Download Update 2013- Drug Therapy during Holy Month of Ramadan

Update 2013- Drug Therapy during Holy Month of Ramadan
Yousef A. Alomi, Bsc, Msc., BCPS, BCNSP, DiBA
[email protected]
[email protected]
Head, National Drug Information Center
Head, General Adminstration of Pharmaceutical Care
Consultant Clinical Pharmacist
Ministery of Health
Islam was built based on five billers (the statement of Faith, prayers of five times daily, charity to poor people, and Fasting of
one Month yearly called Ramadan, and pillgrime to Mecca once in a lif). Fasting the holy Month of Ramadan is stop taking or
ingection any food or drinks from sunrise to sunset, this madate to all adults either male or female, unless tarvelers, risk dangrous of
pregrant and lactatin women, and elderly can not tolerate the fasting, and sick people
In Islam the Sick people allow them to break fasting, then postbond fasting next month if the illness is temporary. If the illnees
perment and the patinet can not fast at all she or he to pay money to poor people as subsiture of fasting for each day breaking fasting.
Not all the illnesses are allowable to break fasting, its only if the fasting affect the patients health negatively, otherwise; if the patient
can fast she or he to fast Ramadan. The problem is raising of medications for chronic disaeses , how can I switch from regular days
time to Fasting Days Times, at what time excatly, does the fasting some medication and increase or decrease their activity, is there
any changes in pharmacokinetics of medications, does the food affect absorption of medication after peoriod of fasting, all thease
question we try to answer them in the remaining of this paper
It estimated there are 1.1–1.5 billion Muslims worldwide, Most Muslims would like not to break fasting, even the fasting will
affect their health. Some studies showed that Muslims receiving medical treatment during Ramadan will deliberately not taken tablets
or other medicine at the prescribed time if that falls drug the day light hours, or alternatively will overdose during night to makeup for
missed day time doses. A study 1 by Aslam M, et.al , reported that 37 (45.7%) patients of 81 were found to change their drug dosage
pattern while fasting; 35 (43.2%) missed doses; 8 (9.8%)took their tablets at different times and 4 (4.9%) patients took all their
medication as one single daily dose after breaking fast in the evening. Another survey 2 of 325 outpatients in a Kuwaiti hospital
found that most of them changed their drug regimens during Ramadan. Sixty four per cent of the patients changed their therapeutic
scheme during the month; 18% took their daily medicines in a single intake, either before the first meal (sunset) or straight after the
last one (before dawn). Another hospital-based study of 334 patients conducted in during the month of Ramadan in 2006 to illustrate
thevarious characteristics including care of patients and changes in lifestyle of type 2 diabetics during Ramadan in Dhahira region,
Oman. Most of the type 2 diabetes patients in the study (93.1%) fasted 30 days during Ramadan. It was noticed that nearly 83% of the
type 2 diabetes patients in our study had poorly controlled FBS levels (83.2%). Insulin/Oral Anti Diabetic Drug (OAD) doses were
unchanged in 49.5% of diabetic patients during Ramadan. 3
Some authors reported that two patients with chronic reversible respiratory disease were admitted to an intensive care unit two
weeks after the start of Ramadan, Both patients admitted due to not having taken their treatment, including inhalers, during daylight
hours. Another study evaluated the changes in frequency of seizures during Ramadan in 124 patients with idiopathic epilepsy,
seizures occurred in 27 patients during this month; 20 of them did not use any antiepileptic drugs from dawn to sunset. The author
concluded that withdrawal of drugs was the most important cause of recurrence of epilepsy during Ramadan. 4
A recent study of wide population-based Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, which showed (in
12,243 people with diabetes from 13 Islamic countries) 43% of patients of type 1 diabetes, and 79% of patients
with type 2 diabetes were fasting during Ramadan; with an estimation of 40–50 million people with diabetes worldwide , and 3.6 1,9 Million in Saudi Arabia will fast during Ramadan, 5-7
Although all previous studies, with patients perception and attitude toward their medications, and dangerous impact of their diseases;
there is no consensus guideline of drug therapy during. Recommendation drug therapy regimen for the disaeses during fasting is very
difficult, due to very little experiences, and no clinical trials about drug fasting during Ramadan or pharmacokinetics of drugs during
fasting. It is not appropriate to change the drug regimen, or dose from several dose per day to two big dose once or twice daily
without scientific evidence that alternative dose is equivalence in efficacy and safety. Further, the patient should stabilized with the
new drug or dose before or during Ramadan. Here are some advices and recommendations by some authors to explore Drug Therapy
During Ramadan as following:
General Recommendation
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Mark Ramadan on your office calendar, and prepare to be the one that brings up the topic for discussion. Patients are unlikely
to initiate the discussion.
Ask about the patient’s beliefs regarding fasting, his/her illness, and the use of oral and injectable drugs when fasting.
Inquire about current control of symptoms and comorbidities.
Inquire about past experiences during Ramadan fasts, and plans for the upcoming Ramadan.
Provide information and Medical education about his or her mental illness as medical, physically-mediated illness
Clearly communicate risks of medication changes, changes in sleeping and eating schedules, and withdrawal from substances.
Explain that decision is ultimately the patient’s, but you can advise him/her and help maximize chances of fasting safely.
Give general preference to medications that will allow for the easiest compliance during Ramadan, e.g. slow-release
preparations, longer elimination half-lives, and once daily dosing.
Consider a switch to slow-release or once-daily medications for the month of Ramadan. These forms may more expensive,
and may require some planning ahead, but it may be worth a switch for some patients.
Recommend dosing schedules coincident with pre-dawn (Suhoor) and sunset (Iftar) meals.
Recommend refraining from fasting according to Islamic rules for those that must take medications at a frequency of more
than twice a day.
Work to find creative compromises, balancing the patients’ preferences and your knowledge of the risks and benefits of
possible plans.
If a patient insists on discontinuing medications, plan a taper in advance.
Recommend tapering use of caffeine and nicotine in the weeks before Ramadan to avoid unpleasant withdrawal syndromes.
Encourage a moderate amount of physical activity; too much exertion may contribute to dehydration, but some activity is
better than a completely sedentary month.
Encourage patient to bring up the issue with their primary care doctor, to discuss which medications may be amenable to
change in dosing schedule.
Consult an imam of masijid or Shiek with help in interpreting rules, and in communicating with and reassuring the patient.
Arrange for follow-up appointments during Ramadan and when concerns arise.
Fasting and Drug dosing schedule
There are many drugs can given to the patient without affecting fasting Ramadan or nullify fasting, accoring “An Islamic view
of certain contemporary medical issues” that was in Morocco 1997; for instant 8
1. Eye and ear drops
2. All substances absorbed into the body through the skin,such as creams,ointments,and medicated plasters
3. Insertion into the vagina of pessaries, medical ovules, and vaginal washes
4. Injections through the skin, muscle, joints, or veins, with the exception of intravenous feeding
5. Oxygen and anaesthetic gases
6. Mouthwash, gargle, or oral spray, provided nothing is swallowed into the stomach.
7. Nose drops, nose sprays, and inhalers
8. Anal injections
Any medication can be enjection through mouth and reach to stomach break fasting. Health care provider can help mulsim patient if
he wish to fasting eith The Holy Month of Ramadan or any Holy Days throug the year, by changing admintartiom time instead of
three or fout time a day and switch to tiwce or once aday without Break-Fast. In Ramadan, instead of morning and evening, it needs
to change to dawn and sunset respectively. Twice daily dose can be taken on 04:30, and 19:00 special in this year 2013 for Riyadh
time, Saudi Arabia. Once daily dose can be taken on 04:30, or 19:00.
We attached Up-to-date 2013 suggested table1 describe type of medication, affect of food, frequency of adminstration, preferable
time of adminstration, and clinical evidence. An table 2 showed Medications, adult maintenance dose in the nornal renal function,
and frequency per day, on regular day, and Medications, adult dose, and frequency per day as alternative during Ramadan, the doses
stated for general indication, table 3 showed medications registration status at Saudi Food and Drug Authority and Ministry of
Health Drug Formulary.
The treating physcian or pharmacist should refer to other referances to doses for specific indications, and FDA or SFDA labeled
indications during conversion to other medications. Any suggestion will be highly appreciated.
Table 1
Medication During Holy Month of Ramadan 8,9
Type of Medication
Adminstration
Evidence Based
Anti-Epileptic Drugs
Once – Twice daily except Valoproic Acid
The food: may decrease the absorption
Time of admin: after 1-2 of Sun set (Iftar)
Interchange: No, can be on specific situation
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Anti-Psychiatrics Drugs
Admin:
Most of them Once daily, some are given Twice
daily
The food: may decrease the absorption
Time of admin: pre-dawn (Suhoor)
Interchange: No, can be on specific situation
Admin: Once daily
The food: may induce ulcer at empty stomach, and
may reduce Warfarin Effect with vegitables
Be carfull of taking large a mount of vitamin K, like
broccoli, spinach, kale, turnip greens, cabbage, they
may decrease the effect of drugs
Aviod garlic, ginger, glucosamine, ginseng, and
ginkgo may incraese the bleeding
Time of admin: after Sun set (Iftar)
Interchange: Switch Heparin to LMWH
Admin: Once daily
The food: No effects
Time of admin: after Sun set (Iftar)
Interchange: Switch to Statin therapy
General Evidence : No Evidence administration
during Ramadan, little evidence
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Antiplatelets and
Anticoagulation Drugs
Drug for Lipid Disorder
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Drug for Infectious
Diseases
Admin: Once – Twice daily
The food: Variable
Time of admin: after Sun set (Iftar)
Interchange: Switch to long acting therapy
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Drug for Asthma
Admin: variable
General Evidence : No Evidence administration
The food: No effects except theophylline
Using Bronchodilator with caffeine (Tea or
Beverages) caan increase te chance of side eefctss,
such excitability, nervousness, and rapid heart beat
Time of admin: Any time
Interchange: Switch to long acting therapy
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Drug for GIT
Admin: Once daily
The food: No effects
Time of admin: pre-dawn (Suhoor)
Interchange: Switch to long acting therapy
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Drugs for Hypertension
Admin: Once - Twice daily
The food: No effects
Aviod of taking ACE Inhibitors with latge a mount
of Dates, Bananas, Oranges, green leafly vegetables
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Time of admin: after Sun set (Iftar)
Interchange: Most of drugs taking once ot twice
daily, and if using short acting Switch to long acting
therapy
Drugs for Cardiac
Arrhythmias
Admin: Once daily
The food: No effects
Time of admin: after Sun set (Iftar)
Interchange: Switch to long acting therapy
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Drug for Pain
Admin: Once daily
The food: No effects
Time of admin: after Sun set (Iftar)
Interchange: Switch to long acting therapy
General Evidence : No Evidence administration
during Ramadan
Specific Evidence: No Evidence of
Pharmacokinetics during fasting Ramadan
Medications During Fasting Program
I do suggest to start this program specially during fating the holy month of Ramadan
1.
2.
3.
4.
5.
6.
7.
8.
9.
Assinge Resposibility of one clinical pharmacist or trained qualify pharmacist
Delnieate scope of services that wish you start with
Define type of popultion and diaseses at starting point
Setup protocols for each disaese drug therapy during regular and fasting days
Start pilot study for certain period of time
Collect the mearument data before and after the services
Evaulaute the services and impact feedback
Present results outcome to consern people medical and pharmacy staff
Expand the scope of services and evalute it periodically
References
1- Aslam M et. Al, Pharmacist, Medicines and the Fast of Ramadan, Pharm J, 259:12; 1997,973-75.
2- Aslam M, Assad A. Drug regimens and fasting during Ramadan: a survey in Kuwait. Public Health 1986;100:49-53.
3- Prakash Patel. et. al. Type 2 Diabetes and its characteristics during Ramadan in Dhahira region, Oman. Oman Medical Journal, 2007, Vol 22, No 3.
16-23
4- N Aadil, I E Houti and S Moussamih, Drug intake during Ramadan, BMJ , 2004;329;778-782
5- Al-arouj M. Et. al., Recommendations for Management of Diabetes During Ramadan, Diabetes Care, 2005, Vol 28 , No 9.
6- Salti I. et. al., A Population-Based Study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries, Results of the
Epidemiology of Diabetes and Ramadan 1422/2001 (EPIDIAR) study, Diabetes Care, 2004, Vol 27 , No 10.
7- Al-nozha M et al, Diabetes mellitus in Saudi Arabia, Saudi Med J 2004, Nov;25(11):1603-10
8- Aadil N, Houti IE, Moussamih S, Drug intake during Ramadan, BMJ 2004;329:778–82
9- Aviod Food Drug Interaction, A guide from National Consumer League and U.S. Food and Drug Adminstration; www.nclnet.org, or
www.fda.gov/drugs, Publication no. (CDER 10-1933)
10- Al Salloum H.,The New Fluoroquinolones, Pharmacy Newsletter,10:2;1420.
11- Levabuterol for Asthma, The Medical Letter on Drug and Therapeutics, 41:4,1999
12- Al-Rasheed M, Proton-Pump Inhibitor, Pharmacy Newsletter,10:1;1420.
13- Saudi National Formulary, SPS & MOH, October 1995.
14- The Sixth Report of Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, Arch Inten Med,
157:24,1997,2413-2445.
15- Drugdex, Vol 137, Exp. September 2008, Micromedex Inc.
16- eBNF, British Medical Association and The Royal Pharmaceutical Society of Great Britain, No 37, march 1999.
17- Gilbert DN et al, The Sanford Guide to Antimicrobial Therapy, 29th Edition, 1999
18- Drugs for Chronic Obstructive Pulmonary Disease, Treatment Guidelines from The Medical Letter, 2007, Volume 5 (Issue
63): 95-100
19- Antiplatelet and Anticoagulant Drugs, Treatment Guidelines from The Medical Letter, 2008, Volume 6 (Issue 69): 29-36
20- Drugs for Epilepsy, Treatment Guidelines from The Medical Letter, 2012, Volume 11 (Issue 126): 9-19
21- Treatment of Peptic Ulcers and GERD, Treatment Guidelines from The Medical Letter, 2008, Volume 6 (Issue 72): 55-59
22- Drugs for Treatment of Chronic Heart Failure, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 121):
69-72
23- Drugs for Hypertension, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 113): 1-10
24- Antifungal Drugs, Treatment Guidelines from The Medical Letter, 2012, Volume 10 (Issue 120): 61-68
25- Drugs for Pain, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 128): 31-42
26- Drugs for Acne,Rosacea, and Psoriasis, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 125): 1-8
27- Drugs for Allergy Disorders, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 129): 43-52
28- Drugs for Asthma, Treatment Guidelines from The Medical Letter, 2013, Volume 10 (Issue 114): 11-18
29- Drugs for Psychiatric Disorder, Treatment Guidelines from The Medical Letter, 2013, Volume 11 (Issue 130): 53-64
Table 2
No
Drug therapy during Regular days 10-29
1.
2.
3.
4.
5.
6.
7.
Regular Days
Acebutolol
Aliskiren
Amiloride HCl
Amitriptyline
Amlodepine besylate
Amoxicillin
Aspirin
8.
9.
10.
11.
12.
13.
14.
Atenolol
Atorvastatine
Aripiprazol
Betoxalol
Bisoprolol
Candesartan
Captopril
15.
Carbamazepine
Drug therapy during Holy Ramadan 10-29
Doses/ Day
200-1200 mg
150-300 mg
5-10 mg
50-150 mg
2.5- 10 mg
250- 500 mg
100 mg (prophylactic
dose)
25-100 mg
10-80 mg
10-30 mg
5-40 mg
5-20 mg
8 -32 mg
12.5- 150 mg
Frequency Per day
Divided in 1-2 doses
In 1 dose
In 1-2 diveded dose
In 1 dose or divided doses
In 1 dose
3 times/day
In 1 dose
Regular Days
Acebutolol
Aliskiren
Amiloride HCl
Amitriptyline
Amlodepine besylate
Cotrimoxazole
Aspirin
In 1-2 doses
In 1 dose
In 1 dose
In 1 dose
In 1 dose
In 1 dose
Divided in 2-3 divided
doses
800 –1600 mg
(Blood Level 8-12
mcg/ml)
In 2-3 divided doses
Atenolol
Atorvastatine
Aripiprazol
Betoxalol
Bisoprolol
Candesartan
Enalapril
Lisinopril
Fosinopril
Perindopril
Quinapril
Ramipril
Trandolapril
Carbamazepine
Carbamazepine SR
16.
17.
18.
19.
20.
21.
22.
23.
Carteolol
Carvedilol
Cefacolr
Celeoxib
Cephalexin
Cerivastatin
Chlorthalidone
Cholestyramine
2.5-10 mg
12.5- 50 mg
250- 500 mg
200 mg
250 -500 mg
0.3mg
12.5- 50 mg
12-36 mg
In 1 dose
Divided in 2 doses
3 times
2 times
4 times
In 1 dose
In 1 dose
Divided in 1- 4doses
Carteolol
Carvedilol
Cefuroxim axitel
Celeoxib
Cefadroxil
Cerivastatin
Chlorthalidone
Cholestyramine
Doses/Day
200-1200mg
150-300 mg
5-10 mg
50-150 mg
2.5- 10 mg
490- 960 mg
100 mg
(prophylactic dose)
25-100 mg
10-80 mg
10-30 mg
5-40 mg
5-20 mg
8 -32 mg
2.5 - 40 mg
5 - 40 mg
10-80 mg
4-8 mg
5-80 mg
1.25-20 mg
1-8 mg
800 – 1600 mg
(Blood Level 8-12
mcg/ml)
800 – 1600 mg
(Blood Level 8-12
mcg/ml)
2.5-10 mg
12.5- 50 mg
250- 500 mg
200 mg
500-1000 mg
0.3mg
12.5- 50 mg
12-36 mg
Frequency Per day
Divided in 1-2 doses
In 1 dose
In 1-2 diveded doses
In 1 dose
In 1 dose
2 times/day
In 1 dose
In 1-2 doses
In 1 dose
In 1 dose
In 1 dose
In 1 dose
In 1 dose
In 1-2 doses
In 1 dose
In 1-2 doses
In 1-2 doses
In 1-2 doses
In 1-2 doses
In 1-2 doses
In 2 divided doses
In 2 divided doses
In 1 dose
Divided in 2 doses
2 times
2 times
2 times
In 1 dose
In 1 dose
In 1 dose
24.
Cimitidine
25.
26.
27.
28.
Ciprofloxacin
Citalopram
Clobazam
Clonazepan
29.
30.
31.
32.
33.
Clopidogrel
Clonidine
Cloxacillin
Cotrimoxazole
Dalteparin
34.
Diclofenac
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
Diflunisal
Digoxin
Diltiazem HCl
Doxazocin Mesylate
Doxycyline
Duloxetine
Eplerenone
Eprosartan
Enalpril maleate
Enoxaparin
45.
Erythromycin
46.
Ethosuximide
47.
48.
49.
50.
51.
52.
53.
54.
Escitalopram
Esomeprazole
Felodipine
Flucloxacillin
Fluconazole
Fluoxetine
Folic acid
Famotidine
400
800 mg
250-750 mg
20-40 mg
20-40 mg
1.5-8 mg
2 times
In 1 dose
2 times
In 1 dose
In 1-2 divided doses
In 2-3 divided doses
Cimitidine
800 mg
In 1 dose
In 1 dose
Divided in 2-3 doses
4 times
2 times/day
In 1-2 doses
Ciprofloxacin
Citalopram
Clobazam
Clonazepan
Clobazam
Clopidogrel
Clonidine
Cefadroxil
Cotrimoxazole
Dalteparin
2 times
In 1 dose
In 1-2 divided doses
In 2 divided doses
In 1-2 divided doses
In 1 dose
Divided in 2 doses
2 times
2 times/day
In 1-2 doses
Divided in 3-4 dses
2 times
Divided in 2-3 doses
In 1 dose
Divided in 3 doses
In 1 dose
Divided in 1-2 doses
In 1 dose
In 1-2 doses
In 1-2 doses
Divided in 1-2 doses
In 1-2 doses
Diclofenac
Diclofenac SR
Diflunisal
Digoxin
Diltiazem SR HCl
Doxazocin Mesylate
Doxycyline
Duloxetine
Eplerenone
Eprosartan
Enalpril maleate
Enoxaparin
4 times
Divided in 2 doses
Clarithroycin
Azithromycin
Ethosuximide
In 1 dose
In 1 dose
In 1 dose
4 times
In 1 dose
In 1 dose
In 1 dose
2 times
Escitalopram
Esomeprazole
Felodipine
Cefadroxil
Fluconazole
Fluoxetine
Folic acid
Famotidine
250-750 mg
20-40 mg
20-40 mg
1.5-8 mg
20-40 mg
75 mg PO daily
0.1-0.6 mg
500-1000mg
490- 960 mg
5000-10,000 IU SC
daily or q12h
75 mg
100 mg
500-1500 mg
0.125- 0.5 mg
120 -360 mg
1-16 mg
100-200 mg
60 mg
25-100 mg
400-800 mg
5- 40 mg
1 mg/kg bid or 1.5
mg/kg SC daily;
250-500 mg
500-1000 mg
750- 1250 mg
(blood level 40-100
mcg/ml)
10-20 mg
20-40 mg
2.5- 10 mg
500-1000mg
50- 400 mg
10-20 mg
1- 5 mg
40 mg
75 mg PO daily
0.1-0.6 mg
250 -500 mg
490- 960 mg
5000-10,000 IU SC daily
or q12h
50- 200mg
75 mg
500-1500 mg
0.125- 0.5 mg
60-360 mg
1-16 mg
100-200 mg
60 mg
25-100 mg
400-800 mg
5- 40 mg
1 mg/kg bid or 1.5 mg/kg
SC daily;
250-500 mg
750- 1250 mg
(blood level 40-100
mcg/ml)
10-20 mg
20-40 mg
2.5- 10 mg
250-500 mg
50- 400 mg
10-20 mg
1- 5 mg
20 mg
2 times
In 1 dose
Divided in 2-3 doses
In 1 dose
Divided in 1-2 doses
In 1 dose
Divided in 1-2 doses
In 1 dose
In 1-2 doses
In 1-2 doses
Divided in 1-2 doses
In 1-2 doses
2 times
1 time
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
2 times
In 1 dose
In 1 dose
In 1 dose
In 1 dose
55.
56.
Fosinopril sodium
Furosemide
57.
Heparin (Unfractionated)
40 mg
10- 80 mg
20- 320 mg
in 1 dose
Divided in 1-2 doses
Divided in 2 doses
60-100 units/kg IV
bolus, then 12-18
units/kg/hr IV; or, 5000
units SC q8-12h
Divided in 2-3 doses
Fosinopril sodium
Furosemide
Torsemide
Enoxaparin OR
Daltaparin OR
10- 80 mg
20-320 mg
5-20 mg
1 mg/kg bid or 1.5
mg/kg SC daily;
5000-10,000 IU SC
daily or q12h
175 IU/kg SC daily
40-200 mg
12.5- 50 mg
8 mcg
58.
59.
60.
Hydralazine HCl
Hydrochlorothaizide
Ipratropium
40-200 mg
12.5- 50 mg
17 mcg/inhalation
Divided in 2-4 doses
In 1 dose
2 inhalations qid PRN
Tinzaparin
Hydralazine HCl
Hydrochlorothaizide
Tiotropium
61.
62.
63.
Indapamide
Irbesartan
Isosorbide Dinitrate
1.25- 5 mg
150- 300 mg
10- 240 mg
(at least 8 hour washout
period to avoid Nitrate
Tolerance)
In 1 dose
In 1 dose
Divided in 3 doses
Indapamide
Irbesartan
Isosorbide Dinitrate SR
64.
65.
66.
67.
68.
69.
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
Isradipine
Itraconazole
Ketoconazole
Labetalol HCl
Lacosamide
Lamotrigine
Lanzoprazole
Levetiracetam
Levofloxacin
Lisinopril
Loratadine
Losartan potassium
Mebendazole
Meloxicam
Methyldopa
Metolazone
Metopralol Succinate SR
5-20mg
400 mg
200- 400 mg
200- 1200 mg
200-400 mg
100-500 mg
15- 30 mg
1000-3000 mg
500 mg
5- 40 mg
10 mg
25- 100 mg
100 mg
7.5-15 mg
250- 2000 mg
1.25-5 mg
50- 400 mg
Divided in 2 doses
Divided in 2 doses
In 1 dose
Divided in 2 doses
Divided in 2 doses
Divided in 2 doses
In 1 dose
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
Divided in 1-2 doses
2 times
In 1 dose
In 2 divided doses
in 1 dose
Divided in 1-2 doses
Isradipine SR
Itraconazole
Ketoconazole
Labetalol HCl
Lacosamide
Lamotrigine
Lanzoprazole
Levetiracetam
Levofloxacin
Lisinopril
Loratadine
Losartan potassium
Mebendazole
Meloxicam
methyldopa
Metolazone
Metopralol sccinate SR
1.25- 5 mg
150- 300 mg
20-120 mg
(at least 8 hour
washout period to
avoid Nitrate
Tolerance)
5-20 mg
400 mg
200- 400 mg
200- 1200 mg
200-400 mg
100-500 mg
15- 30 mg
1000-3000 mg
500 mg
5- 40 mg
10 mg
25- 100 mg
100 mg
7.5-15 mg
250-2000mg
1.25-5 mg
50- 400 mg
81.
Metoprolol Tartrate
50-200 mg
Divided in 1-2 doses
Metoprolol
50-300 mg
Divided in 1-2 doses
Divided in 2 doses
In 1 or 2 doses
In 1-2 doses
In 1-2 doses
In 1 dose
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
In 1 dose
Divided in 2-3 doses
In 1 dose
Divided in 2 doses
In 1 dose
Divided in 2 doses
Divided in 2 doses
Divided in 2 doses
In 1 dose
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
Divided in 1-2 doses
2 times
In 1 dose
In 2 divided doses
in 1 dose
Divided in 1-2 doses
Divided in 1-2 doses
82.
83.
84.
85.
86.
87.
Minocycline
Minoxidil
Montelukast
Moxifloxacin
Nadolol
Nalidixic Acid
50-100 mg
2,5-40 mg
10 mg
400 mg
20-320 mg
500-1000 mg
1-2 times
Divided in 1-2 doses
In 1 dose
In 1 dose
In 1 dose
4 times
Minocycline
Minoxidil
Montelukast
Moxifloxacin
Nadolol
Norfloxacin Ciprofloxacin
Divided in 2-3 doses
Pindolol
Piroxicam
Posaconazole
Pravastatin
Doxazocin Mesylate
Terazosin HCl
Pregabalin
50-100 mg
10-40 mg
10 mg
400 mg
20-320 mg
400-800 mg 250750mg
500-1000mg
5-40 mg
20-120 mg
30-90 mg
30-90 mg
20-120 mg
400 mg
400 mg
400 mg
20-40 mg
10-20 mg
20-40 mg
900-2400 mg
6-12 mg
20-40 mg
10-20 mg
90-150 mg
300-400 mg
(Blood Level 10-20
mcg/ml)
10-60 mg
10-20 mg
400 mg
20-40 mg
1-16 mg
1-20 mg
150-600 mg
88.
89.
90.
Naproxen
Nebivolol
Nifedipine SR
500-1000mg
5-40 mg
20-120 mg
Divided in 1-2 doses
In 1 dose
Divided in 1-2 doses
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
Nifedipine SR
Nifedipine
Nitrofurantoin
Norfloxacin
Ofloxacin
Olmesartan
Olanzapine
Omeprazole
Oxcarbazepine
Paliperidone
Pantoprazole
Paroxetine
Phenobarbital
Pheynetion
In 1 dose
Divided in 3 doses
4 times
2 times
2 times
In 1 dose
In 1 dose
Divided in 1-2 doses
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
In 2-3 dose
Divided in 1-3 doses
105.
106.
107.
108.
109.
Pindolol
Piroxicam
Posaconazole
Pravastatin
Prazosin HCl
30-90 mg
10-120 mg
50-100 mg
400 mg
400 mg
20-40 mg
10-20 mg
20-40 mg
900-2400 mg
6-12 mg
20-40 mg
10-20 mg
90-150 mg
300-400 mg
(Blood Level 10-20
mcg/ml)
10-60 mg
10-20 mg
400 mg
20-40 mg
1-20 mg
Naproxen
Nebivolol
Nifedipine SR
Nifedipine SR
Nifedipine SR
Nifedipine SR
Norfloxacin
Norfloxacin
Ofloxacin
Olmesartan
Olanzapine
Omeprazole
Oxcarbazepine
Paliperidone
Pantoprazole
Paroxetine
Phenobarbital
Pheynetion
Divided in 2 doses
In 1 dose
2 times
In 1 dose
Divided in 2-3 doses
110.
Pregabalin
150-600 mg
111.
Perindopril
112.
113.
Propranolol HCl
Quinapril HCl
1-2 times
Divided in 1-2 doses
In 1 dose
In 1 dose
In 1 dose
2 times
2 times
Divided in 1-2 doses
In 1 dose
Divided in 1-2 doses
In 1 dose
In 1 dose
Divided in 1-2 doses
2 times
2 times
2 times
In 1 dose
In 1 dose
Divided in 1-2 doses
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
In 2 dose
In 1 dose
Divided in 2 doses
In 1 dose
2 times
In 1 dose
In 1 dose
In 1 dose
Divided in 2 doses
4-8 mg
In 1-2 doses
Perindopril
4-8 mg
In 1-2 doses
40-480 mg
5-80 mg
Divided in 2-3 doses
Divided in 1-2 doses
Propranolol HCl (LA)
Quinapril HCl
40-480 mg
5-80 mg
In 1 dose
Divided in 1-2
114.
115.
Ramipril
Ranitidine
In 1-2 doses
2 times
In 1 dose
In 1 dose
Ramipril
Ranitidine
1.25-20 mg
300 mg
In 1-2 doses
In 1 dose
Rabeprazole
1.25-20 mg
150 mg
300 mg
20 mg
116.
Rabeprazole
20 mg
In 1 dose
117.
Risperidone
4-8 mg
In 1 dose
Risperidone
4-8 mg
In 1 dose
118.
Salmetrol 21 Mcg/puff
2 puff
2 times
Salmetrol 21 Mcg/puff
2 puff
2 times
119.
120.
121.
Sertraline
Simvastatin
Sparfloxacin
25-100 mg
20-40 mg
400 mg loading
then 200 mg
In 1 dose
In 1 dose
In 1 dose
Sertraline
Simvastatin
Sparfloxacin
25-100 mg
20-40 mg
400 mg loading
then 200 mg
In 1 dose
In 1 dose
In 1 dose
122.
123.
124.
125.
126.
Spironolactone
Sulindac
Telmisartan
Terazosin HCl
Terbinafine
12.5-100 mg
200-400 mg
40-80 mg
1-20 mg
250 mg
Divided in 1-2 doses
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
Spironolactone
Sulindac
Termisartan
Terazosin HCl
Terbinafine
12.5-100 mg
200-400 mg
40-80 mg
1-20 mg
250 mg
Divided in 2 doses
Divided in 2 doses
In 1 dose
In 1 dose
In 1 dose
127.
Theophylline Plain
Depend on the salt
(Blood Level 10-20)
mcg/ml)
Divided in 3 doses
Theophylline SR
Depend on the salt
(Blood Level 5-15)
mcg/ml)
Divided in 2 doses
128.
129.
130.
131.
132.
133.
134.
135.
Telmisartan
Tinzaparin
Topiramate
Torsemide
Triameterene
Trovafloxacin
Trifluoperazine
Valporic Acid
In 1 dose
In 1 dose
Divided in 2 doses
Divided in 1-2 doses
In 1-2 diveded dose
In 1 dose
2 times
Divided in 2-3 doses
Telmisartan
Tinzaparin
Topiramate
Torsemide
Triameterene
Trovafloxacin
Trifluoperazine
Valporic Acid
Valsartan
Verpamil HCl
Vigabatran
Voriconazol
Zonisamide
In 1 dose
Divided in 3 doses
Divided in 2 doses
Divided in 2 doses
In 1-2 dose
Valsartan
Verpamil HCl (SR)
Vigabatran
Voriconazol
Zonisamide
40-80 mg
175 IU/kg SC daily
200-400 mg
5-20 mg
50-150 mg
200 mg
2-10 mg
1000-3000 mg
(Blood Level 40100 mcg/ml)
80-320 mg
90-480 mg
3 GM
400 mg
100-400 mg
In 1 dose
In 1 dose
Divided in 2 doses
Divided in 1-2 doses
In 1-2 diveded dose
In 1 dose
2 times
Divided in 2 doses
136.
137.
138.
139.
140.
40-80 mg
175 IU/kg SC daily
200-400 mg
5-20 mg
50-150 mg
200 mg
2-10 mg
1000-3000 mg
(Blood Level 40-100
mcg/ml)
80-320 mg
40-480 mg
3 GM
400 mg
100-600 mg
In 1 dose
Divided in 1-2 doses
Divided in 2 doses
Divided in 2 doses
In 1-2 dose
Table 3
Drug therapy Registration and MOH Formulaary Status
No
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
Drug
Status
Acebutolol
Aliskiren
Amiloride HCl
Amitriptyline
Amlodepine besylate
Amoxicillin
Aspirin
Atenolol
Atorvastatine
Aripiprazol
Betoxalol
Bisoprolol
Candesartan
Captopril
Carbamazepine
Carteolol
Carvedilol
Cefacolr
Celeoxib
Cephalexin
Cerivastatin
Chlorthalidone
Cholestyramine
Cimitidine
Ciprofloxacin
Citalopram
Clobazam
Clonazepan
Clopidogrel
Clonidine
Cloxacillin
Cotrimoxazole
Dalteparin
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA ,
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
Drug
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
101.
102.
Levetiracetam
Levofloxacin
Lisinopril
Loratadine
Losartan potassium
Mebendazole
Meloxicam
Methyldopa
Metolazone
Metopralol Succinate SR
Metoprolol Tartrate
Minocycline
Minoxidil
Montelukast
Moxifloxacin
Nadolol
Nalidixic Acid
Naproxen
Nebivolol
Nifedipine 20mg SR
Nifedipine 30mg SR
Nifedipine 10 mg
Nitrofurantoin
Norfloxacin
Ofloxacin
Olmesartan
Olanzapine
Omeprazole
Oxcarbazepine
Paliperidone
Pantoprazole
Paroxetine
Phenobarbital
Status
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA ,
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
70.
Diclofenac
Diflunisal
Digoxin
Diltiazem HCl
Doxazocin Mesylate
Doxycyline
Duloxetine
Eplerenone
Eprosartan
Enalpril maleate
Enoxaparin
Erythromycin
Ethosuximide
Escitalopram
Esomeprazole
Felodipine
Flucloxacillin
Fluconazole
Fluoxetine
Folic acid
Famotidine
Fosinopril sodium
Furosemide
Unfractionated
Heparin
Hydralazine HCl
Hydrochlorothaizide
Ipratropium
Indapamide
Irbesartan
Isosorbide Dinitrate
Isradipine
Itraconazole
Ketoconazole
Labetalol HCl
Lacosamide
Lamotrigine
Lanzoprazole
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
103.
104.
105.
106.
107.
108.
109.
110.
112.
113.
114.
115.
116.
117.
118.
119.
120.
121.
122.
123.
124.
125.
126.
127.
Pheynetion
Pindolol
Piroxicam
Posaconazole
Pravastatin
Prazosin HCl
Pregabalin
Perindopril
Propranolol HCl
Quinapril HCl
Ramipril
Ranitidine
Rabeprazole
Risperidone
Salmetrol 21 Mcg/puff
Simvastatin
Sertraline
Sparfloxacin
Spironolactone
Sulindac
Telmisartan
Terazosin HCl
Terbinafine
Theophylline Plain
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA
128.
129.
130.
131.
132.
133.
134.
135.
136.
137.
138.
139.
140.
Telmisartan
Tinzaparin
Topiramate
Torsemide
Triameterene
Trifluoperazine
Trovafloxacin
Valporic Acid
Valsartan
Verpamil HCl
Vigabatran
Voriconazol
Zonisamide
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA , MOHDF
RSFDA
RSFDA: The Drug had been registered in Saudi Food and Drug Authority
MOHDF : The Drug is Ministery of Health Drug Formulary