CIDOX 200 TABLETS (Each film coated tablet contains cetpodoxime Proxetil

Indications

• Acute bacterial sinusitis
• Community-acquired pneumonia
• Acute exacerbations of chronic bronchitis
• Urinary tract infections
• Skin and soft tissue infections

Dosage

Children: Refer to BNF for Children for specific dosing information.

Adults: Refer to clinical guidelines or product information for specific dosing recommendations.

Mechanism of action

Cetpodoxime exerts its antibacterial effect by binding to penicillin-binding proteins (PBPs) located inside the bacterial cell wall. This binding inhibits the transpeptidation step of peptidoglycan synthesis, which is crucial for cell wall structural integrity. The disruption of the cell wall synthesis ultimately results in lysis of the bacteria.

Pharmacodynamics

Cetpodoxime has a broad spectrum of activity against numerous bacteria, including Streptococcus pneumoniae, Haemophilus influenzae, and Escherichia coli. The drug exhibits time-dependent killing, meaning that the effectiveness is related to the duration of time the drug concentration remains above the minimum inhibitory concentration (MIC) for the target bacteria. Bactericidal activity is generally observed at clinically relevant concentrations.

Pharmacokinetics

Cetpodoxime is well absorbed from the gastrointestinal tract, with peak plasma concentrations typically reached within 1 to 2 hours after oral administration. It has a bioavailability of approximately 50%. The drug is widely distributed throughout the body, including into the respiratory tract, urinary tract, and tissues. Cetpodoxime is primarily excreted unchanged in the urine, with a half-life of approximately 2 to 3 hours. Renal function can significantly affect the clearance of the drug, necessitating dosage adjustments in patients with impaired renal function.

Contra-indications

• Hypersensitivity to cetpodoxime or any component of the formulation
• Severe renal impairment

Adverse effects

• Diarrhea
• Nausea
• Vomiting
• Abdominal pain
• Rash
• Allergic reactions
• Headache
• Dizziness

Interactions

• Antacids may reduce absorption and effectiveness of cetpodoxime
• Probenecid may increase serum levels of cetpodoxime

Precautions

• Use with caution in patients with renal impairment
• Monitor for signs of Clostridium difficile-associated diarrhea
• Ensure appropriate hydration to prevent crystalluria

Pregnancy

Cetpodoxime is categorized as pregnancy category B. Animal studies have not demonstrated a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women.

Breast-feeding

Cetpodoxime is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from moisture and heat. Keep out of reach of children.

Formulations

• Tablets
• Suspension

Indications

• Major depressive disorder
• Generalized anxiety disorder
• Obsessive-compulsive disorder
• Panic disorder
• Post-traumatic stress disorder

Dosage

Children: Refer to the BNF for Children for appropriate dosing recommendations, as pediatric dosing may differ significantly from adult dosing.

Adults: Refer to the specific prescribing information for dosing guidance as it may vary based on individual patient factors and clinical judgment.

Mechanism of action

Proxetil functions as a selective serotonin reuptake inhibitor (SSRI), which means it inhibits the reuptake of serotonin (5-HT) in the presynaptic neuron. By blocking the serotonin transporter (SERT), it increases the availability of serotonin in the synaptic cleft, enhancing serotonergic neurotransmission. This mechanism is believed to contribute to its antidepressant effects.

Pharmacodynamics

The pharmacodynamics of proxetil involve the modulation of serotonin levels in the central nervous system. The increase in serotonin availability leads to improved mood, reduction in anxiety, and overall enhancement of emotional well-being. The onset of therapeutic effects may take several weeks, and the drug is generally well tolerated, with common side effects including gastrointestinal disturbances and changes in sexual function.

Pharmacokinetics

Proxetil is absorbed rapidly after oral administration, with peak plasma concentrations occurring within several hours. It undergoes extensive first-pass metabolism, primarily in the liver, which affects its bioavailability. The drug is metabolized by cytochrome P450 enzymes, and its elimination half-life is generally around 24 hours, allowing for once-daily dosing. It is excreted mainly in urine, with a small amount excreted as unchanged drug.

Contra-indications

• Hypersensitivity to proxetil or any of its components
• Severe hepatic impairment
• Concurrent use with monoamine oxidase inhibitors (MAOIs)

Adverse effects

• Nausea
• Diarrhea
• Dizziness
• Somnolence
• Dry mouth
• Insomnia
• Sexual dysfunction

Interactions

• Caution when used with other central nervous system depressants
• May increase the effects of anticoagulants
• Potential interaction with other serotonergic drugs, increasing the risk of serotonin syndrome

Precautions

• Use with caution in patients with a history of seizures
• Monitor for worsening of depression or emergence of suicidal thoughts
• Consider potential for withdrawal symptoms upon discontinuation

Pregnancy

Proxetil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult clinical guidelines for further information.

Breast-feeding

Proxetil is excreted in breast milk. Caution is advised when administering to nursing mothers.

Storage

Store at room temperature, away from moisture and direct sunlight. Keep out of reach of children.

Formulations

• Oral tablets
• Oral solution