Vertin-32

GENERIC NAME(S): MECLIZINE HCL

Uses
Meclizine is an antihistamine that is used to prevent and treat nausea, vomiting,
anddizziness caused by motion sickness. It may also be used to reduce dizziness and
loss of balance (vertigo) caused by inner ear problems.
How to use Vertin-32
Follow all directions on the product package. If your doctor has prescribed
thismedication, take it as directed. If you are uncertain about any of the information,
consult your doctor or pharmacist.
Take this medication by mouth with or without food. The chewable tablets should be
chewed thoroughly before being swallowed.
The dosage is based on your medical condition and response to treatment. Do not
increase your dose or take this medication more often than directed.
To prevent motion sickness, take the first dose one hour before starting activity such as
travel.
Tell your doctor if your condition does not improve or if it worsens.

Interactions
Drug interactions may change how your medications work or increase your risk for
serious side effects. This document does not contain all possible drug interactions.
Keep a list of all the products you use (including prescription/nonprescription drugs and
herbal products) and share it with your doctor and pharmacist. Do not start, stop, or
change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: antihistamines applied to
theskin (such as diphenhydramine cream, ointment, spray).
Tell your doctor or pharmacist if you are taking other products that cause drowsiness
including alcohol, other antihistamines (such as diphenhydramine), drugs
for sleep oranxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and
narcotic pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products)
because they may contain ingredients that cause drowsiness. Ask your pharmacist
about using those products safely.
This medication may interfere with certain laboratory tests (including allergy skin test),
possibly causing false test results. Make sure laboratory personnel and all your doctors
know you use this drug.

Precautions
Before taking meclizine, 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: breathing problems (such as asthma, emphysema), high pressure in
theeye (glaucoma), heart problems, high blood pressure, seizures, stomach/intestine
problems (such as ulcers, blockage), overactive thyroid (hyperthyroidism), difficulty
urinating (for example, due to enlarged prostate), liver problems, kidney problems.
This drug may make you drowsy. Do not drive, use machinery, or do any activity that
requires alertness until you are sure you can perform such activities safely.
Avoidalcoholic beverages.
Before having surgery, tell your doctor or dentist about all the products you use
(including prescription drugs, nonprescription drugs, and herbal products).
Children may be more sensitive to the side effects of this drug. This drug can often
cause excitement in young children instead of drowsiness.
Older adults may be more sensitive to the side effects of this drug, especially
drowsiness.
During pregnancy, this medication should be used only when clearly needed. Discuss
the risks and benefits with your doctor.
Betahistine dihydrochloride (brand names Veserc, Serc, Hiserk, Betaserc) is an anti-vertigo drug.
It was first registered in Europe in 1970 for the treatment of Mnire's disease. It is commonly
prescribed to patients with balance disorders or to alleviate vertigo symptoms associated
with Mnire's disease.

Mode of action[edit]
Betahistine has a very strong affinity as an antagonist for histamine H3 receptors and a weak affinity
as an agonist for histamine H1receptors. Betahistine seems to dilate the blood vessels within the
inner ear which can relieve pressure from excess fluid and act on the smooth muscle.
Betahistine has two modes of action. Primarily, it has a direct stimulating (agonistic) effect on
H1 receptors located on blood vessels in the inner ear. This gives rise to local vasodilation and
increased permeability, which helps to reverse the underlying problem of endolymphatic hydrops.
More importantly, betahistine has a powerful antagonistic effects at H 3 receptors, thereby increasing
the levels of neurotransmittershistamine, acetylcholine, norepinephrine, and serotonin released from
the nerve endings. The increased amounts of histamine released from histaminergic nerve endings
can stimulate receptors. This stimulation explains the potent vasodilatory effects of betahistine in the
inner ear, that are well documented.

It is postulated that betahistine's increase in the level of serotonin in the brainstem inhibits
the activity of vestibular nuclei.

Adverse effects[edit]

Headache.

Low level of gastric side effects.

Insomnia

Nausea can be a side effect, but the patient is generally already experiencing nausea due to
the vertigo so it goes largely unnoticed.

Patients taking betahistine dihydrochloride may experience several hypersensitivity and

allergic reactions. In the November 2006 issue of "Drug Safety," Dr. Sabine Jeck-Thole and Dr.
Wolfgang Wagner reported that betahistine dihydrochloride may cause several allergic and skinrelated side effects. These include rash in several areas of the body; itching and hives; and
swelling of the face, tongue and mouth. Other hypersensitivity reactions reported include
tingling, numbness, burning sensations, shortness of breath and laboured breathing. The study
authors suggest that hypersensitivity reactions may be a direct result of betahistine's role in
increasing histamine levels throughout the body. Hypersensitivity reactions quickly subside after
betahistine has been discontinued.

Digestive side effects Betahistine may also cause several digestive-related side effects. The
package insert for Serc, a trade name for betahistine, states that patients may experience several
gastrointestinal side effects. These may include nausea, upset stomach, vomiting, diarrhea and
stomach cramping. These symptoms are usually not serious and subside between doses. Patients
experiencing chronic digestive problems may lower their dose to the minimum effective range and by
taking betahistine with meals. Additional digestive problems may require that patients consult their
physician in order to find a possible suitable alternative.
Other side effects Patients taking betahistine may experience several other side effects ranging
from mild to serious. The package insert for Serc states that patients may experience nervoussystem side effects, including headache. Some nervous system events may also partly be
attributable to the underlying condition rather than the medication used to treat it. The study by JeckThole and Wagner also reports that patients may experience headache and liver problems, including
increased liver enzymes and bile-flow disturbances. Any side effects that persist or outweigh the
relief of symptoms of the original condition may warrant that the patient consult their physician to
adjust or change the medication.

Contraindications[edit]
Betahistine is contraindicated for people with pheochromocytoma. People with bronchial asthma and
history of peptic ulcer need to be closely monitored.[citation needed]

Seloken Xl (25mg)

SALT INFORMATION
Metoprolol(25 Mg)
TYPICAL USAGE

Metoprolol is used to treat high blood pressure, fast and irregular heartbeat, chest pain
and for prophylaxis of migraine.
SIDE EFFECTS

Slow heart rate, breathlessness on exertion, dizziness, headache, tiredness, fall in

blood pressure with change of posture, urge to vomit, vomiting, loose stools,
constipation, cold hands and feet.

DRUG INTERACTION

Drugs such as rifampicin, cimetidine, alcohol, hydralazine verapamil, diltiazem,

quinidine, amiodarone, digitalis glycosides, inhalation anaesthetics, lidocaine,
indometacin, epinephrine, nifedipine, and ergotamine may interfere with the metabolism
of metoprolol. Always consult your physician for the change of dose regimen or an
alternative drug of choice that may strictly be required.
MECHANISM OF ACTION

Beta-2 receptors are responsible for the stimulation of heart rate and contractility.
Metoprolol blocks these beta-2 receptors thus lowering the blood pressure and
maintaining the normal heart rate and rhythm.

amiodarone, Cordarone

GENERIC NAME: amiodarone

BRAND NAME: Cordarone
DRUG CLASS AND MECHANISM: Amiodarone is an oral and injectable drug that is used to
correct abnormal rhythms of the heart. (It is an antiarrhythmic medication.) Although amiodarone has
many side effects, some of which are severe and potentially fatal, it has been successful in treating
many arrhythmias when other antiarrhythmic drugs have failed. Amiodarone is considered a "broad
spectrum" antiarrhythmic medication, that is, it has multiple and complex effects on the electrical
activity of the heart which is responsible for the heart's rhythm. Among its most important electrical
effects are:
1.

a delay in the rate at which the heart's electrical system "recharges" after the heart contracts
(repolarization);

2.

a prolongation in the electrical phase during which the heart's muscle cells are electrically
stimulated (action potential);

3.

a slowing of the speed of electrical conduction (how fast each individual impulse is
conducted through the heart's electrical system);

4.

a reduction in the rapidity of firing of the normal generator of electrical impulses in the heart
(the heart's pacemaker);

5.

a slowing of conduction through various specialized electrical pathways (called accessory

pathways) which can be responsible for arrhythmias.

In addition to being an antiarrhythmic medication, amiodarone also causes blood vessels to dilate
(enlarge). This effect can result in a drop in blood pressure. Because of this effect, it also may be of
benefit in patients withcongestive heart failure.
Amiodarone was discovered in 1961 and approved by the FDA in December 1985.
PRESCRIPTION: Yes
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 200 mg. Injection: 50 mg/ml
STORAGE: Tablets and injection should be kept at room temperature, 20-25 C (68-77 F).
PRESCRIBED FOR: Amiodarone is approved for recurrent ventricular fibrillation and
hemodynamically unstable ventricular tachycardia.
DOSING: The recommended dosing schedule is an initial loading dose of 800-1600 mg daily for 1 to
3 weeks, followed by 600-800 mg daily for 1 month, then 400 mg daily for maintenance. Response
should be closely monitored and dosing is individualized for each patient. Amiodarone may be
administered once daily or given twice daily with meals to minimize stomach upset which is seen
more frequently with higher doses.
DRUG INTERACTIONS: Amiodarone may interact with beta-blockers such
as atenolol (Tenormin), propranolol (Inderal), metoprolol (Lopressor), or certain calcium channel
blockers, such as verapamil (Calan, Isoptin, Verelan, Covera-HS) or diltiazem (Cardizem, Dilacor,
Tiazac), resulting in an excessively slow heart rate or a block in the conduction of the electrical
impulse through the heart.
Amiodarone increases the blood levels of digoxin (Lanoxin) when the two drugs are given together. It
is recommended that the dose of digoxin be cut by 50% when amiodarone therapy is started.
Flecainide (Tambocor) blood concentrations increase by more than 50% with
amiodarone. Procainamide(Procan-SR, Pronestyl) and quinidine (Quinidex, Quinaglute)
concentrations increase by 30%-50% during the first week of amiodarone therapy. Additive electrical
effects occurs with these combinations, and worsening arrhythmias may occur as a result. Some
experts recommend that the doses of these other drugs be reduced when amiodarone is started.
Amiodarone can result in phenytoin (Dilantin) toxicity because it causes a two- or three-fold increase
in blood concentrations of phenytoin. Symptoms of phenytoin toxicity including unsteady eye
movement (temporary and reversible), tiredness and unsteady gait.

Ritonavir (Norvir) can inhibit the enzyme that is responsible for the metabolism (break-down) of
amiodarone. Although no clinical problems have been recognized as a result of this interaction, it
would be prudent to avoid this combination for fear of the potential for amiodarone toxicity.
Amiodarone also can interact with tricyclic antidepressants (for example,amitriptyline [Endep,
Elavil]), or phenothiazines (for example, chlorpromazine [Thorazine]) and potentially cause serious
arrhythmias.

Amiodarone interacts with warfarin (Coumadin) and increases the risk of bleeding. The bleeding can
be serious or even fatal. This effect can occur as early as 4-6 days after the start of the combination
of drugs or can be delayed by a few weeks. Clotting studies probably should be done early during
treatment with amiodarone among patients taking warfarin.
Amiodarone can interact with some cholesterol-lowering medicines of the statin class, such
as simvastatin (Zocor), atorvastatin (Lipitor), andlovastatin (Mevacor), increasing the side effects
of statins which include severe muscle breakdown, kidney failure or liver disease. This interaction is
dose-related, meaning that lower doses of statins are safer than higher doses when used with
amiodarone. An alternative statin, pravastatin(Pravachol), does not share this interaction and is safer
in patients taking amiodarone.
Amiodarone inhibits the metabolism of dextromethorphan, the cough suppressant found in most
over-the-counter (and some prescription) coughand cold medications (for example, Robitussin-DM).
Although the significance of the interaction is unknown, these two drugs probably should not be
taken together if possible.
Grapefruit juice may reduce the breakdown of amiodarone in the stomach leading to increased
amiodarone blood levels. Grapefruit juice should be avoided during treatment with amiodarone.
PREGNANCY: Amiodarone should not be used during pregnancy because it can cause fetal harm.
There have been reports of congenitalhypothyroidism or hyperthyroidism when amiodarone was
administered during pregnancy.
NURSING MOTHERS: Amiodarone is excreted in breast milk and may cause adverse effects in the
infant. Breastfeeding should be discontinued by mothers receiving amiodarone.
SIDE EFFECTS: Amiodarone has many side effects and several that are serious. This is only a
partial list. Common side effects include fatigue, eye deposits, tremor, unsteady
gait, nausea, vomiting, constipation, weight loss,dizziness, and visual changes. Amiodarone is also
associated with heart block, low blood pressure, pulmonary fibrosis (scarring of the lungs), heart
failure, cardiac arrest, hypo or hyperthyroidism, blue skin discoloration, liver failure, and cardiogenic
shock.