Drugs used in Thyroid disorders Hawler medical university Collage of pharmacy/ fourth year /pharmacy practice Sham A. Talat Shareef (B.Sc . Msc . clinical pharmacy) 2017-2018 Sham_talat@yahoo.com Head of Department Of Clinical Pharmacy in DOH

Carbimazole

Carbimazole INDICATIONS: Hyperthyroidism Classification :antithyroid drugs CONTRA-INDICATIONS: Severe blood disorders SIDE-EFFECTS▶ Common or very common Arthralgia . fever . headache . jaundice . malaise . mild gastro-intestinal disturbances . nausea . pruritus . rash . taste disturbance.

PATIENT AND CARER ADVICE Warn patient or carers to tell doctor immediately if sore throat, mouth ulcers, bruising, fever, malaise, or non-specific illness develops. Medication dosage form :tablets

Important safety information NEUTROPENIA AND AGRANULOCYTOSIS Doctors are reminded of the importance of recognising bone marrow suppression induced by carbimazole and the need to stop treatment promptly. Patient should be asked to report symptoms and signs suggestive of infection, especially sore throat. A white blood cell count should be performed if there is any clinical evidence of infection. Carbimazole should be stopped promptly if there is clinical or laboratory evidence of neutropenia.

Propylthiouracil trade name

Propylthiouracil INDICATIONS : Hyperthyroidism SIDE-EFFECTS:▶ Common or very common Arthralgia . fever . headache . jaundice . leucopenia . malaise . mild gastro-intestinal disturbances . nausea . pruritus . rash . taste disturbance

SIDE-EFFECTS, FURTHER INFORMATION Hepatotoxicity Severe hepatic reactions have been reported, including fatal cases and cases requiring liver transplant discontinue if significant liver-enzyme abnormalities develop.

PATIENT AND CARER ADVICE PATIENTS should be told how to recognise signs of liver disorder and advised to seek prompt medical attention if symptoms such as anorexia, nausea, vomiting, fatigue, abdominal pain, jaundice, dark urine, or pruritus develop. MEDICINAL FORMS: Tablet

Iodide with iodine

Iodide with iodine CLASSIFICATION: ESSENTIAL TRACE ELEMENTS SIDE-EFFECTS : Bronchitis . conjunctivitis . depression (on prolonged treatment) . Goitre in infants of mothers taking iodides . headache . hypersensitivity reactions . impotence (on prolonged treatment) . insomnia (on prolonged treatment) . lacrimation . laryngitis . pain in salivary glands . rashes.

Iodide with iodine DIRECTIONS FOR ADMINISTRATION For oral solution: dilute well with milk or water. MEDICINAL FORMS: Oral solution IODIDE WITH IODINE (Non-proprietary) Iodine 50 mg per 1 ml, Potassium iodide 100 mg per 1 m

PROPRANOLOL TRADE NAME

Propranolol hydrochloride Classification: non selective beta blocker INDICATIONS : Thyrotoxicosis Thyrotoxic crisis Hypertension Prophylaxis of variceal bleeding in portal hypertension Phaeochromocytoma (only with an alpha-blocker) in preparation for surgery

INDICATIONS Phaeochromocytoma (only with an alpha blocker) in patients unsuitable for surgery Angina Hypertrophic cardiomyopathy Anxiety tachycardia Anxiety with symptoms such as palpitation, sweating and tremor.

INDICATIONS Prophylaxis after myocardial infarction Essential tremor Migraine prophylaxis Arrhythmias

PRESCRIBING AND DISPENSING INFORMATION Modified release preparations can be used for once daily administration. MEDICINAL FORMS: Tablet. Modified released capsule . Oral solution.

Levothyroxine trade names

Levothyroxine sodium INDICATIONS : Hypothyroidism Hypothyroidism in patients with cardiac disease Severe Hypothyroidism Hyperthyroidism (blocking-replacement regimen) in combination with carbimazole CONTRA-INDICATIONS :Thyrotoxicosis

SIDE-EFFECTS Anginal pain (usually at excessive dosage) . arrhythmias (usually at excessive dosage) . diarrhoea(usually at excessive dosage) . excitability (usually at excessive dosage) . fever . flushing . headache . heat intolerance .

SIDE EFFECTS hypersensitivity reactions . insomnia (usually at excessive dosage) . muscle cramp . muscular weakness . oedema . palpitation (usually at excessive dosage) . pruritus .

SIDE EFFECTS rash . restlessness (usually at excessive dosage) . sweating . tachycardia (usually at excessive dosage) . transient hair loss in children . tremor (usually at excessive dosage) . vomiting (usually at excessive dosage). weight-loss

SIDE-EFFECTS, FURTHER INFORMATION Initial dosage in patients with cardiovascular disorders If metabolism increases too rapidly (causing diarrhoea, nervousness, rapid pulse, insomnia, tremors and sometimes anginal pain where there is latent myocardial ischaemia), reduce dose or withhold for 1–2 days and start again at a lower dose

Administration patient education Levothyroxine is more effective when taken in empty stomach or half an hour before morning meal. It is important to take levothyroxine at the same time each day. 

MEDICINAL FORMS: Tablet Oral solution

Alendronate trade name

Alendronic acid or Alendronate (fosmax) INDICATIONS : Treatment of postmenopausal osteoporosis Treatment of osteoporosis in men Prevention and treatment of corticosteroid-induced osteoporosis in postmenopausal women not receiving hormone replacement therapy Pagets disease of bone

PATIENT AND CARER ADVICE Atypical femoral fractures Patients should be advised to report any thigh, hip, or groin pain during treatment with a bisphosphonate. Osteonecrosis of the jaw During bisphosphonate treatment patients should maintain good oral hygiene, receive routine dental check-ups, and report any oral symptoms.

Alendronate CONTRA-INDICATIONS: Abnormalities of oesophagus . hypocalcaemia . other factors which delay emptying (e.g. stricture or achalasia)

Alendronate SIDE-EFFECTS ▶ Common or very common Abdominal distension . abdominal pain . alopecia . asthenia . constipation . diarrhoea . dizziness .

Side effects dyspepsia . flatulence . headache . joint swelling . musculoskeletal pain . esophageal reactions . peripheral oedema . pruritus . regurgitation . vertigo

Alendronate MEDICINAL FORMS Tablet (Fosamax) Oral solution

Risedronat trade name

Risedronat sodium ( Actonel) INDICATIONS : Paget’s disease of bone Treatment of postmenopausal osteoporosis to reduce risk of vertebral or hip fractures Prevention of osteoporosis (including corticosteroid induced osteoporosis) in postmenopausal women Treatment of osteoporosis in men at high risk of fractures MEDICINAL FORMS: tablets

Risedronat sodium ( Actonel) CONTRA-INDICATIONS: Hypocalcaemia SIDE-EFFECTS: ▶ Common or very common Abdominal pain . constipation . diarrhoea . dyspepsia . headache . musculoskeletal pain . Nausea.

DIRECTIONS FOR ADMINISTRATION Swallow tablets whole with full glass of water; on rising, take on an empty stomach at least 30 minutes before first food or drink of the day or, if taking at any other time of the day, avoid food and drink for at least 2 hours before or after risedronate (particularly avoid calcium-containing products e.g. milk; also avoid iron and mineral supplements and antacids); stand or sit upright for at least 30 minutes; do not take tablets at bedtime or before rising.

PATIENT AND CARER ADVICE Patients or carers should be given advice on how to administer risedronate sodium tablets. Oesophageal reactions Patients should be advised to stop taking the tablets and seek medical attention if they develop symptoms of oesophageal irritation such as dysphagia, pain on swallowing, retrosternal pain, or heartburn