20 mg + 375 mg, Tk.
7.00/Cap.; 40 mg, Tk. 10.00/Cap.; Tab., 20 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg, Tk. 5.00/Tab.; 40 mg, Tk. 8.00/Tab.; Inj., Eso-Plus(Asiatic), Tab., 500mg + 20mg, Tk.
40 mg/vial, Tk. 90.00/Inj. 10.00/Tab.; ., 20 mg + 375mg, Tk. 8.00/Tab.
Naspro(Popular), Tab. , 20 mg, Tk. Esoxen (Organic), Tab, 20 mg + 375mg, mg,
10.00/Tab.; 40 mg, Tk. 8.00/Tab. Tk. 8.03/Tab.; 20 mg + 500 mg, Tk.
Neptor(Novartis), Cap. , 20 mg, Tk. 10.03/Tab.
8.00/Cap.; Cap., 40 mg, Tk. 12.00/Cap. Inflect (Kemiko), Tab., 20 mg + 375mg, mg,
Nexcap(UniMed), Cap., 20mg , Tk. 7.00/Cap.; Tk. 8.02/Tab.; 20 mg + 500 mg Tk. 10.03/Tab.
40mg, Tk. 9.00/Cap. Locin(Globe ), Tab., 20 mg + 375 mg, Tk.
Nexcap(Unimed), Cap. , 20 mg, Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
7.00/Cap.; 40 mg, Tk. 9.00/Cap. Nameso(Opsonin), Tab, 20 mg + 375mg,, Tk.
Nexe(Apex ), Tab. , 20 mg, Tk. 5.00/Tab.; 40 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg, Tk. 8.00/Tab.; Cap., 20 mg, Tk. 6.00/Cap. Napexa (UniMed), Tab , 20 mg + 375mg, Tk.
Nexum(Square), Cap, 20 mg, Tk. 7.02/Cap.; 12.00/Tab.; 20 mg + 500 mg, Tk. 16.00/Tab.
40 mg, Tk. 10.03/Cap.; Inj., 40 mg/vial, Tk. Napren ES(Alco), Tab. , 20 mg + 375 mg, Tk.
90.27/Inj.; Tab. , 20 mg , Tk. 10.00/Tab. ; 40 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.
mg , Tk. 14.00/Tab. ; 40 mg, Tk. 8.07/Tab. Napreso(Euro), Tab., 20 mg + 500 mg, Tk.
Nuloc(Monico), Tab., 20mg, Tk. 5.00/Tab.; 10.00/Tab.
40mg, Tk. 90.00/Tab. Napro-A Plus(Acme), Tab20 mg + 375mg,,
Onepro(One Pharma), Cap., 20 mg, Tk. Tk. 8.03/Tab.; 20 mg + 500 mg mg, Tk.
6.99/Cap.; 40 mg, Tk. 9.00/Cap.; Tab., 20 mg, 10.03/Tab.
Tk. 5.00/Tab.; 40 mg, Tk. 7.99/Tab. Naproflex(Somatec), Tab., 20 mg + 375mg,,
Opton(Beximco), Cap., 20mg, Tk. 7.00/Cap. ; Tk. 8.00/Tab.; 375 mg + 20 mg, Tk. 10.00/Tab.
40mg, Tk. 10.00/Cap.; Inj., 40mg, Tk. Naprosyn Plus(Radiant), Tab., 20 mg +
110.00/Inj.; Tab., 40mg, Tk. 8.00/Tab.; 20mg, 375mg,, Tk. 16.05/Tab.; 20 mg + 500 mg, Tk.
Tk. 5.00/Tab. 20.06/Tab.

105
2. GASTRO-INTESTINAL SYSTEM

Naprotec(Sharif), Tab., 20 mg + 375mg, mg, Benign gastric or duodenal ulcer


Tk. 8.03/Tab.; 500mg + 20 mg, Tk. 10.30/Tab. associated with H. pylori, see section
Naprox Plus(Eskayef), Tab, 20 mg + 500 mg, 2.3.6 for eradication therapy.
Tk. 10.00/Tab.; 20 mg + 375mg,, Tk.
8.00/Tab.
Zollinger-Ellison syndrome, initially 60
Naproxen(Zenith), Tab, 20 mg + 375mg,, Tk. mg once daily; usual range 20-120 mg
8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab.; daily (above 80 mg in 2 divided doses).
(Bristol), Tab. , 20 mg + 500 mg, Tk. Erosive reflux oesophagitis, 20 mg daily
10.00/Tab. for 4 weeks, followed by a further 4
Naproxen Plus(Albion), Tab., 20 mg + 500 weeks if not fully healed; 40 mg daily has
mg, Tk. 6.89/Tab. been given for 8 weeks in reflux
Naproxzia(Amico), Tab., 500mg + 20mg, Tk.
10.00/Tab.
oesophagitis refractory to other
Naprozol(General), Tab. , 20 mg + 375 mg, treatment.
Tk. 8.00/Tab.;Tab. , 20 mg + 500 mg, Tk.
10.00/Tab. Proprietary Preparations
Napsec(Drug Intl), Tab., 20 mg + 375mg,, Tk. Anasec(Novo Healthcare), Cap., 40 mg, Tk.
8.05/Tab.; 20 mg + 500 mg Tk. 10.05/Tab. 7.00/Cap.; 20 mg, Tk. 5.00/Cap.; Inj.,
Napxon(Ziska), Tab. ,20 mg + 375mg, mg, Tk. 40mg/Vial, Tk. 70.00/Vial
256.00/Tab.; 500 mg + 20 mg, Tk. 320.00/Tab. Aspra(Apex), Cap. , 20 mg, Tk. 4.00/Cap.;
Nasopain(Julpher ), Tab., 20 mg + 375 mg, AU-20(Decent), Cap., 20mg, Tk. 4.50/Cap.
Tk. 10.0/Tab.; 20 mg + 500 mg, Tk. 12.0/Tab. Cosec(Drug Intl), Cap., 20mg, Tk. 5.05/Cap. ;
Neso(Aristopharma), Tab., 20 mg + 375mg, , 40mg, Tk. 8.05/Cap.; Inj., 40mg/Vial, Tk.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. 90.30/Vial
Nesotem(Team), Tab .20 mg + 500 mg mg, Curacid(Rangs), Cap., 20mg, Tk. 6.00/Cap.;
Tk. 9.50/Tab.; 20 mg + 375mg, Tk. 7.50/Tab. 40mg, Tk. 9.00/Cap.
Novoxen(Orion), Tab. ,20 mg + 375mg,, Tk. Deu(Monico), Cap., 20mg, Tk. 5.00/Cap.; Inj.,
8.02/Tab.; 20 mg + 500 mg Tk. 15.03/Tab. 40mg/Vial, Tk. 80.00/Vial
Nupralgin(Ibn Sina), Tab. 20 mg + 500 mg, Ema(Globe), Cap., 20 mg, Tk. 7.00/Cap; 40
Tk. 300.00/Tab.; 20 mg + 375mg,, Tk. mg, Tk. 9.00/Cap.; Tab., 20 mg, k. 4.75/Tab.;
80.00/Tab. 40 mg, Tk. 8.00/Tab.; IV Inj., 40 mg/vial, Tk.
Progesic(Incepta), Tab. 20 mg + 375mg,, Tk. 80.00/Vial
8.00/.Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. Esoprol(Ziska), Cap., 20mg, Tk. 5.00/Cap;
Progut-N(Popular ), Tab. , 20 mg + 375 mg, 40mg, Tk. 8.00/Cap.
Tk. 8.00/Tab.; 20 mg + 500 mg, Tk. 10.00/Tab. Eupi(Pharmasia), Inj., 40 mg/vial, Tk.
Ranoxen Plus(Rangs), Tab., 20 mg + 500 mg, 80.00/Vial; Cap., 20 mg, Tk. 5.00/Cap.
Tk. 10.00/Tab. Exmart(MST), Tab., 20 mg, Tk. 5/Cap.; 40
Solivo(Healthcare), Tab., 20 mg + 375mg,, Tk. mg, Tk. 8/Tab.
390.00/Tab.; 20 mg + 500 mg, Tk. 450.00/Tab. Exome(Chemist), Tab., 20 mg, Tk. 5.00/Tab.
Twist(Chemist), Tab., 20 mg + 500 mg, Tk. Gap(Euro), Inj., 40mg/Vial, Tk. 9.00/Vial;
10.00/Tab. Cap., 20 mg, Tk. 5.00/Cap.; 40mg, Tk.
Xenap(Astra Biopharma), Tab. , 20 mg + 500 8.00/Cap.
mg,; 375mg + 20mg, TK. 8.02/Tab. G-Omeprazole(Gonoshasthaya), Cap.,20mg,
Xenole(Square), Tab. ,20 mg + 375mg,, Tk. Tk 3.00/Cap. ;Inj., 40 mg/vial, Tk. 65.00/Vial
8.03/Tab.; 20 mg + 500 mg Tk.10.03/Tab. Healer(Amico), Cap., 20mg , TK. 4.00/Cap.;
Inhibita(Delta), Cap., 20 mg, Tk. 4.00/Cap.; 40
mg, Tk. 7.00/Cap.
OMEPRAZOLE[ED][OTC]
Inpro(Biopharma), Cap., 20 mg, Tk.
5.00/Cap.; 40 mg , Tk.7.03/Cap.; Inj., 40
Indications:See notes above mg/vial, Tk. 70.00/Vial
Cautions:See notes above; exclude Inpro(Biopharma), Cap., 20mg, Tk. 5.00/Cap.;
malignancy. 40mg , Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk.
Interactions:See Appendix-2 70.00/Vial
I-Proton(Doctor TIMS), Cap., 20 mg, Tk.
Side-effects: See notes above
5.00/Cap.
Dose: Benign gastric and duodenal Losectil(Eskayef), Tab., 20mg , Tk. 4.00/Tab.;
ulcers, 20 mg once daily for 4 weeks in 10mg, Tk. 2.00/Cap.; 40mg , Tk. 7.00/Cap. ;
duodenal ulceration or 8 weeks in gastric Inj, 40mg/vial , Tk. 90.00/Vial; Powder
ulceration; in severe cases increase to forSuspn., 20mg/Sachet , Tk. 5.00/Sachet;
40 mg daily; long term use not 40mg/Sachet , Tk. 8.00/Sachet; Cap, 20mg,
recommended Tk. 4.99/Cap.; 40mg , Tk. 7.00/Cap. ; Inj. ,
40mg/Vial, Tk. 90.00/Vial
106
2. GASTRO-INTESTINAL SYSTEM

Losek(Bristol), Cap., 20mg , Tk. 3.50/Cap.; Omitac(G.A.Co), Cap., 20 mg, Tk. 5.00/Cap.
40mg, Tk. 7.00/Cap. Omitin(Nipa), Cap., 40 mg, Tk. 7.00/Cap.; 20
Lotil(Albion), Cap., 20 mg, Tk. 2.95/Cap.; 40 mg, Tk. 4.00/Cap.
mg, Tk. 4.00/ Tab. Omizit(White Horse), Cap., 20 mg, Tk.
Neopra(Supreme), Cap, 20mg, Tk. 5.00/Cap.; 4.00/Cap.
Norain(GSK), Cap., 20 mg, Tk. 5.01/Cap. Omsec(Techno), Cap. , 20 mg, Tk. 4.00/Cap.;
Nuprazol(Nuvista), Cap. , 20 mg, Tk. Inj., 40 mg/vial, Tk. 70.00/Vial
5.00/Cap. OP(Globe), Cap., 20 mg, Tk. 4.75/Cap.; 40
O-20(Asiatic), Cap., 20 mg , Tk. mg, Tk. 8.00/Cap.; Inj. , 40 mg/vial,
5.00/Cap.;40mg , Tk. 7.00/Cap. Tk.70.00/Vial
Ome(Somatec), Cap., 20 mg, Tk. 5.00/Cap.; OP max(Concord), Cap., 20 mg, Tk.
40 mg, Tk. 8.00/Cap. 4.00/Cap.; Cap. , 40 mg, Tk. 7.00/Cap.
Omeben(Benham), Cap. , 20 mg, Tk.5/Cap. Opal(Healthcare), Cap., 20mg , Tk.
Omecron(Nipro JMI), Cap., 20 mg, Tk. 10.00/Cap.; 40mg , Tk. 8.00/Cap.; Inj.,
6.00/Cap.; 40 mg, Tk. 8.00/Cap. 40mg/Vial, Tk. 95.00/Vial
Omegut(Popular), Cap., 20mg, Tk. 5.00/Tab.; Opezen(Zenith), Cap., 20 mg,; 40 mg, Tk.
40 mg, Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk. 7.02/Cap.; Tk. 4.01/Cap.; Powder forSuspn.,
80.00/Vial 20mg/Sachet, Tk. 5.00/Sachet
Omelet(Amulet), Cap., 40 mg, Tk. 7.00/Cap.; Peptral(Labaid), Cap., 20 mg, Tk. 5.00/Cap.
Cap., 20 mg, Tk. 5.00/Cap. Piazol(Globex), Cap., 20 mg, Tk. 4.00/Cap.
Omelock(One Pharma), Cap., 20 mg, Tk. PPI(Acme), Inj., 40mg/Vial, Tk. 90.00/Vial; 20
5.00/Cap.; 40 mg , Tk. 7.99/Cap. mg, Tk. 5.01/Cap.; 40mg, Tk. 8.03/Cap.
Omenaaf(Naafco), Cap., 20 mg, Tk. Prazo(Pacific), Cap., 40 mg, Tk. 7.00/Cap.; 20
5.00/Cap.; 40 mg, Tk. 8.00/Cap. mg, Tk. 5.00/Cap. ; Tab., 20 mg, Tk. 2.50/Tab.
Omenix(Incepta), Inj., 40 mg/vial, Tk. Prazole(Renata), Cap., 20 mg, Tk. 4.02/Cap.
90.00/Vial; Suspn., 40 mg, Tk. 10.00/Sachet; Prazomax(SMC Enterprise), Cap., 20 mg, Tk.
Cap. , 20 mg, Tk. 5.00/Cap.; 20mg/Sachet , 4.00/Cap; 40 mg, Tk. 6.00/Cap.
Tk. 6.00/Sachet Prazover(Veritas), Cap., 20 mg, Tk. 5/Cap.
Omenta(Junphar), Cap., 20 mg, Tk.5.0/Cap.; Prazple(Renata), Cap., 20 mg, Tk. 5.00/Cap.
Inj., 40 mg/vial, Tk. 90.00/Vial Presec(UniMed), Cap., 20mg, Tk. 4.00/Cap.;
Omep(Arist), Inj., 40mg/Vial, Tk. 80.00/Vial; 40 mg, Tk. 7.00/Cap.
Cap., 10mg , Tk. 2.00/Cap.; 20mg , Tk. Prevas(General), Cap., 20mg; 40mg, Tk.
5.00/Cap.; 40mg , Tk. 7.00/Cap. 8.00/Cap.; Tk. 5.00/Cap. ; Inj., 40mg/Vial, Tk.
Omepra (Alco), Cap., 20mg, Tk. 4.01/Cap. ; 80.24/Vial
40 mg, Tk. 7.02/Cap. Probitor(Novartis), Cap., 20 mg, Tk 7.00/Cap.;
Omeprazole(APC), Cap., 20 mg, Tk. 40 mg, Tk. 10.00/Cap.
2.50/Cap. Procap(Orion), Inj , 40 mg/vial, Tk. 90.27/Vial;
Omeprol(Ziska), Cap., 20 mg, Tk. 4.00/Cap.; Cap., 20 mg, Tk. 5.01/Cap.; 40mg, Tk.
40 mg, Tk. 6.12/Cap.; Inj., 40mg/Vial, Tk. 8.02/Cap.
70.00/Vial Proceptins(Beximco), Cap., 20mg, Tk.
Omesil(Silva), Cap., 20mg, Tk. 5.02/Cap.; 40 5.00/Cap.; Cap., 40mg, Tk. 8.00/Cap.; Inj.,
mg, Tk. 7.02/Cap. 40mg/Vial, Tk. 100.00/Vial
Ometac(Navana), Cap., 20 mg, Tk. 4.02/Cap.; Prolok(Ibn Sina), Cap. , 20mg, Tk.
40 mg, Tk. 6.02/Cap. 5.00/Cap.; Inj., 40mg/Vial, Tk. 90.00/Vial;
Ometem(Team), Cap., 20 mg, Tk. 4.75/Cap.; 40mg, Tk. 240.00/Cap.
40 mg, Tk. 7.50/Cap. Promezol(Sharif), Cap. , 20 mg,
Ometid(Opsonin), Cap., 20 mg, Tk. 5.02/Cap.; Tk.5.00/Cap.; 40 mg, Tk. 8.00/Cap.
40 mg , Tk. 7.03/Cap.; Inj., 40mg/Vial, Tk. Prosectil(Pharmacil), Cap. , 20 mg, Tk.
90.27/Vial 5.00/Cap.; Inj., 40 mg/vial, Tk. 90.00/Vial
Ometor(Astra Bio), Cap., 20 mg, Tk. Regerd(Organic), Cap. , 20 mg, Tk.
4.00/Cap.; 40 mg, Tk. 8.00/Cap.; Inj. , 40 5.00/Cap.;40 mg , Tk. 7.00/Cap.
mg/vial, Tk. 80.00/Vial Rome(Rephco), Cap. , 20 mg, Tk. 5.00/Cap.
Ometor(Astra),Cap., 20 mg, Tk. 4.00/Cap. Seclo(Square), Inj.,40mg/Vial, Tk. 80.24/Vial;
Omevir(Virgo), Cap., 20 mg, Tk. 5.00/Cap. Tab. , 20 mg, Tk. 5.02/Tab. ; 40 mg, Tk.
Omex(Kemiko), Cap., 20 mg, Tk. 5.02/Cap; 7.00/Tab. ; Cap., 20 mg, Tk. 5.02/Cap.; Cap.,
40 mg, Tk. 7.02/Cap.; Inj., 40mg/Vial, Tk. 40 mg, Tk. 8.03/Cap.
87.00/Vial Seclogen(Biogen), Cap., 20 mg, Tk.
Omex(Kemiko), Cap., 20 mg, Tk. 5.00/Cap.; 5.00/Cap.
40 mg, Tk. 7.00/Cap. Stosec(Opso Saline), Inj., 40 mg/vial, Tk.
Omidex(Modern), Cap., 20 mg. , Tk. 5.00Cap. 52.83/Vial
Omirex(Jayson), Cap., 20 mg, Tk. Xeldrin(ACI), Cap., 10mg, Tk. 2.02/Cap;
5.00/Cap.;Cap., 40 mg, Tk. 8.00/Cap. Cap., 20mg, Tk. 5.02/Cap.; Cap., 40mg, Tk.
107
2. GASTRO-INTESTINAL SYSTEM

8.02/Cap; Inj., 40mg/Vial, Tk. 80.24/Vial; Tab., Panprazo(Pacific), Tab. , 20 mg, Tk.
20mg, Tk. 4.03/Tab.; 4.00/Tab.
Xelopes(Beacon), Cap., 20mg , Tk. 5.02/Cap.; Panpro(Biopharma), Tab., 40mg, Tk.
40mg , Tk. 7.02/Cap.; Inj., 40mg/Vial, Tk. 6.00/Tab., Inj., 40mg/Vial, Tk. 70.00/ Vial,
90.27/Vial 20mg, Tk. 5.00/Tab.
Xerosec(Sanofi), Cap., 10 mg, Tk. 2.51/Cap.; Pansec(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.,
20 mg, Tk.5.00/Cap.; 40 mg, Tk.8.00/Cap. Tab., 40mg, Tk. 7.05/Tab., Inj., 40mg/Vial, Tk.
Zilon(Radiant), Cap. ,20 mg, Tk.5.00/Cap.;40 90.30/ Vial,
mg, Tk. 7.50/Cap. Pansec(Drug Intl), Tab., 20mg, Tk.5.00/Tab.;
40 mg, Tk. 7.00/Tab.; Inj., 40 mg/Vial, Tk.
90.00/Vial
PANTOPRAZOLE
Pansiv(MST), Tab., 20 mg, Tk. 4/Tab.; 40 mg,
Tk. 6/Tab.
Indications: for suppression of acid Pansos(Nipro JMI), Tab., 20mg, Tk.
secretion in gastric or duodenal ulcer, 3.00/Tab.; 40 mg , Tk. 5.00/Tab.
reflux oesophagitis Zollinger-Ellison Pantac(Navana), Tab., 20 mg, Tk. 4.00/Tab.;
syndrome; prophylaxis against acid 40 mg, Tk. 6.00/Tab.
Pantex(ACI), Inj., 40mg/Vial, Tk. 70.47/ Vial,
aspiration syndrome during indcution of
Cap., 20mg, Tk. 4.01/Cap., 40mg, Tk.
anaesthesia. In conjunction with other 6.02/Cap., Tab., 20mg, Tk. 5.02/Tab., 40mg,
drugs, for the eradication of H. pylori Tk. 7.02/Tab.
Interactions: see Appendix-2 Pantid(Opsonin), Inj., 40 mg/Vial , Tk.
Side-effects:see notes above 90.27/Vial, Tab, 20 mg , Tk. 5.02/Tab., 40 mg ,
Dose:by mouth in benign gastric ulcer or Tk. 7.02/Tab.
gastroesophageal reflux disease, 40 mg Pantium(Radiant), Tab, 40mg , Tk.
10.03/Tab., 20mg , Tk. 7.02/Tab.
daily in the morning for 4 weeks,
Panto(Somatec), Tab., 20 mg, Tk. 4.00/Tab.,
followed by further 4 weeks if not fully 40 mg, Tk. 6.00/Tab.
healed. Pantoaid(Novo Health), Tab. , 20 mg, Tk.
Duodenal ulcer or gastritis associated 5.00/Tab.
with H. pylori, 40 mg twice daily (with Pantobex(Beximco), Inj., 40mg/Vial, Tk.
clarithromycin 250mg twice daily and 110.00/ Vial, Tab., 20mg, Tk. 5.00/Tab., 40mg,
metronidazole 400mg twice daily) for 7 Tk. 7.00/Tab.
Pantochem(Chemist), Tab., 20 mg, Tk.
days.CHILD not recommended.
3.00/Tab.; 40 mg, Tk. 5.00/Tab.
Pantodac(Ziska), Tab. , 20 mg, Tk. 4.00/Tab.,
Proprietary Preparations 40 mg, Tk. 6.00/Tab.
Aup(Decent), Tab. 20mg, Tk. 3.00/Tab; Pantogen(General), Tab. , 20mg, Tk.
40mg, Tk. 5.00/Tab. 5.01/Tab., 40mg, Tk. 7.03/Tab.
Europan(Globe), Inj.40 mg/Vial, Tk. 70.00/ Pantogut(Popular), Tab. ,20mg , Tk.
Vial; Tab.20 mg, Tk. 4.00/Tab.; 40 mg, Tk. 5.00/Tab.; 40 mg, Tk. 7.00/Tab.,Inj., 40
6.00/Tab. mg/Vial, Tk. 70.26/ Vial
Exipro(Leon), Tab., 20 mg, Tk. 4.00/Tab.; 40 Pantolok(Ibn Sina), Inj., 40mg/Vial, Tk. 80.00/
mg, Tk. 6.00/Tab. Vial, Tab., 20mg, Tk. 5.00/Tab., 40mg, Tk.
Neopanta(Supreme), Tab., 20mg, 7.00/Tab.
Tk,.4.00/Tab., 40mg, Tk. 6.00/Tab. Pantomax(Pharmacil), Inj. , 40mg/Vial , Tk.
Nixpan(Ad-din), Tab., 20 mg, Tk. 3.00/Tab.; 90.27/Vial
40 mg, Tk. 5.00/Tab. Panton(Bristol Tab, 20mg , Tk. 3.00/Tab.,
P-20 & 40(Asiatic), Tab., 20mg , Tk. 4.00/Tab., 40mg , Tk. 5.00/Tab.
40mg , Tk. 6.00/Tab. Pantonix(Incepta), Inj., 40 mg/Vial, Tk. 90.00/
Pagerd(Organic), Tab, 20 mg, Tk. 4.02/Tab., Vial, Tab, Tk. 5.00/Tab, Tk. 7.00/Tab.
40 mg, Tk. 6.02/Tab. Pantopra(Alco), Tab. , 40mg, Tk. 5.02/Tab.,
Panfast(Monico), Inj., 40mg/Vial, Tk. 20mg, Tk. 3.01/Tab.
90.00/Vial Pantoprazole(Albion), Tab., 20 mg, Tk.
Panoral(Eskayef), Tab, 20 mg, Tk. 5.00/Tab., 3.00/Tab.; 40 mg, Tk. 5.00/Tab.
20 mg, Tk. 5.00/Tab., 40 mg, Tk. 7.00/Tab., 40 Pantoprox(SMC Enterprise), Tab. , 20 mg,
mg, Tk. 7.00/Tab. Tk. 5.00/Tab.
Panotem(Team), Tab., 40 mg, Tk. 6.50/Tab., Pantosec(Techno), Inj., 40 mg/Vial, Tk.
20 mg, Tk. 4.50/Tab. 70.00/Vial
Panoz(Astra Biop), Tab. , 20 mg, Tk. Pantosil(Silva), Tab., 40mg, Tk. 5.01/Tab.,
4.00/Tab., 40 mg, Tk. 7.00/Tab. 20mg, Tk. 4.50/Tab.

108
2. GASTRO-INTESTINAL SYSTEM

Pantover(Veritas), Tab., 20 mg, Tk. Dose: erosive or ulcerative gastroesop-


4.00/Tab.; Inj., 40 mg/Vial, Tk. 70.00/Vial hageal reflux disease, 20 mg daily for 4-
Pantozol(G.A.Co), Tab., 20 mg , Tk. 8 weeks; may be extended for further 8
3.01/Tab., 40 mg , Tk. 5.02/Tab.
Pantrol(Apex), Tab., 20 mg, Tk. 3.00/Tab.
weeks if necessary; maintenance, 20 mg
Panzer(Sun), Tab., 20 mg, Tk. 4.00/Tab.; 40 daily.
mg, Tk. 6.00/Tab. Duodenal ulcer, 20mg daily for 4 weeks.
Panzol(Amico), Tab., 20mg , TK. 3.50/Tab., Pathological hypersecretory conditions
40mg , TK. 5.50/Tab. including Zollinger-Ellison syndrome,
Patanix(Nipa), Tab. , 20 mg, Tk. 4.60/Tab. initially 60 mg once daily, may be
Pentosa(Pharmasia), Tab., 20 mg, Tk. increased to 100-120 mg daily.
4.00/Tab.; 40 mg, Tk. 6.00/Tab.
P-Lock(One Pharma), Tab, 20 mg, Tk.
5.00/Tab., 40 mg, Tk. 6.99/Tab. Proprietary Preparations
Pramax(Concord), Tab., 20 mg, Tk. Acifix(Beximco), Tab., 20mg , Tk. 5.00/Tab.
4.00/Tab.; 40 mg, Tk. 6.00/Tab. Finix(Opsonin), Tab., 20 mg , Tk. 5.03/Tab.
Prazolin(Rephco), Tab., 20 mg, Tk. Nexrab(UniMed), Tab., Tk. 8.00/Tab.
4.00/Tab.; 40 mg, Tk. 6.00/Tab. Paricel(ACI), Cap., 20mg, Tk. 8.00/Cap.,
Pregel(Healthcare), Tab., 40mg, Tk. Tab., 20mg, Tk. 5.04/Tab., 10mg, Tk.
7.00/Tab., 20mg , Tk.5.00/Tab., Inj, 3.51/Tab.
40mg/Vial, Tk. 90.00/Vial, Profast(Renata), Tab. , 20mg Tk. 5.00/Tab.
Protium(UniMed), Tab , 20mg, Tk. 5.00/Tab., Prompton(Radiant), Cap. , 20mg , Tk.
40mg, Tk. 9.00/Tab. 8.02/cap.
Protocid(Acme), Inj., 40 mg/Vial, Tk. 90.00/ R- 20(Asiatic), Tab., 20mg , Tk. 5.00/Tab.
Vial, Tab, 20 mg, Tk. 5.00/Tab., Tab, 40 mg , Rabe(Aristopharma), Tab., 20mg , Tk.
Tk. 7.00/Tab. 5.00/Tab.
Protoloc(Beacon), Tab., 20mg , Tk. .00/Tab., Rabeca(Square), Tab. , 20 mg, Tk. 5.02/Tab.
40mg , Tk. 7.00/Tab. Rabecon(Biopharma), Tab., 20mg, Tk.
Proton(Aristo), Inj., 40mg/Vial,Tk. 80.00/ Vial, 5.00/Tab.
Tab. 45.10g+ 40mg , Tk. 7.00/Tab. Rabemax(General), Tab. , 20mg, Tk.5.00/Tab.
Protonil(Renata), Tab., 20mg, Tk. 4.00/Tab., Rabepes(Beacon), Cap., 20mg , Tk.
40mg, Tk. 6.00/Tab. 8.00/Cap., Tab., 20mg, Tk. 5.02/Tab.
Proton-P(Aristo), Tab., 20mg , Tk. 5.00/Tab. Rabepra(Euro), Tab., 20mg, Tk. 5.00/Tab.
Protozin(Euro), Tab., 20mg, Tk. 5.00/Tab., Rabesec(Drug Intl), Tab., 20mg, Tk. 5.05/Tab.
40mg, Tk. 7.00/Tab. Rabetem(Team), Tab., 20 mg, Tk. 4.50/Tab.
Pz(Modern), Tab., 20 mg, Tk. 4.00/Tab., 45.10 Rabifast(Eskayef), Tab., 20 mg., Tk.
mg, Tk. 6.00/Tab. 5.00/Tab., 20mg, Tk. 5.00/Tab., 20 mg., Tk.
Topra(Jayson), Tab., 20 mg, Tk.3.00/Tab.; 40 5.00/Tab., 20mg, Tk. 5.00/Tab.
mg, Tk.5.02/Tab. Rabigut(Popular), Tab., 20mg, Tk. 5/Tab.
Trupan(Square), Inj. , 40 mg/vial, Tk.80.24/ Rabipep(Organic), Tab.,20 mg, Tk. 5/Tab.
Vial, Tab, 20 mg, Tk.5.02/Tab., 40 mg, Rabizol(Acme), Tab., 20.00 mg, Tk. 5.01/Tab.
Tk.7.02/Tab. Rabonac(Sharif), Tab., 20 mg, Tk. 5.01/Tab.
Zenopan(Zenith), Tab. , 20 mg, Tk. 5.00/Tab. Rabprazo(Pacific), Tab., 20 mg, Tk. 5/Tab.
Zopan(Kemiko), Tab., 20 mg, Tk. 4.01/Tab., Rasonix(Incepta), Cap., 20 mg, Tk. 3.50/Cap.,
40 mg, Tk. 6.02/Tab. 30 mg, Tk. 8.00/Cap., Tab., 20mg, Tk.
5.00/Tab.,
Rasoz(Astra Biopharma), Tab., 20 mg, Tk.
RABEPRAZOLE SODIUM 5.00/Tab.
Razole(Kemiko), Tab., 20 mg, Tk. 5.00/Tab.
Indications: listed in dose Respite(Sanofi), Tab. , 20mg, Tk. 6.02/Tab.
Cautions: see notes above;exclude RP-20(Globe), Tab., 20 mg, Tk. 5.00/Tab.
Xorel(Ibn Sina), Cap. , 20mg, Tk. 4.00/Cap.,
gastric malignancy before starting
Tab., 20mg, Tk. 3.00/Tab.
treatment
Contra-indications:pregnancy and
breast-feedings 2.3.4 CHELATES AND COMPLEXES
Interactions:see Appendix-2
Side-effects: chest pain, neck rigidity, Tripotassium dicitratobismuthate is a
Hypertension, Abnormal ECG, GI bismuth chelate, which promotes healing
diturbances, anxiety, insomnia. of gastric and duodenal ulcers. It may
act by coating the ulcer or by stimulating
bicarbonate secretion. As it is also likely
109
2. GASTRO-INTESTINAL SYSTEM

to adhere to food rather than to the top Cautions: conditions where hypoten-
the surface of the ulcer, patients should sion might precipitate severe complica-
be advised to avoid large food, antacids, tions (e.g. cerebrovascular disease,
and large quantities of milk when taking cardiovascular disease)
bismuth chelate. Contraindications: pregnancy or
Sucralfate is a complex of aluminium planning pregnancy (increases uterine
hydroxide and sulphated sucrose and tone). Should not be used in women of
has minimal antacid properties. It has child-bearing age unless the patient
been used for gastric and duodenal requires NSAID therapy and is at high
ulcers and may act by protecting the risk of NSAID induced ulceration; patient
mucosa from acid pepsin attack. Long must be advised of the risks of taking
term use needs further assessment misoprostol if pregnant
because some aluminium may be Interactions:see Appendix-2
absorbed. Side-effects: diarrhoea (may be severe,
reduced by giving single dose not
SUCRALFATE exceeding 200 micrograms and by
avoiding magnesium containing
Indications: palliative treatment of antacids); also reported: abdominal pain,
benign gastric and duodenal ulceration; dyspepsia, flatulence, nausea and
chronic gastritis vomiting, abnormal vaginal bleeding
Cautions: renal disease (including intermenstrual bleeding,
Interactions:see Appendix-2; antacids menorrhagia, and post menopausal
should not be taken half an hour before bleeding)
or after a dose Dose: benign gastric and duodenal
Side-effects: constipation; gastric dis- ulceration, 800 micrograms daily (in 2-4
comfort reported. divided doses) with breakfast (or main
Dose: 2g twice daily (on rising and at meals) and at bedtime; treatment should
bedtime) or 1g 4 times daily 1 hour be continued for at least 4 weeks and
before meals and at bedtime, taken for 4 may be continued for up to 8 weeks if
weeks or in resistant casees up to 8 required. Prophylaxis of NSAID induced
weeks; max. 8g daily. peptic ulcer, 200 micrograms 2-4 times
daily according to condition of patient.
Proprietary Preparations
Antepsin(Kemiko), Tab., 1000 mg, Tk. Proprietary Preparations
5.52/Tab. Cytomis(Incepta), Tab., 200 mcg, Tk.
Gastalfet(Beximco), Tab., 1000 mg, Tk. 15.00/Tab.
6.00/Tab., 500 mg, Tk. 4.02/Tab. G-Misoprostol(Gonoshasthaya), Tab., 200
Ulsec(Asiatic), Tab., 1000 mg , Tk. 5.50/Tab. mcg, Tk.10.00 /Tab.
Indula(Renata), Tab., 200 mcg, Tk. 15.00/Tab.
Isovent(Square), Tab., 200 mcg, Tk.
2.3.5 PROSTAGALNDIN 15.10/Tab. ; 600 mcg, Tk. 40.13/Tab.
ANALOGUES Misoclear(Acme), Tab., 200 mcg, Tk.
15.04/Tab.
Misoprostol, a synthetic analogue of Misoclear(Acme), Tab., 200 mcg, Tk.
15.00/Tab.
prostaglandin E1 (alprostadil) inhibits
Misopa(Beximco), Tab., 200mcg, Tk.
gastric acid secretion promoting healing 15.00/Tab.
of gastric and duodenal ulcer. It can Misopil(General), Tab., 200mcg, Tk.
protect against NSAID associated gastric 15.00/Tab.
ulcers but not dyspepsia. Misoprostol(Amico), Tab., 200mcg, Tk.
15.00/Tab.
Misotab(Euro), Tab., 200mcg, Tk. 15.00/Tab.
MISOPROSTOL[ED]
Misotec(Sharif), Tab., 200 mcg, Tk.
15.04/Tab.
Indications:see notes above and under Misotol(Ziska), Tab., 200 mcg, Tk. 15.00/Tab.
dose

110
2. GASTRO-INTESTINAL SYSTEM

2.3.6 DRUGS FOR ERADICATION


OF HELICOBACTER PYLORI Pantoprazole 40mg twice daily+
Clarithromycin 500mg twice daily+
Amoxycillin 1g twice daily
The causal role of H. pylori in gastric and
duodenal ulcer is now widely accepted. Ranitidine bismuth citrate 400 mg twice daily +
Long-term healing of gastric and Clarithromycin 500mg twice daily +
duodenal ulcers can be achieved by Amoxicillin 1 g twice daily
eradicating H. pylori, and after such
eradication the incidence of relapse TRIPLE THERAPY COMBINED
decreases. Studies have shown that with PREPARATIONS
H. pylori eradication only 5-10% patients
experienced relapse within a year Proprietary Preparations
compared to 85% of patients who do not Lansoprazole 30 mg + Clarithromycin 500 mg
have H. pylori eradication, and the benifit + Amoxycillin 1 g
appeared to continue for about 7 years. H.Pylori (Acme), Cap. , Tk. 55.16/Cap.
Helicon kit (General), Cap., Tk. 55.37/Cap
It is recommended that the presence of Pylopac(Beximco), Tab., Tk.45.00/blister strip
H. pylori be confirmed before starting Pylotrip (Square), Cap. , Tk. 55.16/Cap.
eradication treatment.
One week’s triple therapy containing a Omeprazole 20 mg + Clarithromycin 500mg +
proton pump inhibitor (omeprazole) and Metronidazole 500mg
clarithromycin with either metronidazole Neo Kit(Beximco), Tab. Tk.55.00/ blister strip
or amoxicillin produces eradication in Amoxicillin + Clarithromycin + Rabeprazole
Sodium
over 90% of patients. Clarithromycin Pylocure (Opsonin), Kit, Tk. 55.36/Tab.
may be substituted with both metroni- Esomeperazole 20mg Cap. 1pc+Amoxacillin
dazole and amoxicillin. Ranitidine or 50mg tab 2 pcs. + Clarithoromycin 500mg tab.
bismuth chelate may be used in place of Maxpro (Renata), Tk. 13.75/Kit
omeprazole. Two weeks’ triple therapy
regimen may give higher eradication rate
but adverse effects are common and 2.4 DRUGS FOR ACUTE
compliance is poor. DIARRHOEA

Recommended regimens for H. pylori Diarrhoea is characterized by increased


eradication (7-day course) volume and frequency of liquid stools. It
is commonly associated with infection,
Omeprazole 20 mg twice daily +
but may result from accumulation of non-
Clarithromycin 500 mg twice daily +
Amoxicillin 1 g twice daily absorbed osmotically active solute in gut
such as in lactose deficiency, or when
Lansoprazole 30 mg twice daily + intestinal motility or morphology is
Clarithromycin 500 mg twice daily + altered. Diarrhoea is a symptom of
Amoxicillin 1 g twice daily gastroenteritis and of most intestinal
infections. The first line of treatment in
Omeprazole 20 mg twice daily +
acute diarrhoea is oral rehydration
Clarithromycin 500 mg twice daily +
Metronidazole 400 mg twice daily therapy (ORT).

Lansoprazole 30 mg twice daily + ORAL REHYDRATION SALTS[ED] [OTC]


Clarithromycin 500 mg twice daily +
Metronidazole 400 mg twice daily
Each sachet of the proprietary
Lansoprazole 30 mg twice daily+ preparations contains: sodium chloride
Metronidazole 400 mg twice daily+ 1.75 g, potassium chloride 0.75 g,
Amoxicillin 1 g twice daily trisodium citrate dihydrate 1.45 g and
anhydrous dextrose 10 g. This is the
Omeprazole 20 mg twice daily + WHO approved formulation for ORS.
Metronidazole 400 mg thrice daily +
Amoxicillin 500 mg thrice daily
111
2. GASTRO-INTESTINAL SYSTEM

Contents of one sachet are dissolved in Cholera Saline (Opsosaline), IVInfusion


500 ml of drinking water for ready use. Tk.69.94/500ml; Tk. 91.72/1000ml
Dianak(Orion), IVInfusion Tk.49.78/500ml Tk.
65.50/1000 ml
Proprietary Preparations Diasol(Libra), IVInfusion TK. 52.60 /500ml;
ACI ORS(ACI), ORS, Tk. 5.00/Sachet; TK. Tk. 65.74/100ml
4.60/Sachet Koloride(Beximco), IVInfusion Tk.
Asaline(Apex), ORS, Tk. 4.58/Sachet 70.14/500ml; Tk. 91.99/1000ml
Easy ORS(Central), ORS, Tk. 4.58/Sachet
Kolosal (Popular), IV Infusion, Tk.
G-ORS(Gonoshasthaya), ORS, Tk 4/Sachet
70.14/500ml, Tk. 92.00/1000ml
K-SALINE FRUITY(Kemiko), ORS, Tk.
5.00/Sachet
K-SALINE N (Kemiko), ORS, Tk. 4.58/Sachet CEREAL BASED ORS
Naafco ORS(Naafco), ORS, Tk.5.00/Sachet
Neorice ORS(Eskayef), ORS, Tk. 12.00/ It contains sodium chloride 3.5 g, pota-
Sachet
ssium chloride 1.5 g, sodium bicarbonate
Neosaline(Eskayef), ORS, Tk. 5.00/ Sachet;
Tk. 5.00/Sachet; Tk. 5.00/Sachet; Tk. 2.5 g and 50 g boiled rice powder to be
5.00/Sachet dissolved in 1 litre of boiled drinking
O Fruity(Zenith), ORS, Tk. 4.58/Sachet water.
O Saline(Zenith),ORS, Tk. 3.44/Sachet; Tk.
3.22/Sachet Proprietary Preparations
OR Saline(Popular), ORS, Tk. 5.00/ Sachet Easy ORS Plus Saline(Central), ORS, Tk.
Oralsaline(Albion),ORS, Tk. 5/Sachet 12.00/Sachet
Oralsaline Sweety(Albion) ORS,Tk. 5/Sachet Rice ORS(Square), ORS, Tk. 10/500 ml
Orasol(Sonear), ORS, Tk. 3.20/Sachet Sachet ;Tk. 6.00/250mlSachet
ORS(Popular), ORS, Tk. 4.58/Sachet Rice Saline(General), ORS, Tk.
Rice ORS(General), ORS, Tk. 10.00/Sachet; 15/500mlSache,Tk. 9.00/250mlSachet
Tk. 15.05/Sachet; Tk. 9.03/Sachet; Tk. Neorice(Eskayef), ORS, Tk. 12.00/Sachet
17.00/Sachet
R-Saline(Rephco), ORS, Tk. 3.20/Sachet
R-Saline N(Rephco), ORS, Tk. 4.50/Sachet ANTIDIARRHOEAL DRUGS WHICH
Saline(Renata), ORS, Tk. 5.00/Sachet REDUCE MOTILITY
Saline R(Renata), ORS, Tk. 4.58/Sachet
SOS(Supreme), ORS, Tk. 4.58/Sachet
LOPERAMIDE HYDROCHLORIDE
SOS(Supreme), ORS, Tk. 5.00/Sachet; Tk.
5.00/Sachet
SOS Plus Mango(Supreme), ORS, Tk. Indications: acute diarrhoea in adults
5.00/Sachet and children over 4 years (see notes
Super (Amico), ORS, TK. 4.60/Sachet above); chronic diarrhoea in adults only
Super Saline(Amico), ORS, Tk. 4.57/Sachet Side-effects: occasional rashes
Unisaline(Ibn Sina), ORS, Tk. 5.00/Sachet;
Tk. 5.00/Sachet; Tk. 5.00/Sachet; Tk.
Dose: acute diarrhoea, 4 mg initially
5.00/Sachet followed by 2 mg after each loose stool
Unisaline Fruity(Ibn Sina), ORS, Tk. for up to 5 days; usual dose 6-8 mg
5.00/Sachet daily, max. 16 mg daily; CHILD 4-8 years
Virgos(Virgo), ORS, Tk. 4.58/Sachet 1 mg 4 times daily for up to 3 days only,
Zenith(Zenith), ORS, Tk. 5.00/Sachet 9-12 years 2 mg 4 times daily for up to 5
Zeosaline(Sharif), ORS, Tk. 4.58/Sachet days
Ziska(Ziska), ORS, Tk. 5.00/ Sachet
Chronic diarrhoea in adults, initially, 4-8
mg daily in divided doses, subsequently
IV REHYDRATION THERAPY adjusted according to response and
given in 2 divided doses for maintenance
Proprietary Preparations
Cholera Saline: Proprietary Preparations
Usual strength for IV infusion, potassium Imotil(Square), Cap., 2 mg, Tk.1/Cap.
chloride 0.1% sodium chloride 0.5% ;and Lopamid(Acme), Cap., 2 mg, Tk. 1/Cap.
sodium acetate 0.393% Loperin, (Opsonin), Cap., 2 mg, Tk. 1/Cap.
Cholenak (Square), IV Infusion, Tk. Nomotil(Ziska), Cap, 2mg, Tk.0.60/Cap.
92/1000ml; , Tk. 70.15/500ml

112
2. GASTRO-INTESTINAL SYSTEM

RACECADOTRIL which increase stool bulk, if necessary.


In some patients there may be important
Indications: is used in the treatment of psychological aggravating factors, which
diarrhoea. It is used, when fluid and respond to reassurance. Anti-diarrhoeal
dietary measures are not sufficiently drugs such as loperamide may some-
effective to control diarrhoea. times be necessary but prolonged use
CautionsandContraindications: may aggravate the condition. Anti-
hypersensitivity to the spasmodics may relieve the pain.
Racecadotril,blood in INFLAMMATORY BOWEL DISEASES
stools,breastfeeding,diarrhea,pregnance, Chronic inflammatory bowel diseases
Renal insufficiencySevere liver or kidney include ulcerative colitis and Crohn’s
diseaseUncontrolled vomiting disease. Drug treatment consists of
Side Effects:nausea, headache aminosalicylates (sulphasalazine,
,angioedema,rashes, Pain,Swelling of mesalazine, balsalazine, olsalazine)
the eyelid, Skin redness,Vomiting, and corticosteroids (hydrocortisone,
Constipation, Chronic diarrhoea budes-onide and prednisolone).
Dose: In infant less than 9 kg:one 10 mg Maintenance of nutrition is important.
sachet 3 times daily. Severe chronic active disease may
In infant from 9 kg to 13: kg two 10 mg require surgery.
sachets 3 times daily MALABSORPTION SYNDROME :
individual conditions need specific
Proprietary Preparations treatment and also general nutritional
Racetril(Incepta), Cap.,100 mg, Tk. 6.00/Cap., consideration. Thus coeliac disease
Suspn.,10 mg, Tk. 7.00/Suspn., 30 mg, Tk. (gluten enteropathy) usually needs a
10.00/Suspn. gluten free diet and pancreatic
Racedot(Square), Cap., 100 mg, Tk.8.03/Cap. insufficiency needs pancreatin supple-
Rehydril(Ibn Sina), Cap., 100mg, Tk. ments.
195.00/Cap.
ULCERATIVE COLITIS : for acute mild
Radola(ACI), Cap.,100mg,Tk. 6.00/Cap.
to moderate diseases affecting rectum or
sigmoid colon, topical corticosteroid
2.5 DRUGS FOR CHRONIC treatment such as prednisolone enemas
DIARRHOEAS or suppositories will induce remission;
foam preparations are especially useful
Chronic diarrhoea may be associated where patients have difficulty retaining
with underlying diseases and therefore liquid enemas. More extensive diseases
symptomatic relief is less appropriate may be treated with an aminosalicylate
than treatment of disease itself. Where but may require oral corticosteroid
the disease process responsible for treatment. Severe extensive or fulminant
chronic diarrhoea can not be disease may need hospital admission,
satisfactorily suppressed, symptomatic intravenous corticosteroid administration,
relief with antimotility drugs such as intravenous fluid and electrolyte
loperamide or diphenoxylate with replacement and/or blood transfusion,
atropine may be appropriate. Bulk parenteral nutrition and antibiotics.
laxatives such as ispaghula (Isop gul), Corticosteroids are unsuitable for
methylcellulose bran etc. have also been maintenance treatment because of side-
used for symptomatic treatment because effects. Sulphasalazine mesalazine
of their absorptive capacity. Opioids with and olsalazine all have value in preven-
a central action (e.g. codeine) are better ting relapse and choice is related in part
avoided because of the risk of to their different side-effects. In resistant
dependence. cases azathioprine(see section 14.2.1)
IRRITABLE BOWEL SYNDROME: This 2 mg/kg daily, given under close
can present with pain, constipation, or supervision may be helpful.
diarrhoea, all of which may benefit from Laxatives are required to facilitate bowel
a high fibre diet with bran or other agents movement when proctitis is present but a
113
2. GASTRO-INTESTINAL SYSTEM

high fibre diet and bulk forming drugs Antispasmodics may provide
such as methylcellulose or ispaghula symptommatic relief when colic is a
(Isop gul) are more useful in adjusting problem. Antibiotics should be used only
faecal consistency. when the diverticula in the intestinal wall
Symptoms of mild ulcerative colitis may become infected. Antidiarrhoeal drugs
be relieved with antidiarrhoeal drugs which slow the intestinal motility (e.g.
such as codeine or loperamide but they codeine, diphen-oxylate and loperamide)
should be used with caution in severe could possibly exacerbate the symptoms
cases as paralytic ileus and toxic of diverticular disease and are therefore
megacolon may be precipitated. For contra-indicated.
similar reasons antispasmodics should
not be used in ulcerative colitis. AMINOSALICYLATES
CROHN’S DISEASE: Treatment
particularly of colonic diseases is similar
MESALAZINE
to that for ulcerative colitis. In small
bowel disease sulphasalazine is of
doubtful value. Oral corticosteroids (e.g. Indications: maintenance of remission
prednisolone) suppress inflammation, in ulcerative colitis
and metronidazole may be beneficial Cautions: elderly, renal impairment,
possibly through antibacterial activity. pregnancy and breast-feeding; avoid
Other antibacterials should be given if administration with lactulose.
specifically indicated and for managing Contraindications: salicylate hypersen-
bacterial overgrowth in the small bowel. sitivity; severe renal impairment.
Infliximab, a monoclonal antibody Side-effects: nausea, diarrhoea, and
inhibiting pro-inflammatory cytokines, abdominal pain; headache; exacerbation
and TNF-alpha has recently been of symptoms of colitis; rarely reversible
indicated for severe Crohn’s disease pancreatitis; reversible myocarditis also
refractory to corticosteroids, but may be reported
associated with development of Dose: by mouth, 1.2-2.4 g daily in
extrapulmonary tuberculosis. divided doses.
In both colitis and Crohn’s disease
general nutritional care and appropriate Proprietary Preparations
Canasa(Drug Intl), Tab., 400mg, Tk. 5/Tab.
supplements are essential. Mesagut(Aristo), Tab., 400mg, Tk. 7.60/Tab.
Cholestyramine and aluminium Pentasa(I)(Feering),Sachet,1gm,Tk.69.19/Sac
hydroxide mixture, bind unabsorbed bile het,2gm,Tk.131/Sachet
salts and provide symptomatic relief of
diarrhoea following ileal disease or SULPHASALAZINE[ED]
resection, in bacterial colonisation of the
small bowel and in post-vagotomy
Indications: induction and maintenance
diarrhoea.
of remission in ulcerative colitis;
PSEUDOMEMBRANOUS COLITIS: This
treatment of active Crohn’s disease
is due to colonisation of the colon with
Cautions: pregnancy; hepatic and renal
Clostridium difficile that may develop
disease, glucose 6-phosphate
after antibiotic therapy. Ampicillin,
dehydrogenase (G6PD) deficiency
clindamycin and lincomycin have been
including breast-feeding of affected
implicated most frequently but few
infants; slow acetylator status; withdraw
antibiotics are free of this side-effect. It is
treatment if blood disorders,
usually of acute onset, but may run a
hypersensitivity reactions, or other
chronic course. Oral vancomycin or
serious disorders occur; upper
metronidazole has been advocated as
gastrointestinal side-effects are common
specific treatment.
with doses over 4g daily; blood counts,
DIVERTICULAR DISEASE: This is
liver function, and rheumatoid arthritis,
treated with a high fibre diet, bran
see section 9.1.3
supplements and bulk forming laxatives.
114
2. GASTRO-INTESTINAL SYSTEM

Contraindications: salicylate and effect may take some days to develop.


sulphonamide hypersensitivity; porphyria They are useful in the management of
Interactions:see Appendix-2 patients with colostomy, ileostomy,
Side-effects: nausea, vomiting, haemorrhoids, anal fissure, chronic
epigastric discomfort, headache, rashes; diarrhoea associated with diverticular
occasionally, fever, minor haemato- disease, irritable bowel syndrome, and
logical abnormalities such as Heinz body ulcerative colitis. Adequate fluid intake
anaemia, reversible neutropenia, folate must be maintained to avoid intestinal
deficiency; reversible azospermia; rarely: obstruction.
pancreatitis, exacerbation of colitis, Methylcelluloseispaghula (Isop gul),
thrombo-cytopenia, agranulo-cytosis, and sterculia are useful in patients who
Steven’s-Johnson syndrome, neuroto- cannot tolerate bran. Methylcellulose
xicity, photo-sensitisation, lupus erythe- also acts as a faecal softener.
matosus like syndrome, and pneu-
monitis; proteinuria and crystalluria; ISPAGHULA HUSK
urine may be orange coloured; soft (Isop Gul husk or ‘bhushi’)
contact lenses may be stained
Dose:by mouth, acute attack 1-2 g 4 Indications:See notes above
times daily (but see Cautions) until Cautions: adequate fluid intake should
remission occurs (if necessary, be maintained to avoid intestinal
corticosteroids may also be given), obstruction; ulcerative colitis.
reducing to a maintenance dose of 500 Contraindications: Intestinal obstruct-
mg 4 times daily; CHILD over 2 years, tion, colonic atony, faecal impaction
acute attack 40-60 mg/kg daily, Side-effects: Flatulence, rarely abdo-
maintenance dose 20-30 mg/kg daily. minal distension
By rectum, as suppositories, alone or in Dose: ADULT 3.5g in water twice daily
conjunction with oral treatment 0.5-1 g preferably after meals; CHILD over 6
morning and night after a bowel years half the adult dose
movement. As an enema, 3 g at night, COUNSELING: Preparations that swell
retained for at least 1 hour. in contact with liquid should always be
carefully swallowed with water and
Proprietary Preparations should not be taken immediately before
Reumazin(Aristo), Tab., 500 mg, Tk.
going to bed
5.20/Tab.
Salazine(Opsonin), Suppository, 500 mg , Tk.
10.00/Supp.; Tab., 500 mg, Tk. 5.23/Tab. Proprietary Preparation
Sulfacol(Drug Intl), Tab., 500 mg, Tk. Albi-Tasty Ispaghul(Albion), Powder 3.5 gm,
5.05/Tab. Tk. 4.00/Sachet
Sulfazin(Popular), Tab., 500 mg, Tk. Fiberlax(Incepta), Effervescent Granules Tk.
5.22/Tab. 400.00/20 gm Container
Zulfidin(UniMed), Tab, 500 mg , Tk. 7.00/Tab Ispergul(Square), Powder, 0, Tk. 395/120gm
Container
2.6 LAXATIVES
LUBIPROSTONE
2.6.1 Bulk forming drugs
2.6.2 Stimulant laxatives Indications: chronic constipation in
2.6.3 Faecal softeners adults, irritable bowel syndrome
2.6.4 Osmotic laxatives Side effects:nausea, diarrhea,
headache,flatulence
Contraindications: liver and kidney
2.6.1 BULK FORMING LAXATIVES disease; chronic diarrhea, bowel
obstruction,diarrhea-predominant IBS
These relieve constipation by increasing Dose:25 microgram twice daily to treat
faecal mass which stimulates peristalsis, constipation; 8 microgram twice daily to
but patients should be told that the full

115
2. GASTRO-INTESTINAL SYSTEM

treat IBS in women 18 years of age and Cautions;Contraindications and Side-


older effects: See notes on stimulant laxatives

Proprietary Preparation Proprietary Preparation


Lubistone(Incepta), Cap. , 8 mcg, Tk. Laxenna(GSK),Tab. 12mg, Tk. 1.25/Tab.
15.00/Cap. ; 24 mcg, Tk. 40.00/Cap.
Lubilax(Beacon), Cap., 24 mcg, Tk. SALINE LAXATIVE
40.12/Cap.; 8 mcg, Tk. 15.05/Cap

Proprietary Preparation
METHYL CELLULOSE Fleetenema(I)(CBFleet)Tk.214.24/133ml.,
Tk,214.24/66ml
Indications: see notes above
Cautions; Contraindications; Side- 2.6.3 FAECAL SOFTENERS
effects; Counseling:see under
Ispaghula Husk
Liquid paraffin the classical lubricating
Dose: 800-1600g twice daily with at
agent, has disadvantages (see below).
least 300 ml water
Bulk laxatives, non-ionic surfactant
“wetting” agents e.g. docusate sodium,
Proprietary Preparation
Celulose(Acme), Tk.0.82/Tab.
and glycerol suppositories also have
softening properties. Such drugs are
useful in the management of
2.6.2 STIMULANT LAXATIVES
haemorrhoids and anal fissure.
Enemas containing 130 ml of arachis oil
BISACODYL (ground-nut oil) would lubricate and
soften impacted faeces and promote
Indications: see under Dose; tablets act bowel movement. For children above 6
in 10-12 hours; suppositories act in 20- years, the dose has to be reduced in
60 minutes proportion to body-weight; not recomm-
Cautions; Contraindications; Side- ended for children under 6 years.
effects: see notes on stimulant
laxatives; tablets, griping; suppositories, LIQUID PARAFFIN
local irritation
Interactions:see Appendix-2 Indication: constipation
Dose:By mouth for constipation, 10 mg Cautions: avoid prolonged use; should
at night; occasionally necessary to not be taken immediately before going to
increase to 15-20 mg; CHILD 5 mg bed
By rectal suppositories, for constipation Side-effects: anal seepage of paraffin
10 mg in the morning; CHILD 5 mg. and consequent anal irritation after
Before radiological procedures and prolonged use, granulomatous reactions
surgery, 10 mg by mouth at bedtime for caused by absorption of small quantities
2 days before examination, and if of liquid paraffin (especially from the
necessary, a 10 mg suppository 1 hour emulsion), lipoid pneumonia, and
before examination. interference with the absorption of
fatsoluble vitamins
Proprietary Preparations Dose:by mouth 10-30 ml of the oral
Bisacodyl(Albion), Tab. , 5 mg, Tk. 0.70/Tab.
emulsion (see below) as required
Duralax(Opsonin), Tab., 5 mg, Tk. 0.71/Tab.
Generic Preparation
SENNA[ED]
Liquid Paraffin Oral Emulsion BP, Oral
Emulsion, contains liquid paraffin 5 ml,
Indications: Constipation; bowel evacu- vanillin 5 mg, chloroform 0.025 ml,
ation before abdominal radiological pro- benzoic acid solution 0.2 ml,
cedures, endoscopy, and surgery; acts
in 8-12 hours.
116
2. GASTRO-INTESTINAL SYSTEM

methylcellulose-20 200 mg, saccharin Side-effects: Flatulence, cramps, and


sodium 500 micrograms, water to 10 ml. abdominal discomfort.
Liquid Paraffin and Magnesium Dose: Expressed in terms of an oral
Hydroxide Oral Emulsion BP, Oral solution containing lactulose 3.35 g/5ml
Emulsion, 25% liquid paraffin in acquous Constipation, ADULT initially 15 ml twice
suspension containing 6% hydrated daily, gradually reduced according to
magnesium oxide. Dose:for patient’s needs; CHILD under 1 year 2.5
constipation, 5-20 ml as and when ml, 1-5 years 5 ml, 6-12 years 10 ml
required. twice daily, gradually reduced.
Hepatic encephalopathy, 30-50 ml 3
Proprietary Preparations times daily, subsequently adjusted to
Frelax (Beximco), Oral emulsion,Tk. 95/100ml produce 2-3 soft stools daily.
Magfin(Incepta), Oral emulsion Tk. 95/100ml
Nesifin(Opsonin), Oral emulsion,Tk. Proprietary Preparations
83.57/100ml
Actilac(Healthcare), Oral Solution, 68%, Tk.
230.00/5ml,; 68%, Tk. 125.00/5ml
2.6.4 OSMOTIC LAXATIVES Asilac(Asiatic), Oral Solution, 68%, Tk.
120.00/100ml,; 68%, Tk. 230.00/200ml
Avolac(Aristopharma), Oral Solution, 68%,
Osmotic laxatives are drugs, which act
Tk. 140.00/100ml, Tk. 250.00/200ml
by retaining fluid in the bowel by the Avolose(Team), Oral Solution, 68%, Tk.
mechanism of osmosis. They may also 135.00/100ml,; 68%, Tk. 245.00/200ml
act by changing the pattern of water Conlax(UniMed), Oral Solution, 68%, Tk.
distribution in the faces. 140.00/100ml
Dlac(Drug Intl), Oral Solution, 68%, Tk.
120.40/100ml,; 68%, Tk. 220.70/200ml,;
LACTITOL 68%, Tk. 70.25/50ml
Ezylax(Orion), Oral Solution, 68%, Tk.
Indications : to promote gut motility in 140.00/100ml,; 68%, Tk. 65.00/50ml
chronic constipation Glovolac(Globex), Oral Solu., 3.40 gm/5 ml,
Tk. 120.00/100 ml
Proprietary Preparations Hepalac(Supreme), Oral Solution, 67%, Tk.
120.00/100ml & Tk. 230.00/200ml
Fibolac(Radiant), Powder, 10 gm/Sachet , Tk.
Inolac(Incepta), Oral Solution, 68%, Tk.
40.00/10 gm Sachet
120.00/100ml
Lacticon(ACI), Powder, 10 gm/Sachet, Tk.
Laclose(Opsonin), Oral Solution, 68%, Tk.
25.00/10gm Sachet
120.37/100ml
Laxitol(Eskayef), Liquid, 3.3335 gm /5 ml, Tk.
Lactolax(Pharmasia), Oral Solu.,, 3.40 gm/5
120.00/100ml,; Powder, 10 gm/Sachet, Tk.
ml, Tk. 100.00/100 ml
12.00/10 gm Sachet,; 3.3335 gm /5 ml, Tk.
Lactomose(Monico), Oral Solution, 68%, Tk.
120.00/100ml,; 3.3335 gm /5 ml, Tk.
140.00/100ml
65.00/50ml,; Powder, 10 gm/Sachet, Tk.
Lactu(Biopharma), Oral Solution, 68%, Tk.
12.00/10 gm Sachet
140.00/100ml,; 68%, Tk. 250.00/200ml
Maxilax(Opsonin), Liquid, 3.3335 gm /5 ml,
Lactulose-H(Hudson), Oral Solu, 3.35gm/5ml,
Tk. 120.00/100 ml ,; 3.3335 gm /5 ml, Tk.
Tk.110.00/100 ml
65.00/50 ml,; Powder, 10 gm/Sachet, Tk.
Laxativ(Rangs), Oral Solu, 3.35gm/5ml, Tk.
12.00/10gm Sachet
100/100ml, Tk. 200/200ml
Sinalax(Ibn Sina), Powder, 10 gm/Sachet, Tk.
Laxol(Navana), Oral Solu., 3.40 gm/5 ml, Tk.
13.00/10 gm Sachet
50.19/50 ml; Tk. 120.00/100 ml; Tk.
200.75/200 ml
LACTULOSE[ED] Laxolac(Globe), Oral Solution, 68%, Tk.
140.00/100ml
Indications: Constipation (may take up Leaxe(Alco), Oral Solution, 68%, Tk.
140.42/100ml ,; 68%, Tk. 250.75/200ml
to 48 hours to act), hepatic (portal Livax(Pacific), Oral Solution, 68%, Tk.
systemic) encephalopathy. 140.00/100ml ,; 68%, Tk. 250.00/200ml
Contraindications: Galactosaemia, Livoton(Kemiko), Oral Solution, 68%, Tk.
intestinal obstruction. 120.00/100ml ,; 68%, Tk. 70.21/50ml
Interactions:See Appendix-2 Loctoz(Amico), Oral Solution, 68%, TK.
100.00/100ml
117
2. GASTRO-INTESTINAL SYSTEM

Niprolac(Nipro JMI), Oral Solu., 3.40 gm/5 ml, Magmil(Pacific), Suspn. , 400 mg /5 ml, Tk.
Tk. 120.00/100 ml 80.00/100ml ,; 400 mg /5 ml, Tk.
Onlac(One Pharma), Oral Solution, 68%, Tk. 120.00/200ml
140.00/100ml Magnason(Jayson), Susp.,Tk. 50.00/100 ml
Oralax(Somatec), Oral Solution, 68%, Tk.
140.00/100ml
MAGNESIUM SULPHATE[ED]
Osmolax(Square), Oral Solution, 68%, Tk.
250/200ml,; Tk. 140/100ml
Premesis(Globe), Oral Solu., 3.40 gm/5 ml, Indications: Rapid bowel evacuation
Tk. 15.00/100 ml (acts in 24 hours when given by
Regulose(General), Oral Solution, 67%, Tk. mouth);injection preparation is used in
201.35/200ml,; 67%, Tk. 120.36/100ml eclampsia and pre eclampsia.
Relacs(ACI), Oral Solution, 68%, Tk.
(See section16.2.2.3)
65.45/100ml.
Serelose(Beximco), Oral Solution, 70%, Tk. Cautions;Contraindications:See under
130.00/100ml Magnesium Hydroxide; hepatic
Sinalac(Ibn Sina), Oral Solution, 68%, Tk. impairment.
140.00/100ml,; 68%, Tk. 230.00/200ml,; Side-effects: Nausea, bloating,
68%, Tk. 70.00/60ml abdominal cramps (usually transient
Sivolac(Sharif), Oral Solution, 68%, Tk. reduced by taking more slowly); rarely
120.37/100ml
vomiting, anal irritation; urticaria,
Softner(Rephco), Oral Solu., 3.40 gm/5 ml,
Tk. 75.00/100 ml; Tk. 125.00/200 ml rhinorrhoea and dermatitis reported.
Tulac(Eskayef), Oral Solution, 68%, Tk. Dose: For rapid bowel evacuation (in 2-4
140.00/100ml,; Tk. 230.00/200ml,; , Tk. hours), 5-10 g in a glassful of water
65.00/50ml, preferably before breakfast.
Tulac(Eskayef), Oral Solu., 3.40 gm/5 ml, Tk.
65.00/50 ml; Tk. 120/100 ml; Tk. 230/200 ml Proprietary Preparation
Tulos(Acme), Oral Solution, 68%, Tk. Mag Sulph(Gonoshasthaya),
230.69/200ml,; Tk. 120.37/100ml Inj.4%Tk3.00/5ml,
Veelac(Albion), Oral Solu., 3.40 gm/5 ml, Tk. Nlepsin(Beximco), I.V. Infusion, Mag.sulph
100.00/100ml; Tk. 195.00/200ml 4%+Nacl 0.45/%+Dextrose 5%,Tk.70.8/100ml
Xylose(Delta), Oral Solu., 3.40 gm/5 ml, Tk. Magsum (Renata)Inj.2.5g/5ml,Tk.18.06
120.00/100 ml
Zenilac(Zenith), Oral Solution, 68%, Tk.
120.00/100ml POLY ETHYLENE GLYCOL
(Macrogol)
MAGNESIUM HYDROXIDE
Indications:chronic constripation
Indications: Mild constipation (acts in 2- Caution,Contraindications:see under
4 hours) Magnisum hydroxide;breast
Cautions: Use only occasionally; the feeding,pregnancy;cardiovascular
elderly; renal impairment; hepatic impairment
impairment Side-effects: flatulence, cramps, and
Contraindication: Intestinal obstruction abdominal discomfort
Interactions:See Appendix-2 (Antacids Dose:chronic constipation, ADULT and
and absorbents) CHILD over 12years, 25mL 1–3 times
Dose: Aqueous suspension containing daily usually for up to 2
about 8% hydrated magnesium oxide, weeks;maintenance, 25mL 1–2 times
25-50 ml as and when required. daily

Proprietary Preparations Proprietary Preparation


Acme’s Milk of Magnesia(Acme), Suspen., Aqualax(Incepta), Susp., 17g/240ml,
400 mg /5 ml, Tk. 60.18/114ml,; (Orion), Tk.120/240ml
Suspen., 400 mg /5 ml, Tk. 50.15/100ml
Modern Milk of Magnesia(Modern), Suspen.,
400 mg /5 ml, Tk. 60.00/100ml
Mom(Opsonin), Suspen., 400 mg /5 ml, Tk.
60.18/100 ml
118
2. GASTRO-INTESTINAL SYSTEM

fissure, and pruritus but good evidence


2.7 PREPARATIONS FOR is lacking. Lignocaine gel and ointment
HAEMORRHOIDS are best applied on a plastic dilator
2.7.1 SOOTHING HAEMORRHOIDAL which ensures contact with the base of
PREPARATIONS the fissure. Alternative local anaesthetics
2.7.2 COMPOUND include amethocaine, cinchocaine, and
HAEMORRHOIDAL pramoxine, but they are more irritant.
PREPARATIONS WITH Local anaesthetics should be used for
CORTICOSTEROIDS short periods only (no longer than 1-2
2.7.3 RECTAL SCLEROSANTS weeks) since they may cause
2.7.4 OTHER PREPARATIONS sensitisation of the anal skin.
ADMINISTRATION. Unless otherwise
indicated a suppository is usually
2.7.5 RECTAL SCLEROSANTS
inserted into the rectum at night and
Anal and perianal pruritus, soreness, morning or after a bowel movement.
and excoriation are best treated by Rectal ointments and creams are applied
application of bland ointments, at night and morning or after a bowel
suppositories or dusting powders. These movement, externally by rectum using a
conditions occur commonly in patients rectal nozzle.
suffering from haemorrhoids, fistulas, Note. Local anaesthetic ointments can
and proctitis. Careful local toilet, as well be absorbed through the rectal mucosa
as, adjustment of the diet to avoid hard therefore excessive application should
stools, taking of bulk forming materials be avoided, particularly in infants and
such as bran (section 2.6.1) and a high children.
residue diet are also helpful. In proctitis
these measures may supplement
2.7.2 COMPOUND PREPARATIONS
treatment with corticosteroids or
WITH CORTICOSTEROIDS
sulphasalazine.
When necessary topical preparations
containing local anaesthetics or Corticosteroids are often combined with
corticosteroids are used provided antiseptics, antibiotics, local anaesth-
perianal thrush has been excluded. etics and soothing agents. They are
Perianal thrush is best treated with suitable for occasional short term use
nystatin by mouth and by local after exclusion of infections, such as
application. herpes simplex; see section 12.3 for
general comments on topical corticos-
teroids.
2.7.1 SOOTHING HAEMORRHOIDAL
Antibiotics may do little more than
PREPARATIONS
encourage the growth of resistant
bacteria and should be avoided.
Bland soothing preparations containing
mild astringents such as bismuth Proprietary Preparations
subgallate zinc oxide and hamamelis Cinchocaine HCl 0.5% + Hydrocortisone 0.5% +
may give symptomatic relief in Neomycin sulphate 1% + Esculin 1%;
haemorrhoids. Many proprietary Anustat(Beximco), RectalOint.,Tk.70.00/15g.
preparations also contain lubricants Anorel(Popular), RectalOint.,Tk.80.30/15g
vasoconstrictors or mild antiseptics Erian (Square),Supp
Tk.8/supp;RectalOintment, Tk. 68.00/15g
Prolonged application of preparations
Methovate(Gaco), Rectal Ointment,
containing resorcinol should be avoided Betametdhasone Valerate0.05 %++Lignocain
because it may interfere with thyroid Hydrochloride 2.5%Tk.30.00/15gm
function. Heparinoids are claimed to
promote the resorption of local oedema
and extravasated blood.
Local anaesthetics are used to relieve
pain associated with haemorrhoids anal
119
2. GASTRO-INTESTINAL SYSTEM

2.7.3 RECTAL SCLEROSANTS 2.8 DRUGS AFFECTING


INTESTINAL SECRETIONS
Oily phenol injection is used to inject 2.8.1 DRUGS ACTING ON THE
haemorrhoids particularly when those GALL BLADDER
are unprolapsed. 2.8.2 PANCREATIN
2.8.1 DRUGS ACTING ON THE
PHENOL GALL BLADDER

Indications: injection of hemorrhoids The bile acids chenodeoxycholic acid


Side-effects: irritation, tissue necrosis and ursodeoxycholic acid are used in
Dose: 2-3 ml of oily phenol injection into selected patients to dissolve cholesterol
the submucosal layer at the base of the gallstones as an alternative to surgery.
pile; several injections may be given at
different sites, max. total injected 10 ml URSODEOXYCHOLIC ACID
at any one time
Indication: dissolution ofcholesterol rich
Generic Preparation gallstone, primary biliary cirrhosis.
Oily Phenol Injection BP, contains Cautions: see notes above
phenol 5% in a suitable fixed oil Contra-indications: chronic liver
disease, peptic ulcer disease, non-
2.7.4 OTHER PREPARATIONS functioning gall bladder, inflammatory
bowl disease, pregnancy, radio-opaque
DIOSMIN WITH HESPERIDIN stone and other conditions of the small
intestine, colon and liver which interfere
Indications: treatment of organic and with entro-hepatic circulation of bile salts
idiopathic chronic venous insufficiency of Interactions:see Appendix-2
the lower limbs with the following Side-effects: nausea, vomiting, diarrhea
symptoms: heavy legs; pain; nocturnal and other gastrointestinal disturbance,
cramps. Treatment of hemorrhoids and gallstone calcification; pruritus.
acute hemorrhoidal attacks Dose: dissolution of gallstone,8-12mg/kg
Side effects: some cases of monor daily as a single dose at bedtime or in
gastrointestinal and autonomic disorders two divided doses; for up to 2 years;
have been reported, but these never treatment is continued for 3-4 months
required cessation of treatment after stones dissolve. Primary biliary
Dose: in venous disease: 2 tablets daily. cirrhosis 10-15mg/kg daily in 2-4 divided
In acute hemorrhoidal attacks: the doses.
dosage can be increased up to 6 tablets
daily as prescribing information may vary Proprietary Preparations
Antigall(Incepta), Tab. , 150 mg, Tk.
from country to country.
13.00/Tab., 300 mg, Tk. 22.00/Tab.
Bilicir(ACI), Tab., 150mg , TK. 11.00/Tab.,
Proprietary Preparations 300mg, TK. 20.00/Tab.
Diosmin 450mg with Hesperidin 50mg Liconor(Opsonin), Liquid, 250 mg/5 ml, Tk.
Alvenor(Beacon), Tab. Tk. 10.00/Tab. 180.68/50ml; Tab, 150 mg , Tk. 11.04/Tab.,
Ardium(Drug Intl), Tab.Tk.8.00/Tab. 300 mg, Tk. 21.00/Tab.
Avonoid(UniMed), Tab. Tk. 8.00/Tab. Livacor(Albion), Tab.,150 mg, Tk. 10.00/Tab.;
Daflon(ACI), Tab., Tk. 13.00/Tab. 300 mg, Tk. 20.00/Tab.
Diohes(Opsonin), Tab. Tk. 8.06/Tab. Liveric(Beximco), Tab., 150mg, Tk.
Diorin(Incepta), Tab. Tk. 8.00/Tab. 11.00/Tab., 300mg, Tk. 20.00/Tab.
Hemoral(Aristopharma), Tab. Tk. 8.00/Tab. Oxycol(UniMed), Tab , 300mg, Tk.
Hemorif(Square), Tab. Tk. 8.06/Tab. 36.00/Tab.; 150mg, Tk. 20.00/Tab.
Normanal(Renata), Tab. Tk. 8.03/Tab. Stener(Healthcare), Tab., 150mg , Tk.
Pilestop(Acme), Tab. Tk. 8.07/Tab. 15.00/Tab.; 300mg , Tk. 25.00/Tab.
Sangril(Healthcare), Tab. Tk. 10.00/Tab. Udca(Biopharma), Tab., 300mg , Tk.
Daflon(I)(Servier),Tab.Tk.12/Tab 20.00/Tab.

120
2. GASTRO-INTESTINAL SYSTEM

Udihep(Mundipharma), Tab. , 150 mg, Tk. Pancreatin may irritate the skin around
12.67/Tab.; S.R Tab. 300 mg, Tk. 23.50/Tab. mouth and anus, particularly if
Uliv(Acme), Tab. , 150.00 mg , Tk. 12.09/Tab. preparations are retained in the mouth or
; 300 mg, Tk. 20.13/Tab.
Urso(Square), Tab. , 150 mg, Tk. 15.00/Tab.,
dosage is excessive. Hypersensitivity
300 mg, Tk. 25.00/Tab. reactions occur occasionally and may
Ursocol(Sun), Tab., 150 mg, Tk. 11.05/Tab.; affect those handling the powder.
Tab., Tk. 20.10/Tab. Dosage is adjusted according to size,
Ursodil(General), Tab. , 300mg, Tk. needs and number/consistency of stools,
25.00/Tab., 150mg, Tk. 15.00/Tab. so that the patient thrives; extra
Ursolic(Drug Intl), Suspn., 250mg/5 ml, Tk. allowance may be needed if heavy
180.55/50ml; Tab., Tk. 11.05/Tab.; 300mg, Tk.
20.10/Tab.
snacks are taken between meals.

Proprietary Preparations
2.8.2 PANCREATIN A-Zyme(Acme), Tab., 325mg, Tk. 3.51/Tab.
Crezyme(Opsonin),Tab., 325mg, Tk.3.50/Tab
Supplements of pancreatin are given by Suzyme(Square),Tab., 325mg, Tk. 3.51/Tab.
mouth to compensate for reduced or Zymet(Beximco), Tab., 325mg, Tk. 3.50/Tab.
absent exocrine secretion in cystic
fibrosis, and following pancreatectomy,
total gastrectomy, or chronic
pancreatitis. They assist the digestion of
starch, fat, and protein.
Pancreatin is inactivated by gastric acid;
therefore pancreatin preparations are
best taken with food (or immediately
before or after food). Gastric acid
secretion may be reduced by giving
cimetidine or ranitidine an hour
beforehand. Con-current use of antacids
also reduces gastric acidity. The newer
enteric coated preparations enclosing
enteric coated granules (or minitablets)
can deliver a higher enzyme
concentration in the duodenum provided
these are swallowed whole without
chewing.

121
3. CARDIOVASCULAR SYSTEM

Chapter-3
CARDIOVASCULAR SYSTEM
3.1 Beta-adrenoceptor blocking drugs p.123
3.2 Drugs affecting renin-angiotensin system and some other
Antihypertensive p.127
3.2.1 Angiotensin converting enzyme inhibitor p.128
3.2.2 Angiotensin II receptor antagonist’s p.132
3.2.3 Renin inhibitors p.136
3.2.4 Alpha adreno-receptor blocking drugs p.136
3.2.5 Angiotensin II receptor blocker Neprilysin Inhibitor (ARNI) p.137
3.2.6 Vasodilator antihypertensive drugs p. 137
3.2.7 Centrally acting Antihypertensive drugs p.138
3.3 Nitrates, calcium-channel blockers, and other antianginal drugs p. 138
3.3.1 Nitrates p.138
3.3.2 Calcium channel blockers p. 139
3.3.3 Other antianginal drugs p. 143
3.3.4 Peripheral and cerebral vasodilators & Neurosensory oxygenator
drugs p.145
3.4 Positive inotropic drugs p. 147
3.5 Diuretics p. 147
3.5.1 Thiazides and related drugs p.147
3.5.2 Loop diuretics p.149
3.5.3 Potassium sparing diuretics p.150
3.5.4 Osmotic diuretics p. 151
3.5.5 Carbonic anhydrase inhibitors p.152
3.6 Antiarrhythmic drugs p. 152
3.7 Sympathomimetic drugs p.155
3.7.1 Inotropic sympathomimetic drugs p.155
3.7.2 Vasoconstrictors p.156
3.7.3 Drugs used in cardiopulmonary resuscitation p.157
3.8 Anticoagulants and protamine sulfate p.158
3.8.1 Parenteral Anticoagulants p.158
3.8.2 Oral Anticoagulants p.161
3.8.3 Protamine sulfate p.161
3.9 Antiplatelet drugs p.162
3.10 Fibrinolytic drugs p.165
3.11 Antifibrinolytic drugs and haemostatics p.167
3.12 Lipid lowering drugs p.168
3.12.1 Anion exchange resins p.168
3.12.2 Fibrates p.169
3.12.3 Statins p.169
3.12.4 Ezetimibe p.173
3.12.5 Omega-3 Fatty Acid Compounds p.173
3.12.6 Nicotinic Acid and Derivatives p.173
3.13 Drugs for the management of pulmonary hypertension p. 174

122
3. CARDIOVASCULAR SYSTEM

3.1 BETA-ADRENOCEPTOR ARRHYTHMIA. Beta-blockers act as


BLOCKING DRUGS anti-arrhythmic drugs by blocking
sympathetic effects on the heart.
Beta-adrenoceptor blocking drugs (beta- HEART FAILURE. Bisoprolol and
blockers) are effective as antihyperten- carvedilol reduce mortality in any grade
sive, antiarrhythmic and antianginal (with of stable heart failure; nebivolol is
exception of prinzmetal’s angina) agents licensed for stable mild to moderate
by blocking the beta-adrenoreceptors in heart failure in patients over 70 year.
the heart. Beta-blockers decrease THYROTOXICOSIS. Beta-blockers are
mortality in acute phase of myocardial also used before operation for the
infarction and in post infarction period. preparation for thyroidectomy. The
Acebutolol, Pindolol Propranolol, thyroid gland becomes less vascular
Penbutolol and Celiprolol have which makes surgery easier.
intrinsic sympathomimetic activity and OTHER USES. Beta-blockers have been
they tend to cause less bradycardia than used to relieve symptoms of anxiety in
the other beta-blockers and may also patients with palpitations, tremor and
cause less coldness of the extremities tachycardia. Beta-blockers are also used
The water-soluble beta-blockers are in the prophylaxis of migraine.
excreted by the renal route. So these
drugs should be used with caution in ATENOLOL[ED]
renal impairment
Beta-blockers may precipitate or Indications : See under dose
aggravate heart failure. However, Cautions: See under propranolol
Bisoprolol, Carvedilol and Metoprolol hydrochloride; reduce dose in renal
are known to reduce mortality in patients impairment
having stable chronic heart diseases. Contraindications: See under propra-
A cardio selective beta-blocker may be nolol hydrochloride
prescribed with extreme caution under Interactions: See Appendix-2
specialist supervision in patients who Side-effects: See under propranolol
have been suffering from bronchial hydrochloride
ashma or chronic obstructive airways Dose: By mouth, Hypertension, 50-100
disease. Atenolol, Bisoprolol mg daily (higher doses rarely necessary)
Metoprolol and Nebivolol are relatively Angina, 50-100 mg daily in 1 or 2 doses
cardioselective, but they are not
cardiospecific. Ultra short acting, highly Proprietary Preparations
cardioselective beta blockers are Apicard (APC), Tab., 50 mg, Tk.0.75/Tab.
Esomolol and Landiolol. Atebit (Asiatic), Tab., 50 mg, Tk. 0.77/Tab.;
HYPERTENSION. Beta-blockers reduce 100 mg, Tk.1.38/Tab.
cardiac output, change baroceptor’s Ateloc (Popular), Tab., 50 mg, Tk. 0.77/Tab.
reflex sensitivity and block peripheral Atenolol (Albion), Tab., 50 mg, Tk. 0.77/Tab.;
100 mg, Tk.1.38/Tab.;
adrenoceptors. Some beta-blockers Atenolol (Amico), Tab., 100mg, TK. 1.38/Tab.;
decrease plasma renin secretion. Some 50mg, TK. 0.77/Tab.
central effect may also contribute to their Atezen (Zenith), Tab., 100 mg, Tk. 1.37/Tab.;
antihypertensive effect. 50 mg, Tk. 0.77/Tab.
ANGINA. Beta-blockers improve Atin (Jayson), Tab., 50mg, Tk. 0.76/Tab.
exercise tolerance by reducing cardiac B-card(Nipa), Tab., 50 mg, Tk. 0.77/Tab.
work and relieve symptoms in patients Betanol (Sanofi), Tab., 100mg, Tk. 1.37/Tab.;
with angina.. 25mg, Tk. 0.45/Tab.; 50mg, Tk. 0.77/Tab.
Betasec (Opsonin), Tab., 50 mg , Tk.
MYOCARDIAL INFARCTION. Atenolol 0.77/Tab.
and Metoprolol may reduce early Cardilock (Alco), Tab., 50 mg, Tk. 0.77/Tab.
mortality after intravenous and subsequ- Cardipro, (Square), Tab. , 50 mg, Tk.
ent oral administration in the acute 0.77/Tab.
phase..

123
3. CARDIOVASCULAR SYSTEM

Cardisef (Supreme), Tab. , 50 mg, Tk. Betacor (Popular), Tab. 2.5mg, Tk.6.00/Tab.;
0.77/Tab.; 100 mg, Tk. 1.36/Tab. 5mg, Tk.10.00/Tab.
Carsec (Medimet), Tab., 100mg, Tk. 1.35/Tab.; Betafix, (Healthcare), Tab, 2.5mg, Tk.
50mg, Tk. 0.75/Tab. 180.00/Tab.; 5mg, Tk. 300.00/Tab.
Etnol (Biopharma), Tab., 50 mg, Tk.0.77/Tab.; Betapro (Beximco), Tab., 10mg, Tk.
100 mg, Tk. 1.38/Tab. 16.00/Tab.; 2.5mg, Tk. 6.00/Tab.; 5mg, Tk.
Lonet (Beximco), Tab., 50 mg, Tk. 0.77/Tab. 10.00/Tab.
Lopres, (Orion), Tab. , 50 mg, Tk. 0.71/Tab. Bislol (Opsonin), Tab., 5 mg, Tk. 10.07/Tab.;
Normaten (Navana), Tab., 50 mg, 2.5 mg, Tk. 6.04/Tab.; 10 mg, Tk. 16.11/Tab.
Tk.0.76/Tab. Bisocor (Square), Tab., 2.5 mg, Tk.
Norpress (Kemiko), Tab., 50 mg, Tk.0.75/Tab. 6.04/Tab. 5 mg, Tk. 10.07/Tab.
Tenocard (Aristo), Tab., 50 mg, Tk. 0.75/Tab. Bisoloc (Orion), Tab., 2.5 mg, Tk. 6.02/Tab.; 5
Tenoloc (Acme), Tab., 50 mg, Tk. 0.77/Tab.; mg, Tk. 10.03/Tab.
100 mg, Tk. 1.37/Tab. Bisopress (NIPRO JMI), Tab., 2.5 mg, Tk.
Tenomin (Pacific), Tab. , 50 mg, Tk. 0.77/Tab. 6.02/Tab.; 5 mg, Tk. 10.03/Tab.
Tenoren (ACI), Tab., 25mg, Tk. 0.45/Tab.; Bisopro (Incepta), Tab. 2.5 mg, Tk.6.00/Tab.;
50mg, Tk. 0.77/Tab., Tab., 100mg, Tk. 5 mg, Tk.10.00/Tab.
1.38/Tab. Bisoren (Renata), Tab. 2.5 mg, Tk.6.00/Tab.;
Tenovir (Virgo), Tab., 50 mg, Tk. 75.00/Tab. 5 mg,Tk.10.00/Tab.
B-prolol (Sharif), Tab., 2.5 mg, Tk. 6.01/Tab.,
Atenolol + Chlorthalidone 5 mg, Tk. 10.03/Tab.
Atechlor, (Silva), Tab, 50 mg + 25 mg, Tk. Cardicor (UniMed), Tab. 2.5 mg, Tk.6.00/Tab.;
2.51/Tab.,Tab., 100 mg + 25 mg, Tk. 3.01/Tab. 5 mg, Tk.10.00/Tab.
Tenoren Plus(ACI), Tab., 50 mg+25 mg, Tk. Cardinor (Labaid), Tab. 2.5 mg, Tk.6.00/Tab.;
3.02/Tab. 5 mg, Tk.10.00/Tab.
Cardobis (Eskayef), Tab, 2.5 mg, Tk.
6.00/Tab.; 5 mg, Tk. 10.00/Tab.
BISOPROLOL FUMARATE
Conbis (RAK), Tab. 2.5 mg, Tk.6.00/Tab.;
5mg, Tk.10.00/Tab.
Indications: Hypertension, angina, Myocard (General), Tab., 2.5mg, Tk.
myocardial infarction, arrhythmias, heart 6.02/Tab.; 5mg, Tk. 10.03/Tab.
failure Myocor (Biopharma), Tab.2.5mg, Tk.
Cautions: See under Propranolol 10.00/Tab.; 2.50mg, Tk. 6.00/Tab.
Nubis (Nuvista), Tab. , 2.5 mg, Tk. 6.00/Tab.;
Hydrochloride; dose max. 10 mg daily 5 mg, Tk. 10.00/Tab.
sould be reduced; if GFR less than Orabis (Ibn Sina), Tab. , 2.5mg, Tk.
20 mL/minute/1.73m2 (max. 10 mg 180.00/Tab. ; 5mg, Tk. 300.00/Tab.
daily) Probis, (ACI), Tab., 2.5mg, Tk. 6.02/Tab.;
Contra-indications: See under 5mg, Tk. 10.03/Tab.
Propranolol Hydrochloride; also acute or Tabis (Navana), Tab., 2.5 mg, Tk. 6.02/Tab.; 5
decompensated heart failure; sino-atrial mg, Tk. 10.03/Tab.
Tenobis- (Drug Intl), Tab., 2.5mg, Tk.
block
6.05/Tab.; 5mg, Tk. 10.05/Tab.
Interactions: See Appeddix -2 Tibeta (Doctor TIMS), Tab. 2.5 mg, Tk.6/Tab.
Side-effects: See under Propranolol Bisoprolol Fumarate + Hydrochlorothiazide
Hydrochloride, muscle weakness and
cramp Ancor Plus (Aristo), Tab. 2.5 mg + 6.25 mg,
Dose: Hypertension and angina, usually Tk.6.00/Tab.; 5 mg + 6.25 mg, Tk.10.00/Tab.
5-10 mg once daily max 20 mg daily. Betacor (Popular), Tab., 2.5mg + 6.25mg
Tab., Tk. 6.00/Tab.; 5.00mg + 6.25mg, Tk.
Adjunct in heart failure, initially 1.25 mg
10.00/Tab.
once daily (in the morning) for 1 week Betafix (Healthcare), Tab., 2.5mg + 6.25mg,
then, if well tolerated, increased to 2.5 Tk. 6.00/Tab.; 5mg + 6.25mg, Tk. 10.00/Tab.
mg/ 4 weeks, upto max. 10 mg daily Bislol Plus (Opsonin), Tab., 10 mg + 6.25 mg
, Tk. 16.00/Tab.; 2.5 mg + 6.25 mg, Tk.
Proprietary Preparations 6.02/Tab.
Ancor (Aristo), Tab. 2.5 mg, Tk.6.00/Tab.; Bisocor (Square), Tab. 2.5 mg + 6.25 mg, Tk.
5mg, Tk.10.00/Tab.; 10 mg, Tk.16.00/Tab. 6.04/Tab.; 5 mg + 6.25 mg, Tk. 10.03/Tab.
Betabis (Acme), Tab. 2.5 mg, Tk.6.01/Tab.; Bisopro (Incepta), Tab. 2.5 mg + 6.25 mg,
5mg, Tk.10.003Tab. 10.00/Tab.; 5 mg + 6.25 mg, Tk.6.00/Tab.

124
3. CARDIOVASCULAR SYSTEM

Probis (ACI), Tab., 2.5mg + 6.25, Tk. Carvista (Incepta), Tab. 6.25mg, Tk.3.00/Tab;
6.02/Tab.; 5mg + 6.25, Tk. 10.03/Tab. 25mg, Tk. 8.00/Tab; 12.5mg,Tk.5.00/Tab.
Tabis Plus (Navana), Tab., 2.5 mg+6.25 mg, Cavelon (Drug Intl), Tab, 12.5mg, Tk.6.05/Tab;
Tk. 6.00/Tab.; 5 mg+6.25 mg, Tk. 10.00/Tab. 6.25mg, Tk.3.05/Tab.
TenobisPlus(DrugIntl),Tab.,10mg+6.25mg, Dilapress (Beximco),Tab, 6.25mg, Tk. 3/Tab.
Tk. 16.05/Tab., 2.5mg+6.25mg, Tk. 6.45/Tab. Dilatrend (Radiant), Tab., 25mg, Tk.
; 5mg+6.25mg, Tk. 10.05/Tab. 22.07/Tab.; 6.25mg, Tk. 11.03/Tab.
Dilgard (General), Tab., 12.5mg, Tk.5.04/Tab.;
Bisoprolol + Amlodipine 25mg, Tk. 8.05/Tab.;6.25mg, Tk. 3.02/Tab.
Bisopro-A 2.5/5(Incepta), Tab. 2.5mg+ 5mg, Dilocard (White Horse), Tab., 6.25 mg,
Tk. 6.00/Tab. Tk.3.00/Tab.; 12.5 mg, Tk. 5.00/Tab.
Diola (Novartis), Tab., 6.25 mg, Tk. 6.25/Tab.;
CARVEDILOL 12.50 mg, Tk. 9.50/Tab.
Durol (Square), Tab. 6.25 mg, Tk.3.01/Tab.
Exepress (Opsonin), Tab., 3.125 mg,
Indications: Hypertension, angina, Tk.1.14/Tab.; 6.25 mg, Tk. 2.26/Tab.; 12.50mg,
adjunct in symptomatic chronic heart Tk. 3.77/Tab.; 25 mg, Tk. 6.04/Tab.
failure Karvedil (ACI), Tab., 12.5mg, Tk.4.03/Tab.;
Cautions: See under propranolol 25mg,Tk. 8.05/Tab.; 6.25mg, Tk. 3.02/Tab.
hydrochloride, acute or decompensated Revodil (Ibn Sina), Tab., 6.25 mg, Tk. 3/Tab.
heart failure requiring intravenous Rovedilol (Healthcare), Tab., 12.5mg, Tk.
7.00/Tab.; 6.5mg, Tk. 4.00/Tab.;
inotropics Ucardol (UniMed), Tab, 12.5mg, Tk.5.00/Tab.;
Contraindication: See under propra- 25mg, Tk.9.00/Tab.;6.25mg, Tk.3.00/Tab.
nolol hydrochloride; hepatic impairment Vedilol (Eskayef), Tab, 12.50mg, Tk.5/Tab.;
Interactions: See Appendix-2 25mg, Tk. 8/Tab. 6.25mg, Tk. 3.00/Tab.
Side-effects: Postural hypotension, Vesodil (Rangs), Tab., 12.5 mg, Tk. 5.00/Tab.;
dizziness, headache, fatigue, gastrointe- 25mg, Tk.8.00/Tab.; 6.25 mg,Tk. 3.00/Tab.
stinal disturbances, bradycardia, painful
extremities,peripheral edema, dry LABETALOL HYDROCHLORIDE
mouth, dry eyes, impotence, (Both alpha and beta adrenergic blocker)
disturbances of micturition, AV block,
exacerbation of intermittent claudication Indications: Hypertension in pregnancy,
,worsening of psoriasis, heart failure, hypertension with angina, and
Dose: Hypertension, initially 6.25 mg hypertension following acute myocardial
twice daily, increase gradually to usual infarction); hypertensive crisis, controlled
dose of 25 mg twice daily; ELDERLY hypotension in anaesthesia
initial dose of 12.5 mg daily may provide Cautions: See under Propranolol
satisfactory control Hydrochloride; renal impairment- dose
reduction may be required; if severe
Proprietary Preparations hepatocellular damage labetalol should
Arilol (Pacific), Tab, 12.5 mg,Tk. 5/Tab; be stopped and not restarted
25mg,Tk.8./Tab;6.25mg, Tk.3/Tab.
Contra-indications: See under
Avidol (Ad-din), Tab., 6.25 mg, Tk. 3.00/Tab.
Cardex (Opsonin), Tab, 12.5mg, Propranolol Hydrochloride
Tk.5.02/Tab;3.125mg,Tk. 1.51/Tab, Interactions: See Appendix-2
6.25mg,Tk.3.01/Tab. Side-effects: Postural hypotension
Cardivas (Sun), Tab., 6.25 mg, Tk. 4.55/Tab.; tiredness, weakness, headache, rashes,
12.50 mg, Tk. 6.55/Tab. scalp tingling, difficulty in micturition,
Carved (Biopharma), Tab, 6.25mg, epigastric pain, nausea, vomiting; liver
Tk.4.50/Tab.
damage
Carvetab (Medimet), Tab., 12.5 mg,
Tk.5.00/Tab.; 6.25 mg, Tk.3.00/Tab. Dose: By mouth, initially 100 mg twice
Carvicard (Novo), Tab, 12.5mg, Tk.5/Tab; daily with food, increased at intervals of
6.2mg, Tk. 3.00/Tab. 14 days to usual dose of 200 mg twice
Carvipress (Acme), Tab; 12.50 mg, daily;
Tk.5.03/Tab;25.mg, Tk. 8.07/Tab;6.25 mg,
Tk.3.01/Tab.

125
3. CARDIOVASCULAR SYSTEM

By intravenous injection, 50 mg over at Metoprol (Beximco), XR Tab.,50mg,


least 1 minute, repeated after 5 minutes Tk. 3.00/Tab.
if necessary; max. dose 200 mg M-Loc (Sharif), Tab.50 mg,Tk.2/Tab.
Preloc (Opsonin), Tab., 50 mg ,
By intravenous infusion, 2 mg/minute
Tk. 2.00/Tab.
until satisfactory response then Presonil (Incepta),Tab.25 mg,
discontinue; Hypertension in pregnancy, Tk. 1.30/Tab.
20 mg/hour, doubled every 30 minutes; Selomet (UniMed), Tab,50mg,
usual max. 160 mg/hour Tk.4/Tab.;50mg,Tk.2/Tab;25mg,
Hypertension following myocardial Tk.1.50/Tab.
infarction, 15 mg/hour, gradually Topress (Eskayef), Tab., 50mg,
increased to max. 120 mg/hour Tk. 2.00/Tab.

Proprietary Preparations NEBIVOLOL(dilate bold vessels in addition to


Labecard (Popular), Tab., 200 mg, Tk. cardiac effect)
10.04/Tab.;100mg,Tk.6.02/Tab.;Inj,
5 mg/ml, Tk. 100.38/Vial Indications: Essential hypertension;
Labegest (Incepta), Tab., 100mg, Tk. adjunct in stable mild to moderate heart
6.00/Tab.; 200 mg, Tk. 10.00/Tab.;
failure in patients over 70 years
Labeta (Beximco), Tab., 200 mg, Tk. 9.00/Tab.
Cautions: See under Propranolol
Hydrochloride, renal impairment avoid if
METOPROLOL TARTARATE[ED](Selective serum creatinine greater than 250
beta1blocker)
micromol/litre
Contra-indications: See under Propra-
Indications: See under Dose
nolol Hydrochloride; also acute or
Cautions: See under propranolol decompensated heart failure requiring
hydrochloride intravenous inotropes
Interactions: See Appendix-2 Interactions: See Appendix-2
Side-effects: See under propranolol Side-effects: See under Propranolol
hydrochloride Hydrochloride; also oedema and
Dose: By mouth; hypertension, initially depression, fatigue, exercise intolarence
25-100 mg daily, main-tenance 100-200 Dose: Hypertension, 5 mg daily;
mg daily in 2 divided doses; ELDERLY initially 2.5 mg daily,
Angina, 50-100 mg 2-3 times daily; increased if necessary to 5 mg daily
Arrhythmias, usually 50mg 2-3 times Adjunct in heart failure, initially 1.25 mg
daily, up to 300 mg daily in divided once daily, then if tolerated increased at
doses if necessay; intervals of 1–2 weeks to 2.5 mg once
Migraine prophylaxis, 100-200mg daily in daily, then to 5 mg once daily, then to
divided dose; Hyperthyroidism (adjunct), max. 10 mg once daily
50mg 4 times daily. Renal impairment for hypertension,
By intravenous injection, Arrhythmias, initially 2.5 mg once daily, increased to 5
up to 5 mg at rate 1-2 mg/minute, mg once daily if required; for heart
repeated after 5 minutes if necessary, failure
total dose 10-15 mg.
Proprietary Preparations
Proprietary Preparations Bipinor (ACI), Tab. 5mg,Tk.8.05/
Angilat (ACI), Inj, 1mg/ml, Tk.120.36/vial; Tab.; 2.5mg, Tk.5.04/Tab.
Tab., 25mg, Tk.1/Tab; 50 mg,TK.1.5/Tab. Cardoneb (Eskayef), Tab.,5 mg,Tk.
Betacard (Aristo), Tab., 50mg, Tk. 2.00/Tab. 10.00/Tab.;2.5mg,Tk.7.00/Tab.
Betaloc (Drug Intl), Tab. 50mg, Tk. Maxineb (Aristo), Tab.,2.5mg,
2.04/Tab.;25mg, Tk.1.55/Tab.; 100mg, Tk.7.00/Tab.; 5mg,Tk.10.00/Tab.
Tk.6.05/Tab.50mg,Tk.4.05/Tab. Nebicard (UniMed), Tab, 5 mg,
Betaone (Acme), Tab. 25 mg, Tk. 1.51/Tab.;50 Tk.12.00/Tab.; 2.5mg,Tk.7.00/Tab.
mg,Tk.2.00/Tab. Nebifast (Drug Intl), Tab. 2.5mg,
Metocard (Popular), Inj.1 mg/ml, Tk.6.00/Tab.; 5mg,Tk.8.00/Tab.
Tk.120.45/vial

126
3. CARDIOVASCULAR SYSTEM

Nebilol (Opsonin), Tab.5 mg, Tk. 8.03/Tab.; Prophylaxis after myocardial infarction,
2.5 mg,Tk.5.02/Tab. 40 mg 4 times daily for 2-3 days, then 80
Nebita (Square), Tab.5 mg, Tk. 10.03/Tab.; mg twice daily, beginning 5 to 21 days
2.5 mg,Tk.7.02/Tab.
after infarction;
Nebivas (Asiatic), Tab., 2.5mg,
Tk.5.00/Tab.;5mg, Tk.10.00/Tab. Migraine prophylaxis and essential
tremor, initially, 40 mg 2-3 times daily,
maintenance 80-160 mg daily
PROPRANOLOL
HYDROCHLORIDE[ED] Proprietary Preparations
Beta (Sun), TR Cap., 40 mg, Tk.2.50/Cap.
Indications: See under dose G-propranolol (Gonoshasthaya), Tab., 40 mg,
Cautions: Pregnancy and breast- Tk. 0.35 /Tab.
Indever (ACI), SR Cap., 40mg, Tk. 0.92/Cap.,
feeding, avoid abrupt withdrawal in
80mg, Tk.1.55/Cap., Tab., 10mg, Tk.
angina, first-degree AV block, hepatic 0.51/Tab., 40mg,Tk. 3.00/Tab.
impairment, renal impairment, diabetes, Propranol (Opsonin), Tab.10 mg , Tk.
myasthenia gravis 0.51/Tab., 40 mg , Tk. 1.51/Tab.
Contraindications: Asthma or history of Propranolol (Albion), Tab., 10 mg,
obstructive airways disease important: Tk.0.24/Tab.; 40 mg, Tk. 0.34/Tab.
see bronchospasm below; uncontrolled
heart failure, prinzmetal’s angina, SOTALOL HYDROCHLORIDE
marked brady-cardia, hypotension, sick
sinus syndrome, second or third degree Indications: Life threating arrythmias
AV block, cardiogenic shock, metabolic including ventricular tachyarrythmias,
acidosis, severe peripheral arterial paroxysmal, supraventricular tachycardia
disease, phaeochromocytoma after cardiac surgery
Interactions: See Appendix-2 Cautions: See under propranolol
Side-effects: Bradycardia, heart failure, hydrochloride; when stopping sotalol the
hypotension, conduction disorders, bron- dose should be reduced gradually
chospasm, exacerbation of intermittent Contraindications: Congenital or
claudication and Raynaud’s phenome- acquired long QT syndrom, renal failure
non, gastrointestinal disturbances, sleep angina, hypertension, and thyrotoxicosis
disturbances Interactions: See Appendix-2
Dose: By mouth, hypertension, initially Side-effects: See under propranolol
80 mg twice daily, increased at weekly hydrochloride
intervals as required; maintenance 160- Dose: By mouth with ECG monitoring
320 mg daily; and mesaurment of corrected QT
Portal hypertension, initially 40 mg twice interval, arrythmias, initially, 80mg daily
daily, increased to 80 mg twice daily in divided dose; higher doses of 480-
acccording to heart rate; max. 160 mg 640mg daily for life threating ventricular
twice daily; arrhythmias under special supervision
Phaeochromocytoma (only with an
alpha-blocker), 60 mg daily for 3 days Proprietary Preparation
before surgery or 30 mg daily in patients Sotalax (Unimed), Tab. 80 mg, Tk. 10/Tab.
unsuitable for surgery;
Angina, initially 40 mg 2-3 times daily;
3.2 DRUGS AFFECTING THE
maintenance 120-240 mg daily;
RENIN-ANGIOTENSIN SYSTEM
Arrhythmias, hypertrophic obstructive
cardiomyopathy, anxiety tachycardia, AND SOME OTHER
and thyrotoxicosis (adjucnt), 10 mg to 40 ANTIHYPERTENSIVE DRUGS
mg 3-4 times daily; 3.2.1 ANGITOTENSIN CONVERTING
Anxiety with symptoms such as ENZYME INHIBITOR
palpitations, sweating, tremor, 40 mg 3.2.2. ANGITOTENSIN-II RECEPTOR
once daily increased to 40 mg 3 times ANTAGONISTS
daily if necessary; 3.2.3. RENIN INHIBITORS

127
3. CARDIOVASCULAR SYSTEM

3.2.4 ALPHA-ADRENOCEPTOR functioning kidney ACE inhibitors are


BLOCKING DRUGS likely to cause severe and progressive
3.2.5 ANGIOTENSIN II RECEPTOR renal failure; they are contraindicated in
BLOCKER NEPRILYSIN patients who have critical renovascular
INHIBITOR (ARNI) disease. Glomerular filtration is likely to
3.2.6 VASODILATOR ANTI- be reduced in the affected kidney with
HYPERTENSIVE DRUGS the treatment by ACE inhibitor.
3.2.7 CENTRALLY ACTING Therefore, ACE inhibitors are not to be
ANTI-HYPERTENSIVE DRUGS prescribed in patients with known or
3.2.1 ANGITOTENSIN-CONVERTING suspected renovascular disease, unless
ENZYME INHIBITORS (ACE the blood pressure uncontrollable by
inhibitors) other drugs. If they are used in these
situations renal function tests are to be
ACE inhibitors inhibit the conversion of done regularly.
angiotensin I to angiotension II. They are Renal function and electrolytes should
effective and well tolerated. be measured before initiating ACE
Heart Failure. ACE inhibitors are very inhibitors and monitored during
useful in all grades of heart failure, treatment. Although ACE inhibitors now
combined when appropriate with a have some special role in some forms of
diuretic and digoxin. Postassium supple- renal disease they can occasionally
ments and potassium-sparing diuretics cause renal impairment, which may lead
should be withdrawn before introducing to renal failure. The elderly are at
an ACE inhibitor because of the risk of particular risk. Concomitant treatment
hyperkalaemia. First-dose phenomenon with NSAIDs increases the risk of renal
may occur when ACE inhibitors are damage, and the use of potassium
intro-duced to patients with heart failure sparing diuretics increase the risk of
who are already taking a loop diuretic hyperkalaemia.
(e.g. furosemide 80 mg daily or more). Cautions : May cause sharp fall of
At the start of treatment the ACE blood pressure especially in patients
Inhibitor should therefore be at a very taking diuretics, on a low-sodium diet, on
low dosage (e.g. captopril 6.25mg) with dialysis, dehydrated or with heart failure.
the patient recumbent and under close They should also be given with caution
medical supervision. in peripheral vascular disease or
Hypertension. ACE inhibitors are generalised atherosclerosis owing to risk
recommended for hypertension when of clinically silent renovascular disease.
thiazides and beta-blockers are Renal function tests should be carried
contraindicated, not tolerated, or fail to out before and during treatment and the
control blood pressure. They are dose should be reduced in renal
particularly indicated for hypertension in impairment. The risk of agranulocytosis
insulin-dependent diabetics with nephro- is possibly increased in collagen
pathy. ACE inhibitors may cause very vascular disease. ACE inhibitors should
rapid fall of blood pressure in some be avoided in patients with a history of
patients who are taking diuretic. The first idiopathic or hereditary angiedema. ACE
dose should preferably be at bed time. inhibitors should be prescribed with
caution in breast-feeding. ACE inhibitors
Myocardial Infarction. ACE inhibitors
should also be given with caution in
are indicated for immediate and long-
patients with peripheral vascular disease
term management of patients who have
or those with severe generalised
had myocardial infarction.
atherosclerosis.
Hospital Management. ACE inhibitor
Anaphylactoid Reactions. ACE
therapy for severe heart failure should
inhibitors should be avoided during
be started in hospital.
dailysis with dextran sulphate to prevent
Renal effects. In patients with severe
anaphylactoid reactions. They should
stenosis of the artery supplying a single
also be withheld before deseusitization
128
3. CARDIOVASCULAR SYSTEM

with bee venom. In the volume depleted Dose: Hypertension, used alone, initially
patients diuretic should be discontiuned 12.5 mg twice daily; if used in addition to
or the dose should be reduced diuretic, or in elderly, initially 6.25 mg
significantly 2-3 days before initiation of two times daily (first dose at bedtime);
an ACE inhibitor. If diuretic therapy usual maintenance dose 25 mg twice
cannot be stopped, clinical supervision daily, max. 50 mg twice daily (rarely 3
is recommended for at least 2 hours times daily in severe hypertension)
after administration of the first dose of Heart failure, initially 6.25-12.5 mg under
the ACE inhibitor or until the blood close medical supervision (see notes
pressure has stabilized. above); usual maintenance dose 25mg
Contra-indications: ACE inhibitors are 2-3 times daily, usual max. 150mg daily
contraindicated in patients with Prophylaxis after infarction in clinically
hypersen-sitivity to ACE inhibitors stable patients with asymptomatic or
(including angioedema) and in known or symptomaitc left ventricular dysfunction,
suspected renovascular disease, aortic initially 6.25mg starting as early as 1 day
stenosis or other outflow tract after infarction, then increased over
obstruction. ACE inhibitors should not be several weeks to maximum tolerated
used in pregnancy level in divided doses
Side-effects: ACE inhibitors can cause Diabetic nephropathy, 50-100mg daily in
profound hypotension and renal divided doses; if further blood press-ure
impairment. They may also cause reduction required, other antihyper-
angioedema, rashes, pruritus, urticaria, tensives may be used in conjunction with
persistent dry cough, pancreatitis and captopril; in severe renal impairment,
upper respiratory tract symptoms such initially 12.5mg twice daily (if concomi-
as sinusitis, rhinitis and sore throat. tant rather than thiazide should be
Gastrointestinal effects reported with chosen)
ACE inhibitors include nausea, vomiting,
dyspepsia, diarrhoea and constipation. Proprietary Preparations
Altered liver function tests, chloestatic Acetor (Drug Int), Tab., 25 mg Tk. 3.05/Tab.
jaundice and hepatitis have been Capotril (Alco)), Tab., 25 mg Tk. 3.00/Tab.
reported. Blood dyscrasias including Captopril (Albion), Tab., 25 mgTk. 3.00/Tab.
thrombocy-topenia, leucopenia, Cardopril (Beximco), Tab. 25 mg, Tk.3.01/Tab.
Catopil (Zenith), Tab., 25 mg, Tk. 3.00/Tab.
neutropenia and haemolytic anemia
have also been reported.
ENALAPRIL MALEATE[ED]
CAPTOPRIL[ED]
Indications: Essential and renovascular
hypertension congestive heart failure,
Indications: Mild to moderate essential
prevention of symptomatic heart failure
hypertension alone or with thiazide
and prevention of coronary ischaemic
therapy and severe hypertension resist-
events in patients with left ventricular
ant to other treatment; congestive
dysfunction
cardiac failure; following myocardial infa-
Cautions: See notes above
rction, diabetic nephropathy (microal-
buminuria greater than 30mg/ day) in Contra-indications : See notes above
insulin-dependent diabetes Interactions: See Appendix-2
Cautions: See notes above Side-effects: See notes above; also
Contra-indications: See notes above palpitation, arrhythmias, angina, chest
Interactions: See Appendix-2 pain, syncope, cerebrovascular accident,
myocardial infarction, anorexia,
Side-effects: See notes above; also
stomatitis, hepatic failure, erythema
tachycardia, serum sickness, weight
multiforme, Stevens-Johnson syndrome,
loss, stomatitis, maculopapular rash,
toxic epider-mal necrolysis, exfoliative
photosensitivity, flushing and acidosis
dermatitis and pemphigus, confusion,
depers-sion, nervousness, asthenia,

129
3. CARDIOVASCULAR SYSTEM

drowsiness, insomnia, blurred vision, further 24 hours, and continuing with 10


tinnitus, sweating, flushing, impotence, mg once daily for 6 weeks or continued;
alopecia, dyspnoea and muscle cramps systolic blood pressure 100-120 mmHg
Dose: Hypertension, used alone, initially initially 2.5 mg increasing to maintena-
5mg once daily; if used in addition to nce dose of 5mg once daily
diuretic, in ELDERLY patients, or in Diabetic nephropathy, intially 2.5 mg
renal impairment, initially 2.5mg daily; daily adjusted to achieve a sitting
usual maintenance dose 10-20mg once diastolic blood pressure below 75 mmHg
daily; in severe hypertension the dose in normotensive insulin dependent
may be increased to max. 40mg once diabetes and below 90 mmHg in
daily. Heart failure (adjunct), hypertensive non-insulin dependent
asymptomatic left ventricular diabetes; usual dose, 10-20 mg daily
dysfunction, initially 2.5mg daily under
close medical supervision; usual Proprietary Preparations
maintenance dose 20mg daily in 1-2 Acepril (Drug Intl), Tab., 10mg, Tk.7.05/Tab.; 5
divided doses mg, Tk. 4.05/Tab.
Lipril (Acme), Tab., 10 mg, Tk. 5.53/Tab.; 5
mg, Tk. 3.01/Tab.
Proprietary Preparations
Lispril (Medimet), Tab., 5 mg, Tk.2.25/Tab.
Anapril (Eskayef), Tab, 5 mg, Tk. 1.51/Tab.;
Nop (Ambee), Tab., 5 mg, Tk.3.55/ Tab
10 mg, Tk. 2.70/Tab.
Stril (ACI), Tab., 5 mg, Tk. 3.02/Tab
Enalapril (Albion), Tab., 5 mg, Tk. 1.52/Tab.;
10 mg, Tk. 2.78/Tab.
Enaril (Beximco), Tab., 5 mg, Tk. 1.00/Tab. PERINDOPRIL
Vasopril (Square), Tab., 5 mg, Tk. 1.25/Tab.;
10 mg, Tk. 2.26/Tab. Indications: Essential and renovascular
hypertension, congestive heart failure
LISINOPRIL Cautions: Inform the physician when
there is swelling of the lips, face, tongue,
Indications: Essential and renovascular and when there is difficulty in breathing
hypertension, congestive heart failure, and swallowing
following myocardial infarction in haemo- Contraindications: See notes above
dynamically stable patients, diabetic Interactions: See Appendix-2
nephropathy in normotensive insulin Side-effects: See notes above;
dependent and hypertensive noninsulin asthenia, flushing mood and sleep
dependent diabetes mellitus disturbances
Cautions: See notes above Dose: Hypertension, initially 2 mg daily
Contraindications: See notes above (before food); usual maintenance
Interactions: See Appendix-2 dosage is 4mg once daily orally in the
Side-effects: See notes above; tachyca- morning, max. 8mg daily, if necessary,
rdia, cerebrovascular accident, myocar- after 1 month of treatment
dial infarction, dry mouth, confusion, Congestive heart failure: treatment
mood change, asthenia, sweating, should be under closed medical
impotence and alopecia supervision, recommended initial dose is
Dose: Hypertension, initially 2.5 mg 2 mg daily orally in the morning which
daily, usual maintenance dose 10-20 mg may be increased to 4 mg daily (once
daily, max. 40 mg daily, if used in blood pressure acceptability has been
addition to diuretic; See notes above demonstrated). In case of renal failure,
Heart failure (adjunct), initially 2.5 mg the dosage of perindopril must be
daily under close medical supervision, adjusted according to the degree of
usual maintenance dose 5-20 mg daily renal failure; periodic determination of
Prophylaxis after myocardial infarction, serum potassium and creatinine levels
systolic blood pressure over 120 mmHg, recommended
5mg within 24 hours followed by further
5mg, 24 hours later, then 10 mg after a
130
3. CARDIOVASCULAR SYSTEM

Proprietary Preparations intervals of 1-2 weeks; max. 10 mg daily


Pendoril (Renata), Tab., 2 mg, Tk. 9.00/Tab., in single or 2 divided doses.
4 mg, Tk. 14.00/Tab., 8 mg, Tk. 24.09/Tab. Prophylaxis after myocardial infarction
Pericard (Asiatic), Tab., 2mg, Tk. 7.00/Tab., initially 2.5 mg twice daily, increased
4mg , Tk. 12.00/Tab.
after 2 days to 5 mg daily, maintenance
Versil(Acme), Tab., 4 mg., Tk. 12.09/Tab.
Cadnyl (Square), Tab., 4 mg, Tk.12.05/Tab.
2.5-5 mg twice daily.
Coversyl (Servier), Tab., 4mg, 16tk/Tab; 8mg, Note. If initial 2.5 mg dose is not
Tk. 25.00/Tab. tolerated, give 1.25 mg twice daily for 2
days before increasing to 2.5 mg twice
Perindopril Erbumine + Indapamide daily, then 5mg twice daily; withdraw if
Coversyl plus (Servier), Tab., 4mg+1.5mg, Tk. 2.5 mg twice daily not tolerated.
21.00/Tab.
Indapa-plus (Drug Intl), Tab., 625 mcg + 2 mg,
Proprietary Preparations
Tk. 6.05/Tab.; 1.25 mg+ 4mg, Tk. 12.05/Tab.
Acecard (Healthcare), Tab, 1.25 mg,
Indapril (Incepta), Tab., 625 mcg + 2 mg, Tk.
Tk.3.00/Tab.; 2.5 mg, Tk. 5.00/Tab.; 5 mg,
12.00/Tab.; 1.25 mg + 4 mg , Tk. 7.00/Tab.
Tk.8.00/Tab.
Midopril (General), Tab., 2 mg + 0.625 mg,
Aceon (Novo Health), Tab., 5 mg, Tk.
Tk. 7.00/Tab.; 4 mg + 1.25 mg, Tk. 12.00/Tab.
8.00/Tab., 2.5 mg, Tk. 5.00/Tab.
Pendoril (Renata), Tab., 625 mcg + 2 mg, Tk.
Aceril (Ibn Sina), Tab.,2.5mg, Tk. 5.00/Tab.,
10.00/Tab.; 1.25 mg + 4 mg , Tk. 15.00/Tab.
5mg, Tk. 240.00/Tab.
Pericard Plus (Asiatic), Tab., 625 mcg + 2 mg
Cartace (Ad-din), Tab., 2.5mg, Tk. 4.60/Tab.
, Tk. 7.00/Tab.; 1.25mg + 4mg , Tk. 12.00/Tab.
Gepril (Globe), Tab., 5 mg, Tk. 8.00/Tab.
Perindal (Opsonin), Tab.,1.25 mg + 4 mg, Tk.
G-Ramipril (Gonoshasthaya), Tab., 2.5 mg,
12.05/Tab.; 625 mcg + 2 mg, Tk. 7.03/Tab.
Tk. 2.50/Tab.; 5 mg, Tk. 4.00/Tab.
Repres Plus (Square), Tab., 4 mg + 1.25 mg,
Mypril (Eskayef), Tab, 2.5 mg, Tk.5.00/Tab.;
Tk. 12.05/Tab.; 2 mg + 0.625 mg, Tk.7.02/Tab.
5mg, Tk. 8.00/Tab.
Nuvace (Orion), Tab., 2.5 mg, Tk. 5.02/Tab., 5
Perindopril erbumine+ Amlodipine
mg, Tk. 8.02/Tab.
Coveram (Servier), Tab. 4mg+5mg, Tk.
Nuvace (Orion), Tab., 2.5 mg, Tk.5.00/Tab.;
21.00/Tab, 4mg+ 10mg, Tk. 21.00/Tab.
5mg, Tk. 8.00/Tab.
Piramil (Novartis), Tab., 2.5 mg, Tk. 7.00/Tab.;
RAMIPRIL 5 mg, Tk. 10.00/Tab.
Pricard (White Horse), Tab., 2.5 mg,
Tk.4.00/Tab.;
Indications: Mild to moderate hyperten-
Primace (Beximco), Tab., 2.5 mg,
sion, congestive heart failure (adjunct); Tk.5.00/Tab.; 5 mg, Tk. 8.00 /Tab.
following myocardial infarction in patie- Protace (UniMed), Tab., 2.5 mg, Tk.5.00/Tab.;
nts with clinical evidence of heart failure; 5 mg, Tk. 8.00/Tab.
prevention of myocardial infarction Racard (Pacific), Tab., 1.25 mg, Tk. 1.88/Tab.;
Cautions: See notes above 2.5 mg, Tk. 3.46/Tab.; 5 mg, Tk. 6.02/Tab.
Contraindications: See notes above Ramace (Opsonin), Tab., 5 mg, Tk. 8.03/Tab.,
1.25 mg, Tk. 2.52/Tab., 2.5 mg, Tk. 5.02/Tab.
Interactions: See Appendix-2
Ramicard (Drug Intl), Tab., 1.25mg, Tk.
Side-effects: See notes above; arrhyth- 2.56/Tab., 2.5mg, Tk. 5.05/Tab., 5mg, Tk.
mias, angina, syncope, stomatitis, dry 8.05/Tab.
mouth, erythema multiforme and Ramil(Popular), Tab. , 1.25 mg, Tk. 2.50/Tab.,
pemphigoid exanthema, precipitation or 5.00mg, Tk. 8.03/Tab., 2.5mg, Tk. 5.02/Tab.
exacer-bation or Raynaud’s syndrome, Ramilok (Aristo), Tab., 2.5 mg, Tk.5.00/Tab.;
conjunctivitis, confusion, impotence, 5mg, Tk.8.00/Tab.
Ramilon(Virgo), Tab. , 2.5 mg, Tk. 4.00/Tab., 5
alopecia, bronchitis and muscle crapmps
mg, Tk. 6.00/Tab., 5mg, Tk. 8.05/Tab.
Dose: Hypertension, initially 1.25 mg Ramipro (General), Tab., 2.5mg, Tk. 5.04/Tab.
daily, increased at intervals of 1-2 Ramoril (Incepta), Tab.,1.25 mg, Tk.
weeks; usual 2.5-5 mg once daily; max. 2.50/Tab., 10 mg, Tk. 12.00/Tab., 2.5 mg, Tk.
10 mg daily; for use along with diuretics 5.00/Tab., 5 mg, Tk. 8.00/Tab.
see notes above Rampril (Rangs), Tab., 2.5mg, Tk. 4.00/Tab.;
Heart failure (adjunct), initially 1.25 mg 5 mg, Tk. 6.00/Tab.
once daily under close medical Ripril (Square), Tab., 2.5 mg, Tk. 5.00/Tab., 5
mg, Tk. 8.00/Tab., 1.25 mg, Tk. 2.52/Tab.
supervision, increased if necessary at

131
3. CARDIOVASCULAR SYSTEM

R-PIL (Biopharma), Tab., 2.5mg , Tk. Proprietary Preparations:


5.02/Tab., 5mg, Tk. 8.03/Tab., 1.25 mg, Tk. Adarbi (NIPRO JMI), Tab., 40 mg, Tk.
3.01/Tab. 12.00/Tab.; 80 mg, Tk. 22.00/Tab.
Tritace (Sanofi), Tab.,2.5mg, Tk. 9.53/Tab., Azisan (Renata), Tab., 40 mg, Tk. 12/Tab.; 80
5mg, Tk. 14.04/Tab. mg, Tk. 22.00/Tab.
Unipril (Acme), Tab.,1.25 mg , Tk. 2.51/Tab.; Tanzil (Drug Intl), Tab., 40 mg, Tk. 12/Tab.
2.5 mg, Tk. 5.03/Tab.; 5 mg, Tk. 8.07/Tab. Zilsart (Acme), Tab., 40 mg, Tk. 12.00/Tab.

Ramipril + Hydrochlorothiazide
CANDESARTAN CILEXETIL
Ramicard Plus (Drug Intl), Tab., 2.5 mg + 12.5
mg, Tk 3.00/Tab.; 5 mg + 25 mg, Tk. 5.00/Tab.
Ramoril Plus (Incepta),Tab.,2.5 mg+12.50mg, Indication: Hypertension
Tk. 5.00/Tab.; 5 mg + 25 mg, Tk. 8.00/Tab. Cautions: See notes above, mild to
Protace H(Unimed), Tab., 2.5 mg + 12.50 mg, moderate hepatic impairment and renal
Tk. 5.00/Tab. impairment
Contraindications: See notes above;
3.2.2 ANGIOTENSIN II RECEPTOR severe hepatic and renal impairment,
ANTAGONISTS (ARB) cholestasis, breast-feeding and
pregnancy
Azilsartan, Losartan, Olmesartan,and Interactions: See Appendix-2
valsartan are specific angiotension-II Side-effects: See notes above;
receptor antagonists; their properties are dizziness, myalgia, headache, nausea,
similar to those of the ACE inhibitors. abdominal pain, back pain, peripheral
Candesartan, Eprosartan, Irbesartan edema, rash and blood disorder
and Telmisartan have been intro-duced Dose: Initial dose is 4mg once daily. A
more recently. However, unlike ACE lower initial dose of 2mg once daily is
inhibitors, they do not cause the suggested for patient with renal
persistent dry cough, which is common impaiment. The dose should be adjusted
with ACE inhibitors. They are useful according to response. The usual
alternatives for patients who have to maintenance dose 4mg once daily with a
discon-tinue an ACE inhibitor beacuse of maximum dose of 16mg once daily
persistent cough.
Cautions: Angiotension-II receptor Proprietary Preparations
antagonists are to be used with caution Giran (Aristo), Tab., 8 mg, Tk. 6.00/Tab.;
16 mg, Tk. 11.00/Tab.
in renal artery stenosis. It is advised that
Candesa (General), Tab., 4 mg, Tk. 3.51/Tab.;
plasma-potassium concentration be 8 mg, Tk. 6.02/Tab.
monitored in the elderly and in patients Vesotan (Rangs), Tab. 16 mg, Tk. 11.00/Tab.;
with renal insufficiency; lower initial 8 mg, Tk. 6.00/Tab.
doses may be suitable in these patients. Candesartan cilexetiL 8 mg +
Anigiotension II receptor antagonists Hydrochlorothiazide 12.50mg ,
should be avoided in pregnancy and Giran (Aristopharma), Tab., Tk. 6.00/Tab.
bilateral renal artery stenosis
Side-effects: Hypotension, hyperkala- IRBESARTAN
emia and angioedema.
Indications: Hypertension, diabetic
AZILSARTAN nephropathy
Cautions: See notes above;
Indication: Hypertnsion alone and in Contraindications: See notes above;
combination with other anti hypertensive breast-feeding and pregnancy
Cautions: See notes above; lactation Interactions: See Appendix-2
Side-effects: See notes above Side-effects: See notes above; diarr-
Dose: 80 mg once daily hoea, dyspepsia, dizziness, myalgia,
asthenia, tinnitus, tachycardia, cough,
rash, urticaria reported

132
3. CARDIOVASCULAR SYSTEM

Dose: Initially 150mg once daily in LK (Pacific), Tab., 25 mg, Tk. 4.50/Tab. ; 50
hypertension, increased, if necessary, mg, Tk. 8.00/Tab. ; 50 mg, Tk. 8.00/Tab.
300mg once daily Lopo (Biopharma), Tab., 25mg, Tk. 4.50/Tab.;
100mg, Tk. 10.00/Tab.;50mg,Tk. 8.00/Tab.
Lopos (Zenith), Tab., 25 mg, Tk. 3.51/Tab.; 50
Proprietary Preparations mg, Tk. 6.02/Tab.
Arbitan (Opsonin), Tab., 150 mg, Tk. Lopoten (Euro), Tab., 25mg, Tk. 3.5/Tab.;
12.05/Tab.; 75 mg, Tk. 6.02/Tab. 50mg, Tk. 6.00/Tab.
Cavapro (UniMed), Tab., 75 mg, Tk. 6.00/Tab.; Loril (Astra Bio), Tab., 100 mg, Tk. 10.00/Tab.;
150 mg, Tk. 12.00/Tab.; 300 mg, Tk. 25 mg, Tk. 4.50/Tab.; 50 mg, Tk. 6.00/Tab.
24.00/Tab. Losa (Alco), Tab., 25 mg, Tk. 3.51/Tab.; 50
Irbes (Eskayef), Tab., 150 mg, Tk. mg, Tk. 6.02/Tab.
9.00/Tab.;150 mg, Tk. 9.00/Tab.; 75mg, Tk. Losacard (Novo Health), Tab., 50 mg, Tk.
5.00/Tab. 8.00/Tab.; 25 mg, Tk. 4.50/Tab.
Isart (ACI), Tab., 150 mg, Tk. 9.06/Tab. Losacor (Healthcare), Tab., 50mg, Tk.
8.00/Tab.
Irbesartan+ Hydrochlorothiazide Losan (Orion),Tab. 100mg,Tk. 12.04/Tab.;25
Arbitan (Opsonin), Tab., 150 mg+12.5mg , Tk. mg,Tk.4.51/Tab.;50 mg, Tk. 8.02/Tab.
12.05/Tab.; 75 mg+12.50, Tk. 6.03/Tab. Losapot (Somatec), Tab.,50mg,Tk. 8.00/Tab.
Cavazide (UniMed), Tab.,150mg+12.5mg, Tk. Losapress (Benham), Tab., 25 mg, Tk.
12.00/Tab.; 300mg+12.5mg, Tk. 24.00/Tab.; 4.05/Tab.; 50 mg, Tk. 8.00/Tab.
75mg+12.5mg, Tk. 6.00/Tab. Losar (Nipa),Tab.;50 mg,Tk.8.00/Tab.
Losarcar (Medimet), Tab., 50mg, Tk.
LOSARTAN POTASSIUM 6.00/Tab.; 25mg, Tk. 3.50/Tab.
Losardil (Drug Intl), Tab.,25mg,
Losaron (Amico), Tab., 50mg , TK. 5.00/Tab.
Indication: Hypertension Losart (Acme),Tab.; 25 mg.,Tk. 4.51/Tab.;100
Cautions: See notes above; hepatic and mg.,Tk.12.03/Tab.; 50 mg.,Tk.8.03/Tab.
renal impairment Losarva (NIPRO JMI), Tab., 25 mg, Tk.
Contraindications: See notes above; 3.00/Tab.; 50mg, Tk. 4.00/Tab.
pregnancy and breast-feeding Losatan (Popular), Tab. , 50mg, Tk. 8.00/Tab.;
Interactions: See Appendix-2 25mg, Tk. 4.50/Tab.
Losium (Ibn Sina), Tab. , 50mg, Tk. 8.50/Tab.
Side-effects: Diarrhoea, dizziness, taste
Parten (Jayson), Tab., 50mg, Tk. 5.03/Tab.
disturbance, myalgia, migrane, urticaria, Pertilos (Navana), Tab., 50 mg, Tk. 8.03/Tab.
pruritus, rash, altered liver function tests
Dose: Usually 50mg once daily (elderly Losartan Potassium + Hydrochlorothiazide
over 75 years, moderate to severe renal Angilock Plus (Square), Tab., 100 mg + 12.5
impairment, intravascular volume mg, Tk. 12.00/Tab.; 100 mg + 25 mg, Tk.
depletion, initially 25mg once daily); if 12.03/Tab.; 50 mg + 12.5 mg, Tk. 8.03/Tab.
Anreb (General), Tab., 100mg + 12.50mg, Tk.
necessary increase after several weeks
12.04/Tab.; 50mg + 12.50mg, Tk. 8.03/Tab.
to 100mg once daily Araten (UniMed), Tab., 50mg + 12.5mg, Tk.
8.00/Tab.
Proprietary Preparations Arbium (Asiatic), Tab.,100mg + 25mg , Tk.
Angilock (Square), Tab.,50 mg,Tk. 10.00/Tab.; 100mg + 12.50mg , Tk.
8.03/Tab.;100 mg,Tk.12.03/Tab.;25mg, Tk. 10.00/Tab.; 50mg + 12.50mg , Tk. 8.00/Tab.
4.51/Tab. Cardisan (Beacon), Tab., 50mg +12.50mg ,
Anreb (General), Tab.,50mg,Tk. Tk. 8.02/Tab.
8.03/Tab.;25mg,Tk.4.51/Tab. Cardoplus (Eskayef), Tab., 50mg + 12.50 mg,
Araten (UniMed), Tab, 50mg,Tk. 8.00/Tab. Tk. 8.00/Tab.; 50mg+12.50 mg, Tk. 8.00/Tab.;
Arbium (Asiatic),Tab.,100mg ,Tk. 12.00/Tab.; Larb (Opsonin), Tab. ,12.5 mg + 100 mg ,
25mg,Tk.3.50/Tab.;50mg , Tk. 8.00/Tab. Tk. 12.00/Tab. ; 25 mg + 100 mg , Tk.
Cardisan (Beacon),Tab. 50mg ,Tk. 8.02/Tab. 12.00/Tab. ; 12.5 mg + 50 mg , Tk. 8.00/Tab.
Cardon (Eskayef),Tab, 50mg ,Tk. LK (Pacific), Tab., 50 mg+ 12.5 mg, Tk. 8/Tab.
8.00/Tab.;25mg,Tk.4.50/Tab.;50mg,Tk. Lok (Globe),Tab., 50 mg +12.50 mg, Tk.8/Tab.
8.00/Tab.;25mg , Tk. 4.50/Tab. Lopo (Biopharma), Tab., 50mg + 12.500mg,
G-losartan (Gonoshasthaya), Tab., 50 mg, Tk. 8.00/Tab.
Tk.5.00/Tab.; 25 mg, Tk. 3.00 /Tab. Lopos (Zenith), Tab. , 100 mg, +25 mg, Tk.
Larb (Opsonin), Tab.,100 mg , Tk. 12.00/Tab. ; 10.04/Tab.
50 mg , Tk. 8.03/Tab. ; 25 mg , Tk. 4.51/Tab.

133
3. CARDIOVASCULAR SYSTEM

Losa (Alco), Tab., 50 mg + 12.5 mg, Tk. Dose: Initially 10 mg once daily; if
8.02/Tab. necessary increased to 20 mg once
Losacard (Novo Health), Tab. , 50 mg + 12.5 daily; max. 40 mg daily.
mg, Tk. 8.00/Tab.
Losacor (Healthcare), Tab., 50mg + 12.50 mg,
Reanal impairment-max. 20mg daily if
Tk. 8.00/Tab. eGFR 20-60mL/minutes/1.73m3 ; avoid if
Losan (Orion), Tab.,50mg + 12.50 mg, Tk. eGFR less than 20mL/minutes/1.73m 3
8.02/Tab.
Losapot (Somatec), Tab. , 50 mg +12.50 Proprietary Preparations
mg, Tk. 8.00/Tab.; 100 mg +12.50 mg, Tk. Abetis (ACI), Tab., 10 mg, Tk. 5.04/Tab. ; 20
12.00/Tab. mg, Tk. 8.05/Tab.; 40 mg, TK. 15.11/Tab.
Losardil (Drug Intl), Tab., 25+12.5mg, Tk. Olmecar (Square), Tab. , 20 mg, Tk.
5.05/Tab.; 50 mg+12.5mg, Tk.8.05/Tab.; 8.03/Tab.; 40 mg, Tk. 15.05/Tab.
100+12.50mg, Tk 12.05/Tab.; 100+25mg, Tk. Olmepres (General), Tab. , 20 mg, Tk.
12.05/Tab. 8.00/Tab.; 40 mg, Tk. 15.00/Tab.
Losart (Acme), Tab.,100 mg + 12.50 mg, Tk. Olmesan (Beximco), Tab., 10 mg, Tk.
12.03/Tab.; 100 mg + 25.00 mg, Tk. 5.00/Tab.; 20 mg, Tk. 8.00/Tab.; 40 mg, Tk.
12.03/Tab.; 50 mg + 12.50 mg, Tk. 8.03/Tab. 15.00/Tab.
Losarva (NIPRO JMI), Tab., 50 mg + 12.5 mg, Olmesart (Sharif), Tab. , 40 mg,Tk.
Tk. 6.00/Tab. 15.04/Tab.; 20 mg, Tk. 8.03/Tab.
Losatan (Popular), Tab., 50.00mg + 12.50mg, Olmesta (Eskayef), Tab, 40 mg , Tk.
Tk. 8.00/Tab. 15.00/Tab.; 20 mg, Tk. 8.00/Tab.; 10 mg , Tk.
Losium (Ibn Sina), Tab., 50mg+ 12.5mg, Tk. 5.00/Tab.; 40 mg , Tk. 15.00/Tab.; 20 mg , Tk.
8.50/Tab. 8.00/Tab.; 10 mg , Tk. 5.00/Tab.;
Nusartan (Nuvista), Tab., 50mg + 12.5mg, Tk. Olmetic (Drug Intl), Tab., 20 mg, Tk. 8.05/Tab.
7.50/Tab. Olmevas (Popular), Tab., 10 mg, Tk.
Osartan (Aristo), Tab., 50mg +12.50mg, Tk. 8.03/Tab.; 20 mg, Tk. 8.00/Tab.
8.00/Tab/ Olsart (Opsonin), Tab. , 10 mg, Tk. 5.00/Tab. ;
Osartil (Incepta), Tab., 100 mg + 12.50 mg, 20 mg , Tk. 8.03/Tab. ; 40 mg , Tk. 15.00/Tab.
Tk. 12.00/Tab.; 100 mg + 25 mg, Tk. Orbas (Acme), Tab. , 20 mg. , Tk. 8.03/Tab. ;
12.00/Tab.; 50 mg +12.50 mg, Tk. 8.00/Tab. 40 mg., Tk. 15.04/Tab.
Oscard (Sharif), Tab., 50 mg + 12.5 mg, Tk. Presulock (Aristo), Tab., 20 mg , Tk. 8.00/Tab.
6.01/Tab. Ransys (Healthcare), Tab., 10 mg , Tk.
Parten (Jayson), Tab., 50 mg + 12.5 mg, Tk. 5.00/Tab.; 20 mg , Tk. 8.00/Tab.; 40 mg, Tk.
6.04/Tab. 15.00/Tab.
Pertilos Plus (Navana), Tab., 50 mg + 12.5 Sevitan (Radiant), Tab. , 20 mg , Tk.
mg, Tk. 8.03/Tab. 10.00/Tab.
Precon (Radiant), Tab., 50mg BP + 12.5mg, Tenicar (UniMed), Tab , 40 mg, Tk.
Tk. 10.50/Tab.; 50mg + 12.5mg, Tk. 8.00/Tab. 15.00/Tab.; 20 mg, Tk. 8.00/Tab.
Rosatan (ACI), Tab., 25mg + 12.5mg, Tk. Xyotil (Incepta), Tab., 20 mg, Tk.
4.03/Tab.; 50mg +12.5mg, Tk. 6.04/Tab. 8.00/Tab.; 40 mg, Tk. 15.00/Tab.

OLMESARTAN MEDOXOMIL Olmesartan Medoxomil + Hydrochlorothiazide


Abetis Plus (ACI), Tab., 12.5 mg + 20 mg,
TK. 8.05/Tab.; 12.5 mg + 40 mg, TK.
Indication: Hypertension 15.00/Tab.
Cautions: Hepatic impairment-dose Olmecar (Square), Tab., 12.5 mg + 20 mg,
should not exceed 20mg daily in Tk. 8.03/Tab.; 12.5 mg + 20 mg, Tk.
moderate impairment 8.00/Tab.
Contra-indications: Biliary obstruction, Olmetic -plus (Drug Intl), Tab., 12.5 mg + 20
severe renal impairment mg, Tk. 8.05/Tab.
Olsart (Opsonin), Tab., 12.5 mg + 20 mg, Tk.
Interactions: See Appendix- 2 8.00/Tab.; 12.5 mg + 40 mg, Tk. 15.06/Tab.;
Side-effects: See notes above; also Orbas (Acme), Tab., 12.5 mg + 20 mg, Tk.
gastro-intestinal disturbances, chest 8.03/Tab.
pain, peripheral oedema, hypertrigly- Ransys (Healthcare), Tab., 12.5 mg + 20 mg,
ceridaemia, fatigue, flue like symptoms, Tk. 8.00/Tab.
cough, pharyngitis, urinary tract Sevitan-HTZ (Radiant), Tab., 12.5 mg + 20
infection, haematuria, hyperuricaemia, mg, Tk. 10.50/Tab.
arthritis, myalgia, pruritis, urticaria,

134
3. CARDIOVASCULAR SYSTEM

Tenizide (UniMed), Tab , 12.5 mg + 20 mg, Proprietary Preparations


Tk. 8.00/Tab. Arovan (Aristo), Cap., 80 mg, Tk. 10.00/Tab.
Xyotil (Incepta), Tab., 12.5 mg + 20 mg, Tk. Cardival (Drug Intl), Tab., 80mg, Tk.
8.00/Tab. 10.05/Tab.
Cardovan (Eskayef), Tab, 160mg. Tk.
TELMISARTAN 16.00/Tab.; 80mg, Tk. 10.00/Tab.;
Diovan (I) (Novartis), Tab., 160 mg, Tk.
74.00/Tab.; 320 mg, Tk. 70.00/Tab.; 40 mg, Tk.
Indication: Hypertension 34.10/Tab.; 80 mg, Tk. 54.00/Tab.
Cautions: See notes above; mild to Disys (Healthcare), Tab., 80 mg,
moderate hepatic impairment and renal Tk.10.00/Tab.; 160 mg, Tk. 18.00/Tab.
impairment Valpress (Silva), Cap., 80mg, Tk. 8.03/Cap.
Valsartil (Incepta), Tab., 160 mg, Tk. 66/Tab.;
Contraindications: See notes above;
40 mg, Tk. 5.00/Tab.; 80 mg, Tk. 9.00/Tab.
biliary obstruction, breast-feeding Valset (Orion), Tab., 80 mg, Tk. 6.04/Tab.
Interactions: See Appendix-2 Valtin (Acme), Tab., 160.00 mg, Tk.
Side-effects: See notes above, 16.04/Tab.; 80.00 mg, Tk. 9.03/Tab.
influenza like symptom, flatulence,
anxiety, vertigo, increased sweating, Valsartan + Hydrochlorothiazide
blood disorder, increase in uric acid Cardival Plus (Drug Intl), Tab., 160 mg +
12.50 mg, Tk. 16.00/Tab.
Dose: Usually 40mg once daily,
Cardovan (Eskayef), Tab, 160 mg + 12.50 mg,
increased if necessary after at least 4 Tk. 16.00/Tab.; 80 mg + 12.50 mg, Tk.
weeks, to max. 80mg once daily 10.00/Tab.;
Co-Diovan (Novartis), Tab. , 80 mg + 12.50
Proprietary Preparations mg, Tk. 48.14/Tab.; 160 mg + 12.50 mg, Tk.
Arbitel (ACI), Tab., 20mg, Tk. 7/Tab.; 40mg, 66.20/Tab.; 160 mg + 25 mg, Tk. 66.20/Tab.
Tk.12.5/Tab.; 80mg, Tk. 20/Tab. Disys (Healthcare), Tab., 80 mg + 12.50 mg,
Telcardis (Unimed), Tab., 40 mg, Tk.10.00/Tab.
Tk.12.50/Tab.; 80 mg, Tk. 20.00/Tab. Valsartil (Incepta), Tab., 160 mg + 12.50 mg,
Mitosan (Novartis), Tab., 40 mg, Tk. 8.00/Tab.; 80 mg +12.50 mg, Tk. 6/Tab.
Tk.13.00/Tab.; 80 mg, Tk. 21.00/Tab. Valzide (Renata), Tab., 160 mg + 25 mg, Tk.
20.00/Tab.; 80 mg + 12.50 mg, Tk. 11/Tab.
Telmisartan + Hydrochlorithiazide
Arbitel (ACI), Tab., 40mg + 12.5mg, Amlodipine + Valsartan
Tk.12.5/Tab.; 80mg +12.5 mg, Tk. 20.00/Tab. Amlosartan (Incepta), Tab., 5 mg +160 mg,
Mitosan Plus (Novartis), Tab., 40 mg + 12.50 Tk. 8.00/Tab.; 5 mg+320 mg, Tk. 9.00/Tab.;
mg, Tk. 13.00/Tab.; 80 mg + 12.50 mg, Tk. 5mg + 80 mg, Tk. 6.00/Tab.
21.00/Tab. Amlovas (Popular), Tab., 5 mg + 80 mg, Tk.
Telcardis Plus (UniMed), Tab., 80 mg + 12.50 9.03/Tab.; 5 mg + 160 mg, Tk. 16.06/Tab.; 5
mg, Tk. 20.00/Tab.;40 mg + 12.50 mg, Tk. mg + 160 mg, Tk. 16.06/Tab.
12.50/Tab. AV (Drug Intl), Tab., 10mg +160mg, Tk.
13.00/Tab.; 5mg +160mg, Tk. 10.00/Tab.; 5 mg
VALSARTAN + 80 mg, Tk. 7.00/Tab.
Avodil VI (Opsonin), Tab., 10 mg + 320 mg,
Tk. 32.00/Tab.
Indications: Hypertension Camoval (Square), Tab., 5 mg + 160 mg, Tk.
Cautions: See notes above; mild to 16.11/Tab.; 5 mg + 80 mg, Tk. 9.06/Tab.
moderate hepatic impairment and renal Co-Disys (Healthcare), Tab., 5 mg + 160 mg,
impairment Tk. 18.00/Tab.; 5 mg + 160 mg, Tk.
18.00/Tab.; 5 mg + 80 mg, Tk. 10.00/Tab.; 5
Contraindications: See notes above;
mg + 80 mg, Tk. 10.00/Tab.
severe hepatic impairment, cirrhosis, Co-Valtin (Acme), Tab.,5 mg + 80 mg, Tk.
biliary obstruction, breast-feeding 9.03/Tab.; 5 mg + 160 mg , Tk. 16.04/Tab.
Interactions: See Appendix-2 Exforge (I)(Novartis), Tab., 10 mg+160 mg, Tk.
Side-effects: See notes above; fatigue, 79.09/Tab.; 5 mg + 80 mg, Tk. 50.50/Tab.; 5
neutropenia reported mg+ 160 mg, Tk. 70.75/Tab.
Dose: usually 80 mg once daily ;(elderly Sacubitril + Valsartan
Arnigen (General), Tab., 97mg + 103mg, Tk.
over 75 years, severe renal impairment,
160.00/Tab.; 49mg + 51mg, Tk. 85.00/Tab.;
initially 40 mg once daily) 24mg + 26mg, Tk. 45.00/Tab.

135
3. CARDIOVASCULAR SYSTEM

Entresto(I) (Novartis), Tab., 24.3 mg + 25.7 3.2.4 ALPHA ADRENOCEPTOR


mg, Tk. 134.00/Tab.; 48.6 mg + 50.4 mg, Tk.
BLOCKING DRUGS
134.00/Tab.; 97.2 mg + 102.8 mg, Tk.
134.00/Tab.
Sabitar (Incepta), Tab., 24.3 mg + 25.7 mg, Prazosin which has post-synaptic alpha-
Tk. 45.00/Tab. ; 48.6 mg + 50.4 mg, Tk. blocking and vasodilator properties,
80.00/Tab. ; 97.2 mg + 102.8 mg, Tk. causes a rapid reduction in blood
120.00/Tab. pressure after the first dose and should
be prescribed carefully; it rarely causes
3.2.3 RENIN INHIBITORS tachycardia. Doxazosin, indoramin,
and terazosin have properties similar to
Renin inhibitors inhibit renin directly; those of prazosin. Alfuzosin,
renin converts angiotensinogen to Doxazosin, Indoramin, Prazosin,
angiotensin. Tamsulosin and Terazosin are
Aliskiren is the first in the class of renin indicated for benign prostatic
blokers. hyperplasia (see also section 6.4.5).
It may be preferred in renal disease. Phenoxybenzamine a powerful alpha-
Aliskiren also neutralizes any blocker with many side effects can be
compensatory increase in plasma renin used with a beta-blocker for the short-
activity even during combined therapy term management of severe
with a thiazide diuretic, an ACE inhibitor, hypertensive emergencies associated
or ARB with phaeochromocytoma.
Phentolamine is a short-acting alpha-
ALISKIREN blocking drug used on rare occasions for
a suppression test for phaechromo-
Indication: Essential hypertension cytoma.
Cautions: Patients taking concomitant
diuretics, on a low-sodium diet, or who PRAZOSIN
are dehydrated (first doses may cause
hypotension initiate with care); renal Indications: See under dose
artery stenosis, renal impairment; Cautions: First dose may cause
monitor plasma-potassium concentration collapse due to hypotension (therefore
and renal function in diabetes mellitus should be taken on retiring to bed),
and heart failure, pregnancy and breast elderly, renal impairment, hepatic
feeding impairment, pregnancy and breast
Contra-indications: Concomitant use feeding
with ACE inhibitors or ARBs in patients Contraindications: Not recomended for
with diabetes, pregnancy and lactation congestive heart failure due to
Interactions: See Appendix-2 mechanical obstruction (e.g. aoritic
Side-effects: Diarrhea, angioedema stenosis)
acute renal failure (reversible on Interactions: See Appendix-2
discontinuation of treatment), anaemia, Side-effects: Postural hypotension,
and hyperkalaemia also reported drowsiness, weakness, dizziness,
Dose: ADULT over 18 years, 150 mg headache, lack of energy, nausea,
once daily palpitati-ons, leucopenia, hepatitis,
jaundice, urinary incontinence; cases of
Proprietary Preparations priapism and impotence reported
Rasilez(I) (Novartis), Tab. 150 mg, Tk. Dose: Hypertension, 1 mg daily at bed-
62.50/Tab.; Tab., 300 mg, Tk. 78.00/Tab. time ;usual maintenance dose 2-10 mg
daily
Aliskiren + Hydrochlorothiazide
Rasilez HCT(I) (Novartis), Tab., 150 mg + 12.5
mg, Tk. 62.50/Tab. Proprietary Preparations
Alphapress (Renata), Tab, 1 mg, Tk.
4.00/Tab., 2 mg, Tk. 6.00/Tab.
136
3. CARDIOVASCULAR SYSTEM

G-prazosin (Gonoshasthaya), Tab.,1 mg, Tk. Caution: Concomitant use with ACE
2.00/Tab.; 2 mg, Tk. 3.00/Tab.; 5 mg, Tk. inhibitor, hypotension, dose titration in
7.00/Tab. renal failure patients (eGFR <30
MinipressXL (I) (Pfizer) Tab., 2.5 mg, Tk.
12.71/Tab.; 5 mg, Tk.21.18 Tk. . . .
mL/min/1.73 m2)
Prazolok (Square), Tab., 1 mg, Tk. 4.00/Tab.; Contraindication: Hypersensitivity to
2 mg, Tk. 6.00/Tab. any component, pregnancy,
Prazopress (UniMed), ERTab, 2.5mg, Tk. Concomitant use with ACE inhibitors.
10.00/Tab.; 5mg, Tk.15.00/Tab., 2mg, Tk. History of angioedema related to
6.00/Tab.; 1mg, Tk. 4.00/Tab. previous ACE inhibitor or ARB therapy,
aliskiren in patients with diabetes,
TERAZOSIN severe hepatic impairment
Side Effects: Angioedema,
Indications: Mild to moderate hypotension, impaired renal function,
hypertension; benign prostatic hyperkalemia, Cough
hyperplasia Dose: Starting dose is 49/51 mg
Cautions: First dose may cause (Sacubitril/Valsartan) twice-daily. Double
collapse due to hypotension (within 30- the dose after 2 to 4 weeks to the target
90 minutes, therefore should be taken maintenance dose of 97/103 mg
on retiring to bed) (may also occur with (sacubitril/valsartan) twice-daily, as
rapid dose increase), cataract surgery tolerated by the patient. Reduce the
and breast feeding starting dose to 24/26 mg
Contraindications: History of postural (sacubitril/valsartan) twice-daily for:
hypotension and micturition syncope patients with severe renal impairment
Interactions: See Appendix- 2 (eGFR <30 mL/min/1.73 m2), patients
Side-effects: Drowsiness,postural with moderate hepatic impairment
hypotension, syncope, asthenia,
headache, dry mouth, gastro-intestinal Proprietary Preparations:
Arnigen (General), Tab.; 97mg+103mg,
disturbances, oedema, blurred vision, Tk.160.00/Tab.; 49mg+51mg, Tk. 85.00/Tab.;
intra-operative floppy iris syndrome, 24mg+26mg,Tk.45.00/Tab.
rhinitis, erectile disorders, tachycardia, Entresto (I) (Novartis),Tab.;24.3mg+25.7
and palpitations, rash, pruritus and mg,Tk.134.00/Tab.; 48.6mg+50.4mg,
angioedema; also reported weight gain, Tk.134.00/Tab.;97.2mg+102.8 mg,
dsypnoea, paraesthesia, thrombocy- Tk. 134.00/Tab.
topenia and pain in extremities Sabitar (Incepta), Tab.; 24.3mg+25.7mg,
Tk.45.00/Tab.;48.6 mg + 50.4
Dose: Hypertension, 1 mg at bed time;
mg,Tk.80/Tab.;97.2mg+102.8 mg, Tk.
usual maintenance dose 2–10 mg once 120/Tab.
daily;

Proprietary Preparation 3.2.6 VASODILATOR


Terazon (Incepta), Tab. 2 mg, Tk. 5.00/Tab.; ANTIHYPERTENSIVE
5mg, Tk. 8.00/Tab. DRUGS
Vasodialator, especially when used in
3.2.5 Angiotensin II receptor
combination with beta blocker and a
blocker Neprilysin Inhibitor thiazide may cause rapid fall in blood
(ARNI) pressure precipitating a hypotensive
crisis.
Sacubitril (Neprilysin inhibitor) and Intravenous injection of Diazoxide can
Valsartan be prescribed in hypertensive
Indication: Reduce the risk of emergencies. Hydralazine given by
cardiovascular death and hospitalization mouth is a useful adjunct to other
for heart failure in patients with chronic treatment;
heart failure (NYHA Class II-IV) and Intravenous infusion of Sodium
reduced ejection fraction (LVEF≤35%). nitroprusside is given in hypertensive

137
3. CARDIOVASCULAR SYSTEM

emergencies on rare occasions when Proprietary Preparation


parenteral treatment is essential. Catapres (Navana), Tab. 0.1mg, Tk.8.03/Tab
Minoxidil should be given when other
antihypertensive drugs have failed to METHYLDOPA [ED]
control severe hypertension; it can
cause tachycardia and fluid retention. Indications: Hypertension, along with
Because of this a beta-blocker and diuretics
frusemide in high dosage must be given Cautions: History of liver impairment;
in combination with this vasodilator. renal impairment; blood counts and liver
Prazosin, Doxazosin and Terasozin (see function tests are advised; history of
section 3.2.3) have alpha-blocking, as depression; positive direct Coombs’ test
well as vasodilator properties. in up to 20% of patients (may affect
blood crossmathcing)
3.2.7 CENTRALLY ACTING ANTI- Note. Drowsiness may affect perform-
HYPERTENSIVE DRUGS ance of skilled tasks (e.g. driving);
Contraindications: Depression, active
Methyldopa which is a centrally acting liver disease, phaeochromocytoma
antihypertensive is safe in pregnancy, in Interactions: See Appendix-2
asthmatics and in heart failure. The daily Side-effects: Dry mouth, stomatitis,
dose is to be kept below 1 g to minimize bradycar-dia, exacerbation of angina,
side-effects. Clonidine has the postural hypotension, sedation, dizzin-
disadvantage that if suddenly withdrawn, ess, myalgia, arthralgia, paraesthesia,
it may cause a hypertensive crisis. nightmares, mild psychosis,
Reserpine is no longer used because of Parkinsonism
adverse side-effects. Moxonidine a Dose: By mouth, Initially 250 mg 2-3
recently introduced centrally acting drug times daily, increased gradually at
may have a role when thiazides, beta- intervals of 2 or more days; max. 2 g
blockers, ACE inhibitors and calcium- daily; ELDERLY initially 125 mg twice
channel blockers are not suitable or daily, increased gradually; max. 2 g daily
have failed to control blood pressure.
Proprietary Preparations
Dopamet (Opsonin), Tab., 250 mg, Tk.
CLONIDINE HYDROCHLORIDE
3.08/Tab.
Dopegyt (Ambee), Tab. 250 mg, Tk. 3.09/Tab.
Indications: Hypertension, migraine, Sardopa (Incepta), Tab., 250 mg, Tk.
menopausal flushing 3.080/Tab.; 500 mg, Tk. 5.90/Tab.
Cautions: Must be withdrawn gradually
to avoid severe rebound hypertension; 3.3 NITRATES, CALCUIM-
Raynaud’s syndrome; history of CHANNEL BLOCKERS AND
depression, pregnancy and breast OTHER ANTIANGINAL DRUGS
feeding; Driving-Drowsiness may affect 3.3.1 NITRATES
performance of skilled tasks 3.3.2 CALCIUM-CHANNEL
Contraindications: Hypersensitivity to BLOCKERS
clonidine and avoid intravenous injection 3.3.3 OTHER ANTIANGINAL DRUGS
Interactions: See Appendix- 2 3.3.4 PERIPHERAL AND CEREBRAL
Side-effects: Dry mouth, sedation, VASODILATORS & NEURO-
depression, fluid retention, bradycardia, SENSORY OXYGENATOR
Raynaud’s phenomenon, headache, DRUGS
dizziness, euphoria, nocturnal unrest, 3.3.1 NITRATES
rash, nausea, constipation, impotence
Dose: By mouth, 50–100 micrograms 3
Nitrates as vasodilators play a beneficial
times daily, increased every second or
role in angina. They are potent coronary
third day; usual max. dose 1.2 mg daily
vasodilators, but their main benefit is

138
3. CARDIOVASCULAR SYSTEM

due to reduction in venous return, which Nitrosol (Beximco), Spray,Tk.225.00/200


reduces left ventricular work. Flushing, Puff,;Tab.,2.6mg, Tk. 5.00/Tab.
headache, and postural hypotension are Nitromint (I) (Egis) Spray, Tk.206.22/Can
Nitrovas (Popular), Oint., 0.4%, Tk.
the main unwanted side-effects of nitrate
130.49/30g,; Tab. , 2.6mg, Tk.4.02/Tab.
preparations. Pactorin (ACI), Spray, 0.40mg/Puff, Tk.
250.00/200 Puff,; Tab., 2.60mg, Tk. 5.00/Tab.
GLYCERYL TRINITRATE [ED] Rectocare (Square), Oint., 0.4%, Tk.
65.45/15gm
Trocer (Incepta), Spray, Tk. 225.00/200 Puff,;
Indications: Prophylaxis and treatment Tab. , 2.6 mg, Tk. 4.00/Tab.
of angina, left ventricular failure Xynocard (White Horse), SR Tab., 2.6 mg, Tk.
Cautions: Severe hepatic or renal 3.00/Tab.
impairment, hypothyroidism, malnutrit-
ion, or hypothermia, recent history of ISOSORBIDE MONONITRATE[ED]
myocardial infarction,
Contraindications: Hypersensitivity to Indications: Prophylaxis of angina,
nitrates, hypotensive conditions and adjunct in congestive heart failure
hypovolaemia, head trauma, cerebral Cautions: See under Glyceryl Trinitrate
haemorrhage, closed angle glaucoma
Contraindications, Side-effect: See
Interactions: See Appendix-2
under Glyceryl Trinitrate
Side-effects: Throbbing headache, Interactions: See Appendix-2
flushing, dizziness, postural hypoten-
Side-effects: See under Glyceryl
sion, tachycardia Prolonged
Trinitrate
administration has been associated with
Dose: Initially 20 mg 2-3 times daily or
methaemog-lobinaemia
40 mg twice daily (10 mg twice daily in
Dose: Sublingually, 0.3-1 mg repeated
those who have not previously received
as required
nitrates); up to 120 mg daily in divided
By intravenous infusion, 10-2000
doses if required
micrograms/minut.
Proprietary Preparations
Proprietary Preparations A-Card (Acme), Tab., 20 mg, Tk. 1.42/Tab.
Angicard (Drug Intl),Tab.,0.5mg,Tk.3.05/Tab Angifix (Incepta), Tab., 20 mg, Tk. 1.42/Tab
Angist (Acme), Tab.; 2.6mg,Tk.4.03/Tab. Esmo (Square), Tab., 20 mg, Tk. 1.43/Tab.
Anril (Square), Spray, 0.40mg/Puff, Tk. Ism (Aristo), Tab., 20mg, Tk. 1.20/Tab.
216.45/200 Puff,; Tab. , 2.6 mg, Tk. 5.00/Tab.; Moniten (ACI), Tab., 20mg, Tk. 1.42/Tab.
0.5 mg, Tk. 3.01/Tab. ; Inj., 5 mg/ml, Tk. Monocard (Drug Intl), Tab., 20mg, Tk.
75.5/Vial
1.43/Tab.; Cap. , 50mg, Tk. 7.05/Cap.
Glytrin (Novo Health), Cap.; 2.6mg, Tk.
Monotrate (Sun), Tab. 20 mg, Tk. 1.42/Tab.
4.00/Cap.
OD Tab. 50 mg, Tk. 4.13/Tab.
GTN (Eskayef), Tab., 2.6 mg,Tk.5.00/Tab.;
2.6mg,Tk.5.00/Tab.
Nidocard (Drug Intl), Inj. 5mg/ml, Tk. 3.3.2 CALCIUM-CHANNEL
100.30/Amp.; Tab., 2.6mg,Tk.5.00/Tab. ; BLOCKERS
6.4mg,Tk.7.04/Tab.; Tk.250.75/200Puff
Nitrin(Healthcare),Spray,Tk.270.00/200puff,;Ta
These drugs depress the contractility of
b.,2.6mg,Tk. 5.00/Tab.
Nitro (UniMed), Tab., 2.6mg, Tk.4.00/Tab.; myocardium, the formation and
Cap., 2.6 mg,Tk.5.03/Cap. propagation of electrical impulses within
Nitrocard (Aristo), Spray,Tk.250.00/200puff, the heart, and diminish coronary or
Tab., 2.6mg, Tk. 5.00/Tab. systemic vascular tone. Verapamil is a
Nitrocontin (Mundipharma), CR Tab, 2.6 mg, negatively inotropic calcium channel-
Tk. 5.36/Tab.; CR Tab., 6.4 mg, Tk. 8.00/Tab. blocker indicated in angina, hypertension
Nitrodil (Medimet), Cap. 2.6 mg, Tk. 4.65/Cap. and arrhythmias; decreases cardiac
Nitrofix (Opsonin), Tab.;2.6 mg,Tk. 4.00/Tab.
Nitrogina (NIPRO JMI), SR Tab., 50 mg, Tk.
output, slows the heart rate, and impairs
4.00/Tab., atroventricular conduction. It may
precipitate heart failure, and should not

139
3. CARDIOVASCULAR SYSTEM

be used with beta-blokcers. Constipation Hipre (Pacific),Tab., 5 mg, Tk. 5.00/Tab.;10


is a common side effect. mg, Tk.7.00/Tab.
Locard (Jayson), Tab., 5mg, Tk. 3.05/Tab.
Lodical (Somatec),Tab.,5 mg,Tk. 5.00/Tab.
AMLODIPINE BESYLATE Lodipin (Aristo),Tab.,5 mg , Tk. 5.00/Tab.
Lovapress (NIPRO JMI), Tab., 5mg, Tk.
Indications: Hypertension, prophylaxis 5.00/Tab.
of angina M-Card (Zenith),Tab.,5mg,Tk.4.01/Tab.
Caution: Hepatic impairment Nelod (Kemiko),Tab. 5 mg,Tk.5.02/Tab.
Pristin (Novo Health), Tab.,5 mg, Tk.
Contraindications: Cardiogenic shock, 4.50/Tab.
significant aortic stenosis, pregnancy SB-Amlod (Sunman-Bardem),Tab .5 mg,
and breast-feeding Tk.5.00/Tab.
Interactions: See Appendix-2 Sidopin (Eskayef), Tab., 5 mg,Tk. 5.00/Tab.
Side-effects: Headache, edema, Vasopin (Silva) Tab., 10mg, Tk. 5.01/Tab.;
fatigue, nausea, flushing, dizziness, gum 5mg, Tk. 4.02/Tab.
hyper-plasia, rashes, dry mouth, Virlon (Virgo), Tab.5mg, Tk. 4.00/Tab.
Xelcard (Healthcare), Tab., 10mg,
palpitations, dyspnoea, muscle cramps,
Tk.7.00/Tab.; 5mg, Tk. 5.00/Tab.
myalgia, arthralgia,
Dose: Hypertension or angina, initially Amlodipine + Atenolol
5 mg once daily, max. 10 mg once daily Aloten (Kemiko), Tab., 5mg + 50mg, Tk.
4.51/Tab.
Proprietary Preparations Aloten Forte (Kemiko), 5 mg + 25 mg, Tk.
Amdin (Alco), Tab., 10mg, Tk.6.02/Tab.; 5 mg, 4.24/Tab.
Tk.4.01/Tab. Amdin (Alco), Tab., 5 mg + 50 mg, Tk.
Amdocal (Beximco), Tab., 10mg, Tk. 4.51/Tab.
7.00/Tab.;5mg, Tk.5.00/Tab. Amdocal (Beximco), Tab., 5mg + 25mg, Tk.
Amlocard (Drug Int.),Tab.,10mg,Tk. 7.05/Tab.; 5.25/Tab.; 5mg + 50mg, Tk. 6.00/Tab.
5mg,Tk.4.55/Tab. Amlocard Plus (Drug Intl), Tab., 5mg+25mg,
Amlopin (Acme),Tab.,10mg,Tk. 7.02/Tab.;5.00 Tk. 5.05/Tab.; 5mg+50mg, Tk. 6.05/Tab.
mg.,Tk.5.01/Tab. Amlocom (Beacon), Tab., 50mg +5mg, Tk.
Amlotab (Incepta) Tab., 10 mg, Tk. 7.00/Tab.; 4.52/Tab.
5 mg, Tk. 5.00/Tab. Amloten (Acme), Tab. , 5 mg + 25 mg, Tk.
Amlovas (Popular),Tab.,10mg,Tk. 5.27/Tab.; 5mg + 50 mg., Tk. 6.01/Tab.
6.02/Tab,;5mg,Tk.16.06/Tab. Amlovas (Popular), Tab., 5 mg + 50 mg, Tk.
Amlowide (Beacon),Tab.,5mg,Tk. 3.02/Tab. 6.00/Tab.
Amocal (Opsonin),Tab.5 mg,Tk. 5.00/Tab.;10 Amocal (Opsonin), Tab., 5 mg + 50 mg , Tk.
mg,Tk.6.02/Tab. 6.02/Tab.
Ampress (Benham), Tab., 5 mg, Tk. 5/Tab. Amtenol (Euro), Tab., 5 mg + 50 mg, Tk.
Amtenol (Euro) Tab., 5 mg,Tk. 4.00/Tab. 5.5/Tab.
Cab (ACI),Tab.,5mg,TK.5.02/Tab. Betacal (Orion), Tab., 50 mg + 5 mg, Tk.
Calchek (General),Tab.,5mg,Tk. 5.01/Tab. 6.02/Tab.
Calock (Medimet), Tab., 5mg, Tk. 3.50/Tab.; Calbeta (UniMed), Tab., 5mg+l 50m, Tk.
10mg, Tk. 3.75/Tab. 6.00/Tab.
Calpin (Globe),Tab.,5 mg,Tk.4.50/Tab. Calchek (General), Tab. , 5mg + 50mg, Tk.
Calpress (Asiatic),Tab.,10mg,Tk. 6.02/Tab.
7.00/Tab.;5mg,Tk.5.00/Tab. Calpin (Globe), Tab., 5 mg + 50 mg, Tk.
Calvasc (UniMed), Tab, 10mg, Tk. 8/Tab.; 6.00/Tab.
5mg, Tk.5.00/Tab. Camlodin (Square), Tab., 5 mg + 25 mg, Tk.
Camlodin (Square), Tab.,5 mg,Tk. 5.02/Tab. 5.02/Tab.; 5 mg + 50 mg, Tk. 6.02/Tab.
Cardifort (Nuvista), Tab., 5 mg, Tk. 5.00/Tab. Cardifort (Nuvista), Tab. , 5 mg + 25mg, Tk.
Cardipin (Renata), Tab., 5 mg, Tk. 5.00/Tab. 5.25/Tab.; 5 mg + 50 mg, Tk. 6.00/Tab.
CCB (Orion), Tab, 5 mg, Tk. 3.01/Tab. Cardipin (Renata), Tab., 5mg + 50mg, Tk.
Cvnor (Navana), Tab., 5 mg, Tk. 5.02/Tab. 6.00/Tab.
Dipinol (Supreme),Tab 5mg, Tk. 3.50/Tab. Combicard (Healthcare), Tab., 5 mg + 50 mg,
Diplor (Ibn Sina),Tab.,10 mg,Tk. 7.00/Tab. Tk. 6.00/Tab.
Emlon (Biopharma),Tab., 5mg ,Tk. 5/Tab. Fixocard (Incepta), Tab., 5 mg + 50 mg, Tk.
G-amlo (Gonoshasthaya), Tab., 10 mg, Tk. 6.00/Tab.; 5 mg + 25 mg, Tk. 5.25/Tab.
4.00 /Tab.; 5mg, Tk. 2.50 /Tab.

140
3. CARDIOVASCULAR SYSTEM

Hipre (Pacific), Tab., 5 mg + 50 mg, Tk. Valdipin (Renata), Tab., 5 mg + 40 mg, Tk.
6.00/Tab. 16.00/Tab.; Tab. , 5 mg + 20 mg, Tk. 9.00/Tab.
Lodical (Somatec), Tab., 50 mg, Tk.6.00/Tab.
Lodicard (Aristo), Tab., 5 mg + 50 mg,, Tk. Amlodipine + Benazepril
6.00/Tab. Amlozep (Beacon), Cap., 5 mg+10mg, Tk.
Pristin-all (Novo Health), Tab., 5 mg + 50 mg, 6.04/Cap.
Tk. 5.00/Tab. Amocal (Opsonin), Cap., 5 mg+10mg, Tk.
Sidoplus (Eskayef), Tab., 5 mg + 50 mg, Tk. 6.02/Cap.
6.00/Tab.;5 mg + 25 mg, Tk. 5.25/Tab. Benadip (Incepta), Cap., 5 mg+10mg, Tk.
Tenocab (ACI), Tab., 5mg +50mg, Tk. 6.00/Cap., 2.5 mg + 10 mg, Tk. 4.00/Tab.; 5
6.02/Tab.; 5mg+25mg, Tk. 5.27/Tab. mg + 20 mg, Tk. 8.00/Tab.
Tenodin (Asiatic), Tab., 5mg + 50mg, Tk. Cacetor (ACI), Cap., 2.5 mg+10mg, Tk.
6.00/Tab.; 5mg + 25mg, Tk. 4.20/Tab. 4.03/Cap.; 5 mg+10 mg, Tk. 6.04/Cap.; 5
Tenopin (Sharif), Tab. , 5 mg + 50 mg, Tk. mg+20 mg, Tk. 8.05/Cap.
4.51/Tab. Camlopril (Square), Cap., 5mg+10 mg, Tk.
Vasopin (Silva), Tab., 5mg + 50mg, Tk. 6.04/Cap.
4.52/Tab. Lodiben (Eskayef), Cap., 5 mg+20mg, Tk.
Cvnor-A (Navana), Tab., 5 mg + 50 mg, Tk. 8.00/Cap.; 2.5 mg + 10mg, Tk. 6.00/Cap.; 5 mg
6.02/Tab. + 10mg, Tk. 4.00/Cap.
Calock Plus (Medimet), Tab. ,5 mg + 50mg,
Tk. 4.50/Tab. CILNIDIPINE
Ampress (Benham), Tab., 5 mg + 50 mg, Tk.
6.00/Tab.
Locard (Jayson), Tab. , 5mg+50mg, Tk. Indications: Hypertension with diabetic
3.02/Tab. nephropathy and hypertriglyceridemia.
Amlodipine + Telmisartan Contraindications and side effects:
Arbitel (ACI), Tab., 5 mg+40 mg, Tk. See notes above
12.50/Tab.; Tab., 5 mg+80 mg, Tk. 18.00/Tab.
Dose: Antihypertensive at doses 10-
Telamlo (UniMed), Tab., 5 mg+40 mg,
Tk.12.50/Tab. 20mg/daily
Amlodipine + Olmesartan Medoxomil Note: Produce less ankle edema
Abecab (ACI), Tab., 5 mg + 20 mg, TK.
10.00/Tab.;5 mg + 40 mg, TK. 15.05/Tab. Proprietary preparations:
Bizoran (Beximco), Tab., 5mg + 40mg, Tk. Cildip (Opsonin), Tab., 10 mg, Tk. 8.00/Tab.; 5
15.00/Tab.; 5mg + 20mg , Tk. 10.00/Tab. mg, Tk. 5.00/Tab.
Calnor (Opsonin), Tab., 5 mg + 20 mg , Tk. Duocard (Acme), Tab., 10 mg, Tk. 9.00/Tab.; 5
8.03/Tab.; 5 mg + 40 mg , Tk. 15.00/Tab. mg, Tk. 7.00/Tab.
Calsart (Globe), Tab. , 5 mg +20 mg, Tk.
8.00/Tab.
DILTIAZEM HYDROCHLORIDE
Camlosart (Square), Tab. , 5 mg + 20 mg, Tk.
10.00/Tab.;5 mg + 40 mg, Tk. 15.05/Tab.
Disartan (Drug Intl), Tab., 5 mg +20 mg, Tk. Indications: Prophylaxis and treatment
5.95/Tab. ; 5 mg + 40 mg, Tk. 12.00/Tab. of angina; hypertension
Duoblock (Aristo), Tab., 5mg + 20 mg, Tk. Cautions: Reduce dose in hepatic and
8.00/Tab. ; 5 mg + 40mg , Tk. 15.00/Tab. renal impairment, heart failure or
Duopres (Incepta), Tab. , 5 mg +20 mg, Tk.
8.00/Tab.; 5 mg + 40 mg, Tk. 14.00/Tab.
singificantly impaired left ventricualr
Duovas (Radiant), Tab. , 5mg + 20mg , Tk. function, bradycardia, first degree AV
10.00/Tab. block or prolonged PR interval
Olmesta (Eskayef), Tab., 5mg + 20 mg, Tk. Contraindications: Severe bradycardia,
8.00/Tab.; left ventricualr failure, second-or third-
Olmevas (Popular), Tab. , 5 mg + 40mg, Tk. degree AV block (unless pacemaker
15.00/Tab.; , 5mg + 20 mg, Tk. 8.00/Tab. fitted) sick sinus syndrome, pergnancy
Olmezest AM (Sun), Tab. 5 mg + 20 mg, Tk.
and breast-feeding
8.50/Tab.
Orbapin (Acme), Tab. , 5 mg + 20.00 mg, Tk. Interactions: See Appendix-2
8.03/Tab.; 5 mg + 40 mg, Tk. 15.00/Tab. Side-effects: Bradycardia, sino-atrial
Ransys (Healthcare), Tab., 5 mg + 20 mg , block, AV block, palpitations,asthenia,
Tk. 8.00/Tab.; 5 mg + 40 mg , Tk. 15.00/Tab. heada-che, hot flushes, gastrointestinal
Tenivasc (UniMed), Tab, 5 mg +20 mg, Tk. disturbances, ankle edema, photosen-
8.00/Tab. sitivity,

141
3. CARDIOVASCULAR SYSTEM

Dose: Angina, 30 to 60 mg 3 times daily Cautions: Sick sinus syndrom (if


(elderly initially twice daily); increased if pacemaker not fitted) hepatic and renal
necessary max of 360 mg daily impairment, left ventricular dysfunction
Contraindications: Aortic stenosis,
Proprietary Preparations pregnancy and breast-feeding, avoid
Cardil (Ibn Sina), Tab., 30 mg, Tk. 2.25/Tab. within 1 month of myocardial infarction
Cardisef (Supreme), Tab., 30mg, Tkj. unstable angina, uncontrolled heart failur
2.00/Tab.; 60mg, Tk. 3.90/Tab. Interactions: See Appendix-2
Cardizem (Drug Intl), SR Tab., 120mg, Tk.
8.05/Tab. ; 90mg, Tk. 6.05/Tab. ; Tab., 30mg,
Side-effects: Headache, flushing,
Tk. 3.05/Tab.; 60mg, Tk. 5.05/Tab. edema, dizziness, palpitations, rash,
Diltiazem (Albion), Tab., 30 mg, Tk. 2.00/Tab. gum hyperplasia, muscle cramps,
Tab., 60 mg, Tk. 3.80/Tab.; SR Tab., 90 mg, polyuria, chest pain, mood disturbances
Tk. 5.61/Tab. Dose: Initially 10 mg as once daily
Diltizem (Square), SR Tab., 90 mg, Tk. before food, increased if necessary after
5.63/Tab. at least 2 weeks to 20mg daily

LACIDIPINE Proprietary Preparations


Canider (ACI), Tab., 10 mg, Tk. 5.04/Tab.
Indication: Hypertension Larcadip (Incepta), Tab., 10 mg, Tk. 5.00/Tab.
Lotensyl (Sun), Tab., 10 mg, Tk. 5.55/Tab.
Cautions: Cardiac conduction
abnormalities, poor cardiac reserve,
hepatic impairment; withdraw if NIFEDIPINE [ED]
ischaemic pain occurs shortly after
initating treatment or if cardiogenic Indications: Hypertension, prophylaxis
shock develops of angina, Raynaud’s phenomenon
Contraindications: Aortic stenosis, Cautions: Heart failure or singificantly
pregnancy and breast-feeding; avoid impaired left ventricualr function, hepatic
within 1 month of myocardial infarction. impairment, diabetes mellitus;
Interactions: See Appendix-2 pregnancy; breast-feeding
Side-effects: Headache, flushing, Contraindications: Cardiogenic shock,
edema, dizziness, palpitations, gum advanced aortic stenosis; within 1 month
hyperplasia, muscle cramps, polyuria, of myocardial infarction; unstable or
chest pain, mood disturbances acute attacks of angina
Dose: Initially 2 mg as a single daily Interactions: See Appendix-2
dose, preferably in the morning, Side-effects: Headache, flushing,
increased after 3-4 weeks to 4 mg daily, dizziness, tachycardia, palpitation,
then if necessary to 6 mg daily increased frequency of micturition, visual
Proprietary Preparations disturba-nces, gum hyperplasia,
Lacicard (Aristo), Tab., 2 mg, Tk. 4.00/Tab.; 4 paraesthesia, myalgia,
mg, Tk. 6.00/Tab. Dose: Mild to moderate hypertension,
Lacidip (Incepta), Tab., 2 mg, Tk. 4.03/Tab.; 10 to 20 mg twice daily adjusted
4mg, Tk. 6.04/Tab. according to response to 20 mg 3 times
Lacitab (Acme), Tab., 2 mg, Tk. 4.03/Tab.; 4
daily.
mg, Tk. 6.04/Tab.
Laciten (Square), Tab., 4 mg, Tk. 6.04/Tab.;
2mg, Tk. 4.03/Tab. Proprietary Preparations
L-cardin (Drug Int.) Tab., 2 mg, Tk. 4.03/Tab Nidipine SR (Square), SR Tab., 20 mg,
Tk.0.64/Tab.
Nifecap (Drug Intl), Cap., 10 mg, Tk. 2.10/Cap.
LERCANIDIPINE HYDROCHLORIDE Nifedipine (Albion), Tab., 10 mg, Tk.0.34/Tab.
Nifin (Acme), Tab., 10 mg, Tk. 0.34/Tab.
Indications: Mild to moderate essential
hypertension NIMODIPINE

142
3. CARDIOVASCULAR SYSTEM

Indications: Prevention and treatment Interactions: See Appendix-2


of ischaemic neurological deficits Side-effects: Constipation, less comm-
following aneurysmal subarachnoid only nausea, vomiting, flushing,
haemorrhage headache, dizziness fatigue, ankle
Cautions: Cerebral oedema or severely edema, erythema, pruritus, urticaria,
raised intracranial pressure; angiedema, Stevens-Johnson
hypotension; renal impairment, syndrome, myalgia, arthralgia,
pregnancy and breast feeding. paraesthesia, increased prolactin
Contra-indications: within 1 month of concentration, hypotension, bradycardia,
myocardial infarction; unstable angina; heart block and asystole
acute porphyria Dose: By mouth, supraventricular arrhyt-
Interactions: See Appendix-2 hmias (but see also Contraindications),
Side-effects: Hypotension, variation in 40-120 mg 3 times daily
heart-rate, flushing, headache, nausea, Angina, 80-120 mg times daily
sweating and feeling of warmth, Hypertension, 240-480 mg daily in 2-3
thrombocytopenia divided doses or once daily with
Dose: Prevention, by mouth, 60 mg sustained release preparations
every 4 hours, starting within 4 days of By slow intravenous injection over 2
aneurysmal subarachnoid haemorrhage minutes (3 minutes in elderaly), 5-10 mg
and continued for 21 days. Treatment, (preferrably with ECG monitoring); in
by intravenous infusion via central paroxysmal tachyarrhythmias a further 5
catheter, initially 1 mg/hour (up to 500 mg after 5-10 minutes,every 4-6hr
micrograms/ interval if required
hour if body-weight less than 70 kg or if Note: Verapamil injection has to be
blood pressure unstable), increased given fast, and interval of 30 minutes
after 2 hours to 2 mg/hour if no severe before giving a beta blocker.
fall in blood pressure; continue for at
least 5 days (max. 14 days); if surgical Proprietary Preparations
intervention during treatment, continue Angimil (Medimet), SR Tab., 240mg, Tk.
for at least 5 days after surgery; max. 7.00/Tab.; Tab., 40mg, Tk. 2.25/Tab.; 80mg,
total duration of nimodipine use 21 days Tk. 4.25/Tab.
Veracal (Incepta), Inj., 5 mg/2 ml, Tk.
30.00/Inj.; Tab, 180 mg , Tk. 6.00/Tab., 240
Proprietary Preparations mg, Tk. 7.00/Tab., 80mg, Tk. 3.00/Tab.
Nimocal (Square), Tab.;30 mg,Tk. 5.03/Tab. Veramil (Rangs), SR Tab., 240 mg, Tk.
Nimodi (Eskayef), Tab.,30mg,Tk. 5.00/Tab. 7.00/Tab.; Tab., 80 mg, Tk. 3.00/Tab.
Verapamil (Albion), Tab. 80 mg, Tk. 3.00/Tab
VERAPAMIL HYDROCHLORIDE[ED]
3.3.3 OTHER ANTIANGINAL DRUGS
Indiactions: See under dose and
preparation Nicorandil, a potassium-channel activa-
Cautions: First-degree AV block, acute tor, has both arterial and venous
phase of myocardial infarction (avoid if vasodilating properties and is indicated
bradycardia, hypotension, left ventricular for the prevention and long-term
failure), patients taking beta-blockers, treatment of angina. When added to
hepatic impairment and breast-feeding other antianginal drugs in refractory
Contraindications: Hypotension, brady- unstable angina,
cardia, second and third degree AV Ivabradine selectively inhibits the
block, sick sinus syndrome, cardiogenic pacemaker; reduces cardiac pacemaker
shock, sinoatrial block, history of heart activity, slowing the heart rate and
failure or singificantly impaired left allowing more time for blood to flow to
ventricular function, atrial flutter or the myocardium.
fibrillation compli-cating Wolff-Parkinson- Ranolazine is used as adjunctive
White syndrome, porphyria, patient therapy in patients who are inadequately
recently treated with beta blockers.

143
3. CARDIOVASCULAR SYSTEM

controlled or intolerant of first line or other arrhythmias (treatment


antianginal drugs. It may be used in ineffective), hypotension, retinitis
combination with amlodipine, beta- pigmentosa; pregnancy and breast-
blockers, or nitrates. feeding
Trimetazidine is a partial inhibitor of Contra-indications: For angina, if heart
fatty acid oxidation without rate below 60 beats per minute; for heart
hemodynamic effects. failure, if heart rate below 70 beats per
minute; unstable or acute heart failure;
NICORANDIL cardiogenic shock; acute myocardial
infarction; unstable angina; immediately
Indications: Prophylaxis and treatment after cerebrovascular accident;sick-sinus
of angina syndrome; sino-atrial block; patients
Cautions: Hypovolaemia, acute pulmo- dependent on pacemaker; second- and
nary edema, acute myocardial infarction third-degree heart block; congenital QT
with acute left ventricular failure, preg- syndrome, hepatic and renal impairment
nancy and breast-feeding Interactions: See Appendix- 2
DRIVING: patients should be warned not Side-effects: Bradycardia, first-degree
to drive or operate machinery until it is heart block, ventricular extrasystoles,
establised that their performance is headache, dizziness, visual
unimpaired disturbances, nausea, palpitations,
Contraindications: Cardiogenic shock, supraventricular extrasystoles,
left ventricular failure with low filling dyspnoea, vertigo, muscle cramps,
pressures, hypotension eosinophilia, hyperuricaemia, and raised
Interactions: See Appendix-2 plasma-creatinine concentration
Side-effects: Headache, flushing, Dose: Initially 5 mg twice daily,
nausea, dizziness, weakness, reduction increased if necessary after 3–4 weeks
in blood pressure and/or increase in to 7.5 mg twice daily (if not tolerated
heart rate; angiedema, hepatic reduce dose to 2.5–5 mg twice daily);
dysfunction also reported ELDERLY initially2.5 mg twice daily
Note. Ventricular rate at rest should not
Dose: Initially 10 mg twice daily (if
be allowed to fall below 50 beats per
susceptible to headache 5 mg twice
minute
daily) usual dose 10-20 mg twice daily,
up to 30 mg twice daily may be used
Proprietary Preparations
Corabid (UniMed), Tab , 5mg, Tk. 35/Tab.;
Proprietary Preparations 7.5mg, Tk. 50.00/Tab.
Corangi (UniMed), Tab, 10mg, Tk. 6.00/Tab. Delpino (Healthcare), Tab., 5mg , Tk.
Nicor (Orion), Tab. 10mg, Tk. 6.00/Tab 25.00/Tab.; 7.5mg , Tk. 35.00/Tab.
IVABRADINE Ivanor (Square), Tab. , 7.5 mg, Tk. 35.11/Tab.
; 5 mg, Tk. 25.08/Tab.
Indications: In Chronic stable angina Ivaprex (Incepta), Tab. , 7.5 mg, Tk.
45.00/Tab.; 5 mg, Tk. 30.00/Tab.
pectoris in patients with Ivaten (Drug Intl), Tab., 5mg, Tk. 25.10/Tab. ;
normal sinus rhythm, who have a 7.5mg, Tk. 35.15/Tab.
contraindication to or intolerance to beta
blockers, In chronic heart failure patients
with reduced ejection fraction RANOLAZINE
(LVEF≤35%) with normal sinus rhythm
with resting heart rate ≥ 70 beats/ min Indications: As adjunctive therapy in the
who have a contraindication to or treatment of stable angina in patients
intolerance to beta blockers, inadequately controlled or intolerant of
inappropriate sinus tachycardia first-line antianginal therapies; also in
Cautions: Mild heart failure including atrial fibrillation and SVT
asymptomatic left ventricular Cautions: Moderate to severe
dysfunction; monitor for atrial fibrillation congestive heart failure; QT interval

144
3. CARDIOVASCULAR SYSTEM

prolongation; elderly; renal impairmen; Cardimet (Eskayef), Tab, 35mg , Tk. 6/Tab.
pregnancy and breast-feeding; renal Feelnor (Incepta),Tab.,35 mg, Tk. 6.00/Tab.
impairment use with caution if eGFR 30– Metacard (Aristo), Tab., 35mg, Tk. 6.00/Tab.
Metavas (NIPRO JMI), MR Tab., 35mg, Tk.
80 mL/minute/ 1.73m 2 ; avoid if eGFR
5.02/Tab.
less than 30 mL /minute/1.73m 2 Metazine (Beximco), Tab., 35mg, Tk. 6/Tab.
Interactions: See Appendix- 2 Trimet (Drug Intl), Tab., 20mg, Tk. 3.05/Tab.,
Side-effects: Flatulence, hot flush, 35mg, Tk. 5.05/Tab.
hypotension, prolonged QT interval, Vastadin (Sharif), Tab., 35 mg, Tk. 5.00/Tab.
peripheral oedema, epistaxis, anxiety, Vestar (Healthcare), Tab., 35mg, Tk. 6/Tab.
anorexia, dysuria, haematuria,
dehydration, pain in extremities, muscle 3.3.4 PERIPHERAL AND CEREBRAL
cramp, joint swelling, visual disturbance, VASODILATORS & NEUROSENSORY
tinnitus, pruritus, sweating, cold OXYGENATOR DRUGS
extremities, disorientation, erectile
dysfunction, parosmia, urticaria, rash Intermittent claudication, a serious
Dose: ADULT over 18 years, initially peripheral vascular complication is due
375 mg twice daily, increased after 2–4 to occlusion of vessels. Cessation of
weeks to 500 mg twice daily and then smoking and exercise are conservative
adjusted according to response to max. measures in the management of
750 mg twice daily (reduce dose to 375– intermittent claudication. Low-dose
500 mg twice daily if not tolerated) aspirin (75-300 mg daily) may be
considered if serum total cholesterol is
Proprietary Preparations elevated. Naftidrofuryl 200 mg 3 times
Ralozine (Incepta), Tab.,500 mg, Tk. daily may improve moderate intermittent
16.00/Tab.
Ranola (General), Tab., 500 mg, Tk.
claudication; but the effect of the drug on
16.05/Tab. the outocme of the disease is uncertain.
Ranolin (Square), Tab., 500 mg, Tk. Patients receiving naftidrofuryl should be
16.05/Tab. assessed for improvement after 3-6
months. Naftidrofuryl may also
TRIMETAZIDINE producesymptomatic improvment
Cilostazole is used in Intermittent
Indication: Angina pectoris claudication to improve walking
Cautions: Pregnancy and breast Nifedipine is useful for reducing the
feeding frequency and severity of vasopastic
Contraindication: Hypersensitivity to attacks.
trimetazidine
Interactions: See Appendix-2 ALMITRINE & RAUBASINE
Side-effects: Gastrointestinal
disturbance, nausea, vertigo Indications: Disorders of memory, lack
Dose: 40 to 60mg given daily by mouth of concentration, hearing loss, dizziness,
in divided doses. 35 mgMR tablet buzzing sounds in the ear
preparations at meal times in the Cautions: Abnormal sensation in the
morning and evening lower limbs, weight loss
Contraindications: Known allergy to
Proprietary Preparations the drug; severe liver disease
Angimet (Orion), Tab., 20 mg, Tk. 3.01/Tab., Side-effects: Nausea, sensations of
35 mg,Tk. 6.00/Tab. heaviness and burning in the stomach,
Anginox (General), Tab., 20mg, Tk. 3.01/Tab., diarrhea, or constipation, agitation,
35mg,Tk. 6.00/Tab.
dizziness; palpitations; sensation of ‘pins
Angirid (Acme), Tab., 35mg, Tk. 5.03/Tab.
Angitrim (Globe), Tab., 35 mg, Tk. 6.00/Tab. and needles’, stinging, weight loss
Angivas (Popular), Tab., 35mg, Tk. 5.00/Tab. Dose: 1 tablet once or twice daily. In
Angivent (Square)Tab., 35mg, Tk. 6.02/Tab. case of missing dose, the next dose at
Antoris (Opsonin), Tab., 35 mg,Tk. 6.02/Tab. the normal time

145
3. CARDIOVASCULAR SYSTEM

Proprietary Preparations Proprietary Preparation


Albasine (Drug Intl), Tab., 30+10mg, Tk. Inosit (ACI),Tab.,500mg,Tk.5.04/Tab. ; 750mg,
12.05/Tab. Tk. 7.55/Tab.
Aruxil (Opsonin), Tab., 30 mg + 10 mg, Tk. Nicosit (Incepta), Tab.,500 mg,
10.00/Tab. Tk. 5.00/Tab.;750 mg,Tk.7.00/Tab.
Duxil (ACI) Tab., 30mg + 10 mg, Tk.
10.05/Tab. OXPENTIFYLLINE / PENTOXIFYLLINE
Truxil (Square) Tab., 30 mg + 10 mg,
Tk.10.03/Tab.
Indication: Peripheral vascular disease
CILOSTAZOL Cautions: Hypotension, coronary artery
disease, renal impairment, severe
hepatic impairment
Indication: Intermittent claudication in
Contraindications: Cerebral haemorr-
patients without rest pain and no
hage, extensive retinal haemorrhage,
peripheral tissue necrosis
acute myocardial infarction, pregnancy
Cautions: Atrial or ventricular ectopy,
and breast-feeding
atrial fibrillation, atrial flutter; diabetes
Interactions: See Appendix-2
mellitus (higher risk of intra-ocular
Side-effects: Gastrointestinal
bleeding)
disturbances headache, sleep
Interactions: See Appendix -2
disturbances, headache, tachycardia,
Contraindications: Active peptic ulcer,
angina, hypotension, thrombocytopenia,
haemorrhagic stroke in previous 6
intrahepatic cholestasis, hypersen-sitivity
months, surgery in previous 3 months,
reactions.
proliferative diabetic retionpathy, poorly
Dose: 400 mg 2-3 times daily
controlled hypertension
Side-effects: Diarrhoea, headache,
Proprietary Preparations
nausea, vomiting, dyspepsia, flatulence, Oxifyl CR (Square), Tab., 400 mg, Tk.
abdominal pain, tachycardia, palpitation, 7.04/Tab.
angina, arrhythmia, dizziness, Trental (Sanofi), Tab., 400 mg, Tk. 15.11/Tab.
ecchymosis, puritus, edema, asthenia
Dose: 100 mg twice daily (30 minutes VINPOCETINE
before or 2 hours after food)
Indications: Acute ischaemic stroke
Proprietary Preparations due to cerebral thrombosis, cerebral
Cilosta (Square),Tab., 100 mg, Tk.12.09/Tab.
Inclaud (ACI), Tab., 100mg, Tk. 10.00/Tab.
embolism; acute circulatory disorder,
Vasocil (Ibn Sina), Tab., 100mg, Tk. hypertensive crisis, the acute cerebro-
12.00/Tab.; 50 mg, Tk.7.00/Tab. vascular disorder, ischemic neurological
deficit, multi infarct dementia, cerebral
INOSITOL NICOTINATE arteriosclerosis, hypertensive
encaphalopathy
Contraindication: Pregnancy
Indications: Peripheral vascular
Interactions: See Appendix-2
disease, hyperlipidaemia
Side-effects: Transient hypotension and
Cautions: Cerbrovascular insufficiency
tachycardia
and unstable angina
Dose: 15mg-30mg in divided dose
Contraindications: Recent myocardial
infraction, acute phase of cerbrovascular
Proprietary Preparations
accident, pregnancy Avintol (ACI), Tab., 5mg, Tk. 3.00/Tab.
Interactions: See Appendix-2 Camiton (Drug Int), Tab., 5 mg, Tk. 4.05/Tab.
Side-effects: Flushing, dizziness Caviton (Opsonin), Tab., 5 mg , Tk. 3.01/Tab.,
nausea, vomiting Inj., 10mg/2 ml, Tk. 40.12/2ml Vial
Dose: 3g daily in 2-3 divided doses; max Cavinton (I) (Richtor) Tab., 5 mg, Tk.
4g daily 9.78/Tab.,Inj.,10mg/2ml.Tk.53.34/2ml
Cerenin (Ambee), Tab. 5 mg, Tk. 3.55/Tab.

146
3. CARDIOVASCULAR SYSTEM

Cereton (General), Tab., 5 mg, Tk. intervals of 4-8 hours according to


4.04/Tab.Inj., 10mg/2 ml, Tk. 40.00/2 ml response
Cerevas (Square),Tab., 5 mg, Tk. 4.03/Tab.
Cerivin (Beximco), Tab., 5 mg, Tk. 4.02/Tab.
Proprietary Preparations
Cognitol (Sun), Tab., 5 mg, Tk. 4.05/Tab.
Agoxin (Aristo), Tab., 250 mcg, Tk. 1.09/Tab.
Vincet (Eskayef), Tab., 5mg , Tk. 4.00/Tab.,
Centoxin (Opsonin), Tab., 250 mcg, Tk.
Vinsetine (Incepta), Tab., 5 mg, Tk. 4.00/Tab.
1.09/Tab.; Syrup, 250 mcg/5 ml, Tk.
Vinton (Aristo),Tab., 5mg, Tk. 4.00/Tab.
75.28/60ml
Vinpoton (Acme), Tab. , 5mg., Tk. 4.01/Tab.
Digoxen (Drug Int.), Cap. 0.1mg, Tk.0.94/Cap;
0.2mg,Tk.1.34/Cap.
3.4 POSITIVE INOTROPIC DRUGS
3.5 DIURETICS
Cardiac Glycosides, phosphodies-terase
3.5.1 THIAZIDES AND RELATED
inhibitors and sympathomime-tics with
DIURETICS
inotropic activity are positive inotropic
3.5.2 LOOP DIURETICS
drugs.
3.5.3 POTASSIUM-SPARING
DIURETICS
DIGOXIN [ED] 3.5.4 OSMOTIC DIURETICS
3.5.5 CARBONIC ANHYDRASE
Indications: Heart failure, suprarventri- INHIBITORS
cular arrhythmia (particularly in atrial
fibrillation)
3.5.1 THIAZIDES AND RELATED
Cautions: Recent infarction; sick sinus
DIURETICS
syndrome; thyroid disease; elderly,
pregnancy
Contra-indications: Renal impairment, Thiazides and related diuretics are
rapid intravenous administration, heart moderately potent. The onset of action
block, hypokalamia of diuresis of this group starts within 1 to
Side-effects: Usually associated with 2 hours of oral administration and the
excessive dosage; anorexia, nausea, action lasts for 12 to 24 hours. They are
vomiting, headache, fatigue, drowsiness, to be given early in the morning so that
confusion, delirium, hallucination, the diuresis does not interfere with
depression, arrhythmia, heart block, normal sleep pattern.
intestinal ischaemia; gynaecomastia on Bendroflumethiazide (Bendrofluazide),
long-term use; thrombocytopenia a thiazide diuretic is widely used; a low
reported dose of 2.5 mg daily is routinely
Interactions: See Appendix-2 prescribed in the treatment of
Dose: By mouth, rapid digitalization, 1- hypertension. Higher doses of thiazides
1.5 mg in divided doses over 24 hours; cause increased level in plasma uric
less urgent digitalization, 250-500 acid, glucose, and lipids and decreased
micrograms daily (higher dose may be level in plasma potassium. Bendroflu-
divided) methiazide (Bendrofluazide) is randomly
Maintenance, 62.5-500 micrograms daily used for heart failure and for the
(higher dose may be divided) according treatment of mild hypertension or with
to renal function and, in atrial fibrillation, other drugs in severe hypertension.
on heart-rate response; usual range, Chlorthalidone, a thiazide related
125-250 micrograms daily (lower dose compound may be given on alternate
may be appropriate in elderly). day to relieve edema. It is also useful if
Emergency loading dose by intravenous acute retention is liable to be
infusion, total dose of 0.5-1 mg given in precipitated by a more rapid diuresis.
divided doses with about half of the total Other thiazides and related diuretics
dose given over 10-20 minutes, followed (including Benzthiazide, Clopamide,
by further fractions of the total dose Cyclopenthiazide,Hydrochlorothiazide
(also given over 10-20 minutes) at ,Hydroflumethiazide and Polythiazide)

147
3. CARDIOVASCULAR SYSTEM

are more expensive than the longer


established thiazides, but have no Proprietary Preparations
special advantages. Dihert (Novartis), SR Tab., 1.5 mg,
Metolazone is especially effective when Tk.8.00/Tab.
combined with a loop diuretic; it can be Hypen (Opsonin),Tab.,1.5 mg,Tk. 5.03/Tab.
Idatix (Incepta), SR Tab., 1.5 mg, Tk.5.00/Tab.
given even in renal failure. The patient
Indamid (Sharif), SR Tab., 1.5 mg,
needs to be monitored carefully due to Tk.5.01/Tab.
profound diuresis. Indapa (Drug Intl),SR Tab.,1.5 mg,Tk.
Xipamide and Indapamide are 5.05/Tab.
structurally similar to chlorthalidone. Indelix (Beximco),SR Tab.,1.5 mg,Tk.
Indapamide can cause less metabolic 6.00/Tab.
disturbances, particularly less impair- Indimide (Healthcare), SR Tab., 1.5 mg,
ment of glucose intolerance. Tk.6.50/Tab.
Ipide (Renata), Tab., 1.5 mg, Tk. 5.00/Tab.
Natrilix (ACI),SR Tab.,1.5 mg,Tk. 9.00/Tab.
HYDROCHLOROTHIAZIDE [ED] Repres (Square),SR Tab.,1.5 mg,Tk.
5.03/Tab.
Trilix (Silva),SR Tab.,1.5 mg,Tk. 5.01/Tab.
Indication: Edema, hypertension
Xelix (Aristo),SR Tab.,1.5 mg,Tk. 5.00/Tab.
Cautions: See under benedrofluazide.
Contraindications: See under benedro-
fluazide METOLAZONE
Interactions: See Appendix-2
Side-effects: See under benedroflua- Indications: Oedema, hypertension
zide Cautions: Electrolytes should be
Dose: Hypertension, 25 mg daily, monitored, particularly with high doses,
increased to 50 mg daily if necessary long-term use, or in renal impairment;
ELDERLY: in some elderly patients an mayexacerbate diabetes, gout, and
initial dose of 12.5 mg daily may be systemic lupus erythematosus; nephrotic
sufficient syndrome, hyperaldoste-ronism, and
Proprietary Preparations malnourishment; avoid in severe liver
Acuren (Incepta), Tab. 50mg, Tk. 1.00/Tab.; disease, hypokalaemia pregnancy and
25mg, Tk. 0.70/Tab. breast feeding
Hypezide (Pacific), Tab.,50mg, Tk. 1.00/Tab. Contraindications: Refractory
HTZ (UniMed), Tab, 25mg, Tk.0.70/Tab. hypokalaemia, hyponatraemia and
hypercalcaemia, symptomatic
INDAPAMIDE hyperuricaemia and Addison’s disease.
Interactions: See Appendix-2
Indication: Essential hypertension Side-effects: Mild gastrointestinal
Cautions: Renal impairment, gout, disturbances, postural hypotension,
hyperparathyroidism (discontinue if altered plasma-lipid concentrations,
hypercalcaema); hyperaldosteronism; metabolic and electrolyte disturbances
pregnancy and breast-feeding including hypokalaemia, hyponatraemia,
Contraindications: Recent cerebrovas- hypomagnesaemia, hypercalcaemia,
cular accident, severe liver disease hyperglycaemia, hypochloraemic
Interactions: See Appendix-2 alkalosis, hyperuricaemia and gout
Side-effects: Hypokalaemia, , dizziness, Dose: Oedema, 5-10 mg daily in the
fatigue, muscular cramps, anorexia, morning, increased if necessary to 20
dyspepsia, rashes, increase in liver mg daily in resistant oedema, max. 80
enzymes, blood disorder, hyponatr- mg daily. Hypertension, initially 5 mg
aemia, metabolic alkalosis, hyperglyce- daily in the morning; maintenance 5 mg
mia, increased plasma urate concentra- on alternate days
tions, paraesthesia, photosensitivity,
impotence, renal impairment Proprietary Preparations
Dose: 2.5 mg daily in the morning
148
3. CARDIOVASCULAR SYSTEM

Merozolyn (UniMed), Tab., 500 mcg, Contraindications: Precoma state


Tk.5.00/Tab., 5 mg, Tk.25.00/Tab associated with liver cirrhosis and renal
failure with anuria
3.5.2 LOOP DIURETICS Interactions: See Appendix-2
Side-effects: Hyponatraemia,
Loop diuretics are the most efficacious hypokalaemia and hypomagnesa-emia,
oral diuretic agent; useful for the hypoch-loraemic alkalosis, increased
treatment of acute episodes of calcium excretion, hypotension,
pulmonary edema due to left ventricular hyperuricaemia; temporary increase in
failure; plasma cholesterol and triglyceride
concentrations and bone marrow
BUMETANIDE depression, pancreatitis, deafress and
myalgia
Dose : By mouth, edema, initially 40 mg
Indication: Oedema
in the morning; maintenance 20 mg daily
Cautions: Hypovolaemia and
or 40 mg on alternate days, increased in
hypotension should be corrected before
resistant edema to 80 mg daily or 40 mg
initiation of treatment; electrolytes
on alternate days; increased in resistant
should be monitored during treatment;
edema to 80 mg daily or more
can exacerbate diabetes mellitus and
In oliguria, initially 250 mg daily; if
gout and prostate enlargement