augmentin

Written by Dr. Zohaib Tahir [Pharm-D, Gomal University, Dera Ismail Khan, Pakistan]

Brand Name

• Augmentin

Generic Name

• Amoxicillin and Clavulanate Potassium

Available Dosage Forms & Their Doses

• Tablets:

• 250 mg/125 mg = 375mg

• 500 mg/125 mg = 625mg

• 875 mg/125 mg = 1g

• Chewable Tablets:

• 125 mg/31.25 mg

• 200 mg/28.5 mg

• 250 mg/62.5 mg

• 400 mg/57 mg

• Oral Suspensions:

• 156 mg/5 mL

• 312.5 mg/5 mL

• 457 mg/5 mL

• Drops:

• 62.5mg/mL

• Injection:

• 1.2g

• 600mg

Prices & Packing Size:

• Drop 62.5 mg/mL: 20 mL: Rs. 170.71

• Inj 1.2 gm: 10 Vial (011523): Rs. 1802.0

• Inj 1.2 gm: Vial (011523): Rs. 180.2

• Inj 600 mg: 10 Vial (010338): Rs. 1035.4

• Inj 600 mg: Vial (010338): Rs. 104.0

• Susp 156.25 mg/5 mL: 60 mL (009264): Rs. 70.0

• Susp 156.25 mg/5 mL: 90 mL (009264): Rs. 368.08

• Susp 312.5 mg/5 mL: 60 mL (018360): Rs. 131.0

• Susp 312.5 mg/5 mL: 90 mL (018360): Rs. 540.0

• Susp 457 mg/5 mL: 35 mL: Rs. 200.13

• Susp 457 mg/5 mL: 70 mL: Rs. 404.29

• Tab 1 gm: 6's (022244): Rs. 362.54

• Tab 375 mg: 6's (006747): Rs. 220.46

• Tab 625 mg: 2x3's (017297): Rs. 278.82

• Tab BD 1 gm: 2x3's (022244): Rs. 339.0

• Tab Blister 1 gm: 2x6's (022244): Rs. 664.08

• Tab Blister 375 mg: 6's (006747): Rs. 268.92

• Tab BL 375 mg: 18's (006747): Rs. 723.82

• Tab BL 625 mg: 12's (017297): Rs. 510.79

Therapeutic Class

• Antibacterial Agent/Antibiotics

Pharmacological Class

• Beta-lactam Antibiotic + Beta-lactamase Inhibitor

Manufacturer

• Manufacturer: Dr. Reddy’s Laboratories Inc., USA (Licensed from GlaxoSmithKline)

Storage

• Store below 25°C.

• Keep in the original container.

Prescription Drug

• Yes – Prescription-only medication

Clinical Pharmacology (Mechanism of Action)

• Amoxicillin inhibits bacterial cell wall synthesis.

• Clavulanic acid inhibits β-lactamase enzymes, extending amoxicillin’s spectrum.

• Together they combat resistant bacteria effectively.

Indications

• Respiratory tract infections,

• Otitis media

• Sinusitis

• Skin and soft tissue infections

• Urinary tract infections.

Contraindication

• Allergy to any penicillin

• History of cholestatic jaundice due to Augmentin

• History of hepatic dysfunction associated with Augmentin

Warnings

• Do not use Augmentin if you have severe kidney disease.

• Avoid use if you have had liver problems or jaundice during previous treatment with amoxicillin and clavulanate.

• Contraindicated in patients allergic to penicillins or cephalosporins (e.g., Amoxil, Ceftin, Cefzil, Moxatag, Omnicef).

• If switching between tablet forms (regular vs. extended-release), use only the prescribed form and strength.

• Improper use of tablet forms may reduce effectiveness or be harmful.

• Augmentin can pass into breast milk and may harm a nursing infant — inform your doctor if you are breastfeeding.

• Augmentin may reduce the effectiveness of birth control pills — use non-hormonal contraception (e.g., condom, diaphragm, spermicide) during treatment.

Dosages:

• Mild/moderate: 250 mg q8h or 500 mg q12h

• Severe: 500 mg q8h or 875 mg q12h

• Note: Take at the meal's start to improve absorption and reduce side effects.

Special Population

Renal Impairment

• CrCl <30 mL/min:

Do not use 875/125 mg tablets or extended-release tablets.

• CrCl 10–30 mL/min:

250–500/125 mg orally every 12 hours (q12h)

• CrCl <10 mL/min:

250–500/125 mg orally every 24 hours (q24h)

Hemodialysis:

250–500/125 mg orally every 24 hours (q24h)

Administer an additional dose during and after dialysis

Hepatic Impairment

• Use with caution

• Monitor liver function regularly

Children

Oral Suspension

• 6-12 yr, 5 mL.

• All three times daily for up to fourteen days, then review.

Injection

• Up to 3 months

• 30 mg/kg every twelve hr in premature and full-term infants during the perinatal period, increasing to eight hr thereafter;

• 3 mth-12 yr

• 30 mg/kg eight or six hourly.

• All are done by IV or intermittent infusion for up to 14 days, then revised.

  
  

Elderly Patients

Elderly patients can receive the same adult doses of Augmentin, but dose adjustments may be necessary based on their renal and hepatic function.

Side Effects

• Common:

• Diarrhea

• Nausea

• Rash

• Headache

• Vaginitis

• Serious (rare):

• Liver dysfunction

• Anaphylaxis

• Colitis

• Seizures

• Hypersensitivity

Drug Interactions

• Probenecid increases amoxicillin levels.

• Allopurinol increases the risk of rash.

• May reduce the efficacy of oral contraceptives.

• May prolong prothrombin time with anticoagulants.

Use in Pregnancy and Lactation

• Pregnancy: Category B – Use only if needed.

• Lactation: Present in breast milk – Use with caution.

Precautions

• Avoid penicillin allergy.

• Caution in liver disease.

• Monitor for superinfections.

• Avoid mononucleosis due to rash risk.

How To Take

• Take exactly as prescribed by your doctor.

• Follow all directions on the label and read the medication guide.

• Best taken at the start of a meal for improved effectiveness.

• Take the medicine every 12 hours.

• Do not crush or chew extended-release tablets.

• You may break the tablet in half but take both halves one at a time.

• Inform your doctor if you have trouble swallowing pills.

• Shake oral suspension well before use.

• Use the provided syringe or a proper measuring device — not a kitchen spoon.

• Augmentin may affect lab test results — inform your healthcare provider.

• Complete the full course of medication, even if symptoms improve early.

• Skipping doses may cause resistant infections.

• Does not work against viral infections (e.g., flu, cold).

• Store tablets at room temperature, away from moisture and heat.

• Store liquid form in the refrigerator and discard after 10 days.

Counseling Points

• Take with meals to reduce GI upset.

• Complete full course of therapy.

• Report prolonged or severe diarrhea.

• Do not skip doses to prevent resistance.

• Use backup contraception if on oral contraceptives.

panadol

پیناڈول

Written by Dr. Zahira Batool [PharmD, Qauid-e-Azam University, Islamabad, Pakistan]

Active ingredient:

Each tablet contains Paracetamol 500 mg.

Excipients:

• Maize starch

• Potassium sorbate (E 202)

• Purified talc

• Stearic acid

• Povidone

• Starch pregelatinised,

• Hypromellose triacetin.

Pack size:

Box of 10 blisters x 12 tablets.

Price:

4 rs per tablet (0.047 dollars)

Manufacturer:

Haleon Pakistan

Therapeutic class:

Analgesic; Antipyretic

Pharmacological class:

Prostaglandin synthesis inhibitor

Indications:

For fast effective temporary relief of pain and discomfort associated

with headache, muscular aches, period pain, arthritis/osteoarthritis,

toothache, migraine headache, cold &amp; flu symptoms, tension

headache, sinus pain/headache, and backache. Reduces fever.

Dosage and recommendation:

Do not exceed the stated dose. The lowest dose necessary to achieve

efficacy should be used for the shortest duration of time. Do not take

this medicine for more than 3 days without medical advice.

Dosage

Maximum day dose 60 mg/kg to be administered in divided doses of

10-15 mg/kg throughout the 24 hours

1. 12 years to adults:

1 to 2 tablets. Maximum daily dose: 8 tablets

2. 7 to 12 years:

½ to 1 tablet, Maximum daily dose: 4 tablets

3. Under 7 years:

Not recommended

Special population:

Renal Impairment:

Patients who have been diagnosed with renal impairment must seek

medical advice before taking this medication

Hepatic Impairment:

This has dose-related toxicity, so avoid large doses.

Method of administration:

Simply place the tablet(s) in your mouth and swallow them down with

water

Contra-indications:

These products are contraindicated in patients with a previous history

of hypersensitivity to paracetamol or any of the excipients.

Adverse effects:

Stop taking this medicine and tell your doctor immediately if:

• You experience allergic reactions such as skin rash or itching,

sometimes with breathing problems or swelling of the lips, tongue,

throat or face.

• You experience a skin rash or peeling, or mouth ulcers.

• You have previously experienced breathing problems with aspirin

or non-steroidal anti-inflammatory drugs and experience a similar

reaction with this product.

• You experience unexplained bruising or bleeding. These reactions

are rare.

Interactions:

Panadol shows interactions with the following drugs:

• Warfarin and other coumarins

• Chloramphenicol

• Hepatotoxic drugs

• Anticonvulsant drugs

• Probenecid

• Cholestyramine

Warnings and precautions:

1. Contains paracetamol. Do not use with any other

paracetamol-containing products. The concomitant use with

other products containing paracetamol may lead to an

overdose.

2. Paracetamol overdose may cause liver failure which can lead

to liver transplant or death.

3. Paracetamol should be used with caution in patients with:

• Impaired liver function: Underlying liver disease increases the

risk of paracetamol-related liver damage

• Impaired kidney function: Administration of paracetamol to

patients with moderate to severe renal impairment may result in

accumulation of paracetamol conjugates.

4. Patients who have been diagnosed with liver or kidney

impairment must seek medical advice before taking this

medication.

5. Cases of hepatic dysfunction/failure have been reported in

patients with depleted glutathione levels, such as those who

are severely malnourished, anorexic, have a low body mass

index or are chronic heavy users of alcohol. In patients with

glutathione-depleted states such as sepsis, the use of

paracetamol may increase the risk of metabolic acidosis.

6. If symptoms persist, medical advice must be sought.

7. Keep out of sight and reach of children.

Overdose:

Important: liver failure and less frequently renal damage can occur

following overdose. Underlying liver disease increases the risk of

paracetamol-related liver damage.

Symptoms and Signs:

Paracetamol overdose may cause liver failure which may require a liver

transplant or lead to death. Acute pancreatitis has been observed,

usually with hepatic dysfunction and liver toxicity. Nausea and

vomiting, the only early features of poisoning, usually settle within 24

hours. Persistence beyond this time, often associated with the onset of

right subcostal pain and tenderness, usually indicates the development of

hepatic necrosis

Treatment:

Immediate medical management is required in the event of an overdose,

even if symptoms of overdose are not present, refer the patient to the

nearest Emergency Medical Centre for management and expert

treatment. If an overdose is confirmed or suspected, seek immediate

advice from your Poison Centre even in patients without symptoms or

signs of overdose due to the risk of delayed liver damage.

Pregnancy:

As with the use of any medicine during pregnancy, pregnant women

should seek medical advice before taking paracetamol. The lowest

effective dose and shortest duration of treatment should be

considered.

Lactation:

Paracetamol is excreted in breast milk but not in a clinically

significant amount at recommended dosages. Available published data

do not contraindicate breastfeeding.

Clinical Pharmacology:

Its mechanism of action is believed to include inhibition of

prostaglandin synthesis, primarily within the central nervous system.

Storage:

Store below 35°C.

mycitracin cream

mycitracin کریم

Written by Dr Syed Saad Ali [PharmD, DOW University Of Health Sciences (DUHS)], Karachi, Pakistan)

Mycitracin, a Triple Antibiotic First Aid Ointment, is a combination of multiple antibiotics used to relieve pain. Its petrolatum base soothes the healing of skin and protects it from skin abrasions, minor cuts, scrapes, nicks, and burns.

Brand Name:

MYCITRACIN® –Plus Pain Reliever Triple Antibiotic First Aid Ointment.

Generic Name:

Triple Antibiotics: Bacitracin, Neomycin Sulphate, and Polymyxin-B Sulphate

(Pain reliever) Lidocaine.

Available Dosage forms and their Doses:

Ointment 14.7 gms (Pack Size).

Price:

RS: 157-245 (Mycitracin Plus Ointment prices may fluctuate based on your location and the online store you purchase from).

Therapeutic Class:

First Aid Triple Antibiotic combination

Ointment is available as a Counter (OTC) product.

Pharmacological Class:

Topical Antibacterial Agents (Antibiotics).

Manufacturer:

Pfizer, a Pharmaceutical Industry Company.

Storage:

Store at a temperature of between 15˚-25˚C (59˚-77˚F).

Tamper-evident, fully sealed packets.

Check and do not use any open or torn packaged product.

Prescription Drug:

Available without a prescription, a non-prescription drug (OTC).

Clinical pharmacology (mechanism of action):

"This combination of three antibiotics plus a pain reliever that works by targeting and eliminating a range of gram-positive and gram-negative bacteria and prevents pain."

Component          Mechanism of Action with Spectrum

Bacitracin inhibits cell wall synthesis. (gram-positive bacteria)

Neomycin             Disrupts protein synthesis (30S ribosome). (Broad-spectrum)

Polymyxin B          Alters cell membrane permeability. (Gram-negative bacteria)

Lidocaine              Blocks sodium channels to inhibit nerve signals. (Analgesic response)

Indications and Dosages: 

Indicate the treatment and prophylaxis of superficial skin infections.

Dose: Apply a small portion of a thin layer of ointment over the affected area of skin, and if needed, then cover it with gauze dressings

Side effects:

These products don’t have any usual side effects; however, if you ever experience any unusual effects after application of this ointment, then contact your pharmacist or doctor.

Some of the rare side effects reported after use of these products include Uncomplicated skin infections or other bacterial and fungal infections.

If you observe any signs of a severe allergic reaction after application, such as a rash, dizziness, apnea (difficulty breathing), or itching or swelling, particularly in the face, lips, tongue, or neck, then immediately contact your healthcare provider, pharmacist, or doctor.

Interactions:

Drug interaction may interfere with the way how your medication works and increase the risk of side effects. It is important to keep a list of all prescription and OTC products you are using with it and show it to your healthcare provider for the provision of safe and effective therapy.

This heading does not include all interactions, but some of the common interactions include,

·         gentamicin

·         mivacurium

·         neomycin

·         netilmicin

·         pipecuronium

·         plazomicin

·         streptomycin

·         succinylcholine

·         tobramycin

Pregnancy:

No sufficient data is available regarding any negative signs of use of this product during pregnancy. However, this product can only be used when needed as per the advice of a doctor or pharmacist.

lactation:

It is unknown if the medications included in the product may pass into the mother's feed. It's better to consult your pharmacist before breastfeeding.

Precautions

·         Use for the External body only.

·         Avoid contact in contact with your eyes. If yes! Then wash immediately with clean warm water and contact your nearest doctor or pharmacist.

·         People who are allergic to any of the components present in this drug are advised to avoid this product.

·         Recommended to get the treatment within 7 days unless prescribed by your physician.

·         Keep out of the reach of children, in case of accidental ingestion accidentally then call the poison and drug control center right away.

Counselling points:

·         Wash and dry the affected area before applying.

·         Apply a thin layer 1–3 times a day or as directed.

·         Wash hands before and after use.