Some Medications Considered Safe for Use During Pregnancy

Some Medications Considered Safe for Use During Pregnancy
Condition	Medication
Asthma	Budesonide inhaled or nasal spray (Pulmicort®, Rhinocort ®)
Bladder infection (UTI)	Nitrofurantoin (Macrobid®)
	- Avoid in patients with possible G6PD deficiency
Cough	Dextromethrophan  (Robitussin DM sugar free ®)
Constipation	Metamucil® , Citrucel®,
	Docusate
	Milk of magnesia.
	Polyethyelene glycol (Miralax®)
Diabetes	Insulin
	Glyburide (Micronase®)
	Metformin (Glucophage®)
Diarrhea	Loperamide (Imodium A-D ®)
Gas	Simethicone
Gastroesophageal reflux disease (GERD),	Ranitidine (Zantac®)
Hayfever, sneezing, runny nose, itchy watery eyes	Chlorpheniramine
	Diphenhydramine                              Clemastine (Tavegyl®)
Headache or fever:	Acetaminophen (APAP,Paracetamol,Panadol, Tylenol®)
Hemorrhoids	Preparation H®
	Anusol
High blood pressure	Methyldopa (Aldomet®)
Hyperprolactinemia	Bromocriptine (Parlodel®)
	Carbergoline (Dostinex®)
Hypothyroidism	Thyroid hormone
	Levothyroxine
Infection	Acyclovir (Zovirax ®)
	Azthitromycin (Zithromax ®)
	Cepaholosporins
	examples: Cephalexin (Keflex®),
	Cefazolin (Ancef ®), cefaclor (Ceclor®)
	Clindamycin (Cleocin®)
	Erythromycin
	Penicillins
	example Amoxicillin (Amoxil®),
	Amoxicillin Clavulanate (Augmentin®),   Amoxicillin-clavulanate has been assigned to pregnancy category B by the FDA Amoxicillin-clavulanate should only be given during pregnancy when need has been clearly established.
	methicillin, carbenicillin
	Metronidazole (Flagyl®)
Insomnia	Doxylamine
Motion sickness	Dimenhydrinate (Dramamine ®)
Nasal congestion	Pseudoephedrine
	-Avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes	Actifed Cold and Allergy ®
	Ingredients: Triprolidine, Pseudoephedrine
	-Avoid in first trimester.
Nasal congestion, sneezing, runny nose, itchy watery eyes, fever, and headache	Actifed Cold and Sinus ®
	Ingredients: Acetaminophen, Chlorpheniramine,
	Pseudoephedrine- Avoid in first trimester.
Nausea	Ginger
	Pyridoxine 25 mg PO TID WITH
	Unisom Sleep Tabs (Doxylamine Succinate 25 mg) 1/2 tablet TID
	Metoclopramide
Preeclampsia	Magnesium sulfate
Vaginal yeast infection	Clotrimazole cream

Recently approved drugs by FDA

AXIRON (testosterone) Topical Solution

Company: Eli Lilly and Company

Date of Approval: November 23, 2010

Treatment for: Hypogonadism -- Male

Axiron (testosterone) is an androgen indicated for replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone.

Gablofen (baclofen) Injection

Company: CNS Therapeutics

Date of Approval: November 19, 2010

Treatment for: Cerebral Spasticity, Chronic Spasticity

Gablofen (baclofen) is a gamma-aminobutyric acid (GABA) ergic agonist indicated for use in the management of severe spasticity.

XGEVA (denosumab) Injection

Company: Amgen Inc.

Date of Approval: November 18, 2010

Treatment for: Osteolytic Bone Metastases of Solid Tumors

Xgeva (denosumab) is a RANK ligand (RANKL) inhibitor indicated for the prevention of skeletal-related events in patients with bone metastases from solid tumors.

HALAVEN (eribulin mesylate) Injection - formerly E7389

Company: Eisai Co., Ltd.

Date of Approval: November 15, 2010

Treatment for: Breast Cancer

Halaven (eribulin mesylate) is a microtubule inhibitor indicated for the treatment of patients with metastatic breast cancer.

EGRIFTA (tesamorelin) Injection

Company: Theratechnologies

Date of Approval: November 10, 2010

Treatment for: Reduction of Excess Abdominal Fat in HIV-Infected Patients with Lipodystrophy

Egrifta (tesamorelin) is a synthetic analogue of growth hormone releasing factor (GRF) for the treatment of excess abdominal fat in HIV patients with lipodystrophy.

KOMBIGLYZE XR (saxagliptin and metformin) Extended-Release Tablets

Company: Bristol-Myers Squibb Company and AstraZeneca

Date of Approval: November 5, 2010

Treatment for: Diabetes Mellitus Type II

Kombiglyze XR (saxagliptin and metformin) is a once-daily fixed dose combination of the dipeptidyl peptidase-4 (DPP-4) inhibitor Onglyza (saxagliptin) and extended release metformin for the treatment of type 2 diabetes.

OFIRMEV (acetaminophen) Intravenous Injection - formerly Acetavance

Company: Cadence Pharmaceuticals, Inc.

Date of Approval: November 2, 2010

Treatment for: Fever, Pain

Ofirmev (acetaminophen) is an intravenous analgesic product for the treatment of acute pain and fever in adults and children.

اهم الادوية اللى اتسحبت من السوق واللى اتغيرت بياناتها نتيجة اكتشاف اعراض جانبية جديدة حسب منظمة الغذاء والدواء العالمية(FDA)

انا جمعت احدث واهم الادوية اللى اتسحبت واللى اكتشف ليها اعراض جانبية جديدة وتم التنبيه عليها وايه الاسباب او الاعراض الجانبية اللى اتسحب عشانها .

مثلا سيبوترامين اتسحب عشان خطورته ع القلب

وفى حاجات ما اتسحبتش بس اكتشفولها خطوره

مثال فوزاماكس بيعالج هشاشة العظام اكتشفو انه بيعمل كسور فى عظام الفخذ

و زينيكال اكتشفو انه ليه تاثير مضر ع الكبد

وغير كده انا جمعتهم كلهم 

لعلاج الهشاشة ممكن يسبب هشاشة !!!!Bisphosphonates(fosamax) (10/13/2010)

The U.S. Food and Drug Administration (FDA) is updating the public regarding information previously communicated describing the risk of atypical fractures of the thigh, known as subtrochanteric and diaphyseal femur fractures, in patients who take bisphosphonates for osteoporosis.  This information will be added to the Warnings and Precautions section of the labels of all bisphosphonate drugs approved for the prevention or treatment of osteoporosis.

اتسحبMeridia (sibutramine) (10/8/2010)         

The U.S. Food and Drug Administration (FDA) is recommending against continued prescribing and use of Meridia (sibutramine) because this drug may pose unnecessary cardiovascular risks to patients. FDA has requested that Abbott Laboratories—the manufacturer of Meridia—voluntarily withdraw this drug product from the United States market. Abbott has agreed to voluntarily stop marketing of Meridia in the United States.

Lamictal (8/12/2010)

The U.S. Food and Drug Administration (FDA) is informing the public that Lamictal (lamotrigine)^†, a medication commonly used for seizures in children two years and older, and bipolar disorder in adults, can cause aseptic meningitis. FDA is revising the Warnings and Precautions section of the drug label and the patient Medication Guide to include information about this risk.

اتسحب فى مصر  Xenical (5/26/2010)

The U.S. Food and Drug Administration (FDA) has approved a revised label for Xenical to include new safety information about cases of severe liver injury that have been reported rarely with the use of this medication. The agency is also adding a new warning about rare reports of severe liver injury to the OTC Drug Facts label for Alli and is working with the manufacturer to ensure that consumers can understand this new warning.

بعد استخدام اكتر من سنة ممكن يسبب هشاشةProton pump inhibitors (05-25-2010)

The U.S. Food and Drug Administration (FDA) is revising the prescription and over-the-counter (OTC) labels for a class of drugs called proton pump inhibitors to include new safety information about a possible increased risk of fractures of the hip, wrist, and spine with the use of these medications.The new safety information is based on FDA's review of several epidemiological studies that reported an increased risk of fractures of the hip, wrist, and spine with proton pump inhibitor use. Some studies found that those at greatest risk for these fractures received high doses of proton pump inhibitors or used them for one year or more.

Prepared & collected by Dr M .Gomaa from FDA official website.

جرعة الباراسيتامول للكبار والاطفال والحد الاقصى اليومى paracetamol dose

الباراسيتامول كلنا عارفين انه اشهر وأأمن مسكن لكن لازم نعرف الجرعه المناسبة عشان ما يبقاش خطير ويبتدى يعمل مشاكل على الكبد وخصوصا فى الاطفال
الجرعة باختصار
الكبار: 1جرام 3مرات  والجرعه لاتتعدى 4جرام فى اليوم
الاطفال:10مجم لكل كجم من وزن الطفل والجرعه لا تتعدى 4 مرات يوميا
الاطفال عمر شهرين بعد التطعيم ياخدو 60مجم يعنى حوالى 2.5 مللى من ادول لانه بيحتوى على (120مج / 5مل)
الجرعات كلها مجمعه فى الجدول ده

Age	Dose
ADULT	two 500mg tablets (i.e. 1gm paracetamol) every four to six hours, not exceeding eight tablets (4gms) in any 24 hour period يعنى 1 جرام 3 مرات واقصى حاجه 4 جرام
Children in general	In general, children's dosages are based on a single dose of 10mg paracetamol per kilogram bodyweight, which can be repeated 4-6 hourly, not exceeding four doses per 24 hours الاطفال عموما جرعتهم 10 مجم لكل كيلو جرام من وزن الطفل بحيث ماتزيدش عن 4 جرعات فى اليوم
2 month old child	following immunisation as a single dose of 60mg (i.e. 2.5mL paracetamol liquid (oral suspension) at a strength 120mg per 5 mL).يعنى 2.5 مللى من ادول شراب جرعة واحدة بس بعد التطعيم
children under 3 months	10mg paracetamol per kilogram bodyweight. If child with jaundice only 5mg/kg لو الطفل عنده صفرا لازم الجرعه تقل النص
3 months to 1 year	a dose of between 60mg and 120mg (i.e. 2.5mL to 5mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.
1 to 5 years	120mg to 250mg (i.e. 5mL to 10mL of paracetamol liquid (oral suspension) at a strength of 120mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.
6 to 12 years	250mg to 500 mg (i.e. 5mL to 10mL paracetamol liquid (oral suspension) at a strength of 250mg/5mL) may be repeated every 4-6 hours to a maximum of 4 doses in 24 hours.

فيديو عن امتصاص الدواء بعد اخذة عن طريق الفم

http://www.youtube.com/watch?v=xiuWdJYyIKs&feature=player_embedded#!

معلومات هامة جدا عن الفرق بين انواع منع الحمل وكيفية اختيار النوع الامثل

وكلامى الان عن الحبوب وخصوصا الانواع الموجودة فى الصيدلية والتى دائما يتم سؤالنا عن الفرق بينهم

فمثلا

ما الفرق بين مارفيلون وياسمين وجينيرا و ميكرو جينون و سيلست وميكرولوت وسيرازيت

بالنسبة لمكونات كل نوع من انواع الحبوب فى الصيدلية قد جمعتها فى الجدول التالى

TRADE NAME	ESTROGEN PART	PROGESTIN PART
YASMIN	Ethinyl estradiol 0.030 mg	Drospirenone 3.000 mg
GYNERA		Gestodene 0.075 mg
MARVELON		Desogestrel 0.150 mg
MICROGYNON 30		Levonorgestrel 0.15 mg
GRACIAL	Ethinyl estradiol 0.040 mg (7 blue tab)	Desogestrel 0.025 mg (7 blue tab)
	Ethinyl estradiol 0.030 mg (15 white tab)	Desogestrel 0.125 mg (15 white tab)
LOGYNON	Ethinyl estradiol 0.03 mg (6 light brown tab)	Levonorgestrel 0.05 mg (6 light brown tab)
	Ethinyl estradiol 0.04 mg (5 white tab)	Levonorgestrel 0.075 mg (5 white tab)
	Ethinyl estradiol 0.03 mg (10 ochreous tab)	Levonorgestrel 0.125 mg (10 ochreous tab)
CILEST	Ethinylestradiol 0.035 mg	Norgestimate 0.250 mg
DIANE-35	Ethinylestradiol 0.035 mg	Cyproterone acetate 2mg
progestin only pills :
CERAZETTE		Desogestrel 0.075 mg
MICROLUT		Levonorgestrel 0.03 mg
ORGAMETRIL		Lynestrenolum 5 mg

من هذا الجدول يتضح ان

 الشق الاستروجينى تقريبا واحد فى كل انواع منع الحمل من نوع COCPs

الحبوب المحتوية على استروجين فقط مثل ميكرولوت وسيرازيت وهى غالبا تستخدم مع الرضاعة

اذا ما الفرق بين الانواع الاخرى

كل الانواع تتفق معا فى قدرتها على منع الحمل ولكن الاختلاف الان فى التاثيرات الجانبية

وتختلف التاثيرات الجانبية حسب الشق البروجيستينى وذلك لاننا قلنا انهم متفقون فى شق الاستروجين

بالنسبة للشق البروجيستينى

يكون له خواص بروجيستينيه وخواص اندروجينية(تستوستيرون ) وكل واحدة من هذه الخواص مسئولة عن بعض الاعراض الجانبية

فمثلا الخواص الاندروجينية قد تسبب ظهور الشعر او حبوب الشباب

والجدول التالى يوضح كل عرض جانبى و المناسب له من حيث قوة الشق البروجيستينى وخواصه التى يجب مراعاتها لتجنب هذا التاثير الغير مرغوب

Problem	Principal
Acne	higher estrogen, lower androgen potency
Break-through bleeding	higher estrogen, higher progestin potency, lower androgen potency
Absent or too light menstrual flow	higher estrogen, lower progestin potency
Depression & Moodiness or irritability	lower progestin potency
Headaches (not menstrual migraines)	lower estrogen, lower progestin potency
Breast soreness	lower estrogen, lower progestin potency
Weight gain	lower estrogen, lower progestin potency
Severe menstrual cramps	higher progestin potency
Endometriosis or endometriosis prevention	lower estrogen, higher progestin potency, higher androgen potency
Breast feeding	progestin only (ESTROGEN suppress milk production)

توضيح الجدول

مثال التاثير الاول ACNE

المطلوب لتقليل هذا التاثير هو خواص استروجينية عالية واندروجينية منخفضة( higher estrogen, lower androgen potency (

بالنسبه للاستروجين كلهم واحد

اذا المطلوب شق بروجيستينى له خواص اندروجينية منخفضة

وهكذا بالنسبه لجميع التاثيرات فى الجدول السابق

كيف نعرف الفرق بينهم فى الخواص ؟

الجدول التالى يوضح الفرق بين الانواع الموجودة فى الصيدلية من حيث الخواص

Progestin	Progestational Activity	Androgenic Activity	e.g
	(relative to 1 mg of norethindrone)	(relative to 1 mg of norethindrone)
norethindrone 1 mg	1	1
norethrindrone acetate 1 mg	1.2	1.6
levonorgestrel 1 mg	5.3	8.3	(microlut & logynon & microgynon)
norgestimate 1 mg	1.3	1.9	(cilest)
desogestrel 1 mg	9	3.4	(marvelon & gracial)
drospirenone 1 mg	1.5	0	(yasmin
cyproterone	<1	antiandrogen	(diane 35)
gestodene	12.6	8.6	(gynera)

بناءا على هذا الجدول والجدول الذى قبلة يمكننا الان ان نستنتج بطريقه علميه وبسيطه ماهو انسب نوع منع حمل لكل حالة

فقد تاتيك حالة فى الصيدلية استخدمت مثلا ميكرو جينون وحدث لها حب شباب وتريد ان تغيره

انت الان بعد هذه الاساسيات تستطيع ان تختار لها نوع يكون خواصه الاندروجينيه منخفضه مثل ياسمين

وبناءا على هذه الخواص فقد قمت بعمل جدول مقترح فيه اختيار نوع منع الحمل المناسب لكل حاله وهى مجرد اقتراحات وكل واحد بناءا على هذا الاساس العلمى يستطيع ان يختار المناسب

واليكم الجدول

Choice of the best contraceptive according to case problems
Problem	Principal	Best one
Acne	higher estrogen, lower androgen potency	YASMIN ,CILEST ,DIAN35
Break-through bleeding	higher estrogen, higher progestin potency, lower androgen potency	MARVELON , GRACIAL ,YASMIN
Absent or too light menstrual flow	higher estrogen, lower progestin potency	YASMIN ,CILEST
Depression & Moodiness or irritability	lower progestin potency	YASMIN ,CILEST
Headaches (not menstrual migraines)	lower estrogen, lower progestin potency	YASMIN ,CILEST
Breast soreness	lower estrogen, lower progestin potency	YASMIN ,CILEST
Weight gain	lower estrogen, lower progestin potency	YASMIN ,CILEST
Severe menstrual cramps	higher progestin potency	GYNERA, MARVELON , GRACIAL, MICROLUT
Endometriosis or endometriosis prevention	lower estrogen, higher progestin potency, higher androgen potency	GYNERA,MICROGYNON , LOGYNON
Breast feeding	progestin only (ESTROGEN suppress milk production)	MICROLUT ,CERAZETT

اتمنى ان تكون هذه المعلومات مفيدة للجميع وان لا يكون فيها تعقيد

ونسال الله عزوجل ان ينفعنا واياكم بما علمنا