Cosferone 10%

Indications

• Rectal and anal disorders
• Haemorrhoids
• Pruritus ani

Dosage

Children: Refer to the BNF for Children for appropriate dosing information.

Adults: For rectal use using aerosol spray: 1 spray up to 3 times a day for no longer than 7 days without medical advice. For ointment: apply several times daily, for short-term use only.

Mechanism of action

Phenol exerts its effects by acting as a potent proteolytic agent. At concentrations of 5% to 7%, it can dissolve tissue through proteolysis. When injected near a nerve, it produces chemical neurolysis, affecting nerve fibers nonselectively. Local anesthetic effects are typically observed within 5 to 10 minutes of application.

Pharmacodynamics

Phenol's pharmacodynamic properties include its ability to cause tissue dissolution and local anesthesia. The local anesthetic effects result from its action on the nerve fibers, leading to a temporary loss of sensation in the affected area. The proteolytic action can assist in the treatment of various skin and mucosal conditions by facilitating tissue breakdown.

Pharmacokinetics

Phenol is absorbed through mucosal surfaces when applied locally. Its metabolism involves biological oxidation and phase I functionalization, primarily through cytochrome P450 enzymes. The elimination of phenol occurs through metabolic pathways, and it can be detected in urine as a result of its metabolism.

Contra-indications

• Infection
• Known hypersensitivity to phenol or its components

Adverse effects

• Local irritation
• Burning sensation
• Paraesthesia
• Vision disorders
• Skin reactions
• Adrenal suppression

Interactions

• Caution with other local anesthetics due to potential additive effects

Precautions

• Use for short periods only-no longer than a few days
• Avoid excessive application, especially on sensitive areas
• Consult product literature for specific guidelines

Pregnancy

Data on the use of phenol during pregnancy is limited; caution is advised.

Breast-feeding

Limited information available; caution is recommended when used in breastfeeding mothers.

Storage

Store in a cool, dry place away from direct sunlight. Keep out of reach of children.

Formulations

• Ointment
• Suppository
• Aerosol spray

Indications

• Hypovolemia
• Shock
• Surgery
• Burns

Dosage

Children: Refer to the specific product information or guidelines for paediatric dosage, as it may vary based on the indication and formulation used.

Adults: Refer to the specific product information or guidelines for adult dosage, as it may vary based on the indication and formulation used.

Mechanism of action

Dextran acts as an osmotic agent. When administered intravenously, it increases plasma volume by drawing water into the vascular space. This expansion of blood volume helps in maintaining blood pressure and improving perfusion to tissues.

Pharmacodynamics

The pharmacodynamics of dextran involves its ability to enhance blood flow and reduce blood viscosity. It can improve rheological properties of blood, thereby facilitating better circulation. Dextran's molecular size allows it to remain in the circulation for an extended period, contributing to its volume-expanding effects.

Pharmacokinetics

Dextran is administered intravenously and is distributed in the vascular compartment. Its elimination occurs through renal filtration, and it is eventually degraded by enzymatic action in the liver. The half-life can vary depending on the molecular weight of the dextran used, with larger molecules generally having a longer half-life.

Contra-indications

• Hypersensitivity to dextran or any component of the formulation
• Severe renal impairment
• Congestive heart failure
• Active bleeding or hemorrhagic disorders

Adverse effects

• Allergic reactions, including anaphylaxis
• Fluid overload
• Hypotension
• Headache
• Nausea and vomiting
• Fever
• Thrombocytopenia
• Acute kidney injury

Interactions

• Anticoagulants - may enhance the effects of anticoagulants leading to increased bleeding risk
• Diuretics - may increase the risk of fluid overload and electrolyte imbalances

Precautions

• Use with caution in patients with cardiovascular disease
• Monitor fluid balance closely in patients with renal impairment
• Careful administration in patients with a history of allergic reactions

Pregnancy

Safety during pregnancy has not been established. Use only if clearly needed and potential benefits justify potential risks.

Breast-feeding

Excretion in human milk is unknown. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from direct sunlight and moisture. Do not freeze.

Formulations

• Injectable solution for intravenous infusion
• Oral formulations (less common, specific to certain indications)

Indications

• Surgical procedures
• Injection of medications
• Preparation of sterile pharmaceutical products
• Management of open wounds
• Use in controlled environments such as hospitals and laboratories

Dosage

Children: Refer to specific drug monographs for dosage information as sterile itself is not a pharmacological agent.

Adults: Refer to specific drug monographs for dosage information as sterile itself is not a pharmacological agent.

Mechanism of action

Sterility itself does not have a mechanism of action as it is a state of cleanliness and does not interact with biological systems. However, the methods used to achieve sterility, such as heat or chemical agents, act by denaturing proteins, disrupting cellular structures, or damaging nucleic acids in microorganisms, leading to their inactivation or destruction.

Pharmacodynamics

The pharmacodynamics of sterile techniques primarily involves the prevention of microbial infection and contamination when administering medications. By ensuring that products are sterile, the risk of adverse effects related to infections is minimized. The effectiveness of sterilization methods can be influenced by factors such as temperature, duration of exposure, and the type of microorganisms present.

Pharmacokinetics

As sterility does not pertain to a specific drug, pharmacokinetics is not applicable. However, the pharmacokinetics of a drug will depend on its formulation, route of administration, and the presence of preservatives or stabilizers that may be used alongside sterile preparations.

Pregnancy

Sterile preparations are generally considered safe during pregnancy as they are used to provide hydration, nutrition, or medications in a controlled manner, but specific formulations should be assessed individually.

Breast-feeding

Sterile solutions used for hydration or nutritional support are typically safe during breastfeeding, but any specific additives or medications within the solutions should be evaluated for safety.

Storage

Sterile solutions should be stored in a cool, dry place, protected from light, and should be used before the expiration date. Once opened, they may have specific storage requirements based on the formulation.

Formulations

• Sterile saline solution
• Sterile water for injection
• Sterile dextrose solution
• Sterile electrolyte solutions

Mechanism of action

Phenol is a potent proteolytic agent. Concentrations in the 5% to 7% range dissolve tissue on contact via proteolysis. In high concentrations when injected next to a nerve, phenol produces a chemical neurolysis which is nonselective across nerve fiber size and most prominent on its outer aspect. Local anesthetic effects occur within 5-10 minutes. The effects of monoamine depletors and monoamine denervators on phenol induced tremor were studied in mice. The tremor induced by phenol was enhanced by pretreatment with reserpine or tetrabenazine, but not with syrosingopine. However, alpha-methyl-p-tyrosine, p-chlorophenylalanine or 6-hydroxydopamine did not affect the tremor. These results suggest that the depletion of central monoamines as a whole contribute to the enhancement of the tremor induced by phenol.