Natrilix SR (Indapamide / diuretik)

Dosage : 1 dd 1

SE : Hipokalemi, fatigue, allergic manifestations

Farmakologi : a thizide-type diuretic -> increases the urinary excrertion of sodium and chloride and to
a lesser degree, the excretion of potassium and magnesium, thereby increasing diuresis and exerting
an antihypertensive action.

Farmakokinetik : a sustained—release formulation, which allows a sustained release of indapamdie

Absorpsi : di GI tract, meals slightly increase rate of absorption

Metabolism : eliminated in the urine (70%) dan feses (22%) in the form of inactive metabolites

Presentation : SR tab 1.5 mg

Irbesartan (an ARB)

Dosage : in elderly (>75) initially 75 mg daily, may increase to max 300 mg daily

SE : mual, muntah, diare, fatigue, dyspnea, heartburn, dizziness

Monitoring : monitor renal function periodically

Mechanism of action : Angiotensin II receptror antagonist -> blocks vasoconstricting and

aldosterone-secreting effects of angiotensin II by binding to AT1 recpetors

Onset : 1-2 hrs

Duration : >24 hr

Absorpsi : rapidly absorbed for the GI tract. Bioavailabilitas : 60-80%. Time to peak plasma
concentration : 1.5-2 hr

Excretion : via bile and urine (as unchanged drug and metabolites); urine (approx 20%)

Brands : Aprovel, Irbeten, Iretensa, dll

Bisoprolol (Beta blocker)

Dosage : 5-10 mg 1 dd 1. Max 20 mg/day

Admin : with or without food

SE : bradikardi, worsening of preexisting hearrt failure, dizziness, headache, GI disturbances (nausea,

vomiting, diare, constipation), cold or numb extremities

Mech : selectively and competitively blocks B1-receptors but has little or no effect on B2 receptors
except at hgh doses

Onset : 1-2 hr
Absorption : Almost completly from GI tract

Metabolism : undergoes minimal first pass metabolism

Excretion : via urine (approx 50% as unchanged drug and 50% as metabolites)

Brands : bisoprolol, bipro, carbisol, concor

Nifedipine (CCB)

Dosage : initially : 5 mg 3 dd 1; maintenance : 10-20 mg 3 dd 1. In elderly, dose reduction may be

necessary

Admin : may be taken with or without food. Avoid grapefruit juice

SE : dizziness, flushing, headache, peripheral edema, tachycardia, palpitations, nausea, constipation,

other GI disturbances, increased micturition frequency, lethargy, eye pain, visual disturbances,
vertigo, migraine, mood disturbances, rashes, pruritus, gingival hyperplasia, myalgia, gynecomastia,
tremor, impotence, fever

Mechanism : prevents Ca ion from entering the slow channels of cardiac and smooth muscles during
depolarisation, producing peripheral and coronary vasodilatation. It reduces afterload, peripheral
resistance and BP, increases coronary blood flow and causes reflex tachycardia.

Onset : Approx: 20 min

Absorp : almost completely in GI tract

Excretion : via urine (80-95%) and feces

Brands : Farmalat, Nifedin

Allopurinol

Dosage : intially 100 mg daily

SE : pruritus, fever, rashes, nausea, vomiting, arthralgia

Mechanism of action : inhibits xanthine oxidase (enzyme that catalyses the conversion of
hypoxanthine to xanthine then uric acid) -> reducing production of purin

Onset : Peak effect : 1-2 week

Absorp : GI tract

Excretion : via urine (70% as oxipurinol, 10% as allopurinol)

Voltadex (Na diclofenac 50 mg)

Ki : ulkus peptikum, hipersensitif terhadap diclofenac, pasien dengan serangan asma, urtikaria, atau
rhinitis bila menggunakan aspirin

Dosis : 25-50 mg 3 dd 1
SE : kejadian trombolitik kardiovaskular, hipertensi, gagal jantung dan edema, risiko ulserasi,
perdarahan dan perforasi gastrointestina, gagal ginjal, kehamilan dan ibu menyusui

Atorvastatin (Dislipidemik agent)

Dosage : Initial 10 or 20 mg 1 dd 1. Max 80 mg/day

Admin : with or without food, but should be taken with food

SE : headache, flatulence, constipation, dyspepsia, nausea, diare, vomiting, anorexia, pain in

extremity, muskuloskeletal and pharyngolaryngeal, miopati, muscle spasms, myalgia, arthtralgia,
nasofaringitis

Mechanism of action : inhibits HMG-CoA reductase (enzyme that catalyzes the conversion of HMG-
CoA to mvalonate) -> induction of the LDL receptors and stimulation of LDL catabolism -> lowered
LDL-cholestrol levels

Absorption : Readily absorbed from the GI tract

Excretion : via fecesl, urine (<2%)

Osteoflam (Glucosamine HCL 250 mg, chondroitin sulphate 200 mg, vit C 25 mg, Mg 5 mg, Zn 2.5
mg, Manganese 0.25 mg, MSM 350 mg)

Glucosamine is a precursor for glysaminoglycans, a major component of joint cartilage. Supplemental

glucosamine may help rebuild cartilage and treat arthritis (studies confirm benefits in relieveing pain
and symptoms of osteoarthritis)

MSM-> a natural checmical found in green plants. Provides a dietary source of sulfur for methionine.

The sulfur content can be used by the bpdy to maintain normal connective tissues, also has exhibited
possible anti-inflammatory, antiatherosclerotic, and chemopreventative activities along with free
radical scavenging, has been reported to : alleviate allergies arthritis, GI upset, muskuloskeletal pain,
and to boost immune system. Posseses antimicrobial effects against organisms such as Giardia
lamblia, Trichomonas vaginalis, and some fungi (may bind to surface receptor sites, blocking the
interaction of parasite host)

Why combine with glucosamine? -> a randomized, double-blind, parallel, placebbo controlled study
concludes that the combination of glucosamine and MSM showed statistically significant decreases
in pain and swelling compared with either single treatment alone.

Dosage : commonly given 2-6 g/day in 2 to 3 divided doses for arthritis or other joint conditions

SE : bloating, constipation,fatigue, headache, indigestion, insomnia

Omeprazole (PPI)

Dosage : 20 mg once in the morning for NSAID related ulceration

Admin : should be taken with food, take immediately before meal

SE : headache, rash, pruritus, fatigue, cough, back or abdominal pain, arthralgia, myalgia, dry mouth,
vertigo, insomnia, depression, agitation, hallucination, dll

Mechanism : PPI, blocks the final step in gastric acid secretion by specific inhibition of H+/K+ ATPase
enzyme system present on the secretory surface of the gastric parietaal cell

Onset : approx. 1 hr

Duration : up to 72 hr

Absorp : Rapid but variably absorbed (oral)

Excretion : Mainly via urine (approx 77%), the remainder in feces (via the bile)