Product Training for Team-A

Beta Blocker

Bisosikh 2.5mg & 5mg
Ameprolol XL 25mg
 Beta Blockers

 Beta blockers (beta-blockers, β-blockers) are a class
of medications that are predominantly used to
manage 
 abnormal heart rhythms
 to protect the heart from a heart attack (after
myocardial infarction)
 Also widely used to treat high blood pressure
(hypertension), although they are no longer the first
choice for initial treatment of most patients.
 Beta Receptors

 Beta receptors are found on cells of
the heart muscles, smooth
muscles, airways, arteries, kidneys, and other tissues.
 There are 3 types of beta receptors (beta 1, 2 & 3).
 Cardiac muscle cells mainly present beta 1 receptor,
so that the drugs which selectively block the beta 1
receptors are called cardio-selective or beta 1
selective blockers.


Selective beta 1 blockers(Cardio-selective)


 Bisoprolol and Metoprolol are 2nd generation beta
blockers or Selective beta 1 blockers or Cardio-
selective beta blockers.
 Bisoprolol – Bisosikh 2.5mg & 5mg
 Metoprolol – Ameprolol XL 25 mg
Mechanism of action of Beta1 selective blockers


Mechanism of action of Beta1 selective blockers


 Block the beta receptor from binding with adrenaline
(epinephrine) and reduces the action of adrenaline.
 Effects of beta 1 blockers include
 Decrease heart rate
 Decrease work load of heart
 Decrease blood pressure
Bisosikh (Bisoprolol 2.5 & 5 mg)

 Bisoprolol

 Uses
 Hypertension
 Heart Failure
 Tachycardia

 Dosage – start with 2.5 mg OD and can increase up

to 10mg per day
 Pharmacokinetics of Bisoprolol

 Half life – 9-12 hr (can take OD or BD)
 Onset of action– 1-2 hr
 Bioavailability – 80%
 Excretion – Renal (Dosage adjustment required in renal
impairment)
 Can take with or without food
 Use with caustion if benefits outweigh risks in
pregnancy.
 NSAID and Antacid can decrease the effects of
betablockers.
Ameprolol XL
(Metoprolol 25 mg)

 Uses of Metoprolol XL

 Hypertension
 Heart Failure
 Tachycardia
 Atrial fibrillation
 Myocardial infarction

 XL means extended release and drugs with XL need to

take only OD (Once a day)
 Dosage – prescribed by the physician according to disease
severity, (25mg OD or 50mg OD)
 Pharmacokinetics of Metoprolol
XL

 Half life – 24hr (can take OD)
 Onset of action– 1-2 hr
 Bioavailability – 75%
 Excretion – Renal (Dosage adjustment required in renal
impairment)
 Can take with or without food
 Use with caution if benefits outweigh risks in
pregnancy.
 NSAID and Antacid can decrease the effects of
betablockers.
 Side Effects of Beta-blockers

 Decrease heart rate
 Decrease blood pressure
 Dizziness
 Headache
 Diarrhea or constipation
 Allergic reaction
 Bronchospasm (therefore contraindicated in
asthmatic patients)
 

Thank You
 Angiotensin Receptors Blocking agents(ARB)

 Antihypertensive DRUG

 Class : ARB ( Angiotensin II Receptor Antagonist ) – selective for type

1 ( AT1 ) angiotensin receptor
Half Life : 6 hours

Action

 Cause dilation of vessels and veins

 Decrease release of aldosterone

 Increase renal excretion of sodium and water

 Mechanisim of action
• It inhibit the angiotensin 2 receptors and
reduce the action of Ag 2 which cause
– Vasoconstriction
– Release of aldosterone
– Sodium reabsorption
Losartan (Losamil & Raysaro)
 Losartan (Losamil & Raysaro)
• It was first ARB to be approved.
• Indications
– Hypertention
– Heart failure
– Diabetes Nephropathy
– Stroke Prevention
• It has shorter half life than olmesartan.
Olmesartan (Olemed 20 & 40 mg)
Olmesartan (Olemed 20 & 40 mg)
Indication
– Hypertention
• It has longer half life than other ARB.
• It is the best in reducing BP.
Indications
– Hypertention ( Olmesartan > Losartan > Valsartan)
– Congestive Heart failure
– Post Myocardial infarct
– Hypertention co existing with type 2 DM
– Diabetic nephropathy
– Stroke Prevention
Contraindications
– Pregnancy
– Bilateral renal artery stenosis
_End Stage Renal Failure
 Side effects of ARB
• Hyperkalaemia
• Angioadema
• Dizziness
• Hypotention
• Dry cough is less common than ACEI
 Sovelpa
Sofosbuvir 400mg + Velpatasvir 100mg
Manufactured by Pharm Evo (Pakistan)
 Sovelpa
Sofosbuvir-velpatasvir is a pangenotypic
NS5A-NS5B inhibitor.
It is the first once-daily single-tablet regimen
with pangenotypic activity.
Has potent activity against Hepatitis C virus
(HCV) genotypes 1, 2, 3, 4, 5, and 6 (All
genotypes)
 Indications & Dosage
Chronic Hepatitis C (HCV) infection
HCV with compensated cirrhosis
HCV with decompensated cirrhosis

Dosage – 1 tablet OD x 12 week (minimum)

Nausea
Side Effects
Symptomatic bradycardia
Rash
Fatigue
Headache
Amiodrone (result bradycardia)
Acid reducing agents (Antacid, PPI, H2
blocker)
Anticonvulsant
Statin group (Atovastatin, Rosuvastatin)
Herbals (St.John Warts)
Some ART

Drugs which shouldn’t taken with Sovelpa

 USP of Sovelpa
Sofos + Velpa combination provides higher
SVR rate (Sustained virological response )
than Sofosbuvir + Daclatasvir combination
in Genotype 3.
More effective & less adverse effects than
Sofosbuvir + Daclatasvir in chronic cirrhotic
patients.
 USP of Sovelpa
Sofos + velpatasvir is recommended for all
genotypes with a cure rate greater than 90%,
and close to 100% in most cases
Active against all genotype
Sofos + Daclatasvir – genotype 2,3
Sofos + Ledipasvir _ genotype 1,4,5,6
Good presentation with Alu Alu packaging
(convenient for buying )
Physicians
Focus Doctors
GI /Liver Physician
Thank You
 Merit Gold
(Methylcobalamin, Lutein & Zeaxanthin, Multivitamins & Minerals)
Manufactured by MMC Healthcare Ltd (India)
 Merit Gold
Methylcobalamin 500 mcg
Lutein 6 mg
Zeaxanthin 300 mcg
Multivitamins & Minerals
 Methylcobalamin

 It is known as Vitamin B 12 .
 Facilitates myelinogenesis and nerve regeneration
and promotes nerve conduction.
 Deficiency can lead to peripheral neuropathy.
 Alleviates pain behavior in diabetic neuropathy, low
back pain, neuralgia.
 Actively improves Diabetic neuropathy
Lutein & Zeaxanthin
Also provides protection of retina against
damage due to light.
 Useful in treating non-proliferative Diabetes
Retinopathy.
Vitamin A
Essential daily nutrient, essential for vision
especially in dim light vision.
Function as antioxidant.
Deficiency can cause night blindness,
xerophthalmia, Bitots spot, corneal ulcer,
hyperkeratosis,etc.
Vitamin B Complex
Plays important role in cellular functioning.
 Involve in nervous system and
neurotransmitter synthesis (B6).
 Helps in improvement of cognitive function
Vitamin C, D, E & Minerals
Dosage
One tablet daily or as prescribed by Healthcare
Professionals.
Merit Gold
 Thank You
for
your kind attention!!!
 42

Probios-B
Prebiotic and Probiotics Capsule
 43

Gastrointestinal Bacteria ( Gut Flora)

 Complex community of microorganisms that live in
the digestive tract
 Help to neutralise some of toxic by products of
digestion
 Reduce harmful substances
 Discourage bad bacteria
 Stimulate digestive process and aid absorption of
nutrients
 44

Gastrointestinal Bacteria ( Gut Flora)

 45

Cause of loss intestinal good bacteria

 Diarrhoea
 Bloating
 Gas
 Constipation
 IBS
 Chronic
illness such as autoimmune diseases
 Abdominal Pain or cramping
 46

- Probiotic helps replace them

- Help balance good and bad bacteria
 47

Probiotics
 Live bacteria and yeasts that are good for digestive
system .
 Our body is full of bacteria, both good and bad.
 Probiotics are called good or helpful bacteria
because they help keep the gut healthy.
 48

Lactobacillus
 Most common probiotics

 Different strains can help with diarrhea and help with people who can’t digest very well .

Bifidobacterium
 Can find in some dairy product

 Help ease the symptoms of irritable bowel

syndrome( IBS) and some other conditions

 Improve digestion

 Enhancing mineral absorption

 49

Sachromyces boulardii
 Probiotic yeast sourced from skin of Lychee and
mangosteen
 Benefiaicl bacteria that stimulate immune system and
protect digestive health.
 Reduce the onset , duration and frequency of antibiotic
associated diarrhea.
 50

Prebiotic
( Fructo-oligosacharides)
 Non- digestiable fiber compounds that stimulate the
growth or activity of beneficial bacteria ( in
gastrointestinal tract ) .

 Increase the number or activity of Bifidobacteria and

Lactic acid bacteria.
 51

Indication
 Infectious diarrhea
 Antibiotic associated diarrhea
 Inflammatory Bowel Disease ( eg – Ulcerative colitis )
 Irritable Bowel syndrome
 Immune Deficiency
 Intestinal Disorder associated with chemotherapy ( eg-
constipation )
 52

Rorabi 10,20
&
Forabi 20
(Rabeprazole)
 53

Rabeprazole
Rabeprazole is an inhibitor of the gastric proton pump.

• Proton Pump Inhibitor

Category

• Suppresses gastric acid secretion by

specific inhibition of the H+/K+
Action ATPase in the gastric parietal cell
 54

Gastric & Duodenal Ulcer

 55

Erosive oesophagitis & Gastroesophagel reflux disease

( GERD)
 56

Dosage and administrations

 20 mg OD for 4-8 weeks

 The maximum overdose was 80 mg.

 Patients with Zollinger- Ellison syndrome-

up to 120 mg rabeprazole.
 57

Zollinger –Ellison Disease

 58

THANK YOU
 Ame-feno
Fenofibrate 200mg Capsule
What is Dyslipidemia?
 Dyslipidemia refers to unhealthy levels of one or more
kinds of lipid (fat) in your blood.

 Your blood contains three main types of lipid:

1. High-density lipoprotein (HDL)
2. Low-density lipoprotein (LDL)
3. Triglycerides

 If you have dyslipidemia, it usually means your LDL

levels or your triglycerides are too high. It can also
mean your HDL levels are too low.
What is Dyslipidemia?

 LDL Cholesterol is considered the “bad” type of

cholesterol. That’s because it can build up and form
clumps or plaques in the walls of your arteries. Too much
plaque in the arteries of your heart can cause a heart
attack.

 HDL is the “good” cholesterol because it helps remove LDL

from your blood.
What is fenofibrate?

 Fenofibrate belongs to a group of drugs known as "fibrates."

 It activates lipoprotein lipase enzyme which eliminate triglycerides
from the blood.

 Fenofibrate is used along with a proper diet (such as a low-

cholesterol/low-fat diet), to help treat high cholesterol and high
triglyceride levels.
 Other lifestyle changes that may help fenofibrate work better
include exercising, losing weight if overweight, and stopping
smoking.
Statins Weakness
VS.
Fibrates Strength
Indications

 Severe hypertriglyceridaemia

 Mixed hyperlipidaemia when a statin is contraindicated or

not tolerated.

 Mixed hyperlipidaemia in patients at high CVS risk in

addition to a statin when triglycerides and HDL cholesterol
are not adequately controlled.

 Diabetic Dyslipidemia
Contraindications

 hepatic insufficiency
 severe renal insufficiency
 children
 hypersensitivity to fenofibrate or any component of this
medication
 gall bladder disease
 chronic or acute pancreatitis
Dosage

Once a day with meal

(fenofibrate is absorbed better with food in the stomach)

 Cholesterol and triglyceride levels should be monitored

every four to eight weeks
Side effects

 Abdominal pain
 Headache
 Backache
 Nausea
 Constipation
 nasal congestion
 runny nose
What to avoid

 Avoid eating foods high in fat or cholesterol, or fenofibrate

will not be as effective.

 Avoid drinking alcohol. It can raise triglyceride levels and

may increase your risk of liver damage.

 Fenofibrate during pregnancy: only if clearly needed and

the benefit outweighs the risk

 Fenofibrate during breastfeeding: Contraindicated

Focus Doctors

 Physician

 Cardiac

 Endocrinologist

 GP
USP

 Fenofibrate is more effective than statins at increasing HDL

cholesterol levels

 Reduce CVD by 27% in Diabetics with dyslipidaemia metabolic

syndrome (combination of diabetes, hypertension and obesity)

 Fenofibrate is quickly absorbed and converted into its active

ingredient fenofibric acid once inside the body
Cardio Vit
 Composition
Coenzyme Q10 = 100mg
Soy Lecithin = 20mg
Vitamin E = 50mg
Vitamin B6 = 10mg

7.7.2018
 What is Coenzyme Q10?

Coenzyme Q10, also known as ubiquinone.

Fat-soluble substance, which resembles a
vitamin.
Present in almost all cells.
It involved in generation of 95% of human
body’s energy.

7.7.2018
 What is Coenzyme Q10?

Therefore, those organs with the highest energy

requirements such as the

Heart
 Liver and
 Kidney

have the highest CoQ10 concentrations.

7.7.2018
 Sources of Coenzyme Q10
 Meat and fish (richest sources of dietary CoQ10) ,also
 found in beef, pork, chicken heart, and chicken liver.
 Dairy products are much poorer sources of CoQ10
compared to animal tissues.
 Broccoli, grapes, and cauliflower are modest sources of
CoQ10. Most fruit and berries represent a poor to very poor
source of CoQ10, with the exception of avocados, which
have a relatively high CoQ10 content.

7.7.2018
 Deficiency of Coenzyme Q10

 There are two major factors that lead to deficiency of CoQ10 in

humans:
 Reduced biosynthesis,
 Increased use by the body
 Example:
Some chronic disease conditions (cancer, heart disease, etc.)
also are thought to reduce the biosynthesis of and increase the
demand for CoQ10 in the body, but there are no definite data to
support these claims.

7.7.2018
 Clinical Indication

Cardiovascular diseases:
Numerous studies have investigated the benefit of
Coenzyme Q10 supplementation for improving
function via
 Enhanced energy production
 Improved contractility of cardiac muscle
 Potent antioxidant activity – particularly
prevention of LDL oxidation.

7.7.2018
 Other Indications
 Hypertension
 Diabetes
 Alzheimer’s disease
 Muscular dystrophy
 Male infertility
 Statin myopathy
 Certain cancer

7.7.2018
Dosage allowance of Coenzyme Q10

Dosage
 There is no established ideal dose of CoQ10. Studies
have used doses of CoQ10 ranging from 50
milligrams to 1,200 milligrams in adults, sometimes
split into several doses over the course of a day.
 A typical daily dose is 100 milligrams to 200
milligrams.

7.7.2018
 Benefits of Soy Lecithin

Lecithin describes a substance that’s naturally found

in the tissues of your body. It’s made up of fatty
acids, and it has a variety of commercial and medical
uses.
The most well-known benefit of lecithin is its ability
to lower cholesterol. Researchers have discovered
that soybean lecithin can contribute to raising HDL
(good) cholesterol and lowering LDL (bad)
cholesterol in blood profiles.

7.7.2018
 Benefits of Soy Lecithin

Improves heart health

Lecithin that comes from soy can improve
cardiovascular health, especially if you’re already at
risk of developing high blood pressure or heart
disease. This is according to a small study in which
participants were given soy products including
lecithin additives.

7.7.2018
 Benefits of Vitamin E

Benefits of consuming more vitamin E-rich

foods can include treating and preventing diseases
of the heart and blood vessels, such as chest pains,
high blood pressure, and blocked or hardened
arteries.

7.7.2018
 Benefits of Vitamin E
 Balances Cholesterol
 Antioxidant action
 Repairs Damaged Skin
 Thickens Hair
 Balances Hormones
 Improves Vision
 Helps People with Alzheimer’s Disease

7.7.2018
 Benefits of Vitamin B6

Vitamin B6 also plays a role in cognitive

development through the biosynthesis of
neurotransmitters.
Vitamin B6 is involved in gluconeogenesis and
glycogenolysis, immune function (for example, it
promotes lymphocyte and interleukin-2 production),
and hemoglobin formation.

7.7.2018
 Summary of Cardio Vit

Used as an anti-oxidant
Used as an adjunct along with main therapy for
cardiovascular diseases.(Congestive Heart Failure,
Hypertension,…)
Salent Features:
 Soy Lecithin- improves heart health
 Vitamin E - give antioxidant activity
 Vitamin B6 - involved in immune function

7.7.2018
 8.10.18
LIPID LOWERING
AGENTS (STATINS)

86
 ROSUMIL 10

8.10.18
ROSUVACEC 10

ATOVACOR10/20
87
WHAT IS DYSLIPIDEMIA?
 Dyslipidemia refers to unhealthy levels of one or more kinds of

8.10.18
lipid (fat) in your blood.

 Your blood contains three main types of lipid:

 High-density lipoprotein (HDL)
 Low-density lipoprotein (LDL)
 Triglycerides

 If you have dyslipidemia, it usually means your LDL levels or your

triglycerides are too high.It can also mean your HDL levels are too
low.
88
WHAT IS DYSLIPIDEMIA?

8.10.18
 LDL Cholesterol is considered the “bad” type of
cholesterol. That’s because it can build up and form
clumps or plaques in the walls of your arteries. Too
much plaque in the arteries of your heart can cause a
heart attack.

 HDL is the “good” cholesterol because it helps remove

LDL from your blood.

89
TREATMENT OPTIONS
 The most commonly used medication to treat

8.10.18
dyslipidemia is a statin. 

 Statins help reduce LDL levels by interfering with

cholesterol production in the liver. 

 There are several types of statin.

 They all work a little differently, with some being

stronger than others.
90
STATINS
Statins that are approved for use in the U.S. include:

8.10.18
Atorvastatin 
Fluvastatin 
Lovastatin
Pravastatin 
Rosuvastatin 
Simvastatin 

91
MOA OF STATINS
 Statins" is a class of drugs that lowers the level

8.10.18
of cholesterol in the blood by reducing the production
of cholesterol by the liver. (The other source of
cholesterol in the blood is dietary cholesterol.)
 Statins block the enzyme in the liver that is
responsible for making cholesterol. This enzyme is
called hydroxy-methylglutaryl-coenzyme A reductase
(HMG-CoA reductase).
 Scientifically, statins are referred to as HMG-CoA
reductase inhibitors.

92
INDICATIONS
 Dyslipidemia

8.10.18
 Hypercholesterolemia
 Hypertriglyceridemia

It should be taken at night because

cholestrol synthesis is maximum at night.

93
INDICATIONS
Prevention of Cardiovascular Diseases

8.10.18
 To prevent heart attacks
 To prevent strokes

 To prevent chest pain

 To lower bad cholesterol and raise good

cholesterol (HDL)
 To lower triglycerides

 To slow the progress of heart disease

94
SIDE EFFECTS
 Nausea

8.10.18
 Vomiting

 GI upset

 Muscle pain (< 5%)

95
 STATINS
 They all work a little differently, with some being stronger
than others.

8.10.18
Comparative effectiveness of routinely used statins
Rosuvastatin Atorvastatin Fluvastatin
Statin and dose
10mg 10mg 20mg
HDL increase % 8% 6% 1%

LDL reduction % 46% 37% 17%

TG reduction % 20% 20% 5%

96
ATORVACOR 10 & 20 MG

8.10.18
97
ROSUMIL 10 & ROSUVACEC 1O MG

8.10.18
98
 ROSUVASTATI
N
 Reduce LDL-C, increase HDL-C more effectively

8.10.18
 Helps more patients achieve lipid goals than other
statins
 Showed improvement in markers of atherosclerosis
like reduction in lipid rich necrotic core
 Reduced rate of progression of maximum CIMT

 Reduction in plaque volume

 Has a role in regression of coronary atherosclerosis and

is beneficial in patients

99
FOCUS DOCTORS
 Cardiologists (Medical,Surgical)

8.10.18
 Physicians
 GP

100
 SODIUM HYALURONATE

 The benefits of hyaluronic acid include its

ability to heal wounds, relieve joint pain, and
support bone health. 
 Hyaluronic acid injections can also keep joints
well-lubricated and is an effective treatment
for osteoarthritis.
 Raysiglip
Sitagliptin 50mg/100mg
Diabetes is a chronic (long-lasting) health condition.
Most of the food you eat is broken down into sugar
(also called glucose) and released into your
bloodstream. When your blood sugar goes up, your
pancreas releases insulin. Insulin causes the blood
sugar enter into body’s cells and use as energy.
If you have diabetes, your body either doesn’t make
enough insulin or can’t use the insulin. When there
isn’t enough insulin ,too much blood sugar stays in
your bloodstream. Over time, that can cause serious
health problems.

What is Diabetes?
Raysiglip
 Sitagliptin

Sitagliptin is a newer generation of anti-

diabetes drug that works by increasing levels of
natural substances called incretins.
Incretins help to control blood sugar by
increasing insulin release, especially after a meal.
They also decrease the glucose level.
 Indications

Type 2 Diabetes Mellitus

Not use in Type 1 DM (Young Diabetes) which is only
treated by insulin injection.
Dosage adjustment require in renal impairment
patient.
 Side Effects
Hypoglycaemia (not common in monotherapy, when take
together with other anti-diabete drug)
Nasopharyngitis
Respiratory tract infection
Headache
Hypersensitivity
Pancreatitis
Renal impairment
Constipation
Vomiting
Arthralgia
 Pharmacokinetic
Bioavailability – 87%
Can take with or without food
Mainly excreted by renal route, dosage adjustment
require in renal impairment
Swallow tablet, do not chew, crush or split
Cannot take together with alcohol
Can take together with other anti-diabetes drugs, have
synergistic effect with Metformin.
Dosage – as prescribed by the physician
Regular glucose monitoring and dose adjustment
required.
 USP of Raysiglip

Delays gastric emptying & appetite.

Holds lessser chance of CVS Side effects than
sulphonylurea.
Weight neutral.
No clinically significant hypoglycemia
 Focus Doctor
Physician
Endocrinologist
GP
Thank You
Osteovit

Manufactured by :-
Flagship Biotech, India
Osteovit
Each Tablet contains
• L-arginine 250 mg
• Sodium Hyaluronate 30 mg
• Chondroitin 100 mg
• Vitamin C 5 mg
• Collagen PeptideII 40 mg
Osteovit
L-arginine
• L-arginine is one of many amino acids the body needs to
function properly.
• Like other amino acids, L-arginine plays a role in building
protein. The body can use the protein to help build muscle
and rebuild tissue.
•Supports calcium absorption & increases bone mass
(i.e prevents osteoporosis)
•Helps support circulation and heart health
•Supports healthy immune system
Sodium Hyaluronate
• Sodium Hyaluronate is a component of synovial fluid,
which also found in subcutaneous tissue.
• It's crucial for the proper development of connective
tissues (tendons) and cartilage.
• It possess good anti-inflammatory properties.
• It helps joints work properly by acting like a lubricant
 Sodium Hyaluronate

• The benefits of hyaluronic acid include its ability to heal

wounds, relieve joint pain, and support bone health. 
• Hyaluronic acid injections can also keep joints well-
lubricated and is an effective treatment for
osteoarthritis.
Collagen Peptide II
• Collagen Peptide is the most abundant collagen found in
cartilage
• It protects cartilages from degeneration from aging
• Promotes cartilage lubrication.
• Reduces inflammation in
synovial membrane.
Chondriotin
• It is a chemical that is normally found in cartilage
around joints in the body.
• It help develop and renew cartilage (the hard
connective tissue mainly located on bones near joints in
the body)
• It also slows the breakdown of cartilage.
- keep it lubricated for better joint movement and
flexibility.
Vitamin C
• Vitamin C is required for the uptake of other nutritents
like Chondroitin
• It also helps to increase absorption of collagen
Indications
• Used as a food supplement for the maintainance of
bone, joint & cartilage .

Dose
• One tablet once daily or as directed by Physicians.
Focus Doctors
• Physicians
• Ortho
• Rehab
• GP
 Nervagest
Pregabalin 75mg

124
 125

Pregabalin
 Pregabalin isa drug used to treat nerve pain. This
type of pain is often not relieved by
traditional painkillers.
 It can be used in combination with
other painkillers to improve your pain relief.
126

VGCC- voltage gated calcium

channel
127
 128

Indication
 Diabetic peripheral neuropathic pain
 Postherapic neuralgia, post traumatic neuralgia
 Fibromyalgia
 Neuropathic pain with spinal cord injury
 Partial seizure
 Neuropathic pain associated with herpes zoster infection,
HIV-related neuropathies, nutritional deficiencies,
toxins, remote manifestations of malignancies and etc.
 Siatica
 129

Side Effects
 Dizziness , Vertigo
 Somnolence
 Peripheral edema
 Weight gain
 Tremor
 Diplopia
 Blurred vision
 Nausea, vomiting
 130

Pharmacokinetics
 It can take with or without food.
 Bioavailability is >90%.
 Dosage adjustment require in renal disease as main
route of excretion is renal route.
 It is not recommended for pregnant women to use
unless the benefits of the medication outweigh the
risk.
 When discontinuing treatment, taper gradually over
minimum of one week.
 131

Dosage
 25 mg upto 300mg
 BD or TDS
 Initial dose followed by increasing weekly upto
300mg.
132
 133

Key Doctors
 Physician (Neuropathic pain, DNP)
 Endocrinologist (Diabetes neuropathic pain)
 Neuromedical (Neuropathic pain, fibromyalgia,
Siatica)
 Ortho (post traumatic neuralgia, Diabetes
neuropathic pain)
 ENT surgeon
 GP
134
Oxamik Injection
Octrotide 0.1mg (100mcg)
Octreotide is a somatostatin analoge.
It mimic the action of somatostatin.
Somatostatin is known as inhibitory hormone of
GI tract and the action include
* Lowers the portal pressure
* Effects on blood vessel – splanic vasoconstriction
(splanic vessels is the vessels which located in GI
tract)
* Inhibit the Glucagon (a hormone which increase
blood sugar level and causes splanic vasodilatation)
* Inhibit pancreatic secretion and GI secretions
* Inhibit the release of Growth hormone

What is Octreotide?
1. Oesophageal Variceal Bleeding

Oesophageal varices are extremely

dilated sub-mucosal veins in the lower
third of the oesophagus.
Can cause bleeding when rupture.
They are most often a consequence of
portal hypertension, commonly due to
cirrhosis.
Octreotide lower the portal pressure and
thereby decrease the variceal bleeding.
And also cause splanic vasoconstriction
and inhibit the glucagon (with is splanic
vasodilator).
Dosage – 50 or 100mcg bolus followed by
continuous IV infusion of 50mcg/hr for 2-
5days Indication
2. Pancreatitis

Pancreatitis is a inflammation of pancreas in

which the pancreatic secretion are leak out
and cause autodigestion of pancreatic tissue
& worsening the disease conditions.
Octrotide can inhibit the pancreatic
secretion therefore can inhibit the
autodigestion effect.
Dosage – 50-100mcg subcutaneously 8hrly or
12 hourly x 3 days

Indication
3. Pancreatic and Gastrointestinal fistula(Internal fistula) &
External fistula

External Pancreatic fistula is drainage of pancreatic fluid through

an abdominal wound or drain tract persisting for more than 7 days.
The most common cause is complication of pancreatic surgery or
percutaneous catheter drainage of pseudocysts.
Internal pancreatic fistulas are most commonly caused by
disruption of the pancreatic duct due to chronic pancreatitis. The
chronic pancreatitis is usually alcoholic in origin in adults, and
traumatic in origin in children. They may also be caused by leakage
from a pancreatic pseudocyst.
Octreotide inhibit pancreatic secretion thereby reduce the output
of fistula.
Also accelerate the closure of fistula in 80% of
patients.
Dosage – 50-100mcg subcutaneously 8hrly or 12 hourly x 3 days
Indication
4. Gastro-entero Pancreatic endocrine
tumor (GEP endocrine tumor)

GEP Endocrine tumors are tumors which

produce gastrointestinal secretions &
pancreatic secretions.
Octreotide inhibit GI secretion and
pancreatic secretion thereby allows
symptoms free period in hypersecretory
patient.
Dosage – 150 – 300 mcg/day

Indication
5. Acromegaly

Acromegaly is a hormonal disorder that

develops when your pituitary gland
produces too much growth hormone during
adulthood. When this happens, your bones
increase in size, including those of your
hands, feet and face.
Octeotide inhibit the growth hormone
secretion.
Dosage – 100mcg subcutaneously x 3 times
a day and late increase upto 500mcg/dose

Indication
6. Diarrhea

Prolongs gastrointestinal transit time.

Decrease endogenous fluid secretion in
jejunum.
Stimulate the intestinal absorption of water
and electrolytes.
In AIDS related diarrhea, octreotide induces
a significant response.
Dosage – 50 – 500mcg/day subcutaneously

Indication
* Hypersensitivity
* Headache
* Bradycardia(reduce heart rate)
* Development of gall stone – 15 to 30% of
patients of subcutaneous octreotide.
* Hypo/hyperglycemia
* Need in glucose monitoring in patient with
Diabetes.
* Decrease B12 levels (in long term use)
* Localized pain, edema or rash at injection site
* Diarrhea
* Constipation
* Nausea, Vomiting

Side Effects
* Absorption is rapid.
* Half Life – 1.7 hr
* Bioavailability – SC,IV – 100%, IM-60%
* Metaboilzed by Liver
* Excretion – renal route
* Use with caution in case of hepatic and renal impairmet.
* It has to keep in cold chain (2-8’C).

Pharmacokinetic
CEPHALOSPORIN

1
 WHAT IS CEPHALOSPORINS?

• Obtained from fungus Cephalosprium

• Bactericidal by inhibiting bacterial cell wall synthesis
• Broad spectrum antibiotics
• Used as alternative to penicillins in penicillin resistant
infections and in penicillin allergic patients

2
CLASSIFICATIONS OF
CEPHALOSPORINS
Cephalosporin drugs are divided into different generations
depending upon their microbial spectrum.
• First generation
• Second generation
• Third generation
• Fourth generation
• Fifth generation

3
CEFIXIME & CEFDINIR

• Cefdinir and Cefixime are partially man made (semi-

synthetic) 3rd generation antibiotics that belong to the drug
class called cephalosporins.
• Bacteria cannot survive without a cell wall, so
Cephalosporins prevent the bacteria from multiplying,
which then prevents bacteria from forming the walls that
surround them.

4
AKUDINIR 300
CAPSULES

152
 INDICATION
AKUDINIR (CEFDINIR)
Community-acquired pneumonia
Acute exacerbations of Chronic Bronchitis
Acute Maxillary Sinusitis
Pharyngitis
Tonsillitis
Acute Bacterial Otitis Media
Uncomplicated skin and skin structure infections
6
 AKUDINIR (CEFDINIR)
A POTENT 3RD GENERATION CEPHALOSPORIN

Mechanism of Action(MOA)
Cefdinir binds and inactivate Penicillin binding protein,
thus inhibit bacterial cell wall synthesis

7
 CEFDINIR DOSAGE (ADULT)
• Cefdinir is taken once or twice daily, depending on the type and
severity of the infection.
• For adult infections the usual dose is 300 mg every 12 hours or
600 mg per day for 5-10 days depending on the nature and severity
of the infection.
• The capsules or suspension can be taken with or without
food.
• Patients with advanced kidney disease may need to take
lower doses to prevent accumulation of cefdinir since it
is eliminated from the body by the kidneys.
155
 CEFDINIR DOSAGE (CHILDREN)

• The recommended dose for children 6 months to 12

years of age is 7 mg/kg every 12 hours or 14 mg/kg per
day for 5-10 days depending on the type of infection.
• For most infections, once daily dosing is as effective as
twice daily dosing, although once daily dosing has not
been evaluated for the treatment of skin infections or
pneumonia.
156
 CEFDINIR IN PREGNANCY

• Cefdinir has been assigned to pregnancy category B

by the FDA. Animal studies have revealed evidence
of maternal toxicity (decreased body weight gain) and
decreased fetal body weight.
• There are no controlled data in human pregnancy.
Cefdinir should be given during pregnancy only if
need is clearly established.
11
POWERXIME 100/200,
POWERXIME DRY SYRUP
&
CECEC-100/200

158
 INDICATION

CECEC & POWERXIME (100/200MG)

 Respiratory tract infections

 Urinary tract infections
 Gonorrhea ( Sexually transmitted Infection - STI)
 Typhoid Fever

13
 8.10.18

CEFIXIME DOSAGE

• The recommended adult dose for middle ear infections,

tonsillitis, sore throat, strep throat, and urinary tract
infections  is 400 mg once daily or divided and given as 200
mg every 12 hours.
• Pediatric patients (6 months and older) have a
recommended dose of 8 mg/kg/day once daily or in two
doses of 4/mg/kg every 12 hours.

160
BETTER SAFETY & EFFICACY OF
CEFIXIME

161
 8.10.18

162
 NSAIDs
(Non-Steroidal Anti-Inflammatory Drugs)
&
Joint Supplement
 OSTEOARTHRITIS(OA)

 Osteoarthritis is a chronic disease of the joints that

causes patients to suffer a progressive functional
disability.

 This disease is not age-related, but once patent, it

progresses with aging(1-3). It is related to a loss of
joint functional ability, and is characterized by
continuous pain.
 Rheumatoid Arthritis(RA)

Is a chronic disease that cause pain, stiffness,

swelling and loss of function in the joints and
inflammation in other body organs.
 Ankylosing Spondylitis

Is an inflammatory disease of the spine and large

joints.
 Gout

Is a disorder characterized by sudden, recurring

attacks of pain and inflammation in one or more
joints.
 COXMIL
60 MG & 90 MG
Salient Features of Etoricoxib

 Standard care for the treatment of pain, fever and inflammatory

diseases
 Rapid onset of action

 Inhibition of cyclooxygenase (COX) – 2, with unwanted side

effects dependent of COX-1: gastrointestinal toxicity

 Inhibition of platelet aggregation and aspirin-sensitive asthma

 One of the latest COX-2 selective inhibitors

 Low G.I side effect

Indication of etoricoxib

For the symptomic relief of ….

1. Osteoarthritis (OA)
2. Rheumatoid Arthritis (RA)
3. Ankylosing Spondylitis

4. Acute Gouty Arthritis

5. Fever
7.7.2018
 ANTIBIOTIC
INJECTIONS
ANTIBIOTIC INJECTIONS

 Izepenem Injection (Meropenem)

 Pipera-T Injection (Piperacillin & Tazobactam )
 Tapim – 1000 Injection ( Cefepime )
 Cefoperan Injection (Cefoperazone & Sulbactam)
 Evozid Injection ( Ceftazidime )

Manufactured by-
BKRS (India) & PharmEvo ( Pakistan)
IZEPENEM 500MG/ 1G INJECTION
( MEROPENEM )

 Beta-lactam antibiotic , Carbapenam family

(Penicillin- like antibiotic)
 Active against Gram positive, Gram negative
(including Pseudomonus) & anaerobic bacteria
 Broad spectrum antibacterial agent
(intravenous)
 Inhibit bacterial cell wall synthesis
 Bactericidal
MEROPENEM

 Overall spectrum is similar to Imipenam

Meropenam is more active against Gram-
negative
less active against Gram - positive
bacteria
 Bioavailability – 100 %
 Half life – 1 hr
MEROPENEM
Indications
 Lower Respiratory tract infections

( pneumonia)
 Skin & Skin structure infections
 Complicated intra-abdominal infections
 Complicated Urinary Tract infections(UTIs)
 Meningitis
 Septicemia
 Febrile Neutropenia
MEROPENEM
Doses
Adult dose - 500 mg or 1 g (1000 mg) 8 hourly
according to the disease conditions
Child dose – 10 – 40 mg/kg 8 hourly according
to the disease conditions

 Dosage should be reduced in renal impaired

patients
 Pregnancy Category B (should be used only if
clearly needed)
MEROPENEM
Side Effects
 Hypersensitivity
 Severe stomach pain
 Diarrhoea
 Convulsions
 Lightheadedness
 Shortness of Breath
 Anaemia
MEROPENEM
Unique Selling points
 Exhibits greater efficacy rate (95.5%) as
compared to imipenem/cilastatin in the
treatment of moderate to severe
intra-abdominal infections
 Shows greater efficacy in the treatment of
febrile neutropenia than ceftazidime
 Safely used in penicillin allergic patients
MEROPENEM
Focus Doctors
 Physicians
 Chest Physicans
 Renal Physicians
 GI Physicians
 Hematologists
 Oncologists
 Neurologists
 Anaestheologists
PIPERA – T 4.5 G INJECTION
(PIPERACILLIN 4 GM & TAZOBACTAM 0.5 MG)

Piperacillin
 Penicillin (Beta-lactam antibiotic)
 active against Gram – Positive & Gram –
negative bacteria (including Pseudomonus)
 but it can be destroyed by Beta-lactamase
producing bacteria
Tazobactam
 β – lactamase inhibitor
PIPERA – T 4.5 G INJECTION
(PIPERACILLIN 4 GM & TAZOBACTAM 0.5 MG)
Combination
 Enhance the activity of piperacillin in
eradicating bacterial infections
 So kill more bacteria ( broad spectrum)
 Bactericidal
PIPERA – T 4.5 G INJECTION
Indications
 Pnemonia
 Skin & Skin structure infections
 Complicated intra-abdominal infections (Appendicitis,
Peritonitis)
 Urinary Tract infections(UTIs)
 Menigitis
 Septicemia
 Febrile Neutropenia
 Postpartum endometritis and pelvic inflammatory
disease
 Bone & Joint Infections
 As Propylative in preoperative cases
PIPERA – T 4.5 G INJECTION

 Doses
Adult dose - 4.5 g- 6 hourly (4 times per day)
for 7-10 Days according to the disease
condition
Child dose – 90 – 100 mg/kg 6 hourly
PIPERA – T 4.5 G INJECTION
Side Effects
 Hypersensitivity
 Diarrhoea
 Insomia
 Nausea
 Fever
 Oral candidiasis
PIPERA – T 4.5 G INJECTION
Unique Selling Points
 Exhibits superior cure rates & bacteriological
eradication rates compared to
imipenam/cilastatin in nosocomial
pneumonia
 Accurate pre-operative choice for
appendicitis complications
 Provides adequate concentration in abscess
as compared to Vancomycin ,Ciprofloxacin
PIPERA – T 4.5 G INJECTION
Focus Doctors
 Physicians
 Chest Physicans
 Renal Physicians
 GI Physicians/Surgeons
 Neurologists
 Hematologists
 Oncologists
 Anaesthologists
 Surgeons
 Ortho
 OG
CEFEPIME INJECTION
 Fourth generation cephalosporin
 Empirical (Broad spectrum) antibiotic with more
coverage to Gram (-) than Ceftazidime and better
coverage to Gram (+) than ceftriazone.
 Has poor activity against beta lactamase producing
bacteria.
 MOA – destroy the bacteria cell wall and kill the
bacteria (Bactericidal activity).
 CEFEPIME INJECTION
 Indications
 Pneumonia
 Urinary Tract Infection
 Skin/ skin structure infection
 Intra-abdominal infection
 Febrile neutropenia
 Poorly cross the Blood Brain Barrier; therefore cannot
use in menigitis.
 Dosage
 IVCefepime 1G 12Hr or 30-50mg/kg in pediatric patients
 Dosage adjustment require in renal impairment patients
 CEFEPIME INJECTION
 Side Effects
 Hypersensitivity reaction (have to do test dose before injection)
 Pain at injection site
 Increased liver enzyme
 Antibiotic induced diarrhea
 Nausea and vomiting
 Safely used in pregnancy.
 Mainly excreted by urine.
 Penetrates into inflammatory fluid is nearly 80%
and into bronchial muscle is nearly 60%.
CEFEPIME INJECTION
 Focus Doctor
 Physicians
 Surgeon
 GIPhysician
 Hematologist
 Oncologist
 Pediatrician
 Ortho Surgeon
CEFOPERAZONE + SULBACTAM
INJECTION
 Cefoperazone is a third generation
cephalosporin. Active against both Gram (+) &
Gram (-) organisms .It is susceptible to
degradation by β-lactamases which are produced
by certain resistant bacteria.
 Sulbactam inhibits β-lactamase activity, thereby
preventing cefoperazone degradation and
therefore, these two combination has a greater
activity against beta-lactamase producing
bacteria. It does not exert clinically significant
antibacterial effect alone.
CEFOPERAZONE + SULBACTAM
INJECTION
 Indications
 Pneumonia
 Urinary Tract Infection
 Skin/ skin structure infection
 Intra-abdominal infection
 Bone and joint infections
 Gynaecological infections
 Cross the Blood Brain Barrier; therefore can use in
meningitis.
 Dosage
 IVCefoperazone+Sulbactam 1G 12Hr or 20-40mg/kg in pediatric
patients
 Dosage adjustment require in renal and liver impairment patients
 CEFOPERAZONE + SULBACTAM
INJECTION
 Side Effects (~ with cefepime)
 Hypersensitivity reaction (have to do test dose before
injection)
 Pain at injection site
 Increased liver enzyme
 Antibiotic induced diarrhea
 Nausea and vomiting
 Safely used in pregnancy.
 Cefoperazone is mainly excreted by liver via bile and sulbactam
via urine.
CEFOPERAZONE + SULBACTAM
INJECTION

 Focus Doctor
 Physicians
 Surgeon
 GIPhysician
 Ortho Surgeon
 OG
 Neuromedical and neurosurgical
 Pediatrician
CEFTAZIDIME INJECTION
 Brand Name – Evozid
 Chemical Name – Ceftazidime 1g Injection
 Manufacturer – PharmEvo
 Country Origin - Parkistan
 It is a third generation cephalosporin. Active
against both Gram (+) & Gram (-) organisms
includine Pseudomonas infection. More G(-)
activity than G(+).
 Has broad spectrum activity.
CEFTAZIDIME INJECTION
 Indications
 Pneumonia
 Urinary Tract Infection
 Skin/ skin structure infection
 Intra-abdominal infection
 Bone and joint infections
 Gynaecological infections
 Sever infection like sepsis
 Cross the Blood Brain Barrier; therefore can use in
meningitis. (Dosage-2g 8Hrly)
 Dosage
 IVCeftazidime 1G 12Hr/8Hr or 30-50mg/kg in pediatric patients
 Dosage adjustment require in renal and liver impairment patients
 CEFTAZIDIME INJECTION
 Side Effects (~ with cefepime)
 Hypersensitivity reaction (have to do test dose before
injection)
 Pain at injection site
 Increased liver enzyme
 Antibiotic induced diarrhea
 Nausea and vomiting
 Safely used in pregnancy.
 Ceftazidine is mainly excreted via urine.
CEFTAZIDIME INJECTION
 Focus Doctor
 Physicians
 Surgeon
 GIPhysician
 Ortho Surgeon
 OG
 Neuromedical and neurosurgical
 Pediatrician
 Anaesthesia (ICU Care)