Hydroxocobalamin 5mg/ml

Solution for injection

Blood diseases:
- Idiopathic anemia or gastrectomy. 
- Spru's disease, diarrhea and other diseases of vitamin B12 deficiency due to poor absorption. 
- Absorption decreases after partial gastric bypass and gastrointestinal distress syndrome as well as rare cases of pregnancy-induced anemia. 
- Support treatment with aminosalicylate because it reduces the absorption of B12.

Addisonian pernicious anaemia and other macrocytic anaemias without neurological involvement:
Initially:    250 micrograms to 1000 micrograms intramuscularly on alternate days for one or two weeks then 250 micrograms weekly until blood count is normal.
Maintenance:    1000 micrograms every two or three months.
Addisonian pernicious anaemia and other macrocytic anaemias with neurological involvement:
Initially:    1000 micrograms on alternate days as long as improvement continues.
Maintenance:    1000 micrograms every two months.
Prophylaxis of macrocytic anaemias associated with vitamin B12 deficiency resulting from gastrectomy, ileal resection, certain ma/absorption states and vegetarianism: 1000 micrograms every two or three months.
Tobacco amblyopia and Leber's optic atrophy:
Initially:    1000 micrograms daily by intramuscular injection for two weeks then twice weekly as long as improvement is maintained.
Maintenance:    1000 micrograms every three months or as required.

Salbutamol (as salbutamol sulfate) 5mg/5ml

Solution for Injection

Geumi Injection is indicated in adults and adolescents.
Geumi Injection provides short-acting (4-6 hour) bronchodilation with a fast onset (within 5 minutes) in reversible airways obstruction. It is indicated for the relief of severe bronchospasm.

Geumi Injection may be administered by the subcutaneous, intramuscular or intravenous route, under the direction of a physician.
Adults:
Subcutaneous route: 500 micrograms (8 micrograms/kg body weight) and repeated every four hours as required.
Intramuscular route: 500 micrograms (8 micrograms/kg body weight) and repeated every four hours as required.
Slow intravenous injection:
250 micrograms (4 micrograms/kg bodyweight) injected slowly. If necessary the dose may be repeated.
The use of Ventolin Injection 500 micrograms in 1ml (500 micrograms/ml, for intravenenous administration may be facilitated by dilution to 10ml with Water for Injection BP (final concentration of 50 micrograms/ml) and 5mls of the diluted preparation (250 micrograms/5ml) administered by slow intravenous injection.
Paediatric Population
The safety and efficacy of Ventolin Injection in children under the age of 12 has not been established. From the available data no recommendation on posology can be made.
Children aged 12 years and over: Dose as per adult population

Digoxin 0.25 mg/ml

Solution for injection

Indicated in the management of chronic cardiac failure, systolic dysfunction, ventricular dilatation, cardiac failure is accompanied by atrial fibrillation.
The management of certain supraventricular arrhythmias, particularly chronic atrial flutter and fibrillation.

Posology:
The dose of digoxin for each patient has to be tailored individually according to age, lean body weight and renal function.
Suggested doses are intended only as an initial guide.
In cases where cardiac glycosides have been taken in the preceding two weeks the recommendations for initial dosing of a patient should be reconsidered and a reduced dose is advised.
The difference in bioavailability between injectable digoxin and oral formulations must be considered when changing from one dosage form to another. For example if patients are switched from oral to the I.V. formulation the dosage should be reduced by approximately 33%.
Adults and paediatric populations over 10 years
Parenteral loading:
Parenteral loading should only be used in patients who have not been given cardiac glycosides within the preceding two weeks.
The total loading dose of parenteral digoxin is 500 to 1000 micrograms (0.5 to 1.0 mg) depending on age, lean body weight and renal function. The total loading dose should be administered in divided doses with approximately half of the total dose given as the first dose and further fractions of the total dose given at intervals of four to eight hours. An assessment of clinical response should be performed before giving each additional dose.
Each dose should be given by I.V. infusion (see Method of Administration, below) over 10 to 20 mins.

Elderly
The possibility of reduced renal function and lower lean body mass should be taken into account when dealing with elderly patients. If necessary, the dosage should be reduced and adjusted to the changed pharmacokinetics to prevent elevated serum dioxin levels and the risk of toxicity. The serum dioxin levels should be checked regularly and hypokalaemia should be avoided.
Renal impairment
The dosing recommendations should be reconsidered if patients are elderly or there are other reasons for the renal clearance of digoxin being reduced. A reduction in both initial and maintenance doses should be considered (see Section 4.4).
Method of administration:
Dilution of digoxin injection:
Digoxin injection can be administered undiluted or diluted with a 4-fold or greater volume of 0.9% Sodium Chloride Injection, 0.18 % Sodium Chloride/4% Glucose Injection or 5% Glucose Injection. A 4-fold volume of diluent equates to adding one 2 ml ampoule of digoxin to 6 ml of injection solution. The use of less than a 4-fold volume of diluent could lead to precipitation of digoxin.
Digoxin injection, when diluted in the ratio of 1 to 250 is known to be compatible with the following infusion solutions and stable for up to 48 h at room temperature (20 to 25 °C):
• Sodium Chloride I.V. Infusion, B.P., 0.9 % w/v.
• Sodium Chloride (0.18 % w/v) and Glucose (4 % w/v) I.V. Infusion, B.P.
• Glucose I.V. Infusion, B.P., 5 % w/v.
A ratio of 1 to 250 can be obtained for example by diluting one 2 ml ampoule with 500 ml of infusion solution.
Dilution should be carried out either under full aseptic conditions or immediately before use. Any unused solution should be discarded (see Section 6.6).
Administration of digoxin injection:
Each dose should be given by I.V. infusion over 10 to 20 mins.
The total loading dose should be administered in divided doses with approximately half of the total dose given as the first dose and further fractions of the total dose given at intervals of four to eight hours. An assessment of clinical response should be performed before giving each additional dose.
The I.M. route is painful and is associated with muscle necrosis. This route cannot be recommended.
Rapid I.V. injection can cause vasoconstriction producing hypertension and/or reduced coronary flow. A slow injection rate is therefore important in hypertensive heart failure and acute myocardial infarction.

Propranolol hydrocloride 1mg/ml

Solution for injection.

Intravenous administration is usually reserved for life-threatening arrhythmias or those occurring
under anesthesia.
1. Supraventricular arrhythmias
2. Ventricular tachycardias
3. Tachyarrhythmias of digitalis intoxication
4. Resistant tachyarrhythmias due to excessive catecholamine action during anesthesia

For intravenous administration.

Methocarbamol 1000 mg/10 ml.

Solution for injection.

The injectable form of methocarbamol is indicated as an adjunct to rest, physical therapy, and other measures for the relief of discomfort associated with acute, painful musculoskeletal conditions. 
Methocarbamol does not directly relax tense skeletal muscles in man.

Methocarbamol Injection may be administered undiluted directly into the vein at a maximum rate of three mL per minute.

It may also be added to an intravenous drip of Sodium Chloride Injection  or five percent Dextrose Injection; one vial given as a single dose should not be diluted to more than 250 mL for I.V. infusion.

After mixing with intravenous infusion fluids, do not refrigerate. 

Tranexamic acid 500mg/10ml

Solution for injection

Prevention and treatment of haemorrhages due to general or local fibrinolysis in adults and children from one year

The administration is strictly limited to slow intravenous injection.

Piracetam 1000 mg/5 ml.

Solution for injection.

Piracetam is administered intravenously and intramuscularly on serious cerebral diseases, states of coma, as well as for arresting of abstinent, preliminary or delirious states or acute complications occurred in the period of psychopharmacotherapy.

The preparation is administered intramuscularly or intravenously in adults starting with the dose of 2-4 g and then the dose can be immediately increased up to 4-6 g per day. The duration of treatment and the individual dose depend on the disease severity and reverse dynamics speed of the clinical presentation. For treatment of ischemic stroke piracetam is administered drop-by-drop in the doses 4-12 g per day during 2-4 weeks.

Amelioration being achieved, piracetam for oral administration should be prescribed.

For treatment of acute brain injuries piracetam is prescribed in the complex with other disintoxication and rehabilitation therapy, and for treatment of psychiatric diseases – with corresponding psychotropic agents.

Administration of piracetam can be sometimes accompanied by administration of psychotropic, cardiovascular and other medicines.

Neostigmine methylsulfate 0.5mg/ml

Solution for injection

Myasthenia Gravis, antagonist to non-depolarizing neuromuscular blockade, Paralytic Ileus, Post-operative Urinary Retention; Paroxysmal Supraventricular Tachycardia

Neostigmine Methylsulfate should be given very slowly by the IV route. A syringe of Atropine Sulfate should always be available to counteract severe cholinergic reactions should they occur.
Myasthenia Gravis
1 – 2.5mg by IM or SC injection at intervals throughout the day, when maximum strength is needed. The usual duration of action of a dose is two to four hours. The total daily dose is usually 5 – 20mg by injection but higher doses may be needed by some patients.
Neonatal Myasthenia Gravis may be treated with 0.1mg Neostigmine intramuscularly initially. Thereafter, the dose must be titrated individually. But is usually 0.05 – 0.25mg IM or 0.03mg/kg IM, every two – four hours. Because of the self-limiting nature of the disease in neonates, the daily dosage should be reduced until the drug can be withdrawn.
Older Children: (Under 12 years of age)
May be given 0.2 – 0.5mg by injection as required. Dosage requirements should be adjusted according to the response of the patient.
Antagonist to Non-depolarizing Neuromuscular Blockade
Reversal of Neuromuscular blockade with Neostigmine should not be attempted unless there is spontaneous recovery from paralysis.
Adults and Children
A single dose of Neostigmine 0.05 – 0.07 mg/kg body-weight and Atropine 0.02 – 0.03 mg/kg body weight, by slow IV injection over one minute is usually adequate for complete reversal of Non-depolarizing Muscle Relaxants within 5 – 15 minutes. The maximum recommended dose of Neostigmine in adults is 5mg and in children 2.5mg.
Atropine and Neostigmine may be given simultaneously, but in patients with Bradycardia, the pulse rate should be increased to 80 per minute with Atropine before administering Neostigmine.
Other Indications
Adults: 0.5 – 2.5mg Neostigmine Methylsulfate by SC or IM injection.
Children: 0.125 – 1mg by injection. Doses may be varied according to the individual needs of the patient.
Elderly: There are no specific dosage recommendations for Neostigmine Methylsulfate in the elderly.

Neostigmine methylsulfate 0.25mg/ml

Solution for injection

Myasthenia Gravis, antagonist to non-depolarizing neuromuscular blockade, Paralytic Ileus, Post-operative Urinary Retention; Paroxysmal Supraventricular Tachycardia

Neostigmine Methylsulfate should be given very slowly by the IV route. A syringe of Atropine Sulfate should always be available to counteract severe cholinergic reactions should they occur.
Myasthenia Gravis
1 – 2.5mg by IM or SC injection at intervals throughout the day, when maximum strength is needed. The usual duration of action of a dose is two to four hours. The total daily dose is usually 5 – 20mg by injection but higher doses may be needed by some patients.
Neonatal Myasthenia Gravis may be treated with 0.1mg Neostigmine intramuscularly initially. Thereafter, the dose must be titrated individually. But is usually 0.05 – 0.25mg IM or 0.03mg/kg IM, every two – four hours. Because of the self-limiting nature of the disease in neonates, the daily dosage should be reduced until the drug can be withdrawn.
Older Children: (Under 12 years of age)
May be given 0.2 – 0.5mg by injection as required. Dosage requirements should be adjusted according to the response of the patient.
Antagonist to Non-depolarizing Neuromuscular Blockade
Reversal of Neuromuscular blockade with Neostigmine should not be attempted unless there is spontaneous recovery from paralysis.
Adults and Children
A single dose of Neostigmine 0.05 – 0.07 mg/kg body-weight and Atropine 0.02 – 0.03 mg/kg body weight, by slow IV injection over one minute is usually adequate for complete reversal of Non-depolarizing Muscle Relaxants within 5 – 15 minutes. The maximum recommended dose of Neostigmine in adults is 5mg and in children 2.5mg.
Atropine and Neostigmine may be given simultaneously, but in patients with Bradycardia, the pulse rate should be increased to 80 per minute with Atropine before administering Neostigmine.
Other Indications
Adults: 0.5 – 2.5mg Neostigmine Methylsulfate by SC or IM injection.
Children: 0.125 – 1mg by injection. Doses may be varied according to the individual needs of the patient.
Elderly: There are no specific dosage recommendations for Neostigmine Methylsulfate in the elderly.

Naloxone 0.4mg/ml.

Solution for injection.

Complete or partial reversal of CNS depressive effects, especially respiratory depression, caused by natural or synthetic opioids and partial agonist/antagonist opioids.

Diagnosis of suspected acute opioid overdose or intoxication.

The medicinal product can be injected intravenously (i.v.), intramuscularly (i.m.) or can be given via intravenous infusion.

The i.m. administration of naloxone hydrochloride should only be used in cases where an i.v. administration is not possible.

The most rapid effect is obtained by means of i.v. administration, which is why this method of administration is recommended in acute cases.

Mecobalamin 500mcg/ml

Solution for injection

Peripheral neuropathies Megaloblastic anemia caused by vitamin B12 deficiency

Posology
Adult Dosage
Injection 500µg
• Peripheral neurophathies
The usual dosage for adults is 1 ampoule (500 µg of mecobalamin) daily, administered intramuscularly or intravenously 3 times a week. The dosage may be adjusted depending on the patient’s age and symptoms.
• Megaloblastic anemia
The usual dosage for adults is 1 ampoule (500 µg of mecobalamin) daily, administered intramuscularly or intravenously 3 times a week. After about 2 months of medication, the dose should be reduced to a single administration of 1ampoule at 1 to 3 months intervals for maintenance therapy.
Method of Administration
Intramuscular, intravenous
 

Hyoscine butylbromide 40mg/2ml

Solution for injection

The relief of acute genitourinary or gastrointestinal spasm (e.g., renal or biliary colic), or to produce smooth muscle relaxation prior to radiological procedures such as pyelography or other diagnostic procedures where spasm may be a problem (e.g., gastro-duodenal endoscopy).

Adults:
One ampoule (40 mg) intramuscularly or intravenously, repeated after half an hour if necessary. Intravenous injection should be performed 'slowly' (in rare cases a marked drop in blood pressure and even shock may be produced by Buscopan). When used in endoscopy this dose may need to be repeated more frequently.
Maximum daily dose of 100mg.
Elderly: No specific information on the use of this product in the elderly is available. Clinical trials have included patients over 65 years and no adverse reactions specific to this age group have been reported.
Paediatric population: Not recommended for children.
Hyoscin should not be taken on a continuous daily basis or for extended periods without investigating the cause of abdominal pain.
Diluent: Hyoscin may be diluted with dextrose or with sodium chloride 0.9% injection solutions.