Life tables
as
Aden C. Irwin, md,
dph
"predictors" of average longevity
improve¬ relatively large but it Cross-sectional mortality analysis decreases over time with advancing age, as does the female advantage. A Physicians are interested in any vertical look down both tables shows prognostic value that life expectancy an initial sharp increase in expected tables may provide for their patients at 1 year of age often a but, because these tables are based on longevity to someone examining a life surprise the cross-sectional mortality rates of table for the first time Des statistiques tirees des tables de and then, persons of different ages at one point among the survivors of each older age mortalite canadiennes ont ete analysees in time, they should always be inter- group, a slowly increasing improve¬ dans le but d'illustrer une utilisation with caution when applied to ment with preted de donnees receuillies et possible age. individuals. Because it is easier to make These cross-sectional changes over publiees regulierement. On demande direct from totals to than comparisons time are shown graphically in Figs. IA que les principes de la demographie carry out an addition every time a table and IB, in which attained age is plotted soient inclus au programme d'education is consulted, each attained age and the medicale au niveau sousgradue. against average longevity for all five corresponding average number of years decennial life tables. The five curves A recent issue of a widely distributed of lifeanremaining have been added to show successive improvements in lon¬ expected average longevity. gevity at younger ages but demonstrate pharmaceutical publication contains a give predicted totals for selected ages the of the often-voiced opinion brief note entitled "Longevity in Can¬ These in Tables IA and IB, sep¬ that fallacy the reason for the increasing pro¬ ada".1 It is based on some routinely are shown arately for males and females, over portion of older persons in the popula¬ published reports of data collected, col- the 40-year period 1931 to 1971. tion today is that people are living lated and analysed by the staff of the A look across both tables or that reduced death rates are health and welfare division of Statistics showshorizontal longer that the expected longevity for Canada. An article in the Journal2 has newborns responsible. by 9.34 years for shown how useful similar reports can males and increased be. Because many physicians find life over this by 14.26 years for females Cohort mortality analysis 40-year period. Throughout tables difficult to interpret (and may These expected average longevity fig¬ therefore dismiss them as being of ures apply to persons who occupy dif¬ little relevance to the practice of med¬ Table IA.Expected average longevity for ferent age groups in successive current icine) I have used the subject of lon¬ males life tables. When the data in Tables IA gevity to illustrate some simple methods of extracting useful information from Selected figures from Canadian life tables have been analysed to illustrate one potential use of routinely collected and published data. A plea is made for the inclusion of the fundamentals of demography in undergraduate medical education.
Methods
childhood and adolescence the
ment is still
the available Canadian life tables.
Sources of data The following data have been ex¬ tracted from current life tables, which are based on the June 1 census popula¬ tion totals and on the corresponding average numbers of deaths for the 3year period encompassing each decennial census year for 1931, 1941, 1951, 1961 and 1971.3 From these raw data statisticians calculate the average expectation of life for persons at each exact age from birth to some arbitrary upper limit usually 105 years. For a group of persons who have attained some given age, the expectation of life is the average number of years yet to be lived if current age-specific mortality continue throughout their lives. life tables are also available for 1956 and 1966, data from them have not been incorporated in this
rates
Although
paper. 60
From the department of preventive medicine, Dalhousie University, Halifax Reprint requests to: Dr. Aden C. Irwin, Department of preventive medicine, Dalhousie University, Halifax, NS B3H 4H7
J 1931 2030405060 70 8090 100 ATTAINED AGE < years )
FIG. IA.Expected average for males, Canada, 1931-71.
longevity
CMA JOURNAL/MARCH 20, 1976/VOL. 114 539
and IB are inspected along the diagonals and then rearranged horizontally. the results are Table NA and IIB, in which the expected average longevity over the 40-year period is now crossclassified by year of birth and by at¬ tained age. This cohort analysis tech¬ nique allows us to follow any birth cohort for varying periods through the decennial life tables, so as to compare earlier life expectancy with later ex¬ perience. A comparison of longevity of different cohorts at birth reflects the average improvement in mortality over the 40 years. This technique will be in¬ creasingly useful as future current life tables become available, providing ad¬ ditional figures at the foot of each year-of-birth column. One example is sufficient to indicate how to interpret these cohort tables: In 1931 the current life tables for males showed an average life expectancy at birth of 60.00 years and an average expected longevity by 40 years of age of 71.98 years (Table IA). However, when the survivors of this 1931 male birth cohort reached 40 years (in the 1971 life table), their average expected longevity was 73.22 years (Table IIA) that is, experience added 1.24 years to their life expectancy at birth.
fore, of limited value in projecting mortality. Health conditions today dif¬ fer greatly from those at the beginning of this century, but cohort mortality incorporates both these changes and any influences to which the cohort was subject. Even though reliable cohort mortality data are limited at present to the available life tables, they do pro¬ vide a more sound basis from which to project mortality, especially when the members of the cohort have reached older ages, when only small changes are expected. It may be wishful thinking to assume that health con¬ ditions will continue to improve indefinitely, even though this has been the experience of physicians currently in practice. The study, interpretation and appli¬ cation of mortality rates, by whatever technique, form a small part of the field of demography, which is "the study of the determinants and conse¬ quences of population trends, as well as the mathematical and statistical study of population dynamics", to quote from the Johns Hopkins Univer¬ sity calendar. This subject is barely mentioned in the undergraduate medical curriculum but all physicians must have some basic knowledge of it if they are to deal intelligently with current Discussion problems. In a recent paper Louria4 made a strong plea for some knowledge A current life table describes mor¬ of population dynamics as part of the tality in some particular period under body of knowledge that all medical conditions then existing and is, there¬ students should acquire: Table
MA.Expected
average
Table
IIB.Expected
average
2 70
i
0
10
i
'
r
¦
i
i
¦
\
2030405060708090 100 ATTAINED AGE
( years )
FIG. IB.Expected average longevity for females, Canada, 1931-71. 540 CMA JOURNAL/MARCH 20, 1976/VOL. 114
longevity
Surely in a world with four billion per¬ and with the certainty that in the lifetime of our children there will be eight billion, population dynamics must be a part of the curriculum of every medical school, and an important part. An under¬ standing of fertility rates, zero population growth, doubling times, birth and death control, the psychophysiologic effects of crowding are as important for the student as cardiac output and the therapy of endotoxic shock. Included in this should be pragmatic aspects of family planning, and an appreciation of the causes of infant mortality in the United States and other sons
areas
of the world.
Much less positive is a recent posi¬ tion paper5 prepared by the epidemiol¬ ogy division of the Canadian Public Health Association on the teaching of epidemiology to undergraduates. Two of a list of seven objectives relate to the use of published data: The student who has had
a
suitable
grounding in epidemiology should be able to: 1) understand and interpret data ex¬ pressed in the form of rates; 4) appreciate the value of statistics and special studies in the rational planning of health
care.
Because epidemiology deals primarily with the study of human population groups, perhaps knowledge of basic de¬ mographic characteristics such as age, sex, geographic distribution and occu¬ pation is implied in this position paper. Finally, how is the practising physi-
for Canadian males
longevity for Canadian females
cian to gain some knowledge of demography? Although there are many texts, ranging in coverage from introductory to exhaustive,6-9 the amount of mathematics may make many physicians reluctant to begin reading them. However, even an attempt will be rewarding, for the introductions to each chapter and much of the discussion between mathematical sections are extremely interesting and relevant. References I. Longevity in Canada, in Patterns of Disease, Don Mills, Parke-Davis, 1975, no 2 2. COLBURN HN, BAKER PM: The use of mortality data in setting priorities for disease prevention. Can Med Assoc 1 110: 679, 1974 3. Life Tables by Sex, Canada and Provinces, 1970-72, Ottawa, Information Canada, 1974 (and previous publications under similar titles) 4. LouaiA DB: The teaching of preventive medicine in medical schools: a limited critique. Prey Med 4: 1, 1975 5. Position paper on teaching epidemiology to undergraduates. Can I Public Health 66: 153, 1975 6. SPIEGELMAN M: Introduction to Demography, 2nd ed, Cambridge, MA, Harvard U Pr, 1968 7. Cox PR: Demography, 4th ed, London, Engl, Cambridge U Pr, 1970 8. PRESSAT R: Demographic Analysis: Methods, Results, Applications, London, EngI, Edward Arnold, 1972 9. SHRYOCK HS, SIGEL JS, et al: The Methods and Materials of Demography, Washington, US Dept of Commerce, bureau of the census, 1973
Noludar Roche. (methyprylon) Rx summary: Indications Insomnia due to mental unrest, excitement, fear, worry or extreme fatigue. Adverse reactions Nausea, headache, drowsiness, vertigo, paradoxical excitation, and skin rash. Precautions As with other hypnotic agents, patients should be advised to abstain from alcohol during treatment with 'Noludar' as the individual response cannot be foreseen. Dosage Adults: 1 capsule at bedtime. Children: over 6 years - 100 mg at bedtime. 2 to 6 years - 75 mg at bedtime. 6 months to 2 years - 50 mg at bedtime. Supply Capsules, 300 mg; 100, 500. Elixir, 50 mg/tsp. (5 ml); 400 ml. Complete prescribing information available on request. ®Reg. Trade Mark Hoffmann-La Roche Limited Vaudreuil, Quebec
Valium® Roche Bactrim * Roche® Suspension Rx Summary Indications: The following types of infections when caused by susceptible pathogens-upper and lower respiratory tract infections (particularly chronic bronchitis and including acute and chronic otitis media); acute, recurrent, and chronic urinary tract infections; genital tract infections (uncomplicated gonococcal urethritis); gastrointestinal infections; and skin and soft tissue infections. Not indicated in infections due to Pseudomonas, Mycoplasma, or viruses. Contraindicat ions: Marked liver damage; blood dyscrasias; hypersensitivity to trimethoprim or sulfonamides; or marked renal impairment when repeated serum assays cannot be carried out. Premature or newborn infants. For the time being, Bactrim is contraindicated during pregnancy. Precaution: As with other sulfonamide preparations, benefit should be appraised versus risk in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies, or bronchial asthma. Possibility of superinfection with a nonsentive organism should be borne in mind. Adverse reactions: Hematological changes, particularly in elderly patients (primarily neutropenia and thrombocytopenia; also, less frequently, leukopenia, aplastic and hemolytic anemia, purpura, agranulocytosis, and bone marrow depression). Nausea, vomiting, gastric intolerance, and rash; also, less frequently, diarrhea, constipation, flatulence, anorexia, pyrosis, gastritis, gastroenteritis, urticaria, headache, and liver changes (elevations in alkaline phosphatase and serum transaminase levels). For complete list of side-effects occasionally reported, please see product monograph. Dosage and administration: Children under 12 years of age. Young children-dosage according to weight. Under 2 years-2.5 ml suspension twice daily. 2 to 5 years-2.5 to 5 ml suspension twice daily or 1 to 2 pediatric tablets twice daily. 6 to 12 years-5 to 10 ml suspension, or 2 to 4 pediatric tablets, or 1 adult tablet twice daily. Adults and children over 12 years of age. Standard dosage-2 tablets twice daily (morning and evening). Minimum dosage and long-term treatment1 tablet twice daily. Maximum dosage (overwhelming infections)3 tablets twice daily. Uncomplicated gonorrhea-2 tablets 4 times daily for 2 days. For complete dosage information, please see product monograph. Supply: Suspension (aniseed-flavoured), each 5 ml containing 40 mg trimethoprim and 200 mg sulfamethoxazole; bottles of 100 and 400 ml. Tablets, containing 80 mg trimethoprim and 400 mg sulfamethoxazole; bottles of 100 and 500. Pediatric tablets, containing 40 mg trimethoprim and 200 mg sulfamethoxazole; bottles of 100 and 500. Product monograph available on request. *Trade Mark of Hoffmann-La Roche Limited ®Reg Trade Mark
Hoffmann-La Roche Limited \NUIDNL. Vaudreuji, Quebec
(diazepam) Rx summary: Indications Symptomatic management of mild to moderate degrees of anxiety in conditions dominated by tension, excitation, agitation, fear or aggressiveness. Spasm in muscular disorders of central or peripheral origin. Contraindications Myasthenia gravis, glaucoma, known hypersensitivity to the drug, and because of lack of sufficient evidence, in children under six months. Adverse reactions Drowsiness, ataxia, fatigue, dizziness, slurred speech, tremors, hypotension, tachycardia and phlebitis. Paradoxical reactions in psychiatric patients. Precautions Abstinence from alcohol during treatment. Caution wherever mental alertness or physical coordination is required. Periodic blood counts and liver function tests advisable in long-term use. Caution in severely depressed patients or those with suicidal tendencies. Dosage (oral) Depending upon seve.ity of symptoms. Adults 2 mg to 10 mg, 2 to 4 times daily. Elderly and debilitated patients - 2 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated. Children - 1 mg to 2½ mg, 3 or 4 times daily initially; increase gradually as needed and tolerated. Parenteral dosage Acute anxiety or tension states or non psychotic emotional disorders: 2 mg to 10 mg i.m. or i.v. Repeat in 3 to 4 hours if necessary. Acute alcoholic withdrawal: 10 mg i.m.
or i.v. initially then 5 to 10 mg in 3 to
4 hours if necessary. Relief of muscle spasm: 5 mg to 10 mg i.m. or i.v. initially then 5 mg to 10 mg in 3 to 4 hours if necessary. Status Epilepticus and severe recurrent seizures: 5 mg to
10 mg i.v. or i.m. and repeat in 2 to 4 hours if necessary. Children: 2 mg to 10 mg i.m. or i.v. or 0.25 mg/kg. Elderly and debilitated: 2 mg to 5 mg in. or iv. SupplyTablets, 2,5, 10mg; 100,1000. Suspension, 5 mg/S ml; 100, 400 ml.
Ampoules 10 mg/2 ml; 5, 25. Disposable Syringe 10 mg/2 ml, in-
dividually packed, 10. Complete prescribing information available on request.
* Reg. Trade Mark for chlordiazepoxide
'Roche' * * Reg. Trade Mark for flurazepam Roche' .Reg. Trade Mark
Hoff mann-La Roche Limited \,..4Vaudreuil, Quebec
CMA JOURNAL/MARCH 20, 1976/VOL. 114 541
as
Aden C. Irwin, md,
dph
"predictors" of average longevity
improve¬ relatively large but it Cross-sectional mortality analysis decreases over time with advancing age, as does the female advantage. A Physicians are interested in any vertical look down both tables shows prognostic value that life expectancy an initial sharp increase in expected tables may provide for their patients at 1 year of age often a but, because these tables are based on longevity to someone examining a life surprise the cross-sectional mortality rates of table for the first time Des statistiques tirees des tables de and then, persons of different ages at one point among the survivors of each older age mortalite canadiennes ont ete analysees in time, they should always be inter- group, a slowly increasing improve¬ dans le but d'illustrer une utilisation with caution when applied to ment with preted de donnees receuillies et possible age. individuals. Because it is easier to make These cross-sectional changes over publiees regulierement. On demande direct from totals to than comparisons time are shown graphically in Figs. IA que les principes de la demographie carry out an addition every time a table and IB, in which attained age is plotted soient inclus au programme d'education is consulted, each attained age and the medicale au niveau sousgradue. against average longevity for all five corresponding average number of years decennial life tables. The five curves A recent issue of a widely distributed of lifeanremaining have been added to show successive improvements in lon¬ expected average longevity. gevity at younger ages but demonstrate pharmaceutical publication contains a give predicted totals for selected ages the of the often-voiced opinion brief note entitled "Longevity in Can¬ These in Tables IA and IB, sep¬ that fallacy the reason for the increasing pro¬ ada".1 It is based on some routinely are shown arately for males and females, over portion of older persons in the popula¬ published reports of data collected, col- the 40-year period 1931 to 1971. tion today is that people are living lated and analysed by the staff of the A look across both tables or that reduced death rates are health and welfare division of Statistics showshorizontal longer that the expected longevity for Canada. An article in the Journal2 has newborns responsible. by 9.34 years for shown how useful similar reports can males and increased be. Because many physicians find life over this by 14.26 years for females Cohort mortality analysis 40-year period. Throughout tables difficult to interpret (and may These expected average longevity fig¬ therefore dismiss them as being of ures apply to persons who occupy dif¬ little relevance to the practice of med¬ Table IA.Expected average longevity for ferent age groups in successive current icine) I have used the subject of lon¬ males life tables. When the data in Tables IA gevity to illustrate some simple methods of extracting useful information from Selected figures from Canadian life tables have been analysed to illustrate one potential use of routinely collected and published data. A plea is made for the inclusion of the fundamentals of demography in undergraduate medical education.
Methods
childhood and adolescence the
ment is still
the available Canadian life tables.
Sources of data The following data have been ex¬ tracted from current life tables, which are based on the June 1 census popula¬ tion totals and on the corresponding average numbers of deaths for the 3year period encompassing each decennial census year for 1931, 1941, 1951, 1961 and 1971.3 From these raw data statisticians calculate the average expectation of life for persons at each exact age from birth to some arbitrary upper limit usually 105 years. For a group of persons who have attained some given age, the expectation of life is the average number of years yet to be lived if current age-specific mortality continue throughout their lives. life tables are also available for 1956 and 1966, data from them have not been incorporated in this
rates
Although
paper. 60
From the department of preventive medicine, Dalhousie University, Halifax Reprint requests to: Dr. Aden C. Irwin, Department of preventive medicine, Dalhousie University, Halifax, NS B3H 4H7
J 1931 2030405060 70 8090 100 ATTAINED AGE < years )
FIG. IA.Expected average for males, Canada, 1931-71.
longevity
CMA JOURNAL/MARCH 20, 1976/VOL. 114 539
and IB are inspected along the diagonals and then rearranged horizontally. the results are Table NA and IIB, in which the expected average longevity over the 40-year period is now crossclassified by year of birth and by at¬ tained age. This cohort analysis tech¬ nique allows us to follow any birth cohort for varying periods through the decennial life tables, so as to compare earlier life expectancy with later ex¬ perience. A comparison of longevity of different cohorts at birth reflects the average improvement in mortality over the 40 years. This technique will be in¬ creasingly useful as future current life tables become available, providing ad¬ ditional figures at the foot of each year-of-birth column. One example is sufficient to indicate how to interpret these cohort tables: In 1931 the current life tables for males showed an average life expectancy at birth of 60.00 years and an average expected longevity by 40 years of age of 71.98 years (Table IA). However, when the survivors of this 1931 male birth cohort reached 40 years (in the 1971 life table), their average expected longevity was 73.22 years (Table IIA) that is, experience added 1.24 years to their life expectancy at birth.
fore, of limited value in projecting mortality. Health conditions today dif¬ fer greatly from those at the beginning of this century, but cohort mortality incorporates both these changes and any influences to which the cohort was subject. Even though reliable cohort mortality data are limited at present to the available life tables, they do pro¬ vide a more sound basis from which to project mortality, especially when the members of the cohort have reached older ages, when only small changes are expected. It may be wishful thinking to assume that health con¬ ditions will continue to improve indefinitely, even though this has been the experience of physicians currently in practice. The study, interpretation and appli¬ cation of mortality rates, by whatever technique, form a small part of the field of demography, which is "the study of the determinants and conse¬ quences of population trends, as well as the mathematical and statistical study of population dynamics", to quote from the Johns Hopkins Univer¬ sity calendar. This subject is barely mentioned in the undergraduate medical curriculum but all physicians must have some basic knowledge of it if they are to deal intelligently with current Discussion problems. In a recent paper Louria4 made a strong plea for some knowledge A current life table describes mor¬ of population dynamics as part of the tality in some particular period under body of knowledge that all medical conditions then existing and is, there¬ students should acquire: Table
MA.Expected
average
Table
IIB.Expected
average
2 70
i
0
10
i
'
r
¦
i
i
¦
\
2030405060708090 100 ATTAINED AGE
( years )
FIG. IB.Expected average longevity for females, Canada, 1931-71. 540 CMA JOURNAL/MARCH 20, 1976/VOL. 114
longevity
Surely in a world with four billion per¬ and with the certainty that in the lifetime of our children there will be eight billion, population dynamics must be a part of the curriculum of every medical school, and an important part. An under¬ standing of fertility rates, zero population growth, doubling times, birth and death control, the psychophysiologic effects of crowding are as important for the student as cardiac output and the therapy of endotoxic shock. Included in this should be pragmatic aspects of family planning, and an appreciation of the causes of infant mortality in the United States and other sons
areas
of the world.
Much less positive is a recent posi¬ tion paper5 prepared by the epidemiol¬ ogy division of the Canadian Public Health Association on the teaching of epidemiology to undergraduates. Two of a list of seven objectives relate to the use of published data: The student who has had
a
suitable
grounding in epidemiology should be able to: 1) understand and interpret data ex¬ pressed in the form of rates; 4) appreciate the value of statistics and special studies in the rational planning of health
care.
Because epidemiology deals primarily with the study of human population groups, perhaps knowledge of basic de¬ mographic characteristics such as age, sex, geographic distribution and occu¬ pation is implied in this position paper. Finally, how is the practising physi-
for Canadian males
longevity for Canadian females
cian to gain some knowledge of demography? Although there are many texts, ranging in coverage from introductory to exhaustive,6-9 the amount of mathematics may make many physicians reluctant to begin reading them. However, even an attempt will be rewarding, for the introductions to each chapter and much of the discussion between mathematical sections are extremely interesting and relevant. References I. Longevity in Canada, in Patterns of Disease, Don Mills, Parke-Davis, 1975, no 2 2. COLBURN HN, BAKER PM: The use of mortality data in setting priorities for disease prevention. Can Med Assoc 1 110: 679, 1974 3. Life Tables by Sex, Canada and Provinces, 1970-72, Ottawa, Information Canada, 1974 (and previous publications under similar titles) 4. LouaiA DB: The teaching of preventive medicine in medical schools: a limited critique. Prey Med 4: 1, 1975 5. Position paper on teaching epidemiology to undergraduates. Can I Public Health 66: 153, 1975 6. SPIEGELMAN M: Introduction to Demography, 2nd ed, Cambridge, MA, Harvard U Pr, 1968 7. Cox PR: Demography, 4th ed, London, Engl, Cambridge U Pr, 1970 8. PRESSAT R: Demographic Analysis: Methods, Results, Applications, London, EngI, Edward Arnold, 1972 9. SHRYOCK HS, SIGEL JS, et al: The Methods and Materials of Demography, Washington, US Dept of Commerce, bureau of the census, 1973
Noludar Roche. (methyprylon) Rx summary: Indications Insomnia due to mental unrest, excitement, fear, worry or extreme fatigue. Adverse reactions Nausea, headache, drowsiness, vertigo, paradoxical excitation, and skin rash. Precautions As with other hypnotic agents, patients should be advised to abstain from alcohol during treatment with 'Noludar' as the individual response cannot be foreseen. Dosage Adults: 1 capsule at bedtime. Children: over 6 years - 100 mg at bedtime. 2 to 6 years - 75 mg at bedtime. 6 months to 2 years - 50 mg at bedtime. Supply Capsules, 300 mg; 100, 500. Elixir, 50 mg/tsp. (5 ml); 400 ml. Complete prescribing information available on request. ®Reg. Trade Mark Hoffmann-La Roche Limited Vaudreuil, Quebec
Valium® Roche Bactrim * Roche® Suspension Rx Summary Indications: The following types of infections when caused by susceptible pathogens-upper and lower respiratory tract infections (particularly chronic bronchitis and including acute and chronic otitis media); acute, recurrent, and chronic urinary tract infections; genital tract infections (uncomplicated gonococcal urethritis); gastrointestinal infections; and skin and soft tissue infections. Not indicated in infections due to Pseudomonas, Mycoplasma, or viruses. Contraindicat ions: Marked liver damage; blood dyscrasias; hypersensitivity to trimethoprim or sulfonamides; or marked renal impairment when repeated serum assays cannot be carried out. Premature or newborn infants. For the time being, Bactrim is contraindicated during pregnancy. Precaution: As with other sulfonamide preparations, benefit should be appraised versus risk in patients with liver damage, renal damage, urinary obstruction, blood dyscrasias, allergies, or bronchial asthma. Possibility of superinfection with a nonsentive organism should be borne in mind. Adverse reactions: Hematological changes, particularly in elderly patients (primarily neutropenia and thrombocytopenia; also, less frequently, leukopenia, aplastic and hemolytic anemia, purpura, agranulocytosis, and bone marrow depression). Nausea, vomiting, gastric intolerance, and rash; also, less frequently, diarrhea, constipation, flatulence, anorexia, pyrosis, gastritis, gastroenteritis, urticaria, headache, and liver changes (elevations in alkaline phosphatase and serum transaminase levels). For complete list of side-effects occasionally reported, please see product monograph. Dosage and administration: Children under 12 years of age. Young children-dosage according to weight. Under 2 years-2.5 ml suspension twice daily. 2 to 5 years-2.5 to 5 ml suspension twice daily or 1 to 2 pediatric tablets twice daily. 6 to 12 years-5 to 10 ml suspension, or 2 to 4 pediatric tablets, or 1 adult tablet twice daily. Adults and children over 12 years of age. Standard dosage-2 tablets twice daily (morning and evening). Minimum dosage and long-term treatment1 tablet twice daily. Maximum dosage (overwhelming infections)3 tablets twice daily. Uncomplicated gonorrhea-2 tablets 4 times daily for 2 days. For complete dosage information, please see product monograph. Supply: Suspension (aniseed-flavoured), each 5 ml containing 40 mg trimethoprim and 200 mg sulfamethoxazole; bottles of 100 and 400 ml. Tablets, containing 80 mg trimethoprim and 400 mg sulfamethoxazole; bottles of 100 and 500. Pediatric tablets, containing 40 mg trimethoprim and 200 mg sulfamethoxazole; bottles of 100 and 500. Product monograph available on request. *Trade Mark of Hoffmann-La Roche Limited ®Reg Trade Mark
Hoffmann-La Roche Limited \NUIDNL. Vaudreuji, Quebec
(diazepam) Rx summary: Indications Symptomatic management of mild to moderate degrees of anxiety in conditions dominated by tension, excitation, agitation, fear or aggressiveness. Spasm in muscular disorders of central or peripheral origin. Contraindications Myasthenia gravis, glaucoma, known hypersensitivity to the drug, and because of lack of sufficient evidence, in children under six months. Adverse reactions Drowsiness, ataxia, fatigue, dizziness, slurred speech, tremors, hypotension, tachycardia and phlebitis. Paradoxical reactions in psychiatric patients. Precautions Abstinence from alcohol during treatment. Caution wherever mental alertness or physical coordination is required. Periodic blood counts and liver function tests advisable in long-term use. Caution in severely depressed patients or those with suicidal tendencies. Dosage (oral) Depending upon seve.ity of symptoms. Adults 2 mg to 10 mg, 2 to 4 times daily. Elderly and debilitated patients - 2 mg, 1 or 2 times daily initially; increase gradually as needed and tolerated. Children - 1 mg to 2½ mg, 3 or 4 times daily initially; increase gradually as needed and tolerated. Parenteral dosage Acute anxiety or tension states or non psychotic emotional disorders: 2 mg to 10 mg i.m. or i.v. Repeat in 3 to 4 hours if necessary. Acute alcoholic withdrawal: 10 mg i.m.
or i.v. initially then 5 to 10 mg in 3 to
4 hours if necessary. Relief of muscle spasm: 5 mg to 10 mg i.m. or i.v. initially then 5 mg to 10 mg in 3 to 4 hours if necessary. Status Epilepticus and severe recurrent seizures: 5 mg to
10 mg i.v. or i.m. and repeat in 2 to 4 hours if necessary. Children: 2 mg to 10 mg i.m. or i.v. or 0.25 mg/kg. Elderly and debilitated: 2 mg to 5 mg in. or iv. SupplyTablets, 2,5, 10mg; 100,1000. Suspension, 5 mg/S ml; 100, 400 ml.
Ampoules 10 mg/2 ml; 5, 25. Disposable Syringe 10 mg/2 ml, in-
dividually packed, 10. Complete prescribing information available on request.
* Reg. Trade Mark for chlordiazepoxide
'Roche' * * Reg. Trade Mark for flurazepam Roche' .Reg. Trade Mark
Hoff mann-La Roche Limited \,..4Vaudreuil, Quebec
CMA JOURNAL/MARCH 20, 1976/VOL. 114 541
