Aug
1
Clarithromycin
August 1, 2009 | Leave a Comment
Generic Name
Clarithromycin (klah-rith-roe-MYE-sin) 91
Brand Names Biaxin
Type of Drug Macrolide antibiotic.
Biaxin XL
Prescribed For
Mild to moderate infections of the upper and lower respiratory tract, tonsillitis, pharyngitis, sinusitis, exacerbation of chronic bronchitis, middle-ear infections, and for duodenal ulcers; also used for skin and other infections, including membrane attack complex (MAC) in people with advanced HIV infection.
General Information
Clarithromycin and other macybYide antibiotics are either bacteri(;((JW (’UaCkeeia-killing) or bacteriostatic (inhibiting bacterial growth), depending on the organism in question and amount of antibiotic present. In ulcer disease, clarithromycin is used to fight Helicobacter pylori infection, which is present in almost all ulcers and most cases of stomach inflammation.
Cautions and Warnings
Do not take clarithromycin if you are allergic or sensitive to any of its ingredients or to any macrolide antibiotic.
Clarithromycin should not be used during pregnancy.
Clarithromycin is primarily eliminated from the body through the liver and kidneys. People with severe kidney disease may require dose adjustments. Liver disease generally does not require an adjustment.
Colitis (bowel inflammation) has been associated with all antibiotics (see “Possible Side Effects”). If colitis does develop, your doctor should start appropriate treatment. Mild cases of colitis usually respond to the discontinuation of the medicine.
Possible Side Effects
Most side effects are mild and go away once you stop taking clarithromycin.
✓ Most common: nausea, upset stomach, changes in sense of taste, headache, he. diarrhea, abdominal pain, vomiting, and rash in children. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop.
✓ Rare: serious abnormal heart rhythms. Contact your doc-
tor if you experience any side effect not listed above.
Drug Interactions
• Clarithromycin may increase the anticoagulant (blood-thinning) effects of warfarin in people who take it regularly, especially older adults. This combination requires careful monitoring by your doctor.
• Do not combine clarithromycin with astemizole or terfenadine.
• Combining clarithromycin and omeprazole raises the amount of both drugs in the blood.
• Two deaths have been reported in people combining Oarithromycin and pimozidp_ ?imuiide should not be used by peibp)e faking a macrolide antibiotic.
• Clarithromycin may raise blood levels of theophylline, possibly leading to a theophylline overdose. It can also increase the effects of caffeine.
• Combining clarithromycin and digoxin, cyclosporine, ergot
alkaloids, or tacrolimus may lead to serious side effects.
Aug
1
Cimetidine
August 1, 2009 | Leave a Comment
Generic Name
Cimetidine (sih-MET-ih-dene)
Brand
Tagamet Tagamet HB 91
Type of Drug Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine); also used for upset stomach, gastroesophageal reflux disease (GERD), benign stomach ulcer, bleeding in the stomach and duodenum, colorectal cancer, prevention of stress ulcer, hyperparathyroidism, fungal infections of the hair and scalp, herpes virus infection, excessive hairiness in women, chronic itching of unknown cause, skin reactions, warts, acetaminophen overdose, and other conditions characterized by the production of large amounts of gastric fluids. Cimetidine may be prescribed to stop the production of stomach acid during surgery.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Cimetidine 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 cimetidine. 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. These drugs are roughly equal in their ability to treat ulcer disease and their risk of side effects.
Cautions and Warnings
Do not take cimetidine if you are allergic or sensitive to any of its ingredients or any histamine H2 antagonist. Cimetidine has a mild antiandrogen effect, which probably causes the painful, swollen breasts that some people experience after taking this drug for a month or more.
People with kidney or liver disease should take cimetidine with caution because 1/3 of each dose is broken down in the liver and passes out of the body through the kidneys.
Do not self-treat with over-the-counter forms of cimetidine without the advice and supervision of your doctor.
The fact that symptalleviated by cimetidine does not dude the possibility of stomach cancer, which can have symptoms similar to other gastrointestinal (GI) disorders. Make sure your doctor screens for possible malignancy.
these symptoms stop 3-4 days after discontinuing the drug. Call your doctor if this happens to you.
Possible Side Effects
Serious side effects are uncommon.
♦ Most common: mild diarrhea, dizziness, rash, painful breast swelling, nausea and vomiting, headache, confusion, drowsiness, hallucinations, and impotence.
♦ Less common: liver inflammation, peeling or red and swollen rash, breathing difficulties, tingling in the hands or feet, delirious feelings, and oozing from the nipples.
✓ Rare: Cimetidine may affect white blood cells or blood platelets. Some symptoms of these effects are unusual bleeding or bruising, unusual tiredness, and weakness. Other rare side effects are inflammation of the pancreas, hair loss (reversible), abnormal heart rhythms, heart attack, muscle or joint pains, and drug reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Separate cimetidine from antacid doses by about 3 hours to avoid reducing cimetidine’s effectiveness. Other drugs that may reduce the absorption of cimetidine are metoclopramide and anticholinergic drugs, including trihexyphenidyl hydrochloride, oxybutynin, and benztropine mesylate.
• Cigarette smoking reverses the healing effect cimetidine has on ulcers.
• Cimetidine may increase the side effects of a variety of drugs, possibly leading to drug toxicity. These drugs include alcohol; aminophylline; oral antidiabetes drugs; benzodiazepine sedatives, except lorazepam, oxazepam, and temazepam; caffeine; calcium channel blockers; carbamweoine; carmustine; chloroquine; tkeCaiTAe; fluorouracil; labetalol; lidoQa« , Tneloprolol; metronidazole; moricizine; mexiletine; narcotic pain relievers; nifedipine; ondansetron; pentoxifylline; phenytoin; procainamide; propafenone; propranolol; quinine; quinidine; tacrine; theophylline drugs, except clyphylline: triamterene; tricyclic antidepressants; valproic acid; and warfarin (a blood-thinner).
• Drugs whose absorption may be decreased by cimetidine are iron, indomethacin, fluconazole, ketoconazole, and tetra-
cycline antibiotics.
• Enteric-coated tablets should not be taken with cimetidine. The change in stomach acidity causes the tablets to disin-
tegrate prematurely in the stomach.
• cimetidine may decrease the effects of digoxin and tocainide.
Food Interactions
None known.
Usual Dose
Adult: 400-800 mg at bedtime; 300 mg 4 times a day with meals and at bedtime; or 400 mg twice a day. To treat GERD-400 mg 4 times a day. Do not exceed 2400 mg a day. Users of Tagamet HB should not take more than 400 mg a day. Smaller doses may be as effective for seniors or those with impaired kidney function.
Overdosage
Little is known about the effects of cimetidine overdose, but victims may experience exaggerated side effects. Two deaths have occurred. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any drug remaining in 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 cimetidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarette smoking is associated with stomach ulcers and reduces cimetidine’s effectiveness.
Call your doctor at once if you develop any unusual side effects such as bleeding or bruisiiAg, tiredness, diarrhea, dizziness, rash, 131 NMbdinations. Black, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you miss a dose of cimetidine, take it as soon as possible. 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: Animal studies reveal no damage to the fetus, although cimetidine does pass into the fetal blood. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Large amounts of cimetidine pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may need less medication due to loss of kidney function and be more susceptible to side effects, especially confusion and other nervous system effects (see “Cautions and Warnings”).
Aug
1
Cilostazol
August 1, 2009 | Leave a Comment
Generic Name
Cilostazol (sil-oe-STAY-zol) Lq
Brand Name Pletal
Type of Drug Antiplatelet.
Prescribed For Intermittent claudication.
General Information
In intermittent claudication, leg muscles go into spasm due to reduced blood flow. This occurs when plaque buildup narrows blood vessels leading to the calf or other leg muscles. People with this condition often develop leg pain after walking only a short distance. Cilostazol prevents blood platelets from “clumping together” to begin the process of forming a blood clot, which can further obstruct arteries and worsen intermittent claudication. This drug is broken down in the liver.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
?P,Ople with congestive heart failure (CHF) should not take cilostazol. Some studies indicate that long-term use of this drug may cause cardiovascular problems.
People with hemostatic disorders or active pathologic bleeding should not take cilostazil.
Drug Interactions
• Avoid mixing cilostazol with ketoconazole, itraconazole, fluconazole, miconazole, fluvoxamine, fluoxetine, nefazodone, or sertraline because this interaction may slow the breakdown of cilostazol, prolonging its effects. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Aspirin can increase the anticoagulant (blood-thinning) effect of cilostazol, but this combination has not caused serious bleeding problems. There is no information on the effect of combining cilostazol and other antiplatelet or anticoagulant drugs. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Diltiazem increases cilostazol blood levels by about 50%. Cilostazol dosage is reduced by 50% when it is combined with diltiazem.
• Erythromycin and similar antibiotics increase cilostazol blood levels. Take half the regular dose of cilostazol when combining it with any of these drugs.
• Combining cilostazol and omeprazole increases the effects of cilostazol. Cilostazol dosage is reduced by 50% when it is combined with omeprazole.
• Smoking reduces the Olectiveness of cilostazol by causing the liver to break it down faster.
Food Interactions
Take this drug on an empty stomach at least 30 minutes before or 2 hours after meals. Do not drink grapefruit juice at any time while
above. with dosage.
dache, infection, abdominal pain, ab- arrhea.
pitations, rapid heartbeat. dizziness, sea, sore throat, runny nose, back pain, arms or legs.
cough, fainting, and muscle aches. cts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
The risk of side effects
♦ Most common: headache
• stool, and diarrhea. • Common: heart palpitations
• stomach, nausea
• swelling in the
♦ Less common: gas,
♦ Rare: Rare side effects body. Contact your fect not listed taking cilostazol because it can interfere with the breakdown of the drug.
Usual Dose
Adult: 100 mg twice a day. 50 mg twice a day when combined with other drugs that may increase the effect of cilostazol. Child: not recommended.
Overdosage
Symptoms of overdose are likely to be the most common side effects. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Several weeks of cilostazol treatment may be necessary before you notice any improvement in symptoms. Maximum benefit usually occurs after 12 weeks.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that cilostazol may harm the fetus, but there is no information on the effect of cilostazol in pregnant women. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
cilostazol may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors can take this drug without special precaution.
Aug
1
Ciclopirox
August 1, 2009 | Leave a Comment
Generic Name
Ciclopirox (sye-kloe-PERE-ox) &
Brand Names
Loprox Penlac
Type of Drug Antifungal,
Prescribed For
Fungus and yeast infections of the nails and skin, including athlete’s foot, candida, and dandruff.
General Information
Ciclopirox slows the growth of a variety of fungus organisms and yeasts and kills many others. The drug penetrates the skin, hair, hair follicles, and sweat glands. Ciclopirox nail lacquer is used for toenail and fingernail fungus infections. Ciclopirox shampoo is used for dandruff.
Cautions and Warnings
Do not use this product if you are allergic or sensitive to any of its ingredients.
Possible Side Effects
Common: burning, itching, stinging, or oozing at the application site.
Drug Interactions None known.
Usual Dose
Cream/Lotion
Adult and Child (age 10 and over): Massage into cleansed affected skin and surrounding area twice a day.
Nail Lacquer
Adult: Apply to infected nails once a day. Use in conjunction with monthly visits to a health care professional.
Child (under age 10): not recommended.
Shampoo
Adult: Wet hair and apply 1-2 tsp to the scalp. Lather and leave on hair and scalp for 3 minutes, then rinse. Avoid contact with eyes. Repeat twice weekly for 4 weeks.
Child (under age 16): not recommended.
Overdosage
Accidental ingestion may cause nausea and upset stomach. Call your local poison control center or hospital for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
This product can be expected to relieve symptoms within the first week of use. Follow your doctor’s directions for the complete 2-4 week course of treatment with the cream or lotion to gain maximum benefit. The nail lacquer may be used for up to 48 weeks. Stopping the medication too soon can lead to a relapse.
When using ciclopirox nail lacquer, do not apply it to any skin other than that which surrounds the infected nails, because of possible irritation. Do not apply nail polish or any other nail lacquer to infected nails while you are using this product.
Avoid using ciclopirox nail lacquer near an open flame, since the product is flammable.
Do not cover cream or lotion with a bandage.
Call your doctor if the affected area burns, stings, or becomes red after you use this product, 13y i1 your symptoms do not clear Up aher 4 weeks of treatment; by then it is unlikely that this product will be effective.
If you forget a dose of ciclopirox, apply it as soon as you remember. Do not apply more than the amount prescribed to make up for the missed dose.
Special Populations
PregnancylBreast-feeding., ciclopirox may pass to the fetus in very small amounts. In animal studies, high doses of ciclopirox given by mouth did not harm the fetus. Caution should be exercised when using ciclopirox during pregnancy.
It is unknown if ciclopirox passes into breast milk. Nursing mothers who must use this drug should consider using infant formula.
Seniors: Seniors may use this drug without special restriction.
Aug
1
Cholinesterase Inhibitors
August 1, 2009 | Leave a Comment
Type of Drug
Cholinesterase Inhibitors
(KO-lin-ESS-tuh -rase)
Brand Names
Generic Ingredient.- Donepezil
Aricept Aricept ODT
Generic Ingredient: Galantamine
Razadyne Razadyne ER
Generic Ingredient: Rivastigmine
Exelon Exelon Transdermal System
Generic Ingredient: Tacrine Cognex
Prescribed For
Alzheimer’s disease. Also used for vascular dementia, dementia associated with Parkinson’s disease, poststroke aphasia (problems with language), and improvement of memory in multiple sclerosis patients.
General Information
Cholinesterase inhibitors work by increasing the function of certain receptors in the brain that are stimulated by the hosmone acetylcholine. They do t.Ns by interfering with cholinesterase, the 1617yme that breaks down acetylcholine. People with Alzheimer’s disease (a degenerative condition of the central nervous system) develop a shortage of this brain chemical early in the disease. There is no evidence that cholinesterase inhibitors reverse the degenerative effects of Alzheimer’s, but they may slow the rate at which the disease worsens.
Cautions and Warnings
Do not take cholinesterase inhibitors if you are allergic or sensitive to any of their ingredients.
Cholinesterase inhibitors must be discontinued before surgery because they increase the effects of anesthetic drugs.
People with heart disease should use cholinesterase inhibitors with caution because they may slow heart rate and cause fainting. Two studies of people with mild symptoms of Alzheimer’s disease taking galantamine revealed a higher rate of death from heart attack, stroke, or sudden death.
Cholinesterase inhibitors may be expected to cause increased stomach acid production and increased activity of the gastrointestinal tract. Possible complications include ulcers or bleeding. Alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may worsen this effect.
Using cholinesterase inhibitors may also lead to urinary blockage, increase the risk of generalized seizures, and worsen asthma or other pulmonary diseases. Use with caution if you have these conditions.
People with severe liver dysfunction should not take galantamine or tacrine.
Possible Side Effects
People taking cholinesterase inhibitors generally experience side effects at about the same rate as those taking a placebo (sugar pill).
♦ Most common: headache, general pain, accidents, nausea, diarrhea, sleeplessness, and dizziness.
✓ Common: tiredness, vomiting, appetite loss, and muscle cramps.
♦ Less common: arthritis, depression, abnormal dreams, fainting, black-and-blue marks, and weight loss.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cholinesterase inhibitors interfere with anticholinergic drugs (often prescribed for stomach disorders).
• Cholinesterase inhibitors can be expected to increase the ef-
fects of cevimeline, surgical anesthetic drugs, and drugs that
irritate the stomach and intestines, such as aspirin, ibupro-
fen, and other NSAIDs.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be slowed by ketoconazole, itraconazole, quinidine, delavirdine, indinavir, nelfinavir, ritonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, norfloxacin, clarithromycin, diltiazem, erythromycin, fluconazole, fluvoxamine, celecoxib, chlorpheniramine, clomipramine, cocaine, doxorubicin, fluoxetine, halofantrine, halopendol, levopromazine, methadone, mibefradil, paroxetine, ranitidine, terbinafine, mifepristone, nefazodone, and grapefruit juice.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be increased by efavirenz, nevirapine, barbiturates, carbamazepine, corticosteroids, phenytoin, pioglitazone, and rifampin.
Food Interactions
Donepezil can be taken with or without food.
Galantamine and rivastigmine should be taken with morning and evening meals.
The rivastigmine transdermal system patch can be used without regard to meals.
Food reduces the absorption of tacrine into the blood. It is best taken on an empty stomach, but you can take it with food if it upsets your stomach.
Usual Dose
Donepezil
Adult: 5 or 10 mg once a day.
Galantamine
Adult: 8-32 mg a day.
Rivastigmine
Adult: 3-12 mg a day, divided into 2 doses.
RiVUtq1M&A0Y2nsdermaI patch
Adult: Apply one 4.6-mg patch every day to start. Dose may be increased to one 9.5-mg patch every day.
Tacrine
Adult: 40-160 mg a day, divided into 4 doses.
Overdosage
Cholinesterase inhibitor overdose can be very serious. Symptoms include severe nausea, vomiting, salivation, sweating, slow heart rate, low blood pressure, slow breathing rate, convulsions, muscle weakness, and collapse. Take the overdose victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Donepezil should be taken just before bedtime.
Follow the special package directions for rivastigmine solution.
Do not remove the rivastigmine patch from its packaging until just before you are ready to apply it. Apply the patch to clean, dry, and hairless skin on the upper or lower back, upper arm, or chest that is also free of any powder, oil, moisturizer, or lotion that could keep the patch from sticking to your skin properly; skin should also be free of cuts, rashes, and irritations. Avoid places where the patch can be rubbed off by tight clothing. When changing your patch, apply your new patch to a different spot of skin (for example, on the right side of your body one day, then on the left side the next day). Do not use the same spot more than once every 14 days. Wear only one patch at a time and change it every.24 hours. If the patch falls off, apply a new patch for the rest of the day, then replace the patch the next day at the same time as usual.
Tobacco or nicotine use increases the rate at which tacrine and rivastigmine are cleared from the body.
If you forget a dose and take your medication once a day, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with the regular schedule. If you take your medication 2 or more times a day, take your dose as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: One animal study of a cholinesterase inhibitor indicated a small risk of birth defects. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
It is not known if cholinesterase inhibitors pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with moderate kidney function loss should not take galantamine. Dosage adjustments are not needed for donepezil, tacrine, or rivastigmine.
Aug
1
Chlorzoxazone
August 1, 2009 | Leave a Comment
Generic Name
Chlorzoxazone (klor-M-uh-zone)
Brand Names
Parafon Forte DSC Strifon Forte DSC
Type of Drug
Skeletal muscle relaxant.
Prescribed For
Pain and spasm of muscular conditions, including strain, sprain, bruising, and lower back problems.
General Information
Chlorzoxazone works primarily on the spinal cord level and on the brain, acting as a mild sedative. This results in fewer spasms, less pain, and greater mobility. Chlorzoxazone provides only temporary relief and is not a substitute for other types of therapy, such as rest, surgery, and physical therapy.
Cautions and Warnings
Do not take chlorzoxazone if you are allergic or sensitive to any of its ingredients, or if you have a condition known as porphyria.
People with poor liver or kidney function should take this drug with caution because serious liver toxicity has rarely occurred in people using chlorzoxazone.
Chlorzoxazone may interact with other drugs that cause nervous system depression (see “Drug Interactions”).
Because it is possible to become dependent on this drug, people with a history of substance abuse should take chlorzoxazone with caution.
Possible Side Effects
♦ Most common: dizziness, drowsiness, lightheadedness, malaise, and aveTStimulation,
♦ Less common: headache, stomach cramps or pain, diar-
rhea, constipation, heartburn, nausea, and vomiting.
• Rare: internal bleeding, liver problems, severe allergic-type skin reactions, and breathing problems. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• The depressive effects of chlorzoxazone may be enhanced by taking it with alcohol, sedatives, sleeping pills, or other nervous system depressants. Avoid these combinations.
Food Interactions
Take this drug with food if it upsets your stomach. The tablets may be crushed and mixed with food.
Usual Dose
Adult: 250-750 mg 3-4 times a day. Child: 125-500 mg 3-4 times a day.
Do not take more medication than is prescribed.
Overdosage
Early signs of chlorzoxazone overdose may include nausea, vomiting, diarrhea, drowsiness, dizziness, lightheadedness, and headache. Victims may also feel sluggish or sickly and lose the ability to move their muscles. Breathing may become slow or irregular, and blood pressure may drop. Contact a doctor immediately or go to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Chlorzoxazone may make you drowsy or reduce your ability to concentrate. Be extremely careful while driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorzoxazone may turn your urine orange to purple-red; this is not dangerous.
Call your doctor if you develop drowsiness, weakness, an allergic reaction, skin rash or itching, breathing difficulties, black or tarry stools, vomiting of material that resembles coffee grounds, liver problems, or any other severe or bothersome side effect.
4f you miss a dose of chlorzoxazone by more than an hour, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of chlorzoxazone in pregnant women has not been established. Pregnant women should only take chlorzoxazone after carefully weighing its potential benefits against its risks.
It is not known if chlorzoxazone passes into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors, especially those with severe liver disease, are more sensitive to the effects of chlorzoxazone.
Jul
16
Allopurinol
July 16, 2009 | Leave a Comment
Generic Name
Allopurinol (al-oe-PURE-in-nol)
Brand Name Zyloprim
Type of Drug
Antigout medication.
Prescribed For
Gout or gouty arthritis; also prescribed to counter the effects of certain therapies for cancer, ulcers, abnormal heart rhythms in heart bypass patients, seizures, and other conditions that may be associated with too much uric acid in the body.
General Information
Unlike other antigout drugs, which affect the elimination of uric acid from the body, allopurinol acts on the system that manufactures uric acid in your body. A high level of uric acid can indicate that you have gout, psoriasis, cancer, or any of a number of other diseases. High levels of uric acid can also be caused by taking certain drugs.
In mouthwash form, allopurinol helps to prevent mouth, stomach, and intestinal ulcers caused by fluorouracil, an antineoplastic drug. Allopurinol may be given before heart bypass surgery to reduce abnormal rhythms and other surgical complications. It can be used to reduce the relapse rates of duodenal ulcers associated with Helicobacter pylori infection and to reduce the vomiting of blood from stomach irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Allopurinol has also been used to control seizures in people for whom standard treatments are not effective.
Cautions and Warnings
Do not take allopurinol if you are allergic or sensitive to any of its ingredients, or if you have ever developed a severe reaction to it. Stop taking the medication immediately and contact your doctor if you develop a rash or any other adverse effects while taking allopurinol. Do not start taking allopurinol again if you stopped it because of a severe reaction.
Allopurinol should be used by children only if they have high uric acid levels due to neoplastic disease or to rare metabolic conditions.
A few cases of liver toxicity have been associated with allopurinol; they improved when the drug was stopped. People taking allopurinol should periodically be tested for liver and kidney function. People with severely compromised kidney function should ake a reduced dose of allopurinol.
Possible Side Effects
✓ Most common: rash associated with severe, allergic, or sensitivity reaction to allopurinol. If you develop an unusual rash or other sign of drug toxicity, stop taking this medication and contact your doctor.
✓ Less common: nausea, vomiting, diarrhea, intermittent stomach pain, gas, upset stomach, headache, insomnia, tingling or numbness in the hands and feet, muscle or joint pain, and drowsiness or lack of ability to concentrate.
✓ 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
• Large doses of drugs that make your urine more acidic, like megadoses of vitamin C, may increase the risk of kidney stone formation.
• Alcohol, diazoxide, mecamylamine, or pyrazinamide can increase the amount of uric acid in your blood; an increase in your allopurinol dose may be required.
• Allopurinol may increase the action of azathioprine, mercaptopurine, or cyclophosphamide and other anticancer drugs, leading to possible toxicity, bleeding, or infection.
• Allopurinol may prolong the effects of chloropropamide, and can lead to hypoglycemic reactions in patients with kidney disease.
• Taking allopurinol with probenecid or sulfinpyrazone may cause excessive reduction of uric acid.
• Allopurinol may interact with some anticoagulant (blood-thinning) medications, reducing the rate at which the anti-coagulant is broken down in the body. Dosage reduction may be necessary.
• People who are susceptible to ampicillin, amoxicillin, bacampicillin, or hetacillin rash are more likely to develop such a reaction while also taking allopurinol.
• Combining a thiazide diuretic or an ACE inhibitor (for high blood pressure or heart failure) with allopurinol increases the risk of a drug-sensitivity reaction.
• Combining vidarabine with allopurinol may increase the risk of neurotoxic effects and anemia, nausea, pain, and itching.
• Large doses of allopurinol—more than 600 mg a day—may increase the effects of and risk of toxic reactions to theophylline by interfering with its clearance from the body.
Food Interactions
Take each dose with food or a full glass of water. Drink 10-12 glasses of water, juices, soda, or another liquid each day to avoid the formation of crystals in your urine or kidneys.
Usual Dose
Adult and Child (age 11 and over): 100-800 mg a day, depend-, ing on disease and response.
Child (age 6-10): 300 mg a day.
Child (under age 6): 150 mg a day.
The dose should be reviewed periodically by your doctor to be sure that it is producing the desired therapeutic effect.
Overdosage
The expected symptoms of overdose are exaggerated side effects. Allergic skin reactions to allopurinol can be severe and at times fatal. Allopurinol overdose victims should be taken to a hospital. ALWAYS bring the prescription bottle or container.
Special Information
Allopurinol can make you drowsy or make it difficult to concentrate: Take care while driving a car or operating hazardous equipment.
Gout attacks may actually increase during the first few months of taking allopurinol. These attacks should subside.
Call your doctor at once if you develop rash, hives, itching, chills, fever, nausea, muscle aches, unusual tiredness, fever, yellowing of the whites of the eyes or skin, painful urination, blood in the urine, irritation of the eyes, or swelling of the lips or mouth.
Avoid large doses of vitamin C, which can cause the formation of kidney stones during allopurinol treatment. Be sure to drink 1012 8-oz. glasses of water a day while taking this medication.
If you forget to take a dose of allopurinol, take it as soon as possible. If it is almost time for your next regular dose, double this dose. For example, if your regular dose is 100 mg and you miss a dose, take 200 mg at the next usual dose time.
Special Populations
Pregnancy/Breast-feeding: Allopurinol may cause birth defects or interfere with fetal development. Check with your doctor before taking it if you are or might be pregnant.
Allopurinol passes into breast milk. Nursing mothers who must take allopurinol should use infant formula.
Seniors: No special precautions are required. Follow your doctor’s directions and report any side effects at once.
Jul
16
Aliskiren
July 16, 2009 | Leave a Comment
Generic Name
Aliskiren (ah-LISS-kih-ren)
Brand Name Tekturna
Combination Product
Generic Ingredients: Aliskiren + Hydrochlorothiazide Tekturna HCT
Type of Drug
Direct renin inhibitor. Prescribed For
High blood pressure.
General Information
Renin is produced by the kidney in response to a reduction in blood volume and the amount of blood passing through the kidney. Once in the blood, renin reacts with other hormones to forma very powerful blood vessel constrictor called angiotensin E that directly raises blood pressure. Renin also works with a hormore called aldosterone to raise blood pressure and it prevents sodium from being eliminated from the body. This increases the amount of water in the system, raising blood volume and increasing blood pressure. Aliskiren inhibits renin and all of its actions, thereby !owering blood pressure. The blood pressure lowering is usually seen with 2 weeks of starting on treatment. When aliskiren treatment is stopped, blood pressure gradually rises to pre-treatment levels. Only about 21/2% of any dose is absorbed into the blood and it takes about a week to reach a steady level in the blood. Most of the drug that is absorbed is broken down in the liver. The rest passes out of the body unchanged in the urine. Aliskiren may be used alone or with other hypertensives, however its use with maximum doses of an ACE inhibitor has not been adequately studied.
Cautions and Warnings
Do not take aliskiren if you are allergic or sensitive to any of its ingredients.
Angioedema swelling of the face, hands or feet, tongue, or throat can occur at any time during aliskiren treatment. If this happens, stop taking the medicine and go to your doctor’s office or a hospital emergency room for treatment. This reaction can interfere with your breathing.
The safety of aliskiren in people with moderate to severe kidney disease is not known.
The combination of aliskiren and an ACE inhibitor can lead to high blood levels of potassium.
Aliskiren may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, it should still be considered a useful blood pressure treatment.
Possible Side Effects
✓ Common: nausea, dizziness, and sleeplessness.
✓ Less common: diarrhea, abdominal pain, upset stomach, GERD, cough, rash high blood uric acid levels, gout, kidney stones, headache, nose and throat irritation, fatigue, upper respiratory infection, and back pain.
✓ Rare: difficulty breathing; swelling of the hands, face, eyes, or whole body; and seizures. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Mixing aliskiren with irbesartan can reduce the amount of aliskiren into the blood by 50%. This may reduce the effectiveness of aliskiren.
• Aliskiren has been studied together with both hydrochlorothiazide and valsartan and can be combined with them in blood pressure management. It has been used with amlodipine but may not be better than high dose amlodipine alone.
• Aliskiren’s interaction with ACE inhibitors is not yet fully known.
• Atorvastatin and ketoconazole slow the breakdown of aliskiren, resulting in an increase of aliskiren blood levels by 50% or more. Dosage adjustment may be necessary.
Aliskiren can reduce blood levels of the diuretic furosemide, reducing the diuretic’s effect.
Food Interactions
Aliskiren can be taken without regard to food or meals. Avoid taking it with high fat meals because they can drastically reduce the amount of aliskiren absorbed into the blood.
Usual Dose
Adult (age 18 and over)
Tekturna: 50-300 mg at the same time every day. Tekturna HCT. 1 tablet a day.
Child: not recommended. Overdosage
The most likely symptom of overdose is low blood pressure (symptoms include dizziness and fainting). If you think you have taken an overdose, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor at once if you develop swelling of the face, eyes, lips, tongue, or throat; difficulty swallowing or breathing; hoarseness; or other signs of a drug reaction or allergy.
If you forget a dose, take it as soon as you remember. If you do not remember until 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: Aliskiren can injure or kill a developing fetus. Pregnant women should not take aliskiren. Women who suspect they are pregnant must call their doctor at once and stop taking aliskiren when pregnancy is confirmed. In those rare cases where aliskiren is considered life-saving for the mother and there is no substitute for aliskiren, your doctor may advise that you continue on the medicine and then check your baby’s development with periodic ultrasound examinations.
It is not known if this drug passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may have higher blood levels of aliskiren and be more susceptible to drug side effects, but starting dose adjustment is not required.
Jul
16
Aggrenox
July 16, 2009 | Leave a Comment
Brand Name
Aggrenox
Generic Ingredients
Dipyridamole + Aspirin
Type of Drug Antiplatelet.
Prescribed For
Prevention of recurrent stroke or transient ischemic attack (TIA)— “mini-stroke.”
General Information
Stroke is often the result of a clot blocking flow in a blood vessel supplying the brain. Aggrenox helps prevent blood clot formation by reducing the “stickiness” of platelets, blood cells that stick together to form the beginnings of all clots. In one study, Aggrenox reduced the risk of stroke by over 30% compared to placebo in people who had recently had a stroke or TIA.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients or any nonsteroidal anti-inflammatory drug (NSAID). People who have asthma, nasal polyps, or chronic runny nose, are likely to be sensitive to aspirin.
The aspirin in Aggrenox can cause Reye’s syndrome, a severe reaction (vomiting, lethargy, and belligerence, and possibly worsening to coma) in children under age 16.
People with a history of stomach ulcers or stomach problems should avoid Aggrenox.
People who have angina or have had a recent heart attack should be very cautious about taking this drug. It may worsen chest pain.
People with low blood pressure, liver disease, or kidney failure should be cautious about taking this drug.
People taking Aggrenox may bleed for longer amounts of time. Those with bleeding disorders should avoid Aggrenox.
Possible Side Effects
✓ Most common: headache, upset stomach, abdominal pain, nausea, and diarrhea.
✓ Common: pain, tiredness, and vomiting.
✓ Less common: convulsions, rectal bleeding, blood in the stool, hemorrhoids, back pain, accidental injuries, stomach bleeding, feeling unwell, weakness, fainting, memory loss, arthritis, joint or muscle pain, coughing, and respiratory infection.
✓ 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
• Avoid alcohol. People who take 3 or more drinks a day while using any aspirin-containing product are more likely to develop stomach ulcers or bleeding.
• Aspirin may reduce the blood-pressure-lowering effects of angiotensin-converting enzyme (ACE) inhibitor drugs, beta blockers, and diuretics.
• Combining aspirin and acetazolamide or an NSAID can cause kidney problems.
• Aspirin can increase the blood-thinning effects of anticoagulant (blood-thinning) drugs such as warfarin. Avoid this combination.
• Aspirin can increase the effects of oral antidiabetes drugs, possibly leading to low blood sugar.
• Aspirin counteracts the uric-acid-eliminating effects of probenecid and sulfinpyrazone.
• Aspirin can increase the toxic effects of anticonvulsant drugs and methotrexate.
• Dipyridamole increases the level of adenosine in the blood and may increase cardiovascular-related side effects. The adenosine dosage may need to be adjusted when these two drugs are combined.
• Dipyridamole may interfere with cholinesterase inhibitors used to treat myasthenia gravis.
Food Interactions
Aggrenox is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 1 capsule (200 mg of sustained-release dipyridamole and 25 mg of aspirin) morning and evening.
Child: not recommended.
Overdosage
Symptoms include a sensation of warmth, flushing, sweating, restlessness, weakness, dizziness, low blood pressure, and rapid heartbeat. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you experience blood in your stool, persistent diarrhea, or abdominal or stomach pain.
Avoid alcohol while taking this drug.
In people taking Aggrenox, minor cuts may take longer than normal to stop bleeding.
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.
Swallow Aggrenox tablets whole; do not crush or chew them.
Special Populations
Pregnancy/Breast-feeding: Pregnant women should avoid Aggrenox because of its aspirin content. Aspirin can cause bleeding problems in mother and fetus and result in a low-birth-weight infant. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Both ingredients in Aggrenox pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may need a reduced dose of Aggrenox.
Jul
16
Adapalene
July 16, 2009 | Leave a Comment
Generic Name
Adapalene (uh-DAP-uh-lene)
Brand Name Differin
Type of Drug Anti-acne.
Prescribed For Acne.
General Information
Adapalene is similar to a retinoid. Retinoids are compounds related to vitamin A and are used in acne treatment. When adapalene is applied to an acne lesion, it modifies several of the processes involved in skin cell function. It reduces inflammation in the acne lesion and slows the formation of the material that fills the lesion. Very little adapalene is absorbed through the skin.
Cautions and Warnings
Do not use adapalene if you are allergic or sensitive to any of its ingredients. If you are sunburned, wait until your sunburn clears before applying adapalene to your skin. Avoid sun or sunlamp exposure while using adapalene. If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas where you have applied adapalene. Extreme wind or cold can also be irritating to skin where adapalene has been applied.
Adapalene can irritate the skin if used in combination with products such as medicated or abrasive soaps or cleansers, astringents, or soaps and cosmetics with a strong drying effect. Avoid products containing sulfur, resorcinol, or salicylic acid.
Adapalene can be highly irritating if it gets into your eyes or if it is applied to your lips, the angles of your nose, mucous membranes, cuts, abrasions, or sunburned or damaged skin. Avoid using depilatories or waxing while using adapalene.
Possible Side Effects
V Most common: redness, irritation, dryness, scaling, itching, and burning are common after applying adapalene to your skin. These effects usually occur during the first 24 weeks of adapalene use and subside as treatment continues. Symptoms may be severe enough to cause you to stop using adapalene; call your doctor if this happens to you.
V Rare: skin irritation, stinging sunburn, and worsening acne. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
None known.
Usual Dose
Adult and Child (age 12 and over): Wash affected areas with a mild or soapless cleanser and apply a thin layer of adapalene at bedtime.
Child (under age 12): not recommended.
Overdosage
Chronic ingestion of adapalene can cause liver toxicity and other side effects associated with swallowing large amounts of vitamin A. Swallowing adapalene gel is extremely dangerous for pregnant women, who should not take more vitamin A than is contained in their prenatal vitamins. Infants who swallow adapalene should be taken to a hospital emergency room for treatment.
Special Information
Stop using adapalene and call your doctor if you develop a severe skin reaction or any sign of drug allergy or reaction (symptoms include rash, hives, itching, changes in complexion, and breathing difficulties or irregularities).
Adapalene may exacerbate your acne at first, but you should see improvement within 2 weeks.
If you must be in the sun, be sure to apply sunscreen or wear protective clothing over areas to which you have applied adapalene.
Using more than a thin film of adapalene does not produce better results and may be more irritating to the skin.
If you forget to apply a dose of adapalene, apply it as soon as you remember. If it is almost time for your next application of adapalene, skip the dose you forgot and continue with your regular schedule.
Special Populations
PregnancylBreast-feeding., Animal studies of adapalene have shown no effects on the fetus. Since the effect of adapalene on pregnant women is not known, the drug should be used only when the possible benefits outweigh the risks.
It is not known if adapalene passes into breast milk. Nursing mothers should use infant formula.
Seniors: Seniors may use this drug without special precautions.