DALACIN-C 600mg/4ml I.M/I.V Price

Overview

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This medicine contains an important and useful components, as it consists of
Clindamycin (as phosphate)is available in the market in concentration

Name

Allopurinol

Precaution

- Allopurinol should be used with caution in patients with a history of renal impairment, as the drug is primarily excreted through the kidneys. Dose adjustment is necessary in individuals with reduced kidney function to prevent the accumulation of the drug and minimize the risk of adverse effects. - Patients with a history of gout flare-ups should be closely monitored when initiating therapy, as a flare-up may occur early in treatment. Starting with a low dose and gradually increasing it can help minimize this risk. - Allopurinol should be used with caution in individuals with hepatic impairment, as liver function may be affected, and dose adjustments may be necessary. - Long-term use of allopurinol may increase the risk of developing kidney stones, particularly in patients with a history of kidney disease or dehydration. Adequate hydration should be maintained during therapy. - Severe hypersensitivity reactions, including skin rashes, fever, and liver damage, can occur. Patients should be educated about the signs and symptoms of such reactions and seek immediate medical attention if any occur. - Use with caution in patients with a history of peptic ulcer disease or gastrointestinal issues, as allopurinol can cause nausea, vomiting, and abdominal discomfort. - In patients undergoing chemotherapy or radiation, allopurinol should be used cautiously, as it may increase the risk of toxicity due to altered metabolism in cancer treatments. - It is important to monitor patients for signs of hepatitis or liver dysfunction, especially during prolonged therapy.

Indication

- Allopurinol is primarily indicated for the treatment of gout, a condition caused by the accumulation of uric acid crystals in joints. It works by reducing uric acid production in the body, which helps to prevent gout attacks. - It is also indicated in the management of hyperuricemia associated with certain cancers or chemotherapy, where high levels of uric acid can lead to complications like tumor lysis syndrome. - Allopurinol is used to prevent kidney stones in patients with elevated uric acid levels, particularly those with a history of recurrent uric acid stones. - The drug is also prescribed for the treatment of hyperuricemia in conditions like psoriasis, and in some cases, it may be used to manage elevated uric acid levels in patients with certain metabolic disorders, including Lesch-Nyhan syndrome. - It is sometimes used off-label for other conditions involving elevated uric acid levels or hyperuricemia, though these indications are less common.

Contra indication

- Allopurinol is contraindicated in patients who are hypersensitive to the drug or any of its components. Serious skin reactions, including Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), have been reported, and allergic reactions can be severe. - It should not be used during acute gout attacks, as it can exacerbate symptoms in the short term. Allopurinol is more effective as a preventive treatment rather than for the management of an acute flare. - The drug is contraindicated in patients with a history of severe liver or kidney dysfunction, especially in those with a creatinine clearance below 20 mL/min, as its metabolism and clearance can be significantly impaired. - It should be avoided in pregnant women unless the benefits outweigh the risks, and it is generally not recommended during breastfeeding, as the safety profile in these populations is not well-established. - Allopurinol is contraindicated in patients with a history of certain skin conditions or severe hypersensitivity reactions to other medications, particularly those causing toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome (SJS). - It should not be combined with certain other drugs like azathioprine or mercaptopurine, as it can increase their toxicity.

Side Effect

- Common side effects of allopurinol include gastrointestinal symptoms such as nausea, vomiting, diarrhea, and abdominal discomfort. These are typically mild and improve over time. - Skin rashes are the most common adverse effect, and in some cases, these can be severe and lead to life-threatening conditions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), especially in those with a genetic predisposition. - Some patients may experience headaches, dizziness, or fatigue, which can impact daily activities. - Allopurinol can lead to liver function abnormalities, and in rare cases, severe liver toxicity or hepatitis can occur. Routine liver function monitoring is advised during long-term treatment. - Rarely, allopurinol can cause blood disorders such as leukopenia, thrombocytopenia, or anemia. Regular blood counts are recommended during therapy. - Renal issues such as interstitial nephritis or worsening kidney function can occur, particularly in those with pre-existing renal conditions. - In some cases, allopurinol may lead to an increase in uric acid levels during the initial phase of treatment before the levels begin to drop, potentially triggering an acute gout attack. - Long-term use can increase the risk of kidney stones, especially in patients who are dehydrated or who do not maintain proper hydration during treatment. - Less common side effects include dizziness, hair loss, and conjunctivitis (eye inflammation).

Pregnancy Category ID

3

Mode of Action

- Allopurinol works by inhibiting xanthine oxidase, an enzyme responsible for converting purines into uric acid. By inhibiting this enzyme, allopurinol decreases the production of uric acid in the body. - This reduction in uric acid levels prevents the formation of urate crystals that accumulate in the joints, which is the underlying cause of gout attacks. By lowering uric acid, it also helps to reduce the risk of kidney stones and other complications associated with hyperuricemia. - Allopurinol’s action does not directly relieve the pain of an acute gout attack; instead, it is used as a long-term treatment to prevent future flare-ups by keeping uric acid levels within a normal range. - The drug also helps reduce the risk of kidney damage and other complications related to excess uric acid in the bloodstream, such as in conditions like tumor lysis syndrome or in patients undergoing chemotherapy. - Allopurinol can be used in conjunction with other medications to manage acute gout attacks, but its primary role is in preventing the recurrence of gout and managing hyperuricemia in the long term.

Interaction

- Allopurinol may interact with other medications that affect the metabolism of purines, such as azathioprine or mercaptopurine. These drugs are metabolized by xanthine oxidase, and when used in combination with allopurinol, their effects can be potentiated, leading to toxicities. - Diuretics, particularly thiazide diuretics, can increase the risk of allopurinol-related side effects, such as kidney dysfunction or hyperuricemia, especially when dehydration occurs. - Allopurinol can increase the blood levels of certain drugs, such as the anticoagulant warfarin, increasing the risk of bleeding. Monitoring of INR (international normalized ratio) is necessary when initiating or adjusting therapy with warfarin. - Medications that affect renal function, such as cyclosporine, may increase the risk of renal toxicity when used with allopurinol. Close monitoring of renal function is recommended. - The use of allopurinol in combination with other medications that lower uric acid, such as probenecid, may be considered, but these should be used with caution due to the potential for increased uric acid crystal formation during the initial phase of treatment. - Antacids, such as aluminum or magnesium hydroxide, can interfere with the absorption of allopurinol, reducing its effectiveness. It is recommended to space the dosing of allopurinol and antacids apart. - The use of allopurinol with certain antifungal agents, such as fluconazole, may increase the blood concentration of allopurinol, necessitating dose adjustment.

Pregnancy Category Note

Information not available

Adult Dose

- The typical starting dose for allopurinol in the treatment of gout is 100 mg once daily. The dose may be gradually increased based on the patient’s uric acid levels and response to therapy. - The usual maintenance dose is between 200-300 mg daily, but higher doses (up to 800 mg daily) may be necessary for patients with more severe gout or high uric acid levels. Doses should be titrated carefully. - For patients with impaired renal function, a reduced dose is recommended. The dose may be adjusted based on creatinine clearance, with a typical starting dose of 50-100 mg per day for those with mild to moderate renal impairment. - Allopurinol is typically taken once a day, but in cases of severe renal impairment, the dose may be divided to prevent accumulation of the drug.

Child Dose

- Allopurinol is generally not recommended for use in children under 6 years of age unless directed by a physician. For children older than 6 years, the dose of allopurinol is typically calculated based on body weight. - The usual pediatric starting dose for gout or hyperuricemia is 2-10 mg/kg per day, depending on the severity of the condition and renal function. - For children with mild to moderate renal impairment, dose adjustments are required to avoid toxicity, and the drug should be prescribed under close medical supervision. - Long-term use in children should be monitored closely, and any adverse effects, particularly on renal function, should be addressed promptly.

Renal Dose

- In patients with mild renal impairment (creatinine clearance >50 mL/min), the usual starting dose of allopurinol is 100 mg daily, and it may be gradually increased as needed. - For moderate renal impairment (creatinine clearance 30-50 mL/min), the starting dose should be reduced to 50-100 mg daily, and adjustments should be made based on the patient’s response. - In patients with severe renal impairment (creatinine clearance <30 mL/min), the dose should be reduced further to 50 mg or less, with careful monitoring of renal function and possible dose adjustments. - Allopurinol should be used with caution in patients with advanced kidney disease, as the risk of toxicity increases when the drug accumulates in the body. Regular monitoring of renal function is required to ensure safe dosing.

Administration

Information not available