Jun
1
Clopidogrel 75 mg
June 1, 2011 | Leave a Comment
Clopidogrel (generic Plavix)
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Pharmacological Effects:
Clopidogrel - antiplatelet drugs. Effect of the drug is due to the ability of clopidogrel selectively inhibit the binding of adenosine receptors of platelets, thus inhibited the activation of a complex glycoprotein IIb / IIIa and decreases platelet aggregation. Clopidogrel increases the bleeding time. Antiplatelet action of clopidogrel is dose dependent, with use of the drug at the recommended therapeutic doses, the maximum therapeutic effect occurs within 3-7 days. Clopidogrel irreversibly blocks ADP receptors of platelets, so that they lose their ability to aggregate, the restoration of normal function was restored 7 days after drug withdrawal, as we update platelets.
After oral administration the drug is rapidly absorbed from the gastrointestinal tract. Bioavailability is about 50% and is independent of food intake. Clopidogrel - prodrug, is metabolized in the liver with the formation of the active substance - thiol metabolite of clopidogrel. The main metabolite is a carboxylic acid derivative, which determine the pharmacokinetic profile. Peak drug concentrations in plasma observed after 60 minutes after oral administration. Excreted in the urine and feces as metabolites. The half-life of about 8 hours.
Indications:
Clopidogrel is administered as a prophylactic agent in patients suffering from diseases of the cardiovascular system, in particular for the prevention of atherothrombotic events in patients with myocardial infarction, ischemic stroke and patients with peripheral artery disease.
Clopidogrel is also used in combination with acetylsalicylic acid for the treatment of acute coronary syndrome without ST segment elevation ST (in particular, patients with unstable angina or myocardial infarction without wave Q).
Clopidogrel is used in treatment of patients with acute myocardial infarction-segment elevation ST, when the patient shows thrombolytic therapy.
How to use:
Clopidogrel is taken orally. A tablet recommended to swallow whole, without chewing or crushing, drinking plenty of water. Clopidogrel does not depend on food intake. The duration of treatment and dose usually determines the physician for each patient individually.
Adult and elderly patients for the prevention of atherothrombotic events is usually prescribed for 75mg of the drug (1 tablet), 1 per day. Receiving the drug for prevention after myocardial infarction should be started a few days later, but no later than 35 days later, after suffering an ischemic stroke - after 1 week but no later than 6 months.
Patients with acute coronary syndrome without ST-segment elevation is usually prescribed 300mg once the drug (4 tablets) at the beginning of treatment, then transferred to taking 75mg of the drug 1 per day in combination with acetylsalicylic acid. Dose of acetylsalicylic acid determines the physician individually, usually it is 75-325mg per day, however, due to the increased risk of bleeding did not exceed the recommended daily dose of aspirin 100mg. Maximum therapeutic effect observed after 3 months of therapy.
In acute myocardial infarction is usually prescribed 300mg of the drug once at the beginning of treatment, then switching to the use of a drug 75mg once daily in combination with acetylsalicylic acid. When treating patients over the age of 75 years, the drug starts with 75mg of the drug 1 time per day, skipping the loading dose of the drug at the beginning of therapy. Duration of treatment for at least 4 weeks.
Data on the need for dose adjustment of the drug in patients with impaired liver function and / or kidney disease, are absent.
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Side effects:
Using the drug clopidogrel in patients noted the development of such adverse reactions:
From the blood system: thrombocytopenia, granulocytopenia, neutropenia, anemia (including aplastic anemia), in a few cases noted the development of thrombotic thrombocytopenic purpura syndrome (Moshkovitsa) and Henoch-Schonlein purpura. In addition, frequently noted the development of different localization of bleeding in patients receiving the drug clopidogrel, including gastrointestinal and nasal bleeding, as well as ocular and intracranial hemorrhage
From the gastrointestinal tract and liver: stomatitis, nausea, vomiting, indigestion, pain in the epigastric region, violations of the chair, gastritis and peptic ulcers of the stomach and duodenum. In addition, the possible elevation of liver enzymes and increased levels of bilirubin in the blood.
Allergic reactions: skin rash, itching, rash, maculopapular rash, bronchospasm, angioedema.
Other: cough, arrhythmia, pulmonary embolism, fatigue, confusion, headache, fever, myalgia, arthralgia, hematuria.
With the development of side effects should stop taking the drug and call your doctor.
In the case of bleeding, including hidden, you should contact your doctor, since the drug prolongs bleeding time and increases the risk of complications from bleeding. If the observed development of abnormal bleeding, including bleeding gums, it is necessary to conduct a study of the hemostatic system, in addition, when using the drug clopidogrel is recommended to regularly monitor liver function.
Patients taking the drug clopidogrel, should inform health care workers (including dentists) of the medication.
Contraindications:
Individual hypersensitivity to the drug.
Severe liver damage, jaundice, accompanied by cholestasis.
Due to the fact that the drug contains lactose, it is not prescribed to patients with glucose-galactose malabsorption and hereditary lactase deficiency.
Clopidogrel is not used for the treatment of patients with active bleeding, including bleeding from the peptide ulcer or intracranial hemorrhage.
Clopidogrel is contraindicated during pregnancy and breastfeeding.
In connection with unproven efficacy and safety of the drug in patients under 18 years of clopidogrel should not be used in pediatrics.
Clopidogrel should be prescribed with care to patients with an increased risk of bleeding due to trauma, surgical interventions, as well as violations of the blood system.
Clopidogrel should be used with caution in patients suffering from impaired renal function and / or liver.
Do not take the drug for 7 days before the scheduled surgery.
Pregnancy:
Clopidogrel is contraindicated in pregnancy due to the fact that the safety of the drug to the fetus is not proven.
If necessary, use during lactation should solve the issue of a possible interruption of breastfeeding.
Interaction with other drugs:
The combined use of medication with acetylsalicylic acid indicated a mutual enhancement of their effect on platelet aggregation. Safety of combined treatment with these drugs for more than 12 months is not proven.
Clopidogrel should be used with caution in conjunction with heparin, but the drug clopidogrel to patients receiving heparin therapy, does not require dosage adjustment of the latter.
In the appointment of the drug to patients receiving other thrombolytic drugs, caution should be exercised.
With the simultaneous application of clopidogrel with warfarin may increase the risk of bleeding. Should not be prescribed clopidogrel for patients receiving warfarin therapy.
Clopidogrel should be prescribed with care with medications that have a high degree of association with plasma proteins.
With the simultaneous appointment of a drug with non-steroidal anti-inflammatory drugs with caution.
With the simultaneous application of the drug with antacid drugs are not observed changes in pharmacokinetic parameters of clopidogrel.
Caution must be exercised in the appointment of the drug clopidogrel patients taking inhibitors of glycoprotein IIb / IIIa.
Overdose:
In the application of excessive doses of the drug in patients there is an increase in bleeding time.
No specific antidote. In case of overdose symptomatic treatment is shown. In the case require immediate correction of the state, shows platelet transfusion.
Product:
Film-coated tablets, 10 pieces per blister, 1 or 2 blisters per carton.
Storage Conditions:
Clopidogrel is recommended that you store in a dry place away from direct sunlight at a temperature above 25 degrees Celsius.
Shelf life - 3 years.
Synonyms:
Plavix, Zilt, Agregal, Listab.
Ingredients:
1 tablet, film coated contains:
Clopidogrel bisulfate (recalculated as clopidogrel) - 75mg;
Excipients, including lactose.
Attention!
Before using the drug Clopidogrel you should consult your doctor. These operating instructions refer to a free transfer and is intended solely for information. For more information, please contact the manufacturer annotations. Buy Clopidogrel online without a prescription (no rx needed), but consult your doctor before purchasing the drug.
May
19
Casodex (Bicalutamide) 50 mg
May 19, 2011 | Leave a Comment
Buy Casodex without a prescription cheap online. Order generic Casodex without rx online with fast delivery at internet pharmacy. Purchasing Casodex on line is an easy and convenient way to get this drug.
Generic Name: Bicalutamide
Brand name: Casodex
Generic Ingredient: Nilutamide Nilandron
Type of Drug: Antiandrogen.
Prescribed For: Prostate cancer.
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General Information
Antiandrogens are prescribed together with another hormone product for prostate cancer. Casodex Bicalutamide competes with testosterone and other natural androgens (male hormones) by binding to the same places in body tissue where androgens normally bind. Prostate cancer is androgen sensitive and responds to treatments that counteract the effects of androgen or remove the sources of androgen.
Cautions and Warnings
Do not take Casodex if you are allergic or sensitive to it or any of its ingredients.
People taking Casodex may develop severe liver injury. People with liver disease may be at greater risk for serious side effects.
Almost 40% of men taking Casodex bicalutamide as single therapy for prostate cancer develop breast pain and enlargement. Casodex may also reduce sperm count.
Two of every 100 people taking nilutamide develop interstitial pneumonitis (symptoms include cough, chest pain, fever, and breathing difficulties). People with lung disease and Asians may be at greater risk. Report any breathing difficulty or worsening of pre-existing breathing difficulty to your doctor immediately.
Isolated cases of aplastic anemia (a potentially fatal blood disorder) have been reported in people taking nilutamide, but the relationship between the drug and the disease is not established.
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Possible Side Effects
Most common: hot dashes, hot flushes, general pain, headache, weakness, back pain, nausea, constipation, sleeplessness, breathing difficulties, and swollen breasts. Nilutamide, difficulty seeing in the dark and loss of testicle function.
Common: diarrhea and pelvic pain.
Less common: vomiting, abdominal pains, chest pain, flu-like symptoms, high blood pressure, swelling in the ankles or lower legs, high blood sugar, weight loss, dizziness, tingling in the hands or feet, sweating, rash, nighttime urination, blood in the urine, urinary or other infection, loss of libido, impotence, breast pain, painful urination, anemia, and bone pain.
Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Casodex Bicalutamide and nilutamide increase the effect of oral anticoagulant (blood-thinning) drugs such as warfarin. Dosage adjustment may be necessary.
• Nilutamide may increase the risk of the potentially serious side effects of phenytoin, theophylline, or vitamin K antagonists.
Food Interactions
None known.
Usual Dose of generic Casodex Bicalutamide
Adult: Casodex 50 mg once a day, morning or night.
Nilutamide
Adult: Casodex 300 mg a day, reduced to Casodex 150 mg a day after 30 days.
Overdosage
Symptoms of Casodex overdose may include nausea, vomiting, tiredness, headache and dizziness. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Report anything unusual to your doctor, especially pain or tenderness in the upper right abdomen, yellowing of skin or whites of eyes, severe itching, dark urine, persistent appetite loss, and unexplained flu-like symptoms. These may be signs of severe liver toxicity. Also report any breathing difficulties, cough, chest pain or fever.
Up to half of people taking Casodex can take from a few seconds to a few minutes to adapt to darkness. This can be a problem especially when driving at night or through tunnels. Wearing tinted glasses will minimize this effect. Up to 5% of people taking Casodex may experience intolerance to alcohol. Symptoms include flushing, tiredness, and lightheadedness. If you experience this reaction, you should avoid alcohol.
Casodex Bicalutamide should be taken at the same time each day for best results. If you forget a dose of Casodex, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Call your doctor if you forget to take more than 1 dose.
Pregnancy/Breast-feeding: Antiandrogens are not intended for use by women.
Seniors: Seniors may take Casodex without special precaution.
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1
Clarithromycin 250, 500 mg
August 1, 2009 | Leave a Comment
Generic Name: Clarithromycin
Brand Names: Biaxin
Buy Clarithromycin online without a prescription and save up to 80% purchasing this antibiotic at a cheap price from internet generic pharmacy offering more than 400 high quality pharmaceutical products both antibiotics like Clarithromycin and others. Brand name of the drug is Biaxin. Purchase Clarithromycin cheap from the comfort of your home and without the need to visit a doctor to get a prescription (generic Biaxin Clarithromycin is available without rx). All orders are shipped the same day and will be delivered to you within several working days. No prescription Clarithromycin is a great saver of your money and time. Clarithromycin 250 mg and Clarithromycin 500 mg are available to order online. 500 mg Clarithromycin is more expensive than Clarithromycin 250 mg, that is why it is recommended to check what dose of pills you require. Generic online pharmacy offers a wide range of cheap antibiotics without a prescription such as Amoxil, Zithromax, Augmentin, Levaquin and others. Buy Clarithromycin online in any quantity you require - the more you buy the cheaper a price per pill will be. Please, consult your doctor before buying Clarithromycin on line without a prescription.
Type of Drug Macrolide antibiotic.
Prescribed For: Mild to moderate infections of the upper and lower respiratory tract, tonsillitis, pharyngitis, sinusitis, exacerbation of chronic bronchitis, middle-ear infections, and for duodenal ulcers; also used for skin and other infections, including membrane attack complex (MAC) in people with advanced HIV infection.
General Information
Clarithromycin is bacteriostatic (inhibiting bacterial growth), depending on the organism in question and amount of antibiotic present. In ulcer disease, clarithromycin is used to fight Helicobacter pylori infection, which is present in almost all ulcers and most cases of stomach inflammation.
Cautions and Warnings
Do not take clarithromycin if you are allergic or sensitive to any of its ingredients or to any macrolide antibiotic.Clarithromycin should not be used during pregnancy.
Clarithromycin is primarily eliminated from the body through the liver and kidneys. People with severe kidney disease may require dose adjustments. Liver disease generally does not require an adjustment.
Colitis (bowel inflammation) has been associated with all antibiotics (see “Possible Side Effects”). If colitis does develop, your doctor should start appropriate treatment. Mild cases of colitis usually respond to the discontinuation of the medicine.
Possible Side Effects
Most side effects are mild and go away once you stop taking clarithromycin.
✓ Most common: nausea, upset stomach, changes in sense of taste, headache, he. diarrhea, abdominal pain, vomiting, and rash in children. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop.
✓ Rare: serious abnormal heart rhythms. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Clarithromycin may increase the anticoagulant (blood-thinning) effects of warfarin in people who take it regularly, especially older adults. This combination requires careful monitoring by your doctor.
• Do not combine clarithromycin with astemizole or terfenadine.
• Combining clarithromycin and omeprazole raises the amount of both drugs in the blood.
• Two deaths have been reported in people combining Clarithromycin should not be used by peibp)e faking a macrolide antibiotic.
• Clarithromycin may raise blood levels of theophylline, possibly leading to a theophylline overdose. It can also increase the effects of caffeine.
• Combining clarithromycin and digoxin, cyclosporine or tacrolimus may lead to serious side effects.
Aug
1
Cilostazol
August 1, 2009 | Leave a Comment
Generic Name
Cilostazol (sil-oe-STAY-zol) Lq
Brand Name Pletal
Type of Drug Antiplatelet.
Prescribed For Intermittent claudication.
General Information
In intermittent claudication, leg muscles go into spasm due to reduced blood flow. This occurs when plaque buildup narrows blood vessels leading to the calf or other leg muscles. People with this condition often develop leg pain after walking only a short distance. Cilostazol prevents blood platelets from “clumping together” to begin the process of forming a blood clot, which can further obstruct arteries and worsen intermittent claudication. This drug is broken down in the liver.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
?P,Ople with congestive heart failure (CHF) should not take cilostazol. Some studies indicate that long-term use of this drug may cause cardiovascular problems.
People with hemostatic disorders or active pathologic bleeding should not take cilostazil.
Drug Interactions
• Avoid mixing cilostazol with ketoconazole, itraconazole, fluconazole, miconazole, fluvoxamine, fluoxetine, nefazodone, or sertraline because this interaction may slow the breakdown of cilostazol, prolonging its effects. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Aspirin can increase the anticoagulant (blood-thinning) effect of cilostazol, but this combination has not caused serious bleeding problems. There is no information on the effect of combining cilostazol and other antiplatelet or anticoagulant drugs. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Diltiazem increases cilostazol blood levels by about 50%. Cilostazol dosage is reduced by 50% when it is combined with diltiazem.
• Erythromycin and similar antibiotics increase cilostazol blood levels. Take half the regular dose of cilostazol when combining it with any of these drugs.
• Combining cilostazol and omeprazole increases the effects of cilostazol. Cilostazol dosage is reduced by 50% when it is combined with omeprazole.
• Smoking reduces the Olectiveness of cilostazol by causing the liver to break it down faster.
Food Interactions
Take this drug on an empty stomach at least 30 minutes before or 2 hours after meals. Do not drink grapefruit juice at any time while
above. with dosage.
dache, infection, abdominal pain, ab- arrhea.
pitations, rapid heartbeat. dizziness, sea, sore throat, runny nose, back pain, arms or legs.
cough, fainting, and muscle aches. cts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
The risk of side effects
♦ Most common: headache
• stool, and diarrhea. • Common: heart palpitations
• stomach, nausea
• swelling in the
♦ Less common: gas,
♦ Rare: Rare side effects body. Contact your fect not listed taking cilostazol because it can interfere with the breakdown of the drug.
Usual Dose
Adult: 100 mg twice a day. 50 mg twice a day when combined with other drugs that may increase the effect of cilostazol. Child: not recommended.
Overdosage
Symptoms of overdose are likely to be the most common side effects. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Several weeks of cilostazol treatment may be necessary before you notice any improvement in symptoms. Maximum benefit usually occurs after 12 weeks.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that cilostazol may harm the fetus, but there is no information on the effect of cilostazol in pregnant women. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
cilostazol may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors can take this drug without special precaution.
Aug
1
Ciclopirox
August 1, 2009 | Leave a Comment
Generic Name
Ciclopirox (sye-kloe-PERE-ox) &
Brand Names
Loprox Penlac
Type of Drug Antifungal,
Prescribed For
Fungus and yeast infections of the nails and skin, including athlete’s foot, candida, and dandruff.
General Information
Ciclopirox slows the growth of a variety of fungus organisms and yeasts and kills many others. The drug penetrates the skin, hair, hair follicles, and sweat glands. Ciclopirox nail lacquer is used for toenail and fingernail fungus infections. Ciclopirox shampoo is used for dandruff.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
Possible Side Effects
Common: burning, itching, stinging, or oozing at the application site.
Drug Interactions None known.
Usual Dose
Cream/Lotion
Adult and Child (age 10 and over): Massage into cleansed affected skin and surrounding area twice a day.
Nail Lacquer
Adult: Apply to infected nails once a day. Use in conjunction with monthly visits to a health care professional.
Child (under age 10): not recommended.
Shampoo
Adult: Wet hair and apply 1-2 tsp to the scalp. Lather and leave on hair and scalp for 3 minutes, then rinse. Avoid contact with eyes. Repeat twice weekly for 4 weeks.
Child (under age 16): not recommended.
Overdosage
Accidental ingestion may cause nausea and upset stomach. Call your local poison control center or hospital for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
This product can be expected to relieve symptoms within the first week of use. Follow your doctor’s directions for the complete 2-4 week course of treatment with the cream or lotion to gain maximum benefit. The nail lacquer may be used for up to 48 weeks. Stopping the medication too soon can lead to a relapse.
When using ciclopirox nail lacquer, do not apply it to any skin other than that which surrounds the infected nails, because of possible irritation. Do not apply nail polish or any other nail lacquer to infected nails while you are using this product.
Avoid using ciclopirox nail lacquer near an open flame, since the product is flammable.
Do not cover cream or lotion with a bandage.
Call your doctor if the affected area burns, stings, or becomes red after you use this product, 13y i1 your symptoms do not clear Up aher 4 weeks of treatment; by then it is unlikely that this product will be effective.
If you forget a dose of ciclopirox, apply it as soon as you remember. Do not apply more than the amount prescribed to make up for the missed dose.
Special Populations
PregnancylBreast-feeding., ciclopirox may pass to the fetus in very small amounts. In animal studies, high doses of ciclopirox given by mouth did not harm the fetus. Caution should be exercised when using ciclopirox during pregnancy.
It is unknown if ciclopirox passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use this drug without special restriction.
Aug
1
Cholinesterase Inhibitors
August 1, 2009 | Leave a Comment
Type of Drug
Cholinesterase Inhibitors
(KO-lin-ESS-tuh -rase)
Brand Names
Generic Ingredient.- Donepezil
Aricept Aricept ODT
Generic Ingredient: Galantamine
Razadyne Razadyne ER
Generic Ingredient: Rivastigmine
Exelon Exelon Transdermal System
Generic Ingredient: Tacrine Cognex
Prescribed For
Alzheimer’s disease. Also used for vascular dementia, dementia associated with Parkinson’s disease, poststroke aphasia (problems with language), and improvement of memory in multiple sclerosis patients.
General Information
Cholinesterase inhibitors work by increasing the function of certain receptors in the brain that are stimulated by the hosmone acetylcholine. They do t.Ns by interfering with cholinesterase, the 1617yme that breaks down acetylcholine. People with Alzheimer’s disease (a degenerative condition of the central nervous system) develop a shortage of this brain chemical early in the disease. There is no evidence that cholinesterase inhibitors reverse the degenerative effects of Alzheimer’s, but they may slow the rate at which the disease worsens.
Cautions and Warnings
Do not take cholinesterase inhibitors if you are allergic or sensitive to any of their ingredients.
Cholinesterase inhibitors must be discontinued before surgery because they increase the effects of anesthetic drugs.
People with heart disease should use cholinesterase inhibitors with caution because they may slow heart rate and cause fainting. Two studies of people with mild symptoms of Alzheimer’s disease taking galantamine revealed a higher rate of death from heart attack, stroke, or sudden death.
Cholinesterase inhibitors may be expected to cause increased stomach acid production and increased activity of the gastrointestinal tract. Possible complications include ulcers or bleeding. Alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may worsen this effect.
Using cholinesterase inhibitors may also lead to urinary blockage, increase the risk of generalized seizures, and worsen asthma or other pulmonary diseases. Use with caution if you have these conditions.
People with severe liver dysfunction should not take galantamine or tacrine.
Possible Side Effects
People taking cholinesterase inhibitors generally experience side effects at about the same rate as those taking a placebo (sugar pill).
♦ Most common: headache, general pain, accidents, nausea, diarrhea, sleeplessness, and dizziness.
✓ Common: tiredness, vomiting, appetite loss, and muscle cramps.
♦ Less common: arthritis, depression, abnormal dreams, fainting, black-and-blue marks, and weight loss.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cholinesterase inhibitors interfere with anticholinergic drugs (often prescribed for stomach disorders).
• Cholinesterase inhibitors can be expected to increase the ef-
fects of cevimeline, surgical anesthetic drugs, and drugs that
irritate the stomach and intestines, such as aspirin, ibupro-
fen, and other NSAIDs.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be slowed by ketoconazole, itraconazole, quinidine, delavirdine, indinavir, nelfinavir, ritonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, norfloxacin, clarithromycin, diltiazem, erythromycin, fluconazole, fluvoxamine, celecoxib, chlorpheniramine, clomipramine, cocaine, doxorubicin, fluoxetine, halofantrine, halopendol, levopromazine, methadone, mibefradil, paroxetine, ranitidine, terbinafine, mifepristone, nefazodone, and grapefruit juice.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be increased by efavirenz, nevirapine, barbiturates, carbamazepine, corticosteroids, phenytoin, pioglitazone, and rifampin.
Food Interactions
Donepezil can be taken with or without food.
Galantamine and rivastigmine should be taken with morning and evening meals.
The rivastigmine transdermal system patch can be used without regard to meals.
Food reduces the absorption of tacrine into the blood. It is best taken on an empty stomach, but you can take it with food if it upsets your stomach.
Usual Dose
Donepezil
Adult: 5 or 10 mg once a day.
Galantamine
Adult: 8-32 mg a day.
Rivastigmine
Adult: 3-12 mg a day, divided into 2 doses.
RiVUtq1M&A0Y2nsdermaI patch
Adult: Apply one 4.6-mg patch every day to start. Dose may be increased to one 9.5-mg patch every day.
Tacrine
Adult: 40-160 mg a day, divided into 4 doses.
Overdosage
Cholinesterase inhibitor overdose can be very serious. Symptoms include severe nausea, vomiting, salivation, sweating, slow heart rate, low blood pressure, slow breathing rate, convulsions, muscle weakness, and collapse. Take the overdose victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Donepezil should be taken just before bedtime.
Follow the special package directions for rivastigmine solution.
Do not remove the rivastigmine patch from its packaging until just before you are ready to apply it. Apply the patch to clean, dry, and hairless skin on the upper or lower back, upper arm, or chest that is also free of any powder, oil, moisturizer, or lotion that could keep the patch from sticking to your skin properly; skin should also be free of cuts, rashes, and irritations. Avoid places where the patch can be rubbed off by tight clothing. When changing your patch, apply your new patch to a different spot of skin (for example, on the right side of your body one day, then on the left side the next day). Do not use the same spot more than once every 14 days. Wear only one patch at a time and change it every.24 hours. If the patch falls off, apply a new patch for the rest of the day, then replace the patch the next day at the same time as usual.
Tobacco or nicotine use increases the rate at which tacrine and rivastigmine are cleared from the body.
If you forget a dose and take your medication once a day, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with the regular schedule. If you take your medication 2 or more times a day, take your dose as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: One animal study of a cholinesterase inhibitor indicated a small risk of birth defects. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
It is not known if cholinesterase inhibitors pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with moderate kidney function loss should not take galantamine. Dosage adjustments are not needed for donepezil, tacrine, or rivastigmine.
Aug
1
Cholestyramine
August 1, 2009 | Leave a Comment
Generic Name
Cholestyramine (kol-es-TYE-rah-meen) 0
Brand Names
LoCHOLEST Questran
LoCHOLEST Light Questran Light Prevalite
The information in this profile also applies to the following drugs:
Generic Ingredient: Colesevelam Hydrochloride WelChol
Generic Ingredient: Colestipol Hydrochloride Colestid
Type of Drug
Anti -hyperli pidemic (blood-fat reducer).
Prescribed For
High blood-cholesterol levels; generalized itching associated with bile duct obstruction—cholestyramine only; colitis; digitalis or thyroid overdose; and pesticide poisoning.
General Information
Cholestyramine resin lowers blood-cholesterol levels by absorbing bile acids in the bowel. Since the body uses cholesterol to make the bile acids—needed to digest fat—fat digestion can only continue by making more bile acid from blood cholesterol. This results in lower blood-cholesterol levels 4-7 days after starting cholestyramine.
Cholestyramine w3Cks entirely Within the bowel and is never absorbed into the bloodstream. Though usually given 3-4 times a day, there appears to be no advantage to taking it more often than twice a day. The cholesterol-lowering effect of cholestyramine may be increased when it is taken with an HMG-CoA inhibitor or nicotinic acid. In some kinds of hyperlipidemia, colestipol may be more effective in lowering total blood cholesterol than clofibrate.
Cautions and Warnings
Do not use cholestyramine if you are allergic or sensitive to any of its ingredients or if your bile duct is blocked. The powder form should not be taken dry; doing so may result in the inhalation of powder into your lungs or a clogged esophagus.
If you are being treated for hypothyroidism, diabetes, kidney or blood vessel disorder, obstructive liver disease, or alcholism, consult your doctor before taking cholestyramine.
Cholestyramine may cause or worsen constipation and hemorrhoids. Most constipation is mild, but some people may need to stop the medication or take less of it.
Possible Side Effects
✓ Most common: constipation, which may be severe and in rare cases result in bowel impaction. Hemorrhoids may be worsened.
♦ Less common: abdominal pain and bloating, and bleeding disorders or black-and-blue marks due to interference with the absorption of vitamin K, a necessary factor in the blood clotting process. One person developed night-blindness because the medication interfered with vitamin A absorption into the blood. Other side effects include belching, gas, nausea, vomiting, diarrhea, heartburn, and appetite loss. Your stool may have an unusual appearance because of a high fat level.
✓ Rare: Rare side effects can affect your mouth, stomach and intestines, muscles and joints, mental status, urinary tract, and breathing. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
O Cholestyramine interferes with the absorption of virtually all oral drugs, including acetaminophen, amiodarone, aspirin, cephalexin, chenodiol, clindamycin, clofibrate, contraceptive drugs, corticosteroids, diclofenac, iopanoic acid, iron, digitalis drugs, furosemide, gemfibrozil, glipizide, hydrocortisone, imipramine (an antidepressant), methyldopa, mycophenolate, nicotinic acid, penicillin, phenobarbital, phenytoin, piroxicam, propranolol, tetracycline, thiazide diuretics, thyroid drugs, tolbutamide, trimethoprim, ursodiol, warfarin and other anticoagulant (blood-thinning) drugs, and vitamins A, D, E, and K. Take other medications at least 1 hour before or 4-6 hours after taking cholestyramine.
Food Interactions
Take this medication before meals. The powder may be mixed with soda, water, juice, cereal, or pulpy fruits, such as applesauce or crushed pineapple. Cholestyramine bars should be thoroughly chewed and taken with plenty of fluids. Colestipol pills are swallowed whole.
Usual Dose
Cholestyramine: 4 g (1 packet) or 1 level scoopful taken 1-2 times a day or up to 6 times a day.
Colesevelam: 6 tablets once a day or in 2 divided doses. Colestipol: 2-16 g (1-6 packets) once a day or in divided doses.
Overdosage
The most severe effect of overdose is obstruction of the gastrointestinal tract. Take the overdose victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Do not swallow the granules or powder in their dry form. Prepare each packet of powder by mixing it with soup, cereal, or pulpy fruit or by adding the powder to a 6-oz. glass of liquid, such as a carbonated beverage. If some of the drug sticks to the sides of the glass, rinse it with liquid and drink the remainder.
Constipation, gas, nausea, and heartburn may occur and then disappear with continued use of this medication. If constipation is a problem, your doctor may recommend drinking more fluids and taking a fiber supplement. Call your doctor if these side effects persist or if you develop unusual problems such as bleeding from the gums or rectum.
If you miss a dose of cholestyramine, skip it and continue with your regular scheduke. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: While cholestyramine does not affect the fetus directly, it may prevent the absorption of vitamins A, D, and E and other nutrients essential to the fetus’ proper development–even when you take, a prenatal vitamin supplement.
When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Cholestyramine is not absorbed into the body. However, reduced absorption of vitamins A, D, and E and other nutrients may make your milk less nutritious. Nursing mothers who must take cholestyramine should use infant formula.
Seniors: Seniors are more likely to experience side effects, especially those relating to the bowel.
Aug
1
Chlorzoxazone
August 1, 2009 | Leave a Comment
Generic Name
Chlorzoxazone (klor-M-uh-zone)
Brand Names
Parafon Forte DSC Strifon Forte DSC
Type of Drug
Skeletal muscle relaxant.
Prescribed For
Pain and spasm of muscular conditions, including strain, sprain, bruising, and lower back problems.
General Information
Chlorzoxazone works primarily on the spinal cord level and on the brain, acting as a mild sedative. This results in fewer spasms, less pain, and greater mobility. Chlorzoxazone provides only temporary relief and is not a substitute for other types of therapy, such as rest, surgery, and physical therapy.
Cautions and Warnings
Do not take chlorzoxazone if you are allergic or sensitive to any of its ingredients, or if you have a condition known as porphyria.
People with poor liver or kidney function should take this drug with caution because serious liver toxicity has rarely occurred in people using chlorzoxazone.
Chlorzoxazone may interact with other drugs that cause nervous system depression (see “Drug Interactions”).
Because it is possible to become dependent on this drug, people with a history of substance abuse should take chlorzoxazone with caution.
Possible Side Effects
♦ Most common: dizziness, drowsiness, lightheadedness, malaise, and aveTStimulation,
♦ Less common: headache, stomach cramps or pain, diar-
rhea, constipation, heartburn, nausea, and vomiting.
• Rare: internal bleeding, liver problems, severe allergic-type skin reactions, and breathing problems. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• The depressive effects of chlorzoxazone may be enhanced by taking it with alcohol, sedatives, sleeping pills, or other nervous system depressants. Avoid these combinations.
Food Interactions
Take this drug with food if it upsets your stomach. The tablets may be crushed and mixed with food.
Usual Dose
Adult: 250-750 mg 3-4 times a day. Child: 125-500 mg 3-4 times a day.
Do not take more medication than is prescribed.
Overdosage
Early signs of chlorzoxazone overdose may include nausea, vomiting, diarrhea, drowsiness, dizziness, lightheadedness, and headache. Victims may also feel sluggish or sickly and lose the ability to move their muscles. Breathing may become slow or irregular, and blood pressure may drop. Contact a doctor immediately or go to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Chlorzoxazone may make you drowsy or reduce your ability to concentrate. Be extremely careful while driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorzoxazone may turn your urine orange to purple-red; this is not dangerous.
Call your doctor if you develop drowsiness, weakness, an allergic reaction, skin rash or itching, breathing difficulties, black or tarry stools, vomiting of material that resembles coffee grounds, liver problems, or any other severe or bothersome side effect.
4f you miss a dose of chlorzoxazone by more than an hour, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of chlorzoxazone in pregnant women has not been established. Pregnant women should only take chlorzoxazone after carefully weighing its potential benefits against its risks.
It is not known if chlorzoxazone passes into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors, especially those with severe liver disease, are more sensitive to the effects of chlorzoxazone.
Aug
1
Chlorpromazine
August 1, 2009 | Leave a Comment
Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
• Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
• Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
• Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
• Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
• Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
• Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
• Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
• Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
• Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
• Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.
Aug
1
Chlorpheniramine Maleate
August 1, 2009 | Leave a Comment
Generic Name
Chlorpheniramine Maleate
(KLOR-ten-ERE-uh-mene MAL-ee-ate) M
Brand Names
Aller-Chlor Efidac 24
Chlor-Trimeton Pediox S
Chlor-Trimeton Allergy 8 Hour Prohist+8 Chlor-Trimeton Allergy 12 Hour QDALL AR
The information in this profile also applies to the following drugs: Generic Ingredient: Cyproheptadine Hydrochloride 0
Generic Ingredient: Dexchlorpheniramine Maleate 19
Type of Drug Antihistamine,
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy, and other symptoms of allergy such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from body cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
Use chlorpheniramine maleate with care if you have a history of thyroid disease, heart disease, high blood pressure, or diabetes. This drug should be avoided or used with extreme care if you have narrow-angle glaucoma, stomach ulcer or other stomach problems, enlarged prostate, or problems passing urine. It should not be used by people who have deep-breathing problems such as asthma, emphysema, or chronic bronchitis.
Possible Side Effects
V Less common: rash or itching, sensitivity to bright light, increased sweating, chills, lowered blood pressure, headache, rapid heartbeat, sleeplessness, dizziness, disturbed coordination, confusion, restlessness, nervousness, irritability, euphoria (feeling “high”), tingling in the hands or feet, blurred or double vision, ringing in the ears, upset stomach, appetite loss, nausea, vomiting, constipation, diarrhea, urinary difficulties, chest tightness, wheezing, stuffy nose, and dryness of the mouth, nose, or throat. Young children may also develop nervousness, irritability, tension, and anxiety.
Drug Interactions
• chlorpheniramine maleate should not be taken with a mono-amine oxidase inhibitQ(aMkdepiessank, because the combination may cause severe side effects.
• The effects of sedatives, benzodiazepines such as diazepam, and sleeping medications will be increased when any of these drugs is combined with chlorpheniramine maleate. It is extremely important for your doctor to know if you are taking any other medication with chlorpheniramine maleate so that the dosage of that medication can be properly adjusted.
• Anti chol inergenics may cause an increase in side effects of chlorpheniramine maleate.
• Be extremely cautious when drinking alcoholic beverages while taking this drug, which enhances the intoxicating and sedating effects of alcohol.
Food Interactions
You may take this drug with food if it upsets your stomach.
Usual Dose
chlorpheniramine
Adult and Child (age 13 and over): 4 mg every 4-6 hours; do not take more than 24 mg a day.
Child (age 6-12): 2 mg every 4-6 hours; do not take more than 12 mg a day.
Child (age 2-5): 1 mg every 4-6 hours; do not take more than 4 mg a day.
chlorpheniramine, Sustained-Release
Adult and Child (age 13 and over): 8-12 mg at bedtime, or every 8-12 hours during the day; do not take more than 24 mg a day. Child (age 6-12): 8 mg during the day or at bedtime.
Child (under age 6): not recommended.
Cyproheptadine
Adult and Child (age 15 and over): 4-20 mg a day; do not exceed 32 mg a day.
Child (age 7-14): 4 mg 2-3 times a day; do not exceed 16 mg a day.
Child (age 2-6): 2 mg 2-3 times a day; do not exceed 12 mg a day.
Dexchlorpheniramine
Adult and Child (age 12 and over): 2 mg every 4-6 hours. Child (age 6-11): 1 mg every 4-6 hours.
Child (age 2-5): 0.5 mg every 4-6 hours.
Dexchlorpheniramine, Sustained-Release
Adult and Child (age 12 and over): 4-6 mg every 8-10 hours and at bedtime.
Child (age 6-11): 4 mg once a day and at bedtime. Child (under age 6): not recommended.
Tripelennamine
Adult and Child (age 12 and over): 25-50 mg every 4-6 hours; do not take more than 600 mg a day. Adults may take up to 3100-mg, sustained-release tablets a day, although this much is not usually needed.
Child (under age 12): 2 mg per lb. of body weight a day in divided doses; no more than 300 mg a day should be given.
Overdosage
Symptoms of overdose include depression or stimulation, especially in children; dry mouth: fixed or dilated pupils; flushing of the skin; upset stomach; unsteadiness; and convulsions. Overdose victims should be made to vomit as soon as possible with ipecac syrup—available at any pharmacy—to remove excess drug from the stomach. Take the victim to a hospital emergency room immediately if the victim is unconscious.or if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause tiredness or loss of concentration: Be extremely cautious when driving or doing anything that requires close attention.
If you forget a dose of this drug, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feeding., Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of some antihistamines pass into breast milk. NV ing mothers who must take chlorpheniramine maleate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects. Dosage reduction may be needed.