Aug
1
Chlordiazepoxide
August 1, 2009 | Leave a Comment
Generic Name
Chlordiazepoxide (klor-dye-az-uh-PDX-ide) 91
Brand Name
Librium
Type of Drug Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation, and withdrawal symptoms of alcoholism; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Chlordiazepoxide is a member of the group of drugs known as benzodiazepines.
Benzodiazepines work by a direct effect on the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and are usually as effective, if not more so.
Cautions and Warnings
Do not take chlordiazepoxide if you are allergic or sensitive to any of its ingredients or to another benzodiazepine, including clonazepam.
Chlordiazepoxide can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other condkjo(\SiVN\,NhjCb chlordiazepoxide should be used with caution are severe depression, especially with suicidal tendencies, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease.
Chlordiazepoxide should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage. It has also produced similar reactions among hyperactive and aggressive pediatric patients.
Chlordiazepoxide is not intended for more than 3-4 months of continuous use. Your condition should be reassessed before continuing chlordiazepoxide beyond that time.
Chlordiazepoxide may be addictive. Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use, but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state.
Dosage of chlordiazepoxide should be decreased gradually over 4-8 weeks after prolonged use.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are sickly.
♦ Most common: mild drowsiness during the first few days of therapy.
✓ Less common: depression, lethargy, disorientation, edema, headache, inactivity, slurred speech, stupor, dizziness, tremor, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver - dysfunction. If you experience any of these symptoms, stop taking the medicine and contact your doctor immediately.
♦ 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
• Chlordiazepoxide is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, mono-amine oxidase inhibitor and other antidepressants, and antihistamines. Taking chlordiazepoxide with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Smoking may reduce the effectiveness of chlordiazepoxide by increasing the rate at which it is broken down by the body.
• The effects of chlordiazepoxide may be prolonged when it is
taken with cimetidine, contraceptive drugs, disulfiram, flu-
oxetine, isoniazid, ketoconazole, metoprolol, probenecid,
propoxyphene, propranolol, rifampin, or valproic acid.
• Theophylline may reduce chlordiazepoxide’s sedative effects.
• If you take antacids, separate them by at least 1 hour from your chlordiazepoxide dose to prevent them from interfering with the passage of chlordiazepoxide into the bloodstream.
• Chlordiazepoxide may increase blood levels of digoxin and the chances for digoxin toxicity.
• Levodopa + carbidopa’s effectiveness may be reduced by chlordiazepoxide.
• Phenytoin blood concentrations may be increased when taken with chlordiazepoxide, resulting in possible phenytoin toxicity.
Food Interactions
Chlordiazepoxide is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 5-100 mg a day. This range is due to individual response related to age, weight, disease severity, and other characteristics.
Child (age 6 and over): may be given if deemed appropriate by a doctor. Starting dose-5 mg 2-4 times a day. Maintenance dose—up to 30 mg a day for some children, but must be individualized to obtain maximum benefit.
Child (under age 6): not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be lakes to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Chlordiazepoxide can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
If you forget a dose of chlordiazepoxide, 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: Chlordiazepoxide may cause birth defects if taken during the first 3 months of pregnancy. Avoid chlordiazepoxide while pregnant.
Chlordiazepoxide may pass into breast milk. Nursing mothers who must take chlordiazepoxide should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of chlordiazepoxide and generally require smaller doses to achieve the same effect.
Jul
16
Albuterol
July 16, 2009 | Leave a Comment
Generic Name
Albuterol (al-BUE-tuh-rawl) 91
Brand Names
AccuNeb Proventil HFA
ProAir HFA Ventolin HFA
Proventil* Vospire ER
Combination Products
Generic Ingredients: Albuterol + 1pratropium Bromide Combivent DuoNeb
The:nformation in this profile also applies to the following drugs:
Generic Ingredient: Levalbuterol Xopenex
Generic Ingredient., Pirbuterol Maxair
*Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Bronchodilator.
Prescribed for
Bronchospasm associated with asthma or other obstructive pulmonary diseases, or induced by exercise.
General Information
Albuterol is similar to other bronchodilator drugs, such as metaproterenol and isoetharine, but it has a weaker effect on nerve receptors in the heart and blood vessels; therefore, it is somewhat safer for people with heart conditions. Levalbuterol is a special form of albuterol that carries a lower risk of side effects.
Cautions and Warnings
Do not use Albuterol if you are allergic or sensitive to any of its ingredients. Albuterol should be used with caution by people with a history of angina pectoris (a condition characterized by brief attacks of chest pain), heart disease, irregularities in heart beat, high blood pressure, stroke or seizure, diabetes, thyroid disease, prostate disease, or glaucoma. Excessive use of albuterol inhalants may worsen asthma or other respiratory conditions, and may increase breathing difficulties rather than relieve them. In the most extreme cases, people have had heart attacks after using excessive amounts of inhalant.
Possible Side Effects
V Most common: worsening of asthma, ear infection, upper respiratory infection, stuffy nose, dizziness, headache, nausea, vomiting, and muscle cramps.
♦ Less common: angina, abnormal heart rhythms, rapid heartbeat and heart palpitations, allergic reaction, fever, and tremors.
Drug Interactions
• Albuterol’s effects on the cardiovascular system may be increased by monoamine oxidase inhibitor (MA01) and tricyclic antidepressants. These drugs should not be administered together or within 2 weeks of discontinuation of MAOls or tricyclic antidepressants.
• Beta-blocking drugs such as propranolol not only block the effects of albuterol but may cause severe bronchospasm in people with asthma.
• Albuterol may reduce the amount of digoxin in the blood of people taking both drugs. Digoxin dose adjustment may be required.
• Albuterol may exacerbate certain effects of non-potassium sparing diuretics (loop or thiazide diuretics).
Food Interactions
Albuterol tablets are more effective when taken on an empty stomach-1 hour before or 2 hours after meals—but can be taken with food if they upset your stomach.
Usual Dose
Albuterol and Pirbuterol Inhalation
Adult and Child (age 4 and over): 1-2 puffs every 4-6 hours. Asthma triggered by exercise may be prevented by taking 2 puffs 15 minutes before exercising.
Albuterol Inhalation Solution
Child (age 2-12): starting dose-0.63 mg or 1.25 mg 3 or 4 times a day. Deliver over 5-15 minutes by nebulizer.
Levalbuterol Inhalation Solution
Adult and Child (age 12 and over): 0.63 mg 3 times a day every 6-8 hours. Some people may benefit from 1.25 mg at each dose. Deliver over 5-15 minutes by nebulizer.
Child (age 6-11): 0.31 mg 3 times a day every 6-8 hours, by nebulizer.
Albuterol Inhalation Aerosol
Adult and Child (age 4 and over): 2 inhalations every 4-6 hours. Adults and children age 4 and over may prevent asthma brought on by exercise by inhaling twice 15 minutes before exercising.
Albuterol Sustained-Release Tablets
Adult and Child (age 12 and over): 4-8 mg every 12 hours. Dosage may be cautiously increased to a maximum of 32 mg a day. People being switched from regular to sustained-release tablets generally take the same dosage per day, in fewer tablets—for example, a 4-mg tablet every 12 hours (1 dose) instead of a 2-mg tablet every 6 hours (2 doses).
Child (age 6-12): 4 mg every 12 hours.
Overdosage
Overdose of albuterol inhalation usually results in exaggerated side effects, including chest pain and high blood pressure. People who inhale too much albuterol should see a doctor. Overdose of albuterol tablets may lead to changes in heart rate, palpitations, unusual heart rhythm, chest pain, high blood pressure, fever, chills, cold sweats, nausea, vomiting, and dilation of the pupils. Convulsions, sleeplessness, anxiety, and tremors may also develop, and the victim may collapse. If the albuterol overdose was taken within the past 1/2 hour, give the victim syrup of ipecac to induce vomiting. Do not give ipecac if the victim is unconscious or convulsing. If symptoms have already begun to develop, the victim may need to be taken to a hospital emergency room. Call for instructions, and ALWAYS bring the prescription bottle or container.
Special Information
If you are inhaling albuterol, be sure to follow the inhalation instructions that come with the product. The drug should be inhaled during the second half of your inward breath, since this will allow it to reach deeper into your lungs. Wait about 1-2 minutes between inhalations. Do not inhale albuterol if you have food or anything else in your mouth.
Do not take more albuterol than your doctor prescribes. Taking more than you need can worsen your symptoms. If your condition worsens after taking your medicine, call your doctor at once and stop taking it.
Call your doctor immediately if you develop chest pain, palpitations, rapid heartbeat, muscle tremors, dizziness, headache, facial flushing, or urinary difficulty, or if you continue having breathing difficulties after taking the medicine.
Do not crush or chew the extended-release tablets.
If you forget a dose of albuterol, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: When used during childbirth, albuterol can slow or delay natural labor. It can cause rapid heartbeat and high blood sugar in the mother and rapid heartbeat and low blood sugar in the baby. Albuterol also causes birth defects in animal studies. When your doctor considers this drug crucial, its benefits must be cautiously weighed against its risks.
It is not known if albuterol passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors with cardiovascular disease should use albuterol with caution.
Jul
16
Adefovir
July 16, 2009 | Leave a Comment
Generic Name
Adefovir (ah-deh-FOE-veer)
Brand Name Hepsera
Type of Drug Antiviral.
Prescribed For
Chronic active hepatitis B in adults.
General Information
Hepatitis B is one of several different types of hepatitis, a viral infection of the liver. Adefovir is an antiviral drug that can reduce the amount of hepatitis B virus in the bloodstream and slow its spread to healthy liver tissue, however, it cannot cure chronic hepatitis B. People with chronic hepatitis B may develop liver cirrhosis or liver cancer and it is not known if adefovir can prevent these conditions from occurring. Like other viruses and bacteria, the hepatitis B virus can become resistant to the effects of adefovir.
Adefovir works against the hepatitis C virus in a way similar to that of certain human immunodeficiency virus (HIV) drugs. It interferes with an enzyme called reverse transcriptase, which is an essential component of the viral reproduction process. Almost half of each dose is eliminated via the urine within 24 hours of taking it.
Cautions and Warnings
Do not take adefovir if you are allergic or sensitive to any of its ingredients.
Adefovir can be toxic to the kidneys, especially in people who already have some kidney problems. Since it is eliminated from the body through the kidneys, people with kidney disease are often given lower doses of adefovir.
In some cases, hepatitis can become severely aggravated upon discontinuation of adefovir. Your doctor should check your liver for’ 2 weeks after the drug is stopped. it is possible that antiviral therapy may have to be re-started.
Adefovir has some activity against the human immunodeficiency virus (HIV). An HIV blood test is recommended before starting adefovir treatment. If you are HIV positive, adefovir could make the HIV virus resistant to future antiviral drugs.
People taking adefovir can develop liver disease, liver enlargement, fat degeneration, and lactic acidosis (potentially fatal metabolic imbalance). This may be a reason for your doctor to stop your adefovir treatment. This occurs most frequently in obese women.
Possible Side Effects
In studies, side effects reported in the treated group were similar in frequency to placebo.
✓ Most common: weakness, headache, stomach pain, and nausea.
✓ Less common: intestinal gas, diarrhea, and upset stomach.
Drug Interactions
This drug was studied extensively in an attempt to predict possible drug interactions. No major interaction problems have been revealed.
• Taking drugs that can be toxic to the kidneys (such as amino-glycosides, cyclosporine, nonsteroidal anti-inflammatory drugs (NSAIDs), tacrolimus, and vancomycin) together with adefovir can lead to the more rapid appearance of kidney damage.
• Ibuprofen, when taken in dosages of 800 mg 3 times a day, will increase adefovir blood levels by about 20 %, however the importance of this finding is unknown.
Food Interactions
Adefovir may be taken without regard to food or meals.
Usual Dose
Adults: 10 mg once a day. People with kidney disease requiring dialysis may take only 10 mg a week. The exact dosage is based on the severity of kidney disease.
Child: not recommended.
Overdosage
Gastrointestinal symptoms are the most likely outcome of an adefovir overdose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Practice safe sex and safe needle use. People taking adefovir may still spread hepatitis B through sexual contact or by sharing needles. Practice safe sex using condoms and dental dams.
Do not share personal items that can have blood or body fluids on them, such as toothbrushes or razor blades.
Try to take adefovir at the same time every day.
Adefovir must be taken continuously to maintain its effectiveness. Be sure to keep enough adefovir on hand so that you do not run out of medicine.
If you take adefovir on a regular schedule and forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose of this medicine. Call your doctor if you forget 2 or more doses in a row. Skipping or forgetting too many doses can make the hepatitis C virus resistant to adefovir.
Call your doctor at once if you feel very weak or tired, cold (especially in your arms and legs), dizzy or lightheaded, have unusual muscle pain, trouble breathing, stomach pain with nausea and vomiting, or have a fast or irregular heartbeat. These could be signs of lactic acidosis.
Call your doctor if you experience jaundice (symptoms include yellowing of the skin or whites of the eyes), appetite loss for a few days or more, lower stomach pain, nausea, dark urine, or bowel movements that are light in color. These could be signs of liver toxicity.
Special Populations
Pregnancy/Breast-feeding: Animal studies with adefovir have revealed a tendency for some birth defects when the dosage administered was more than 20 times the average human dose. There is no information on the effect of adefovir during pregnancy. The company that produces adefovir has established a registry to collect information on pregnant women who take this drug. When this drug is considered crucial by your doctor, its potential benefits may be carefully weighed against its risks.
It is not known if adefovir passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may be more sensitive to adefovir’s side effects because of the natural loss of kidney function that occurs with advancing age.
Jul
2
Isotretinoin in Acne Treatment
July 2, 2009 | Leave a Comment
Isotretinoin
Dermatologists have one last big gun, a powerful medicine to use in desperate cases when nothing else has worked. Isotretinoin has stirred a lot of emotions—from excitement to fear—because it is so effective but also has some extremely serious side effects. This drug is approved for severe cystic acne, and it really should be reserved for acne that is not responding to other treatments.
From the time of its introduction, the maker of Accutane strove to get across the point that this drug can cause birth defects. Women who take this medication must. not get pregnant while they are on the drug or for several months after stopping it. (The compound stays in the body for a while.) Nonetheless, the manufacturer’s warnings have not been enough. Every year some women on isotretinoin do conceive, despite all the precautions. As a result, the FDA and the manufacturer have limited the access to this medicine. To prescribe it, a dermatologist must have enrolled in the iPLEDGE program, which educates physicians about the drug. Patients are also required to enroll in the iPLEDGE program and view the educational DVD before taking the first dose. The program uses telephone- and computer-based tracking to verify that female patients are get-** Isotretinoin (Accutane, Amnesteem, Cla r a v i s, S o t r e t.
Isotretinoin is chemically related to vitamin A, so it controls cell division. Four to 5 months of treatment usually results in significant clearing of acne, sometimes lasting years.
Common side effects: Dry lips and mouth; dry, crusty skin; upset stomach; hair loss; nosebleed; sun sensitivity; elevated cholesterol; and reduced night vision
Serious side effects: Birth defects; depression, potentially leading to suicidal thoughts or behaviors; inflammation of the pancreas; pressure on the brain (pseudotumor cerebri) causing severe headache
Downside: Despite efforts to keep this drug away from pregnant women, each year some babies are exposed in utero and born with birth defects. Women must use two different and effective means of contraception throughout the time they are taking Isotretinoin.
Cost: Varies widely from about $100 to $400 for 1 month of treatment
ting regular pregnancy tests to ensure that they do not take this medication during pregnancy. Patients who do not enroll in the program cannot get their prescriptions filled. More information is available online at www.ipledgeprogram.com.
Q. I have been on Accutane to treat bad acne for almost a month. I have taken 26 tablets, but stopped taking it when I thought I might be pregnant.
I found out yesterday that I am indeed pregnant, and I am scared. I want to have this baby, but after reading about the drug causing birth defects, I am not sure. What should I do?
A. We were shocked to learn that you have become pregnant while taking Accutane. This acne medicine can cause very serious birth defects in a fetus.
That is why the manufacturer recommends every woman have a pregnancy test before she starts on this drug and use effective contraception throughout therapy. Every time a pill is removed from its packaging, a symbol reminds the patient not to take this drug during pregnancy.
Please discuss this serious matter with your physician and your partner. The drug company can provide further information about your odds of having a baby with severe health problems.