Coronary heart disease (CHD) has assumed epidemic proportions in India & by 2010, 60% of the world's heart disease is expected to occur in India . Chronic stable angina is the commonest initial manifestation of CHD. It is observed that despite an extensive use of conventional therapy, 85% of patients still complain of anginal symptoms. Also, the hemodynamic adverse events limit the use of current antianginal agents.

Ranolazine is the first agent to be approved for angina after almost a decade. Studies with ranolazine have established its efficacy both as a monotherapy & in combination with other antianginal agents. Ranolazine reduces anginal symptoms and improves the quality of life without any effect on hemodynamic parameters. It is well tolerated with its safety documented up to 3 years. Interestingly, it also exhibits antiarrhythmic properties. Recently, ranolazine has been approved as a first-line agent for management of angina by US FDA in November 2008. Taking the above into consideration Cipla has recently launched ranolazine under the brand name CORVELA .

It is recommended to initiate with 1 tablet of CORVELA (ranolazine extended release 500 mg) twice daily and increase it to maximum of 2 tablets of CORVELA twice daily, based on clinical symptoms. The maximum dose of CORVELA should be limited to 500 mg twice daily in patients on diltiazem, verapamil, and other moderate CYP3A inhibitors (eg. erythromycin, fluconazole). The dose should be down-titrated based on clinical response in patients concomitantly treated with P-gp inhibitors, such as cyclosporine.

CORVELA should not be taken with strong inhibitors of CYP3A (eg. ketoconazole, itraconazole, clarithromycin), with inducers of CYP3A (eg. rifampin, rifabutin, refapentin, phenytoin, phenobarbital, cabamazepine) & by patients with clinically significant hepatic impairment.

Available as:
NICOCHEW 2mg and 4mg sugar free chewing gum

Smoking was thought to be a very fascinating phenomenon once. Formerly regarded solely as a “lifestyle choice,” smoking is now recognized as a chronic, relapsing disorder caused because of addiction. Large number of diseases has been associated with chronic smoking, causing a great amount of mortality and morbidity. By stopping as early as possible, there can be a reduction in the risk of cancer, lung and heart disease. There is also a reduction in the damage caused to the lungs. The introduction of nicotine replacement therapy (NRT) to cut down addiction, has successfully led to a decrease in the mortality and morbidity and to better quality of life in tobacco users.

Nicochew contains nicotine polacrilex and is available in two strengths as 2mg and 4mg chewing gums. The principal mechanism of action of Nicochew is to partially replace the nicotine formally obtained from tobacco. It provides small and sustained quantities of nicotine without the harmful gases of smoking, to reduce the severity of withdrawal symptoms and cravings. Second possible mechanism of benefit has been suggested to be the potential for nicotine medications to desensitize nicotinic anticholinergic receptors (nAchRs). Such desensitization would result in a reduced effect of nicotine from cigarettes, such that if a person relapses to smoking while taking NRT, the cigarette would be less satisfying and the person less likely to resume. Hence NRT also provide a coping mechanism, making cigarettes less rewarding to smoke.

Overall, NRT offers low abuse potential and adherence advantages because of the ease of usage. NRT can be used and is considered relatively safe during pregnancy or in patients with unstable cardiac disease, if the alternative is smoking. Medicinal nicotine is unlikely to be more harmful in this context than continued intake of nicotine (and the associated tar, carbon monoxide, and other harmful products) from cigarettes.

INDICATIONS
Nicochew chewing gum is indicated for smoking cessation therapy.

DOSAGE AND ADMINISTRATION
If 25 or more cigarettes a day; use 4 mg nicotine gum.
Less than 25 cigarettes a day; use 2 mg nicotine gum.

Use according to the following 12 week schedule:  

Weeks 1-6	Weeks 7-9	Weeks 10-12
1 gum every 1 to 2 hours	1 gum every 2 to 4 hours	1 gum every 4 to 8 hours

Do not exceed more than 24 gums a day.
Over a 12-week period, NICOCHEW allows the body to gradually adjust to have less nicotine. Fewer and fewer gums of NICOCHEW will be required until no longer needed. This means that it will leave the smoker, smoke-free in 12 weeks.

MTP kit contains 1 tablet of mifepristone 200 mg to be given orally and 4 tablets of 200 mcg misoprostol to be given vaginally

M ifepristone has anti-progestational activity. The anti-progestational activity of mifepristone results from competitive interaction with progesterone at progesterone-receptor sites. As mifepristone inhibits the activity of progesterone it results in termination of pregnancy. Mifepristone also exhibits anti-glucocorticoid and weak anti-androgenic activity.

Misoprostol is a synthetic prostaglandin E1. It causes myometrial contractions by interacting with specific receptors on myometrial cells. This interaction results in a change in calcium concentration, thereby initiating muscle contraction. By interacting with prostaglandin receptors, misoprostol causes the cervix to soften and the uterus to contract, resulting in the expulsion of the uterine contents.

MTP Kit is indicated for the medical termination of intrauterine pregnancy up to 63 days of gestation. The regimen has also been recommended by WHO and RCOG.

For purposes of this treatment, pregnancy is dated from the first day of the last menstrual period in a presumed 28 days cycle with ovulation occurring at mid-cycle.

The dosage is mifepristone 200 mg orally followed 1–3 days later by misoprostol 800 mcg (4 tablets of 200 mcg) vaginally. The misoprostol may be administered by a clinician or self-administered by the woman. For women at 49–63 days of gestation, if abortion has not occurred 4 hours after administration of misoprostol, a second dose of misoprostol 400 mcg (2 tablets of 200 mcg) may be administered vaginally or orally (depending upon preference and amount of bleeding).

The patient should return for a follow-up visit approximately 14 days after the administration of mifepristone. This visit is very important to confirm by clinical examination or ultrasonographic scan that a complete termination of pregnancy has occurred.

Combace: Worlds First Preservative Free Ace Combination

Ocular inflammation and infection often coexist and the clinician is always in search of a medication, which offers efficacy, tolerance and convenience. Combination of antibiotic-steroid exerts efficacy in resolving both infection and inflammation. Steroids are to be used preserve normal structure of involved tissues while antibiotic component reduces risk of infection. Thus a combination of corticosteroid and antibacterial strikes a favorable balance.

Combace is a fixed dose combination of gold standard steroid (Prednisolone
acetate l) and ace bactericidal (Moxifloxacin), which is preservative free.

Generally most of the commercially available ophthalmic formulations have benzalkonium chloride ( BAK ) as the preservative which reduces corneal epithelial cell integrity , compromises the epithelial barrier, impairs and delays corneal healing, causes a loss of goblet cells, reduces tear function and decreases Tear Film Break Up Time (TBUT). In short it its cytotoxic and ultimately chronic exposure leads to dry eyes.

Advantages of being preservative free:

• Can be used efficiently in individuals hypersensitive to BAK
• For patients prone to dry eye, blepharitis or other ocular surface disorders.
• Maintains health and integrity of the ocular surface
• Effective , soothing and well tolerated
• Absence of BAK makes a significant difference for preference as prophylaxis for cataract or refractive surgery.

Prednisolone acetate: Gold standard steroid

It is the most potent topical ophthalmic corticosteroids with highest anti-inflammatory activity compared to other ophthalmic steroids.

It has highest aqueous humor concentration (of 669.9 ng/ml) compared to other ophthalmic steroids with a clinical cure rate of 68%, treating external ocular inflammatory conditions of the eye.

Moxifloxacin: First USFDA approved BAK free topical ophthalmic quinolone.

Moxifloxacin has

• Faster kill speed thus ensures complete eradication of bacteria
• Broad Spectrum activity : Improves Gram +ve activity, maintained Gram –ve activity
• Activity against non tuberculous Mycobacteria, Chlamydia trachomatis.
• Good solubility at physiological pH.
• Higher the solubility, higher the concentration, higher the penetration in stroma and anterior chamber.

Absence of BAK makes a significant difference for preferring an antibiotic as prophylaxis for cataract or refractive surgery

Indications

Combace ophthalmic suspension is indicated for steroid-responsive inflammatory ocular conditions for which a corticosteroid is indicated and where bacterial infection or a risk of bacterial ocular infection exists.

Ocular steroids are indicated in inflammatory conditions of the palpebral and bulbar conjunctiva, cornea and anterior segment of the globe where the inherent risk of steroid use in certain infective conjunctivitis is accepted to obtain a diminution in edema and inflammation. They are also indicated in chronic anterior uveitis and corneal injury from chemical radiation, or thermal burns, or penetration of foreign bodies. The use of a combination drug with an anti-infective component is indicated where the risk of infection is high or where there is an expectation that potentially dangerous numbers of bacteria will be present in the eye.

The combination can also be used for post-operative inflammation and any other ocular inflammation associated with infection.

Dosage and Administration

Shake well before use

One or two drops of Combace instilled into the conjunctival sac(s), every 4 to 6 hours. During the initial 24 to 48 hours, the dosage may be increased to 1 or 2 drops every two hours.

Frequency must be decreased gradually or warranted by improvement in clinical signs.

Care should be taken not to discontinue the therapy prematurely

Combace Highlights:  

• World's first Preservative free antibacterial-steroid combination
• Fast acting and long lasting
• No Corneal Toxicity, since BAK is absent
• Can be used effectively and safely in patients with Ocular Surface disorders
• Safe and well tolerated, hence increase in compliance may be seen
• Increase in compliance results in increase in efficacy and hence better final outcomes.
• Uniform sized particles in a homogenous suspension: Uniform drug distribution
• No clumping, hence no irritation to the ocular surface.

Corticosteroids have been used to treat inflammatory conditions of the eye since the 1950s and have been injected intraocularly since 1974.

Triamcinolone acetonide injectable suspension is a synthetic corticosteroid with anti-inflammatory action. Triamcinolone acetonide possesses glucocorticoid activity typical of this class of drug, but with little or no mineralocorticoid activity

Corticosteroids like intravitreal traimcinolone acetonide have been demonstrated to depress the production of eosinophils and lymphocytes, but erythropoiesis and production of polymorphonuclear leukocytes are stimulated. Inflammatory processes (edema, fibrin deposition, capillary dilatation, migration of leukocytes and phagocytosis) and the later stages of wound healing (capillary proliferation, deposition of collagen, cicatrization) are inhibited

Triamcinolone acetonide is a relatively safe and effective agent for treatment of conditions requiring long term ocular steroid administration such as uveitis , macular edema secondary to retinal vascular disease and intraocular proliferations such as choroidal neovascularizations ( CNV) in age related macular degeneration ( ARMD) , vitreous and diabetic retinopathy .In addition, triamcinolone acetonide can be used intra operatively by both the anterior and posterior segment surgeons to aid in visualization of the vitreous and removal of retinal membranes

Intravitreal triamcinolone acetonide thus has opened new avenues for the treatment of intraocular edematous and neovascular diseases

Dosage form
Single use 1 mL vial containing 40 mg/mL of sterile triamcinolone acetonide suspension

Indications
Intravitreal Triamcinolone acetonide has been used for various diseases. Severe chronic and inflammatory processes involving the eye, such as herpes zoster opthalmicus, iritis, iridocyclitis, diffuse posterior uveitis and choroiditis, optic neuritis, chorioretinitis, sympathetic opthalmia, diffuse diabetic macular edema, chronic cystoid macular edema, prevention of PVR, and identification of vitreous during vitrectomy in patients with rhegmatogenous retinal detachment, macular edema secondary to CRVO and BRVO. chronic uveitis, pars planitis, diabetic papillopathy, uveitic cystoid macular edema serous retinal detachment in Vogt-Koyanagi-Harada syndrome, exudative age related macular degeneration, chronic prephthisical ocular hypotomy, persistent psedophakic cystoid macular edema, ocular Ischemic syndrome, etc.

Dosage and Method of administration

Dosage for Treatment of Ophthalmic Diseases

The initial recommended dose of RETILONE i s 4 mg (100 micro liters of 40 mg/mL suspension) with subsequent dosage as needed over the course of treatment.

Dosage for Visualization during Vitrectomy

The recommended dose of RETILONE is 1 to 4 mg (25 to 100 micro liters of 40 mg/mL suspension) administered intravitreally.

Preparation for Administration

STRICT ASEPTIC TECHNIQUE IS MANDATORY. The vial should be vigorously shaken for 10 seconds before use to ensure a uniform suspension. Prior to withdrawal, the suspension should be inspected for clumping or granular appearance (agglomeration). An agglomerated product results from exposure to freezing temperatures and should not be used. After withdrawal, RETILONE should be injected without delay to prevent settling in the syringe. Careful technique should be employed to avoid the possibility of entering a blood vessel or introducing organisms that can cause infection.

Administration

Use fresh sterile hypodermis 27 gauge needles, 1 inch more in length to inject RETILONE.

The injection procedure should be carried out under controlled aseptic conditions, which include the use of sterile gloves, a sterile drape, and a sterile eyelid speculum (or equivalent). Adequate anesthesia and a broad-spectrum microbicide should be given prior to the injection.

Following the injection, patients should be monitored for elevation in intraocular pressure and for endophthalmitis. Monitoring may consist of a check for perfusion of the optic nerve head immediately after the injection, tonometry within 30 minutes following the injection, and biomicroscopy between two and seven days following the injection. Patients should be instructed to report any symptoms suggestive of endophthalmitis without delay.

The highlights of RETILONE are as follows:  

• Crystalline nature of the drug together with its sequestration in the vitreous, ensures an effective concentration in the vitreous cavity
• Stabilises the blood-retinal barrier
• Down regulates the production of VEGF
• Synergistic effect of IVTA with anti-VEGF's
• IVTA with PDT effective and safe in exudative AMD
• New alternative to laser therapy.
• Rapid resolution of macular edema and improvement in visual acuity.
• Promising treatment for patients with DME refractory to laser Rx.
• Safe and effective in treating uveitis
• Quick symptom relief in recalcitrant VKC

Currently the use of ß-lactamase inhibitors is the most successful strategy to restore the efficacy of ß-lactam antibiotics. Accumulating experience with ß-lactam/ß-lactamase inhibitor combinations has resulted in a better appreciation of their role in clinical practice. Importantly, they are indicated for the empirical treatment of a variety of infections, particularly against mixed infections involving anaerobes and against certain multi-resistant pathogens responsible for nosocomial infections. When compared with more conventional regimens, ß-lactam/ß-lactamase inhibitor combinations are relatively well tolerated and are at least as efficacious if not superior. The available oral formulations also provide convenient outpatient or step-down therapy against susceptible pathogens.

The formulation of cefixime and clavulanic acid in CLACENT is one of example of ß-lactam/ß-lactamase inhibitor combinations product.

Cefixime, is an orally active third generation cephalosporin (beta lactam antibiotic) with in vitro antibacterial activity against most important lower respiratory pathogen. The drug is active against Haemophilus influenzae, Moraxella catarrhalis , penicillin susceptible Streptococcus pneumoniae, Streptococcus pyogenes and many Enterobacteriaceae.

Cefixime is distinguished by its 3-hour elimination half life which permit twice daily or in many instances once daily administration.

Several trial have established the clinical efficacy of the drug in patients with lower respiratory tract infection ( LRTI ).In comparative studies cefixime had similar efficacy to amoxicillin plus clavulanic acid ,cefaclor, cefalexin, cefuroxime axetil and clarithromycin. Cefixime also have a role as the oral component of intravenous to oral switch therapy.

In common with cephalosporins such as cefotaxime and beta lactam agent like latamoxef cefixime is stable to hydrolysis by a wider range of beta lactamases than cephalexin, cephradine and cefadroxil and beta lactamase stability was similar to that of ceftizoxime.

However, cefixime was found to be ineffective against bacteria which produces ESBL enzyme and resistance is seen in such types of bacteria.

Clavulanic acid was the first clinically useful ß-lactamase inhibitor to be described in the literature, and is an irreversible ‘suicide' inhibitor of intracellular and extracellular ß-lactamases, demonstrating concentration-dependent and competitive inhibition. It has a high affinity for the class A ß-lactamases. This wide range of ß-lactamases, which includes the plasmid-mediated TEM and SHV enzymes, is found frequently in members of the Enterobacteriaceae, Haemophilus influenzae and Neisseria gonorrhoeae . The chromosomally mediated ß-lactamases of Klebsiella pneumoniae , Proteus mirabilis , Proteus vulgaris , Bacteroides fragilis and Moraxella catarrhalis are also inhibited, as are the extended-spectrum ß-lactamases. The frequency of ß-lactamase mediated resistance has continued to rise over the years, but the majority of clinically significant ß-lactamases are inhibited by clavulanate.

Clavulanate is a highly effective inhibitor of extended-spectrum ß-lactamases (ESBLs) Oxyimino-cephalosporin–clavulanate combinations are active in vitro against most ESBL-producing Escherichia coli and Klebsiella spp. isolates
at ≤1–2 mg/L .

Clavulanic acid penetrates into periplasm of pathogens rapidly so as to intercept the, ß -lactamase before all labile antibiotics has been destroyed. Also, clavulanic acid was shown to be synergistic with a number of penicillins and cephalosporins that are readily hydrolyzed by plasmid-mediated ß-lactamases.

Excellent protection was afforded to beta lactam antibiotic when clavulanic acid was added to gram-negative, gram-positive, and anaerobic organisms initially resistant to this labile antibiotic.

The extended spectrum ß-lactamases, for example, despite hydrolyzing penicillins, all generations of cephalosporins, and in some cases monobactams, remain susceptible to ß-lactamase inhibitors, so where pathogens that produce these enzymes are a particular problem, ß-lactam/ ß-lactamase inhibitor combinations may be extremely useful.

Thus CLACENT offers:

1. Greater activity against both gram positive & gram negative pathogens including high beta lactamase enzyme producers
2. Excellent protection to beta lactam antibiotics from both intracellular & extracellular beta lactamase enzymes
3. Synergistic effect as result of complementary binding to penicillin binding proteins (PBPs)
4. High Beta lactamase stability with minimal resistances
5. Favorable pharmacokinetic properties with good distribution into most of the respiratory tissues.
6. Well tolerated safety profile
7. Enhanced patient compliance as once to twice daily dosage adequate to treat infection

INDICATIONS
CLACENT is indicated for the treatment of:
Respiratory tract infections – Bronchitis, Bronchiectasis, Pneumonia
ENT Infections – Chronic Maxillary Sinusitis, Chronic Otitis Media
Urinary tract infections – Acute uncomplicated and complicated urinary tract infection

DOSAGE AND METHOD OF ADMINISTRATION
Adults and Children over 10 Years : One tablet twice daily

The usual course of treatment is 7 days. This may be continued for up to 14 days if required.

Burden of Diabetic Complications
Diabetes reduces life expectancy by 5 to 10 years and premature cardiovascular disease is the most common cause of morbidity and mortality amongst diabetic individuals. The process of atherosclerosis is a major contributor to the cardiovascular complications in diabetes, with almost 50% of diabetics having significant evidence of atherosclerosis at diagnosis. Clinically, dyslipidaemia is highly correlated with atherosclerosis, and up to 97% of patients with diabetes are dyslipidaemic. Further, more than 40% of these patients' develop one or more microvascular conditions like neuropathy, retinopathy or nephropathy during the course of the disease with uncontrolled hyperglycaemia the major contributor to these conditions.

Effective Glucose Control
Glycaemic control is fundamental to the management of diabetes. Emerging data shows that oral monotherapy is often initially successful, but associated with high secondary failure rate. To overcome such failures of monotherapy, a combination therapy of oral anti-diabetic agents with complementary modes of action is generally considered. The combination of a sulphonylurea with metformin is commonly used in clinical practice and has been shown to be effective in controlling hyperglycaemia in patients experiencing sub-optimal control with monotherapy, or even as an initiation therapy in patients with marked hyperglycaemia (HbA 1c : 9–11%).

Effective Lipid Control
Elevated LDL-C levels are an important component of diabetic dyslipidemia and play a crucial role in the atherosclerosis associated with diabetes. The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) and the American Diabetes Association (ADA) has reinforced LDL as the primary target of cholesterol-lowering therapy. Since statins are the most potent LDL lowering agents they are the first line agents in the treatment of diabetic dyslipidemia being with atorvastatin the statin of choice in diabetics.

Non-adherence:
Medication non-adherence is an important issue that greatly contributes to the sub-optimal achievement of therapeutic goals. It has been shown that medication non-adherence is present in more than 1 of every 5 diabetic patients and is responsible for higher HbA 1c , blood pressure, and LDL-C levels. In addition, non-adherent patients had significantly increased risk for all-cause hospitalization and all-cause mortality.

TRIPILL , a fixed-dose combination containing two anti-hyperglycaemic agents viz metformin and glimepiride and a lipid-lowering agent, atorvastatin, can target two major contributing factors leading to diabetes complications, namely, hyperglycaemia and dyslipidaemia, and thereby, play an important role in the primary as well as secondary prevention of diabetic complications. This combination can also address the issue of non-adherence by providing the convenience of three agents in a single tablet.

TRIPILL is available as:
TRIPILL 1
Each tablet contains:
Atorvastatin…………………………………………...10 mg
Glimepiride……………………………………………..1 mg
Metformin Hydrochloride extended-release……….500 mg

TRIPILL 2
Each tablet contains:
Atorvastatin…………………………………………...10 mg
Glimepiride……………………………………………..2 mg
Metformin Hydrochloride extended-release……….500 mg

INDICATIONS

TRIPILL is indicated along with lifestyle therapy in diabetic patients:

• With dyslipidaemia (elevated total cholesterol, LDL-C, or triglycerides)
• With cardiovascular disease (CVD)
• Without CVD, but with one or more CVD risk factors like hypertension, smoking, etc.

DOSAGE AND ADMINISTRATION
The initial recommended dose is one tablet of TRIPILL 1 or TRIPILL 2 Tablets , once daily.

Dosage should not exceed five tablets TRIPILL 1 per day or four tablets per day of TRIPILL 2 .

The last two decades has seen an increasing incidence in invasive fungal infections due to the huge rise of immunocompromised patients .Invasive fungal infections are associated with prolonged hospital stay and a high mortality.

The most common fungal infections are candidiasis, cryptococcosis, aspergillosis, and the endemic mycoses including zygomycosis, fusarium and penicilliosis.

The treatment options for invasive mycoses have been limited to 3 groups of drugs and these all have their own limitations- inadequate spectrum, resistance, toxicities and drug-drug interactions.

Amphotericin B since its discovery in 1960 has been the gold standard for treatment of fungal infections but its use was hugely limited by its acute toxicity and nephrotoxicity.

With the other lipid preparations of amphotericin B these side effects have been reduced, and the liposomal formulation is the most efficacious with the least exhibited toxicity.

Now Cipla has created a “Magic Bullet” in Phosome. Cipla's technology encapsulates Amphotericin B in liposomes with a bilayered structure. This unique drug delivery technology delivers the potency of the parent compound with much less toxicity.

Indications

• Empirical therapy for presumed fungal infection in febrile, neutropenic patients.
• Treatment of Cryptococcal Meningitis in HIV infected patients.
• Treatment of patients with Aspergillus species, Candida species and/or Cryptococcus species infections refractory to or with renal impairment or toxicity to AMB
• Treatment of visceral leishmaniasis.

The recommended initial dose of PHOSOME for each indication for adult and

paediatric patients is as follows:

Indication	Dose(mg/kg/day)
Empirical therapy	3
Systemic fungal infections: Aspergillus Candida Cryptococcus	3-5
Cryptoccal meningitis in HIV infected patients	6

Dosing and rate of infusion should be individualized to the needs of the specific patient to ensure maximum efficacy while minimizing systemic toxicities or adverse events.

Doses recommended for visceral leishmaniasis are presented below:

For immunocompetent patients who do not achieve parasitic clearance with the recommended dose, a repeat course of therapy may be useful.

For immunocompromised patients who do not clear parasites or who experience relapses, expert advice regarding further treatment is recommended.

Each vial of PHOSOME contains 50mg of amphotericin B IP encapsulated in liposomes.

Hypertension is highly prevalent throughout the world with 1 out of every 5 adult Indian having hypertension. Studies have shown that any monotherapy is able to normalize BP in only about 20-30% of hypertensives while c ombination therapy improves the BP response rate in 75-90%. Currently, focus is increasingly on the use of RAAS blocker-CCB combination in the management of hypertension.

CRESAR AM is a fixed dose combination of telmisartan 40 mg and amlodipine 5 mg. CRESAR AM provides a balanced and additive BP reduction. In addition, the combination provides effective cardioprotection, vascular protection & renoprotection. In addition, edema a commonly seen side-effect of amlodipine monotherapy is attenuated by addition of a telmisartan; which improves the safety profile of the combination. Morever, CRESAR AM is a combination that can be safely used for management of hypertensives with any comorbid condition.

The recommended dose is one tablet of CRESAR AM once daily. If necessary, the dose may be increased to two tablets of CRESAR AM once daily. In small, fragile or elderly patients or patients with hepatic insufficiency, the patient should be initiated on separate tablets of telmisartan 40 mg & amlodipine 2.5 mg. When the patient is able to tolerate up to 5 mg of amlodipine, the patient may be shifted to one tablet of CRESAR AM.

There is a risk of pain with all refractive surgery.  The goal of post operative management includes the prevention and relief of pain. Steroids and NSAIDs are used for management of post operative pain and inflammation.

RATIONALE FOR KETODROPS LS
Clinical trials reported transient stinging and burning on instillation of 0.5% ketorolac. A reduced concentration of ketorolac would possibly diminish patient's complaints of stinging and burning after its instillation.

The new formulation of ketorolac was developed with the specific goal of maintaining the efficacy while minimizing the side effects associated with NSAIDs.

Ketorolac 0.4% has fewer side effects, such as less foreign body sensation as well as stinging and burning than the 0.5% ketorolac. Therefore, ketorolac 0.4% appears to be more comforatable. This increase in comfort may lead to improved patient compliance.

Significantly less foreign body sensation as well as less stinging and burning could be explained, in part, by the reduction of active ingredient, but also it could be related to the reduced BAK concentrations in 0.4% ketorolac formulation.

KETODROPS LS contains Ketorolac tromethamine 0.4% (20% less active ingredient) and is preserved with BAK 0.006% (40% less preservative). Ketorolac tromethamine ophthalmic solution 0.4% is a member of the pyrrolo-pyrrole group of nonsteroidal anti-inflammatory drugs (NSAIDs) for ophthalmic use.

INDICATIONS
KETODROPS LS ophthalmic solution is indicated for the reduction of ocular pain and burning/stinging following corneal refractive surgery.

DOSAGE AND ADMINISTRATION
The recommended dose of KETODROPS LS ophthalmic solution is one drop four times a day in the operated eye as needed for pain and burning/stinging for up to 4 days following corneal refractive surgery.

Ketorolac tromethamine ophthalmic solution has been safely administered in conjunction with other ophthalmic medications such as antibiotics, beta blockers, carbonic anhydrase inhibitors, cycloplegics, and mydriatics.

HIGHLIGHTS

• HPMC advantage – offers cooling and soothing effects
• Improved Patient Compliance
• As effective as Ketorolac 0.5%
• Effective in pain and inflammation management
• Decreases conjunctival inflammation and relieves ocular itch.
• Reduces incidence of clinically significant CME.
• Superior to flurbiprofen – inhibits miosis and is non-irritating to ocular surface
• Safe and well tolerated

URISODA is a urinary alkalizer that contains sodium bicarbonate, sodium citrate, citric acid and tartaric acid as effervescent granules

URISODA	Per gram	Per sachet (4 g)
Sodium bicarbonate	440.3 mg	1761.2 mg
Sodium citrate	157.5 mg	630.0 mg
Citric acid	178.8 mg	715.2 mg
Tartaric acid	222.5 mg	890.0 mg

Indications

• URISODA by virtue of its contents of sodium bicarbonate, sodium citrate and citric acid is used as an orally administered gastric, systemic and urinary alkalinizer
• URISODA is used to provide symptomatic relief of dysuria in cases of cystitis where there is no definite clinical evidence of a bacterial infection. It may be given to relieve discomfort in mild urinary tract infections
• URISODA is used in the treatment of chronic metabolic acidosis, especially when caused by renal tubular acidosis
• URISODA is useful as an antacid to neutralize gastric acid
• URISODA can also be used in conjunction with uricosuric agents in the treatment of gout to prevent uric acid nephropathy. It is also useful in conditions where long term maintenance of alkaline urine is desirable, and in the prevention and treatment of uric acid and cystine kidney stones

Dosage and Administration

URISODA is to be diluted in water prior to intake, and may be washed down with additional water, if needed.

In adults:
1-2 sachets (4 to 8 g) in ¾ glass of water to be administered two to three times daily. Drink after effervescence has settled down to avoid eructation.

In children 6-12 years of age:
One sachet (4 g) in half a glass of water two or three times daily. Drink after effervescence has settled down to avoid eructation.

Children below 6 years:
As directed by the physician.

Available as:
Sachet containing 4 g of URISODA

Highlights:

• URISODA is used as a urinary alkalizer for symptomatic relief of dysuria in cases of cystitis, in conjuction with uricosurics agents in treatment of gout and for the prevention and treatment of uric acid and cystine kidney stones
• URISODA may be used as a gastric and systemic alkalizer
• Long term safety and efficacy has been established for 8 weeks, urinary pH increased significantly and it is maintained for 8 weeks

Influenza causes significant morbidity and mortality

• Pandemics of influenza killed at least 50 million people in the 20 th century. Although less severe, the more frequent influenza epidemics killed a much greater number of people

Vaccination substantially reduces mortality and Hospitalizations from

• Pneumonia/influenza
• Respiratory conditions complicated by influenza
• Cardiac events triggered by influenza in patients with heart disease like MI and stroke

Prevention is better than cure: “Vaccination is the cornerstone of prevention” (WHO):

• Vaccination reduces morbidity and mortality
• Vaccination is cost-effective, and in some cases cost-saving
• Vaccination of the workforce can substantially reduce the indirect costs of influenza to institutions and society.

INFLUVAC is an inactivated subunit vaccine for influenza. It contains surface antigens (Haemagglutinin and Neuraminidase) for 3 subtypes of influenza virus. This vaccine complies with the World Health Organization (WHO) recommendation (northern hemisphere) and the competent authority decision for the applicable season. It is updated every year according to the recommendations from WHO and competent authority.

Indications

Prophylaxis of influenza, especially in those who run an increased risk of associated complications.

Vaccination is particularly recommended for the following categories of patients :

• Persons aged ≥ 65 years, regardless of their health condition.
• Adults and children with chronic disorders of the pulmonary or cardiovascular systems, including asthma.
• Adults and children with chronic metabolic diseases such as diabetes mellitus.
• Adults and children with chronic renal dysfunction.
• Adults and children with immunodeficiencies due to disease or immunosuppressant medication (e.g., cytostatics or corticosteroids) or radiotherapy.
• Children and teenagers (aged 6 months–18 years) who receive long-term acetylsalicylic acid-containing medication and might, therefore, be at risk of developing Reye's syndrome following an influenza infection.

Dosage and Method of Administration

Adults and children above 35 months of age: 0.5 ml

Children aged 6 months–35 months: Clinical data are limited; doses of 0.25 ml or 0.5 ml have been used. For children who have not previously been vaccinated, a second dose should be given after an interval of at least 4 weeks.

Immunization should be carried out by intramuscular or deep subcutaneous injection.