Monday, September 16, 2013

IMATINIB


Imatinib, marketed by Novartis as Gleevec (U.S.) or Glivec (Europe/Australia/Latin America), and sometimes referred to by its investigational name STI-571, is a tyrosine-kinase inhibitor used in the treatment of multiple cancers, most notably Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia (CML). Like all tyrosine-kinase inhibitors, imatinib works by preventing a tyrosine kinase enzyme, in this case BCR-Abl, from phosphorylating subsequent proteins and initiating the signaling cascade necessary for cancer development, thus preventing the growth of cancer cells and leading to their death by apoptosis. Because the BCR-Abl tyrosine kinase enzyme exists only in cancer cells and not in healthy cells, imatinib works as a form of targeted therapy—only cancer cells are killed through the drug's action. In this regard, imatinib was one of the first cancer therapies to show the potential for such targeted action, and is often cited as a paradigm for research in cancer therapeutics.
Imatinib has been cited as the first of the exceptionally expensive cancer drugs, costing $92,000 a year. Doctors and patients complain that this is excessive, given that its development costs have been recovered many times over, and that the costs of synthesizing the drug are orders of magnitude lower. In the USA, the patent protecting the active principle will expire on 4 January 2015 while the patent protecting the beta crystal form of the active principal ingredient will expire on 23 May 2019.
The developers of imatinib were awarded the Lasker Award in 2009 and the Japan Prize in 2012.

4-[(4-methylpiperazin-1-yl)methyl]-N-(4-methyl-3-{[4-(pyridin-3-yl)pyrimidin-2-yl]amino}phenyl)benzamide



USE
Imatinib is used to treat chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs) and a number of other malignancies. One study demonstrated that imatinib mesylate was effective in patients with systemic mastocytosis, including those who had the D816V mutation in c-Kit.However, since imatinib binds to tyrosine kinases when they are in the inactive configuration and the D816V mutant of c-Kit is constitutively active, imatinib does not inhibit the kinase activity of the D816V mutant of c-Kit. Experience has shown, however, that imatinib is much less effective in patients with this mutation, and patients with the mutation comprise nearly 90% of cases of mastocytosis.

ADVERSE EFFECTS
The most common side effects include: feeling sick (nausea), diarrhoea, headaches, leg aches/cramps, fluid retention, visual disturbances, itchy rash, lowered resistance to infection, bruising or bleeding, loss of appetite; weight gain, reduced number of blood cells (neutropenia, thrombocytopenia, anemia), and edema.
Severe congestive cardiac failure is an uncommon but recognized side effect of imatinib and mice treated with large doses of imatinib show toxic damage to their myocardium.
If imatinib is used in prepubescent children, it can delay normal growth, although a proportion will experience catch-up growth during puberty.

MECHANISM OF ACTION

Imatinib is a 2-phenyl amino pyrimidine derivative that functions as a specific inhibitor of a number of tyrosine kinase enzymes. It occupies the TK active site, leading to a decrease in activity.
There are a large number of TK enzymes in the body, including the insulin receptor. Imatinib is specific for the TK domain in abl (the Abelson proto-oncogene), c-kit and PDGF-R (platelet-derived growth factor receptor).
In chronic myelogenous leukemia, the Philadelphia chromosome leads to a fusion protein of abl with bcr (breakpoint cluster region), termed bcr-abl. As this is now a constitutively active tyrosine kinase, imatinib is used to decrease bcr-abl activity.
The active sites of tyrosine kinases each have a binding site for ATP. The enzymatic activity catalyzed by a tyrosine kinase is the transfer of the terminal phosphate from ATP to tyrosine residues on its substrates, a process known as protein tyrosine phosphorylation. Imatinib works by binding close to the ATP binding site of bcr-abl, locking it in a closed or self-inhibited conformation, and therefore inhibiting the enzyme activity of the protein semi-competitively. This fact explains why many BCR-ABL mutations can cause resistance to imatinib by shifting its equilibrium toward the open or active conformation.
Imatinib is quite selective for bcr-abl – it does also inhibit other targets mentioned above (c-kit and PDGF-R), but no other known tyrosine kinases. Imatinib also inhibits the abl protein of non-cancer cells but cells normally have additional redundant tyrosine kinases which allow them to continue to function even if abl tyrosine kinase is inhibited. Some tumor cells, however, have a dependence on bcr-abl. Inhibition of the bcr-abl tyrosine kinase also stimulates its entry in to the nucleus, where it is unable to perform any of its normal anti-apoptopic functions.
The Bcr-Abl pathway has many downstream pathways including the Ras/MapK pathway, which leads to increased proliferation due to increased growth factor-independent cell growth. It also affects the Src/Pax/Fak/Rac pathway. This affects the cytoskeleton, which leads to increased cell motility and decreased adhesion. The PI/PI3K/AKT/BCL-2 pathway is also affected. BCL-2 is responsible for keeping the mitochondria stable; this suppresses cell death by apoptosis and increases survival. The last pathway that Bcr-Abl affects is the JAK/STAT pathway, which is responsible for proliferation.

COST
In 2013, more than 100 cancer specialists published a letter in Blood saying that the prices of many new cancer drugs, including imatinib, is so high that U.S. patients couldn't afford them, and that the level of prices, and profits, was so high as to be immoral. Signatories of the letter included Brian Druker, Carlo Gambacorti-Asserini, and John Goldman, developers of imatinib. In 2001, imatinib was priced at $30,000 a year, which was based on the price of interferon, then the standard treatment, and would have recouped the development costs in 2 years. After unexpectedly becoming a blockbuster, its price was increased to $92,000 per year in 2012, with annual revenues of $4.7 billion. All its research and development costs were covered in the first $1 billion, and everything else was profit. Other doctors have complained about the cost. For GIST the cost is $64,800 a year.
Prices for a 100 mg pill of Gleevec internationally range from $20 to $30,although generic imatinib is cheaper, as low as $2 per pill.

Wednesday, September 4, 2013

20 Ways to Privent Cancer - 1

1.   Filter your tap water

2.   Stop topping your tank

3.   Marinate meat first

4.   Caffeinate every day

5.   Water down your risk

6.   Load up on green greens

7.   Snack on Brazil nuts

8.   Burn off your risk

9.   Skip the dry cleaner

10. Ask about breast density

11. Head off cell phone risks

12. Block cancer with color

13. Pick a doc with a past

14. Eat clean foods

15. Do a folic acid check

16. Up your calcium intake

17. Commit to whole grains

18. Pay attention to pain

19. Avoid unnecessary scans

20. Drop 10 pounds



1. Filter your tap water


You'll reduce your exposure to known or suspected carcinogens and hormone-disrupting chemicals. A report from the President's Cancer Panel on how to reduce exposure to carcinogens suggests that home-filtered tap water is a safer bet than bottled water, whose quality often is not higher—and in some cases is worse—than that of municipal sources, according to a study by the Environmental Working Group. (Consumer Reports' top picks for faucet-mounted filters: Culligan, Pur Vertical, and the Brita OPFF-100.) Store water in stainless steel or glass to avoid chemical contaminants such as BPA that can leach from plastic bottles.

Sunday, August 25, 2013

PROPRANOLOL

Propranolol is a beta-blocker. Beta-blockers affect the heart and circulation (blood flow through arteries and veins).

Propranolol is used to treat tremors, angina (chest pain), hypertension (high blood pressure), heart rhythm disorders, and other heart or circulatory conditions. It is also used to treat or prevent heart attack, and to reduce the severity and frequency of migraine headaches.


(RS)-1-(1-methylethylamino)-3-(1-naphthyloxy)propan-2-ol

USES
For,
Hypertension
Angina pectoris
Tachyarrhythmias
Myocardial infarction
Control of tachycardia/tremor associated with anxiety, hyperthyroidism or lithium therapy.
Essential tremor
Migraine prophylaxis
Cluster headaches prophylaxis
Tension headache (Off label use)
Shaky hands
Hyperhidrosis
There has been some experimentation in psychiatric areas:
Treating the excessive drinking of fluids in psychogenic polydipsia,
Antipsychotic-induced akathisia,
Aggressive behavior of patients with brain injuries
Post-traumatic stress disorder
Calming down individuals with phobias via sedative effects
Performance anxiety
Glaucoma
Thyrotoxicosis via deiodinase inhibition
Primary exertional headache
While once first-line treatment for hypertension, the role for beta-blockers was downgraded in June 2006 in the United Kingdom to fourth-line as they perform less well than other drugs, particularly in the elderly, and evidence is increasing that the most frequently used beta-blockers at usual doses carry an unacceptable risk of provoking type 2 diabetes.
Propranolol is also used to lower portal vein pressure in portal hypertension and prevent esophageal variceal bleeding and ascites.


MECHANISM OF ACTION
Propranolol is a non-selective beta blocker, that is, it blocks the action of epinephrine and norepinephrine on both β1- and β2-adrenergic receptors. It has little intrinsic sympathomimetic activity (ISA) but has strong membrane stabilizing activity (only at high blood concentrations, e.g. overdosage). Research has also shown that propranolol has inhibitory effects on the norepinephrine transporter and/or stimulates norepinephrine release (present experiments have shown that the concentration of norepinephrine is increased in the synapse but do not have the ability to discern which effect is taking place).[31] Since propranolol blocks β-adrenoceptors, the increase in synaptic norepinephrine only results in α-adrenergic activation, with the α1-adrenoceptor being particularly important for effects observed in animal models. Therefore, some have suggested that it be looked upon as an indirect α1 agonist as well as a β antagonist. Probably owing to the effect at the α1-adrenoceptor, the racemic and the individual enantiomers of propranolol have been shown to substitute for cocaine in rats, with the most potent enantiomer being S-(–)-propranolol. In addition, some evidence suggests that propranolol may function as a partial agonist at one or more serotonin receptors (possibly 5-HT1B).
Both enantiomers of the drug have a local anesthetic (topical) effect, which is normally mediated by blockade of voltage-gated sodium channels. Few studies have demonstrated propranolol's ability to block cardiac, neuronal, and skeletal voltage-gated sodium channels, accounting for its known "membrane stabilizing effect" and anti-arrhythmic and other central nervous system effects.

Important information about propranolol :

You should not use this medication if you are allergic to propranolol, if you have asthma, a slow heart rate, or a serious heart condition such as "sick sinus syndrome" or "AV block" (unless you have a pacemaker). If you need surgery, tell the surgeon ahead of time that you are using propranolol. You may need to stop using the medicine for a short time. Do not skip doses or stop using propranolol without first talking to your doctor. You may need to use less and less before you stop the medication completely.
Avoid drinking alcohol. It may increase your blood levels of propranolol.

Propranolol is only part of a complete program of treatment for hypertension that may also include diet, exercise, and weight control. Follow your diet, medication, and exercise routines very closely if you are being treated for hypertension.

If you are being treated for high blood pressure, keep using propranolol even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.


DOSAGES

Usual Adult Propranolol Dose for Hypertension:

Initial dose: 40 mg orally twice a day or 80 mg sustained release once a day, whether used alone or added to a diuretic. The dose should be administered at bedtime (approximately 10 PM).
Maintenance dose: 120 to 240 mg/day or 120 to 160 mg/day of sustained release
Maximum dose: 640 mg/day.

Usual Adult Propranolol Dose for Angina Pectoris:

Total daily doses of 80 to 320 mg orally 2 to 4 times a day have been shown to increase exercise tolerance and to reduce ischemic changes in the ECG.
Sustained release: Initial dose: 80 mg orally once a day. Dosage should be gradually increased at 3 to 7 day intervals. The average optimal dosage appears to be 160 mg/day.

Usual Adult Propranolol Dose for Arrhythmias:

Oral: 10 to 30 mg 3 to 4 times a day, before meals and at bedtime.
IV: 1 to 3 mg at a rate not exceeding 1 mg/min.
Sufficient time should be allowed for the drug to reach the site of action even when a slow circulation is present. A second dose may be given after 2 minutes. Thereafter, additional drug should not be given in less than 4 hours. Additional propranolol should not be given when the desired alteration in rate and/or rhythm is achieved.

Usual Adult Propranolol Dose for Myocardial Infarction:

180 to 240 mg/day in 3 to 4 divided doses.

Usual Adult Propranolol Dose for Migraine Prophylaxis:

Initial dose: 80 mg/day orally in divided doses.
Maintenance dose: 160 to 240 mg/day.
The dosage may be increased gradually to achieve optimum migraine prophylaxis. If a satisfactory response is not obtained within 4 to 6 weeks after reaching the maximum dose, propranolol therapy should be discontinued.
Sustained release: Initial dose: 80 mg orally once a day.
Maintenance dose: 160 to 240 mg once a day.

Usual Adult Propranolol Dose for Benign Essential Tremor:

Initial dose: 40 mg orally twice a day.
Maintenance dose: 120 to 320 mg/day.
Optimum reduction of essential tremor is usually achieved with a dose of 120 mg/day.
Occasionally, it may be necessary to administer 240 to 320 mg/day.

Usual Adult Propranolol Dose for Aortic Stenosis:

20 to 40 mg orally 3 to 4 times a day, before meals and at bedtime.
Sustained release: 80 to 160 mg orally once a day.

Usual Adult Propranolol Dose for Pheochromocytoma:

Preoperatively: 60 mg/day orally in divided doses for 3 days prior to surgery, concomitantly with an alpha-adrenergic blocking agent.
Management of Inoperable Tumor: 30 mg/day orally in divided doses.

Usual Pediatric Propranolol Dose for Arrhythmias:

Oral: Children: Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 8 hours; titrate dosage upward every 3 to 5 days; usual dose: 2 to 4 mg/kg/day; higher doses may be needed; do not exceed 16 mg/kg/day

IV: Children: 0.01 to 0.1 mg/kg slow IV over 10 minutes; maximum dose: 1 mg (infants); 3 mg (children).

Usual Pediatric Propranolol Dose for Hypertension:

Children:
Immediate release formulations:
Initial: 0.5 to 1 mg/kg/day in divided doses every 6 to 12 hours; increase gradually every 5 to 7 days
Usual dose: 1 to 5 mg/kg/day
Maximum dose: 8 mg/kg/day

Children and Adolescents 1 to 17 years:
Immediate release formulations:
Initial: 1 to 2 mg/kg/day divided in 2 to 3 doses/day; titrate dose to effect
Maximum dose: 4 mg/kg/day up to 640 mg/day; sustained release formulation may be dosed once daily. (National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents).

Usual Pediatric Propranolol Dose for Thyrotoxicosis:

Neonates: Oral: 2 mg/kg/day in divided doses every 6 to 12 hours; occasionally higher doses may be required.

Adolescents: Oral: 10 to 40 mg/dose every 6 hours.


BRANDS

Beptazine           Propranolol, Dihydralazine Sulphate                           M.M.LABS
Beptazine -H        Propranolol, Dihydralazine Sulphate,Hydrochlorothiazide       M.M LABS
Betaprp -DZ         Propranolol, Diazepam                                         Consern Pharma Pvt Ltd.
ciplar 10                proranolol                                                    cipla
inderal 10
Avlocardyl, Deralin, Dociton, Inderalici, InnoPran XL, Sumial, Anaprilinum, Bedranol SR



Thursday, August 22, 2013

PRAZOSIN

Prazosin  is a sympatholytic drug used to treat high blood pressure and anxiety, PTSD, and panic disorder. It is an alpha-adrenergic blocker that is specific for the alpha-1 receptors. These receptors are found on vascular smooth muscle, where they are responsible for the vasoconstrictive action of norepinephrine. They are also found throughout the central nervous system.
In addition to its alpha-blocking activity, prazosin is an antagonist of the MT3 receptor (which is not present in humans), with selectivity for this receptor over the MT1 and MT2 receptors.

Prazosin is orally active and has a minimal effect on cardiac function due to its alpha-1 receptor selectivity. However, when prazosin is initially started, heart rate and contractility go up in order to maintain the pre-treatment blood pressures because the body has reached homeostasis at its abnormally high blood pressure. The blood pressure lowering effect becomes apparent when prazosin is taken for longer periods of time. The heart rate and contractility go back down over time and blood pressure decreases.
The antihypertensive characteristics of prazosin make it a second-line choice for the treatment of high blood pressure.
Prazosin is also useful in treating urinary hesitancy associated with prostatic hyperplasia, blocking alpha-1 receptors, which control constriction of both the prostate and ureters. Although not a first line choice for either hypertension or prostatic hyperplasia, it is a choice for patients who present with both problems concomitantly
This medication has shown to be effective in treating severe nightmares in children and people with PTSD symptoms.[4] Veterans have also been treated successfully at Seattle's VA Puget Sound Health Care System (VAPSHCS) for sleep disturbance related to PTSD. Doses are lower for this purpose than for control of blood pressure.

2-[4-(2-furoyl)piperazin-1-yl]-6,7-dimethoxyquinazolin-4-amine

BRAND NAMES  -
Mizide
Cyber-cr           Raptakos
Czopress XL Tab    CMG Biotech
Minipress Xl       Pfiser
Minipress Xl ITS   Pfiser
Prazocip -1 tab    Cipla
 Prazocip XL       Cipla
Prazopress         Sun pharma
Prazopress XL      Sun
Prazopress 1       sun
Prazopress 2       sun
Prazopress XL 5    Sun


Do NOT use prazosin if:
you are allergic to any ingredient in prazosin
Contact your doctor or health care provider right away if any of these apply to you.

Before using prazosin:

Some medical conditions may interact with prazosin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding
if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
if you have allergies to medicines, foods, or other substances
if you have chest pain, heart disease, narcolepsy, or kidney problems
if you will be having eye surgery
Some MEDICINES MAY INTERACT with prazosin. Tell your health care provider if you are taking any other medicines, especially any of the following:

Diuretics (eg, furosemide, hydrochlorothiazide) or verapamil because they may increase the risk of prazosin's side effects
Beta-blockers (eg, propranolol) or phosphodiesterase inhibitors (eg, sildenafil) because their actions and the risk of their side effects may be increased by prazosin
This may not be a complete list of all interactions that may occur. Ask your health care provider if prazosin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use prazosin:

Use prazosin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take prazosin by mouth with or without food.
If you miss a dose of prazosin, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use prazosin.

Important safety information:

Prazosin may cause dizziness, lightheadedness, or fainting after the first dose. Take the first dose at bedtime. If you get up during the night, sit up and stand slowly. Continue to sit up and stand slowly while you are taking prazosin.
Prazosin may cause dizziness, drowsiness, lightheadedness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use prazosin with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Prazosin may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects.
Avoid engaging in any hazardous tasks for at least 24 hours after taking the first dose, missing several doses, increasing the dose, or taking other high blood pressure medications.
Before drinking alcohol, discuss it with your doctor.
Tell your doctor or dentist that you take prazosin before you receive any medical or dental care, emergency care, or surgery.
Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms.
Prazosin may interfere with certain lab tests, including tests for pheochromocytoma (an adrenal gland tumor). Be sure your doctor and lab personnel know you are taking prazosin.
Use prazosin with extreme caution in the ELDERLY; they may be more sensitive to its effects.
Prazosin should not be used in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using prazosin while you are pregnant. Prazosin is found in breast milk. If you are or will be breast-feeding while you use prazosin, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of prazosin:
All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Dizziness; drowsiness; dry mouth; frequent urination; headache; lack of energy; lightheadedness; nasal congestion; nausea; weakness.

Seek medical attention right away if any of these SEVERE side effects occur:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; fainting; fast or irregular heartbeat; depression; severe or persistent dizziness; swelling of the hands or feet.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.


Sunday, August 18, 2013

PHENOXYBENZAMINE

This medication is used to treat high blood pressure and heavy sweating due to a certain tumor of the adrenal glands (pheochromocytoma). Phenoxybenzamine belongs to a class of drugs known as alpha blockers. It works by relaxing and widening blood vessels so that blood can flow more easily.
OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.
This drug may also be used with other medications to treat certain blood circulation problems (e.g., Raynaud's syndrome).
It is also used to treat certain conditions which involve difficulty urinating (e.g., neurogenic bladder, partial prostatic obstruction).

alpha adrenergic blocker   .


(RS)-N-benzyl-N-(2-chloroethyl)-1-phenoxypropan-2-amine

PHARMACOLOGY
Phenoxybenzamine is used as an anti-hypertensive due to its efficacy in reducing the vasoconstriction caused by epinephrine (adrenaline) and norepinephrine. Phenoxybenzamine forms a permanent covalent bond with adrenergic receptors. Based on known information about the structures of these receptors, it likely involves attack by the cysteine at position 3.36 in transmembrane helix 3 to form a stable linkage. Thus, it remains permanently bound to the receptor, preventing adrenaline and noradrenaline from binding. This causes vasodilatation in blood vessels, due to its antagonistic effect at the alpha-1 adrenoceptor found in the walls of blood vessels, resulting in a drop in blood pressure. A side effect of phenoxybenzamine is reflex tachycardia.
It will also affect the postsynaptic alpha 1 and 2 receptors in the nervous system, and so reduce sympathetic activity. This results in further vasodilation, pupil constriction, an increase in GI tract motility and secretions, and glycogen synthesis.
It also has partial agonist/antagonist properties at the serotonin 5-HT2A receptor. Due to its 5-HT2A antagonism, it is useful in the treatment of carcinoid tumor, a neoplasm that secretes large amounts of serotonin and causes diarrhea, bronchoconstriction, and flushing.


DOSE

The dose of phenoxybenzamine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of phenoxybenzamine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (capsules):
For high blood pressure caused by pheochromocytoma:
Adults—At first, 10 milligrams (mg) two times a day. Then, your doctor may increase your dose to 20 to 40 mg two or three times a day.
Children—Dose is based on body weight and must be determined by your doctor. The usual starting dose is 0.2 mg per kilogram (kg) (0.09 mg per pound) of body weight taken once a day. Then, your doctor may increase your dose to 0.4 to 1.2 mg per kg (0.18 to 0.55 mg per pound) of body weight a day. This is divided into three or four doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Keep out of the reach of children.
Do not keep outdated medicine or medicine no longer needed.


SPECIAL PRECAUTIONS
tell your doctor and pharmacist if you are allergic to phenoxybenzamine or any other drugs.
tell your doctor and pharmacist what prescription and nonprescription medications you are taking, especially medications for diet control, high blood pressure, asthma, cough, colds, allergies, and glaucoma; and vitamins.
tell your doctor if you have or have ever had heart or kidney disease, a stroke, or transient ischemic attacks (TIA).
tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking phenoxybenzamine, call your doctor immediately.
if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking phenoxybenzamine.
you should know that this drug may make you drowsy. Do not drive a car or operate machinery until you know how this drug affects you.
remember that alcohol can add to the drowsiness caused by this drug.



SIDE EFFECTS

Phenoxybenzamine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
nasal congestion  , dizziness  , upset stomach  , sexual dysfunction (difficulty ejaculating)  , dizziness

If you experience any of the following symptoms, call your doctor immediately:
fainting  , fast heartbeat    , vomiting

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].




DRUG INTERACTIONS
Using phenoxybenzamine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Acebutolol
Alprenolol
Atenolol
Betaxolol
Bevantolol
Bisoprolol
Bucindolol
Carteolol
Carvedilol
Celiprolol
Dilevalol
Esmolol
Labetalol
Levobunolol
Mepindolol
Metipranolol
Metoprolol
Nadolol
Nebivolol
Oxprenolol
Penbutolol
Pindolol
Propranolol
Sotalol
Talinolol
Tertatolol
Timolol
Vardenafil

BRANDS

Dibenzyline

China - 2 Results
酚苄明/phenoxybenzamine
酚苄明 - 丽珠制药/Phenoxybenzamine - Livzon  [ 丽珠制药厂 / Livzon Pharm ]
India - 4 Results
BIOPHENOX  [ United Biotech ]
FENOBEN  [ Celon (Revilon) ]
FENOXENE  [ Samarth ]
phenoxybenzamine
Indonesia - 1 Results
phenoxybenzamine
Hong Kong - 1 Results
phenoxybenzamine
Malaysia - 1 Results
phenoxybenzamine
Philippines - 1 Results
phenoxybenzamine
Singapore - 1 Results
phenoxybenzamine
Thailand - 2 Results
Adrenaline Atlantic  [ Atlantic Lab ]   [ Vana ]
phenoxybenzamine
Vietnam - 0 Results
USA - 2 Results
Demser  [ Merck & Co Inc ]
phenoxybenzamine



Sunday, August 11, 2013

PERINDOPRIL


Perindopril is comes under the group of long-acting ACE inhibitor. It is used to treat high BP, heart failure or stable coronary artery disease in form of perindopril arginine  or perindopril erbumine. According to the Australian government's Pharmaceutical Benefits Scheme website, based on data provided to the Australian Department of Health and Aging by the manufacturer, perindopril arginine and perindopril erbumine are therapeutically equivalent and may be interchanged without differences in clinical effect. However the dose prescribed to achieve the same effect will differ due to different molecular weights for the two forms.
Perindopril is used alone or in combination with other medications to treat high blood pressure. Perindopril is in a class of medications called angiotensin-converting enzyme (ACE) inhibitors. It makes blood flow more smoothly by preventing the production of certain natural chemicals that tighten the blood vessels.
Perindopril comes as a tablet to take by mouth. It is usually taken once or twice a day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take perindopril exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Your doctor may start you on a low dose of perindopril and gradually increase your dose.
Perindopril controls high blood pressure but does not cure it. Continue to take perindopril even if you feel well. Do not stop taking perindopril without talking to your doctor.




SPECIAL PRECAUTIONS
Before taking perindopril,
Tell your doctor and pharmacist if you are allergic to perindopril, benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), quinapril (Accupril), ramipril (Altace), trandolapril (Mavik), or any other medications.
tell your doctor if you have diabetes (high blood sugar) and you are taking aliskiren (Tekturna, in Amturnide, Tekamlo, Tekturna HCT). Your doctor will probably tell you not to take perindopril if you have diabetes and you are also taking aliskiren.
tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: cyclosporine (Neoral, Sandimmune), diuretics ('water pills'), heparin, indomethacin (Indocin), lithium (Eskalith, Lithobid), and potassium supplements (K-Dur, Klor-Con, others). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
tell your doctor if you are on dialysis and if have or have ever had heart failure; lupus (SLE); scleroderma; diabetes; swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, and/or lower legs (angioedema); or kidney or liver disease.
tell your doctor if you plan to become pregnant or are breast-feeding.
you should know that diarrhea, vomiting, not drinking enough fluids, and sweating a lot can cause a drop in blood pressure, which may cause lightheadedness and fainting.
DIET
Talk to your doctor before using salt substitutes containing potassium. If your doctor prescribes a low-salt or low-sodium diet, follow these directions carefully.
IF YOU FORGOT YOUR DOSE...
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.
SIDE EFFECTS
Perindopril may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
Cough,  headache,  weakness,  dizziness,  diarrhea,  stomach pain,  upset stomach
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
hoarseness,  difficulty swallowing or breathing,  lightheadedness,  fainting
fever, sore throat, chills, and other signs of infection
irregular or rapid heartbeats
Perindopril may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.


If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

Sunday, August 4, 2013

NITRENDIPINE

Nitrendipine is a dihydropyridine calcium channel blocker. It is used in the treatment of primary hypertension.


ethyl methyl 2,6-dimethyl-4-(3-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate


Nitrendipine is absorbed through gut and metabolized by liver before it goes into the systemic circulation and reaches the cells of the smooth muscles and cardiac muscle cells.
 It binds more effectively with L-type calcium channels in smooth muscle cells because of its lower resting membrane potential. The Nitrendipine diffuses into the membrane and binds to its high affinity binding site on the inactivated L-type calcium channel that’s located in between each of the 4 intermembrane components of the α1 subunit. The exact mechanism of action of Nitrendipine is unknown, but it is believed to have important tyrosine and threonine residues in its binding pocket and its binding interferes with the voltage sensor and gating mechanism of the channel. Thought to have a domain-interface model of binding. In hypertension, the binding of Nitrendipine causes a decrease in the probability of open L-type calcium channels and reduces the influx of calcium. The reduced levels of calcium prevent smooth muscle contraction within these muscle cells. Prevention of muscle contraction enables smooth muscle dilation. Dilation of the vasculature reduces total peripheral resistance, which decreases the workload on the heart and prevents scarring of the heart or heart failure.

INDICATION AND DOSE
Hypertension
Adult: 20 mg daily as a single dose or in 2 divided doses; may be increased to 20 mg bid as necessary to control resistant hypertension.
Elderly: Initially, 10 mg daily.
Hepatic impairment: Initially, 5-10 mg once daily.
OVERDOSAGE
Symptoms: Flushing, headache, BP reduction with circulatory collapse, changes in heart rate (tachycardia, bradycardia). Management: Initially, gastric lavage with subsequent activated charcoal. Dopamine or noradrenaline may be used for excessive hypotension. Atropine or orciprenaline may be used for bradycardia.
ADVERSE DRUG REACTIONS
Hypotension, flushing, oedema, dizziness, palpitation, fatigue, headache, nausea, bloating, diarrhoea, paraesthesias, tachycardia, asthenia, drowsiness, angina, MI, irritability, respiratory disorders, hypersensitivity reactions, increased urine output, elevated LFTs, myalgia, tremor, blood count changes, gingival hyperplasia.
DRUG INTERACTIONS
Effects may be enhanced by other antihypertensives. Increased sodium excretion with diuretics at the start of treatment. May prolong effects of pancuronium, vecuronium. May increase digoxin levels. Reduced levels/effects with rifampicin, phenytoin, carbamazepine or phenobarbitone. Levels/effects may be increased with cimetidine, valproic acid, erythromycin, troleandomycin, clarithromycin, roxithromycin, ketoconazole, itraconazole, fluconazole, nefazodone, protease inhibitors, quinupristin or dalfopristin.
Potentially Fatal: Effects may be enhanced by other antihypertensives. Increased sodium excretion with diuretics at the start of treatment. May prolong effects of pancuronium, vecuronium. May increase digoxin levels. Reduced levels/effects with rifampicin, phenytoin, carbamazepine or phenobarbitone. Levels/effects may be increased with cimetidine, valproic acid, erythromycin, troleandomycin, clarithromycin, roxithromycin, ketoconazole, itraconazole, fluconazole, nefazodone, protease inhibitors, quinupristin or dalfopristin.

FOOD INTERACTIONS  -    Concentration may be increased with grapefruit juice.

BRANDS                  -      COMPANY  -  COUNTRY
Balodipine                          Taiyo Pharmaceutical, Japan
Balotein                               Medisa Shinyaku, Japan
Baylotensin                        Tanabe Mitsubishi Pharma, Japan
Bayniroad                           Taisho Yakuhin, Japan
Bayotensin                         Bayer Vital, Germany
Bayotensin mite              Bayer Vital, Germany
Baypresol                            Bayer, Spain
Baypress                              Bayer, Austria;   Bayer, Belgium;   Bayer, Switzerland;    Bayer, Colombia;     Bayer, Czech Republic;       Bayer, Denmark;       Bayer, Greece;     Bayer, Hungary;      Bayer, Italy;      Bayer, South Korea;          Bayer, Netherlands;      Bayer, Thailand;       Bayer, Turkey;     Bayer Animal Health, Luxembourg;      Bayer Santé, France
Baypress mite                   Bayer, Switzerland
Caltren                                 Libbs, Brazil
Cardiazem                          Sanitas, Chile
Cenipres (Nitrendipine and Enalapril)- Ferrer, Austria
Cobatensin                         Kobayashi Kako, Japan
Ditrenil                                                Siam Bheasach, Thailand
Dosperopin                        Towa Yakuhin, Japan
Ecatelisin            Zensei Yakuhin, Japan
Ellenal                  Sanwa Kagaku, Japan
Eneas (Nitrendipine and Enalapril)  -  Abbott, Turkey; Dream Pharma, South Korea; Ferrer, Dominican Republic; Ferrer, Guatemala; Ferrer, Honduras; Ferrer, Luxembourg; Ferrer, Nicaragua; Ferrer, El Salvador; Ferrer Farma, Spain; Galenica, Greece; Galenica, Romania
ENEAS (Nitrendipine and Enalapril)- Ferrer, Germany; Merck, Germany
Enit (Nitrendipine and Enalapril) - Adeka, Turkey;   Ferrer, Luxembourg;    Ferrer Farma, Spain;     Gap, Greece
Gericin                                 Seid, Spain
Grifonitren                         Chile, Chile
Jutapress                             Juta, Germany; Q-Pharm, Germany
Leonitren                            Mentinova, Greece
Lisba                                      Rafarm, Greece
Lostradyl                             Chrispa, Greece
Lusopress                            Berlin-Chemie, Bulgaria;   Berlin-Chemie, Estonia;   Instituto Luso Farmaco, Czech Republic;     Luso, Latvia;     Lusofarmaco, Lithuania;      Lusofarmaco, Romania;      Lusofarmaco, Slovakia;       Lusofarmaco, Tunisia
Miniten                               Utopian, Thailand
Nelconil                               Pharmathen, Greece
Nian                                      Ying Yuan, Taiwan
Nidrel                                   UCB Pharma, France
Nifecard                              Bros, Greece
Nilzipin                                                Kyorin Rimedio, Japan
Niprina                                 Esteve, Spain
Nirapel                                 Ivax, Argentina
Nitopress                            Kyowa Yakuhin, Japan
Nitotelocin                         Choseido Pharmaceutical, Japan
Nitregamma                      Wörwag Pharma, Germany
Nitren Lich                          Winthrop, Germany
Nitren                                   Siu Guan, Taiwan
Nitren-acis                         Acis, Germany
Nitrencord                          Biosintética, Brazil
Nitrend KSK                       KSK-Pharma, Germany
Nitrendil                             Bagó, Argentina; Elmor, Venezuela
Nitrendilat                                         Medilat, Greece
Nitrendipin - 1 A Pharma             1A Pharma, Germany
Nitrendipin AbZ                               AbZ-Pharma, Germany
Nitrendipin Actavis                        Actavis, Germany; Balkanpharma, Bulgaria
Nitrendipin AL                                  Aliud, Bulgaria; Aliud, Germany
Nitrendipin Aristo                           Aristo Pharma, Germany
Nitrendipin Basics                           Basics, Germany
Nitrendipin beta                              Betapharm, Germany
Nitrendipin dura                              Mylan dura, Germany
Nitrendipin Heumann                          Heumann, Germany
Nitrendipin JENAPHARM                             mibe, Germany
Nitrendipin Lindopharm                              Lindopharm, Germany
Nitrendipin Sandoz                                      Sandoz, Germany
Nitrendipin STADA                STADA, Germany
Nitrendipin-corax                   Corax, Germany
Nitrendipin-CT                           CT Arzneimittel, Germany
Nitrendipine - Pacific Pharm - Pacific, China
Nitrendipine Myla                    Mylan, France
Nitrendipine Teva                 Teva Santé, France
Nitrendipine Xinhua Pharm - Xinhua, China
Nitrendipine-Xinhua Pharm -  Xinhua, China
Nitrendipino Andromaco   Andromaco, Chile
Nitrendipino L.CH.               Chile, Chile
Nitrendipino Mintlab          Mintlab, Chile
Nitrendipino Ratiopharm   Ratiopharm, Spain
Nitrendipino Rider           Rider, Chile
Nitrendipino Stada           STADA, Spain
Nitrendipin-ratiopharm  Ratiopharm, Germany; Ratiopharm, Czech Republic
Nitrendypina Anpharm   Anpharm, Poland
Nitrensal                             TAD, Germany
Nitrepin                               Zdravlje, Serbia
Nitrepress                          Hexal, Czech Republic; Hexal, Germany; Hexal, Lithuania
Nitre-Puren                       Actavis, Germany
Nitresan                              Pro.Med., Poland; Pro.Med.CS, Czech Republic; Pro.Med.CS, Estonia; Pro.Med.CS, Lithuania; Pro.Med.CS, Slovakia
Nitrezic                                                Ohara Yakuhin, Japan
Nivitron                               Coup, Greece
Potional                               Kleva, Greece
Ravena                                 STADA, Bulgaria
Shetlazorna                        Nisshin Seiyaku - Yamagata, Japan
Shu Mai Te                         Great Wall Pharmaceutical Factory, China
Spidox               Finixfarm, Greece
Tensogradal           Kern, Spain
Tepanil   -           Norma Hellas, Greece
Unipres   -              Krka, Czech Republic; Krka, Hungary; Krka, Lithuania; Krka, Slovenia
Unipress  -                  Krka, Slovakia
Vastensium    -           Salvat, Spain

Vipres (Nitrendipine and Enalapril)  -  Ferrer Farma, Spain

Thursday, July 25, 2013

NIFEDIPINE

Nifedipine is a dihydropyridine calcium channel blocker. Its main uses are as an antianginal (especially in Prinzmetal's angina) and antihypertensive, although a large number of other indications have recently been found for this agent, such as Raynaud's phenomenon, premature labor, and painful spasms of the esophagus such as in cancer and tetanus patients. It is also commonly used for the small subset of pulmonary hypertension patients whose symptoms respond to calcium channel blockers.


3,5-dimethyl 2,6-dimethyl-4-(2-nitrophenyl)-1,4-dihydropyridine-3,5-dicarboxylate

DOSE

The recommended starting dose for immediate-release nifedipine capsules is 10 mg, taken 3 times daily. With the extended-release version, the recommended starting nifedipine dosage is 30 to 60 mg, taken once daily. Nifedipine rapidly lowers blood pressure, and patients are commonly warned they may feel dizzy or faint after taking the first few doses. Tachycardia (fast heart rate) may occur as a reaction. These problems are much less frequent in the sustained-release preparations of nifedipine (such as Adalat OROS). A more novel release system is GITS (Gastro-Intestinal Therapeutic System), which - according to Bayer - provides 24-hour continuous release through an osmotic push system. Recent trials with GITS include INSIGHT (for blood pressure) and ACTION (for angina).
Extended release formulations of nifedipine should be taken on an empty stomach, and patients are warned not to consume anything containing grapefruit or grapefruit juice, as they raise blood nifedipine levels. There are several possible mechanisms, including the lowering of CYP3A4 activity.


USES
The approved uses for are the long-term treatment of hypertension (high blood pressure) and angina pectoris. In hypertension, recent clinical guidelines generally favour diuretics and ACE inhibitors, although calcium channel antagonists, along with thiazide diuretics, are still favoured as primary treatment for over 55's and black patients.
Sublingual nifedipine has previously been used in hypertensive emergencies. This was found to be dangerous, and has been abandoned. Sublingual nifedipine causes blood-pressure lowering through peripheral vasodilation. It can cause an uncontrollable decrease in blood pressure, reflex tachycardia, and a steal phenomenon in certain vascular beds. There have been multiple reports in the medical literature of serious adverse effects with sublingual nifedipine, including cerebral ischemia/infarction, myocardial infarction, complete heart block, and death. As a result of this, the FDA reviewed all data regarding the safety and efficacy of sublingual nifedipine for hypertensive emergencies in 1995, and concluded that the practice should be abandoned because it was neither safe nor efficacious. An exception to the avoidance of this practice is in the use of nifedipine in the treatment of hypertension associated with autonomic dysreflexia in spinal cord injury.


OVERDOSAGE
A number of persons have developed toxicity due to acute overdosage with nifedipine, either accidentally or intentionally, and via either oral or parenteral administration. The adverse effects include lethargy, bradycardia, marked hypotension and loss of consciousness. The drug may be quantitated in blood or plasma to confirm a diagnosis of poisoning in hospitalized patients or to assist in a medicolegal death investigation. Analytical methods usually involve gas or liquid chromatography and specimen concentrations are usually in the 100-1000 μg/L range.


BRANDS

ADALAT ORS CAP                               BAYER
ANGIBLOCK CAP                                 ALKEM
CALBLOC                                            UNISERCH
CALCIGARD                              TORRENT
CARDULES CAP                        NICHOLAS
DEPICOR CAP                            MERCK
DEPICOR SR CAP                       MERCK
DEPIN CAP                                 Zydus cadila
NICARDIA CAP                            J.B.Chemichels
Nicardia retard                           ,,
NEFEDINE TAB                            Nicolas piramal
Nifelat cap                                   Cipla
Niferil tab                                     usv


Tuesday, July 23, 2013

NEBIVOLOL

Nebivolol is a β1 receptor blocker with nitric oxide-potentiating vasodilatory effect used in treatment of hypertension and, in Europe, also for left ventricular failure. It is highly cardioselective under certain circumstances
Nebivolol slows down the activity of your heart by stopping messages sent by some nerves to your heart. It does this by blocking tiny areas (called beta-adrenergic receptors) where the messages are received by your heart. Nebivolol also relaxes (widens) some blood vessels. These two things together allow the pressure of blood within your blood vessels to be reduced and make it easier for your heart to pump blood around your body. This is of benefit in hypertension (where your blood pressure is too high), and in heart failure (which is a condition where the pumping action of your heart is reduced).
In the US, Nebivolol (nebivolol systemic) is a member of the drug class cardioselective beta blockers and is used to treat High Blood Pressure and Mitral Valve Prolapse.

1-(6-fluorochroman-2-yl)-{[2-(6-fluorochroman-2-yl)-2-hydroxy-ethyl]amino}ethanol


PHARMACOLOGY
Beta blockers help patients with cardiovascular disease by blocking β receptors, while many of the side-effects of these medications are caused by their blockade of β2 receptors. For this reason, beta blockers that selectively block β1 receptors (termed cardioselective or β1-selective beta blockers) produce fewer adverse effects (for instance, bronchoconstriction) than those drugs that non-selectively block both β1 and β2 receptors. Nebilovol has been marketed by Cipla Ltd under brand name Nebicip; by Forest Laboratories under the name Bystolic; by Micro Labs under the brand name Nebilong; ; and by Menarini under the names Hypoloc, Lobivon, Nebilet, Nebilox, Nobiten, and Temerit. In a laboratory experiment conducted on biopsied heart tissue, nebivolol proved to be the most β1-selective of the β-blockers tested, being approximately 3.5 times more β1-selective than bisoprolol. However, the drug's receptor selectivity in humans is more complex and depends on the drug dose and the genetic profile of the patient taking the medication. The drug is highly cardioselective at 5 mg. However, at doses above 10 mg, nebivolol loses its cardioselectivity and blocks both β1 and β2 receptors. (While the recommended starting dose of nebivolol is 5 mg, sufficient control of blood pressure may require doses up to 40 mg). Furthermore, nebivolol is also not cardioselective when taken by patients with a genetic makeup that makes them "poor metabolizers" of nebivolol (and other drugs) or with CYP2D6 inhibitors. As many as 1 in 10 Whites and even more Blacks are poor CYP2D6 metabolizers and therefore might benefit less from nebivolol's cardioselectivity although currently there are no directly comparable studies

Before taking nebivolol
Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start taking nebivolol it is important that your doctor or pharmacist knows:

If you are pregnant, trying for a baby or breast-feeding.
If you have liver or kidney problems.
If you have low blood pressure or poor circulation.
If you have asthma or breathing difficulties.
If you have diabetes.
If you have psoriasis (a skin problem).
If you have myasthenia gravis (a condition causing muscle weakness).
If you have been told you have a slow heartbeat or heart block (a slow and irregular heartbeat).
If you have been told you have Prinzmetal's angina (chest pain caused by spasms of the heart's blood vessels).
If you have phaeochromocytoma (a tumour on your adrenal gland).
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 a medicine, or if you have ever had any other severe allergic reaction.


BRANDS

ASIVOL        -           AS PHARMA
BIPINOR            -    ACI  (Bangladesh)
BYSTOLIC          -    Forest (United States)
EBIVOL              -    Actavis Group (Poland)
ENDOLOL          -     Heto       India
EZOCEM            -    OZONE Laboratories        -   Poland, Romania
LOVISPES        -      Specifar SA           Slovenia, Teva, Poland
NEBEST           -    USV               -    India
Nebeta                Abdi Ibrahim, Georgia
Nebicard        Biofarm, Poland;         Hexal, Latvia;        Sandoz, Lithuania;      Torrent, India;     Torrent  -      Vietnam
Nebicard-H             (Nebivolol and Hydrochlorothiazide)           Torrent   -    India
Nebicard-SM       (Nebivolol and Levamlodipine)        Torrent  -  India
Nebicard-V      (Nebivolol and Valsartan)       Torrent  -   India
Nebilet        Adcock Ingram Pharmaceuticals -  South Africa;          Berlin-Chemie  -   Georgia;                Berlin-Chemie -  Tunisia;            Biotoscana -  Peru;                  Menarini -  Costa Rica;                         Menarini  -  Dominican Republic;                      Menarini  -    Honduras;              Menarini  -  Nicaragua;   Menarini  -   Panama;       Menarini  -   El Salvador;                 Menarini Laboratorios  -   Guatemala
Nebilet Plus     (Nebivolol and Hydrochlorothiazide (pediatric))       Berlin-Chemie  -   Georgia
Nebilong       Micro Carsyon  - India
Nebilong-H    (Nebivolol and Hydrochlorothiazide)         Micro Carsyon  -  India
Nebimac      -   Macleods  -   India
Nebimac-H    (Nebivolol and Hydrochlorothiazide)       Macleods  -   India
Nebinad        Farma-Projekt   -  Poland
Nebinex         Glenmark   -  India
Nebinex-AM     (Nebivolol and Amlodipine)         Glenmark  -   India
Nebinorm      Medicament  -   Romania
Nebipil           Alkem  -  India
Nebipril-SA   (Nebivolol and Levamlodipine)      Alkem   -   India
Nebispes      Galex  -   Poland;                Galex  -   Slovenia;        Nycomed  -   Latvia;        Pharmanova -Serbia
Nebistar                Lupin  -  India
Nebistar-SA        (Nebivolol and Levamlodipine)          Lupin  -  India
Nebiten       Anthus  -  India
Nebiten-H     (Nebivolol and Hydrochlorothiazide)               Anthus  -   India
NebivoLek            Sandoz  -    Poland
Nebivolol Actavis         Actavis  -   Romania
Nebivolol AL            Aliud   -  Germany
Nebivolol EG       Eurogenerics  -   Luxembourg
Nebivolol Hexal           1A Pharma  -   Poland;       Hexal  -   Luxembourg
Nebivolol Mylan        Generics  -  Slovenia
Nebivolol Pliva          Pliva   -  Poland
Nebivolol Teva            Teva   -  Romania
Nebivor           Orion  -   Poland
Neblotensol           Gerot-Lannach  -  Romania
Nedal     Polfa Warszawa  -   Poland
Nemirostad         STADA     Lithuania
Nemont        Norameda  - Lithuania
Nerose         Norameda  -  Lithuania
Nevol            Medley  -   India
Nevol-H(Nebivolol and Hydrochlorothiazide)          Medley  -   India
Niavas         Ranbaxy   -   India
Niavas-D(Nebivolol and Hydrochlorothiazide)                     Ranbaxy  -   India
Nobiten           Menarini   -   Luxembourg
Nobizide(Nebivolol and Hydrochlorothiazide)      Menarini International-L      -    Italy
Nolet                 Antibiotice    -   Romania
Nonblon             Aversi     -  Georgia
Nonblon H   (Nebivolol and Hydrochlorothiazide)          Aversi  -   Georgia
Nubeta         Abbott  -   India
Nubeta-H      (Nebivolol and Hydrochlorothiazide)       Abbott  -   India
Nubeta-SM       (Nebivolol and Levamlodipine)     Abbott   -   India
X-Pressol          Labormed Pharma  Romania
Zenebi         FDC    India
Zinebi        FDC  -   India
Anfibol      Drugtech   Chile
Betalol       East West   India
Betalol-H     (Nebivolol and Hydrochlorothiazide)         East West  -   India
Bivol       Specifar  -  Greece
Bravylol      -   Tchaikapharma  -  Bulgaria
Conébilox       (Nebivolol and Hydrochlorothiazide)         Negma  -  France
Ezocem    S.C. Labormed Pharma   -   Czech Republic
Hypoloc      Berlin-Chemie   -   Germany;             Menarini  -   Austria;                   Menarini -  Denmark;   Menarini   -  Finland;                  Menarini    -   Greece;             Menarini  -   Luxembourg;                  Menarini   -      Netherlands
Lobibeta       Alet Pharmaceuticals   -   Greece
Lobivon Plus    (Nebivolol and Hydrochlorothiazide)           Menarini  -  Spain   
Lobivon       Berlin-Chemie   -  Germany;              Menarini  -  Spain;                Menarini     -   Greece; Menarini   -   Italy;                   Menarini    Netherlands
Nabila       Tecnofarma  -  Chile
Nebalex      Specifar   -   Bulgaria
Nebest-H      (Nebivolol and Hydrochlorothiazide)       USV  -   India
Nebicar           OEP Phils   -   Philippines
Nebicard       Medicamenta  -   Bulgaria;       Sandoz-  Estonia;        Torrent  -   Myanmar;                    Torrent  -  Philippines
Nebicor        Adipharm -  Bulgaria
Nebicur        Kleva     Greece
Nebilan      G.L. Pharma  -   Bulgaria;                 Lannacher  -   Austria
Nebilet plus  (Nebivolol and Hydrochlorothiazide)     Menarini  -   Lithuania;    Menarini  -  Latvia;    Menarini  -   Malta
Nebilet
A. Menarini  -   United Kingdom;     Berlin Chemie  -   Bosnia & Herzegowina;        Berlin-Chemie, Bulgaria;     Berlin-Chemie, Czech Republic;             Berlin-Chemie -  Germany;            Berlin-Chemie  -   Croatia (Hrvatska);    Berlin-Chemie  - Hungary;              Berlin-Chemie -  Poland;                Berlin-Chemie, Romania;         Berlin-Chemie, Serbia;          Berlin-Chemie   -   Slovakia;                   Biotoscana, Colombia; CSL, Australia; ITF – Labomed   Chile;       Leti  -   Venezuela;      Menarini, Argentina; Menarini, Switzerland; Menarini, Estonia; Menarini  -  Ireland;       Menarini  -  Lithuania;      Menarini  -   Latvia;      Menarini  -  Malta;       Menarini  -   Netherlands; Menarini, Portugal; Menarini, Singapore; Menarini, Slovenia;      Menarini, Thailand
Nebilet Plus (Nebivolol and Hydrochlorothiazide)        Berlin-Chemie, Bulgaria; Menarini, Estonia
Nebilet plus(Nebivolol and Hydrochlorothiazide)          Menarini, Switzerland
Nebiloc      Menarini, Netherlands
Nebilostad      STADA, Netherlands
Nebilox       Berlin-Chemie, Germany; GlaxoSmithKline, Italy
Nébilox       Negma, France
Nebinorm          Glenmark, Lithuania; Medicamenta, Czech Republic
Nebiphar          Teva, Estonia; Teva, Lithuania; Teva, Latvia
Nebirod        Sopharma, Bulgaria
Nebisam     Specifar, Lithuania; Specifar, Latvia
Nebiscal              +pharma, Czech Republic
Nebiscop        Specifar, Estonia; Specifar, Lithuania; Specifar, Latvia
Nebispes        Galex, Czech Republic; Nycomed, Lithuania; Specifar, Estonia
Nebiten                  G.L. Pharma, Estonia; G.L. Pharma, Lithuania; Lannacher Heilmittel, Latvia
Nebitrix      Glenmark, Bulgaria; Glenmark, Czech Republic
Nebivolol - 1 A Pharma               1A Pharma, Germany
Nebivolol +pharma                    +pharma, Czech Republic
Nebivolol 1A Pharma        1A Pharma, Estonia; 1A Pharma, Lithuania
Nebivolol AAA                     AAA-Pharma, Germany
Nebivolol AbZ        AbZ-Pharma, Germany
Nebivolol Actavis       Actavis, Switzerland; Actavis, Bulgaria; Actavis, Estonia; Actavis, United Kingdom; Actavis, Lithuania; Actavis, Latvia; Actavis, Malta; Actavis, Netherlands
Nébivolol Actavis      Actavis, France
Nebivolol Apotex       Apotex, Spain; Apotex Europe, Netherlands
Nébivolol Arrow        Arrow, France
Nebivolol Axapharm      Axapharm, Switzerland
Nébivolol Biogaran    Biogaran, France
Nebivolol CF       Centrafarm, Netherlands
Nebivolol Cinfa         Cinfa, Spain
Nébivolol CristerS     CristerS, France
Nebivolol Dival       Dival Classics, Netherlands
Nebivolol Edigen       Germed, Spain
Nébivolol EG     EG Labo, France
Nébivolol Evolugen       Evolupharm, France
Nebivolol G.L.         G.L. Pharma, Austria
Nebivolol Generis       Generis, Portugal
Nebivolol Glenmark       Glenmark, Netherlands
Nebivolol Heumann        Heumann, Germany
Nebivolol HEXAL          Hexal, Germany
Nébivolol Isomed           Teva Santé, France
Nebivolol Labesfal                     Labesfal, Portugal
Nebivolol Mylan                  Mylan, Spain; Mylan, Netherlands
Nébivolol Mylan                   Mylan, France
Nebivolol Normon              Normon, Spain
Nebivolol Orion                  Orion, Estonia; Orion, Lithuania; Orion, Latvia
Nebivolol PCH         Pharmachemie, Netherlands
Nebivolol Pensa                Pensa Pharma, Spain
Nebivolol Pliva      Pliva, Croatia (Hrvatska); Pliva, Hungary
Nebivolol Portfarma         Portfarma, Estonia; Portfarma, Lithuania; Portfarma, Latvia
Nébivolol Qualimed           Qualimed, France
Nébivolol Ranbaxy             Ranbaxy, France
Nebivolol Ratio                      Ratiopharm, Spain
Nebivolol Ratiopharm               Ratiopharm, Spain
Nébivolol Ratiopharm               Ratiopharm, France
Nebivolol Sandoz           Sandoz, Bulgaria; Sandoz, Switzerland; Sandoz, Czech Republic; Sandoz, Germany; Sandoz, United Kingdom; Sandoz, Netherlands; Sandoz Farmaceutica, Spain
Nébivolol Sandoz            Sandoz, France
Nebivolol Spirig                Spirig HealthCare, Switzerland
Nebivolol STADA                       STADA, Germany
Nebivolol Streuli                      Streuli Pharma, Switzerland
Nebivolol Teva             Teva, Bulgaria
Nébivolol Teva              Teva Santé, France
Nebivolol Tevagen                       Teva, Spain
Nebivolol Torrent                  Torrent Pharma, Lithuania
Nebivolol Winthrop                Winthrop Pharmaceuticals, United Kingdom
Nébivolol Winthrop                 Sanofi-Aventis, France
Nebivolol Zentiva                   Sanofi Aventis, Spain
Nébivolol Zydus                    Zydus, France
Nebivolol/Alapis Bulgaria            Alapis, Bulgaria
Nebivolol-1A Pharma                        1A Pharma, Latvia
Nebivolol-Acino                      Acino, Germany
Nebivolol-aconitum             Aconitum, Lithuania
Nebivolol-Actavis             Actavis, Germany
Nebivolol-CT                      CT Arzneimittel, Germany
Nebivolol-Mepha          Mepha, Switzerland
Nebivololo Actavis         Actavis Italy, Italy
Nebivololo Alter              Alter, Italy
Nebivololo Angenerico                  Angenerico, Italy
Nebivololo Doc Generici         DOC Generici, Italy
Nebivololo Dr Reddy's             Dr Reddy's, Italy
Nebivololo EG               EG, Italy
Nebivololo Mylan                Mylan, Italy
Nebivololo Pensa                 Pensa Pharma, Italy
Nebivololo Ranbaxy          Ranbaxy Italia, Italy
Nebivololo Ratiopharm        Ratiopharm Italia, Italy
Nebivololo Sandoz                 Sandoz, Italy
Nebivololo Teva                     Teva Italia, Italy
Nebivololo Winthrop             Winthrop Ph.Italia, Italy
Nebivolol-ratiopharm             Merckle, Bulgaria;              Merckle, Estonia;           Ratiopharm, Germany; Ratiopharm, Latvia
Nebivolol-Tchaikapharma          Tchaikapharma, Bulgaria
Nebivolol-Teva                         Teva, Germany;           Teva, Estonia;       Teva, Lithuania;          Teva, Latvia; Teva Pharma, Switzerland
Nebizita                       Specifar, Bulgaria
Nemirostad                STADA, Estonia; STADA, Latvia
Nexivol                       Abdi Ibrahim, Turkey
Nibel                        Belupo, Croatia (Hrvatska)
Nobiten                  Menarini, Belgium
Nomexor               Menarini, Austria
Nomexor plus HCT(Nebivolol and Hydrochlorothiazide)     Menarini, Austria
Noviblock     Medicamerc, Greece
Pertium       Saval, Chile
Silostar Plus(Nebivolol and Hydrochlorothiazide)          Uriach-Aquilea, Spain
Silostar                     Uriach-Aquilea, Spain
Temerit                    Menarini, France
TemeritDuo(Nebivolol and Hydrochlorothiazide)        Menarini, France
Vasoxen          I.E. Ulagay, Turkey
Volone             Farmal, Croatia (Hrvatska)