Daily Healthy: general

Comparison between Povidone Iodine 10% and Acriflavine 0.1%

<div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Availability in Hospital Keningau</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l17 level1 lfo1; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Acriflavin 0.1% Lotion      (Zontron)</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l4 level1 lfo2; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Povidone Iodine 10%      (Septidin 10%)</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"><br />Table of comparison between Povidone and Acriflavin</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div><table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; mso-padding-alt: 0cm 0cm 0cm 0cm; mso-yfti-tbllook: 1184;"> <tbody><tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">  <td style="border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Product</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td>  <td style="border-left: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Acriflavine   lotion 0.1%</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td>  <td style="border-left: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Povidone   Iodine 10% lotion</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td> </tr><tr style="mso-yfti-irow: 1;">  <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Indication</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">(As per   Leaflet)</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l14 level1 lfo3; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Treatment of infected        wound or burns and for skin infections</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l2 level1 lfo4; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Antiseptic against        Bacteria, Fungi, Viruses, Protozoa, Cysts & Spores for minor burns,        wounds & Pre operative Operation for the skin</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul></td> </tr><tr style="mso-yfti-irow: 2;">  <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Application</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l0 level1 lfo5; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Apply a little on the        affected parts and  spread gently 2-3 times per day</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l20 level1 lfo6; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Pre operation preparation        of the skin : Wet the operation site with water. Apply povidone, work up        a lather using sterile gauze, scrub site for 5 minutes. Rinse off with        water using wet sterile gauze. Paint the surgical site with Povidone 10%        and permit to air dry</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l12 level1 lfo7; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Minor burns, wounds skin        infection: Apply twice daily to affected area with clean gauze or cotton        bud</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul></td> </tr><tr style="mso-yfti-irow: 3; mso-yfti-lastrow: yes;">  <td style="border-top: none; border: solid windowtext 1.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Coverage</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.25pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l13 level1 lfo8; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Slow acting disinfectant,        usually bacteriostatic against many gram negative bacteria and less        effective against gram negative</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l8 level1 lfo9; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Ineffective against spores</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div></td>  <td style="border-bottom: solid windowtext 1.0pt; border-left: none; border-right: solid windowtext 1.0pt; border-top: none; padding: 0cm 5.4pt 0cm 5.4pt; width: 150.3pt;" valign="top" width="200">  <ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l5 level1 lfo10; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Broad-spectrum; effective        against fungi, Gram-neg. and positive organisms, yeast, Protozoa and        viruses.</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul></td> </tr></tbody></table><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">   Remarks</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l16 level1 lfo11; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Antiseptics, as an      alternative for topical wound treatment, tend to be microbicidal and have      a broader spectrum of antimicrobial activity than antibiotics</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l1 level1 lfo12; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">In comparison to most      antibiotics, antiseptics reduce the likelihood of resistance emerging due      to their multiple mechanisms of action targeting various aspects of cell      biology in microbes</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l19 level1 lfo13; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Overall, the properties of      an ideal antiseptic include a broad spectrum of activity , the ability to      penetrate biofilms , necrotic tissue, and eschar, a low potential for      acquired resistance, supportive effects for wound healing by impeding      excessive inflammation, and good local tolerability</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l15 level1 lfo14; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Povidone has better spectrum      of coverage compared to Acriflavine.</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l3 level1 lfo15; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">However as noted in product      leaflet, Povidone should be used in caution and not to be used regularly      in breastfeeding, pregnancy and in patients with thyroid disorder.</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l7 level1 lfo16; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Povidone is also      contraindicated in very low birth weight infants (below 1500g) and not to      be used regularly in children below 2 years old and neonates. </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l9 level1 lfo17; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">However there is no specific      information regarding Acriflavine in product information. </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><br /></div><div class="MsoNormal" style="line-height: normal; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">References</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></div><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l11 level1 lfo18; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Acriflavine 0.1% Lotion      (Zontron) Product Information</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l6 level1 lfo19; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">Povidone Iodine 10% (      Septidin) Product Information</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l10 level1 lfo20; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">http://www.edoc.co.za/modules.php?name=News&file=article&sid=393</span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><ul type="disc"><li class="MsoNormal" style="line-height: normal; mso-list: l18 level1 lfo21; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; tab-stops: list 36.0pt;"><span style="font-family: "Arial",sans-serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;">https://www.sciencedirect.com/science/article/pii/S1743919117305368 </span><span style="font-family: "Times New Roman",serif; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-MY;"></span></li></ul><span style="font-size: large;"></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><span style="font-size: xx-small;"><br /></span></span><span style="font-family: "trebuchet ms" , sans-serif; font-size: large;"><span style="font-size: xx-small;"><br /></span></span><br /><span style="font-size: small;"><br /></span><span style="font-size: small;"><br /></span><span style="font-size: small;"><br /></span>

Availability Comparison general Indication Comparison between Povidone Iodine 10% and Acriflavine 0.1%

Availability in Hospital Keningau Acriflavin 0.1% Lotion (Zontron) Povidone Iodine 10% (Septidin 10%) Table of comparison between...

Statins - Induced Transaminitis

7:39 AM Meme Art Studio 0 Comment

<b>Introduction </b><br /><br /><ul><li><span style="background: white; text-indent: -0.25in;">The most commonly reported hepatic adverse effect is the phenomenon known as <b>transaminitis</b></span><b style="background-color: white; text-indent: -0.25in;">, </b><span style="background-color: white; text-indent: -0.25in;">in which liver enzyme levels are elevated (transient) in the absence of proven hepatotoxicity and commonly occurs in the first 12 weeks of therapy. </span><span style="background-color: white; text-indent: -0.25in;"> </span></li><li><span style="background-color: white; text-indent: -0.25in;">This class effect is usually asymptomatic, reversible, and dose-related.</span></li><li><span style="background: white; text-indent: -0.25in;">There are changing data on the occurrence of these negative hepatic effects, recommendations on their actual risk, monitoring required, and safety of use in those with preexisting hepatic disorders.</span></li></ul><br /><b>Effects of Statins on The Liver</b><br /><ul><li><span style="background: white; text-indent: -0.25in;">Statins exert a potent inhibition of hepatic 3-hydroxyl-3-methylglutaryl coenzyme A reductase, which accounts for the reduction in LDL cholesterol observed with these drugs.</span></li><li><span style="background: white; text-indent: -0.25in;">Although the underlying mechanism remains unclear, hepatotoxicity may result from changes in the lipid components of the hepatocyte membrane, leading to an increase in its permeability with a subsequent “leakage” of liver enzymes.</span></li><li><span style="background: white; text-indent: -0.25in;">This is supported by the observation that elevations in aminotransferase levels.</span></li></ul><div><br /></div><div class="MsoNormal"><b><span style="line-height: 107%;">Incidence of Elevation of Liver Enzymes During Statin Treatment<span style="font-size: 14pt;"><o:p></o:p></span></span></b></div><ul><li><span style="background: white; text-indent: -0.25in;">The incidence of elevated aminotransferase levels with different types of statins generally <b>did not exceed 3%</b> of the studied patients' sample.</span><span style="text-indent: -0.25in;"> </span></li><li><span style="background: white; text-indent: -0.25in;">There seems to be a <b>direct relationship</b> between the <b>statin dose</b> and the <b>incidence of transaminitis.</b></span><span style="text-indent: -0.25in;"><b> </b></span></li><li>The reported average incidence of elevations in serum aminotransferase levels to >3x ULN was < 1% in patients receiving low to moderate doses.</li><li>Similarly, the incidence of transaminitis increases up to 2% to 3% in those receiving high doses of statins.</li><li><span style="background: white; text-indent: -0.25in;">The incidence of <b>transaminase elevations is similar among all statins,</b> despite their different pharmacokinetic characteristics</span></li><li>Most cases of transaminitis exhibit spontaneous improvement without the need for drug discontinuation, probably a result of the development of adaptation or tolerance.</li></ul><div></div><div><b>Management and Monitoring</b></div><div><b><br /></b></div><div><b><br /></b></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ5Jtpp03r9vmhoH3DVjVy1Er2SxORFkorP2jttTeHcjkkKTRVjQAlDN6eMC3r7pBKcqYcX_guz4of4GeB1w4fHIJUirSIq0D5b1keGjim0t-4G6jSR2dnY5wWc3NbqVNaMkTQkJtUuYU/s1600/Statin+Algorithm.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img alt="" border="0" data-original-height="605" data-original-width="454" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZ5Jtpp03r9vmhoH3DVjVy1Er2SxORFkorP2jttTeHcjkkKTRVjQAlDN6eMC3r7pBKcqYcX_guz4of4GeB1w4fHIJUirSIq0D5b1keGjim0t-4G6jSR2dnY5wWc3NbqVNaMkTQkJtUuYU/s640/Statin+Algorithm.jpg" title="Algorithm for management of abnormal liver enzymes before and during statin treatment" width="480" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Algorithm for Management of Abnormal Liver Enzymes Before and During Statin Treatment</td></tr></tbody></table><br /><br /><b>Statins in Preexisting Liver Dysfunction</b><br /><div><ul><li>US FDA continues to recommend that statins be contraindicated in patients with chronic liver disease; however, several authors have recommended starting <b>low-dose statin</b> treatment (because of the possible greater incidence of liver enzyme elevations with higher doses) and having levels rechecked 2 weeks later.</li><li><span style="background: white; text-indent: -0.25in;">LFT monitoring should be performed every month for the first 3 to 4 months and 4 times a year thereafter.</span></li><li><span style="font-size: 7pt; font-stretch: normal; font-variant-numeric: normal; line-height: normal;">  </span><span style="background: white; text-indent: -0.25in;">If the levels of transaminases increase to > 3X baseline values, discontinuation of the drug should be considered.</span></li><li>Clinical correlation with worsening of underlying disease, as well as exclusion of alcohol abuse and drug interactions, should be done before attempting permanent discontinuation of the drug. </li><li>Once levels return to baseline, rechallenge can be considered. </li></ul><div><br /></div><div><b>Conclusion</b></div><div><ul></ul><ul><li><span style="background: white;">The latest reviewed data indicate or support the recommendation from US FDA that “all currently marketed statins appear to be associated with a very low risk of serious liver injury.”</span></li><li><span style="background: white;">Clinicians should not withhold statin therapy for patients whose transaminase elevations have no clinical relevance or are attributable to known stable chronic conditions. Evaluating other causes for alteration in LFTs should be made before establishing a causal relationship with a statin agent.</span></li><li><span style="background: white;">Statin use need not be avoided in patients with preexisting liver dysfunction if its use is clearly indicated.</span></li><li>However, as reported in literature, potential of statins to cause significant and serious hepatic effects should not be overlooked in daily clinical practice</li></ul></div><div></div><div><b>References </b></div><div><ul></ul><ol><li><span style="font-family: inherit;">Rossana M. Calderon, MD, Luigi X. Cubeddu, MD, Ronald B. Goldberg, MD, and Eugene R. Schiff, MD. Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. <i>Mayo Clinic Proceedings 2010 Apr; 85(4): 349–356<b>.</b></i></span></li><li><span style="font-family: inherit; font-size: small;">Jimmy Jose. Statins and its hepatic effects: Newer data, implications, and changing recommendations. <i>J Pharm Bioallied Sci. 2016 Jan-Mar; 8(1): 23–28.</i></span></li><li><span style="font-family: inherit; font-size: small;">Edward Onusko MD. Statins and elevated liver tests: What’s the fuss?.<i>J Fam Pract </i><i>2008 July;57(7):449-452.</i></span></li><li><span style="font-family: inherit; font-size: small;">US Food and Drug Administration (FDA) <span class="ref-journal" style="text-indent: -0.25in;">P<i>h</i><span class="ref-journal">RMA/FDA/ASSLD drug induced hepatotoxicity white paper post marketing considerations: November 2000.</span></span></span></li><li><span style="font-family: inherit; font-size: small;"><span style="background: white none repeat scroll 0% 0%; text-indent: -0.25in;">US Department of Health and Human Services. Food and Drug Administration (FDA) Center for Drug Evaluation and Research (CDER) Center for Biologics Evaluation and Research (CBER) </span><span class="ref-journal" style="text-indent: -0.25in;">Guidance for industry: drug-induced liver injury: premarketing clinical evaluation</span><span style="text-indent: -0.25in;"> Published July 2009 </span></span></li></ol></div></div>

general interaction pharmacokinetics side effect Statins - Induced Transaminitis

Introduction The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis , in which liver enzyme levels are ...

Rate control in Atrial Fibrilation

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<br /> <br /><div class="MsoNormal"></div><ul><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">If LVEF<40% or any sign of CHF, smallest dose of <b style="mso-bidi-font-weight: normal;">beta-blocker</b> is recommended to achieve rate control.</span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Amiodarone</b> is an option to patient with haemodynamic instability or severely reduced LVEF.</span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">If LVEF>40%, <b style="mso-bidi-font-weight: normal;">beta-blocker or diltiazem or verapamil</b> are recommended because of its rapid onset of action and effectiveness at high sympathetic tone compared to digoxin.</span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">In both condition, <b style="mso-bidi-font-weight: normal;">digoxin</b> may be added to achieve initial resting heart rate target which is <110bpm.</span></span></li></ul><table border="1" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: medium none;"> <tbody><tr style="mso-yfti-firstrow: yes; mso-yfti-irow: 0;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Therapy</b></span></span></div></td>  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Acute Intravenous rate control</b></span></span></div></td>  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Long-term oral rate control</b></span></span></div></td>  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 191.55pt;" valign="top" width="255"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Comments</b></span></span></div></td> </tr><tr style="mso-yfti-irow: 1;">  <td colspan="4" style="border: 1pt solid; padding: 0in 5.4pt; width: 6.65in;" valign="top" width="638"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Beta-Blocker</b></span></span></div></td> </tr><tr style="mso-yfti-irow: 2;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Bisoprolol</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Not available</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">1.25–20 mg once daily or split.</span></span></div></td>  <td rowspan="5" style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 191.55pt;" valign="top" width="255"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Bronchospasm is rare – in cases of asthma, recommend beta-1 selective agents (avoid carvedilol).</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Contra-indicated in acute cardiac failure and a history of severe bronchospasm.</span></span></div></td> </tr><tr style="mso-yfti-irow: 3;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Carvedilol</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Not available</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">3.125–50 mg BD.</span></span></div></td> </tr><tr style="mso-yfti-irow: 4;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Metoprolol</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">2.5–10 mg intravenous bolus</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(repeated as required)</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">100–200 mg total daily dose</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(according to preparation)</span></span></div></td> </tr><tr style="mso-yfti-irow: 5;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Nebivolol</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Not available</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">2.5–10 mg once daily or split.</span></span></div></td> </tr><tr style="mso-yfti-irow: 6;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Esmolol</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">0.5 mg/kg intravenous bolus over</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">1 min; then 0.05–0.25 mg/kg/min.</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div></td> </tr><tr style="mso-yfti-irow: 7;">  <td colspan="4" style="border: 1pt solid; padding: 0in 5.4pt; width: 6.65in;" valign="top" width="638"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Calcium Channel Blockers</b></span></span></div></td> </tr><tr style="mso-yfti-irow: 8;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Diltiazem</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">15–25 mg intravenous bolus</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(repeated as required)</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">60mg TDS up to 360mg total daily dose</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(120-360mg OD modified release)</span></span></div></td>  <td rowspan="2" style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 191.55pt;" valign="top" width="255"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Use with caution in combination with beta-blockers. Reduce dose with hepatic impairment and start with smaller dose in renal impairment. Contra-indicated in LV failure with pulmonary congestion or LVEF <40%.</span></span></div></td> </tr><tr style="mso-yfti-irow: 9;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Verapamil</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">2.5–10 mg intravenous bolus</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(repeated as required)</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">40-120mg TDS</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(120-480mg OD modified release)</span></span></div></td> </tr><tr style="mso-yfti-irow: 10;">  <td colspan="4" style="border: 1pt solid; padding: 0in 5.4pt; width: 6.65in;" valign="top" width="638"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Cardiac glycosides</b></span></span></div></td> </tr><tr style="mso-yfti-irow: 11;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Digoxin</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">0.5 mg intravenous bolus</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">(0.75–1.5 mg over 24 hours in</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">divided doses)</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">0.0625–0.25 mg daily dose</span></span></div></td>  <td rowspan="2" style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 191.55pt;" valign="top" width="255"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">High plasma levels associated with increased risk of death. Check renal function before starting and adapt dose in patients with CKD. Contra-indicated in patients with accessory pathways, ventricular tachycardia and hypertrophic cardiomyopathy with outflow tract obstruction.</span></span></div></td> </tr><tr style="mso-yfti-irow: 12;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Digitoxin</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">0.4–0.6 mg intravenous bolus.</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">0.05–0.3 mg daily dose.</span></span></div></td> </tr><tr style="mso-yfti-irow: 13;">  <td colspan="4" style="border: 1pt solid; padding: 0in 5.4pt; width: 6.65in;" valign="top" width="638"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b style="mso-bidi-font-weight: normal;">Specific Indications</b></span></span></div></td> </tr><tr style="mso-yfti-irow: 14; mso-yfti-lastrow: yes;">  <td style="border: 1pt solid; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small; mso-spacerun: yes;">    </span><span style="font-size: small;">Amiodarone</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">300mg intravenously diluted in 250mL 5% dextrose over 30-60 minutes via central venous cannula.</span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><br /></span></span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">*If ongoing requirement, 900mg diluted in 500-1000mL for over 24 hours.</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 95.75pt;" valign="top" width="128"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">200mg daily</span></span></div></td>  <td style="border-color: -moz-use-text-color; border-style: none solid solid none; border-width: medium 1pt 1pt medium; padding: 0in 5.4pt; width: 191.55pt;" valign="top" width="255"><div class="MsoNormal" style="line-height: normal; margin-bottom: 0in;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Suggested as adjunctive therapy in patients where heart rate control cannot be achieved using combination therapy.</span></span></div></td> </tr></tbody></table><div class="MsoNormal" style="tab-stops: 328.1pt;"><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;"><b>References:</b></span></span></div><ol><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">2016 ESC Guidelines for the management of atrial fibrillation</span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">https://www.nice.org.uk/guidance/cg180/resources/atrial-fibrillation-management-pdf-35109805981381 </span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Pharmacologic Management of Newly Detected Atrial Fibrillation by AAFP, 2017</span></span></li><li><span style="font-family: Verdana,sans-serif;"><span style="font-size: small;">Lexicomp</span></span></li></ol>

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