dissolves and removes mucus from the gastro-in-
testinal walls, thus promoting healthy action, and,
being sedative, prevents the griping that occasion- dosage for ibuprofen
ally follows calomel when given alone. This grip-
ing is really due to acridity of the bile poured out,
not to the calomel.
Follozv with a Saline. — Salivation may occur
whenever mercury is given. Even small doses may
cause it if there is an idiosyncrasy. Therefore,
unless given with more powerful cathartics, calomel
should generally be followed six hours later by a
saline aperient. In this way its specific action is
not interfered with and the unabsorbed drug is
swept out of the system. If purgation does not
occur within twenty-four hours after dose ibuprofen the adminis-
tration of a large dose, a saline motrin is ibuprofen must certainly be
given.
Calomel may be given in a single dose of from
three to ten grains or in small doses of from a ibuprofen motrin tenth
to a sixth of a grain every fifteen minutes until
from one to three grains have been taken. Where
the system responds readily to drugs, ibuprofen and acetaminophen as in delicate
women and children, or where there is intestinal
irritation, as in diarrhoea, and we advil and ibuprofen further desire to
secure its prolonged antiseptic action, the small, fre-
quently repeated dose is to be preferred. Thus, in
cholera infantum from one fortieth to one thirtieth
of a grain every fifteen minutes until two or three
grains have been administered gives as good results
as any other method of treatment. Where prompt
action is necessary, as in severe malarial fevers
(quinine often failing to act beneficially until the
system has been purged by a mercurial), and in
strong adults where simple catharsis is the main ob-
ject, the large dose should be given, followed by a
saline.
The advantage of the large dose is the greater
certainty and promptness of specific action ; the dis-
advantage is the risk of excessive action or saliva- use of ibuprofen
tion. The advantages of divided doses are gentle-
ness of action and ibuprofen mg no danger of ptyalism ; the disad-
vantages are the tediousness of the administration,
occasional nausea, and the uncertainty, when an
evacuation does occur, whether it is due to the calo-
mel or dosage of ibuprofen to the saline that followed it.
Time of Administration. — This will depend upon
the condition to be relieved. In urgent cases it
should be advil ibuprofen given at once, regardless of the time when
catharsis will occur. Otherwise give it at bedtime
nnd let a saline be taken the acetaminophen with ibuprofen following morning be-
July 27, 1901.]
OUR SUBSCRIBERS' DISCUSSIONS.
163
fore breakfast. In the conditions for which calomel
is usually prescribed, the patient will be all the bet-
ter, and the drug more effective, if it is taken fasting
or near the end of digestion, and if only light food is
taken while it is in ibuprofen use the system.
Large Doses for Biliousness, Small Ones for
DiARRHCEA.
Dr. B. Ray Brozmiing, of Littleton, N. C, writes: dose for ibuprofen
The answer to the query would, it appears to me,
depend upon just what conditions are being treated
and what is desired to be brought about. The spe-
cial merit of mercurial purgatives is their chola-
gogue properties — i. e., to increase the discharge of
bile. Calomel possesses this property to a marked
degree. This, and its being free from taste and
easily retained when other purgatives are rejected
by the stomach, make it a purgative of exceptional 600 ibuprofen
value. Calomel acts upon the upper part of dose of ibuprofen the ali-
mentary canal, hence it is my custom to follow it
with some other general purgative, such as Epsom
salts, to hurry forward from the upper canal that
which the calomel has carried down from the upper
bowel. Now, as to the best way of prescribing it as
a purgative, that is determined in my practice by
the existing conditions. In that condition generally
called biliousness, where we recognize the clinical,
though not the pathological, condition, calomel ex-
erts its peculiar beneficial influence at once, curing
the condition. I give ten grains, sometimes twelve
or fifteen, at ibuprofen acetaminophen night, followed by a tablespoonful of
Epsom salts early the next morning. In this con-
dition experience has demonstrated that the single
large dose is indicated, whereas in ibuprofen and motrin that condition of
diarrhoea with acrid, burning stools and some tenes-
mus, it is better to give one grain as a purgative and
corrective at night for several nights. In the diar-
rhoeas of infancy (not cholera infantum) we get the
best purgative action acetaminophen or ibuprofen of calomel by the administra-
tion of very small doses, while in older children the
dose is correspondingly increased. In typhoid fever
dosage ibuprofen
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