Antihypertensive drugs

Antihypertensive drugs are medicines that help lower blood pressure in peoplewhose blood pressure is too high. Blood pressure is a measurement of the force with which blood moves through the body's system of blood vessels. Although everyone's blood pressure goes up and down in the course of a typical day,some people have blood pressure that stays high all the time.


This conditionis known as hypertension. Hypertension is not the same as nervous tension. People who have high blood pressure are not necessarily tense, high-strung, ornervous. They may not even be aware of their condition. Being aware of high blood pressure and doing something to control it are extremely important, however. Untreated, high blood pressure can lead to diseases of the heart and arteries, kidney damage, or stroke, and can shorten life expectancy.

Treatments for high blood pressure depend on the type of hypertension. Most cases of high blood pressure are called essential or primary hypertension, meaning that the high blood pressure is not caused by some other medical condition. For most people with primary hypertension, it is difficult to figure outthe exact cause of the problem. However, such hypertension usually can be controlled by some combination of antihypertensive drugs and changes in daily habits(such as diet, exercise, and weight control). Controlling primary hypertension is however a lifelong commitment. Although people may be able to reducethe amount of medicine they take as their blood pressure improves, they usually must continue taking it for the rest of their lives.

In people with secondary hypertension, the high blood pressure may be due tomedical problems such as kidney disease, narrowing of certain arteries, or tumors of the adrenal glands. Correcting these problems often cures the high blood pressure, and no further treatment is needed.

Many different types of drugs are used, alone or in combination with other drugs, to treat high blood pressure. The major categories are:

* Angiotensin-converting enzyme (ACE) inhibitors, such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril(Accupril), and ramipril (Altace). ACE inhibitors work by preventing a chemical in the blood, angiotensin I, from being converted into a substance that increases salt and water retention in the body. These drugs also make blood vessels relax, which further reduces blood pressure.
* Angiotensin II receptor antagonists, such as losartan (Cozaar) and losartan with hydrochlorothiazide (Hyzaar). These drugs act at a later step in the same process that ACE inhibitors affect. Like ACE inhibitors, they lower blood pressure by relaxingblood vessels.
* Beta blockers, such as atenolol (Tenormin), metoprolol(Lopressor), nadolol (Corgard), propranolol (Inderal), and timolol (Blocadren). Beta blockers affect the body's response to certain nerve impulses. This,in turn, decreases the force and rate of the heart's contractions, which lowers blood pressure.
* Blood vessel dilators (vasodilators), such as hydralazine (Apresoline) and minoxidil (Loniten). These drugs lower blood pressure by relaxing muscles in the blood vessel walls.
* Calcium channel blockers, such as amlopidine (Norvasc), diltiazem (Cardizem), isradipine (DynaCirc), nifedipine (Adalat, Procardia), and verapamil (Calan, Isoptin, Verelan).Drugs in this group slow the movement of calcium into the cells of blood vessels. This relaxes the blood vessels and lowers blood pressure.
* Diuretics, such as chlorthalidone (Hygroton), furosemide (Lasix), hydrochlorothiazide (Esidrix, HydroDIURIL), and metolazone (Zaroxolyn). These drugs control blood pressure by eliminating excess salt and water from the body.
* Nerve blockers, such as alpha methyldopa (Aldomet), clonidine (Catapres), guanabenz (Wytensin), guanadrel (Hylorel), guanethidine (Ismelin), prazosin(Minipress), rauwolfia derivatives (Reserpine), and terazosin (Hytrin). These drugs control nerve impulses along certain nerve pathways. This allows blood vesselsto relax and lowers blood pressure.

The recommended dosage depends on the type, strength, and form of antihypertensive drug. Check with the physician who prescribed the drug or the pharmacist who filled the prescription for the correct dosage. Always take antihypertensive drugs exactly as directed. Never take larger or more frequent doses, and do not miss any doses. Some antihypertensive drugs may take several weeks to noticeably lower blood pressure. Once it begins to work and symptoms improve, continuing to take the medicine is just as important. Stopping some hypertensive drugs suddenly may cause serious problems. Check with the physician who prescribed the medicine to find out if it is necessary to gradually taper down before stopping the medicine completely.

Antihypertensive drugs will not cure high blood pressure, but will help control the condition. To avoid the serious health problems that high blood pressure can cause, patients may have to take medicine for the rest of their lives.Furthermore, medicine alone may not be enough. People with high blood pressure also may need to avoid certain foods and keep their weight under control.The health care professional who is treating the condition can offer advice on what measures may be necessary.

Anyone taking antihypertensive drugs should not take any other prescription or over-the-counter medicine without first checking with his or her physician.Some medicines may increase blood pressure. Most patients who take antihypertensive drugs are not bothered by side effects. However, antihypertensive drugs may interact with many other medicines. When this happens, the effects ofone or both of the drugs may change or the risk of side effects may be greater. Anyone taking antihypertensive drugs should not take any other prescription or nonprescription (over-the-counter)medicine without first checking with his or her physician.

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WARFARIN

GENERIC NAME: warfarin
BRAND NAME: Coumadin

DRUG CLASS AND MECHANISM: Coumadin is an oral anticoagulant that inhibits the synthesis of clotting factors, thus preventing blood clot formation. Blood clots can occur in the veins of the lower extremities, usually after periods of immobility. These clots can break off and become lodged in the blood vessels of the lung (pulmonary embolism), causing shortness of breath, chest pain, and even life-threatening shock. Blood clots can also occur in the atria of the heart during atrial fibrillation, and around artificial heart valves. One of these clots can also break off and obstruct a blood vessel in the brain, causing an embolic stroke with paralysis. Coumadin is important in preventing the formation of blood clots. It is also important to prevent extension of clots already formed, and to minimize the risk of blood clot embolization to other vital organs such as the lungs and brain.

PRESCRIBED FOR: Coumadin is used in treating patients with blood clots in the lower extremities to prevent extension of the clot, and to reduce the risk of pulmonary embolism. Patients with pulmonary embolism are treated with Coumadin to prevent further blood clot emboli. Coumadin is also used in patients with atrial fibrillation and artificial heart valves to reduce the risk of strokes. It is also helpful in preventing blood clot formation in certain orthopedic surgeries such as knee or hip replacements. Coumadin is also used in preventing blood clot closure of coronary artery stents.

DOSING: Coumadin may be taken with or without food. Since Coumadin is metabolized by the liver and excreted by the kidneys, dosages need to be lowered in patients with liver and kidney dysfunction. Frequent blood tests are performed to measure blood clotting time (protime) during Coumadin treatment. Protime results help doctors adjust medication dose to avoid excessive blood thinning and risk of bleeding.

DRUG INTERACTIONS: Many drugs, both prescription and nonprescription (OTC), can affect the anticoagulant action of Coumadin. Some medications can enhance the action of Coumadin and cause excessive blood thinning and life-threatening bleeding. A few examples of such medications include Aspirin, acetaminophen (Tylenol and others), alcohol, ibuprofen (Motrin), cimetidine (Tagamet), oxandrolone (Oxandrin), certain vitamins, and antibiotics. Patients on Coumadin should regularly consult their doctor before instituting any medications on their own. It is also advisable for patients on Coumadin to carry identifications to alert other health professionals.

PREGNANCY: Coumadin should be avoided by pregnant women or women who may become pregnant. Birth defects and fetal bleeding have been reported.

SIDE EFFECTS: The two most serious side effects are bleeding and necrosis (gangrene) of the skin. Bleeding can occur in any organ or tissue. Bleeding around the brain can cause severe headache and paralysis. Bleeding in the joints can cause joint pain and swelling. Bleeding in the stomach or intestines can cause weakness, fainting spells, black tarry stools, vomiting of blood, or coffee ground material. Bleeding in the kidneys can cause back pain and blood in urine. Other side effects include purple, painful toes, rash, hair loss, bloating, diarrhea, and jaundice (yellowing of eyes and skin). Signs of overdose include bleeding gums, bruising, nosebleeds, heavy menstrual bleeding, and prolonged bleeding from cuts.

PRECAUTIONS: Before taking warfarin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This medication should not be used if you have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if you have: blood disorders (e.g., hemophilia), bleeding conditions (e.g., active ulcers), uncontrolled severe high blood pressure (malignant hypertension), recent or planned surgery, received certain procedures (e.g., spinal cord injections, major anesthesia). Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, kidney disease, alcohol abuse, tissue damage (e.g., gangrene, necrosis), trauma, high blood pressure, severe diabetes, congestive heart failure, cancer, collagen vascular disease (e.g., lupus, polyarteritis), radiation therapy, underactive or overactive thyroid, poor nutrition, intestinal absorption problems, low blood levels of vitamin K, swelling of the arms/legs (edema), high cholesterol/fat blood levels, catheters in your body (e.g., urinary or intravenous type), side effects with heparin treatment (heparin-induced thrombocytopenia), family members who did not respond to warfarin treatment, conditions that make it difficult to follow a warfarin treatment plan (e.g., dementia, psychosis). Avoid alcohol while taking this drug because it may increase the risk of stomach bleeding. Avoid getting injections into the muscles (intramuscular-IM). If they must be given, limit injections to the arms. The FDA has stated that generic warfarin products are interchangeable. However, consult your doctor and pharmacist before switching warfarin products. If you have an illness or infection that causes vomiting, diarrhea or fever for more than a few days, contact your doctor immediately because these conditions can affect how well this drug works. This medication can cause heavy bleeding. Be extra careful to avoid injuries (e.g., avoid contact sports). Use an electric razor when shaving and a soft toothbrush when brushing your teeth. It is important that all your doctors and dentists know you take warfarin. Caution is advised when using this drug in the elderly because they may be more sensitive to its effects. This medication must not be used during pregnancy because of possible fetal harm and birth defects. Discuss reliable forms of birth control with your doctor. If you become pregnant or think you may be pregnant, inform your doctor immediately. You will be switched over to another anticoagulant (e.g., heparin-type) during pregnancy. Consult your doctor for more information. This medication does not pass into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.
DRUG INTERACTIONS: This drug should not be used with the following medications because very serious interactions may occur: imatinib, mifepristone. If you are currently using any of these medications, tell your doctor or pharmacist before starting warfarin. Many drugs and herbal products interact with warfarin. Before using this medication, tell your doctor or pharmacist of all prescription and nonprescription/herbal products you may use, especially of: acetaminophen (repeated use or large doses), allopurinol, aminoglutethimide, amiodarone, anabolic steroids (e.g., danazol, stanozolol), certain injectable cephalosporin antibiotics (e.g., cefamandole, cefotetan), macrolide antibiotics (e.g., erythromycin, clarithromycin), certain oral and injectable penicillin-type antibiotics (e.g., dicloxacillin, piperacillin), quinolone antibiotics (e.g., ciprofloxacin, levofloxacin), certain other antibiotics (e.g., chloramphenicol, metronidazole), azole antifungals (e.g., voriconazole, vaginal miconazole), barbiturates (e.g., phenobarbital), birth control pills, certain drugs to treat cancer (e.g., capecitabine, fluorouracil), carbamazepine, drugs to lower cholesterol or triglycerides (e.g., cholestyramine, fenofibrate, gemfibrozil, lovastatin, simvastatin), cimetidine, corticosteroids (e.g., prednisone), disulfiram, glucagon, griseofulvin, herbal/dietary products (e.g., bromelains, co-enzyme Q, danshen, dong quai, garlic, ginkgo biloba, ginseng, St. John's wort), nonsteroidal anti-inflammatory drugs (NSAIDs such as celecoxib, ibuprofen, topical methylsalicylate), omeprazole, propafenone, propoxyphene, quinidine, quinine, rifamycins (e.g., rifampin, rifabutin), certain sedatives (e.g., chloral hydrate, ethchlorvynol, glutethimide), sulfa drugs, sulfinpyrazone, SSRI antidepressants (e.g., fluoxetine, fluvoxamine), tamoxifen, drugs to treat thyroid disease (e.g., levothyroxine, propylthiouracil), vitamin E, vitamin K, zafirlukast. Check all prescription and nonprescription medicine labels carefully since many contain pain relievers/fever reducers (NSAIDs such as ibuprofen, naproxen, or aspirin) which can increase the risk of bleeding/anti-platelet effect when used with warfarin. Low-dose aspirin, as prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention or to prevent clotting of artificial heart valves (usually these dosages are 81-325 mg per day), should be continued. Consult your doctor or pharmacist for more details. Related drugs (anti-platelet drugs such as clopidogrel, dipyridamole, ticlopidine) prescribed for specific medical reasons should be continued, unless otherwise directed by your doctor. Consult your doctor or pharmacist for more details including the possible serious side effects associated with ticlopidine (e.g., immune system problem, liver disease when used with warfarin). While taking warfarin, it is important to eat a normal, balanced diet. The amount of vitamin K in your body affects the way that warfarin works. It is best to avoid sudden changes in your diet, especially unusual increases or decreases in the amount of foods high in vitamin K (e.g., liver, broccoli, cauliflower, cabbage, Brussels sprouts, kale, spinach and other green leafy vegetables, green tea, and certain vitamin supplements). It is best to avoid strictly vegetarian diets that consist of foods high in vitamin K. This product can affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug.
OVERDOSE: If overdose is suspected, contact your local poison control center or emergency room immediately. US residents can call the US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly. Symptoms of overdose may include unusual or prolonged bleeding, dark urine or black stools.

NOTES: Do not share this medication with others. Laboratory and/or medical tests (e.g., blood tests such as PT/INR, complete blood count) should be performed periodically to monitor your progress or check for side effects. It is important to keep all lab and medical appointments. Consult your doctor or pharmacist for more details.

MISSED DOSE: If you miss a dose, use it as soon as you remember if it is on the same day. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up because this could increase your risk for bleeding. Keep a record of missed doses to give to your doctor or pharmacist. Call your doctor or pharmacist if you miss 2 or more doses in a row.

STORAGE: Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

MEDICAL ALERT: Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (USA), or 1-800-668-1507 (Canada).


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Multiple Sclerosis: Intrathecal Baclofen Pump

http://www.medicinenet.com

Baclofen is a medication commonly used to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements.

How Does Baclofen Work?

Normally muscles receive electrical signals via nerves to contract and relax. Spasticity is caused by an imbalance of electrical signals coming from the spinal cord through the nerves to the muscle. This imbalance causes the muscle to become hyperactive, resulting in involuntary spasms. Baclofen works by restoring the normal balance and reducing muscle hyperactivity. In this way, it allows for more normal muscle movement

What Are the Side Effects of Baclofen Therapy?

Side effects may include:

* dizziness
* Drowsiness
* Headaches
* Nausea
* Weakness

What Is Intrathecal Baclofen?

Baclofen can be taken orally as a pill or delivered directly into an area of the spine called the intrathecal space. The intrathecal space contains the cerebrospinal fluid -- the fluid surrounding the spinal cord and nerve roots. Often MS patients receive intrathecal Baclofen because oral Baclofen causes unpleasant side effects, such as confusion, weakness, and sleepiness. But intrathecal Baclofen delivers the drug right to the target site in the spinal cord. Since the medication does not circulate throughout the body, only tiny doses are required to be effective. Therefore, side effects are minimal.

What Is the Intrathecal Baclofen Pump System?

The intrathecal Baclofen pump system is the way doctors give the drug directly into the spinal fluid. The system consists of a catheter (a small, flexible tube) and a pump. The pump -- a round metal disc, about one inch thick and three inches in diameter -- is surgically placed under the skin of the abdomen near the waistline.

The pump stores and releases prescribed amounts of medicine through the catheter. The pump is refilled by inserting a needle through the skin into a filling port in the center of the pump. With a programmable pump, a tiny motor moves the medication from the pump reservoir through the catheter. Using an external programmer, your treatment team can make adjustments in the dose, rate, and timing of the medication.

People with the pump must return to their doctor's office for pump refills and medication adjustments, typically every 2-3 months. The pump is taken out and replaced at the end of the battery's life span (which is usually 5 to 7 years).

Who Is a Candidate for the Intrathecal Baclofen Pump?

Anyone who has spasticity that is not responsive to oral treatment is a candidate.

If you are considering intrathecal Baclofen therapy, you will generally meet with a treatment team that may include a doctor specialized in rehabilitation (physiatrist), a physical therapist , an occupational therapist , a nurse, and a social worker. All of these professionals work as a team to provide a comprehensive evaluation of your spasticity symptoms and to establish a treatment plan adapted to your personal needs.


What Are the Advantages of the Baclofen Pump System?

The Baclofen pump system:

* Efficiently reduces spasticity and involuntary spasms, promoting a more active lifestyle, better sleep, and reduced need for oral medications.
* Continuously delivers Baclofen in small doses directly to the spinal fluid, increasing the therapeutic benefits and causing fewer and less severe side effects than the oral medication.
* Can be individually adjusted to allow infusion rates that vary over a 24-hour period.
* Can be turned off when it isn't needed.
* Reduces or eliminates pain and discomfort from spasms and spasticity.

What Are the Disadvantages of the Baclofen Pump System?

There are certain risks that must be considered with any surgery. Risks include:

* An adverse reaction to anesthesia
* Infection
* Bleeding
* Bladder control can be altered, causing loss of urine unexpectedly
* Pump malfunction: If the pump malfunctions, it may deliver too much medicine at once. In that instance, you will develop symptoms such as drowsiness, dizziness, weakness, insomnia (difficulty falling and/or staying asleep), lightheadedness, nausea, constipation, vomiting, loose muscles, trouble with vision, coma, respiratory depression, seizures, dry mouth, double vision, decreased concentration, diarrhea, or delayed responsiveness. Should this occur, go to the nearest Emergency Department immediately. A doctor can give you a drug called Physostigmine to counteract Baclofen.
* Kinked catheter: If the catheter becomes "kinked," surgery may be necessary to replace the catheter.

How Will My Doctor Know If the Baclofen Pump System Is Right for Me?

If your treatment team recommends the Baclofen pump system after your evaluation, you will have a trial of the therapy to test the potential effectiveness of the medication.

During the medication trial, Baclofen is injected into the spinal canal (using a small needle) and the treatment team assesses its effectiveness over 2-4 hours. If your muscles don't relax during the first trial, a larger dose may be given on a later date to determine its effectiveness.

If you experience positive results with the intrathecal medication you can decide with your doctor and family members if you should have a Baclofen pump system implanted during a surgical procedure.

What Happens After the Procedure?

After the implantation procedure, you will stay in the hospital a few days so your recovery can be closely monitored. While you are in the hospital, the dose of Baclofen will be adjusted.


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Erythropoietin (Eprex®, NeoRecormon®, Aranesp®)

What is erythropoietin?

Erythropoietin is a type of protein that occurs naturally in the body. It can also be ade as a medicine. It stimulates the bone marrow to make red blood cells.

Erythropoietin can be given as a treatment for a low red blood cell count (anaemia), as an alternative to a blood transfusion|. Our red blood cells contain haemoglobin, which carries oxygen around the body. If your haemoglobin level falls too low after treatment with certain types of chemotherapy| or radiotherapy|, your doctor may recommend a course of erythropoietin.

There are two types of erythropoietin that work in similar ways. These are:

* epoetin (Binocrit®, Eprex®, NeoRecormon®, Dynepo® )
* darbepoetin (Aranesp®).


Why it is given

Towards the end of your treatment, particularly if you have had a lot of chemotherapy, your red blood cell count may fall. If you have too few red blood cells (anaemia), you will feel very tired| and may also be breathless|.

If you are anaemic, you will usually be treated with a blood transfusion. Erythropoietin is sometimes given as an alternative to a blood transfusion. It will help your red blood cell count to increase and can relieve the symptoms of anaemia. It takes about 2–3 weeks for the treatment to begin to raise your red blood cell level. You will have regular blood tests while you are having treatment with erythropoietin, to make sure that your red blood cell levels stay within a normal range.

What it looks like

Erythropoietin is a colourless fluid in a small glass bottle or a pre-filled syringe.

How it is given

Erythropoietin is normally given by an injection under the skin (subcutaneously), most often in the thigh or abdomen. It can be given from once a day, to one injection every three weeks, depending on the type of erythropoietin used and on advice from your doctor. You, or a person caring for you, can be taught how to give the injections so that you can continue the treatment at home, or it may be given by a district nurse or GP practice nurse.

Possible side effects

The amount of erythropoietin that occurs naturally in the body is very small. When erythropoietin injections are given, the amount in the body increases greatly. For this reason it causes side effects, even though it is a naturally occurring substance. The side effects are not usually severe however.

People react to drugs in different ways, so it is not possible to predict who is going to have side effects or which they will have. The most common side effects are listed below.

If you notice any effects which you think may be due to the drug, but which are not listed here, please discuss them with your doctor or nurse.

Flu-like symptoms Some people have flu-like symptoms, such as joint pains, weakness, dizziness and tiredness. These are more likely to occur at the start of your treatment. Your doctor may prescribe a painkiller, such as paracetamol, to help with these symptoms.

Headaches Some people may develop severe headaches, although this is rare. Let your nurse or doctor know if you develop this side effect.

High blood pressure can occur Your doctor will closely monitor your blood pressure while you are receiving erythropoietin. Let your doctor know if you take medication for high blood pressure.

Skin irritation may occur at the injection site This can be reduced by giving the injection in different places.

Skin rash You may develop a skin rash, which may be itchy.

Let your doctor or nurse know if you have any side effects.

Length of treatment

Erythropoietin can be given before anaemia develops to help prevent it occurring, or it can be started as soon as your anaemia has been diagnosed. The injections usually continue until one month after your chemotherapy course has finished, or until you are no longer anaemic.

Additional information

You may be given iron tablets or injections to help with production of new red blood cells.

Your erythropoietin should be stored in the fridge.

A number of trials| have looked at the benefits of using erythropoietin in the treatment of people with different types of cancer. The results from some of these trials have raised questions about its safety, and have suggested that sometimes erythropoietin may cause the cancer to grow in size. There is also concern that erythropoietin might increase the risk of developing a blood clot (thrombosis).

These results are being reviewed by the drug safety authorities. In the meantime there is no doubt that some people with cancer will definitely benefit from having erythropoietin, but the benefits and risks of its use should be carefully considered for each individual person.

Not all types of erythropoietin are suitable for Jehovah's Witnesses. Your doctor or pharmacist can give you further advice about this.
References Back To Top

This section has been compiled using information from a number of reliable sources including:

* Martindale: The Complete Drug Reference (35th edition). Sweetman et al. Pharmaceutical Press, 2006.
* British National Formulary (56th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2008.
* Erythropoetin (alpha and beta) and darbepoetin for the treatment of cancer-treatment induced anaemia - National Institute for Health and Clinical Excellence (NICE) 2008.

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CIPROBAY

Generic name: Ciprofloxacin
Product Brand Name: Ciprobay
Product Manufacturer: Bayer (Germany)

1. Description: Ciprobay is an antibiotic used to treat certain infections caused by bacteria, such as pneumonia; gonorrhea; infectious diarrhea; typhoid fever; inhalational anthrax (after exposure); and bone, joint, skin, and urinary tract infections. Antibiotics will not work for colds, flu, or other viral infections.
Cipro also is used to treat patients with cystic fibrosis who have lung infections. It also is used to treat some malignant ear infections and tuberculosis (TB). Cipro may be used with another medicine to treat disseminated Mycobacterium avium complex (MAC). Talk to your doctor about the possible risks of using this drug for your condition.
Cipro was approved by the U.S. Food and Drug Administration for use in patients who have been exposed to the inhaled form of anthrax.

2. Ciprobay is Prescribed for: Ciprois used to treat infections of the skin, lungs, airways, bones, and joints caused by susceptible bacteria. Cipro is also frequently used to treat urinary infections caused by bacteria such as E. coli. Cipro is effective in treating infectious diarrheas caused by E. coli, campylobacter jejuni, and shigella bacteria.

3. Drug Mechanism: Cipro is an antibiotic used to treat bacterial infections. Many common infections in humans are caused by single cell organisms, called bacteria. Bacteria can grow and multiply, infecting different parts of the body. Medicines that control and eradicate these bacteria are called antibiotics. Cipro works by interfering with an enzyme that allows bacteria to reproduce. This enzyme interference halts the growth of bacteria and eventually leads to death of the bacteria.

4. Dosage Form: Cipro may be taken with or without food. Cipro is partially metabolized by the liver and excreted by the kidney. Dosages require adjustment in patients with severely abnormal liver or kidney function. Antacids block the absorption of ciprofloxacin and they should not be taken together.

5. Drug Interactions: Cipro administered together with theophylline can lead to elevated blood levels of theophylline. Theophylline is used to open airways in the treatment of asthma. Toxic levels of theophylline can lead to seizures, and disturbances in heart rhythm. If concurrent use of ciprofloxacin and theophylline cannot be avoided, frequent blood tests to monitor theophylline blood levels are performed. Cipro should be used with caution in patients with central nervous system diseases such as seizures, because rare seizures have been reported in patients receiving this medication. Cipro should be avoided in children and adolescents under 18 years old, as safe use in these patients have not been established.
Many antibiotics, including Cipro, can alter the normal bacteria in the colon and encourage overgrowth of a bacteria responsible for the development of inflammation of the colon (pseudomembranous colitis). Pseudomembranous colitis can cause fever, abdominal pain, diarrhea, and sometimes even shock. Patients taking ciprofloxacin can develop sensitivity of the skin to direct sunlight. Cipro can enhance the action of the anticoagulant warfarin (Coumadin), and increase the risk of bleeding.

6. Pregnancy: Cipro should be avoided in pregnancy, as safe use in these patients have not been established.

7. Nursing Mothers: Cipro should be avoided in nursing mothers, as safe use in these patients have not been established.

8. Dietary and Alcohol Considerations: Do not take Cipro with dairy products such as milk or yogurt alone. If you have dairy products as part of a meal, you may take Cipro with the meal. Drink at least eight full glasses of water or other liquid every day. Do not drink or eat a lot of caffeine-containing products such as coffee, tea, cola, or chocolate. Cipro increases nervousness, sleeplessness, heart pounding, and anxiety caused by caffeine.

9. Uses: This medication is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for virus infections (e.g., common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness.

10. How to use: Read the Patient Information Leaflet provided by your pharmacist before you start using ciprofloxacin and each time you get a refill. If you have any questions, consult your doctor or pharmacist. This medication may be taken with or without food, usually twice a day in the morning and evening or as directed by your doctor. The dosage and length of treatment is based on your medical condition and response to treatment. Drink plenty of fluids while taking this medication unless your doctor tells you otherwise.
Take this medication 2 hours before or 6 hours after taking any medications or antacids containing magnesium, aluminum, or calcium. Some examples include quinapril, certain forms of didanosine (chewable/dispersible buffered tablets or pediatric oral solution), vitamins/minerals, antacids, dairy products (e.g., milk, yogurt), calcium-enriched juice, and sucralfate. Other products include bismuth subsalicylate, iron, and zinc. These medications/products bind with ciprofloxacin and prevent its full absorption. However, this medication may be taken with dairy products or calcium-enriched juice as part of a meal because food helps prevent this effect.
Ask your doctor or pharmacist about safely using nutritional supplements/replacements with this medication.
Antibiotics work best when the amount of medicine in your body is kept at a constant level. It is important not to miss a dose. To help you remember and to keep the drug at a constant level, take it at the same times every day. Continue to take this medication until the full prescribed amount is finished, even if symptoms disappear after a few days. Stopping the medication too early may allow bacteria to continue to grow, which may result in a return of the infection. Tell your doctor if your condition persists or worsens.

11. Possible Side Effects: The most frequent side effects include nausea, vomiting, diarrhea, abdominal pain, rash, headache, and restlessness. Rare allergic reactions have been described, such as hives and anaphylaxis (shock).

12. Storage: Keep this medication in the container it came in, tightly closed, and out of reach of children. Ciprofloxacin should be stored at below 30°C (86°F) and away from excess heat and moisture (not in the bathroom). Keep away from light. Talk to your pharmacist about the proper disposal of your medication. Throw away any medication that is outdated or no longer needed.

13. Package Size and Type: Tablets: 250mg, 500mg. Tablets Ciprobay.

Before starting to take this medicine, it is vital that you should consult your doctor! Do not use it on your own initiative, without medical advice.




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Betaferon (interferon beta-1b)

Main use : Multiple sclerosis
Active ingredient : Interferon beta-1b

How does it work?

Betaferon injection contains the active ingredient interferon beta-1b, which is a type of medicine called an immunomodulator.
Interferons are a family of small protein molecules that are produced by cells in response to viral infections or various synthetic and biological inducers. Three major classes of interferons have been identified: alfa, beta and gamma. They work in a complicated way that is not fully understood, but are thought to boost the immune system, causing it to attack infected or abnormal cells.
Interferon beta is used to treat multiple sclerosis (MS). In some people, this disease follows a course of relapse and remission, where symptoms worsen for a while, then improve before worsening again. It is these people who can benefit from interferon beta. The medicine helps to reduce the frequency and severity of the relapses. It is not fully understood how interferon beta works in MS, because the disease and its cause are not fully understood.

Betaferon is given by injection under the skin (subcutaneously) every other day.

Interferon beta is not effective in all people with multiple sclerosis and, because it can have significant side effects, it is recommended that all patients are assessed by a neurologist before starting treatment.

It is not known how long treatment should be continued for. However, it is recommended that patients should be clinically evaluated after two years of treatment. You may develop neutralising antibodies to this medicine that make it less effective. The medicine should be stopped if your MS becomes progressively worse despite treatment.
What is it used for?

* Relapsing/remitting multiple sclerosis (characterised by at least two relapses over the previous two years, in people who are able to walk unaided).
* Secondary progressive multiple sclerosis in people with active disease evidenced by relapses.
* Treatment of patients who have experienced a single multiple sclerosis-like attack, severe enough to need treatment with intravenous corticosteroids, if alternative diagnoses have been excluded and they are at high risk of developing clinically definite multiple sclerosis.

Warning!

* Treatment with this medicine should only be started by a specialist in multiple sclerosis.
* Carefully follow the instructions provided with your injections. Some people have experienced skin reactions at the injection site that can result in scarring. To minimise the risk of this, a different injection site should be used each time you inject. Using an autoinjector can also reduce the risk of skin reactions. Ask your doctor about this. If you experience any break in your skin, which may be associated with swelling or drainage of fluid from the injection site, you should consult your doctor before administering any more injections. If you get more than one such skin lesion you may need to stop treatment until they have healed.
* This medicine can cause flu-like symptoms such as aches and pains, fever, chills, sweating or headache. These tend to be worse at the start of treatment and improve with continued treatment. You may want to take a medicine to reduce these symptoms, for example, aspirin or ibuprofen. Ask your doctor or pharmacist for advice.
* This medicine has been associated with depression that can occur at any time during treatment. You should discuss this with your doctor before starting treatment. It is important to talk to your doctor immediately if you have any distressing thoughts or feelings, thoughts about suicide or self-harm, mood changes, or any other unusual change in behaviour while having treatment with this medicine. It may be necessary to stop treatment.
* This medicine has rarely been associated with liver problems. Symptoms that could indicate liver problems include unexplained itching, nausea and vomiting, abdominal pain; loss of appetite or flu-like symptoms; yellowing of the skin or eyes (jaundice); or unusually dark urine. Tell your doctor if you experience any of these symptoms during treatment with this medicine.
* This medicine may rarely decrease the number of blood cells in your blood. Tell your doctor immediately if you experience any of the following symptoms during your treatment, as they may indicate problems with your blood cells: unexplained bruising or bleeding, purple spots, sore mouth or throat, mouth ulcers, high temperature (fever) or other signs of infection, or suddenly feeling tired, breathless, or generally unwell.
* During treatment with this medicine you should have regular blood tests to monitor your liver function and the levels of blood cells in your blood.
* Betaferon contains human albumin and hence carries a potential risk for transmission of viral diseases. A risk for transmission of Creutzfeld-Jacob disease (CJD) cannot be excluded.

Use with caution in

* Rare disorder of the immune system in which abnormal proteins are found in the blood (monoclonal gammopathy)
* History of depression
* History of seizure disorders, eg due to brain injury or epilepsy
* Heart disease, such as angina, heart failure or irregular heartbeats (arrhythmias)
* History of an overactive or underactive thyroid gland
* Decreased blood cell production by the bone marrow, causing lower than normal levels of blood cells in the blood
* Severely decreased kidney function
* Severely decreased liver function
* History of liver disease
* History of alcohol abuse
* History of inflammation of the pancreas (pancreatitis)
* History of raised levels of fats called triglycerides in the blood.

Not to be used in

* Children and adolescents under 18 years of age
* People with severe depression or thoughts of suicide
* Uncontrolled epilepsy
* Untreated liver disease
* Pregnancy
* Breastfeeding.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

* This medicine should not be used during pregnancy, because it may be harmful to the developing foetus and may increase the risk of miscarriage. Women who could get pregnant should use an effective method of contraception to prevent pregnancy while having treatment with this medicine. If you get pregnant during treatment or want to try for a baby you should consult your doctor immediately for medical advice.
* It is not known if this medicine passes into breast milk. The manufacturer states that it should not be used during breastfeeding. Alternatively, breastfeeding can be stopped. This decision will depend on the importance of the medicine to the mother. Seek medical advice from your doctor.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Because a side effect is stated here, it does not mean that all people using this medicine will experience that or any side effect.

* Flu-like symptoms such as aches and pains, fever, chills, sweating and headache. These tend to be worse at the start of treatment and improve with continued treatment.
* Injection site reactions such as pain, redness, swelling, skin discolouration or breakdown of cells (necrosis)
* Disturbance in the normal numbers of blood cells in the blood
* Temporary weakness or rigidity of muscles after the injection that may prevent voluntary movements
* Pain in the muscles or back
* Depression
* Dizziness
* Difficulty in sleeping (insomnia)
* Gut disturbances, such as diarrhoea, constipation, nausea, vomiting, abdominal pain
* Rash or itching
* Hair loss (alopecia)
* Increased blood pressure
* Chest pain
* Loss of appetite
* Heavy or irregular menstrual bleeding
* Under or overactive thyroid
* Anxiety
* Confusion
* Seizures (convulsions)
* Inflammation of the liver (hepatitis)

The side effects listed above may not include all of the side effects reported by the drug's manufacturer.For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while using this one, to ensure that the combination is safe.

No formal interaction studies have been conducted with this medicine.

The manufacturer states that using this medicine in combination with other immunomodulating drugs, for example glatiramer, is not recommended due to lack of clinical experience.

There may be an increased risk of side effects on the liver or blood cells if other medicines that can affect the liver or blood cells are used in combination with this one.

This medicine may increase the blood level of the following medicines:

* antiepileptic medicines
* certain antidepressants
* zidovudine.

Other medicines containing the same active ingredient

There are currently no other medicines available in the UK that contain interferon beta-1b.

Avonex and Rebif contain interferon beta-1a.
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