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baclofen baclofen (Baclospas, Balgipen, Lioresal) is a derivative of GABA, a neurotransmitter in the brain which damps down the effects of stimulant neurotransmitters. It is used as a skeletal muscle relaxant in patients who suffer from strokes, cerebral palsy, meningitis, multiple sclerosis or spinal injury. Adverse effects include drowsiness, nausea, vomiting confusion, fatigue and excitability. Rarely, it may cause dizziness, a fall in blood pressure, euphoria, hallucinations, depression, pins and needles, slurred speech, tremors, floppy muscles, insomnia, visual disturbances, rashes, allergic reactions, itching, noises in the ears (tinnitus), difficulty passing urine and impairment of liver function. Precautions: It should not be used in patients with peptic ulcers. Use with caution in patients with epilepsy, serious mental illness, diabetes, strokes or impaired heart, kidney or liver function. Use with caution in the elderly, in pregnancy and in breastfeeding mothers. Tests of kidney and liver function should be carried out before and at regular intervals during treatment. The drug should be stopped gradually to reduce the risk of withdrawal effects which may affect the ability to drive. Interactions: Anti-blood pressure drugs, lithium, fentanyl, morphine, tricyclic antidepressants, levodopa, carbidopa, sedatives and sleeping drugs.
balsalazide balsalazide (Colazide) is a salicylate used to treat mild to moderate ulcerative colitis (chronic diarrhoeal disorder) and to prevent its recurrence. See 20 Drugs used to Treat Diarrhoea. Adverse effects include headache, abdominal pain, stomach and bowel upsets, gallstones. Precautions: Do not use in patients with an allergy to salicylates, severe liver or kidney damage, in pregnancy or while breastfeeding. Use with caution in patients with asthma, bleeding disorders, ulcer, mild liver or kidney damage. Any unexplained bleeding, bruising, sore throat or generally feeling unwell should be reported.
bambuterol bambuterol (bambuterol hydrochloride, Bambec) is converted into terbutaline in the body. Terbutaline is a selective beta2 stimulant used as a bronchodilator to treat asthma. See 14 Drugs used to Treat Bronchial Asthma. Adverse effects and Precautions are similar to those listed under salbutamol.
barbiturate barbiturate drugs are derived from barbituric acid. They were previously widely used as sleeping drugs (see 1 Sleeping Drugs) and as sedatives (see 2 Drugs used to Treat Anxiety). Some are used as anti-epileptic drugs (see 15 Drugs used to Treat Epilepsy). They depress brain function and are capable of producing drug dependence (see Introduction). Adverse effects and Precautions of barbiturates are listed under phenobarbitone. Rapidly acting barbiturates are used intravenously as general anaesthetics. They include thiopentone sodium and methohexitone sodium.
barrier barrier preparations usually contain water-repellent substances such as dimethicone and other silicones. They are applied as creams and ointments which also contain an oily base of white, soft paraffin or lanolin. They protect the skin from irritants, pressure, urine and faeces.
basiliximab basiliximab (Simulect) is an antibody that is used with ciclosporin and corticosteroids to prevent rejection in patients who have had a kidney transplant. Adverse effects include allergic reactions. Precautions: Do not use in patients who are pregnant or breastfeeding.
bath additives Bath additives usually contain an oily base (e.g. liquid paraffin, soya oil). They are used to soften the skin to treat eczema, itching and other dry skin disorders. They may have other drugs added such as antiseptics. Coal tar derivatives are frequently used as bath additives in preparations used to treat chronic eczema and psoriasis.
becaplermin becaplermin (Regranex) is a growth hormone derived from human blood that is used to treat ulcers of the skin caused by nerve damage due to poorly controlled diabetes. Adverse effects include infection, ulcers, redness of the skin and pain. Rarely blisters and swelling may occur. Precautions: Do not use in patients with cancer at or near the ulcer site, in pregnancy or while breastfeeding. Use with caution in patients with osteomyelitis (inflammation of the marrow and hard tissue of the bone), diseases of the arteries or infected ulcers.
beclometasone beclometasone (beclomethasone) is a potent corticosteriod (see 37 Corticosteroids). It is used by inhalation to treat asthma (Aerobec, Asmabec, Beclazone, Becloforte, Becodisks, Becotide, Filair, Pulvinal Beclometasone, Qvar, in Ventide preparations) see 14 Drugs used to Treat Bronchial Asthma. It is also used to treat hayfever and perennial rhinitis (Beclo-aqua, Beconase, Care Hayfever Relief, Nasobec, Zonivent) see 17 Antihistamine Drugs and Immunosuppressants; and to treat skin disorders (e.g. eczema) (Propaderm) see 45 Drugs used to Treat Skin Disorders. Adverse effects: see 37 Corticosteroids. By inhalation: may cause hoarseness and thrush of the mouth and throat. To the skin: see 45 Drugs used to Treat Skin Disorders. To the nose: May cause irritation, nose bleeds, taste and smell disturbances. Precautions: Use inhalations with caution in patients with active or dormant tuberculosis of the lungs, in breastfeeding mothers and in pregnancy, use nose sprays with caution in patients with untreated infections of the nose, in pregnancy and in breastfeeding mothers. For precautions on skin applications, see 45 Drugs used to Treat Skin Disorders.
Beechams Beechams All in One contains paracetamol, guaiphenesin and phenylephrine; Beechams Cold and Flu, Beechams Flu-Plus Berry Fruits, Beechams Flu-Plus Powder, Beechams Hot Blackcurrant, Beechams Hot Lemon and Beechams Hot Lemon and Honey contain paracetamol and phenylephrine; Beechams Flu-Plus caplets contain paracetamol, caffeine and phenylephrine; Beechams Lemon tablets contain aspirin; Beechams Powders and Beechams Powders capsules contain aspirin and caffeine; Beechams Throat Plus contains benzalkonium and hexylresorcinol.
Begrivac Begrivac is an inactivated flu vaccine.
benzalkonium benzalkonium (benzalkonium chloride) is used as an antiseptic and disinfectant. It has effects like cetrimide. It is used as a preservative in eye drops and is present in some skin applications and throat lozenges.
benzocaine benzocaine (ethyl aminobenzoate) is a local anaesthetic. It is available in lozenges (in Merocaine, in Tyrozets) to relieve pain in the mouth and throat and also in local applications (AAA Spray). May rarely cause allergic reactions. Avoid prolonged use. Use with caution in pregnancy and breastfeeding mothers.
benzodiazepines benzodiazepines are discussed in 1 Sleeping Drugs and 2 Drugs used to Treat Anxiety. Adverse effects include drowsiness, light-headedness, fatigue, loss of control over voluntary movements (ataxia), confusion, constipation, depression, double vision or blurred vision, headache, low blood pressure, loss of memory, incontinence of urine or difficulty in passing urine, jaundice due to liver damage, changes in libido (sexual drive), altered salivation, nausea, skin rashes, slurred speech, forgetfulness, tremor, vertigo, blood disorders, depression of breathing and, with injectable preparations, thrombophlebitis (inflammation of the vein) at the site of injection. Paradoxical reactions may occur, which include talkativeness, excitement, anxiety, hallucinations, aggressiveness, antisocial behaviour, spasm of muscles, rage and disturbed sleep. Adjustment of dose up or down may make symptoms worse. In a susceptible person, benzodiazepines can trigger underlying depression and the patient may become suicidal. Harmful effects of benzodiazapines may be more frequent and severe in the elderly; the smallest dose possible should be used for the shortest duration of time. Elderly people run the risk of developing incoordination of movement, drowsiness and agitation. They may wet themselves in the night or have difficulty in passing urine, and they may become confused and forgetful. Benzodiazepines cause tolerance and dependence; see 2 Drugs used to Treat Anxiety. Precautions: Do not use in patients who have difficulty breathing or who sometimes stop breathing for a moment in their sleep (sleep apnoea syndrome), with severe liver disease, myasthenia gravis (muscle weakness due to neuromuscular abnormality), phobic or obsessional states, drug or alcohol abuse, chronic psychosis, or as sole treatment for depression or anxiety depression. They should be used with caution in patients with chest disorders, porphyria (a hereditary disorder of metabolism), impaired kidney or liver function, in the elderly, in pregnancy, labour and in breastfeeding mothers. They may impair the ability to drive a motor vehicle or operate machinery, and they increase the effects of alcohol. See risks of withdrawal, 2 Drugs used to Treat Anxiety. Interactions: Increased sedative effects with alcohol, general anaesthetics, opiate pain-relievers, antidepressants, antipsychotics, antihistamines, lofexidine, baclofen and nabilone; erythromycin blocks metabolism of midazolam and increases its blood level; isoniazid blocks metabolism of diazepam; rifampicin increases metabolism of diazepam; fluvoxamine increases blood levels of some benzodiazepines; anti-epileptics increase metabolism and reduce the effectiveness of clonazepam; phenytoin blood levels are affected by diazepam and possible other benzodiazepines; itraconazole, ketoconazole and fluconazole increase blood levels of midazolam and cause prolonged sedative effects; blood pressure lowering effects of anti-blood pressure drugs increased by benzodiazepines; increased sedation with alpha-blockers; diltiazem and verapamil block metabolism of midazolam and increase its blood level; disulfarim blocks metabolism of benzodiazepines and increases their sedative effects; benzodiazepines occasionally antagonize effects of levodopa; cimetidine blocks metabolism of benzodiazepines and increases their blood levels; and omeprazole blocks metabolism of diazepam and increases its blood level.
benzoic acid benzoic acid has antibacterial and anti-fungal properties. It is used as a preservative in medicines, foods and cosmetics. Salts of benzoic acid are more soluble in water than benzoic acid and are used as astringents. They are added to some oral preparations as a preservative. They can become oxidized and cause discoloration. Benzoic acid is applied to the skin to treat fungal infections of the skin, usually as a compound ointment with salicylic acid. It may also be used to clean ulcers and remove dead skin from wounds (in Aserbine). Adverse effects: It may cause allergic reactions and large doses by mouth may irritate the stomach. It may irritate the skin, eyes and mucous membranes (e.g. lining of the mouth).
benzoin benzoin (sumatra benzoin, in Frador) is from a balsam resin. It is used in inhalations to treat catarrh and in skin applications as an antiseptic and protective agent.
benzoin tincture compound benzoin tincture compound (Friar’s Balsam) contains Sumatra benzoin, storax, aloes and alcohol. Its vapours are inhaled by adding it to boiling water and breathing in the steam. It is used in this way to relieve a blocked nose caused by a cold.
benzophenone benzophenone (oxybenzone) is a sunscreen agent. Rarely, it may cause contact dermatitis and make the skin sensitive.
benzoyl peroxide benzoyl peroxide (in Acnecide, in Benzamycin, in Brevoxyl, Panoxyl, in Quinoderm, in Quinoped) is an antiseptic (45 Drugs used to Treat Skin Disorders) and is also used for removing dead skin (45 Drugs used to Treat Skin Disorders). It is mainly used in skin applications to treat acne. Adverse effects include skin irritation and peeling. Occasionally it may cause contact dermatitis. Precautions: Avoid contact with eyes and lining of nose and mouth. May bleach fabrics. Do not use to treat acne rosacea.
benzydamine benzydamine (benzydamine hydrochloride) is an anti-inflammatory drug. It is present in Difflam Oral Rinse solution and Difflam Spray to treat a sore mouth and throat. It may cause numbness of the mouth. It is also present in Difflam cream used to treat muscle and joint pains.
benzyl alcohol benzyl alcohol is used as an antiseptic, and as a weak local anaesthetic, in various skin applications.
benzyl benzoate benzyl benzoate (Ascabiol) is used to treat scabies (see p. 230) Adverse effects: It may irritate the skin and occasionally cause skin rashes. It can produce a burning sensation when applied to the genitals or areas of skin that have scratch marks. Precautions: Do not use in children. Avoid contact with eyes and mucous membrances (e.g. lining of the nose, mouth, vagina). Do not use on broken or infected skin. Use with utmost caution in pregnancy and breastfeeding mothers.
beractant beractant (Survanta) is used to treat respiratory distress syndrome (hyaline membrane disease) in premature babies. Adverse effects: Bleeding into the lungs. Precautions: Continuous monitoring required to avoid too much oxygen entering the bloodstream.
bergamot oil bergamot oil is obtained from the fresh peel of fruit of Citrus bergamia (Rutaceae). It is used in perfumes and especially in hair preparations. It is also used in suntan applications, see p. 209. There is doubt that concentrations below 1% have any tanning effect and there is evidence that psoralens produce skin cancer in mice.
beta-blockers beta-blockers are discussed in Chapter 22. Adverse effects include slowing of the heart rate, fall in blood pressure, heart block, numbness and pins and needles in the hands and feet, coldness of the fingers and toes, mental depression, tiredness on exertion, insomnia, nightmares, drowsiness, confusion, weariness, fatigue, visual disturbances and hallucinations. Beta-blockers may occasionally produce a reversible depression associated with disorientation in time and place, short-term memory loss, clouded thinking and emotional changes. They may cause nausea, vomiting, stomach upsets, bowel changes, allergic reactions, wheezing; and, very rarely, blood disorders, loss of hair, a psoriasis-like skin rash and dry eyes. Precautions: Beta-blockers should not be used in patients with untreated heart failure, serious heart block, serious disorders of the circulation or untreated phaeochromocytoma (tumour of the sympathetic nervous system). They should be used with caution in late pregnancy and in breastfeeding mothers, and they should be withdrawn gradually in patients with angina. Note: Beta-blockers that are most soluble in water are less likely to enter the brain and cause disturbed sleep and nightmares etc. than the ones that are soluble in fat (lipid soluble). They include atenolol, celiprolol, nadolol and sotalol. However, because they are water soluble they are excreted by the kidneys and they may accumulate in the blood of patients whose kidney function is impaired, lower doses should therefore be given in such patients. Some beta-blockers may be able to stimulate as well as block beta-receptors (e.g. oxprenolol, pindolol and acebutolol), they therefore cause less slowing of the heart and coldness of the fingers and toes. However, remember that all beta-blockers slow the heart rate and may precipitate heart failure in those patients prone to develop heart failure. Sotalol may cause life-threatening disorders of heart rhythm. Beta-blockers affect blood sugar control and must be used with caution in diabetics. They may also mask some of the early symptoms of hypoglycaemia (see p. 195). Selective blockers should be used in diabetics but avoided if patient has frequent attacks of hypoglycaemia. Non-selective beta-blockers should definitely not be used in patients with asthma or obstructive airways disease and selective ones should preferably not be used. Beta-blockers should be used with caution in patients with heart failure controlled by digoxin and diuretics, impaired kidney or liver function, thyrotoxic crisis and general anaesthesia (withdraw before elective surgery). Interactions: verapamil, Class I anti-arrhythmic drugs, anti-diabetic drugs, general anaesthetics, reserpine, anti-blood pressure drugs, ergot drugs, cimetidine, sedatives, sleeping drugs, sympathomimetics, indomethacin. Note: Sotalol should no longer be used to treat angina, raised blood pressure or over-active thyroid. It must only be used to treat certain disorders of heart rhythm. To change over from sotalol to another drug the dose of sotalol should be gradually reduced over 1–2 weeks, the patient carefully monitored (particularly those with coronary heart disease), and at the same time replacement treatment should be started.
beta-lactam beta-lactam antibiotics have a similar basic chemical structure – a lactam ring. They include the penicillins, cephalosporins and cephalomycins. See Chapter 46.
betahistine betahistine (betahistine dihydrochoride, Serc) is used to treat vertigo, noises in the ears (tinnitus) and hearing loss associated with Ménière’s disease (for symptoms see p.79). It produces effects similar to histamine. Adverse effects include flushing, tingling, chilliness, nausea, vomiting, diarrhoea, headache, rashes, itching, rapid beating of the heart, and shivering. Precautions: It should be given with caution to patients with asthma or peptic ulcer. It should not be given to children and should not be given with antihistamines. Use with caution in pregnancy and breastfeeding mothers.
betaine hydrochloride betaine hydrochloride when dissolved in water forms hydrochloric acid. It is used to treat patients unable to produce hydrochloric acid in their stomachs. It is present in Kloref and Kloref-S used as potassium supplements.
betalactamases betalactamases are enzymes produced by certain bacteria that disrupt the chemical structure of beta-lactam antibiotics (the beta-lactam ring) thus making the antibiotics inactive, see p. 234.
bezafibrate bezafibrate (Bezagen, Bezalip, Bezalip-Mono, Zimbacol) is a fibrate drug used to reduce high blood cholesterol and fat levels (see Chapter 26). Adverse effects: Stomach and bowel upsets, itching, nettle-rash, impotence, headache, dizziness, vertigo, fatigue, hair loss and muscle damage, producing weakness and pain. Precautions: It should not be used in patients with severe liver or kidney impairment, gall-bladder disease, in pregnancy or in breastfeeding mothers. The risk of muscle damage is increased in patients with impaired kidney function and possibly underworking of the thyroid gland (see fibrates for warnings on muscle damage). Use of ciclosporin or a statin drug at the same time may increase the risks. Interactions: Anticoagulants, anti-diabetic drugs, MAOIs.
bicalutamide bicalutamide (Casodex) is an anti-androgen drug (see p. 251) used to treat cancer of the prostate gland. Adverse effects include hot flushes, weakness, itching, tenderness and swelling of the breasts and sleepiness. Rarely it may cause jaundice, liver damage, blood disorders and disorders of the heart (e.g. angina, heart failure, disorders of rhythm), stomach and bowel upsets, insomnia, dizziness, loss of appetite, dry mouth, decreased libido, impotence, sweating, rashes, breathlessness, changes in weight, fluid retention (causing swelling of the ankles), chest and abdominal pains and raised blood sugar level. Adverse effects are more likely in the elderly. Precautions: Use with caution in patients with impaired liver function. Liver function tests at start and during treatment should be considered. Interactions: Cimetidine, ketoconazole, oral anticoagulants.
biguanides biguanides are a group of drugs used to treat diabetes. See Chapter 42. The only available drug in this group is metformin.
bile acid sequestrants bile acid sequestrants, see Chapter 26.
BiNovum BiNovum is a biphasic oral contraceptive. See p. 190.
biphosphonates biphosphonates (bisphosphonates) are used to treat bone disorders. Disodium etidronate is used to treat Paget’s disease of bone. It slows down the increased rate of bone turnover that occurs in this disease. Sodium pamidronate and sodium clodronate are used to treat raised blood calcium levels in patients suffering from secondary bone cancer. Disodium etidronate is available with calcium carbonate (Didronel PMO tablets) to treat osteoporosis of the spine.
bisacodyl bisacodyl (Dulcolax) is a stimulant laxative. See Chapter 21. It may cause abdominal cramps and suppositories may produce local rectal irritation.
bismuth salts bismuth salts by injection were once widely used to treat syphilis. Soluble bismuth salts are harmful because they can be absorbed into the body and they should not be used. Insoluble salts are included in some antacid mixtures and as protectives in some skin preparations, as an astringent in haemorrhoidal preparations, in suppositories and in diarrhoea mixture. Bismuth salts by mouth have occasionally caused brain damage and bone and joint disorders after prolonged use as antacids. They can make the faeces black.
bleomycin bleomycin (Bleo-Kyowa) is used as an anti-cancer drug (see Chapter 51). It interferes with DNA synthesis in cancer cells inhibiting growth and cell division. Adverse effects include fever, anorexia, tiredness, nausea, and pain and inflammation at the injection site. Occasionally it may produce delayed effects on the lungs (interstitial pneumonia and fibrosis). Previous radiotherapy to the chest is an aggravating factor. The majority of patients may develop hard (indurated) red, tender swellings on their finger tips, ridging of the nails, lesions of the skin and mucous membranes, blisters (bullae) over pressure points and loss of hair. These usually disappear once the drug is stopped. Precautions: It should not be used in pregnant or breastfeeding women nor in patients with chest infections. Patients on treatment should have a chest X-ray weekly. The dose should be reduced in patients with impaired kidney function.
Bocasan Bocasan antiseptic produces similar effects to hydrogen peroxide. It contains sodium perborate monohydrate and sodium hydrogen tartrate. It is used as a mouth rinse to treat gingivitis and stomatitis. Do not use in patients with impaired kidney function.
borotanic complex borotanic complex is a constituent of Phytex paint, which is used to treat fungus infections of the skin and nails. The borax part of the complex has antibacterial and antifungal properties and the tannic acid part acts as an astringent.
botulinum toxin botulinum toxin (botulinum A toxin-haemagglutinin complex, Botox, Dysport, NeuroBloc) is used to treat blepharospasm (spasm of the eyelids) and one-sided facial spasm. It is given by injection into the muscles of the upper and lower eyelids and upper facial area. Adverse effects include irritation and watering of the eye, drooping of the upper eyelid, double vision and other disturbances of vision, bruising and swelling of eyelids and paralysis of muscles around the eye. Precautions: Do not use in pregnancy or in breastfeeding mothers or in disorders such as myasthenis gravis (muscle weakness due to neuromuscular abnormality). It is also used to treat spasmodic torticollis (spasms in the neck which restrict movement).
bowel cleaning solutions bowel cleaning solutions are used before surgery, endoscopy and radiological examinations of the bowel to ensure that it is completely empty of solid contents. Adverse effects include nausea, bloating, abdominal cramps, vomiting, irritation of the anus, nettle-rash and allergic reactions. Precautions: Do not use in patients with an obstruction of the stomach or intestine, perforated bowel, distension or inflammation of the bowel or if weight is less than 20 kg. Use with caution in pregnancy, in patients with ulcerative colitis (chronic diarrhoeal disorder), diabetes, oesphageal reflux, impaired gag reflex and in patients who are unconscious or semiconscious. Medicines taken by mouth within one hour of taking a bowel-cleansing solution may not be absorbed and may not therefore be effective. Preparations include Klean-Prep.
Brasivol Brasivol contains aluminium oxide in large particles and is used as an abrasive together with a cleansing base to treat acne.
bretylium bretylium (bretylium tosylate) is used to treat disorders of heart rhythm (see Chapter 24). Adverse effects: These include fall in blood pressure and nausea, and initial worsening of the disorder. Damage to tissue at site of injection may occur. Precautions: Do not use in patients with phaeochromocytoma (tumour of the sympathetic nervous system). Use with caution to treat disorders of heart rhythm caused by digoxin and do not give noradrenaline(norepinephrine) or other sympathomimetic drugs.
Brevinor Brevinor is a combined oral contraceptive. See p. 189.
brimonidine brimonidine (Alphagan) eye drops are used where β-blockers are ineffective or unsuitable, or in addition to β-blockers, in the treatment of open-angle glaucoma or high blood pressure in the eye. See Chapter 13. Adverse effects include swelling in the eye and distension of blood vessels in the eye (ocular hyperaemia), stinging, itching, allergic reactions, dry mouth, headache, fatigue and drowsiness. Precautions: Use with caution in patients with severe heart disease, depression, insufficient blood supply to the brain or heart, Raynaud's syndrome (for symptoms see p.118), low blood pressure on standing, blood clots, kidney or liver damage, in pregnancy or while breastfeeding. Do not wear soft contact lenses.
brinzolamide brinzolamide (Azopt) eye drops are used where β-blockers are ineffective or unsuitable, or in addition to β-blockers, in the treatment open-angle glaucoma or high blood pressure in the eye. See Chapter 13. Adverse effects include disturbed vision, pain in the eye, distension of blood vessels in the eye (ocular hyperaemia), unpleasant taste in the mouth, headache. Precautions: Do not use in patients with liver or severe kidney damage, disorders of blood chemistry, history of allergy to to sulphonomides or while breastfeeding. Use with caution in patients with pseudoexfoliative, pigmentary or narrow angle glaucoma, diabetes, eye disorders, those who wear contact lenses or in pregnancy.
Brolene Brolene eye drops and ointment contain the antiseptic dibromopropamidine isethionate. The eye drops also contain benzalkonium as a preservative. Not suitable for people wearing contact lenses. Of little value in treating infections of the eye except for acanthamoeba keratitis (neomycin may be used as additional treatment).
bromocriptine bromocriptine (bromocriptine mesylate, Parlodel) stimulates dopaminergic receptors. It is used in the treatment of parkinsonism, (see Chapter 16). It stops production of the milk-producing hormone proclatin, and it is used to prevent lactation after childbirth. It blocks the release of growth hormone by the pituitary gland and may be used to treat acromegaly due to overworking of the pituitary gland. It is also used to treat certain types of infertility in women, cyclical benign breast disease and severe mastalgia (painful breasts). Adverse effects include nausea, vomiting, dizziness, fall in blood pressure on standing up after sitting or lying down (may produce dizziness and light-headedness), dryness of the mouth, leg cramps, headaches, nasal congestion, constipation, and sedation. Rarely, high doses may causes hallucinations, confusion, involuntary movements (dyskinesia), coldness of the fingers and toes and a scarring disorder in the abdomen (retroperitoneal fibrosis) – stop immediately if this occurs. Precautions: Use with caution in patients with a history of psychotic illness and in patients with severe heart disease. It stimulates ovulation, therefore regular gynaecological examinations should be carried out and mechanical forms of contraception should be used if patient wishes to avoid conception. There is a risk of peptic ulcers in patients being treated for acromegaly. Do not use in patients with toxaemia of pregnancy, in women with raised blood pressure following childbirth or in patients allergic to it or to ergot drugs. Interactions: Alcohol, erythromycin, metoclopramide, antiblood pressure drugs.
bronchodilators bronchodilators are used to treat asthma. See Chapter 14.
budesonide budesonide is a potent corticosteriod used in a nasal spray to treat hayfever (seasonal rhinitis and perennial allergic rhinitis), vasomotor rhinitis and nasal polyps (Rhinocort Aqua) see p. 74; by inhalation to treat asthma (Pulmicort, Symbicort) see Chapter 14; in ointments and creams to treat skin disorders such as eczema and psoriasis (Preferid) see p. 211; and used orally in chronic diarrhoea (Budenofalk, Entocort). Adverse effects: When applied up the nose it may cause sneezing, stinging, dryness, slight nose bleeds and rarely raised pressure in the eyes, and by inhalation from an aerosol it may cause hoarseness, thrush of the mouth and throat, rarely skin rashes and paradoxical wheezing. Inhalations should not be used in patients with active tuberculosis. Nasal sprays and inhalations should be used with caution in pregnancy and in patients with viral or fungal infections. For general adverse effects and Precautions see Chapter 37 on corticosteriods; for adverse effects on the skin, see corticosteroid skin applications p. 211.
bumetanide bumetanide (Burinex, in Burinex A, in Burinex K) is a loop diuretic (see Chapter 29). Adverse effects and Precautions are similar to those listed under frusemide. Bumetanide may also cause rashes, muscle pains and thrombocytopenia.
bupivacaine bupivacaine (bupivacaine hydrochloride, in Marcain, in Marcain with adrenaline) is a local anaesthetic with effects and uses similar to lidocaine(lignocaine), but it works for a longer duration. Overdose may cause a fall in blood pressure, muscle twitching, depression of respiration and convulsions. Its use in childbirth may cause the baby’s heart to slow down. It should be used with caution in patients with liver or heart disorders, or who are elderly and/or debilitated.
buserelin buserelin is a gonadotrophin-releasing hormone analogue which is used in Superfact nasal spray to treat cancer of the prostate dependent on male sex hormones for growth. It initially stimulates the pituitary to produce luteinising hormone (LH), but the end result is that it prevents the release of LH causing a reduction in testosterone production by the testes. Adverse effects include hot flushes, irritation of the nose when nasal spray is used, loss of libido, depression, headache, dizziness, nausea, vomiting, diarrhoea, nettle-rash, and rarely swelling of the breasts. Precautions: Do not use if testicles have been removed, or in tumours which are not sensitive to male hormones. Interactions: Nasal decongestants. Buserelin is also used in Supercur nasal spray to treat endometriosis (it initially stimulates and then blocks the production of hormones by the ovaries and stops the periods). It is also used as part of infertility treatment – it desensitizes the pituitary gland prior to stimulating ovulation with gonadotrophins. Adverse effects include hot flushes, dry vagina, loss of libido, emotional upsets, breast tenderness and changes in size, headache, migraine, nausea, depression, abdominal pain, fatigue, weight changes, nervousness, dizziness, drowsiness, back pain, muscle pain, acne, nettle-rash, itching, constipation, vomiting, sleep disturbances, blurred vision, growth of body hair, pins and needles in the hands and feet, ovarian cysts and irritation of the nose. Precautions: Do not use in pregnancy and use a mechanical means of contraception if sexually active. Do not use in breastfeeding mothers, in women with undiagnosed vaginal bleeding or who are suffering from hormone dependent cancer. Use with utmost caution in patients at risk of developing osteoporosis and in patients who are depressed.
buspirone buspirone (Buspar) is an anti-anxiety drug (see Chapter 2) not related to the benzodiazepines. Adverse effects: Dizziness, headache, nervousness, light-headedness, excitement and nausea. Rarely, rapid beating of the heart, chest pain, drowsiness, confusion, dry mouth, fatigue and sweating. Precautions: Do not use in patients with epilepsy or who suffer from severe kidney or liver impairment. Do not use in pregnancy or when breast feeding. Use with caution in patients with impaired kidney or liver function. In order to avoid withdrawal symptoms, reduce benzodiazepines slowly over several weeks before starting a patient on buspirone. Interactions: MAOIs, alcohol may impair driving skills.
busulfan busulfan (Myleran) is an anti-cancer drug. See Chapter 51. Adverse effects: It may cause blood disorders producing haemorrahages and bone-marrow damage (this may be irreversible and come on several months after treatment is stopped). Loss of periods (amenorrhoea) may start up to six months after the drug is stopped. It may cause deep pigmentation of the skin and scarring of the lungs. Precautions: It should not be used in pregnancy or by breastfeeding mothers. Frequent blood counts should be carried out during and after treatment.
butoxyethyl nicotinate butoxyethyl nicotinate is used for removing dead skin (a keratolytic), see p. 217. It is present in Actinac lotion, used to treat acne.
butyrophenones butyrophenones are a group of antipsychotic drugs. See Chapter 3. The group includes benperidol, droperidol and haloperidol. They are likely to produce more pronounced movement disorders than other antipsychotics. Benperidol is used to treat deviant antisocial sexual behaviour. As well as being used as antipsychotics, droperidol and haloperidol are also used to treat nausea and vomiting produced by anti-cancer drugs. See Chapter 18. Haloperidol is also used to treat motor tics.