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Eisai HI-Eisai / Zuellig Eperisone HCl Spastic paralysis in the following diseases: Cerebrovascular diseases,spastic spinal paralysis, cervical spondylosis, post-operative sequelae (including cerebrospinal tumor), sequelae to trauma (spinal trauma, head injury), amyotrophic lateral sclerosis, cerebral palsy, spinocerebellar degeneration, spinal vascular diseases, and other encephalomyelopathies. Improvement of myotonic symptoms in the following diseases: Cervical syndrome, periarthritis of the shoulder, lumbago. Tension-type headache. Adults: 3 tabs (eperisone HCl 150 mg) daily in 3 divided doses after meals. The dose may be adjusted depending on the patient's age and symptoms. Should be taken with food (Take after meals.). Patients with a history of hypersensitivity to any ingredients of Myonal. Myonal should be administered with care in the following: Patients with a history of drug hypersensitivity, hepatic function disorder. Effects on the Ability to Drive or Operate Machinery: Weakness, lightheadedness, sleepiness or other symptoms may occur. In the event of such symptoms, the dosage should be reduced or treatment discontinued. Patients should be cautioned against engaging in potentially hazardous activities requiring alertness eg, operating machinery or driving a car. Use in pregnancy & lactation: The safety of eperisone HCl in pregnant women has not been established. It should only be used in pregnant women or women suspected of being pregnant if the expected therapeutic benefits are evaluated to outweigh the possible risk of treatment. It has been reported that eperisone HCl is excreted in breast milk in an animal study (in rats). It is advisable to avoid the administration of eperisone HCl to nursing mothers. When eperisone HCl must be used, breastfeeding should be discontinued during treatment. Use in children: Safety in children has not been established (insufficient clinical experience). Use in the elderly: Since the elderly often have a physiological hypofunction, it is advisable to take such measures as the reduction in the dose under careful supervision. Adverse reactions were reported in 416 of 12,315 patients (3.38%). Clinically Significant Adverse Reactions (incidence unknown): Since shock and anaphylactoid reactions may occur, patients should be carefully observed. In the event of symptoms eg, redness, itching, urticaria, edema of the face or other parts and dyspnea etc, treatment should be discontinued and appropriate measures taken. Other Adverse Reactions: Hepatic: Elevation of AST (GOT), ALT (GPT) and AI-P, etc (<0.1%). Since these symptoms may occur, patients should be carefully observed. In the event of such abnormalities, treatment should be discontinued and appropriate measures taken. Renal: Proteinuria and elevation of BUN, etc (<0.1%). In the event of such abnormalities, treatment should be discontinued and appropriate measures taken. Hematologic: Anemia (<0.1%). Hypersensitivity: Rash (0.1-5%). Pruritus (<0.1%). Incidence Unknown: Erythema exudativum multiforme. In the event of such symptoms, treatment should be discontinued. Psychoneurologic: Sleepiness, insomnia, headache and numbness in the extremities (0.1-5%). Stiffness and tremor in the extremities (<0.1%). Gastrointestinal: Nausea/vomiting, anorexia, stomach discomfort, abdominal pain, diarrhea, constipation and thirst (0.1-5%). Stomatitis and feeling of enlarged abdomen (<0.1%). Urinary: Urinary retention, urinary incontinence and feeling of residual urine (<0.1%). General: Weakness, lightheadedness and generalized fatigue (0.1-5%). Muscle hypotonia and dizziness (<0.1%). Others: Hot flushes (0.1-5%). Diaphoresis and edema (<0.1%). Click to view ADR Monitoring Website Myonal should be administered with care when co-administered with methocarbamol. It has been reported that disturbance of visual accommodation occurred after the concomitant use of methocarbamol with tolperisone HCl, an analogue compound. View more drug interactions with Myonal Store at temperatures not exceeding 30C. Protect from moisture. Myonal tablets also contain carnauba wax, carmellose, microcrystalline cellulose, titanium oxide, stearic acid, calcium stearate, sucrose, talc, precipitated calcium carbonate, cornstarch, white shellac, hydroxypropylcellulose, pullulan, povidone K 30, macrogol 6000 and hydrated silicon dioxide as inactive ingredients. Eperisone HCl is 4'-ethyl-2-methyl-3-piperidinopropiophenone HCl. Molecular Formula: C17H25NOHCl. Molecular Weight: 295.85. Eperisone HCl occurs as a white, crystalline powder. It is freely soluble in water, in methanol and in glacial acetic acid, soluble in ethanol, sparingly soluble in acetic anhydride, and practically insoluble in ether. A solution of eperisone HCl in methanol (1 in 100) shows no optical rotation. Melting Point: About 167C (decomposition, after drying). Partition Coefficient: 0.411 (water:1-octanol, 25C). Muscle relaxant. Pharmacology: Skeletal Muscle Relaxation: Inhibition of Experimentally-Induced Muscle Rigidity: Eperisone HCl suppresses intercollicular section-induced decerebrate rigidity ( -rigidity) and ischemic decerebrate rigidity ( -rigidity) in rats dosedependently. Suppression of Spinal Reflexes: In spinal cats, eperisone HCl suppresses mono- and polysynaptic reflex potentials induced through spinal nerve efferent root stimulation to a similar degree. Reduction of Muscle Spindle Sensitivity via -Motor Neurons: Eperisone HCl suppresses the activity of afferent nerve fibers (Ia

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fibers) from human muscle spindles at 20 min after administration. Eperisone HCl suppresses the spontaneous discharge of -motor neurons, but does not act directly on muscle spindles in animals. Accordingly, eperisone HCl reduces muscle spindle sensitivity via the -motor neurons. ++ Vasodilatation and Augmentation of Blood Flow: Vasodilatory Action: Eperisone HCl dilates the blood vessels due to Ca antagonistic action (in guinea pigs) on the vascular smooth muscle and muscular sympatholytic actions (in humans). Augmentation of Blood Flow: Eperisone HCl increases the volume of blood flow in skin, muscle, external and internal carotid arteries and vertebral arteries in humans, monkeys and dogs. Analgesic Action and Inhibition of the Pain Reflex in the Spinal Cord: When eperisone HCl is perfused into the spinal cord of rats, a tail pinch-induced pain reflex is suppressed, but the reflex returns with the withdrawal of eperisone HCl. This suggests that eperisone HCl possesses an analgesic action at the spinal cord level. Facilitation of Voluntary Movement: When eperisone HCl is used in the treatment of spastic paralysis in patients with cerebral apoplexy, it improves the cybex torque cure and electromyogram and facilitates voluntary movements eg, extension and flexion of the extremities, without reducing the muscular force. Pharmacokinetics: Blood Concentration: Eperisone HCl was administered orally to 8 healthy adult male volunteers at a single dose of 150 mg/day for 14 consecutive days and the plasma concentration was determined at days 1, 8 and 14. The time to reach the peak plasma concentration (tmax) ranged from 1.6-1.9 hrs, the plasma concentration (Cmax) was 7.5-7.9 ng/mL, elimination half-life (t1/2) was 1.6-1.8 hrs, and the area under the plasma concentration-time curve (AUC) was 19.7-21.1 nghr/mL. The plasma concentration profiles of eperisone HCl determined at days 8-14 did not significantly vary from those of the 1st day. Clinical Studies: Cervical Syndrome, Periarthritis of the Shoulder and Lumbago: In open-labeled clinical trials and a double-blind, controlled clinical trial undertaken to determine the effects of eperisone HCl on myotonic symptoms associated with these diseases, an efficacy rate of 52.1% (234/449) was achieved. (When fairly effective responses are included, the efficacy rate was as high as 80.4%.) Spastic Paralysis: In opened-labeled clinical trials and a double-blind clincal trial, the usefulness of eperisone HCl has been established for spastic paralysis associated with diseases eg, cerebrovascular disturbances, spastic spinal paralysis or cervical spondylosis. Improvement rates for rigidity and stiffness in patients with spastic paralysis were 42.3% (197/466) and 45.1% (174/386), respectively. MIMS Class ATC Classification Poison Schedule
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Muscle Relaxants M03BX09 - eperisone ; Rx Tab 50 mg (white, sugar-coated) x 100's.

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Pharmacology: Motilium is a specific blocker of dopamine receptors. It speeds gastrointestinal peristalsis, causes prolactin release, and is used as antiemetic and tool in the study of dopaminergic mechanisms. Motilium for patients Motilium Interactions Motilium Contraindications Domperidone should not be used when patient have gastrointestinal hemorrhage, mechanical obstruction or perforation problems. Domperidone accumulation has been reported in patients with hepatic impairment. Additional information about Motilium Motilium Indication: For management of dyspepsia, heartburn, epigastric pain, nausea, and vomiting. Mechanism Of Action: Gastrointestinal emptying (delayed) adjunct; peristaltic stimulant: The gastroprokinetic properties of domperidone are related to its peripheral dopamine receptor blocking properties. Motilium facilitates gastric emptying and decreases small bowel transit time by increasing esophageal and gastric peristalsis and by lowering esophageal sphincter pressure. Antiemetic: The antiemetic properties of domperidone are related to its dopamine receptor blocking activity at both the chemoreceptor trigger zone and at the gastric level. Drug Interactions: Not Available Food Interactions: Take 15 to 30 minutes before meals. Generic Name: Domperidone Synonyms: Not Available Drug Category: Antiemetics; Dopamine Antagonists Drug Type: Small Molecule; Approved Other Brand Names containing Domperidone: Motilium; Nauzelin; Lopac-D-122; Absorption: Fast Toxicity (Overdose): Side effects include galactorrhea, gynecomastia, or menstrual irregularities. Protein Binding: 91%-93% Biotransformation: Not Available Half Life: 7 hours Dosage Forms of Motilium: Tablet Oral Chemical IUPAC Name: 6-chloro-3-[1-[3-(2-oxo-3H-benzimidazol-1-yl)propyl]piperidin-4-yl]-1H-benzimidazol-2-one Chemical Formula: C22H24ClN5O2 Domperidone on Wikipedia: http://en.wikipedia.org/wiki/Domperidone Organisms Affected: Humans and other mammals

Generic Name: Essential Amino Acids Brand Name: Ketosteril Classifications: Ketoanalogs; Essential amino acids Therapeutic Actions: Normalizes metabolic process, promotes recycling product exchange. Reduces ion concentration of potassium, magnesiumand phosphate. Indications Protein energy malnutrition Prevention and treatment of conditions caused by modified or insufficient protein metabolism in chronic renal failure Contraindications: Allergy and hypersensitivity to any content of this drug Hypercalcemia Disturbed amino acid metabolism Caution use for patietn with phenylketonuria Dosage Four to eight tabs TID 1 tab/5kg body weight/day Adverse Hypercalcemia may develop Nursing Considerations Evaluate for any contraindications Take drug as prescribed Warn the patient about possible side effects and how to recognize them Give with food if GI upset occurs Frequently assess for hypercalcemia Pantoprazole Generic Name: Pantoprazole sodium Dosage Form: tablet, delayed release Short-Term Treatment of Erosive Esophagitis Associated With Gastroesophageal Reflux Disease (GERD) Pantoprazole sodium delayed-release tablets USP are indicated in adults for the short-term treatment (up to 8 weeks) in the healing and symptomatic relief of erosive esophagitis. For those adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole sodium delayed-release tablets USP may be considered. Safety of treatment beyond 8 weeks in pediatric patients has not been established. Pediatric indication and usage information in pediatric patients ages five years and older with erosive esophagitis associated with GERD is approved for Wyeth Pharmaceuticals Inc. s Pantoprazole sodium delayed-release tablets. However, due to Wyeth Pharmaceuticals Inc. s marketing exclusivity rights, this drug product is not labeled with that pediatric information. Maintenance of Healing of Erosive Esophagitis Pantoprazole sodium delayed-release tablets USP are indicated for maintenance of healing of erosive esophagitis and reduction in relapse rates of daytime and nighttime heartburn symptoms in adult patients with GERD. Controlled studies did not extend beyond 12 months. Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome Pantoprazole sodium delayed-release tablets USP are indicated for the long-term treatment of pathological hypersecretory conditions, including Zollinger-Ellison syndrome. Pantoprazole Dosage and Administration Indication Dose Frequency

Short-Term Treatment of Erosive Esophagitis Associated With GERD (2.1) Adults 40 mg Once Daily for up to 8 wks

Maintenance of Healing of Erosive Esophagitis (2.1) Adults 40 mg Once Daily

Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome (2.1) Adults 40 mg Twice Daily

See Full Prescribing Information for administration instructions Recommended Dosing Schedule Pantoprazole sodium is supplied as delayed-release tablets. The recommended dosages are outlined in Table 1. Table 1: Recommended Dosing Schedule for Pantoprazole Sodium Delayed-Release Tablets USP Indication Dose Frequency

Short-Term Treatment of Erosive Esophagitis Associated With GERD Adults 40 mg Once Daily for up to 8 weeks*

Maintenance of Healing of Erosive Esophagitis Adults 40 mg Once Daily

Pathological Hypersecretory Conditions Including Zollinger-Ellison Syndrome Adults 40 mg Twice Daily**

* For adult patients who have not healed after 8 weeks of treatment, an additional 8-week course of Pantoprazole sodium delayed-release tablets USP may be considered. ** Dosage regimens should be adjusted to individual patient needs and should continue for as long as clinically indicated. Doses up to 240 mg daily have been administered.

Pediatric dosing information in pediatric patients ages five years and older with erosive esophagitis associated with GERD is approved for Wyeth Pharmaceuticals Inc. s Pantoprazole sodium delayed-release tablets. However, due to Wyeth Pharmaceuticals Inc. s marketing exclusivity rights, this drug product is not labeled with that pediatric information. Administration Instructions Directions for method of administration for each dosage form are presented in Table 2. Table 2: Administration Instructions Formulation Delayed-Release Tablets Route Oral Instructions* Swallowed whole, with or without food

* Patients should be cautioned that Pantoprazole sodium delayed-release tablets USP should not be split, chewed, or crushed. Pantoprazole Sodium Delayed-Release Tablets USP Pantoprazole sodium delayed-release tablets USP should be swallowed whole, with or without food in the stomach. If patients are unable to swallow a 40 mg tablet, two 20 mg tablets may be taken. Concomitant administration of antacids does not affect the absorption of Pantoprazole sodium delayed-release tablets USP. MOA: Pantoprazole is a proton pump inhibitor (PPI) that suppresses the final step in gastric acid production by covalently binding to the (H+, K+)-ATPase enzyme system at the secretory surface of the gastric parietal cell. This effect leads to inhibition of both basal and stimulated gastric acid secretion, irrespective of the stimulus. The binding to the (H+, K+)-ATPase results in a duration of antisecretory effect that persists longer than 24 hours for all doses tested (20 mg to 120 mg).