Interactions

Your healthcare professionals (e.g., doctor or pharmacist) may already be aware of any possible drug
interactions and may be monitoring you for it. Do not start, stop or change the dosage of any
medicine before checking with them first.
Storage
Store at or below 77 degrees F (25 degrees C) in a dry place away from light and moisture. Do not
store in the bathroom. Keep all medicines away from children and pets.
Nursing Responsibilities
-Instruct the patient to refer to the health care professionals if the symptoms worsen
-Assess the client’s history

2. Drugs Affecting the Male Reproductive System

2.1 Androgens
Brand Name: Androderm

Administration
Prior to initiating therapy, confirm the diagnosis of hypogonadism by ensuring that serum
testosterone concentrations have been measured in the morning on at least two separate days and
that these serum testosterone concentrations are below the normal range
Adverse Effects
Abnormal dreams, Acne, Anaphylaxis, Bladder irritability, Breast soreness, Cholestatic jaundice, Deep
vein thrombosis, Dry skin, Fatigue, Gynecomastia, Headache, Insomnia, Menstrual irregularities,
Priapism, Suppression of factors II, V, VII and Virilization
Pregnancy
Contraindicated in pregnant women; drug is teratogenic and may cause fetal harm when
administered to a pregnant woman based on data from animal studies and its mechanism of action;
exposure of female fetus to androgens may result in varying degrees of virilization
Action
Endogenous androgen; promotes growth and development of male sex organs and maintains
secondary sex characteristics in androgen-deficient males
Uses
This medicated patch contains testosterone. It is used for hormone replacement in men who are not
able to produce enough testosterone (for example, due to hypogonadism). This medication is
absorbed through the skin, enters your bloodstream, and helps your body reach normal
testosterone levels.
Nurse responsibilities
- Read the Patient Information Leaflet provided by the pharmacist before start using testosterone
and each time get a refill.
-Notice the client for any questions, and llow the patient if needs for products for the skin and allow
the patient to know the undesirable effects
- Read the dosing instructions carefully for each product. Do not change products without prefer
doctor or pharmacist
-Instruct the patient about the dosages, If any symptoms may occur inform immediately.
Side Effects
Itching, irritation, and discomfort at the application site may occur during the first few days as your
body adjusts to the patch. Other side effects may include acne, headache, hair loss, anxiety, and a
change in sexual desire.
STORAGE:
Store patches in their protective pouches at room temperature away from heat, light and moisture.
Do not store in the bathroom.

2.2 Anabolic Steroids

Nursing Responsibilities:
The health care provider should instruct patients to report immediately any use of warfarin and any
bleeding.
The health care provider should instruct patients to report any of the following side effects of
androgens.
Adult or Adolescent Males: Too frequent or persistent erections of the penis, appearance or
aggravation of acne.
Women: Hoarseness, acne, changes in menstrual periods or more hair on the face.
All Patients: Any nausea, vomiting, changes in skin color or ankle swelling.
Generic Name: oxymetholone
Brand Name: Anadrol-5

Side Effects
·diarrhea, excitation, restlessness,
·trouble sleeping (insomnia), or
·breast swelling in men.
Dosage
The recommended daily dose of Anadrol-50 in children and adults is 1-5 mg/kg body weight per day.
The usual effective dose is 1-2 mg/kg/day but higher doses may be required, and the dose is
individualized. Response is not often immediate, and three to six months should be given
INDICATIONS
treatment of anemias caused by deficient red cell production. Acquired aplastic anemia, congenital
aplastic anemia, myelofibrosis and the hypoplastic anemias due to the administration of myelotoxic
drugs often respond.
ANADROL Tablets should not replace other supportive measures such as transfusion, correction of
iron, folic acid, vitamin B12 or pyridoxine deficiency, antibacterial therapy and the appropriate use of
corticosteroids.
DOSAGE AND ADMINISTRATION
The recommended daily dose in children and adults is 1-5 mg/kg body weight per day. The usual
effective dose is 1-2 mg/kg/day but higher doses may be required, and the dose should be
individualized. Response is not often immediate, and a minimum trial of three to six months should
be given. Following remission, some patients may be maintained without the drug; others may be
maintained on an established lower daily dosage. A continued maintenance dose is usually
necessary in patients with congenital aplastic anemia.
DRUG INTERACTIONS
Warfarin: Clinically significant pharmacokinetic and pharmacodynamic interactions between anabolic
steroids and warfarin have been reported in healthy volunteers. When anabolic steroid therapy is
initiated in a patient already receiving treatment with warfarin, the INR
(international normalized ratio) or prothrombin time (PT) should be monitored closely and the dose
of warfarin adjusted as necessary until a stable target INR or PT has been achieved. Furthermore, in
patients receiving both ANADROL Tablets and warfarin, careful monitoring of the INR or PT and
adjustment of the warfarin dosage, if indicated, are recommended when the ANADROL dose is
changed or discontinued. Patients should be closely monitored for signs and symptoms of occult
bleeding.
Anticoagulants: Anabolic steroids may increase sensitivity to oral anticoagulants. Dosage of the
anticoagulant may have to be decreased in order to maintain the desired prothrombin time. Patients
receiving oral anticoagulant therapy require close monitoring, especially when anabolic steroids are
started or stopped.
Drug/Laboratory Test Interferences
Therapy with androgenic anabolic steroids may decrease levels of thyroxine-binding globulin
resulting in decreased total T4 serum levels and increased resin uptake of T3 and T4. Free thyroid
hormone levels remain unchanged and there is no clinical evidence of thyroid dysfunction. Altered
tests usually persist for 2 to 3 weeks after stopping anabolic therapy.
CONTRAINDICATIONS
Carcinoma of the prostate or breast in male patients., Carcinoma of the breast in females with
hypercalcemia;, androgenic anabolic steroids may stimulate osteolytic resorption of bones,
Oxymetholone can cause fetal harm when administered to pregnant women. It is contraindicated in
women who are or may become pregnant. If the patient becomes pregnant while taking the drug,
she should be apprised of the potential hazard to the fetus, Nephrosis or the nephrotic phase of
nephritis, Hypersensitivity to the drug andSevere hepatic dysfunction.

·Anavar (oxandrolone)
·Dianabol (methandienone )
·Winstrol (stanozolol)
·Restandol (testosterone undecanoate)

2.3 Drugs for Treating Penile Erectile Dysfunction

Brand name: Viagra
Generic Name: Sildenafil
Uses
to treat male sexual function problems (impotence or erectile dysfunction-ED). In combination with
sexual stimulation, sildenafil works by increasing blood flow to the penis to help a man get and keep
an erection.
Side Effects
Dizziness, headache, flushing, or stomach upset may occur. Vision changes such as increased
sensitivity to light, blurred vision, or trouble telling blue and green colors apart may also occur.
Interactions
can cause a serious drop in your blood pressure when used with nitrates. A serious drop in blood
pressure can lead to dizziness, fainting, and rarely heart attack or stroke. Do not use sildenafil with
any of the following: certain drugs used to treat chest pain/angina (nitrates such as nitroglycerin,
isosorbide), recreational drugs called "poppers" containing amyl nitrate, amyl nitrite, or butyl nitrite.
Storage
Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all
medications away from children and pets.
Do not flush medications down the toilet or pour them into a drainage
Nurse Responsibilities
-Educate the patient that This drug does not protect against sexually transmitted diseases, To
reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying
position, and This drug may make you dizzy or cause vision problems. Alcohol or marijuana
(cannabis) can make you more dizzy.
- Read the Patient Information Leaflet provided by your pharmacist before the patient start taking
sildenafil and each time get a refill.

3. Drugs for STD

Generic name: Ceftriaxone
Brand name: Cephalosporins

Indication
In patients with significant renal disease and hepatic dysfunction, maximum dose is 2 g/day. In
patients receiving intermittent hemodialysis, give 1 to 2 I.V. every 24 hours after dialysis session.
Administration
-Before giving drug, ensure patient is not allergic to penicillins or cephalosporins
-Obtain specimen for culture and sensitivity tests before giving first dose. Begin therapy while
awaiting results
Adverse Reaction
-Skin: Pain, induration, tenderness at injection site and rash
-Other: Hypersensitivity reactions, serum sickness, anaphylaxis
Interactions
Aminoglycosides: May increase nephrotoxicity and cause synergestic effect against some strains of
Pseudomonas aeruginosa and Enterobateriaceae species
Contraindication
-Patients with hypersensitive to drug or other cephalosporins
-Use cautiously in patients hypersensitive to penecilin because of possibility of cross-sensitivity with
other beta-lactum antibiotics
Nurse Responsibilities
-Monitor for patients for superinfection, diarrhea, and anemia and treat appropriately
-Tell the patient to report adverse reaction promptly
-Instruct patient to report discomfort at I.V.
-Tell patient to notify prescriber about loose stools or diarrhea

J. Drugs Affecting Fluid and Electrolyte Balance

Brand name: Bisalax
Generic name: Bisacodyl
Manufacturer: Cipia
Distributor: Phil Pharmawealth
General Action
Constipation & bowel evacuation before investigational procedures or surgery.
Dosage/Direction for Use/ Nursing responsibilities
Constipation Adult 5-15 mg tab daily at night or 10 mg supp in the morning. Complete bowel
evacuation 10 mg up to 20 mg by mouth, followed by 10 mg supp the next morning. Childn >10 yr
Same as adult dose; <10 yr 5 mg rectally in the morning for constipation; >4 yr 5 mg by mouth
alternatively at night. Bowel evacuation 15 mg by mouth the night before & 5 mg rectally the
morning of the procedure.
Contraindications
Abdominal discomfort eg, colic or cramps. Diarrhea w/ excessive loss of water & electrolytes in
prolonged use. Possibility of developing atonic non-functioning colon.
Adverse Reactions
Irritation & proctitis or sloughing of the epithelium in repeated use.
Brand name: Movelax
Generic name: Lactulose
General Action / Uses Chronic & habitual constipation & for patients who will benefit from
soft stools. Prevention & treatment of portal systemic encephalopathy (PSE). Hepatic
coma.
Side effects
Flatulence, abdominal cramps (generally transient), hypernatremia, nausea, vomiting, diarrhea in
excessive dose.
Nursing responsibilities
May be taken with or without food: May be taken w/ meals to reduce GI discomfort. Dilute w/ water,
milk, or fruit juice to improve taste.
Dosage/Direction for Use
Chronic & habitual constipation & for patients who will benefit from soft stools Adult & childn >10 yr
15-30 mL as a single dose or in 2 divided doses, doses up to 45 mL/day may be used; 5-10 yr 10 mL
bid; 1-5 yr 5 mL bid; <1 yr 2.5 mL bid. Adjust doses according to patient's response. 24-48 hr may be
needed to produce normal bowel movement for constipation. Prevention & treatment of PSE Adult
& elderly Initially 30-50 mL tid. Subsequent doses should be adjusted to produce 2-3 soft stools
daily. Prevention of hepatic coma Adult Initially 25 mL tid. Subsequent doses should be adjusted to
obtain soft stools.
Special Precautions
Perform a thorough bowel cleansing w/ a nonfermentable soln prior to electrocautery procedures
during proctoscopy or colonoscopy. DM, lactose intolerance, unusual diarrhea. Monitor periodically
serum electrolytes (ie, K, Cl, CO2) in elderly & debilitated patients using lactulose for >6 mth.

K. Nutritional Supplements
Brand Name: Enervon Activ
Generic Name:ascorbic acid + calcium carbonate + colecalciferol
Uses: Nutritional supplement to help promote optimum physical & mental performance.
Side effects Nicotinamide (>100 mg/day): Flushing of the face, arms & chest. Fe (doses of elemental
Fe >120 mg/day): GI effects eg, nausea, vomiting, bloating & upper abdominal discomfort. Ginseng
(high doses >3 g/day): HTN, nervousness, insomnia, edema, diarrhea & skin reactions. Royal jelly:
Hypersensitivity reactions eg, eczema, rhinitis, urticaria & bronchospasm.
Nursing responsibilities: make sure to educate patient on taking this as it says on the instruction
label
Drug Interactions
Ginseng: May enhance the effect of oral hypoglycemics (eg, glimepiride, glipizide). Decreased effect
of MAOIs (eg, selegiline, phenelzine, moclobemide. Decreased blood prothrombin levels w/ warfarin.
Dosage/Direction for Use
1-2 softgel cap daily.
Contraindications
Hypersensitivity. Pregnancy & lactation.
Brand Name: Appebon with Iron Capsule
Generic Name: Buclizine HCl 25 mg, vit B1 10 mg, vit B6 5 mg, vit B12 10 mcg, elemental Fe
25 mg (as Fe fumarate 76 mg)
Uses: Nutritional supplement in patients w/ depressed appetite.
Side effects: May impair ability to drive or operate machinery.
Nursing responsibilities: make sure to educate patient on taking this as it says on the instruction
label
Drug Interactions
May potentiate CNS depressant effect of barbiturates, tranquilizers & alcohol.
Dosage/Direction for Use
1 cap daily.
Special Precautions
May impair ability to drive or operate machinery.

Brand Name: ImmunPro

Generic name: sodium ascorbate + zinc sulphate monohydrate
Indications/Uses
Treatment & prevention of vit C & Zn deficiencies.
Adverse Reactions
Vit C: Nausea, vomiting, heartburn, abdominal cramps, fatigue, flushing, insomnia & sleepiness (at
high doses ie, ≥1 g daily). Zn: GI effects eg, nausea & vomiting (doses >40 mg).
Nursing responsibilities: Advice patient to take it as directed
Dosage/Direction for Use
Adult 1 tab once daily.
Contraindications
Hypersensitivity.
Special Precautions
Patients on Na-restricted diet.

L. Immunizing Agents
Brand Name: Benadryl AB
Generic name: Diphenhydramine
Indications/Uses
Perennial & seasonal (hay fever) allergic rhinitis; vasomotor rhinitis, allergic conjunctivitis due to
inhalant allergens & foods; amelioration of allergic reactions to blood or plasma, dermatographism;
adjunct to epinephrine for anaphylactic reactions after acute manifestations have been controlled.
Active treatment & prophylaxis for motion sickness & parkinsonism.
Dosage/Direction for Use
Adult 50 mg tid-qid. Childn >20 lb 12.5-25 mg tid-qid. Max: 300 mg/day. Base on body wt: 5 mg/kg/24
hr. Motion sickness To be taken 30 min before exposure to motion.
Administration
May be taken with or without food.
Nursing responsibilities: make sure patient is comfortable and aware with contraindications like
hypersensitivity
Adverse Reactions
Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills, dryness of
mouth, nose & throat; hypotension, headache, palpitations, tachycardia, extrasystoles; hemolytic
anemia; thrombocytopenia, agranulocytosis; sedation, sleepiness, dizziness, disturbed coordination,
fatigue, confusion, restlessness, excitation, nervousness, tremor, irritability. Insomnia, euphoria,
paresthesia, blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis. Hysteria, neuritis,
convulsions; epigastric distress, anorexia, nausea, vomiting, diarrhea, constipation; urinary frequency,
difficult urination, urinary retention, early menses; thickening of bronchial secretions, tightness of
chest & wheezing nasal stuffiness.
Drug Interactions
Increased effects w/ alcohol & other CNS depressants (hypnotics, sedatives, tranquilizers). Prolonged
& intensified anticholinergic effects w/ MAOIs. Prolonged & intensified anticholinergic effects w/
MAOIs.
ATC Classification
R06AA02 - diphenhydramine ; Belongs to the class of aminoalkyl ethers used as systemic
antihistamines.

Brand Name: Imuran

Generic Name: Azathioprine
Indications/Uses
To enhance the survival of organ transplants (renal, cardiac & hepatic); to reduce the corticosteroid
requirements of renal transplant recipients; treatment of moderate to severe inflammatory bowel
disease (Crohn's disease or ulcerative colitis); severe RA; SLE; dermatomyositis & polymyositis;
autoimmune chronic active hepatitis; pemphigus vulgaris; polyarteritis nodosa; autoimmune
hemolytic anemia; chronic refractory idiopathic thrombocytopenic purpura; relapsing remittent
multiple sclerosis.
Dosage/Direction for Use
Transplantation Adult & childn 5 mg/kg/day on the 1st day of therapy. Maintenance: 1-4 mg/kg/day.
Other conditions Adult & childn Initially 1-3 mg/kg/day. Maintenance: <1-3 mg/kg/day. Inflammatory
bowel disease Treatment duration: 12 mth. Multiple sclerosis Adult 2-3 mg/kg/day.
Administration
Should be taken on an empty stomach: Take at least 1 hr before or 3 hr after food/milk.
Nursing responsibilities: make sure patient is educated with the adverse effects; like avoid UV rays
Adverse Reactions
Viral, fungal & bacterial infections; diarrhea; bone marrow depression, leukopenia,
thrombocytopenia; nausea.
Drug Interactions
Live or killed vaccines; ribavirin; penicillamine; co-trimoxazole, ACE inhibitors, cimetidine,
indomethacin; allopurinol, oxipurinol & thiopurinol; olsalazine, mesalazine or sulfasalazine; high-dose
methotrexate; warfarin & acenocoumarol.
Contraindications
Hypersensitivity to azathioprine & 6-mercaptopurine. Pregnancy & lactation.
ATC Classification
L04AX01 - azathioprine ; Belongs to the class of other immunosuppressants.
Brand Name: ImmunoMax Forte Syrup
Generic Name: sodium carboxymethyl betaglucan
Indications/Uses
Dietary supplement. Adjuvant to prevent & reduce duration & severity of moderate to severe asthma
& allergic rhinitis, upper resp tract infections & other diseases of immunologic imbalance. In
combination w/ anti-infectives & pre- & postsurgical procedures to help prevent & reduce post-op
infections.
Dosage/Direction for Use
ImmunoMax 6-12 yr 1-2 tsp (5-10 mL) daily, 2-5 yr ½-1 tsp (2.5-5 mL) daily. ImmunoMax Forte 6-12 yr
½-1 tsp (2.5-5 mL) daily.
Contraindications
Hypersensitivity to β-glucans. Pregnancy & lactation.
Nursing responsibilities: have patient take this as prescribed by doctor or as needed
ATC Classification
A13A - TONICS ; Used as tonics.

Brand Name: Hyphen

Generic name: Diphenhydramine
Indications/Uses
Amelioration of allergic reactions to blood or plasma, anaphylaxis as an adjunct to epinephrine &
other uncomplicated allergic conditions when oral therapy is impossible or contraindicated. Active
treatment of motion sickness. Parkinsonism in the elderly who are unable to tolerate more potent
agents, mild cases of parkinsonism in other age groups & other cases of parkinsonism in
combination w/ centrally acting anticholinergic agents.
Dosage/Direction for Use
Adult 10-50 mg IV at a rate generally not exceeding 25 mg/min or 100 mg deep IM. Max 400 mg
daily. Childn 5 mg/kg/24 hr or 150 mg/m2/24 hr divided into 4 doses IV at a rate not exceeding 25
mg/min. Max: 300 mg daily.
Adverse Reactions
Urticaria, drug rash, anaphylactic shock, photosensitivity, excessive perspiration, chills; mouth, nose
& throat dryness; hypotension, headache, palpitations, tachycardia, extrasystoles; hemolytic anemia,
thrombocytopenia, agranulocytosis; sedation, sleepiness, dizziness, disturbed coordination, fatigue,
confusion, restlessness, excitation, nervousness, tremor, irritability, insomnia, euphoria, paresthesia,
blurred vision, diplopia, vertigo, tinnitus, acute labyrinthitis, neuritis, convulsions; epigastric distress,
anorexia, nausea, vomiting, diarrhea, constipation; urinary frequency, difficult urination, urinary
retention, early menses; thickening of bronchial secretions, tightness of chest or throat & wheezing,
nasal stuffiness.
Nursing responsibilities: make sure patient takes this as directed
Contraindications
Hypersensitivity. Not to be used as local anesth. Lactation. Not to be used in neonate or premature
infant.
Special Precautions
Patients w/ narrow-angle glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction,
symptomatic prostatic hypertrophy, bladder-neck obstruction; history of bronchial asthma,
increased IOP, hyperthyroidism, CV disease, HTN. Local necrosis w/ SC or intradermal use.
Concomitant use w/ alcohol & other CNS depressants; MAOIs. May impair ability to drive or operate
machinery. Pregnancy. Childn. Elderly >60 yr.
Drug Interactions
Inhibits metabolism of some β-blockers including metoprolol & venlafaxine. Reduced metabolism of
temazepam. Enhanced sedative effects of CNS depressants including alcohol, barbiturates,
hypnotics, opioid analgesics, anxiolytic sedatives & antipsychotics. Additive antimuscarinic action w/
other antimuscarinic drugs eg, atropine & some antidepressants (both TCA & MAOIs). Ventricular
arrhythmias w/ astemizole & terfenadine. Mask the warning signs of damage caused by ototoxic
drugs eg, aminoglycosides. Suppress cutaneous histamine response to allergen extracts.
ATC Classification
R06AA02 - diphenhydramine ; Belongs to the class of aminoalkyl ethers used as systemic
antihistamines.

Brand Name: Soniphen Injection

Generic name: Diphenhydramine
Indications/Uses
Symptomatic relief of seasonal, perennial, vasomotor rhinitis; allergic conjunctivitis; mild,
uncomplicated allergic skin manifestations of urticaria & angioedema; amelioration of allergic
reactions to blood or plasma; dermatographism; anaphylactic reactions adjunctive to epinephrine &
other standard measures after acute manifestations have been controlled. Management of
parkinsonism (including drug-induced) in the elderly who are unable to tolerate more potent agents;
mild cases of parkinsonism (including drug-induced) in other age groups; in other cases of
parkinsonism (including drug-induced) in combination w/ centrally acting anticholinergics. Short-term
management of insomnia. Relief of cough caused by minor throat & bronchial irritation. Prevention &
treatment of nausea, vomiting, &/or dizziness associated w/ motion sickness.
Dosage/Direction for Use
Cap Antihistamine 1 cap 6 hrly. Max: 300 mg/day. Antiparkinsonism 1 cap 6 hrly. Nighttime sleep aid
1 cap 20 min before going to bed. Antitussive 1 cap 8 hrly. Max: 300 mg/day. Motion sickness 1 cap
30 min before exposure to motion. Subsequent doses may be given 6 hrly & at bedtime for the
duration of exposure. Max: 300 mg/day. IV/deep IM inj Do not exceed 25 mg/min IV rate. Adult 10-50
mg/dose, may be increased up to 100 mg. Max: 400 mg/day. Childn 5 mg/kg body wt/day or 150
mg/m2/day 6 hrly in 4 divided doses daily. Max: 300 mg/day. Renal impairment Dosage intervals
should be increased from 6-12 hr depending on the degree of renal impairment.
Administration
May be taken with or without food: May be taken w/ meals/milk. Subsequent doses for motion
sickness may be taken before meals.
Nursing responsibilities: in the case of nausea, have kidney basin available in the case of emesis
Special Precautions
Liver disease (cirrhosis), glaucoma, urinary retention, myasthenia gravis, seizure disorders,
hyperthyroidism, CV disease & HTN. Concomitant use w/ other antihistamines, sedatives or
tranquilizers; alcohol; other diphenhydramine-containing products eg, topical formulations. Avoid
use >7-10 nights. Insomnia persisting continuously for >2 wk. Local necrosis in SC or intradermal.
May impair ability to drive or operate machinery. Not recommended during pregnancy. Childn.
Elderly.
References
https://www.pharmapproach.com/introduction-to-pharmacology/
https://www.drugs.com/html
https://www.medicinenet.com
https://go.drugbank.com
https://www.mims.com/
https://www.rxlist.com/
https://apps.medicines.org.au/files/txpperia.pdf