Dexamethasone + Chloramphenicol + Clotrimazole Pharmacology

Dexamethasone + Chloramphenicol + Clotrimazole

About Dexamethasone + Chloramphenicol + Clotrimazole
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Mechanism of Action of Dexamethasone + Chloramphenicol + Clotrimazole
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Pharmacokinets of Dexamethasone + Chloramphenicol + Clotrimazole
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Onset of Action for Dexamethasone + Chloramphenicol + Clotrimazole
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Duration of Action for Dexamethasone + Chloramphenicol + Clotrimazole
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Half Life of Dexamethasone + Chloramphenicol + Clotrimazole
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Side Effects of Dexamethasone + Chloramphenicol + Clotrimazole
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Contra-indications of Dexamethasone + Chloramphenicol + Clotrimazole
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Special Precautions while taking Dexamethasone + Chloramphenicol + Clotrimazole
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Pregnancy Related Information
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Old Age Related Information
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Breast Feeding Related Information
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Children Related Information
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Indications for Dexamethasone + Chloramphenicol + Clotrimazole
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Interactions for Dexamethasone + Chloramphenicol + Clotrimazole
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Typical Dosage for Dexamethasone + Chloramphenicol + Clotrimazole
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Schedule of Dexamethasone + Chloramphenicol + Clotrimazole
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Storage Requirements for Dexamethasone + Chloramphenicol + Clotrimazole
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Effects of Missed Dosage of Dexamethasone + Chloramphenicol + Clotrimazole
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Effects of Overdose of Dexamethasone + Chloramphenicol + Clotrimazole
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Dexamethasone

About Dexamethasone
A potent synthetic glucocorticoid, Antiasthmatic, anti-inflammatory and immunosuppressant.
Mechanism of Action of Dexamethasone
The drug exerts it`s pharmacological action by penetrating and binding to cytoplasmic receptor protein and causes a structural change in steroid receptor complex. This structural change allows it`s migration in to the nucleus and then binding to specific sites on the DNA which leads to transcription of specific m-RNA and which ultimately regulates protein synthesis. It exerts highly selective glucocorticoid action. It stimulates the enzymes needed to decrease the inflammatory response.
The drug exerts anti-inflammatory and immunosuppressant actions as follows: - 1) Induce lipocortins in macrophages, endothelium, and fibroblasts which inhibits phospholipase A2 and thus decreases the production of Prostaglandins, leukotriens (LT), and platelet activating factor, 2) Causes negative regulation of genes for cytokines in macrophages, endothelial cells and lymphocytes and thus decreases the production of interleukins (IL-1, IL-2, IL-3, IL-6), TNF-a, GM-CSF (granulocyte macrophage colony stimulating factor), Gama interferon and suppresses fibroblast proliferation and T-lymphocyte functions and interferes chemo taxis. 3) Decreases the production of acute phase reactants from macrophages and endothelial cells and interferes complement function. 4) Decreases the production of ELAM-1(Endothelial leukocyte adhesion molecule-1) and ICAM-1(intracellular adhesion molecule-1) in endothelial cells. 5) Inhibit IgE mediated histamine and LT-C4 release from basophiles and the effects of antigen-antibody reaction is not mediated 6) Reduces the production of collagenase and stromolysin and thus prevents tissue destruction.
Dexamethasone has antiemetic properties, particularly against acute and delayed vomiting induced by cancer chemotherapy. It may be used alone for prevention of acute symptoms associated with moderately-emetogenic treatment and is combined with a 5-HT3 antagonist for highly-emetogenic treatment. Dexamethasone is also effective for the prevention of postoperative nausea and vomiting, and may be used to manage nausea and vomiting in palliative care.
Pharmacokinets of Dexamethasone
Absorption: Well absorbed orally, Distribution: Distributed in to muscle, liver, kidney, skin, and intestine. It crosses the placenta and also secreted in breast milk, Metabolism: Metabolized in liver in to inactive metabolites by glucuronide and sulfate conjugation. Excretion: Metabolites are excreted mainly through urine and a small amount is excreted through faeces.
Onset of Action for Dexamethasone
1 to 2hours
Duration of Action for Dexamethasone
2 or more days
Half Life of Dexamethasone
36 to 54 hours
Side Effects of Dexamethasone
1.Susceptibility to infection
2.Peptic ulcer
3.Haemorrhage
4.Glycosuria
5.Hyperglycaemia
6.Osteoporosis
7.Atrophy of adrenal cortex(on prolonged therapy)
8.Suppression of adrenocorticotropic hormone
9.Cushing`s syndrome
10.Inhibition of growth in children
11.Amenorrhoea
12.Behavioral disturbances
13.Thromoembolic disorders
14.Myopahy
15.Weaknss
16.Lymphocytopenia
17.Muscle wasting
18.Gastrointestinal discomfort
19.Increased appetite
20.Delayed wound healing
21.Headache
22.Euphoria
23.Insomnia
24.Seizures
25.Heart failure
26.Arrhythmias
27.Posterior sub capsular cataract
28.Glaucoma
29.Hirsutism
30.Increased intracranial pressure
Eye preparation:
1.Burning
2.Redness
3.Stinging in the eye
4.Blurred vision


Contra-indications of Dexamethasone
1.Hypersensitivity to the drug
2.Psychosis
3.Tuberculosis
4.Untreated infections
5.Systemic fungal infections
6.Osteoporosis
7.Congestive heart failure
8.Renal impairment
Special Precautions while taking Dexamethasone
1.Avoid sudden discontinuation of the drug
2.Use lower dosages as much as possible
3.Ocular herpes simplex
4.Primary glaucoma
5.Peptic ulcer
6.Epilepsy
7.Recent myocardial infarction
8.Heart failure
9.Diabetes mellitus
10.Hypothyroidism
11.Cirrhosis
12.Stress
13.Sepsis
14.Hypertension
15.Myasthenia gravis
16.Hepatic impairment
17.Non specific Ulcerative colitis
18.Diverticulitis
19.Recent intestinal anastomosis
20.Thromboembolic disorders
Eye preparation:
1.Cataracts
2.Contact lens wearer
3.Diabetes
4.Glaucoma



Pregnancy Related Information
Contraindicated.
Old Age Related Information
Use with caution.
Breast Feeding Related Information
Use with caution.
Children Related Information
Use with caution.
Neonates: Contraindicated
Indications for Dexamethasone
1.Inflammatory conditions
2.Allergic reactions
3.Shock
4.Anaphylaxis
5.Intra-articular and soft tissue inflammation
6.Asthma
7.Rheumatoid arthritis
8.Adrenal insufficiency
9.Tuberculous meningitis
10.Respiratory diseases
11.Malignancies
12.Cerebral oedema.
13.Acute gout
14.Nausea and vomiting induced by cancer chemotherapy
15. Pemphigus
Interactions for Dexamethasone
ENDOCRINE SYSTEM: Barbiturates: Decreases efficacy of dexamethasone.
Carbamazepine, Primidone: Decreases efficacy.
Oral contraceptives: Increases efficacy of dexamethasone.
Ephedrine: Decrease efficacy of dexamethasone.
Oestrogens: Decrease efficacy of dexamethasone
Hydantoins: Decrease efficacy of dexamethasone
Ketoconazole: Increase efficacy of dexamethasone
Rifampicin: Decreases efficacy.
Dexamethasone effects the actions of the following:
Anticholinesterases: Efficacy antagonised in myasthenia gravis.
Oral anticoagulants: Altered response.
Cyclosporine: Increased cyclosporine efficacy leading to enhanced toxicity.
Digitalis glycosides: Increased toxicity associated with hypokalaemia.
Isoniazid: Decreased serum levels of isoniazid.
Salicylates: Decreased serum levels of salicylates.
Diuretics: Increase efficacy may cause increased hypokalaemia and increased hyperglycemia.
Non-depolarising muscle relaxants: Altered response.
Theophyllines: Altered response of either agent.
IUCDs: contraceptive failure.
Lab. Tests: a) Increases serum cholesterol levels.
Increases urine glucose levels.
Decreases Thyroid I131 uptake. Decreases T3 serum levels. Decreases serum potassium.
Brain Scan: Dexamethasone alters result of brain scan due to decreased uptake of radioactive material.

Typical Dosage for Dexamethasone
Oral: 0.5 to 10mg/day depending up on the severity of the condition.
I.M. or I.V.: 0.5 to 20mg/day I.M. or as slow I.V. injection depending up on the severity of the condition; repeated as required up to 80mg/day.
Antiemetic: 4 to 8 mg by mouth immediately before moderately-emetogenic chemotherapy and 20 mg by intravenous injection for more severely emetogenic chemotherapy.
Children: 100mcg to 500mcg/kg/day
Schedule of Dexamethasone
H
Storage Requirements for Dexamethasone
Store at room temperature in a well closed light resistant container. Protect from excess heat and moisture. Keep out of reach of children.
Effects of Missed Dosage of Dexamethasone
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Dexamethasone
Provide symptomatic treatment and supportive measures.

Chloramphenicol

About Chloramphenicol
Bacteriostatic antibiotic, A systemic broad ? spectrum antibacterial agent.
Mechanism of Action of Chloramphenicol
Chloramphenicol is a broad spectrum antibiotic which is primarily bacteriostatic & exerts some bactericidal action at higher concentration. It acts by inhibiting bacterial protein synthesis. Chloramphenicol attaches to 50S subunit of ribosome and interfering with transfer of elongating peptide chain to the newly attached aminoacyl-tRNA at the ribosome-m RNA complex. It prevents the access of aminoacyl-tRNA to the acceptor site for amino acid incorporation. By acting as a peptide analogue it inhibits peptide bond formation
Pharmacokinets of Chloramphenicol
Absorption: Well absorbed orally, Distribution: Widely distributed & good CSF penetration. It is secreted in bile & milk Metabolism: It is conjugated with glucuronic acid in liver, Excretion: Excreted mainly in urine.

Onset of Action for Chloramphenicol
7 hours

Duration of Action for Chloramphenicol
Up to 3 days
Half Life of Chloramphenicol
3 to 5 hours
Side Effects of Chloramphenicol
1.Bone marrow depression
2.Aplastic anaemia
3.Agranulocytosis
4.Thrombocytopenia
5.Gray baby syndrome
6.Super infections
7.Rashes & Hypersensitivity reactions
8.Angioedema
9.Nausea
10.Vomiting
11.Diarrhoea
12.Pain at injection site
Contra-indications of Chloramphenicol
1.Hypersensitivity to chloramphenicol
2.As a prophylactic agent in infections & In the treatment of trivial infections

Special Precautions while taking Chloramphenicol
1.Renal impairment
2.Hepatic impairment
3.Concurrent use of other drugs which cause bone marrow suppression
4.Porphyria
5.G6PD deficiency
Pregnancy Related Information
Contraindicated.
Old Age Related Information
May be used.
Breast Feeding Related Information
Contraindicated.
Children Related Information
Use with caution
Neonates: Contraindicated
Indications for Chloramphenicol
1.Meningitis caused by H. influenzae
2.Typhoid fever
3.Brain abscesses
4.Wound infections
5.Pelvic inflammatory diseases
6 Conjunctivitis & Intraocular infections
7.Anaerobic infections
8.Ear infection
9.Infections where other antibiotics are not effective
10.In urinary tract infections

Interactions for Chloramphenicol
Dicoumarol, Phenytoin, Phenobarbital, Tolbutamide & Chlorpropamide: Efficacy enhanced when Chloramphenicol administered concomitantly since it inhibits the metabolism of these drugs.
Cyclophosphamide: Efficacy reduced.
Acetaminophen: Efficacy of Chloramphenicol potentiated leading to toxicity.
Iron salts and Vit. B12: Haematologic response decreased.
Penicillin: Decreases efficacy of penicillin and increases serum concenteration of chloramphenicol.
Rifampicin: Reduces serum chloramphenicol levels (hepatic enzyme induction).
Tricyclic Anti-Depressants: Blood levels and adverse effects increased.
Mannitol & Hydrochlorothiazide: Increases renal excretion of chloramphenicol.
Typical Dosage for Chloramphenicol
Adults:
0.25 to 0.5gm four times daily or 50mg/kg/day
In severe infections & Meningitis: 100mg/kg/day four times daily
Maximum total dose: 28gm
Children:
25 to 50mg/kgm/day four times daily
In severe infections: 100mg/kg/day four times daily
Schedule of Chloramphenicol
H
Storage Requirements for Chloramphenicol
Store at a temperature range of 15 degree C to 30 degree C.

Effects of Missed Dosage of Chloramphenicol
Take the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Chloramphenicol
Treatment is supportive & symptomatic. The drug is removed from the body by charcoal hemoperfusion

Clotrimazole

About Clotrimazole
A broad-spectrum antifungal antibiotic, imidazole derivative, Oral Nonabsorbed Antifungal Agent.
Mechanism of Action of Clotrimazole
Clotrimazole is fungicidal or fungistatic depending on the drug concentrations. It inhibits the conversion of Lanosterol to 14 demethyl Lanosterol by inhibiting the cytochromeP450 enzyme 14 alpha demethylase and impair ergosterol synthesis which is an essential constituent of cell membrane. Inhibition of ergosterol synthesis will alter the membrane permeability of the susceptible fungus and kill or inhibit them.
Pharmacokinets of Clotrimazole
Absorption: Absorption is minimal after topical administration.
Onset of Action for Clotrimazole
N/A
Duration of Action for Clotrimazole
3 hours
Half Life of Clotrimazole
N/A
Side Effects of Clotrimazole
1.Stinging
2.Erythema
3.Burning
4.Pruritis
5.Vesication
6.Desquamation
7.Urticaria
8.Burning
9.Peeling
10.Irritation
Contra-indications of Clotrimazole
Hypersensitivity to Clotrimazole
Special Precautions while taking Clotrimazole
1.Avoid contact with eyes, nose and mouth.
2.Do not wear occlusive dress over the medicament.
Pregnancy Related Information
Use with caution.
Old Age Related Information
Use with caution.
Breast Feeding Related Information
Use with caution.
Children Related Information
Use with caution.
NEONATES: contraindicated
Indications for Clotrimazole
1.Tinea pedis
2.Tinea cruris
3.Tinea versicolor
4.Tinea corporis
5.Cutaneous candidiasis
6.Vulvovaginal candidiasis
Interactions for Clotrimazole
Polyene Antibiotics : Antagonises effects of polyene antibiotics.
Typical Dosage for Clotrimazole
Topical: Clotrimazole cream, lotion and solution 1 % is used.
Clean and dry the affected area and apply the medicament with gentle massage 2 -3 times daily for 2 - 4 weeks.
Vaginal candidiasis: Insert 1 applicator full (vaginal cream 1%) intravaginally at night for 1 -2 weeks.
Vaginal tablets 100. 200 and 500mg tablet is available.
Vulvovaginal candidiasis: Insert 100mg tablet intravaginally at bed time for 7 consecutive days or 200 mg tablet for 3 consecutive days or 500 mg tablet for 1 day at night.
Oral lozenge 10 mg is available
Oropharyngeal candidiasis: 1 lozenge orally 5 times daily for 2 weeks
Prophylaxis of Oropharyngeal candidiasis: 1 lozenge is used 3 times daily
Gel: Insert with an applicator intravaginally at night for 1 - 2 weeks.
Powder (1% w/ w): dusted over the body parts as required
Schedule of Clotrimazole
H
Storage Requirements for Clotrimazole
Store at room temperature (15 - 25 degree C). Protect from heat and moisture. Keep out of the reach of children
Effects of Missed Dosage of Clotrimazole
Apply the missed dose as soon as noticed and if it is the time for next dose then skip the missed dose. Continue the regular schedule. Do not double the dose.
Effects of Overdose of Clotrimazole
Give supportive measures and symptomatic treatment.

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Dexamethasone + Chloramphenicol + Clotrimazole is a generic medicine name and there are several brands available for it. Some of the brands for dexamethasone + chloramphenicol + clotrimazole might be better known than dexamethasone + chloramphenicol + clotrimazole itself. If the pharmacy that's willing to deliver medicines to your home doesn't have dexamethasone + chloramphenicol + clotrimazole in stock, you can ask for one of the branded alternatives for dexamethasone + chloramphenicol + clotrimazole.