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Celestamine Ns

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Indications:

severe symptoms of atopic dermatitis, angioedema, urticaria, seasonal and perennial allergic rhinitis, food allergy and drug reactions, seborrheic dermatitis, neurodermatitis, allergic asthma, ocular allergic manifestations such as conjunctivitis and iridocyclitis and allergic reactions to insect bites.

Contraindications:

patients with systemic fungal infections in those with hypersensitivity to any component chemical structure or similar drugs, pregnancy and lactation.

Adverse reactions:

Adverse effects most frequently reported include fatigue, headache, drowsiness, dry mouth, gastrointestinal disturbances such as nausea and gastritis, and allergy symptoms such as rashes. On rare occasions during the marketing of loratadine have been reported cases of alopecia, anaphylaxis, hepatic failure. fluid and electrolyte disorders: sodium retention, potassium loss, alkalosis hypocalcemic, fluid retention, congestive heart failure in susceptible patients, hypertension. Musculoskeletal: Muscle weakness, corticosteroid myopathy, muscle wasting, worsening of myasthenic symptoms in myasthenia gravis, osteoporosis, spinal fractures, compression, aseptic necrosis of femoral and humeral heads, pathologic fracture of long bones, tendon rupture . Gastrointestinal: peptic ulcer with possible subsequent perforation and hemorrhage, pancreatitis, abdominal distension, ulcerative esophagitis. Dermatologic: Impairment of wound healing, skin atrophy, thin fragile skin, petechiae and ecchymoses, facial erythema, increased sweating, suppression of reactions such as allergic dermatitis, urticaria, angioedema. Neurologic: convulsions, increased intracranial pressure with papilledema (pseudotumor cerebri) usually after treatment, vertigo, headache. Endocrine: Menstrual irregularities, development of cushingoid state, suppression of fetal intrauterine growth or childhood, lack of secondary response suprerrenal cortex or the pituitary, particularly in times of stress, such as trauma, surgery, or state disease, decreased carbohydrate tolerance, manifestations of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents in diabetic patients. Ophthalmic: posterior subcapsular cataracts, increased intraocular pressure, glaucoma, exophthalmos. Metabolic: negative nitrogen balance due to protein catabolism. Psychiatric: Euphoria, violent changes of mood, from depression to frank psychotic manifestations, personality changes, excessive irritability, insomnia. Other: anaphylactoid and hypersensitivity reactions and reactions or similar hypotensive shock

Interactions:

Loratadine: When administered concomitantly with alcohol, loratadine has no potentiating effects as measured by psychomotor performance studies. It has been reported an increase in plasma concentrations of loratadine after administration of ketoconazole, erythromycin or cimetidine in controlled clinical studies, but there has been no clinically significant changes (including electrocardiographic). Caution should be exercised when co-administering other drugs that inhibit hepatic metabolism until they can make definitive interaction studies. Betamethasone: Concomitant use of phenobarbital, rifampin, phenytoin or ephedrine, may increase the metabolism of corticosteroids decreasing its therapeutic action. Patients administered concomitantly with a corticosteroid and an estrogen can be observed by increasing the effects of corticosteroid. Simultaneous administration of corticosteroids with diuretics that cause increased elimination of potassium, hypokalemia may increase the concomitant use of corticosteroids with cardiac glycosides may increase the chance of arrhythmias or digitalis toxicity associated with hypokalemia. Corticosteroids may increase potassium depletion caused by amphotericin B. In all these patients managed with either of these treatments combined, shall make determinations of serum electrolytes, particularly potassium levels should be monitored carefully. Concomitant use of corticosteroids with anticoagulants of the coumarin type can increase or decrease the anticoagulant effect, possibly requiring dose adjustment. The combined effects of nonsteroidal anti-inflammatory corticosteroid drugs or alcohol with corticosteroids may increase the incidence or increase the severity of gastrointestinal ulcers. Corticosteroids may reduce concentrations of salicylate in blood. Aspirin should be used carefully in conjunction with corticosteroids in hypoprothrombinemia case. When corticosteroids are administered to diabetics may require adjustment of antidiabetic drugs. Concomitant use of corticosteroids with somatropin may inhibit the response to somatropin.

Warnings:

Patients with severe hepatic impairment should be given a lower dose initially, as these patients may have a slower clearance of the drug, the recommended starting dose is 5 mg once daily or 10 mg on alternate days. May require adjustments in dosage in the process of remission or exacerbation of the disease, depending on the patient’s individual response to treatment and the burden to the patient is exposed, such as severe infection, surgery or injury. After the suspension of the long-term corticosteroid therapy or high doses, is recommended close observation of patients for up to one year. May occur, secondary adrenocortical insufficiency induced by the drug as a result of too rapid corticosteroid suspension. This can be minimized by gradually decreasing the dose. The effect of corticosteroid increased in patients with hyperthyroidism, or cirrhosis. Corticosteroids must be used cautiously in patients with ocular herpes simplex because of possible corneal perforation. Corticosteroid treatment may lead to the emergence of mental disorders. Emotional instability or psychotic tendencies may be aggravated pre-existing by corticosteroids. Caution is advised in cases of: nonspecific ulcerative colitis if there is possibility of impending perforation, abscess and a pyogenic infection, diverticulitis, recent intestinal anastomoses, active or latent peptic ulcer, renal failure, hypertension, osteoporosis and myasthenia gravis. As the complications of steroids depend on the magnitude of the doses and duration of treatment must be balanced against each individual case the potential benefit of the drug against the potential risks. Corticosteroids may mask some signs of infection, new infections may develop during use. When using corticosteroids may occur a reduction in resistance and an inability to localize infection. Prolonged use of corticosteroids may produce posterior subcapsular cataracts, glaucoma with possible damage to the optic nerve and promote the development of secondary ocular infections from fungi or viruses. Standard and high doses of corticosteroids may increase blood pressure, salt and water retention and increased excretion of potassium. It is less likely that these effects occur with synthetic derivatives except when used at high doses. Should be considered salt restriction and potassium supplementation in the diet. All corticosteroids increase calcium excretion. During corticosteroid therapy should not be performed immunization procedures, especially in those patients receiving high doses, due to the potential risk of neurological complications and lack of antibody response. It should be noted that patients treated with immunosuppressive doses of corticosteroids to avoid exposure to chickenpox or measles, and if they have been exposed, consult your doctor. This is especially important in children. Corticosteroid therapy in patients with active tuberculosis should be restricted to those cases of fulminating or disseminated tuberculosis in which the corticosteroid is used concomitantly with proper TB treatment. If corticosteroids were indicated in patients with latent tuberculosis, it is necessary to establish close monitoring because the disease can be reactivated. During prolonged corticosteroid therapy, these patients should receive chemoprophylaxis. The growth and development of children receiving prolonged corticosteroid therapy, should be carefully observed, since the administration of corticosteroids may disrupt the growth rates and inhibit the endogenous production of corticosteroids. The steroid may alter motility and sperm count.

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Consultants Corner

Dr. Hani Najjar

Dr. Hani Najjar Pediatrics, Neurology

Dr. Faisal Dibsi

Dr. Faisal Dibsi Specialist of Otolaryngology - Head and Neck Surgery

Dr . Dirar Abboud

Dr . Dirar Abboud Hepatologist – Gastroenterologist

Dr. Talal Sabouni

Dr. Talal Sabouni UROLOGY AND KIDNEY TRANSPLANT

Dr. Tahsin Martini

Dr. Tahsin Martini Degree status: M.D. in Ophthalmology

Dr. Samer Al-Jneidy

Dr. Samer Al-Jneidy Pediatrician

Yaser Habrawi , F.R.C.S.Ed

Yaser Habrawi , F.R.C.S.Ed Consultant Ophthalmologist

Samir Moussa M.D.

Samir Moussa M.D. ENT Specialist

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