ALKAN Health Science Business & Technology College

Department of Clinical Pharmacy

Community Portfolio and Monograph

By Melkam Fekadu 258/12

section D

Submitted to: - pharmacy department

Date:-November 8 2023
ACKNOLDGEMENT................................................................
INTRODUCTION...............................................................................
COMMUNITY PHARMACY Meaning ...........................................................
SERVICES RENDERS IN THE COMMUNITY
PHARMACY.............................................................
CLINICAL PHARMACY SERVICES IN COMMUNITY
PHARMACY.....................................................
DESCRIPTION OF ATTACHMENT
AREA.............................................................................
OBSERVATION AND
DISCUSSION.......................................................................................
Strength and Weakness..................................................................................
SUMMARY AND
RECOMMENDATIONS.............................................................................
Recommendation.............................................................................................
DRUG MONOGRAPH FOR SALBUTAMOL..........................................................
Generic name……………………………………………………………….
Brand names………………………………………………………………..
Strength and Dosage form………………………………………………….
Mechanism of action and Indication………………………………………
Dosage and Administration………………………………………………….
Side effects………………………………………………………………….
Pregnancy and Breastfeeding……………………………………………….
Precaution…………………………………………………………………..
DRUG MONOGRAPH FOR PREDNISOLONE…………………………………..
Generic name……………………………………………………………….
Brand names………………………………………………………………..
Strength and Dosage form………………………………………………….
Mechanism of action………………………………………………………
Indication………………………………………………………………….
Dosage and Administration……………………………………………….
Side effects………………………………………………………………….
Pregnancy and Breastfeeding……………………………………………….
Precaution…………………………………………………………………..
DRUG MONOGRAPH FOR LORATADINE..........................................................
Generic name……………………………………………………………….
Brand names………………………………………………………………..
Strength and Dosage form………………………………………………….
Mechanism of action………………………………………………………
Indication…………………………………………………………………...
Dosage and Administration………………………………………………….
Side effects………………………………………………………………….
Pregnancy and Breastfeeding……………………………………………….
Precaution…………………………………………………………………..
DRUG MONOGRAPH FOR DICLOFENAC..........................................................
Generic name……………………………………………………………….
Brand names………………………………………………………………..
Strength and Dosage form………………………………………………….
Mechanism of action………………………………………………………
Indication…………………………………………………………………...
Dosage and Administration………………………………………………….
Side effects………………………………………………………………….
Pregnancy and Breastfeeding……………………………………………….
Precaution…………………………………………………………………..
DRUG MONOGRAPH FOR
HTDROCHLOROTHIAZIDE...................................................................................
Generic name……………………………………………………………….
Brand names………………………………………………………………..
Strength and Dosage form………………………………………………….
Mechanism of action………………………………………………………
Indication…………………………………………………………………...
Dosage and Administration………………………………………………….
Side effects………………………………………………………………….
Pregnancy and Breastfeeding……………………………………………….
Precaution…………………………………………………………………..
REFERANCE………………………………………………………………………...
ACKNOLEDGEMENT
I am grateful for Hana pharmacy for permitting me to practice in their pharmacy. Especial thanks for all
staff members for helping me through telling information about the drugs and how to communicate with
community effectively.
 PORTFOLIO
INTRODUCTION
 Community pharmacy meaning
Community pharmacy is a type of pharmacy that provides pharmacy services to the public in a
local area. It involves a registered pharmacist who can dispense medicines, counsel patients, and
provide other pharmaceutical and cognitive services. Community pharmacy is also known as retail
pharmacy or chemist.
Community pharmacists are considered to be the most accessible health professional to the public,
as they are available to provide personalized advice about health and medicine on a walk-in basis,
without the need for an appointment. They are responsible for processing prescriptions, checking
for drug interactions, dispensing medications, disposing of medication, providing advice, and
promoting healthy lifestyle.

 Service rendered in community pharmacy

Community pharmacy services have evolved beyond the traditional dispensing of medications and
now offer a wide range of services to help people stay on their medications. These services
include:
 Medication therapy management: This service involves a pharmacist reviewing a patient’s
medication regimen to ensure that it is safe and effective.

 Health screenings: Community pharmacists can perform health screenings to identify

potential health problems, such as high blood pressure, high cholesterol, and diabetes.

 Medication synchronization: This service involves aligning a patient’s medication refills so

that they can be picked up at the same time each month, making it easier for patients to manage
their medications.

 Adherence packaging: Many pharmacies offer adherence packaging, which is a service where
medications are packaged into blister packs or strips rather than bottles, making it easier for
patients to remember to take their medications.

Community pharmacists are also responsible for processing prescriptions, checking for drug
interactions, dispensing medications, disposing of medication, providing advice, and promoting
healthy lifestyle.

 Clinical pharmacy services in community pharmacy

Clinical pharmacy services in community pharmacy are a relatively new concept that has been
gaining popularity in recent years. Clinical pharmacy services involve pharmacists working with
patients and other healthcare professionals to optimize medication use and improve patient
outcomes. Some examples of clinical pharmacy services that may be offered in community
pharmacies include:
 Medication therapy management: This service involves a pharmacist reviewing a
patient’s medication regimen to ensure that it is safe and effective.

 Chronic disease management: Community pharmacists can work with patients who have
chronic diseases, such as diabetes or hypertension, to help them manage their conditions.

 Anticoagulation management: Community pharmacists can work with patients who are
taking anticoagulant medications, such as warfarin, to monitor their therapy and adjust their
dosages as needed.

 Smoking cessation: Community pharmacists can provide counseling and support to

patients who are trying to quit smoking.

 Pain management: Community pharmacists can work with patients who are experiencing
chronic pain to help them manage their pain and improve their quality of life.

Clinical pharmacy services in community pharmacy can help improve patient outcomes and reduce
healthcare costs by optimizing medication use and improving medication adherence

Attachment area description

 Name and location of pharmacy: - Hana pharmacy located in Holeta, Oromia
 Human resource organization: - there are 2 clinical pharmacists, 2 druggists and 1 cashier.
 Average number of customer per day: - above 150 /day by prescription and OTC 50/day
 Lay out of pharmacy: -
 Dispensing area
 Patient or customers area
 Drugs shelves
 Payment area
 Drug store

OBSERVATION AND DISCUSSION

 Analysis of strength and weakness of the pharmacy and services
Strength: The drugs are well arranged pharmacologically and therapeutically.
All pharmacist is well communicates with the patients/customers.
The drug is well labeled.
Weakness: The prescriptions are not recorded properly on time.
 Compression of attachment site with available standard
The provided good services for the patients have good interaction.
Full files most of the standards the dispensing criteria’s.

 Lessons learned during my stay

I have learned how to dispense and communicate with patients, how to get good relationship with
customers.

SUMMARY AND RECOMMENDATIONS

The pharmacy has good standards and it full fills the pharmacy standards.
 Recommendation
I recommended that, the pharmacist to record the prescription on time and not to increase the
prices all days which means let it be fair to be affordable.
 SALBUTAMOL

Generic name: salbutamol

Brand names: Ventolin, Airomir, Asthalin, Asmatol, Azmasol,

Strength and Dosage form

 Salbutamol inhaler 100 micrograms (mcg) per dose

 Salbutamol dry powder inhaler 200 mcg per dose

 Salbutamol oral syrup 2 mg/5 ml

 Salbutamol tablets 2mg and 4mg

 Salbutamol respirator solution 5 mg/ml - for use with nebulizer

 Salbutamol injection 500 micrograms/ml

 Salbutamol solution for infusion 5mg/5ml

Mechanism of action and Indication

Salbutamol is a short acting beta-2 adrenoceptor agonist. Activation of beta-2 receptors relaxes
bronchial smooth muscle, relaxes myometrial smooth muscle in uterus, causes tremor of skeletal
muscle and tends to stimulate uptake of potassium into cells. Beta-2 receptors (transmembrane
G-protein coupled receptors) are normally activated by circulating adrenaline (hormone, released
from adrenal medulla). Salbutamol is not entirely specific and has slight cross-reactivity with beta-
1 adrenoceptors leading to tachycardia and increased force of cardiac contraction (generally only
seen with very high doses). Beta-2 receptors also mediate vasodilatation, glycogenolysis, lipolysis
and are found on cells of the immune system.

Salbutamol is indicated to relieve wheezing, coughing, chest tightness and breathlessness in

people with asthma and chronic obstructive pulmonary disease (COPD), including chronic
bronchitis and emphysema.

Salbutamol injection is also used for the management of uncomplicated premature labor between
22 and 37 weeks of pregnancy.
 Dosage and Administration for salbutamol

The recommended dose of salbutamol depends on the age of the patient, condition being treated and
the formulation being used.

A general guide to the recommended dosage is given below.

 Asthma symptoms and bronchospasm

 Salbutamol inhaler 100 micrograms (mcg) per dose:

o Adults: 1-2 puffs every 4 hours up to 4 times (8 puffs) in 24 hours to relieve symptoms.
To prevent symptoms caused by exercise or other triggers, the recommended dose is 2
puffs 15 minutes before exposure.

o Children: 1 puff (increased to 2 puffs if required) every 4 hours up to 4 times (8 puffs) in

24 hours to relieve symptoms. To prevent symptoms caused by exercise or other triggers,
the recommended dose is 1 puff (increased to 2 puffs if required) 15 minutes before
exposure.

 Salbutamol dry powder inhaler 200 mcg per dose:

o Adults, adolescents aged 12 years and over and children 4 to 11 years of age: 1 inhalation up
to 4 times per day to relieve symptoms. To prevent symptoms caused by exercise or other
triggers, the recommended dose is 1 inhalation 10 to 15 minutes before exposure.

 Salbutamol oral syrup 2 mg/5 ml:

o Adults (over 18 years old): The usual dose is 5 ml to 20 ml, up to 4 times a day.

o Children over 12 years old: The usual dose is 5 ml to 10 ml, 3 or 4 times a day.

o Children aged between 6 and 12 years: The usual dose is 5 ml, 3 or 4 times a day.

o Children aged between 2 and 6 years: The usual dose is 2.5 ml to 5 ml, 3 or 4 times a day.

o Elderly (over 65 years old): The usual dose is 5 ml, up to 3 times a day.

 Salbutamol tablets 2mg and 4mg:

o Adults: The recommended dose is 4mg 3 or 4 times a day. Your doctor may increase
this gradually up to a maximum of 8mg three or four times a day. Some patients may
be treated successfully with 2mg three or four times a day.
 o Children over 12 years old: The recommended dose is 2 mg to 4 mg 3 or 4 times a day.

o Children aged between 6 and 12 years: The recommended dose is 2 mg 3 or 4 times a day

o Children aged between 2 and 6 years: The recommended dose is 1 to 2 mg 3 or 4

o Elderly or patients known to be sensitive to this product or other similar drugs: The
recommended dose is initially 2 mg 3 or 4 times a day.

 Salbutamol respirator solution 5 mg/ml - for use with nebulizer:

o Intermittent treatment - Adults and adolescents aged 12 years and over: The usual dose is 0.5
ml to 1 ml of respirator solution (2.5 to 5 mg salbutamol). Some patients may require up to 2
ml (10 mg salbutamol).

o Intermittent treatment - Children aged 18 months to 12 years: The usual dose is 0.5 ml to 1 ml
o (2.5 to 5 mg salbutamol) of Ventolin Respirator Solution.

o Intermittent treatment may be given up to 4 times per day.

o Continuous treatment: The usual dose is 1 to 2 mg of salbutamol per hour. This dose can be
obtained by diluting 1 or 2 ml of respirator solution to 100 ml with sterile normal saline
solution to produce a solution containing 50 or 100 micrograms/ml of salbutamol, and
inhaling the mist from a suitable nebulizer.

 Severe bronchospasm and status asthmatics

 Salbutamol injection 500 micrograms/ml:

o Adults: The recommended dose for subcutaneous or intramuscular injection is 500 micrograms
(8 micrograms/kg bodyweight) and repeated every 4 hours as required.

 Salbutamol solution for infusion 5mg/5ml:

o Adults: The recommended dose is 250 micrograms (4 micrograms/kg bodyweight) injected

slowly. If necessary the dose may be repeated. 250 micrograms in 5 mL (50 micrograms/mL)
is a suitably dilute preparation for slow intravenous injection.

In status asthmatics, infusion rates of 3 to 20 micrograms per minute are generally adequate but
in patients with respiratory failure, higher dosage has been used with success. A starting dose
of
5 micrograms per minute is recommended with appropriate adjustment in dosage according to
 patient response.

 Preterm labor

 Salbutamol solution for infusion 5mg/5ml:

o Infusion rates of 10-45 micrograms per minute are generally adequate to control uterine
contractions but greater or lesser infusion rates may be required according to the strength and
frequency of contractions
 Side effects

The following side effects can occur when using salbutamol:

1. Common side effects include:

 Tremors
 Headache
 Palpitations
 Muscle cramps
 Nausea
 Dizziness

2. Uncommon side effects include:

 Mouth and throat irritation

 Sleep disturbances
 Restlessness
 Sweating

3. Rare side effects include:

 Allergic reactions such as rash, itching, swelling of the face, lips, tongue or throat,
difficulty breathing or swallowing, or sudden wheezing.
 Chest pain due to heart problems such as angina .

 The frequency and severity of these side effects can vary depending on the individual. It
is important to note that the frequency of these side effects is not known

Pregnancy and Breastfeeding

Current studies says “ Asthma medicines like salbutamol should be continued in pregnancy, as
the baby needs oxygen to stay alive, grow and develop. Very little salbutamol may reaches the
baby but it has not been shown to cause harm “.

it is also safe to use salbutamol while breastfeeding. It is important that you continue to treat
your asthma while breastfeeding to keep well. It’s not known how much salbutamol gets into
breast milk, but it’s likely to be a very small amount.
Precautions

It is important to note that salbutamol has several warnings and precautions that should be taken
into account.

Patients with a history of hypokalemia, heart disease, high blood pressure, congestive heart
failure, heart rhythm disorder, epilepsy, diabetes, overactive thyroid, kidney problems,
adrenal gland tumor, hypersensitivity, elderly, children, during pregnancy and breastfeeding
should exercise caution when taking this medication.

PREDNISOLONE

Generic name: prednisolone

Brand names: Flo-Pred, Millipred, Orapred, Pediapred, prelone, Veripred

Dosage form and strength

Dosage Form Strength

Tablet 5 (mg)

Orally-disintegrating tablet 10 mg, 15 mg, 30

(prednisolone sodium mg
phosphate)

Oral solution 5 mg per 5 milliliters

(mL), 10 mg/5 ml,
15 mg/5 mL, 20
mg/5 mL, 25 mg/5
mL

Eye drops (prednisolone 0.12%, 0.55%, 1%

acetate)

Eye drops (prednisolone sodium 1%

phosphate)
Mechanism of action

Prednisolone binds to specific glucocorticoid receptors (GRs) in the cytoplasm of target cells to
form glucocorticoid receptor (GR) complexes. This complex translocate to the nucleus and
interacts with DNA to modify gene transcription up-regulating the expression of anti-
inflammatory proteins (transactivation), and represses the expression of pro-inflammatory
proteins (trans repression). The predominant anti-inflammatory action of prednisolone is
mediated by inhibition of prostaglandin (PG) synthesis via two actions on the arachidonic acid
(AA).

Indications

Prednisolone indications include various types of allergies, inflammatory conditions,

autoimmune disorders, and cancers. Some examples of prednisolone indications are:

 Adrenocortical insufficiency
 Multi sclerosis
 Eye inflammation
 Asthma
 Dermatitis
 High blood calcium
 Rheumatoid arthritis
 Hematologic disorders
 Collagen diseases
 Ophthalmic diseases
 Respiratory diseases
 Gastrointestinal diseases
 Psoriasis
 Lupus
 Ulcerative colitis

Dose and administration

The dosage and administration of prednisolone depend on the condition being treated, the
patient’s age, weight, and response to treatment. The following is a general guideline for
prednisolone dosage.
PO: (Adults):

Most uses—5–60 mg/day as a single dose or in divided doses.

Multiple sclerosis—200 mg/day for 7 days, then 80 mg every other day for 1 mo.

Asthma exacerbations—120–180 mg/day in divided doses 3–4 times/day for 48 hr, then 60–80
mg/day in 2 divided doses.

PO: (Children):

Anti–inflammatory/Immunosuppressive—0.1–2 mg/kg/day in 1–4 divided doses.

Nephritic syndrome—2 mg/kg/day (60 mg/m2/day) in 1–3 divided doses daily (maximum dose:
80 mg/day) until urine is protein free for 4–6 weeks, followed by 2 mg/kg/dose (40 mg/m2/dose)
every other day in the morning, gradually taper off over 4–6 weeks.

Asthma exacerbations—1 mg/kg q 6 hr for 48 hr, then 1–2 mg/kg/day (maximum: 60 mg/day)
divided twice daily.
Side effects

System Side Effect Frequency Severity

Metabolic Fluid Common Moderate

retention

Increased Common Moderate

appetite

Weight gain Common Moderate

Cardiovascular Increased Common Moderate

blood
pressure

Endocrine Adrenal Common Severe

suppression

Cushing’s Common Severe

syndrome
 Growth Common Severe
suppression

Gastrointestinal Peptic Common Severe

ulceration

Pancreatitis Rare Severe

Immunologic Increased Common Moderate

susceptibility
to infections

Musculoskeletal Osteoporosis Common Moderate

Ocular Glaucoma Rare Severe

Cataract Rare Severe

It’s important to note that the incidence and severity of side effects depend on the dose, duration
of treatment, and individual patient factors.

Prednisolone During pregnancy and lactation

Pregnancy category: - C

During lactation this drug should be used only if clearly needed because it will be excreted into
the milk and High doses for long periods of time could produce infant growth and development
problems, interfere with infant endogenous corticosteroid production, and occasionally cause
temporary loss of milk supply.

-If this drug is necessary, the lowest dose should be prescribed; avoiding breastfeeding for 4
hours after a dose should minimize exposure to the infant.
-If maternal doses exceed 40 mg per day, the infant should be monitored for adrenal suppression.

Precautions for prednisolone

We have to use precautions for patients:-

 Suffer from or have ever been treated for tuberculosis

 Having inflammatory bowel disease such as crohn’s disease
  Having high blood pressure
 Who have ever had blood clots
 Having a heart condition
 Having liver or kidney problem
 Having diabetes
 Suffer from epilepsy
 Who have taken prednisolone tablet (or other steroids ) before and had muscular problem
 Who are receiving treatment for myasthenia gravies ( a rare muscle weakness disorder )

LORATADINE
Generic name: loratadine
Brand names: Alavert, Claritin, Claritin Reditab, ohm Allergy Relief, Tavist ND, Wal-itin

Strength and Dosage forms

oral capsule (10 mg),
oral syrup (5 mg/5 mL),
oral tablet (10 mg),
oral tablet chewable (5 mg),

oral tablet, disintegrating (10 mg; 5 mg)

Mechanism of action
Works by blocking one type of receptor for histamine (the H1 receptor) and thus prevents
activation of cells by histamine. The drug also has mast cell stabilizing property.

Indication

Loratadine is an antihistamine medication that is used to relieve the symptoms of allergies such
as hay fever, urticaria, chronic idiopathic urticaria, and other skin allergies. It can treat both nasal
and eye symptoms such as sneezing, runny nose, and itchy or burning eyes. Loratadine can also
alleviate itching from hives

Dosage and Administration

 Usual Adult Dose for Allergic Rhinitis: 10 mg orally once a day

-Maximum dose: 10 mg/day
 Use: Temporary relief of symptoms associated with hay fever or other upper respiratory
allergies (e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

 Usual Adult Dose for Urticaria:

10 mg orally once a day

-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies
(e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

 Usual Pediatric Dose for Allergic Rhinitis:

2 to 5 years: 5 mg orally once a day

-Maximum dose: 5 mg/day

6 years and older: 10 mg orally once a day

-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies
(e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat)

 Usual Pediatric Dose for Urticaria:

2 to 5 years: 5 mg orally once a day

-Maximum dose: 5 mg/day

6 years and older: 10 mg orally once a day

-Maximum dose: 10 mg/day

Use: Temporary relief of symptoms associated with hay fever or other upper respiratory allergies
(e.g., runny nose, itchy, watery eyes, sneezing, itching of the nose/throat.

Side effects
The most commonly reported side effects included headache, somnolence nervousness,
and fatigue.
Nervous system

Very common (10% or more): Headache (up to 12%)

Common (1% to 10%): Sedation/somnolence
Very rare (less than 0.01%): Dizziness, convulsion

Frequency not reported: Syncope, paresthesia.

Psychiatric

Common (1% to 10%): Nervousness

Uncommon (0.1% to 1%): Insomnia

Frequency not reported: Depression, paroniria.

Other
Common (1% to 10%): Fatigue

Frequency not reported: Fever, viral infection, tinnitus, malaise.

Gastrointestinal

Common (1% to 10%): Dry mouth

Very rare (less than 0.01%): Nausea, gastritis

Frequency not reported: Dyspepsia, diarrhea, constipation, abdominal/gastric pain, altered taste,
increased saliva.

Metabolic

Uncommon (0.1% to 1%): Increased appetite.

Dermatologic

Very rare (less than 0.01%): Angioedema, rash, alopecia

Frequency not reported: Pruritus, rash on face.

Genitourinary

Frequency not reported: Increased frequency of urination, urine discoloration, menstruation

delay.

Cardiovascular

Very rare (less than 0.01%): Tachycardia, palpitation

Frequency not reported: Hypertension, hypotension, chest pain.

Hypersensitivity
Very rare (less than 0.01%): Hypersensitivity reactions, anaphylaxis.

Hepatic

Very rare (less than 0.01%): Abnormal hepatic function.

Respiratory
Frequency not reported: Epistaxis, nasal dryness, pharyngitis, coughing.

Musculoskeletal

Frequency not reported: Myalgia

Pregnancy and lactation

Pregnancy category :- B

Lactation :- Because of its lack of sedation and low milk levels, maternal use of loratadine
would not be expected to cause any adverse effects in breastfed infants. Loratadine might have a
negative effect on lactation, especially in combination with a sympathomimetic agent such as
pseudoephedrine. The British Society for Allergy and Clinical Immunology recommends
loratadine at its lowest dose as a preferred choice if an antihistamine is required during
breastfeeding.

Over all its not recommended. Alternate Drugs to Consider are Desloratadine , Fexofenadine
Precautions

Don’t give for patients who are allergic to loratadine or desloratadine (Clarinex) , or any
other medications or ingredients in loratadine preparations.
Avoid taking loratadine for two days before having any skin tests for allergies, as it may
affect the test results.
Do not use loratadine in larger or smaller amounts or for longer than recommended, and do
not give it to a child younger than 2 years old.
Monitoring of electrolytes, especially in elderly patients and high doses.
Avoiding use in patients with gout, diabetes, or asthma.
Being careful with driving or operating machinery, as it may cause dizziness or blurred
vision.
Avoiding alcohol consumption.
Checking blood sugar levels regularly, as it may raise them.
Protecting oneself from sun exposure, as it may increase sensitivity.
Not stopping the medication without doctor’s approval, as this may worsen the condition.

DICLOFENAC
Generic name: diclofenac [ dye-KLOE-fen-ak ]
Brand names: Cambia, Zipsor, Zorvolex, Cataflam, Voltaren, Voltaren-XR, Dyloject

Strength and dosage form

Capsule 35mg

Immediate release 50mg

Tablet
extended release tablet 100mg

Enteric coted tablet 50mg /

75mg
Oral solution 50 mg

Mechanism of action and indication of diclofenac

Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID) that has analgesic, anti-

inflammatory, and antipyretic properties. The mechanism of action of diclofenac is not
 completely understood, but it is believed to inhibit the synthesis of prostaglandins by blocking
the enzyme cyclooxygenase (COX). Prostaglandins are mediators of inflammation, pain, and
fever. Diclofenac is a potent inhibitor of both COX-1 and COX-2 ..

Diclofenac is used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or
rheumatoid arthritis. It is also used to treat ankylosing spondylitis, dysmenorrhea, and migraine

Dosage and administration

Indication Dosage Form Strength Usual Adult Dose

Osteoarthritis Diclofenac free acid 35 mg 35 mg orally 3 times a day

capsules

Diclofenac potassium 50 mg 50 mg orally 2 or 3 times a day

immediate-release
tablets

Diclofenac sodium 50 mg or 50 mg orally 2 or 3 times a day or 75 mg orally 2 times a

enteric-coated tablets 75 mg day

Diclofenac sodium 100 mg 100 mg orally once a day

extended-release
tablets

Ankylosing Diclofenac sodium 25 mg 25 mg orally 4 times a day. An additional 25 mg dose

Spondylitis enteric-coated and may be administered at bedtime, if necessary
delayed-release
tablets

Dysmenorrhea Diclofenac potassium 50 mg 50 mg orally 3 times a day. An initial dose of 100 mg

immediate-release orally followed by 50 mg oral doses may provide better
tablets relief for some patients; initiate treatment upon
appearance of the first symptoms and continue for a few
days

Rheumatoid Diclofenac potassium 50 mg 50 mg orally 3 or 4 times a day

Arthritis immediate-release
tablets
 Diclofenac sodium 50 mg or 50 mg orally 3 to 4 times a day or 75 mg orally twice a
enteric-coated and 75 mg day
delayed-release
tablets

Diclofenac sodium 100mg 100mg orally once a day

extended-release
tablets

Migraine Diclofenac potassium 50mg (1 50mg orally once

for oral solution packet)
packets

Side effects

Diclofenac can cause several side effects.

Common side effects include indigestion, gas, nausea, vomiting, stomach pain, diarrhea,
constipation, headache, dizziness, drowsiness, itching, sweating, stuffy nose, increased
blood pressure, and swelling or pain in arms or legs.
Other common side effects include disturbances of the gut, loss of appetite, and skin
rashes. Diclofenac is more likely than ibuprofen to cause stomach-related side effects.
Mild side effects of diclofenac can include abdominal pain, diarrhea, dizziness, fluid
retention, feeling sleepy, and hair loss
Rare but serious side effects include stomach/abdominal pain that doesn’t go away,
black/tarry stools, vomit that looks like coffee grounds, chest/jaw/left arm pain, shortness
of breath, unusual sweating, confusion, weakness on one side of the body, trouble
speaking, and sudden vision changes.

During pregnancy and lactation period

NSAID use in pregnancy prior to 20 weeks gestation should be based on a benefit-risk

assessment; some authorities recommend avoiding NSAIDs throughout pregnancy whenever
possible.
-If NSAID use is necessary between 20- and 30-weeks' gestation, limit use to the lowest effective
dose for the shortest duration possible; ultrasound monitoring of amniotic fluid should be
considered if NSAID use extends beyond 48 hours; if oligohydramnios occurs, discontinue
NSAID and treat appropriately.
-NSAID use is not recommended in women attempting to conceive as it may impair female
fertility.

During lactating time the drug is excreted in milk in insignificant or undetectable quantities but
no adverse effects have been detected in breastfed babies whose mothers were taking it. So it is
considered safe for both (breastfeeding mothers and the baby).

Precautions

Some precautions for diclofenac are:

 Do not use diclofenac if there is a history of allergic reaction to aspirin or NSAIDs (non-
steroidal anti-inflammatory drugs).
 Diclofenac can increase risk of fatal heart attack or stroke, especially if it’s used long
term or take high doses, or if there is heart disease. Do not use this medicine just before
or after heart bypass surgery.

 Diclofenac may also cause stomach or intestinal bleeding, which can be fatal. These
conditions can occur without warning while using this medicine, especially in older
adults.
 It will be better to take diclofenac with food or milk to prevent stomach upset. But don’t
take more than the recommended dose or for longer than prescribed.
 Avoid alcohol and caffeine while using diclofenac, as they may increase the risk of
bleeding or stomach irritation.

HYDROCHLOROTHIAZIDE

Generic name: hydrochlorothiazide

Brand names: HydroDIURIL, Esidrix, Microzide

Strength and Dosage forms: oral capsule (12.5 mg), oral tablet (12.5 mg; 25 mg; 50 mg)

Mechanism of action and indication

Hydrochlorothiazide is a type of medication that belongs to the class of thiazide diuretics, or
water pills. It works by interfering with the renal tubular mechanism of electrolyte reabsorption,
which means it helps your body get rid of excess salt and water by increasing the amount of
urine you produce.

Hydrochlorothiazide is used to treat high blood pressure and fluid retention caused by various
conditions, such as heart failure, liver disease, or kidney disease. It can also be used to treat
nephrogenic diabetes insipidus, a rare disorder that causes excessive thirst and urination.

Dose and administration

Usual Adult Dose for Hypertension:

Initial dose: 25 mg orally once daily

Maintenance dose: May increase to 50 mg orally daily, as a single or 2 divided doses

Comments:
-Patients usually do not require doses in excess of 50 mg daily when used concomitantly with
other antihypertensive agents.
Usual Adult Dose for Nephrocalcinosis:
Initial: 25 mg orally once daily
Maintenance dose: May increase to 50 mg twice daily
Usual Adult Dose for Osteoporosis:
Initial: 25 mg orally once daily
Maintenance dose: May increase to 50 mg daily
Usual Adult Dose for Diabetes Insipidus:
Initial: 50 mg orally once daily
Maintenance dose: May increase to 100 mg orally daily

Usual Pediatric Dose for Edema:

Less than 6 months: Up to 3 mg/kg/day (up to 1.5 mg/pound) orally in 2 divided doses

Less than 2 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2
divided doses
Maximum dose 37.5 mg per day
2 to 12 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided
doses
Maximum dose 100 mg per day

Usual Pediatric Dose for Hypertension:

Less than 6 months: Up to 3 mg/kg/day (up to 1.5 mg/pound) orally in 2 divided doses

Less than 2 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2
divided doses
Maximum dose 37.5 mg per day

2 to 12 years: 1 to 2 mg/kg/day (0.5 to 1 mg/pound) orally daily as a single dose or in 2 divided

doses
Maximum dose 100 mg per day

Side effects

Hydrochlorothiazide is a medication that can cause various side effects, depending on the
frequency and severity of use. Some of the most common and mild side effects of
hydrochlorothiazide are:

Dizziness, especially when standing up

Weakness or fatigue
Headache
Erectile dysfunction
Tingling in hands, legs, and feet
Stomach upset, nausea, vomiting, or loss of appetite
Electrolyte imbalance, which can cause muscle cramps, spasms, or irregular heartbeat
High blood sugar levels
Sensitivity to sunlight

Some of the rare and serious side effects of hydrochlorothiazide are:

Allergic reaction, which can cause rash, itching, swelling, trouble breathing, or
anaphylaxis
 Pancreatitis, which is a severe inflammation of the pancreas that can cause abdominal
pain, fever, nausea, vomiting, or jaundice
Blood disorders, such as anemia, thrombocytopenia, or leukopenia, which can cause pale
skin, bruising, bleeding, infections, or fatigue
Liver damage, which can cause yellow eyes or skin, dark urine, clay-colored stools, or
abdominal pain
Kidney damage, which can cause decreased urine output, swelling, blood in urine, or
back pain
Eye problems, such as glaucoma or vision loss.

Pregnancy and Lactation

Pregnancy category: - c

Breast feeding:-Use is not recommended and a decision should be made to discontinue

breastfeeding or discontinue the drug.

Precautions

Monitoring of electrolytes, especially in elderly patients and high doses.

Avoiding use in patients with kidney or liver disease, gout, diabetes, or asthma.

Being careful with driving or operating machinery, as it may cause dizziness or

blurred vision.
Avoiding alcohol consumption.
Checking blood sugar levels regularly, as it may raise them.
Protecting oneself from sun exposure, as it may increase sensitivity.
Avoid if there is allergies for hydrochlorothiazide.
Not stopping the medication without doctor’s approval is important, as this may worsen
the condition
References:-

Adults: National Health Interview Survey, 2018. Available at: https://www.cdc.

gov/nchs/nhis/shs/tables.htm. Accessed January 8, 2021. 2. Centers for Disease Control and
Prevention.

Current asthma prevalence by race and ethnicity (2016-2018). Available at:

https://www.cdc.gov/asthma/ most_recent_national_asthma_data.htm. Accessed January 8,
2021. Medicines.org.uk
En.wikipedia.org
Feda.gov
Drugs.com