list down all the commonly used medicines with their generic name and in front of them their action/use purpose also with their dosage and max dose limit beyond which they r toxic, also mention if their is any specific caution associated.
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commonly used medicines generic name dose max dose toxicity caution list 2025
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I now have substantial data from authoritative medical textbooks plus web sources. Let me compile the comprehensive reference guide.
Commonly Used Medicines - Quick Reference Guide
Disclaimer: This is a general educational reference. Always follow prescriber instructions. Dosages listed are for average healthy adults unless noted. Renal/hepatic impairment, age extremes, and drug interactions can significantly alter safe dosing.
ANALGESICS & ANTIPYRETICS
1. Paracetamol (Acetaminophen)
Brand names: Panadol, Tylenol, Calpol
| Parameter | Details |
|---|---|
| Action/Use | Analgesic (mild-moderate pain), antipyretic. Weak COX-1/COX-2 inhibitor peripherally; also acts via endocannabinoid & serotonergic systems. No significant anti-inflammatory effect. |
| Usual Dose | 325-500 mg every 4-6 hrs (adult) |
| Max Daily Dose | 4 g/day (many experts now say 3 g/day in elderly, alcoholics, or malnutrition) |
| Toxic Dose | ≥7.5-10 g in a single ingestion raises hepatotoxicity risk; ≥15 g can be fatal due to fulminant hepatic necrosis (centrilobular) |
| Cautions | Liver disease, chronic alcohol use (≥3 drinks/day), malnutrition, prolonged fasting, anorexia. Even 4 g/day can raise liver enzymes. Antidote: N-acetylcysteine (NAC). Rare: hemolytic anemia, methemoglobinemia, anaphylaxis |
2. Ibuprofen
Brand names: Brufen, Advil, Motrin, Nurofen
| Parameter | Details |
|---|---|
| Action/Use | NSAID - non-selective COX-1/COX-2 inhibitor. Anti-inflammatory, analgesic, antipyretic. Used for pain, fever, arthritis, dysmenorrhea |
| Usual Dose | 200-400 mg every 4-6 hrs (OTC); up to 800 mg 3-4x/day (prescription) |
| Max Daily Dose | OTC: 1,200 mg/day; Prescription: 3,200 mg/day |
| Toxic Dose | >400 mg/kg in children causes serious toxicity; adults - doses >3,200 mg/day chronically carry major GI/renal/CV risk |
| Cautions | Active peptic ulcer, renal impairment, cardiovascular disease (increases MI/stroke risk), last trimester of pregnancy (premature closure of ductus arteriosus), asthma (aspirin-sensitive), elderly (use lowest effective dose), concurrent anticoagulant use |
3. Aspirin (Acetylsalicylic Acid)
Brand names: Ecotrin, Disprin, Bayer Aspirin
| Parameter | Details |
|---|---|
| Action/Use | Low dose (75-100 mg): irreversible COX-1 inhibition → antiplatelet → prevents MI, stroke, TIA. Higher doses: analgesic, antipyretic, anti-inflammatory |
| Usual Dose | Antiplatelet: 75-100 mg/day; Analgesic/antipyretic: 325-650 mg every 4-6 hrs |
| Max Daily Dose | Analgesic use: 4,000 mg/day |
| Toxic Dose | Salicylate toxicity (salicylism) begins above 150 mg/kg; severe toxicity >300 mg/kg. Signs: tinnitus, hyperventilation, metabolic acidosis |
| Cautions | Reye's syndrome - NEVER give to children <16 with viral illness. Peptic ulcer disease, bleeding disorders, renal/hepatic impairment, asthma (aspirin-exacerbated respiratory disease), gout. Avoid in last trimester of pregnancy |
4. Naproxen
Brand names: Naprosyn, Aleve, Anaprox
| Parameter | Details |
|---|---|
| Action/Use | NSAID; anti-inflammatory, analgesic, antipyretic. Used for arthritis, gout, dysmenorrhea, musculoskeletal pain |
| Usual Dose | 250-500 mg twice daily |
| Max Daily Dose | 1,250 mg/day (prescription); OTC 660 mg/day |
| Toxic Dose | >1,000 mg/kg in animal models; in humans, overdose causes GI bleeding, renal failure |
| Cautions | Same NSAID class warnings: GI ulceration, renal impairment, cardiovascular risk. Longer half-life than ibuprofen means accumulation risk in elderly and renal impairment |
5. Diclofenac
Brand names: Voltaren, Cataflam, Voveran
| Parameter | Details |
|---|---|
| Action/Use | NSAID (slight COX-2 preference). Analgesic, anti-inflammatory. Used for arthritis, musculoskeletal pain, acute gout, dental/post-surgical pain |
| Usual Dose | 50 mg 2-3x/day or 75 mg twice daily |
| Max Daily Dose | 150 mg/day |
| Toxic Dose | Overdose >5 mg/kg associated with significant GI/renal toxicity |
| Cautions | Higher cardiovascular risk than other NSAIDs. Hepatotoxicity (monitor LFTs). Caution in heart failure, hypertension |
6. Ketorolac
Brand names: Toradol, Ketanov
| Parameter | Details |
|---|---|
| Action/Use | Potent NSAID analgesic (used almost exclusively for analgesia, not inflammation). Short-term moderate-severe acute pain |
| Usual Dose | 10-30 mg IM/IV every 6 hrs; 10 mg orally every 4-6 hrs |
| Max Daily Dose | 40 mg/day (oral); 120 mg/day (parenteral) |
| Toxic Dose | Severe GI bleeding, acute renal failure at above-limit doses |
| Cautions | Limit use to 5 days maximum (oral or parenteral). NOT for chronic use. Contraindicated in renal impairment, peptic ulcer, perioperative CABG pain, >65 years at higher risk |
ANTIBIOTICS
7. Amoxicillin
Brand names: Amoxil, Trimox, Moxatag
| Parameter | Details |
|---|---|
| Action/Use | Aminopenicillin antibiotic. Inhibits bacterial cell wall synthesis (beta-lactam). Treats respiratory tract infections, UTIs, ear/throat infections, H. pylori (in combination), dental infections |
| Usual Dose | 250-500 mg every 8 hrs (mild-moderate); 875 mg every 12 hrs (severe) |
| Max Daily Dose | 3,000 mg/day (standard); up to 6,000 mg/day for severe infections (e.g., community-acquired pneumonia) |
| Toxic Dose | Not classically toxic at high doses; major risk is anaphylaxis. Extremely high doses can cause seizures |
| Cautions | Penicillin allergy (anaphylaxis risk - cross-react ~1-10% with cephalosporins), renal impairment (dose reduction needed), mononucleosis (causes maculopapular rash with amoxicillin - avoid) |
8. Amoxicillin-Clavulanate
Brand names: Augmentin, Co-amoxiclav
| Parameter | Details |
|---|---|
| Action/Use | Beta-lactam + beta-lactamase inhibitor. Broader spectrum - covers beta-lactamase-producing organisms. Used for skin/soft tissue, respiratory, dental, bite wound infections |
| Usual Dose | 875/125 mg twice daily (adults) |
| Max Daily Dose | 3,000 mg amoxicillin component/day |
| Toxic Dose | Similar to amoxicillin; clavulanate adds hepatotoxicity risk |
| Cautions | Cholestatic hepatitis (especially with repeated courses). Avoid in penicillin allergy. Higher GI side effects than amoxicillin alone. Take with food to reduce GI upset |
9. Azithromycin
Brand names: Zithromax, Azee, Z-pak
| Parameter | Details |
|---|---|
| Action/Use | Macrolide antibiotic. Inhibits bacterial protein synthesis (50S ribosome). Used for respiratory infections (atypical pneumonia, Chlamydia, Mycoplasma), STIs, skin infections |
| Usual Dose | 500 mg Day 1, then 250 mg Days 2-5 (Z-pack) OR 500 mg/day x 3 days |
| Max Daily Dose | 500 mg/day |
| Toxic Dose | Overdose is uncommon; major toxicity is cardiac (QT prolongation → torsades de pointes) |
| Cautions | QT prolongation - avoid with other QT-prolonging drugs (quinolones, antipsychotics, anti-arrhythmics). History of cardiac arrhythmia. Hepatic impairment. Not first-line in bacteremic pneumococcal pneumonia |
10. Ciprofloxacin
Brand names: Cipro, Ciplox
| Parameter | Details |
|---|---|
| Action/Use | Fluoroquinolone antibiotic. Inhibits DNA gyrase (topoisomerase II/IV). Broad-spectrum: UTIs, respiratory, GI infections (typhoid, traveler's diarrhea), anthrax, bone/joint infections |
| Usual Dose | 250-750 mg twice daily (oral); 200-400 mg every 8-12 hrs (IV) |
| Max Daily Dose | 1,500 mg/day (oral); 1,200 mg/day (IV) |
| Toxic Dose | Tendon rupture, CNS toxicity (seizures) at high doses/accumulation |
| Cautions | Tendinitis/tendon rupture (especially Achilles, risk ↑ in elderly + corticosteroids). Not recommended in children/adolescents (cartilage toxicity). QT prolongation. Avoid in epilepsy. Reduces seizure threshold. Photosensitivity. Avoid antacids/dairy (↓ absorption). FDA Black Box Warning on tendinopathy and CNS effects |
11. Doxycycline
Brand names: Vibramycin, Doryx, Doxin
| Parameter | Details |
|---|---|
| Action/Use | Tetracycline antibiotic. Inhibits 30S ribosome. Broad-spectrum: atypical pneumonias, Chlamydia, Lyme disease, Rocky Mountain spotted fever, malaria prophylaxis, acne |
| Usual Dose | 100 mg twice daily (loading: 200 mg first day) |
| Max Daily Dose | 200 mg/day |
| Toxic Dose | Severe hepatotoxicity in pregnancy at IV doses >2 g/day |
| Cautions | Contraindicated in pregnancy (fetal bone/teeth toxicity) and children <8 years (permanent tooth discoloration, impaired bone growth). Photosensitivity (avoid sun). Take with full glass of water; remain upright for 30 min (esophageal ulceration). Avoid with antacids, iron, calcium |
12. Metronidazole
Brand names: Flagyl, Metrogyl
| Parameter | Details |
|---|---|
| Action/Use | Nitroimidazole antibiotic/antiprotozoal. DNA strand breakage in anaerobic bacteria and protozoa. Used for anaerobic infections, H. pylori, Clostridioides difficile (C. diff), Giardia, Trichomonas, dental infections, intra-abdominal infections |
| Usual Dose | 400-500 mg 3x/day (or 250 mg 3x/day for mild infections); 500 mg IV every 8 hrs |
| Max Daily Dose | 4,000 mg/day (acute); chronic use 2,000 mg/day |
| Toxic Dose | Neurotoxicity (peripheral neuropathy, encephalopathy, cerebellar dysfunction) with prolonged high-dose use |
| Cautions | Disulfiram-like reaction with alcohol (severe nausea, vomiting, flushing) - avoid alcohol during and 48 hrs after therapy. Peripheral neuropathy with prolonged use. Avoid in first trimester pregnancy. Metallic taste common. Potentiates warfarin |
CARDIOVASCULAR DRUGS
13. Amlodipine
Brand names: Norvasc, Amlip
| Parameter | Details |
|---|---|
| Action/Use | Calcium channel blocker (dihydropyridine). Blocks L-type calcium channels in vascular smooth muscle → vasodilation → antihypertensive, antianginal |
| Usual Dose | 5 mg once daily |
| Max Daily Dose | 10 mg/day |
| Toxic Dose | Overdose >10 mg causes severe hypotension, reflex tachycardia, cardiogenic shock |
| Cautions | Peripheral edema (dose-dependent), hepatic impairment (start 2.5 mg). Gingival hyperplasia. Avoid grapefruit juice (inhibits CYP3A4, elevates drug levels). Relatively safe in renal disease |
14. Lisinopril / Enalapril (ACE Inhibitors)
Brand names: Zestril, Prinivil (Lisinopril); Vasotec (Enalapril)
| Parameter | Details |
|---|---|
| Action/Use | ACE inhibitor. Blocks conversion of angiotensin I → angiotensin II → reduces vasoconstriction and aldosterone release. Used for hypertension, heart failure, post-MI cardioprotection, diabetic nephropathy |
| Usual Dose | Lisinopril: 5-10 mg once daily; Enalapril: 5-10 mg twice daily |
| Max Daily Dose | Lisinopril: 40 mg/day; Enalapril: 40 mg/day |
| Toxic Dose | Severe hypotension and acute renal failure in overdose or bilateral renal artery stenosis |
| Cautions | Dry persistent cough (very common - class effect, ~10-15%). Angioedema (rare but life-threatening - more in Black patients). Absolutely contraindicated in pregnancy (teratogenic - fetal renal dysgenesis). Avoid in bilateral renal artery stenosis. Monitor potassium (hyperkalemia risk) and renal function. Stop before major surgery if indicated |
15. Losartan / Valsartan (ARBs)
Brand names: Cozaar (Losartan); Diovan (Valsartan)
| Parameter | Details |
|---|---|
| Action/Use | Angiotensin receptor blocker. Blocks AT1 receptor. Same indications as ACE inhibitors but without the cough. Used for hypertension, heart failure, diabetic nephropathy (especially losartan) |
| Usual Dose | Losartan: 25-50 mg once daily; Valsartan: 80-160 mg once daily |
| Max Daily Dose | Losartan: 100 mg/day; Valsartan: 320 mg/day |
| Toxic Dose | Severe hypotension, hyperkalemia, renal failure |
| Cautions | Absolutely contraindicated in pregnancy (same as ACE inhibitors). Hyperkalemia risk (especially with K-sparing diuretics, K supplements). Avoid combining with ACE inhibitors (dual RAAS blockade). Renal function monitoring required |
16. Metoprolol / Atenolol (Beta-Blockers)
Brand names: Lopressor, Toprol-XL (Metoprolol); Tenormin (Atenolol)
| Parameter | Details |
|---|---|
| Action/Use | Cardioselective beta-1 blocker. Reduces heart rate, contractility, and blood pressure. Used for hypertension, angina, post-MI protection, heart failure (metoprolol succinate), arrhythmias (atrial fibrillation rate control) |
| Usual Dose | Metoprolol: 25-100 mg once/twice daily; Atenolol: 25-50 mg once daily |
| Max Daily Dose | Metoprolol: 200-400 mg/day; Atenolol: 100 mg/day |
| Toxic Dose | Overdose causes severe bradycardia, heart block, hypotension, bronchospasm |
| Cautions | Do NOT abruptly stop (rebound angina/MI risk). Contraindicated in acute decompensated heart failure, 2nd/3rd degree heart block, sick sinus syndrome (without pacemaker). Caution in asthma/COPD (though cardioselective ones are safer). Masks hypoglycemia symptoms in diabetics |
17. Atorvastatin / Rosuvastatin (Statins)
Brand names: Lipitor (Atorvastatin); Crestor (Rosuvastatin)
| Parameter | Details |
|---|---|
| Action/Use | HMG-CoA reductase inhibitor. Reduces LDL cholesterol, reduces cardiovascular mortality. Used for hypercholesterolemia, dyslipidemia, primary and secondary CV prevention |
| Usual Dose | Atorvastatin: 10-40 mg once daily (at any time); Rosuvastatin: 5-20 mg once daily |
| Max Daily Dose | Atorvastatin: 80 mg/day; Rosuvastatin: 40 mg/day |
| Toxic Dose | Myopathy/rhabdomyolysis at high doses or with interacting drugs (fibrates, cyclosporin, certain antibiotics) |
| Cautions | Myopathy/rhabdomyolysis (muscle pain/weakness - check CK). Hepatotoxicity (check LFTs at baseline). Contraindicated in pregnancy (teratogenic). Grapefruit juice interaction (CYP3A4). Avoid simvastatin >20 mg with amlodipine. Do not use with gemfibrozil (extreme rhabdomyolysis risk) |
18. Furosemide (Frusemide)
Brand names: Lasix
| Parameter | Details |
|---|---|
| Action/Use | Loop diuretic. Blocks Na-K-2Cl transporter in ascending loop of Henle. Potent diuresis. Used for heart failure (pulmonary edema), hypertension, peripheral edema, hypercalcemia |
| Usual Dose | 20-40 mg once/twice daily (oral); 20-40 mg IV (acute use) |
| Max Daily Dose | 600 mg/day (in severe refractory cases) |
| Toxic Dose | Profound dehydration, electrolyte imbalances (hypokalemia → arrhythmias) |
| Cautions | Hypokalemia (supplement K+ or add K-sparing diuretic). Hyponatremia, hypomagnesemia. Ototoxicity (especially at high IV doses or with aminoglycosides). Gout exacerbation. Monitor electrolytes and renal function. Sulfa allergy cross-reactivity (controversial) |
GASTROINTESTINAL DRUGS
19. Omeprazole / Pantoprazole (PPIs)
Brand names: Prilosec, Losec (Omeprazole); Protonix, Pantocid (Pantoprazole)
| Parameter | Details |
|---|---|
| Action/Use | Proton pump inhibitor. Irreversibly inhibits H+/K+-ATPase in parietal cells → profound acid suppression. Used for GERD, peptic ulcer disease, H. pylori eradication (in triple therapy), Zollinger-Ellison syndrome, NSAID-induced ulcer prevention |
| Usual Dose | Omeprazole: 20 mg once daily (take 30-60 min before meal); Pantoprazole: 40 mg once daily |
| Max Daily Dose | Omeprazole: 80 mg/day (up to 120 mg in Z-E syndrome); Pantoprazole: 80 mg/day |
| Toxic Dose | Very high therapeutic index; overdose is rare |
| Cautions | Long-term use (>1 year): hypomagnesemia, C. difficile infection risk, bone fracture (osteoporosis), B12 deficiency, hyponatremia. Reduces clopidogrel efficacy (CYP2C19 - use pantoprazole or rabeprazole instead). Should not be used long-term without reassessment |
20. Ranitidine / Famotidine (H2-Blockers)
Brand names: Zantac (Ranitidine - now recalled); Pepcid (Famotidine)
| Parameter | Details |
|---|---|
| Action/Use | H2-receptor antagonist. Blocks histamine at H2 receptors of parietal cells → reduces acid secretion. Used for GERD, peptic ulcers, dyspepsia. Less potent than PPIs |
| Usual Dose | Famotidine: 20 mg twice daily or 40 mg once daily at bedtime |
| Max Daily Dose | Famotidine: 40 mg/day (OTC); 160 mg/day (Zollinger-Ellison) |
| Toxic Dose | Mental status changes (confusion, agitation) especially in elderly and renally impaired |
| Cautions | Dose reduce in renal impairment. Ranitidine has been withdrawn from market (NDMA contamination). Famotidine preferred. Less drug interactions than PPIs |
21. Metoclopramide
Brand names: Reglan, Maxolon
| Parameter | Details |
|---|---|
| Action/Use | Dopamine D2 antagonist, also 5-HT4 agonist. Prokinetic (increases gastric motility), antiemetic. Used for nausea/vomiting, gastroparesis, GERD, post-op nausea |
| Usual Dose | 10 mg 3-4x/day (30 min before meals) |
| Max Daily Dose | 40 mg/day |
| Toxic Dose | Extrapyramidal reactions (dystonia, akathisia) even at therapeutic doses, especially in children and young adults |
| Cautions | Tardive dyskinesia (irreversible involuntary movements) with prolonged use - do NOT use for >12 weeks. Extrapyramidal effects (acute dystonia - treat with diphenhydramine or benztropine). Avoid in Parkinson's disease (worsens symptoms). Caution in seizure disorders |
DIABETES MEDICATIONS
22. Metformin
Brand names: Glucophage, Riomet
| Parameter | Details |
|---|---|
| Action/Use | Biguanide. Reduces hepatic glucose production (inhibits complex I of mitochondrial respiratory chain), improves insulin sensitivity, reduces intestinal glucose absorption. First-line for Type 2 diabetes |
| Usual Dose | Start 500 mg twice daily with meals; titrate to 1,000 mg twice daily |
| Max Daily Dose | 2,550 mg/day (but 2,000 mg is usually the practical maximum for tolerability) |
| Toxic Dose | Lactic acidosis (rare but serious, often precipitated by renal failure, dehydration, or contrast media use) |
| Cautions | Contraindicated in eGFR <30 mL/min/1.73m² (lactic acidosis risk). Caution eGFR 30-45. Hold 48 hrs before/after IV contrast (iodinated contrast can cause AKI). Hold before surgery. Avoid in hepatic impairment, heart failure, sepsis, alcohol excess. GI side effects (nausea, diarrhea) - take with food. Long-term use depletes B12 (monitor) |
23. Glimepiride / Glipizide (Sulfonylureas)
Brand names: Amaryl (Glimepiride); Glucotrol (Glipizide)
| Parameter | Details |
|---|---|
| Action/Use | Stimulates insulin secretion from pancreatic beta-cells (closes K-ATP channels). Used for Type 2 diabetes |
| Usual Dose | Glimepiride: 1-4 mg once daily; Glipizide: 5-10 mg once or twice daily |
| Max Daily Dose | Glimepiride: 8 mg/day; Glipizide: 40 mg/day |
| Toxic Dose | Prolonged hypoglycemia (especially in elderly, renal failure, missed meals) |
| Cautions | Major risk: hypoglycemia (especially if meal skipped, renal/hepatic impairment, elderly). Contraindicated in Type 1 diabetes, pregnancy, severe renal/hepatic impairment. Weight gain. Cross-allergy with sulfa drugs |
RESPIRATORY DRUGS
24. Salbutamol / Albuterol (Short-Acting Beta-2 Agonist)
Brand names: Ventolin, Proventil, Salamol
| Parameter | Details |
|---|---|
| Action/Use | Selective beta-2 adrenergic agonist. Relaxes bronchial smooth muscle → bronchodilation. Used for acute asthma/COPD exacerbations (reliever/rescue inhaler) |
| Usual Dose | Inhaler: 100-200 mcg (1-2 puffs) every 4-6 hrs as needed; Nebulizer: 2.5 mg every 20 min (acute) |
| Max Daily Dose | Inhaler: 800-1,600 mcg/day; Frequent use indicates poor asthma control |
| Toxic Dose | Tachycardia, hypokalemia, tremor, hyperglycemia at excessive doses |
| Cautions | Overuse masks poor asthma control (predictor of fatal asthma). Tachycardia/palpitations (caution in cardiac disease). Hypokalemia (especially with high doses + diuretics + corticosteroids). Use spacer device for better lung delivery |
25. Montelukast
Brand names: Singulair
| Parameter | Details |
|---|---|
| Action/Use | Leukotriene receptor antagonist (LTRA). Blocks CysLT1 receptors → reduces bronchoconstriction and inflammation. Used for asthma prophylaxis, allergic rhinitis |
| Usual Dose | 10 mg once daily at bedtime (adults) |
| Max Daily Dose | 10 mg/day |
| Toxic Dose | Low toxicity profile; overdose not well characterized |
| Cautions | FDA Black Box Warning: Serious neuropsychiatric events (agitation, aggression, depression, suicidal ideation) - assess risk-benefit, especially in patients with anxiety or mood disorders. Not for acute asthma relief |
CNS / NEUROLOGICAL DRUGS
26. Sertraline / Fluoxetine / Escitalopram (SSRIs)
Brand names: Zoloft (Sertraline); Prozac (Fluoxetine); Lexapro (Escitalopram)
| Parameter | Details |
|---|---|
| Action/Use | Selective serotonin reuptake inhibitors. Block serotonin transporter (SERT) → increased synaptic serotonin. Used for depression, anxiety disorders (GAD, panic, social anxiety, OCD, PTSD) |
| Usual Dose | Sertraline: 50-100 mg/day; Fluoxetine: 20-40 mg/day; Escitalopram: 10-20 mg/day |
| Max Daily Dose | Sertraline: 200 mg/day; Fluoxetine: 80 mg/day; Escitalopram: 20 mg/day (10 mg in elderly) |
| Toxic Dose | Serotonin syndrome (hyperthermia, rigidity, clonus, agitation) - risk with combination of multiple serotonergic agents |
| Cautions | FDA Black Box Warning: Increased suicidal ideation in children, adolescents, and young adults. Allow 2-4 weeks for therapeutic effect. Do NOT combine with MAOIs (serotonin syndrome - fatal). Discontinuation syndrome (taper slowly, especially paroxetine). QT prolongation (especially escitalopram >20 mg, citalopram >40 mg). Fluoxetine has very long half-life (no discontinuation syndrome but many drug interactions via CYP2D6) |
27. Diazepam / Lorazepam (Benzodiazepines)
Brand names: Valium (Diazepam); Ativan (Lorazepam)
| Parameter | Details |
|---|---|
| Action/Use | Positive allosteric modulator of GABA-A receptor → CNS depression. Used for anxiety, seizures (acute/status epilepticus), alcohol withdrawal, muscle relaxation, procedural sedation |
| Usual Dose | Diazepam: 2-10 mg 2-4x/day; Lorazepam: 0.5-2 mg 2-3x/day |
| Max Daily Dose | Diazepam: 40 mg/day; Lorazepam: 10 mg/day |
| Toxic Dose | Alone: relatively safe in overdose; combined with alcohol/opioids - fatal respiratory depression |
| Cautions | Dependence/addiction (physical dependence develops within 2-4 weeks). Never abruptly discontinue (withdrawal = seizures, delirium). Avoid in elderly (↑ fall risk, confusion - Beers Criteria). Contraindicated in respiratory failure, sleep apnea, myasthenia gravis. Sedation - do not drive. Propylene glycol toxicity with IV lorazepam (limit duration) |
28. Gabapentin / Pregabalin
Brand names: Neurontin (Gabapentin); Lyrica (Pregabalin)
| Parameter | Details |
|---|---|
| Action/Use | Binds voltage-gated calcium channels (alpha-2-delta subunit) → reduces neurotransmitter release. Used for neuropathic pain, epilepsy (adjunct), fibromyalgia (pregabalin), postherpetic neuralgia, anxiety (pregabalin) |
| Usual Dose | Gabapentin: 300-900 mg 3x/day; Pregabalin: 75-150 mg twice daily |
| Max Daily Dose | Gabapentin: 3,600 mg/day; Pregabalin: 600 mg/day |
| Toxic Dose | CNS depression, respiratory failure (especially with opioids or benzodiazepines) |
| Cautions | Dose reduce in renal impairment (renally cleared). Sedation, dizziness, ataxia (fall risk). Abuse potential (euphoric effects). FDA Black Box Warning (2019): Serious respiratory depression, especially with opioids, CNS depressants, or in patients with respiratory disease. Abrupt discontinuation can cause seizures |
29. Tramadol
Brand names: Ultram, Tramal, Contramal
| Parameter | Details |
|---|---|
| Action/Use | Atypical opioid - weak mu-opioid receptor agonist + inhibits serotonin/norepinephrine reuptake. Moderate pain (musculoskeletal, neuropathic, post-operative) |
| Usual Dose | 50-100 mg every 4-6 hrs as needed |
| Max Daily Dose | 400 mg/day (300 mg in elderly >75 years) |
| Toxic Dose | Seizures (lowers seizure threshold); serotonin syndrome; respiratory depression at high doses |
| Cautions | Avoid with SSRIs, MAOIs, SNRIs (serotonin syndrome). Lowers seizure threshold - avoid in epilepsy. Avoid in renal/hepatic failure (accumulation). CYP2D6 polymorphism - ultra-rapid metabolizers have excess morphine conversion. Withdrawal syndrome (opioid + SSRI type). Controlled substance in many countries |
30. Morphine / Oxycodone (Opioids)
Brand names: MS Contin (Morphine); OxyContin, Percocet (Oxycodone)
| Parameter | Details |
|---|---|
| Action/Use | Mu-opioid receptor agonists. Powerful analgesics. Used for severe acute pain (post-op, trauma), cancer pain, dyspnea in palliative care |
| Usual Dose | Morphine: 5-15 mg every 4 hrs (oral immediate release); Oxycodone: 5-15 mg every 4-6 hrs |
| Max Daily Dose | No absolute max in palliative/cancer care (titrate to pain); acute/non-cancer: start low and justify escalation |
| Toxic Dose | Triad: miosis + coma + respiratory depression (respiratory rate <8/min = overdose) |
| Cautions | High addiction potential - controlled substances. Antidote: Naloxone (Narcan). Constipation (use laxative prophylactically). Avoid in head injury (masks neurological deterioration). Avoid in severe asthma, COPD (respiratory depression). Dose reduce in renal failure (morphine-6-glucuronide accumulation). Codeine - never give to children <12 or breastfeeding mothers (ultra-rapid metabolizer risk - neonatal death) |
ANTICOAGULANTS / ANTIPLATELETS
31. Warfarin
Brand names: Coumadin, Jantoven
| Parameter | Details |
|---|---|
| Action/Use | Vitamin K antagonist. Inhibits vitamin K-dependent clotting factors (II, VII, IX, X) and proteins C and S. Used for DVT/PE treatment and prevention, atrial fibrillation stroke prevention, mechanical heart valves |
| Usual Dose | Individualized - target INR 2-3 (most indications); 2.5-3.5 for mechanical valves. Typical starting dose 2-5 mg/day |
| Max Daily Dose | No fixed max - dose is guided by INR monitoring |
| Toxic Dose | INR >4-5: major bleeding risk. INR >8-10: severe/life-threatening bleeding |
| Cautions | Narrow therapeutic index - multiple drug and food interactions (CYP2C9). Vitamin K-rich foods (leafy greens) reduce effect. Dozens of drug interactions. Antidote: Vitamin K (slow reversal) + 4-factor PCC (rapid reversal for life-threatening bleeding). Contraindicated in pregnancy (teratogenic - warfarin embryopathy) |
32. Rivaroxaban / Apixaban (Direct Oral Anticoagulants)
Brand names: Xarelto (Rivaroxaban); Eliquis (Apixaban)
| Parameter | Details |
|---|---|
| Action/Use | Direct factor Xa inhibitors. Used for AF stroke prevention, DVT/PE treatment and prevention, post-op VTE prophylaxis. No INR monitoring required |
| Usual Dose | Rivaroxaban: 20 mg once daily (with evening meal); Apixaban: 5 mg twice daily (2.5 mg in high-risk elderly) |
| Max Daily Dose | Rivaroxaban: 20 mg/day (standard); Apixaban: 10 mg twice daily (initial VTE treatment phase) |
| Toxic Dose | Uncontrolled bleeding (no easily reversible antidote until recently) |
| Cautions | Antidote: Andexanet alfa (specific reversal for rivaroxaban/apixaban). Avoid in severe renal impairment (apixaban is safer than rivaroxaban in CKD). Avoid in pregnancy. Renal function monitoring required. Watch for signs of occult bleeding |
THYROID MEDICATIONS
33. Levothyroxine (T4)
Brand names: Synthroid, Eltroxin, Levoxyl
| Parameter | Details |
|---|---|
| Action/Use | Synthetic thyroid hormone (T4). Replaces or supplements endogenous thyroid hormone. Used for hypothyroidism, thyroid cancer suppression |
| Usual Dose | 1.6 mcg/kg/day (average adult: ~100-125 mcg/day). Start low (25-50 mcg) in elderly or cardiac disease |
| Max Daily Dose | Titrate to TSH target (no fixed max); suppression therapy for thyroid cancer may require higher doses |
| Toxic Dose | Thyrotoxicosis: palpitations, atrial fibrillation, angina, bone loss, heat intolerance |
| Cautions | Take 30-60 min before breakfast (food reduces absorption by 20-40%). Interact with iron, calcium, antacids (take 4 hrs apart). Adjust dose in pregnancy (requirement increases ~30-50%). Cardiovascular disease: start low, increase slowly. Narrow therapeutic window - TSH monitoring every 6-12 weeks until stable, then annually |
ALLERGY / ANTIHISTAMINES
34. Cetirizine / Loratadine / Fexofenadine (2nd-Gen Antihistamines)
Brand names: Zyrtec (Cetirizine); Claritin (Loratadine); Allegra (Fexofenadine)
| Parameter | Details |
|---|---|
| Action/Use | Selective H1-receptor antagonists (peripherally acting). Less CNS penetration than 1st-gen. Used for allergic rhinitis, urticaria, atopic dermatitis |
| Usual Dose | Cetirizine: 10 mg once daily; Loratadine: 10 mg once daily; Fexofenadine: 120-180 mg once daily |
| Max Daily Dose | Cetirizine: 10 mg/day (20 mg with physician supervision for chronic urticaria); Loratadine: 10 mg/day; Fexofenadine: 180 mg/day |
| Toxic Dose | QT prolongation in massive overdose (especially with ketoconazole or erythromycin - obsolete concern for newer agents) |
| Cautions | Cetirizine causes mild sedation (avoid driving if affected). Fexofenadine is the least sedating. Dose reduce in renal impairment (cetirizine, loratadine). Loratadine: dose reduce in hepatic impairment. Avoid 1st-generation antihistamines (diphenhydramine, chlorpheniramine) in elderly (Beers Criteria - anticholinergic effects, delirium, urinary retention) |
CORTICOSTEROIDS
35. Prednisolone / Dexamethasone
Brand names: Omnipred (Prednisolone); Decadron (Dexamethasone)
| Parameter | Details |
|---|---|
| Action/Use | Systemic corticosteroids. Bind glucocorticoid receptors → anti-inflammatory, immunosuppressive effects. Wide range: asthma exacerbations, allergy, inflammatory conditions, adrenal insufficiency, autoimmune disease, cerebral edema (dexamethasone), croup, COVID-19 severe disease (dexamethasone) |
| Usual Dose | Prednisolone: 5-40 mg/day (varies by indication); Dexamethasone: 0.5-10 mg/day |
| Max Daily Dose | Prednisolone: up to 60 mg/day for acute conditions; pulse dosing can exceed this |
| Toxic Dose | Cumulative doses are the concern, not single doses |
| Cautions | Do NOT abruptly stop after prolonged use (adrenal suppression/crisis). Long-term effects: osteoporosis (supplement Ca/Vit D), hyperglycemia, hypertension, weight gain, Cushing's syndrome, cataracts, avascular necrosis (femoral head), immunosuppression (TB reactivation). Use lowest effective dose for shortest duration. Cover with stress doses during illness/surgery if on long-term therapy |
SUMMARY QUICK REFERENCE TABLE
| # | Generic Name | Class | Primary Use | Usual Dose | Max Dose | Key Toxicity Limit | Critical Caution |
|---|---|---|---|---|---|---|---|
| 1 | Paracetamol | Analgesic/Antipyretic | Pain, Fever | 325-500 mg q4-6h | 4 g/day | ≥15 g → fatal hepatotoxicity | Liver disease, alcohol |
| 2 | Ibuprofen | NSAID | Pain, Inflammation | 200-400 mg q4-6h | 3,200 mg/day (Rx) | Chronic use >3,200 mg | Peptic ulcer, renal, CV |
| 3 | Aspirin | Antiplatelet/NSAID | CV prevention, Pain | 75-100 mg (antiplatelet) | 4,000 mg/day | >150 mg/kg salicylism | No children <16 with virus |
| 4 | Naproxen | NSAID | Arthritis, Pain | 250-500 mg BD | 1,250 mg/day | GI/renal at excess doses | Elderly: accumulation risk |
| 5 | Diclofenac | NSAID (COX-2 preference) | Arthritis, Pain | 50 mg TDS | 150 mg/day | >5 mg/kg | Highest CV risk of NSAIDs |
| 6 | Ketorolac | NSAID Analgesic | Acute severe pain | 10-30 mg q6h | 120 mg/day | GI bleed at >5 days | Max 5 days use only |
| 7 | Amoxicillin | Penicillin antibiotic | Respiratory/UTI | 250-875 mg q8-12h | 3-6 g/day | Seizures at very high doses | Penicillin allergy, mono |
| 8 | Amox-Clavulanate | Beta-lactam + inhibitor | Broader infections | 875/125 mg BD | 3 g/day (amox component) | Hepatotoxicity | Penicillin allergy |
| 9 | Azithromycin | Macrolide antibiotic | Atypical pneumonia, STI | 500 mg/day x 5 days | 500 mg/day | QT prolongation | Cardiac arrhythmia risk |
| 10 | Ciprofloxacin | Fluoroquinolone | UTI, GI, respiratory | 250-750 mg BD | 1,500 mg/day | Tendon rupture, CNS | Avoid in children |
| 11 | Doxycycline | Tetracycline | Atypical infections, Lyme | 100 mg BD | 200 mg/day | Hepatotoxicity in pregnancy | No children <8, no pregnancy |
| 12 | Metronidazole | Nitroimidazole | Anaerobic, H. pylori | 400-500 mg TDS | 4 g/day | Peripheral neuropathy | No alcohol |
| 13 | Amlodipine | CCB | Hypertension, Angina | 5 mg OD | 10 mg/day | Hypotension at overdose | Avoid grapefruit |
| 14 | Lisinopril | ACE Inhibitor | Hypertension, HF | 5-10 mg OD | 40 mg/day | AKI, hyperkalemia | No pregnancy, bilateral RAS |
| 15 | Losartan | ARB | Hypertension, DKD | 25-50 mg OD | 100 mg/day | Same as ACE-I | No pregnancy |
| 16 | Metoprolol | Beta-blocker | HTN, Angina, HF | 25-100 mg BD | 400 mg/day | Bradycardia, HF | No abrupt stop |
| 17 | Atorvastatin | Statin | Dyslipidemia | 10-40 mg OD | 80 mg/day | Rhabdomyolysis | No pregnancy, CK monitoring |
| 18 | Furosemide | Loop diuretic | Fluid overload, HTN | 20-40 mg OD | 600 mg/day | Hypokalemia → arrhythmia | Ototoxicity risk |
| 19 | Omeprazole | PPI | GERD, PUD | 20 mg OD | 80 mg/day | Low (high therapeutic index) | Long-term: Mg/B12/bone |
| 20 | Famotidine | H2-blocker | GERD, PUD | 20 mg BD | 40-160 mg/day | Confusion in elderly/renal | Renal dose adjustment |
| 21 | Metoclopramide | Prokinetic/Antiemetic | Nausea, Gastroparesis | 10 mg TDS | 40 mg/day | Extrapyramidal effects | Max 12 weeks; avoid in Parkinson's |
| 22 | Metformin | Biguanide | Type 2 Diabetes | 500-1,000 mg BD | 2,550 mg/day | Lactic acidosis | eGFR <30: contraindicated |
| 23 | Glimepiride | Sulfonylurea | Type 2 Diabetes | 1-4 mg OD | 8 mg/day | Hypoglycemia | Elderly, renal impairment |
| 24 | Salbutamol | SABA | Acute Asthma/COPD | 100-200 mcg PRN | 800 mcg/day | Tachycardia, hypokalemia | Overuse masks poor control |
| 25 | Montelukast | LTRA | Asthma, Allergic Rhinitis | 10 mg OD | 10 mg/day | Not well characterized | FDA Black Box: neuropsychiatric |
| 26 | Sertraline | SSRI | Depression, Anxiety | 50-100 mg OD | 200 mg/day | Serotonin syndrome | No MAOIs; suicidality warning |
| 27 | Diazepam | Benzodiazepine | Anxiety, Seizures | 2-10 mg 2-4x/day | 40 mg/day | Fatal with opioids + alcohol | Dependence, no abrupt stop |
| 28 | Gabapentin | Anticonvulsant/Neuropathic | Neuropathic pain, Epilepsy | 300-900 mg TDS | 3,600 mg/day | Resp. depression with opioids | Renal dose reduction |
| 29 | Tramadol | Opioid/Serotonin | Moderate pain | 50-100 mg q4-6h | 400 mg/day | Seizures, Serotonin syndrome | Avoid with SSRIs/MAOIs |
| 30 | Morphine | Opioid | Severe pain | 5-15 mg q4h (oral) | Titrate to effect | Respiratory depression | Antidote: Naloxone |
| 31 | Warfarin | Anticoagulant | AF, DVT, PE, Valves | INR-guided | INR-guided | INR >4 = major bleed risk | Multiple drug/food interactions |
| 32 | Apixaban | Factor Xa inhibitor | AF, DVT, PE | 5 mg BD | 10 mg BD (acute phase) | Uncontrolled bleeding | Renal monitoring; antidote: andexanet |
| 33 | Levothyroxine | Thyroid hormone | Hypothyroidism | ~1.6 mcg/kg/day | TSH-guided | Thyrotoxicosis | Take on empty stomach; Ca/Fe interaction |
| 34 | Cetirizine | 2nd-gen antihistamine | Allergy, Urticaria | 10 mg OD | 10 mg/day | QT at massive overdose | Mild sedation; renal reduction |
| 35 | Prednisolone | Corticosteroid | Inflammation, Asthma | 5-40 mg/day | 60 mg/day acute | Cumulative adverse effects | No abrupt stop; multiple long-term effects |
Key Abbreviations: OD = once daily, BD = twice daily, TDS/TID = three times daily, QID = four times daily, q4-6h = every 4-6 hours, PRN = as needed, HTN = hypertension, HF = heart failure, PUD = peptic ulcer disease, GERD = gastroesophageal reflux disease, SABA = short-acting beta agonist, CCB = calcium channel blocker, ACE-I = ACE inhibitor, ARB = angiotensin receptor blocker, DKD = diabetic kidney disease, CK = creatine kinase, INR = international normalized ratio, RAS = renal artery stenosis, eGFR = estimated glomerular filtration rate.
Sources: Katzung's Basic and Clinical Pharmacology (16th Ed), Goodman & Gilman's Pharmacological Basis of Therapeutics, The Washington Manual of Medical Therapeutics, Harrison's Principles of Internal Medicine (22nd Ed), Goldman-Cecil Medicine, Harriet Lane Handbook (23rd Ed), Tintinalli's Emergency Medicine.
i want this but all indian commonly used list with all the rest similar instructions with categorise tem all into which caategory / use purpose they fall
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I have all the data I need from the NLEM India, medical textbooks, and pharmacology references. Let me now compile the full India-specific comprehensive reference.
🇮🇳 Commonly Used Medicines in India - Complete Reference Guide
Based on: National List of Essential Medicines India (NLEM), Katzung's Pharmacology, Goodman & Gilman's, Harrison's, and WHO Essential Medicines List. Disclaimer: For educational purposes only. Dosages are for average healthy adults. Always follow prescriber instructions. Renal/hepatic impairment, elderly patients, and pregnancy require dose adjustments.
CATEGORY 1: ANALGESICS & ANTIPYRETICS (Pain Killers / Fever Reducers)
1. Paracetamol (Acetaminophen)
Indian Brands: Crocin, Calpol, Dolo 650, Fepanil, Metacin, P-500
| Action / Use | Analgesic + antipyretic. Weak COX inhibitor centrally. No anti-inflammatory effect. Used for fever, headache, bodyache, post-vaccination fever, mild-moderate pain |
| Usual Dose | 500-650 mg every 4-6 hrs (adult); children: 10-15 mg/kg/dose |
| Max Daily Dose | 4,000 mg/day (3,000 mg/day in elderly, alcohol users, malnourished) |
| Toxic Dose | ≥7.5-10 g raises hepatotoxicity risk; ≥15 g can be fatal - causes centrilobular hepatic necrosis |
| Specific Caution | Liver disease, chronic alcoholism, malnutrition, fasting. Antidote: N-Acetylcysteine (NAC). Do NOT combine multiple paracetamol-containing products (Dolo 650 + cold syrups = inadvertent overdose risk) |
2. Ibuprofen
Indian Brands: Brufen, Combiflam (with paracetamol), Advil, Ibugesic
| Action / Use | NSAID - non-selective COX-1 and COX-2 inhibitor. Anti-inflammatory, analgesic, antipyretic. Used for fever, arthritis, muscle pain, dysmenorrhea, dental pain |
| Usual Dose | 200-400 mg every 6-8 hrs with food |
| Max Daily Dose | OTC: 1,200 mg/day; Prescription: 2,400-3,200 mg/day |
| Toxic Dose | Chronic >3,200 mg/day - GI bleed, acute kidney injury, cardiovascular events |
| Specific Caution | Active peptic ulcer, renal impairment, heart failure, last trimester of pregnancy (premature ductus arteriosus closure), asthma. Avoid in dengue fever (bleeding risk). Always take with food or antacid |
3. Diclofenac
Indian Brands: Voveran, Voltaren, Diclomol, Reactin, Dynapar (injection)
| Action / Use | NSAID with mild COX-2 preference. Analgesic, anti-inflammatory. Widely used in India for musculoskeletal pain, post-op pain, renal colic (injection), arthritis, spondylitis |
| Usual Dose | 50 mg twice/thrice daily (oral); 75 mg IM injection (single dose acute) |
| Max Daily Dose | 150 mg/day |
| Toxic Dose | >150 mg/day chronically - GI ulceration, hepatotoxicity, cardiovascular events |
| Specific Caution | Highest cardiovascular risk among common NSAIDs. Hepatotoxicity (monitor liver enzymes). Avoid IM injection >2 days. Gastric protection (PPI) recommended if used >5 days. Caution in hypertension and heart failure |
4. Nimesulide
Indian Brands: Nimulid, Nise, Nimegesic, Nimodol
(Withdrawn or restricted in many countries but still widely used in India)
| Action / Use | Preferential COX-2 inhibitor. Anti-inflammatory, analgesic, antipyretic. Widely used in India for fever, acute musculoskeletal pain, dental pain, dysmenorrhea |
| Usual Dose | 100 mg twice daily after meals |
| Max Daily Dose | 200 mg/day |
| Toxic Dose | Hepatotoxicity even at normal doses - cases of fulminant liver failure reported |
| Specific Caution | Banned in children <12 years in India (2011 ban by DCGI) due to hepatotoxicity. Short-term use only (max 15 days). Contraindicated in hepatic disease, renal failure, peptic ulcer. Not recommended in pregnancy. EU, Canada, USA do not approve it |
5. Aceclofenac
Indian Brands: Zerodol, Hifenac, Acemiz, Acenac
| Action / Use | NSAID; prodrug converted to diclofenac. Anti-inflammatory and analgesic. Used for osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, acute musculoskeletal conditions |
| Usual Dose | 100 mg twice daily after meals |
| Max Daily Dose | 200 mg/day |
| Toxic Dose | GI bleed, renal failure, liver toxicity at excessive doses |
| Specific Caution | Same NSAID class cautions - GI protection recommended. Better GI tolerability than diclofenac but not zero risk. Avoid in renal/hepatic impairment, last trimester pregnancy |
6. Aspirin (Acetylsalicylic Acid)
Indian Brands: Ecosprin, Disprin, Aspro, Loprin (75 mg for cardioprotection)
| Action / Use | Low dose (75 mg): irreversible COX-1 inhibitor → antiplatelet → prevents MI, stroke. Higher doses: analgesic, antipyretic, anti-inflammatory. Also used for Kawasaki disease |
| Usual Dose | Antiplatelet: 75-150 mg once daily; Analgesic: 300-600 mg every 4-6 hrs |
| Max Daily Dose | Analgesic: 3,000-4,000 mg/day |
| Toxic Dose | Salicylism (tinnitus, nausea, hyperventilation) at >150 mg/kg; life-threatening at >300 mg/kg |
| Specific Caution | NEVER give to children <16 with viral illness (Reye's syndrome - fatal). Peptic ulcer, bleeding disorders, gout, asthma (aspirin-exacerbated respiratory disease in 10-20%). Avoid in dengue. Contraindicated last trimester pregnancy |
CATEGORY 2: ANTIBIOTICS (Infection Fighters)
7. Amoxicillin
Indian Brands: Mox, Novamox, Wymox, Amoxil
| Action / Use | Aminopenicillin. Inhibits bacterial cell wall synthesis. Used for respiratory tract infections, ear/throat infections, UTI, dental infections, typhoid (in combination), H. pylori eradication |
| Usual Dose | 250-500 mg every 8 hrs; 875 mg every 12 hrs for severe infections |
| Max Daily Dose | Standard: 3,000 mg/day; severe infections up to 6,000 mg/day |
| Toxic Dose | Very high doses can cause seizures; anaphylaxis is main concern even at therapeutic doses |
| Specific Caution | Penicillin allergy (risk of anaphylaxis). Cross-reactivity with cephalosporins (~1-10%). Avoid in infectious mononucleosis (Epstein-Barr virus) - causes widespread maculopapular rash. Dose reduce in renal failure |
8. Amoxicillin + Clavulanate (Co-Amoxiclav)
Indian Brands: Augmentin, Clavam, Moxikind-CV, Amoxyclav
| Action / Use | Beta-lactam + beta-lactamase inhibitor. Covers beta-lactamase-producing organisms. Used for skin/soft tissue infections, dental, respiratory, bite wounds, UTI, sinusitis |
| Usual Dose | 625 mg (500/125) twice/thrice daily; 1 g (875/125) twice daily for severe |
| Max Daily Dose | 3,000 mg amoxicillin component/day |
| Toxic Dose | Cholestatic jaundice and hepatotoxicity |
| Specific Caution | Higher GI side effects than amoxicillin alone (diarrhea, nausea). Risk of cholestatic hepatitis especially with repeated courses. Take with food. Avoid if penicillin allergic |
9. Cefixime
Indian Brands: Taxim-O, Zifi, Cefolac, Gramocef
| Action / Use | 3rd-generation cephalosporin (oral). Active against gram-negative organisms. Used for UTI, respiratory tract infections, gonorrhea, typhoid (in combination), acute otitis media |
| Usual Dose | 200-400 mg once or twice daily |
| Max Daily Dose | 400 mg/day |
| Toxic Dose | Diarrhea, pseudomembranous colitis at high doses/prolonged use |
| Specific Caution | Cephalosporin allergy (10% cross-reactivity with penicillin). Dose reduce in renal impairment. C. difficile-associated diarrhea. Not active against Pseudomonas or MRSA |
10. Ceftriaxone
Indian Brands: Monocef, Oframax, Cefaxone, Rocephin
| Action / Use | 3rd-generation cephalosporin (IV/IM). Broad spectrum. Used for severe pneumonia, meningitis, typhoid, septicemia, gonorrhea, intra-abdominal infections, pelvic inflammatory disease |
| Usual Dose | 1-2 g once daily IV/IM; meningitis: 2 g twice daily |
| Max Daily Dose | 4 g/day |
| Toxic Dose | Biliary sludge/pseudolithiasis (calcium-ceftriaxone precipitate, especially in neonates); hepatotoxicity |
| Specific Caution | Do NOT co-administer with calcium-containing IV solutions in neonates (fatal precipitate). Cephalosporin/penicillin allergy. Dose adjust in severe renal AND hepatic impairment combined. Can cause Coombs-positive hemolytic anemia |
11. Azithromycin
Indian Brands: Azithral, Zithromax, Azee, Azibact
| Action / Use | Macrolide antibiotic. Inhibits 50S ribosome. Atypical pneumonia (Mycoplasma, Chlamydia, Legionella), STIs, typhoid (in combination), upper respiratory infections, skin infections |
| Usual Dose | 500 mg on Day 1, then 250 mg Days 2-5 OR 500 mg daily x 3 days |
| Max Daily Dose | 500 mg/day |
| Toxic Dose | QT prolongation → ventricular arrhythmia (torsades de pointes) |
| Specific Caution | QT prolongation - avoid with other QT-prolonging drugs (fluoroquinolones, antipsychotics). Not first-line for bacteremic pneumococcal pneumonia. Hepatic impairment. Overuse is driving resistance in India |
12. Ciprofloxacin
Indian Brands: Ciplox, Cifran, Quintor
| Action / Use | Fluoroquinolone. Inhibits DNA gyrase. UTI, typhoid, traveler's diarrhea (E. coli), respiratory infections, anthrax, bone/joint infections |
| Usual Dose | 250-500 mg twice daily (oral); 200-400 mg IV every 8-12 hrs |
| Max Daily Dose | 1,500 mg/day (oral) |
| Toxic Dose | Tendon rupture, seizures, QT prolongation at high/accumulating doses |
| Specific Caution | Tendinopathy/tendon rupture (Achilles, especially in elderly + steroids). Avoid in children and adolescents (cartilage toxicity). Reduces seizure threshold. Photosensitivity. Avoid antacids, iron, dairy (chelation - reduces absorption). FDA/DCGI Black Box Warning |
13. Ofloxacin / Levofloxacin
Indian Brands: Oflox, Zanocin (Ofloxacin); Levoflox, Loxof (Levofloxacin)
| Action / Use | Fluoroquinolone. Broader spectrum than ciprofloxacin against gram-positives. Used for respiratory infections (atypical pneumonia, community-acquired pneumonia), UTI, typhoid, multidrug-resistant TB (second-line) |
| Usual Dose | Ofloxacin: 200-400 mg twice daily; Levofloxacin: 500-750 mg once daily |
| Max Daily Dose | Levofloxacin: 750 mg/day |
| Toxic Dose | QT prolongation, seizures, tendon rupture |
| Specific Caution | Same fluoroquinolone class warnings. Levofloxacin has higher QT prolongation risk than ciprofloxacin. Dose reduce in renal impairment. Avoid in epilepsy. Widely overused in India - major contributor to antibiotic resistance |
14. Doxycycline
Indian Brands: Doxrid, Doxt, Vibramycin
| Action / Use | Tetracycline. Inhibits 30S ribosome. Atypical pneumonia, Lyme disease, brucellosis, leptospirosis, malaria prophylaxis, rickettsial infections (scrub typhus - very common in India), acne, cholera |
| Usual Dose | 100 mg twice daily (loading 200 mg first day) |
| Max Daily Dose | 200 mg/day |
| Toxic Dose | IV doses >2 g/day in pregnancy - fulminant hepatotoxicity |
| Specific Caution | Contraindicated in pregnancy and children <8 years (permanent tooth discoloration, impaired bone growth). Photosensitivity (avoid sun). Take with full glass of water; sit upright 30 min (esophageal ulceration). Avoid with antacids, iron, calcium salts |
15. Metronidazole
Indian Brands: Flagyl, Metrogyl, Aldezol, Metro
| Action / Use | Nitroimidazole. Anaerobic bacteria + protozoa. Amoebiasis, giardiasis, H. pylori (triple therapy), C. difficile, Trichomonas vaginalis, anaerobic infections, dental infections, intra-abdominal infections |
| Usual Dose | 400-500 mg three times daily (oral); 500 mg IV every 8 hrs |
| Max Daily Dose | 4,000 mg/day (short-term); chronic treatment 2,000 mg/day |
| Toxic Dose | Peripheral neuropathy, cerebellar dysfunction with prolonged high-dose use |
| Specific Caution | No alcohol during and 48 hrs after (severe disulfiram-like reaction: flushing, vomiting, palpitations). Peripheral neuropathy with long-term use. Avoid in 1st trimester pregnancy. Metallic taste. Potentiates warfarin. Mutagenic in high doses (avoid prolonged unnecessary use) |
16. Co-trimoxazole (Trimethoprim + Sulfamethoxazole)
Indian Brands: Bactrim, Septran, Co-Trimoxazole
| Action / Use | Antifolate antibiotic combination. Inhibits sequential steps in folate synthesis. UTI, Pneumocystis jirovecii pneumonia (PCP) prophylaxis and treatment (HIV patients), nocardiosis, Stenotrophomonas, Cyclospora infection |
| Usual Dose | 960 mg (160/800) twice daily (standard); single-strength 480 mg for UTI prophylaxis |
| Max Daily Dose | 1,920 mg/day (standard) |
| Toxic Dose | Stevens-Johnson syndrome, aplastic anemia, crystalluria, kernicterus in neonates |
| Specific Caution | Sulfonamide allergy. Folate deficiency risk - avoid in pregnancy (first trimester especially). Avoid in neonates (kernicterus). Hyperkalemia (TMP component). Monitor renal function. G6PD deficiency - hemolytic anemia |
17. Isoniazid (INH)
Indian Brands: Isokin, Lositrin (part of anti-TB regimens: 4FDC, Akurit)
| Action / Use | Antitubercular. Inhibits mycolic acid synthesis (InhA enzyme). First-line anti-TB drug. Also used for TB prophylaxis in contacts and HIV patients |
| Usual Dose | 5 mg/kg/day (max 300 mg/day in adults); intermittent regimen: 10 mg/kg 3x/week |
| Max Daily Dose | 300 mg/day (daily regimen) |
| Toxic Dose | >10-15 mg/kg seizures due to pyridoxine antagonism; hepatotoxicity |
| Specific Caution | Pyridoxine (Vitamin B6) deficiency - always co-prescribe Pyridoxine 10-25 mg/day (prevents peripheral neuropathy). Hepatotoxicity - monitor LFTs monthly. Slow acetylators (genetically common in Indians) have higher toxicity risk. Drug interactions: reduces phenytoin metabolism (phenytoin toxicity). Avoid alcohol |
18. Rifampicin (Rifampin)
Indian Brands: Rifampin, R-Cin, Rimactane (part of 4FDC anti-TB regimens)
| Action / Use | RNA polymerase inhibitor. First-line anti-TB. Also used for leprosy, brucellosis, meningococcal prophylaxis, MRSA (in combination) |
| Usual Dose | 10 mg/kg/day (max 600 mg/day); take on empty stomach |
| Max Daily Dose | 600 mg/day |
| Toxic Dose | Fulminant hepatitis at high doses, especially combined with INH |
| Specific Caution | Potent CYP450 inducer - reduces levels of MANY drugs (oral contraceptives → contraceptive failure, antiretrovirals, warfarin, antifungals, antiepileptics). Turns urine/tears/sweat orange-red (warn patients). Hepatotoxicity. Flu-like syndrome with intermittent regimen. Avoid in jaundice |
CATEGORY 3: ANTIFUNGALS
19. Fluconazole
Indian Brands: Flucos, Forcan, Syscan, Zocon
| Action / Use | Triazole antifungal. Inhibits ergosterol synthesis (CYP51/Erg11). Used for candidal infections (oral thrush, vaginal candidiasis, esophageal candidiasis), cryptococcal meningitis, dermatophytosis, onychomycosis |
| Usual Dose | Vaginal candidiasis: 150 mg single dose; Oral candidiasis: 100-200 mg/day x 7-14 days; Cryptococcal meningitis: 400-800 mg/day |
| Max Daily Dose | 800 mg/day (severe infections) |
| Toxic Dose | QT prolongation and liver toxicity at high doses |
| Specific Caution | QT prolongation - avoid with QT-prolonging drugs. CYP2C9/CYP3A4 inhibitor (interacts with warfarin, phenytoin, sulfonylureas - may cause hypoglycemia or bleeding). Avoid in pregnancy (teratogenic - craniofacial defects). Hepatotoxicity with prolonged use |
CATEGORY 4: ANTIVIRALS / ANTIPARASITICS
20. Albendazole
Indian Brands: Zentel, Bandy, Bendex
| Action / Use | Benzimidazole antihelmintic. Inhibits tubulin polymerization in parasites. Used for intestinal worm infestations (roundworm, hookworm, threadworm, tapeworm), neurocysticercosis, hydatid disease, lymphatic filariasis |
| Usual Dose | Single dose 400 mg (deworming); 400 mg twice daily x 28 days (neurocysticercosis, hydatid) |
| Max Daily Dose | 800 mg/day (systemic parasitic infections) |
| Toxic Dose | Hepatotoxicity with prolonged high-dose therapy |
| Specific Caution | Contraindicated in pregnancy (teratogenic - causes embryotoxicity). Take with fatty meal (increases absorption). Can cause paradoxical worsening in neurocysticercosis (give steroids concurrently). Monitor LFTs in prolonged use |
CATEGORY 5: CARDIOVASCULAR DRUGS
21. Amlodipine
Indian Brands: Amlip, Stamlo, Norvasc, Amlo
| Action / Use | Dihydropyridine calcium channel blocker (CCB). Vasodilates peripheral arteries and coronaries. Used for hypertension, stable angina, vasospastic angina |
| Usual Dose | 5 mg once daily |
| Max Daily Dose | 10 mg/day |
| Toxic Dose | Severe hypotension, reflex tachycardia, cardiogenic shock in overdose |
| Specific Caution | Pedal edema (dose-dependent, most common side effect). Gingival hyperplasia with long-term use. Start at 2.5 mg in hepatic impairment. Avoid grapefruit juice (CYP3A4 inhibition - increases drug level). Relatively safe in renal disease |
22. Atenolol / Metoprolol (Beta-Blockers)
Indian Brands: Aten, Tenormin (Atenolol); Met-XL, Metolar (Metoprolol)
| Action / Use | Cardioselective beta-1 blocker. Reduces heart rate, blood pressure, cardiac workload. Used for hypertension, angina, post-MI, arrhythmias (AF rate control), migraine prophylaxis, hyperthyroidism (symptom control) |
| Usual Dose | Atenolol: 25-100 mg once daily; Metoprolol: 25-100 mg once/twice daily |
| Max Daily Dose | Atenolol: 100 mg/day; Metoprolol: 200 mg/day |
| Toxic Dose | Severe bradycardia, heart block, bronchospasm, hypotension |
| Specific Caution | Never stop abruptly (rebound angina, hypertensive crisis, MI). Contraindicated in 2nd/3rd degree AV block, sick sinus syndrome (no pacemaker), acute decompensated HF, severe asthma. Masks hypoglycemia symptoms in diabetics. Cold extremities (peripheral vasoconstriction) |
23. Enalapril / Ramipril (ACE Inhibitors)
Indian Brands: Envas, Renalapril (Enalapril); Cardace, Hopace (Ramipril)
| Action / Use | ACE inhibitor. Blocks angiotensin I → II conversion → reduces vasoconstriction and aldosterone. Used for hypertension, heart failure, post-MI cardioprotection, diabetic nephropathy (proteinuria reduction) |
| Usual Dose | Enalapril: 5-10 mg twice daily; Ramipril: 2.5-10 mg once daily |
| Max Daily Dose | Enalapril: 40 mg/day; Ramipril: 10 mg/day |
| Toxic Dose | Severe hypotension (first-dose effect), hyperkalemia, acute kidney injury |
| Specific Caution | Dry persistent cough (~10-15% - class effect). Angioedema (rare, life-threatening - more common in people of South Asian descent). Absolutely contraindicated in pregnancy (fetal renal agenesis, oligohydramnios, death). Monitor potassium and creatinine. Avoid in bilateral renal artery stenosis |
24. Telmisartan / Losartan (ARBs)
Indian Brands: Telma, Telsartan (Telmisartan); Losar, Repace (Losartan)
| Action / Use | Angiotensin receptor blocker. Blocks AT1 receptor. Same indications as ACE inhibitors without the cough. Telmisartan also has PPAR-gamma activity (mild metabolic benefit). Used for hypertension, heart failure, diabetic nephropathy |
| Usual Dose | Telmisartan: 40-80 mg once daily; Losartan: 25-100 mg once daily |
| Max Daily Dose | Telmisartan: 80 mg/day; Losartan: 100 mg/day |
| Toxic Dose | Hypotension, hyperkalemia, acute renal failure |
| Specific Caution | Absolutely contraindicated in pregnancy. Hyperkalemia (avoid with K-sparing diuretics/K-supplements/ACE inhibitors). Monitor renal function. Do NOT combine ARB + ACE inhibitor (ONTARGET trial showed harm) |
25. Atorvastatin / Rosuvastatin (Statins)
Indian Brands: Atorva, Lipicure, Aztor (Atorvastatin); Rozavel, Crestor (Rosuvastatin)
| Action / Use | HMG-CoA reductase inhibitor. Reduces LDL, triglycerides; raises HDL. Reduces MI, stroke, and CV mortality. Used for dyslipidemia, primary and secondary cardiovascular prevention, diabetic patients |
| Usual Dose | Atorvastatin: 10-40 mg once daily (any time); Rosuvastatin: 5-20 mg once daily (evening) |
| Max Daily Dose | Atorvastatin: 80 mg/day; Rosuvastatin: 40 mg/day |
| Toxic Dose | Rhabdomyolysis (myoglobinuria, acute renal failure) at high doses especially with interacting drugs |
| Specific Caution | Myopathy/rhabdomyolysis - muscle pain/weakness; check CK if symptomatic. Contraindicated in pregnancy (teratogenic). Hepatotoxicity (baseline and periodic LFTs). Grapefruit juice interaction (Atorvastatin - CYP3A4). Never combine with gemfibrozil (extreme rhabdomyolysis risk). Rosuvastatin has higher potency but also higher Asian population blood levels - consider lower starting doses in Indians |
26. Clopidogrel
Indian Brands: Plavix, Clopivas, Deplatt, Clopilet
| Action / Use | ADP receptor (P2Y12) antagonist - antiplatelet. Irreversibly inhibits platelet aggregation. Used with aspirin as dual antiplatelet therapy (DAPT) after MI, stent placement, ACS, ischemic stroke prevention |
| Usual Dose | 75 mg once daily (maintenance); loading dose 300-600 mg (acute ACS) |
| Max Daily Dose | 75 mg/day (maintenance) |
| Toxic Dose | Major/fatal bleeding at any dose especially combined with anticoagulants |
| Specific Caution | CYP2C19 polymorphism (poor metabolizers - ~14% of Indian population - have reduced efficacy). PPIs reduce efficacy (omeprazole and esomeprazole most - use pantoprazole instead). Do NOT stop abruptly after coronary stenting (stent thrombosis risk). Hold 5-7 days before elective surgery |
27. Nitroglycerin / Isosorbide Mononitrate (Nitrates)
Indian Brands: Nitrostat (GTN); Imdur, Monolong (Isosorbide mononitrate)
| Action / Use | Nitric oxide donor → venodilation + coronary vasodilation → reduces preload, cardiac work, and angina. GTN sublingual: acute angina attack. Isosorbide mononitrate: angina prophylaxis, heart failure |
| Usual Dose | GTN sublingual: 0.3-0.5 mg PRN (repeat every 5 min x 3); Isosorbide mononitrate: 30-120 mg once daily (sustained release) |
| Max Daily Dose | Isosorbide mononitrate: 120 mg/day |
| Toxic Dose | Severe hypotension, reflex tachycardia, methemoglobinemia at excessive doses |
| Specific Caution | Nitrate tolerance - require a nitrate-free interval of 8-12 hrs daily (take SR form in morning). Absolute contraindication: PDE-5 inhibitors (sildenafil/tadalafil/vardenafil) - severe fatal hypotension. Hypotension (headache common due to vasodilation). Avoid in severe aortic stenosis, hypotension, obstructive HCM |
28. Furosemide
Indian Brands: Lasix, Frusenex, Frusemide
| Action / Use | Loop diuretic. Blocks Na-K-2Cl transporter in loop of Henle → profound diuresis. Used for acute pulmonary edema, heart failure, peripheral edema, hypertension, hypercalcemia, ascites |
| Usual Dose | 20-40 mg once/twice daily (oral); 20-40 mg IV (acute) |
| Max Daily Dose | 600 mg/day (refractory conditions) |
| Toxic Dose | Profound dehydration, hypokalemia → fatal arrhythmias |
| Specific Caution | Hypokalemia - always check potassium and supplement if needed (or add spironolactone). Hyponatremia, hypomagnesemia. Ototoxicity at high IV doses (especially with aminoglycoside antibiotics). Gout exacerbation. Hyperuricemia. Dehydration in elderly |
29. Digoxin
Indian Brands: Lanoxin, Digoxin (generic)
| Action / Use | Cardiac glycoside. Inhibits Na-K-ATPase → increases intracellular calcium → positive inotropy. Slows AV node conduction. Used for heart failure (rate control in AF) and atrial fibrillation with fast ventricular rate |
| Usual Dose | 0.125-0.25 mg once daily |
| Max Daily Dose | 0.25 mg/day (most patients; loading dose 0.5-1 mg over 24 hrs) |
| Toxic Dose | Very narrow therapeutic index - toxic range begins just above therapeutic. Digoxin toxicity level: >2 ng/mL |
| Specific Caution | Narrow therapeutic index - monitor serum levels (therapeutic: 0.5-2 ng/mL). Hypokalemia, hypomagnesemia, hypercalcemia dramatically increase toxicity risk. Renal failure - accumulation and toxicity (dose reduce significantly). Toxicity signs: bradycardia, heart block, nausea, visual disturbances (yellow-green halos), arrhythmias. Antidote: Digibind (Digoxin-specific antibody fragments) |
30. Hydrochlorothiazide (HCTZ) / Chlorthalidone
Indian Brands: HCT, Aquazide (HCTZ); combination products: Dytor Plus, Telma-H
| Action / Use | Thiazide diuretic. Inhibits Na-Cl symporter in distal convoluted tubule. Mild diuresis + vasodilation. Used for hypertension (first-line), heart failure, nephrogenic diabetes insipidus, hypercalciuria |
| Usual Dose | HCTZ: 12.5-25 mg once daily; Chlorthalidone: 12.5-25 mg once daily |
| Max Daily Dose | HCTZ: 50 mg/day (hypertension) |
| Toxic Dose | Hypokalemia, hyponatremia, hyperglycemia, hyperuricemia |
| Specific Caution | Hypokalemia (monitor K+). Hyperuricemia/gout exacerbation. Hyperglycemia (worsen diabetes control). Hyperlipidemia. Avoid in severe renal failure (eGFR <30 - ineffective). Photosensitivity. More effective in African/South Asian patients than ACE inhibitors as monotherapy |
CATEGORY 6: GASTROINTESTINAL DRUGS
31. Pantoprazole / Rabeprazole / Omeprazole (PPIs)
Indian Brands: Pan, Pantodac (Pantoprazole); Razo, Rablet (Rabeprazole); Omez, Ocid (Omeprazole)
| Action / Use | Proton pump inhibitor. Irreversibly blocks H+/K+-ATPase on parietal cells → profound acid suppression. Used for GERD, peptic ulcer, H. pylori eradication, NSAID-induced ulcer prevention, Zollinger-Ellison syndrome |
| Usual Dose | Pantoprazole: 40 mg once daily (30-60 min before breakfast); Rabeprazole: 20 mg once/twice daily; Omeprazole: 20 mg once daily |
| Max Daily Dose | Pantoprazole: 80 mg/day; Omeprazole: 80 mg/day |
| Toxic Dose | Very high therapeutic index; even overdose is usually non-fatal |
| Specific Caution | Long-term use (>1 year): hypomagnesemia, B12 deficiency, C. difficile infection, bone fractures (osteoporosis), hyponatremia. Omeprazole reduces clopidogrel efficacy (CYP2C19 inhibition) - use pantoprazole or rabeprazole in cardiac patients. Reassess need regularly; overuse is rampant in India |
32. Domperidone
Indian Brands: Domstal, Domperi, Vomistop, Motilium
| Action / Use | Peripheral dopamine D2 antagonist. Prokinetic and antiemetic. Does NOT cross blood-brain barrier significantly. Used for nausea/vomiting, gastroparesis, GERD, functional dyspepsia. Also used to increase breast milk production (galactagogue) |
| Usual Dose | 10 mg three times daily before meals (max 30 mg/day) |
| Max Daily Dose | 30 mg/day |
| Toxic Dose | QT prolongation and cardiac arrhythmias |
| Specific Caution | QT prolongation - avoid doses >30 mg/day and avoid in elderly (European Medicines Agency restricted to ≤10 mg TDS, max 10 days for safety). Avoid with other QT-prolonging drugs. Rare: galactorrhea, gynecomastia (prolactin elevation). Do NOT use domperidone as galactagogue in high-risk patients. Restricted in many countries but heavily used in India |
33. Ondansetron
Indian Brands: Emeset, Zofer, Ondanset, Perinorm (metoclopramide preferred in older patients)
| Action / Use | 5-HT3 receptor antagonist. Antiemetic. Used for chemotherapy-induced nausea/vomiting (CINV), post-operative nausea/vomiting (PONV), severe acute vomiting, radiation-induced nausea |
| Usual Dose | 4-8 mg every 8 hrs (oral or IV) |
| Max Daily Dose | 32 mg/day (IV - being revised to 16 mg/single IV dose) |
| Toxic Dose | QT prolongation → torsades de pointes; serotonin syndrome in combination with other serotonergic drugs |
| Specific Caution | QT prolongation - avoid with other QT-prolonging drugs; caution in hepatic impairment. Single IV dose limit now 16 mg (FDA revision). Avoid in congenital long QT syndrome. Constipation (common). Headache. Not first-line for routine gastroenteritis vomiting in children (use ORS first) |
34. Ranitidine / Famotidine (H2-Blockers)
Indian Brands: Zinetac, Rantac (Ranitidine - largely withdrawn); Famocid (Famotidine)
| Action / Use | H2-receptor antagonist. Reduces gastric acid secretion. Less potent than PPIs. Used for peptic ulcer, GERD, dyspepsia, prophylaxis of stress ulcers |
| Usual Dose | Famotidine: 20 mg twice daily or 40 mg once at night |
| Max Daily Dose | Famotidine: 40 mg/day (OTC); up to 160 mg/day (Zollinger-Ellison) |
| Toxic Dose | Confusion, agitation (especially elderly and renally impaired) |
| Specific Caution | Ranitidine has been largely withdrawn from Indian market (NDMA carcinogen contamination, 2020). Use famotidine instead. Dose reduce in renal impairment. Fewer drug interactions than PPIs |
35. Lactulose
Indian Brands: Looz, Duphalac, Lactugal
| Action / Use | Osmotic laxative. Increases osmotic pressure in colon, draws water in → soft stools. Also traps NH4+ in colon → used for hepatic encephalopathy (reduces ammonia absorption) |
| Usual Dose | Constipation: 15-30 mL once/twice daily; Hepatic encephalopathy: 30-45 mL 3-4x/day until 2-3 soft stools/day |
| Max Daily Dose | 90 mL/day (hepatic encephalopathy) |
| Toxic Dose | Electrolyte disturbances (hypokalemia, hypernatremia) with massive doses |
| Specific Caution | Galactosemia contraindication (contains galactose/lactose). Flatulence, abdominal cramps at start. Diabetic patients - contains sugar (use with caution). Do NOT use in bowel obstruction |
CATEGORY 7: DIABETES MEDICATIONS
36. Metformin
Indian Brands: Glycomet, Glumet, Metlong, Gluconorm
| Action / Use | Biguanide. Reduces hepatic glucose output, improves insulin sensitivity. No hypoglycemia when used alone. First-line for Type 2 Diabetes, also used in PCOS |
| Usual Dose | Start 500 mg twice daily with meals; titrate up to 1,000 mg twice daily |
| Max Daily Dose | 2,550 mg/day (practically 2,000 mg for tolerability) |
| Toxic Dose | Lactic acidosis (rare but potentially fatal - mortality ~50%) |
| Specific Caution | Stop if eGFR <30 mL/min; caution at eGFR 30-45. Hold 48 hrs before and after IV iodinated contrast (contrast nephropathy → lactic acidosis). Hold before major surgery. Avoid in hepatic impairment, congestive heart failure (active), sepsis, alcohol excess. Long-term B12 deficiency (monitor). GI side effects - take with food, use extended-release formulation |
37. Glimepiride / Glibenclamide (Sulfonylureas)
Indian Brands: Amaryl, Glimer (Glimepiride); Daonil (Glibenclamide/Glyburide)
| Action / Use | Stimulates insulin secretion from pancreatic beta cells (closes K-ATP channels). Used for Type 2 diabetes when metformin is insufficient |
| Usual Dose | Glimepiride: 1-4 mg once daily (with breakfast); Glibenclamide: 2.5-10 mg once/twice daily |
| Max Daily Dose | Glimepiride: 8 mg/day; Glibenclamide: 20 mg/day |
| Toxic Dose | Severe prolonged hypoglycemia (can be life-threatening, especially in elderly, fasting, renal impairment) |
| Specific Caution | Hypoglycemia is major risk - must not skip meals. Avoid glibenclamide in elderly and CKD (prolonged hypoglycemia). Glimepiride safer in mild-moderate renal impairment. Avoid in Type 1 diabetes. Weight gain. Cross-allergy with sulfa drugs |
38. Sitagliptin / Vildagliptin (DPP-4 Inhibitors)
Indian Brands: Januvia (Sitagliptin); Galvus (Vildagliptin); Zita, Sitamet (fixed dose combinations)
| Action / Use | Inhibits DPP-4 enzyme → increases incretin levels (GLP-1, GIP) → glucose-dependent insulin release. Low hypoglycemia risk when used alone. Used for Type 2 diabetes |
| Usual Dose | Sitagliptin: 100 mg once daily; Vildagliptin: 50 mg twice daily |
| Max Daily Dose | Sitagliptin: 100 mg/day (50 mg in moderate CKD; 25 mg in severe CKD) |
| Toxic Dose | Not well characterized; generally well tolerated |
| Specific Caution | Pancreatitis (rare but reported - stop if severe abdominal pain). Nasopharyngitis, upper respiratory infections common. Vildagliptin: hepatotoxicity risk - check LFTs every 3 months. Do not use vildagliptin if ALT/AST >3x ULN. Dose reduce sitagliptin in renal impairment |
39. Insulin (Regular / NPH / Glargine)
Indian Brands: Actrapid, Huminsulin-R (Regular); Insulatard, Huminsulin-N (NPH); Lantus, Basalog (Glargine); Novomix (Biphasic)
| Action / Use | Hormone - binds insulin receptor → facilitates glucose uptake. Regular insulin: short-acting (meals, acute hyperglycemia, DKA). NPH: intermediate-acting. Glargine (basal): long-acting (24 hr coverage). Type 1 DM, Type 2 DM (when oral agents fail), gestational diabetes, DKA, hyperglycemic emergencies |
| Usual Dose | Individualized - based on blood glucose monitoring |
| Max Daily Dose | No fixed maximum - titrated to glucose targets |
| Toxic Dose | Hypoglycemia at any dose greater than needed |
| Specific Caution | Hypoglycemia - most critical risk (tachycardia, sweating, confusion, seizures, death if severe). Never inject into a lipodystrophic area (erratic absorption). Rotate injection sites. Refrigerate unused vials. Glargine/detemir cannot be mixed with other insulins. Nocturnal hypoglycemia with NPH - consider switching to glargine. Monitor blood glucose regularly |
CATEGORY 8: RESPIRATORY / ALLERGY DRUGS
40. Salbutamol (Albuterol)
Indian Brands: Asthalin, Salbutol, Ventorlin, Derihaler
| Action / Use | Selective beta-2 agonist. Bronchodilator. Rescue/reliever inhaler for acute asthma and COPD exacerbations. Also used for premature labor tocolysis and hyperkalemia (IV) |
| Usual Dose | Inhaler MDI: 100-200 mcg (1-2 puffs) every 4-6 hrs PRN; Nebulizer: 2.5 mg every 20 min (acute) |
| Max Daily Dose | 800-1,600 mcg/day via inhaler (frequent use indicates uncontrolled asthma) |
| Toxic Dose | Tremor, tachycardia, hypokalemia, hyperglycemia at excessive doses |
| Specific Caution | Overuse masks poorly controlled asthma - predictive of near-fatal asthma. Tachycardia/palpitations (caution in cardiac disease). Hypokalemia at high doses (especially with thiazides/furosemide/steroids). Use with spacer for better lung delivery. Paradoxical bronchospasm possible (switch inhaler if occurs) |
41. Budesonide / Beclomethasone (Inhaled Corticosteroids)
Indian Brands: Budecort, Pulmicort (Budesonide); Beclate, Clenil (Beclomethasone)
| Action / Use | Inhaled corticosteroid (ICS). Reduces airway inflammation. Controller medication - does NOT provide immediate relief. Used for persistent asthma, eosinophilic COPD, non-allergic rhinitis |
| Usual Dose | Budesonide: 200-800 mcg/day in 1-2 divided doses; Beclomethasone: 200-1,600 mcg/day |
| Max Daily Dose | Budesonide: 1,600 mcg/day; Beclomethasone: 2,000 mcg/day (high dose) |
| Toxic Dose | Systemic corticosteroid effects at very high doses; local effects at standard doses |
| Specific Caution | Always rinse mouth after use (prevents oral candidiasis). Hoarseness (dysphonia). High-dose long-term ICS can cause adrenal suppression and osteoporosis. Safe in pregnancy (budesonide preferred). No bronchodilator effect - must use with SABA for acute attacks |
42. Levocetirizine / Cetirizine (Antihistamines)
Indian Brands: Levocet, Xyzal (Levocetirizine); Okacet, Zyrtec (Cetirizine)
| Action / Use | 2nd/3rd generation H1-receptor antagonist. Minimal sedation. Used for allergic rhinitis, urticaria, atopic dermatitis, allergic conjunctivitis, pruritus |
| Usual Dose | Levocetirizine: 5 mg once daily (evening); Cetirizine: 10 mg once daily |
| Max Daily Dose | Levocetirizine: 5 mg/day (2.5 mg in renal impairment); Cetirizine: 10 mg/day |
| Toxic Dose | QT prolongation in massive overdose |
| Specific Caution | Mild sedation possible (avoid driving if affected). Dose reduce in renal impairment. Avoid chlorpheniramine (Avil) in elderly (anticholinergic effects - urinary retention, confusion, glaucoma, falls - Beers Criteria). Levocetirizine slightly less sedating than cetirizine |
43. Montelukast
Indian Brands: Montair, Singulair, Mozep
| Action / Use | Leukotriene receptor antagonist (LTRA). Blocks CysLT1 receptor → reduces bronchospasm, mucus production, and eosinophilic inflammation. Used for asthma prophylaxis, allergic rhinitis, exercise-induced asthma. Very widely used in Indian children |
| Usual Dose | Adults: 10 mg once daily at night; Children 6-14 yrs: 5 mg once daily |
| Max Daily Dose | 10 mg/day (adults) |
| Toxic Dose | Not well characterized; low toxicity profile |
| Specific Caution | FDA (2020) and CDSCO Black Box Warning: Serious neuropsychiatric effects including agitation, aggression, hallucinations, depression, suicidal ideation/behavior. Assess risk especially in patients with anxiety or mental health disorders. NOT for acute asthma relief (no bronchodilator effect). Widely overused in India for non-evidence-based indications |
CATEGORY 9: CNS / NEUROLOGICAL / PSYCHIATRIC DRUGS
44. Phenytoin
Indian Brands: Eptoin, Dilantin
| Action / Use | Anticonvulsant. Stabilizes voltage-gated Na+ channels → reduces neuronal excitability. Used for generalized tonic-clonic seizures, partial seizures, status epilepticus (IV), trigeminal neuralgia |
| Usual Dose | 100-200 mg twice/thrice daily (oral); status epilepticus: 15-20 mg/kg IV slowly |
| Max Daily Dose | 600 mg/day (individualized by blood levels) |
| Toxic Dose | Very narrow therapeutic index - toxic range >20 mcg/mL. Therapeutic: 10-20 mcg/mL |
| Specific Caution | Narrow therapeutic index - monitor serum levels. Toxicity: nystagmus (early), ataxia, diplopia, confusion, seizure paradox at very high levels. Gingival hyperplasia (long-term). Teratogenic (fetal hydantoin syndrome) - avoid in pregnancy if possible. Multiple drug interactions (CYP inducer). Osteoporosis with long-term use. IV: do NOT exceed 50 mg/min (cardiac arrhythmia/hypotension) |
45. Carbamazepine
Indian Brands: Tegrital, Mazetol, Zeptol
| Action / Use | Anticonvulsant + mood stabilizer. Na+ channel blocker. Used for epilepsy (generalized and partial), trigeminal neuralgia, bipolar disorder, neuropathic pain |
| Usual Dose | 200 mg twice daily; titrate to 400-600 mg twice daily |
| Max Daily Dose | 1,600 mg/day |
| Toxic Dose | Aplastic anemia, agranulocytosis (idiosyncratic); hyponatremia; ataxia, diplopia at high levels (>12 mcg/mL) |
| Specific Caution | HLA-B*1502 allele (common in Asian Indians and South/East Asians) dramatically increases risk of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS/TEN) - DCGI recommends genetic testing before use in Indian/Asian patients. Aplastic anemia (rare). Hepatotoxicity. Strong CYP inducer - reduces levels of oral contraceptives, warfarin, other antiepileptics. Teratogenic (neural tube defects) - supplement folic acid. Monitor CBC and LFTs |
46. Sodium Valproate / Valproic Acid
Indian Brands: Encorate, Valparin, Valance, Epival
| Action / Use | Broad-spectrum anticonvulsant + mood stabilizer. Multiple mechanisms (Na+ channel blockade, GABA enhancement, T-type Ca2+ channel inhibition). Used for all seizure types (drug of choice for generalized epilepsy), bipolar disorder, migraine prophylaxis |
| Usual Dose | 200-500 mg twice/thrice daily; titrate to 1,000-2,000 mg/day |
| Max Daily Dose | 60 mg/kg/day (or 2,500 mg/day in adults) |
| Toxic Dose | Hepatic failure (especially in children <2 years on polytherapy); pancreatitis; hyperammonemic encephalopathy |
| Specific Caution | Highly teratogenic - Neural tube defects (1-2%), cognitive impairment in children born to mothers on valproate. Contraindicated in women of childbearing potential unless no alternative - DCGI and EMA warnings. Hepatotoxicity (especially in children <2 years). Weight gain. Polycystic ovaries. Thrombocytopenia. Monitor ammonia in confusion. Drug interaction with carbamazepine, phenytoin |
47. Alprazolam / Clonazepam (Benzodiazepines)
Indian Brands: Alprax, Restyl (Alprazolam); Rivotril, Lonazep (Clonazepam)
| Action / Use | GABA-A positive modulator → CNS sedation. Alprazolam: anxiety, panic disorder. Clonazepam: epilepsy (especially absence, myoclonic seizures), anxiety, restless legs syndrome |
| Usual Dose | Alprazolam: 0.25-0.5 mg three times daily; Clonazepam: 0.5-1 mg twice/thrice daily |
| Max Daily Dose | Alprazolam: 4 mg/day; Clonazepam: 20 mg/day (epilepsy) |
| Toxic Dose | Alone: high safety; combined with opioids or alcohol = fatal respiratory depression |
| Specific Caution | Physical dependence and addiction within 2-4 weeks. Never abruptly stop (withdrawal = seizures, delirium, death). Taper slowly over weeks. Avoid in elderly (falls, cognitive impairment - Beers Criteria). Respiratory depression (avoid in sleep apnea, COPD). Sedation - do not drive. Alprazolam - Schedule H drug in India, high abuse potential |
48. Amitriptyline
Indian Brands: Tryptomer, Elavil, Amitril
| Action / Use | Tricyclic antidepressant (TCA). Inhibits serotonin + norepinephrine reuptake; also antihistaminic, anticholinergic. Used for depression (less used now), neuropathic pain (small fiber neuropathy, post-herpetic neuralgia, diabetic neuropathy), migraine prophylaxis, fibromyalgia, insomnia (low dose) |
| Usual Dose | Neuropathic pain/migraine: 10-25 mg at night; Depression: 75-150 mg/day in divided doses |
| Max Daily Dose | 150-300 mg/day |
| Toxic Dose | Cardiotoxic in overdose - QRS widening, ventricular arrhythmias, hypotension, anticholinergic toxidrome. Toxic dose: as low as 10-20 mg/kg |
| Specific Caution | Very dangerous in overdose - TCA overdose is a medical emergency (sodium bicarbonate antidote for cardiac arrhythmias). Anticholinergic effects: urinary retention, constipation, blurred vision, dry mouth. Avoid in elderly, BPH, glaucoma, recent MI. Sedation (take at night). Do NOT combine with MAOIs. |
CATEGORY 10: THYROID MEDICATIONS
49. Levothyroxine (T4)
Indian Brands: Thyronorm, Eltroxin
| Action / Use | Synthetic T4 thyroid hormone. Replaces endogenous thyroid hormone. Used for hypothyroidism (very common in India, especially women), thyroid cancer suppression post-thyroidectomy |
| Usual Dose | ~1.6 mcg/kg/day; start at 25-50 mcg in elderly/cardiac disease; average adult ~100-125 mcg |
| Max Daily Dose | Titrate to TSH (no fixed max; suppression therapy may require higher doses) |
| Toxic Dose | Thyrotoxicosis: palpitations, AF, angina, weight loss, tremor, bone loss |
| Specific Caution | Take on empty stomach 30-60 min before breakfast. Food, calcium, iron, antacids, PPIs reduce absorption (take 4 hrs apart). Dose requirement increases in pregnancy (~30-50% increase - adjust immediately). Start low and go slow in cardiac patients (risk of angina/MI with rapid initiation). Monitor TSH every 6-12 weeks until stable, then annually |
50. Carbimazole / Propylthiouracil (PTU) - Antithyroid Drugs
Indian Brands: Neomercazole (Carbimazole); Propycil (PTU)
| Action / Use | Thionamides. Inhibit thyroid peroxidase → reduce T3/T4 synthesis. Carbimazole is prodrug of methimazole. Used for hyperthyroidism (Graves' disease, toxic goiter, thyroid storm) |
| Usual Dose | Carbimazole: 15-60 mg/day (in divided doses initially); maintenance 5-15 mg/day; PTU: 100-200 mg every 8 hrs initially |
| Max Daily Dose | Carbimazole: 60 mg/day; PTU: 600 mg/day |
| Toxic Dose | Agranulocytosis (most dangerous) |
| Specific Caution | Agranulocytosis (~0.2-0.5%) - warn patient to report sore throat/fever immediately (stop drug and check CBC). Hepatotoxicity (PTU > carbimazole). PTU preferred in first trimester of pregnancy and thyroid storm; carbimazole preferred thereafter (teratogenic in first trimester - aplasia cutis, choanal atresia). Monitor thyroid function every 4-6 weeks |
CATEGORY 11: VITAMINS & SUPPLEMENTS
51. Calcium + Vitamin D3
Indian Brands: Shelcal, Calcimax, Ostocalcium, Calshine
| Action / Use | Calcium carbonate/citrate (elemental calcium source) + Cholecalciferol (D3). Bone mineralization. Used for osteoporosis prevention/treatment, rickets, osteomalacia, calcium deficiency, hypoparathyroidism, during pregnancy/lactation |
| Usual Dose | Calcium: 500-1,000 mg elemental calcium/day; Vit D3: 400-800 IU/day (deficiency: 1,000-2,000 IU/day or weekly 60,000 IU for loading) |
| Max Daily Dose | Calcium: 2,500 mg/day elemental; Vitamin D3: up to 4,000 IU/day (safe upper limit) |
| Toxic Dose | Calcium: hypercalcemia, kidney stones, milk-alkali syndrome (>2,500 mg/day); Vit D: toxicity at prolonged >10,000 IU/day |
| Specific Caution | Take calcium carbonate with food (requires acid for absorption); calcium citrate can be taken without food. Calcium reduces absorption of thyroxine, iron, fluoroquinolones, bisphosphonates (separate by 2-4 hrs). Calcium supplements (not dietary) linked to small increase in cardiovascular risk - reassess regularly |
52. Iron (Ferrous Sulfate / Ferrous Ascorbate)
Indian Brands: Feronia, Autrin, Feriron, Orofer, Haemaccel
| Action / Use | Iron supplementation. Essential for hemoglobin synthesis. Used for iron-deficiency anemia (very prevalent in India, especially in women, children, pregnant women), as supplement during pregnancy |
| Usual Dose | Ferrous sulfate: 200 mg twice/thrice daily (60 mg elemental iron per tablet); Ferrous ascorbate: 100 mg once daily |
| Max Daily Dose | 200 mg elemental iron/day (therapeutic) |
| Toxic Dose | Acute iron poisoning: >60 mg/kg elemental iron in children (necrotizing gastroenteritis, metabolic acidosis, multiorgan failure). GI toxicity starts at >20 mg/kg |
| Specific Caution | Take on empty stomach for best absorption (but with food if GI upset). GI side effects common: nausea, constipation, black stools. Avoid with antacids, dairy, tea (reduces absorption). Separate from levothyroxine by 4 hrs. Do NOT give IV iron in active infection. Antidote for acute poisoning: Deferoxamine |
53. Folic Acid
Indian Brands: Folvite, Folinal, Vitafol
| Action / Use | B-vitamin (B9). Essential for DNA synthesis and cell division. Used for megaloblastic anemia (folate deficiency), neural tube defect prevention in pregnancy, methotrexate-induced folate deficiency |
| Usual Dose | Deficiency treatment: 5 mg once daily; Pregnancy prophylaxis: 0.4-5 mg/day |
| Max Daily Dose | 5 mg/day (standard therapeutic) |
| Toxic Dose | Very low toxicity - high doses can mask B12 deficiency neurological signs |
| Specific Caution | High-dose folic acid can mask Vitamin B12 deficiency (corrects anemia but allows neurological damage to progress - subacute combined degeneration of spinal cord). Always check B12 before treating macrocytic anemia with folic acid alone. High-risk pregnancy (epilepsy patients on valproate/carbamazepine, prior NTD) should receive 5 mg/day |
CATEGORY 12: ANTIMALARIALS
54. Chloroquine / Hydroxychloroquine
Indian Brands: Lariago (Chloroquine); HCQs, Plaquenil (Hydroxychloroquine)
| Action / Use | 4-aminoquinoline. Interferes with heme polymerization in P. falciparum. Chloroquine: malaria treatment (chloroquine-sensitive P. vivax - prevalent in India). Hydroxychloroquine: rheumatoid arthritis, SLE, lupus nephritis |
| Usual Dose | Chloroquine (malaria): 600 mg base on Day 1, 300 mg at 6 hrs, then 300 mg/day x 2 days; HCQ (RA/SLE): 200-400 mg/day |
| Max Daily Dose | Chloroquine: varies by indication; HCQ: 400 mg/day (≤5 mg/kg/day to minimize retinal toxicity) |
| Toxic Dose | Chloroquine: cardiac arrhythmias and CNS effects; 2.5-3 g in adults can be fatal |
| Specific Caution | Retinal toxicity (hydroxychloroquine >5 mg/kg/day or >5 years) - annual ophthalmology screening required. QT prolongation (cardiac arrhythmia risk). G6PD deficiency - avoid chloroquine (hemolysis). Chloroquine resistance increasingly common in India for P. falciparum - check local resistance patterns. Myopathy and neuropathy with long-term use |
55. Artemether + Lumefantrine
Indian Brands: Coartem, LA-Malarin, Artemether-Lumefantrine (generic)
| Action / Use | Artemisinin-based combination therapy (ACT). First-line for uncomplicated P. falciparum malaria in India. Artemether: rapid parasite reduction; Lumefantrine: prevents recrudescence |
| Usual Dose | Weight-based 6-dose regimen over 3 days: 80 mg/480 mg (4 tablets) at 0, 8, 24, 36, 48, and 60 hrs (adult >35 kg) |
| Max Daily Dose | Per protocol regimen (no additional dosing) |
| Toxic Dose | QT prolongation; hemolytic anemia in G6PD deficiency |
| Specific Caution | Take with fatty food (lumefantrine absorption greatly enhanced). QT prolongation - avoid in cardiac arrhythmias. G6PD deficiency (check before use). Do NOT use artemisinin monotherapy (promotes resistance). WHO-recommended; increasingly important given rising falciparum resistance |
CATEGORY 13: SKIN / TOPICAL DRUGS
56. Clotrimazole / Ketoconazole / Fluconazole (Antifungals)
Indian Brands: Candid, Canesten (Clotrimazole); Nizoral, Ketostar (Ketoconazole); Zocon (Fluconazole systemic)
| Action / Use | Inhibit ergosterol synthesis in fungal cell membrane. Clotrimazole: topical for dermatophytosis (ringworm, tinea), candidal infections (vaginal, oral). Ketoconazole: systemic fungal infections (historically); topical/shampoo for pityriasis versicolor, seborrheic dermatitis |
| Usual Dose | Clotrimazole cream: apply 2-3x/day for 2-4 weeks; Ketoconazole 2% shampoo: twice weekly |
| Max Daily Dose | Per topical instruction; systemic ketoconazole 200-400 mg/day |
| Toxic Dose | Systemic ketoconazole: fatal hepatotoxicity |
| Specific Caution | Oral ketoconazole largely withdrawn/restricted globally due to severe hepatotoxicity and drug interactions - topical use is safe. Systemic antifungals: multiple CYP interactions. Complete full course to prevent relapse of tinea infections (very common in Indian climate) |
57. Betamethasone / Mometasone (Topical Corticosteroids)
Indian Brands: Betnovate, Diprovate (Betamethasone); Elocon, Momate (Mometasone)
| Action / Use | Topical glucocorticoids. Anti-inflammatory, antipruritic, vasoconstrictive. Used for eczema, psoriasis, contact dermatitis, seborrheic dermatitis, lichen planus, allergic skin reactions |
| Usual Dose | Apply thin layer 1-2x/day to affected area |
| Max Daily Dose | Limit to prescribed area and duration |
| Toxic Dose | Systemic absorption with extensive use → adrenal suppression; local effects |
| Specific Caution | STEROID MISUSE IS A MAJOR PROBLEM IN INDIA - sold OTC and widely misused for skin lightening, acne, ringworm (fatal: steroid fungus syndrome). Long-term facial use: skin atrophy, telangiectasia, striae, perioral dermatitis, steroid acne. Never use on face with potent steroids (betamethasone). Do NOT use on infected skin without antifungal cover. Do NOT use >4 weeks on body; >2 weeks on face |
CATEGORY 14: PAIN MODIFIERS / NEUROPATHIC PAIN
58. Pregabalin / Gabapentin
Indian Brands: Pregalin, Lyrica (Pregabalin); Gabantin, Neurontin (Gabapentin)
| Action / Use | Alpha-2-delta calcium channel subunit blocker → reduces neurotransmitter release. Used for neuropathic pain (diabetic neuropathy - very common in India, post-herpetic neuralgia, fibromyalgia), epilepsy adjunct, generalized anxiety disorder (pregabalin) |
| Usual Dose | Pregabalin: 75 mg twice daily; titrate to 150-300 mg twice daily; Gabapentin: 300 mg 3x/day |
| Max Daily Dose | Pregabalin: 600 mg/day; Gabapentin: 3,600 mg/day |
| Toxic Dose | CNS depression, respiratory failure (especially with opioids/benzodiazepines) |
| Specific Caution | Dose reduce in renal impairment (renally excreted). Sedation, dizziness, weight gain, peripheral edema. Abuse potential (euphoric high - increasingly abused in India). FDA Black Box Warning: Respiratory depression risk, especially combined with opioids or CNS depressants. Never abruptly stop (withdrawal seizures). Schedule H1 drug in India |
COMPREHENSIVE SUMMARY TABLE - India-Specific Quick Reference
| # | Generic Name | Indian Brands | Category | Primary Use | Usual Dose | Max Dose | Toxic / Danger Zone | Critical Caution |
|---|---|---|---|---|---|---|---|---|
| 1 | Paracetamol | Crocin, Dolo 650 | Analgesic/Antipyretic | Pain, Fever | 500-650 mg q4-6h | 4 g/day | ≥15 g = fatal liver failure | Liver disease; never combine multiple products |
| 2 | Ibuprofen | Brufen, Combiflam | NSAID | Pain, Inflammation | 200-400 mg q6-8h | 3,200 mg/day | Chronic excess: GI bleed, AKI | Dengue; peptic ulcer; renal disease |
| 3 | Diclofenac | Voveran, Dynapar | NSAID | Pain, Arthritis | 50 mg BD-TDS | 150 mg/day | >150 mg/day chronic | Highest CV risk NSAID |
| 4 | Nimesulide | Nimulid, Nise | NSAID | Fever, Pain | 100 mg BD | 200 mg/day | Hepatotoxicity even at normal dose | Banned in children <12 in India |
| 5 | Aceclofenac | Zerodol, Hifenac | NSAID | Arthritis, Pain | 100 mg BD | 200 mg/day | GI bleed, AKI | Take with food; avoid in pregnancy |
| 6 | Aspirin | Ecosprin, Disprin | Antiplatelet/NSAID | CV prevention, Pain | 75-150 mg/day (antiplatelet) | 4 g/day (analgesic) | >150 mg/kg = salicylism | Never give children <16 with viral illness (Reye's) |
| 7 | Amoxicillin | Mox, Novamox | Antibiotic (penicillin) | RTI, UTI, dental | 250-875 mg q8-12h | 3-6 g/day | Seizures at extreme doses | Penicillin allergy; avoid in mono |
| 8 | Amox-Clavulanate | Augmentin, Clavam | Antibiotic (extended) | Broader infections | 625 mg BD-TDS | 3 g amoxicillin/day | Cholestatic hepatitis | Penicillin allergy; take with food |
| 9 | Cefixime | Taxim-O, Zifi | Antibiotic (3rd gen oral) | UTI, RTI, typhoid | 200-400 mg OD-BD | 400 mg/day | C. diff at high/prolonged use | Cephalosporin allergy; renal dose adjust |
| 10 | Ceftriaxone | Monocef, Oframax | Antibiotic (3rd gen IV) | Severe infections | 1-2 g IV OD | 4 g/day | Biliary sludge | No calcium IV in neonates |
| 11 | Azithromycin | Azithral, Azee | Antibiotic (macrolide) | Atypical pneumonia, STI | 500 mg OD x 3-5 days | 500 mg/day | QT prolongation | Cardiac arrhythmia; overuse→resistance |
| 12 | Ciprofloxacin | Ciplox, Cifran | Antibiotic (FQ) | UTI, typhoid, GI | 250-500 mg BD | 1,500 mg/day | Tendon rupture, seizures | Avoid children; tendinopathy |
| 13 | Ofloxacin/Levofloxacin | Oflox, Levoflox | Antibiotic (FQ) | RTI, UTI, TB (2nd line) | 400 mg BD / 500-750 mg OD | 800 mg/day / 750 mg/day | QT prolongation | Avoid epilepsy; renal dose adjust |
| 14 | Doxycycline | Doxrid, Doxt | Antibiotic (tetracycline) | Scrub typhus, atypical inf. | 100 mg BD | 200 mg/day | IV >2g/day in preg. = hepatic failure | No children <8; no pregnancy |
| 15 | Metronidazole | Flagyl, Metrogyl | Antibiotic/antiprotozoal | Amoebiasis, anaerobes | 400 mg TDS | 4 g/day | Neuropathy at prolonged high dose | No alcohol; avoid 1st trimester |
| 16 | Co-trimoxazole | Septran, Bactrim | Antibiotic (sulfonamide) | UTI, PCP | 960 mg BD | 1,920 mg/day | SJS, aplastic anemia | Sulfa allergy; G6PD; no neonates |
| 17 | Isoniazid | Isokin, 4FDC | Anti-TB | Tuberculosis | 5 mg/kg/day (max 300 mg) | 300 mg/day | Seizures at >10-15 mg/kg | Always give Pyridoxine B6 with it |
| 18 | Rifampicin | R-Cin, 4FDC | Anti-TB | Tuberculosis | 10 mg/kg/day (max 600 mg) | 600 mg/day | Fulminant hepatitis | Potent CYP inducer; OCP failure |
| 19 | Fluconazole | Flucos, Zocon | Antifungal | Candidiasis, Cryptococcal | 100-400 mg OD | 800 mg/day | QT prolongation; hepatotoxicity | Pregnancy contraindicated; CYP interactions |
| 20 | Albendazole | Zentel, Bandy | Antihelmintic | Worm infestations | 400 mg single dose | 800 mg/day | Hepatotoxicity (prolonged use) | Contraindicated in pregnancy |
| 21 | Amlodipine | Amlip, Stamlo | CCB | Hypertension, Angina | 5 mg OD | 10 mg/day | Severe hypotension in overdose | Pedal edema; avoid grapefruit |
| 22 | Atenolol/Metoprolol | Aten, Met-XL | Beta-blocker | HTN, Angina, Arrhythmia | 25-100 mg OD-BD | 100-200 mg/day | Bradycardia, HF, bronchospasm | Never stop abruptly |
| 23 | Enalapril/Ramipril | Envas, Cardace | ACE Inhibitor | HTN, HF, DKD | 5-10 mg OD-BD | 40 mg/day | Hypotension, AKI, hyperkalemia | No pregnancy; dry cough; angioedema |
| 24 | Telmisartan/Losartan | Telma, Losar | ARB | HTN, HF, DKD | 40-80 mg / 25-100 mg OD | 80 mg / 100 mg/day | Hyperkalemia, AKI | No pregnancy; don't combine with ACE-I |
| 25 | Atorvastatin/Rosuvastatin | Lipicure, Rozavel | Statin | Dyslipidemia, CV prevention | 10-40 mg OD | 80 mg / 40 mg/day | Rhabdomyolysis | No pregnancy; no gemfibrozil combo |
| 26 | Clopidogrel | Plavix, Deplatt | Antiplatelet | Post-MI, stent, ACS | 75 mg OD | 75 mg/day | Bleeding | CYP2C19 polymorphism; avoid omeprazole |
| 27 | Isosorbide Mononitrate | Imdur, Monolong | Nitrate | Angina, HF | 30-60 mg OD (SR) | 120 mg/day | Hypotension; methemoglobinemia | Fatal with sildenafil/tadalafil |
| 28 | Furosemide | Lasix, Frusenex | Loop diuretic | Heart failure, Edema, HTN | 20-40 mg OD-BD | 600 mg/day | Hypokalemia → arrhythmia | Ototoxicity; gout; dehydration |
| 29 | Digoxin | Lanoxin | Cardiac glycoside | AF rate control, HF | 0.125-0.25 mg OD | 0.25 mg/day | Toxic at >2 ng/mL serum level | Narrow TI; hypokalemia increases toxicity |
| 30 | HCTZ | Combo products | Thiazide diuretic | Hypertension | 12.5-25 mg OD | 50 mg/day | Hypokalemia, hyponatremia | Gout; hyperglycemia |
| 31 | Pantoprazole/Rabeprazole | Pan, Razo | PPI | GERD, PUD, H. pylori | 40 mg OD before breakfast | 80 mg/day | High TI; rarely dangerous in OD | Long-term: B12, Mg deficiency, bones |
| 32 | Domperidone | Domstal, Domperi | Prokinetic/Antiemetic | Nausea, Gastroparesis | 10 mg TDS | 30 mg/day | QT prolongation | Max 10 days per EMA; avoid elderly |
| 33 | Ondansetron | Emeset, Zofer | 5-HT3 antagonist | CINV, PONV, severe nausea | 4-8 mg q8h | 32 mg/day | QT prolongation, arrhythmia | IV single dose ≤16 mg; hepatic dose adjust |
| 34 | Famotidine | Famocid | H2-blocker | GERD, PUD | 20 mg BD | 40-160 mg/day | Confusion in elderly | Renal dose adjust; Ranitidine withdrawn |
| 35 | Lactulose | Looz, Duphalac | Osmotic laxative | Constipation, Hepatic enc. | 15-30 mL BD | 90 mL/day | Electrolyte imbalance | Galactosemia contraindicated |
| 36 | Metformin | Glycomet, Glumet | Biguanide | Type 2 DM, PCOS | 500-1000 mg BD with meals | 2,550 mg/day | Lactic acidosis | Stop if eGFR <30; hold before contrast |
| 37 | Glimepiride | Amaryl, Glimer | Sulfonylurea | Type 2 DM | 1-4 mg OD | 8 mg/day | Severe prolonged hypoglycemia | Avoid in elderly, CKD; never skip meals |
| 38 | Sitagliptin | Januvia, Zita | DPP-4 inhibitor | Type 2 DM | 100 mg OD | 100 mg/day | Pancreatitis (rare) | Dose reduce in CKD; check LFTs |
| 39 | Insulin (glargine etc.) | Lantus, Basalog | Hormone | Type 1 and 2 DM | Individualized | Titrated to glucose | Hypoglycemia at any excess dose | Rotate injection sites; do not mix glargine |
| 40 | Salbutamol | Asthalin, Ventorlin | SABA | Acute Asthma/COPD | 100-200 mcg PRN inhaler | 800-1600 mcg/day | Tachycardia, hypokalemia | Overuse masks uncontrolled asthma |
| 41 | Budesonide (inhaled) | Budecort, Pulmicort | ICS | Asthma controller | 200-800 mcg/day | 1,600 mcg/day | Systemic effects at very high doses | Rinse mouth after use; not for acute attacks |
| 42 | Levocetirizine | Levocet, Xyzal | Antihistamine | Allergy, Urticaria | 5 mg OD (night) | 5 mg/day | QT (massive overdose) | Renal dose adjust; mild sedation |
| 43 | Montelukast | Montair, Singulair | LTRA | Asthma, Allergic rhinitis | 10 mg OD night | 10 mg/day | Not well characterized | Black Box: neuropsychiatric effects |
| 44 | Phenytoin | Eptoin | Anticonvulsant | Epilepsy, SE | 100-200 mg BD-TDS | 600 mg/day | Toxic >20 mcg/mL | Narrow TI; teratogenic; gingival hyperplasia |
| 45 | Carbamazepine | Tegrital, Mazetol | Anticonvulsant | Epilepsy, TN, Bipolar | 200-400 mg BD | 1,600 mg/day | SJS/TEN (especially HLA-B*1502) | Test HLA-B*1502 in Indian patients |
| 46 | Sodium Valproate | Encorate, Valparin | Anticonvulsant | Epilepsy, Bipolar | 200-500 mg BD-TDS | 2,500 mg/day | Hepatic failure in children <2; encephalopathy | Teratogenic - avoid in women of childbearing age |
| 47 | Alprazolam/Clonazepam | Alprax, Rivotril | Benzodiazepine | Anxiety, Epilepsy | 0.25-1 mg BD-TDS | 4 mg / 20 mg/day | Fatal with opioids + alcohol | Dependence; never abruptly stop |
| 48 | Amitriptyline | Tryptomer | TCA | Neuropathic pain, Depression | 10-75 mg at night | 150-300 mg/day | Cardiac arrhythmia in overdose ≥10 mg/kg | Very dangerous in OD; sodium bicarb antidote |
| 49 | Levothyroxine | Thyronorm, Eltroxin | Thyroid hormone | Hypothyroidism | ~1.6 mcg/kg/day | TSH-guided | Thyrotoxicosis at excess | Empty stomach; no Ca/Fe within 4 hrs |
| 50 | Carbimazole | Neomercazole | Antithyroid | Hyperthyroidism | 15-60 mg/day | 60 mg/day | Agranulocytosis | Report sore throat/fever immediately |
| 51 | Calcium + Vit D3 | Shelcal, Calcimax | Supplement | Osteoporosis, Deficiency | 500-1000 mg Ca + 400-800 IU D3 | 2,500 mg Ca/day; 4,000 IU D3/day | Hypercalcemia, kidney stones | Separate from iron/levothyroxine by 4 hrs |
| 52 | Iron (Ferrous Sulfate) | Feronia, Autrin | Supplement | Iron-deficiency anemia | 200 mg FeSO4 BD-TDS | 200 mg elemental/day | >60 mg/kg in children = fatal | Antidote: Deferoxamine; separate from Ca, tea |
| 53 | Folic Acid | Folvite | Vitamin | Anemia, Pregnancy | 5 mg OD (treatment) | 5 mg/day | Very low toxicity | Can mask B12 deficiency |
| 54 | Chloroquine/HCQ | Lariago/Plaquenil | Antimalarial | Malaria, SLE, RA | Varies by indication | 400 mg HCQ/day | 2.5-3 g CQ can be fatal | Retinal toxicity; annual eye check; G6PD |
| 55 | Artemether+Lumefantrine | Coartem | Antimalarial | Falciparum malaria | 6-dose 3-day regimen | Protocol regimen | QT prolongation | Take with fatty food; G6PD |
| 56 | Clotrimazole (topical) | Candid, Canesten | Antifungal (topical) | Tinea, Candidiasis | Apply 2-3x/day | Per instruction | Local only; systemic rare | Complete full course |
| 57 | Betamethasone (topical) | Betnovate, Diprovate | Topical steroid | Eczema, Psoriasis, Dermatitis | Thin layer 1-2x/day | Limited to area | Systemic absorption; skin atrophy | Massive misuse in India for skin lightening |
| 58 | Pregabalin | Pregalin, Lyrica | Neuropathic pain | Diabetic neuropathy, Fibromyalgia | 75-300 mg BD | 600 mg/day | Resp. depression with opioids | Abuse potential; renal dose reduction |
Key Abbreviations: OD = once daily, BD = twice daily, TDS = three times daily, QDS = four times daily, PRN = as needed, RTI = respiratory tract infection, UTI = urinary tract infection, HTN = hypertension, HF = heart failure, DM = diabetes mellitus, DKD = diabetic kidney disease, AF = atrial fibrillation, AKI = acute kidney injury, GI = gastrointestinal, CNS = central nervous system, CV = cardiovascular, CKD = chronic kidney disease, TI = therapeutic index, ICS = inhaled corticosteroid, SABA = short-acting beta-2 agonist, LTRA = leukotriene receptor antagonist, FQ = fluoroquinolone, PUD = peptic ulcer disease, GERD = gastroesophageal reflux disease, TCA = tricyclic antidepressant, TN = trigeminal neuralgia, SE = status epilepticus, SJS = Stevens-Johnson syndrome, PCOS = polycystic ovary syndrome, OCP = oral contraceptive pill, OD = overdose (in context), NLEM = National List of Essential Medicines.
Sources: National List of Essential Medicines India (NLEM), Katzung's Basic and Clinical Pharmacology (16th Ed), Goodman & Gilman's Pharmacological Basis of Therapeutics, Harrison's Principles of Internal Medicine (22nd Ed), Goldman-Cecil Medicine, WHO Essential Medicines List 2025, DCGI (Drugs Controller General of India) drug advisories.
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