Pediatric Drug Companion Jitender Nagpal, HPS Sachdev, Panna Choudhary
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Analgesics, Antipyretics and Anti-inflammatory Drugs1

 
ASPIRIN (ACETYL SALICYLIC ACID)
Refers to acetylsalicylic acid. One of the oldest NSAIDS still widely used; often described as the prototype of the class.
 
Indications and Dosage
 
Adverse Effects
Nausea, vomiting, occult blood loss in stools, gastric mucosal damage, peptic ulceration
Hypersensitivity—rashes, urticaria, angioedema
Salicylism—seen with anti-inflammatory doses—dizziness, tinnitus, vertigo, impairment of hearing and vision
 
Contraindications
  • Hypersensitivity
  • Peptic ulcer disease
    2
  • Children with chicken pox or influenza—risk of Reye's Syndrome
  • Bronchial asthma
 
Toxicity
Causes direct stimulation of the central nervous system, the respiratory centre, and uncoupling of oxidative phosphorylation.
Disorientation, nausea, vomiting, dehydration, hyperpnea, hyperpyrexia, oliguria, tinnitus and bronchospasm are the usual clinical features
Blood sugar, fluid and electrolytes, acidosis and bleeding profile need monitoring
Treatment: Emesis/lavage, charcoal, supportive therapy for fluid electrolyte and blood sugar disturbances, alkalinization of urine. Hemodialysis indicated in – renal failure, persistent CNS manifestations, Non-cardiogenic pulmonary edema, progressive deterioration of patient, persistent acidosis (<7.1) and Salicylate levels > 100 mg% at 6 hrs.
Pregnancy Category: B in early and D in late pregnancy.
Lactation: Compatible.
 
Available as
Tab:
DISPRIN 350mg
ASPIN–100 100mg
DELISPRIN–75,100mg
Injn:
BIOSPIRIN (lysine ASA + glycine)–500mg
 
CELECOXIB
Newer NSAID with selective inhibition of cyclooxygenase–2 enzyme not yet tested in the pediatric age group.3
 
Indications and Dosage
Osteoarthritis and rheumatoid arthritis. Dose in pediatric age group not defined. In adults 100–200 mg twice a day.
 
Available as:
Cap:
CELCOX (100,200mg)
COBIX (100,200mg)
ZYCEL (100, 200mg)
 
CODEINE
Opioid analgesic used predominantly as an antitussive. Able to exert antussive action and sub analgesic doses.
 
Indications and dosage
 
Adverse Effects
Constipation is the predominant side effect. Abuse liability is low.
 
Contraindications
Same as those for all opioids.
Pregnancy Category: C
Lactation: Compatible.
 
Available as:
Tab:
CODEINE SULPHATE (15mg)
Syrup:
CODINLINCTUS (15mg/5ml+menthol 0.2mg)
 
DEXTROPROPOXYPHENE
Opioid analgesic related to Methadone with similar analgesic potency to codeine. Analgesic action 4is supra –additive when used in combination with paracetamol or Ibuprofen
 
Indications and Dosage
 
Contraindications
Gross Hepatic Damage
 
Adverse effects
Constipation is less likely side effects as compared to codeine. Abuse liability is low.
Pregnancy category: C
Lactation: Compatible
 
Available as:
Cap:
PARVON (paracetamol 400 mg+ dextropropoxyphene 65 mg)
PARVON FORTE (ibuprofen 400 mg + dextropropoxyphene 65 mg)
PARVODEX (dextropropoxyphene 65 mg)
ORTHODEX (paracetamol 325 mg + dextropropoxyphene 65 mg + ibuprofen 400 mg)
 
DICLOFENAC SODIUM
NSAID with anti-inflammatory, analgesic and antipyretic action.
 
Indications and Dosage
 
Adverse Effects
Body as a Whole: Abdominal pain or cramps, * headache,* fluid retention, abdominal distention.5
Digestive: Diarrhea,* indigestion,* nausea,* constipation,* flatulence, liver test abnormalities,* PUB, i.e., peptic ulcer, with or without bleeding and/or perforation, or bleeding without ulcer.
Nervous System: Dizziness. Skin and Appendages: Rash, pruritus.
Special Senses: Tinnitus.
*Incidence, 3–9% (incidence of unmarked reactions is 1–3%).
 
Contraindications
Active or recurrent peptic ulcers, hypersensitivity, asthmatic patients in who attacks are precipitated by aspirin or other NSAID's.
Pregnancy Category: B in early and D in late pregnancy
Lactation
 
Available as:
Tab:
VOVERAN (50mg, 75mg SR, 100mg SR)
DICLONAC (50mg, 50mg DT, 100mg SR)
Combinations: DICLONAC-P (Diclofenac 50 mg + Paracetamol 500 mg)
Injn:
DICLONAC (25mg/ml– 3ml, 15 ml)
VOVERAN (25mg/ml–3 ml)
Topical:
DICLONAC GEL (1%), VOVERAN emulgel (1%), VOLINI Gel (1%)
 
IBUPROFEN
First NSAID of the propionic acid derivative class with analgesic, antipyretics and anti-inflammatory efficacy rated somewhat lower than high dose aspirin.
 
Indications and Dosage
 
Adverse Effects
Better tolerated than aspirin, side effects are less and milder. Gastric discomforts, nausea and vomiting although less than aspirin are still the most common side effects. Gastric erosion and occult blood loss are rare. CNS side effects include headache, dizziness, blurring of vision, tinnitus and depression. The rashes, itching and other hypersensitivity are infrequent.
 
Contraindications
Active or recurrent peptic ulcers, hypersensitivity, asthmatic patients in whom attacks are precipitated by aspirin or other NSAID's
 
Toxicity
In cases of acute over dosage, the stomach should be emptied by vomiting or lavage, though little drug will likely be recovered if more than an hour has elapsed since ingestion. Because the drug is acidic and is excreted in the urine, it is theoretically beneficial to administer alkali and induce diuresis. In addition to supportive measures, the use of oral activated charcoal may help to reduce the absorption and reabsorption of ibuprofen.
Pregnancy Category: B in early and D in late pregnancy
Lactation: Compatible
 
Available as
Tab:
BRUFEN (200,400,600 mg)
IBUGESIC (200,400,600 mg)
Cap:
IBUGESIC (300 mg S. R.)
Susp.:
APROFEN (100 mg/5 ml)
7
IBUGESIC (100 mg/5 ml)
PREMOBIL (100 mg/5 ml)
 
INDOMETHACIN
Potent anti-inflammatory drug and promptly acting antipyretic but analgesic action is restricted to inflammatory or tissue injury related pain.
 
Indications and Dosage
 
Adverse Effects
50% incidence of gastrointestinal and CNS side effects. Marked gastric irritation, nausea, anorexia, gastric bleeding and diarrhea. Frontal headache, dizziness, ataxia, mental confusion depression and psychosis. Increased risk of bleeding due to decreased platelet aggregation. Can induce asthma in aspirin sensitive individuals.
 
Toxicity
Nausea, vomiting, intense headache, dizziness, mental confusion, disorientation, or lethargy. There have been reports of paresthesia, numbness, and convulsions. Treatment is symptomatic and supportive. The stomach should be emptied as quickly as possible if the ingestion is recent. If the patient is unable to vomit, gastric lavage should be performed. Once the stomach has been emptied, activated charcoal may be given. The patient should be followed for several days because 8gastrointestinal ulceration and hemorrhage have been reported as adverse reactions of indomethacin. Use of antacids may be helpful.
 
Contraindications
Seizure disorders, kidney disease, peptic ulcer disease.
Pregnancy Category: B;D in 3rd trimester
Lactation: Not recommended
 
Available as:
Cap
INDOCAP (25 mg, 75 mg S. R.
INMECIN (25 mg, 50 mg)
 
KETOPROFEN
Similar to ibuprofen with a slightly longer half-life. In addition has been shown to stabilize lysosomes.
 
Indications and Dosage
 
Adverse Effects and Contraindications
Same as ibuprofen.
 
Available as
Tab:
REDUFEN (50mg, 100 mg SR)
RHOFENID (100mg, 200mg)
Injn:
RHOFENID (50mg [5mg/ml])
Pregnancy Category: B; D in 3rd trimester (one of the drugs recommended for rheumatic diseases in pregnancy due to short t ½)
Lactation: Excreted in milk. Caution is advised.9
 
KETOROLAC
NSAID of pyrrolo-pyrrole group with analgesic efficacy equivalent to morphine but free of respiratory depressant action. Recently tested in children.
 
Indications and Dosage
 
Adverse Effects
In a 3–year study of ketorolac use in 1,747 children, four patients experienced hypersensitivity reactions (two possibly as a result of latex allergy), two patients with underlying renal conditions had renal complications, and one child had gastrointestinal bleeding. Notwithstanding the reported low incidence of adverse effects, particular concern has been expressed about the possible increased risk of post-operative bleeding, impaired renal function, and gastrointestinal bleeding. Continuous use >5 days not recommended.
 
Contraindications
  • Renal impairment or in patients at risk for renal failure.
  • As prophylactic analgesic before any major surgery and is contraindicated intraoperatively when hemostasis is critical because of the increased risk of bleeding.
 
Toxicity
Controlled over dosage studies in adults (dose × 3) caused abdominal pain and peptic ulcers which healed after discontinuation of dosing. Metabolic acidosis has been reported following intentional overdosage. Dialysis does not significantly clear ketorolac tromethamine from the blood stream.10
Pregnancy: C
Lactation: Excreted in milk
 
Available as
Tab:
KETANOV (10 mg)
CADOLAC (10 mg)
ZOROVON (10 mg)
Injn:
KETANOV (1 ml–30 mg/ml)
CADOLAC (1 ml–30 mg/ml)
ZOROVON (1 ml–30 mg/ml)
 
LEFLUNOMIDE
Isoxazole immunomodulatory agent found to be effective in arthritis and other autoimmune diseases. The drug is under evaluation for the use in juvenile rheumatoid arthritis. Not recommended for pediatric use.
 
Available as
Tab:
LEFUMIDE (10 mg)
 
MEPHENAMIC ACID
Anthranilic acid derivative NSAID primarily used as an analgesic but not popular due to poor efficacy.
 
Indications and Dosage
 
Adverse Effects
Diarrhea and epigastric distress are common. Skin rashes, dizziness and other CNS manifestations have occurred. Hemolytic anaemia is a rare but serious complication.11
Pregnancy Category: C
Lactation: Excreted into human milk. Compatible
 
Available as:
Tab:
DYSMEN−500 (500mg)
MEFTAL −250 mg, 500 mg
 
MELOXICAM
Newer NSAID with specific action against COX–2 enzyme.
 
Indications and Dosage
Role in JRA and pediatric use under evaluation.
 
Adverse Effects
Allergic reaction, anaphylactoid reactions including shock, face edema, fatigue, fever, hot flushes, malaise, syncope, weight decrease, weight increase. Angina pectoris, cardiac failure, hypertension, hypotension, myocardial infarction, vasculitis. Convulsions, paresthesia, tremor, vertigo. Colitis, dry mouth, duodenal ulcer, eructation, esophagitis, gastritis. Agranulocytosis, leucopenia, purpura, thrombocytopenia. Hepatitis, jaundice, liver failure. Psychiatric disturbances, bullous eruption, urticaria.
 
Contraindications
Hypersensitivity and children known to develop asthma with other NSAIDs.
 
Toxicity
In cases of acute overdose, gastric lavage followed by activated charcoal is recommended. Gastric lavage performed more than 1 hour after overdose has little benefit in the treatment of overdose. Administration of activated charcoal is recommended for patients who present 1–2 hours after 12overdose. For substantial overdose or severely symptomatic patients, activated charcoal may be administered repeatedly. Accelerated removal of meloxicam by 4 g oral doses of cholestyramine given 3 times a day was demonstrated in a clinical trial. Administration of cholestyramine may be useful following an overdose. Forced diuresis, alkalinization of urine, hemodialysis, or hemoperfusion may not be useful due to high protein binding
Pregnancy Category: C
Lactation : Compatible
 
Available as
Tab
MEL-OD (7.5,15 mg)
MELOGESIC (7.5,15 mg)
 
MORPHINE SULPHATE
Principal drug of the opiod group often described as the prototype of the group.
 
Indications and Dosage
 
Adverse Effects
Constipation, lightheadedness, dizziness, drowsiness, sedation, nausea, vomiting, sweating, dysphoria and euphoria are the most common side effects observed in older children. Apnea is and respiratory depression are particularly seen in neonates. Local reactions at injection sites, urticaria and swelling of lips are known to occur due to histamine release.13
 
Contraindications
Hypersensitivity to morphine. Because of its stimulating effect on the spinal cord, morphine should not be used in convulsive states, such as those occurring in status epilepticus, tetanus, and strychnine poisoning. The drug should be administered with extreme caution in children with poor respiratory reserve, hypotensive states, children with head injury or raised intra cranial pressure and those with gastrointestinal obstruction or acute abdominal conditions.
 
Toxicity
Acute over dosage with morphine is manifested by respiratory depression, somnolence progressing to stupor or coma, skeletal muscle flaccidity, cold and clammy skin, constricted pupils, and, sometimes, bradycardia, hypotension and death. Marked mydriasis rather than miosis may be seen due to severe hypoxia in overdose situation. Naloxone should be administered intravenously; however, because its duration of action is relatively short, the patient must be carefully monitored until spontaneous respiration is reliably reestablished. If the response to opiod antagonists is suboptimal or not sustained, additional naloxone may as be re-administered, as needed, or given by continuous infusion to maintain alertness and respiratory function; Opiod antagonists should not be administered in the absence of clinically significant respiratory or circulatory depression secondary to morphine overdose.
Pregnancy Category: B; D late pregnancy
Lactation: Compatible, inhibits milk ejection
 
Available as:
Tab:
RILIMORF SR (60 mg)MORCONTIN CR (10mg, 30mg)
Injn:
MORPHINE SULPHATE (10, 15,20mg vials)
14
 
NALOXONE
It is a Oxymorphone opiod antagonist which competitively blocks all opioid actions.
 
Indications and Dosage
Note
  • The patient who has satisfactorily responded to naloxone should be kept under continued surveillance and repeated doses should be administered, as necessary, since the duration of action of some narcotics may exceed that of naloxone.
 
Adverse effects
Abrupt reversal of narcotic depression may result in nausea, vomiting, sweating, tachycardia, increased blood pressure and tremulousness. In postoperative patients, larger than necessary dosage of naloxone HCl may result in significant reversal of analgesia, and in excitement. Hypotension, hypertension, ventricular tachycardia and fibrillation, and pulmonary edema have been associated with the use of naloxone HCl postoperatively.
 
Contraindications
Naloxone HCl injection is contraindicated in patients known to be hypersensitive to it. Naloxone HCl injection should be administered cautiously to persons including newborns of mothers who are known or suspected to be physically dependent on opioids. In such cases, an abrupt and complete reversal of narcotic effects may precipitate an acute abstinence syndrome.15
 
Toxicity
There is no clinical experience with naloxone HCl overdosage in humans.
 
Available as
Injn:
NALOX (0.4 mg/ml)
NARCOTAN (0.4 mg/ml, 0.02mg/ml)
 
Storage
Protect from light. Store at controlled room temperature 15–30°C (59–86°F).
 
NAPROXEN
Newer propionic acid derivative that has a longer half-life allowing twice daily administration. It is particularly potent in inhibiting leukocyte migration.
 
Indications and Dosage
 
Adverse Effects
In controlled clinical trials with about 80 children and in well-monitored open studies with about 400 children with juvenile arthritis, the incidences of rash and prolonged bleeding times were increased, the incidences of gastrointestinal and central nervous system reactions were about the same, and the incidences of other reactions were lower in children than in adults.
 
Contraindications
The drug is contraindicated in patients who have had allergic reactions to naproxen. It is also contraindicated in patients in whom aspirin or other nonsteroidal anti-inflammatory/analgesic drugs induce the syndrome of asthma, rhinitis, 16and nasal polyps. Serious gastrointestinal toxicity such as bleeding, ulceration, and perforation, can occur at any time, with or without warning symptoms.
Caution should be exercised if the drug is given to patients with creatinine clearance of less than 20 ml/minute because accumulation of naproxen metabolites has been seen in such patients.
 
Toxicity
General management same is that for other NSAIDs. In animals 0.5 g/kg of activated charcoal was effective in reducing plasma levels of naproxen. Hemodialysis does not decrease the plasma concentration of naproxen because of the high degree of its protein binding.
 
Available as
Tab :
ARTAGEN (250 mg)
NAPROSYN (250 mg, 500mg)
 
NIMESULIDE
Novel NSAID with the unique chemical structure in which the Carboxylic acid group is replaced by a sulfonanilide moiety. It is particularly promoted as an antipyretic. It is a partially selective inhibitor of the Cox–2 enzyme with a Cox–2: Cox–1 inhibition ratio of 10:1.
 
Indications and Dosage
 
Adverse Effects
Epigastric pain, heart burn, nausea, diarrhea, vomiting, pruritus, dizziness, headache, skin rash. Particular concern has been expressed about it is that are toxicity as there have been case reports of liver cell failure.17
 
Contraindications
Hypersensitivity, peptic ulcer disease, hepatic impairment.
 
Available as
Tab:
  • NIMULID (100mg)
  • NICIP(100mg)
  • NISE(100 mg)
Kid Tab:
  • NISE (50 mg)
  • PRONIM (50mg)
Susp:
  • (50 mg/5 ml):
  • NIMULID
  • NISE
  • NOBEL
  • NULID
 
PARACETAMOL
Paracetamol is a clinically proven analgesic and antipyretic. Paracetamol produces analgesia by elevation of the pain threshold and antipyresis through action on the hypothalamic heat regulating center. Paracetamol is equal to aspirin in analgesic and antipyretic effectiveness and it is unlikely to produce many of the side effects associated with aspirin and aspirin-containing products.
 
Indications and Dosage
 
Adverse Effects
Caution needs to be exercised by using the drug in patients with hepatic impairment. It is one of the drugs associated with the development of analgesic nephropathy on prolonged use. It has no effect on cellular metabolism or platelet function 18as against aspirin. It is much safer than aspirin in terms of gastric irritation, ulceration and bleeding. Hypersensitivity reactions are rare and it does not produce many metabolic effects or acid-base disturbances.
 
Contraindications
Hypersensitivity. Caution needs to be exercised in patients with renal or hepatic disease.
 
Toxicity
In children (<12 years of age), an acute over dosage of less than 150 mg/kg has not been associated with hepatic toxicity. Early symptoms following a potentially hepatotoxic overdose may include: nausea, vomiting, diaphoresis and general malaise. Clinical and laboratory evidence of hepatic toxicity may not be apparent until 48–72 hours post ingestion. If more than 150 mg/kg or an unknown amount was ingested, obtain a plasma Paracetamol level as soon as possible, but no sooner than 4 hours following ingestion. If an Paracetamol extended release product is involved, it may be appropriate to obtain an additional plasma Paracetamol level 4–6 hours following the initial Paracetamol level. If either Paracetamol level plots above the treatment line on the Paracetamol overdose nomogram, N–acetylcysteine treatment should be initiated and continued for a full course of therapy. If an assay cannot be obtained and the estimated Paracetamol ingestion exceeds 150 mg/kg, dosing with N –acetylcysteine should be initiated and continued for a full course of therapy. Specific treatment is said to be essential if the plasma drug levels are above the line joining 200 mcg per ml at 4 hours and 50 mcg per ml at 15 hours.
 
Available as
Syp:
FEBREX (125, 250 mg/5 ml) (Indoco)
19
Tab:
  • FEBREX (500, 650 mg) (Indoco)
 
PENTAZOCINE
Pentazocine lactate is a poor opioid analgesic which is 1/3 as potent as morphine. Sedation, respiratory depression, taking diarrhoea, constipation are much less severe following its administration
 
Indications and Dosage
Caution: Pentazocine lactate should not be mixed in the same syringe with soluble barbiturates because precipitation will occur
 
Adverse Effects
The safety and efficacy of pentazocine lactate as a premedication for sedation have not been established in pediatric patients less than one year old. The safety and efficacy of pentazocine lactate as preoperative or pre-anesthetic medication have been established in pediatric patients 1–16 years of age. Information on the safety profile of pentazocine lactate as a postoperative analgesic in children less than 16 years is limited.
Respiratory depression, dyspnea, transient apnea in a small number of newborn infants whose mothers received pentazocine lactate during labor. Nausea, dizziness or lightheadedness, vomiting, euphoria are commonly observed. Circulatory depression, shock, hypertension, constipation, dry mouth and urinary retention are uncommon.
 
Contraindications
Hypersensitivity. Caution should be exercised while administering the drug to patients with low 20respiratory reserve hepatic or renal impairment, and those with seizure disorders.
 
Toxicity
Clinical experience with pentazocine lactate over dosage has been insufficient to define the signs of this condition. Oxygen, intravenous fluids, vasopressors, and other supportive measures should be employed as indicated. Assisted or controlled ventilation should also be considered. For respiratory depression due to over dosage or unusual sensitivity to pentazocine lactate. Parenteral naloxone is a specific and effective antagonist.
Pregnancy Category: B; D in late pregnancy
Lactation: Compatible; may cause inhibition of milk ejection reflex.
 
Available as
Injn:
DOLOWIN (30 mg/ml)
FORTWIN (30 mg/ml)
Tab:
FORTWIN (25 mg)
 
PETHIDINE
Although chemically unrelated to morphine it has similar actions on opioid receptors. Dose to those 1/8–1/10 in analgesic potency; however is analgesic efficacy approaches near to morphine. Is it causes equivalent sedative and respiratory depressant actions. Effect on the smooth muscles is less marked and causes less histamine release.
 
Indications and Dosage
Note
  • If necessary, pethidine may be given intravenously, but the injection should be given very slowly, 21preferably in the form of a diluted solution. Rapid intravenous injection of narcotic analgesics, including pethidine increases the incidence of adverse reactions; severe respiratory depression, apnea, hypotension, peripheral circulatory collapse, and cardiac arrest have occurred. Pethidine should not be administered intravenously unless a narcotic antagonist and the facilities for assisted or controlled respiration are immediately available.
 
Adverse Effects
The major hazards of pethidine, as with other narcotic analgesics, are respiratory depression and, to a lesser degree, circulatory depression; respiratory arrest, shock, and cardiac arrest have occurred. The most frequently observed adverse reactions include lightheadedness, dizziness, sedation, nausea, vomiting, and sweating. Euphoria, dysphoria, weakness, headache, agitation, tremor, uncoordinated muscle movements, severe convulsions, transient hallucinations and disorientation, visual disturbances are also seen.
 
Contraindications
Hypersensitivity to pethidine. Pethidine is contraindicated in patients who are receiving monoamine oxidase (MAO) inhibitors or those who have recently received such agents. Therapeutic doses of pethidine have occasionally precipitated unpredictable, severe, and occasionally fatal reactions in patients who have received such agents within 14 days. Caution should be exercised in children with asthma, respiratory depression or hypotensive states.
Pregnancy Category: B;D in late pregnancy
Lactation: Compatible; may cause inhibition of milk ejection reflex.22
 
PIROXICAM
Newer NSAID with anti-inflammatory activity equivalent to that of indomethacin and an analgesic potency equal to that of aspirin. It has specific activity against the COX–2 enzyme allowing for better tolerability. It inhibits the chemotaxis of leucocytes and decreases the ratio of T-helper to T-suppressor lymphocytes.
 
Indications and Dosage
Role in children not fully defined and not approved for use.
 
Adverse Effects
Other than the gastrointestinal symptoms, edema, dizziness, headache, changes in hematological parameters, and rash have been reported in a small percentage of patients
 
Contraindications
Piroxicam should not be used in patients who have previously exhibited hypersensitivity to it, or in individuals with the syndrome comprised of bronchospasm, nasal polyps, and angioedema precipitated by aspirin or other nonsteroidal anti-inflammatory drugs.
 
Toxicity
The absence of experience with acute overdosage precludes characterization of sequelae and recommendation of specific antidotal efficacy at this time. It is reasonable to assume, however, that the standard measures of gastric evacuation and general supportive therapy would apply. In addition to supportive measures, the use of activated charcoal may effectively reduce the absorption and reabsorption of piroxicam. Experiments in dogs have demonstrated that the use of 23multiple-dose treatments with activated charcoal could reduce the half-life of piroxicam elimination from 27 hours (without charcoal) to 11 hours and reduce the systemic bioavailability of piroxicam by as much as 37% when activated charcoal is given as late as 6 hours after administration of piroxicam.
 
Available as
Tab:
DOLONEX(20 mg)
PIROX (20 mg)
Disp Tab:
DOLONEX-DT(20 mg)
PIROX –DT(20 mg)
Injn:
DOLONEX (20 mg/ml, 40 mg/ml)
DOLOCARE (20 mg/ml)
 
ROFECOXIB
Rofecoxib is an oral COX–2 selective inhibitor that exhibits anti-inflammatory, analgesic, and antipyretic properties. It has an 800–fold greater selectivity for COX–2 than COX–1. Phase II clinical trials suggest that a dose range of 12.5 or 25 mg/day−1 is as effective as diclofenac, 150 mg/day−1, for osteoarthritis. The drug has been found to be particularly effective as an anti-inflammatory analgesic agent to be employed for use in osteoarthritis, rheumatoid arthritis and postoperative analgesia. The drug has been found to have excellent tolerability even at five times its currently prescribed dosage.
 
Indications and Dosage
24
Pregnancy: C
 
Available as
Tab
ACROBAT (12.5,25 mg)
COXTWO (12.5,25,50 mg)
Susp
MCROFY (25 mg/5ml)
ROFIBAX (25 mg/5ml)
 
TENOXICAM
A congener of piroxicam with similar properties and uses. It has been used for treating osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and the in adults.
 
Indications and Dosage
Adverse effects and contraindication profile is similar to that of piroxicam.
Pregnancy and Lactation: Contraindicated
 
Available as
NOVOTIL (20 mg)
TOBOTIL (20 mg)
 
TRAMADOL
An opioid with antitussive and potent analgesic activity however therapeutic doses have no respiratory depressant action.
 
Indications and Dosage
 
Adverse Effects
Seizures have been reported in patients receiving tramadol HCl within the recommended dosage range. Spontaneous post-marketing reports indicate that seizure risk is increased with doses of tramadol HCl above the recommended range. Serious and rarely fatal anaphylactoid reactions have been reported in patients receiving therapy with tramadol HCl. These reactions often occur following the first dose. Caution should be exercised while using the drug in cases of head injury, acute abdominal condition. And those with the renal and hepatic disease. Other side effects include nausea, constipation, headache somnolence, vomiting, dizziness, pruritus, sweating, dyspepsia, dry mouth and diarrhea.
 
Contraindications
Hypersensitivity, patients receiving any other sedative– hypnotic medication.
Preganncy: C
Lactation: Not recommended
 
Available as
Cap
TRADOL(50 mg)
Tab
TRUMP(50 mg)
Injn:
TRADOL(100 mg/ml), TRANDOL (50 mg/ml)