Side-effects repeat oral dosing

In this condition, ephedrine is used primarily as a chronic medication for mild or only moderately acute cases, especially in children. In severe asthma, the response to ephedrine is usually poor. Compared with epinephrine, ephedrine is less reliable, is slower in action and longer in duration, and probably more often produces undesirable side effects. The average dose is 25 to 50 mg, orally, repeated three or four times a day. Resistance often develops it may often be controlled by discontinuing the drug for a few days. In many patients, ephedrine produces anxiety, nervousness, and insomnia, so a barbiturate is often administered at the same time. Capsules containing either 15 mg of amobarbital, 25 mg of pentobarbital sodium, or 30 mg of phenobarbital in addition to 25 mg of ephedrine sulfate have been used in the past. 

Corticosteroids have been used to treat a variety of ocular diseases. Traditionally, delivery of corticosteroids for posterior-segment eye diseases has been achieved through oral systemic therapy and periocular injections. Oral corticosteroids have not been widely used to treat DME, but when used for posterior inflammatory uveitis, they require high concentrations to reach therapeutic levels in the posterior segment. These high doses often result in systemic side effects (24). Periocular corticosteroid administration often must be repeated and may be associated with complications such as ptosis and inadvertent needle penetration of the globe. 

B. Parenteral injection is an alternate route of administration, but is not likely to result in more rapid reversal of anticoagulant effects, and is associated with potentially serious side effects. If hemorrhage is present, use fresh frozen plasma for rapid replacement of coagulation factors. Subcutaneous administration is preferred over IM injection, although both can cause hematomas. The maximum volume is 5 mL or 50 mg per dose per injection site. The adult dose is 10-25 mg, and that tor children is 1-5 mg this may be repeated in 6-8 hours. Switch to oral therapy as soon as possible. Intravenous administration is rarely used because of the risk of anaphylactoid reaction. The usual dose is 10-25 mg (0.6 mg/kg in children under 12 years), depending on the severity of anticoagulation, diluted in preservative-free dextrose or sodium chloride solution. Give slowly at a rate not to exceed 1 mg/min or 5% of the total dose per minute, whichever is slower. 

In this study patients were treated for up to 83 days with these intravenous cimetidine doses without side-effects or loss of efficacy. Another recent study [68] demonstrated that continuous intravenous infusion of ranitidine at 100% of the previously effective oral equivalent dose will effectively control acid output in 95 % of patients with ZES, thus limiting the need for repeated dose adjustments and gastric output assessment in patients who require parenteral therapy. It must be stressed, however, that the adequacy of the administered dose should be checked by measuring acid output after a few hours to ensure that acid output is less than 10 mEq/h. It was recommended [14, 35, 66] that acid output be rechecked... 

We have observed that for the initiation of effective therapy, 50 to 100 mg have to be administered orally which is at the upper limit of toxic effects as mentioned above. In the last 2 years, we have treated patients for 2 weeks with local 0.1% vitamin A acid until this treatment becomes irritant and then we commence oral treatment. The oral dosage can be reduced to about 20 mg twice daily and after 4 weeks to about 10 mg twice daily. Simultaneously, local treatment can be reduced below the development of irritancy by application of 0.05% vitamin A acid ointment and in some cases we can reduce the vitamin A acid concentration in the ointment to 0.01% (Figure 22.2). Thus the side effects of local and oral therapy can be avoided by combination of both types of treatment which suggests that in the future when programming the therapy of ichthyotic patients, the combination of local and oral therapy should be considered. When we have stopped oral therapy and tried to initiate a maintenance treatment with local vitamin A acid at low concentrations, relapses occur within 2 months. After the re-appearance of ichthyotic lesions, oral administration of vitamin A acid at the lower dose was repeated with satisfactory results. 

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