metoclopramide

What is metoclopramide?
Metoclopramide increases muscle contractions in the upper digestive tract. This speeds up the rate at which the stomach empties into the intestines.
Metoclopramide is used short-term to treat heartburn caused by gastroesophageal reflux in people who have used other medications without relief of symptoms.
Metoclopramide is also used to treat slow gastric emptying in people with diabetes (also called diabetic gastroparesis), which can cause nausea, vomiting, heartburn, loss of appetite, and a feeling of fullness after meals.

Important information about metoclopramide

NEVER TAKE METOCLOPRAMIDE IN LARGER AMOUNTS THAN RECOMMENDED, OR FOR LONGER THAN 12 WEEKS. High doses or long-term use of metoclopramide can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements. The longer you take metoclopramide, the more likely you are to develop a serious movement disorder. The risk of this side effect is higher in women, diabetics, and older adults.

Before taking metoclopramide

You should not take this medication if you are allergic to metoclopramide, or if you have:

• bleeding or blockage in your stomach or intestines;
• a perforation (hole) in your stomach or intestines;
• epilepsy or other seizure disorder; or
• an adrenal gland tumor (pheochromocytoma).

To make sure you can safely take metoclopramide, tell your doctor if you have any of these other conditions:

• kidney disease;
• liver disease (especially cirrhosis);
• congestive heart failure;
• high blood pressure;
• Parkinson's disease;
• diabetes (your insulin dose may need adjusting); or
• a history of depression.

FDA pregnancy category B. Metoclopramide is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Metoclopramide can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Metoclopramide should not be given to a child.

Avastin

What is Avastin ?
Avastin (bevacizumab) is a cancer medicine that interferes with the growth of cancer cells and slows their growth and spread in the body.
Avastin is used to treat a certain type of brain tumor, and certain types of cancers of the kidney, lung, colon and rectum. It is usually given as part of a combination of cancer medicines.
Avastin may also be used for purposes not listed in this medication guide.

Important information about Avastin

Treatment with Avastin may cause you to have problems with wound healing, which could result in bleeding or infection. If you need to have any type of surgery, you will need to stop receiving Avastin at least 4 weeks ahead of time. Do not start using Avastin for at least 4 weeks after surgery, or until your surgical incision heals.
Before being treated with Avastin, tell your doctor if you have a bleeding or blood-clotting disorder, heart disease, congestive heart failure, high blood pressure, or a history of heart attack, stroke, blood clots, or stomach or intestinal bleeding (including perforation).Some people receiving a Avastin injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel dizzy, nauseated, light-headed, sweaty, itchy, or have a fast heartbeat, chills, wheezing, or chest pain during the injection

Before receiving Avastin

You should not use Avastin if you are allergic to bevacizumab, or if you have:

• untreated or uncontrolled high blood pressure;
• severe or uncontrolled bleeding;
• an open skin wound;
• an open surgical incision;
• if you have had surgery within the past 4 weeks (28 days);
• if you have recently been coughing up blood; or
• if you plan to have surgery within the next 4 weeks (28 days).

To make sure you can safely receive Avastin, tell your doctor if you have any of these other conditions:

• a bleeding or blood-clotting disorder;
• a history of stomach or intestinal bleeding;
• a history of perforation (a hole or tear) in your esophagus, stomach, or intestines;
• heart disease, congestive heart failure;
• high blood pressure; or
• a history of heart attack, stroke, or blood clots.

FDA pregnancy category C. It is not known whether Avastin will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using bevacizumab. Avastin may cause a woman's ovaries to stop working correctly. Symptoms of ovarian failure include 3 or more missed menstrual periods in a row. This may affect your fertility (ability to have children). Talk to your doctor about your specific risks. It is not known whether bevacizumab passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are being treated with Avastin. Older adults may be more likely to have side effects from Avastin

   

metronidazole

GENERIC NAME: metronidazole

BRAND NAME: Flagyl

DRUG CLASS AND MECHANISM: Metronidazole is an antibiotic effective against anaerobic bacteria and certain parasites. Anaerobic bacteria are single-celled, living organisms that thrive in environments in which there is little oxygen (anaerobic environments) and can cause disease in the abdomen (bacterial peritonitis), liver (liver abscess), and pelvis (abscess of the ovaries and the Fallopian tubes). Giardia lamblia and ameba are intestinal parasites that can cause abdominal pain and diarrhea in infected individuals. Trichomonas is a vaginal parasite that causes inflammation of the vagina (vaginitis). Metronidazole selectively blocks some of the functions within the bacterial cells and the parasites resulting in their death.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS:

• Tablets: 250 and 500 mg.
• Tablets, extended release: 750 mg.
• Capsule: 375 mg.
• Cream: 0.75% and 1%.
• Lotion: 0.75%.
• Gel: 0.75%
• 1%. Injection: 5 mg/ml

STORA PRESCRIBED FOR: Metronidazole is used to treat parasitic infections including Giardia infections of the small intestine, amebic liver abscess, and amebic dysentery (infection of the colon causing bloody diarrhea), bacterial vaginosis, trichomonas vaginal infections, and carriers of trichomonas (both sexual partners) who do not have symptoms of infection. Metronidazole is also used alone or in combination with other antibiotics in treating abscesses in the liver, pelvis, abdomen, and brain caused by susceptible anaerobic bacteria. Metronidazole is also used in treating infection of the colon caused by a bacterium called C. difficile. (Many commonly-used antibiotics can




Alter the type of bacteria that inhabit the colon. C. difficile is an anaerobic bacterium that can infect the colon when the normal types of bacteria in the colon are inhibited by common antibiotics. This leads to inflammation of the colon (pseudomembranous colitis) with severe diarrhea and abdominal pain.) Metronidazole also is used in combination with other drugs to treat Helicobacter pylori (H. pylori) that causes stomach or intestinal ulcers. Metronidazole topical gel is used for treating acne rosacea, and the vaginal gel is used for treating bacterial vaginosis.
DOSING: Metronidazole may be taken orally with or without food. In the hospital, metronidazole can be administered intravenously to treat serious infections. The liver is primarily responsible for eliminating metronidazole from the body, and doses may need to be reduced in patients with liver disease and abnormal liver function.
Various metronidazole regimens are used. Some examples are listed below.

• Amebic dysentery: 750 mg orally 3 times daily for 5-10 days
• Amebic liver abscess: 500-750 mg orally three times daily for 5-10 days
• Anaerobic infections: 7.5 mg/kg orally every 6 hours not to exceed 4 grams daily
• Bacterial Vaginosis: 750 mg (extended release tablets) once daily for 7 days. One applicator-full of 0.75% vaginal gel, once or twice daily for 5 days.
• Clostridium difficile infection: 250-500 mg orally 4 times daily or 500-750 orally 3 times daily
• Giardia: 250 mg orally three times daily for 5 days

 GE: Metronidazole should be stored at room temperature and protected from light.

Before taking metronidazole

Before taking metronidazole make sure your doctor or pharmacist knows:

• If you have liver problems or are on kidney dialysis.
• If you are pregnant, trying for a baby or breast-feeding.
• If you have a dependency on alcohol.
• If you suffer from the rare blood disorder called porphyria.
• If you are taking other medicines, including those available to buy without a prescription, herbal and complementary medicines.
• If you have ever had an allergic reaction to this or any other medicine.

How to take metronidazole

• Before starting this treatment, read the manufacturer's printed information leaflet.
• Take metronidazole exactly as directed by your doctor or dentist.
• You must take metronidazole at regular intervals and complete the course you have been given, even if you feel well.
• Take the tablets with a glass of water, with or just after food. Swallow the tablets whole - do not crush or chew them.

If you forget to take a dose, take it as soon as you remember unless it is nearly time for your next dose, in which case leave out the missed dose. Do not take two doses together to make up for a missed dose.

Lansoprazole

Lansoprazole

Lansoprazole: is a proton-pump inhibitor (PPI) which prevents the stomach from producing gastric acid. It is manufactured by a number of companies worldwide under several brand names (some brand names include: Prevacid, Helicid, Zoton, Inhibitol, Monolitum). It was first approved by the U.S. Food and Drug Administration (FDA) in 1995^.

Lansoprazole is a proton-pump inhibitor (PPI) in the same pharmacologic class as omeprazole. Lansoprazole has been marketed for many years and is one of several PPIs available. Lansoprazole is a racemate [1:1-mixture of the enantiomers dexlansoprazole (Kapidex) and levolansoprazole]. Dexlanprantazole is an enantiomerically pure active ingredient of a commercial drug as a result of the 'enantiomeric shift'.

Side effects

·                    Infrequent: dry mouth, insomnia, drowsiness, blurred vision, rash, pruritus

·                    Rarely and very rarely: taste disturbance, liver dysfunction, peripheral oedema, hypersensitivity reactions (including bronchospasm, urinary, angioedema, anaphylaxis), photosensitivity, fever, sweating, depression, interstitial nephritis, blood disorders (including leukopenia, leukocytosis, pancytopenia, thrombocytopenia), arthralgia, myalgia, skin reactions including (erythroderma Stevens–Johnson syndrome, toxic epidermal necrolysis, bullous eruption)

·                    Severe: Gastro-intestinal disturbances (such as nausea 1.3%, abdominal pain 2.1%, diarrhea 3.8%).

Proton-pump inhibitors may be associated with a greater risk of hip fractures, Clostridium difficile-associated diarrhea. Patients are frequently administered the drugs in intensive care as a protective measure against ulcers, but this use is also associated with a 30% increase in occurrence of pneumonia.



The drug is sold under several brand names, including:
Brand names

·                    Agopton (Germany)

·                    Digest (Indonesia)

·                    Duogast (Syria)

·                    Gastrolan (Indonesia)

·                    Lanciprol (Greece)

·                    Lansazol (Jordan)

·                    Lansobene (Austria)

·                    Lansoloc (South Africa)

·                    Lansoprazol (Denmark)

·                    Lansoptol (Hungary)

·                    Lansor (Turkey)

·                    Lansox (Italy)

·                    Lanston LFDT (South Korea)

·                    Lenzo (India)

·                    Lanzol (India, Ireland)

·                    Lanzotec (Jordan)

·                    Lanzul (Slovenia)

·                    Lanton (Israel)

·                    Lanzo (Sweden)

·                    Lanzor (France, South Africa)

·                    Lanzostad (Lithuania, Latvia, Estonia)

·                    Laprazol (Greece)

·                    Limpidex (Italy)

·                    Monolitum (Spain)

·                    Ogast and OgastORO (France)

·                    Ogastro (Mexico)

·                    Prevacid (U.S. and Canada)

·                    Prosogan and Prosogan FD (Indonesia)

·                    pro-ulco (Spain)

·                    Refluxon (Hungary)

·                    Sabax (Serbia)

·                    SOLOX (New Zealand)

·                    Takepron (Japan)

·                    Zolt (Finland)

Naproxen sodium

Naproxen sodium  is a nonsteroidal anti-inflammatory drug (NSAID) commonly used for the reduction of pain, fever, inflammation and stiffness caused by conditions such as:

osteoarthritis kidney stones rheumatoid arthritis psoriatic arthritis

gout ankylosing spondylitis menstrual cramps tendinitis bursitis

It is also used for the treatment of primary dysmenorrhea. It works by inhibiting both the COX-1 and COX-2 enzymes. Naproxen and naproxen sodium are marketed under various trade names, including: Aleve, Anaprox, Antalgin, Feminax Ultra, Flanax, Inza, Midol Extended Relief, Nalgesin, Naposin, Naprelan, Naprogesic, Naprosyn, Narocin, Proxen, Synflex and Xenobid.

Naproxen was originally marketed as the prescription drug Naprosyn by Syntex in 1976, and naproxen sodium was first marketed under the trade name Anaprox in 1980. It remains a prescription-only drug in much of the world. In the United States, the Food and Drug Administration (FDA) approved its use as an over-the-counter (OTC) drug in 1994; OTC preparations in the U.S. are mainly marketed by Bayer HealthCare under the trade name Aleve and generic store brand formulations. In Australia, packets of 275 mg tablets of naproxen sodium are Schedule 2 pharmacy medicines, with a maximum daily dose of 5 tablets or 1375 mg. In the United Kingdom, 250 mg tablets of naproxen were approved for OTC sale under the brand name Feminax Ultra in 2008, for the treatment of primary dysmenorrhoea in women aged 15 to 50. Aleve became available over-the-counter in most provinces in Canada on 14 July 2009, it became available in Quebec during the summer of 2010 but can only be dispensed by a pharmacy employee after an assessment of the patient's needs. It most recently became available in British Columbia in March 2011.

Risks and adverse effects

COX-2 selective and non-selective NSAIDs have been linked to increases in the number of serious and potentially fatal cardiovascular events such as myocardial infarctions and stroke. A 2011 meta-analysis published in the British Medical Journal states that, of all NSAIDs evaluated, naproxen was associated with the smallest overall cardiovascular risks.The drug had roughly 50% of the associated risk of stroke as compared with ibuprofen and was also associated with a reduced number of myocardial infarctions as compared to control groups.
NSAID Painkillers, such as Naproxen, may interfere and reduce efficiency of SSRI antidepressants.

Structure and details

Naproxen is a member of the 2-arylpropionic acid (profen) family of NSAIDs. The free acid is an odorless, white to off-white crystalline substance. It is lipid-soluble and practically insoluble in water. It has a melting point of 152-154 °C.

Ibuprofen

Ibuprofen is known to have an antiplatelet effect, though it is relatively mild and somewhat short-lived when compared with aspirin or other better-known antiplatelet drugs. In general, ibuprofen also acts as a vasodilator, having been shown to dilate coronary arteries and some other blood vessels. Ibuprofen is a core medicine in the World Health Organization's "WHO Model List of Essential Medicines", which is a list of minimum medical needs for a basic healthcare system.
Ibuprofen was derived from propionic acid by the research arm of Boots Group during the 1960s.^[6] It was discovered by Andrew RM Dunlop, with colleagues Stewart Adams, John Nicholson, Vonleigh Simmons, Jeff Wilson and Colin Burrows, and was patented in 1961. Originally marketed as Brufen, ibuprofen is available under a variety of popular trademarks, including Motrin, Nurofen, Advil, and Nuprin.

Important information about ibuprofen

Ibuprofen may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term. Do not use ibuprofen just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
Get emergency medical help if you have chest pain, weakness, shortness of breath, slurred speech, or problems with vision or balance.
This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking ibuprofen, especially in older adults.
Call your doctor at once if you have symptoms of stomach bleeding such as black, bloody, or tarry stools, or coughing up blood or vomit that looks like coffee grounds.
Do not take more of this medication than is recommended. An overdose of ibuprofen can cause damage to your stomach or intestines. Use only the smallest amount of ibuprofen needed to get relief from your pain, swelling, or fever.

Before taking ibuprofen

Do not use ibuprofen just before or after heart bypass surgery (coronary artery bypass graft, or CABG).
This medicine may cause life-threatening heart or circulation problems such as heart attack or stroke, especially if you use it long term.
This medicine may also cause serious effects on the stomach or intestines, including bleeding or perforation (forming of a hole). These conditions can be fatal and can occur without warning while you are taking ibuprofen, especially in older adults.
You should not use this medication if you are allergic to ibuprofen, aspirin or other NSAIDs.
Ask a doctor or pharmacist if it is safe for you to take this medication if you have:

• a history of heart attack, stroke, or blood clot;
• heart disease, congestive heart failure, high blood pressure;
• a history of stomach ulcers or bleeding;
• asthma;
• polyps in your nose;
• liver or kidney disease;
• systemic lupus erythematosus (SLE);
• a bleeding or blood clotting disorder; or
• if you smoke.

FDA pregnancy category D. Taking ibuprofen during the last 3 months of pregnancy may harm the unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using ibuprofen. It is not known whether ibuprofen passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medicine to a child without the advice of a doctor

Ranitidine

Ranitidine (trade name Zantac) is a histamine H₂-receptor antagonist that inhibits stomach acid production. It is commonly used in treatment of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD). Ranitidine is also used alongside fexofenadine and other antihistamines for the treatment of skin conditions such as hives. Ranitidine is also known to give false positives for methamphetamine on drug tests.^[1]

Medical use

^{Certain preparations of ranitidine are not available over the counter (OTC) in various countries. In the United States, 75 mg and 150 mg tablets are available OTC. Zantac OTC is manufactured by Boehringer Ingelheim. In Australia, packs containing 7 or 14 doses of the 150 mg tablet are available in supermarkets, small packs of 150 mg and 300 mg tablets are Schedule 2 Pharmacy Medicines. Larger doses and pack sizes still require a prescription.
Outside the United States and Canada, ranitidine is combined with bismuth (which acts as a mild antibiotic) as a citrate salt (ranitidine bismuth citrate, Tritec), to treat Helicobacter pylori infections. This combination is usually given with clarithromycin, an antibiotic.
Ranitidine's main role is in treating gastric and duodenal ulcers and gastroesophageal reflux disease. It is also used to treat pediatric reflux, where it is preferred over a PPI, because it does not induce histologically relevant hyperplastic changes in the parietal cells. Liquid formulations are available for administering to children.
Ranitidine can also be co-administered with NSAIDs to reduce the risk of ulceration. Proton pump inhibitors are more effective for the prevention of NSAID-induced ulcers.[2]
Ranitidine can be administered preoperatively to reduce the risk of aspiration pneumonia. The drug not only increases gastric pH, but also reduces the total output of gastric juice. Ranitidine may have an antiemetic effect when administered preoperatively.
It can be administered IV in intensive care units to critically ill patients (particularly geriatric ones) to reduce the risk of gastric bleeding.
The usual dose of ranitidine is either 150 mg twice a day or 300 mg once every twenty four hours, usually at night. For ulcer treatment, a 300 mg nighttime dose is especially important - as the increase in gastric/duodenal pH promotes healing overnight when the stomach and duodenum are empty. Conversely, for treating reflux, smaller and more frequent doses are more effective.
Ranitidine used to be administered long term for reflux treatment, sometimes indefinitely. However, PPIs have taken over this role.}

^{In some patients with severe reflux, up to 600 mg of ranitidine can be administered daily, usually in 4 lots of 150 mg. Such a high dose was not unusual in the past, but nowadays a once-a-day PPI is used instead - both for convenience and because they are more effective in raising gastric pH. Patients with Zollinger-Ellison syndrome have been given doses of 6000 mg per day without any harm.}