Diagnosis and Treatment of Common Skin Diseases Virendra N Seghal, Govind Srivastava, Vibhu Mendiratta
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Systemic Drugs Commonly Used in Dermatologic PracticeChapter 1

2
 
ACYCLOVIR (Acivir, Herpex, Herperex, Zovirax)
Indications: Herpes zoster, Herpes simplex labialis and progenitalis, chickenpox.
Available: 200, 400, 800 mg tablets.
Dosage:
Herpes simplex: 200 mg, 5 times a day for 5 days.
Herpes zoster and chickenpox: 800 mg, 5 times a day for 7 days.
Side effects: Headache, nausea, central nervous system (CNS) effects.
Contraindications: Hypersensitivity, glaucoma, psychiatric disturbances, depression.
Drug interactions: Probenacid increases, and prolongs the plasma levels.
 
ALBENDAZOLE (Alzad, Worenil, Zentel)
Indications: Deworming in certain chronic urticaria.
Available: 400 mg tablet.
Dosage: Single dose of 400 mg.
Side effects: Hepatic changes.
Contraindications: Pregnancy, lactation.
Drug interactions: Anti-diabetics and H2 receptor antagonists.
 
ALLOPURINOL (Zyloric)
Indications: Clinical conditions of excess uric acid deposition including arthritis (gout).
Available: 100 mg tablets3
Dosage:
Adults: 100-900 mg/day.
Children: 10-20 mg /kg/day, maximum up to 400 mg.
Contraindications: Hypersensitivity to drug.
Side effects: Allergic rashes, gastrointestinal (GIT) symptoms.
 
AMPHOTERICIN –B (Fungizone)
Indications: In progressive and potentially fatal cases of cryptococcosis, North American blastomycosis, disseminated candidiasis, mucormycosis, sporotrichosis, aspergillosis, histo-plasmosis, coccidioidomycosis, and American mucocutaneous leishmaniasis.
Available: 50 mg injections.
Dosage: Slow intravenous (IV) infusion over 6 hours at a concentration of 0.1 mg/ml. The therapy is instituted with a day dose of 0.25 mg/kg body weight and gradually built to a maximum of 1.5 mg/kg body weight.
Duration: Several months.
Side effects: Phlebitis, chemical irritation from extra-vasation, headache, nausea, vomiting, diarrhoea, weight loss, dyspepsia, fever, muscle, joint and epigastric pain, anaemia, thrombocytopenia, leucopenia, agranulocytosis, haemorrhagic gastroenteritis, abnormal renal functions, anuria, tinnitus, hearing loss, vertigo, blurred vision, diplopia, peripheral neuropathy, convulsions, acute liver failure, anaphylactoid reaction, flushing, pruritus, rash, erythema, ventricular fibrillation, hypo- or hypertension.
Contraindications: Hypersensitivity, pregnancy.
Drug interactions: Corticosteroids, concomitant use of nephrotoxic and ototoxic drugs may add to its toxicity.4
 
AMYLOBARBITONE (Vesparax)
Indication: Anxiety, pruritus due to acute/chronic urticaria, dermatoses.
Available: In combination (Hydroxyzine 25 mg, secobarbitone 75 mg, amylobarbitone 25 mg).
Dosage: 1-2 tablets at bedtime.
Side effects: Dryness of mouth, giddiness.
 
ANTACIDS (Almacarb, Digene, Diovol, Gellusil, Gelacin-P, Magacone, Maylox, Polycrol gel Forte)
Indication: Hyperacidity, concomitant administration of drug(s) capable of causing gastric irritation.
Available: Tablets and gel.
Dosage: 2 tablets 3 to 6 times a day or 10 ml 3 to 6 times a day after meals.
Side effects: Magnesium compounds may produce laxative effect causing diarrhoea, while aluminium and calcium compounds may produce constipation and occasionally cause intestinal obstruction. Antacids containing aluminium lead to decreased absorption of fluoride and accumulation of aluminium in the tissues, serum, bones and central nervous system. Calcium carbonate and sodium bicarbonate may cause rebound hyperacidity and milk-alkali syndrome. Silicate renal stones may form due to chronic use of magnesium trisilicate.
Contraindication: Antacids containing sodium compound should be avoided in hypertension and congestive heart failure.
Drug interactions: Aluminium hydroxide may decrease the absorption of digoxin, isoniazid, phenytoin, corticosteroids, quinidine, phenothiazines, oral anticholinergics, oral iron, and warfarin. They may also chelate tetracyclines.5
 
ANTIHISTAMINICS
Indication: Symptomatic relief of pruritus, urticaria, angioedema, atopic dermatitis, drug reactions, serum sickness, urticaria pigmentosa, systemic mastocytosis, contact dermatitis, acute, subacute and chronic eczemas, lichen planus, scabies, and in various other itchy disorders.
Available: Capsules, injections, syrup and tablets.
Dosage: Shown in Table 1.1.
Duration: A few days to several weeks, depending on the clinical improvement.
Side effects: Hypotension, headache, palpitations, tachycardia, drowsiness, sedation, dizziness, confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, blurred vision, diplopia, vertigo, epigastric distress, urinary frequency or retention, haemolytic anaemia, agranulocytosis, pancytopenia, urticaria, drug rash, photosensitivity (except triprolidine), and dryness of the mouth, nose and throat.
Contraindication: Hypersensitivity, monoamine oxidase (MAO) therapy, narrow-angle glaucoma, stenosing peptic ulcer, symptomatic prostrate hypertrophy, bladder neck obstruction, nursing mothers, central nervous system depression, and asthma.
Drug interaction: Addition of depressive affect with alcohol and other central nervous system (CNS) depressant, concomitant use of MAO inhibitors or epinephrine; Phenothiazines may interact with anticholinergics, antidiarrhoeal mixtures, antacids and guanethidine.
 
ASTEMIZOLE (Asteong, Allerzole, Stemiz)
Indication: Chronic allergic dermatological disorders and other delayed allergic reactions.
Available: 5 mg, 10 mg tablets.6
Table 1.1   Antihistamines: H1 receptor (antagonist) blockers
General Name (1)
Trade Name (2)
Dose* (Adults) (3)
Remarks (4)
Chlorpheniramine maleate (2 and 4 mg)
Piriton, Tristina QID
1tab TDS or
Antiallergic
Cetirizine dihydrochloride (10 mg, 20 mg)
Sizon, Zyrtec
Levocetirizine dihydrochloride (5 mg)
Allrite, L-cetron Nexcet
Ebastine (10 mg)
Ebast
1 tab. OD
Azatadine maleate (1 mg)
Zadine (tab., syp.)
Pheniramine maleate (25 and 50 mg)
Avil**, Triominic
1tab BD or TDS
Moderate sedation
Dexchlorpheniramine Maleate (2 and 6 mg)
Polaramine
1tab TDS or QID
Mild sedation
Halopyramine HCl (25 mg)
Synistamine**
1tab TDS or QID
Acute allergic disorders
Hydroxyzine HCl (10 and 25 mg)
Atarax, Hyrax, Prugo QID
1tab TDS or of action
Longer duration
Promethazine HCl (10 and 20 mg)
Phenergan TDS
1tab BD or
Marked sedation
Mepyramine maleate (50 and 100 mg)
Antihisan BD
1tab TDS or
Low sedation
Methdilazine HCl (8 mg)
Dilosyn BD
1tab OD or
Powerful anti-pruritie
Dimethidine maleate (1 and 2.5 mg)
Foristal, Foristal lontabs
1tab TDS or QID
Slight sedation
Cyproheptidine HCl (4 mg)
Practin, Ciplactin
1tab BD, TDS or QID
High sedation appetite stimu-lation
Triprolidine HCl (25 mg)
Mebryl
1tab TDS or QID
Sun protective, low sedation
Diphenhydramine HCl (12.5 mg)
Bendryl, Dimiril
1cap OD or BD
Moderate sedation
Isothipendyl HCl (4 mg/ml)
Andantol**
1 to 2 amp stat
In anaphylactic shock
Mebhydrolin napadi-sylate (76 mg)
Incidal
1tab TDS or QID
Low sedation
Embramine (25 mg)
Mebryl
1tab BD or TDS
Potent anti-allergic
Astemizole (5,10 mg)
Astelong, Stemiz
1tab before breakfast
Potent H1 antagonist non sedating
Loratadine (10 mg)
Lorfast, Loridin Lorinol-10
1tab OD
Non-sedating, Potent
Desloratadine (5 mg)
Dazit, Des – OD
Ketotifen fumerate (1 mg)
Ketasama Ketotif
1tab BD
More effective in allergic, rhin-itis and asthma
Fexofenadine hydrochloride (180 mg)
Allegra, Altiva
1tab a day
Truly non-sedating
Prednisolone (5 mg, 10 mg, 20 mg)
Omnacortil, Wysolone
1 tab 2 times a day.
7
Dexamethasone (0.5 mg)
Dexona, Wymesone
1 tab 2 times a day.
Betamethasone (0.5 mg)
Betnelan, Betnesol, Celestone
1 tab 2 times a day.
Hydrocortisone succinate (100 mg) I.V.
Cort-S, Efcorlin, Hycosone
1 to 2 times
Diethylcarbamazine (50 mg, 100 mg)
Banocide, Hetrazan, Unicarbazan
1 tab 2 times a day.
Levamisole (50 mg, 150 mg
Dicaris, Vermisol
1 tab on 2 consecutive days.
Competitive H2 receptor antagonists
Cimetidine (200 mg)
Cimetidine, Cimetin Lock-2
Ranitidine (150 mg)
Rantac, Ranitin Zinetac
* In children, a propotionately lower dose should be given.
** Injections are also available.
OD—Once a day, BD—2 times a day, TDS—3 times a day, QID—4 times a day
Available: 5 mg, 10 mg tablets.
Dosage: Adult 10 mg once a day before meals up to a maximum of 30 mg per day. Children up to 6 years 1 mg/kg body weight and after 6 years 5 mg/day.
Duration: 1 day to a few weeks.
Side effects: Dry mouth, weight gain, diarrhoea, abdominal pain, rarely rashes and eczema.
Contraindication: Hypersensitivity, pregnancy.
Drug indication: May potentiate MAO inhibitors, CNS depressants and alcohol.
 
AZATHIOPRINE (Imuran)
Indication: Pemphigus, bullous pemphigoid, pityriasis rubra pilaris, systemic lupus erythematous, Behçet's disease, Crohn's disease, livido reticularis, psoriatic arthropathy, Wegener's 8disease, livido reticularis, psoriatic arthropathy, Wegener's granulomatosis, pyoderma gangrenosum and rheumatoid arthritis.
Available: 50 mg tablets.
Dosage: 1 to 2.5 mg/kg body weight/day as a single or divided dose. Therapeutic response is slow and may take 6 to 8 weeks. However, no response even after 12 weeks of treatment infers that the disease is refractory to azathioprine.
Duration: Several weeks to months. A maintenance dose of 0.5 mg/kg/day may be required for several months.
Side effects: Leucopenia, thrombocytopenia, macrocytic anaemia, bleeding tendency, secondary infection, nausea, vomiting, abdominal pain, hepatotoxicity, skin rashes, alopecia, fever, and negative nitrogen balance.
Contraindication: Hypersensitivity, pregnancy, severe anaemia, and serious infections.
Drug interaction: Allopurinol, gold salts, antimalarials, penicillamine.
 
AZIDOTHYMIDINE (See Zidovudine) BETA CAROTENE (Antoxyl, Antoxid-HC, Betasclerobion, Comscav, Exerge, Revox, Selace, Soltene)
Indication: Erythropoetic protoporphyria.
Available: 30 mg capsules.
Dosage: Adults- 30 to 300 mg a day; children under 14 years – 30 to 150 mg a day, in single or divided dosage with meals. The capsules may be opened and given with fruit juice to children.
Duration: Several weeks.9
Side effects: Loose motions, yellowish discolouration of the skin.
Contraindication: Pregnancy, impaired liver and kidney functions.
 
BLEOMYCIN (Bleuim, Bledmax)
Indication: Squamous cell carcinoma of the skin.
Available: Injection 15 mg.
Dosage: 30 mg 2 times weekly may vary from 15 mg/day to 15 mg/week. Total dose: 300 to 400 mg.
Side effects: Mucocutaneous toxicity, pulmonary fibrosis dermatitis, and hepatonephrotoxicty.
Contraindication: Pre-existing lung disorders. Avoid mixing with glutathione.
Drug interaction: Cisplatin increases its toxicity. After nephrotoxic drugs cause more kidney damage.
 
CHLOROQUINE (Ciplaquin, Lariago, Melaquin, Melurbin, Nivaquine, Resochin).
Indication: Discoid lupus erythematosus, polymorphous light eruptions, porphyria cutanea tarda, sarcoidosis, rheumatoid arthritis, solar uriticaria, disseminated granuloma annulare, DNA autosensitization, erythema nodosum, leprosum.
Available: 250 mg tablets.
Dosage: 1 tablets 3 times a day for 1 to 2 weeks; to be tapered off gradually over a period of 3 to 6 weeks.
Side effects: Anorexia, nausea, vomiting, diarrhoea, abdominal cramps, visual disturbance, optic atrophy, headache, psychic, stimulation, hypotension, ECG abnormalities, skin and mucosal pigmentation, agranulocytosis, blood dyscrasias, bleaching of the hair.10
Contraindication: Retinal or visual field changes, long-term therapy in children, pregnancy, lactation, glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.
Drug interaction: Other anti-malarials.
 
CARBAMAZEPINE (Mazetol, Tegretol, Zeptrol)
Indication: Post herpetic neuralgia, trigeminial neuralgia.
Available: 100, 200, 400 mg tablets.
Dosage: 100 to 400 mg/day in divided dosage for 3 to 4 weeks.
Side effects: Hepatitis, aplastic anaemia, rashes, blurred vision, Steven-Johnson's syndrome, and ankle swelling.
Contraindication: AV block, porphyria, bone marrow depression, and hypersensitivity.
Drug interaction: Contraceptive failure, depress the effect of anticoagulants.
 
CHLORDIAZEPOXIDE (Equibrome, Equilibrium, Librium)
Indication: Allaying the anxiety and depression associated with various skin dermatoses.
Available: 5, 10 mg tablets.
Dosage: 1 to 3 tablets a day in divided doses.
Side effects: Excitement, drowsiness, confusion, rashes, gastrointestinal upsets, hepatic dysfunction, blood dyscrasias.
Contraindication: Hypersensitivity reaction.
 
CETRIZINE (Cetzone, Cetgel, Coszin, Zyncet)
Indication: Atopic eczema, urticaria, dermographism, acute allergic reactions.11
Available: 10 mg tablet, 5 mg/5 ml syrup.
Dosage: 10 mg once a day.
Side effects: Drowsiness, dry mouth dizziness.
Drug interaction: Potential the effect of sedating hypnotics, antihistamines and alcohol.
 
CHLORAMPHENICOL (Chloromycetin, Catilan, Enterojet, Lykacetin, Reclor)
Indication: Pyodermas, bacterial infections of the soft tissue.
Available: 250, 500 mg capsules/injections.
Dosage: 1 to 2 g a day in 4 divided doses in adults; 50-100 mg/kg/day in children.
Duration: 7 days to 3 weeks.
Side effects: Bone marrow depression, skin rashes, nausea, vomiting, anorexia, diarrhoea, peripheral neuritis, retrobulbar neuritis, grey-baby syndromes in newborn.
Contraindication: Anaemia, infants, pregnancy.
 
CLEMASTINE FUMERATE (Clamist, Tavegyl, Tavist)
Indication: Hay fevers, allergic reactions, urticaria, acute and chronic eczemas.
Available: 1 mg tablet, 0.5 mg/5 ml syrup.
Dosage: Adults and children 1.2 mg, 1 mg respectively 2 times a day.
Side effects: Fatigue, sedation, CNS stimulation, skin rash, and gastralgia.
Contraindication: Narrow angle glaucoma, Children under 1 year of age.12
Drug Indication: Sedating, hypnotic, MAO inhibitors, and alcohol.
 
CEPHALEXIN (Alcephin, Alsporin, Celorin, Factagard, Nufex, Phexin, Sepexin, Sporidex)
Indication: Penicillinase producing staphylococci and other Gram +ve and Gram –ve bacteria, syphilis, actinomycosis caused by A. israelii.
Available: 250 and 500 mg capsules, 125 mg/5 ml syrup and 500 and 100 mg injections.
Dosage: 1 to 2 g a day in 4 divided doses in adults. In children 25 to 100 mg/kg/day in 4 divided doses.
Duration: 7 days to 1 month.
Side effects: Abdominal pain, diarrhoea, nausea, anogenital pruritus, rashes, intestinal and vaginal moniliasis.
Contraindications: Hypersensitivity, kidney failure.
 
COLLAGEN IMPLANT (Zyderm)
Indication: For the correction of contour deformities of dermis in non-weight bearing areas, distensible acne scars, atrophy from disease or trauma, nasoloabial folds, glabella frown lines, viral pockmarks.
Available: 0.1, 0.5 and 1 ml sterile syringes containing highly purified bovine dermal collagen dispersed in phosphate buffered physiological saline and 0.3 per cent lidocaine.
Dosage: A test implant 0.1 ml is administered into the volar surface of forearm to test that the patient is not allergic to it. This is carefully observed for 4 weeks. Then, corrective implantation is done under strict asepsis. Through a fine gauge needle, the collagen is implanted in the scar. The scar is overcorrected 1.5 to 2 times, except in periorbital areas.13
Side effects: Swelling, erythema, induration and/or urticaria at the implant site, lumpy scar formation, raising of a depressed lesion due to over correction.
Contraindication: Hypersensitivity, personal or family history of autoimmune diseases, lidocaine allergy.
Drug interaction: With previously implanted other injectable materials like silicone fluid.
 
COLCHICINE (Colchicine, Colsalide, Goutmil)
Indication: Erythema nodosum leprosum, collagen vascular disorders, Behçet's disease, palmoplanter pustulosis, dermatitis herpetiformis, Sweet's syndrome, necrotizing vasculitis.
Available: 0.5 mg and 1 mg tablets.
Dosage: 1 to 2 mg a day in divided doses.
Duration: Several weeks.
Side effects: Vomiting, diarrhoea, abdominal pain, nausea, bone marrow depression, aplastic anaemia, agranulocytosis, thrombocytopenia, peripheral neuritis, myopathy, purpura, alopecia, azoospermia, vitamin B12 malabsorption.
Contraindication: Hepatic dysfunction, pregnancy, elderly, small children.
Drug interaction: Inhibited by acidifying agents and potentiated by alkalinizing agents; sulphinpyrazone.
 
CLOFAZIMINE (Clofazine, Eklof, Hansepran, Lamprene)
Indication: Leprosy, reaction in leprosy, pyoderma gangrenosum, discoid lupus erythematous, pustulosis palmeriset plantaris, pustular psoriasis, lupus vulgaris.
Available: 50 and 100 mg capsules.14
Dosage: Leprosy—–50 to 100 mg a day. During reactional episodes, the dose may be increased up to 300 to 400 mg a day. In other conditions, the dosage varies from 100 to 300 mg a day for several weeks.
Side effects: Pink to brown discolouration of skin, especially of the lesion of leprosy, xeroderma, ichthyoses, pruritus, phototoxicity, acneiform, eruptions, rashes, discolouration of conjunctiva, sweat, hair, sputum, tears, urine and faeces, nausea, vomiting, abdominal pain.
 
CYANOCOBALAMINE (Neurobion, Triredisol-H, Vitamin B12)
Indication: Adjuvant therapy in herpes zoster, psoriasis, meralgia paraesthetica.
Available: 50 mg tablets, 500 and 1,000 mg injections.
Dosage: 1 to 3 tablets a day, or 1 to 2 ml intramuscular (IM) injection every alternate days, for 2 to 3 weeks.
Contraindications: Hypersensitivity reaction.
 
CYCLOPHOSPHAMIDE (Cycloxan, Endoxan)
Indication: Adjuvant therapy of pemphigus, recalcitrant cases of airborne contact dermatitis (ABCD), Hodgkin's disease, systemic lupus erythematosis (SLE), mycosis fungoids, Wegener's granulomatosis.
Available: 50, 100, 200 mg tablets.
Dosage: 2 to 3 mg/kg body weight/day.
Side effects: Alopecia, gonadal suppression, pulmonary fibrosis, cardiotoxicity.
Contraindication: Acute urinary tract infection, bladder haemorrhage, myelosuppression, lactation and pregnancy.15
Drug interaction: Dexorubicin and daunorubicin, increase risk of cardiotoxicity. Allopurinol and chloramphenicol, increase bone marrow toxicity.
 
CORTICOSTEROIDS
Indication: Corticosteroid responsive dermatoses, erythema multiforme, collagen vascular disorders.
Available: Betamethasone (Betacortril, Betaforte, Betnelan, Celestone, Systacort)-0.5 mg and 1.0 mg tablets and injections.
Dexamethasone (Dexona, Decadron, Dexasol), 4 mg/ml injection and 0.5 mg tablets.
Prednisolone (Deltacortril, Hostacortin-H, Wysolone, Cohydeltra)-5 mg tablets.
Dosage: 3 to 8 tablets a day in divided doses with meals. A high-dose may be given in certain specialized disorders such as pemphigus (Tables 1.2 and 1.3).
Side effects: Sodium and fluid retention, congestive heart failure, potassium loss and hypocalcaemic alkalosis, hypertension, hypocalcaemia, steroid myopathy, muscle atrophy, tendon rupture, osteoporosis, aseptic necrosis of femoral and humeral heads, spontaneous fractures, vertebral compression fractures, thrombophlebitis, necrotizing angiitis, cardiac arrhythmias, pancreatitis, abdominal distension, ulceration with perforation, impaired wound healing, thin and fragile skin, petichae, ecchymosis, suppression of skin test reactions, subcutaneous fat atrophy, striae, purpura, hyperpigmentation, hirsutism, acneiform eruptions, urticaria, convulsions, catatonia, increased intracranial pressure with papilloedema, vertigo, headache, psychosis, neuropathy, insomnia, psychiatric disturbances, amenorrhoea, menstrual irregularities, development of Cushinoid state, growth suppression in children, secondary adrenocortical and pituitary unresponsiveness, manifest diabetes mellitus, posterior subcapsular cataract, increased intraocular pressure, glaucoma, exophthalmos, aggravation or masking of infections, malaise, epidural lipomatosis.16
Table 1.2   Relative duration of action of oral corticosteroids
Duration of action
Generic name
Trade name
Short acting (24-36 hours)
Cortisone, prednisolonePrednisone, Methyl Prednisolone
Wysolone, Hostacortin-H
Intermediate acting (48 hours)
Triamcinolone
Kenacort, Ledercort,
Long acting
Betamethasone
Betnelan, Walacort
(Over 48 hours)
Dexamethasone
Decadron, Idizone.
Table 1.3   Equivalent doses of oral corticosteroids
Generic name
Equivalent dose
Betamethasone
0.5 mg
Dexamethasone
0.5 mg
Methyl Prednisolone
4.0 mg
Triamcinolone
4.0 mg
Prednisolone
5.0 mg
Prednisone
5.0 mg
Hydrocortisone
20.0 mg
Cortisone
25.0 mg
Contraindications: Acute infection, herpes simplex, psychiatric disorders, pregnancy, idiopathic thrombocytopenic purpura.
Drug interaction: Insulin, oral hypoglycaemics, phenytoin, phenobarbital, ephedrine, rifampicin, coumarin, potassium, depleting diuretics, aspirin.
 
CYCLOSERINE (Cyclorin, Seromycin)
Indications: Tuberculosis, acute urinary tract infections caused by Enterobacter and E. coli.
Available: 250 mg capsules.
Dosage: 500 mg to 1 g a day in divided doses monitored by the blood levels.17
Side effects: Convulsions, drowsiness, somnolence, headache, tremor, dysarthria, vertigo, disorientation, loss of memory, mental confusion, allergic dermatitis, aggression, hyperirritability, paraesthesia, elevated transaminases, anaemia.
Contraindications: Hypersensitivity, epilepsy, depression, severe anxiety or psychosis, alcohol, severe renal insufficiency, pregnancy.
 
DIAMINO-DIPHENYL SULPHONE (Dapsone, Novophone)
Indication: Leprosy, dermatitis herpetiformis, vasculitis, pyoderma gengrenosum, mycetoma, chronic bullous dermatosis of childhood (CBDC), cystic acne.
Available: 50 mg, 100 mg tablets
Dosage: 1 to 2 mg/kg body weight/day.
Duration: For leprosy, it is given for 6 months to 2 years or more. In other conditions, it is given for a few weeks to months.
Side effects: Headache, nausea, vomiting, anorexia, fatigue, dapsone syndrome, nervousness, haemolysis, erythema multiforme, erythema nodosum, toxic epidermal necrolysis, multiforme, erythema nodosum, toxic epidermal necrolysis, neuropathy, bone marrow depression, liver and kidney function derangement, fixed drug eruptions.
Contraindications: Hepatitis, G-6-PD deficiency, pregnancy, hypersensitivity.
Drug interaction: Probenecid.
 
DIAZEPAM (Calmpose, Calmod, Medipam, Placidox, Valium)
Indication: Symptomatic relief of anxiety associated with various skin disorders.18
Available: 5 and 10 mg tablets a day in divided doses.
Dosage: 2 to 3 tablets a day in divided doses.
Side effects: Hypersensitivity, drowsiness, ataxia, rise in ocular tension, hiccough, fall in blood pressure, respiratory depression, thrombophlebitis, nervousness.
Contraindications: Respiratory failure, hypersensitivity.
 
DOXYCYCLINE (Doxy 1, Doxy, Minicycline)
Indications: Skin and soft tissue infections, acne vulgaris, venereal diseases.
Available: 100 mg tablets/capsules.
Dosage: 100 mg 1 or 2 times a day for 7 to 15 days or month.
Side effects: Tooth discolouration, enamel hypoplasia, reduced fibula growth rate.
Contraindication: Hypersensitivity.
Drug interaction: Antacid, milk, calcium, magnesium, and iron reduce its absorptions.
 
ERYTHROMYCIN (Althrocin, Eltocin, E-Mycin, Erythrocin, Erythrokem, Eromed – 333, Thyromycin)
Indications: Pyodermas, erythrasma, syphilis.
Available: 250 mg tablets.
Dosage: 1 to 2g a day in divided doses.
Side effects: Nausea, vomiting, gastric upsets, abdominal pains, eosinophilia, hepatic dysfunction.
Contraindication: Jaundice, pregnancy, hypersensitivity.19
 
ETHAMBUTOL (Albutol, Butoltabs, Combutol, Coxytol, Iditol, Mycobutol, Tibitol).
Indications: Tuberculosis.
Available: 400 and 800 mg tablets.
Dosage: 15 to 25 mg/kg/day as a single dose after food. After first 60 days of treatment, decrease the dose to 12 to 15 mg/kg/day. Regular eye checkup is warranted every month.
Side effects: Decrease in visual acuity, optic neuritis, changes in colour perception, anaphylactoid reactions, dermatitis, pruritus, joint pains, anorexia, nausea, vomiting, gastrointestinal upsets, abdominal pain, fever, malaise, headache, dizziness, mental confusion, disorientation, peripheral neuritis, elevation of serum uric acid levels and precipitation of gout.
Contraindication: Hypersensitivity, optic neuritis. Children under 13 years of age, kidney failure.
 
ETRETINATE (Tigaeson)
Indications: Pityriasis rubra pilaris, Darier's disease, ichthyoses, porokeratosis, pachyonychia-congenita, psoriasis, subcorneal pustular dermatosis (SCPD), planter warts.
Available: 25 and 50 mg tablets.
Dosage: 1 mg/kg body weight/ day.
Duration: Several weeks.
Side effects: Dryness of the skin and mouth, cheilitis, pruritus, epistaxis, musculoskeletal symptoms, thinning of hair, headache, increased susceptibility to sunburns, peeling of palms and soles.
Contraindications: Pregnancy, lactation.20
 
FLUCONAZOLE (Forcan, Flustan, Fluzide, Flutrox, Onecan, Syscan)
Indications: Candidiasis, pityriasis versicolor.
Available: 50, 100, 150, 200 mg tablets/capsules.
Dosage: Depends on site of infection. Varies from 100 to 200 mg a day or 150 mg weekly or 450 mg single dose in pityriasis versicolour.
Side effects: Nausea, headache, skin rashes, GIT disturbances.
Contraindication: Hypersensitivity.
Drug interactions: Increase serum levels of warferium, phenytoin and sulphonylureas.
 
ETHIONAMIDE/PROTHIONAMIDE (Trecator –SC)
Indications: Tuberculosis, leprosy.
Available: 250 mg tablets.
Dosage: 500 mg a day. It should be administered with pyridoxine.
Side effects: Gastrointestinal intolerance, metallic taste, peripheral neuritis, optic neuritis, psychiatric disturbance, skin rashes, thrombocytopenia, pellagra-like syndrome, postural hypotension, jaundice, hepatitis, diabetes mellitus, stomatitis, gynaecomastia, impotence.
Contraindication: Severe hepatic damage, hypersensitivity, pregnancy.
 
5-FLUOROURACIL (Five flurd, Fluracil, Oncouracil)
Indications: Topical therapy for basal cell carcinoma, warts.
Available: Inj: 50 mg, 250 mg/ml, cap: 250 mg21
Dosage: 12 mg/kg body weight once a day for 4 necessary days. Topical application as lotion.
Side effects: Bone marrow depression, serious infection (with systemic therapy)
Contraindications: Pregnancy, bone marrow depression, debility.
 
INDOMETHACIN (Ciplacid, Idicin, Indocid, Indocap)
Indications: Rheumatoid arthritis, psoriatic arthropathy, ankylosing spondylitis.
Available: 25 and 50 mg capsules.
Dosage: 75 to 150 mg a day in divided doses with meals. It is preferable to give the smallest effective dose.
Side effects: Nausea, vomiting, diarrhoea, heart burn, epigastric pain, abdominal cramps, peptic ulceration, gastrointestinal bleeding, cholestatic jaundice, stomatitis, soreness of mucous membranes, headache, dizziness, insomnia, arrhythmias, leucopenia, visual disturbance, bronchospasm, rashes, urticaria, erythema multiforme.
Contraindications: Hypersensitivity, active gastrointestinal lesions, elderly, impaired renal function, psychiatric illness, pregnancy, lactation, infections.
Drug interactions: Frusemide, thiazide derivatives, beta blockers, lithium, triamterene, coumarins, hydantoins, sulphonamides, sulphonylureas.
 
INTERFERONS (Alferon, Inron, Nulip, Roferon-A, Rebif)
Indications: AIDS related Kaposi's sarcoma, viral infection.
Available: Injection.22
Dosage: 3 million IU a day for 16 to 24 weeks subcutaneous or intra muscular. Maintenance dose is 3 million IU 3 times per week.
Side effects: Headache, dizziness, GIT disturbance, CNS depression.
Contraindications: Allergies, acute tuberculosis.
Drug interaction: Enhances effect on theophyllin.
 
GRISOFULVIN (Fulcin forte, Grisovin, Grisomed, Gris-OD)
Indications: Ringworm infections of the skin, hair, and nail, lichen planus.
Available: 125 mg, 375 mg tablets.
Dosage: 250 to 500 mg two times a day with meals/ 375 mg a day.
Duration: 3 weeks to 6 months depending on the type of fungal infection.
Side effects: Nausea, vomiting, diarrhoea, headache, heart burn, peripheral neuritis, lethargy, fatigue, confusion, hepatotoxicity, leucopenia, neutropenia, albuminuria, cysteinuria, urticaria, photosensitivity, lichenoid drug eruption, systemic lupus erythmatous-like eruptions, erythema multiforme.
Contraindications: Pregnancy, hypersensitivity.
Drug interactions: Barbiturates, warfarin.
 
GOLD SALTS (Myochrisine, Solganol)
Indications: Adjuvant therapy in pemphigus vulgaris, psoriatic arthropathy, rheumatoid arthritis.23
Available: 50 mg injection of aurothioglucose and gold sodium thiomalate.
Dosage: After an initial test dose of 10 mg IM, 25 mg IM is given the next week and 50 mg IM thereafter.
Duration: Several weeks or months.
Side effects: Flushing, erythema, weakness, dizziness, hypotension, leucopenia, arganulocytosis, thrombocytopenia, eczematous, papular and pruritic dermatoses, erythema nodosum, chrysiasis, exfoliative dermatitis, stomatitis.
Contraindications: Pregnancy, renal failure, hepatic insufficiency, elderly, hypertensives.
Drug interactions: Penicillamine, antimalarials, cytotoxic drugs.
 
ISOTRETINON (Accutane)
Indications: Severe recalcitrant cystic acne, keratoacanthoma, mycosis fungoids, actinic keratosis, xeroderma pigmentosum, porokeratosis of Mibelli.
Dosage: 0.5 mg/kg/day, 40 to 60 mg a day up to a total of 5 g in the first instance.
Duration: 15 to 20 weeks; a period of rest for 8 to 10 weeks before the next course.
Side effects: Cheilitis, pruritus, dry skin, conjunctivitis, exfoliation, headache, diarrhoea, proneness to infection, intolerance to contact lenses, disturbed night vision.
Contraindication: Pregnancy.24
 
ISONIAZID (Erbazid, Isonex, Isokin, Nydrazid)
Indications: Cutaneous tuberculosis.
Available: 50, 100 and 300 mg tablets.
Dosage: Adults—5 mg/kg/day to a maximum of 300 mg a day; children—10 to 20 mg/kg/day up to a maximum of 200 to 300 mg a day as a single dose empty stomach.
Side effects: Peripheral neuropathy, convulsions, toxic encephalopathy, optic neuritis and atrophy, memory impairment, nausea, vomiting, epigastric distress, elevated liver enzymes, bilirubinaemia, jaundice, hepatitis, agranulocytosis, haemolytic, sideroblastic and aplastic anaemia, thrombocytopenia, eosinophilia, fever, rashes, erythema multiforme, lymphadenopathy, pellagra, gynaecomastia, hyperglycaemia, systemic lupus like syndrome.
Contraindications: Hypersensitivity, liver failure, pregnancy, lactation.
Drug interactions: Phenytoin, paraamino salicylic acid, alcohol.
 
ITRACONAZOLE (Canditral, Itaspar, Sporanox)
Indications: Dermatophytosis, Onychomycosis, candidiasis, systemic mycosis.
Available: 100 mg capsules.
Dosage: 100 to 200 mg in single/divided dosage/400 mg pulse in 2 divided dosages with meals for 7 days.
Side effects: Nausea, vomiting, rash, pruritus, pedal oedema, depression, loss of libido, impotence, vertigo.
Contraindications: Sensitivity to azole.25
Drug interactions: Terfinadine, astemizole, digoxin, phenytoin, rifampicin.
 
KETOCONAZOLE (Fungicide, Nizral)
Indications: Recalcitrant candidiasis, candiduria, coccidiomycosis, histoplasmosis, chromo (blasto)mycosis, paracoccidioidomycosis.
Available: 200 mg tablets.
Dosage: Single a day dose of 200 to 400 mg in adults. Children weighing 20 kg or less—50 mg; 20 to 40 kg—100 mg; 40 kg or more—200 mg.
Duration: Minimum treatment duration for candidiasis is 1 to 2 weeks; for other systemic mycosis, 6 months. Chronic mucocutaneous candidiasis, however, require maintenance therapy.
Side effects: Headache, dizziness, drowsiness, abdominal pain, fever, diarrhoea, hepatocellular dysfunction, fatigue, nausea, vomiting, jaundice, dark urine, pale stools, pruritus, photophobia, gynaecomastia.
Contraindications: Hypersensitivity, pregnancy, lactation, infancy.
Drug interactions: Antacids, coumarin as an anticoagulants, rifampicin, phenytoin.
 
PARA-AMINOSALICYLIC (PAS) ACID AND SALTS
Indications: Tuberculosis, both pulmonary and extra-pulmonary.
Available: Granules.26
Dosage: Adults—10 to 12 g orally per day in 2 to 3 divided doses; children—200 to 300 mg/kg/day in 3 to 4 divided doses.
Side effects: Nausea, vomiting, diarrhoea, abdominal pain, fever, skin eruptions of various type, erythema mutiforme, infectious mononucleosis-like syndrome, leucopenia, arganulocytosis, thrombocytopenia, haemolytic anaemia, jaundice, hepatitis, encephalopathy, Loffler's syndrome, vasculitis, hypocalcaemia, acidosis, goitre with or without myxoedema.
Contraindications: Hypersensitivity, severe impairment of renal functions and/or hypercalaemia.
Drug interactions: Probenecid, oral anticoagulants, digitalis, diuretics. PAS inhibits the absorption of rifampicin; thus they should be given at different time interval. It also increases levels of isoniazid by decreasing its acetylation.
 
METHOTREXATE (Biotrexate, Methotrexate, Neotrexate)
Indications: Severe recalcitrant psoriasis, psoriatic arthropathy and erythroderma, pityriasis rubra plaris, mycosis fungoids.
Available: 2.5 mg tablets.
Dosage: 5 mg to 22.5 mg every week in three divided doses 12 hours apart.
Duration: Several weeks or months.
Side effects: Anaemia, leucopenia, thrombocytopenia, septicaenia, oral and gastrointestinal ulcerations, enteritis, diarrhoea, hepatic toxicity, azotemia, cystitis, oligospermia, renal failure, headache, drowsiness, blurred vision, infections, erythematous rashes, pruritus, urticaria, alopecia, acne.
Contraindications: Severe renal or hepatic disorder, pregnancy, severe anaemia.27
Drug intractions: Salicylates, sulphonamides, phenylbutazone, phenytoin, tetracycline, chloramphenicol, pyrimethamine, oral coagulants, alcohol.
 
LEVAMISOLE (Dicaris, Kertrax, Levsol, Vizole, Vermisole)
Indications: Used as immunomodulator in atopic dermatitis, erythema nodosum leprosum, roundworm and hookworm infestation.
Available: 50 and 150 mg tablets.
Dosage: For immunomodulatory effect, given 100 mg on 2 consecutive days every week for several weeks. For deworming a single dose of 150 mg in adults and 50 mg in children is given. It may be repeated after 7 days.
Side effects: Anorexia, retching.
Contraindications: Hypersensitivity, pregnancy.
Drug interactions: Lipophilic agents such as ether, carbon tetrachloride, tetrachloroethylene and chloroform.
 
METRONIDAZOLE (Aristogyl, Flagyl, Monizole, Metrogyl, Orogyl, Robicide, Unimazole)
Indications: Cutaneous amoebiasis, trichomonal infections, cutaneous leishmaniasis, rosacea.
Available: 200 and 400 mg tablets, 200 mg/5 ml suspension, and IV infusion.
Dosage: 400 to 800 mg 3 times a day; for children—25 to 30 mg/kg body weight/day in divided doses.
Duration: 5 to 10 days.28
Side effects: Nausea, metallic taste, headache, anorexia, vomiting, epigastric distress, glossitis, stomatitis, candidiasis, leucopenia, dizziness, vertigo, ataxia, seizures, insomnia, dysuria, urticaria, flushing, nasal congestion, flattening of T-wave in electrocardiogram (ECG).
Contraindications: Pregnancy, lactation, organic disease of CNS, history of blood dyscrasia.
Drug interactions: Alcohol, disulphiram, warfarin.
 
MINOCYCLINE (Cynomycin)
Indications: Non-gonococcal urethritis, chancroid, gonorrhoea, lymphogranuloma venereum, skin and soft tissue infection, acne vulgaris.
Available: 50 and 100 mg capsules.
Dosage: 100 mg 1 or 2 times a day for 5 to 15 days.
Side effects: GIT disturbance, tooth discolouration, facial pigmentation.
Contraindications: Hypersensitivity, hepatic and renal impairment.
Drug interactions: Methoxyfluranes, anticonvulsants, antacids.
 
PENICILLINS
Indications: Wide variety of bacterial infections of skin and the subcutaneous tissue, syphilis, actinomycosis.
Available: Tablets, capsules and injections.
Dosage: Depends on the type of penicillin used as well as on the disease and the severity of infection.
Side effects: Anaphylaxis, wheezing, sneezing, urticaria, pruritus, maculopapular and morbilliform rashes, glossitis, 29stomatitis, sore mouth and tongue, black-hairy tongue, epigastric distress, diarrhoea, pseudomembranous enterocolitis, elevation of liver enzymes, anaemia, haemolytic anaemia, thrombocytopenia, leucopenia, interstitial nephritis, neurotoxicity, mental disturbances, confusion, headache, dizziness, fatigue, oral and rectal moniliasis, neuropathy, sciatic neuritis, Jarish-Herxheimer reaction.
Contrindications: Hypersensitivity.
Drug interaction: Concurrent use of bacteriostatic antibiotics.
 
PENICILLAMINE (Cuprimine)
Indications: Progressive systemic sclerosis, rheumatoid arthritis.
Available: 125 and 250 mg tablets and capsules.
Dosage: 1 to 4 g a day in divided dose; for children 20 mg/kg/ days.
Side effects: High incidence of toxic reactions, generalised pruritus, rashes, drug eruptions, systemic lupus-like disease, urticaria, exfoliative dermatitis, anorexia, epigastric pain, nausea, vomiting, hepatic dysfunction, bone marrow, depression, glossitis, gingivo-stomatitis, proteinuria, tinnitus, optic neuritis, hyperpyrexia, alopecia, increased skin friability.
Contraindications: Pregnancy, anaemia.
Drug interactions: Gold therapy, antimalarials, cytotoxic drugs, oxyphenbutazone, phenylbutazone.
 
PARACETAMOL (Calpol, Crocin, Paracin, Molin, Pyrigesic)
Indications: Used as an analgesic and antipyretic.
Available: 500 mg tablets.30
Table 1.4   Penicillin
Type of Penicillin (1)
Trade Preparation (2)
Route of Administration (3)
Penicillinase Resistance (4)
Acid stability (5)
Penicillin-G
Pentid, Omnamycin
IV, IM, Oral
No
No
Procaine Penicillin
Penprodural
IM
No
No
Penicillin –V
Kaypen
Oral
No
Yes
Benzathin Penicillin
Diapen, Penidure
IM
No
No
Methicillin
IV, IM
Yes
No
Nafcillin
IV, IM, Oral
Yes
Yes
Oxacillin
IV, IM, Oral
Yes
Yes
Cloxacillin
Klox, Bioclox, Staphnil, Cloxycap
IM, Oral
Yes
Yes
Dicloxacillin
Oral
Yes
Yes
Ampicillin
Synthocillin, Eskay-cillin, Albercillin
IV, IM, Oral
No
Yes
Hetacillin
Oral
No
Yes
Bacampicillin
Oral
No
Yes
Amoxycillin
Mox, Novamox, Synamox, Flemoxin
Oral
No
Yes
Cyclacillin
Oral
No
Yes
Carbenicillin
Carbelin, Biopence, Pyopen
IV, IM, Oral
No
Yes
Ticrarcillin
IV, IM
No
No
Piperacillin
IV, IM
No
No
Mezlocillin
IV, IM
No
No
31Dosage: 1 to 3 tablets a day in divided dosage.
Side effects: Drowsiness, headache, hyperventilation, renal stones, methaemoglobulinaemia, haemolysis, fever, neutropenia, jaundice.
Contraindications: Renal and hepatic impairment.
 
PARA-AMINOBENZOIC ACID (PABA, Potaba)
Indications: Scleroderma, dermatomyositis, morphea, pemphigus, Peyronie's disease.
Available: 500 mg tablets.
Dosage: Adults—12 g/day in 4 divided dosage; children—1 g/4 kg/day divided doses.
Side effects: Anorexia, nausea, fever, rashes.
Contraindications: Pregnancy, hypersensitivity to sulphonamides.
Drug interactions: Sulphonamide.
 
PENTOXIFYLLINE (Flexitol, Trental)
Indications: Trophic disorders, lower leg ulcers and gangrene.
Available: 400 mg tablets and injection 20 mg/ml.
Dosage: 400 mg 2 or 3 times a day.
Side effects: Nausea, vomiting, dyspepsia, bloating, vertigo, rashes.
Contraindications: Retinal haemorrhage, acute myocardial infarction (MI), severe haemorrhage.
Drug interactions: Potentiate effect of antihypertension.32
 
OXYPHENYLBUTAZONE/PHENYLBUTAZONE (Algesin, Suganril, Sioril, Zolandin,)
Indications: Rheumatoid arthritis, ankylosing spondylitis, herpes zoster, psoriatic arthropathy.
Available: 100 mg tablets.
Dosage: 1 to 2 tablets 3 times a day with meals.
Side effects: Abdominal discomfort, oedema, nausea, dyspepsia, rashes, anaemia, leucopenia, thrombocytopenia, urticaria, drug fever, pruritus, haematuria, toxic epidermal necrolysis, oliguria, optic neuritis, tinnitus, generalised lymphadenopathy.
Contraindications: Children under 14 years, senile patients, hypersensitivity, cardiac failure, blood dyscrasias, gastrointestinal lesions, pregnancy, lactation.
Drug interactions: Coumarins, insulin, sulphonamide, oral antidiabetics, alcohol.
 
NIFEDEPINE (Calcigard, Depin, Nifelat, Nificard)
Indications: Raynaud's phenomenon due to various causes.
Available: 5, 10 and 20 mg tablets.
Duration: 10 to 30 mg a day.
Side effects: Light heartedness, giddiness, flushing, headache, palpitation, peripheral oedema, postural hypotension, nasal and chest congestion, joint stiffness, dermatitis, pruritus, sleep disturbance, sexual dysfunction, syncope.
Contraindications: Hypersensitivity, hypotension, pregnancy.
Drug interactions: Concomitant use of beta blockers may precipitate congestive heart failure; severe hypotension or angina.33
 
POTASSIUM IODIDE
Indications: Sporotrichosis, chromoblastomycosis, erythema nodosum.
Available: Tablets and crystals.
Dosage: Erythema nodosum—3 to 10 drops of saturated solution of potassium iodide (SSK-I) 2 times a day in orange juice for 1 week, then gradually tapered off in 2 to 4 weeks. Sporotrichosis/chromoblastomycosis: Start with 5 drops of SSK-I 3 time a day and gradually built to 30 drops thrice a day in 2 to 3 weeks period. The dose is to be given after meals with orange juice. Antacids are also administered to reduce gastric irritation. It should be given for 1 to 3 months guided by the resolution of the lesions.
Side effects: Nausea, vomiting, abdominal discomfort, gastric, thyroid aberration, rashes, erythema multiforme, pustular lesions.
Contraindications: Peptic ulceration, thyroid dysfunction.
 
PREDNISOLONE (Cohydeltra, Deltacortril, Hostcortin-H, Wysolone)
Indications: Infectious eczematoid dermatitis, eczemas, pemphigus, bullous pemphigoid, other corticosteroid responsive dermatoses.
Available: 5, 10, 20 mg tablets.
Dosage: 3 to 20 tablets a day depending upon the indication.
Side effects: Fluid and electrolyte imbalance, myopathies, thromboembolism, gastritis, peptic ulceration, pancreatitis, florid infections, atrophy of skin, impaired wound healing increased intracranial tension, cataract, psychosis, catabolism, diabetes precipitation.34
Contraindications: Active focus of infection, herpes simplex infection, peptic ulceration.
 
PROPANTHELINE (Pro-Banthine)
Indications: Disabling hyperhidrosis of palms and soles.
Available: 7.5 mg tablets.
Dosage: 1 tablet 2 or 3 times a day.
Side effects: Xerosmia, loss of taste, nausea, bloated feeling, paralytic ileus, urinary hesitancy and retention, dysuria, blurred vision, mydriasis, cycloplegia, increased ocular tension, palpitation, bradycardia, headache, flushing, drowsiness, dizziness, nasal congestion, decreased sweating, suppression of lactation, allergic reactions, urticaria.
Contraindications: Hypersensitivity, narrow angle glaucoma, unstable cardiovascular status, obstructive uropathy, myasthenia gravis, toxaemia of pregnancy.
Drug interactions: Antihistaminics, alpha prolidine, hyclizine, meperidine, tranquilizers, tricyclic antidepressants, quinidine, nitrites, nitrates, alkalinizing agents, primidone, monoamine oxidase inhibitors, corticosteroids, haloperidol, antacids.
 
PSORALENS
Indications: Vitiligo, enhancing pigmentation, enhancing sun-light tolerance.
Available: 5, 20 and 25 mg tablets/ capsules; 0.2 to 1 per cent lotion.35
Dosage: The tablets/capsules to be taken as a single dose in the morning with breakfast, and the affected part exposed to gradually increasing duration of sunlight after 2 hours of ingestion. The lotion is to be applied to the white patch protecting the normal skin with a bland cream, and immediately expose to the sun for gradually increasing duration. This treatment should be given every alternate day. Patient should use sunglasses and protect lips while exposing to the sun (Tables 1.5 and 1.6).
Duration: Several weeks/months.
Side effects: Stinging, burning, sun-burns, gastric discomfort, nausea, nervousness, insomnia.
Contraindications: Hepatic insufficiency, hydroa, polymorphous light eruption, photosensitivity disorders, pregnancy, children under 12 years.
For a topical a therapy, expose to the sun for half minute a day for the first week, one minute for the second week, and 2 to 4 minutes for the third week. After treatment, cover the vitiligo patches adequately to prevent further irradiation.
Table 1.5   Psoralens
Generic name
Trade Name
Availability
Recommended Dosage
8-methyl
Oxoralen, Octamop Macsoralen
5, 10 mg cap. 1% lotion
10 to 20 mg for adults and children Over 12 years
4,5,8, Trime-thylpsoralens (Trioxalen)
Trisoralen, Trimop Tripsoren
5, 25, 50 mg cap
0.6 mg/kg body weight
Psoralen
Manaderm Psoralen
5, 10 mg tab
10 to 20 mg
36
Table 1.6   Sun exposure time in different types of skins using oral psoralens*
Exposure
Fair skin (Type IV) (minutes)
Medium (Type V)(minutes)
Dark skin (Type VI) (minutes)
First
5
8
10
Second
8
12
15
Third
10
15
20
Fourth
12
18
25
Fifth
16
24
30
Sixth
20
30
35
Seventh
25
35
40
Eigth
30
40
45
onwards
* This exposure schedule is meant only for oral psoralens.
 
PYRAZINAMIDE (Copyrazine, PZA-Ciba, Piraldina)
Indications: Tuberculosis.
Available: 500 mg tablets.
Dosage: 20 to 35 mg/kg/day in 3 to 4 divided doses.
Side effects: Abnormality of hepatic functions, fever, anorexia, malaise, liver tenderness, hepatomegaly, adverse effect on blood clotting, jaundice, gout, sideroblastic anaemia, skin rashes.
Contraindications: Severe hepatic damage, acute intermittant porphyria, children, gout patients.
 
PYRIDOXINE (Vitamin B6)
Indications: All patients receiving isoniazid, cycloserine, penicillamine, hydralazine and oral contraceptives, as they all increase their requirements of pyridoxine.
Available: 25 to 50 mg tablets.
Dosage: 1 to 2 tablets a day.37
Contraindications: Patients receiving levo-dopa(L-dopa) should not be given pyridoxine over 5 mg a day as it reverses action of levo-dopa.
 
RIFAMPICIN (R-Cin, Rifamycin, Rifacillin, Rimactane, Siticox, Tibirim)
Indications: Cutaneous tuberculosis, leprosy, leishmaniases.
Available: 150, 300, 450 and 600 mg capsules.
Dosage: Tuberculosis—450 to 600 mg capsules to be given before breakfast a day for 3 to 6 months, combined with other antitubercular drugs. Leprosy—Given either—a day 450 to 600 mg for first 90 days of therapy, or it is given every month supervised 600 mg for 6 to 18 months with other antileprosy drugs.
Side effects: Flu-like syndrome, heart burn, epigastric distress, anorexia, nausea, vomiting, headache, drowsiness, menstrual and visual disturbances, liver function derangement, pruritus, urticaria, rashes, bone marrow suppression, haematuria, renal insufficiency.
Contraindication: Hypersensitivity.
Drug interactions: Concomitant use of other hepatotoxic, anticoagulants, oral contraceptives, para-aminosalicylic acid (PASA). Corticosteroids, digitalis derivatives, oral hypoglycaemics, and dapsone.
 
RANITIDINE (Aciloc, Histac, Ranitidine, Rantac, Zinetac)
Indications: Adjuvant therapy in chronic urticaria.
Available: 150 and 300 mg tablets.
Dosage: 150 mg 2 times a day.38
Side effects: Skin rashes, headache, dizziness, leucopenia, hellucination.
Contraindication: Hypersensitivity.
Drug interaction: Antacids interface with its absorption.
 
STREPTOMYCIN (Ambistryn-S, Merstrept, Streptonex)
Indications: Cutaneous tuberculosis, donovanosis, chancroid with bubo, pyodermas with microorganisms sensitive to streptomycin.
Available: Streptomycin sulphate injection 0.75, 1g.
Dosage: In cutaneous tuberculosis 0.75 to 1g a day for first 90 days of therapy in combination with other antitubercular drugs. In donovanosis, 1g IM 2 timas a day for 10 days. In chancroid with inguinal bubo 1g IM a day for 10 to 15 days.
Side effects: Proteinuria, red cell, white cell and granular casts in urine, azotemia, oliguria, increased liver enzymes, hepatomegaly, hepatic necrosis, tinnitus, dizziness, vertigo, reversible/irreversible deafness, confusion, depression lethargy, nausea, vomiting, stomatitis, visual disturbances, purpura, rash, urticaria, exfoliative dermatitis.
Contraindications: Liver and kidney derangement, hypersensitivity, pregnancy and lactation.
Drug interactions: Concomitant or sequential administration of other ototoxic neurotoxic or nephrotoxic drugs, cisplatin, cephaloridine, polymyxin–B, colistin, vancomycin, ethcrynic acid, frusemide, mannitol, sodium mercaptomerin, anaesthetics, neuromuscular blocking drugs, massive citrate, anticogulate blood transfusion, gentamicin, tobramycin, Mixing of streptomycin with penicillin in the same syringe may decrease its efficacy.39
 
SPECTINOMYCIN (Trobicin)
Indications: Acute gonococcal urethritis and proctitis due to penicillinase-producing Neisseria gonorrhoeae (PPNG).
Available: 2 g, 4 g injections.
Dosage: 2 g IM in a single dose both for males and females. In disseminated gonococcal infection (DGI) given as 2 g IM 2 times a day for 3 days.
Side effects: Pain at injections site, urticaria, dizziness, chills, nausea, fever insomnia, elevation of hepatic enzymes.
Contraindications: Atopic individual, pregnancy, infants, hypersensitivity.
 
TERBINAFINE (Daskil, Fungotek, Lamisil, Sebifin)
Indications: Dermatomycosis, pityriasis versicolour.
Available: 250 mg tablets, topical cream (10 mg/gm).
Dosage: 1 tab a day for 7 consecutive days, if needed, repeat.
Side effects: Rashes urticaria, redness, itching, stinging at site.
Contraindication: Hypersensitivity.
 
TETRACYCLINE (Alcycline, Hostacycline, Resteclin, Therocycline, Teramycin)
Indications: Pyodermas, infective eczemas, syphilis, gonorrhoea, donovanosis, chancroid, acne vulgaris, non-specific urethritis.
Available: 250 mg capsule, 500 mg tablet.
Dosage: 1 to 4 g a day in divided doses.40
Side effects: Gastrointestinal upset, hepatic damage, renal damage, photosensitivity, rashes, fixed drug eruptions, growth retardation, pesudotumour cerebri, staining of teeth.
Contraindications: Infants and children, pregnancy, lactation, hypersensitivity.
 
THALIDOMIDE (CG-217)
Indications: Erythema nodosum leprosum (ENL), Weber-Christian disease, actinic prurigo, polymorphic light eruption, prurigo nodularis, aphthosis and genital ulcers, sarcoidosis, chronic discoid lupus erythematosis.
Available: 100 mg tablets.
Dosage: 200 to 300 mg a day in divided doses.
Duration: Several days to weeks. In ENL a reduced maintenance dose to be given for a few months to prevent recurrence.
Side effects: Paraesthesia, convulsions, dryness of skin and mouth, erythema, persistent oedema, urticaria, nausea, constipation, increased appetite, teratogenecity, long-term polyneuropathy and muscle weakness, decreased sperm count.
Contraindications: Pregnancy, females of reproductive age group.
 
THIABENDAZOLE (Mentezol)
Indications: Cutaneous larva migrans, creeping eruption.
Available: 500 mg tablet, and 500 mg/5 ml suspension.
Dosage: 25 mg/kg in 2 divided doses after meals.
Duration: 2 days.41
Side effects: Anorexia, nausea, vomiting, dizziness, epigastric distress, fatigue, drowsiness, diarrhoea, erythema multiforme.
Containdication: Hypersensitivity.
 
THIACETAZONE (Bi-teban, Isokin-T forte, Isozone)
Indication: Tuberculosis.
Available: 50, 75 and 150 mg tablets.
Dosage: 150 mg a day in 3 divided doses along with other antitubercular drugs.
Side effects: Anorexia, nausea, vomiting, drug fever, skin rashes, Steven-Johnson syndrome, anaemia, granulocytopenia, agranulocytosis, kidney and liver damage.
Contraindications: Hypersensitivity, hepatic disease, renal failure.
 
TINIDAZOLE (Tiniba, Tizole, Trag, Zil)
Indications: Trichomoniasis, cutaneous amoebiasis.
Available: 150 to 300 and 1000 mg tablets.
Dosage: Trichomoniasis, either 2 g as a single dose or 300 mg 2 times a day for 3 days, simultaneously treat both sexual partners. Amoebiasis, either 2 g once a day for 2 to 3 days or 600 mg 2 times a day for 5 days.
Side effects: Nausea, dizziness, headache, dryness of mouth, darkly coloured urine.
Contraindications: Neurological disorders, blood dyscrasias, early pregnancy, lactation.42
 
TRIMETHOPRIM + SULPHADIAZINE (Aurbil, Antrima, Triglobe)
Indications: Primary and secondary pyodermas.
Available: Tablets (Sulphadiazine 410 mg and Trimethoprim 90 mg)
Dosage: 1 tablet 2 times a day for adults; 2 to 5 mg/kg/ day of trimethoprim for children.
Side effects: Gastrointestinal upsets, nausea, rashes, blood dyscrasias, glossitis.
Contraindications: Infants, G-6-PD deficiency, pregnancy.
Drug interactions: Warfarin, sulfonylureas.
 
TRIMETHOPRIM + SUlPHAMETHOXAZOLE (Bactrim, Chemortin forte, Synstat, Septran, Tprim forte)
Indications: Primary and secondary pyodermas, other skin and soft tissue infections. Chancroid, donovanosis.
Available: Single strength (400 mg sulphamethoxazole and 80 mg trimethoprim).
Dosage: 1 tablet 2 times a day for adults. For children 4 to 10 mg of trimethoprim a day in 2 divided doses.
Side effects: Nausea, vomiting, gastric upsets, anorexia, rashes, fixed drug eruptions, blood dyscrasias.
Contraindications: Hypersensitivity, neonates, pregnancy, G-6-PD deficiency.
Drug interactions: Warfarin, sulphonyluera, methotrexate.
 
XANTHINOL MICOTRIATE (Complamina)
Indications: Peripheral vascular disease, scleroderma, Raymond's phenomenon, chilblains.43
Available: 150 mg tablets.
Dosage: 300 to 600 mg, 3 times a day.
Side effects: Flushing, sense of heat.
Contraindications: Recent MI, recent CVA, acute haemorrhage, decompensated cardiac insufficiency.
Drug interactions: Concomitant use of ganglion blockers and sympatholytic drugs to be avoided.
 
VITAMIN-A (Aquasol-A, Arovit, Vitamin –A)
Indications: Disorders of kertinization, pityriasis rubra pilaris, Darier's disease, acne vulgaris.
Available: 10,000, 25,000 and 50,000 IU capsules.
Dosage: 10,000 to 50,000 IU a day.
Duration: Several weeks.
Side-effects: Hypervitaminosis - A syndrome, fatigue, malaise, lethargy, night sweats, abdominal discomfort, anorexia, vomiting, bone pains, irritability, headache, vertigo, increased intracranial pressure, drying and cracking of skin and lips, pruritus, desquamation, jaundice.
Contraindications: Renal insufficiency, massive dose during pregnancy.
Drug interaction: Oral contraceptives.
 
ZIDOVUDINE (Retrovir, Zidovir)
Indications: Asymptomatic and symptomatic HIV disease.
Available: 100 mg tablets.44
Dosage: Initially 200 mg 6 times a day, then 500 to 1500 mg/day in 4 to 5 divided doses (adult dose).
Side-effects: Anorexia, myalgia, insomnia, nausea, rash, abdominal pain, anaemia, leucopenia.
Contraindications: Children less than 3 months age, anaemia, neutropenia.
Drug interactions: Metabolism inhibited by aspirin codeine, neurophene, dapsone, indomethacin.
 
ZINC SULPHATE (Zincolak, Zink)
Indications: Acrodermatitis enteropathica, acne vulgaris, chronic non-healing ulcers.
Available: 220 mg capsules.
Dosage: For infants with acrodermatitis enteropathica, one-fourth of the capsules given 1 or 2 times a day with milk for several months. Adults, 1 capsule a day for several weeks.
Side-effects: Nausea, vomiting, gastritis.
Contraindication: Peptic ulceration.
Drug interaction: Tetracycline.
 
VITAMIN-E (Evion, Evit, Tocofer)
Indications: Progressive systemic sclerosis, epidermolysis bullosa, as an antioxidant
Available: 30, 100, 200 and 400 IU capsules
Dosage: 200 to 1,600 IU a day in divided doses
Duration: Several weeks to months
Side-effects: None.45
 
METHYL PREDNISOLONE (Medrolr tabs, Zempred)
Indications: Drug-induced dermatitis, contact dermatitis and atopic dermatitis. dermatitis herpetiformis, pemphigus, severe psoriasis and severe seborrheic dermatitis, allergic and inflammatory conditions of skin.
Available: As 2 mg, 4 mg, 8 mg, 16 and 32 mg tablets.
Duration: The initial oral dose is 4-48 mg daily depending on the disease. Corticosteroids given in multiple doses throughout the day are more effective but also more toxic than the same total daily dose given once daily, or every other day. Methylprednisolone should be taken with food.
Side-effects: Fluid retention, weight gain, high blood pressure, potassium loss, headache, muscle weakness, puffiness of the face, hair growth on the face, thinning and easy bruising of the skin, glaucoma, cataract, peptic ulceration, worsening of diabetes, irregular menses, growth retardation in children, convulsions, and psychic disturbances. Psychic disturbances may include depression, euphoria, insomnia, mood swings, personality changes, and even psychotic behaviour.
Contraindications: Pulmonary tuberculosis, diabetes, hypertension, cataract, Herpes simplex, peptic ulceration.
 
CYCLOPHOSPHAMIDE (Endoxan, Cytoxan)
Indications: Pemphigus group of disorders, vasculitis, Wegener's granulomatosis, systemic sclerosis, severe rheumatoid arthritis, lupus erythematosus, advanced mycosis fungoides, pyoderma gangrenosum.
Available: Tablets of 25 and 50 mg and powder for intravenous injection (100 mg).46
Dose: Given in a dose of 40-50 mg/kg administered intravenously over 3-5 days in divided doses. Oral dose is 1-5 mg/kg daily.
Side-effects: Include hair loss, vomiting, diarrhoea, mouth sores, sterlity and jaundice. Kidney failure, (leukopenia), anaemia, and thrombocytopenia. Cyclophosphamide also may cause inflammation of the urinary bladder with bleeding (haemorrhagic cystitis), increased risk of malignancy.
Contraindications: Pregnancy, lactation.
 
AZATHIOPRINE (Azoran, Lmmuran)
Indications: Pemphigus, SLE, Systemic sclerosis, vasculitis, chroniactinic dermatitis, actinic reticuloid, dermatitis (air borne, photodermatitis and atopic dermatitis).
Available: Azathioprine tablet, film coated 50 mg.
Dose: 2-4 mg per Kg per day. Dose is determined according to the levels of the enzyme TPMT (thiopurine methyltransferase).
Side-effects: Bone marrow suppression (anaemia, leucopenia, thrombocytopenia), hepatotoxicity, immunosuppression (increased risk of malignancies), mutagenic potential to both men and women.
Contraindications: Pregnancy, hepatitis
 
RITUXIMAB (Mabthera)
Indications: Non-Hodgkin's lymphoma, follicular lymphoma, chronic lymphocytic leukemia, refractory pemphigus vulgaris, bullous pemhigoid, severe, active Rheumatoid arthritis.
Available: MabThera 100 mg (10 mg per ml) concentrate for infusion MabThera 500 mg (10 mg per ml) concentrate for solution for infusion.47
Dosage: Weekly cycles of rituximab (375 mg per square meter of body-surface area).
Side-effects: Pyelonephritis, septicemia, fall in B cells.
 
DEFLAZCORT (Defcort, Calcort)
Indications: Severe allergic reactions, e.g. anaphylaxis, asthma, rheumatoid arthritis, juvenile chronic arthritis, polymyalgia rheumatica. Inflammatory skin disorders, including pemphigus vulgaris, bullous pemphigoid and pyoderma gangrenosu, dermatomyositis, systemic lupus erythematosus, Mixed connective tissue disease. polyarteritis nodosa, sarcoidosis, idiopathic thrombocytopenic purpura.
Available: As round, white tablets, 6 mg.
Dosage: 18-54 mg per day, depending on the severity of condition.
Side-effects: Raised blood sugar level, Increased appetite and weight gain, increased susceptibility to infections and increased severity of infections, abdominal bloating, nausea, ulceration in the stomach or intestine, pancreatitis, ulceration or thrush infection in the throat, muscle weakness or wasting, osteoporosis, skin thinning, acne, stretch marks, hirsutism, psychiatric reactions, cushing's syndrome, menstrual disturbance, sodium and water retention, hypertension, hypokalemia.
Contraindications: People with widespread infection, rare hereditary problems of galactose intolerance, the Lapp lactose deficiency or glucose-galactose malabsorption (Calcort tablets contain lactose), head injury or stroke.
 
FAMVIR (Famcyclovir)
Indications: Cold sores, herpes zoster, genital herpes and chicken pox.48
Available: As tablets-125 mg, 250 and 500 mg.
Duration:
Indications
Daily Dosage
Duration
Herpes Zoster
500 mg × 3 times
7 days
Genital herpes
• Recurrent infection
1000 mg × 2 times
1 day
• Suppressive therapy
250 mg × 2 times
1 year
• Orolabial or genital HSV infection (HIV-Infected patients)
500 mg × 2 times
7 days
Herpes labialis
1500 mg × 1 time
1 day
Side-effects: Mild to extreme stomach upset, headaches, mild fever.
 
VALACYCLOVIR (As Valcivir, Valtrex)
Indications: Cold sores, herpes zoster, genital herpes and chicken pox.
Available as tablets: 500 mg tablets.
Indications
Daily Dosage
Duration
Adult dosage
Herpes Zoster
1g × 3 times
7 days
Genital herpes
• First episode
1g × 2 times
10 days
• Recurrent
  1. Episodic
  2. Suppressive therapy (Immunocompetent patients)
  3. Suppressive (HIV infected patients)
500 mg × 2 times
1g od
500 mg × 2 times
3 days
1 year
6 months
Herpes labialis
1500 mg × 1 time
1 day
Pediatric dosage
Chicken pox
2-< 18 yrs of age
20 mg per kg per
(Immunocompetent Patient of)
dose × 3 times a day
5 days
Herpes labialis
Patient<or equal to 12 year of age
2 gm × 2 times
1 day
49Side-effects: Aggressive behavior, unsteady movement, shaky movements, confusion, speech problems, hallucinations (seeing or hearing things that are really not there), seizures, and coma. Headache, nausea, stomach pain, vomiting, and dizziness. Side-effects in HIV-infected adults include headache, tiredness, and rash. Other less common side effects include painful periods in women, joint pain, depression, low blood cell counts, and changes in liver and renal function tests.
Contraindication: Allergy to ingredients, renal disease, HIV, pregnancy and lactation.
 
Aciclovir
Indications
Daily Dose
Duration
Orofacial herpes
20 mg × 5 times
5 days
Genital herpes
• First episode
200 mg × 5 times
10 days
• Recurrent episode
  1. Suppressive therapy
  2. Interm ittent therapy
400 mg × 2 times or
200 mg × 3-5 times
200 mg × 5 times
up to 12 months
5 days
Herpes Zoster
800 mg × 5 times
7-10 days
Chicken pox (age)
• <2 years
200 mg × 4 times
7 days
• 2-6 year
400 mg × 4times
7 days
• >6 year
800 mg × 4 times
7 days
• Adults
800 mg × 5 times
7 days