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Pediatrics Case No 6.Cough

ছোট বাচ্চাদের কাশি হলে কিভাবে চিকিৎসা দিবেন?

কিভাবে বুঝবেন, এইটা Dry cough নাকি productive cough?

productive cough সাধারণত lower RTI /lung parenchyma তে ইনফেকশন বুঝায়, সাধারণত নিউমোনিয়াতে productive cough হয়–

এই ক্ষেত্রে X-Ray করলে consolidation পাবেন, কিংবা patchy opacityপাবেন-

আর Auscultate করলে Creps পাবেন.

বাচ্চার কাশির সাথে মিউকাস যাবে, রাতে দিনে সব সময় একই রকম থাকবে- কোনো diurnal variation থাকবেনা—

যদি productive cough confirm হন, তাহলে ৩ টা মেডিসিন দেওয়া নিষেধ – এন্টিহিস্টামিন, Butamirate, (Mirakof) Dextromethorphan,

productive cough এর চিকিৎসা হবে–

cough expectorant agent দিয়ে–

Ambroxol

Bromhexine

Acetylecysteine এই সব দিয়ে

Treatment Management:-

Pediatric Drop 1:- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Indications of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox is indicated in-

  • Productive cough
  • Acute and chronic inflammatory disorders of upper and lower respiratory tracts associated with viscid mucus including acute and chronic bronchitis
  • Inflammatory disease of rhinopharyngeal tract (laryngitis, pharyngitis, sinusitis and rhinitis) associated with viscid mucus
  • Asthmatic bronchitis bronchial asthma with thick expectoration
  • Bronchiectasis
  • Chronic pneumonia etc.

Pharmacology of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambroxol is the active metabolite of bromhexine and it has been proven that this metabolite possesses a greater bronchosecretolytic effect than bromhexine. It improves sputum rheology by hydrating mechanism leading to liquefaction of mucus in the lumen of respiratory tract, thus facilitating expectoration of mucus and reducing dyspnea. It stimulates production of phospholipids of surfactant by alveolar cells, thus contributing to the lowering of superficial tension in the alveoli. It also reduces bronchial hyperactivity. Ambroxol has anti inflammatory properties owing to the inhibitory effect on the production of cellular cytokines and arachidonic acid metabolites. In patients with COPD it traditionally improves airway patency.

Dosage & Administration of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Average daily dose (preferably after meal):

Pediatric Drops:

  • 0-6 months: 0.5 ml 2 times a day
  • 6-12 months: 1 ml 2 times a day
  • 1-2 years: 1.25 ml 2 times a day

Syrup:

  • 2-5 years: 2.5 ml (1/2 teaspoonful) 2-3 times a day
  • 5-10 years: 5 ml (1 teaspoonful) 2-3 times a day
  • 10 years and adults: 10 ml (2 teaspoonful) 3 times a day.

Sustained release capsule: Adult and children over 12 years old: 1 capsule once daily.

Interaction of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox should not be taken simultaneously with antitussives (e.g.Codeine) because phlegm, which has been liquefied by Ambrox might not be expectorated.

Contraindications of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Contraindicated in known hypersensitivity to Ambroxol or Bromhexine.

Side Effects of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Gastrointestinal side effects like epigastric pain, stomach overfill feeling may occur occasionally. Rarely allergic responses such as eruption, urticaria or angioneurotic edema have been reported.

Pregnancy & Lactation

Teratogenic and fetal toxicity studies have shown no harmful effect of Ambroxol. However, it is advised not to use it in pregnancy, especially during the1st trimester. Safety during lactation has not been established yet.

Precautions & Warnings

Ambrox should be given cautiously to patients with gastric and duodenal ulceration or convulsive disorders. Patients with hepatic and renal insufficiency should take it with caution.

Therapeutic Class of Pediatric Drop :- Ambrox 6mg/ml 15ml Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Cough expectorants & mucolytics

০-৬ মাস। ৮ ফোটা করে দিনে ২ বার,

৬ মাস থেকে এক বছর – ১৫ ফোটা করে দিনে ২ বার

১ বছর থেকে ২ বছর–

সিরাপ Ambrox (৭-১০ দিন)

Syrup 2: Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Indications of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox is indicated in-

  • Productive cough
  • Acute and chronic inflammatory disorders of upper and lower respiratory tracts associated with viscid mucus including acute and chronic bronchitis
  • Inflammatory disease of rhinopharyngeal tract (laryngitis, pharyngitis, sinusitis and rhinitis) associated with viscid mucus
  • Asthmatic bronchitis bronchial asthma with thick expectoration
  • Bronchiectasis
  • Chronic pneumonia etc.

Pharmacology of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambroxol is the active metabolite of bromhexine and it has been proven that this metabolite possesses a greater bronchosecretolytic effect than bromhexine. It improves sputum rheology by hydrating mechanism leading to liquefaction of mucus in the lumen of respiratory tract, thus facilitating expectoration of mucus and reducing dyspnea. It stimulates production of phospholipids of surfactant by alveolar cells, thus contributing to the lowering of superficial tension in the alveoli. It also reduces bronchial hyperactivity. Ambroxol has anti inflammatory properties owing to the inhibitory effect on the production of cellular cytokines and arachidonic acid metabolites. In patients with COPD it traditionally improves airway patency.

Dosage & Administration of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Average daily dose (preferably after meal):

Pediatric Drops:

  • 0-6 months: 0.5 ml 2 times a day
  • 6-12 months: 1 ml 2 times a day
  • 1-2 years: 1.25 ml 2 times a day

Syrup:

  • 2-5 years: 2.5 ml (1/2 teaspoonful) 2-3 times a day
  • 5-10 years: 5 ml (1 teaspoonful) 2-3 times a day
  • 10 years and adults: 10 ml (2 teaspoonful) 3 times a day.

Sustained release capsule: Adult and children over 12 years old: 1 capsule once daily.

Interaction of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox should not be taken simultaneously with antitussives (e.g.Codeine) because phlegm, which has been liquefied by Ambrox might not be expectorated.

Contraindications of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Contraindicated in known hypersensitivity to Ambroxol or Bromhexine.

Side Effects of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Gastrointestinal side effects like epigastric pain, stomach overfill feeling may occur occasionally. Rarely allergic responses such as eruption, urticaria or angioneurotic edema have been reported.

Pregnancy & Lactation of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Teratogenic and fetal toxicity studies have shown no harmful effect of Ambroxol. However, it is advised not to use it in pregnancy, especially during the1st trimester. Safety during lactation has not been established yet.

Precautions & Warnings of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Ambrox should be given cautiously to patients with gastric and duodenal ulceration or convulsive disorders. Patients with hepatic and renal insufficiency should take it with caution.

Therapeutic Class of Syrup : Ambrox 15mg/5ml 100ML Bottle (AS A Ambroxol Hydrochloride Cough expectorants & mucolytics).

Cough expectorants & mucolytics

১/২ চামচ করে দিনে ২ বার-

২ থেকে ৫ বছর: ১ চামচ করে দিনে ২ বার—

Bromhexine ( Mucolyt) নামে পাওয়া যায়-

Syrup 3: Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Indications of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Mucolyt is indicated in the treatment of respiratory tract disorders associated with productive cough. This include-

  • Tracheobronchitis
  • Bronchitis with emphysema
  • Bronchiectasis
  • Bronchitis with bronchospasm
  • Chronic inflammatory pulmonary conditions and
  • Pneumoconiosis.

Pharmacology of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Bromhexine Hydrochloride is an oral mucolytic agent. It disrupts the structure of acid mucopolysaccharide fibres in mucoid sputum and produces less viscous mucus, which makes easier the expectoration. It is rapidly & completely absorbed from the gastrointestinal tract. It is widely distributed into the body tissues.

Dosage & Administration of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

The recommended doses for adults and children are stated below:

  • Adult & Children over 12 years: 10 ml (2 teaspoons) 3 times daily
  • Children 6-12 years: 5 ml (1 teaspoon) 3 times daily
  • Children 2-6 years: 2.5 ml (1/2 teaspoon) 3 times daily
  • Bromhexine Hydrochloride is not recommended for children under 2 years of age without advice.

Interaction of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

There are no known significant interactions with other drugs.

Contraindications of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

It is contraindicated in known hypersensitivity to Bromhexine Hydrochloride or any of the ingredients of this product.

Side Effects of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Gastrointestinal side effects may occur occasionally. A transient rise in serum aminotransferase values has been reported. Other reported side effects include-headache, vertigo (dizziness) and allergic reactions.

Pregnancy & Lactation of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Use in Pregnancy: Special care is recommended during pregnancy. The benefits of bromhexine must be assessed against possible effects on children.

Use in Lactation: Bromhexine is expected to enter breast milk. Therefore it is not recommended that bromhexine be taken by lactating mothers.

Precautions & Warnings of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Since mucolytics may disrupt the gastric mucosa bromhexine should be used with care in patients with a history of peptic ulcer disease. Care is also advisable in asthmatic patients. Clearance of bromhexine and its metabolites may be reduced in patients with severe hepatic or renal impairment.

Therapeutic Class of Syrup : Mucolyt 4mg/5ml 100ml/200ml Bottle (AS A Bromhexine Hydrochloride AS A Cough expectorants & mucolytics).

Cough expectorants & mucolytics

 : (৭-১০ দিন)

২ থেকে ৫ বছর-

আধা চামচ করে দিন ২ বার,

৫ বছর থেকে ১০ বছর

১ চামচ দিনে ২ বার-

১০ বছরের পর ২ চামচ করে দিনে ২ বার

ধরুন, কারো কাশি প্রথম dry ছিলো, পরে productive হয়ে গেছে–

এই ক্ষেত্রে Acetylecysteine সবচেয়ে ভালো কাজ করে–

১ বছরের পর থেকে দেওয়া যায়-

dose

1-2 বছর-

Tablet 4:- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

২-৩ চামচ পানিতে মিশিয়ে দিনে ১ বার,

২-৭ বছর-

দিনে ২ বার

৭ বছরের উপরে হলে দিনে ৩ বার অথবা Viscotine 600 mg দিনে একবার– ৭-১০ দিন

Indications of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Viscotin is indicated as an adjuvant treatment in certain clinical condition characterized by the presence of thick and viscous mucoid or mucopurulent secretions such as: Chronic bronchopulmonary diseases (chronic obstructive pulmonary disease, emphysema with bronchitis, chronic asthmatic bronchitis, bronchiectasis); Acute bronchopulmonary diseases (asthma with bronchial mucus plugging, bronchitis, bronchopneumonia, tracheobronchitis, bronchiolitis, pulmonary complications of cystic fibrosis, pulmonary complications associated with surgery).

Pharmacology of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Acetylcysteine is a mucolytic agent that reduces the viscosity of secretions probably by the splitting of disulphide bonds in mucoproteins. Moreover it gives antisecretory effect. These results in clearing of respiratory ducts and facilitate breathing. Acetylcysteine also has anti-oxidant properties by reacting with free radicals and also by serving as a precursor to glutathione, which is an important intra and extra-cellular antioxidant. By providing anti-oxidant action, it neutralizes exogenous and endogenous oxidants, which in fact act as pathogens in respiratory inflammations.

Dosage & Administration

Effervescent tablet or Dispersible tablet: Adults and children above 6 years: One effervescent tablet of Acetylcysteine 600 mg a day (preferably in the evening). The duration of treatment should be 5 to 10 days in the acute treatment, whereas it may be continued in the chronic states for several months, according to the advice of the physician. Dissolve the tablets in a glass containing a small quantity of water, mixing it, if necessary, with a spoon. A palatable solution is thus obtained, which can be drunk directly from the glass.

Effervescent Granules:

  • Adults and children above 6 years: 1 sachet Acetylcysteine 200 mg or 2 sachets Acetylcysteine 100 mg, 2-3 times a day.
  • Children (2-6 years of age): 1 sachet Acetylcysteine 100 mg from 2 to 4 times a day, according to the age.

The duration of treatment should be 5 to 10 days in the acute treatment, whereas it may be continued in the chronic states for several months, according to the advice of the physician.

Dissolve the contents of the sachets in a glass containing a small quantity of water; mixing it, if necessary, with a spoon. A palatable solution is thus obtained, which can be drunk directly from the glass.

Nebuliser Solution: The 20% solution may be diluted to a lesser concentration with either Sodium Chloride for injection, Sodium Chloride for inhalation, sterile water for injection, or sterile water for inhalation.

  • Adult: 5-10 ml of 10% or 20% solution by Nebuliser every 6-8 hr PRN.
  • Children: 1-11 months: 1-2 ml of 20% or 2-4 ml of 10% solution by Nebuliser every 6-8 hr PRN.
  • 12 months-11 years: 3-5 ml of 20% or 6-10 ml of 10% solution by Nebuliser every 6-8 hr PRN.
  • Below 12 years: 5-10 ml of 10/20% solution by Nebuliser every 6-8 hr PRN.

** Diagnostic Bronchograms: 1-2 ml of 20% or 2-4 ml of 10% solution 2-3 times by Nebulisation or by instillation intratracheally prior to procedure.

** Nebulisation tent or croupette: This form of administration requires very large volumes of the solution, occasionally as much as 300 ml during a single treatment period. If a tent or croupette must be used, the recommended dose is the volume of acetylcysteine (using 20%) that will maintain a very heavy mist in the tent or croupette for the desired period. Administration for intermittent or continuous prolonged periods, including overnight, may be desirable.

** Direct Instillation: When used by direct instillation, 1-2 ml of a 20% solution may be given as often as every hour. When used for the routine nursing care of patients with tracheostomy, 1-2 ml of a 20% solution may be given every 1-4 hours by instillation into the tracheostomy.

Interaction of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

The thiol group of Viscotin can reduce the efficacy of certain antibiotics such as ampicillin, tetracycline, macrolides, cephalosporins, aminoglycosides and amphotericin. Concomitant use of Viscotin and amoxicillin will increase the level of the antibiotic in tissues. It is, therefore, advisable to use the two medicines 2 hours apart from each other. Viscotin can increase the inhibitory effect of thrombocyte aggregation and vasodialation by nitroglycerine.

Contraindications of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Known hypersensitivity to Acetylcysteine. Acetylcysteine contains aspartame, thus it is contraindicated in patients suffering from phenylketonuria.

Side Effects of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Like all medicines, Viscotin can cause side effects, although not everybody gets them. In very rare cases, severe immune reactions may occur such as anaphylactic shock and severe skin reaction. In rare cases the oral administration can be followed by shortness of breath, upset stomach and bronchospasm. The most frequent side effects are headache, increased heart rate, stomatitis, pruritus, urticaria, nausea, vomiting, abdominal pain, fever, decrease in the blood pressure, diarrhoea and noises in the ears.

Pregnancy & Lactation of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

In case of pregnancy & lactation the medicine should be taken consulting physician or pharmacist.

Precautions & Warnings of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Patients suffering from bronchial asthma must be strictly controlled during the therapy; should bronchospasm occur, the treatment must immediately be suspended. Caution should be taken in patients suffering from or with a history of peptic ulcer. As Viscotin contains sodium (156.9mg per dose) this has to be taken into consideration by patients on a controlled sodium diet. The possible presence of a sulphureous odor does not indicate an alteration of the product but is a characteristic of the active ingredient contained in Viscotin. It is preferable not to mix other drugs with the Viscotin solution.

Overdose of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Overdose of Viscotin may cause nausea, vomiting or diarrhoea.

Therapeutic Class of Tablet :- Viscotine 600mg (Effervescent) (AS A Acetylcysteine Antidote preparations, Cough expectorants & mucolytics).

Antidote preparations, Cough expectorants & mucolytics

এবার আসি একটা সিনারিও

স্যার, আমার বাচ্চার ৪ মাস বয়স, ২ দিন সর্দি ছিলো, এখন অনেক কাশি,

কাশির জন্য ঘুমাতে পারছেনা,

আপনার জিজ্ঞাসা —

কোন কফ বের হয়?

বাচ্চার মা বলবে, কফ যায়না, তবে কাশতে কাশতে বমি করে দেয়–

এইযে — কফ বের হয়না, কাশতে কাশতে বমি করে দেয়, তখন আপনি জিজ্ঞাস করবেন– কখন কাশি বাড়ে,

বাচ্চার মা বলবে, দিনের বেলায় একটু কম থাকলেও রাতে আর ভোরে অনেক বাড়ে–

যেসব কাশি এইরকম রাতে আর ভোরে বাড়ে- তা Most commonly upper ARTI থেকে হয়–

Dry cough হয় এখানে-

এই ড্রাই কফ কনফার্ম হবার জন্য Chest auscultate করে দেখবেন,

Chest clear থাকলে এইটা Dry cough হিসাবে চিকিৎসা দিবেন–

এখানে বাচ্চার খুব Throat irritation হয়- Throat irritation এর কারণে vomiting এর মত হতে পারে–

এই ক্ষেত্রে আমাদের যা করতে হবে-

১.. বাচ্চাকে ঠান্ডায় রাখা যাবেনা-

২.. বাচ্চার throat irritation কমানোর জন্য একটা Antihistamine দিবেন — সাথে প্লাস মাইনাস একটা cough suppressant রাখতে পারেন।৷ Butamirate citrate (Mirakof preferable)

৩…. এন্টিহিস্টামিন +Mirakof এ না কমলে রাতে Budicort দিয়ে নেবুলাইজেশন দিতে পারেন—

Dose-

Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Indications of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

 

Mirakof is used to relieve dry (non-productive) cough. Dry cough may be caused by a recent viral infection. Mirakof is also used for pre & post-operative cough sedation in patients who will undergo surgical procedures and bronchoscopy. It can be used in the acute cough of any etiology, whooping cough and cough due to acute lower respiratory tract infections (tracheitis, laryngitis, bronchitis) etc.

Pharmacology of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Butamirate Citrate acts directly on the brain’s cough center to suppress cough. Butamirate Citrate is safe and non-sedating which is neither chemically nor pharmacologically related to opium alkaloids. Butamirate Citrate is rapidly and completely absorbed after oral administration. Maximum concentration is reached within 9 hours with the sustained-release tablet. This is extremely protein-bound and plasma elimination half-life is about 13 hours. The active metabolites of Butamirate Citrate have also antitussive action.

Dosage & Administration of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Use in adult:

  • Butamirate Citrate 50 mg tablet: 2-3 tablets daily.
  • Butamirate Citrate syrup: 15 ml 4 times daily.

Use in children & adolescents:
Butamirate Citrate 50 mg tablet:

  • Adolescent over 12 years old: 1-2 tablets daily.

Butamirate Citrate syrup:

  • Children (3-6 yrs): 5 ml 3 times daily.
  • Children (6-12 yrs): 10 ml 3 times daily.
  • Adolescent: 15 ml 3 times daily.

Butamirate Citrate pediatric drops:

  • Children ( 2 months- 1 yrs): 0.50 ml 4 times daily.
  • Children (1-3 yrs): 0.75 ml 4 times daily.

Interaction of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Concomitant use with expectorants should be avoided.

Contraindications of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Hypersensitivity to the active ingredient.

Side Effects of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Tolerance of Mirakof is good.Adverse reactions such as rash,nausea,diarrhoea and vertigo have been observed in a few rare cases,resolving after dose reduction or treatment withdrawal.

Pregnancy & Lactation of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Butamirate Citrate should not be used during the first trimester of pregnancy. During the remainder of pregnancy, it can be used if indicated by a physician but with caution. As a general rule, for safety reasons, in the absence of data on elimination of the active substance in breast milk, the benefits of Butamirate Citrate administration during breast feeding should be carefully weighed against the risks.

Precautions & Warnings of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Mirakof suppresses the cough reflex and therefore the concomitant use with expectorants should be avoided, since it may lead to mucus retention in the airways, which increases the risk of bronchospasm and respiratory infections. If the cough persists for more than 7 days (more than 3 days in children younger than12 years of age) doctor must be consulted.

Overdose Effects of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Accidental overdose with Mirakof can cause the following symptoms: drowsiness, nausea, vomiting, diarrhoea, loss of balance and hypotension. Standard emergency procedures should be followed: activated charcoal, saline laxatives and standard cardio-respiratory resuscitation.

Therapeutic Class of Pediatric Drop 5: Mirakof 5mg/ml 15ml Bottle( AS A Butamirate Citrate Cough suppressant )

Cough suppressant

৬ মাস পর্যন্ত প্রতিকেজিতে ২.৫ ফোটা করে দিনে ৩ বার

অথবা ৬ মাস পর্যন্ত ১০ ফোটা করে দিনে ৪ বার,

৬ মাসের পর ২ বছর পর্যন্ত

syrup Mirakof আধা চামচ করে দিনে ৩ বার-

২ বছরের পর ১ চামচ করে দিনে ৩–৪ বার

  • Antihistamine এর ক্ষেত্রে প্রিভিয়াস গাইড লাইন সমূহে বাচ্চাদের জন্য first Generation suggest করা হত
  • কিন্ত রিসেন্ট নিউজিল্যান্ডের সরকারি গবেষণা অনুযায়ী বাচ্চাদের কে first generation avoid করবে, first generation blood brain barrier cross করে, যার কারণে drowsiness and future memory impairment করতে পারে-সেইজন্য বাচ্চাদের Second generation দিবে-
  • সেকেন্ড জেনারেশন এন্টিহিস্টামিন অনেক আছে, ৬ মাসের আগে Cetirizin টা সবচেয়ে রিস্ক ফ্রি
  • Fexo ২ বছরের পরে দিতে পারবেন-
  • ৬ মাসের আগে Cetirizin drop দিবেন-

Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Indications of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

 

Acitrin is indicated for the relief of symptoms associated with seasonal & perennial allergic rhinitis. It is also indicated for the treatment of the uncomplicated skin manifestations of chronic idiopathic urticaria and allergen induced asthma.

Pharmacology of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Cetirizine Hydrochloride is a potent H1 receptor antagonist without any significant anticholinergic and antiserotonic effects. At pharmacologically active dose levels, it has almost no drowsiness effect and does not cause behavioral changes. It inhibits the histamine-mediated early phase of the allergic reaction and also reduces the migration of inflammatory cells and the release of mediators associated with the late phase of the allergic reaction.

Pharmacokinetics: Cetirizine 10 mg achieves peak plasma concentrations of 257 mcg/L within one hour of administration (980 mcg/L in children). Food does not affect the extent of absorption, but it may slightly reduce the rate. Peak blood levels 0.3 micrograms/ml are reached between thirty & sixty minutes after administration of 10 mg dose of Cetirizine. Its plasma half-life is approximately 11 hours. Absorption is very consistent from one subject to the next. Its renal clearance is 30 ml/minute and the excretion half-life is approximately nine hours.

Dosage & Administration of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Cetirizine oral dosage form:

  • Adults and Children 6 years and older: 1 tablet or 2 teaspoonfuls daily (or 1 teaspoonful twice daily).
  • Children 2-6 years: 1 teaspoonful once daily or 1/2 teaspoonful twice daily.
  • Children 6 months to 2 years : 1/2 teaspoonful once daily. The dose in children 12-23 months of age can be increased to a maximum dose as 1/2 teaspoonful every 12 hours.

Cetirizine injectable dosage form: Cetirizine is a single use injectable product for intravenous administration only. The recommended dosage regimen is once every 24 hours as needed for treatment of acute urticaria. Administer Cetirizine as an intravenous push over a period of 1 to 2 minutes. Cetirizine is not recommended in pediatric patients less than 6 years of age with impaired renal or hepatic function.

  • Adults and adolescents 12 years of age and older: The recommended dosage is 10 mg administered by intravenous injection.
  • Children 6 to 11 years of age: The recommended dosage is 5 mg or 10 mg depending on symptom severity administered by intravenous injection.
  • Children 6 months to 5 years of age: The recommended dosage is 2.5 mg administered by intravenous injection.

Interaction of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

No clinically significant drug interactions have been found with Theophylline, Azithromycin, Pseudoephedrine, Ketoconazole or Erythromycin and with other drugs.

Contraindications of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

It is contraindicated in patients with a history of hypersensitivity to Cetirizine or hydroxyzine.

Side Effects of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

The most common side effects that occurred more frequently on Acitrin is somnolence.

Pregnancy & Lactation of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

US FDA Pregnancy Category of Cetirizine Hydrochloride is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Cetirizine Hydrochloride has been shown to be excreted in human milk. So, caution should be exercised when Cetirizine Hydrochloride is administered to a nursing woman.

Precautions & Warnings of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Caution should be exercised when driving a car or operating a heavy machinery.

Use in Special Populations of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Hepatic or renal insufficiency: In patients with mild to moderate hepatic and renal impairment, total body clearance of Acitrin is reduced and AUC and half-life increased by about 2 to 3 fold. Clearance is reduced in proportion to the decline in creatinine clearance. Plasma levels are unaffected by hemodialysis. The plasma elimination half-life in dialysis patients is approximately 20 hours and the plasma AUC is increased by about threefold.

Pediatric Use: The safety of Acitrin has been demonstrated in pediatric patients aged 6 months to 5 years.

Elderly use: The clearance of Acitrin is reduced in elderly patients, but only in proportion to the decrease in creatinine clearance.

Therapeutic Class of Pediatric Drop 7:-Acitrin 2.5mg/ml 15ml Bottle (AS A Cetirizine Hydrochloride Sedating Anti-histamine)

Sedating Anti-histamine

প্রতি কেজিতে ২ ফোটা করে দিনে ১ বার-

৬ মাসের পরে সিরাপ দিতে পারেন-

৬ মাস থেকে ২ বছর.

Syrup: acitrn/Deslor

১/২ চামচ করে দিনে ১ বার

Drug manufacturer নির্দেশিকা অনুযায়ী Fexofenadin ২ বছরের পরে দিবে-

এখন Pediamin syrup কাদের কে দিবেন?

কোনো বাচ্চার প্রচুর কাশি, আপনি চাচ্চেন, তার কাশিও কমুক, রাতে ঘুম ও ভালো হোক, তাদের কে pediamin ( diphenhydramine syrup ) দিতে পারবেন- একবারি অল্প ডোজে দিবে-

৬ মাসের পরে Maximum Daily আধা চামচ দিবেন।

Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Indications of Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Adryl syrup is indicated for the treatment of allergic diseases such as hay fever, allergic rhinitis, urticaria, angioedema, atopic dermatitis, contact dermatitis, gastrointestinal allergy, pruritus, physical allergies, reaction to injection of contrast media, reaction to therapeutic preparation and allergic transfusion reactions; also postoperative nausea and vomiting and motion sickness. It is also used for the treatment of certain forms of parkinsonism and certain allergic conjunctivitis. Sometimes it may use as a night time sleep aid and for the short-term management of insomnia.

Pharmacology Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Diphenhydramine has anti-histaminic (H1-receptor), anti-emetic, anti-vertigo and sedative and hypnotic properties. The anti-histamine action occurs by blocking the spasmogenic and congestive effects of histamine by competing with histamine for H1 receptor sites on effector cells, preventing but not reversing responses mediated by histamine alone. Such receptor sites may be found in the gut, uterus, large blood vessels, bronchial muscles, and elsewhere. Anti-emetic action is by inhibition at the medullary chemoreceptor trigger zone. Anti-vertigo action is by a central antimuscarinic effect on the vestibular apparatus and the integrative vomiting center and medullary chemoreceptor trigger zone of the midbrain.

Dosage & Administration Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Antihistamine and antitussive:
Tablet:

  • Adults: 25 mg to 50 mg 3 to 4 times daily.
  • Children (10 years or over): 25 mg 3 or 4 times daily or as directed by the physician.

Syrup:

  • Children under 2 years: 2.5 mL every 4 to 6 hours.
  • Children 2 to under 6 years: 5 mL every 4 to 6 hours.
  • Children 6 to 12 years: 10-20 mL every 4 to 6 hours.
  • Adults and children≥12 years: 10-20 mL every 4 to 6 hours.

Sleep aid:
Adults and children over 12 years: 50 mg at bedtime.

Interaction Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Antidepressants, particularly of the tricyclic and monoamine oxidase inhibitor types may interact with diphenhydramine. MAO inhibitors prolong and intensify the anticholinergic effects of antihistamines. The CNS effect is increased by alcohol and other CNS depressant drugs.

Contraindications Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Diphenhydramine is contraindicated for the premature or newborn infants. Hypersensitivity to any of the component of this drug. Asthma attack, narrow angle glaucoma, prostatic hypertrophy, stenosing peptic ulcer, pyloroduodenal obstructions, bladder neck obstruction, patients receiving antidepressant therapy.

Side Effects Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Side-effects include drowsiness, dizziness and dryness of mouth, nausea and vomiting. Other infrequently reported effects are vertigo, palpitation, blurring of vision, headache, restlessness, insomnia and thickening of bronchial secretions. Allergic reactions, diarrhoea, vomiting and excitation may also occur.

Pregnancy & Lactation Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Safety for use in pregnancy and lactation has not been established. Its use therefore in such patients should involve consideration of expected benefits and possible risks.

Precautions & Warnings Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Patients should be cautioned not to operate vehicles or hazardous machinery until their response to the drug has been determined.

Overdose Effects Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Antihistamine over dosage reactions may vary from central nervous system depression to stimulation. Stimulation is particularly likely in children. Atropine-like signs and symptoms such as dryness of mouth, fixed and dilated pupils, flushing and gastrointestinal symptoms may also occur.

Therapeutic Class Syrup 8:-Adryl 10mg/5ml 100ml Bottle (AS A Diphenhydramine Hydrochloride Sedating Anti-histamine).

Sedating Anti-histamine

fexo /desloratadine এই গুলি ২ বছরের পরে দিতে বলা হলেও ২ বছরের আগে ৬ মাসের পরেও দেওয়া যায়, its not absolutely contraindicated..

Just better to avoid antihistamine as much as possible —

Dose– budicort inhaler

বাচ্চার মা বলতেছে,

স্যার, Mirakof and fexo চলতেছে,

অর্থাৎ Cough suppressant + Antihistamine চলতেছে, কিন্ত রাতে অনেক কাশি হয়, কাশতে কাশতে মুখ দিয়ে লালা বের হয়,

এর মানে বাচ্চার Throat irritation হচ্ছে — কি করবেন?

রাতে Steroid nebulization দিয়ে irritation কমিয়ে দেন-

Dose:

১ বছরের আগে-

Budicort solution 0.5 ml + 2.5 ml N/S দিয়ে নেবুলাইজেশন দেন- (রাতে একবার দিলে রাতে Cough frequency কমবে)

১ বছরের বেশি হলে-

Budicort 1 ml +2 ml N/S (রাতে ১ বার)

General Queries:-

1.Vaiya brodil er role ta ki?

Answer is:-

Asthma /Bronchospasm hole দিবে .

2.Tofen tahole kokhon use korte hobe?

Answer is:-

chronic treatment of mild atopic asthma in children.

Chronic allergic Rhinitis etc.use Korte hobe

3.Tab.viscotin (600)

1+0+1 —15 day.

Oneke evabe dey.

Etar maximum dose koto?

R fatal risk & contraindication ki?

Answer is:

৩বেলাও dewa jai, COPD te valo kaj kore.. Jhamela ache karo karo anaphylactoid reaction hoy.tokhon na dewa e better.

Raiyyan Tahsan Date:25-01-2025 Saturday Time:2-19-55pm

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