DIABETIC KETO ACIDOSIS

LOSARTAN POTASSIUM

Losartan is an angiotensin II receptor antagonist drug used mainly to treat high blood pressure (hypertension). Losartan was the first angiotensin II receptor antagonist to be marketed. Losartan potassium is available in JAN AUSHADHI price 11 RS for 10 tab available as generic form.
As with all angiotensin II type 1 receptor (AT1) antagonists, losartan is indicated for the treatment of hypertension. It may also delay progression of diabetic nephropathy, and is also indicated for the reduction of renal disease progression in patients with type 2 diabetes, hypertension and microalbuminuria (>30 mg/24 hours) or proteinuria (>900 mg/24 hours).
Although clinical evidence shows calcium channel blockers and thiazide-type diuretics are preferred first-line treatments for most patients (from both efficacy and cost points of view), an angiotensin II receptor antagonist such as losartan is recommended as first-line treatment in patients under the age of 55 who cannot tolerate an ACE inhibitor. The LIFE study demonstrated losartan was significantly superior to atenolol in the primary prevention of adverse cardiovascular events (myocardial infarction or stroke), with a significant reduction in cardiovascular morbidity and mortality for a comparable reduction in blood pressure. A study hints that losartan has a beneficial effect on mitochondria by reversing age related dysfunction in maintaining normal blood pressure and cellular energy usage. The maximal effects on blood pressure usually occur within 3–6 weeks upon starting losartan.
Losartan is also available as hydrochlorothiazide/losartan, a combination drug with a low dose thiazide diuretic to achieve an additive antihypertensive effect.

(2-butyl-4-chloro-1-{[2'-(1H-tetrazol-5-yl)biphenyl-4-yl]methyl}-1H-imidazol-5-yl)methanol

Mechanism of action and pharmacological actions
Losartan is a selective, competitive angiotensin II receptor type 1 (AT1) receptor antagonist, reducing the end organ responses to angiotensin II. Losartan administration results in a decrease in total peripheral resistance (afterload) and cardiac venous return (preload) All of the physiological effects of angiotensin II, including stimulation of release of aldosterone, are antagonized in the presence of losartan. Reduction in blood pressure occurs independently of the status of the renin-angiotensin system. As a result of losartan dosing, plasma renin activity increases due to removal of the angiotensin II feedback.
Losartan is a uricosuric. Because losartan can cause hyperkalemia, potassium supplements or salt substitutes containing potassium should not be used without appropriate monitoring by a physician.

Pharmacokinetics
Losartan is well absorbed following oral administration and undergoes significant first-pass metabolism to produce 5-carboxylic acid metabolite, designated as EXP3174. This metabolite is a long-acting (6 to 8 hr), noncompetitive antagonist at the AT1 receptor, and contributes to the pharmacological effects of losartan. EXP3174 is 10-40 times more potent in blocking AT1 receptors than losartan. Losartan's bioavailability is about 32%.
Metabolism is primarily by cytochrome P450 isoenzymes CYP2C9 and CYP3A4. Peak plasma concentrations of losartan and E-3174 occur about one hour and three to four hours, respectively, after an oral dose. Both losartan and E-3174 are more than 98% bound to plasma proteins. Losartan is excreted in the urine, and in the feces via bile, as unchanged drug and metabolites. About 4% of an oral dose is excreted unchanged in urine, and about 6% is excreted in urine as the active metabolite. The terminal elimination half lives of losartan and E-3174 are about 1.5 to 2.5 hours and 3 to 9 hours, respectively.

BRANDS
Alsartan - aristo, angilo-nitro, Czartan- macleods,giftan - systopic, Lara alkem, Lo - east west
Lopt - rhine, lopar , lomax, lopo, lorsave, lortan, losa, losacar, losaday, losaden, losagard, losain, losak, losakind, losamax, losamed, losan, losanorm, losapot,
Losar, losariv, losartan, losartas, losatrust, losatec, losavas, losavik, losacard, loscom, loset, losin , losit, losium, lopsi, lostat, lossi, lot, lotak, lotace, loza
Omnitan, nusar, osart, presartan , repace resilo , revas, rigard, saan, tozaar, vazortan, zaart, zargo, zilos, zortan, zyltan

FRUSEMIDE

Furosemide or frusemide is a loop diuretic used in the treatment of congestive heart failure and edema. It is most commonly marketed by Sanofi under the brand name Lasix, PRICE OF FRUSEMIDE 40 IN JAN AUSHADHI STORE just 4 rs for 10 tab, It has also been used to prevent Thoroughbred and Standardbred race horses from bleeding through the nose during races.
Along with some other diuretics, furosemide is also included on the World Anti-Doping Agency's banned drug list due to its alleged use as a masking agent for other drugs.

4-chloro-2-(furan-2-ylmethylamino)- 5-sulfamoylbenzoic acid

use
Furosemide is primarily used for the treatment of hypertension and edema. It is the first-line agent in most people with edema due to congestive heart failure. It is also used for hepatic cirrhosis, renal impairment, nephrotic syndrome, in adjunct therapy for cerebral/pulmonary edema where rapid diuresis is required (IV injection), and in the management of severe hypercalcemia in combination with adequate rehydration.

ADVERSE EFFECTS
Although disputed, it is considered ototoxic: "usually with large parenteral doses and rapid administration and in renal impairment". Furosemide also can lead to gout due to hyperuricemia. Hyperglycemia is also a common side effect.
The tendency, as for all loop diuretics, to cause low potassium levels (hypokalemia) has given rise to combination products, either with potassium itself (e.g. Lasix-K) or with the potassium-sparing diuretic amiloride (Co-amilofruse).


What are the precautions when taking furosemide (Lasix)?

Before taking furosemide, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney problems, liver problems, inability to make urine, gout, lupus.

If you have diabetes, furosemide may affect your blood sugar level. Check your blood sugar level regularly as directed and share the results with your doctor. Your doctor may need to adjust your diabetes medication or diet.


What happens if I miss a dose?

Furosemide is sometimes used only once, so you may not be on a dosing schedule. If you are using the medication regularly, take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.


What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include feeling very thirsty or hot, heavy sweating, or hot and dry skin.


What should I avoid while taking furosemide?

Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid becoming dehydrated. Follow your doctor's instructions about the type and amount of liquids you should drink while you are taking furosemide.

FOSINOPRIL

Fosinopril is an angiotensin converting enzyme (ACE) inhibitor used for the treatment of hypertension and some types of chronic heart failure. Fosinopril is the only phosphinate-containing ACE inhibitor marketed.

(2S,4S)-4-cyclohexyl-1-(2-{[2-methyl-1-(propanoyloxy)propoxy](4-phenylbutyl)phosphoryl}acetyl)pyrrolidine-2-carboxylic acid


Fosinoprilat and Fosinopril
Fosinoprilat proved to have the same problem as enalaprilat and the other carboxylate-containing ACE inhibitors (namely poor oral bioavailability). Addition of a hydrophobic side-chain modulated the ionisation characteristics of the molecule making it more bioavailable. Fosinopril is administered as a prodrug and is converted in vivo to the active form fosinoprilat.

Congestive heart failure and angiotensin II 
In congestive heart failure, the ability of the heart to pump enough blood to satisfy the physiological needs of the body is reduced.This condition has a variety of causes, including damaged heart valves, myocardial infarction, hypertension, vitamin B1 deficiency, and genetic mutations. When subsequent blood flow to the kidneys is reduced, the kidneys respond by increasing the secretion of renin from the juxtaglomerular apparatus. Renin converts the inactive angiotensinogen into angiotensin I, which is converted to angiotensin II (AII) by angiotensin converting enzyme (ACE). AII can have negative effects on the cardiovascular system after events such as heart failure and myocardial infarction. AII causes arterial vasoconstriction and hypertension resulting in an increase in afterload, increasing the resistance against which the heart works. Additionally, chronic increase in production of AII is associated with structural changes to the myocardium which reduces the functionality of the heart.

Effects of Fosinopril on treating heart failure
Fosinopril is de-esterified by the liver or gastrointestinal mucosa and is converted to its active form, fosinoprilat. Fosinoprilat competitively binds to ACE, preventing ACE from binding to and converting angiotensin I to angiotensin II. Inhibiting the production of AII lowers peripheral vascular resistance, decreases afterload and decreases blood pressure, thus helping to alleviate the negative effects of AII on cardiac performance. In heart failure patients, fosinopril increases exercise tolerance and lowers the frequency of events associated with worsening heart failure, such as dyspnea, the need for supplemental diuretics, fatigue, and hospitalizations. In a study examining the effects of fosinopril on insulin-like growth factor 1 (IGF-1) and IGF binding protein serum concentrations in high cardiovascular risk patients, a six-month treatment of fosinopril was associated with an elevation in IGF-1. Since a decline in IGF-1 is associated with an increased risk of ischemic heart disease, fosinopril may reduce ischemic risk.

Benefits of Fosinopril
Unlike other ACE inhibitors that are primarily excreted by the kidneys, fosinopril is eliminated from the body via both renal and hepatic pathways. This characteristic of fosinopril makes the drug a safer choice than other ACE inhibitors for heart failure patients with impaired kidney function resulting from poor perfusion as fosinopril can still be eliminated by the liver, preventing accumulation of the drug in the body.

Brands
fovas10 mg,20mg
fosinase 10,20

HOME REMEDIES FOR HAIR FALL TREATMENT 3

Home Remedy for Hair Fall

BASIC SKIN CARE TIPS

Skin of our body can be considered as important as any other vital organ in the human system. The Skin and muscles provide an important shelter to the inner organs which are delicate and need to be protected. Apart from its utility in the body system, skin contributes to a large extent to the outer appearance and the beauty of an individual. Who doesn't want a clean and glowing skin that magnifies the a beauty or attractiveness of a person. A healthy and glowing skin is also the indication of the healthy state of the body. Mentioned here in the article, are a few basic skin care tips that should be kept in mind to have healthy skin and a beautiful appearance.

Regular washing of the skin
This is the very basic and logically obvious method to maintain a good skin that is to keep it clean. You should wash your skin on a daily basis as part of your bath or otherwise with suitable cleaning agents.
It is not necessary always to use expensive and fancy skin care products to be used daily, rather the experts advice that a mild and scentless cleansing agent must be used on a daily basis which will get you rid of the dirt, germs and dead skin accumulated over it. The cleansing soap is preferred to have moisturizing qualities as well.
Deodorant body soaps and antibacterial soaps should not be used for a regular use.

Moisturizing the skin
With our day to day activities and exposure to pollution, Sun and harsh weather conditions like rain etc , our skin tends to lose the much needed miniaturization needed to keep it healthy and breathing.
It is easy to moisturize your skin and is as simple as rubbing the moisturizer after you take bath to the body. Again, there is not need to go after very costly products and you can chose a average priced but good quality solution available in the market for daily use.
If you have oily skin and have concerns due to the same then you can try using the products that don't cause clogging of the pores , they are known as non comedogenic products.


Use Sunscreen for skin protection
We all know the ill effects that the Sun's UV rays can have on our skin. These are the harmful rays that can cause major skin diseases as grave as skin cancer. It is recommended by the dermatologists to use Sun screens to effectively protect the skin against these hazardous effects.
Dermatologists suggest that whatever be the weather condition, be it rainy, sunny or even during snowfall we should ensure the use sun protection. The UV rays are present in abundance in the environment and are often reflected by these agents on to our skin. This exposure to UV rays for a long time may cause skin diseases like wrinkles, moles and discoloration.
Use Skin care products of a trusted brand which provides UVA and UVB level of protection and is SPF 15 or more.


Skin Care for Acne Prone skin
If you are prone to acne breakouts, then you need to handle the cleansing differently and with greater care.
Use cleanser products specially formulated for acne affected skin conditions. These products generally have an agent named as benzyl peroxide which is helpful in cleaning the soars caused due to acne.
You have to be gentle in cleaning your skin as being rough may cause burst those acne breakouts aggravating the problem. Use only non-comedogenic moisturizers.

DRY SKIN SOLUTIONS

Avoid These Dry Skin Mistakes Today

Your Skin is the largest organ "on" your body. In fact, that is the first thing people notice about you. That is why, from time immemorial, the care of the skin has been the preoccupation of many.

Your skin is 70% water, and many skin problems are associated with dry skin. That is why many skin preparations are made, using the concept of preventing moisture from leaving the skin. They therefore use occlusive agents, that is ingredients that clog your pores, thus theoretically sealing moisture in.

There is a problem with this approach however, and I'll explain shortly, but first...

Let's Learn About Your Skin. How it is Made, and How it Actually Works.

Your skin consists of two distinct layers: The outer layer, the epidermis, consists of dry mature cells and forms the protective layer. The inner layer or dermis consists of collagen. This gives the skin strength and flexibility. The dermis also contains the sweat glands, nerves, blood capillaries hair follicles and sebaceous glands.

Your skin is an important, vital, living, dynamic organ without which you could not survive. Among its many functions, it regulates your body temperature, and through its more than 2,000,000 sweat pores, is an organ of excretion. Your skin should also be allowed to breathe.

With this background, it's easy to understand why the following ingredients do NOT belong on your skin:

Mineral Oil A mixture of refined liquid hydrocarbons derived from petroleum. Mineral oil is the stabilizing ingredient of many skin care products. Mineral oil forms an occlusive film on your skin, blocking your pores, and interfering with normal skin respiration. It may, therefore, not only harm your skin but be a contributing cause of blemishes.
Petroleum
(Petrolatum) Petroleum products such as Vaseline, etc., do not penetrate your skin, but sit on the surface blocking natural respiration, excretion, and absorption of other nutrients. It is also an occlusive agent, and should be avoided.
Lanolin Derived from sheep wool, Lanolin is a common lubricating ingredient in many cosmetics and creams. In addition t being occlusive, it has been proven to cause allergic reactions in skin of sensitive people.
Solvent Solvent alcohols in the form of propyl of isopropyp are drying to your skin
Collagen This animal product is added to cosmetics as a moisturizing agent. The molecules are too large to penetrate your skin. They therefore clog your pores, and in some cases cause allergic reactions.
Here's an interesting exercise. Check your skin care products now and see how many of them have one or more or the above offending products. You may be surprised.

    Other ingredients to avoid are:
Artificial Colors Known to cause allergic reactions in some people.
ARTIFICIAL FRAGRANCES Known to create allergic skin reactions and photosensitivity in some people.
The jury is still out on such chemicals as Retin A, Retinol, and Alpha Hydroxy Acids. A prudent approach is to avoid their use, especially now that something better safer, and more in tune with your skin's normal physiology, is available.

Stevens Skin Softener Cream...a New Approach to Skin Care

Rather than using occlusive agents that clog your pores to prevent moisture from leaving your skin, Stevens Skin Softener Cream is designed to put moisture into your skin.

For this it uses Jojoba oil, Apricot kernel oil, Almond oil, Purcelin oil, Avocado oil and Squalene. Not only do these natural oils take moisture deep into your skin, but Jojoba, Avocado and Almond oils have the same consistency and molecular structure as sebum, your skin's own natural lubricating oil. They therefore also serve to lubricate your skin.

Why is this so important to you?

You see, your skin is 70% water. Sebum, your skin's own natural lubricating oil, functions to lubricate your skin and prevent it from drying out. This natural protection breaks down with many skin problems, and also as you get older. Women especially, experience an estimated 32% reduction per decade in sebum production, after age 20. Do you understand now why everything you have tried for your dry skin has not worked, and why Stevens Skin Softener Cream will? Try It!!!

URSODEOXYCHOLIC ACID

Ursodeoxycholic acid is also known as Ursodiol  and the abbreviation UDCA, is one of the secondary bile acids, which are metabolic byproducts of intestinal bacteria.

3α,7β-dihydroxy-5β-cholan-24-oic acid

OR

(R)-4-((3R,5S,7S,8R,9S,10S,13R,14S,17R)-3,7-dihydroxy-

10,13-dimethylhexadecahydro-

1H-cyclopenta[a]phenanthren-17-yl)pentanoic acid

Formula  -  C24H40O4

Mol. mass  -  392.56 g/mol

Endogenous effects

Primary bile acids are produced by the liver and stored in the gall bladder. When secreted into the intestine, primary bile acids can be metabolized into secondary bile acids by intestinal bacteria. Primary and secondary bile acids help the body digest fats. Ursodeoxycholic acid helps regulate cholesterol by reducing the rate at which the intestine absorbs cholesterol molecules while breaking up micelles containing cholesterol. Because of this property, ursodeoxycholic acid is used to treat (cholesterol) gallstones non-surgically.

While some bile acids are known to be colon tumor promoters (e.g. deoxycholic acid), others such as ursodeoxycholic acid are thought to be chemopreventive, perhaps by inducing cellular differentiation and/or cellular senescence in colon epithelial cells.

It is believed to inhibit apoptosis.

Ursodeoxycholic acid has also been shown experimentally to suppress immune response such as immune cell phagocytosis. Prolonged exposure and/or increased quantities of systemic (throughout the body, not just in the digestive system) ursodeoxycholic acid can be toxic.

Pharmaceutical USE

Ursodeoxycholic acid is marketed under the trade names Actigall, Ursosan, Ursofalk, BILIVER, Egyurso, Urso, Urso Forte, Deursil and Coric.

Ursodeoxycholic acid can be chemically synthesized and was brought to market by the Montreal-based Axcan Pharma in 1998, which continues to market the drug.

The drug reduces cholesterol absorption and is used to dissolve (cholesterol) gallstones in patients who want an alternative to surgery. The drug is very expensive, however, and if the patient stops taking it, the gallstones tend to recur if the condition that gave rise to their formation does not change. For these reasons, it has not supplanted surgical treatment by cholecystectomy.

It is the only FDA approved drug to treat primary biliary cirrhosis.

A Cochrane review to evaluate if ursodeoxycholic acid has any beneficial effect in primary biliary cirrhosis patients included 16 randomized clinical trials with a total of 1447 patients. The primary outcome measures were mortality and mortality or liver transplantation. Although treatment with ursodeoxycholic acid showed a reduction in liver biochemistry, jaundice, and ascites, it did not decrease mortality or liver transplantation.

In absence of biochemical response to 13-15mg/kg/day ursodeoxycholic acid, its use is associated with an incidence of 20% hepatocellular carcinoma in patients with primary biliary cirrhosis in 15 years.

In children, its use is not licensed, as its safety and effectiveness are not established.

In double the recommended daily dose ursodeoxycholic acid reduces elevated liver enzyme levels in patients with primary sclerosing cholangitis, but its use was associated with an increased risk of serious adverse events (the development of cirrhosis, varices, death or liver transplantation) in patients who received ursodeoxycholic acid compared with those who received placebo). After adjustment for baseline stratification characteristics, the risk was 2.1 times greater for death,transplantation, or minimal listing criteria in patients on ursodeoxycholic acid than for those on placebo (P = 0.038). Serious adverse events, were more common in the ursodeoxycholic acid group than the placebo group

Research by the Imperial College London has produced promising results in the treatment of arrhythmia, both in patients who have suffered a heart attack and in foetuses, by using ursodiol to change the electrical properties of myofibroblast cells. Myofibroblasts disrupt the transmission of electrical signals controlling heart rhythm.

SOURCE

The drug is generally not derived from animals.However, it is believed up to 10,000 bile bears are kept on farms in China, Vietnam and South Korea for the purpose of harvesting ursodeoxycholic acid. Ursodeoxycholic acid is found in large quantities in bear bile.

Indication & Dosage

Dissolution of cholesterol-rich gallstones

Adult: 6-12 mg/kg daily as a single dose at bedtime or in 2-3 divided doses continued for 3-4 mth after radiological disappearance of stones. Doses may be divided unequally with a higher dose given before bedtime to counteract increase in biliary cholesterol saturation which occurs in early morning. Max: 15 mg/kg.

Hepatic impairment:Chronic liver disease (except primary biliary cirrhosis): use with caution.

Primary biliary cirrhosis

Adult: 10-15 mg/kg daily in 2-4 divided doses.

Prophylaxis of gallstones in patients undergoing rapid weight loss

Adult: 300 mg bid.

Hepatic impairment: Chronic liver disease (except primary biliary cirrhosis): use with caution.

DRUG INTERACTIONS

Cholestyramine, charcoal and antacids may reduce effectiveness. Aluminum-based antacids may reduce absorption. Oestrogens and clofibrate may counteract effectiveness of ursodeoxycholic acid by increasing cholesterol elimination in bile. Possible increase in ciclosporin serum concentration. Decreased effectiveness of dapsone. Possible decrease in serum ciprofloxacin and nitrendipine.

Mechanism of Action     

Ursodeoxycholic acid suppresses hepatic synthesis and secretion of cholesterol and also inhibits intestinal absorption of cholesterol.

Absorption: Rapidly and completely absorbed from the GI tract.

Distribution:Protein binding: 96-98%. Undergoes enterohepatic recycling.

Metabolism:Partly conjugated in the liver before being excreted into the bile. Free and conjugated forms undergo 7a-dehydroxylation to lithocholic acid under the influence of gut bactera. Some are reabsorbed and then further conjugated and sulfated by the liver.

Excretion:Faeces.

Brand Names

Acido Ursodesossicolico Actavis

Actavis Italy, Italy

Acido Ursodesossicolico Angenerico

Angenerico, Italy

Acido Ursodesossicolico Doc

DOC Generici, Italy

Acido Ursodesossicolico Dorom

Dorom, Italy

Acido Ursodesossicolico EG

EG, Italy

Acido Ursodesossicolico Mylan

Mylan, Italy

Acido Ursodesossicolico ratiopharm

ratiopharm Italia, Italy

Acido Ursodesossicolico Winthrop

Winthrop Ph.Italia, Italy

Actigall

Novartis, New Zealand; Watson, United States

Adursal

Leiras, Finland

Audecol

Ariston, Argentina

Bilenor (Ursodeoxycholic Acid and Chenodeoxycholic Acid)

Myung Moon, South Korea

Bilifalk

Dr Falk, Spain

Buraue

Yoshindo, Japan

Canlin

Everest, Taiwan

Choleron

Aversi, Georgia

Cholit-Ursan

STADA, Germany

Choludexan

Sigma, Georgia

Cisbile

Winston, Taiwan

Clotipide

AC Farma, Peru

Coleretik

Sherfarma, Peru

Daewoongursa

Daewoong, Vietnam

Delursan

Axcan, France

Desoxil

Crinos, Italy

Destolit

Norgine, United Kingdom; Sanofi-Aventis, Portugal

Deursil

Sanofi-Aventis, Italy

De-ursil

Sanofi-Aventis, Switzerland

De-ursil RR

Sanofi-Aventis, Switzerland

De-ursil RR mite

Sanofi-Aventis, Switzerland

Dexo

Dominguez, Argentina

Estazor

Fahrenheit, Indonesia

Fraurs

Francia Farmaceutici, Italy

Genurso

Genovate, Taiwan

Legan

Chin Teng, Taiwan

Liconor

Opsonin, Bangladesh

Ligat

TTY Biopharm, Taiwan

Lipo

Gentle, Taiwan

Lithofalk (Ursodeoxycholic Acid and Chenodeoxycholic Acid)

Falk, Germany

Litoff

Caber, Italy

Litomen

Best, Colombia

Litursol

Crinos, Italy

PMS-Ursodiol C

Pharmascience, Canada

Precoat

Tatsumi Kagaku, Japan

Proursan

Pro.Med., Poland

Reptor

Fuso Pharmaceutical, Japan

Sodan

Chen Ho, Taiwan

Solutrat

Sandoz, Argentina

Tantosan

Newai Chem, Taiwan

Ubiron

Medisa Shinyaku, Japan

UDC AL

Aliud, Germany

UDC HEXAL

Hexal, Germany

UDCA Ferring

Ferring, Argentina

Udihep

Win-Medicare, India; Win-Medicare, Thailand

Udihep Forte

Win-Medicare, India

Udoxyl

Ind-Swift, India

Uliden

Swiss Pharm, Taiwan

Urchil

Aamorb, India

Urchil Forte

Aamorb, India

Urdafalk

Darya-Varia, Indonesia; Falk, Indonesia

Urdahex

Kalbe, Indonesia

Urdenacin

Taiyo Pharmaceutical, Japan

Urdes

Errekappa Euroterapici, Italy

Urdeston

Towa Yakuhin, Japan

Urdex

Towa Yakuhin, Japan

Urdox

CP, Malta; Wockhardt, United Kingdom

Urose

Hwang's, Taiwan

Uroso

Johnson, Taiwan

Urosofalk

Dr. Falk, Portugal

Ursa 200MG

Daewoong, Vietnam

Ursa

Dae Woong, South Korea; Daewoong, Thailand

Ursacol

Zambon, Brazil; Zambon, Colombia; Zambon Italia, Italy

Ursidesox

Duncan, Argentina

Ursilon

IBI, Italy

Urso Forte

Aptalis, United States

Urso Heumann

Heumann, Germany

Urso

Aptalis, United States; Axcan, Canada; Mitsubishi Tanabe Pharma, Hong Kong; Mitsubishi-Tokyo, Taiwan; Tanabe Mitsubishi Pharma, Japan

Urso DS

Axcan, Canada

Ursobil

ABC Farmaceutici, Georgia; ABC Farmaceutici, Italy

Ursobilane

Estedi, Spain

Ursocam

Polfarmex, Poland

Ursocel

ABL Pharma, Peru

Ursochol

Zambon, Belgium; Zambon, Switzerland; Zambon, Germany; Zambon, Spain; Zambon, Indonesia; Zambon, Netherlands

Ursocid

Ta Fong, Taiwan

Ursodeoxycholic acid Zensei

Zensei Yakuhin, Japan

Ursodeoxycholic Acid-Daewoong Pharm

Daewoong Pharmaceutial Co. Ltd, China

Ursodeoxycholic Acid-Sunve Pharm

Sunve, China

Ursodeoxycholzuur Imphos

Imphos, Netherlands

Ursodesoxycholic Acid

Ying Yuan, Taiwan

Ursodil

General Pharma, Bangladesh

Ursodiol CorePharma

CorePharma, United States

Ursodiol Epic Pharma

Epic Pharma, United States

Ursodiol Glenmark

Glenmark, United States

Ursodiol Lannett

Lannett, United States

Ursodiol Mylan

Mylan, United States

Ursodiol RR Zentiva

Sanofi-Aventis, Switzerland

Ursodiol Teva

Teva, United States

Ursodiol Watson

Watson, United States

Ursodiol Zentiva

Sanofi-Aventis, Switzerland

Ursodiol

HLB, Argentina

Ursodox

Signova, India

Ursofalk

Farmasa, Mexico; ARIS, Turkey; Biotoscana, Chile; Biotoscana, Colombia; Biotoscana, Peru; Cevallos, Argentina; Codali, Belgium; Codali, Luxembourg; Dr Falk, Hong Kong; Dr. Falk, Israel; Dr. Falk, Norway; Dr. Falk, Russian Federation; Dr. Falk Pharma, Czech Republic; Dr. Falk Pharma, Serbia; Eureco, Netherlands; Falk, Bosnia & Herzegowina; Falk, China; Falk, Germany; Falk, United Kingdom; Falk, Hungary; Falk, Ireland; Falk, Lithuania; Falk, Malta; Falk, Philippines; Falk, Poland; Falk, Romania; Falk, Singapore; Falk, Slovakia; Falk, Thailand; Falk Pharma GmbH, Latvia; Farmak, Estonia; Galenica, Greece; IFET, Greece; Meda, Sweden; Merck, Austria; Orphan, Australia; Salus, Slovenia; Schwabe, Costa Rica; Schwabe, Guatemala; Schwabe, Honduras; Schwabe, Panama; Schwabe, El Salvador; Tramedico, Netherlands; Vifor, Switzerland; Würth, Croatia (Hrvatska); Zydus Cadila, India

Ursoflor

So.Se. Pharm, Italy

Ursogal

Galen, United Kingdom

Ursol

Siu Guan, Taiwan

Ursolic

Gentle, Taiwan; Guardian Pharmatama, Indonesia

Ursolin

Berlin, Thailand

Ursolisin

Magis, Italy

Ursolit

CTS, Israel

Ursolvan

Sanofi-Aventis, France

Ursomac

GMP, Georgia

Ursomax

Altius, Argentina

Ursophalc

Falk, Georgia

Ursopol

ICN, Poland

Ursosan

Evolan, Sweden; Pro.Med.CS, Bosnia & Herzegowina; Pro.Med.CS, Czech Republic; Pro.Med.CS, Estonia; Pro.Med.CS, Georgia; Pro.Med.CS, Lithuania; Pro.Med.CS, Romania; Pro.Med.CS, Serbia; Pro.Med.CS, Slovenia; Pro.Med.CS, Slovakia

Ursotan

Sanofi-Aventis, South Africa

Ursultec

Otifarma, Italy

Urzac

Quesada, Argentina

Usol

Shyh Dar, Taiwan

SILYMARIN

Silibinin  also known as silybin, is the major active constituent of silymarin, a standardized extract of the milk thistle seeds containing mixture of flavonolignans consisting of among others of silibinin, isosilibinin, silicristin, and silidianin. Silibinin itself is mixture of two diastereomers silibinin A and silybinin B in approximately equimolar ratio. Both in vitro and animal research suggest that silibinin has hepatoprotective (antihepatotoxic) properties that protect liver cells against toxins. Silibinin has also demonstrated in vitro anti-cancer effects against human prostate adenocarcinoma cells, estrogen-dependent and -independent human breast carcinoma cells, human ectocervical carcinoma cells, human colon cancer cells, and both small and nonsmall human lung carcinoma cells.

Chemically modified silibinin, silibinin dihydrogen disuccinate disodium a solution for injection, is currently being tested as a treatment of severe intoxications with hepatotoxic substances, such as death cap  poisoning. There is also clinical evidence for the use of silibinin as a supportive element in alcoholic and Child grade ‘A’ liver cirrhosis

Cholagogues, Cholelitholytics & Hepatic Protectors

Chemical Formula  -  C25-H22-O10

 Molecular Weight  -  482

(2R,3R)-3,5,7-trihydroxy-

2-[(2R,3R)-3-(4-hydroxy-3-methoxyphenyl)-2-(hydroxymethyl)

-2,3-dihydrobenzo[b][1,4]dioxin-6-yl]chroman-4-one

Hepatic diseases

Adult: 140 mg bid/tid.

Administration-   Should be taken with food.

Contraindications-   Hypersensitivity, pregnancy, lactation

MECHANISM OF ACTION

Silymarin is an active principle from the fruit of Silybum marianum, which contains a mixture of flavonolignans. It reduces the turnover of membrane phospholipids and stabilises the cell membranes of hepatocytes. It has potent antioxidant action and prevents lipid peroxidation.

Pharmacology

Poor water solubility and bioavailability of silymarin led to the development of enhanced formulations. Silipide  a complex of silymarin and phosphatidylcholine is about 10 times more bioavailable than silymarin. It has been also reported that silymarin inclusion complex with β-cyclodextrin is much more soluble than silymarin itself.There have also been prepared glycosides of silybin, which show better water solubility and even stronger hepatoprotective effect. Silibinin has been reported to exert a neuroprotective effect in mice.

Silymarin, as other flavonoids, has been shown to inhibit P-glycoprotein-mediated cellular efflux. The modulation of P-glycoprotein activity may result in altered absorption and bioavailability of drugs that are P-glycoprotein substrates. It has been reported that silymarin inhibits cytochrome P450 enzymes and an interaction with drugs primarily cleared by P450s cannot be excluded.

Toxicity

The acute toxicity of silymarin and silybin were investigated by oral and intravenous route in various animal species. No mortality or any signs of adverse effects were observed after silymarin at oral doses of 20 g/kg in mice and 1 g/kg in dogs. The median lethal dose (LD50) after intravenous infusion values are 400 mg/kg in mice, 385 mg/kg in rats and 140 mg/kg in rabbits and dogs. These data demonstrate that the acute toxicity of silymarin is very low.

Similarly, its subacute and chronic toxicity are very low; the compound is also devoid of embryotoxic potential.

Brand Names

Alepa-forte  -   Duopharm, Germany

Bao-Gan  -  Chen Ta, Taiwan

Bilsyl  -  Anglopharma, Colombia

Carsil   -   Briz, Latvia; Corpus Medica, Lithuania; Sopharma, Bulgaria; Sopharma, Estonia; Sopharma, Georgia

Carsil Forte  -  Sopharma, Georgia

Cefasilymarin  -  Cefak, Germany

Ci Ning  -  Shanxi C&Y Pharmaceutical Co., Ltd., China

Darsil  -  Darnitsa, Georgia

Dilacan Silymarin  -  CanCap, Taiwan

Durasilymarin  -  Mylan dura, Germany; Wyeth, Taiwan

Econlin  -  Health Chemical, Taiwan

Eliamine  -  Panion & BF, Taiwan

Elianine  -  Panion & BF, Taiwan

Enpex  -  Yuan Chou, Taiwan

Flavobion  -  Nycomed, Czech Republic; Zentiva, Slovakia

Forliver  -  Root, Taiwan

Gen Bo  -  Chen Ho, Taiwan

Hanomarin   -  Han All, South Korea

Hegrimarin  -  Strathmann, Germany; Strathmann, Hungary

HepaBesch  -  Strathmann, Germany

Hepa-Loges  -  Loges, Germany

Hepanat  -  Yung Shin, Taiwan

Hepanavit  -  Keyfarm, Peru

Hepar-Pasc  -  Pascoe, Germany

Hepasil  -  Signova, India

Hepatoflam  -  Sherfarma, Peru

Hepatos  -  Hevert, Germany

Hepa-V  -  UBI, Taiwan

Hepavit  -   Littman, Philippines

Hepawell  -  Quest Vitamins, Taiwan

Heplant  -  Spitzner,           Germany

Heprin  -  Dong Kook,       Taiwan

Higaflam  -  Sherfarma,    Peru

Higanatur  -  Sherfarma,  Peru

Higaox  -  Sherfarma,       Peru

Kenbo  -  Yung Chang,     Taiwan

Kupfer Q Forte (Silibinin and Ubidecarenone)  -  BioGenet, Ecuador

Kupfer Q Recargado (Silibinin and Ubidecarenone)  -  BioGenet, Ecuador

Lagosa  -  Dragenopharm, Georgia;      Worwag, Slovakia;       Wörwag Pharma, Czech Republic;      Wörwag Pharma, Germany;         Wörwag Pharma, Poland;        Wörwag Pharma, Romania

Laragon      -  Roemmers, Argentina

Legacell  -   Dae Won, South Korea

Legalon Forte  -  Bayer, Chile

Legalon  -   Bu Kwang, South Korea;         Grünenthal, Colombia;            Madaus, Bulgaria;                Madaus, Georgia;           Madaus, Hungary;            Madaus, Luxembourg;           Madaus, Oman;            Madaus, Philippines;               Madaus, Poland;       Madaus, Slovakia;      Madaus, Thailand;             Maskati, Bahrain;    Nycomed, Mexico;     Nycomed, South Africa;    Nycomed Pharma, Brazil;     Rottapharm, China;    Rottapharm, Spain;      Rottapharm, Italy;      Rottapharm, Malta;    Rottapharm Madaus, Portugal;              Rottapharm/Madaus, Germany;          Rottapharm-Madaus, Romania;         Zuoz, Venezuela

Lemarin  -  Hans-E Lembecke, Taiwan

Leprotek  -  Zdravlje, Serbia

Levalon  -  Micro B & B, India

Leveron  -  Vesco Pharmaceutical, Thailand

Limarin  -  Serum Institute, India

Liparin  -  Guardian Pharmatama, Indonesia

Lipositol Q10 Forte (Silibinin and Ubidecarenon)  -  Kronos, Ecuador

Livercon  - Sheng Chung Tang, Taiwan

Liverman-   Dong-A, South Korea

Liveron  -  Hua Shin, Taiwan

Livorin  -  Weidar, Taiwan

Livosil Forte  -  Centaur, India

Lolian  -     Hwang's, Taiwan

Marina   -    T Man, Thailand

Miltis   -   Millimed, Thailand

Pharmarin   -   Pharmaland, Thailand

Phytohepar  -  Steigerwald, Germany

Poken   -  Meider, Taiwan

Pougenin   -   Hua Shin, Taiwan

Poulican-U    -         Sinphar, Taiwan

Procam    -      Everest, Taiwan

Prohep Forte   -      Lupin, India

Samarin    -    Berlin, Thailand

SE Mariendistel    -    Spitzner, Germany

Shui Lin Jia    -    Tasly, China

Sican    -     Astar, Taiwan

Silarine    -     Vir, Spain

Silegon    -    Teva, Hungary

Silibene   -    Merckle Recordati, Germany

Silibin    -    Hwang's, Taiwan

Silibinum    -    Arena, Romania

Silicur   -    Hexal, Germany; Hexal, Luxembourg

Siligen    -    Synmosa, Taiwan

Silima    -    Souriree, Taiwan

Silimar    -    Zydus Cadila, India

Silimarin   -    Germed Pharma, Italy

Silimarina Genfar     -      Genfar, Ecuador;       Genfar S.A., Colombia;      Genfar S.A., Costa Rica;        Genfar S.A., Guatemala;           Genfar S.A., Nicaragua;         Genfar S.A., El Salvador Silimarinã

Biofarm, Romania;    Fabiol, Romania

Silimarit    -    Bionorica, Germany

Silimax    -    Filofarm, Poland

Silimin    -    Kojar, Taiwan

Silin    -    Shun Sheng, Taiwan

Silirin   -    Chin Teng, Taiwan

Silliver   -   Chung Mei, Taiwan

Siluma

Ming Ta, Taiwan

Silvaysan

Sanum-Kehlbeck, Germany

Silybon  -   Micro Labs, India

Silycon  -  AND, Taiwan

Silygal  -  Teva, Czech Republic

Silygen   -   Siu Guan, Taiwan

Silygen-F   -Hor Chen, Taiwan

Silygen-H   -    Hor Chen, Taiwan

Silyhep    -   Kojar, Taiwan

Silyma   -    Ming Ta, Taiwan

Silyman   -   Han Mi, South Korea

Silymarin AL   -   Aliud, Czech Republic; Aliud, Germany

Silymarin Belupo   -  Belupo, Croatia (Hrvatska)

Silymarin dura   -    Mylan dura, Germany

Silymarin Stada   -  STADA, Germany

Silymarin Vramed   -   Vramed, Bulgaria

Silymarin    -    Belupo, Bosnia & Herzegowina;    Pei Li, Taiwan; Quality Pharmaceutical, Hong Kong; Sedico, Oman; Shou Chan, Taiwan; Tai Yu, Taiwan

Silymarin-CT   -    CT Arzneimittel, Germany

Silyme-V   -   Oriental, Taiwan

Silymin   -   Swiss Pharm,   Taiwan

Silyrin  -  Talent, India

Simepar Forte    -    Mepha, Estonia; Mepha, Latvia

Sison   -    Dr. Alson Labs, India

Sivylar   -    Ranbaxy, India; Ranbaxy, Thailand

Sucan  -    Yu Sheng, Taiwan

Suganlin  -  Fisherman, Taiwan

Sulican  -  Yu Sheng, Taiwan

Sylimarol  -   Herbapol Poznan, Poland

Syliverin  -  Aflofarm, Poland

Symatone  -  Patron, Taiwan

Winmarin  -  Winston, Taiwan

Legalon SIL   -  Madaus, Austria; Madaus, Belgium; Madaus, Spain; Rottapharm/Madaus, Germany; Zeller, Switzerland

RACECADOTRIL

Racecadotril, also known as acetorphan, is an antidiarrheal drug which acts as a peripherally acting enkephalinase inhibitor. Unlike other medications used to treat diarrhea, which reduce intestinal motility, racecadotril has an antisecretory effect—it reduces the secretion of water and electrolytes into the intestine. It is available in India (It was first introduced in 1993 and is widely used in France) and other European countries, as well as most of South America and some South East Asian countries, but not in the United States. It is sold under the tradenames Hidrasec or, in France, Tiorfan. In Italy it is sold under the tradename Tiorfix.

In india trade names  REDOTTIL, ZEDOTT .

A small randomized controlled trial found racecadotril to significantly reduce the duration and volume of watery diarrhea in children when given as an adjunct to oral rehydration therapy.

Racecadotril, also known as acetorphan, is an antidiarrheal drug which acts as a peripherally acting enkephalinase inhibitor. Unlike other medications used to treat diarrhea, which reduce intestinal motility, racecadotril has an antisecretory effect—it reduces the secretion of water and electrolytes into the intestine. It is available in India (It was first introduced in 1993 and is widely used in France) and other European countries, as well as most of South America and some South East Asian countries, but not in the United States. It is sold under the tradenames Hidrasec or, in France, Tiorfan. In Italy it is sold under the tradename Tiorfix.

In india trade names  REDOTTIL, ZEDOTT .

A small randomized controlled trial found racecadotril to significantly reduce the duration and volume of watery diarrhea in children when given as an adjunct to oral rehydration therapy.

Indication & Dosage      

Acute diarrhoea

Adult: 100 mg tid, up to 7 days.

Administration - May be taken with or without food.

Special Precautions  -    Renal insufficiency, pregnancy, lactation.

Adverse Drug Reactions -  Vomiting, nausea, constipation, abdominal pain, thirst, vertigo and headache.

Mechanism of Action

                Racecadotril increases the availability of endogenous opioids (enkephalins) by inhibiting the membrane-bound enkephalinase. These enkephalins activate δ-opioid receptors in the GI tract. This leads to a reduction in cAMP mucosal levels, resulting in a reducted secretion of water and electrolytes in the intestinal lumen.  Onset: Within 30 min.

IUPAC NAME   -   (RS)-benzyl N-[3-(acetylthio)-2-benzylpropanoyl]glycinate

Chemical Formula  - C21-H23-N-O4-S

Molecular Weight  -  385

Therapeutic Categories - Antidiarrheal agent ,  Enkephalinase inhibitor

Foreign Names

Racecadotrilum (Latin)

Racecadotril (German)

Racécadotril (French)

Racecadotrilo (Spanish)

..........................................

Brand Names

AD             -  Hetero, India

Aquasec    -  Micro Nova, India

Cadotril    - Medifarma, Peru

Diarfix      -  CristerS, France

Dirasec     -  Abbott, India

Du La Bao  -  Baili Pharmaceutical, China

Enuff          -  Hetero, India

Feng Hai Ting - Zhengda Fenghai Pharmaceutical, China

Hidrasec   - Abbott, China;       Abbott, Philippines;                 Bagó, Ecuador;                Ferrer, Costa Rica; Ferrer, Dominican Republic;          Ferrer, Guatemala;            Ferrer, Honduras;                     Ferrer, Mexico; Ferrer, Nicaragua;    Ferrer, Panama;     Ferrer, El Salvador;    Fournier, Bulgaria;    Fournier, Romania; Galenica, Greece;     Laboratoire Sophartex, Vietnam;      Leti, Venezuela;      Silesia, Chile;  

  Solvay, Thailand

Hidrasec Children (pediatric) -  Fournier, Bulgaria

Hidrasec Infants (pediatric)-Fournier, Bulgaria

Hydral     -  Alembic, India

Lomorest   -  Zuventus, India

Mo Ni Ka   -  Hailing, China

Mold       -  Aversi, Georgia

Pedidot    -  Elder, India

Racaril    -East West, India

Racedot    -  Macleods, Georgia

Race-F     -  Bestochem, India

Racotil    -  Cipla, India

Racy       -  Abbott, India

Redotil    -  Dr. Reddy's, India

Resorcal Lactantes/Ninos (pediatric) - Andromaco, Chile

Resorcal   - Andromaco, Chile

Tiorfan    - Abbott, Germany; Bago, Brazil; Bioproject, Tunisia; Bioprojet, France; CPH, Portugal; Ferrer, Peru; Ferrer Farma, Spain

Tiorfan Infantil - CPH, Portugal

Tiorfan Niños (pediatric) - Ferrer, Peru

Tiorfan nourrissons (pediatric) - Bioproject, Tunisia

Tiorfanor  - Bioprojet, France

Tiorfast   - Bioprojet, France

Tiorfix    - Costanzafarma, Italy

Zomatril   -  FDC, India

...................................

LOPERAMIDE

Loperamide is a synthetic piperidine derivative, is an opioid drug used against diarrhea resulting from gastroenteritis or inflammatory bowel disease. In most countries it is available generically and under brand names such as Lopex, Imodium, Dimor, Fortasec, Lopedium, and Pepto Diarrhea Control. It was developed at Janssen Pharmaceutica

Loperamide slows the rhythm of digestion so that the small intestines have more time to absorb fluid and nutrients from the foods you eat.

Loperamide is used to treat diarrhea. Loperamide is also used to reduce the amount of stool in people who have an ileostomy (re-routing of the bowel through a surgical opening in the stomach).

It is an opioid-receptor agonist and acts on the μ-opioid receptors in the myenteric plexus of the large intestine; by itself it does not affect the central nervous system.

It works by decreasing the activity of the myenteric plexus, which, like morphine, decreases the tone of the longitudinal smooth muscles but increases the tone of circular smooth muscles of the intestinal wall. This increases the amount of time substances stay in the intestine, allowing for more water to be absorbed out of the fecal matter. Loperamide also decreases colonic mass movements and suppresses the gastrocolic reflex.

IUPAC NAME   - 4-[4-(4-chlorophenyl)-4-hydroxypiperidin-1-yl]- N,N-dimethyl-2,2-diphenylbutanamide.

IMPORTENT

You should not use this medication if you are allergic to loperamide, or if you have:

stools that are bloody, black, or tarry; or 

if you have diarrhea that is caused by taking an antibiotic.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:

a fever; 

mucus in your stools;

a history of liver disease; or

if you are taking an antibiotic.

FDA pregnancy category C. It is not known whether loperamide will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Loperamide can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using loperamide.

Do not give this medicine to a child without medical advice.

IF YOU FORGET A DOSE -

If you are taking scheduled doses of loperamide, 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.

Loperamide Dosing Information

Usual Adult Dose for Diarrhea -- Acute:

Tablets, capsules, and liquid:

Initial: 4 mg orally after the first loose stool, then

Maintenance: 2 mg after each loose stool, not to exceed 16 mg in any 24-hour period. Clinical improvement is usually observed within 48 hours.

Chewable tablets:

Initial: 4 mg after the first loose stool, then

Maintenance: 2 mg after each subsequent loose stool, but not exceeding 8 mg in 24 hours.

Usual Adult Dose for Diarrhea -- Chronic:

Tablets, capsules, and liquid:

Initial: 4 mg orally once followed by 2 mg orally after each loose stool, not to exceed 16 mg in any 24-hour period.

Maintenance: The average daily maintenance dosage is 4 to 8 mg. Clinical improvement is usually observed within 10 days. If clinical improvement is not observed at a maximum dosage of 16 mg for duration of 10 days, symptoms are unlikely to be controlled by further administration.

Usual Pediatric Dose for Diarrhea -- Acute:

2 to 6 years (13 to 20 kg):

Liquid formulation only to be used in this age group.

Initial: 1 mg orally 3 times a day for the first day, then

Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.

6 to 8 years (20 to 30 kg):

Tablets, capsules, and liquid:

Initial: 2 mg orally twice a day for the first day, then

Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.

Chewable tablets:

Initial: 2 mg orally after the first loose stool, then

Maintenance: 1 mg orally after each subsequent loose stool, but not exceeding 4 mg in 24 hours.

8 to 12 years (greater than 30 kg):

Tablets, capsules, and liquid:

Initial: 2 mg orally 3 times a day for the first day, then

Maintenance: 0.1 mg/kg/dose after each loose stool, but not exceeding initial dose.

Chewable tablets:

Initial: 2 mg orally after the first loose stool, then

Maintenance: 1 mg orally after each subsequent loose stool, but not exceeding 6 mg in 24 hours.

12 to 18 years:

Tablets, chewable tablets, capsules, and liquid:

Initial: 4 mg after the first loose stool, then

Maintenance: 2 mg after each subsequent loose stool, but not exceeding 8 mg in 24 hours.

Usual Pediatric Dose for Diarrhea -- Chronic:

less than 2 years:

Therapeutic dose for the treatment of chronic diarrhea has not been established for this patient population.

IMPORTENT

You should not use this medication if you are allergic to loperamide, or if you have:

stools that are bloody, black, or tarry; or 

if you have diarrhea that is caused by taking an antibiotic.

Ask a doctor or pharmacist if it is safe for you to take this medicine if you have:

a fever; mucus in your stools;   a history of liver disease; or

if you are taking an antibiotic.

FDA pregnancy category C. It is not known whether loperamide will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Loperamide can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using loperamide.

Do not give this medicine to a child without medical advice.

IF YOU FORGET A DOSE -

If you are taking scheduled doses of loperamide, 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

Loperamide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:       dry mouth,    dizziness,      drowsiness,     vomiting,     stomach pain, discomfort, or distention (enlargement)   ,   constipation,     fatigue,    

If you experience any of the following symptoms, call your doctor immediately:    skin rash,      hives,     itching,   wheezing,   difficulty breathing

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].

AVAILABLE BRANDS   -   LOPAMIDE TAB    ,   IMODIUM CAP    ,   ANDIAL