increase toxicity of lithium and methotrexate.

Increased
NSAIDs, ANALGESICS, MUSCLE nephrotoxicity w/ ciclosporin and tacrolimus.
RELAXANTS MOA: Ibuprofen inhibits synthesis of prostaglandins in body
tissues by inhibiting cyclooxygenase-1 and 2. It has anti-
CELECOXIB (NSAIDs) (Celcoxx, Celebrex, Cofidec) inflammatory, analgesic and antipyretic properties.
Onset: Analgesic: 30-60 min. Anti-inflammatory: ≤7 days
(oral).
Adult : PO Osteoarthritis 200 mg/day in 1 or 2 divided doses.
May increase to 200 mg bid. Rheumatoid arthritis 100-200
mg bid. Ankylosing spondylitis Initial: 200 mg/day in 1 or 2
divided doses. May increase to 400 mg/day after 6 wk. MELOXICAM (NSAIDs) (Mobic)
Dysmenorrhoea; Pain relief Initial: 400 mg followed by 200
mg on the 1st day. Maintenance: 200 mg bid.
Osteoarthritis Adult: 200 mg/day as a single dose or in 2 Acute exacerbations of osteoarthritis
divided doses. May increase to 200 mg bid if necessary. Adult: 7.5 mg daily up to max 15 mg daily as a single dose.
Dysmenorrhoea, Pain relief Adult: Initially, 400 mg followed Rheumatoid arthritis, Ankylosing spondylitis
by 200 mg if necessary on the 1st day. Maintenance: 200 mg Adult: 15 mg daily as a single dose. Patients w/ increased risk
bid. of adverse effects: Initially 7.5 mg daily.
Rheumatoid arthritis Adult: 100-200 mg bid. Elderly: 7.5 mg daily for long-term treatment.
Juvenile idiopathic arthritis Child: ≥2 yr ≥10 kg to ≤25 kg: 50 Juvenile rheumatoid arthritis
mg bid; >25 kg: 100 mg bid. Child: ≥2 yr 0.125 mg/kg once daily. Max: 7.5 mg daily.
Ankylosing spondylitis Adult: Initially, 200 mg/day as a single Administration: May be taken with or without food. May be
dose or in 2 divided doses. May increase to 400 mg/day after taken w/ meals if GI discomfort occurs.
6 wk. Drug Interactions: Increased risk of severe GI effects w/
Administration: may be taken with or without food.Px aspirin or warfarin. May antagonise antihypertensive effects
counsel: This drug may cause dizziness, if affected do not of ACE inhibitors and angiotensin II receptor antagonists. May
drive or operate machinery. reduce natriuretic effects of furosemide and thiazides.
MOA: Celecoxib is a selective cyclooxygenase-2 (COX-2) Enhanced toxicity of methotrexate. May increase plasma
inhibitor primarily responsible to reduce mediators of pain lithium concentration.
and inflammation. Its action is due to inhibition of MOA: Meloxicam is an oxicam derivative which exhibits
prostaglandin synthesis via inhibition of COX-2. analgesic, antipyretic and anti-inflammatory actions. It
Pharmacokinetics: reversibly inhibits the cyclooxygenase-1 and -2 (COX-1 and -2)
Absorption: Absorbed from the GI tract. May delay enzymes, thus resulting in reduced synthesis of prostaglandin
absorption with high fat meal. Time to peak plasma precursors.
concentration: Approx 3 hr.

MEFENAMIC ACID (NSAIDs) (Ponstan, Gardan, ETORICOXIB (NSAIDs) (Arcoxia)

Dolfenal, Revalan)
Ankylosing spondylitis, Rheumatoid arthritis
Adult : PO 500 mg tid. Adult: 90 mg once daily.
Mild to moderate pain, Rheumatoid arthritis, Dental pain, Child: <16 yr Contraindicated.
Postoperative pain, Dysmenorrhoea, Osteoarthritis, Osteoarthritis
Menorrhagia Adult: 30 mg once daily, increased to 60 mg once
Adult: 500 mg tid. daily if needed.
Child: >6 mth 25 mg/kg daily in divided doses for up to 7 Child: <16 yr Contraindicated.
days. Acute gout
Should be taken with food. Adult: 120 mg once daily. Max duration: 8 days.
Special Precaution: Patient w/ known CV disease or risk Child: <16 yr Contraindicated.
factors for CV disease, history of GI bleeding or peptic Administration: May be taken with or without
ulceration, fluid retention or heart failure. Renal and hepatic food.
impairment. Pregnancy and lactation. ADR: Potentially Fatal: Stevens-Johnson syndrome,
Description: Mefenamic acid, an anthranilic acid derivative, is exfoliative dermatitis and toxic epidermal necrolysis; upper GI
a prototypical NSAID. It reversibly inhibits the ulceration, perforation and bleeding.
cyclooxygenase-1 and -2 (COX-1 and -2) enzymes, thus Drug Interaction: May increase INR w/ oral anticoagulants.
resulting in reduced synthesis of prostaglandin precursors. It May decrease effects of ACE inhibitors, angiotensin II
has analgesic and antipyretic properties w/ minor anti- antagonist and diuretics. May increase lithium plasma
inflammatory activity. concentrations. May reduce plasma levels w/ rifampicin.
Duration: ≤6 hr. Increased serum concentrations of ethinylestradiol.
MOA: Etoricoxib is a selective cyclooxygenase-2 (COX-2)
inhibitor primarily responsible to reduce mediators of pain
IBUPROFEN (NSAIDs) (Advil, Dolan FP, Medicol) and inflammation. Its action is due to inhibition of
prostaglandin synthesis via inhibition of COX-2.
Adult : PO Rheumatoid arthritis; Osteoarthritis 400-800 mg
3-4 times/day. Max: 3.2 g/day. Mild to moderate pain;
Dysmenorrhoea; Fever 200-400 mg 4-6 hrly. Max: 2.4 g/day. EPERISONE (Muscle Relaxant) (Myonal, Perispa)
IV Pain relief 400-800 mg 6 hrly, as needed. Max: 3.2 g/day.
Fever Initially, 400 mg followed by 400 mg 4-6 hrly, or 100-
200 mg 4 hrly. Max: 3.2 g/day. Topical/Cutaneous Pain and Muscle spasms
inflammation associated w/ musculoskeletal and joint Adult: 50 mg tid.
disorders As 5% cream, foam, gel, spray soln or 10% gel: Administration: Should be taken with food. Take after meals.
Apply as directed. Drug Interaction: Avoid concomitant use with tolperisone HCl
Special Precautions: Bleeding disorders, CV disease. Infants and methocarbamol.
w/ increased total bilirubin. Premature neonates w/ existing MOA: Eperisone is centrally-acting skeletal muscle relaxant
or at risk of infection. Hepatic and renal impairment. Elderly used to improve myotonic symptoms.
(avoid chronic use).
Drug Interactions: Increased risk of GI bleeding w/ warfarin,
corticosteroids, SSRIs and aspirin. May reduce the natriuretic
effects of diuretics. Reduced antihypertensive effect of ACE
inhibitors and angiotensin II receptor antagonists. May

1
NAPROXEN (NSAIDs) (Flanax, Skelan)

Dysmenorrhoea, Acute musculoskeletal disorders Drug Interaction: Concomitant use of salicylates, other
Adult: Initially, 500 mg followed by 250 mg 6-8 hrly. Max: NSAIDs, anticoagulant (e.g. warfarin, heparin) or
1,250 mg on the 1st day and 1,000 mg thereafter. corticosteroids may increase risk of bleeding and combination
Elderly: Dose reduction may be needed. use is not recommended. Caution if used with thrombolytics,
Rheumatic disorders anti-platelets, selective serotonin reuptake inhibitors,
Adult: 0.5-1 g daily as a single or in 2 divided doses. pentoxyfylline due to elevated bleeding risk. May increase
Elderly: Dose reduction may be needed. toxic effects of hydantoines and sulphonamides. May reduce
Juvenile idiopathic arthritis effects of antihypertensives. Increased risk of red cell line
Child: >5 yr 10 mg/kg/day in 2 divided doses 12 hrly. toxicity with zidovudine, monitor complete blood count and
reticulocyte count. Renal function may be worsened when
Acute gout used with ciclosporin or tacrolimus. May increase
Adult: Initially, 750 mg followed by 250 mg 8 hrly. hypoglycaemic effect of sulfonylureas. Probenacid may
Elderly: Dose reduction may be needed. increase plasma concentration of Dexketoprofen.
Renal Impairment: Severe: Contraindicated. Potentially Fatal: NSAIDS may increase blood lithium levels;
Administration: Should be taken with food. and increase haematological toxicity of methotrexate.
Drug Interaction: May enhance methotrexate toxicity. Food Interaction: Reduced absorption rate when
Reduced BP response to ACE inhibitors or angiotensin II administered with food.
receptor antagonists. Increased risk of serious GI events (e.g. MOA: Dexketoprofen is an isomer of ketoprofen. It is a
ulcer) w/ aspirin. Increased risk of GI bleeding w/ warfarin. propionic acid derivative with analgesic, anti-inflammatory
May reduce the natriuretic effects of furosemide or thiazide and antipyretic properties. It is a non-steroidal anti-
diuretics. May increase serum lithium concentrations and inflammatory drug (NSAID) that reduces prostaglandin
reduce renal lithium clearance. Delayed absorption w/ synthesis via inhibition of cyclooxygenase pathway (both
antacids, colestyramine or sucralfate. May interfere w/ the COX-1 and COX-2) activity.
antihypertensive effects of β-blockers (e.g. propranolol). May Onset: About 30 min.
increase serum levels w/ probenecid. Duration: About 4-6 hr.
Food Interaction: Rate of absorption may be reduced w/
food.
MOA: Naproxen, a propionic acid derivative, is a prototypical
NSAID. It reversibly inhibits the cyclooxygenase-1 and -2 PARACETAMOL (Analgesics (Non-Opioid) &
(COX-1 and -2) enzymes, thus resulting in reduced synthesis
of prostaglandin precursors. It can inhibit platelet Antipyretics)
aggregation, has anti-inflammatory, analgesic and antipyretic
actions.
Onset: Analgesic: 30-60 min. Adult : PO 0.5-1 g 4-6 hrly. Max: 4 g/day. Rectal As supp: 0.5-
Duration: Analgesic: <12 hr. 1 g 4-6 hrly. Max: 4 g/day. IV 33-50 kg: 15 mg/kg as a single
dose, at least 4 hrly. Max: 60 mg/kg/day up to 3 g/day; >50
kg: 1 g as a single dose, at least 4 hrly. Max: 4 g/day. Admin
by infusion over 15 min.
Administration: May be taken with or without food.
KETOPROFEN (NSAIDs) Food Interaction: Alcohol may increase risk of hepatotoxicity.
MOA: Paracetamol exhibits analgesic action by peripheral
blockage of pain impulse generation. It produces antipyresis
Adult: PO Rheumatic disorders 100-200 mg/day in 2-4 by inhibiting the hypothalamic heat-regulating centre. Its
divided doses. Max: 300 mg/day in divided doses. Pain and weak anti-inflammatory activity is related to inhibition of
inflammation 25-50 mg 6-8 hrly. Max: 300 mg/day. IM Pain prostaglandin synthesis in the CNS.
and inflammation associated w/ musculoskeletal and joint Synonym: acetaminophen.
disorders; Pain following orthopaedic surgery 50-100 mg by Onset: Oral: <1 hr. IV: 5-10 min (analgesia); w/in 30 min
deep inj into the gluteal muscle 4 hrly. Max: 200 mg/24 hr for (antipyretic).
up to 3 days. Rectal Rheumatic disorders 100 mg at night. Duration: 4-6 hr (analgesia). IV: ≥6 hr (antipyretic).
Recommended total dose (combined oral and rectal): Not to
exceed 200 mg/day. Topical Local pain relief As 2.5% gel:
Apply 2-4 times/day for up to 10 days. As 30 mg plaster:
Apply 1 plaster bid.
Administration: Should be taken with food. Preferably taken PARACETAMOL + ORPHENADRINE (Analgesics
w/ or after meals. (Non-Opioid) & Antipyretics / Analgesics (Opioid)
Drug Interaction: Increases plasma concentrations of lithium (Norgesic)
and methotrexate. Reduces effects of antihypertensives (e.g.
ACE inhibitors, angiotensin II receptor antagonists). Increased
risk of GI bleeding w/ warfarin. Decreased protein binding of Pain and muscular spasms in musculoskeletal disorders
ketoprofen and increased risk for serious GI events w/ aspirin Adult: Each tablet containing paracetamol 450 mg and
and other NSAIDs. Increased risk of developing renal failure orphenadrine citrate 35 mg: 2 tablets tid.
w/ diuretics. Increased risk of GI bleeding and ulceration w/ Srug Interaction: Increased paracetamol absorption with
corticosteroids. Increased plasma levels w/ probenecid. metoclopramide and domperidone. Decreased paracetamol
Salicylate reduces conjugation and renal elimination of absorption with cholestyramine. May increase risk of
ketoprofen. bleeding with warfarin and coumarins. Increased
Food Administration: Avoid alcohol due to increased GI anticholinergic side effects with other anticholinergic drugs.
irritation. Additive CNS effects with propoxyphene. Increased
MOA: Ketoprofen exhibits anti-inflammatory, analgesic and bupropion levels with concurrent use. May antagonise
antipyretic properties. It potently inhibits the enzyme actions of centrally acting anticholinesterases e.g. donepezil,
cyclooxygenase resulting in prostaglandin synthesis galantamine, rivastigmine, tacrine. May decrease levodopa
inhibition. absorption with concurrent use.
Potentially Fatal: Increased risk of liver damage with alcohol.
MOA: Paracetamol, a para-aminophenol derivative, is a
DEXKETOPROFEN (NSAIDs) (Ketesse) peripherally acting analgesic with antipyretic and weak anti-
inflammatory activity. Orphenadrine, an analog of
diphenhydramine, is a skeletal muscle relaxant and is
Mild to moderate pain postulated to act on cerebral motor center or on the medulla
Adult: 12.5 mg every 4-6 hr or 25 mg every 8 hr. Max: 75 through an atropine-like central action. It has anticholinergic,
mg/day. local anaesthetic effects and some antihistaminic effects.
Elderly: Initial total daily dose should not exceed 50 mg/day. Orphenadrine is used either as the hydrochloride or the
May increase to the doses recommended for general citrate and doses are expressed in terms of the relevant salt.
population only if well tolerated.

2
PARACETAMOL + TRAMADOL (Analgesics (Non- Drug Interaction: Increased risk of GI bleeding w/ anti-
platelets and SSRIs. May exacerbate cardiac failure, reduce
Opioid) & Antipyretics / Analgesics - Opioid) GFR and increase plasma glycoside levels. Increased risk of
(Algesia, Dolcet, TDL Plus) nephrotoxicity w/ ciclosporin and tacrolimus. Increased
absorption w/ cimetidine. Increased risk of GI ulceration w/
corticosteroids. May interfere w/ the natriuretic action of
Moderate to severe pain diuretics. May displace other highly protein-bound drugs.
Adult: Each tab contains tramadol HCl 37.5 mg and May increase steady state plasma lithium levels. May
paracetamol 325 mg: 2 tab 6 hrly. Max: 8 tab/day. Max antagonise the effect of antihypertensives. May reduce the
duration: 5 days. excretion of methotrexate, leading to acute toxicity.
Administration: May be taken with or without food. Swallow Increased risk of convulsions w/ quinolones. May interfere w/
whole, do not divide/chew/crush. mifepristone-mediated termination of pregnancy.
Drug Interaction: Increased risk of seizures and serotonin Potentially Fatal: May enhance the effect of anticoagulants
syndrome w/ SSRIs, SNRIs, TCAs, and 5-HT agonists (e.g. (e.g. warfarin). Increased risk of serious GI events w/ aspirin
sumatriptan). Increased CNS depression w/ barbiturates, and other NSAIDs.
benzodiazepines, other anxiolytics, hypnotics, sedative Food Interaction: Food decreases the rate of absorption.
antidepressants, sedative antihistamines, neuroleptics, MOA: Piroxicam is an NSAID, belonging to the oxicam group.
centrally-acting antihypertensive drugs, thalidomide and It reversibly inhibits cyclooxygenase-1 and -2 (COX-1 and -2)
baclofen. Decreased analgesic efficacy w/ ondansetron. enzymes, which results in decreased formation of
Increased INR w/ warfarin. prostaglandin precursors.
Potentially Fatal: May enhance serotonergic, neuroexcitatory
and/or seizure-potentiating effect of MAOIs.
Food Interaction: Increased sedative effect w/ alcohol. Food
may delay time to peak plasma levels. SARIDON
MOA: Tramadol is a centrally acting opioid analgesic which
binds to mu-opioid receptors and weakly inhibits the Paracetamol 250 mg, Propyphenazone 150 mg,
reuptake of norepinephrine and serotonin. Paracetamol, a Caffeine 50 mg
para-aminophenol derivative, has analgesic, antipyretic and (Analgesics (Non-Opioid) & Antipyretics)
weak anti-inflammatory activity. Together, tramadol and
paracetamol has faster onset of action compared to tramadol
alone and longer duration of action compared to paracetamol Indication: Relief of pain eg mild to severe headache,
alone. toothache, menstrual discomfort, post-op & rheumatic pain,
Duration: 5 hr. pain & fever associated w/ colds & flu.
Adult 1-2 tab. Adolescent 12-16 yr 1 tab. May be taken up to
TRAMADOL (Analgesics - Opioid) (Tramal, 3 single doses w/in 24 hr. Do not take for >1 wk or at doses
Tramacet) higher than recommended.

Adult : PO Moderate to severe pain 50-100 mg 4-6 hrly. ANTIVERTIGO DRUGS

Extended-release tab: 50-100 mg 1-2 times/day. Max: 400
mg/day. IV/IM Moderate to severe pain 50-100 mg 4-6 hrly.
Post-op pain Initial: 100 mg, then 50 mg every 10-20 min if BETAHISTINE (Serc, Betavert, Exigo, Ergo, Verist)
needed, up to 250 mg for the 1st hr. Maintenance: 50-100 mg
4-6 hrly. Max: 600 mg/day.
Administration: May be taken with or without food. Indication: Meniere's disease.
Incompatibility: Diazepam, diclofenac Na, flunitrazepam, Adult : PO As betahistine HCl: Initial: 8-16 mg tid.
glyceryl trinitrate, indometacin, midazolam, piroxicam, Maintenance: 24-48 mg/day. As betahistine mesilate: 6-12
phenylbutazone, aciclovir, clindamycin. mg tid.
Drug Interaction: Increased risk of convulsions or serotonin Administration: Should be taken with food.
syndrome w/ SSRI, serotonin-norepinephrine reuptake Contraindication: Pheochromocytoma
inhibitors (SNRI), TCA and other seizure threshold lowering Drug Interaction: Diminished therapeutic effect w/
drugs (e.g. bupropion, mirtazapine, tetrahydrocannabinol). antihistamines. May decrease bronchodilator effects of β2
Decreased serum concentrations w/ carbamazepine. May agonists. Increased serum concentrations w/ MAOIs
potentiate the anti-depressant effect of norepinephrine, 5-HT Food Interaction: Food intake slows down absorption of
agonists or lithium. Increased INR and ecchymoses w/ betahistine.
coumarin derivatives (e.g. warfarin). MOA: Betahistine acts as both partial histamine H1-receptor
Potentially Fatal: Increased risk of seizures w/ MAOIs. agonist and histamine H3-receptor antagonist in neuronal
Food Interaction: Enhanced CNS depressant effect w/ alcohol. tissue. It improves the microcirculation in the labyrinth, thus
MOA: Tramadol inhibits reuptake of norepinephrine, reducing endolymphatic pressure.
serotonin and enhances serotonin release. It alters
perception and response to pain by binding to mu-opiate
receptors in the CNS. CINNARIZINE (Peripheral Vasodilators & Cerebral
Onset: Approx 1 hr. Activators / Antivertigo Drugs) (Cinnabloc)
Duration: 9 hr.

Adult : PO Vertigo and vestibular disorders 30 mg tid or 75

PIROXICAM (NSAIDs) (Feldene, Kapirox, Picaxor) mg 1-2 times/day. Motion sickness 30 mg 2 hr before travel
then 15 mg 8 hrly during the journey if necessary.
Cerebrovascular disorders 75 mg once daily. Peripheral
Oral vascular disease 75 mg bid or tid.
Ankylosing spondylitis, Osteoarthritis, Rheumatoid arthritis Administration: Should be taken with food.
Adult: 20 mg daily as a single dose, divided doses may be Drug Interaction: Increased sedative effect w/ CNS
depressants or TCAs.
used if necessary. Treatment should be reviewed w/in 14 Food Interaction: Increased sedative effect w/ alcohol.
days of starting. Description: Cinnarizine is a non-competitive antagonist of
Elderly: Use the lowest effective dose for the shortest smooth muscle contractions caused by various vasoactive
duration. agents (e.g. histamine). It selectively inhibits Ca influx into
depolarised cells, thereby reducing free Ca ions available for
Topical/Cutaneous the induction and maintenance of contraction.
Pain and inflammation
Adult: As 0.5% gel: Apply to the affected area 3-4 times daily.
Treatment should be reviewed after 4 wk.
Administration: Should be taken with food.

3
 domperidone levels and subsequently increasing the risk of
ANTIEMETIC DRUGS QT prolongation.
MOA: Domperidone is a peripheral dopamine-receptor
MECLIZINE (Bonamine) blocker. It increases oesophageal peristalsis, enhances
gastroduodenal coordination and lower oesophageal
sphincter pressure, gastric motility, and peristalsis, thus
Motion sickness 25-50 mg. Adult & childn ≥11 yr 25-50 mg. facilitating gastric emptying and decreasing small bowel
Childn 5-10 yr 12.5 mg. All doses to be taken 1 hr before transit time.
travel for 24-hr protection. Nausea & vomiting of pregnancy
25-50 mg/day. Labyrinthine & vestibular disturbances 25-
100 mg/day. Radiation sickness 50 mg 2-12 hr prior to LAXATIVES, PURGATIVES
radiation therapy.
Administration : May be taken with or without food.
Drug Interaction: CNS depressants including barbiturates, BISACODYL (Dulcolax)
alcohol, tranquilizers & sedatives. Pain relievers, cold &
allergy medication.
Bowel evacuation
Adult: Initially, 10-20 mg the night before the procedure
METOCLOPRAMIDE followed by 10 mg rectal supp the next morning.
Alternatively, 10 mg on each of the 2 nights before the
procedure.
Adult : PO GERD 10-15 mg 4 times/day. If symptoms are Child: 4-10 yr 5 mg the night before the procedure and 5 mg
intermittent, may give single doses of 20 mg prior to
provoking situation. Max duration: 12 wk. rectal supp the following morning; >10 yr Same as adult dose.
Diabetic gastric stasis 10 mg 4 times/day for 2-8 wk. Nausea Constipation
and vomiting associated w/ cancer chemotherapy or Adult: 5-10 mg at night, up to 20 mg may be given as
radiotherapy 10 mg, up to tid. Max duration: 5 days necessary.
Prophylaxis of post-op nausea and vomiting 10 mg as a Child: 4-10 yr 5 mg at night; >10 yr Same as adult dose.
single dose by IM or slow IV inj over at least 3 min. IV Rectal
Prophylaxis of chemotherapy-induced nausea and vomiting Constipation
For highly emetogenic drugs/regimens: Initial: 2 mg/kg by Adult: As supp or enema: 10 mg in the morning.
slow inj over at least 15 min, 30 min before chemotherapy. Child: ≤10 yr 5 mg in the morning; >10 yr Same as adult dose.
Repeat 2 hrly for 2 doses, then 3 hrly for 3 doses. For less Should be taken on an empty stomach. Do not take w/in 1 hr
emetogenic drugs/regimens: 1 mg/kg may be used. Max of antacids, milk or other dairy products.
duration: 5 days Risk of dyspepsia and gastric irritation w/ antacids. Increased
Drug Interaction: Antagonistic effect w/ anticholinergics and risk of electrolyte imbalance w/ diuretics or adreno-
morphine derivatives. Potentiation of sedative effects w/ CNS corticosteroids.
depressants. Additive effect w/ other neuroleptics on the Increased risk of dyspepsia and gastric irritation w/ milk
occurrence of extrapyramydal disorders. May increase the products.
risk of serotonin syndrome w/ serotonergic drugs (e.g. SSRIs). Description: Bisacodyl stimulates peristalsis by directly
May decrease digoxin bioavailability. May increase ciclosporin irritating the smooth muscle of the large intestine. It alters
bioavailability. May prolong the neuromuscular blocking water and electrolyte secretion, producing net interstitial
effect of mivacurium and suxamethonium. Increased fluid accumulation and laxation.
exposure levels w/ strong CYP2D6 inhibitors (e.g. fluoxetine). Onset: 6-12 hr (oral); 15-60 min (supp); 5-20 min(enema).
May reduce plasma concentration of atovaquone.
Potentially Fatal: Mutual antagonistic effect w/ levodopa or
dopaminergic agonists. LACTULOSE (Lilac, Movelax)
Food Interaction: May potentiate sedative effect w/ alcohol.
MOA: Metoclopramide blocks dopamine receptors and in
higher doses, it also blocks serotonin receptors in Dosage Admnistration: Constipation Adult: As powd or 3.335
chemoreceptor trigger zone of the CNS. It enhances the g/5 mL soln: Initially, 10-20 g (15-30 mL) daily as a single dose
response to acetylcholine of tissue in upper GI tract causing or in 2 divided doses, may increase up to 45 mL of the soln (or
enhanced motility and accelerated gastric emptying w/o up to 40 g of the reconstituted powd) daily. Adjust gradually
stimulating gastric, biliary, or pancreatic secretions. It also according to patient's response. Child: As 3.335 g/5 mL soln:
increases lower esophageal sphincter tone. 1 mth to 1 yr 2.5 mL; >1-5 yr 5 mL; >5-10 yr 10 mL; >10-18 yr
Onset: Oral: 30-60 min; IV: 1-3 min; IM: 10-15 min. 15 mL. All doses to be given bid. Hepatic encephalopathy
Duration: Therapeutic: 1-2 hr. Adult: As powd or 3.335 g/5 mL soln: 60-100 g (90-150 mL)
daily in 3 divided doses, adjust as necessary to produce 2-3
DOMPERIDONE soft stools daily.
Administration: May be taken with or without food. May be
taken w/ meals to reduce GI discomfort. Dilute w/ water,
Dosage Administration: Nausea and vomiting milk, or fruit juice to improve taste.
Adult: 10 mg tid. Max: 30 mg daily. Drug Interaction: Reduced effect w/ non-absorbable
Child: ≤12 yr <35 kg: 250 mcg/kg up to tid. Max: 750 mcg/kg antacids, neomycin and other oral anti-infectives.
daily; >12 yr ≥35 kg: Same as adult dose. Concomitant use w/ other laxatives may falsely suggest that
Gastrointestinal motility disorders adequate lactulose dosage has been achieved.
Adult: 10 mg tid. Max: 30 mg daily. MOA: Lactulose promotes peristalsis by producing an osmotic
Rectal effect in the colon w/ resultant distention. In hepatic
Nausea and vomiting encephalopathy, it reduces absorption of ammonium ions
Adult: 30 mg bid. and toxic nitrogenous compounds, resulting in reduced blood
Child: ≤12 yr >15 kg: 750 mcg/kg bid; >12 yr ≥35 kg: Same as ammonia concentrations.
adult dose. Onset: Constipation: Up to 24-48 hr. Hepatic encephalopathy:
Elderly: No dosage adjustment needed. At least 24-48 hr.

Administration: Should be taken on an empty stomach. Take STANDARDIZED SENNA CONCENTRATE

15-30 min before meals. (Senokot/(Forte))
Drug Interaction: May antagonise the hypoprolactinaemic
effect of bromocriptine. May antagonise the prokinetic effect
w/ opioid analgesics and antimuscarinics. Senokot: Each tablet contains 187 mg Standardized Senna
Potentially Fatal: Additive effect w/ other drugs which Concentrate equivalent to 8.6 mg Sennosides A and B.
prolong QT interval. Potent CYP3A4 inhibitors (e.g. Senokot Forte: Each tablet contains 374 mg Standardized
ketoconazole, erythromycin or ritonavir) may increase serum Senna Concentrate equivalent to 17.2 mg Sennosides A and
B.Dosage Admnistration: Senokot Adult 2 tab. Max: 4 tab bid.

4
Childn >60 lb 1 tab. Max: 2 tab bid. Senokot Forte Adult 1-2 associated ulceration 20 mg/day. GERD 20 mg once daily for
tab. Max: 2 tab bid. 4 wk, may continue for another 4-8 wk if needed. Refractory
Administration: May be taken with or without food: oesophagitis: 40 mg/day. Maintenance: 20 mg/day (after
Preferably taken at bedtime. healing of oesophagitis); 10 mg/day (acid reflux). Erosive
MOA: STANDARDIZED SENNA CONCENTRATE oesophagitis 20 mg daily for 4-8 wk. Maintenance: 20
(SENOKOT/SENOKOT FORTE) tablet are natural vegetable mg/day. Acid-related dyspepsia 10 or 20 mg/day 2-4 wk.
laxatives derived from the senna plant that has been Zollinger-Ellison syndrome Initial: 60 mg once daily. Dose
standardized for predictable results. The active components Range: 20-120 mg/day. All doses to be given once in the
responsible for its laxative effect in STANDARDIZED SENNA morning but doses >80 mg in 2 divided doses. Prophylaxis of
CONCENTRATE (SENOKOT/SENOKOT FORTE) are senna acid aspiration during general anaesth 40 mg in the evening
glycosides or sennosides. Glycosides are converted into and another 40 mg 2-6 hr pre-op. H.pylori infection 20 mg
aglycones through the enzymatic action of colonic bacteria, bid or 40 mg once daily w/ clarithromycin and either
which induce colonic peristalsis and bowel evacuation. This amoxicillin or metronidazole. IV Gastric and duodenal ulcers;
action is virtually colon-specific, since these compounds have NSAID-associated ulceration; GERD 40 mg once daily infused
little or no action in the stomach and small intestine. over 20-30 min or slow inj over 5 min until PO can be
resumed. Zollinger-Ellison syndrome Initial: 60 mg/day,
adjust if needed. Daily doses >60 mg/day should be given in 2
divided doses.
ANTACIDS, ANTIREFLUX AGENTS & Administration: Cap: Should be taken with food. Take
ANTIULCERANTS immediately before a meal.
Mups Tab: May be taken with or without food.
Powd For Oral Susp: Should be taken on an empty stomach.
SODIUM BICARBONATE Take at least 1 hr before a meal.
Delayed-Release Cap: Should be taken on an empty stomach.
Take at least 1 hr before meals. Swallow whole, do not
Relief of symptoms of hyperacidity (eg, belching, heartburn, chew/crush. For patients w/ difficulty swallowing, cap may be
acid indigestion, gas pains), gastritis & peptic ulcer. Urine carefully opened & entire contents sprinkled in a spoonful of
alkalinizer. applesauce. Swallow drug/food mixt w/o chewing
Dosage Admnistration: Adult 325-mg tab 3-6 tab qid. 650-mg immediately after prep. Drug/food mixt should not be stored
tab 2-4 tab tid. for future use.
Administration: Should be taken with food. Drug Interaction: Increased risk of hypomagnesaemia w/
diuretics. May increase INR and prothrombin time w/
warfarin. Increased risk of digoxin-induced cardiotoxic
CIMETIDINE effects. May increase plasma concentration benzodiazepines
(e.g. diazepam), clarithromycin and methotrexate. Decreased
absorption of itraconazole, ketoconazole, posaconazole,
Adult : PO Benign gastric and duodenal ulceration 800 mg dasatinib, iron salts. May prolong elimination of diazepam,
daily at bedtime or 400 mg bid for at least 4 wk (duodenal cilostazol, phenytoin and ciclosporin. May reduce the
ulcer), 6 wk (gastric ulcer) and 8 wk (NSAID-associated ulcer). antiplatelet effect of clopidogrel.
Maintenance: 400 mg daily at bedtime or bid. GERD 400 mg 4 Potentially Fatal: May decrease plasma concentrations and
times/day or 800 mg bid for 4-12 wk. Zollinger-Ellison pharmacological effects of rilpivirine, nelfinavir and
syndrome 300 or 400 mg 4 times/day. Prophylaxis of GI atazanavir.
haemorrhage from stress ulceration 200-400 mg 4-6 hrly. Food Interaction: Avoid concomitant St John's wort as it may
Prophylaxis of acid aspiration during general anaesth 400 decrease omeprazole levels.
mg 90-120 min before induction of anaesth up to 400 mg 4 MOA: Omeprazole is a substituted benzimidazole gastric
hrly if needed. Non-ulcer dyspepsia Max: 800 mg/day in antisecretory agent and is also known as PPI. It blocks the
divided doses. Prophylaxis of nocturnal heartburn 100 mg at final step in gastric acid secretion by specific inhibition of
bedtime. Short bowel syndrome Initial: 400 mg bid, adjusted H+/K+ ATPase enzyme system present on the secretory
according to response. Pancreatic insufficiency 800-1600 surface of the gastric parietal cell. Both basal and stimulated
mg/day in 4 divided doses. IV Benign gastric and duodenal acid are inhibited.
ulceration; Zollinger-Ellison syndrome Intermittent infusion: Onset: Approx 1 hr.
300 mg 6-8 hrly infused over 15-20 min. Max: 2400 mg/day. Duration: Up to 72 hr.
Continuous infusion: 37.5 mg/hr (900 mg/day). A 150 mg IV
loading dose may be given in patients requiring rapid
elevation of gastric pH. ALUMINUM HYDROXIDE + MAGNESIUM
Administration: Should be taken with food. HYDROXIDE (Antacid)
Drug Interaction: Reduces absorption of dasatinib,
ketoconazole, itraconazole and posaconazole. May increase
serum levels of phenytoin, theophylline, lidocaine, Dosage Administration: Gastrointestinal hyperacidity
hydroxyzine and oral anticoagulants. Absorption may be (Adult):
reduced by antacids. Decreased bioavailability w/ Chew 2-4 tab 4 times a day or as required. Max: 16 tab per 24
metoclopramide, sucralfate or propantheline. May potentiate hours.
the myelosuppressive effects (e.g. agranulocytosis, Child: ≥12 years Same as adult dose.
neutropenia) of myelosuppressive drugs (e.g. Drug Interaction: Interferes with the absorption of
antimetabolites, alkylating agents) or therapies (e.g. ciprofloxacin, chloroquine, hydroxychloroquine,
radiation). chlorpromazine, cefdinir, cefpodoxime, ketoconazole,
Food Interaction: Food delays the rate and slightly decreases levothyroxine, rifampicin, rosuvastatin, tetracyclines,
extent of absorption. May enhance gastric mucosal irritation vitamins. May reduce the effect of polystyrene sulphonate.
w/ alcohol. Decreased serum concentration of velpatasvir. Increased
MOA: Cimetidine competitively inhibits histamine at H2- absorption with citrate-containing preparations. May
receptors of the gastric parietal cells resulting in decreased decrease absorption of Fe salts.
gastric acid secretion, gastric volume and hydrogen ion Magnesium hydroxide: Increases the excretion of salicylates.
concentration. It is also used in patients w/ pancreatic MOA: Aluminium hydroxide is a slow-acting antacid that
insufficiency to reduce the breakdown of pancreatic enzyme binds phosphate in the gastrointestinal tract to form
supplements. insoluble complexes and reduces phosphate absorption. It
Onset: 1 hr. also acts as an astringent and may cause diarrhoea.
Duration: 4-5 hr. Magnesium hydroxide is a fast-acting antacid which
counteracts the constipating effect of aluminium hydroxide.
OMEPRAZOLE (Acifre, Losec, Prosec, Risek)

Dosage Administration: Adult : PO Peptic ulcer 20 or 40

mg/day in severe cases for 4 wk (duodenal ulcer) or 8 wk
(gastric ulcer). Maintenance: 10-20 mg/day. NSAID-

5
CALCIUM CARBONATE (CaCO3) once in the morning for up to 4 wk (duodenal ulcer) or up to
8 wk (gastric ulcer). H.pylori infection 30 mg bid, usually w/
clarithromycin and amoxicillin or metronidazole. NSAID-
Dosage Administration: Hyperphosphataemia in patients associated ulceration 30 mg once in the morning for 4-8 wk.
with chronic renal failure Prophylaxis of NSAID-induced ulcers 15-30 mg once in the
Adult: Initially, 2.5 g daily, given in divided doses, may morning. Zollinger-Ellison syndrome Initial: 60 mg once in the
increase up to 17 g daily in divided doses if needed. morning. Daily doses >120 mg should be given in 2 divided
Hyperacidity doses. IV Erosive oesophagitis 30 mg over 30 min for up to 7
Adult: Per tablet contains 500 mg calcium carbonate: Take 1- days.
2 tablets as needed, up to a max of 16 tablets/day. May suck Administration: Should be taken on an empty stomach. Take
or chew tablets. Pregnant women: 1-2 tablets as needed, up before meals.
to a max of 7 tablets in 24 hr. Drug Interaction: Increased risk of hypomagnesaemia w/
Administration: May be taken with or without food. Take w/ diuretics and digoxin. May decrease plasma concentration of
meals for better absorption. Avoid taking w/ large amount of erlotinib, dasatinib and lapatinib. May decrease the
fibre-rich food. bioavailability of itraconazole and ketoconazole. May increase
Drug Interaction: Co-administration with thiazide diuretics or plasma concentration of cilostazol and methotrexate.
vit D may lead to milk-alkali syndrome and hypercalcaemia. Reduced bioavailability w/ antacids and sucralfate.
Decreased absorption with corticosteroids. Decreases Potentially Fatal: May decrease serum levels and
absorption of tetracyclines, atenolol, iron, quinolones, pharmacological effects of rilpivirine and atazanavir.
alendronate, Na fluoride, Zn and calcium-channel blockers. Food Interaction: Avoid St John's wort as it may decrease the
Enhances cardiac effects of digitalis glycosides and may serum levels of lansoprazole.
precipitate digitalis intoxication. MOA: Lansoprazole is a substituted benzimidazole, and is also
Food Interaction: Absorption may be increased with food. known as PPI due to its property to block the final step of acid
Decreased absorption with bran, foods high in oxalates and secretion by inhibiting H+/K+ ATPase enzyme system in gastric
whole grain cereals. Calcium may reduce iron absorption. parietal cell. Both basal and stimulated acid are inhibited.
MOA: Calcium carbonate can neutralise gastric acid rapidly Onset: Oral: 1-3 hr.
and effectively. However, it may adversely activate Ca Duration: Oral: >1 day.
dependent processes, leading to secretion of gastric and
hydrochloric acid. It can induce rebound acid secretion and,
prolonged high doses may cause hypercalcemia, alkalosis and
milk-alkali syndrome.
REBAMIPIDE (Mucosta)

ESOMEPRAZOLE Dosage Administration: Gastritis, Peptic ulcer

Adult: 100 mg tid, in the morning, evening and before
bedtime.
Dosage Administration: Adult : PO Erosive oesophagitis 40 Administration: May be taken with or without food.
mg once daily for 4 wk, up to another 4 wk if needed. MOA: Description: Rebamipide is a mucosal protective agent
Maintenance: 20 mg once daily. GERD 40 mg once daily for 4 and is postulated to increase gastric blood flow,
wk, up to another 4 wk if needed. Maintenance or GERD w/o prostaglandin biosynthesis and decrease free oxygen radicals.
erosive oesophagitis: 20 mg once daily. Peptic ulcer 20 mg
bid for 7 days or 40 mg once daily for 10 days as triple
therapy w/ amoxicillin and clarithromycin. Prophylaxis of
NSAID-induced ulcers 20 or 40 mg/day. NSAID-associated RANITIDINE (Zantac)
ulceration 20 mg once daily for 4-8 wk. Zollinger-Ellison
syndrome Initial: 40 mg bid. Usual range: 80-160 mg/day.
Daily doses >80 mg should be given in 2 divided doses. IV Dosage Administration: PO Benign gastric and duodenal
GERD 20 or 40 mg by inj over at least 3 min or infusion over ulceration Initial: 300 mg at bedtime or 150 mg bid for 4-8
10-30 min once daily for ≤10 days until PO can be resumed. wk. Maintenance: 150 mg at bedtime. Max: 300 mg bid.
NSAID-associated ulceration 20 mg/day by inj over at least 3 NSAID-associated ulceration 150 mg bid or 300 mg at
min or infusion over 10-30 min until PO can be resumed. bedtime for 8-12 wk. Prophylaxis: 150 mg bid. H. Pylori
Gastric and duodenal ulcers 80 mg infusion over 30 min infection 300 mg at bedtime or 150 mg bid w/ amoxicillin and
followed by continuous infusion 8 mg/hr over 72 hr, until PO metronidazole for 2 wk. Continue w/ ranitidine for a further 2
can be resumed given as 40 mg once daily for 4 wk. wk. GERD 150 mg bid or 300 mg at bedtime for up to 8 wk.
Administration: Delayed-Release Cap: Should be taken on an Severe: 150 mg 4 times/day for 12 wk. Erosive oesophagitis
empty stomach. Take 1 hr before meals. 150 mg 4 times/day. Maintenance: 150 mg bid.
Tab: May be taken with or without food. Hypersecretory conditions Initial: 150 mg bid or tid. Max: 6
Drug Interaction: Increased risk of digoxin-induced g/day. Prophylaxis of acid aspiration during general anaesth
cardiotoxic effects. Increased risk of hypomagnesaemia w/ 150 mg 2 hr before induction of anaesth, and preferably a
diuretics. May increase INR and prothrombin time w/ dose of 150 mg on the previous evening. Chronic episodic
warfarin. May increase serum concentration of tacrolimus, dyspepsia 150 mg bid for up to 6 wk. Short-term
saquinavir, methotrexate. May interfere the elimination of symptomatic relief of dyspepsia 75 mg, up to 4 doses/day if
drugs metabolised by CYP2C19 (e.g. diazepam). May decrease needed. Max: 2 wk of continuous use at one time. IV
the bioavailability of ketoconazole, erlotinib and Fe salts. Hypersecretory conditions Initial: 1 mg/kg/hr, may increase
Potentially Fatal: May decrease serum concentration and by increments of 0.5 mg/kg/hr after 4 hr if needed.
pharmacological effects of rilpivirine, atazanavir and Administration: May be taken with or without food.
nelfinavir. May decrease the antiplatelet effects of Drug Interaction: Delayed absorption and increased peak
clopidogrel. serum concentration w/ propantheline bromide. Ranitidine
Food Interaction: Avoid St John's wort as it may decrease the minimally inhibits hepatic metabolism of coumarin
serum levels of esomeprazole. anticoagulants, theophylline, diazepam and propanolol. May
MOA: Esomeprazole is a PPI that suppresses gastric acid alter absorption of pH-dependent drugs (e.g. ketoconazole,
secretion by inhibiting H+/K+ ATPase in the gastric parietal midazolam, glipizide). May reduce bioavailability w/ antacids.
cell. It is the S-isomer of omeprazole. Food Interaction: May cause gastric mucosal irritation w/
Onset: W/in 1 hr. alcohol.
MOA: Ranitidine competitively blocks histamine at H2-
receptors of the gastric parietal cells which inhibits gastric
LANSOPRAZOLE acid secretion. It does not affect pepsin secretion,
pentagastrin-stimulated intrinsic factor secretion or serum
gastrin.
Dosage Administration: Adult : PO Acid-related dyspepsia
15-30 mg once in the morning for 2-4 wk. GERD 15-30 mg
once in the morning for 4-8 wk. Maintenance: 15-30 mg once
daily. Erosive oesophagitis 30 mg once in the morning for up
to 8 wk. Maintenance: 15 mg once daily. Peptic ulcer 30 mg

6
RABEPRAZOLE

Dosage Administration: PO GERD 20 mg/day for 4 wk.

Maintenance: 10 or 20 mg/day. Erosive oesophagitis 20
mg/day for 4-8 wk. May continue for up to 8 wk if needed.
Maintenance: 10 or 20 mg/day. Peptic ulcer disease 20
mg/day for 4-8 wk (duodenal ulcer) or 6-12 wk (gastric ulcer).
Zollinger-Ellison syndrome Initial: 60 mg/day up to max 120
mg/day if needed. All doses to be taken once in the morning
but daily doses >100 mg should be given in 2 divided doses.
H. pylori infection 20 mg bid w/ clarithromycin and either
amoxicillin or metronidazole for 1 wk.
Administration: Delayed-Release: May be taken with or
without food.
Drug Interaction: May decrease serum concentration of
ketoconazole, itraconazole and clopidogrel. Increased risk of
hypomagnesaemia w/ diuretics and digoxin. May increase
prothrombin time and INR of warfarin. May increase plasma
concentration of saquinavir and methotrexate. Decreased
serum levels w/ sucralfate.
Potentially Fatal: May decrease plasma concentrations and
pharmacological effects of rilpivirine and atazanavir.
Food Interaction: Avoid St John's wort as it may decrease the
serum levels of rabeprazole.
MOA: Rabeprazole is a PPI that suppresses gastric acid
secretion by inhibiting H+/K+ ATPase at the secretory surface
of the gastric parietal cell.
Onset: W/in 1 hr.
Duration: 24 hr.

PANTOPRAZOLE

Dosage Administration: PO GERD 20-40 mg for 4 wk, up to 8

wk if needed. Maintenance: 20-40 mg/day. Erosive
oesophagitis 20-40 mg for up to 16 wk if needed. Peptic ulcer
40 mg for 2-4 wk (duodenal ulcer) or 4-8 wk for (benign
gastric ulceration). Prophylaxis of NSAID-induced ulcers 20
mg. Zollinger-Ellison syndrome Initial: 80 mg. Max: 240
mg/day. Daily doses >80 mg should be given in 2 divided
doses. All doses to be taken once daily in the morning.
H.pylori infection 40 mg bid w/ clarithromycin and either
amoxicillin or metronidazole. IV Zollinger-Ellison syndrome
80 mg once or twice daily until PO can be resumed. Max: 240
mg/day in divided doses. GERD; Peptic ulcer 40 mg/day until
PO can be resumed.
Administration: Normal Release: May be taken with or
without food.
Controlled-Release: Should be taken on an empty stomach.
Take 1 hr before meals. Swallow whole, do not chew/crush.
Drug Interaction: Increased risk of digoxin-induced
cardiotoxic effects. Increased risk of hypomagnesaemia w/
diuretics. May increase INR and prothrombin time of
warfarin. May increase serum concentration of methotrexate
and saquinavir. Delayed absorption and decreased
bioavailability w/ sucralfate. Decreased absorption of
ketoconazole, itraconazole.
Potentially Fatal: May decrease serum levels and
pharmacological effects of rilpivirine, atazanavir and
nelfinavir.
MOA: Pantoprazole is a substituted benzimidazole, and also
known as PPI due to its property to block the final step of acid
secretion by inhibiting H+/K+ ATPase enzyme system in gastric
parietal cell. Both basal and stimulated acid are inhibited.
Duration: >24 hr.