Paul James replied: "It is important that you take all your medications. Whilst it is not possible to provide an exhaustive explanation of the use of all of the medications provided, the following is a brief de ion of the medications that may have been prescribed to you, and of some of their benefits and potential side effects. 1. Amoxicillin 875mg and clavulanate 125mg combined, one tablet morning and night, for 5 days. Total 10 capsules. (You may have either this drug OR Clindamycin) a. This is a standard antibiotic provided to all adults over 60kg in weight. It prevents jaw infection. b. Brand names include Augmentin DuoForte or Clavulin DuoForte c. In children under 14 years, a formula of ~15mg amoxicillin per kilo of body weight is used in two daily divided doses. For example, if your child weighs 45kg, then he/she would likely take 4mL of Clavulin duo suspension (with 400mg amoxicillin, and 57mg clavulanate in 5mL) twice daily. For 55kg adults, Clavulin Duo tablets of amoxicillin 500mg and 125mg clavulanate would be taken twice daily. The pharmacist will direct you with the appropriate level of medication. d. People with known anaphylactic allergies to amoxicillin, penicillin or to the -lactam group of antibiotics should not generally take this drug. If an itchy rash occurs, discontinue the drug and call your medical GP, the surgeons office, or the Public Hospital emergency office for advice. e. Rarely the drug combination can cause cholestatic jaundice (yellowing of the eye sclera and skin). It rarely causes diarrhoea, and will not normally cause nausea or vomiting. It can lead to vaginal thrush in the susceptible, and in such people a preventative anti-fungal pessary can be provided. f. The drug is taken immediately before or with the first mouthful of food. g. In those on the birth control pill, the drug can increase oestrogen metabolism, rendering the patient susceptible to pregnancy during the 28 day cycle. h. People may get a rash if they have a concurrent infection of Glandular Fever (Epstein Barr Virus). 2. Piroxicam dispersible 20mg, one in the evening, for ten days only. a. This is a standard anti-inflammatory drug, and it reduces swelling and pain from the first 24 hours after the first dose is ingested. It is designed to be dissolved in 50mL of water and then drunk. b. It is important that you fully take the course for 10 days. Not more or less. c. Brand names include Feldene-D, Mobilis-D, Pirohexal-D and Rosig-D. It is designed to be taken once daily, in the evening, and it can be taken with or without food. d. It should not be taken by people who are chronically taking other anti-inflammatory drugs (NSAIDs), and in those who have known gastritis or peptic ulcer disease. It should not be taken by people with aspirin sensitive asthma, and with those who have a general sensitivity to aspirin or other NSAIDs. e. Piroxicam can interact with thiazide diuretics, -blockers and with serum protein bound drugs such as warfarin. f. It should not be taken by those under 14 years. In people less than 55kg, half the dosage (10mg/day) need only be taken. g. It is advised that you DO NOT engage in moderate to heavy exercise and in particular to not become dehydrated whilst on this drug. Prolonged dehydration may lead to renal/kidney failure. 3. Paracetamol 500mg combined with codeine 30mg. Take two tablets every six hours for the first 24 hours following surgery, and then taken as needed no less than six hourly thereafter. Twenty tablets are provided. a. Brand names include Panadeine Forte and Codalgin Forte. Plain paracetamol (acetaminophen) has a number of brand names including Panadol, Dymadon, Chemists Own Paracetamol, Herron Paracetamol, Paracetamol, Parahexal, Paralgin, Setamol and Tylenol. Panadol reduces fever and pain, and with codeine adds a powerful combination to the control of immediate post-operative pain. b. The first dose should be begun before the local anaesthetic wears off. It is then used regularly, six hourly, and for the first twenty four hours. Thereafter, use as needed, and do not take the next dose before six hours has expired. In an adult, no more than 8 tablets can be taken in a 24 hour day. c. The six hourly dose is calculated safely as ~15mg/kg of body weight. For a 70kg person, this is approximately 1000mg of acetaminophen (Panadol/Paracetamol), or two 500mg tablets. For a 35kg child, a safe dose would be 500mg, or one 500mg tablet (or equivalent in syrup). Only take what is directed. d. In adults, a single dose of 10-15 tablets of Panadol can lead to acute liver failure. Over-doses of Panadol/Paracetamol/acetaminophen should be immediately reported to your local Public Hospital Emergency Department. e. You may cease Panadeine use in favour of plain paracetamol in the event of nausea or vomiting f. Codeine can lead to a histamine release with general itchiness and rash. It commonly causes nausea, and which is poorly relieved with vomiting. If nausea occurs, cease your Panadeine Forte first, and maintain your medication using plain Panadol/Paracetamol/acetaminophen. g. Codeine also can cause constipation, especially if over used. Prunes are a natural remedy for this. h. The inactive codeine molecule is metabolised by the liver cytochrome P450 CYP2D6 iso-enzyme system to the active morphine moiety. This metabolism is poor in those who have a genetic deficiency of the relevant enzyme, or in those taking drugs which block the enzyme such as fluoxetine (Prozac). In such patients, pain relief with codeine preparations may be poor. i. Codeine will interact with other opioid drugs such as oxycodon, morphine or methadone (DO NOT TAKE IN COMBINATION) 4. Ansthetic mouth salts, containing benzocaine. 100gm. Use a teaspoon in half a glass of hot (38- 40C) water, and soak the wounds before using the Oral Surgery Mouth Soak. a. This solution has been especially prepared, and is only available from City Pharmacy at 53 Hunter Street, Newcastle, Tel.: 4929 2866 (Mr Bob Lundy, Compound Pharmacist) b. The salts contain a small amount of benzocaine which aims to produce a numbing effect over your mouth and wounds. The salt aims to clean and sooth. Bicarbonate has a subtle bubbling action. c. It is safe to use the solution as regularly as you want, but three times a day is the advice given by the practice. You can only commence using the solution 24 hours after surgery. Do not swallow. d. Early use of the mouth salts can lead to loss of the socket blood clot. This in turn leads to dry socket. e. Prepare using a half glass of hot water (not scalding) with a level teaspoon of salts. Use a small mouthfull to soak over the wounds, and do not rinse. Continue until the glass is empty. 5. Oral Surgery Mouth Soak, containing aqueous 0.2% solution of chlorhexidine, 200mL bottle. Use as a mouth soak over the wounds only. DO NOT RINSE. Use one capful, morning, midday and at night as a soak. Do not swallow. a. This solution is very important to use regularly as it prevents colonisation of your wounds by oral plaque and bacteria. Use it before your meal, or if it affects taste, use it after eating and after general tooth brushing. You may use a large cotton ball to help allow the chlorhexidine to soak directly over a wound. You can only commence using the solution 24 hours from surgery. b. It is very important not to have sticky, smear-forming protein drinks such as milk, and which can retard the chlorhexidine molecule from preventing bacterial attachment to wound margins. c. The preparation has minimal alcohol content, which reduces stinging to your mouth wounds. Use the Ansthetic Mouth Salts to reduce wound stinging before you use the Oral Surgery Mouth Soak. d. The preparation is not poisonous, and can be safely ingested in small quantities. Drinking the solution is not advised or recommended, and a flavouring has been added to prevent this. e. Do not rinse, as this can open up fresh wounds and cause bleeding & clot & wound breakdown. f. Prolonged use beyond two weeks can lead to an unsightly discolouration to the teeth or a dark film over your tongue. Dental discolouration is easily removed by your general dentist at your next visit. 6. Clindamycin, 150mg capsules. Take two capsules, each morning and night, for 6 days. There are 25 to a packet. (You may either have this drug OR amoxicillin/clavulanate) a. Marketed as Dalacin C or Cleocin this drug is provided as an alternative to amoxicillin/clavulanate in those that are allergic to penicillins, or who are having titanium implant or bone graft surgery. b. It has superior bone penetrating qualities, and apart from expense it is an ideal drug for the prophylaxis and treatment of maxillofacial infections. c. It can lead (and very, very rarely so) to pseudomembranous colitis; an infection of the bowel caused by Clostridium difficile. In people who develop diarrhoea following treatment by clindamycin, consultation should be sought by their GP, with investigations to exclude for C. difficile infection. (It is important to consider that there are many causes of diarrhoea, and which may be unrelated to clindamycin use. Extreme examples can include food poisoning such as by salmonella or other causes of diarrhoea such as by giardiasis or cryptosporidium infections). d. It is extremely rare to be allergic to, or become sensitised to Clindamycin. e. You can take the medication with or without food, and it is recommended to take the tablets with a full glass of water to prevent oesophagitis. got to to find out more"