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FDC - Irrational
FDC - Irrational
HUBLI- 21
Department of Pharmacology
Hydralazine induced –
1) Salt and water retention is counteracted by Bendroflumethiazide.
2) Tachycardia and palpitations are counteracted by propranolol.
General Comments:
The 3 drugs should be prescribed and taken separately and should NOT
be used in fixed dose combination.
***
2. Tab. Betatrop :
Atenolol…………. 50 mg
Nifedipine (SR) …..20 mg
Indications :
1) Moderate to Severe hypertension.
2) Exertional Angina.
Justification :
This combination of the cardioselective β1 receptor blocker Atenolol
and the calcium channel blocker, Nifedipine (an arteriolar dilator)
is used as it provides-
1) An additive antihypertensive effect- Atenolol decreases cardiac
output and Nifedipine decreases peripheral resistance.
General Comments:
The two drugs should be prescribed and taken separately and should
be used in a fixed dose combination form.
***
3) Tab. Enapril - HT : Enalapril ……… 10 mg.
Hydrochlorthiazide ……. 25 mg.
Indication:
1) Moderate to severe hypertension.
2) Congestive Cardiac Failure.
1) It is NOT possible to alter the dose of one drug independent of the other.
Contraindications:
1) Pregnancy.
2) Patients with bilateral renal artery stenosis.
3) Patients suffer
4) ing from persistent cough, as it causes dry persistent cough in
approximately 15% of patients.
General Comments:
The two drugs should be prescribed and taken separately and NOT used as
fixed dose combination tablet.
***
4) Tab. Acezide :
Captopril ………25 mg.
Hydrochlorthiazide …..25 mg.
Indication:
1) Moderate to severe hypertension
2) Congestive cardiac failure
Contraindications:
1) Pregnancy.
2) Patients with bilateral renal artery stenosis.
3) Patients suffering form persistent cough.
General Comments:
The two drugs should be prescribed and taken separately and NOT used as
fixed dose combination.
***
5) Tab. Livogen Captabs : Folic Acid ……… 750 ug
Vitamin B12 …….. 7.5 ug
Ferrous fumarate …… 200 mg
Indications:
To treat anaemias due to Folic acid, Vitamin B12 and Iron deficiency.
Dose and Route:
One tablet 3 times a day after food, orally.
Using all 3 drugs in a fixed dose combination is NOT justified as:
1) It is rare for a person to suffer from Folic acid, Vitamin B 12 and Iron
deficiency at the same time.
General Comment:
Depending on the cause of anaemia, a single specific drug should be used
and such type of shotgun therapy using multiple haematinics in fixed dose
combination should be avoided.
Indications:
Mixed bacterial infections (gram –ve bacilli and penicillinase producing
Staph. aureus), Surgical, Orthopaedic, Respiratory tract, Skin and soft tissue
infections.
Contraindication:
H/O hypersensitivity to penicillin.
General Comment:
Routine use of this fixed dose combination is NOT justifiable.
***
7) Tab. Enteroflox-T : Norfloxacin ……. 400 mg
Tinidazole ……. 600 mg
Contraindications:
1) H/O hypersensitivity to Norfloxacin and / or Tinidazole.
2) Pregnancy.
3) Children.
Special Precaution:
1) Patients predisposed to seizures, having neurological disorders.
2) Avoid alcohol as disulfiram like reaction to Tinidazole will occur.
General Comments:
Its routine use for case of pure amoebic or bacillary dysentery is NOT
rational and hence is NOT recommended.
***
8) Tab. Imol : Ibuprofen ……. 400 mg
Paracetamol ……. 325 mg
Indications:
1) Rheumatoid arthritis.
2) Osteoarthritis.
3) Ankylosing spondylitis.
4) Museculoskeletal disorders.
5) To relive postoperative pain, postpartum pain, toothache.
Contraindications:
1) H/O hypersensitivity to Ibuprofen and / or Paracetemol.
2) Active peptic ulcer.
Special Precautions:
1) Bronchial asthma.
2) Renal, Hepatic or Bleeding disorders.
3) Those receiving Coumarin anticoagulants.
4) Pregnancy.
General Comments:
1) Contraindication to one component e.g. hypersensitivity to Ibuprofen or
Paracetamol contraindicates the whole preparation.
2) This fixed dose combination is NOT rational and hence NOT justifiable.
***
Disadvantages:
Using the 2 drugs in a fixed dose combination has following disadvantages:
4) It is NOT possible to alter the dose of one drug independent of the other.
5) H/O hypersensitivity to any one drug contraindicates the fixed dose
combination tablet.
6) Contraindication to any one drug contraindicates the fixed dose
combination tablet e.g Atenolol is contraindicated in patients having
associated Congestive cardiac failure, sinus bradycardia, A V blocks.
Therefore, this fixed dose combination tablet cannot be used in
hypertensives and patients of exertional. Angina having these associated
diseases.
General Comments:
The two drugs should be prescribed and taken separately and should be used
in a fixed dose combination form.
3) Tablet Enapril - HT : Enalapril - 10 mg.
Hydrochlorthiazide - 25 mg.
Indication:
3) Moderate to sever hypertension.
4) Congestive Cardiac Failure.
5) It is NOT possible to alter the dose of one drug independent of the other.
6) To avoid first does severe hypertensive effect of Enalapril, it is usually
started in small doses of 2.5 mg or 5 mg daily and the thiazide diuretic is
usually stopped. The diuretic therapy is restarted later if required. One
cannot take this precaution if fixed dose combination tablet is used.
Contraindications:
5) Pregnancy.
6) Patients with bilateral renal artery stenosis.
7) Patients suffering form persistent cough. Causes dry persistent cough is
apropos 15% of patients as its causes.
General Comments:
The two drugs should be prescribed and taken separately and NOT used as
fixed dose combination tablets.
4) Tablet Acezide : Captopril - 25 mg.
Hydrochlorthiazide - 25 mg.
Indication:
3) Moderate to severe hypertension
4) Congestive Cardiac Failure
Contraindications:
4) Pregnancy.
5) Patients with bilateral renal artery stenosis.
6) Patients suffering form persistent cough.
General Comments:
The two drugs should be prescribed and taken separately and NOT used as
fixed dose combination.
5) Tablet Livogen Captabs : Folic Acid - 750 ug
Vitamin B12 - 7.5 ug
Ferrous Fumarate - 200 mg
Indication:
To treat anaemias due to Folic acid, Vitamin B12 and Iron deficiency.
Side Effect:
Constipation or gastrointestinal upsets due to Iron fumarate.
General Comment:
Depending on the cause of anaemia, a single specific drug should be used
and such type of shotgun therapy using multiple haematinics in fixed does
combination should be avoided.
6) Capsule Amipiclox : Ampicillin - 250 mg
Cloxacillin - 250 mg
Indication:
Mixed bacterial infections (gram –ve bacilli and penicillinase producing
Staph. aureus), Surgical, Othopaedic, Respiratory Tract, Skin and soft tissue
infections.
Contraindication:
H/O hypersensitivity to penicillin.
General Comment:
Routine use of this fixed dose combination is NOT justifiable.
Contraindications:
4) H/O hypersensitivity to Norfloxacin and / or Tinidazole.
5) Pregnancy.
6) Children.
Special Precaution:
3) Patients predisposed to seizures, having neurological disorders.
4) Avoid alcohol as disulfiram like reaction to Tinidazole will occur.
General Comments:
Its routine use for case of pure amoebic or bacillary dysentery is NOT
rational and hence is NOT recommended.
8) Tablet Imol : Ibuprolen - 400 mg.
Paracetamol - 325 mg.
Indications:
6) Rheumatoid arthritis.
7) Osteoarthritis.
8) Ankylosing spondylitis.
9) Museculoskeletal disorders.
10) To relive postoperative pain, postpartum pain, toothache.
Contraindications:
3) H/O hypersensitivity to Ibuprofen and / or Paracetemol.
4) Active peptic ulcer.
Special Precautions:
5) Bronchial asthma.
6) Renal, Hepatic or Bleeding disorders.
7) Those receiving Coumarin anticoagulants.
8) Pregnancy.
General Comments:
3) Contraindication to one component e.g. hypersensitivity to Ibuprofen or
Paracetamol contraindicates the whole preparation.
4) This fixed dose combination is NOT rational and hence NOT justifiable.