1.

Noveron

Indications Listed in Dosage.

Adult : IV Facilitate endotracheal intubation; Muscle relaxant in

Dosage general anaesth; Facilitate mechanical ventilation in intensive care
Initial: 600 mcg/kg by inj. Maintenance: 150 mcg/kg by inj or by infusion
at 300-600 mcg/kg/hr.
Intravenous
Dosage Details Facilitate endotracheal intubation, Facilitate mechanical ventilation
in intensive care, Muscle relaxant in general anaesthesia
Adult: Initially, 600 mcg/kg by inj. Higher doses of 1 mg/kg may be used
for intubation during rapid sequence induction of anaesth. Maintenance:
150 mcg/kg by inj (may reduce to 75-100 mcg/kg for prolonged
inhalational anaesth) or by infusion at 300-600 mcg/kg/hr.
Child: Same as adult dose.
Elderly: Maintenance: 75-100 mcg/kg.

Obese patients (≥130% of ideal body wt): Reduce dose, based on ideal
Special Patient
body wt. Biliary tract disease: Maintenance: 75-100 mcg/kg by inj or
Group
300-400 mcg/kg/hr by infusion.

Renal
Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.
Impairment

Hepatic
Maintenance: 75-100 mcg/kg by inj or 300-400 mcg/kg/hr by infusion.
Impairment

Alkaline soln; amphotericin, amoxicillin, azathioprine, cefazolin,

Incompatibility cloxacillin, dexamethasone, diazepam, enoximone, erythromycin,
famotidine, furosemide, hydrocortisone Na succinate, insulin, intralipid,
methohexital, methylprednisolone, prednisolone Na succinate, thiopental,
trimethoprim, vancomycin. Y-site: Micafungin.
Patient w/ biliary tract disease, neuromuscular disease, previous
Special poliomyelitis, burn injury, severe electrolyte disturbances, Eaton-Lambert
Precautions syndrome, myasthenia gravis, CV disease, resp disease, pulmonary HTN;
obese patients. Renal and hepatic impairment. Elderly. Pregnancy and
lactation.

Changes in vital signs, prolonged neuromuscular block, myopathy; inj

Adverse Drug
site pain/reaction.
Reactions
Potentially Fatal: Anaphylaxis.

ROUTE(S) : Parenteral
Pregnancy
Category (US
 Category C: Either studies in animals have revealed adverse effects on
FDA) the foetus (teratogenic or embryocidal or other) and there are no
controlled studies in women or studies in women and animals are not
available. Drugs should be given only if the potential benefit justifies the
potential risk to the foetus.

Monitoring
Monitor heart rate, BP, twitch response, assisted ventilation status.
Parameters

Symptoms: Prolonged neuromuscular blockade. Management: Maintain

Overdosage patent airway, controlled ventilation and adequate sedation. May
administer an anticholinesterase agent in conjunction w/ an appropriate
anticholinergic agent once recovery from neuromuscular block is
observed.
Increased effect w/ halogenated volatile anaesth (e.g. enflurane,
Drug isoflurane), antibiotics (e.g. aminoglycoside, lincosamide and polypeptide
Interactions antibiotics, acylamino-penicillin antibiotics), diuretics, quinidine, quinine,
Mg and lithium salts, Ca channel blockers, local anaesth, acute admin of
phenytoin or β-blocking agents, corticosteroid (long-term use) and after
intubation w/ suxamethonium. Decreased effect w/ Ca chloride and KCl,
protease inhibitors (e.g. gabexate, ulinastatin), chronic admin of
phenytoin or carbamazepine.
Description: Rocuronium competes for nicotinic cholinoreceptors at the
Mechanism of motor end-plate, resulting to neuromuscular blockade.
Action Onset: Good intubation conditions: W/in 1-2 min. Max neuromuscular
blockade: W/in 4 min.
Duration: Approx 30-50 min.
Pharmacokinetics:
Distribution: Volume of distribution: Approx 0.25 L/kg. Plasma protein
binding: Approx 30%.
Metabolism: Minimally hepatic, converted to 17-desacetylrocuronium
(main metabolite).
Excretion: Via urine (up to 40% w/in 24 hr) and bile. Elimination half-
life: Approx 1.2-1.4 hr.

Storage Store between 2-8°C. Protect from light.

MIMS Class Neuromuscular Blocking Agents

M03AC09 - rocuronium bromide ; Belongs to the class of other

ATC
quaternary ammonium-containing agents used as peripherally-acting
Classification
muscle relaxants.
2. Ketamin

Indications Induction of anaesth.

Dosage Adult : IV 1-4.5 mg/kg as inj or infuse 0.5-2 mg/kg. IM 6.5-13 mg/kg.

Intramuscular
Dosage Details Induction of anaesthesia
Adult: 6.5-13 mg/kg. A dose of 10 mg/kg produces surgical anaesth w/in 3-4
min after inj lasting for 12-25 min. Increments of half to the full induction dose
may be repeated as needed for maintenance of anesth. For diagnostic or other
procedures not involving intense pain: 4 mg/kg as initial dose.

Intravenous
Induction of anaesthesia
Adult: 4.5 mg/kg via slow IV inj over 60 sec. A dose of 2 mg/kg produces
surgical anaesth w/in 30 sec after inj lasting for 5-10 min. Increments of half to
the full induction dose may be repeated as needed for maintenance of anesthesia.
Alternatively, a total induction dose of 0.5-2 mg/kg via infusion, given at an
appropriate rat, and maintained at 10-45 mcg/kg/min, adjusted according to
response.
50 mg/mL and 100 mg/mL vials may be further diluted in 5% dextrose or 0.9%
Reconstitution NaCl to prepare a maintenance infusion containing 1 mg/mL (or 2 mg/mL in
patients w/ fluid restrictions).

Incompatibility Barbiturates and diazepam.

Patient w/ HTN, eclampsia or pre-eclampsia, severe coronary or myocardial

Contraindications
disease, cerebrovascular accident or cerebral trauma.

Patient w/ cardiac decompensation, chronic alcoholic or acutely alcohol-

Special intoxicated patients, pre-anaesth elevated CSF pressure, globe injuries, increased
 intraocular pressure (e.g. glaucoma), neurotic traits or psychiatric illness (e.g.
Precautions schizophrenia, acute psychosis), acute intermittent porphyria, seizures,
hyperthyroidism, pulmonary or upper resp infection, intracranial mass lesions,
head injury, or hydrocephalus, hypovolaemia, dehydration, cardiac disease esp
coronary artery disease (e.g. CHF, myocardial ischaemia, MI). Pregnancy and
lactation.
Emergence reactions (e.g. vivid dreams, hallucinations, confusion, irrational
Adverse Drug behaviour); increased muscle tone sometimes resembling seizures; temporary
Reactions HTN and tachycardia, hypotension, bradycardia, arrhythmias, apnoea,
laryngospasm, resp depression, diplopia, nystagmus, nausea, vomiting,
lacrimation, hypersalivation, raised intraocular and CSF pressure, transient rash
and pain at inj site, cystitis.
ROUTE(S) : Parenteral
Pregnancy
Category (US
FDA)
Category B: Either animal-reproduction studies have not demonstrated a foetal
risk but there are no controlled studies in pregnant women or animal-
reproduction studies have shown an adverse effect (other than a decrease in
fertility) that was not confirmed in controlled studies in women in the 1 st
trimester (and there is no evidence of a risk in later trimesters).

Patient Avoid driving, operating hazardous machinery or engaging in hazardous

Counselling activities w/in 24 hr or more after anaesth.

Monitor heart rate, BP, resp rate, transcutaneous oxygen saturation, emergence
Monitoring
reactions. Cardiac function should be continuously monitored in patients w/
Parameters
increased BP or cardiac decompensation.

Symptoms: Resp depression. Management: Employ supportive ventilation.

Overdosage
Mechanical support of respiration is preferred to admin of analeptics.

Prolonged recovery time w/ barbiturates or narcotics. May potentiate

Drug Interactions neuromuscular blocking effects of atracurium and tubocurarine including resp
depression w/ apnoea. May increase risk of bradycardia, hypotension or
decreased cardiac output w/ halogenated anaesthetics. May potentiate CNS
depression and risk of resp depression w/ CNS depressants (e.g. phenothiazines,
sedating H1-blockers, skeletal muscle relaxants). May antagonise hypnotic effect
of thiopental. May increase risk of HTN w/ thyroid hormones. May increase risk
of hypotension w/ antihypertensive agents. Reduction in seizure threshold
resulting in unpredictable extensor-type seizures when given concurrently w/
theophylline.

Food Interaction May potentiate CNS depression when used concurrently w/ alcohol.

Description: Ketamine is a noncompetitive N-methyl-D-aspartate receptor

Mechanism of antagonist that blocks glutamate. It has a direct action on the cortex and limbic
Action system. It produces a cataleptic-like state wherein the patient is withdrawn from
the surrounding environment.
Onset: 30 sec (IV); 3-4 min (IM).
Duration: 5-10 min (IV); 12-25 min (IM).
 Pharmacokinetics:
Absorption: Rapidly absorbed following parenteral admin.
Distribution: Crosses the placenta. Volume of distribution: 3 L/kg.
Metabolism: Hepatic biotransformation to norketamine (active metabolite).
Other metabolic pathways include hydroxylation of the cyclohexone ring and
conjugation w/ glucuronic acid.
Excretion: Via urine as metabolites. Elimination half-life: 10-15 min (alpha
phase); 2.5 hr (beta phase).

Storage Store between 20-25°C.

MIMS Class Anaesthetics - Local & General

3. Durogesic

Manufacturer Johnson & Johnson

Contents Fentanyl
Management of chronic & intractable pain in patients requiring
Indications/Uses
continuous opioid administration for an extended period of time.
Individualised based upon the status of the patient & should be
assessed at regular intervals after application. Patch should be replaced
Dosage/Directions every 72 hr. Initial dose selection: Appropriate initiating dose should be
for Use based on patient's current opioid use. Ped Should be administered only
to opioid-tolerant ped patient (>2 yr) who are already receiving at least
30 mg or oral morphine equiv/day.
Special Precautions Use in the management of acute post-op pain may result in serious
hypoventilation/resp depression, opioid-naive & non-opioid tolerant
states, chronic pulmonary disease, drug dependence, increased
intracranial pressure; cardiac, hepatic & renal diseases; fever. Childn.
 Elderly.
Hypoventilation, nausea, vomiting, constipation, somnolence,
Adverse Reactions confusion, hallucination, euphoria, pruritus & urinary retention.
View ADR Monitoring Form
CNS depressant drugs. Ritonavir, ketoconazole, itraconazole,
Interactions troleandomycin, nelfinavir, nefazodone, verapamil, diltiazem,
amiodarone.
Preg Safety (US) C, D (if prolonged use/high doses at term)
MIMS Class Analgesics (Opioid)
N02AB03 - fentanyl ; Belongs to the class of phenylpiperidine
ATC Classification
derivative opioids. Used to relieve pain.
Regulatory
G
Classification
Presentation/Packing
Form Packing/Price
Durogesic transdermal patch
5 × 1's
12 mcg/hr
Durogesic transdermal patch
5 × 1's (Rp600,000/boks)
25 mcg/hr
Durogesic transdermal patch
5 × 1's (Rp1,080,000/boks)
50 mcg/hr

4. Trilac

Manufacturer Novell Pharma

Contents Triamcinolone acetonide
IA: Synovitis of OA, RA, acute & subacute bursitis, acute gouty
arthritis, epicondylitis, acute nonseptic tenosynovitis & post-traumatic
OA. Intradermal: Keloids, discoid lupus erythematosus, necrobiosis
Indications/Uses
lipoidica diabeticorum, alopecia areata & localized hypertrophic,
infiltrated, inflammatory lesions of lichen planus, psoriatic plaques,
granuloma annulare & neurodermatitis.
Dosage/Directions IA/IB Initially 2.5-5 mg for smaller joints & 5-15 mg for larger joints.
for Use Max: ≥20 mg. Intradermal Initially 1 mg/inj site.
Administration Should be taken with food.
Contraindications Systemic fungal infections. Idiopathic thrombocytopenic purpura.
Special Precautions Hypothyroidism, cirrhosis, ocular herpes simplex,
hypoprothrombinemia, nonspecific ulcerative colitis, diverticulitis,
 fresh intestinal anastomoses, active or latent peptic ulcer, renal
insufficiency, HTN, osteoporosis, acute glomerulonephritis, vaccinia,
varicella, exanthema, Cushing's syndrome, antibiotic-resistant
infections, DM, CHF, thromboembolitic tendencies, thrombophlebitis,
convulsive disorders, metastatic carcinoma, myasthenia gravis.
Prolonged use & abrupt discontinuation. Renal disease. Pregnancy &
lactation.
Fliud & electrolyte disturbance; musculoskeletal, GI, dermatologic &
endocrine disorders; convulsions, increased intracranial pressure w/
papilloedema, vertigo, headache, neuritis, paresthesias, aggravation of
preexisting psychiatric conditions; posterior subcapsular cataracts,
Adverse Reactions increased IOP, glaucoma, exophthalmos; hyperglycemia, glycosuria,
-ve nitrogen balance, necrotizing angiitis, thrombophlebitis,
thromboembolism, aggravation or masking of infections, syncopal
episodes.
View ADR Monitoring Form
Phenytoin, phenobarb, rifampicin, corticosteroids, diuretics,
Interactions
hypoglycemics, anticholinesterases, salicylates.
Preg Safety (US) C, D (in 1st trimester)
MIMS Class Corticosteroid Hormones
H02AB08 - triamcinolone ; Belongs to the class of glucocorticoids.
ATC Classification
Used in systemic corticosteroid preparations.
Regulatory
G
Classification
Presentation/Packing
Form Packing/Price
Trilac powd for inj 40
(vial) 1 mL x 1's (Rp80,000/vial)
mg/mL
Trilac powd for inj 10
(vial) 5 mL x 1's (Rp90,000/vial)
mg/mL
Trilac tab 4 mg 3 × 10's (Rp70,000/boks)
Manufacturer: Novell Pharma
5. Epineprin + Lidokain

Indications Listed in Dosage.

Adult : Inj Local or regional anesth; Nerve blocks; Epidural and

Dosage caudal anesth Per mL preparation contains lidocaine HCl 20 mg and
epinephrine 5 mcg: Dosage depends on factors such as route, type and
extent of surgical procedure, duration of anesth and patient's condition
and age. Max dose of lidocaine given w/ epinephrine: 7 mg/kg and not
>500 mg.
Injection
Dosage Details Local or regional anaesthesia, nerve blocks, epidural and caudal
anaesthesia
Adult: Per ml prep contains lidocaine HCl 20 mg and epinephrine 5
mcg. Dosage depends on several factors such as route, type and extent
of surgical procedure, duration of anaesthesia and patient's condition
and age. Max dose of lidocaine given with epinephrine: 7 mg/kg and not
 >500 mg.
Child: 3 mth-12 yr: Per ml prep contains lidocaine HCl 20 mg and
epinephrine 5 mcg. Dosage depends on several factors such as route,
type and extent of surgical procedure, duration of anaesthesia and
patient's condition and age. Max dose 3 mg/kg. Ideal body weight
should be used in children with high body weight.

Can be diluted if necessary in glucose 5%, sodium chloride 0.9% and

Reconstitution
lactated Ringer's solution.

Y-site administration: ampicillin, thiopental, ampthotericin B cholesteryl

Incompatibility sulphate complex; in syringe: cefazolin, sodium bicarbonate; when
admixed: aminophylline, hyaluronidase, mephentemine, amphotericin
B, decarbazine, methohexital and thiopental.

Tachycardia, hypertension, cerebral arteriosclerosis, ischaemic heart

Contraindications
disease, IV admin, anaesthetise digits or appendages, myasthenia gravis.

Epilepsy, impaired cardiac conduction, CHF, DM, closed angle

Special glaucoma, impaired liver function (if site of admin is likely to result in
Precautions high blood levels), severe renal dysfunction. Local anaesthetic effect
may be reduced if injected into an inflamed or infected area.
Cerebrovascular insufficiency, hyperthyroidism. Neonates, elderly,
patients in poor general condition (optimise patient's condition before
major block), pregnancy.
Severity of adverse effects in CNS and CVS are directly related to blood
Adverse Drug levels of lidocaine; the effects are more likely to occur after systemic
Reactions administration rather than infiltration; dizziness; muscle twitching; local
anaesthetic of mouth/throat impairs swallowing and increases the risk of
aspiration (patients cautioned against eating or drinking for 3-4 hr after
anaesthesia); transient effect on auditory system of neonate; erythema;
pigmentation; pain; headache; palpitations; local necrosis; pulmonary
oedema; hyperglycaemia; bradycardia; reduced cardiac output; anxiety.
Epidural may cause hypotension, bradycardia, nausea and vomiting.
Intraoral inj may cause stress reactions such as diaphoresis, palpitation,
hyperventilation, generalised pallor and faintness. Topically: papules,
burns, rash, skin irritation, burning sensation and blanching.
Potentially Fatal: Severity of adverse effects in CNS and CVS related
to blood levels of lidocaine; effects more likely to occur after systemic
administration rather than infiltration. CNS toxicity (due to inadvertent
IV admin), medullary depression with tonic & clonic convulsions;
ventricular fibrillation; severe hypertension with cerebral haemorrhage
and pulmonary oedema; unconsciousness; possibly respiratory arrest.
Allergic reactions including anaphylactic symptoms and possibly life
threatening asthmatic episodes in susceptible patients may occur due to
sodium metabisulphate constituent. Central nerve blocks may cause CV
depression (especially in hypovolaemia). Retrobulbar inj may reach
subarachnoid space causing CV collapse, apnoea, convulsions,
temporary blindness. Paracervical block may cause foetal
bradycardia/tachycardia (careful monitoring of foetal heart rate is
 necessary).
Lidocaine has a narrow therapeutic index. Symptoms: dizziness,
Overdosage paresthesia, sedation, confusion, coma, seizures, ataxia; respiratory
arrest, pulmonary oedema; arrhythmias, cardiac toxicity (sinus arrest,
AV block, asystole, and hypotension); QRS and QT intervals are usually
normal, although they may be prolonged after massive overdose; renal
failure; metabolic acidosis and hypertension which may result in
subarachnoid haemorrhage and hemiplegia. Treatment: supportive and
symptom specific. Lidocaine not removed by haemofiltration.
Significance of interaction depends on route of delivery and systemic
Drug Interactions exposure; lidocaine prolongs duration of action of suxamethonium;
benzodiazepines & barbiturates raise the convulsive threshold to
lidocaine; vasopressors potentiate pressor effects of adrenaline; BP may
increase with non-selective β-blockers, TCAs, halogenated inhalational
anaesthetics and α-blockers; general anaesthetics may increase
sensitivity of myocardium to dysrhythmic effects of epinephrine;
lidocaine may increase levels and effects of benzodiazepines, calcium
channel blockers, ciclosporine, aminophylline, fluvoxamine, mexiletine,
mirtazapine, ropinirole, theophylline, trifluoperazine, dextromethorphan,
fluoxetine, nefazodone, paroxetine, risperidone, TCAs and venlafaxine.
Levels and effects of lidocaine may be increased by propranolol,
chlorpromazine, delavirdine, fluoxetine, miconazole, pergolide,
quinidine, quinine, ritonavir, ropinirole, cimetidine, azole antifungals,
clarithromycin, diclofenac, doxycycline, erythromycin, isoniazid,
nicardipine and verapamil. Lidocaine may decrease levels and effects of
codeine, hydrocodone, oxycodone, tramadol, carbamazepine, nafcillin,
nevirapine, phenobarbital, phenytoin and rifamycins. Midazolam,
cisapride, ergot alkaloids, lovastatin and simvastatin are not
recommended in combination with lidocaine.
Potentially Fatal: Possible additive cardiac effects with amiodarone
(ECG monitoring should be considered).

St John's Wort may reduce lidocaine level, avoid; ephedra and yohimbe
Food Interaction
may cause CNS stimulation, avoid.

Lidocaine may increase creatinine phosphokinase which may interfere

Lab Interference
with diagnosis of MI.

Description: Lidocaine is a local anaesthetic which decreases

Mechanism of permeability of sodium ions, blocking induction and conduction of
Action nerve impulses. Combination with epinephrine restricts systemic spread
of lidocaine, vascular absorption and its duration of local anaesthetic
effect.
Onset: Peak effect: approx 5 min.
Duration: Approx 2 hr; dose and anaesthetic procedure dependant.
Pharmacokinetics:
Absorption: Topical: lidocaine: minimal; epinephrine: minimal; readily
absorbed from GI tract, mucous membranes, damaged skin, inj sites
including muscle.
 Distribution: Crosses placenta and blood-brain barrier. Volume of
distribution: lidocaine: 1.1-2.1 L/kg, altered by many patient factors eg
CHF, liver disease. Protein binding: lidocaine: 60-80% to α 1 acid
glycoprotein.
Metabolism: Lidocaine: 90% via hepatic 1st pass metabolism to active
metabolites which can cause CNS toxicity. Epinephrine: metabolised by
monoamine oxidase and catechol-o-methyltransferase taken up in the
adrenergic neuron; circulating ephedrine is hepatically metabolised.
Excretion: Lidocaine: elimination half life: 2 hr; excreted via urine
(<10% unchanged). Ephedrine: excreted via urine as inactive
metabolites and small amounts of unchanged drug.

Protect from light. Transdermal systems: 20-25 °C. Inj: store at 2-8 °C
Storage
and discard within 3 days of opening.

MIMS Class Anaesthetics - Local & General