Introduction to Medicines Information
Useful resources and basic enquiries
October 2017
eMC
http://emc.medicines.org.uk/
1. What is the half-life of atenolol?
Atenolol 100mg Film-Coated Tablets
Accord Healthcare Ltd
Summary of Product Characteristics last updated on the eMC: 26/04/2016
5.2 Pharmacokinetic properties
The plasma half-life of atenolol is about 6-9 hours.
2. Is Colpermin® safe to use in patients with an allergy to soya?
Colpermin IBS Relief Capsules (Use of Control-F)
McNeil Products Ltd
Summary of Product Characteristics last updated on the eMC: 22/04/2016
4.4 Special warnings and precautions for use
Colpermin contains Arachis oil (peanut oil) and should not be taken by patients known to be allergic to peanut. As there is a possible relationship between allergy to peanut and allergy to Soya, patients with Soya allergy should also avoid Colpermin.
3. What is the manufacturer’s recommended dose of IV Tazocin® for an adult with a CrCL of 15mL/min?
Tazocin 4g/0.5g powder for solution for infusion
Pfizer Limited
Summary of Product Characteristics last updated on the eMC: 02/09/2017
4.2 Posology and method of administration
CrCl: <20 ml/min / Maximum dose suggested: 4 g / 0.5 g every 12 hours4. Can Cordarone X® Intravenous be administered in normal saline?
Cordarone X Intravenous
SANOFI
Summary of Product Characteristics last updated on the eMC: 31/05/2017
6.2 Incompatibilities
Cordarone X Intravenous is incompatible with saline and should be administered solely in 5% dextrose solution.
(sufficient, but also)
4.2 Posology and method of administration
The standard recommended dose is 5mg/kg bodyweight given by intravenous infusion over a period of 20 minutes to 2 hours. This should be administered as a dilute solution in 250ml 5% dextrose. This may be followed by repeat infusion up to 1200mg (approximately 15mg/kg bodyweight) in up to 500ml 5% dextrose per 24 hours, the rate of infusion being adjusted on the basis of clinical response (see section 4.4).
In extreme clinical emergency the drug may, at the discretion of the clinician, be given as a slow injection of 150-300mg in 10-20ml 5% dextrose over a minimum of 3 minutes. This should not be repeated for at least 15 minutes.
5. What does a Cozaar® 25mg tablet look like?
COZAAR 12.5 mg, 25 mg, 50 mg and 100 mg Film-Coated Tablets
Merck Sharp & Dohme Limited
Summary of Product Characteristics last updated on the eMC: 09/12/2016
3. PHARMACEUTICAL FORM
COZAAR 25 mg tablet: White, oval unscored film-coated tablets marked 951 on one side and plain on the other.
BNF / BNF for Children
www.medicinescomplete.com
1. What is the interaction between azathioprine and allopurinol? How should it be managed?
Interactions search results for azathioprine
Allopurinol enhances effects and increases toxicity of azathioprine (reduce dose of azathioprine to one quarter of usual dose)
2. Can ramipril be used in a mother breast-feeding a neonate?
RAMIPRIL
http://dx.doi.org/10.18578/BNF.569976968
Information on the use of ACE inhibitors in breast-feeding is limited. Ramipril is not recommended; alternative treatment options, with better established safety information during breast-feeding are available.
3. When should levels be taken for a patient on IV aminophylline? What is the usual therapeutic range?
AMINOPHYLLINE
http://dx.doi.org/10.18578/BNF.986714576
Monitoring requirements
If aminophylline is given intravenously, a blood sample should be taken 4–6 hours after starting treatment. The plasma-theophylline concentration for optimum response is 10-20 mg/L (55-110 micromol/L).
4. What starting dose of candesartan should be used for hypertension in a patient with eGFR of 29mL/min/1.73m2?
CANDESARTAN CILEXETIL
http://dx.doi.org/10.18578/BNF.790958181
Initially 4mg daily
Medicines Complete
http://www.medicinescomplete.com
1. Is there an interaction between aminophylline and olanzapine?
Dashboard> Stockley's Drug Interactions
Interactions search results for aminophylline olanzapine
Theophylline + Olanzapine
The concurrent use of theophylline and olanzapine does not appear to affect the pharmacokinetics of either drug
2. Can clarithromycin cause an abnormal taste?
AHFS Drug Information > Anti-infective Agents 8:00 > Antibacterials 8:12 > Macrolides 8:12.12 > Other Macrolides 8:12.12.92
Clarithromycin > Cautions > GI effects
Diarrhoea, nausea, and abnormal taste were reported in 3–6% of patients receiving oral clarithromycin in clinical studies.
3. Is there any evidence that levothyroxine is a useful agent to induce weight loss?
AHFS Drug Information > Hormones and Synthetic Substitutes 68:00 > Thyroid and Antithyroid Agents 68:36 > Thyroid Agents 68:36.04
Thyroid Agents General Statement > Other Uses
The use of thyroid agents, alone or in combination with other drugs, in the treatment of obesity and for weight loss is unjustified and has been shown to be ineffective.
Thyroid Agents General Statement > Precautions and Contraindications
Although thyroid agents have been used alone and in combination with other drugs for the treatment of obesity, dosages of thyroid agents within the usual range of daily requirements are ineffective for weight reduction in euthyroid individuals. Higher dosages may produce serious and even life-threatening manifestations of toxicity, especially when given in conjunction with sympathomimetic agents (e.g., amphetamines) used for their anorectic effect. The use of thyroid agents for the treatment of obesity or for weight loss is unjustified and contraindicated.
4. Is it safe for a patient on warfarin to take grape seed extract?
Dietary Supplements > Monographs > G
Grape Seed Extract > Interactions
None reported, but in theory bleeding tendency may be increased with anticoagulants, aspirin and anti-platelet drugs.
Stockley’s Herbal Medicines Interactions
Search grapeseed warfarin = no hits.
5. Can Zocor® 10mg tablets be administered down an NG tube?
Handbook of Drug Administration via Enteral Feeding Tubes > Monographs > S
Simvastatin
Film-coated tablets - Simvastatin is almost insoluble in water.
Zocor 10mg tablets (other strengths not tested) disperse in 10mL of water and flush via an 8Fr NG tube (NB see monograph for detailed administration instructions)
Micromedex
http://www.wales.nhs.uk/sitesplus/878/page/42366
1. What is the dose of zoledronate for Paget’s Disease?
Drugdex > Zoledronic Acid > Adult Dosage > Dosing & Indications > Paget's disease
Paget's disease: 5 mg IV as a single infusion infused over a period of at least 15 minutes
2. How is the interaction between warfarin and broccoli managed?
DrugDex Drug Interactions tab > Add Warfarin and Broccoli detail:
Warning:
Concurrent use of WARFARIN and VITAMIN K FOODS may result in altered anticoagulant effectiveness.
Clinical Management:
Warfarin should be taken consistently in relation to meals. Large changes in dietary consumption of foods high in vitamin K should be avoided or accompanied by careful monitoring of the international normalized ratio (INR).
3. What is POLOCARD?
DRUGDEX Tox and Drug under Product look up
Polocard = Aspirin
Martindale Productlook up
Polocard = Aspirin
4. What is green lipped mussel used for?
Green Lipped Mussel > ALtMeDex Evaluations
Asthma or Arthritis but inconclusive data
Martindale > Green Lipped Mussel > Product look up > link to monograph profile
It has been promoted for the treatment of rheumatic disorders including rheumatoid arthritis. It has also been tried in asthma.
SPS
http://www.sps.nhs.uk
1. Can you use trimethoprim in a breastfeeding mum?
Lactation Safety Information
Use when breastfeeding / CautionAlternative / Alternative microbiologically appropriate antibacterial
Comments / Limited published evidence of safety
Small amounts in breast milk
For short-term use only due to risk of folate deficiency
Therapeutic group summary / Safety in Lactation: Sulphonamides and trimethoprim
Evidence link / LactMed
(NB this answer may not apply to all patients; such queries should always be considered on an individual basis)
2. Aranesp has been left out of the fridge for 2 days at 25°C in its original packaging. What expiry date should be given?
Darbepoetin alfa
Refrigerated Storage
Aranesp, Aranesp SureClick · Amgen Ltd
Manufacturer / Amgen LtdTrade name / Aranesp, Aranesp SureClick
Formulation / Injection, pre-filled syringe
Stability Data / In the event of an inadvertent temperature excursion the following data may be used:
Stability data indicate that products stored within the intact original packaging remain stable when exposed to a single temperature excursion of up to 30°C, for up to 1 week.
Please also refer to the manufacturer’s product literature for recommended storage information at https://www.medicines.org.uk
Expiry Date Alteration / Yes. If the product has been stored at higher temperatures of up to 30°C, it must either be used within 7 days or disposed of.
Return to fridge / No
Comments / The product should be kept in the outer carton to protect from light and should not be frozen.
Refrigerated Medicine Review Date / 19th May 2017
Reviewed by / London MI Service
3. Is there any guidance on which medicines can be used in the treatment of hayfever in pregnancy?
Search term: loratadine
Articles: 2nd one relevant, i.e.
UKMi Q&A 29.7.
Which medicines can be used to treat intermittent allergic rhinitis during pregnancy?
· The preferred treatment for intermittent allergic rhinitis (IAR) in pregnancy is the application of topical preparations as these have increased local activity and lower systemic exposure, therefore reducing the risk posed to the foetus.
· If nasal congestion predominates, intranasal corticosteroids are the treatments of choice during pregnancy. Sodium cromoglicate nasal spray is also suitable for use during pregnancybut may be less effective.
· If an intranasal preparation does not fully relieve symptoms or is not tolerated, consider an oral antihistamine. Chlorphenamine has traditionally been the antihistamine of choice but can cause sedation. Loratadine or cetirizine are the antihistamines now recommended for use during pregnancy.
· Intranasal decongestants are of limited benefit in IAR and are generally only recommended for relieving nasal congestion prior to the use of topical corticosteroids.
· Any medication prescribed during pregnancy should be at the lowest effective dose for the shortest time necessary.
4. Is there any guidance on lactose-free statins?
Search term: simvastatin
UKMi Medicines Q and A: Q&A 234.3
Is there a lactose-free lipid regulating medicine?
Provides table.
NHS Evidence (NICE)
https://www.evidence.nhs.uk/
1. Find patient information on stroke treatments
Search term: stroke
> Filter to Types of Information = Information for the public
> Many results but 1 good source is NHS Choices, 7 February 2017
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