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Psoriasis Treatments
What is psoriasis?
Psoriasis is a non-allergic, chronic skin condition that has a genetic predisposition and can affect anyone at any age. It is characterised by red scaly patches of skin ranging from mild, with a few patches usually at the backs of the knees and elbows, and minimal discomfort, to severe with psoriatic lesions covering large areas of the body and causing extreme itching, pain and discomfort. Psoriasis is thought to be an automimmune disease, where certain cells of the immune system (T lymphocytes) are triggered to overproduce inflammatory chemicals, particularly TNF alpha, a cytokine that stimulates excessive growth and proliferation of keratinocytes (epidermal skin cells), causing thickening and scaling of the skin as well as inflammation.
Treatment for psoriasis
Calcipotriol is a derivative of calcitriol or Vitamin D (also known as 1,25 dihydroxycholecalciferol or 1,25(OH)2D3). Vitamin D is primarily involved regulating calcium metabolism but has other actions including inhibition of cell proliferation, stimulation of cell differentiation and immunomodulation. Calcipotriol binds to the same receptor in skin cells as Vitamin D and has the same activity in regulating cell growth and differentiation but is less effective in terms of calcium metabolism. Calcipotriol is used as a topical treatment for psoriasis and helps to prevent over production of hardened keratinocytes and restores normal cell growth and behaviour to the epidermal skin cells.
Tazarotene is a retinoid pro-drug of Vitamin A that affects skin cell behaviour and helps reverse abnormal changes in keratinocyte behaviour; it also has anti-inflammatory properties.
Both medications reduce the inflammation, scaling and thickening of psoriatic plaques and relieve symptoms of psoriasis.
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APO-Leflunomide 20mg
APO-Leflunomide general information
What is APO-Leflunomide used for?
APO-Leflunomide tablets 20mg are used to treat rheumatoid arthritis and active psoriatic arthritis, which are both autoimmune disorders (when the immune system attacks self), have an overactive immune system and have a genetic predisposition. Rheumatoid arthritis is a chronic progressive disease of the joints in which inflammation causes joint destruction and deformity of the joints. APO-Leflunomide 20 can help slow down the process of joint destruction and improve functional ability and quality of life and is particularly helpful in patients who do not respond to other treatments or if other treatments cannot be used. Psoriatic arthritis is a form of arthritis that is often also associated with psoriasis of the skin, characterised by raised red patches covered in silvery scales, but can develop before skin symptoms appear. Psoriatic arthritis differs from rheumatoid arthritis by being negative for rheumatoid factor, a blood test for an antibody that is usually positive in rheumatoid arthritis. APO-Leflunomide tablets 20mg are used only for treating inflammation of the joints in psoriatic arthritis not for the skin condition alone. Rheumatoid arthritis and active psoriatic arthritis are both characterised by periods of remission and periods of flare up when symptoms worsen and joints become painful and swollen. APO-Leflunomide tablets 20mg will not cure arthritic disease but can be used to relieve symptoms of the disease including pain, inflammation, tenderness, stiffness and swelling in the affected joints, and improve the functional use of affected joints.
How does APO-Leflunomide work?
APO-Leflunomide tablets 20mg contain leflunomide, a disease-modifying antirheumatic drug (DMARD) that is used to relieve inflammatory symptoms of the arthritic diseases rheumatoid arthritis and active psoriatic arthritis. Leflunomide in APO-Leflunomide tablets 20mg acts as an immunomodulatory drug with immunosuppressive characteristics, which means that it can suppress the immune system by interacting directly with the lymphocytes (white blood cells) involved in the immune response. Leflunomide in APO-Leflunomide tablets 20mg works by several possible mechanisms. It is thought to inhibit the production by lymphocytes of inflammatory mediators called cytokines, such as interleukins and prostaglandins, particularly tumour necrosis factor (TNF), interleukin 1 (IL1) and interleukin 6 (IL6). Leflunomide in APO-Leflunomide tablets also inhibits proliferation of rapidly dividing inflammatory lymphocytes by blocking the action of dihydroorotate dehydrogenase, an enzyme involved in pyrimidine synthesis, which inhibits lymphocyte proliferation, and helps reduce the inflammation that is responsible for the pain and swelling of rheumatic joints. These actions of leflunomide in APO-Leflunomide tablets 20mg dampen down the immune response by interacting with immune cells that influence the immune response to autoantigens (directed against self) and help reduce progression of the disease and reduce symptoms.
What does APO-Leflunomide contain?
APO-Leflunomide contains the active ingredient leflunomide 20mg, a disease-modifying antirheumatic drug (DMARD) used to treat rheumatoid arthritis and active psoriatic arthritis. They also contain lactose, crospovidone, magnesium stearate, and colloidal silicon dioxide.
Treating rheumatic diseases with APO-Leflunomide
APO-Leflunomide tablets 20mg contain leflunomide, a disease-modifying antirheumatic drug (DMARD) that is used to treat rheumatoid arthritis and active psoriatic arthritis, to improve symptoms of the disease, which include pain, inflammation, tenderness, stiffness and swelling in the affected joints. Rheumatoid arthritis and psoriatic arthritis (a form of arthritis that is often also associated with psoriasis of the skin, causing raised red patches covered in silvery scales) are both autoimmune disorders (when the immune system attacks self) and are characterised by an overactive immune system and a genetic predisposition. Leflunomide in APO-Leflunomide tablets 20mg is an immunomodulatory drug and acts directly on the lymphocytes (white blood cells) involved in the immune response, by inhibiting the production of cytokines, which are inflammatory mediators. Also, Leflunomide in APO-Leflunomide tablets 20mg blocks the proliferation of rapidly dividing inflammatory lymphocytes, which helps reduce the inflammation. APO-Leflunomide 20 can help slow down the process of joint destruction and improve joint function and quality of life, by reducing pain and inflammation but will not cure arthritic disease.
What are the side effects of APO-Leflunomide?
The most commonly reported side effects when taking APO-Leflunomide tablets 20mg include diarrhoea, nausea, vomiting, abdominal pain, stomatitis (oral mucosal disorder) anorexia, weight loss, hair loss, eczema, rash, pruritus (itching), dry skin, mild increase in blood pressure, paraesthesia (tingling of the skin).
When should APO-Leflunomide not be used?
You should not use APO-Leflunomide tablets 20mg if you:
- are allergic to leflunomide or any ingredients in APO-Leflunomide
- are pregnant or are breastfeeding
- have kidney or liver disease
- have hypoproteinaemia (oedema – water retention, and loss of protein from the blood) such as nephrotic syndrome
- have reduced immunity or immunodeficiency (such as due to AIDS)
- have severe uncontrolled infection
- are taking medicines that interact with APO-Leflunomide, including other immunomodifiers like methotrexate, the anticoagulant warfarin, immunisation with a live vaccine, statins, cholestyramine or activated charcoal for high cholesterol, repaglinide for diabetes, rifampicin for tuberculosis, non-steroidal anti-inflammatories like diclofenac or corticosteroids for inflammation
What medications interact with APO-Leflunomide?
Several medications interact with APO-Leflunomide tablets 20mg and should either not be taken while you are taking APO-Leflunomide or only after discussion and instruction from your doctor:
- Drugs that cause a serious reaction with APO-Leflunomide: other immunomodifiers like methotrexate could cause liver toxicity, immunisation with a live vaccine, non-steroidal anti-inflammatories like diclofenac or corticosteroids for inflammation
- Drugs that affect APO-Leflunomide: cholestyramine or activated charcoal for high cholesterol
- Drugs that are affected by APO-Leflunomide: the anticoagulant warfarin, repaglinide for diabetes, statins for for high cholesterol, rifampicin for tuberculosis
How should APO-Leflunomide be taken?
You should take your APO-Leflunomide tablets 20mg swallowed whole once daily with or without food and at the same time each day. The dose you take depends on what you are being treated for and you will probably be started on a loading dose (high dose) which will then be reduced after 3 days. You should start to see a response after 4-6 weeks, with further improvement after 4-6 months. You should continue to take your APO-Leflunomide tablets 20mg for as long as recommended by your doctor, which may be for several months or longer.
How long should you take APO-Leflunomide?
You should continue to take your APO-Leflunomide tablets 20mg for as long as recommended by your doctor, which may be for several months or longer.
Missed dose of APO-Leflunomide
If you miss a dose of APO-Leflunomide tablets 20mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.
How should APO-Leflunomide be stored?
You should store your APO-Leflunomide tablets 20mg below 25°C in a cool dry place.
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Cold Sore Treatments
What are cold sores?
Herpes Simplex Virus (HSV) is a virus that infects mucous membrane cells and exists in two forms;HSV I that infects the lips, mouth and face, and HSV-II that infects the genitals. A cold sore is the result of an infection with HSV I and early warning signs of active virus include a tingling sensation on the lips or face. If untreated at an early stage the virus will multiply rapidly and within 24 hours a cold sore will form, starting as small blisters on the surface of the skin, which join up to form a weeping sore. This is when the virus is contagious and can spread to form more cold sores or can infect others by direct contact. Eventually the immune system kicks in to kill the virus and the cold sore crusts over to form a scab as it heals.
Once infected with HSV it is always possible that re-infection will occur, as the virus can persist undetected by travelling down a nerve fibre and lying dormant or inactive in a nerve cell, to be reactivated under certain conditions, such as by stress, illness, sunlight or a compromised immune system.
Treatments for cold sores
Acyclovir is an antiviral drug that can be used to treat infection with HSV-1. It is a nucleoside analogue, which means that it becomes incorporated into the viral DNA within the host cell and replaces building blocks needed for viral DNA synthesis. This inhibits the action of viral DNA polymerase and prevents normal viral DNA synthesis, without affecting normal processes of the host cells, which prevents the virus replicating and therefore stops the growth and spread of the virus. If applied to the skin within 24 hours of the first tingle, acyclovir can prevent a cold sore from developing. However, it can be used at any stage of infection, to prevent spread of infection, reduce and relieve painful symptoms, and speed up the heeling process to help heal blisters and sores caused by the infection. Acyclovir can also be taken orally to suppress recurrent infection of HSV and to prevent infection in people who are immunocompromised. Valacyclovir is a similar antiviral to acyclovir and is a prodrug of acyclovir that is more readily absorbed and is converted to acyclovir by the liver.
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APO-Montelukast 10mg
Apo-Montelukast general information
What is Apo-Montelukast used for?
Apo-Montelukast tablets 10mg are used for treatment of asthma in adults and adolescents age over 15 years, for management of chronic asthma, to help prevent day-time and night-time symptoms, including coughing, wheezing and tightness of the chest; also exacerbations of asthma, but not to treat asthma attack. Apo-Montelukast tablets 10mg can be used in addition to other asthma medications, including inhaled corticosteroids and bronchodilators. Apo-Montelukast tablets 10mg are also used as prophylaxis to prevent exercise-induced asthma. Apo-Montelukast 10mg are also used to treat seasonal allergy to pollen (hay fever), and perennial allergy, such as to animal fur, mould and house dust mites. Both forms of allergy can cause allergic rhinitis with symptoms including nasal congestion, runny itchy nose, sneezing, tearing, itchy, red, and puffy eyes and problems sleeping.
How does Apo-Montelukast work?
Apo-Montelukast tablets 10mg contain montelukast sodium, which is a selective and orally active (can be taken in tablet form) leukotriene receptor antagonist that is used to prevent leukotriene-mediated inflammation in asthma and allergic rhinitis. Leukotrienes are chemicals produced by inflammatory cells like mast cells and eosinophils that are found in the airways and mediate the inflammatory responses. Montelukast in Apo-Montelukast tablets 10mg binds to specific receptors for the cysteinyl leukotrienes (LTC4, LTD4, LTE4) on the cells of the airways, including smooth muscle cells and also macrophages, which inhibits the action of leukotrienes. In asthma leukotriene-mediated effects cause bronchoconstriction (narrowing of the airways), inflammation, swelling and mucous secretion. In allergic rhinitis leukotrienes are released in the nasal passages after exposure to an allergen like pollen or house dust mites and cause irritation and inflammation. Apo-Montelukast tablets 10mg help prevent bronchoconstriction, mucous secretion, vascular permeability, and eosinophil recruitment to relieve symptoms of asthma and allergic rhinitis.
What does Apo-Montelukast contain?
Apo-Montelukast tablets 10mg contain the active ingredient montelukast sodium, which is a leukotriene receptor antagonist that prevents leukotriene-mediated inflammation in asthma and allergic rhinitis. They also contain lactose anhydrous, cellulose microcrystalline, croscarmellose sodium, silica (colloidal anhydrous), magnesium stearate, hypromellose, hydroxyproprylcellulose, yellow iron oxide, red iron oxide, titanium dioxide, purified water.
Treating asthma with Apo-Montelukast
Apo-Montelukast tablets 10mg contain montelukast, a leukotriene receptor antagonist that prevents leukotriene-mediated inflammation in asthma. Leukotrienes are chemicals that mediate inflammation and are involved in the pathophysiology asthma, causing bronchoconstriction (narrowing of the airways), swelling and mucous secretion. Montelukast in Apo-Montelukast tablets 10mg binds to the leukotriene receptors and block the action of leukotrienes in the airways, which helps to reduce asthma symptoms including coughing, wheezing and tightness of the chest. You should not use Apo-Montelukast tablets 10mg for asthma attack; for this you need a fast acting bronchodilator inhaler.
Treating allergy with Apo-Montelukast
Apo-Montelukast tablets 10mg contain montelukast, a leukotriene receptor antagonist that prevents leukotriene-mediated inflammation that is involved in the pathophysiology of allergic rhinitis. Leukotrienes are released in the nasal passages after exposure to an allergen like pollen or house dust mites and cause irritation and inflammation. Montelukast in Singulair tablets 10mg binds to the leukotriene receptors and blocks the action of leukotrienes in the nasal passages, which helps to reduce symptoms of allergic rhinitis like nasal congestion, runny nose and sneezing.
Should you take Apo-Montelukast with other asthma medications?
You can take Apo-Montelukast tablets 10mg as well as your other asthma medication, including inhaled bronchodilators and corticosteroids, only if recommended by your doctor.
What are the side effects of Apo-Montelukast?
The most commonly reported side effects when taking Apo-Montelukast tablets 10mg include abdominal pain and headache.
When should Apo-Montelukast not be used?
You should not use Apo-Montelukast tablets 10mg if you:
- are allergic to montelukast or any ingredients in Apo-Montelukast
- are taking phenobarbital which interacts with Apo-Montelukast tablets
- are under 15 years, you should take the chewable tablets for children instead
How should Apo-Montelukast be taken?
You should take your Apo-Montelukast tablets 10mg swallowed whole with a glass of water with or without food, once daily preferably in the evening. You should continue to take your Apo-Montelukast tablets 10mg for as long as recommended by your doctor, and for asthma you should continue to take your Apo-Montelukast tablets 10mg even if you feel better, as it is intended as a long-term medication to help control your asthma.
How long should you take Apo-Montelukast?
You should continue to take your Apo-Montelukast tablets 10mg for as long as recommended by your doctor, and for asthma you should continue to take your Apo-Montelukast tablets 10mg even if you feel better, as it is intended as a long-term medication to help control your asthma.
Missed dose of Apo-Montelukast
If you miss a dose of Apo-Montelukast tablets 10mg take it as soon as you remember, unless it is time to take the next dose, then skip the missed dose. Do not take a double dose.
How should Apo-Montelukast be stored?
You should store your Apo-Montelukast below 25°C in a cool dry place and protect from heat and moisture.
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Healthcare Logistics
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