Section 4.2
Addition of text regarding the following:
· Reduced dosage in hepatic impairment
· Reduced dosage in moderate to severe renal impairment
· Reduced dosage in debilitated patients.
· Cross-reference to other concomitant illnesses/conditions in section 4.4
Section 4.3
Deletion:
· Acute abdomen
Additions:
· Risk of paralytic ileus
· Diarrhoea
Supplementary/amended information:
· Acute respiratory depression
· Obstructive airways disease (to be covered under section 4.4)
· Convulsive disorder (move to section 4.4)
· Interaction with MAOI (move to section 4.5)
· Head Injury
· Biliary colic (cross reference to biliary tract disorders in section 4.4)
Section 4.4
Deletions:
· Myasthenia gravis
· Biliary colic
Additions:
· Convulsive disorders (moved from section 4.3)
· Urethral stricture
· Palliative care
· Cross-referencing to section 4.2 (elderly, hepatic, renal)
Amendments/Supplementary:
· Asthma and decreased respiratory reserve
· Biliary tract disorders
· History of drug abuse and dependence
Section 4.5
Deletions:
· Cisapride (no longer on UK market)
· Cimetidine
· Anaesthetics and hypotensives
Additions:
· Antidiarrhoeals and antiperistaltic agents (increased risk of severe constipation)
Amended/supplementary information:
· Antipsychotics
· MAOIs (severe CNS excitation or depression with pethidine, similar interaction possible with other opioids – moved from section 4.3)
· Ciprofloxacin
Section 4.6
Additional of the following text
· Gastric stasis may increase the mother’s risk of inhalation pneumonia
Section 4.8
Deletions:
· Muscle rigidity
· Effects more common in ambulatory patients & in those without severe pain
· Raised intracranial pressure
Additions:
· Tachycardia
· Dizziness
· Headache
· Rash
· Visual disturbances
· Sexual – decrease in libido or potency
· Respiratory depression
Supplementary/amended information:
· Hypothermia (moved to Overdose)
· Restlessness (moved to Overdose)
· Confusion/mental clouding
· Mood changes – dysphoria
· Urinary retention & tolerance to urinary effects
Section 4.9
Amendment of overdose symptoms:
· Principle overdose symptoms listed first (coma, pinpoint pupils, respiratory depression)
Addition of overdose symptoms:
· Bradycardia, severe dizziness, severe drowsiness, severe restlessness or nervousness, hallucinations, convulsions (especially in infants and children)
Deletion of overdose symptoms:
· Nausea, vomiting, tremor, miosis, dysphoria (not identified in standard texts as key overdose symptoms)
Amendment of overdose treatment:
· Use of naloxone
Section 6.2
Deletion:
· Chlorpromazine hydrochloride injection
Addition:
· Doxorubicin
· Fluorouracil
· Consult specialised references for compatibility information
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