Aug
13
Estazolam - Estrogens - Eszopiclone - Exemestane - Exenatide
August 13, 2009 | Leave a Comment
Generic Name
Estazolam (es-TAZ-oe-lam) V
Type of Drug Benzodiazepine sedative.
Prescribed For
Insomnia and sleep disturbances.
General Information
Estazolam is a member of the group of drugs known as benzodiazepines. They work by a direct effect on the brain. Benzodiazepines make it easier to go to sleep and decrease the number of times you wake up during the night. Estazolam is considered an intermediate-acting sedative and generally remains in your body long enough to give you a good night’s sleep with minimal “hangover.”
Cautions and Warnings
Do not take estazolam if you are allergic or sensitive to any of its ingredients. Severe allergic reactions may occur. People with respiratory disease taking estazolam may experience sleep apnea (intermittent cessation of breathing during sleep). People who already have, or suspect they have, sleep apnea should not take estazolam.
People with kidney or liver disease should be carefully monitored while taking estazolam. Take the lowest possible dose to help you sleep.
Clinical depression may be increased by estazolam, which can depress the nervous system. Intentional overdose is more common among depressed people who take sleeping pills than among those who do not.
All benzodiazepines can be addictive if taken for long periods of time and can cause drug withdrawal symptoms if discontinued suddenly. It should be used With caution in people with a history 0 YATUg dependence. Withdrawal symptoms include tremors, Muscle cramps, insomnia, agitation, diarrhea, vomiting, sweating, and convulsions.
People with a history of seizures should not abruptly stop taking estazolam.
Possible Side Effects
♦ Common: drowsiness, headache, dizziness, talkativeness,
nervousness, apprehension, poor muscle coordination, light-
headedness, daytime tiredness, muscle weakness, slow-
ness of movement, hangover, and euphoria (feeling “high”).
♦ Less common: nausea, vomiting, rapid heartbeat, confusion, temporary memory loss, upset stomach, stomach cramps and pain, depression, blurred or double vision and other visual disturbances, constipation, changes in sense of taste, appetite changes, stuffy nose, nosebleeds, common cold symptoms, asthma, sore throat, cough, breathing difficulties, diarrhea, dry mouth, allergic reaction, fainting, abnormal heart rhythm, itching, acne, dry skin, sensitivity to bright light or to the sun, rash, nightmares or strange dreams, sleeplessness, tingling in the hands or feet, ringing or buzzing in the ears, ear or eye pain, menstrual cramps, frequent urination and other urinary difficulties, blood in the urine, discharge from the penis or vagina, lower back and joint pain, muscle spasms and pain, fever, swollen breasts, and weight changes.
✓ Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• As with all benzodiazepines, the effects of estazolam are enhanced if it is taken with an alcoholic beverage, antihistamine, sedative, barbiturate, anticonvulsant medication, antidepressant, or monoamine oxidase inhibitor antidepressant.
• Carbamazepine and phenytoin may reduce blood levels and the effectiveness of estazolam by stimulating liver enzymes responsible for its breakdown.
• Ketoconazole, itraca(\ailzAe, netazodone, fluvoxamine, diltiamm,’isoniazid, some macrolide antibiotics, contraceptive drugs, cimetidine, and disulfiram may increase the effect of estazolam by interfering with the drug’s breakdown in the liver. Probenecid also increases estazolam’s effects by interfering with it passing through the kidneys into urine.
• Cigarette smoking, rifampin, and theophylline may reduce the effect of estazolam.
• Levodopa + carbidopa’s effectiveness may be decreased by estazolam.
• Estazolam may increase the amount of zidovudine (an HIV drug—also known as AZT), phenytoin, or digoxin in your bloodstream, increasing the chances of side effects.
• The combination of clozapine and benzodiazepines has led to respiratory collapse in a few people. Estazolam should be stopped at least 1 week before starting clozapine treatment.
Food Interactions
Estazolam may be taken with food if it upsets your stomach.
Usual Dose
Adult (age 18 and over): 1-2 mg at bedtime.
Senior: 1 mg at bedtime. Small or frail patients should start on 0.5 mg. Dosage should be increased cautiously.
Child (under age 18): not recommended.
Overdosage
The most common overdose symptoms are confusion, sleepiness, depression, loss of muscle coordination, and slurred speech. Coma and death may also occur. People who take an estazolam overdose must be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach: Call your doctor or a poison control center before doing this. The victim must be taken to a hospital emergency room for treatment if 30 minutes have passed since the overdose was taken or if symptoms have begun to develop. ALWAYS bring the prescription bottle or container.
Special Information
Never take more estazolam than your doctor has prescribed. Avoid alcoholic beverages and other nervous system depressants while taking estazolam.
Exercise caution while performing tasks that require concentration and such as driving: estazolam may make you tired, dizzy, or lightheaded. People taking estazolam or any other sleeping medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, and cooking with no memory of the event.
If you take estazolam daily for 3 or more weeks, you may experience some withdrawal symptoms when you stop taking the
drug, especially temporary sleep disturbance. In rare cases, patients discontinuing estazolam have suffered seizures or delirium. Patients with a history of seizures should taper when stopping use
of this drug.
If you forget to take a dose of estazolam and remember within about 1 hour of your regular time, take it right away. If you do not remember until later, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Estazolam absolutely should not be used by pregnant women or by women who may become pregnant.
Estazolam passes into breast milk. The drug should not be taken by nursing mothers.
Seniors: Seniors are more susceptible to the effects of estazolam. Type of Drug
Estrogens (ES-troe-jens)
Brand Names
Generic Ingredient: Conjugated Estrogens Premarin Premarin Cream
Generic Ingredient: Conjugated Estrogens (Synthetic) Cenestin Enjuvia
Generic Ingredients: Conjugated Estrogens + Medroxyprogesterone
Premphase Prempro
Generic Ingredient: Esterified Estrogens Menest
Generic Ingredients: Esterified Estrogens + Methyttestosterone Estratest
Generic Ingredient: Estradio(& Alora,
Climara Divigel Elestrin Estrace Estraderm
Estring Estrogel
Evamist Transdermal Spray Femring
Femtrace Gynodiol
Innofem Menostar Vagifem
Vivelle Vivelle-Dot
Generic ingredients: Estradiol + Drospirenone Angeliq
Generic Ingredients: Estradiol + Levonorgestrel Climara Pro Nuvaring
Generic Ingredients: Estradiol + Norgestimate 99 Pretest
Generic Ingredient: Estropipate
Ogen Cream Ortho-Est
Generic Ingredients: Ethinyl Estradiol + Norethindrone Activella Combipatch FemHRT 1/5
Prescribed For
Moderate to severe menopausal symptoms such as hot flashes, night sweats and sleep problems, vaginal dryness and irritation (creams and gels); also prescribed for ovarian failure, osteoporosis prevention, male breast cancer, advanced prostate cancer, abnormal bleeding of the uterus, female castration, Turner’s syndrome, and birth control.
General Information
Six estrogens have been identified in women but only 3 are present in large amounts: estradiol, estrone, and estriol. Estradiol is the most potent and most important. Other estrogens are produced by chemical conversions in the body. Estradiol, for example, is transformed into estrone, which in turn becomes estriol. Estrogens all have the same actions and side effects; only potency varies. More potent types require smaller dosages to produce the same effect.
Millions of women have taken hormone replacement therapy (HRT) to manage menopausal symp<oms, but studies show that HRT doeq WMpYove quality of life for most. Women who experience severe menopause symptoms must weigh the benefits of prolonged hormone replacement therapy against its risks.
Estrogens are largely responsible for the growth and maintenance of the female reproductive system and sex characteristics. They affect the release of hormones from the pituitary gland (con-troller of hormone production and regulator of basic bodily functions). These hormones control the functioning of capillaries (smallest blood vessels), may cause fluid retention, affect protein breakdown in the body, prevent ovulation and breast engorgement after childbirth, and influence the shaping and maintenance of the skeleton through an effect on calcium.
Estrogen products differ in their hormone content and dosage. Some may affect one part of the body more than another. Generally, though, estrogens are interchangeable as long as dosage differences are taken into account.
Cautions and Warnings
Do not take estrogens if you are allergic or sensitive to any of their ingredients.
Products containing an estrogen and a progestin should not be used for the prevention or treatment of bladder-control problems, heart disease, or mental decline (dementia).
Women with an intact uterus who choose hormone replacement therapy for menopausal symptoms should take the lowest effective dose for the shortest possible time to minimize the risks associated with these medicines. The results of a very large study called the Women’s Health Initiative (WHI) first published in 2002 and updated with new reports, have drastically changed the face of estrogen replacement therapy. The study found a small but insignificant increase in the risk of non-fatal heart attacks. There was no increase in heart disease in the estrogen plus progestin part of the WHI. Early results of the WHI found 4-6 more cases of invasive breast cancer for every 10,000 women in the study and tumors were harder to detect. But this result was not confirmed after more than 7 years of additional study. Estrogens may also lead to abnormal mammograms. An increased risk of a stroke was found in the WHI study. The risk of blood clots forming in the body was doubled in women taking hormone therapy. This study did show some benefits of long-term hormone replacement in colon cancer and osteoporosis, but these benefits may not outweigh the risks of hormone replacement therapy.
Women with liver damage or disease, blood-clotting problems, or abnormal vaginal bleeding whose cause is unknown, should not take estrogens.
Women who smoke cigarettes and take estrogen have a greater risk of cardiovascular side effects, including stroke and blood clotting.
Estrogens may increase the risk of endometriat cancer by 4.514 times in postmenopausal women taking them without progestin for prolonged periods of time; the risk depends on duration of treatment and dosage. Women who have a strong family history of breast cancer or who have breast nodules or cysts or an abnormal mammogram should be cautious about using estrogens. Women with estrogen-dependent cancer or breast cancer should not take estrogens, except some being treated for breast cancer that has spread. Women taking an estrogen for breast cancer that has spread to their bones can develop large increases in blood calcium.
Postmenopausal women taking estrogen are 2-3 times more likely to develop gallbladder disease.
Estrogens can raise blood pressure. Pressure usually returns to normal when the drug is stopped.
People with thrombophlebitis should avoid these drugs. The risk is greatest with very high dosages. Lower hormone dosages may not be a problem.
Estrogens should not be used to treat painful breast enlargement that sometimes develops after giving birth.
Estrogens can cause significant increases in blood triglycerides and cause pancreas inflammation in women with inherited blood-fat disorders.
Vaginal estrogen cream may stimulate bleeding of the uterus. It may also cause breast tenderness, vaginal discharge, and withdrawal bleeding if the product is suddenly stopped. Women with endometriosis may experience heavy vaginal bleeding.
Women taking hormone replacement therapy are at a 50% greater than normal risk of senile dementia.
Drospirenone, a progestin and an ingredient in Angeliq, can raise blood potassium levels in some people because it opposes the hormone aldosterone. It should not be used in people with conditions that can lead to high blood potassium such as kidney disease or a poorly functioning adrenal gland. Drospennone should be used with caution by women who we also taking other medicines that raise tl(QW potassium, such as nonsteroidal antiWkvmmMory drugs (NSAIDs), potassium-sparing diuretics, potassium supplements, angiotensin-converting enzyme (ACE) inhibitors, All receptor antagonists, and heparin. Your doctor may want to check your blood potassium level if you might be at risk of high blood potassium.
Possible Side Effects
v Most common: breast enlargement or tenderness, ankle and leg swelling, appetite loss, weight changes, water retention and bloating, nausea, vomiting, and abdominal cramps. The estrogen patch may cause rash, irritation, and redness where it is applied.
V Less common: bleeding gums, breakthrough vaginal bleeding, vaginal spotting or discharge, changes in menstrual flow, painful menstruation, premenstrual syndrome (PMS), absence of menstrual periods during and after estrogen use, uterine fibroid enlargement, vaginal Candida infection, a cystitis-like condition, mild diarrhea, yellowing of the skin or whites of the eyes, eye lesions, contact-lens intolerance, rash, hair loss, development of new hairy patches, migraine, mild dizziness, depression, increased sex drive (women), and decreased sex drive (men).
♦ Rare: stroke, blood-clot formation, dribbling or sudden passage of urine, loss of coordination, chest pain, leg pain, breathing difficulties, slurred speech, and changes in vision. Men who take large estrogen dosages for prostate cancer have a greater risk of heart attack, phlebitis, and blood clots in the lungs. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Phenytoin, ethotoin, mephenytoin, and topiramate may interfere with estrogen’s effects.
• Estrogens may reduce the effect of oral anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
• Estrogens may increase the side effects of antidepressants and phenothiazine sedatives.
• Low estrogen dosages may increase 0\enolhiazine’s effectiveness.
% ‘ittrogens may increase cyclosporine and corticosteroid blood levels. Dosage adjustments of the non-estrogen drugs may be needed.
• Estrogens may reduce the effectiveness of thyroid replacement therapy.
• Rifampin, barbiturates, carbamazepine, St. John’s wort, and other drugs that stimulate the liver to break down drugs may reduce estrogen blood levels.
• Estrogens may interfere with tamoxifen and bromocripline.
• Women, especially those ova. 35, who smoke cigarettes and take estrogen have a much greater risk of developing stroke, hardening of the arteries, or blood clots in the lungs. The risk increases with age and tobacco use.
• Estrogens interfere with many diagnostic tests. Make sure your doctor knows you are taking estrogen before conducting any blood tests or other diagnostic procedures.
Food Interactions
Estrogens may be taken with food to reduce nausea and upset stomach. Avoid drinking grapefruit juice if you are taking this drug.
Usual Dose
Dosage varies. All of these products, including the transdermal skin patch, may be taken continuously or on a cyclic schedule of 3 weeks on, 1 week off.
Tablets
Chlorotrianisene: 12-200 mg.
Conjugated estrogens: 0.3-30 mg.
Conjugated estrogens, synthetic: 0.625-1.25 mg. Esterified estrogens: 0.3-30 mg.
Estradiol: 0.5-30 mg.
Estropipate: 0.625-7.5 mg.
Ethinyl estradiol: 0.02-3.0 mg.
Estradiol Transdermal Patch (0.025, 0.0375, 0.05, 0.075, or 0.1 mg) Alora, Estraderm, and Esclim: 1 patch twice a week: or use 1
patch twice a week for 3 weeks, stop for 1 week, then start again. Climara and Fempatch: 1 patch every week; or use 1 patch once
a week for 3 weeks, stop for 1 week, then start again.
Estradiol Transdermal Spray: 1-3 Sprays (1.53 mg estradiol in each spray
face of the forearm, starting near the elbow. Do not allow the sprays to overlap each other. Allow the spray to dry for about 2 minutes and do not wash the arm for 30 minutes. Do not apply the spray to any other part of the body.
3Wkw1 Onext to each other every morning on the inner sur-Estradiol Gel: Spread 1 pumpful of the gel as thinly as possible over the entire area on the inside and outside of your arm from wrist to
shoulder, once a day at the same time every day.
Vaginal Cream
Conjugated estrogens: 0.52 g a day for 3 weeks; stop for 1 week,
then start again.
Dienestrol: 1 applicatorful 12 times a day for 12 weeks, half the
original dosage for another 12 weeks, then 1 applicatoviO 13 times
a week.
Estradiol: 24 g a day for 2 weeks, half the starting dosage for an-
other 2 weeks, then 1 g 13 times a week.
Estropipate: 24 g a day for 3 weeks; stop for 1 week, then start again.
Estradiol Ring
Insert once every 3 months.
Overdosage
Symptoms may include nausea and vaginal bleeding in adult women. 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
Call your doctor if you develop breast pain or tenderness, swelling of the feet and lower legs, rapid weight gain, chest pain, breathing difficulties, pain in the groin or calves, unusual or persistent vaginal bleeding, missed menstrual period, lumps in the breast, sudden severe headache, dizziness or fainting, disturbances in speech or vision, weakness or numbness in the arms or legs, abdominal pain, sudden severe vomiting, depression, yellowing of the skin or whites of the eyes, or jerky or involuntary muscle movement.
Women taking estrogens or combined estrogen and progestin therapy should have yearly lamasN exams, perform monthly breast self -Paw i)26ions, and have regular mammograms.
Talk to your health care provider about ways to reduce risk factors for heart disease (blood-pressure control, improving your diet, stopping tobacco use) and osteoporosis (an appropriate diet, vitamin D and calcium supplements, weight-bearing exercise).
Tell your doctor if you are having surgery or require bedrest: your doctor may have you stop taking estrogen 4-6 weeks beforehand to prevent the risk of blood clots.
Your doctor should reevaluate your need for estrogen vaginal cream every 36 months. Do not stop using the drug suddenly because this may increase your risk of developing unpredicted or breakthrough vaginal bleeding.
Women using the cream who develop breast tenderness, start to bleed, or have other vaginal discharge should contact their doctors at once.
Estrogen skin patches should be applied to a clean, dry, non-oily, hairless area of intact skin, preferably on the abdomen. Do not apply it to your breasts or waist, or to any area where tightfitting clothes may loosen the patch from your skin. The application site should be rotated to prevent irritation, and each site should have a patch-free period for 7 days.
Good dental hygiene is important while taking estrogen because estrogen may increase your risk of oral infection. Dental work should be completed prior to starting estrogen, if possible.
Vaginal estrogen cream should be inserted high into the vagina, about 2/3 of the length of the applicator.
Press the vaginal ring into an oval and insert as deeply as possible in the upper 1/3 of the vagina.
Some of these products contain tartrazine (a commonly used orange dye and food coloring). If you are allergic to tartrazine or have asthma, check with your pharmacist to find out if your estrogen product contains this coloring agent.
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.
Authorities note that the risk of serious complications for an individual woman taking hormone replacement therapy is very small. Thus, you may decide to take hormones but your decision should be based on a complete discussion of the facts and your individual situation with your doctor. Continue to talk with your doctor regularly about weighing tt% i1%’Ks against the benefits of taking estrQ(;e5\.
Special Populations
Pregnancy/Breast-feeding: Estrogens harm the fetus and should never be used during pregnancy for any reason.
Estrogens pass into breast milk and reduce its flow. Nursing mothers who must take them should use infant formula.
Seniors: The risk of side effects increases with age, especially if you smoke. Women age 65 or older taking estrogens may be more likely to develop a stroke, blood clot, or dementia, a condition where people suddenly or gradually lose normal mental function and intellectual capacity.
Generic Name
Eszopiclone (ess-oh-PIK-lone)
Brand Name Lunesta
Type of Drug Sedative.
Prescribed For Insomnia.
General Information
Eszopiclone is a nonbenzodiazepine sleeping pill that is believed to work in much the same way as the drug zolpidem and as benzodiazepine-type sleeping pills and sedatives. Unlike the benzodiazepines, however, eszopiclone has little muscle-relaxing or antiseizure effects. This drug is rapidly absorbed and usually starts working within a few minutes. Eszopiclone causes little or no “hangover,” and there are no rebound effects after stopping the drug. In studies of eszopiclone, tolerance to its effects did not develop even after 6 months of continued use. Eszopiclone is broken down in the liver, and the level of this drug in the body does not increase after you take it for several days.
Cautions and Warnings
Do not take eszopiclone if you are allergic or sensitive to any of its ingredients.
People With severe liver disease should use eszopiclone with caution and must take less of this medication than those with normal liver function or mild liver disease.
Sleeping problems often result from a physical or psychological illness. Eszopiclone does not affect the underlying causes of
insomnia. It should be taken only with your doctor’s knowledge. If you cannot sleep even after 7-10 days of taking eszopiclone, con-
tact your doctor.
Eszopiclone has caused amnesia (memory loss), but this happens mostly at dosages larger than 2 mg per night.
Suddenly stopping eszopiclone after having taken it for some time may produce drug withdrawal (symptoms include fatigue, nausea, flushing, lightheadedness, crying, vomiting, stomach cramps, panic, nervousness, and general discomfort).
People with a history of substance abuse may be more likely to develop drug dependence on eszopiclone. Eszopiclone doses of 612 mg are similar to 20 mg of diazepam in their potential for abuse.
Eszopiclone is a nervous system depressant and may cause loss of coordination and concentration. It should be taken just before bedtime. People taking sleep medicine may experience unusual and complex reactions while asleep, such as driving, making phone calls, or cooking with no memory of the event. Eszopiclone may also interfere with normal activities the next day, especially if taken with alcohol.
Eszopiclone should be avoided by people with severe depression, severe lung disease, and sleep apnea (intermittently stopping breathing when you are asleep). You should not take this drug if you are drunk.
Possible Side Effects
Adults
Some side effects are more likely with larger doses (viral infection, dry mouth, dizziness, hallucinations, infections, rash, and unpleasant taste).
♦ Most common: headache, drowsiness, unpleasant taste, and lung infections.
✓ Common: dry mouth, dizziness, and nausea.
✓ Less common: nervousness, vomiting, viral infections, anxiety, confusion, depression, hallucinations, reduced sex drive, rash, male breast e”k-aigement and/or pain, painful meR%k5UMlrjn, chest pain, migraines, and swelling of the arms or legs.
♦ 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
• Mixing eszopiclone with olanzapine can affect your coordination and ability to perform tasks.
• Mixing eszopiclone with ketoconazole more than doubles blood levels of eszopiclone. Other drugs that may have a similar interaction include itraconazole, clarithromycin, nefazodone, troleandomycin, ritonavir, and nelfinavir.
• Rifampin can be expected to drastically reduce the effectiveness of eszopiclone because it increases levels of liver enzymes that break down eszopiclone.
• Avoid combining eszopiclone with alcohol and other nervous system depressants, including sedatives, narcotics, barbiturates, antidepressants, and antihistamines.
Food Interactions
For the most rapid and complete effect, take eszopiclone on an empty stomach at least 2 hours after a meal. It will take longer for eszopiclone to work if you have had a high-fat meal immediately before taking it.
Usual Dose
, abnormal dreaming, nery
Adult (q% 1% and over): 2-3 mg immediately before bedtime or after you are in bed and have trouble falling asleep. Eszopiclone can act very quickly.
Child (up to age 17): not recommended.
Senior: 1-2 mg immediately before bedtime.
People with liver disease: 1 mg.
Possible Side Effects (continued) Seniors
Some side effects are more com the cluding dry mouth, pain, and unpleasant easant
♦ Most common: headache.
♦ Common: pain, dry mouth, diarrhea, rrhea, and upset
♦ Less common: accidental injury,
ousness, nerve pain, itching, and urinary• Rare: Rare side effects can occur in almost any part body. Contact your doctor if you
ou experience any side ef fect not listed above.
infection. of - , mon with larger doses in
Overdosage
Overdose can result in nervous system depression, from unconsciousness to light coma. Combining eszopiclone with alcohol or other nervous system depressants may be fatal or affect other body organs. One person took up to 36 mg of eszopiclone and fully recovered. Take the victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Eszopiclone may cause tiredness, drowsiness, and an inability to concentrate. Be careful when driving or performing any task that requires concentration on the day following a dose. Make sure you get 7-8 hours of sleep after taking eszopiclone.
People taking eszopiclone on a regular basis may develop a drug withdrawal reaction if the medication is stopped suddenly (see “Cautions and Warnings”).
Do not take a double dose of this medication.
Special Populations
Pregnancy/Breast-feeding: Some animal studies with doses of eszopiclone up to 800 times the human equivalent showed it did not affect a developing fetus, and other studies showed some modest effects. However, there is no information on the use of eszopiclone in pregnant women. If your doctor considers eszopiclone crucial for you, its potential benefits must be carefully weighed against its risks.
It is not known if eszopiclone passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, who are likely to be more sensitive to eszopiclone and its side effects, should start on a 1 -mg dose and take the lowest effective dosage.
Generic Name
Etanercept (eh-TAN-er-sept)
Brand Name Enbrel
Type of Drug
Immune system modulator.
Prescribed For
Rheumatoid arthritis, juvenile rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and psoriasis.
General Information
Etanercept binds to a specific protein in the body known as tumor necrosis factor (TNF) and blocks it from interacting with cell surfaces. TNF is involved in normal inflammatory and immune responses and the inflammatory processes of rheumatoid arthritis, juvenile rheumatoid arthritis, and other conditions. Etanercept can also interfere with biological actions that are either caused or regulated by TNF.
Cautions and Warnings
Do not use etanercept if you are allergic or sensitive to any of its ingredients.
Serious infections and malignancies are possible in people using etanercept because of its ability to suppress the immune response. This may be more common in people with other conditions that predispose them to infections such as advanced or uncontrolled diabetes.
Levels of blood platelets and some white blood cells may be reduced in rare cases, leading to persistent fever, bruising, bleeding, and pale skin. Contact your doctor if any of these symptoms develop.
Etanercept may increase the risk of some nervous system disorders including multiple sclerosis.
Etanercept may cause or worsen congestive heart failure.
In rare cases people taking etanercept have developed a lupus-like syndrome which may disappear when the drug is discontinued.
People taking etanercept should not receive any live vaccines, because the body may not be able to respond as expected to the vaccine.
Possible Side Effects
RPndmt may develop at the site where etanercept is injected. Injection sites should be rotated among the thigh, abdomen, and upper arm to avoid excessive bruising or other skin damage.
Possible Side Effects (continued)
♦ Most common: infection, injection-site reactions, upper respiratory infection, headache, and runny nose.
♦ Common’. nausea, dizziness, sore throat. cough, weak-
ness, abdominal pain, rash, and respiratory problems.
♦ Less common: upset stomach, sinus irritation, vomiting.
swelling in the legs or feet, mouth sores, and hair loss.
✓ Rare: malignancy, stroke, seizure, tingling in the hands or feet, nervous system irritation similar to multiple sclerosis, eye inflammation, joint pain, generalized pain, appetite loss, blood vessel inflammation in the skin, dry eyes, lumps under the skin, fever, flu-like symptoms, weight gain, chest pain, flushing, diarrhea, taste changes, difficulty breathing, worsening of existing lung conditions, itching, and skin reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Do not mix etanercept in the same syringe as another drug.
• Using etanercept with anakinra increases the risk of serious infections.
Food Interactions None known.
Usual Dose
Adult: rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis-50 mg a week. Plaque psoriasis: 50 mg twice a week, reducing to 50 mg a week after 3 months.
Child (age 4-17): 0.36 mg per lb. of body weight, up to 50 mg a week, 3-4 days apart.
Child (under age 4): not recommended.
Overdosage
In one study, ‘A patient accidentally self-administered 62 mg of etanercept twice a week for 3 weeks with no ill effects. 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
Etanercept is taken by injection under the skin. Be sure you understand how to measure the proper dose of etanercept and how
to self-inject it.
To mix and inject etanercept: Withdraw all the water supplied with the medicine into a syringe and slowly inject it into the vial containing etanercept. Swirl the mixture gently to avoid excess foaming in the vial. Do not shake the vial.
Do not combine etanercept with any other injectable drug. Etanercept may be stored in a refrigerator for up to 14 days after it is mixed.
Single-use pre-filled syringes must be refrigerated. Do not use past the provided expiration date.
If you forget to administer a dose, do so as soon as you remember. Remember that etanercept doses must be administered at least 3 days apart. Call your doctor or pharmacist if you have any questions about how to time your etanercept doses.
Special Populations
PregnancylBreast-feeding. The safety of using etanercept during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if this drug passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors are more likely to develop infections while using etanercept.
Generic Name
Exemestane (ex-eh-MES-tane)
Bnj(kod WaYne Aromasin
Type of Drug Aromatase inhibitor.
Prescribed For
Breast cancer. Also prescribed for prostate cancer prevention.
General Information Some breast cancers depend on the presence of the hormone estrogen to stimulate their growth. Depriving these cancers of estrogen is an effective way of treating the condition. Exemestane significantly reduces the amount of estrogen in the blood by binding permanently to an enzyme called aromatase, an essential element in the conversion of androgen (male hormones) to estrogen in premenopausal and postmenopausal women. Exemestane does not affect other hormones in the body. Exemestane is broken down in the liver.
Cautions and Warnings
Do not take exemestane if you are allergic or sensitive to any of its ingredients.
Exemestane may be prescribed for men and postmenopausal women only.
Possible Side Effects
✓ Most common: fatigue, hot flashes, pain, depression, sleeplessness, anxiety, nausea, and breathing difficulties.
✓ Common: flu-like symptoms, leg swelling, high blood pressure, dizziness, headache, vomiting, abdominal pain, leg swelling or other fluid retention, sweating, appetite loss, constipation, and coughing.
✓ Less common: increased appetite, diarrhea, fever, weakness, tingling in the hands or feet, broken bones, bronchitis, sinusitis, rash, itching, urinary infection, and swollen lymph glands.
♦ Rare: chest pain; confusion; reduced sensitivity to stimulation; upset stomach; joint, back, or other bone pain; respiratory infection; sore throat; runny nose; and hair loss. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Estrogen-containing drugs reduce the effectiveness of exemestane. Do not combine these drugs.
• Rifampin, phenytoin, carbamazepine, phenobarbital, and St. John’s wort may potentially reduce the effectiveness of
exemestane.
Food Interactions
Take this drug with a meal. The amount of exemestane absorbed into the blood is increased by 40% when taken with a high-fat meal.
Usual Dose
Adult: 25 mg once a day with or just after a meal. Dose adjustment is not needed in people with kidney or liver disease. Child: not recommended.
Overdosage
Doses as large as 600 mg have been well tolerated by women with advanced breast cancer. Overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the prescription bottle or container.
Special Information
If you forget a dose, skip the forgotten dose and continue with your regular schedule. Contact your doctor if you skip more than one dose.
Special Populations
Pregnancy/Breast-feeding: Exemestane is intended only for postmenopausal women. It can cause birth defects and miscarriage and should not be used by pregnant women or women who may become pregnant.
Exemestane may pass into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may take this drug without special precaution.
Generic Name
Exenatide (ex-EN-ah-tide)
Brand Name Byetta
7Vpe of Drug Incretin mimetic.
Prescribed For Type 2 diabetes.
General Information
Exenatide is a unique drug that improves blood sugar control in people with type 2 diabetes who have been unsuccessful with diabetes pills. It is added to existing therapy and does not replace other treatments. Exenatide has many of the same actions as GLP-1, a natural incretin hormone. It differs chemically and works differently from other diabetes medications, including insulin.
Exenatide begins working about 30 minutes after injection and continues to work for at least 8 hours. It helps the pancreas to release insulin into the blood in response to sugar levels, so insulin rises when blood sugar is high and declines as blood sugar declines. It reduces the production of a hormone called glucagon, which raises blood sugar. Exenatide also keeps food in the stomach longer, which in turn helps reduce the amount of sugar absorbed from dietary sources. Exenatide increases the number of beta cells (that produce insulin) in animals and may have the same effect in humans. This could help reduce the need for other medicines and improve diabetes control.
Cautions and Warnings
Do not take exenatide if you are allergic or sensitive to any of its ingredients.
This drug is not a substitute for insulin. Exenatide has only been studied together with metformin, glitazones, and/or sulfonylureas. It has not been studied with other diabetes pills or insulin.
People with severe kidney disease should not use exenatide.
People with severe stomach or intestinal disease should not use exenatide.
Inflammation of the pancreas can occur with this drug. Symptoms include nausea, vomiting, fever, rapid pulse, and painful and swollen abdomen that may develop slowly and worsen when you eat or may be severe and constant.
Low blood sugar may ziccurit you are taking exenatide with a S\00ny)urea-type antidiabetes drug or with a glitazone.
Antibodies to exenatide may develop, but antibody levels generally go down with time. Most patients who develop antibodies still have good sugar control and similar types of side effects as people who do not develop exenatide antibodies.
Possible Side Effects
♦ Most common: nausea, vomiting, diarrhea, and low blood sugar (when mixed with a sulfonylurea-type drug or metformin plus a sulfonylurea).
♦ Less common: low blood sugar (when mixed with a glitazone), feeling jittery, dizziness, headache, and upset stomach.
✓ Rare: rash, abdominal swelling and pain, constipation, and kidney failure. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Exenatide has been studied with a number of other medications commonly taken by people with diabetes (digoxin, lovastatin, lisinopril, and acetaminophen) and no significant interactions were noted.
• Combining exenatide with a sulfonylurea-type drug may lead to hypoglycemia (low blood sugar). Your doctor may change your sulfonylurea dose to solve this problem.
• Take all oral medicines at least 1 hour before you inject exenatide to ensure maximum absorption. If you must take oral drugs with food or meals, take them with a snack or meal when exenatide is not being injected. Exenatide extends the time that drugs remain in the stomach and may reduce the amount of medication absorbed when taken by mouth.
• Exenatide may reduce the effectiveness of oral contraceptive pills. Take them at least 1 hour before an injection of exenatide.
• Exenatide may increase the amount of warfarin in the body and increase the risk of bleeding.
Food Interactions
None known. Usual Dose
Adult: 5 or 10 mcg twice a day by subcutaneous injection %M)iT) an hour before breakfast and dk”"tj.
CAWVEOnafide has not been studied in children. Overdosage
The effects of an exenatide overdose are severe nausea, severe vomiting, and severe, rapid drops in blood sugar levels. An oral sugar source may help, but overdose victims should be taken to a hospital emergency room for evaluation and treatment. ALWAYS bring the exenatide pen with you.
Special Information
Each dose of exenatide must be given as an injection under the skin of the thigh, abdomen, or upper arm within 1 hour before your breakfast and dinner meals. For information on how to properly administer this drug, see page 1242.
If you forget a dose of exenatide, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Exenatide injection is clear and colorless. Do not use if it has any color, is cloudy, or if there are any particles floating in it.
Keep this drug in the refrigerator, and do not use it after the expiration date has passed.
This drug may lead to a loss of appetite and loss of body weight. Do not change your regular dosage if this happens to you.
Special Populations
PregnancylBreast-feeding. In animal studies using doses equal to 3 times the usual human dose, exenatide was shown to affect the growth of the fetus. If you are or might be pregnant and your doctor considers this drug crucial, its potential benefits must be weighed against its risks.
Small amounts of exenatide may pass into breast milk and may affect a nursing infant. Nursing mothers taking this drug should use infant formula.
Seniors: Seniors may take this drug without special restriction. Generic Name
Jul
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Acetazolamide
July 16, 2009 | Leave a Comment
Generic Name
Acetazolamide (uh-sete-uh-ZOLE-uh-mide) [6j
Type of Drug
Carbonic-anhydrase inhibitor.
Prescribed For
Glaucoma and prevention or treatment of mountain sickness; also prescribed for epilepsy and treatment of drug-induced swelling or swelling due to congestive heart failure.
General Information
By blocking an enzyme in the body called carbonic anhydrase, acetazolamide produces a weak diuretic effect that helps to treat glaucoma by reducing pressure inside the eye. Acetazolamide’s antiseizure properties are also produced by its effect on carbonic anhydrase, though exactly how acetazolamide prevents seizure is not well understood.
Cautions and Warnings
Do not take acetazolamide if you are allergic or sensitive to any of its ingredients or to sulfa drugs.
Do not take acetazolamide if you have low blood sodium or potassium, diabetes, or serious kidney, liver, or Addison’s disease.
Possible Side Effects
Side effects of short-term therapy are usually minimal.
✓ Most common: nausea or vomiting; tingling feeling in the arms, legs, lips, mouth, or anus; appetite and weight loss; a metallic taste; increased frequency in urination; diarrhea; not feeling well; occasional drowsiness; and weakness. You may also experience rash, drug crystals in the urine, painful urination, low back pain, urinary difficulty, and low urine volume.
♦ Rare: Rare side effects can affect the liver, mental state, blood sugar, muscles, and senses. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Avoid over-the-counter drug products that contain stimulants or anticholinergics, which tend to aggravate glaucoma and cardiac disease.
• Acetazolamide may increase blood concentrations of cyclosporine (used to prevent the rejection of transplanted organs).
• Acetazolamide may block or delay the absorption of primidone (prescribed for seizure).
• Avoid aspirin because it may enhance acetazolamide side effects.
• Combining diflunisal and acetazolamide can result in an excessive lowering of eye pressure.
Food Interactions
Acetazolamide may be taken with food if it upsets your stomach. Because acetazolamide can increase potassium loss, take this drug with potassium-rich foods such as bananas, citrus fruits, melons, and tomatoes.
Usual Dose
Glaucoma
Adult: 250-1000 mg a day.
Child: 4.5-6.75 mg per lb. a day in divided doses.
Diuresis in congestive heart failure or drug-induced swelling Adult: 250-375 mg a day.
Child: 2.25 mg per lb., once daily in the morning.
Epilepsy: 375-1000 mg a day in divided doses.
Mountain Sickness: 500-1000 mg a day. If possible begin medication 24-48 hours before ascent.
Overdosage
Symptoms of overdose include drowsiness, loss of appetite, nausea, vomiting, dizziness, tingling in the hands or feet, weakness, tremors, or ringing or buzzing in the ears. In case of overdose, induce vomiting as soon as possible with ipecac syrup—available at any pharmacy—and take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Acetazolamide may cause minor drowsiness and confusion, particularly during the first 2 weeks of therapy. Be careful when driving or doing any task that requires concentration.
Call your doctor if you develop sore throat, fever, unusual bleeding or bruises, tingling in the hands or feet, rash, or unusual pains.
Acetazolamide can increase sensitivity to the sun. Avoid prolonged sun exposure and protect your eyes while taking this drug.
Be sure to drink plenty of water or fluids while taking acetazolamide.
If you forget a dose, 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
Pregnancy/Breast-feeding: High doses of this drug may cause birth defects or interfere with fetal development. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Small amounts of acetazolamide may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to this drug’s side effects.