Snwg MY-BOOKLET-PUB Edited (1) (1)

PharmZone
Pharmacy Unit, Klinik Kesihatan

Senawang 1st Edition

2022

1 DIOSMIN 50MG HESPERIDIN 450MG
2 PREDNISOLONE
3 SCABIES TREATMENT
4 ACNE TREATMENT
5 HEADLICE

TREATMENT

6 GRISEOFULVIN
7 COSMOFER
8 FERRIC AMMONIUM CITRATE (FAC)
9 MEDICATION THAT CANNOT BE SPLIT / BREAK

CONTENTS

1. DIOSMIN 50MG HESPERIDIN 450MG (DAFLON®)

DOSING INFORMATIONS

INDICATIONS Venous circulation disorders Acute hemorrhoidal attack

Recommended dose Recommended dose

ADULTS 2 tablets daily 2 tabs Daflon TDS x 4 days = 24 tabs
2 tabs Daflon BD x 3 days = 12 tabs
(1 tab at midday and 1 tab in the
evening at mealtimes)

PEDIATRICS Should be avoided in child & adolescent < 18 yrs

 There are no or limited amount of data from the use in pregnant women.
PREGNANT  As a precautionary measure, it is preferable to avoid the use of DAFLON

during pregnancy.

 It is unknown whether the active metabolites are excreted in human milk.
LACTATING  A decision must be made whether to discontinue breast-feeding or to

discontinue DAFLON therapy

AVAILABLE
PRODUCT

2. PREDNISOLONE

a) Bell’s Palsy

 Bell's palsy [BP] is defined as acute idiopathic peripheral facial palsy or paralysis.

 Additional symptoms frequently include:

Pain around or behind the ear

Impaired tolerance to ordinary levels of noise

Disturbed sense of taste on the same side

 It affects men and women more or less equally.

Bell Palsy Regimen: Short course prednisolone regimen:
T. Prednisolone 60 mg x 5/7 T. Prednisolone 50-60 mg OD x 5/7
T. Prednisolone 50 mg x 1/7

T. Prednisolone 40 mg x 1/7

T. Prednisolone 30 mg x 1/7

T. Prednisolone 20 mg x 1/7

T. Prednisolone 10 mg x 1/7

3. SCABIES TREATMENT

Patient Category Recommended Therapy
Newborn to 2 months of
Crotamitone 10% cream
age Permethrin 5%
Children (2 months to 2
Crotamitone 10%
years old) 6% sulphur in calamine / petrolatum

Children (2-12 years old) Emulsion benzyl benzoate 12.5%
Permethrin 5%

Adult Emulsion benzyl benzoate 25%
Permethrin 5%

Pregnant women Permethrin 5%
6% sulphur in calamine/ petrolatum

COUNSELLING POINTS

Emulsion Benzoyl Benzoate (EBB) 12.5% & 25%

1. Apply from neck to soles, avoid head and face area
2. Apply on the skin surface continously for 24 hours for 2-3 days.
3. Rinse off after 24 hours and then reapply, with a bath taken in between each application. A

third application may be required in some cases i.e. HIV/
immunocompromised patients.
4. Wash off thoroughly after the recommended time period.
5. Use of EBB is contraindicated in pregnancy, breast feeding woman and infant of <2 years old.

Permethrin 5% Lotion

1. Apply over whole body include face, neck, scalp and ears in
2. infants & HIV patients who has scabietic lesions on the head.
3. Otherwise in normal adults, apply from neck to soles.
4. Wash off after 8 - 12 hours
5. Repeat 1 week later

6% sulphur in calamine/ petrolatum

1. Rinse off after 24 hours and then reapply every day for the next 3
days (with a bath taken in between each application).

4. ACNE TREATMENT

Cetrimide 1%, 2% solution

1. Apply solution onto the face twice daily
2. Cetrimide mix with water on palms, rub hand together until froth
3. Apply froth on face
4. Then rinse off with water & dap dry

Benzyl Peroxide 5%; 10%

1. Apply on the acne spot after washing skin. May apply twice/ thrice a day if needed.
2. Start on night for a week, if no irritation, then can apply twice a day.
3. Stop if skin irritation occurs.

5. HEADLICE TREATMENT

Permethrin 1% Lotion

Side effects : Mild skin irritation, burning

1. Apply lotion onto clean towel-dried hair, ensuring every strand comes in contact with
lotion for at least 10 minutes.

2. Rinse completely
3. Re-apply after 7-10 days (to ensure total recovery)

Gamma Benzene Hexachloride (GBH) 0.1% Lotion

Side effects : CNS effects (Dizziness, Headache, Nausea, Vomiting), Skin Irritation, Contact
Dermatitis.
• Not for use by infant as it can cause toxic encephalopathy.
1. Before using the GBH shampoo, make sure hair is clean by using regular shampoo

without conditioner and dry it. However, do not wash hair within 1 hour before using GBH
shampoo.
2. Shake the GBH shampoo bottle well.
3. Use 1 ounce (30ml) or not more than 2 ounces (60ml) of GBH shampoo on dry hair to wet
the hair and scalp.
4. Do not add water to the hair at this time
5. Also, put GBH Shampoo on the short hairs at the back of neck and sideburns.
6. Keep GBH Shampoo on hair for 4 minutes
7. Do not wear a shower cap or any covering on head while waiting for the 4 minutes to
pass.
8. Rinse thoroughly with warm water and towel dry briskly.
9. Remove the dead lice, nits and nit-shells using a fine-toothed comb

6. GRISEOFULVIN

ADULT DOSING

INDICATION DOSAGE

Tinea pedis 1g ORALLY once a day OR q12h for 4 to 8
weeks

Tinea cruris 500mg - 1000 ORALLY OD daily in single or
divided dose for 2-6 weeks / until infection
has cleared

Tinea corporis 500mg -1000mg ORALLY OD daily for 2 to 4
weeks (single or in divided dose)

Tinea capitis 500mg-1g ORALLY once a day for 4 to 6
weeks

8-12 weeks (refractory cases of tinea
capitis)

1 g ORALLY single dose daily OR divided
Onychomycosis q12hr for at least 3 months (fingernails) or at

least 6 months (toenails)

PEDIATRIC DOSING

INDICATION DOSAGE
Tinea pedis
 (13.6 to 22.7 kg) 125 to 250 mg ORALLY OD for
4 to 8 weeks

 (> 22.7 kg) 250 to 500 mg ORALLY OD for 4 to 8
weeks

Tinea cruris  (13.6 to 22.7 kg) 125 to 250 mg ORALLY OD for
2-6 weeks/until infection has cleared

 (> 22.7 kg) 250 to 500 mg ORALLY OD until
infection has cleared

Tinea corporis  (13.6 - 22.7 kg) 125 to 250 mg ORALLY OD for 2
to 4 weeks

 (> 22.7 kg) 250 to 500 mg ORALLY OD for 2 to 4
weeks

 Child 1 mth -11 yrs:
10-20 mg/kg/day PO x 4-6 wks, max per dose
1g)

Tinea capitis  Child > 2 years
20-25 mg/kg/day OD for 6- 8 weeks / until
culture is clear

Onychomycosis  If there is partial response, the dose can be
increased to 15 mg/kg per day and/or the
length of therapy extended up to 12 weeks

 (13.6 to 22.7 kg) 125 to 250 mg ORALLY OD for
at least 4 months (fingernails) or at least 6
months (toenails)

 (> 22.7 kg) 250 to 500 mg ORALLY OD for at
least 4 months (fingernails) or at least 6 months
(toenails)

7. IRON DEXTRAN (COSMOFER)

Intravenous iron should only be used if
the benefits outweigh the risk

Dose calculation (Formula used in Klinik Kesihatan Senawang):

Dose (mg) = Body weight (kg) x [Target Hb - Actual Hb] (g/dl)
x 2.4 + storage (depot) iron (mg)

Where:

Body weight*

Target Hb Below 35 kg 35 kg and above
13 g/dl 14g/dl

Storage iron (mg) 15 mg/kg 500 mg

*Body weight (kg): (use ideal body weight IBW) if BMI>30

TO CALCULATE THE TOTAL IRON DEFICIT

Example:
Patient weight = 63 kg Target Hb = 14 g/dl Actual Hb = 7.4 g/dl

Step 1: Total iron deficit: 63 kg x [14 - 9] g/dl x 2.4 + 500 mg
: 1256 mg

To ensure dose does not exceed 20mg/kg= 20 mg x 63kg = 1260mg
dose obtained does not required to be rounded down.

NO. OF AMPOULES TO BE ADMINISTERED

Step 2: Required volume (ml) : 1 ml = 50 mg (availability)
: X ml = 1256 mg
: 25.12 ml

Step 3: No. of ampoules: 1 amp = 2 ml
: X amp = 25.12 ml : 12.56 » 13 ampoules

Points need to be noted:
1. Divide the calculated dose by the patient's weight (IBW if BMI >30, or (ABW

if BMI<30) to ensure it does NOT exceed 20mg/kg.

2. If dose exceeds 20mg/kg it should be rounded down to 20mg/kg

8. FERRIC AMMONIUM CITRATE (FAC)

Ferric ammonium citrate 400 mg/5 ml mixture (FAC syrup) is a
commonly prescribed medication for prevention and treatment of

iron-deficiency anemia in premature infants

Administration:
It is suggested that the dose should be taken well diluted with water.

Dosage
a) The dosing of FAC syrup is based on elemental iron needed per day.
b) As per Frank Shann Drug Doses, 2020. ferrous salts dosage is as below:

 Prophylaxis: 2 mg/kg/day.
 Treatment: 6 mg/kg/day.
 Maintenance: 2 mg/kg/day.

Age Elemental Iron
> 1 month 6 mg/kg/day in divided doses
Infants < 28 days
Not recommended

In Klinik Kesihatan, Ferric ammonium citrate 400
mg/5 ml contains 16 mg/ml Elemental Fe.

FAC 400mg/5ml concentration should NEVER be used to calculate the volume of
FAC syrup required for each dosing.

Example:
Q. Baby (weighs 9.4kg, requires treatment for iron-deficiency anemia

CALCULATE THE TOTAL VOLUME OF MEDICATION NEEDED

A volume of 3.53 ml FAC syrup
can be administered to patient

9. MEDICATION THAT CANNOT BE SPLIT / BREAK

GENERIC NAME DOSAGE FORM REASON

Montelukast Sodium Tablet Film-Coated
Diosmin & Hesperidin Tablet Film-Coated
Diltiazem Hydrochloride Tablet Prolonged release
Tablet Film-Coated
Etoricoxib Tablet Controlled release
Tamsulosin Capsules
Dutasteride Tablet N/A
Hyoscine Butyl-bromide Tablet Loses its Integrity
Finasteride Tablet
Acarbose Tablet Film-coated
Potassium Chloride Tablet Unscored tablets
Gliclazide MR Capsule Extended-release
Meloxicam Tablet Modified-Release
Bisacodyl Tablet
Diltiazem Tablet N/A
Carbamazepine Capsule Enteric-coated
Tramadol Capsules Sustained-release
Isosorbide dinitrate Tablet Controlled-release
Pentoxifylline Tablet
Glyceryl trinitrate Tablet N/A
Metformin XR Capsule N/A
Gemfibrozil Capsule Modified-release
Gabapentin Tablet Sublingual
Propranolol Tablet Extended-release
Pantoprazole Tablet N/A
Acyclovir Capsule N/A
Itraconazole Tablets Modified-release
Telmisartan Tablet Film-coated
Sodium valproate Loses its integrity
N/A
Film-coated
Enteric-coated

GENERIC NAME DOSAGE FORM REASON
Doxycycline Capsule N/A
Tablet
Erythromycin Ethylsuccinate Capsule Film-coated
Amoxicillin Capsule N/A
Amoxicillin/ Tablet N/A
Gelusil Tablet
Iberet-Folic Capsule Film-coated
Zincofer Tablet Sustained release
Clopidogrel Tablet
Tablet N/A
Doxazosin Mesylate CR Tablet Enteric-coated
Fenofibrate Tablet Controlled-release
Lamotrigine Capsule
Nifedipine Tablet Film-coated
Phenytoin Tablet Extended-release
Capsule
Isosorbide dinitrate Capsule Film coated
Theophylline SR Tablet N/A
Calcitriol Capsule
Alfacalcidol Tablet Extended-Release
Chlorpromazine Capsule Sustained-released
Tablet
Tolterodine Tartrate Tablet N/A
Felodipine Tablet N/A
Tablet Film coated
Essential phospholipid Tablet Extended-release
Daclatasvir Tablet Extended-release
Efavirenz N/A
Loses its integrity
Tenofovir & Emtricitabine Loses its integrity
Diclofenac sodium Loses its integrity
Warfarin Enteric coated
Extended-release
Ampicillin/ Sulbactam Film-coated

References

1. BNF.org. (2020). BNF for children 2008: The essential resource for
clinical use of medications in children (2020-2021st ed.). BNF for
Children.

2. Lexicomp. (2020). Drug information handbook with international
trade names index 2014-2015 (29th ed.). Lexi-Comp ISBN 978-1-
59195-381-4.

3. Mims. (n.d.). Search Drug Information, Interactions, Images,
Dosage & Side Effects | MIMS. https://www.mims.com/Malaysia

4. Ministry of Health. (2021). Home - Micromedex. MIMS
GATEWAY. https://www.micromedexsolutions.com/micromedex2/libr
arian/deeplinkaccess?institution=institutionname^ubmma^myMIMS
GW2019&SearchTerm=&source=deepLink

5. Taketomo, C. K., Hodding, J. H., & Kraus, D. M. (2019). Lexi-comp's
pediatric dosage handbook: Including neonatal dosing, drug
administration, & extemporaneous preparations (26th ed.). Lexi-
Comp ISBN: 978-1-59195-380-7.

6. UpToDate. (n.d.). Griseofulvin: Drug
information. https://www.uptodate.com/contents/griseofulvin-drug-
information

A Publications of Drug Information
Service

Advisor
Mazrene Binti Saleh

Chief Editor
Cheng Ying Sing

Editors
Hemarani a/p Nachimuthu

Kamalini a/p Sudraj
Tel: 06-6766075