Sep
26
Formoterol - Fosfomycin - Fosinopril - Fosrenol - Ganciclovir
September 26, 2009 | Leave a Comment
Generic Name
Formoterol (for-MOH-ter-ol)
Brand Names
Foradil Aerolizer Perforomist Foradil Certihaler
Combination Product
Generic Ingredients: Formoterol + Budesonide Symbicort
The information in this profile also applies to the following drug:
Generic Ingredient: Arformoterol Brovana
Type of Drug Bronchodilator.
Prescribed For
Maintenance of asthma, bronchospasm during exercise, and chronic obstructive pulmonary disorder, including chronic bronchitis, and emphysema.
General Information
Formoterol is a long-acting beta-2 agonist, used in the prevention of asthma attacks and bronchial spasms. It is not effective in stopping an asthma attack once it has begun. Patients suffering from severe asthma should always have a short-acting bronchodilator available in case of an acute attack.
Cautions and Warnings
Do not use formoterol if you are allergic or sensitive to any .,oAits ingredients.
Formoterol skn\)NO not be used by patients with significantly or rapidly worsening asthma. In some asthma patients, formoterol may increase the chance of death from asthma.
Formoterol is not a replacement for corticosteroid inhalers. Patients should continue to use their corticosteroid inhalers at the same dosage in conjunction with formoterol.
Patients who have been taking inhaled, short-acting beta-2 agonises should stop regular use of these, and use them only to treat
acute asthma symptoms.
Formoterol can cause paradoxical bronchospasm, a potentially
life-threatening condition. Patients who experience symptoms
should discontinue use of formoterol immediately.
Formoterol can cause irregular heartbeat and should be used
with caution by patients with a history of heart disease or high blood pressure. Patients with a history of seizures, strokes, or diabetes should also be carefully monitored for a recurrence or worsening of these conditions.
Possible Side Effects
? Most common: tremors, dizziness, insomnia, and chest pain.
? Common: restlessness, weakness, sore throat, and difficulty breathing.
¦ Less common: lightheadedness, angina, abnormal heart rhythm, heart palpitations, and bronchospasrn.
? Rare: severe worsening of asthma, extreme allergic reaction, and angioedema (a potentially life-threatening swelling of the lips and throat). Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Formoterol’s effects may be increased by monoamine oxidase inhibitor (MA01) antidepressants, tricyclic antidepressants, thyroid drugs, other bronchodilators. and some antihistamines.
• The effect of formoterol may be lessened by beta-blocking drugs, such as propranolol.
• Formoterol may antagonize the effects of blood-r:~ssurelowering drugs, especially reserpine, methyldupa, and guanethidine.
• Using formoterol with antihistamt z;, disopyramide; phe- nothja,Z:MtS,’D10cBinamide; quinidine and similar drugs: theo- phylline; and tricyclic antidepressants may increase the risk of heart damage and life-threatening cardiac arrhythmias.
Food Interactions None known.
Usual Dose
Arlormoterol
Adult: Inhale 15 mcg every 12 hours. Child: not recommended.
Formoterol
Adult and Child (age 5 and over)
Foradil Aerolizer: Inhale 12 mcg every 12 hours. Foradil Certihaler: Inhale 10 mcg every 12 hours.
Perforomist: Inhale 20 mcg every 12 hours. Child (under age 5): not recommended.
Formoterol + Budesonide Combination Adult: Inhale 1 puff every 12 hours. Child: riot recommended.
Overdosage
Formoterol overdose may cause nausea, vomiting, tremor, sleepiness, rapid or irregular heartbeat, low blood sugar, blood acidity, and life-threatening cardiac arrhythmias. Patients experiencing severe symptoms should go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
The drug should be inhaled during the second half of your inward breath. This will allow the medication to reach more deeply into your lungs.
Be sure to follow your doctor’s directions for the use of formoterol. Using more than you need can increase the risk of side effects and worsen your symptoms. If your condition worsens after taking formoterol, stop taking it and call your doctor at once.
Call your doctor at once if you develop chest pains, rapid heartbeat, palpitations, muscle tremors, dizziness, headache, or swelling of the throat, or if you still have trouble breathing after using the medication.
If a dose of formoterol is forgotten, take it as soon as you remember. If it is almost time (Ox your next dose, skip the dose you forgot aMmMinue with your regular schedule. Do not take a double dose.
Formoterol capsules must only be used with the inhaler that is provided with this medicine. Do not use other medicines with the formoterol inhaler. Patients should be aware that the gelatin cap-sure may fragment, causing a risk that gelatin particles will be inhaled. This risk is minimized by being careful to pierce the gelatin capsule only once. Capsules should be used immediately after they are taken from the blister pack.
Special Populations
Pregnancy/Breast-feeding: The safety of formoterol in pregnant women has not been studied. The potential benefit of using this medication must be carefully weighed against its risks.
It is not known if formoterol passes into breast milk. Nursing mothers who take this should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug. Follow your doctor’s directions and report any side effects at once.
Fosamax see Bisphosphonates, page 164
Generic Name
Fosfomycin (fos-foe-MYE-sin)
Brand Name Monurol
Type of Drug Urinary anti-infective.
Prescribed For
Uncomplicated urinary infections.
General Information
Fosfomycin kills a variety of bacteria. It works by preventing bacteria from sticking to the wall of the urinary tract and by interfering with bacterial cell division. In the body, it is converted V) its active form—free (WS bacteria that are resistant to other antibiotics are not resistant to fosfomycin, so this drug may work where others have failed.
Cautions and Warnings
bo not take fosfomycin if you are allergic or sensitive to any of its ingredients. Fosfomycin is meant to be taken once, in a single dose. Taking more than 1 packet of fosfomycin only increases side effects; it does not improve the drug’s effectiveness.
Drug Interactions
• Metoclopramide reduces fosfomycin blood levels. Food Interactions
You may take fosfomycin with or without food. Usual Dose
Adult (age 12 and over): 1 packet mixed with water. Child (under age 12): riot recommended.
Overdosage
Little is known about the effects of fosfomycin overdose. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Do not take fosfomycin powder in its dry form. Mix the contents of the packet with 3-4 oz. of cool or cold water until it dissolves. Then drink the solution immediately.
Call your doctor if your infection does not improve within 2 or 3 days.
Special Populations
Pregnancy/Breast-feeding: The safety of using fosfomycin during pregnancy is, mV&nown. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if fosfomycin passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take fosfomycin without special restriction.
above. vaginal irritation, runny nose, nau-
ts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
¦ Less common: diarrhea
and headache
Rare: Rare side effects body. Contact your fect not listed
Generic Name
Fosinopril (tos-IN-oe-pril) 41
Brand Name Monopril
Combination Product
Generic Ingredients: Fosinopril + Hydrochlorothiazide IM
Monopril HCT Type of Drug
Angiotensin-converting enzyme (ACE) inhibitor.
Prescribed For
High blood pressure and heart failure. Also prescribed for renal failure, kidney hypertension, post-heart attack management, management of people with a high risk of heart disease, diabetes, chronic kidney disease, and preventing a second stroke.
General Information
Fosinopril sodium and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving the symptoms of heart failure. Fosinopril also affects the production of other hormones and enzymes that participate in the regulation of blood vessel dilation. Fosinopril begins working 2-6 hours after you take it.
Cautions and Warnings
Do not take fosinopril if you are allergic or sensitive to any of its ingredients. Severe reactions may involve angioedema, a possibly life-threatening swelling of the face, throat, or intestines (see “Special Information”). These reactions are more likely in hemodialysis patients and those undergoing venom immunization.
Fosinopril occasionally causes very low blood pressure or affects your kidneys. ‘four doctor should check your urine for changes during the first few months of treatment.
ACE inhibitors can affect your white-blood-cell count, possibly increasing your susceptibility to infection. Blood counts should be checked periodically.
Fosinopril may cause serious injury or death to the fetus it taken during pregnancy. Pregnant women should, not take fosinopril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
v Most common: chronic cough and dizziness, especially when rising from a sitting or lying position. The cough usually goes away a few days after you stop taking the medicine.
? Less common: chest pain, low blood pressure, fatigue, diarrhea, headache, vomiting, and nausea.
¦ Rare: Rare side effects can affect your heart, sleeping, stomach and intestines, skin, sex drive, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• The blood-pressure-towering effect of fosinopril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking an ACE inhibitor.
• Fosinopril may increase the effects of lithium: this combination should be used with caution.
• Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood pressure-lowering effects of fosinopril and other ACE inhibitors. This may cause reductions in kidney function.
• Fosinopril may increase potassium levels in your blood, especially when taken with dyazide or other potassium-sparing diuretics.
• Antacids and fosinopril should be taken at least 2 hours apart.
• Capsaicin may trigger or aggravate the cough associated with fosinopril, kt)eTapy.
• Indomethacin may reduce the blood-pressure-lowering effects of fosinopril.
• Phenothiazine sedatives and antivomiting drugs may increase the effects of fosinopril.
• Severe sensitivity reactions can occur in people taking allopurinol.
Fosinopril may affect blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects while less digoxin in the blood can compromise its
effectiveness.
Food Interactions
You may take fosinopril with food if it upsets your stomach.
Usual Dose
Adult: 10-80 mg once a day. People with liver disease may require lower dosages.
Overdosage
The principal effect of ACE inhibitor overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop swelling of the face or throat, if you have sudden difficulty in breathing, or if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception. Unexplained swelling of the face, lips, hands, and feet can also affect the larynx (throat) and tongue and interfere with breathing. If this happens, the victim should be taken to a hospital emergency room at once.
Some people who start taking an ACE inhibitor after they are already on a diuretic (an agent that increases urination) experience a rapid drop in blood pressure after their first doses or when the dosage is increased. To prevent this from happening, you may be told to stop taking the diuretic 2 or 3 days before starting the ACE inhibitor or to increase your salt intake during that time. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet quickly from a sitting or lying position when taking fosinopril.
Avoid strenuous exercise or very hot weather, because heavy sweating or dehydration can cause a rapid decrease in blood pressure.
Avoid over-the-counter diet pills, decongestants, and other stimulants that can raise blood pressure. Also, do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you forget to take a dose of fosinopril, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might be pregnant should not take ACE inhibitors. Stop taking the drug and contact your doctor if you become pregnant.
Large amounts of fosinopril pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of fosinopril.
Brand Name
Fosrenol
Generic Ingredient Lanthanum Carbonate
Type of Drug Phosphate binder.
Prescribed For
High blood phosphate levels (hyperphosphatemia) in people with end-stage renal disease (ESRD).
General Information
People with ESRD, a form of kidney disease, tend to retain phosphorous. High phosphate levels, in turn, can affect calcium balance in the body and cause deposits of this mineral to build up in the wrong places. Lanthanum helps manage high blood phosphate levels by binding to phosphate in food before it can be absorbed into the blood. This is the same mechanism used by other phosphate-lowering drugs (se,4e%Tner and the antacids aluminum hydroxide -6nd calcium carbonate). Lanthanum, like other phosphate binders, must be taken with meals so that it can bind phosphate ions in the stomach before they can be absorbed into the blood. Very little of this drug is absorbed into the blood and it is not broken down in the body Cautions and Warnings
Do not take fosrenol if you are allergic or sensitive to any of its
ingredients.
People with an active peptic ulcer, ulcerative colitis, Crohn’s
disease, or bowel obstruction should use this medication with
caution.
Researchers found no difference in bone fracture rates or over-
all survival for lanthanum than for other phosphate-binding treatments over 3 years. The study period was too short to assume that it would improve bone fractures or survival beyond 3 years.
Possible Side Effects
Side effects primarily affect the digestive tract and are similar to other phosphate-lowering treatments in type and frequency.
¦ Most common: nausea. vomiting, complications with the dialysis graft, diarrhea, constipation, abdominal pains, and low blood pressure.
¦ Common: bronchitis and runny nose.
? Less common: high blood calcium levels.
? Rare: Other side effects may affect any organ or organ system. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Lanthanum strongly binds to phosphate in the stomach and might also bind to other medications in the stomach. However, no interaction was found in tests conducted with warfarin, digoxin, enalapril, furosemide, metoprolol, or phenytoin.
• Compounds known to interact with antacids should not be taken within 2 hours of taking lanthanum.
Food Interactions
This drug must be taken with or immediately after meals.
usual Dose
Adult: 750-1500 mg with or immediately after each meal. Completely chew each tablet before you swallow it. Do not swallow whole tablets.
Child: not recommended.
Overdosage
There have been no reports of lanthanum overdose, even with single doses up to 1000 mg per pound of body weight. Symptoms of overdose are likely to occur in the digestive tract. Overdose victims may be taken to a hospital emergency room for evaluation. ALWAYS bring the prescription bottle or container.
Special Information
If you forget to take lanthanum with or immediately after a meal, skip the forgotten dose and continue with your regular schedule.
Be sure to follow the low-phosphate diet your doctor prescribes. It is a key element in helping to manage your blood phosphate levels.
Special Populations
PregnancylBreast-feeding., Animal studies with doses several times the maximum human dose revealed some harm to the developing fetus. Pregnancy in a woman with end-stage renal disease, especially those on dialysis, is uncommon because of reduced fertility and carries serious risks for a woman and her baby, including anemia, uncontrolled high blood pressure, and infection. This drug is not recommended for pregnant women.
It is not known if lanthanum passes into breast milk. Nursing mothers who must take it should consider using infant formula.
Seniors: Seniors may use this medication without special restriction.
Generic Name
Ganciclovir (ga.-SYE-kloe-vem) IM
Brand Name
Vitrasert
The information in this profile also applies To The tollowing drug:
GD’K)Phc )ngredient: Valganciclovir Valcyte
Type of Drug
Antiviral.
Prescribed For
Cytornegalovirus (CMV) infections of the eye and CMV infections in other parts of the body, in people with compromised immune
systems.
General Information
Ganciclovir works by preventing reproduction of the virus CMV. Unlike other antiviral drugs, it works only against this virus and herpes simplex virus. The drug is eliminated through the kidneys.
Though most often used for CMV retinitis (eye infection), ganciclovir has also been used for CMV infections of the urine, blood, throat, and semen. It is also used to prevent CMV infection. Ganciclovir is helpful in controlling CMV infection in heart, kidney, and kidney-pancreas transplant patients. Valganciclovir is not indicated for use in liver transplant patients.
Valganciclovir (Valcyte) is broken down by the body into ganciclovir, and all information in this profile applies to both drugs, unless otherwise noted.
Cautions and Warnings
Do not take ganciclovir if you are allergic or sensitive to any of its ingredients.
Ganciclovir causes anemia, reduced white-blood-cell count, and blood-platelet loss. Regular monitoring of blood and platelet counts is recommended while taking this drug.
Ganciclovir is intended only for people who are immunocompromised. It is not intended to treat or prevent CMV infections in newborns.
Detachment of the retina has been noted in people taking ganciclovir, as well as in people with CMV who have not taken the drug. The relationship between ganciclovir and this effect is not well known.
Ganciclovir causes increased sensitivity to the sun; use a sunscreen or wear protective clothes when you go outside.
People with kidney disease should use qw\6,7_l1DAr with caution, and may (eqtst% ieatment at a lower dosage.
Studies of ganciclovir in blacks, Hispanics, and Caucasians showed a trend toward higher blood levels among Caucasians than other groups.
Intravenous ganciclovir has been given to a small number of children under age 12 with mixed results. Side effects were similar to those experienced by adults taking the drug.
Possible Side Effects
¦ Most common: fever, diarrhea, abdominal pain, reduced white-blood-cell counts, anemia, rash, sweating, nausea, vomiting, and appetite loss.
¦ Common: infection; chills; stomach gas; low platelet counts
(symptoms include bleeding or oozing blood); tingling-,
burning; numbness or pain in the hands, arms, legs, or feet-,
itching; pneumonia; weakness; and headache.
Drug Interactions
• Pentamidine, flucytosine, vincristine, vinblastine, adriamycin, amphotericin B, trimethoprim-sulfamethoxazole, and other cytotoxic drugs may increase the side effects of ganciclovir and should be used together only if absolutely necessary, and only if the potential benefits outweigh the risks.
• People taking imipenem-cilastatin together with ganciclovir have experienced seizures. Avoid this combination.
• Mixing ganciclovir with other drugs that can be damaging to the kidneys may increase the rate and extent of kidney damage.
• Probenecid interferes with ganciclovir release through the kidneys and substantially increases blood levels of ganciclovir.
• Mixing ganciclovir with the anti-HIV drugs didanosine or zidovudine (AZT) may increase didanosine or AZT levels and reduce ganciclovir levels. Because AZT and ganciclovir both cause anemia and low white-blood-cell counts, many people cannot tolerate this combination.
Food Interactions
High-fat, high-calorie meals can increase the amount of ganciclovir absorbed into the blood. Take this drug with food.
Usual Dose Gar1r.(qtZ,41N
Adult and Child (age 13 and over): 3000 mg a day, divided into 3 or 6 equal doses. People with reduced kidney function will need to have their dosage reduced accordingly, possibly to as little as 500 mg 3 times a week.
Child (under age 13): not recommended.
Valganciclovir
Adult and Child (age 13 and over): 900 mg a day, divided into 2 equal doses of 450 mg each. People with reduced kidney function will need to have their dosage reduced accordingly, possibly to as little as 500 mg 3 times a week.
Child (under age 13): not recommended.
Overdosage
Little is known about the effects of ganciclovir overdose. As much as 6000 mg a day has been taken with only temporary lowering of white-blood-cell count. Call your hospital emergency room for instructions in case of ganciclovir overdose.
Special Information
Ganciclovir does not cure CMV eye infection, and immunocompromised people taking this drug may find their disease worsening. Dosage reductions or discontinuation of the drug may be necessary if white-blood-cell or platelet counts get too low.
Ganciclovir may cause infertility in men and women. Women of child-bearing age should use effective contraception while taking this drug. Men should use a condom while taking the drug and for at least 90 days afterward to avoid passing the drug to their partners.
Good dental hygiene is important while taking ganciclovir to minimize the risk of infection. If you have dental work done while taking this drug, expect the healing process to take longer.
Regular blood tests are necessary to watch for white-bloodcell or platelet-level alterations.
It is very important to take ganciclovir exactly as directed. If you forget a dose, take it as soon as you remember and continue with your regular schedule.
Special Populations
PregnancylBreas>-feeding. Animal studies showed ganciclovir to be toxic to the fetus. There is no reliable information about its effect in pregnant women, but it should be taken only when the possible Oe”6% Outweigh the risks. Women who are likely to become pregnant while taking this drug should use reliable contraception.
It is not known if ganciclovir passes into breast milk, but the possible side effects of this drug on a nursing infant should be kept in mind. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors often have reduced kidney function; dosage adiustments may be needed.
Generic Name
Gemfibrozil oem-Fl-broe-zil)
Brand Name Lopid
Type of Drug
Anti-hyperlipidemic (blood-fat reducer). Prescribed For
High blood triglycerides.
General Information
Gemfibrozil consistently reduces blood triglycerides and reduces the risk of heart disease in people with high levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, and high levels of low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol. It works by affecting the breakdown of body fats and by reducing the amount of triglyceride manufactured by the liver. It is usually prescribed only for people with very high blood-fat levels who have not responded to dietary changes or other therapies. Gemfibrozil usually has little effect on blood-cholesterol levels, although it may reduce blood cholesterol in some people.
Cautions and Warnings
Do not take gemfibrozil if you are allergic or sensitive to any of its ingredients or have severe liver or kidney disease. Some people taking gemfibrozil have experienced worsening of kidney function.
Gemfibrozil users may have an increased risk of developing gallbladder disease and gallstones.
People taking gemfibrozil and fenofibmte may develop pancreatitis (inflammation 0 the pancreas).
People taking gemfibrozil may develop muscle aches and inflammation. Tell your doctor if you experience muscle tenderness or weakness.
Estrogen drugs may cause massive increases in triglyceride levels. Stopping estrogen therapy in these cases may reduce triglyceride levels to normal.
Gemfibrozil may cause a moderate rise in blood sugar and mild decreases in white-blood-cell counts.
Possible Side Effects
¦ Most common: abdominal and stomach pain, fatigue, heartburn, gas, diarrhea, nausea, and vomiting.
¦ Less common: rash, itching, dizziness, blurred vision, anemia, reduced levels of white blood cells, increased blood sugar, and muscle pain—especially in the arms or legs.
¦ Rare: dry mouth, constipation, appetite loss, upset stom-
ach, sleeplessness, tingling in the hands or feet, ringing or
buzzing in the ears, back pain, painful muscles or joints,
swollen joints, feeling unwell, reduction in blood potassium,
and abnormal liver function. Contact your doctor if you ex-
perience any side effect not listed above.
Drug Interactions
• Gemfibrozil increases the effects of oral anticoagulant (blood-thinning) drugs. Your anticoagulant dosage must be reduced when starting gemfibrozil.
• Combining gemfibrozil with a statin cholesterol- lowering drug (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, or simvastatin) has led to the destruction of skeletal muscles. This effect may begin as early as 3 weeks after you start taking the combination or may not appear for months.
• Combining gemfibrozil and sulfonylurea antidiabetes drugs or repaglinide may cause unexpectedly low blood sugar levels. The sulfonylurea drug dosage may need adjustment.
• Gemfibrozil can substantially increase the amount of glitazone antidiabetes drugs in the blood. Glitazone dosages may need to be adjusted.
• Combining gemfibrozil and cyclosporine may decrease the effectiveness of cyclosporine. This combination should only be used if it is absolutely necessary and the lowest possible dose of gemfibrozil is used.
Food Interactions
Gemfibrozil is best taken on an empty stomach 30 minutes before meals but may be taken with food if it upsets your stomach. It is important that you follow your doctor’s dietary instructions.
Usual Dose
Adult: 1200 mg a day, divided into 2 doses taken 30 minutes
before breakfast and dinner. Child: not recommended.
Overdosage
There have been reported cases of overdosage with gemfibrozil. Symptoms reported with overdosage were abdominal cramps, abnormal liver function tests, diarrhea, joint and muscle pain, nausea, and vomiting. Induce vomiting with ipecac syrup—available at any pharmacy—but call your doctor or local poison control center before doing this. If you go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Your doctor should perform periodic blood counts during the first year of gemfibrozil treatment to check for anemia or other changes in blood components. Liver-function tests are also necessary. Blood-sugar levels should be checked periodically while you are taking gemfibrozil, especially if you are diabetic or have a family history of diabetes.
Gemfibrozil may cause dizziness or blurred vision. Be careful when driving or doing any task that requires concentration.
Gemfibrozil is less effective if you are greatly overweight.
Call your doctor if side effects become severe or intolerable, especially diarrhea, nausea, vomiting, or stomach pain or gas. These may disappear if your doctor reduces the dosage.
If you forget a dose, 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
Pregnancy/Breast-feeding: The safety of using gemfibrozil during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carelO%-y weighed against its risks.
It is R(PM1)Wnif this drug passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors are more likely to develop drug side effects due to normal declines in kidney function.
Aug
13
Ezetimibe - Famciclovir - Famotidine - Felbamate - Felodipine
August 13, 2009 | Leave a Comment
Ezetimibe (eh-HIHI-firri-ibe)
Brand Name Zetia
Combination Product
Generic Ingredients: Ezetimibe + Simvastatin Vytorin
Type of Drug
Cholesterol - lowering agent.
Prescribed For
High cholesterol, high LDL (”bad”) cholesterol, high triglycerides, and low HDL (”good”) cholesterol; also prescribed for two rare genetic disorders called homozygous familial hypercholesterolemia and homozygous sitosterolemia.
General Information
Unlike statin drugs, ezetimibe interferes with the absorption of cholesterol through the intestine and into the bloodstream. Ezetimibe may be helpful for people whose LDL (”bad”) cholesterol remains high despite treatment with a statin drug. Cholesterol-lowering medicines should always be used together with appropriate diet and exercise.
Ezetimibe may be taken alone but is often taken in combination with a statin drug (generally simvastatin). Vytorin is a brand-name combination of these 2 medications. See Stalin Cholesterol-Lowering Agents, page 1052.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
People with liver disease or elevated liver enzyme measurements should not take ezetimibe because its effects on the liver are not known.
Ezetimibe does not slow hardening of the arteries.
There may be a risk of myopathy (skeletal muscle disorder) with ezetimibe; contact your doctor if you experience any unexplained muscle pain, tenderness, or weakness. Ezetimibe + simvastatin has the same effect as simvastatin alone; see Statin Cholesterol-Lowering Agents, page 1052.
Possible Side Effects
Ezetimibe side effects are similar to those reported by people taking a placebo (sugar pill).
V Most common: headache, back pain, joint pain, and abdominal pain.
C,Ibmrnon: muscle ache and respiratory infection.
V Less common: fatigue, chest pain, diarrhea, sore throat, and cough.
For additional information about ezetimibe + simvastatin, see Statin Cholesterol- Lowering Agents, page 1052.
Drug Interactions
• Cholestyramine reduces the amount of ezetimibe absorbed
in the blood. Separate these drugs by 2 hours or more.
• Cyclosporine (to prevent organ transplant rejection) may substantially increase the amount of ezetimibe in the blood. This combination must be monitored closely by your doctor.
• Gemfibrozil (another blood-fat reducer) can increase the amount of ezetimibe in the blood.
• Fenofibrate may increase the effects of ezetimibe. Fibrates
other than fenofibrate should not be used with ezetimibe due to
the risk of gallbladder complications. For additional informa-
tion about ezetimibe + simvastatin, see Statin Cholesterol-
Lowering Agents, page 1052.
Food Interactions
This drug can be taken without regard to food or meals.
Usual Dose
Ezetimibe
Adult and Child (age 10 and over): 10 mg once a day. Child (age 9 and under): not recommended.
Ezetimibe + Simvastatin
Adult: 10 mg ezetimibe plus 10-80 mg simvastatin once a day in the evening. The simavastatin dose depends on individual need.
Overdosage
Little is known about the effects of ezetimibe overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If you are taking more than one drug to lower cholesterol or another blood fat, consider the side effects of all of those drugs combined.
,S’D'L’6a) Populations
Pregnancy/Breast-feeding: Little is known about the effects of ezetimibe during pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks. Statin drugs should never be taken by a pregnant woman or nursing mother.
It is not known if ezetimibe passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this drug without special precaution.
Generic Name
Famciclovir (fam-SYE-kloe-vere)
Brand Name Famvir
Type of Drug Antiviral.
Prescribed For
Herpes zoster (shingles), genital herpes, herpes labilalis (cold sores), and herpes simplex in HIV-infected people.
General Information
Famciclovir is absorbed into the body and converted to the antiviral penciclovir, the drug that actually works against shingles by interfering with the reproduction of DNA in the herpes virus. Famciclovir does not affect DNA in uninfected body cells. Famciclovir is broken down by the liver and eliminated from the body through the kidneys.
Cautions and Warnings
Do not take famiciclovir if you are allergic or sensitive to any of its ingredients.
Those with reduced kidney function should have their dosage adjusted accordingly.
Severe liver disease reduces the maximum possible concentration of Famciclovir in the blood and increases the time it takes to reach this maximum level; however, dosage adjustment is not normally required.
Possible Side Effer.%
♦ Most common: headache, nausea, and diarrhea.
♦ Less common: fever, fatigue, pain, vomiting, constipation, appetite loss, dizziness, tingling in the hands or feet, sleepiness, sore throat, sinus irritation, itching, gas, dysmemorrhea, and signs of shingles.
Possible Side Effects (continued)
Rare: chills, abdominal pain, back or joint pain, and upset stomach. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Probenecid, cimetidine, and theophylline interfere with the elimination of famciclovir from the body, possibly leading to higher levels of famciclovir in the blood.
• People who took famciclovir and digoxin together experienced increased digoxin In their blood.
Food Interactions None known.
Usual Dose
Shingles
Adult (age 18 and over): 500 mg every 8 hours for 1 week. People with reduced kidney function may require a reduced dose taken as infrequently as once a day.
Genital Herpes
Adult (age 18 and over): 1000 mg twice daily for 1 day; or 250 mg twice a day for up to 1 year for suppression; or 250 mg 3 times a day for 7 days for initial episode. People with reduced kidney function take the same dose but less often, as infrequently as once every 2 days. HIV-infected people should take 500 mg twice a day for 7 days.
Cold Sores
Adult (age 18 and over): 1500 mg as a single dose. Initiate therapy at the earliest sign or symptom of a cold sore (tingling, itching, or burning).
Overdosage
Little is known about the effects of famciclovir ovecdose. Overdose victims should be %Mn to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Famciclovir treatment should be started as soon as shingles is diagnosed. For maximum benefit, be sure to complete the full week of treatment.
Famciclovir is not a cure for genital herpes and it is not known if it will prevent the transmission of the herpes virus to another person. Avoid sexual intercourse when herpes lesions are present even while taking famciclovir for genital herpes.
Begin taking famciclovir at the first sign of a herpes attack (symptoms include pain, tenderness, burning, itching, tingling, ulcers, or scabs). The effectiveness of starting famciclovir 6 hours or more after symptoms or lesions appear has not been established.
Call your doctor if you experience any unusual or intolerable side effects.
If you forget a dose of famciclovir, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot. Do not take a double dose. Call your doctor if you forget more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Famciclovir should only be taken by a pregnant woman if it is absolutely necessary and the possible benefits outweigh the risks to the fetus.
In animal studies, penciclovir (the active form of famciclovir) passed into breast milk in high concentrations but it is not known if this holds true for humans. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors clear famciclovir from the bloodstream more slowly than younger people and should have their dosage adjusted according to their level of kidney function.
Generic Name
Famotidine (fam-OE-tih-dine) 91
Brand Names
Fluxid Pepcid AC
Pepcid Pepcid Complete
Type of Drug Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine). This drug is also used to treat gastroesophageal reflux disease (GERD),
stress ulcer, and other conditions characterized by the production of large amounts of gastric fluids; to prevent stress ulcer and stomach and upper intestinal bleeding; and to stop the production of stomach acid during surgery. Pepcid AC is approved for heartburn.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Famotidine is effective in treating the symptoms of ulcer and preventing complications of the disease, although an ulcer that does not respond to another histamine H2 antagonist will probably not respond to famotidine. Histamine H2 antagonists differ only in their potency. Cimetidine is the least potent; 1000 mg are roughly equal to 300 mg of either nizatidine or ranitidine, or 40 mg of famotidine. All these drugs have roughly equivalent success rates in treating ulcer disease and comparable risk of side effects.
Cautions and Warnings
Do not take famotidine if you are allergic or sensitive to any of its ingredients or to any histamine H2 antagonist.
People with kidney or liver disease should take famotidine with caution because 1/3 of each dose is broken down in the liver and the rest passes out of the body through the kidneys.
Do not self-treat with over-the-counter (OTC) forms of famotidine without the advice and supervision of your doctor.
Possible Side Effects
✓ Most common: headache.
✓ Less common: dizziness, mild diarrhea, and constipation.
✓ 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
• T-_Meat-coated tablets should not be taken with famotidine. The change in stomach acidity that famotidine produces causes the tablets to disintegrate prematurely in the stomach.
• Antacids, anticholinergics, and metoclopramide may slightly reduce the amount of famotidine absorbed into the blood. No special precaution is needed.
Food Interactions
Famotidine may be taken without regard to food or meals.
Usual Dose
Adult 20-40 mg at bedtime, or 20 mg twice a day for 4-8 weeks. Dosage should be reduced in people with severe kidney disease.
Child (age 1-16): 0.23-0.45 mg per lb. of body weight, at bedtime or in 2 divided doses, up to 40 mg a day.
Child (under age 1): Consult your doctor.
Over-the-counter forms of famotidine such as Pepcid AC or Pepcid Complete should only be used for the temporary relief of heartburn, and are not recommended for children under 12 years of age. Do not take more than 2 capsules or chewable tablets in 24 hours.
Overdosage
Little is known about the effects of famotidine overdose, but victims may experience exaggerated side effects. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any remaining drug from the stomach. Victims who have definite symptoms should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take famotidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug. Antacids may be taken together with famotidine if needed.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarettes worsen stomach ulcers and may reduce famotidine’s effectiveness.
Call your doctor at once if you develop any unusual side eiiecls such as bleeding or bruising,’ iWness, diarrhea, dizziness, or rash. &’A&, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you forget a dose of famotidine, 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 revealed no Pregnancy/Breast-feeding: Although animal studies
damage to the fetus, famotidine should be avoided by women who are or might be pregnant. When this drug is considered crucial by your doctor, its possible benefits must be carefully weighed against
its risks.
Famotidine may pass into breast milk. Nursing mothers who
must take this drug should use infant formula.
Seniors: Seniors may need lower doses due to loss of kidney function and may be more susceptible to side effects.
Generic Name
Felbamate (FEL-bam-ate)
Brand Name Felbatol
Type of Drug Anticonvulsant.
Prescribed For
Partial seizures and Lennox-Gastaut syndrome in children.
General Information
Felbamate is related to the older sedative meprobamate. Exactly how felbamate works is not known, but it raises the seizure threshold and prevents the seizure impulse from spreading in the brain, as do other anticonvulsants. Felbamate should only be used when other seizure drugs have failed because of the risks associated with it. About half of each dose passes out of the body through the kidneys; the other half is broken down and eliminated by the liver.
Cautions and Warnings
Do not take felbamate if you am allergic or sensitive to any of its ‘Irigredlents or to any related drugs such as meprobamate.
Felbamate is associated with an increase in the risk of aplastic anemia, a potentially fatal condition.
Possibly fatal liver failure occurs in people taking felbamate much more often than normal. Regular liver function tests are recommended. People with liver disease should not take felbamate.
Felbamate is not recommended as first-line epilepsy treatment. Felbamate should be used only by those with severe epilepsy for whom the benefits outweigh the risks. Doctors prescribing felbamate should be thoroughly familiar with the drug and must obtain written, informed consent from patients before prescribing.
Felbamate should never be suddenly stopped or seizures may become more frequent. Dosage should be gradually reduced or replaced by another anticonvulsant.
Felbamate may cause increased sensitivity to the sun. Wear protective clothing and use sunscreen while taking this drug. People with kidney disease may require lower doses.
Possible Side Effects
Adult
♦ Most common: sleeplessness, sleepiness, fatigue, headache, dizziness, nervousness, upset stomach, vomiting, constipation, nausea, and appetite loss.
V Common: anxiety, tremors, walking unusually, depression, tingling in the hands or feet, diarrhea, liver inflammation, abdominal pains, respiratory infections, abnormal vision, and taste changes.
✓ Less common: weakness, dry mouth, stupor, abnormal thinking, rash, sinus irritation, sore throat, muscle aches, fever, and chest 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.
Child
✓ Most common: abdominal pain, fever, respiratory infections, sleeplessness, sleepiness, nervousness, vomiting, constipation, and black-and-blue marks.
✓ Common: headache, appetite loss, hiccups, sore throat, coughing, middle ear infections, fatigue, weight loss, temporary loss of urine control, qak”,,NbNW)ng unusually, weak-))855, abnormal thinking, emotional instability, pinpoint pupils, rash, upset stomach, and low white-blood-cell count.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if your child experiences any side effect not listed above.
Drug Interactions
• Combining felbamate and other antiseizure drugs usually requires dosage adjustments due to the risk of drug interaction. Dosage of felbamate should be reduced by 20-33% to reduce the risks of associated side effects.
• Combining felbamate and carbamazepine reduces blood levels of both drugs by roughly half. Dosage adjustments are necessary.
• Combining phenobarbital and felbamate increases the amount of phenobarbital in the blood and decreases felbamate levels. Dosage adjustments are necessary.
• If you combine felbamate and phenytoin, your phenytoin dosage may have to be reduced by as much as 40%. This combination also decreases felbamate blood levels by almost 50%.
• Felbamate increases blood levels of valproic acid and methsuximide.
Food Interactions
Felbamate is best taken on an empty stomach but may be taken with food if it causes upset stomach.
Usual Dose
Adult and Child (age 14 and over): 1200-3600 mg a day, divided into 3-4 doses.
Child (age 2-13): 6.8-20.5 mg per lb. a day, divided into 3-4 doses.
Overdosage
Overdose symptoms may include upset stomach, increased heart rate, and felbamate side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Do not take more felbamate than your doctor has prescribed. Felbamate can cause drowsiness; be careful when, driving perfQ(ft g
Avoid prolonged exposure to the sun while taking felbamate. Call your doctor if you develop any bothersome or persistent side effect.
Maintain good dental hygiene while taking felbamate and use extra care when brushing or flossing because this drug can cause swollen gums. See your dentist regularly.
km ,s %2& nq6re concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 3 or 4 hours, then go back to your regular schedule. Do not take
a double dose.
Special Populations
Pregnancy/Breast-feeding: This drug may cross into fetal circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Felbamate passes into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors, especially those with liver, kidney, or heart disease, may be more sensitive to the effects of this drug and should receive lower doses.
Generic Name
Felodipine (feh-LOE-dih-pene) 91
Brand Name Plendil
Combination Product
Generic Ingredients: Enalapril + Felodipine Lexxel
Type of Drug
Calcium channel blocker.
Prescribed For High blood pressure.
General Information
Felodipine is one of many calcium channel blockers available in the U.S. Its once-daily dosage schedule makes it particularly stilted to treating high blood Felodipine blocks the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them. This dilating effect reduces blood pressure, the amount of oxygen used by the heart muscle, and the risk of blood vessel spasm. Felodipine is therefore useful in
treating not only high blood pressure but also angina pectoris (brief attacks of chest pain), a condition related to poor oxygen supply
to the heart muscles.
Felodipine only affects the movement of calcium into muscle cells-, it has no effect on calcium in the blood.
Lexxel is a combination of felodipine and enalapril, an angiotensin converting enzyme (ACE) inhibitor.
Cautions and Warnings
Do not take felodipine if you are allergic or sensitive to any of its ingredients.
On rare occasions, felodipine may cause very low blood pressure that may lead to stimulation of the heart and rapid heartbeat and can worsen angina. This reaction may happen when treatment is first started, when dosage is increased, or if the drug is rapidly withdrawn; it may be avoided by reducing dosage gradually.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken only once daily—have a greater chance of having a heart attack than do people taking beta blockers or other medications for the same purpose. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Patients taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina.
People with severe liver disease may require dosage adjustments.
People taking felodipine who have had a heart attack and have lung congestion may experience worsened heart failure, since this drug can actually reduce the force of each heartbeat.
Possible Side Effects
Side effects produced by calcium channel blockers are generally mild and rarely cause people to stop taking them. Side effects are more common with higher doses and in older patients.
I Most common: swelling in the ankles, feet, or legs; dizziness; lightheadedness; muscle weakness or cramps; facial flushing; and headache.
V Less common: respiratory infections, cough, tingling in the hands or feet, upset stomach, abdominal pains, chest pains,
stomach, , heart palpitations,
Drug Interactions
• Felodipine may increase the amount of beta-blocking drugs in the bloodstream. This can lead to heart failure, very low blood pressure, or an increased incidence of angina. However, in many cases these drugs have been taken together with no problem.
• Felodipine increases the effects of other blood-pressurelowering drugs. Such drug combinations are often used to treat hypertension.
• Cimetidine, ranitidine, and azole antifungals such as ketoconazole and itraconazole increase the amount of felodipine in the blood and may account for a slight increase in the drug’s effect.
• Phenytoin and other hydantoin antiseizure medicines, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect on the body.
• Erythromycin and cyclosporine may increase the side effects of felodipine.
• Felodipine may increase the effects of digoxin, theophylline (prescribed for asthma and other respiratory problems), and oral anticoagulant (blood-thinning) drugs.
• Felodipine may also interact with quinidine (prescribed for abnormal heart rhythm) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.
• Qd(Gii= Channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
You may take felodipine with food if it upsets your stomach. Avoid taking felodipine with grapefruit juice—it doubles the amount of drug absorbed.
Possible Side Effects (continued) nausea, constipation, diarrhea
throat, runny nose, back pain, rash.
and
♦ Rare: Rare side effects can affect the heart,
blood, and joints. It can affect and
your mood, sex drive,
urinary tract. Contact your do you experience side effect not listed above.
ctor if any Usual Dose
2.5-10 mg a day. No patient should take more than 20 mg a day. Do not stop taking felodipine abruptly. The dosage should be reduced gradually over a period of time.
Overdosage
Felodipine overdose can cause low blood pressure. If you think you have taken an overdose of felodipine, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop constipation, nausea, very low blood pressure, breathing difficulties, increased heart pain, dizziness, or lightheadedness, or if other side effects are bothersome or persistent.
Swelling of the hands or feet may develop within 2 or 3 weeks of starting felodipine. The chances of this happening depend on age and dosage. It occurs in less than 10% of people under age 50 taking 5 mg a day and in more than 30% of those over age 60 taking 20 mg a day.
Be sure to continue taking your medication even if you feel well, and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure.
Do not break or crush felodipine tablets.
It is important to maintain good dental hygiene while taking felodipine and to use extra care when using your toothbrush or dental floss because of the chance that the drug will make you more susceptible to certain infections.
If you forget to take a dose of felodipine, 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. Do not take a double dose.
Special Populations
Pregnancy1filreast-feeding. Animal studies of felodipk”e have shown that it crosses RAW the Zeta) circulation and causes birth iNlfEcls. Women who are or who might become pregnant while taking this drug should not take it without their doctor’s approval. The potential benefit of taking felodipine must be carefully weighed against its risks.
It is not known if felodipine passes into breast milk. Nursing mothers who take felodipine should use infant formula.
Seniors: Seniors, especially those with liver disease, are more sensitive to the effects of this drug.
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
Cevimeline
August 1, 2009 | Leave a Comment
Generic Name
Cevimeline (seh-VIM-ih-lene) 9
Brand Name Evoxac
Type of Drug Cholinergic.
Prescribed For
Dry mouth in people with syndrome.
General Information
Sj6gren’s syndrome jS a group 0j symptoms related to a lack of bodily secretions. People with this condition have very dry eyes and mucous membranes, facial lesions, and neck swelling. It often occurs in menopausal woman and is often associated with rheumatoid arthritis, poor blood circulation in the legs, and tooth decay. Cevimeline increases secretions in the mouth by binding to specific nervous system receptors and causing the release of more saliva.
Cautions and Warnings
Do not take cevimeline if you are allergic or sensitive to any of its
ingredients.
This drug may make breathing more difficult and worsen lung conditions such as asthma, chronic bronchitis, or chronic obstructive pulmonary disease (COPD).
Eye conditions like glaucoma or inflammation of the iris may be worsened by cevimeline.
Cevimeline may affect the heart, and some people with severe heart disease, including those with a history of severe angina or heart attack, may not be able to compensate for this effect.
Cevimeline may worsen gallstones and kidney stones and should be avoided by people with a history of these conditions.
Cevimeline may cause visual blurring, especially at night.
Possible Side Effects
✓ Most common: excessive sweating, headache, nausea, sinus irritation, respiratory infection, runny nose, and diarrhea.
✓ Common: upset stomach, abdominal pains, urinary infection, coughing, and sore throat.
✓ Less common: vomiting, back pain, injury, rash, conjunctivitis (pinkeye), dizziness, bronchitis, severe joint pain, fatigue, bone pain, sleeplessness, hot flushes, excess salivation, chills, and anxiety.
✓ Rare: frequent urination, weakness, and flushing. Other 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
• Combining cevimeline with a beta blocker can lead to heart rhythm disturbances.
• Cevimeline may interfere with the effects of anticholinergics, found in Some medications for abdominal or stomach spasms or cramps.
• Cholinergics such as bethanechol, donepezil, physostigmine, pilocarpine, and pyridostigmine can add to the effects of cevimeline.
• Some drugs may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. These include amiodarone, celecoxib, chlorpheniramine, cimetidine, ciprofloxacin, clarithromycin, clomipramine, cocaine, diltiazem, erythromycin, fluconazole, fluoxetine, halofantrine, indinavir, itraconazole, ketoconazole, methadone, mibefradil, nelfinavir, paroxetine, quinidine, ranitidine, ritonavir, saquinavir, and terbinafine.
Food Interactions
Grapefruit juice may interfere with the breakdown of cevimeline in the liver, increasing the chance of drug side effects. Food interferes with the absorption of cevimeline into the bloodstream. Take this drug on an empty stomach.
Usual Dose
Adult: 30 mg 3 times a day. Child: not recommended.
Overdosage
Overdose symptoms can include exaggerated drug side effects including headache, visual impairment, excess tearing and/or sweating, difficulty breathing, stomach or intestinal spasms, nausea, vomiting, diarrhea, changes in heart rhythm, blood pressure changes, shock, mental confusion, and tremors. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
cevimeline may cause blurred vision, possibly interfering with driving or performing tasks that require reliable vision, especially at night or in low light.
If you sweat excessively while taking cevimeline, be sure to drink a lot of water. Excessive sweating can lead to dehydration.
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Pregnant women should take cevimeline only if it is considered crucial by your doctor, since its effect on the developing fetus is not known.
It is not known if cevimeline passes into breast milk, but nursing mothers who must take this drug should consider using infant formula.
Seniors: Older adults should be cautious about using this drug because of its possible effects on the kidney, liver, and heart, and on other diseases or medications.
Jul
16
Aldosterone Blockers
July 16, 2009 | Leave a Comment
Type of Drug
Aldosterone Blockers (al-DOH-stir-own)
Brand Names
Generic Ingredient: Eplerenone Inspra
Generic Ingredient. Spironolactone Aldactone
Combination Product
Generic Ingredients: Hydrochlorothiazide + Spironolactone Aldactazide
Prescribed For
High blood pressure, cirrhosis, and congestive heart failure (CHF); also used for people with low blood potassium who require a diuretic.
General Information
Aldosterone blockers limit the access of aldosterone—a hormone that helps to regulate several different body functions—from its receptor. Too much aldosterone results in high sodium levels, which can lead to water retention and potassium loss; it can also affect the size, shape, and function of the heart. Aldosterone blockers are generally combined with other medicines in the management of disease. These drugs are useful in removing excess body fluids in conditions associated with high aldosterone levels.
One in every ten people with high blood pressure has excess aldosterone in their systems. In people with congestive heart failure (CHF), aldosterone levels can be 20 times higher than normal, which can worsen their condition, making the use of aldosterone blockers an important part of their treatment. Aldosterone block-ers also help the heart return to normal size, shape, and function in people with heart failure. Eplerenone is broken down in the liver, primarily by an enzyme system known as CYP3A4.
Cautions and Warnings
Do not take aldosterone blockers if you are allergic or sensitive to any of their ingredients.
Do not use aldosterone blockers if you have kidney failure or high blood potassium.
People with liver disease should be cautious about using a!- dosterone blockers.
People taking an aldosterone blocker should have their potassium levels checked periodically.
People with diabetes who have albumin in their urine should not take aldosterone blockers.
Possible Side Effects
Eplerenone
✓ Less common: dizziness, diarrhea, fatigue, flu-like symptoms, coughing, abdominal pain, elevation of blood cholesterol and/or triglyceride levels, elevation of blood potassium levels, and albumin in the urine.
✓ Rare: enlargement of the breasts in males, irregular menstrual cycles in women, and painful breasts. Contact your doctor if you experience any side effect not listed above.
Spironolactone
✓ Less common: drowsiness, lethargy, headache, gastrointestinal upset, cramps and diarrhea, rash, mental confusion, fever, feeling unwell, enlargement of the breasts in males, impotence, and irregular menstrual cycles or deepening of the voice in women.
Drug Interactions
• Do not combine eplerenone with itraconazole or ketoconazole. These drugs can cause the amount of eplerenone in the blood to increase by up to 500% and may cause fatal increases in blood potassium.
• Mixing eplerenone with erythromycin, fluconazole, saquinavir, or verapamil increases the amount of eplerenone in the blood. People taking this combination must watch for signs of high blood potassium (see “Special Information”) and have their blood potassium levels checked regularly.
• Combining a potassium supplement and an aldosterone blocker can lead to dangerously high blood levels of potassium. Do not use a salt-substitute or take any extra potassium unless prescribed by your doctor.
• Combining an aldosterone blocker with an ACE inhibitor or an angiotensin H receptor blocker (ARB) may significantly raise blood potassium. Be sure your doctor monitors your potassium levels if you combine these drugs.
• Spironolactone may interfere with anticoagulant (blood-thinning) drugs and mitotane (an anticancer drug).
• Aspirin can interfere with the diuretic effect of spironolactone but does not alter its effect on high blood pressure or CHF.
• Combining spironolactone with alcohol, barbiturates, or narcotics can lead to dizziness or fainting when rising suddenly from a sitting or lying position.
• Combining spironolactone and a corticosteroid can lead to very low blood potassium.
• Spironolactone may alter your response to drugs used during general anesthesia.
• Lithium generally should not be combined with any diuretic.
• Combining nonsteroidal anti-inflammatory drugs (NSAIDs) with aldosterone blockers can lead to severe elevations of blood potassium and reduce the blood-pressure-lowering effect of the diuretic.
• Spironolactone may raise digoxin blood levels and increase the risk of severe digoxin side effects. Your doctor may have to adjust your digoxin dosage.
• St. John’s wort (a CYP3A4 inducer) may decrease eplerenone levels by about 30%.
Food Interactions
Food appears to increase the amount of spironolactone absorbed into the blood. Take this drug with food at the same time every day. Eplerenone may be taken without regard to food or meals. Taking this drug with grapefruit juice increases the amount of drug absorbed into your body.
Usual Dose
Eplerenone
Adult 50-100 mg a day. Child: not recommended.
Spironolactone
Adult: Starting dosage is 50-100 mg a day in divided doses for high blood pressure; 25-200 mg a day in divided doses for high fluid levels related to other diseases; and 25-100 mg a day for low potassium levels related to diuretic use.
Child: 1-2 mg per lb. of body weight a day.
Spironolactone + Hydrochlorothiazide Adult: 1-4 tablets daily.
Overdosage
Eplerencne overdose may lead to low blood pressure and high blood potassium. Spironolactone overdose may lead to drowsiness. confusion, rash, nausea, vomiting, dizziness, and diarrhea. Rarely. coma may occur in people with severe liver disease. High blood potassium may also occur, especially in people with kidney zsease. Call your local poison control center or a hospital emercency room for more information. If you seek treatment, ALWAYS oring the prescription bottle or container.
Special Information
<e a c!osterone blockers exactly as they are prescribed.
High blood levels of potassium associated with aldosterone blockers may cause weakness, lethargy, drowsiness, muscle pain or cramps, and muscular fatigue. Use caution while doing anything that requires intense concentration, like driving or operating machinery.
Do not use a salt substitute or take anything else that is a source of extra potassium, including many multivitamin or supplement products.
People with high blood pressure should not self-medicate with over-the-counter cough, cold, or allergy remedies containing stimulants. These drugs can raise blood pressure effectiveness and have an adverse effect on the heart.
!f you forget a dose, 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
Pregnancy/Breast-feeding: Animal studies with eplerenone showed no effects on a developing fetus. Spironolactone crosses into the fetal circulation. When your doctor considers either of these drugs crucial, their potential benefits must be carefully weighed against their risks.
Jul
5
NSAIDs (nonsteroidal anti-inflammatory drugs) side-effects and downsides
July 5, 2009 | Leave a Comment
NSAID Nastiness
The biggest recognized drawback to NSAIDs has always been their tendency to cause digestive tract distress. That’s because of how they work in the body. These drugs block the manufacture of a class of chemicals called prostaglandins. These hormonelike compounds have a profound impact on cells throughout the body.
f you sprain your ankle, have a tooth extracted, or develop arthritis, you will experience pain, redness, warmth, and inflammation. This is in large measure due to prostaglandins made by a protein called cyclooxygenase-2 (COX-2). Blocking their formation with NSAIDs like ibuprofen or naproxen means there is less inflammation and pain.
But some prostaglandins made by another protein, COX-1, are beneficial. They protect the stomach lining from damage. If you disrupt their production by blocking COX-1 with NSAIDs, many people complain of symptoms such as nausea, indigestion, abdominal pain, constipation, and diarrhea. It is estimated that more than half of the people taking NSAIDs experience unpleasant gastrointestinal (GI) symptoms.68
Far more worrisome are ulcers, which can bleed or, in the worst case, perforate. A bleeding ulcer or a hole in the stomach wall can very quickly turn into a life-threatening crisis. All too often there are no early warning symptoms that someone is on the verge of disaster.
Although it is hard to know exactly how many people are affected each year, experts estimate that more than 100,000 are hospitalized because of complications caused by NSAIDs and more than 16,000 die.’ The researchers admit these numbers are probably conservative.
Although most physicians have known for a long time that NSAIDs can be hard on the stomach, they didn’t realize that the same drugs can be disastrous for the small intestine. That’s because until recently the small intestine could not be examined directly. Now a small video camera the size of a capsule can be swallowed and the image it transmits can be monitored on a television as the capsule passes into the small intestine.
“If deaths from gastrointestinal toxic effects of NSAIDs were tabulated separately in the National Vital Statistics reports, these effects would constitute the 15th most common cause of death in the United States. Yet these toxic effects remain largely a ’silent epidemic,’ with many physicians and most patients unaware of the magnitude of the problem. 70 Furthermore, the mortality statistics do not include deaths ascribed to the use of over-the-counter NSAIDs “7l
—Michael M. Wolfe et al., The New England Journal of Medicine, 1999
Investigators discovered in a preliminary study that 71 percent of the patients taking NSAIDs had erosions or ulcers in their small intestine, compared to only 10 percent of those not taking these drugs.72 This unexpected finding suggests that NSAID damage to the intestinal tract is even more common and serious than previously suspected.
Frequently, aspirin is sold with an enteric coating that protects the stomach from harm. The coating is designed to dissolve in the small intestine instead, releasing the aspirin there. When we asked gastroenterologist Waqar Qureshi, MD, chief of endoscopy at Baylor University and the Michael E. DeBakey Veterans Affairs Medical Center in Houston, about such formulations, he said, “Enteric-coated drugs might, in fact, cause more damage than regular medications.”" This is because the damage occurs in the small intestine, where the tissue is less resistant to irritating chemicals than the stomach is and where the damage may go undetected.
The COX-2 Catastrophe
With such GI toxicity associated with_ NSAIDs, it’s hardly any wonder that doctors and patients were excited to learn about COX-2 inhibitors. Vioxx, Bextra, and Celebrex were introduced with the idea that they would be gentler on the stomach than other NSAIDs. That’s because these newfangled members of the class were supposed to be “selective.” They would block only the COX-2 enzyme, relieving inflammation as well as aspirin or other NSAIDs do. By sparing the COX-1 enzyme, prostaglandins would be created to protect the stomach from irritation. The promise: pain relief with much less risk of digestive upset or stomach ulcers.
As soon as COX-2 inhibitors were introduced in 1999, they took off like rocket ships. Aggressive advertising directed at consumers and enthusiastic prescribing by physicians turned Celebrex and Vioxx into overnight sensations. Tens of millions of people started popping these pills in the hope that they would relieve pain without the usual problems.
There was just one big oops. By selectively blocking the COX-2 enzyme to relieve inflammation, a crucial prostaglandin called prostacyclin was also reduced. This compound is our friend. It dilates blood vessels and keeps the sticky part of blood, called platelets, from clumping together to form clots. Without adequate amounts of prostacyclin circulating throughout the body, there is an increased risk of blood clots that can trigger heart attacks and strokes.
Early in the development of COX-2 inhibitors some researchers worried that there could be cardiovascular dangers. In 2000, a large Vioxx study suggested that the pain reliever could cause an increased risk of heart attacks and other vascular complications. 74
Neither the FDA nor the manufacturer acted on those early warning flags. In one of the darkest hours in the history of American medicine, millions were allowed to continue taking COX-2 inhibitors until the fall of 2004. By then the handwriting was on the wall. First Vioxx and then Bextra were pulled off the market. In the interim, it is estimated that more than 100,000 people who had been taking COX-2 inhibitors suffered heart attacks and strokes.75 According to FDA safety officer David Graham, MD, as many as 40,000 people may have died .71
The Broken Promise
If COX-2 inhibitors like Vioxx, Bextra, and Celebrex had truly protected the digestive tract from damage, it might have been easier to justify their approval, aggressive marketing tactics, and high prices. But an editorial in the Journal of the American Medical Association described the science behind COX-2 inhibitors as a “house of cards” based on wishful thinking. They were marketed “with unrealistic expectations about pain relief, marked gastrointestinal protection, and safety.”77
Canadian researchers tracked hospital admissions caused by gastrointestinal bleeding before and after the introduction of COX-2 inhibitors (Vioxx, Celebrex, and Mobic). Instead of dropping when the new drugs became available, as investigators had expected, the rate of hemorrhage and hospitalization for older people paradoxically rose by 10 percent .78 British researchers asked a similar question: Would COX-2 inhibitors be easier on the stomach than traditional NSAIDs? The an-
FDA NSAID WARNING
“NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, m ocardial infarction [heart attack], and stroke, which can be fatal.-71 rt
—FDA Public Health Advisory, April 7, 2005
saver: There was no evidence to suggest that the newer drugs were less harmful to the digestive tract.” In hindsight, it looks as if we were all sold an expensive bill of goods.
Other NSAID Troubles
No sooner did the FDA wake up to the risk of heart attacks and strokes associated with COX-2 inhibitors than the agency had to deal with the possibility that other NSAIDs might pose a similar problem. Decades after these drugs began to be marketed, the FDA reviewed the data and decided that all such prescription pain relievers should carry a stronger black-box warning.
The FDA goes on to warn that people with risk factors for cardiovascular disease are especially vulnerable to these life-threatening problems. That includes almost everyone with arthritis. If you accumulate enough birthdays to develop osteoarthritis, you are bound to have some hardening of the ar-
OTHER NSAID ADVERSE EFFECTS
• High blood pressure
• Fluid retention, edema
• Congestive heart failure
• Stomach ulcer (bleeding)
• Perforation of the stomach
• Perforation of the small intestine
• Perforation of the large intestine
• Kidney damage
• Severe allergic reaction
• Skin rash (toxic)
• Itching
• Stevens-Johnson syndrome
• Liver damage
• Blood disorders (anemia)
• Asthma worsening
teries. But that’s not all. The FDA has gone on to emphasize other problems with NSAIDs as well.
It is easy for your eyes to glaze over when looking at such a list. You may also assume that some of these potential side effects are rare events, but that could be a dangerous assumption. A study of older and potentially sicker patients revealed a startling incidence of kidney damage associated with Celebrex. More than 20 percent of the people taking this COX-2 inhibitor experienced kidney toxicity (fluid retention, high blood pressure, and kidney failure).81 If patients had some kidney impairment before the study started (a common situation in older people), the likelihood of kidney toxicity jumped to more than 50 percent! We assume other NSAIDs are likely to have a similar effect on kidney function.
NSAID Survival Strategy
By now it should be clear that nonsteroidal anti-inflammatory drugs, including the COX-2 inhibitors, can be trouble with a capital T! They aren’t all that effective for arthritis, especially of the knee. Some NSAIDs may actually contribute to joint deterioration if they are taken for years. Then there’s the risk of serious side effects like bleeding ulcers, hypertension, heart
Aspirin
Aspirin prevents blood clots and lowers the risk of heart attacks and strokes. Unlike other NSAlDsJt does not raise blood pressure.
Aspirin remains the best buy for pain relief. At pennies a day, it reduces the inflammation that is at the root of so many chronic ailments, including arthritis, diabetes, and Alzheimer’s disease. Regular aspirin users seem to develop fewer cancers of the colon, rectum, prostate, pancreas, ovary, skin, lung, and breast.
Downside: Damage to the stomach lining. The potential for indigestion, gastritis, and ulcers makes this drug inappropriate for many. Bleeding or perforated ulcers can be life threatening. Anyone on long-term aspirin therapy must be under medical supervision.
Cost: Approximately $2 to 5 per month
ASPIRIN AND BAKING SODA
Although it will not be identical to Alka-Seltzer, you can create your own buffered, soluble aspirin. In a glass, combine:
• 2 uncoated aspirins
• 8 ounces club soda or sparkling water
•’/p teaspoon baking soda
• Juice from 1/4 wedge lemon
Wait till the aspirins dissolve and then drink. This formula is not appropriate for people on a sodium-restricted diet.
attacks, strokes, and kidney or liver damage. Why would anyone in his or her right mind take such medicine?
The most obvious answer is that there aren’t very many pharmaceutical alternatives. Doctors have relatively little to offer beyond NSAIDs when it comes to pain and inflammation. And sometimes you hurt so much that you need something to help you move your bones around. When used in the short-term and with appropriate safeguards, it may be possible to take an NSAID. But which one should you consider?
Aspirin remains our first choice by far. No other NSAID or OTC pain reliever has ever been proven more effective. In addition, aspirin reduces the risk of heart attacks and thrombotic (clotting) strokes. As a bonus, there is growing evidence that aspirin may diminish the likelihood of developing many common cancers. We discourage the use of enteric-coated aspirin because this merely moves the aspirin to the small intestine, where it can do serious damage.
Our preferred method for taking aspirin is as a liquid. In Europe, Australia, Canada, New Zealand, and dozens of other countries you can find several soluble, effervescent aspirin products. Brands like Aspro and Disprin are very popular because all you do is drop the aspirin tablets into a glass of water, where they fizzle and dissolve within seconds. This makes them a little faster acting and possibly a little less irritating to the stomach (though there is no guarantee of protection).
Soluble aspirin never really caught on in the United States, except in the form of Alka-Seltzer. It is a combination of as-pirin, sodium bicarbonate, and citric acid advertised for relief of “acid indigestion, sour stomach, heartburn with headache, body aches and pains.” The trouble with Alka-Seltzer is that it’s way more expensive than plain aspirin and there’s too much sodium for folks who have congestive heart failure or salt-sensitive hypertension.
If you would prefer not to pay an arm and a leg for fizzy aspirin, you could make your own soluble aspirin for a fraction of the cost. All you have to do is buy some club soda or sparkling water. Drop two regular-strength aspirin tablets in the fizzy water and let them dissolve. It will take a couple of minutes.