CORRESPONDENCE
VELOSEF 250 CAPSULES VELOSEF 500 CAPSULES
-. C. FOR ORAL SUSPENSION
VELOSEF 125 VELOSEF 250 FOR ORAL SUSPENSION Cphradln. for Oral SuspensIon VELOSEF FOR INJECTION, 500 mg mid 1 g Csphradhie for InjectIon
ACTION: Gephradine isa semi-synthetic, cephaloaporin antibiotic exhibiting bactericidal activity through inhibition of ceil-wall synthesis. INDICATIONS: Infections In the respiratory and genitourinary tracts, and in the akin and soft tissues, due to susceptibie organisms. Sensitivity tests should be performed: therapy may be inatituted before receiving the resulta. CONTRAINOICATIONS: Hypersensitivity to the cephaiosporin group of antibiotics. WARNlNGS: There is evidence of partial cross-allerganicity between the peniillins and the cephalosporins. Therefore, cephradine should be used with caution in patients with known hypersenaltivity to penicillins. Antibiotics, including cephradine, should be used cautloualy and only when absolutely necessary In patients with a history of allergies, particularly to drugs. Usage during pregnancy and lactation: Safety for use of this product during pregnancy has not been established. Cephradine is secreted in breast milk. PRECAUTIONS: Patients should be obeerved carefully during therapy. Allergic reactions require discontinuation of VELOSEF and appropriate treatment. Proionged use of VELOSEF may result in overgrowth of nonsusceptible organisms: appropriate messures should be instituted. DurIng long-term therapy, hematoiogical, renal and hepatic functions should be monitored periodically. Patients with known or suspected renal impalrment should be obeerved carefully since cephradine may accumulate in the serum and tissues unless dosage is suitabiy reduced. See DOSAGE AND ADMINISTRATION section. Indicated surgical procedures should be performed in conjunction with antibiotic therapy; e.g., the incision and drainage of abscesses. After treatment with cephalosporins, a false-poaltive resction for glucose in the urine may occur, but not with enzymebased tests. A false-positive Coomba test has also been reported. VELOSEF for Injection is not compatible with Lactated Ringer's Solution or other calcium-containing infusion fluids. ADVERSE REACTIONS: Usually limited to gastrointestinal disturbances and occasional hypersensitivity, but may include hematological and hepatobiliary disturbances, sa well as alevated BUN, LDH or serum creatinine; superinfection; vaginitis and joint pains. Thrombophlebitis following IV. injection and sterile abscesses after IM. injection have occurred. Only occasionally severe enough to warrant cess.tion of therapy DOSAGE AND ADMINISTRATION: The presence of food in the gastrointestinal tract delays the absorption and reduces the pesk level but does not affect the total amount of cephradine absorbed. VELOSEF Capaules and VELOSEF for Oral Suspension Adults: Respiratory tract infections: 250 mg, q6h. Pneumococcal lobar pneumonia: 500 mg, q6H. Genitourinary tract infections: 500 mg, q6h. Prolonged therapy is edvisable for the treatment of prostatitis and epididymitis. Children: 25 to 50 mg/kg/day, divided into four equally spaced dossa, e.g.: VELOSEF for Oral Suspension 250 mg/5 ml 125 mg/5 ml Child's Weight '/,toltsp.q8h lOkg(221ba) '/.to1tsp.q6h lto2tsp.q6h 20kg(.lbe) lto2tsp.q6h 2to4tsp.q6h 4Okg(881ba) Smaller doses than those indicated above should not be used. For otitis media due to H. influenzae, doses from 7510 100 mg/kg/day are recommended. VELOSEF for Injection: For uae in serious and life-threatening infections or where oral therapy is not possible. Average adult daily dose is 2 -4 g, depending on the infection. In children, a daily dose of 50- 100 mg/kg is recommended. All patients; all formulations: Larger doses (up to 1 g q6h in adults or up to 25 mg/kg q6h in children) may be given for severe or chronic infections: maximum daily dose should not exceed 4 g. Therapy should be continued for a minimum 0148 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by hemolytic streptococci, a minimum 10-daytreatment period is recommended. Stubborn infections may require trestment for several weeks with frequent bacteriological and clinical appraisal. A modified dosage schedule in patients with decreased renal function is necessary. Each patient should be considered individually: the following schedule is recommended as a guideline. Initial loeding dose: 750 mg. Maintenance dose: 500 mg at the time intervals listed below: Time Interval Crestinine Clearance (ml /min/1 .73m2) 6-l2hours > 20m1/min 12-24hours is-igmI/min 24-40 hours 10-14 mI/mm 40-SOhours 5-9m1/min 50-70hours < SmI/min DOSAGE FORMS: Capsules of 250 mg and 500 mg in bottles of 50, and bottles of VELOSEF 125 and 250 for Oral Suspension which, after reconstitution, provide 100 ml of pleassntly flavoured suspension containing 25 mg/mI and 50 mg/mi respectively. VELOSEF for Injection is provided as a sterile powder for reconstitution in vials containing 500 mg or 1 g. Consult Product Monograph for reconstitution procedure. Product Monograph available to physicians and pharmacists on request.
E R. SQUIBB & SONS LTD. 2365 COTE DE LIESSE, MONTREAL, QUE. H4N 2M7
Transcendental Meditation To the editor: I would like to endorse Dr. Toane's statement on the benefits of Transcendental Meditation (TM) in stress-related disease (Can Med A ssoc J 114: 1095, 1976) and amplify his remarks. TM is effective in relieving muscle tension pain, which Dr. Toane did not mention, especially when there are palpable "trigger points" in the painful muscles without signs of radicular involvement. This simple mental exercise is even more effective when practised in conjunction with an independent daily program of gradttated, relaxed, natural, physical recreation such as swimming, dancing or playing games. Local injections and other passive treatments are unnecessary with this management and I have more grateful patients from this combined natural method, performed by the patient, than I have had from previous methods of biofeedback training or teaching "progressive muscle relaxation", originated by Dr. Edmund Jacobsen. However, because a vicious circle of inactivity must be broken by the patient, explanation, reassurance and encouragement are vital for success. If necessary, this natural physical and mental exercise program can be supplemented by the "bioenergetic" techniques of Alexander Lowen, but this is time-consuming and costly with the patient depending on an individual teacher for a long period. TM can be effective in the treatment of muscle tension pain attributed to "arthritis", disc degeneration, or entrapment of a nerve or a spinal root, for example. TM also has wide application in the treatment of musculoskeletal pain, as in whiplash. I trust this letter will not provoke Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
a "pain in the neck" among your readers. W. Sr. J. BUCKLER, MB, BS, D PHYS MED 1937 Knox Rd. Vancouver, BC
To the editor: Like most, if not all, devotees to TM, Dr. Toane is quick to deny that this medium is a religion. Anyone who has read and studied the Maharishi's writings must come to the conclusion that the ritual of TM is a religion of pagan origin. A pamphlet disclosing the pagan, occult nature of TM, entitled "Transcendental Meditation. Religion or Science?" is available from a Christian publishing house, Book Fellowship International, Box 164, North Syracuse, NY 13212. As a Christian I feel it is my responsibility to inform readers that TM is a deceptive and satanic practice. There is quite enough occult influence in our society without the "honourable profession" becoming involved. It might be argued that the end justifies the means, but there are many instances of diseases being cured by magic, voodoo and witchcraft; I do not think our profession would stoop to using these methods. J.D. TOWN, BA, MD 527 Admiral St. Woodstock, ON
To the editor: I compliment Dr. Buckler's use of TM in patients with muscle tension pain. Individuals report that muscle relaxation occurs as a spontaneous byproduct of the mental process. I can only reiterate the need in this and other medical conditions for regularity of practice of the technique (twice daily) and follow-up provided by the organization. Although patient compliance is usually high the physician would do well to reinforce continually his patients' use of TM as he would any other productive therapy. I agree with Dr. Town's desire that the medical use of practices shrouded in mystery, folklore and the occult be viewed critically by the responsible phy-
CMA JOURNAL/OCTOBER 9, 1976/VOL. 115 607
VELOSEF 250 CAPSULES VELOSEF 500 CAPSULES
-. C. FOR ORAL SUSPENSION
VELOSEF 125 VELOSEF 250 FOR ORAL SUSPENSION Cphradln. for Oral SuspensIon VELOSEF FOR INJECTION, 500 mg mid 1 g Csphradhie for InjectIon
ACTION: Gephradine isa semi-synthetic, cephaloaporin antibiotic exhibiting bactericidal activity through inhibition of ceil-wall synthesis. INDICATIONS: Infections In the respiratory and genitourinary tracts, and in the akin and soft tissues, due to susceptibie organisms. Sensitivity tests should be performed: therapy may be inatituted before receiving the resulta. CONTRAINOICATIONS: Hypersensitivity to the cephaiosporin group of antibiotics. WARNlNGS: There is evidence of partial cross-allerganicity between the peniillins and the cephalosporins. Therefore, cephradine should be used with caution in patients with known hypersenaltivity to penicillins. Antibiotics, including cephradine, should be used cautloualy and only when absolutely necessary In patients with a history of allergies, particularly to drugs. Usage during pregnancy and lactation: Safety for use of this product during pregnancy has not been established. Cephradine is secreted in breast milk. PRECAUTIONS: Patients should be obeerved carefully during therapy. Allergic reactions require discontinuation of VELOSEF and appropriate treatment. Proionged use of VELOSEF may result in overgrowth of nonsusceptible organisms: appropriate messures should be instituted. DurIng long-term therapy, hematoiogical, renal and hepatic functions should be monitored periodically. Patients with known or suspected renal impalrment should be obeerved carefully since cephradine may accumulate in the serum and tissues unless dosage is suitabiy reduced. See DOSAGE AND ADMINISTRATION section. Indicated surgical procedures should be performed in conjunction with antibiotic therapy; e.g., the incision and drainage of abscesses. After treatment with cephalosporins, a false-poaltive resction for glucose in the urine may occur, but not with enzymebased tests. A false-positive Coomba test has also been reported. VELOSEF for Injection is not compatible with Lactated Ringer's Solution or other calcium-containing infusion fluids. ADVERSE REACTIONS: Usually limited to gastrointestinal disturbances and occasional hypersensitivity, but may include hematological and hepatobiliary disturbances, sa well as alevated BUN, LDH or serum creatinine; superinfection; vaginitis and joint pains. Thrombophlebitis following IV. injection and sterile abscesses after IM. injection have occurred. Only occasionally severe enough to warrant cess.tion of therapy DOSAGE AND ADMINISTRATION: The presence of food in the gastrointestinal tract delays the absorption and reduces the pesk level but does not affect the total amount of cephradine absorbed. VELOSEF Capaules and VELOSEF for Oral Suspension Adults: Respiratory tract infections: 250 mg, q6h. Pneumococcal lobar pneumonia: 500 mg, q6H. Genitourinary tract infections: 500 mg, q6h. Prolonged therapy is edvisable for the treatment of prostatitis and epididymitis. Children: 25 to 50 mg/kg/day, divided into four equally spaced dossa, e.g.: VELOSEF for Oral Suspension 250 mg/5 ml 125 mg/5 ml Child's Weight '/,toltsp.q8h lOkg(221ba) '/.to1tsp.q6h lto2tsp.q6h 20kg(.lbe) lto2tsp.q6h 2to4tsp.q6h 4Okg(881ba) Smaller doses than those indicated above should not be used. For otitis media due to H. influenzae, doses from 7510 100 mg/kg/day are recommended. VELOSEF for Injection: For uae in serious and life-threatening infections or where oral therapy is not possible. Average adult daily dose is 2 -4 g, depending on the infection. In children, a daily dose of 50- 100 mg/kg is recommended. All patients; all formulations: Larger doses (up to 1 g q6h in adults or up to 25 mg/kg q6h in children) may be given for severe or chronic infections: maximum daily dose should not exceed 4 g. Therapy should be continued for a minimum 0148 to 72 hours after the patient becomes asymptomatic or evidence of bacterial eradication has been obtained. In infections caused by hemolytic streptococci, a minimum 10-daytreatment period is recommended. Stubborn infections may require trestment for several weeks with frequent bacteriological and clinical appraisal. A modified dosage schedule in patients with decreased renal function is necessary. Each patient should be considered individually: the following schedule is recommended as a guideline. Initial loeding dose: 750 mg. Maintenance dose: 500 mg at the time intervals listed below: Time Interval Crestinine Clearance (ml /min/1 .73m2) 6-l2hours > 20m1/min 12-24hours is-igmI/min 24-40 hours 10-14 mI/mm 40-SOhours 5-9m1/min 50-70hours < SmI/min DOSAGE FORMS: Capsules of 250 mg and 500 mg in bottles of 50, and bottles of VELOSEF 125 and 250 for Oral Suspension which, after reconstitution, provide 100 ml of pleassntly flavoured suspension containing 25 mg/mI and 50 mg/mi respectively. VELOSEF for Injection is provided as a sterile powder for reconstitution in vials containing 500 mg or 1 g. Consult Product Monograph for reconstitution procedure. Product Monograph available to physicians and pharmacists on request.
E R. SQUIBB & SONS LTD. 2365 COTE DE LIESSE, MONTREAL, QUE. H4N 2M7
Transcendental Meditation To the editor: I would like to endorse Dr. Toane's statement on the benefits of Transcendental Meditation (TM) in stress-related disease (Can Med A ssoc J 114: 1095, 1976) and amplify his remarks. TM is effective in relieving muscle tension pain, which Dr. Toane did not mention, especially when there are palpable "trigger points" in the painful muscles without signs of radicular involvement. This simple mental exercise is even more effective when practised in conjunction with an independent daily program of gradttated, relaxed, natural, physical recreation such as swimming, dancing or playing games. Local injections and other passive treatments are unnecessary with this management and I have more grateful patients from this combined natural method, performed by the patient, than I have had from previous methods of biofeedback training or teaching "progressive muscle relaxation", originated by Dr. Edmund Jacobsen. However, because a vicious circle of inactivity must be broken by the patient, explanation, reassurance and encouragement are vital for success. If necessary, this natural physical and mental exercise program can be supplemented by the "bioenergetic" techniques of Alexander Lowen, but this is time-consuming and costly with the patient depending on an individual teacher for a long period. TM can be effective in the treatment of muscle tension pain attributed to "arthritis", disc degeneration, or entrapment of a nerve or a spinal root, for example. TM also has wide application in the treatment of musculoskeletal pain, as in whiplash. I trust this letter will not provoke Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
a "pain in the neck" among your readers. W. Sr. J. BUCKLER, MB, BS, D PHYS MED 1937 Knox Rd. Vancouver, BC
To the editor: Like most, if not all, devotees to TM, Dr. Toane is quick to deny that this medium is a religion. Anyone who has read and studied the Maharishi's writings must come to the conclusion that the ritual of TM is a religion of pagan origin. A pamphlet disclosing the pagan, occult nature of TM, entitled "Transcendental Meditation. Religion or Science?" is available from a Christian publishing house, Book Fellowship International, Box 164, North Syracuse, NY 13212. As a Christian I feel it is my responsibility to inform readers that TM is a deceptive and satanic practice. There is quite enough occult influence in our society without the "honourable profession" becoming involved. It might be argued that the end justifies the means, but there are many instances of diseases being cured by magic, voodoo and witchcraft; I do not think our profession would stoop to using these methods. J.D. TOWN, BA, MD 527 Admiral St. Woodstock, ON
To the editor: I compliment Dr. Buckler's use of TM in patients with muscle tension pain. Individuals report that muscle relaxation occurs as a spontaneous byproduct of the mental process. I can only reiterate the need in this and other medical conditions for regularity of practice of the technique (twice daily) and follow-up provided by the organization. Although patient compliance is usually high the physician would do well to reinforce continually his patients' use of TM as he would any other productive therapy. I agree with Dr. Town's desire that the medical use of practices shrouded in mystery, folklore and the occult be viewed critically by the responsible phy-
CMA JOURNAL/OCTOBER 9, 1976/VOL. 115 607
