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Library of Congress Cataloging-in-Publication Data
Ebadi, Manuchair S.
Desk reference of clinical pharmacology / author, Manuchair Ebadi. 2nd ed.
p. ; cm.

List of Orientation Articles xxi
List of Tables xxiv
List of Figures xxv
Chapter 1
The Pharmacokinetic Basis of Therapeutics 1
Chapter 2
The Pharmacodynamic Basis of Therapeutics 17
Chapter 3
Adverse Reactions and Drug–Drug Interactions 21
Chapter 4
Herb–Drug Interactions 23
Chapter 5
Food–Drug Interactions 31
Alphabetical Presentation of Drugs 35
Index 745

IX
P
REFACE TO THE
F
IRST
E
DITION
Hippocrates (460–377 B.C.) lamented, “Life is short, and
the art long; the occasion fleeting; experience fallacious;
and judgment difficult.” New drugs and novel avenues of
treatment are emerging rapidly, requiring constant vigilance
to remain informed.
The CRC Desk Reference of Clinical Pharmacology,
designed and prepared specifically for physicians and other

one sentence the exact therapeutic use of a medication. For
example: “Halcinonide, a topical adrenocorticoid with anti-
inflammatory properties is indicated in inflammation of
acute and chronic corticosteroid-responsive dermatoses.”
Each entry gives the name of the drug, its classification,
its dosage, its indications, its mechanism of action, its phar-
macokinetic properties if appropriate, its side effects, and its
signs and symptoms of overdosage. The section on pharma-
cokinetics has been designed to be meaningful in nature. For
example, if a drug is mainly eliminated unchanged, it is noted
that its dose should be adjusted downward in renal failure.
Another unique feature of the book is that items of infor-
mation have been given in a comprehensive fashion. For
example, Table 21 provides information to be used in the
treatment of hypertensive emergics. This includes provision
of pharmacological properties of sodium nitroprusside, dia-
zoxide, labetalol, nitroglycerin, phentolamine, trimethaphan,
hydralazine, and nicardipine. All these drugs have their own
separate entries but have also been assembled in a mean-
ingful fashion in one place.
The author expresses his heart-felt appreciation and grat-
itude to Professor Gerald A. Kerkut of the University of
Southampton and David Grist of CRC Press LLC for the
confidence rendered and for the kind invitation to prepare
a volume on clinical pharmacology. Their valuable guid-
ance, direction, and support have been immense and are
gratefully acknowledged.
The author also acknowledges the contribution of the
members of the international advisory board in the process
of designing, writing, and completing this desk reference.

Metropolitan and Flower and Fifth
Hospitals and Chairman, Department
of Psychiatry, Grasslands Hospital
Valhalla, New York
Arnold Schwartz, Ph.D.
Professor and Chairman
Department of Pharmacology and Cell
Biophysics
University of Cincinnati
College of Medicine
Cincinnati, Ohio
X PREFACE TO THE FIRST EDITION
The author also expresses his everlasting admiration to
Margaret McCall and to Lori Ann Clapper for their mag-
nificent dedication, uncompromising diligence, and compe-
tent skills in typing the entire manuscript, and to John
Enrique Mata for designing and drawing the art work. The
exceptional and rare talent, skills, and expertise of Gail
Renard, the project editor, and Kathy Johnson, the typesetter,
in refining this volume, are gratefully and respectfully
acknowledged. Thanks are also due to Cindy Carelli,
Carolyn Lea, Julie Haydu, and Becky McEldowney—all of
CRC—for their help and professionalism.
The author hopes that by providing simple and unique
diagrams, comprehensive tables, and more than 2000
entries, the CRC Desk Reference of Clinical Pharmacology
will become a valuable and essential reference book for
physicians and other members of the medical profession in
their quest to alleviate the mental and physical sufferings
of their fellow human beings.

treatment of a broad range of human diseases with new
medications. Given the rapid pace of new discovery,
genetic- and cell-based therapeutics have now become a
common part of the physicians’ armamentarium. A few
examples will be given concerning two leading causes of
death—cancer and cardiovascular diseases—to illustrate this.
At the midpoint of the 20th century, our knowledge of
cancer was based on epidemiology and pathology, and treat-
ment consisted of surgery and radiation therapy. More mod-
ern views on carcinogenesis favor a genetic cause for
cancer. The incidence of cancer increases sharply with age,
and various models have been proposed to account for this
increase. The human immune system can mount a specific
response to cancer. Intense research is aimed at dissecting
the intricacies of the interaction between the immune sys-
tem and tumor cells.
A driving force behind this research is the idea that
cancer-directed immunity can be enhanced to improve the
outcome for patients with the disease. The specificity of the
immune response makes cancer immunotherapy extremely
effective because it offers the promise of reducing damage
to the bystander normal tissues and lessening the severe
side effects associated with cancer therapies. Another mod-
ern treatment is monoclonal antibodies, which exhibit a
favorable pharmacokinetic profile. Pharmacokinetic vari-
ability among patients is low, which helps ensure that all
patients receiving a given dose achieve appropriate expo-
sure to the drug. Unlike many therapeutics now used in
cancer patients, monoclonal antibodies are not subject to
metabolic drug–drug interactions and are not substrates of

Part One: The book still has brief, concise, and infor-
mative A–Z drug facts from abciximab to zolpidem tartrate.
Part Two: The book again presents some very novel and
exciting entries not seen in any existing textbooks of phar-
macology. These items will include, but not be limited to,
the items listed below.
DRUG METABOLISM AND TRANSPORT
Two key aspects of how the body handles drugs and other
chemicals are metabolism and transport. Metabolism is crit-
ical because it enables the body to process highly lipophilic
molecules for further metabolism and eventual excretion,
inactivates biologically active molecules, or detoxifies poten-
tially toxic chemicals. Transport processes are critical
because they determine the ability of drugs and other chem-
icals to gain access to sites of metabolism or to physiological
or toxicological targets within tissues. The remarkable
advances in molecular and cell biology and the development
of novel in vitro model systems to study the various processes
involved in metabolism and transport have expanded our
knowledge and led to numerous new therapeutic approaches
to the treatment of chemically induced toxicity and disease.
Familial hypercholesterolemia
(LDL receptor
defective/absent)
LDL clearance
Dyslipidemia with no specific
genetic defect
LDL clearance
Hypertension Increase in HDL
Peripheral artery disease Angiogenesis

of targets, hundreds of preclinical animal studies, and some
20 clinical trials ongoing. Any successful trial with an anti-
sense compound will open a floodgate of new therapies for
a panoply of diseases.
THE MANAGEMENT OF EATING DISORDERS
AND OBESITY
There is increasing awareness about eating disorders and
their predispositions. Efforts are expanding on prevention,
early identification, and intervention in eating disorders.
Clinicians are developing treatment strategies incorporating
newer technologies including the Internet, which might
eventually reduce costs while improving access to, and
effectiveness of, therapy. Regarding obesity, the greater
focus is on prevention, and strategies for prevention are
being evaluated. Researchers are identifying the effects of
maternal behaviors during pregnancy that “imprint” the
fetus for increased postnatal weight gain and obesity-asso-
ciated disease complications. As we learn about such effects,
we may be able to recommend behaviors for pregnant women
that would reduce the future risk for their infants.
PREVENTIVE NUTRITION
Preventive nutrition incorporates dietary practices and inter-
ventions directed toward the reduction of disease risk (pri-
mary prevention), improvements in disease states already
manifest (secondary prevention), and improvement in
health outcomes. Preventive nutrition is a critical compo-
nent not only of preventive medicine, but also of therapeutic
medicine and provides approaches for preventing disease
and reducing its impact once it occurs.
ADOPTIVE IMMUNOTHERAPY

from traditional small chemical medicinals to a wide variety
of biomolecules, including peptide/protein- and nucleic acid-
based therapeutics. All of these therapies require the admin-
istration of stable dosage forms in adequate concentrations
and exposure periods to realize their potential. For the treat-
ment of many forms of cancer, the presentation and mainte-
nance of adequate drug concentrations to the target tissues
without exposure to drug-sensitive normal tissues are the
major limitations for successful chemotherapy.
IMMUNOTHERAPY OF CANCER
Tumor immunology is a scientific discipline that is driven
by clinical translation. For many decades, scientists both at
the bench and at the bedside have struggled with deter-
mining the role immunity may play in tumor eradication,
if an for many years, the major question driving the field
was whether human tumors were immunogenic. Over the
last decade, literally thousands of immunogenic proteins
related to tumors have been identified, resulting in a host
of new targets for immunomodulation.
PROTEASOME INHIBITORS IN CANCER
THERAPY
Inhibition of the proteasome in cultured cells, mostly of
tumor origin, produced profound stabilization of hundreds,
if not thousands, of proteins, ultimately turning on the
PREFACE TO THE SECOND EDITION XIII
programmed cell death machinery at concentrations that
directly correlated to the intrinsic inhibition constant of the
proteasome. Such observations begged further investigation
of proteasome inhibition in the treatment of human cancers.
RECOMBINANT ANTIBODIES FOR CANCER

Analgesics; non-narcotic agents
Androgenic steroids
Anesthetics; inhalation
Angiotensin-converting enzyme (ACE) inhibitors for
hypertension
Anorexia nervosa and bulimia nervosa; treatment of
Antacids
Antianxiety agents
Antibacterial drugs of choice
Antidepressants
Antidiarrheal medication
Antidiuretic hormone
Antidotes
Antiemetic preparations
Antihistamines (H
1
receptor antagonists)
Antihypertensive medications
Antineoplastic agents
Antiparasitic medications and their side effects
Antipsychotics
Antiviral agents
Arrhythmias
Arthritis and degenerative joint disease; treatment of
Asthma; treatment of
Autonomic receptors
Benzodiazepines; uses of
Beta-adrenergic-receptor-blocking agents
Bioavailability of drugs; factors influencing
Botulinum toxin A; uses of

Gastroesophageal reflux disease (GERD);
treatment of
Gaucher’s disease; treatment of
Gene therapy; e.g., for acquired immune deficiency
syndrome (AIDS)
Gilles de la Tourette’s syndrome; treatment of
Glaucoma; treatment for
Gonorrhea; treatment of
Gout; treatment of
Heart failure; treatment of
Hemostatic mechanisms and drugs influencing them
Hiccup; treatment of
Hirsutism; treatment of
Human immunodeficiency virus (HIV) infection;
treatment for
Huntington’s disease; the search for treatment continues
XIV PREFACE TO THE SECOND EDITION
Hyperglycemia; drug-induced
Hypertension; treatment of
Hypertensive emergencies; treatment of
Hypnotics
Hypoglycemia; drug-induced
Hypothalamic hormones
Immunization; agents used in
Immunosuppressive medications
In vitro fertilization; drugs for
Insomnia; treatment with benzodiazepines
Insulin preparations
Iodine-containing products
Ischemic stroke; treatment of

Ovulation; drugs to induce
Pancreatic enzymes preparations
Panic disorder; treatment of
Parasitic infections; treatment of
Parkinson’s disease; treatment of
Penicillins
Peptic ulcer; treatment of
Photosensitivity; medication-induced
Psychiatric symptoms caused by drugs
Psychotropic medications; side effects of
Pulmonary toxicity; drug-induced
Quinolone and fluoroquinolone antibiotics
Radiopaque agents
Restless legs syndrome; treatment of
Retinoids
Seizures; treatment of
Serotonin receptor subtypes
Sexual dysfunction caused by drugs
Sexually transmitted diseases; treatment of
Shingles; treatment of
Sinusitis; treatment of
Stuttering; treatment of
Suicide; prevention of
Sulfonamides
Syphilis; treatment of
Tetracyclines
Thrombolytic agents; a need for improvement
Thyroid preparations
Trace minerals essential for health
Traveler’s diarrhea; prevention of

M. Ebadi, Ph.D., FACCP
Grand Forks, North Dakota
XV
A
CKNOWLEDGMENTS FOR THE
S
ECOND
E
DITION
The author expresses his appreciation to Dr. Judith E.
Spiegel, Senior Editor of Life Sciences for CRC Press, for
the gracious invitation to prepare this second edition, and
to Gail Renard, the production editor, for polishing and
refining the book. The author remains eternally grateful and
in awe of Gail’s judgment and titanic contributions to
restructuring and refining five books for him in an admirable
fashion.
The author expresses his loving tribute to his two sons,
John Ebadi, Ph.D. (specializing in Oriental medicine and
Eastern healing art) and Mark Ebadi, M.D. (specializing
in Western medicine and Western healing art), for their
input on how to bridge past and present medical wisdom
and how to respect not only the immense contributions of
many ancient cultures but also the amazing advances made
by physicians today to the well being of human beings in
their quest to prevent disease, prolong life, and reduce
morbidity.
The author remains indebted to Victoria Swift, the
director of the art department at the University of North
Dakota School of Medicine and Health Sciences, for her

for their support and extending arms of friendship whenever
needed in supporting the author’s numerous research programs
at the University of North Dakota.
The author salutes Charles E. Kupchella, Ph.D., president
of the University of North Dakota; Peter Alfonso, Ph.D., vice
president for research, the University of North Dakota; H.
David Wilson, M.D., dean and vice president for health affairs,
University of North Dakota School of Medicine and Health
Sciences, Joshua Wynne, M.D., M.B.A., M.P.H., executive
associate dean, University of North Dakota School of Medicine
and Health Sciences, and Randy Eken, associate dean for
administration and finance, University of North Dakota School
of Medicine and Health Sciences, for confidence displayed in
the author’s talent and supporting him whenever needed.
The author remains humbled and in awe of hundreds of
physicians who read and made the first edition a success
but also reviewed the book, lit the path, and gave direction
on how to write the revised edition.
XVI
NOTICE
The indications and dosages of all drugs in this book have
been recommended in the medical literature and conform to
the practices of the general medical community. The medi-
cations described do not necessarily have specific approval
by the U.S. Food and Drug Administration for use in the
diseases and dosages for which they are recommended. The
package insert for each drug should be consulted for use and
dosage as approved by the PDA. Because standards for usage
change, it is advisable to keep abreast of revised recommen-
dations, particularly concerning new drugs.

became professor and chairman of the newly created
Department of Pharmacology, Physiology, and Therapeu-
tics; in November 1999, he became professor of neuro-
science; and in December 1999, he was appointed associate
dean for research and program development. In September
2000, Dr. Ebadi was appointed director of the Center of
Excellence in Neurosciences at the University of North
Dakota School of Medicine and Health Sciences, and in
March 2002, associate vice president for medical research
at the University of North Dakota.
During his academic career, Professor Ebadi has
received 36 awards, including the Burlington Northern Fac-
ulty Achievement Award (1987) and the University of
Nebraska’s systemwide Outstanding Teaching and Creative
Activity Award (1995), and was inducted into the Golden
Apple Hall of Fame (1995) for having received 11 Golden
Apple awards from the national Golden Apple Foundation
for excellence in teaching. He is a member of 18 research
and scholarly societies including Alpha Omega Alpha
Honor Medical Society.
In 1976, Dr. Ebadi became the Mid-America State Uni-
versities Association’s (MASUA) honor lecturer; in 1987,
he received an award for “meritorious contributions to
pharmaceutical sciences” from the University of Missouri
Alumni Association; in 1995, he was honored by a resolu-
tion and commendation of the board of regents of the Uni-
versity of Nebraska for having developed a sustained record
of excellence in teaching, including creative instructional
methodology; and in 1996, he received the Distinguished
Alumni Award from Park University, his alma mater. In

Herbal Medicine (CRC Press, 2002) became a best seller.
In 2005 Dr. Ebadi, along with Professor Ronald F. Pfeiffer,
M.D., published a book entitled Parkinson’s Disease, which
received excellent reviews in JAMA (293, 2281, 2005), and
in the New England Journal of Medicine (352, 1304, 2005),
and won first prize in the neurology category of the 2006
British Medical Association’s Book Competition.
On February 26, 2004, Dr. Ebadi received the University
of North Dakota Foundation’s Thomas J. Clifford Faculty
Achievement Award for Excellence in Research and, on
September 7, 2004, he received from President Charles E.
Kupchella, the designation of Chester Fritz Distinguished
Professor of Pharmacology and of Clinical Neuroscience, the
highest honor bestowed by the University of North Dakota.
XVIII THE AUTHOR
On July 21, 2005, Dr. Ebadi received the Pendelton
Honor from Eugene DeLorme, J.D., director of Indians into
Medicine Programs; from Dr. David Gipp, president of
United Indian Nations; and from Dr. Frank Williams, vice
president of the tribal board in appreciation of his providing
research support for the Indian nations. Dr. Ebadi has served
as a member of the United States Pharmacopoeia conven-
tion since 1970. On March 2, 2006, Dr. Ebadi was appointed
senior advisor to the president of the University of North
Dakota.
XIX
HOW TO USE THIS BOOK
This book may be used as an encyclopedia of medications
in which compounds appear under their generic names in
alphabetical order from Abacavir sulfate, to Zopiclone, the

Alzheimer’s disease, arrhythmias, arthritis, asthma, conges-
tive heart failure, constipation, Crohn’s disease, duodenal
ulcer, erectile dysfunction, fungal infections, Gaucher’s dis-
ease, Gilles de la Tourette syndrome, glaucoma, gonorrhea,
gout, heart failure, human immunodeficiency virus (HIV)
infection, Huntington’s disease, hypertension, insomnia,
Legionnaires’ disease, mania, migraine, multiple sclerosis,
mycoses, narcolepsy, obesity, osteoporosis, otitis media,
panic disorder, parasitic infections, Parkinson’s disease,
peptic ulcer, seizure disorders, sinusitis, syphilis, upper res-
piratory tract infections, urinary tract infections, uveitis,
vaginal candidiasis, and Wilson’s disease.
Orientation articles provide an encyclopedic listing of
medications dealing with aminoglycoside antibiotics,
analgesics, androgens, angiotensin-converting enzyme
inhibitors, antianxiety agents, antibacterial drugs, antide-
pressants, antidiarrheal medications, antidotes, antiemetics,
antipsychotics, antiviral agents, diuretics, estrogen prepara-
tions, expectorants, laxatives, lipid-lowering drugs, orphan
drugs, radiopaque agents, sulfonamides, tetracyclines,
thrombolytic agents, and many others.
In many cases, newly introduced medications, such as
the use of melatonin for sleep disorders, have been included.
Discussion of some novel medications, such as tizanmidine
for the treatment of spasticity or urapidel for the treatment
of hypertension, has been provided. Discussion of the rap-
idly growing family of peptides, such as trefoil peptides,
with a possible healing factor for peptic ulcers and inflam-
matory bowel diseases, and many other novel avenues of
therapeutics have been introduced. Whenever possible, the

Beta-adrenergic-receptor-blocking agents 105
Bioavailability of drugs 107
Botulinum toxin A 110
Bronchodilators: β-adrenergic agonists for the treatment of asthma 113
Calcium-channel blockers for the treatment of hypertension 120
Cephalosporins 143
Cerebroactive medications 144
Chlamydial infections 146
Cholinergic drugs 153
Cholinergic-receptor-blocking agents 154
Cirrhosis 159
Congestive heart failure 170
Constipation 171
Corticosteroids 171
Crohn’s disease 175
Cytokines 179
Dermatological disorders 190
Diabetes mellitus 196
Diarrhea 196
Diuretics 207
Duodenal ulcers 217
Enzymes and hormones of the gastrointestinal tract 228
Epileptic seizures 229
Erectile dysfunction 235
Ergot alkaloids 238
Estrogenic preparations 249
Expectorants 261
Fungal infections 288
XXII LIST OF ORIENTATION ARTICLES
Gastroesophageal reflux disease (GERD) 292

Manic symptoms, drugs that induce 402
Migraine headaches 444
Monoamine oxidase inhibitors 468
Multiple sclerosis 472
Myasthenia gravis 473
Mycoses 475
Myoclonus 475
Narcolepsy 484
Neurotransmitters and their receptor subtypes 489
Newborns 491
Nitrate products 499
Nondepolarizing neuromuscular blocking drugs 503
Nonsteroidal antiinflammatory drugs 505
Nursing infants 508
Obesity 509
Oculotoxicity 511
Opioid peptides 517
Opioids 517
Oral hypoglycemic agents 518
Orphan drugs 519
Osteoporosis 527
Otitis media 527
Ototoxicity 528
Ovulation 529
Pancreatic enzymes 539
LIST OF ORIENTATION ARTICLES XXIII
Panic disorder 540
Parasitic infections 543
Parkinson’s disease 548
Penicillins 557

Vitamins 729
Vomiting caused by antineoplastic agents 729
Wilson’s disease 732
Wound infection and sepsis in surgical patients 732
XXIV
LIST OF TABLES
Table 4.1 Herbs Interacting with Drugs 24
Table 4.2 Stages in Hemostasis 26
Table 4.3 Formation of Fibrin 26
Table 4.4 Potential and Documented Interactions of Herbs and Warfarin 29
Table 5.1 Medications with Which Grapefruit Juice Should Not Be Considered in an Unsupervised Manner 34
Table 1 Comparison of Orally Administered Sulfonylurea Hypoglycemic Agents 38
Table 2 Antipsychotic Agents 39
Table 3 The Pharmacologic Efficacy of Various Compounds Possessing Analgesic, Antipyretic, Uricosuric,
and Antiinflammatory Actions 41
Table 4 Composition and Acid-Neutralizing Capacity of Nonprescription Antacid Preparation (Suspensions) 59
Table 5 Side Effects of Antidepressant Drugs 65
Table 6 The Inhibition of Monoamine Uptake by Antidepressants 66
Table 7 The Affinity of Antidepressants for Various Receptors 66
Table 8 Examples of Anabolic and Androgenic Steroids 72
Table 9 Summary of Benzodiazepine Derivatives 103
Table 10 Comparison of H
2
-Receptor Antagonists 157
Table 11 Preparations of Adrenocortical Steroids and Their Synthetic Analogs 172
Table 12 Comparison of the Pharmacokinetic Profiles of Digoxin and Digitoxin 203
Table 13 Actions of Adrenergic and Dopaminergic Agents on Their Receptors 208
Table 14 Actions of Glucocorticoids 305
Table 15 GnRH Analogs with Agonist Activity 310
Table 16 Summary Pharmacology of Nitrous Oxide, Cyclopropane, Halothane, and Ether 318