Xylocaine viscous (2% lidocaine hydrochloride)

Question: What is xylocaine viscous and how to use it?

Answer: Xylocaine Viscous® is 2% lidocaine hydrochloride, it is indicated for use as an anesthetic, in order to reduce pain in the mouth and throat.

How to use:

Adults: Gargle with 15 ml of xylocaine viscous for 30 seconds, and remove it after that. But if you want to have slightly anesthesia in your neck, you can swallow the drug. The drug can be administered up to every 3 hours (in one day should not take more than 8 times).

Infants and children younger than 3 years:

Dose: 1.25 ml, using the cotton swab dipped in the drug, and applied to the area for anesthesia. The drug can be administered up to every 3 hours (in one day should not take more than 8 times).

Children older than or equal to 3 years:

Dose: Gargle with 5 ml of drug for 30 seconds. The drug can be administered up to every 3 hours (in one day should not take more than 8 times).

References:

1. Dana WJ, Fuller MA, Goldman MP, Golembiewski JA, Gonzales JP, Lowe JF, et al. Drug Information Handbook, 21st ed. Hudson, Ohio, Lexi-Comp, Inc .; 2012: 1080-2.

2. Xylocaine® 2% Viscous. Product information. AstraZeneca 2008

Why should omeprazole, ranitidine be taken before or after meals.?

Question: Why is omeprazole taken before a meal and why is ranitidine taken after a meal?

Answer: Omeprazole is one medicine of the group of proton pump inhibitors (PPIs), it have alkaline properties, not tolerate acidic conditions. The drug is dissolved in an alkaline condition. So it is necessary to take this medicine at least 30 minutes before meals, to make the drug dissolved before absorption later.

In addition, mechanism of action of drug is inhibition of the enzyme H + / K + -ATPase in the active form, which occurs after taking meals.

Therefore, the group of PPIs drugs should be taken 30-60 minutes before a meal, in order to prepare the drug ready to inhibit the enzyme.

It is not different between taking ranitidine before or after meals. Moreover, food does not affect the absorption of ranitidine, ranitidine can be administered after a meal. Ranitidine dispensing to patients depended on the time that patients often have symptoms.

For example, if a patient has symptoms after eating the food, ranitidine may be administered at least 1 hour before meals, to reduce too much acid secretion during of taking meal.

References:

1. Brunton LL, Lazo JS, Parker KL, eds. The Pharmacological Basis of Therapeutics, 11th ed. New York: McGraw-Hill, 2006 and 11e (online edition).

2. McEvoy G K. Ranitidine hydrochloride. AHFS Drug Information [serial online] 2008;: [42 screens]. Available from: URL: http: //online.statref.com/Document/Document.aspx? DocId = 928 & FxId = 1 & Scroll = 302 & Index = 0 & SessionId = C61A90CQQMZXVLQO.

3. Dana WJ, Fuller MA, Goldman MP, Golembiewski JA, Gonzales JP, Lowe JF, et al. Drug Information Handbook, 21st ed. Hudson, Ohio, Lexi-Comp, Inc .; 2012: 1080-2.

Topical corticosteroids are safety for pregnant women or not?

Question: Topical corticosteroid as triamcinolone acetonite 0.02%-0.1% cream, betamethasone valerate 0.1% cream, are they safety for pregnant women in every quarter or not? If using a short course not more than 2 weeks.

Answer: Corticosteroid that used external (including dosage form of cream) mostly classified into pregnancy category C according to FDA of USA. The data from the study in animals have shown that corticosteroids (for external use) can be absorbed into the body and could be harmful to the fetus. It should be used with caution when using medications that contain high concentrations.

There is information that the use of a high strength in large quantities more than 300 grams of drugs throughout the period of pregnancy is associated with low birth weight. But when consider to the risk of babies born with disabilities.

From data searching do not found that topical corticosteroid for external use increase the risk of impaired or premature infants. However, recommended that pregnant women, if required topical corticosteroid for external use, you should take drugs with a low to medium strength only and in the shortest time.

References:

1. Chi CC, Wang SH, Mayon-White R, Wojnarowska F. Pregnancy outcomes after maternal exposure to topical corticosteroids: a UK population-based cohort study. JAMA Dermatol 2013; 149: 1274-80.

2. Samarasekera EJ, Sawyer L, Wonderling D, Tucker R, Smith CH. Topical therapies for the treatment of plaque psoriasis: systematic review and network meta-analyses. Br J Dermatol 2013; 168: 954-67

Theophylline SR 200 mg can be administered 3 times a day or not.

Question: Can theophylline SR 200 mg tablet be administered three times a day or not?

Answer: Theophylline SR 200 mg is a medication for bronchodilators, which is indicated for the treatment of asthma and chronic obstructive pulmonary disease (COPD). In general, dose in adults and children with body weight more than 45 kg is 200-300 mg every 12 hours, and maximum dose per day is 600 mg. The dose may be adjusted increased or decreased, based on the results of treatment and adverse drug reactions.

In general dose of this drug is 2 times a day or every 12 hours. But in people with enzymes that changes theophylline faster than normal. The drug may be administered 3 times a day.

References:

1. American pharmacists association. Drug information handbook with international trade names index. 21st ed. The United States of America: Lexi-Comp Inc; 2012

2. Globalrph the clinician's ultimate reference. Pulmonary-aminophylline and theophylline. 1993 [updated 2012 Jun 27]. Available from: http://www.globalrph.com/pulmonary_theophylline.htm#Theophylline

Omeprazole for gastro-intestinal diseases

Question: Can omeprazole treat both acute and chronic gastritis? And is it suitable for using this drug without gastric wounds? How long does it take to know that I am so relieved.?

Answer: Omeprazole is a medication to inhibit gastric acid secretion. Indications of drug are treatment of gastrointestinal diseases involved with acid in the stomach, such as gastric ulcer, duodenal ulcer, esophageal inflammation (erosive esophagitis), gastro-esophageal reflux disease (GERD), and disorders of extremely acid secretion (eg. zollinger-ellison syndrome, multiple endocrine adenoma and systemic mastocytosis).

As well as omeprazole is used in combination with antibiotic to eliminate Helicobacter pylori which is a common bacteria that causes ulcers in the stomach and intestines.

Stomach inflammation (gastritis) is caused by many factors, such as alcohol, use of certain drugs, viral or bacterial infection, reflux of bile, certain types of anemia. These factors may cause stomach inflammation, irritation or be wound up.

Treatment will vary according to the cause and severity of symptoms, and omeprazole is not a main drug be used to treat the diseases.

References:
1. Berardi RR, Fugit RV. Peptic ulcer disease. In: Dipiro JT, L.Talbert R, Yee GC, Matze GR, Wells bG, Posey LM, editors. Pharmacotherapy: A pathophysiology approach, 8th edition. China: McGrawHill; 2011. p. 563-85.
2. Sepulveda AR. Autoimmune atrophic gastritis. 2012. Available from: http://emedicine.medscape.com/ article / 176036-overview # a0104.
3. Bestpractice. bmj. Gastritis. London: BMJ Publishing Group Ltd; c2014 [updated 2013 Sep 04]. Available from: http://bestpractice.bmj.com/best-practice/monograph/816.html

What is guideline for using MgSo4 to treatment of acute asthma?

Question: I suspect that bringing MgSo4 (50%) used alternately with Berodual NB in the treatment of asthma.

I do not know the guidelines used. And it is effective or not.

Answer: As recommended by the Global initiative for Asthma (GINA) guideline 2014 (the guidelines of the International), found that the use of magnesium sulfate (MgSO4) nebulizer for asthma treatment, not recommended as the initial treatment of acute asthma attack, because there is no difference from the standard treatment. But MgSo4 can be used as additional treatment in patients with acute severe asthma attack, if the standard method has low response to treatment. In these patients showed that adding MgSO4 (nebulizer) can increase FEV1%, O2 saturation and can decrease rate of going to hospital.
Reference: 1. The Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2014. Available from: http://www.ginasthma.org 
2. Blitz, M, Blitz S, Hughes R, Diner B, Beasley R, et al. Aerosolized magnesium sulfate for acute asthma: a systematic review. Chest 2005;128:337-44
3. Gallegos-Solorzano MC, Pérez-Padilla R, Hernández-Zenteno RJ. Usefulness of inhaled magnesium sulfate in the coadjuvant management of severe asthma crisis in an emergency department. Pulm Pharmacol Ther 2010;23:432-7.

Aldara (imiquimod) for warts.

Question: If Aldara has been stopped for 2 weeks after using, and I restart the drug  again later. It’ll be drug resistant to infection, or not?

Answer: Aldara is a drug that has chemical substance named imiquimod. The drug is used for treatment of external genital warts and warts around the anus. The drug stimulates the immune system cells at areas where the disease occurs, not affect the pathogens directly. So do not make the infection developed into resistance. If you stop for 2 weeks after using the drug and then restart later, you can begin again. The maximum duration of treatment is 16 weeks.

References:

1. MIMS Thailand. Aldara. c2014. Available from: http://www.mims.com/Thailand/drug/info/Aldara/

2. Perkins N, Nisbet M, Thomas M. Topical imiquimod treatment of aciclovir-resistant herpes simplex disease: case series and literature review. Sex Transm Infect 2011; 87: 292-5.

3. Aldara® [package insert]. England: 3M Health Care; 2010.

How long can we use tretinoin cream for acne?

Question: I want to ask about the use of Retin A to treat acne for a long time, such as 3-4 years. Is it dangerous or not? I cannot give up using this drug because acne will return. So I continued to use but I am worry about long time use of drug.

Answer: Retin-A® with generic name of the drug known as tretinoin, a derivative of vitamin A.

The literature review has not found out about the safety of using tretinoin to treat acne for a long time (3-4 years). Ssearch found recommendations that for safety should not be used 0.05% tretinoin cream for more than 48 weeks, and 0.02% tretinoin cream should not be used longer than 52 weeks.

However a study of the use of tretinoin emollient cream 0.05% in the treatment of skin damage caused by sun exposure by applying tretinoin cream once daily for 2 years. The most common adverse reactions are found such as redness, dryness, itching and burning skin but not found serious adverse reactions at the epidermis compared with placebo.

References:

1. Kang S, Bergfeld W, Gottlieb AB, Hickman J, Humeniuk J, Kempers S, et al. Long-term efficacy and safety of tretinoin emollient cream 0.05% in the treatment of photodamaged facial skin: a two-year, randomized, placebo-controlled trial. Am J Clin Dermatol 2005; 6 (4): 245-53.

2. Shalita A, Weiss J, Chalker D, Ellis D, Greenspan A, Katz H, et al. A comparison of the efficacy and safety of adapalene gel 0.1% and tretinoin gel 0.025% in the treatment of acne vulgaris: A multicenter trial. Am J Clin Dermatol 1996; 34 (3): 482-5.

3. Olsen EA, Katz HI, Levine N, et al. Tretinoin emollient cream for photodamaged skin: results of 48-week, multicenter, double-blind studies. J Am Acad Dermatol 1997; 37: 217-26.

How long should we take finasteride tablet?

Question: I have hair loss caused by genetics, so I went to the doctor for taking medicine named finasteride tablet. I have taken finasteride (1 mg) tablet for three months. I don’t know how long should I take this drug?  The doctor did not tell me anything and I do not dare ask him.

Answer:  Finasteride (1 mg) tablet is used for treatment of hair loss in men caused by genetics, the drug should be used for at least 3 consecutive months. After that it will start to see effective in stimulating hair growth and prevent the loss of pre-existing hair.

There is evidence supported that taking finasteride for 12 months continuously, can increase the amount of hair undoubtedly.

The duration of treatment depends on the consideration of the doctor according to the result of treatment.

There have been reports on medication use: Using finasteride 1 mg for a period of 5 years, also see the effective of treatment without severe side effect.

References:

1. Merck & Co., Inc. Propecia® (Finasteride) Tablets, 1 mg. Available form: www.accessdata.fda.gov/drugsatfda_docs/label/2011/020788Orig1s022lbl.pdf - 110k - 2011-06-17.

2. Blumeyer A, Tosti A, Messenger A, Reygagne P, Del Marmol V, Spuls PI, et al. Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men. J Dtsch Dermatol Ges 2011; 9 (suppl 6): S1-57.

3. Olsen EA, Messenger AG, Shapiro J, Bergfeld WF, Hordinsky MK, Roberts JL, et al. Evaluation and treatment of male and female pattern hair loss. J Am Acad Dermatol 2005; 52: 301-11.

4. The Finasteride Male Pattern Hair Loss Study Group. Long term (5-year) multinational experience with finasteride 1 mg in the treatment of men with androgenetic alopecia. Eur J Dermatol 2002; 12: 38-49.

How much glutathione can we eat without harmful?

Question: If I eat a lot of Glutathione, it would be harmful or not?

Answer: Glutathione is commercially available in various doses, generally one capsule may have 450 to 600 mg of glutathione.

Oral dose of glutathione is 1-2 capsules or equal to 450-1200 mg per day.

Searching for information found that no studies about the safety of eating glutathione clearly. But found that eating glutathione 500 to 1,000 mg daily for 6 months is not reported serious side effects.

Common side effects such as dizziness, back pain, hot flushes, liquid stool, eye twitching, ear infections, urinary tract infections, constipation, flatulence, and increasing body weight.

And there is no any study using oral glutathione more than 1,000 mg per day.

References:

1. Allen J, Bradley RD. Effects of oral glutathione supplementation on systemic oxidative stress biomarkers in human volunteers. J Altern Complement Med 2011; 17 (9): 827-33.

2. Arjinpathana N, Asawanonda P. Glutathione as an oral whitening agent: A randomized, double-blind, placebo-controlled study. J Dermatolog Treat 2012; 23 (2): 97-102.

3. John P, Richie JR, Nichenametla S, Neidig W, Calcagnotto A, Haley JS, et al. Randomized controlled trial of oral glutathione supplementation on body stores of glutathione. Eur J Nutr 2014; [Epub ahead of print].

Diclofenac potassium, Ibuprofen potassium.

Question: I need to know that medicine in the form of potassium salt, such as diclofenac potassiun, ibuprofen potassium. If patients with heart disease eat these medicines, how can drugs affect potassium levels and affect the function of the heart?

Answer: Generally, when the potassium chloride solution was injected into the blood vessels 10 meq. The level of potassium in the blood approximately increases 0.1 meq/litre.

For drugs in oral form, there is very little amount of potassium in oral form of potassium salt.

Such as diclofenac potassium 50 mg, there is potassium only 0.15 meq. After eating the medicine, potassium levels in the blood are increased very little.

It does not affect potassium levels in the blood. And it affect very little on the functioning of the heart.

However, patients with heart disease should carefully eat potassium that may be obtained from other sources. It may be harmful from receiving too much potassium.

Reference:

1. Lederer E, Batuman V. Hyperkalemia. Available from: http://emedicine.medscape.com/article/240903-overview.

2. Diclofenac (systemic): Drug information. Available from: http://cursoenarm.net/UPTODATE/contents/mobipreview.htm?16/0/16385/abstract-text/2232043/pubmed.

Metoclopramide, Hyoscine And Domperidone

Question: Can we take plasil (metoclopramide) together with buscopan (hyoscine), or take buscopan with domperidone?

Answer: Plasil can increase the movement in the gastrointestinal tract, by acting through neurotransmitters (=acetylcholine), and inhibiting the function of the neurotransmitter (=dopamine) in the gastrointestinal tract. Plasil also has anti-vomiting because it can inhibit the function of the neurotransmitter (=dopamine) in and out of the brain.

Buscopan can reduce the mobility of gastrointestinal tract, by acting through inhibiting the function of neurotransmitter (=acetylcholine). So buscopan should not be administered together with plasil. Buscopan can be used to relieve abdominal pain.

Domperidone increases mobility in the gastrointestinal tract, by inhibiting the function of the neurotransmitter (=dopamine) outside the brain. When giving buscopan together with domperidone may antagonistic effect on the movement of the digestive tract. So both of them should not be used together.

Reference:

1. Lacy CF, Armstrong LL, Goldman MP, Lance LL, editors. Drug Information Hand, 21st ed. Ohio: Lexi-comp; 2012-2013.

2. Tatro DS, editor. Drug Interaction Facts. St. Louis, Missourit: Wolter Kluwer Health; 2013.

3. Interactions-check. Drug-Drug Interactions: domperidone. Available at: http://www.drugs.com/interactions-check.php?drug_list=1612-0,2047

Can domperidone cause intestinal swallow or not?

Question: If I have taken domperidone tablet continuously for a long time, can drug make me be intussusception?

Answer: Intussusception is a condition of the intestine which can move into the next part of the intestine. It has not known the cause of intussusception.  And intusssudception is the most common cause of an intestinal obstruction in children. 

Domperidone is able to increase the movement of the intestines and stomach, used to treat nausea, vomiting, indigestion and side effects of a drug is dry mouth, headache, migraine, cardiac arrhythmias, larger breast, lactation increasing.

Currently, there are no reports that domperidone causes intestinal swallow or causes gastrointestinal disorders.

Reference:

1. Hay W, Levin M, Abzug M. Current diagnosis & treatment pediatrics. 21st ed. The McGill- hill: 2012. p. 636.

2. Lacy CF, Armstrong LL, Goldman MP, Lance LL., Editors. Drug Information Handbook 21st ed., Ohio, USA: Lexi - Comp Inc; 2012-2013.

Glucosamine And Osteoarthritis

Osteoarthritis is a degenerative condition of the joints and tissues. It have tension of muscle and pain, later the joint swelling etc. When late-stage symptoms, the joints will look malformed.
Besides medication to relieve pain or inflammation in order to prevent the spread of disease. There are supplements that may be helpful.

Glucosamine sulfate is a compound found in the form of drugs and supplements.
Dose generally is 1500 mg daily.

Studies in vitro, Found that glucosamine sulfate has a stimulating effect on the synthesis and inhibit the degradation of Proteoglycans, which is an important component in cartilage that acts as a cushion between the joint of bones. And glucosamine has a mild anti-inflammatory effects as well.

Clinical studies (studies in humans) show results similar to the treatment of non-steroidal anti-inflammatory steroids. (NSAIDs), but the initial results from glucosamine are slower and relief of symptoms are gradually better, not as fast as drug use (=NSAIDS). The results of relieving the symptoms range from moderate to a maximum. Report: 14 in 15 issues benefits of Glucosamine sulfate over the non-steroidal anti-inflammatory steroids (NSAIDs) are glucosamine can delay the movement of the knee joint toward each other. This result is clearly seen after 1 year of using glucosamine and more apparently after 3 years of continuous use.

The most common adverse reactions are nausea, diarrhea, heartburn, abdominal pain. Other symptoms are less common are headaches, dizziness, insomnia, edema, dermatitis, tachycardia.

Precautions: Glucosamine should not be used in people who are allergic to seafood. Because glucosamine may be prepared from marine animals which can cause severe allergic reactions.

Antacids

People who have the habit of

1. Eating spicy foods.

2. Not eating on time.

3. Coffee lovers.

4. Take medication for pain on an empty stomach frequently.

5. Smoking.

6. Drinking soda.

7. Have accumulated stress.

8. Anxiety regularly.

Symptoms that these people often find, is the abdominal pain from excess acid in the stomach. In the future this symptoms can lead to gastric ulcer, duodenal ulcers or acid reflux. The drugs used to relieve symptoms, one of them is "antacid".

How do antacids work?

The mechanism of action of antacids is neutralizing the acid in the stomach or intestines. 

When the acidity reduced, the corrosion of acid to cause ulcers or lesions are mild enough to result to relieve the symptoms of abdominal pain and others.

Types of antacids

1. Drugs that contain the compound of aluminum Hydroxide (AlOH3).

2. Drugs that contain the compound of Magnesium hydroxide (MgOH2) Tri magnesium silicate or magnesium carbonate (MgCO3).

Both of drugs above are often used together. Both drugs are absorbed into the bloodstream a little. They have specific action in the stomach, so they do not interfere acid - base in the body.

Side effect of both drugs: Aluminium Hydroxide cause constipation, Magnesium hydroxide cause diarrhea.

So, they makes a little effect to digestive system, when used as the combination of two drugs

Aluminium Hydroxide may be used to reduce the amount of phosphorus in the blood in patients with kidney disease. While Magnesium hydroxide should cautiously be used in patients with kidney disease.

So the combination of two drugs should not be used in patients with kidney disease. Drugs in this group, such as Antacil, Maalox, Alum milk

3. Drugs that contain the compound of sodium bicarbonate (NaHCO3) or sodamint.

Sodium bicarbonate is a type of fast-acting antacid. However it inactivates quickly, the effective of treatment is shortly.

Precaution of this drug:

Sodamint can be absorbed through the stomach into the bloodstream, it can cause blood and urine alkaline conditions more than normal. As well as having a lot of sodium in the blood stream.

This medication is suitable to be used to relieve excess acid or gastrointestinal irritation while the symptoms are occurring. But it is not suitable for use regularly continue to control the acidity.

The drug is used to reduce the acid in the digestive tract. But you may find the use of sodium bicarbonate to control the conditions of acidity in the blood in patients with kidney disease. such as ENO.

4. Drugs that contain the compound of calcium carbonate (CaCO3).

Effective of the treatment and onset of this drug are rather moderate. Calcium carbonate may cause constipation.

Other drugs that support the effectiveness of antacids

1. Simethicone or Dimethyl Polysiloxane poly (MPS).

Simethicone is surfactant that can drain bubbles and gas out of digestive food in stomach. So it used to relieve dyspepsia or abdominal distention due to excessive gas in stomach and intestines. Drug in this group, such as Air-X.

2. Bismuth subsalicylate.

As a bactericide is used to treat an infection that causes excess acid in the stomach.

The drug can reduce acid a little. Drugs in this group, such as Gastro-bismol.

3. Algenic acid or sodium Alginate.

Algenic acid is the same substance of the starch. It can swell to gel when exposed to gastric acid, and then can capturing the carbon dioxide and become to be foam. The foam is viscous and floating on the surface of the digestive food in the stomach. So it can reduce vapor of gastric acid to the esophagus, and reduce irritation of stomach from gastric acid.

This drug is often used in combination with other antacids such as sodium bicarbonate. Drugs in this group include Gaviscon. (Gaviscon is a drug containing sodium bicarbonate. calcium carbonate and sodium Alginate.)

(Gaviscon Dual Action has the amount of drug more than usual formula Gaviscon)

Reference:

1. Hoogerwerf WA, Pasricha PJ. Agent used for control of gastric acidity and treatment of peptic ulcers and gastroesophageal reflux disease. In: Hardman JG, Limbird LE, editors. Goodman & Gilman's the pharmacological basis of therapeutics. 10th ed. New York: The McGraw-Hill Companies, Inc; 2001. p.1005-20

2. Bismuth subsalicylate. In: DRUGDEX System (database on Internet). Ann Arbor (MI): Truven Health Analytics; 2014 [cited 23 May 2014]. Available from: http://www.micromedexsolutions.com

3. Erwin K, et al. Drug Fact and Comparisons. Missouri: Wolters Kluwer Health; 2009.p.1774-80.

4. Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther. 2000 Jun; 14 (6): 669-90.

5. MIMS Thailand. 134th ed. Bangkok: TIMs; 2014.