ANALSIK

Komposisi
Methampyrone 500 mg, diazepam 2 mg.
Indikasi/Kegunaan
Meredakan nyeri sedang hingga berat, terutama kolik & nyeri pasca op, jika perlu
diberikan terapi kombinasi dg trankuilizer.
Dosis/Cara Penggunaan
Dws 1 kapl, jika nyeri tetap timbul, lanjutkan dg 1 kapl tiap 6-8 jam. Maks: 4 kapl/hr.
Pemberian
Sebaiknya diberikan bersama makanan.
Kontraindikasi
TD <100 mmHg, psikosis akut. Hamil, laktasi. Bayi usia 1 bln pertama. 
Perhatian Khusus
Ggn fungsi hati & ginjal, pasien depresi berat, pasien dg kelainan darah.
Efek Samping
Agranulositosis, reaksi alergi, mengantuk, pusing, konstipasi, depresi, hipotensi, mual,
tremor, retensi urin, vertigo.
View ADR Monitoring Form
Interaksi Obat
Klorpromazin, simetidin, alkohol, obat depresan SSP lain.
AMLODPINE

Indications and Dosage

Oral
Chronic stable angina, Hypertension, Prinzmetal's angina

Adult: Initially, 5 mg once daily. Dosage is individualised and may be increased after at least 1-2
weeks. Max: 10 mg once daily.
Child: 6-17 years Initially, 2.5 mg once daily, may increase to 5 mg once daily after 4 weeks
intervals according to clinical response.
Elderly: Initially, 2.5 mg once daily.

Hepatic Impairment
Severe: Initially, 2.5 mg once daily, may be titrated according to clinical response.

Administration
May be taken with or without food.

Contraindications
Severe hypotension, cardiogenic shock, left ventricular outflow tract obstruction (e.g. high-grade
aortic stenosis), heart failure after acute MI.

Special Precautions
Patients with aortic stenosis, congestive heart failure, hypertrophic cardiomyopathy, outflow
tract obstruction, severe obstructive coronary disease. Hepatic impairment. Elderly and children.
Pregnancy and lactation.

Adverse Reactions
Significant: Peripheral oedema, hypotension, angina/MI.
Blood and lymphatic system disorders: Leucopenia, thrombocytopenia.
Cardiac disorders: Bradycardia, ventricular tachycardia, chest pain, palpitation.
Ear and labyrinth disorders: Tinnitus.
Eye disorders: Visual disturbance, diplopia, conjunctivitis.
Gastrointestinal disorders: Nausea, dyspepsia, diarrhoea, constipation, abdominal pain.
General disorders and admin site conditions: Fatigue, asthenia.
Investigations: Weight gain, elevated hepatic enzymes.
Musculoskeletal and connective tissue disorders: Muscle cramps, arthralgia, back pain.
Nervous system disorders: Headache, somnolence, dizziness, extrapyramidal symptoms.
Psychiatric disorders: Insomnia, anxiety, depression.
Renal and urinary disorders: Micturition disorder, nocturia.
Reproductive system and breast disorders: Sexual dysfunction, gynaecomastia.
Respiratory, thoracic and mediastinal disorders: Pulmonary oedema, dyspnoea, cough, rhinitis.
Skin and subcutaneous tissue disorders: Rash, skin discolouration, pruritus.
Vascular disorders: Flushing.

Pregnancy Category (US FDA)

PO: C

Patient Counseling Information

This drug may cause dizziness, headache, fatigue or nausea, if affected, do not drive or operate
machinery.

Monitoring Parameters
Monitor BP, heart rate, pulse, frequency and intensity of angina, weight, and peripheral oedema.

Overdosage
Symptoms: Bradycardia, dysrhythmia, marked hypotension, excessive peripheral vasodilation,
reflex tachycardia, shock. Management: Perform gastric lavage and administration of charcoal
up to 2 hours after ingestion. Initiate active cardiovascular support, monitor cardiac and
respiratory function, elevation of extremities and attention of circulation fluid volume and urine
output. For restoring vascular tone and blood pressure, may give a vasoconstrictor and IV Ca
gluconate to reverse the effects of Ca channel blocker.

Drug Interactions
Increased systemic plasma concentration with immunosuppressants (e.g. ciclosporin,
tacrolimus). Increased serum concentration of simvastatin. Increased exposure with CYP3A4
enzyme inhibitors (e.g. protease inhibitors, azole antifungals, erythromycin, diltiazem).
Decreased plasma concentration with CYP3A4 inducers (e.g. rifampicin).

Food Interaction
Increased plasma concentration with grapefruit or grapefruit juice. Decreased plasma
concentrations with St. John’s wort.

Lab Interference
May result to false-positive aldosterone/renin ratio (ARR).

Action
Description: Amlodipine, a dihydropyridine Ca-channel blocker, reduces peripheral vascular
resistance and BP by relaxing coronary vascular smooth muscle and coronary vasodilation
through inhibition of Ca ion transmembrane influx into cardiac and vascular smooth muscles.
Onset: 24-48 hours.
Duration: 24 hours.
Pharmacokinetics:
Absorption: Well absorbed from the gastrointestinal tract. Bioavailability: Approx 60-65%. Time
to peak plasma concentration: 6-12 hours.
Distribution: Crosses placenta and enters breast milk. Volume of distribution: 21 L/kg. Plasma
protein binding: Approx 98%.
Metabolism: Extensively metabolised in the liver to inactive metabolites.
Excretion: Via urine (60% as metabolites, 10% as unchanged drug). Terminal elimination half-
life: 35-50 hours.