Manzoor (Pharm-D)

Heparin belongs to a group of medications known as anticoagulants. Anticoagulants work by reducing coagulability and helping Stop clots to form in blood vessels. Anticoagulants are sometimes referred to as “blood thinners,” although they do not actually agitate the blood. Heparin does not dissolve the already formed blood clots, but could prevent the formation of formed clots, which increase and cause serious problems. It is used during dialysis, blood transfusions and blood sampling. It is also given prior to surgery to reduce the risk of blood clots. It was approved in 1939 by the Food and Drug Administration (FDA). Heparin Uses Heparin can be used to treat and prevent the following conditions and symptoms: Prevention of peripheral artery thromboembolism Prophylaxis of deep vein thrombosis and pulmonary embolism Blood clot in the lung Prevention of blood clot in the lung Blood clotting disorders Peripheral artery obstruction Heart attack Acute syndrome of the heart Blood clot in a deep vein Treatment of deep vein thrombosis, pulmonary embolism, unstable angina pectoris and acute peripheral arterial occlusion. Prevention of blood clot following percutaneous coronary intervention Heparin Mechanism of Action Heparin interacts with the natural plasma protein antithrombin III to induce a Conformational change that significantly improves the activity of the antithrombin III serine protease, As a result, the activated coagulation factors, in particular Xa, are involved in the coagulation sequence and IIa. Small amounts of heparin inhibit the Xa factor and larger amounts inhibit thrombin (Factor IIa). Heparin also prevents the formation of a stable fibrin clot by inhibiting the activation of fibrin Stabilizing factor. Heparin has no fibrinolytic activity. Therefore, the existing lumps will not lyse. Heparin reversibly binds to antithrombin III (ATIII) and leads to an almost immediate inactivation of factors IIa and Xa. The heparin-ATIII complex may also inactivate factors IX, XI, XII and plasmin. The mechanism of action of heparin is ATIII-dependent. It works primarily by accelerating the neutralization rate of some antithrombin-activated coagulation factors, but other mechanisms may be involved. The antithrombotic effect of heparin correlates well with the inhibition of factor Xa. Heparin is not thrombolytic or fibrinolytic. Prevents the progression of existing blood clots by inhibiting further coagulation. The lysis of the existing clots is based on endogenous thrombolytics. Heparin Mechanism of Action is by stopping the formation of blood clots in the veins. It can prevent the formation of blood clots or stop the formation of blood clots that are formed by the increase. Pregnancy and Heparin It is not known if heparin can harm an unborn child. However, this drug is sometimes used alone or with aspirin to prevent loss of pregnancy or other problems in pregnant women. Talk to your doctor about the risks of using heparin during pregnancy. This drug doesn’t cross the Breast milk but Do not use this medicine during breast-feeding without first consulting your doctor. Precautions Tell your doctor or pharmacist before taking this medicine Allergic to it; or other ingredients contained in these formulations. Tell your doctor or pharmacist about your medical history, in particular about: bleeding / blood problems (such as low platelet count, hemophilia), high blood pressure (hypertension), heart problems (such as heart attack, heart attack). To reduce the risk of cuts, bruises or injuries, be careful with sharp objects such as razors and nail clippers and avoid activities such as contact sports. should not be administered by intramuscular injection or after major trauma. This medicine can cause stomach bleeding. Daily alcohol intake during the use of this medicine increases the risk of stomach bleeding. Limit alcoholic beverages. Tell your doctor or dentist about all the products you use (including prescription drugs, non-prescription drugs and herbal products). Caution should be exercised in older adults, particularly women over the age of 60, who may be more sensitive to the side effects of this medicine, particularly bleeding. Heparin should only be used in pregnant women when clearly necessary. Discuss the risks and benefits with your doctor. It does not enter breast milk. Ask your doctor before breast-feeding. Heparin Side effects More common side effects The more common side effects of this drug include: Bleeding that takes longer to stop Bruising more easily Allergic reactions, such as hives, chills, and fever Increased liver enzymes on liver function test results Irritation, pain, redness, or sores at the injection site Dizziness Weakness Serious side effects and their symptoms can include the following: Headaches Serious allergic reactions. Severe bleeding. Heparin-induced thrombocytopenia. Interaction Medications that increase the risk of bleeding will add to the effects of heparin and further increase the risk of bleeding that is associated with heparin. Such medications include Aspirin, Clopidogrel Warfarin, Other anticoagulants, Ibuprofen Naproxen Diclofenac and others. Heparin Doses Adult Heparin Dose Continuous Intravenous Infusion Usual Adult Initial Dose of Heparin for Deep Vein Thrombosis is 10,000 units IV infusion and then a Maintenance dose of 5000 to 10,000 units IV every 4 to 6 hours. Usual Adult initial Dose for Deep Vein Thrombosis (Prophylaxis) is 5000 units by IV continous infusion and a Maintenance dose of 20,000 to 40,000 units per 24 hours by continuous IV infusion. Usual Adult and initial Dose for Prevention of Thromboembolism in Atrial Fibrillation is 5000 units by Continuous IV infusion and then Maintenance dose of 20,000 to 40,000 units per 24 hours by continuous IV infusion. Usual Adult initial Dose of Heparin for Pulmonary Embolism 5000 units by Continuous IV infusion and then Maintenance dose of 20,000 to 40,000 units per 24 hours by continuous IV infusion. Usual Adult initial Dose for Thrombotic/Thromboembolic Disorder is 5000 units by Continuous IV infusion and then a Maintenance dose of 20,000 to 40,000 units per 24 hours by continuous IV infusion. Usual Adult Dose for Blood Transfusion is Addition of 400 to 600 USP units per 100 mL of whole blood is usually employed to prevent coagulation. Intermittent Intravenous Injection Usual initial dose is 10,000 Units, in 50—100 mL of 5% Dextrose Injection or 0.9% Sodium Chloride Injection. Then After every 4-6 hours  5000—10,000 Units, in 50—100 mL of

Leflunomide is an oral medication that can be used to treat psoriatic arthritis and moderate to severe psoriasis. It belongs to a class of drugs called disease-modifying anti-inflammatory drugs (DMARDs). This class of drugs can reduce joint damage and disability caused by rheumatoid arthritis. Leflunomide is often used to treat rheumatoid arthritis alone or in combination with other DMARDs. It was approved by the FDA in September 1998. The FDA initially approved leflunomide for the treatment of rheumatoid arthritis. Technically, leflunomide has never been approved by the FDA for the treatment of psoriasis and psoriatic arthritis. Leflunomide Uses It is used in the treatment and prevention of the following conditions Rheumatoid arthritis psoriatic arthritis Systemic lupus erythematosus Arthritis pain Mechanism Leflunomide reduces inflammation by suppressing the activity of immune cells responsible for inflammation. It suppresses immune cells by inhibiting dihydroorotate dehydrogenase, an enzyme necessary for the production of DNA and RNA. Without DNA or RNA, immune cells (and most other types of cells) can not proliferate or function (or exist). Because of its unique and different mechanism of action, it is useful when combined with other drugs for the treatment of rheumatoid arthritis. Contraindications Leflunomide is contraindicated in the following conditions A known allergy to the drug or one of its components. Existing problems with your bone marrow A severe immunodeficiency disease Pregnant women also should not take leflunomide. An existing severe, uncontrolled infection Leflunomide Side effects More common side effects The more common side effects of this drug include: Nausea Headache Abnormal liver tests Diarrhea Stomach upset Rash While Serious side effects can include the following: Pneumonia, Tuberculosis, Serious skin disorder. Worsening lung function. Low blood cell counts. Pregnancy And Breast Feeding It is contraindicated during pregnancy. Do not use in pregnant women or those of child-bearing age who do not use a reliable method of contraception. It is not known if it passes into breast milk or may injure a breast-fed baby. Do not breast-feed while taking this medicine. Interactions Tell your doctor if you’re taking any of the following medicines before starting this medicine: Acetaminophen Aspirin Ibuprofen and naproxen Statin drugs Hydroxychloroquine Iron products Laniazid, Rifamate, isoniazid Rifampin Methotrexate Niacin Dose This drug should be taken with a meal. Leflunomide is usually given as a 20 mg tablet once a day. Sometimes patients only receive 10 mg, especially if they have side effects at the highest dose. Doctors often prescribe a “loading dose” that must be taken at the time of the first prescription of the drug. The usual loading dose is 100 mg daily during the first 3 days, followed by 20 mg daily. Doctors can reduce the dose to 10 mg per day if side effects occur. It may take up to four weeks for the arthritis to improve. Related Drugs & Medicines

Celecoxib is used to treat pain or inflammation caused by many conditions including arthritis, ankylosing spondylitis and menstrual cramps. Celecoxib is a non-steroidal anti-inflammatory drug (NSAID). It works by reducing the hormones that cause inflammation and pain in the body. Celecoxib Uses It is used in the treatment and prevention of the following conditions Osteoarthritis, Rheumatoid arthritis, Acute pain, Menstrual symptoms, Painful menstruation and Ankylosing spondylitis and To reduce numbers of colon and rectum polyps in patients with familial adenomatous polyposis. Mechanism This medicine belongs to a class of medications called nonsteroidal anti-inflammatory drugs (NSAIDs). A class of medications is a group of medicines that work in a similar way. These medications are often used to treat similar conditions. NSAIDs block an enzyme called cyclo-oxygenase (COX). COX is in your body to produce chemicals that cause pain and inflammation. By blocking COX, NSAIDs like this medicine prevent the formation of these chemicals. This in turn reduces pain and inflammation. Unlike most NSAIDs, which inhibit both types of cyclooxygenase (COX-1 and COX-2), celecoxib is a selective non-competitive inhibitor of the enzyme cyclooxygenase-2 (COX-2). The mechanism of action of Celecoxib is the inhibition of prostaglandin synthesis by inhibiting COX-2. Celecoxib Side effects The more common side effects that can occur with celecoxib include: constipation stomach pain heartburn respiratory tract infection diarrhea gas dizziness nausea vomiting headache Serious side effects can include the following: Stroke. Chest pain or heart attack High blood pressure Edema. Bleeding and ulcers in your stomach and intestine. Allergic reactions. Skin reactions Liver problems. Asthma attacks Precautions Do not take celecoxib if you Are allergic to celecoxib or any of the other ingredients of this formulation. Have had an allergic reaction to a group of medicines called “sulphonamides” Currently have an ulcer in your stomach or intestines, or bleeding in your stomach or intestines Are taking acetylsalicylic acid or any other anti-inflammatory and pain-relieving medicine (NSAID) Have severe liver disease Have severe kidney disease Are pregnant. Are breast-feeding Have had asthma, nose polyps, severe nose congestion, or an allergic reaction such as an itchy skin rash, swelling of the face, lips, tongue or throat, breathing difficulties or wheezing Have had problems with your blood circulation (peripheral arterial disease) or if you have had surgery on the arteries of your legs Have an inflammatory disease of the intestines such as ulcerative colitis or Crohn’s disease Have heart failure, established ischaemic heart disease, or cerebrovascular disease. Interaction Always consult your healthcare practitioner before using any medication concurrently with celecoxib. Other medications may affect how Celexocib works and Celexocib may affect how the other drugs work. There may be an interaction between celecoxib and any of the following: Phenytoin Furosemide ACE inhibitors Fluconazole or ketoconazole Lithium Aspirin Warfarin This is not a complete list of Medicine which interact with celecoxib. Always ask your GP before using any medicine. Dose The usual recommended dose For the management of osteoarthritis, is 100 mg twice daily or 200 mg as a single dose. The usual recommended dose For rheumatoid arthritis, is 200 mg twice daily. The usual recommended dose  For acute pain or menstrual cramps, the dose is 400 mg as a single dose on the first day followed by an additional 200 mg if needed, then 200 mg twice daily as needed. The usual recommended daily dose is 200 mg taken as a single dose or as 100 mg twice daily. The usual recommended dose  For FAP, is 400 mg twice daily.

Sertraline is an antidepressant called SSRI (Selective Serotonin Reuptake Inhibitor). Sertraline affects chemicals in the brain that can be out of balance in people with depression, panic, anxiety or compulsive symptoms. Do not use sertraline if you have been taking MAOIs such as isocarboxazid, linezolid, methylene blue, phenelzine, rasagiline, selegiline or tranylcypromine for the last 14 days. Uses Sertraline is used to treat and prevent the following conditions The symptoms of a depressive illness, including the symptoms associated with anxiety. Sertraline tablets are also indicated for the treatment of obsessive-compulsive disorder (OCD). Sertraline tablets are also indicated for the treatment of OCD in children. Panic disorder, Posttraumatic stress disorder (PTSD), Premenstrual dysphoric disorder, Social anxiety disorder. Precautions Talk to your doctor if you Are Allergic to sertraline or any other medicines in the past Have a heart problem Have ever taken any other medicines for depression Are trying to become pregnant, are already pregnant or you are breastfeeding have an eye problem called glaucoma. Mechanism Sertraline selectively inhibits the reuptake of serotonin into the presynaptic membrane. This leads to an increase in synaptic serotonin concentration in the CNS, resulting in many functional changes associated with an increase in serotonergic neurotransmission. It is suggested that these modifications are responsible for the antidepressant effect observed during long-term antidepressant administration. It has also been hypothesized that obsessive-compulsive disorder is caused by deregulation of serotonin because it is treated with sertraline and the drug corrects this imbalance. Sertraline Side effects More common side effects Side effects for adults and children can include: Insomnia Tiredness and fatigue Nausea, loss of appetite, diarrhea, and indigestion Increased sweating Sexual problems, including decreased sex drive and ejaculation failure Tremor or shaking Side effects in children Nose bleed Abnormal increase in muscle movement or agitation more frequent urination urine leakage heavy menstrual periods aggressiveness slowed growth rate and weight change. Serious side effects can include the following: Suicide attempts Acting on dangerous impulses Aggressive or violent behavior Thoughts about suicide or dying New or worse depression New or worse anxiety or panic attacks Agitation, restlessness, anger, or irritability Trouble sleeping An increase in activity or talking more than normal Serotonin syndrome Severe allergy Abnormal bleeding Seizures or convulsions Manic episodes. Changes in appetite or weight. Low sodium levels. Interaction All SSRIs, including sertraline, should not be taken with any of the monoamine oxidase inhibitor (MAOI) class of antidepressants, for example Phenelzine Isocarboxazid Tranylcypromine Selegiline and Procarbazine. Other drugs that inhibit monoamine oxidase include linezolid and intravenous methylene blue. Dosage The recommended dosage (at the beginning) for depression is a 50 mg tablet daily. If necessary, the dose can be gradually increased to 200 mg per day. The generally recommended social anxiety disorder (social anxiety disorder) is 25 mg per day (half a 50 mg tablet) and increases to 50 mg a day after a week. The maximum recommended dose of Sertraline for the treatment of social phobia is 200 mg daily. Usual Recommended Dose In premenstrual dysphoric disorder, you should take a 50 mg tablet daily, during the menstrual cycle (maximum 150 mg daily) or within the last 14 days before the start of your (maximum) menstrual period. 100 mg a day. Do not stop taking your medication and do not change your dose without first consulting your doctor. The dose of sertraline prescribed by your doctor depends on the condition you are treating. If you have an anxiety disorder, your doctor may start with a low dose and increase it after the first week of treatment. It is important to follow the instructions of your doctor. Remember that Sertralin will take a while to start working. Therefore, take it as prescribed, even if it does not seem to change much. Do not take more than the dose prescribed by your doctor. Your dose of sertraline should be taken once a day. You can take your dose at any time of the day, but always try to keep the same time, it will also help you remember to take it. Sertraline tablets can be taken with or without food on an empty stomach or on an empty stomach. If you miss a dose of sertraline at the usual time, take it as soon as you remember. If you do not remember until the next day, simply skip the missed dose and continue as usual with the next dose. Do not take a double dose if you forget to take the previous dose. You must take sertraline daily as long as your doctor tells you. In case of depression, it is normal for your doctor to ask you to take it for at least six months after you feel better, as this may reduce the risk of further depression. Frequently asked Questions 1. Can I drive while taking Sertraline? Sertraline may limit your ability to drive, use machines or ride a bike. For example, it can reduce your ability to concentrate and some people are tired or dizzy. Do not drive or use machines until you know how this medicine affects you and if you are certain it will not affect your performance. 2. Can I drink alcohol while taking Sertraline? Drinking alcohol in moderation while taking sertraline should not cause problems for most people. However, if you discover that the medicine makes you feel tired or dizzy, alcohol can make things worse. However, it is generally recommended that you do not use alcohol while taking antidepressants, as alcohol can make depression worse. If you want to drink alcohol, you should consult your doctor if it is a good idea for you.

Bupropion is a prescription medicine for the treatment of depression. It can improve mood and well-being. It can work by restoring the balance between certain natural chemicals in the brain. It belongs to the class of antidepressants amino-ketone, which are no longer chemically related to the selective inhibitors of serotonin reuptake (SSRI). This prescription medicine can also be used to treat attention deficit hyperactivity disorder (ADHD). It can also be used as a prescription treatment to help stop smoking by reducing the craving for nicotine and nicotine exposure. It can be used to prevent seasonal depression in autumn and winter. This medicine can also be used with other medicines to treat bipolar disorder. It can also be used to treat anxiety in people with depression. Bupropion Uses Major depressive disorder Depressed mood Bipolar disorder, Anxiety, and Persistent depressive disorder Obesity Mild depression Anxious mood It may also be used to help quit smoking Bupropion mechanism Bupropion selectively inhibits the neuronal uptake of dopamine, norepinephrine and serotonin; The increase in norepinephrine may reduce the symptoms of nicotine withdrawal, and the increase in dopamine in neural sites may reduce the desire for nicotine and the desire to smoke. Bupropion shows moderate anticholinergic effects. Bupropion Side effects The most common side effects of bupropion are: Dizziness Nervousness Constipation trouble sleeping dry mouth nausea vomiting Tremor headache Joint aches Ringing in your ears Urinating more than usual Flushing Appetite loss Gas Abdominal pain Serious side effects Mental health effects Eye problems Seizures If you have nausea, take your medicine with food. Bupropion can cause serious side effects like it contain a “Black Box Warning” Like other antidepressants, bupropion should carry a black box that indicates an increased risk of suicidal thoughts and behavior in children, adolescents, and adolescents aged 18 and 24 years. The black box warning warns of the need to monitor patients taking antidepressants for signs of worsening depression and the onset of suicidal thoughts, especially during the first months of treatment or when the dose rises or falls. Interactions Antidepressants such as, Nortriptyline, Imipramine, Venlafaxin Desipramine, Paroxetine Fluoxetine or Sertraline. High side effects may include seizures. If these medicines are needed, your doctor may start with a low dose and slowly increase it. Antipsychotics such as Thioridazine Haloperidol, Risperidone. Increased side effects may include seizures. If these medicines are needed, your doctor may start with a low dose and slowly increase it. Monoamine oxidase inhibitors (MAOI) such as Phenelzine or Selegiline. Using these medicines with bupropion can cause severe hypertension. There must be at least 14 days between the use of MAOIs and the use of bupropion. Beta-blockers like Metoprolol. Increased side effects may include low blood pressure. Your doctor may reduce the dose of these medications if you are taking bupropion. Antiarrhythmia such as Propafenone or Flecainide. Strong side effects include weakness and changes in the heartbeat (too fast or too slow). Your doctor may reduce the dose of these medications if you are taking bupropion. Theophylline Increased side effects may include seizures. If you need this medicine, your doctor may start with a low dose and gradually increase it. Corticosteroids are, for example, Prednisone or Methylprednisolone. Using these medications with bupropion can cause seizures. If these medicines are needed, your doctor may start with a low dose and gradually increase it. Using these drugs with bupropion will increase side effects Levodopa and Amantadine. Increased side effects may include restlessness, agitation, shaking, loss of body movement, dizziness, balance disorders or difficulty walking. Substances that dilute the blood, such as Ticlopidine or Clopidogrel. If you are taking any of these medicines with bupropion, your doctor may adjust the dose of bupropion to keep bupropion levels in your body too high. Dosage The usual starting dose for adults with depression is 100 mg twice daily, 3 to 100 mg twice daily. The maintenance dose is 100 mg three times a day. Bupropion immediate release tablets are usually given in one, two or three doses daily. For immediate release tablets, a single dose should not exceed 150 mg and each dose should be separated by 6 hours. For depression, the recommended dose of immediate release tablets is 100 mg (300 mg / day) three times daily. The maximum dose is 450 mg daily. The starting dose is 100 mg twice daily. The dose may be increased to 100 mg three times daily after three days and to 150 mg three times daily after several weeks if the initial response is insufficient. The initial dose of sustained release tablets is 150 mg per day; The target dose is 150 mg twice daily. The maximum dose is 200 mg twice daily. The starting dose of prolonged-release tablets is 150 mg per day; The target dose is 300 mg per day; The maximum dose is 450 mg daily. Prolonged tablets are given once daily. When used to quit smoking, bupropion usually starts at 150 mg once daily for three days, and then the dose is increased to 150 mg twice daily for 7 to 12 weeks if the patient tolerates the initial dose. Smoking is stopped two weeks after starting treatment with bupropion. The dose of seasonal affective disorder is 150 mg once daily up to 300 mg daily using bupropion hydrochloride prolonged release tablets. Alternatively, treatment with 174 mg bupropion hydrobromide can be started daily and increased to a target dose of 348 mg daily. Starting  treatment before the onset of seasonal depressive symptoms and continue the winter season.