See also Insulin . General information Insulin lispro induces more rapid and constant release of insulin from the injection site, since it consists of monomeric insulin. The change of one or more amino acids in the insulin molecule prevents insulin from forming dimers or hexamers. More rapid absorption, rapid availability, and rapid inactivation make the action better than that of endogenously secreted insulin. When the interval…

See also Insulin General information Insulin glargine is a long-acting human insulin analogue, in which phenylalanine is removed from site 30 of the C terminal of the B chain and two arginine molecules replace it, adding two positive charges; asparagine on site 21 of the A chain is replaced by the more stable glycine to avoid deamination. Older long-acting insulins, such as protamine zinc insulin and…

See also Insulin . General information Insulin detemir is a long-acting insulin analogue that lacks threonine at the B30 position and is acylated with a 14-carbon myristoyl fatty acid side-chain at the epsilon-amino group of the lysine in the B28 position. This stimulates binding to albumin and increases the half-life, extending its duration of action. The pharmacokinetic profile of detemir does not differ in various age…

See also Insulin General information Insulin aspart is a rapid-acting synthetic insulin in which proline is replaced by aspartate at position 28 in the B chain. Insulin aspart has been reviewed [ ]. Its adverse effects and the resulting adverse reactions do not differ from those of soluble human insulin and it has a similar effect on the blood glucose concentration [ ]. The binding of…

See also Insulin aspart ; Insulin detemir ; Insulin glargine ; Insulin lispro General information Insulin is used for substitution therapy in patients with an absolute or relative deficiency of insulin. Most of the insulins now prescribed are either human or highly purified insulins of animal origin or synthetic insulins closely related to human insulin. The use of insulin of lesser purity is declining, but it…

General information Inosine pranobex is a synthetic product, also known as isoprinosine or inosine dimepranol acedobene, with antiviral properties that are assumed to be related to its effect on T cell-mediated immunity rather than to direct antiviral activity. It has been tried in a wide range of viral diseases and also in rheumatoid arthritis [ ], multiple sclerosis [ ], and alopecia [ ]. However, clinical…

General information Pulmonary delivery of drugs is the administration route of choice in respiratory diseases such as chronic obstructive pulmonary disease and asthma. Different devices are available, including metered-dose inhalers, dry powder inhalers, and nebulizers, and nearly 80% of asthmatic patients worldwide use metered dose inhalers [ ]. Chlorofluorocarbons have been used as an aerosol propellant in metered-dose inhalers; however, they deplete the ozone layer and…

See also Vaccines General information Influenza vaccine viruses are propagated in embryonated chicken eggs. The virus-containing extra-embryonic fluid is harvested, purified, and inactivated with formalin. Inactivated flu vaccine is produced either as whole virus vaccine or ether-disrupted split or subunit preparations. However, many other new or modified influenza vaccines are already available or are expected to appear in the near future, for example vaccines containing new…

See also Monoclonal antibodies General information Infliximab is a chimeric, human-murine anti-TNF monoclonal antibody. It was initially approved by the Food and Drug and Administration in August 1998 for the treatment of moderately to severely active Crohn’s disease [ , ] in patients with an inadequate response to conventional therapies and those with enterocutaneous fistulae. The indications were expanded in June 2002 and April 2003 to…

See also Alpha-adrenoceptor antagonists General information Indoramin is a postsynaptic selective alpha 1 -adrenoceptor antagonist that is chemically distinct from the quinazolines. Unlike some other alpha-blockers, indoramin lowers blood pressure without a resulting reflex tachycardia or postural hypotension [ ]. However, it has largely been supplanted by more modern drugs, such as doxazosin, prazosin, and terazosin. You’re Reading a Preview Become a Clinical Tree membership for…

See also Non-steroidal anti-inflammatory drugs (NSAIDs) General information Indoprofen is one of several NSAIDs that have been withdrawn because of adverse reactions. The UK Licensing Authority suspended the product licence on grounds of safety in 1983, and in 1984 the Italian manufacturers decided to withdraw it from the world market. The UK decision was taken because there was a high rate of adverse drug reactions in…

See also Non-steroidal anti-inflammatory drugs (NSAIDs) General information Indometacin is the best-known and most thoroughly tested indoleacetic acid derivative. It is one of the most effective non-steroidal anti-inflammatory drugs (NSAIDs), and most of its toxic and therapeutic effects appear to be due to marked inhibition of prostaglandin synthesis. Because of its potency, its clinical efficacy is comparable, if not superior, to any other NSAID, but for…

See also HIV protease inhibitors General information Indinavir is an HIV protease inhibitor. As for most other protease inhibitors, the use of indinavir has been markedly simplified by co-administration of low-dose ritonavir, which allows indinavir to be given twice daily with or without food (so-called “boosted indinavir”). However, increased exposure to indinavir also results in increased adverse reactions. Drug studies Comparative studies In a randomized comparison…

General information Indapamide is a thiazide-like diuretic. Although it was introduced as a specific antihypertensive drug without appreciable diuretic action, the effects of indapamide are no different from those of bendroflumethiazide. Organs and systems Cardiovascular Indapamide has been associated with prolongation of the QT interval and Brugada syndrome in the setting of severe hypokalemia and hyponatremia [ ]. A 64-year-old man developed generalized weakness and dizziness.…

General information Indanediones have the same mechanism of action as the coumarins. However, they are generally more toxic than the coumarins, and can cause allergic reactions capable of involving many organs and sometimes resulting in death [ ]. These reactions are mainly observed with phenindione and are very rare with other indanediones, such as fluindione. In an MRC trial, there was a 2.25% incidence of reactions,…

See also Antivenoms , Hymenoptera venoms General information Desensitization is used in the treatment of IgE-mediated disease. Increasing doses of an allergen are injected subcutaneously over a varying time span. The aim of the treatment is to decrease sensitivity to the allergen and prevent the clinical symptoms caused by exposure to the allergen. Following immunotherapy, there can be an initial rise in specific serum IgE to…

General information Immunoglobulin preparations are concentrated protein solutions derived from pooled plasma from adults or animals. They contain specific antibodies in proportion to the infectious and immunization experience of the population from whose plasma they are prepared [ ]. Large numbers of donors (at least 1000 donors per lot of final product) are used, in order to ensure inclusion of a broad spectrum of antibodies. Intravenous…

General information Imiquimod is an immune response enhancer that induces production of interferon and several other cytokines. It is used, in formulations containing 5%, to treat external genital and perianal warts/condylomata acuminata in adults [ ]. As imiquimod-treated warts regress, serum concentrations of interferon-alfa, interferon-beta, interferon-gamma, and tumor necrosis factor rise [ ]. Trials of imiquimod have failed to identify any particular systemic or laboratory abnormalities.…

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See also Angiotensin-converting enzyme inhibitors General information Imidapril is a long-acting, non-sulfhydryl ACE inhibitor that has been used in patients with hypertension, congestive heart failure, acute myocardial infarction, and diabetic nephropathy. It is a prodrug, rapidly converted in the liver to its active metabolite imidaprilat, which has a half-life of about 15 hours. Imidapril and its metabolites are mainly excreted in the urine. Organs and systems…