ICC-2 — Pharmacology: GIT, Hepatobiliary, Rheumatology & Orthopaedics
Written by Betra Youhanna, a medical student and not a doctor — check every detail against your own teaching.
lecture-sourced finals-triage sheet · 239 drugs across 35 classes · GIT · Hepatobiliary · Rheumatology · Orthopaedics · Vascular Medicine · Haematology
Indications
Side effects
★ High-yield (SBA-flagged)
#NNN = source card · gaps =
Indications
- ★ GERD / PUD acid suppression — healing 20–40 mg daily, prevention 20 mg daily
- Non-variceal upper-GI bleed — first-line PPI
- Zollinger–Ellison syndrome — high-dose acid suppression
- Component of levofloxacin quadruple (LOAD) H. pylori regimen
Indications
- ★ GERD / PUD — lecturer-priority PPI; healing 20–40 mg, prevention 20 mg daily
- SSc reflux/oesophagitis (as a PPI)
Indications
- ★ GERD / PUD — lecturer-priority PPI; healing 40 mg (no 20 mg healing option, unlike others), prevention 20–40 mg
- IV PPI infusion in acute bleeding PU resuscitation bundle
Indications
- GERD / PUD — healing 15–30 mg, prevention 15 mg daily
- Zollinger–Ellison syndrome — high-dose acid suppression
Indications
- GERD / PUD — healing 20 mg, prevention 20 mg daily
Indications
- Acid suppression in GERD — compete with K⁺ at H⁺/K⁺-ATPase (reversible); acid-stable, longer-lasting, fewer interactions than PPIs
Indications
- ★ Main H2-RA — 40 mg healing / 20 mg maintenance
- Acid suppression in bleeding PU (IV H2 blocker); ZES adjunct
Indications
- GERD step-up (150 mg BD); H2-RA 150–300 mg BD
Side effects
- NDMA contamination concern — safety debated
Side effects
- ★ multiple drug interactions — why it is not commonly used
Indications
- Neutralise gastric acid — GERD step-up; frequent/liberal use in bleeding PU
Side effects
- Aluminium salts constipating; magnesium salts laxating
Indications
- Acid-neutralising component of Maalox / Mylanta
Indications
- Anti-gas/flatulence surfactant (component of Mylanta) — breaks up gas bubbles
Indications
- ★ Bismuth quadruple therapy — current first-line H. pylori eradication
Indications
- Antiemetic — D2 blockade at CTZ/area postrema
- Prokinetic — D2 blockade in gut ↑ motility; SSc dysmotility
Indications
- Prokinetic — GERD (no concrete evidence); SSc dysmotility
- Antiemetic — butyrophenone D2 antagonist
Indications
- Prokinetic tried in GERD (no concrete evidence)
Indications
- Nausea/vomiting, esp. vestibular / motion sickness (H1 + muscarinic pathway)
Indications
- ★ Chemotherapy-induced nausea/vomiting — most useful class
Indications
- Antiemetic — substituted benzamides (metoclopramide, trimethobenzamide), butyrophenones (domperidone, droperidol), phenothiazines (prochlorperazine, promethazine, thiethylperazine)
Indications
- Adjuncts in chemo anti-emesis protocols
Side effects
- (see corticosteroid entries)
Indications
- Anticipatory / adjunct antiemetic
Indications
- Delayed chemotherapy-induced nausea
Indications
- GI smooth-muscle antispasmodic — stomach/intestine/bladder spasm
- Antiemetic — muscarinic antagonist for motion sickness/vestibular emesis
Side effects
- Anticholinergic: dry mouth, blurred vision, constipation
- Contraindicated: glaucoma, myasthenia gravis, paralytic ileus, toxic megacolon, GI/urinary obstruction (BPH), pregnancy, breastfeeding, CV-unstable haemorrhage
Indications
- Anticholinergic antispasmodic; pregnancy-safe exception (vs hyoscine)
- IBS antispasmodic
Side effects
- Anticholinergic: dry mouth, blurred vision, constipation
Indications
- Muscolotropic (direct smooth-muscle) antispasmodic — colon; IBS
Side effects
- No anticholinergic effects (muscolotropic)
Indications
- Muscolotropic antispasmodic
Indications
- Muscolotropic antispasmodic; IBS
Side effects
- Fewer SEs than anticholinergics BUT contraindicated in intestinal obstruction
Indications
- IBS antispasmodic combination (clidinium bromide/chlordiazepoxide)
Indications
- GERD — GABA-B agonist reducing transient LES relaxations (TLESRs), 40 mg
Indications
- ★ IBS-C first-line soluble fibre; bulk-forming laxative ↑ colonic distension → ↑ contraction
Indications
- Osmotic laxative — draws water into colonic lumen
- ★ Hepatic encephalopathy — first-line after first episode; acidifies colon, traps ammonia; oral + enema
- HRS — titrate to 2–3 stools/day
Side effects
- Can itself cause osmotic diarrhoea (drug cause of osmotic diarrhoea)
Indications
- Stimulant laxative — irritant, stimulates gut-wall afferents
Indications
- Intestinal secretagogue (Cl⁻ channel activator) — normal-transit constipation; IBS-C
Indications
- Guanylate cyclase agonist — IBS-C
Indications
- ★ 5-HT4 agonist — slow-transit constipation (stimulates motility); IBS-C
Indications
- Antidiarrhoeal — acute & chronic diarrhoea 2 mg; IBS-D; Crohn's symptomatic; enteral-nutrition diarrhoea; short-bowel antimotility
Side effects
- ★ Classic precipitant of toxic megacolon in colitis — abolishes protective peristalsis
Indications
- IBS-D — mu/delta opioid receptor agonist/antagonist
Indications
- IBS-D — 5-HT3 receptor antagonist
Indications
- Bile-acid sequestrant — IBS-D; Crohn's bile-acid diarrhoea post-ileal resection; pruritus of PBC (first-line) and PSC
Side effects
- Binds bile salts → can cause steatorrhoea / malabsorption
Indications
- Bile-acid sequestrant — IBS-D
Indications
- Non-absorbable antibiotic — IBS (with probiotics); hepatic encephalopathy add-on (semisynthetic rifampin analogue, oral bioavailability <0.4%); weak evidence for reducing recurrent diverticulitis
Side effects
- NOT recommended (with antibiotics) in acute pancreatitis — treat only proven infection
Indications
- TCA — IBS pain/bloating; low-dose in fibromyalgia & CRPS
Side effects
- Cholestatic (hepatocanalicular) drug-induced liver injury
Indications
- SNRI — IBS; fibromyalgia; CRPS
Indications
- SSRI — IBS; fibromyalgia; Raynaud's 3rd-line (serotonin-reuptake antagonist)
Indications
- TCA — fibromyalgia (reduces muscle pain, improves sleep)
Indications
- Fibromyalgia — 6-week trial
Indications
- ★ GLP-2 analogue — promotes intestinal adaptation in short-bowel syndrome
Indications
- Antisecretory (oral/patch) — reduce high stoma output in short-bowel syndrome
Indications
- Antimotility in short-bowel syndrome
Indications
- Antimotility — short bowel; Crohn's diarrhoea; CRPS first-line analgesic
Indications
- ★ First step mild–moderate UC — induction & maintenance; reduces CRC incidence in UC; enema (local) / oral / IV by severity
- Topical for solitary rectal ulcer syndrome
Indications
- UC — aminosalicylate (used less due to more SEs); RA DMARD; seronegative spondyloarthropathies — PsA (without psoriasis), ReA, EntA, AS; safe in pregnancy/lactation
- Composition: 5-aminosalicylic acid + sulphapyridine; sulphapyridine (90% absorbed) carries most action, 5-ASA stays in bowel
- MOA: inhibits lymphocyte function + neutrophil migration
Side effects
- Rashes; liver abnormalities/enzyme rise; haemolysis in G6PD deficiency; neutropenia; azoospermia; pulmonary infiltrates
- Monitoring: LFTs + CBC regularly
Indications
- ★ Short-acting GC — IV 100 mg 6-hourly in severe UC; IV 400 mg/day in IBD; topical/rectal foam & suppositories
Side effects
- (see class SEs) — diabetes, hypertension on systemic use
Indications
- ★ GCA first-line — 40–80 mg once daily (40 if no visual sx; 60–80/1 mg·kg if ocular); Takayasu's; UC (oral after IV response); AIH; severe acute AIH; PM/DM ( context); intermediate-acting GC
Side effects
- (class) diabetes, hypertension; osteoporosis (prevent with Ca/vit D/bisphosphonate)
Indications
- IBD induction — 40 mg/day, no maintenance role; Crohn's induction; PM/DM main-line 0.5–1.5 mg/kg/day, slow taper; SLE (, safe in pregnancy); AIH monotherapy taper 60→≤20 mg
Side effects
- (class) — muscle-strength recovery lags enzyme fall in PM/DM; monitor recurrent weakness + steroid toxicity
Indications
- IBD IV 60 mg/day; intermediate-acting GC
- ★ Acute cellular allograft rejection — pulse 500–1000 mg IV for 1–3 days
- SLE — pulsed for status epilepticus/coma; AIH-ALF ~60 mg/day IV; chemo antiemetic adjunct
Indications
- ★ Long-acting, most potent GC; chemo antiemetic adjunct
Indications
- ★ Controlled ileal-release — terminal-ileal / proximal-colon Crohn's & UC; 9 mg/day, 15× more potent than prednisone but minimal systemic absorption (high first-pass)
- Rectal enema (Enemacort) for distal UC; AIH steroid-sparing 3 mg TID + azathioprine
Side effects
- Fewer systemic SEs (high first-pass); contraindicated in AIH with acute severe hepatitis or cirrhosis
Indications
- ★ Mineralocorticoid replacement — has mineralocorticoid AND some glucocorticoid activity (not pure)
Indications
- Pure mineralocorticoid (no glucocorticoid activity)
Indications
- IBD maintenance — UC & Crohn's, steroid-sparing; transplant antiproliferative; RA/SLE/PM-DM/vasculitis maintenance; AIH combination with prednisone; lupus-nephritis maintenance; safe in pregnancy
- MOA: prodrug → 6-MP → ↓ purine synthesis
Side effects
- ★ Bone-marrow suppression / myelosuppression — check TPMT before starting (low activity → severe myelosuppression 4–10 wks)
- Infections (esp. herpes zoster), hepatotoxicity, pancreatitis, hypersensitivity, malignancy; veno-occlusive disease; NOT in decompensated cirrhosis
Indications
- IBD maintenance; active metabolite of azathioprine
Side effects
- Marrow suppression (as thiopurine); named as a cause of acute pancreatitis
Indications
- Immunosuppressive maintenance; TPMT testing before use
Side effects
- Myelosuppression risk with low TPMT
Indications
- ★ RA — most effective DMARD, drug of choice for early aggressive joint disease; JIA, seronegative SpA (peripheral), PM/DM, SLE (cutaneous+articular), uveitis, ANCA vasculitis; Crohn's steroid/immunosuppressive-resistant (IM/IV, not oral); GCA/Takayasu steroid-sparing; SSc myositis overlap
- MOA: inhibits dihydrofolate reductase → ↓ purine/DNA synthesis, ↓ neutrophil function
Side effects
- ★ Hepatotoxicity & hepatic fibrosis (worse with pre-existing liver disease); pneumonitis / pulmonary fibrosis
- Bone-marrow suppression, oral ulcers, nausea/vomiting; teratogenic — stop 3 mo pre-conception; CI CrCl <30
- Mandatory folic acid 1 mg/day co-prescription; associated with hepatic adenoma / non-cirrhotic portal HTN
Indications
- Transplant antiproliferative; Crohn's maintenance if conventional fails; lupus-nephritis induction (diffuse proliferative/membranous) & maintenance; cutaneous lupus, small-vessel vasculitis, SSc-ILD, myositis, uveitis; SSc pulmonary fibrosis
- MOA: prodrug → MPA → inhibits T- & B-cell proliferation
Side effects
- GI upset/diarrhoea, leucopenia/anaemia, infections, hepatotoxicity; teratogenic — stop 3 mo prior
Indications
- RA / JIA / psoriatic arthritis DMARD when MTX not tolerated; PsA & SpA
- MOA: inhibits dihydroorotate dehydrogenase → ↓ pyrimidine synthesis (B>T cells)
Side effects
- Hepatotoxicity, diarrhoea, alopecia, rash, hypertension, rare peripheral neuropathy; teratogenic (stop 3 mo pre-conception); extremely long half-life (up to 2 yr) — washout with cholestyramine
Indications
- SLE induction (proliferative/CNS lupus); systemic vasculitis; SSc-ILD; neuro-Behçet's; RA immunosuppressive; SSc pulmonary fibrosis pulses
- MOA: alkylating agent — breaks DNA (B>T cells)
Side effects
- ★ Haemorrhagic cystitis & bladder cancer; infertility/ovarian failure (30–70%, 100% if age >30)
- Myelosuppression, infection, pneumonitis/pulmonary fibrosis, gonadal toxicity, teratogenic; reduce dose 30% if CrCl <30
Indications
- Transplant — blocks IL-2 gene transcription → prevents T-cell activation; RA; refractory lupus nephritis/membranous, uveitis, myositis, psoriasis/PsA; safe in pregnancy
Side effects
- ★ Nephrotoxicity / chronic kidney injury; ↑ creatinine + hyperkalaemia, hypertension, hyperuricaemia → gout, anaemia, tremor/headache; a "CAN'T LEAP" cause of hyperuricaemia
Indications
- Transplant — calcineurin inhibitor, block IL-2 transcription; reduced chronic-rejection incidence vs cyclosporine era
Side effects
- (none explicitly stated; class calcineurin toxicity)
Indications
- Transplant — blocks IL-2 receptor signal transduction; immunosuppressive + antineoplastic; chronic rejection escalation (reverses ~50%)
Indications
- Transplant mTOR inhibitor; chronic-rejection escalation
Indications
- ITP — rapid bridging therapy (reduces antibody-mediated splenic destruction; works fast, ~4 days) incl. pregnancy; myositis steroid-sparing
Indications
- SLE (prevents flares, discoid, DM rash), inflammatory-arthritis adjuvant, antiphospholipid syndrome, Sjögren/palindromic rheumatism, hypercholesterolaemia; RA DMARD (least toxic — safe to combine); baseline in ALL SLE patients; safe in pregnancy
- MOA: accumulates in lysosomes → ↑ pH; ↓ IL-1/IL-6/interferons; stabilises neutrophil lysosomes
Side effects
- ★ Retinal toxicity / maculopathy — baseline + annual fundus exam
- Skin hyperpigmentation (grey-black), hair bleaching, myopathy
Indications
- Antimalarial DMARD — stabilises neutrophil lysosomes (RA); alternative amoebicidal agent for amoebic liver abscess
Side effects
- Skin pigmentation, retinopathy (fundus exam needed), myopathy
Indications
- ★ Wilson's disease — preferred copper chelator, ~20 mg/kg/day; RA DMARD (inhibits neovascularisation, neutrophils, lymphocytes)
Side effects
- Rashes, bone-marrow suppression, proteinuria; rare cause of drug-induced lupus
Indications
- Wilson's disease — alternative chelator if penicillamine intolerant
Indications
- ★ Anti-TNF-α — IBD (UC & Crohn's; first-line for fistulising/perianal or moderate-severe step-down); RA (IV, must combine with MTX); seronegative SpA
Side effects
- ★ TB reactivation (screen first); injection/infusion reactions, drug-induced lupus/autoantibodies, LFT abnormalities, cytopenias, malignancy (lymphoma, skin); CI: active TB, ILD, demyelinating disease, CHF NYHA III/IV; annual cost ~£8,000
Indications
- Anti-TNF — IBD biologic (SC); RA; SpA
Side effects
- (anti-TNF class — TB reactivation, etc.)
Indications
- Anti-TNF fusion protein (TNF-R2 + IgG1 Fc; NOT a monoclonal Ab) — RA (25 mg SC twice weekly), SpA; FMF (TNF-inhibitor option)
Side effects
- Injection-site reactions/irritation; TB reactivation & anti-TNF class effects
Indications
- IL-1 receptor antagonist (recombinant IL-1Ra) — RA, systemic JIA, auto-inflammatory syndromes/FMF
Side effects
- Injection-site reactions, bacterial/viral infections (esp. URTI), neutropenia
Indications
- Anti-IL-6 receptor mAb (IV monthly) — RA, systemic JIA, FMF; GCA steroid-sparing in relapse
Side effects
- Infections (URTI/pharyngitis — most common), neutropenia, elevated lipids, elevated liver enzymes
Indications
- CTLA-4–Ig fusion protein — blocks CD28 costimulation → inhibits T-cell activation; RA, active psoriatic arthritis
Side effects
- Increased infections; contraindicated in COPD
Indications
- Anti-CD20 mAb (depletes B cells) — ANCA-associated vasculitis, Sjögren's, seropositive RA, SLE, SSc-ILD; refractory myositis (biologic of choice); SSc lung disease; unresponsive/exacerbating TTP (with plasma exchange), pre-emptive for relapse
Side effects
- ★ PML (progressive multifocal leukoencephalopathy) & HBV reactivation; infusion reactions; rare vasculitis/psoriasis
Indications
- IL-12/23 blocker — psoriasis, PsA (IBD biologic option)
Side effects
- Contraindicated in enteropathic arthritis (do NOT use)
Indications
- Refractory RA, polyarticular JIA, axial SpA/PsA, dermatomyositis; selectivity — tofacitinib JAK1/3, baricitinib JAK1/2, upadacitinib JAK1
Side effects
- Dyslipidaemia, neutropenia/thrombocytopenia, infections (TB, herpes zoster), venous thromboembolism; EULAR risk-assess if age >65, smoker, CV/malignancy/VTE risk
Indications
- Antiplatelet — irreversibly inhibits cyclo-oxygenase → ↓ thromboxane A2 → ↓ platelet aggregation (effect lasts 7–10 days = platelet lifespan); NSAID/salicylate analgesic
- Possible chronic CRC chemoprevention (low-dose / COX-2, >10 yr); high-dose treats gout
Side effects
- ★ Directly damages oesophageal/gastric mucosa → PUD & upper-GI bleed (esp. elderly, perforated PU); low-dose aspirin CAUSES gout; hepatic steatosis pattern DILI
Indications
- NSAID (propionic acid) analgesic
Side effects
- ★ Classic NSAID culprit for PUD bleed with daily use (e.g. osteoarthritis)
Side effects
- Idiosyncratic immunoallergic DILI (allergen/hapten mechanism)
Indications
- COX-2 selective NSAID — OA second-line (with PPI cover)
Indications
- NSAIDs by chemical class — analgesic/anti-inflammatory in rheumatic disease, OA, gout, SpA
Side effects
- (NSAID class SEs — GI, renal, asthma)
Indications
- Acute gout & prophylaxis — inhibits microtubule formation; cover during ULT initiation; FMF treatment of choice (prevents attacks & amyloidosis, up to 3 mg/day; safe in pregnancy); CPPD/pseudogout acute & prophylaxis; mucocutaneous Behçet's
Side effects
- ★ GI intolerance — diarrhoea, vomiting
- ★ Interaction: clarithromycin (CYP3A4 inhibitor) → ↑ colchicine → pancytopenia; avoid erythromycin (rhabdomyolysis) — use azithromycin
Indications
- ★ Gout prophylaxis / urate-lowering — competitive xanthine oxidase inhibitor (over-producers & under-excretors); once daily, titrate to CrCl, life-long
Side effects
- Can precipitate an acute flare on initiation (cover with NSAID/colchicine/steroid)
Indications
- Urate-lowering — xanthine oxidase inhibitor; hepatic clearance (usable in renal impairment)
Side effects
- ★ Higher risk of CVD-related & all-cause mortality vs allopurinol (ACR 2020)
Indications
- Uricosuric — gout prophylaxis
Side effects
- (uricosuric class — renal calculi; use only if normal renal function)
Indications
- Uricosuric — gout prophylaxis
Indications
- Uricosuric — normal renal function only
Side effects
- Risk of renal calculi (uricosuric class)
Indications
- Uricosuric adjunct in gout; ARB 2nd-line in Raynaud's
Indications
- Uricosuric adjunct in gout
Indications
- ★ Community-acquired cholecystitis/cholangitis — most common agent (+ metronidazole); ERCP prophylaxis 500 mg 1 h pre; EUS-FNA prophylaxis; abdominal sepsis Tier 2; SBP (community, low-MDR); variceal-bleed antibiotic prophylaxis; perianal/abscess Crohn's
Indications
- ★ Amoebic liver abscess first-line — 750 mg TDS 5–10 days (intestinal + hepatic amoebiasis); anaerobic cover in intra-abdominal sepsis/cholangitis; appendicectomy prophylaxis (+ cefuroxime); perianal Crohn's/IBD abscess; empiric anti-giardia in chronic diarrhoea
Indications
- Oral ERCP prophylaxis alternative (amoxicillin-clavulanate); SIBO (duodenal aspirate sensitive to amox-clav)
Indications
- IV ERCP prophylaxis alternative — ampicillin-sulbactam 3 g IV
Indications
- ★ MRSA cover — ERCP/PEG-PEJ if MRSA risk; Tier-4 gram-positive in abdominal septic shock (15–20 mg/kg); one of lecturer's "most important 4" biliary-sepsis drugs
Indications
- ★ Infected pancreatitis — lecturer top priority (good pancreatic penetration), 1 g/8h; healthcare-associated/Grade-III cholangitis first choice; abdominal sepsis Tier-1 carbapenem; preferred dual anti-Pseudomonal with amikacin; SBP with ESBL risk
Indications
- ★ Carbapenem backbone in abdominal septic shock 500 mg/6h; infected pancreatitis; healthcare-associated cholangitis; SBP with ESBL risk; cilastatin = renal DHP-I inhibitor combined with imipenem
Indications
- Carbapenem (anaerobic cover) — high-MDR community SBP & healthcare-associated SBP 1 g OD; biliary sepsis Grade III option
Indications
- Anti-Pseudomonal β-lactam — infected pancreatitis 4.5 g/6h; healthcare-associated cholangitis; SBP without ESBL risk
Indications
- Aminoglycoside — abdominal sepsis Tier-2 (15–20 mg/kg/24h); preferred dual anti-Pseudomonal combo with meropenem
Indications
- Quinolone — abdominal sepsis Tier-2; SBP community low-MDR; levofloxacin quadruple (LOAD) H. pylori regimen
Indications
- SBP active treatment (IV) & prophylaxis; gallbladder empyema (+ anaerobic cover); Whipple's induction alternative; variceal-bleed prophylaxis
Indications
- SBP (community low-MDR) 2 g/8h; community cholangitis (+ metronidazole); gallbladder empyema
Indications
- Oral SBP treatment (BD, 7 days) & prophylaxis; variceal-bleed antibiotic prophylaxis
Indications
- Appendicectomy prophylaxis (+ metronidazole)
Indications
- Anti-Pseudomonal cephalosporin; NOT preferred with meropenem (both β-lactams, same MOA)
Indications
- Anti-Pseudomonal cephalosporins; cholangitis regimens
Indications
- Monobactam — anti-Pseudomonal cover
Indications
- MRSA-active cephalosporin
Indications
- Gram-positive / VRE-active — preferred over vancomycin/teicoplanin if renally impaired; abdominal septic shock Tier 4, 600 mg/12h
Indications
- Gram-positive/MRSA cover — abdominal septic shock Tier 4
Indications
- Broad (MRSA/VRE/anaerobe) cover; very expensive
Indications
- Broad-spectrum reserve agent (very expensive) in GI-infection selection
Indications
- Levofloxacin quadruple (LOAD) H. pylori regimen component
Indications
- Clarithromycin-based H. pylori triple/sequential (now largely abandoned — resistance)
Side effects
- Potent CYP3A4 inhibitor → colchicine toxicity/pancytopenia
Indications
- Preferred macrolide substitute (avoids colchicine interaction)
Indications
- (macrolide — named as agent to AVOID with colchicine)
Side effects
- Rhabdomyolysis risk with colchicine (avoid); cholestatic hepatitis DILI
Indications
- Levofloxacin quadruple (LOAD) H. pylori regimen component
Indications
- Whipple's disease induction (+ penicillin or ceftriaxone) 2 weeks
Indications
- Whipple's induction alternative (+ streptomycin)
Side effects
- Affects platelet function — stop 7 days pre platelet testing; rare cause of drug-induced lupus
Indications
- Whipple's maintenance — 160/800 mg daily for 1 year (crosses BBB)
Indications
- Echinocandin — abdominal septic shock Tier-3 antifungal, 70 mg day 1 then 50 mg
Indications
- Echinocandin — preferred antifungal in hepatic disease (abdominal septic shock)
Indications
- HSV in GI context — 5–15 mg/kg q8h, 7 mg/mL, infuse over 1 h with hydration
Side effects
- Phlebitis / renal damage if concentration too high or infused fast — hence dilution + slow infusion + hydration
Indications
- CMV — 5 mg/kg IV over 1 h
Side effects
- Increased toxicity / excessive plasma levels if infused rapidly
Indications
- Alternative amoebicidal agents for amoebic liver abscess
Indications
- Luminal amoebicide — added if cyst passage continues after metronidazole
Indications
- Hydatid disease — 10–15 mg/kg/day, 1-month courses (14-day gaps), 3–6 mo; peri-operative (4 days pre → 1 mo post)
Side effects
- CI: early pregnancy, marrow suppression, chronic hepatic disease, large rupture-risk cysts, inactive/calcified cysts
Indications
- Hydatid disease — 40–50 mg/kg/day, 3–6 mo; peri-operative chemoprophylaxis
Side effects
- (as benzimidazole — same CIs as albendazole)
Indications
- Periodic deworming of pet dogs (5 mg/kg) in endemic areas — hydatid prevention
Indications
- ★ Non-selective β-blocker — variceal primary prophylaxis for medium/large varices; may slow small-varix growth; portal-pressure reduction via β1 (↓CO) + β2 (splanchnic vasoconstriction)
Indications
- Non-selective β-blocker — portal hypertension
Indications
- NSBB + α1 blockade → also reduces intrahepatic/variceal outflow resistance
Indications
- ★ Acute variceal haemorrhage — vasopressin analogue, splanchnic venoconstriction; most studied; 2 mg/4h ×2 days then 1 mg/4h; cirrhotic variceal bleeding first-line
- ★ Hepatorenal syndrome (AKI-HRS) — first-line vasoconstrictor
Indications
- Variceal haemorrhage vasoactive drug; HRS vasoconstrictor; refractory hypotension in acute liver failure
Indications
- Acute variceal haemorrhage — 250 mcg IV bolus then 250 mcg/h; (physiological inhibitor of insulin/gastrin — , )
Indications
- Somatostatin analogue — NET hormonal symptom control (± tumour-modulating) with lanreotide; acute variceal haemorrhage 50 mcg bolus then 50 mcg/h; HRS (with midodrine, anti-splanchnic-vasodilation); short-bowel antisecretory (SC/IV)
Indications
- Somatostatin analogue — NET hormonal symptom control
Indications
- α1 agonist — HRS (with octreotide)
Indications
- HRS vasoconstrictor infusion; ALF renal failure / severe hypotension
Indications
- Vasopressor for severe hypotension / renal failure in acute liver failure
Indications
- ★ First-line diuretic for cirrhotic ascites (± furosemide) — start 100 mg/day, max 400 mg/day
Indications
- Loop diuretic added to spironolactone in cirrhotic ascites if inadequate
Side effects
- Named as a "CAN'T LEAP" cause of hyperuricaemia/gout (Lasix); a drug cause of acute pancreatitis
Indications
- ★ Paracetamol hepatotoxicity antidote — replenishes hepatic glutathione → detoxifies NAPQI; also ALF of other causes (except possibly ischaemic), esp. early-grade encephalopathy; SSc mucolytic
Indications
- Raised ICP / cerebral oedema in acute liver failure
Indications
- ★ Chronic HCV — treat all patients; pangenotypic: sofosbuvir; sofosbuvir/velpatasvir; sofosbuvir/velpatasvir/voxilaprevir; glecaprevir/pibrentasvir. Genotype-specific: sofosbuvir/daclatasvir (memorise); sofosbuvir/ledipasvir; ombitasvir/paritaprevir/ritonavir; dasabuvir; grazoprevir/elbasvir
- Classes by suffix — protease inhibitors (-previr: glecaprevir, grazoprevir, paritaprevir, voxilaprevir); NS5A (-asvir: velpatasvir, ledipasvir, ombitasvir, daclatasvir, pibrentasvir, elbasvir); polymerase (-buvir: sofosbuvir, dasabuvir). Ritonavir = pharmacokinetic booster.
Indications
- Chronic HBV — high-barrier nucleos(t)ide analogue, oral, long-term until HBsAg loss; minimal resistance; HBV-related acute liver failure
Side effects
- High tolerability, rare side effects, no specific contraindications (NUC class)
Indications
- Chronic HBV nucleos(t)ide analogue (with tenofovir); HBV-related ALF
Indications
- Chronic HBV — finite 48 weeks SC, induces immune control; HDV first-line ≥48 weeks; FMF biologic option (interferon-alpha)
Side effects
- Flu-like — fever, chills, headache, malaise, myalgia; psychological/mood impairment; low tolerability, many contraindications, no resistance risk
Indications
- HDV — HBV entry inhibitor (emerging therapy)
Indications
- ★ PBC first-line — 13–15 mg/kg/day, lifelong; PSC (debatable/controversial; high-dose 28–30 mg/kg/day associated with harm); cholestatic DILI (no clear evidence)
Indications
- Iron chelation — secondary iron overload (dyserythropoiesis) when phlebotomy contraindicated, 20–40 mg/kg/day
Indications
- Oral iron chelator — secondary iron overload
Indications
- ★ NASH — improves histology in biopsy-proven NASH (± T2DM)
Indications
- ★ Moderate–advanced non-cirrhotic MASH — oral thyroid-hormone-receptor β agonist (FDA March 2024)
Indications
- Not recommended as a specific NASH treatment (no proven histological benefit); use only if there is coexisting type-2 diabetes
Indications
- Anticoagulant — early/thrombotic-predominant DIC (e.g. COVID); anticoagulation in liver disease (as therapy-complication cause of bleeding); redraw sample for pseudo-thrombocytopenia
- Monitoring: unfractionated heparin monitored by APTT; prolongs PT, APTT and TT
Side effects
- HIT — drug-induced immune thrombocytopenia; bleeding
Indications
- Oral anticoagulant — monitored by INR (via PT)
Side effects
- Prolongs PT/INR; increases GI-bleeding risk (aorto-enteric fistula, UGIB)
Side effects
- Raises fibrin degradation products
Indications
- Von Willebrand disease (most types) & mild haemophilia A — releases VWF + FVIII from endothelium; SC/IV/intranasal; desmopressin-responsive VWD
Side effects
- Facial flushing, headache, water retention, hyponatraemia
Indications
- Antifibrinolytic (inhibits plasmin binding to fibrin) — VWD adjunct; trauma bleeding; oral/IV/topical
Indications
- Fibrinogen/factor replacement — DIC & low fibrinogen in liver disease; contains VWF/FVIII
Indications
- Coagulopathy of liver disease — immediate but temporary correction of prolonged PT/APTT
Indications
- Haemophilia A with FVIII inhibitors — bispecific mAb mimicking FVIIIa cofactor activity (bridges FIXa + FX)
Indications
- ★ GIST — tyrosine kinase inhibitor of KIT & PDGFRα; neoadjuvant/bridging to make mass operable; targeted therapy
Side effects
- Acquired resistance via new mutations
Indications
- Gastric carcinoma (Marsden: epirubicin + cisplatin + 5-FU); anal cancer Nigro regime (5-FU + cisplatin); inoperable cholangiocarcinoma (gemcitabine + cisplatin)
Indications
- Gastric carcinoma — Marsden regimen
Indications
- Gastric carcinoma Marsden regimen; anal cancer Nigro chemoradiotherapy (5-FU + mitomycin OR 5-FU + cisplatin)
Indications
- Anal cancer — Nigro regime (5-FU + mitomycin)
Indications
- Inoperable cholangiocarcinoma (+ cisplatin)
Indications
- HCC systemic therapy by BCLC stage
Side effects
- Association with liver lesions (drug history relevant to hepatic lesions)
Indications
- Raynaud's first-line CCB; anal fissure topical 0.3% (lowers resting anal pressure, fewer headaches than GTN)
Indications
- Raynaud's CCB; anal fissure topical 2%
Indications
- Anal fissure — 0.2% ointment (NO donor → relaxes internal sphincter, restores blood flow); topical patch adjunct in Raynaud's
Side effects
- Headache (limits adherence)
Indications
- Severe Raynaud's / digital ulcers — IV synthetic prostacyclin; SSc pulmonary hypertension prostanoid; SSc renal crisis (continuous low dose)
Indications
- Prostanoids — SSc pulmonary hypertension (mimic prostacyclin → vasodilation, ↓ platelet aggregation, ↓ remodelling)
Indications
- PDE-5 inhibitors — SSc pulmonary hypertension (↑ cGMP → pulmonary vasodilation)
Indications
- Endothelin-1 receptor antagonists — SSc pulmonary hypertension (block ET-1 → ↓ vasoconstriction & smooth-muscle proliferation)
Indications
- Heart-failure adjunct in SSc pulmonary hypertension
Indications
- Anti-fibrotic adjunct — SSc pulmonary fibrosis
Indications
- Analgesic — OA first-line (± topical NSAID); CRPS first-line; occasional evening dose in BJHS
Side effects
- ★ Hepatotoxicity — intrinsic dose-dependent; CYP2E1 → NAPQI → glutathione depletion → zone-3 (centrilobular) necrosis; most common cause of ALF in Europe/US; ~15% mortality with overt injury; antidote NAC
Indications
- Severe CRPS pain — consider slow-release
Side effects
- ★ Avoid in acute pancreatitis — increases sphincter of Oddi pressure
Indications
- CRPS first-line analgesic (often combined)
Indications
- Transdermal opioid patches — CRPS
Indications
- Lidocaine patches — sensitive painful skin in CRPS
Indications
- Energy-storage hormone (physiology — , ); replacement/glycaemic control implied in hyperglycaemia (refeeding, pancreatitis)
Side effects
- Refeeding syndrome driver — insulin-triggered intracellular K⁺/Mg²⁺/PO₄²⁻/thiamine shift → hypokalaemia/hypomagnesaemia/hypophosphataemia
Indications
- Energy-release / counter-regulatory hormone — stimulates gluconeogenesis, glycogenolysis, lipolysis (physiology)
Side effects
- Named as a splanchnic vasodilator mediator of portal hypertension
Indications
- ★ Pernicious anaemia / B12-deficiency — lifelong replacement (higher doses if neuro impairment); B12-malabsorption (terminal-ileal disease, gastrectomy, SIBO)
Indications
- Folate-deficiency / megaloblastic anaemia; treat both folic acid + B12 if PA still possible; Crohn's anaemia; CRC protective dietary factor
Indications
- Refeeding syndrome — replace (utilisation ↑ on refeeding; deficiency → hyperlactataemia)
Indications
- Micronutrient replacement in malabsorption/deficiency states
Side effects
- Niacin (nicotinic acid) — "CAN'T LEAP" cause of hyperuricaemia/gout
Indications
- Osteoporosis prevention with long-term corticosteroids (GIOP) — recommended ≥40 yr / >3 mo steroids; PBC-related osteoporosis; CRPS bone protection; PM/DM steroid prophylaxis
Side effects
- Directly damage oesophageal mucosa (GERD aggravator); caution if oesophageal/gastric varices present
Indications
- Anal fissure — blocks ACh at presynaptic motor terminals → internal-sphincter paresis, breaks spasm cycle (3–6 mo)
Indications
- Haemorrhoid sclerotherapy — quinine urea (alternative sclerosant)
Indications
- (local joint inflammation — see corticosteroids)
Side effects
- Weakens tendons → extensor-mechanism/tendon rupture — do NOT inject the knee joint itself
Indications
- (anti-tuberculous therapy context; no explicit indication stated)
Side effects
- Idiosyncratic (metabolic) hepatotoxicity / steatosis; drug-induced lupus
Side effects
- Idiosyncratic cholestatic hepatitis
Side effects
- ★ Hepatic failure without necrosis (microvesicular steatosis); direct hepatotoxicity; hepatic necrosis pattern; a drug cause of AP; impairs LES/damages oesophageal mucosa
Side effects
- Idiosyncratic (metabolic) hepatotoxicity; hepatic necrosis pattern; drug cause of AP
Side effects
- Drug-induced chronic hepatitis; idiosyncratic hepatotoxicity; cholestatic hepatitis pattern
Side effects
- Cholestatic (hepatocanalicular) DILI; drug-induced lupus
Side effects
- Idiosyncratic immunoallergic hepatotoxicity; steatosis
Side effects
- Idiosyncratic immunoallergic hepatotoxicity; steatosis
Side effects
- Idiosyncratic immunoallergic hepatotoxicity; drug-induced lupus
Side effects
- Idiosyncratic immunoallergic hepatotoxicity
Side effects
- Hepatic necrosis / steatohepatitis pattern DILI
Side effects
- Classical drug-induced lupus (anti-histone); hydralazine also granulomatous DILI
Side effects
- Granulomatous DILI; damages oesophageal mucosa (GERD aggravator)
Side effects
- Inhibit P450s that biotransform other drugs → ↑ DILI risk; sulfonamides also steatosis/idiosyncratic hepatotoxicity
Side effects
- Drug cause of acute pancreatitis
Side effects
- Idiosyncratic (metabolic) hepatotoxicity; steatosis
Indications
- Endoscopic injection sclerosant into ulcer base for bleeding PU (alcohol)
Side effects
- Named as a cause of acute pancreatitis (ethanol) and induces hepatic CYP2E1 (↑ DILI)
Side effects
- Aminophylline ↑ cAMP → affects platelet function (stop 7 days pre-testing); theophylline impairs LES → GERD aggravator
Indications
- (anti-tuberculous therapy context; no explicit indication stated)
Side effects
- "CAN'T LEAP" causes of hyperuricaemia / gout
Side effects
- Antibiotic that produces steatorrhoea / malabsorption
Indications
- Endoscopic haemostasis — local adrenaline injection into ulcer base for bleeding PU / non-variceal UGIB
Side effects
- ★ Never used alone — must combine with a second modality
- (Also a laboratory platelet-aggregometry / PFA-100 agonist — , , not a therapeutic use)