Common Specialities
Common Issues
Common Treatments


4-Steps 0.5% W/W Gel

4-Steps 0.5% W/W Gel

Manufacturer: Aeran Lab India Pvt Ltd
Medicine composition: Piroxicam
Prescription vs.OTC: Prescription by Doctor required

4-Steps 0.5% W/W Gel is used in the treatment of swelling, pain and joint stiffness resulting from arthritis. This medication belongs to a group of drugs called NSAIDs (Nonsteroidal anti-inflammatory drugs). It works by inhibiting the production of certain substances in the body that leads to inflammation.

Take the medication orally after consulting with your doctor. The usual dosage in 1 tablet per day. Avoid lying down immediately after taking this medication. You should take this medication with milk, food or an antacid to prevent stomach problems. The doctor will prescribe the dose based on your medical condition and how you are responding to the treatment. It is often recommended to take the lowest possible dose to prevent various problems like stomach bleeding and other problems. Side effects of this medication are stomach problems, drowsiness, nausea and dizziness. You should consult your doctor if these side effects become severe. 4-Steps 0.5% W/W Gel can also raise your blood pressure. In rare cases, this drug can also result in serious liver problems. If you see symptoms of liver damage like dark urine, nausea, vomiting, yellow eyes/skin and loss of appetite then consult a doctor immediately.

You also need to take certain precautions before taking this medication. You need to inform your doctor about any allergies that you may have before starting a course of this medication. This drug may also contain certain inactive ingredients that can cause allergic reactions in the body. You should also inform the doctor about any history of blood disorders, anemia and heart conditions before taking this medication. It is advised to avoid driving or perform any other activity that require alertness immediately after taking this medication. You should also try to stay off alcohol and tobacco while taking this medications as it increases the risk of stomach bleeding.

4-Steps 0.5% W/W Gel is used to relieve symptoms of pain and inflammation in rheumatoid arthritis patients.
4-Steps 0.5% W/W Gel is used to relieve symptoms of pain and inflammation in osteoarthritis patients.
4-Steps 0.5% W/W Gel is not recommended if you have a known history of allergy to Nonsteroidal anti-inflammatory drugs.
4-Steps 0.5% W/W Gel is not recommended in patients with known history of Asthma.
Coronary Artery Bypass Surgery (CABG)
4-Steps 0.5% W/W Gel is not recommended in patients undergone heart surgery.
In addition to its intended effect, 4-Steps 0.5% W/W Gel may cause some unwanted effects too. In such cases, you must seek medical attention immediately. This is not an exhaustive list of side effects. Please inform your doctor if you experience any adverse reaction to the medication.
Abdominal Pain Major Common
Constipation Major Common
Headache Major Common
Dizziness Major Less Common
Burning Sensation in Stomach Major Less Common
Excessive air or gas in stomach Minor Common
shakiness in the legs, arms, hands, or feet Minor Less Common
Loss of strength Minor Less Common
Restlessness Minor Rare
Change in appetite Minor Rare
How long is the duration of effect?
The effect of this medicine lasts for an average duration of 48 to 72 hours.
What is the onset of action?
The effect of this medicine can be observed in 30 min to 1 hour.
Are there any pregnancy warnings?
This medicine is not recommended for pregnant women.
Is it habit forming?
No habit forming tendencies were reported.
Are there any breast-feeding warnings?
This medicine is not recommended for breastfeeding women.
Below is the list of medicines, which have the same composition, strength and form as 4-Steps 0.5% W/W Gel, and hence can be used as its substitute.
Missed Dose instructions
The missed dose can be taken as soon as you remember. However, the missed dose should be skipped if it is almost time for your next dose.
Overdose instructions
A doctor should be contacted immediately if an overdose of 4-Steps 0.5% W/W Gel is suspected. Signs and symptoms of overdose include stomach irritation, difficulty in breathing, black colored stools etc. Immediate medical attention is needed if an overdose is confirmed.
United States
Whenever you take more than one medicine, or mix it with certain foods or beverages, you're at risk of a drug interaction.
Interaction with Disease
Asthma Major
4-Steps 0.5% W/W Gel should not be taken if you have NSAID-sensitive asthma. Any such history should be reported to the doctor so that appropriate substitution can be done.
Gastro-Intestinal toxicity Major
4-Steps 0.5% W/W Gel and other NSAIDs should be taken after consulting a doctor especially if the intended duration is longer than a month. Any symptom indicating ulceration and bleeding like chronic indigestion, coffee colored dry blood in stools or vomiting of blood should be reported immediately.
Interaction with Alcohol
Alcohol Moderate
This medicine should not be consumed with alcohol. Symptoms of stomach bleeding (such as the presence of dried and coffee colored blood in cough or stools) should be reported to the doctor immediately.
Interaction with Lab Test
Information not available.
Interaction with Food
Information not available.
Interaction with Medicine
Warfarin Major
These medications may increase the risk of bleeding if taken together. Inform the doctor if you are receiving any pain medications or if you have any bleeding disorder. An alternate class of medicine should be considered based on the clinical condition.
Corticosteroids Moderate
Use with caution as this combination will increase the risk of gastrointestinal bleeding. Inform the doctor if you are taking either of the medicines. Consider taking alternative medicine after consulting your doctor.
Fluoroquinolone Moderate
These medications may increase the central nervous system stimulation and causes tremors, involuntary body movements, and seizures. Inform the doctor if you are receiving antibiotics belongs to fluoroquinolones. Consider the alternate class of medicine based on the clinical condition.
Angiotensin converting enzyme inhibitors Moderate
4-Steps 0.5% W/W Gel may alter the effect of antihypertensives, therefore should be used with caution. Inform the doctor if you are receiving antihypertensives like captopril, enalapril, benazepril. Monitoring of blood pressure is necessary. Any changes in the blood pressure should be informed to the doctor. Dose adjustments are to be made based on the clinical condition.

Popular Questions & Answers

I have a desk job from last 2 years and my weight has been gone upto 75 to 80 please help.

Bachelor of Ayurveda, Medicine and Surgery (BAMS), Post graduate diploma in Dietetics and clinical nutrition, Diploma in yoga teacher
Dietitian/Nutritionist, Dhule
I have a desk job from last 2 years and my weight has been gone upto 75 to 80 please help.
Move every 30 mins while sitting at work, add more fresh fruits and have green tea, take a steps over lift.

I'm suffering from blood sugar this is a new problem but since 26 years I'm on blood pressure medicine. What can I do for blood sugar.

General Physician,
I'm suffering from blood sugar this is a new problem but since 26 years I'm on blood pressure medicine. What can I do...
Hello, Thanks for your query on Lybrate "As"per your clinical history is concerned please follow like this - 1)Take your blood pressure medication as usual 2)Add [PIOBIT-GM tab]for sugar and start with one tab and increase to twice a day after 15 days,as per your clinical response . Do take few preventive steps like this- 1)Try to eat healthy foods. Choose foods lower in fat and calories and higher in fiber. Focus on fruits, vegetables and whole grains. 2)Get more physical activity. Aim for 30 minutes of moderate physical activity a day. Take a brisk daily walk. If you can't fit in a long workout, break it up into smaller sessions spread throughout the day. 3)Try to lose excess weights. If you're overweight, losing even 7 percent of your body weight can reduce the risk of diabetes. To keep your weight in a healthy range, focus on permanent changes to your eating and exercise habits. Hope that helps

Does turmeric stops hair growth on cheeks and Near eye (baby hair) for men? How to apply and for how long? If it doesn't work suggest other remedies to stop hair growth?

General Physician, Mumbai
Does turmeric stops hair growth on cheeks and Near eye (baby hair) for men?
How to apply and for how long? If it does...
If hair follicles are present than hair is going to grow and so turmeric is not going to stop hair growth and only therapy is laser treatment for stopping the growth
1 person found this helpful

How to get rid of dandruff. Its in huge amount. I met doctor also ,he gave me ZPTO dandisole shampoo but the condition is even worsening. My hair fall treatment is also going side by side .I take multivitamins nd finasteride tablets nd apply minoxidil topical solution on my scalp. What should I do now doctor? please help nd does getting bald help to solve the problem.

Homeopath, Delhi
How to get rid of dandruff. Its in huge amount. I met doctor also ,he gave me ZPTO dandisole shampoo but the conditio...
Hello, you are taking temporary meds to treat your hair fall as well as dandruff. Finasteride tabs in long run may produce some side effects in the system & minoxidal topical solution remains effective till you apply on scalp & after stopping you will experience more hair fall. Please take constitutional holistic homeopathic treatment to treat your hair problem. You can take skype consultation if you are living far away from delhi or phone consultation for treatment. Thanks.

Popular Health Tips

How to Tell a Partner About Penis Infections?

MD - General Medicine
Sexologist, Delhi
How to Tell a Partner About Penis Infections?

Every man wants to avoid a penis infection, and that's part of the reason most men adhere to very good penis care regimens. Avoiding sexually transmitted diseases is one of the main reasons a man uses a condom at each and every encounter (or if he doesn't, he knows he should!). But sometimes, despite a man's best efforts, he could wind up with a penis infection. Some of these can be easily treated, but others will be with him for life, and can dramatically change how he lives his life in the future.

One of the most unpleasant parts of a penis infection is having to tell former and current partners about the condition. These individuals deserve to know about what is going on so they can get themselves tested and take other steps to protect their own health. But for the person who has to tell them, breaking the news is definitely not an easy matter.

Here are some tips to help the man who must tell a former or current partner about sexually transmitted diseases that he might have shared with them.

1) Be absolutely sure. Don't tell them just on a hunch that a disease might be present. Have the tests, then have the results in hand when making that call.

2) Call or tell them in person. Though it might be tempting to send an email, it's always best to tell them in person, if possible, so they can ask questions immediately. If in-person won't work, call them. And if that won't work, try texting them with a request to talk - now.

3) Don't lay blame. Odds are that if a man has a sexually transmitted disease, he's not entirely sure where it came from. If there was only one partner, then obviously it could be clear - but even so, never lay blame on another person when calling to tell them the news. The idea is to get them concerned for their health and get them to get tested, not to make them feel defensive or ashamed.

4) Get the word out fast. Not only do they need to know, they need to know yesterday - so make sure to get the word to them as soon as possible. This can help them get the care they need much sooner, and can prevent them from passing it on to someone else if it turns out they do have the sexually transmitted disease.

5) Come prepared with answers. There will be many questions, of course, and most of them need to be answered by their doctor. But a man might be able to provide some insight to the partner when he mentions the disease. For instance, a guy who has been diagnosed with gonorrhea can reassure their partner that it can be cured, as long as they get to the doctor quickly and take the medication as directed.

6) Be ready for emotion. The very idea of a sexually transmitted disease can make someone feel anxious, depressed, angry, horrified, ashamed, defensive and many other emotions - sometimes all at once! And when that emotion hits, they are likely to vent on the most convenient target, which happens to be the guy who just called them with the bad news. So be prepared to listen to what they have to say yet stay calm and cool, even when dealing with that tidal wave of emotion.

Finally, a man should take every step possible to make sure he never has to make that kind of phone call or visit again. He can do this by practicing even better penis care than he has in the past, including always wrapping up the member when it's time to get busy.

And of course, daily care matters as well. He can help ensure a strong, healthy penis with a good penis health crème (health professionals recommend Man 1 Man Oil, which is clinically proven mild and safe for skin). This crème should contain a plethora of protective ingredients, such as L-arginine for better blood flow and oxygenation, alpha lipoic acid to fight free radicals and vitamin A to eradicate bacteria.

7 people found this helpful

When Penis Odor Is Due to TMAU

MD - General Medicine
Sexologist, Delhi
When Penis Odor Is Due to TMAU

Sex is both a sensual and sensory experience, so it's not unusual for a man to want to make sure nothing about him is offensive to a partner's senses. Unfortunately, in all too many cases, a man is prone to carrying a certain level of penis odor around with him. When that odor level is high, it can be a significant turn-off to bedmates. In most cases, paying proper attention to basic penis health and hygiene can prevent or treat off-putting penis odor. But there are some instances in which more extensive steps may need to be taken. Such is the case when that penis odor is due to a condition known as TMAU.

About TMAU

TMAU is short for trimethylaminuria, a metabolic disorder often called "fish odor syndrome" or "fish malodor syndrome." While TMAU is much more often found in women, it can occur in men.

It's actually surprising that TMAU is more common in women, for the disorder is a genetic condition and the likelihood of a man inheriting it is as equal as it is for a woman. In both cases, if both of a person's parents carry the gene, there is a 25% chance that a child will have TMAU. It's theorized that the reason more women seem to have TMAU is because something exacerbates the TMAU to make it more pronounced. Many theories believe it is the higher levels of estrogen in women that "worsens" the condition. Similarly, it's thought that perhaps men with symptomatic TMAU have both the genes and higher levels of estrogen than the general male population has.

How it works

Whatever the reason for the variation between genders, TMAU works in the same way. Trimethylamine is an organic compound used in food digestion, during which it is converted into trimethylamine oxide. When this conversion does not occur, trimethylamine hangs out in the body until it is disposed of through sweat, breath and urine. When unconverted, trimethylamine has a very strong fishy odor, which becomes pronounced when it leaves the body.

In men, this can create a strong body odor, and an especially strong penis odor, due to the heavy sweating common in the penile area as well as to deposits of urine that remain on the penis after urination.

TMAU is entirely benign, but the intense odor associated with it can cause many men to feel embarrassed or nervous. Men who suspect their penis odor (or other body odor) may be due to TMAU should ask their doctor for what is called a "choline load" test.

TMAU does not have a cure, but many men find that dietary changes can help reduce the odor. This involves avoiding foods such as eggs, beans, fish, and red meat which are associated with TMAU. (Working with a nutritionist is advised if this route is taken.)

Some men have found antibiotics somewhat helpful in fighting TMAU, and at least one study found that incorporating charcoal and copper chlorophyllin supplements produced positive results for many participants.

Penis odor caused by TMAU may also lessen if other sources of penis odor are attacked, and using an exceptional penis health crème (health professionals recommend Man1 Man Oil, which is clinically proven mild and safe for skin) may help with this. The best crème will therefore be one with vitamin A, with anti-bacterial properties which attack one of the primary sources of everyday persistent penis odor. The more resilient the penis skin, the better able it will be to resist odor as well. For that reason, the crème should also include alpha lipoic acid, an antioxidant that fights the free radicals that can lead to unwanted oxidative stress.

Dealing With Penis Pain - What Not to Do?

MD - General Medicine
Sexologist, Delhi
Dealing With Penis Pain - What Not to Do?

When a man looks for some relief from pain, itching or other irritations, he naturally reaches for a variety of potions and lotions he has in the medicine cabinet. And yes, these definitely work if a man has a minor irritation on most parts of the body, such as his hands, feet, or even his face. But when it comes to penis care, many men are quite surprised to learn that the ointments and other treatments that are okay for the rest of the body are a big no-no for the delicate penis skin.

Why not use regular ointments?

No matter how much penis pain a man is feeling, or how rashy and red his penis might be, there are some medications he should never reach for to find relief. That's because these creams might contain ingredients that are far too harsh for the delicate skin. For instance, a guy might look to the cortisone cream in order to soothe a terribly itchy penis, but this is a mistake - the steroid content in the cream can cause long-term problems.

Besides that, remember that the urethra at the tip of the penis is a gateway to even more delicate tissues. Using an ointment of any kind that isn't specifically designed for the penis is bad enough, but using a crème that then gets into the tip of the penis can mean pain and swelling for those tissues just inside, which only adds to a guy's penis pain woes.

Relieving penis pain the right way

So what can a guy do about penis pain? How can he ease a red penis that is crying out for relief? A careful, measured approach is the best way to go. Here's what he can do.

1) Examine why it happened. What caused the pain? What was happening when it began? Sometimes this is easy to pinpoint, but other times it seems a mystery. The closer a man can get to the time it began, the more he might be able to narrow it down to anything from a sensual encounter to the use of a new soap to an injury he didn't realize was really that bad at the time.

2) Decide how bad it is. Penis pain that is fleeting, very minor or comes from an obvious cause that can be remedied probably doesn't require a visit to the doctor. However, penis pain that persists, is bad enough to take a man's breath away or that doesn't really have an obvious cause might be good reason to get a professional medical opinion.

3) Try home remedies first. If it isn't bad enough for the doctor, a guy can treat it at home. Start with the tried-and-true options, such as a warm or cool compress, a soothing bath to remove any and all residue and airing out the penis for a while. If simple home remedies don't work after several hours, it might be time to consider the doctor again.

4) Take over the counter medications. Sometimes over the counter medications can help for minor irritations - but again, keep in mind that this should only be used if a guy knows what caused the pain. For instance, a sore and red penis that resulted from overzealous masturbation could benefit from a guy taking ibuprofen or acetaminophen, over the counter painkillers, to ease the pain.

5) Think about ways to prevent the pain. If a guy knows what caused the pain - for instance, he used a latex condom right before the swelling and redness started - then he can take steps to avoid that in the future. Knowing how to prevent penis pain is always much better than figuring out how to treat it!

Finally, a guy can't go wrong with a high-quality penis health crème (health professionals recommend Man 1 Man Oil, which is clinically proven mild and safe for skin). The use of soothing Shea butter and vitamin E is a great idea for the penis that feels red, bruised or otherwise painful.

1 person found this helpful

Simple Steps To Help You Say No!

B.A.(H)Psychology, M.A.Psychology, Ph. D - Psychology
Psychologist, Noida
Simple Steps To Help You Say No!

Humans are social animals who thrive on reciprocality. It is in our basic nature to be socially courteous, and the word 'No' feels like a conflict that warns a potential relationship. Many of us tend to comply with every single request that is put forward to us by our peers, family, or at the workplace by our superiors. We choose to take up more jobs than we can efficiently handle and put unnecessary stress on ourselves even at the cost of our time and well-being. Must we always do that? 

Why is it so hard to say 'No'?

People have the notion that saying 'No' can come across as rude or uncaring. You may feel that you are letting someone down by turning down their request or risking a relationship. But, it has mostly to do with your self-confidence than your relationships with people. It may branch from overbearing parents, high expectations set by your peers and mentors or experiencing parenthood yourself and setting unreasonable standards for yourself. Childhood influences are usually the biggest cause of people always saying ‘yes’ all the time.

People who have low self-confidence tend to value their own needs less than the needs of others. Saying 'No' feels rude, and no one wants to be impolite.

Well... saying 'No' does not mean you are being rude or disagreeable.

At the end of the day, it is more about how you say 'no', rather than just saying the word 'No'. Saying 'No' is about valuing and respecting your own time and priorities. 

How to start saying say 'No'?
If you want to take a step back and start saying 'No' to make sure your own needs are valued, here’s what you need to do.

  1. Refuse politely, when it seems not possible: Do not overcomplicate responses and try to be as simple in your responses as you can be. If you are asked to do something, and you want to say 'no', try to be polite in your body language and state that it is not convenient for you at the moment and that you would rather get back to it later.
  2. Seek time before committing: The transition from saying ‘yes’ all the time to saying no does take time! Start to give yourself more time and ask people to get back to you later. This way you can begin to build more self-confidence and learn to say no over time. This also allows you to evaluate your response instead of immediately saying yes or no to the person asking the favor or task.
  3. Do not feel guilty: Deep down if you want to do a favor, you can go ahead with it, but you should also understand that it is okay to say no, and there is no need to associate guilt with it. You should set boundaries and allow people around you to understand how much favors they can ask you for instead of presenting you with an endless amount of favors from you.
  4. Set your boundaries: Refusal does not amount to rejection as you have just as much right to say ‘no’ as the person who is asking the favor from you. You are simply turning down a request, and in most situations, there is a middle ground for compromises where both you and the requester can be satisfied. If you have limited time to fulfill a request, let the person know and help out only as much as you can without overstepping your boundaries.

Bringing in these changes can help you be more self-confident, and at the same time enable you to say no when you need to without weighing yourself down with expectations and fear or rejection.

5256 people found this helpful

Platelet Rich Plasma Therapy For Hair Growth!

Dermatologist, Bangalore
Platelet Rich Plasma Therapy For Hair Growth!

Hair loss has become more a social problem than a cosmetic one. With the increased use of chemicals for hair care, increased pollution, stress, and changing lifestyles, there are more people losing hair at a much younger age. While there have been multiple therapies which have been identified for this, including hair transplant and micro needling, one which is least invasive is using the patient’s own plasma which can help regrow hair. With hair loss not just being a cosmetic concern but a major emotional concern (ask one who is losing hair in their 30s!!), there are various takers for this.

The blood has a liquid medium known as plasma. This is rich in proteins and has cells which can grow into different types of cells if required, known as totipotent cells. It also has various growth factors, which promote the growth of tissue where they are. When blood is centrifuged (rotated at high speeds), this separates the plasma. This plasma contains the growth factors and various tissue cells. This is then injected into the scalp via microneedles in the area of hair loss. These cells grow into hair follicles and produce hair.


  • Using the patient’s own blood, so it is safer
  • Natural results, as it is the patient’s own cells that have grown the hair
  • It is nonsurgical
  • Requires about 1 hour per sitting
  • Quick recovery period
  • Economical compared to other methods.
  • The procedure may need to be repeated if required, depending on the desired results.

PPR is being used widely, either alone or in conjunction with a hair transplant. The growth factors in the PPR stimulate and promote hair growth, even when used in cases of hair transplant. This procedure is also known as vampire hair transplant, as it involves drawing the patient’s own blood and using it for hair regrowth.


  • Case discussion where the reason for hair fall is identified.
  • If there are underlying causes like hypothyroidism, they should be treated also for better results.
  • The patient is identified as a suitable candidate for RPR
  • Local Anaesthesia is given.
  • Blood is centrifuged to obtain the PPR
  • PPR is injected into the scalp using microneedles
  • The patient is monitored for a while and sent home
  • Sessions are repeated every month for best results (4 to 6 Sessions).

While some have had very good hair growth, there are others who have not had great results. Results cannot be promised universally and may vary. However, overall results have been promising and PPR is said to become a widely used mode of treatment for hair loss.

In case you have a concern or query you can always consult an expert & get answers to your questions!

9 people found this helpful