Aug
13
Flecainide - Flucytosine - Fluoroquinolone - Fluoxymesterone - Flurazepam - Flutamide
August 13, 2009 | Leave a Comment
Generic Name
Flecainide (FLEH-kan-ide) E
Brand Name Tambocor
Type of Drug Antiarrhythmic.
Prescribed For
Abnormal heart rhythm. General Information
Flecainide is prescribed in situations where the abnormal heart rhythm is so severe as to be life-threatening and the patient does not respond to other drug treatments. Like other antiarrhythmic drugs, flecainide works by affecting the movement of nervous impulses within the heart. Flecainide’s effects may not become apparent for 3-4 days after you start taking it.
Cautions and Warnings
Do not take flecainide if you are allergic or sensitive to any of its ingredients or if you have heart block, unless you have a cardiac pacemaker. As with other antiarrhythmic drugs, there is no proof that flecainide helps people live longer or avoid sudden death.
Flecainide causes or worsens arrhythmias m 7% 0 people who take it; this, tks’ , imTeases with certain kinds of underlying heart disease and higher doses of the drug. Flecainide causes or worsens heart failure in about 5% of people taking it because it tends to reduce the force and rate of each heartbeat.
Flecainide is extensively broken down in the liver. People with poor liver function should not take flecainide unless the benefits clearly outweigh the risks.
Changes in the pH of urine may affect the effectiveness of flecainide.
Possible Side Effects
♦ Most common: dizziness, fainting, lightheadedness, unsteadiness, visual disturbances including blurred vision and seeing spots before the eyes, breathing difficulties, headache, nausea, fatigue, heart palpitations, chest pain, tremors, weakness, constipation, bloating, a bad taste in your mouth, and abdominal pain.
♦ Less common: new or worsened heart arrhythmias or heart failure, heart block, slowed heart rate, vomiting, diarrhea, upset stomach, loss of appetite, stomach gas, dry mouth, tingling in the hands or feet, partial or temporary paralysis, loss of muscle control, flushing, sweating, ringing or buzzing in the ears, anxiety, sleeplessness, depression, not feeling well, twitching, weakness, convulsions, speech disorders, stupor, memory loss, personality loss, nightmares, apathy, eye pain, unusual sensitivity to bright light, sagging eyelids, reduced white-blood-cell or blood-platelet counts, impotence, reduced sex drive, frequent urination, urinary difficulty, itching, rash, fever, muscle ache, closing of the throat, and swollen lips, tongue, or mouth.
Drug Interactions
• The combination of propranolol and flecainide may cause an exaggerated lowering in heart rate. Other drugs that slow the heart may also interact with flecainide to produce an excessive slowing of heart rate.
• Avoid megadoses of vitamin C while taking this drug.
• The amount of flecainide in your blood and its effect on your heart may be increased if it is taken together with cimetidine, disopyramide, or verapamil.
• YQW dXSz, 0 ‘i’lecainide should be halved when given with amiodarone.
• Smokers may need a larger dose of flecainide than nonsmokers.
• Flecainide may increase the amount of digoxin in the bloodstream, increasing the chance of side effects.
Food Interactions
A strict vegetarian diet and anything that makes urine less acid interferes with flecainide’s elimination from the body, increasing drug
toxicity. Usual Dose
Adult: starting dose-50-100 mg every 12 hours. Maximum dosage is 400 mg a day.
Child (under 18 years): not recommended.
Overdosage
Flecainide overdose affects heart function, causing slower heart rate, low blood pressure, and possible death from respiratory failure. Victims of flecainide overdose should be taken.to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Flecainide can make you dizzy, lightheaded, or disoriented. Take care while driving or performing complex tasks.
Call your doctor if you develop chest pains, an abnormal heartbeat, breathing difficulties, bloating in your feet or legs, tremors, fever, chills, sore throat, unusual bleeding or bruising, yellowing of the whites of your eyes, or any other intolerable side effect.
If you forget to take a dose of flecainide and remember within 6 hours, take it as soon as possible. If you do not remember until later, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: At high doses, flecainide damages an animal fetus. When this drug is considered crucial by your doctor, its potential benefits must be weighed against its risks.
Flecainide passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with reduced kidney or liver functkcm -aye more likely to develop si(je, eip,,ZkS and require a lower dosage.
Generic Name
Flucytosine (floo-SYE-toe-sene)
Brand Name Ancobon
Type of Drug Antifungal.
Prescribed For
Serious blood-borne fungal infections.
General Information
Flucytosine is meant for fungal infections—Candida, chromomycoses, and cryptococcus—carried in the blood that affect the urinary tract, respiratory tract, central nervous system, heart, and other organs. It is not meant for fungal infections of the skin, such as common athlete’s foot.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
People with kidney disease must be closely monitored by their doctors and should take this medication with extreme caution; daily dosage must be reduced.
Flucytosine can worsen bone-marrow depression in people whose itnR1US1Q Systems are already compromised. Liver and kidney function and blood composition should be monitored while you are taking this drug.
The safety and efficacy of flucytosine have not been established in children.
Possible Side Effects
V Most common: unusual tiredness or weakness, liver inflammation, yellowing of the eyes or skin, abdominal pain, diarrhea, loss of appetite, nausea, vomiting, rash, redness, itching, sore throat, fever, and unusual bleeding or bruising.
V Less common: chest pains, breathing difficulties, sensitivity to the sun or bright light, dry mouth, duodenal ulcers, severe bowel irritation, stomach bleeding, interference with kidney function, kidney failure, reduced red- and whiteblood-cell counts or other changes in blood composition, headache, hearing loss, confusion, dizziness, weakness, shaking, sedation, psychosis, hallucinations, heart attack, and low blood-sugar and potassium levels.
Drug Interactions
• Amphotericin B increases flucytosine’s effectiveness: this
combination is generally used to produce better results.
• Flucytosine may interfere with some routine blood tests.
• Cytosine may inactivate the antifungal activity of flucytosine.
Food Interactions
Take flucytosine with food if it upsets your stomach.
Usual Dose
22-66 mg per lb. a day, in divided doses.
Overdosage
Little is known about the effects of flucytosine overdose, but it may cause exaggerated drug side effects. If you seek treatment at a hospital, ALWAYS bring the prescription bottle or container.
Special Information
Take the capsules a few at a time over 15 minutes to avoid nausea and vomiting.
Call your doctor if you develop unusual tiredness or weakness; yellowing of the skin or whites of the eyes; rash, redness, or itching; so(Q %Toal or fever; unusual bleeding or bruising; or any persistent or intolerable side effect.
Maintain good dental hygiene while taking flucytosine. Use extra care when using your toothbrush or dental floss because of the risk that flucytosine will make you more susceptible to infection. Dental work should be completed prior to starting on this drug.
FLUOROQUINOLONE ANTI-INFECTIVES
Exposure to sunlight may cause rash, itching, redness, discoloration of the skin, or severe sunburn. Stay out of direct sunlight when taking flucytosine.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 3 or 4 hours, then go back to your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Flucytosine causes birth defects in animals and crosses the placenta. Flucytosine should be used by pregnant women only when its potential benefits clearly outweigh its risks.
It is not known if flucytosine passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Dosage adjustment may be required due to age-related loss of kidney function.
Type of Drug
Fluoroquinolone Anti-Infectives
(flor-oe-OUIN-oc-lone)
Brand Names
Generic Ingredient: CiproftoxacinIGI
Ciloxan Eyedrops Cipro XR
Cipro Proquin XR
Generic Ingredient: Gatifloxacin Zymar Eyedrops
Generic Ingredient: Gemifloxacin Factive
Generic Ingredient: Levofloxacin A
Iquix Eyedrops QtAy’ ” Eyedrops
LevackujR
Generic Ingredient: Lomefloxacin Maxaquin
Generic Ingredient: Moxifloxacin
Avelox Vigamox Eyedrops
Generic Ingredient: Norfloxacin
Noroxin
Generic Ingredient: Ofloxacin 92
Floxin Ocuflox Eyedrops
Floxin Otic
Prescribed For
Infections of the lower respiratory system, sinuses, urinary tract, skin, bone and joints, lungs, and prostate; also prescribed for sexually transmitted diseases, prostatitis, infectious diarrhea, bronchitis, pneumonia, typhoid fever, anthrax, and traveler’s diarrhea. The eyedrops are used to treat ocular infections, the eardrops for ear infections.
General Information
Fluoroquinolone anti-infectives work against many organisms that traditional antibiotics have trouble killing. They do not work against the common cold, flu, or other viral infections. The fluoroquinolones were first used as treatment for urinary infections and then other uses developed over the years. The new uses depend on how well the specific drug penetrates different body tissues as well as on how they have been tested in the laboratory. Individual fluoroquinolones are not all equally effective in treating all infections.
Cautions and Warnings
Do not take a fluoroquinolone if you are allergic or sensitive to any of its ingredients, or to any drug in this group, or have had a reaction to related medications such as nalidixic acid. Severe, possibly fatal, allergic reactions can occur even after the very first dose. These reactions include cardiovascular collapse, loss of consciousness, tingling, swelling of the face or throat, breathing difficulties, itching, and rash. Stop taking the drug if you experience allergic symptoms and seek medical help at once.
Fluoroquinolones may cause increased pressure on parts of the brain, leading to convulsions and psychotic reactions. Other possiblp. tIWA include tremors, restlessness, lightheadedness, confusion, and hallucinations. Fluoroquinolones should be used with caution in people with head trauma, seizure disorders, or other nervous system conditions.
Moxifloxacin should not be used by people with liver disease.
Moxifloxacin should be avoided by people with heart rhythm problems or those taking drugs that can affect heart rhythm.
People with kidney disease require reduced dosage of these drugs, except in the case of moxifloxacin.
People taking fluoroquinolones may be unusually sensitive to the sun. Avoid the sun while taking this drug and for several days following therapy, even if you are using sunscreen.
People taking a fluoroquinolone may develop colitis that could range from mild to very serious. Contact your doctor if you develop diarrhea or cramps.
Fluroquinolones can worsen myasthenia gravis. Use with caution.
Prolonged fluoroquinolone use can lead to fungal overgrowth.
Patients taking a fluoroquinolone may experience ruptures of the shoulder, hand, Achilles tendon, or other tendons that may require surgery or lead to extended disability.
Possible Side Effects
Side effects are rarely serious.
♦ Common: nausea (most likely with ciprofloxacin and moxifloxacin), vomiting, and diarrhea (may be most likely with moxifloxacin and ofloxacin).
✓ Less common: dizziness, abdominal pain, headache, and liver inflammation.
✓ Rare: Rare side effects, including some severe drug reactions, can occur in almost any part of the body. In once-daily studies of ciprofloxacin eardrops, there were a few reports of nausea, formation of flaky scales, inflammation of the external ear, temporary hearing loss, ringing or buzzing in the ears, middle-ear inflammation, tremors, high blood pressure, and fungal infection. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Separate your fluoroquinolone dose from that of antacids, didanosine, iron supplements, or zinc by 2-6 hours. These drugs decrease the amount of fluoroquinolone absorbed. Moxifloxacin must be taken 4 hours before or 8 hours after antacids, iron, or zinc.
• Nitrofurantoin may antogonize norfloxacin’s antibacterial effects. Do not take these drugs together.
• Moxifloxacin can increase the risk of abnormal heart rhythms.
Combining this drug with astemizole, erythromycin, tricyclic
antidepressants, and antipsychotics increases the risk of ab-
normal heart rhythms associated with this drug.
• People taking drugs to correct abnormal heart rhythms should avoid Fluoroquinolones.
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and anti-inflammatory drugs should not be combined with fluoroquinolones because of the increased risk of stimulation and seizures.
• Sucralafate reduces the amount of fluoroquinolone absorbed in the blood. Take sucralafate at least 6 hours after taking a fluoroquinolone.
• Probenecid may increase the risk of some fluoroquinolone side effects. Cimetidine may also increase fluoroquinolone blood levels.
• Fluoroquinolones (except moxifloxacin) may increase the effect of oral anticoagulant drugs such as warfarin. Your anticoagulant dosage may have to be reduced.
• Fluoroquinolones may increase the toxic effects of cy-
closporine (used for organ transplants) on your kidneys.
• Fluoroquinolones (except moxifloxacin) may increase theophylline blood levels and the risk of side effects.
• Azlocillin may increase the risk of ciprofloxacin side effects.
• Ciprofloxacin and norfloxacin may increase caffeine’s effects.
Food Interactions
Levofloxacin, lomefloxacin, and moxifloxacin may be taken with or without food. Take ofloxacin and norfloxacin at least 2 hours before or 2 hours after meals or antacids. Ciprofloxacin is best taken 1 hour before or 2 hours after meals, but may be taken with food. Dairy products and calcium-fortified orange juice interfere with the absorption of ciprofloxacin and should be avoided.
Usual Dose
Check with your doctor if you suffer from kidney failure as your fluoroquinolone dosage may need to be reduced.
Tablets
Adult
Ciprofloxacin: 100-750 mg twice a day. Ciprofloxacin XR: 1000 mg once a day.
Gemifloxacin: 320 mg once a day. Levotioxacin: 250-750 mg once a day.
Lomefloxacin: 400 mg a day. Moxifloxacin: 400 mg a day.
Norfloxacin: 400 mg every 12 hours; a single dose of 800 mg
may be taken for gonorrhea. Ofloxacin: 200-400 mg every 12 hours.
Child: not recommended.
Eyedrops
Ciprolloxacin: 1-2 drops in the affected eye several times a day.
Gatifloxacin: days 1-2-2 drops in the affected eye every 2 hours while awake, up to 8 times a day, then 4 times a day for the next 5 days.
Levofloxacin: days 1-2-1-2 drops in the affected eye every 2 hours while awake, up to 8 times a day. Days 3-7-1-2 drops in the affected eye every 4 hours while awake, up to 4 times a day.
Moxifloxacin: 1 drop in the affected eye 3 times a day for I week.
Ofloxacin: bacterial conjunctivitis—days 1-2, place 1-2 drops in the affected eye every 2-4 hours while awake; days 3-7, place 1-2 drops in the affected eye every 4-6 hours while awake. Bacterial corneal ulcer—days 1-2, place 1-2 drops in the affected eye every 30 minutes while awake; awaken 4-6 hours after you go to sleep for one more dose; days 3-7 or 9, place 1-2 drops in the affected eye every hour while awake; days 7-9, or through the end of treatment, place 1-2 drops in the affected eye 4 times a day.
Eardrops
Ofloxacin: 5-10 drops in the affected ear twice a day.
Overdosage
Overdose symptoms generally mimic drug side effects. Overdose may cause kidney failure and, in the case of moxifloxacin, abnormal heart rhythms. Call your local poison control center or a hospital emergency room for more information. You may be, koNO to induce vomiting with ipecac syrup—available at any pharmacybefQ(e, %’Kmg the victim to an emergency room. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Take each dose with a full glass of water. Be sure to drink at least 8 glasses of water a day while taking any of these drugs to help avoid kidney side effects.
Drug sensitivity reactions can develop even after only 1 dose. Stop taking the drug and get immediate medical attention if you feel faint or develop itching, rash, facial swelling, breathing difficulties, convulsions, depression, visual disturbances, dizziness, headache, lightheadedness, or any sign of a drug reaction.
Colitis can be caused by any anti-infective medication. If diarrhea develops, call your doctor at once.
Avoid excessive sunlight. Call your doctor if you become sensitive to the sun.
Call your doctor if you experience pain, inflammation, or rupture of a tendon.
Follow your doctor’s directions exactly. Complete the full course of drug therapy, even if you feel well.
Eyedrops
To avoid infection, do not let the eyedropper tip touch your finger, eyelid, or any surface. Wait 5 minutes before using another eye-drop or eye ointment.
Call your doctor at once if your vision declines or if eye stinging, itching or burning, redness, irritation, swelling, or pain worsens.
Fluoroquinolones can cause changes in vision, dizziness, drowsiness, and lightheadedness. Be careful when driving or performing any task that requires concentration.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies have shown that fluoroquinolones may damage the fetus or reduce the likelihood of a successful pregnancy. When a fluoroquinolone is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Fluoroquinolones pass into breast milk. Nursing mothers who must take them should use infant formula.
Seniors: With the exception of moxifloxacin, seniors may require reduced dosage due to age-related decreases in kidney function. The risk of a ruptured tendon may increase in seniors, especially those taking a corticosteroid. In the case of eyedrops, seniors may also need less medication.
Generic Name
Fluoxymesterone (flue-OX-ee-MES-ter-one)
Brand Name Halotestin
Type of Drug
Androgen (male hormone).
Prescribed For
Men: hormone replacement or augmentation and male menopause; also prescribed as male contraception for up to 12 months, and for delayed puberty.
Women: breast pain and fullness in women who have given birth, and certain types of breast cancer.
General Information
Fluoxymesterone is an androgen. Androgens are responsible for the normal growth and development of male sex organs and for maintaining secondary sex characteristics including hair distribution, vocal cord thickening, muscle development, and fat distribution.
Cautions and Warnings
Do not use fluoxymesterone if you are allergic or sensitive to any of its ingredients.
Androgens do not improve athletic performance and may cause serious side effects.
Women taking any androgen may develop deepening of the voice, oily skin, acne, hairiness, increased sex drive, and menstrual irregularities.
Androgens should be avoided if possible by young boys who have not gone through puberty.
Fluoxymesterone W(1C1.ens gynecomastia (a condition characterized by swollen male breast tissue).
Men with unusually high blood levels of calcium, known or suspected prostate cancer or prostate destruction, or breast cancer should not use fluoxymesterone, nor should anyone with severe liver, heart, or kidney disease.
Long-term, high-dose androgen therapy may cause severe liver disease, including hepatitis and cancer, reduced sperm count, and
water retention.
Blood cholesterol may be raised by androgens. This can be a
problem for people who have heart disease.
Androgens may cause or worsen sleep apnea (a condition char-
acterized by intermittent cessation of breathing during sleep). For patients with diabetes, this drug may affect blood sugar
levels.
Possible Side Effects
Men
✓ Most common: inhibition of testicle function, impotence, chronic erection, and painful enlargement of breast tissue.
Women
✓ Most common: unusual hairiness, male-pattern baldness. deepening of the voice, and enlargement of the clitoris. These changes are usually irreversible once they occur. Increased blood calcium and menstrual irregularities may also develop.
Men and Women
✓ Most common: changes in sex drive, headache, anxiety, depression, a tingling feeling, sleep apnea, flushing, rash, acne, habituation (the drug may be habit-forming), excitation, chills, sleeplessness, water retention, nausea, vomiting, diarrhea, hepatitis (symptoms include yellowing of the skin or whites of the eyes), liver inflammation, and liver cancer. Symptoms resembling those of a stomach ulcer may also develop.
Drug Interactions
• Fluoxymesterone may increase the effect of an oral anticoagulant (blood-thinner); dosage 131 the anticoagulant may have tD be reduced.
• Combining an androgen and imipramine or another tricyclic
antidepressant may result in a severe paranoid reaction.
• Androgens may decrease insulin requirements.
Food Interactions
Take fluoxymesterone with meals if it upsets your stomach.
Usual Dose
Adult; 5-40 mg a day. Child: not recommended.
Overdosage
Symptoms include nausea, vomiting, and diarrhea. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Androgens must be taken only under the close supervision of your doctor. The dosage and clinical effects of fluoxymesterone vary widely and require constant monitoring.
Call your doctor if you develop nausea or vomiting, swelling of the legs or feet, yellowing of the skin or whites of the eyes, or a painful or persistent erection. Women should call their doctors immediately if they develop a deep or hoarse voice, acne, hairiness, male-pattern baldness, or menstrual irregularities.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations_ Fluoxymesterone should never be
taken by pregnant or nursing women because it can affect the developing fetus and nursing infant.
Seniors: Seniors are more likely to develop prostate enlargement or prostate cancer. A marked increase in sex drive may also occur.
Generic Name
Flurazepam (110-13AZ-uh-pam) A
Brand Name
Dalmane
Type of Drug Benzodiazepine sedative.
Prescribed For
Insomnia and sleep disturbances.
General Information
Flurazepam is a member of the group of drugs known as benzodiazepines. Benzodiazepines work by a direct effect on the brain. They make it easier to go to sleep and decrease the number of times you wake up during the night. Flurazepam and quazepam remain in your bloodstream longer than other drugs in this class, thus resulting in the greatest incidence of morning “hangover.”
Cautions and Warnings
Do not use flurazepam if you are allergic or sensitive to any of its ingredients.
People with kidney or liver disease should be carefully monitored while taking flurazepam. Take the lowest possible dose to help you sleep.
People with respiratory disease may experience sleep apnea (intermittent cessation of breathing during sleep) while taking flurazepam.
Clinical depression may be increased by flurazepam, which can depress the nervous system. Intentional overdose is more common among depressed people who take sleeping pills than among those who do not.
Some people have experienced amnesia while taking flurazepam.
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 of drug dependence. Withdrawal symptoms include tremors, muscle cramps, insomnia, agitation, diarrhea, vomiting, sweating, and convulsions.
Tapering the drug when stopping may help prevent withdrawal symptoms. People with a history of seizures should be particuarly cautious when stopping use of this drug.
Possible Side Effects
V Common: drowsiness, headache, dizziness, talkativeness, nervousness, appip-henslon, poor muscle coordination, lightheadedness, daytime tiredness, muscle weakness, slowness of movement, hangover, and euphoria (feeling “high”).
V Less common: nausea, vomiting, rapid heartbeat, confusion, temporary memory loss, upset stomach, stomach cramps and pain, depression, blurred or double vision and Possible Side Effects (continued)
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, rash, acne, dry skin, sensitivity to the sun, 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 other 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 flurazepam are enhanced if it is taken with an alcoholic beverage, antihistamine, sedative, barbiturate, anticonvulsant medication, antidepressant, or monoamine oxidase inhibitor antidepressant.
• Contraceptive drugs, cimetidine, disulfiram, and isoniazid may increase the effect of flurazepam by reducing the drug’s breakdown in the liver. Probenecid also increases flurazepam’s effects.
• Cigarette smoking, rifampin, and theophylline may reduce the effect of flurazepam on your body by increasing the rate at which it is broken down by the liver.
• Levodopa + carbidopa’s effectiveness may be decreased by flurazepam.
• Flurazepam may increase the amount of zidaw-adwie tan HIV drug—also known as pnenytoin, or digoxin in your WZWMTeam, increasing the chances of side effects.
• Mixing clozapine with a benzodiazepine has led to respiratory collapse in a few people. Flurazepam should be stopped at least 1 week before starting clozapine treatment.
Food Interactions
Flurazepam may be taken with food if it upsets your stomach.
Usual Dose
Adult and Child (age 15 and over): 15-30 mg at bedtime. Dosage must be individualized for maximum benefit.
Senior: starting dose-15 mg at bedtime.
Child (under age 15): not recommended.
Overdosage
The most common overdose symptoms are confusion, sleepiness, depression, loss of muscle coordination, and slurred speech. Coma may also occur. Patients who overdose on this drug 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. If 30 minutes have passed since the overdose was taken or if symptoms have begun to develop, take the victim immediately to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Never take more flurazepam than your doctor has prescribed. Avoid alcoholic beverages and other nervous system depressants while taking tlurazepam.
Exercise caution while performing tasks that require concentration and coordination. Flurazepam may make you tired, dizzy, or lightheaded.
If you take flurazepam daily for 3 or more weeks, you may experience some withdrawal symptoms when you stop taking the drug. Do not stop taking flurazepam suddenly or increase or decrease your dosage without first consulting your doctor.
If you forget a dose and remember within 1 hour, take it as soon as you remember. 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: Flurazepam absolutely should not be used by pregnaskt. v3 )men or by women who may become pregnant.
Flurazepam passes into breast milk. The drug should not be taken by nursing mothers.
Seniors: Seniors are more susceptible to the effects of flurazepam.
Generic Name
Flutamide (FLUE-tuh-mide)
Type of Drug Antiandrogen.
Prescribed For
Prostate cancer and excessive hairiness in women.
General Information
Prostatic cancer is sensitive to anything that removes the source of androgen (male hormone). Flutamide works by slowing the uptake of androgen or by interfering with the binding of androgen to body tissues. It is always prescribed together with a luteinizing hormone-releasing hormone (LHRH) drug.
Cautions and Warnings
Do not take flutamide if you are allergic or sensitive to any of its ingredients.
Severe liver injury may occur with flutamide; your doctor should monitor your liver function. People with severe liver disease should not take flutamide.
This drug may cause jaundice and severe blood conditions, including hemolytic anemia. People with certain blood disorders and people who smoke are at greater risk for these side effects.
A few men taking this drug have developed breast cancer. Flutamide may reduce sperm counts.
Possible Side Effects
♦ Most common: diarrhea, cystitis, and bleeding from the rectum.
✓ Common: rectal irritation, blood in the urine, hot flashes, loss of libido, impotence, nausea, rash, and swollen breasts.
✓ Less common’. drowsiness, confusion, depression, anxiety, nervousness, appetite loss, stomach problems, anemia, low white-blood-cell and blood-platelet counts, arm or leg swelling, urinary and muscle problems, and high blood pressure.
Possible Side Effects (continued)
♦ Rare: hepatitis, jaundice, and breathing difficulties. Contact your doctor if you experience any side effect not listed
above.
Drug Interactions
• Flutamide may increase the effects of blood-thinning drugs
such as warfarin. Dosage adjustment may be necessary.
Food Interactions None known.
Usual Dose
Adult: 250 mg (2 capsules) every 8 hours, 3 times a day. Total daily dose should be 750 mg.
Child: not recommended.
Overdosage
Overdose symptoms may include tiredness or low activity levels, slow breathing, weakness, tearing, appetite loss, vomiting, swollen and tender breasts, and liver inflammation. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Report anything unusual to your doctor, especially pain or tenderness in the upper right abdomen, yellowing of the skin or whites of the eyes, severe itching, dark urine, persistent appetite loss, and unexplained flu-like symptoms. These may be signs of severe liver toxicity.
Flutamide can turn your urine amber or yellow-green and cause unusual sun sensitivity. Use sunscreen and wear long-sleeved protective clothing while you are taking flutamide.
Flutamide must be taken exactly as prescribed. Call your doctor if you miss a dose of this drug.
Special Populations
Pregnancy/Breast-feeding: This drug is not intended for use by women.
Seniors: Seniors may take this drug without special precaution.
Aug
13
Fenofibrate - Finasteride - Fioricet - Fiorinal - Fiorinal with Codeine
August 13, 2009 | Leave a Comment
Generic Name
Fenofibrate (fen-oe-Flli-brace) IM
Brand Names
Antara TriCor
Lipoten Triglide Lofibra
Type of Drug
Anti-hyperlipidemic (blood-fat reducer).
Prescribed For
High blood cholesterol and/or triglycerides; also prescribed for syndrome X, a condition which increases the risk of type 2 diabetes.
General Information
Fenofibrate works by interfering with the body’s ability to make triglyceride and by increasing its breakdown by enzymes in the body. It also reduces levels of uric acid, total cholesterol, low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol—and other blood lipids. High-density lipoprotein (HDL) cholesterol—the “good” cholesterol—levels are increased. This drug should only be used in people with very high triglyceride levels who are at risk for pancreatitis (inflammation of the pancreas) and have not responded to other treatments, including statin drugs. Generic fenofibrate is not equivalent to the TriCor brand because of a new product formulation and should not be substituted for the brand unless your doctor approves of the switch.
Cautions and Warnings
Do not take fenofibrate if you are allergic or sensitive to any of its ingredients.
People taking fenofibrate and other triglyceride-lowering drugs are mate WOV to die from causes unrelated to triglyceride levels. Fenofibrate reduces the risk of a heart attack or other cardiac event in people with high triglyceride levels and low levels of HDL cholesterol, especially among people with diabetes. The evidence for this benefit is not as strong as it is for the statin drugs.
People taking fenofibrate and gemfibrozil may develop pancreatitis (inflammation of the pancreas).
People with liver or severe kidney disease should avoid fenofibrate. People with less severe kidney disease require reduced
dosage.
People taking fenofibrate are more likely to develop gallstones.
Fenofibrate can destroy muscle cells, leading to kidney failure, especially when combined with a statin cholesterol-lowering drug see “Drug Interactions”).
Possible Side Effects
• Most common: abnormal liver function, abdominal pain, and respiratory disorders.
♦ Common: rash, headache, upset stomach, pain, weakness, tiredness, and flu-like symptoms.
♦ Less common: joint pain, abnormal heart rhythms, reduced sex drive, dizziness, increased appetite, sleeplessness, tingling in the hands or feet, nausea, vomiting, diarrhea, abdominal pain, constipation, stomach noise or gas, frequent urination, vaginal irritation, runny nose, cough, sinus irritation, eye irritation, blurred vision, conjunctivitis (pinkeye). earache, and tiny particles inside the eye (”floaters”).
♦ Rare: allergic reactions including severe rash, itching, liver inflammation or enlargement, gallstones, gallbladder disease, muscle aches, and increased sensitivity to the sun. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Combining fenofibrate and a statin cholesterol-lowering drug (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) can lead to severe muscle pain, muscle cell destruction, and kidney failure. If you have extremely high blood-fat levels, the potential benefits of this combination may outweigh the risks. In people taking this combination, the health of muscles and kidneys must be monitored regularly via blood tests.
• Fenofibrate increases the effects of anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
• Combining fenofibrate and cyclosporine can increase the risk of kidney toxicity. This combination should only be used if it is absolutely necessary and the lowest possible dosage is
taken.
• If you are taking cholestyramine or colestipol (both are used
to reduce blood-fat levels) as well as fenofibrate, take the
fenofibrate at least 1 hour before or 4-6 hours after these
drugs.
Food Interactions
All forms of fenofibrate, except TriCor, should be taken with food to get the best effect. TriCor may be taken without regard to food or meals.
Usual Dose
These products may not be substituted for each other because of important dosage differences.
Antara
Adult: 43-130 mg a day with food.
Senior: Begin with 43 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
Lofibra
Adult: 67-200 mg a day with food.
Senior: Begin with 67 mg a day. This beginning dosage also applies to people with kidney disease.
Child: not recommended.
Lipofen
Adult: 50-150 mg a day with food.
Senior: Begin with 50 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
TriCor
Adult: 48-145 mg a day.
Senior: Begin with 48 mg a day. This dosage also applies to
people with kidney disease. Child; mk recommended.
Triglide
Adult: 50-160 mg a day.
Senior: Begin with 50 mg a day. This dosage also applies to
people with kidney disease. Child: not recommended.
Overdosage
Little is known about the effects of fenofibrate overdose. Victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
People should take fenofibrate only after a triglyceride- lowering diet and other medications have failed. While taking fenofibrate, follow the diet recommended by your doctor.
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.
Special Populations
Pregnancy/Breast-feeding: Fenofibrate causes fetal injury and death in animal studies. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
This drug should not be taken by nursing mothers because of its potential to affect the nursing infant.
Seniors: Seniors are more likely to experience side effects and should never start with more than the lowest recommended dosage.
Generic Name
Finasteride (fin-ASS-ter-ide) 19
Brand Names
Proscar Propecia
The information in this profile also applies to the following drug:
Generic Ingredient: Dutasteride Avodart
Type of Drug
Alpha-reductase inhibitor and androgen hormone inhibitor.
Prescribed for
Benign prostatic hyperplasia (BPH) and male-pattern baldness. May also play a role in preventing prostrate cancer.
General Information
Finasteride works by interfering with the action of the enzyme alphareductase, which converts testosterone into 5-dihydrotestosterone (DHT). By suppressing DHT levels, finasteride reduces the size of the prostate in most men who take the drug for BPH. You may need to take finasteride for 6-12 months before its effects can be
assessed.
Urine flow improves in about 60% of men taking finasteride for BPH and symptoms improve in about 30%. In one study, men experienced a significant regression in prostate size after 3 months, and the reduction was maintained through the 12-month study period: these men experienced a significant improvement in urine flow that could be maintained up to 36 months.
Studies of finasteride for hair loss on the top and back-middle of the scalp show new hair growth in 65-80% of men taking the drug continuously for 2 years. The drug must be taken for 3 months or more before it begins to have an effect and must be taken continuously to maintain hair growth. Once you stop taking this drug, any new hair you have grown is likely to fall out in the next 12 months. Between 14-17% of men taking the drug continued to lose hair throughout the study period.
Finasteride has been studied as therapy following radical prostatectomy surgery and in the prevention of first-stage prostate cancer, acne in women, and unusual hairiness.
Cautions and Warnings
Do not take finasteride if you are allergic or sensitive to any of its ingredients.
This drug should not be used in women or children. Pregnant women must not handle the tablets and capsules because of the risk to the fetus.
People who do not respond to finasteride may have a condition that causes BPH-like symptoms, such as prostate cancer, bladder or nerve disorders, or physical obstruction of the urinary tubes. Finasteride cannot be used to treat these conditions.
Because it is broken down in the liver, finasteride must be used with caution by people with liver disease.
Finasteride may mask symptoms of prostate cancer by causing a reduction in the level of prostate-specific antigen (PSA), an increasingly acknowledged indicator of prostate cancer.
Possible Side Effects
Side effects are generally mild and often subside with continued use of the drug.
Drug Interactions
• Finasteride may reduce the effectiveness of theophylline and aminophylline, although dosage adjustments usually are not required.
• Finasteride affects the PSA blood test used for prostate cancer screening. Be sure your doctor knows you are taking this drug if you have a PSA test done or are being tested for prostate cancer.
• Dustasteride blood levels may increase when mixed with ritonavir, ketoconazole, cimetidine, and ciprofloxacin, all of which are inhibitors of a liver enzyme called CYP3A4. Blood levels of dutasteride also increase with verapamil and diltiazem.
Food Interactions
You may take finasteride with food if it upsets your stomach.
Usual Dose
Outasteride
Adult: 0.5 mg (1 capsule) once a day. Child: not recommended.
Finasteride
Adult: BPH-5 mg once a day. Male-pattern baldness-1 mg once a day.
Child: not recommended.
Women should not take finasteride. Overdosage
S%’& Ptecls are unlikely. Doses of dutasteride as high as 400 mg a day have been taken with no adverse side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Possible Side Effects (continued)
v Common: impotence, loss of sex semen, breast tenderness an
• and drug sensitivity reaction
• rash.
x drive, decreased amount nd enlargement, testicular ions including lip swelling Special Information
Women who are or might be pregnant should not handle crushed finasteride tablets because small amounts of the drug may be absorbed into the blood, possibly affecting the fetus.
If your sexual partner is or might be pregnant and you start taking finasteride, you must wear a condom during sex to avoid directly exposing her to finasteride in the semen.
Semen volume may decrease while on finasteride. Impotence or reduced sex drive is also a risk.
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. Call your doctor if you miss a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: This drug is not intended for women. Finasteride will harm the fetus if taken during pregnancy. It is not known if finasteride passes into breast milk.
Seniors: Seniors with liver disease should use this drug with caution.
Brand Name
Fioricet
Generic Ingredients
Acetaminophen + Butalbital + Caffeine 91
Other Brand Names
Americet Femcet
Dolgic LQ Margesic
Dolgic Plus Medigesic
Esgic Repan
Esgic-Plus Triad
Type 101 Drug
Barbiturate and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fioricet is one of many combination products containing a barbiturate—butalbital—and an analgesic—acetaminophen. Products of this kind also often contain a sedative or a narcotic. Other analgesic combinations, such as Rorinal, substitute aspirin for
acetaminophen.
Cautions and Warnings
Do not take Fioricet if you are allergic or sensitive to any of its ingredients.
Use this drug with caution if you have kidney or liver disease or a history of porphyria.
Chronic (long-term) use of Fioricet may lead to drug dependence or addiction. It is not recommended for multiple or recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an inability to concentrate. Alcohol increases the CNS depression caused by this drug.
The safety and effectiveness of these medications have not been established in children under age 12.
For additional information see “Cautions and Warnings” in Acetaminophen (page 7).
Possible Side Effects
♦ Most common: lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, upset stomach and a feeling of intoxication.
V Less common: weakness, headache, agitation, tremor, uncoordinated muscle movement, disorientation, dry mouth, constipation, facial flushing, changes in heart rate, palpitations, feeling faint, urinary difficulties, rash, and itching.
For additional information see “Possible Side Effects” in Acet-
aminophen (page 7).
Drug Interactions
• Combining Fioricet with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
These medications may reduce the effectiveness of corticosteroids, contraceptives containing estrogen, beta blockers (e.g. propranolol), doxycycline, felodipine, griseofulvin, nifedipine, phenylbutazone, quinine, theophylline, warfarin, and tricyclic antidepressants.
For additional information see “Drug Interactions” in Acetaminophen (page 7).
Food Interactions
Fioricet is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not exceed 6 doses a day.
Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, facial flushing, sweating, and thirst. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fioricet may cause drowsiness. Be careful when driving or performing any task that requires concentration.
You should avoid alcohol while taking this medication.
Do not take Fioricet for longer or in amounts greater than prescribed.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping Fioricet may lead to withdrawal symptoms.
Call your doctor if your headache or pain persists or gets worse, or if you develop side effects that are bothersome or persistent.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one and continue
W<tkh IV61 schedule. Do not take a double dose.
For additional information see “Special Information” in Acetaminophen (page 7).
Special Populations
Pregnancy/Breast-feeding: Fioricet should not be taken during pregnancy. It is associated with birth defects, prolonged labor and delayed delivery, and breathing problems in newborns. Regular use of Fioricet during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fioricet passes into breast milk. Breast-feeding while using Fioricet may cause babies to become tired, short of breath, or have a slow heartbeat. Nursing mothers who must take this drug should use infant formula.
Seniors: Fioricet may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal
Generic Ingredients
Aspirin + Butalbital + Caffeine &9
Other Brand Names
Butalgen Fiorimor
Farbital Fortabs
Fiorigen Lanorinal
Type of Drug
Barbiturate and analgesic (pain reliever) combination. Prescribed For
Symptom relief of tension headache.
General Information
Pain relief products often combine an analgesic with a sedative. The analgesic ingredient in Fiorinal is aspirin; other brand-name products, such as Esgic and Fioricet, contain acetaminophen. The sedative ingredient in pain-relief combinations may be a barbiturate, narcotic, or other sedative. Fiorinal contains the barbiturate butalbital. Fiorinal also contains caffeine, which is ofte” \Ased in analgesic combinations that km,-M beadache because it enhances kkNt %m-relieving effect of aspirin.
Cautions and Warnings
Do not take Fiorinal if you are allergic or sensitive to any of its ingredients.
Do not give Fiorinal to children or teenagers with chickenpox or flu-like symptoms due to the aspirin content and danger of
Reye’s syndrome.
Use Fiorinal with extreme caution if you suffer from peptic ulcer,
problems with blood clotting or other bleeding disorders, or are
about to have surgery.
This drug should be used with caution if you have kidney or
liver disease, diabetes, or a history of porphyria.
Long-term use of this drug may cause drug dependence and addiction. It is not recommended for the treatment of multiple recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an
inability to concentrate. Alcohol increases the CNS depression caused by butalbital.
The safety and efficacy of Fiorinal use in children under age 12 has not been established.
For additional information see “Cautions and Warnings” in Aspirin (page 110).
Possible Side Effects
✓ Most common: lightheadedness, dizziness, and sedation.
♦ Less common: nausea, vomiting, flatulence, and rash. For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Combining Fiorinal with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
• Fiorinal may enhance the effects of oral anticoagulants (blood thinners), oral antidiabetes drugs, insulin, and mmsteroidal anti-inflammatory drugs ~VASAYDs).
• F10final may decrease the effectiveness of medications taken for gout, including probenicid and sulfinpyrazone.
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal is best taken on an empty stomach but may be taken with
food if it upsets your stomach.
usual Dose
1-2 tablets or capsules every 4 hours or as needed. Do not exceed
6 doses a day. Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin, lowered heart rate or blood pressure, nausea, vomiting, stomach pain, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose are rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, and bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fiorinal may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking Fiorinal.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take Fiorinal for longer or in amounts greater than prescribed.
Call your doctor if your headache pain persists or gets worse, or if you develop any bothersome or persistent side effect.
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.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
PregriancylBreast-feeding. Fiorinal should not be taken during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. Fiorinal increases the risk of birth defects and may cause breathing or bleeding prob-lems in newborns. Regular use of Fiorinal during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal passes into breast milk. Breast-feeding while using Fiorinal may cause tiredness, shortness of breath, or slowed heartbeat in the baby. Nursing mothers who must take Fiorinal should use infant formula.
Seniors: Fiorinal may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal with Codeine
Generic Ingredients
Aspirin + Butalbital + Caffeine + Codeine Phosphate 19
Type of Drug
Barbiturate, narcotic, and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fiorinal with Codeine is one of many combination products containing a barbiturate, an analgesic, and a narcotic. In Fiorinal with Codeine, butalbital is the barbiturate, aspirin is the analgesic, and codeine is the narcotic. These products often also contain a sedative, and acetaminophen may be substituted for aspirin.
Cautions and Warnings
Do not take Fiorinal with Codeine if you are allergic or sensitive to any of its ingredients. Even recommended doses of aspirin can cause severe allergic reaction in those with an aspirin allergy.
Do not take this medication if you suffer from peptic ulcer, bleeding disorders, or a history of porphyria.
Use this medication with cautiOi) 11 you have kidney or liver
disease of diabetes.
Fiorinal with Codeine may cause postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term use of this drug may cause drug dependence or addiction.
It is not recommended for treatment of multiple, recurrent head-
aches.
Fiorinal with Codeine is a respiratory depressant and affects the
central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Alcohol increases the depression caused
by codeine and butalbital.
Do not give Fiorinal with Codeine to children or teenagers with
chickenpox or flu-like symptoms. The aspirin content presents the
danger of Reye’s syndrome.
For additional information see “Cautions and Warnings” in As-
pirin (page 110).
Possible Side Effects
✓ Most common: dizziness, sleepiness, nausea, and vomiting.
♦ Less common: dry mouth, difficulty swallowing, heartburn, rapid heart rate, leg pain and muscle fatigue, urinary problems, rash, fever, earache, stuffy nose, and ringing in the ears. Narcotic analgesics may aggravate convulsions in those who have had them.
For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Interaction with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, or other drugs that produce sedation may cause tiredness, drowsiness, and trouble concentrating.
• Taking Fiorinal with Codeine with a monoamine oxidase inhibitor antidepressant may cause increased central nervous system effects.
• This medication may reduce the effectiveness of medications for the treatment of gout including probenicid and sulfapyrazone.
• Fiorinal with Codeine may enhance the effects of blood thin- ners, oral antidiabetes drugs, insulin, and anti-inflammatory drugs (NSAIDs).
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal with Codeine is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not ex-
ceed 6 doses a day.
Overdosage
Usual overdose symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose include rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, or bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking this drug.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take this drug for longer or in amounts greater than prescribed.
Call your doctor if you experience breathing difficulties, or persistent nausea, vomiting, or constipation.
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.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
Pregnancy/Breast-teeding-. Fiorinal with Codeine should not be used during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. This drug increases the risk of birth defects and may cause breathing or bleeding problems in newborns. Regular use of Fiorinal with Codeine during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal with Codeine passes into breast milk. Breast-feeding while using this drug may cause tiredness, shortness of breath, or a slow heartbeat in the baby. Nursing mothers who must take this drug should use infant formula.
Seniors: This drug may have a greater depressant effect on seniors. Other effects that may be more prominent are stimulation, disorientation, lightheadedness, and dizziness or fainting when rising suddenly from a sitting or lying position.
Aug
13
Ezetimibe - Famciclovir - Famotidine - Felbamate - Felodipine
August 13, 2009 | Leave a Comment
Ezetimibe (eh-HIHI-firri-ibe)
Brand Name Zetia
Combination Product
Generic Ingredients: Ezetimibe + Simvastatin Vytorin
Type of Drug
Cholesterol - lowering agent.
Prescribed For
High cholesterol, high LDL (”bad”) cholesterol, high triglycerides, and low HDL (”good”) cholesterol; also prescribed for two rare genetic disorders called homozygous familial hypercholesterolemia and homozygous sitosterolemia.
General Information
Unlike statin drugs, ezetimibe interferes with the absorption of cholesterol through the intestine and into the bloodstream. Ezetimibe may be helpful for people whose LDL (”bad”) cholesterol remains high despite treatment with a statin drug. Cholesterol-lowering medicines should always be used together with appropriate diet and exercise.
Ezetimibe may be taken alone but is often taken in combination with a statin drug (generally simvastatin). Vytorin is a brand-name combination of these 2 medications. See Stalin Cholesterol-Lowering Agents, page 1052.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
People with liver disease or elevated liver enzyme measurements should not take ezetimibe because its effects on the liver are not known.
Ezetimibe does not slow hardening of the arteries.
There may be a risk of myopathy (skeletal muscle disorder) with ezetimibe; contact your doctor if you experience any unexplained muscle pain, tenderness, or weakness. Ezetimibe + simvastatin has the same effect as simvastatin alone; see Statin Cholesterol-Lowering Agents, page 1052.
Possible Side Effects
Ezetimibe side effects are similar to those reported by people taking a placebo (sugar pill).
V Most common: headache, back pain, joint pain, and abdominal pain.
C,Ibmrnon: muscle ache and respiratory infection.
V Less common: fatigue, chest pain, diarrhea, sore throat, and cough.
For additional information about ezetimibe + simvastatin, see Statin Cholesterol- Lowering Agents, page 1052.
Drug Interactions
• Cholestyramine reduces the amount of ezetimibe absorbed
in the blood. Separate these drugs by 2 hours or more.
• Cyclosporine (to prevent organ transplant rejection) may substantially increase the amount of ezetimibe in the blood. This combination must be monitored closely by your doctor.
• Gemfibrozil (another blood-fat reducer) can increase the amount of ezetimibe in the blood.
• Fenofibrate may increase the effects of ezetimibe. Fibrates
other than fenofibrate should not be used with ezetimibe due to
the risk of gallbladder complications. For additional informa-
tion about ezetimibe + simvastatin, see Statin Cholesterol-
Lowering Agents, page 1052.
Food Interactions
This drug can be taken without regard to food or meals.
Usual Dose
Ezetimibe
Adult and Child (age 10 and over): 10 mg once a day. Child (age 9 and under): not recommended.
Ezetimibe + Simvastatin
Adult: 10 mg ezetimibe plus 10-80 mg simvastatin once a day in the evening. The simavastatin dose depends on individual need.
Overdosage
Little is known about the effects of ezetimibe overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If you are taking more than one drug to lower cholesterol or another blood fat, consider the side effects of all of those drugs combined.
,S’D'L’6a) Populations
Pregnancy/Breast-feeding: Little is known about the effects of ezetimibe during pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks. Statin drugs should never be taken by a pregnant woman or nursing mother.
It is not known if ezetimibe passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this drug without special precaution.
Generic Name
Famciclovir (fam-SYE-kloe-vere)
Brand Name Famvir
Type of Drug Antiviral.
Prescribed For
Herpes zoster (shingles), genital herpes, herpes labilalis (cold sores), and herpes simplex in HIV-infected people.
General Information
Famciclovir is absorbed into the body and converted to the antiviral penciclovir, the drug that actually works against shingles by interfering with the reproduction of DNA in the herpes virus. Famciclovir does not affect DNA in uninfected body cells. Famciclovir is broken down by the liver and eliminated from the body through the kidneys.
Cautions and Warnings
Do not take famiciclovir if you are allergic or sensitive to any of its ingredients.
Those with reduced kidney function should have their dosage adjusted accordingly.
Severe liver disease reduces the maximum possible concentration of Famciclovir in the blood and increases the time it takes to reach this maximum level; however, dosage adjustment is not normally required.
Possible Side Effer.%
♦ Most common: headache, nausea, and diarrhea.
♦ Less common: fever, fatigue, pain, vomiting, constipation, appetite loss, dizziness, tingling in the hands or feet, sleepiness, sore throat, sinus irritation, itching, gas, dysmemorrhea, and signs of shingles.
Possible Side Effects (continued)
Rare: chills, abdominal pain, back or joint pain, and upset stomach. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Probenecid, cimetidine, and theophylline interfere with the elimination of famciclovir from the body, possibly leading to higher levels of famciclovir in the blood.
• People who took famciclovir and digoxin together experienced increased digoxin In their blood.
Food Interactions None known.
Usual Dose
Shingles
Adult (age 18 and over): 500 mg every 8 hours for 1 week. People with reduced kidney function may require a reduced dose taken as infrequently as once a day.
Genital Herpes
Adult (age 18 and over): 1000 mg twice daily for 1 day; or 250 mg twice a day for up to 1 year for suppression; or 250 mg 3 times a day for 7 days for initial episode. People with reduced kidney function take the same dose but less often, as infrequently as once every 2 days. HIV-infected people should take 500 mg twice a day for 7 days.
Cold Sores
Adult (age 18 and over): 1500 mg as a single dose. Initiate therapy at the earliest sign or symptom of a cold sore (tingling, itching, or burning).
Overdosage
Little is known about the effects of famciclovir ovecdose. Overdose victims should be %Mn to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Famciclovir treatment should be started as soon as shingles is diagnosed. For maximum benefit, be sure to complete the full week of treatment.
Famciclovir is not a cure for genital herpes and it is not known if it will prevent the transmission of the herpes virus to another person. Avoid sexual intercourse when herpes lesions are present even while taking famciclovir for genital herpes.
Begin taking famciclovir at the first sign of a herpes attack (symptoms include pain, tenderness, burning, itching, tingling, ulcers, or scabs). The effectiveness of starting famciclovir 6 hours or more after symptoms or lesions appear has not been established.
Call your doctor if you experience any unusual or intolerable side effects.
If you forget a dose of famciclovir, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot. Do not take a double dose. Call your doctor if you forget more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Famciclovir should only be taken by a pregnant woman if it is absolutely necessary and the possible benefits outweigh the risks to the fetus.
In animal studies, penciclovir (the active form of famciclovir) passed into breast milk in high concentrations but it is not known if this holds true for humans. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors clear famciclovir from the bloodstream more slowly than younger people and should have their dosage adjusted according to their level of kidney function.
Generic Name
Famotidine (fam-OE-tih-dine) 91
Brand Names
Fluxid Pepcid AC
Pepcid Pepcid Complete
Type of Drug Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine). This drug is also used to treat gastroesophageal reflux disease (GERD),
stress ulcer, and other conditions characterized by the production of large amounts of gastric fluids; to prevent stress ulcer and stomach and upper intestinal bleeding; and to stop the production of stomach acid during surgery. Pepcid AC is approved for heartburn.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Famotidine is effective in treating the symptoms of ulcer and preventing complications of the disease, although an ulcer that does not respond to another histamine H2 antagonist will probably not respond to famotidine. Histamine H2 antagonists differ only in their potency. Cimetidine is the least potent; 1000 mg are roughly equal to 300 mg of either nizatidine or ranitidine, or 40 mg of famotidine. All these drugs have roughly equivalent success rates in treating ulcer disease and comparable risk of side effects.
Cautions and Warnings
Do not take famotidine if you are allergic or sensitive to any of its ingredients or to any histamine H2 antagonist.
People with kidney or liver disease should take famotidine with caution because 1/3 of each dose is broken down in the liver and the rest passes out of the body through the kidneys.
Do not self-treat with over-the-counter (OTC) forms of famotidine without the advice and supervision of your doctor.
Possible Side Effects
✓ Most common: headache.
✓ Less common: dizziness, mild diarrhea, and constipation.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• T-_Meat-coated tablets should not be taken with famotidine. The change in stomach acidity that famotidine produces causes the tablets to disintegrate prematurely in the stomach.
• Antacids, anticholinergics, and metoclopramide may slightly reduce the amount of famotidine absorbed into the blood. No special precaution is needed.
Food Interactions
Famotidine may be taken without regard to food or meals.
Usual Dose
Adult 20-40 mg at bedtime, or 20 mg twice a day for 4-8 weeks. Dosage should be reduced in people with severe kidney disease.
Child (age 1-16): 0.23-0.45 mg per lb. of body weight, at bedtime or in 2 divided doses, up to 40 mg a day.
Child (under age 1): Consult your doctor.
Over-the-counter forms of famotidine such as Pepcid AC or Pepcid Complete should only be used for the temporary relief of heartburn, and are not recommended for children under 12 years of age. Do not take more than 2 capsules or chewable tablets in 24 hours.
Overdosage
Little is known about the effects of famotidine overdose, but victims may experience exaggerated side effects. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any remaining drug from the stomach. Victims who have definite symptoms should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take famotidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug. Antacids may be taken together with famotidine if needed.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarettes worsen stomach ulcers and may reduce famotidine’s effectiveness.
Call your doctor at once if you develop any unusual side eiiecls such as bleeding or bruising,’ iWness, diarrhea, dizziness, or rash. &’A&, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you forget a dose of famotidine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations revealed no Pregnancy/Breast-feeding: Although animal studies
damage to the fetus, famotidine should be avoided by women who are or might be pregnant. When this drug is considered crucial by your doctor, its possible benefits must be carefully weighed against
its risks.
Famotidine may pass into breast milk. Nursing mothers who
must take this drug should use infant formula.
Seniors: Seniors may need lower doses due to loss of kidney function and may be more susceptible to side effects.
Generic Name
Felbamate (FEL-bam-ate)
Brand Name Felbatol
Type of Drug Anticonvulsant.
Prescribed For
Partial seizures and Lennox-Gastaut syndrome in children.
General Information
Felbamate is related to the older sedative meprobamate. Exactly how felbamate works is not known, but it raises the seizure threshold and prevents the seizure impulse from spreading in the brain, as do other anticonvulsants. Felbamate should only be used when other seizure drugs have failed because of the risks associated with it. About half of each dose passes out of the body through the kidneys; the other half is broken down and eliminated by the liver.
Cautions and Warnings
Do not take felbamate if you am allergic or sensitive to any of its ‘Irigredlents or to any related drugs such as meprobamate.
Felbamate is associated with an increase in the risk of aplastic anemia, a potentially fatal condition.
Possibly fatal liver failure occurs in people taking felbamate much more often than normal. Regular liver function tests are recommended. People with liver disease should not take felbamate.
Felbamate is not recommended as first-line epilepsy treatment. Felbamate should be used only by those with severe epilepsy for whom the benefits outweigh the risks. Doctors prescribing felbamate should be thoroughly familiar with the drug and must obtain written, informed consent from patients before prescribing.
Felbamate should never be suddenly stopped or seizures may become more frequent. Dosage should be gradually reduced or replaced by another anticonvulsant.
Felbamate may cause increased sensitivity to the sun. Wear protective clothing and use sunscreen while taking this drug. People with kidney disease may require lower doses.
Possible Side Effects
Adult
♦ Most common: sleeplessness, sleepiness, fatigue, headache, dizziness, nervousness, upset stomach, vomiting, constipation, nausea, and appetite loss.
V Common: anxiety, tremors, walking unusually, depression, tingling in the hands or feet, diarrhea, liver inflammation, abdominal pains, respiratory infections, abnormal vision, and taste changes.
✓ Less common: weakness, dry mouth, stupor, abnormal thinking, rash, sinus irritation, sore throat, muscle aches, fever, and chest pain.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Child
✓ Most common: abdominal pain, fever, respiratory infections, sleeplessness, sleepiness, nervousness, vomiting, constipation, and black-and-blue marks.
✓ Common: headache, appetite loss, hiccups, sore throat, coughing, middle ear infections, fatigue, weight loss, temporary loss of urine control, qak”,,NbNW)ng unusually, weak-))855, abnormal thinking, emotional instability, pinpoint pupils, rash, upset stomach, and low white-blood-cell count.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if your child experiences any side effect not listed above.
Drug Interactions
• Combining felbamate and other antiseizure drugs usually requires dosage adjustments due to the risk of drug interaction. Dosage of felbamate should be reduced by 20-33% to reduce the risks of associated side effects.
• Combining felbamate and carbamazepine reduces blood levels of both drugs by roughly half. Dosage adjustments are necessary.
• Combining phenobarbital and felbamate increases the amount of phenobarbital in the blood and decreases felbamate levels. Dosage adjustments are necessary.
• If you combine felbamate and phenytoin, your phenytoin dosage may have to be reduced by as much as 40%. This combination also decreases felbamate blood levels by almost 50%.
• Felbamate increases blood levels of valproic acid and methsuximide.
Food Interactions
Felbamate is best taken on an empty stomach but may be taken with food if it causes upset stomach.
Usual Dose
Adult and Child (age 14 and over): 1200-3600 mg a day, divided into 3-4 doses.
Child (age 2-13): 6.8-20.5 mg per lb. a day, divided into 3-4 doses.
Overdosage
Overdose symptoms may include upset stomach, increased heart rate, and felbamate side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Do not take more felbamate than your doctor has prescribed. Felbamate can cause drowsiness; be careful when, driving perfQ(ft g
Avoid prolonged exposure to the sun while taking felbamate. Call your doctor if you develop any bothersome or persistent side effect.
Maintain good dental hygiene while taking felbamate and use extra care when brushing or flossing because this drug can cause swollen gums. See your dentist regularly.
km ,s %2& nq6re concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 3 or 4 hours, then go back to your regular schedule. Do not take
a double dose.
Special Populations
Pregnancy/Breast-feeding: This drug may cross into fetal circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Felbamate passes into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors, especially those with liver, kidney, or heart disease, may be more sensitive to the effects of this drug and should receive lower doses.
Generic Name
Felodipine (feh-LOE-dih-pene) 91
Brand Name Plendil
Combination Product
Generic Ingredients: Enalapril + Felodipine Lexxel
Type of Drug
Calcium channel blocker.
Prescribed For High blood pressure.
General Information
Felodipine is one of many calcium channel blockers available in the U.S. Its once-daily dosage schedule makes it particularly stilted to treating high blood Felodipine blocks the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them. This dilating effect reduces blood pressure, the amount of oxygen used by the heart muscle, and the risk of blood vessel spasm. Felodipine is therefore useful in
treating not only high blood pressure but also angina pectoris (brief attacks of chest pain), a condition related to poor oxygen supply
to the heart muscles.
Felodipine only affects the movement of calcium into muscle cells-, it has no effect on calcium in the blood.
Lexxel is a combination of felodipine and enalapril, an angiotensin converting enzyme (ACE) inhibitor.
Cautions and Warnings
Do not take felodipine if you are allergic or sensitive to any of its ingredients.
On rare occasions, felodipine may cause very low blood pressure that may lead to stimulation of the heart and rapid heartbeat and can worsen angina. This reaction may happen when treatment is first started, when dosage is increased, or if the drug is rapidly withdrawn; it may be avoided by reducing dosage gradually.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken only once daily—have a greater chance of having a heart attack than do people taking beta blockers or other medications for the same purpose. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Patients taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina.
People with severe liver disease may require dosage adjustments.
People taking felodipine who have had a heart attack and have lung congestion may experience worsened heart failure, since this drug can actually reduce the force of each heartbeat.
Possible Side Effects
Side effects produced by calcium channel blockers are generally mild and rarely cause people to stop taking them. Side effects are more common with higher doses and in older patients.
I Most common: swelling in the ankles, feet, or legs; dizziness; lightheadedness; muscle weakness or cramps; facial flushing; and headache.
V Less common: respiratory infections, cough, tingling in the hands or feet, upset stomach, abdominal pains, chest pains,
stomach, , heart palpitations,
Drug Interactions
• Felodipine may increase the amount of beta-blocking drugs in the bloodstream. This can lead to heart failure, very low blood pressure, or an increased incidence of angina. However, in many cases these drugs have been taken together with no problem.
• Felodipine increases the effects of other blood-pressurelowering drugs. Such drug combinations are often used to treat hypertension.
• Cimetidine, ranitidine, and azole antifungals such as ketoconazole and itraconazole increase the amount of felodipine in the blood and may account for a slight increase in the drug’s effect.
• Phenytoin and other hydantoin antiseizure medicines, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect on the body.
• Erythromycin and cyclosporine may increase the side effects of felodipine.
• Felodipine may increase the effects of digoxin, theophylline (prescribed for asthma and other respiratory problems), and oral anticoagulant (blood-thinning) drugs.
• Felodipine may also interact with quinidine (prescribed for abnormal heart rhythm) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.
• Qd(Gii= Channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
You may take felodipine with food if it upsets your stomach. Avoid taking felodipine with grapefruit juice—it doubles the amount of drug absorbed.
Possible Side Effects (continued) nausea, constipation, diarrhea
throat, runny nose, back pain, rash.
and
♦ Rare: Rare side effects can affect the heart,
blood, and joints. It can affect and
your mood, sex drive,
urinary tract. Contact your do you experience side effect not listed above.
ctor if any Usual Dose
2.5-10 mg a day. No patient should take more than 20 mg a day. Do not stop taking felodipine abruptly. The dosage should be reduced gradually over a period of time.
Overdosage
Felodipine overdose can cause low blood pressure. If you think you have taken an overdose of felodipine, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop constipation, nausea, very low blood pressure, breathing difficulties, increased heart pain, dizziness, or lightheadedness, or if other side effects are bothersome or persistent.
Swelling of the hands or feet may develop within 2 or 3 weeks of starting felodipine. The chances of this happening depend on age and dosage. It occurs in less than 10% of people under age 50 taking 5 mg a day and in more than 30% of those over age 60 taking 20 mg a day.
Be sure to continue taking your medication even if you feel well, and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure.
Do not break or crush felodipine tablets.
It is important to maintain good dental hygiene while taking felodipine and to use extra care when using your toothbrush or dental floss because of the chance that the drug will make you more susceptible to certain infections.
If you forget to take a dose of felodipine, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy1filreast-feeding. Animal studies of felodipk”e have shown that it crosses RAW the Zeta) circulation and causes birth iNlfEcls. Women who are or who might become pregnant while taking this drug should not take it without their doctor’s approval. The potential benefit of taking felodipine must be carefully weighed against its risks.
It is not known if felodipine passes into breast milk. Nursing mothers who take felodipine should use infant formula.
Seniors: Seniors, especially those with liver disease, are more sensitive to the effects of this drug.
Aug
12
Donnatal - Doxazosin - Doxercalciferol - Dronabinol - Dyazide
August 12, 2009 | Leave a Comment
Brand Name
Donnatal
Generic Ingredients
Atropine Sulfate + Hyoscyamine Sulfate + Phenobarbital + Scopolamine Hydrobromide EQ
Other Brand Names Antispas
Antispasmodic Barbidonna
Bellatal
Donnapine
Donnatal Extentabs Hyosophen Spasmolin
The information in this profile also applies V) the following drugs: Generic /nqcedjer)t: Hyoscyamine Sulfate 0
Anaspaz ED-SPAZ
A-Spas S/L Hyosol
Cytospaz Hyosyne
Donnamar IB-Stat
Levbid Levsin
Levsinex Timecaps Medispaz
DONNATAL
Neosol NuLev Spasdel Symax
Generic Ingredient: Propantheline 92 Pro-Banthine
Type of Drug
Anticholinergic combination.
Prescribed For
Stomach spasm and gastrointestinal (GI) cramps; also used to treat motion sickness.
General Information
Donnatal is a mild antispasmodic sedative. Its principal action is to counteract the effect of acetylcholine, an important neurohormone. Donnatal is used only to relieve symptoms. not to treat the underlying condition, and there is considerable doubt among medical experts that this drug lives up to its claims. In addition to the brand names listed above, there are about 50 other anticholinergic combinations with similar properties. All are used to relieve cramps and all are about equally effective. Some have additional ingredients to reduce or absorb excess gas in the stomach, to coat the stomach, or to control diarrhea. Donnatal and products like it should not be used for more than the temporary relief of symptoms.
Cautions and Warnings
Do not take Donnatal if you are allergic or sensitive to any of its ingredients.
Donnatal should not be used by people with glaucoma, rapid heartbeat, severe intestinal disease such as ulcerative colitis, intestinal obstruction, urinary difficulties, asthma, myasthenia gravis, acute intermittent porphyria, acute bleeding with unstable heart function, or hiatal hernia.
Phenobarbital may be, habit-forming and should not be admin(Ste_%16 10 people with a history of drug dependence.
Donnatal should be used with caution in children and in people with brain damage, spastic paralysis, Down’s syndrome, heart disease, high blood pressure, hyperthyroidism (overactive thyroid gland), kidney or liver disease, autonomic neuropathy, or gastric ulcer.
Donnatal can reduce your ability to sweat and may lead to heat exhaustion. Avoid extended heavy exercise and limit your exposure to high temperatures.
Possible Side Effects
♦ Most common: blurred vision, dry mouth, urinary difficulties, flushing, and dry skin.
♦ Less common: rapid or unusual heartbeat, increased sensitivity to bright light, loss of the sense of taste, headache, nervousness, tiredness, weakness, dizziness, sleeplessness, nausea, vomiting, fever, stuffy nose, heartburn, loss of sex drive, decreased sweating, constipation, feeling bloated, and allergic reactions such as fever and rash.
Drug Interactions
• Although Donnatal contains only a small amount of phenobarbital, it is wise to avoid alcohol or other sedative drugs. Although unlikely, phenobarbital interactions are possible with anticoagulants, adrenal corticosteroids, narcotics, sleeping pills, digitalis or other cardiac glycosides, and antihistamines.
• Some phenothiazine drugs, sedatives, tricyclic antidepressants, and narcotics may increase the side effects of the atropine sulfate ingredient in Donnatal, causing dry-mouth, urinary difficulties, and constipation. The effectiveness of phenothiazines to control psychotic symptoms may be decreased.
• Combining Donnatal and the antiviral amantadine may increase the side effects of Donnatal.
• Donnatal may increase the side effects of atenolol and digoxin.
• Antacids may decrease Donnatal’s effectiveness; do not take antacids within 1 hour of taking Donnatal.
Food Interactions
‘%ke Donnatal 30-60 minutes before meals.
Usual Dose
Donnatal
Adult (age 13 and over): 1-2 tablets, capsules, or tsp. 3-4 times a day, or 1 extended-release tablet every 12 hours.
Child (age 2-12): 112 the adult dosage. Child (under age 2): not recommended.
Propantheline
Adult-. 15 mg 3 times a day before meals, and 30 mg at bedtime. Senior: 7.5 mg 3 times a day.
Child (under age 12): not recommended.
Overdosage
Symptoms of overdose include dry mouth; difficulty swallowing; thirst; blurred vision; sensitivity to bright light; flushed, hot, or dry skin; rash; fever; abnormal heart rate; high blood pressure; urinary difficulties; restlessness; confusion; delirium; and breathing difficulties. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you experience persistent diarrhea, bloating, fever, heart palpitations, rash, flushing, or eye pain.
Do not crush or chew Donnatal tablets.
Dry mouth usually can be relieved by chewing gum or sucking hard candy or ice chips. Constipation can be treated with a stool-softening laxative.
Donnatal may reduce the amount of saliva in your mouth, making it easier for bacteria to grow there. Pay special attention to dental hygiene while taking this medication to prevent cavities and gum disease.
Donnatal may cause drowsiness and blurred vision. Be careful when driving or operating hazardous equipment.
If you forget to take a dose of Donnatal, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Donnatal may cause drug dependency or breathing problems in newborns and may interfere with labor aM delivery. When this drug is considered crucial by your doctor, its potential must be carefully weighed against its risks.
Donnatal may pass into breast milk and may reduce the amount of milk produced. It may cause tiredness, shortness of breath, and a slower-than-normal heartbeat in infants. Nursing mothers who must take this medication should consider using infant formula.
Seniors: Seniors are often more sensitive to the side effects of Donnatal, such as excitement, confusion, drowsiness, agitation, constipation, dry mouth, and urinary difficulties. Memory may be impaired and glaucoma worsened.
Generic Name
Doxazosin (dok-SAY-zoe-sin) In
Brand Names
Cardura. Cardura XL
Type of Drug Antihypertensive.
Prescribed For
High blood pressure and benign prostatic hyperplasia (BPH); also used with digoxin and diuretic drugs to treat congestive heart failure.
General Information
Doxazosin mesylate and other alpha-adrenergic blocking agents, or alpha blockers, reduce blood pressure by dilating (widening) blood vessels. They achieve this effect by blocking nerve endings known as alpha, receptors. The maximum blood-pressurelowering effect of doxazosin is seen between 2 and 6 hours after taking a dose. In BPH treatment, doxazosin works by relaxing smooth muscles in the prostate and neck of the bladder. Doxazosin helps the symptoms of BPH, and taking it for several years may eliminate the need for surgery or allow the use of a less invasive type of surgery. Doxazosin’s effect lasts for 24 hours. It is mostly broken down in the liver; little passes out of the body via the kidneys.
Doxazosin may slightly reduce cholesterol levels and improve the ratio of high-density lipoprotein (HDL)—”good” cholestemAand low-density lipoprotein (ILDL}—”bad cholesterol”—a positive step for peQ¢kp_%Aln a blood-cholesterol problem.
Cautions and Warnings
Do not take doxazosin if you are allergic or sensitive to any of its ingredients or to any alpha blocker.
Doxazosin may cause dizziness and fainting, especially the first few doses. This is known as a first-dose effect, which can be minimized by limiting the first dose to 1 mg at bedtime. First-dose effects occur in about i % of people taking an alpha blocker and may recur if the drug is stopped for a few days and then started
again.
Doxazosin should be taken with caution if you have liver
disease.
White-blood-cell counts may be slightly decreased in people
taking doxazosin.
Rarely, alpha blockers, including doxazosin, have led to pri-
apism (painful and prolonged erection). Call your doctor immediately if this happens. If not treated promptly, this condition can lead to impotence.
Possible Side Effects
✓ Most common: headache, dizziness, and weakness.
♦ Less common: heart palpitations, abnormal heart rhythms, chest pain, nausea, diarrhea, constipation, abdominal pain or discomfort, gas, breathing difficulties, nosebleed, sore throat, runny nose, muscle or joint pain, visual disturbances, conjunctivitis (pinkeye), ringing in the ears, fainting, depression, decreased sex drive or sexual function, tingling in the hands or feet, nervousness, tiredness, anxiety, sleeplessness, poor muscle coordination, muscle stiffness, poor bladder control, frequent urination, itching, rash, sweating, fluid retention, facial swelling and flushing, and back, neck, shoulder, arm, or leg pain.
✓ Rare: vomiting, dry mouth, sinus irritation, bronchitis, cold or flu symptoms, worsening of asthma, coughing, hair loss, weight gain, and fever. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Doxazosin may interact with beta blockers to ‘increase the risk of dizziness or fa:kv%1)g alter the first dose of doxazosin.
• TW-1 UDOd-pressure-lowering effect of doxazosin may be reduced by indomethacin.
• When taken with other blood-pressure-lowering drugs, dox-
azosin produces a severe reduction of blood pressure.
• The blood-pressure-lowering effect of clonidine may be reduced by doxazosin.
Doxazosin should be taken with caution in combination with clarithromycin, ketoconazole, and itraconazole.
Food Interactions None known.
Usual Dose
Adult: 1 mg morning or evening to start; may be increased to a total of 16 mg, taken once a day. Extended-release tablets-4 mg once daily at breakfast; may be increased to a total of 8 mg. Do not chew, cut, or crush extended-release tablets.
Child: not recommended.
Overdosage
Overdose may produce drowsiness, poor reflexes, and very low blood pressure. Overdose victims should be taken to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Take doxazosin exactly as prescribed. Do not stop taking it unless directed to do so by your doctor. Avoid over-the-counter drugs that contain stimulants because they may increase your blood pressure.
Doxazosin may cause dizziness, headache, and drowsiness, especially 2-6 hours after you take your first dose, although these effects can persist after the first few doses. Use caution when getting up from a sitting or lying position.
Call your doctor if you develop severe dizziness, heart palpitations, or any bothersome or persistent side effect.
Wait 12-24 hours after taking your first dose of doxazosin before driving or doing anything that requires concentration. Take your dose at bedtime to minimize this problem.
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 coT)- tinue with your regular schedule. Do R(ak%’Ke a double dose.
4VIWIal Populations
Pregnancy/Breast-feeding: The safety of using doxazosin during pregnancy is not known, although animal studies have shown that alpha blockers may affect fetal development. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Small amounts of doxazosin pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver disease, may be more sensitive to the effects and side effects of doxazosin.
Generic Name
Doxercalciferol (dox-er-kal-Sffl-fer-ahl)
Brand Names
Drisdol Liquid Hectorol Capsules
Type of Drug
Vitamin D supplement.
Prescribed For
Elevated parathyroid hormone levels in patients undergoing kidney dialysis.
General Information
Doxercalciferol is a synthetic form of vitamin D that is processed in the body to form active vitamin D. Vitamin D, along with parathyroid hormone, are key elements of the calcium-regulating system in the body. Normally, your body releases parathyroid hormone if blood calcium levels are too low. Parathyroid hormones move calcium from the place where it is found in greatest quantity—your bones—into the bloodstream. This can have disastrous effects for a wide variety of body functions where calcium is crucial including muscle contraction, nervous system function, bone fragility, and blood clotting. Doxercalciferol helps to stabilize the system and normalize parathyroid hormone levels that can be artificially elevated in dialysis patients.
Cautions and Warnings
Do not use doxercalciferol if you are allergic or sensitive to any of its ingredients.
Do not take any other Vitamin D supplement while taking this dwg.
People with a tendency toward high calcium or vitamin D levels should not take doxercalciferol.
Before taking this medication, tell your doctor if you have liver disease. You may not be able to take doxercalciferol, or you may require a dosage adjustment or special monitoring during treatment.
Dialysis patients experience increases in blood calcium and phosphate while taking this drug.
Drug Interactions
• Do not take antacids that contain magnesium while you are taking doxercalciferol.
• Cholestyramine may reduce the absorption of doxercalciferol.
• Prolonged use of mineral oil may reduce the absorption of doxercalciferol.
• Do not combine any other over-the-counter or prescription medicines, or vitamin supplements with doxercalciferol without first talking with your doctor.
• The following medicines can slow the transformation of doxercalciferol to its active form in the body, reducing its effectiveness: ketoconazole, erythromycin, delaviridine, indinavir, nelfinavir, ritonavir, amiodarone, aprepitant, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, diltiazem, fluconazole, fluvoxamine, gestodene, itraconazole, mifepristone, nefazodone, norfloxacin, mibefradil, and verapamil.
• The following drugs can increase the breakdown of doxercalciferol in the liver, possibly reducing its effectiveness: efavirenz, nevirapine, barbiturates, carbamazepine, glucocorticoids, modafinil, phenobarbital, phenytoin, rifampin, St. John’s wort, oxcarbazepine, pioglitazone, and rifabutin. Dosage adjustment may be needed.
• Digoxin may cause symptoms of alcohol intolerance when combined with disulfiram or mettot)idazole.
Food (”WTactions
Avoid grapefruit products as they can slow the transformation of doxercalciferol to its active form in the body, reducing its effectiveness.
You may need to limit your consumption of foods containing vitamin D. Consult your doctor.
constipation, general discomfort, nausea, difficulty breathing, and itching.
of appetite, indigestion, weight gain, on, sleepiness, and slowed heart rate.
Possible Side Effects
♦ Common: swelling, headache, dizziness,
✓ Less common: loss joint pain,
Usual Dose
Adult:starting dose-10 mcg 3 times a week during kidney dialysis treatment. Dosage may be adjusted to 2.5 mcg at 8-week in-
tervals if necessary.
Child: not recommended.
Overdosage
Symptoms include weakness, headache, drowsiness, nausea, vomiting, dry mouth, metallic taste in mouth, constipation, muscle pain, bone pain, and irregular heartbeat. Call your local poison control center or a hospital emergency room for more information. It you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Compliance with dosage instruction, diet, and calcium supplementation is important while taking doxercalciferol.
Lab tests are required to monitor therapy while taking doxercalciferol.
Doxercalciferol may cause dizziness. Use caution while driving or performing other tasks requiring alertness, coordination, or physical dexterity.
Special Populations
Tell your doctor or pharmacist if you are pregnant, planning on becoming pregnant, or breast-feeding.
The safety of using doxercalciferol 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 doxercalciferol passes into breast milk. Nursing mothers who must use this drug should use infant formula.
Seniors: Seniors may use this drug without special precaution.
Generic Name
Dronabinol (droe-Mla-ih,bl)
Brand Name Marino)
Type of Drug Antinauseant.
Prescribed For
Nausea and vomiting associated with cancer chemotherapy, and appetite stimulation and weight-loss prevention in people with acquired immunodeficiency syndrome (AIDS).
General Information
Dronabinol is a legal form of marijuana. The psychoactive chemical in marijuana is delta-9-THC. Dronabinol has all of the psychological effects of marijuana and is therefore considered to be a highly abusable drug. It can cause personality changes, feelings of detachment, hallucinations, and euphoria (feeling “high”). Younger adults have reported a greater success rate with dronabinol, probably because they are better able to tolerate these effects.
Most people start taking dronabinol while in the hospital so their response to the drug and its possible adverse effects can be monitored. Dronabinol has also been studied as a glaucoma treatment.
Cautions and Warnings
Do not take dronabinol if you are allergic or sensitive to any of its ingredients, to marijuana, or to sesame oil.
Dronabinol should not be used to treat nausea and vomiting caused by anything other than cancer chemotherapy.
Dronabinol should be used with caution in those with a history of seizure disorders or substance abuse.
Dronabinol has a profound effect on mental states; it will impair your ability to operate complex equipment or engage in any activity that requires intense concentration, sound judgment, or coordination—such as driving a car.
Dronabinol produces withdrawal symptoms when the drug is stopped. These may develop within 12 hours of the drug’s discontinuation and include restlessness, sleeplessness, and irritability. Within a day after the drug has been stopped, stuffy nose, hot flashes, sweating, loose stools, hiccups, or appetite loss may occur. The symptoms usually subside within a few days,
Dronabinol should be used with caution by people with heart disease or high blood pressure. Dronabinol should be used with caution by people with a manic-depressive or schizophrenic history because it may aggravate the underlying disease.
Possible Side Effects
V Most common: drowsiness, euphoria, dizziness, anxiety, muddled thinking, perceptual difficulties, poor coordination, irritability, a separation in time and space, depression, weakness, sluggishness, nausea and vomiting, headache, hallucinations, memory lapses, loss of muscle coordination, unsteadiness, paranoia, depersonalization, disorientation, confusion, rapid heartbeat, and dizziness when rising from a sitting or lying position.
♦ Less common: difficulty talking or slurred speech, facial flushing, excessive perspiration, nightmares, ringing or buzzing in the ears, fainting, diarrhea, loss of bowel control, and muscle pain.
Drug Interactions
• Dronabinol increases the effects of alcohol, sleeping pills, sedatives, and other depressants. It also enhances the effects of psychoactive drugs including tricyclic antidepressants, amphetamines, cocaine, and other stimulants.
• Dronabinol may increase the effects of fluoxetine and disulfiram.
• The effects of theophylline drugs are reduced by dronabinol.
• Combining dronabinol and antihistamines or anticholinergic drugs may cause either rapid heartbeat or excessive drowsiness.
Food Interactions
This drug may be taken without regard to food or meals; as an appetite stimulant, it is often taken before meals.
Usual Dose
Antiemetic: 5 mg 1-3 hours before starting chemotherapy treatment and repeated every 2-4 hours after treatment, for a total of 4-6 doses a day. Dosage may be increased up to 15 mg per dose if needed; psychiatric side effects increase greatly at higher dosages.
Appetite Stimulant: 2.5 mg before lunch or dinner, or 2.5 mg at bedtime. Dosage may be increased to 20 mg a day.
Overdosage
Overdose symptoms may occur at usual dosages or at higher dosages if the drug is being abused. The primary symptoms of
overdose are the psychological symptoms listed above (see “Possible Side Effects”). In some cases, overdose may lead to panic reactions or seizure. Contact a hospital or local poison center for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Be careful when driving or performing any task that requires concentration. Avoid alcohol and other central nervous system (CNS) depressants.
Dronabinol may cause acute psychiatric or psychological side effects. Call your doctor if any develop.
The capsules must be stored in the refrigerator.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding; Animal studies have shown adverse effects on the fetus. When this drug is considered crucial by your doctor, its benefits must be carefully weighed against its risks.
Dronabinol passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to this drug, especially its psychological effects.
Brand Name
Dyazide
Generic Ingredients Hydrochlorothiazide + Triamterene 5§1
Other Brand Names
Maxzide Maxzide-25
The information in this 10TOVile also applies to the following drugs:
Generic Ingredients: Amiloride + Hydrochlorothiazide 92 Hydro-Ride Moduretic
Generic Ingredients: Spironolactone + Hydrochlorothiazide KI
Aldactazide Spironazide
Alzide Novo-Spirozine Spirozide
Type of Drug
Diuretic that increases urination).
Prescribed For Hypertension (high blood pressure) or any condition where it is de-
sirable to eliminate excess water from the body. General Information
Dyazide combines a thiazide diuretic and a potassium-sparing diuretic. The latter, triamterene, helps the body retain potassium while producing a diuretic effect. This balances the other ingredient, hydrochlorothiazide, which normally causes a loss of potas- sium. Different products contain differing concentrations of these 2 drugs. Dyazide should be used only when you need its exact proportion of ingredients, and should not be used for initial therapy of hypertension or edema. It may be used alone or with other anti hypertensive drugs such as beta blockers. Dosage adjustment may be necessary.
Cautions and Warnings
Do not use dyazide if you are allergic or sensitive to any of its ingredients or to any sulfa drug or if you have a history of allergy.
Do not use Dyazide if you have nonfunctioning kidneys, bronchial asthma, or hyperkalemia (high blood potassium levels).
Do not combine any potassium supplement and Dyazide without your doctor’s knowledge. Dyazide may reduce blood levels of sodium and potassium and raise blood calcium levels.
Dyazide should be used with caution in people with diabetes, liver disease, or an electrolyte imbalance.
Possible Side Effects
♦ Most common: appetite loss, drowsiness, lethargy, head-
ache, gastrointestinal upset, cramping, and diarrhea.
V Less common: rash—possibly severe, mental confusion, fever, feeling unwell, impotence, bright red tongue, burnt”g sensation in the tongue, tingling in the toes and fingers, restlessness, anemia or other effects on blood components, increased sensitivity to sunlight, and dizziness when rising quickly from a sitting position. Dyazide may also produce muscle spasms, gout, weakness, and blurred vision.
Drug Interactions
other blood pressure
• Dyazide increases the effect of
drugs. This is why other blood-pressure drugs are often prescribed with Dyazide, but dosage adjustments may be required.
• Combining Dyazide and digitalis drugs, amphotericin B, or adrenal corticosteroids increases the risk of body-fluid imbalance. If you are taking insulin or an oral antidiabetic drug and begin taking Dyazide, the insulin or antidiabetic dosage may have to be modified.
• Dyazide may increase the risk of allopurinol side effects.
• Dyazide may decrease the effects of oral anticoagulant (blood-thinning) drugs.
• Antigout drug dosage may have to be modified since Dyazide raises uric-acid levels.
• Dyazide may prolong the effects of chemotherapy drugs on reducing white-blood-cell counts.
• Dyazide may increase the effects of diazoxide, which may lead to symptoms of diabetes.
• Dyazide should not be taken with loop diuretics because the combination can lead to an extreme diuretic effect and an extreme effect on blood-sodium levels.
• Dyazide may increase the effect of vitamin D, which may cause high blood-calcium levels.
• Propantheline and other anticholinergics may increase the diuretic effect of Dyazide.
• Lithium carbonate taken with Dyazide should be monitored carefully by a doctor due to an increased risk of lithium side effects.
• Cholestyramine and colestipol prevent Dyazide from being absorbed. Dyazide should be taken at least 2 hours before cholestyramine or colestipol.
• Methenamine and other urinary agents may reduce the effect of Dyazide.
• Some nonsteroidal anti-inflammatory drugs (NSNDs), particularly indomethacin, may reduce the effect of Dyazide. Sulindac, another NSAID, may increase its effect.
• Potassium-sparing diuretics should be used with caution in combination with ACE inhibitors.
Food Interactions
Take this drug with food if it upsets your stomach.
usual Dose
Adult
Amiloride combination: 1-2 tablets daily with meals.
Spironolactone combination: 1-8 tablets daily.
Triamterene combination: 1-2 capsules or tablets a day. Child: not recommended.
Overdosage
Symptoms may include tingling in the arms or legs, weakness, fatigue, changes in heartbeat, a sickly feeling, dry mouth, restlessness, muscle pain or cramps, urinary difficulties, nausea, and vomiting. In some cases, low blood pressure and decreased respiration may occur. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Dyazide causes excess urination at first, but this subsides after several weeks of use. Diuretics are usually taken early in the day to prevent excessive nighttime urination that may interfere with sleep.
Dyazide may make you drowsy. Be careful when driving or performing any task that requires concentration.
Call your doctor if you develop muscle pain, sudden joint pain, weakness, cramps, nausea, vomiting, restlessness, excessive thirst, tiredness, drowsiness, increased heart or pulse rate, diarrhea, dizziness, headache, or rash.
People with diabetes may experience an increased blood-sugar level and require dosage adjustments of their antidiabetic medications.
Avoid other drugs while taking Dyazide unless otherwise directed by your doctor. Avoid alcohol.
If you are taking Dyazide for the treatment of hypertension or congestive heart failure (CHF), avoid over-the-counter cough, cold, or allergy medications, which may contain Ft%m\)%an1s.
Take Dyazide exactly -as prescribed. Be aware that all triarRtt~tl)Z-’hydrochlorothiazide products are not equal to each other and should not be freely substituted. Check with your doctor and pharmacist before switching brands.
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.
Aug
12
Dimenhydrinate - Diphenhydramine Hydrochloride - Disopyramide - Dofetilide
August 12, 2009 | Leave a Comment
Generic Name
Dimenhydrinate (dye-men-HYE-drih-nate) A
Brand Names
Calm-X Dramamine
Dimetabs Triptone
The information in this profile also applies to the following drugs: Generic Ingredient: Meclizine 91
Antivert Bonine
An tOmA 2S Meni-D
Antivert 50 Ru-Vert-M Antrizine
Type of Drug
Antihistamine and antiemetic (an agent that prevents or relieves nausea and vomiting).
Prescribed For
Nausea, vomiting, vertigo, and dizziness associated with motion
sickness.
General Information
Dimenhydrinate, which depresses middle ear function, is a mixture of diphenhydramine—an antihistamine believed to be the active ingredient—and another ingredient. Meclizine is an antihistamine. It takes a little longer to start working than dimenhydrinate, but its effects last much longer. Meclizine does a better job of preventing motion sickness than treating its symptoms. It takes 30 minutes to 1 hour to work and lasts for 12-24 hours.
Cautions and Warnings
Do not take dimenhydrinate if you are allergic or sensitive to any of its ingredients. Newborn babies should not be given this drug.
People with a prostate condition, stomach ulcer, intestinal obstruction, bladder problems, difficulty urinating, glaucoma, asthma, or abnormal heart rhythms should use dimenhydrinate only while under a doctor’s care.
Because it controls nausea and vomiting, dimenhydrinate may hide the symptoms of appendicitis or overdoses of other drugs.
Possible Side Effects
✓ Most common: drowsiness.
♦ Less common: confusion; nervousness; excitation; restlessness; headache; sleeplessness, especially in children; tingling; heavy or weak hands; fainting; dizziness; tiredness; rapid heartbeat; low blood pressure; heart palpitations; blurred or double vision; difficult or painful urination; increased sensitivity to the sun; appetite loss; nausea; vomiting; diarrhea; upset stomach; constipation; nightmares; rash; drug reaction (symptoms include rash, itching, hives, and breathing difficulties); ringing or buzzing in the ears-, dry mouth, nose, or throat; stuffy nose-, wheezing: and increased chest phlegm OT chest tightness.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• Taking dimenhydrinate with an alcoholic beverage, other antihistamine, sedative, or other central-nervous-system (CNS)
depressant may cause excessive dizziness, drowsiness, or other signs of depression.
• Side effects of anticholinergics may be increased when taken with dimenhydrinate.
• Combining dimenhydrinate and certain antibiotics that cause dizziness or other ear-related side effects may mask early signs of these side effects, especially in infants and children.
Food Interactions
Take dimenhydrinate with food or milk if it upsets your stomach.
Usual Dose
Dimenhydrinate
Adult and Child (age 13 and over): 50-100 mg-1 or 2 tablets or 4-8 tsp.-30 minutes prior to travel; then every 4-6 hours; do not take more than 400 mg a day.
Child (age 6-12): 25-50 mg-1/2 or 1 tablet or 2-4 tsp.—every 6-43 hours; do not take more than 150 mg a day.
Child (age 2-5): up to 25 mg-1/2 or 1 tablet or 2 tsp.-every 6-8 hours; do not take more than 75 mg a day.
Child (under age 2): Consult your doctor.
Meclizine
Adult and Child (age 13 and over): 25-50 mg 1 hour before travel; repeat every 24 hours for duration of journey. Up to 100 mg a day in divided doses may be needed to control dizziness from other causes.
Child: not recommended.
Overdosage
Symptoms of overdose include drowsiness, clumsiness, unsteadiness, feeling faint, facial flushing, and dry mouth, nose, or throat. Convulsions, coma, and breathing difficulties may also develop. Overdose victims should be taken to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
N1 Maximum effectiveness against motion sickness, take dimenhydrinate 1-2 hours before traveling; it may still be effective if taken 30 minutes before traveling.
This drug may cause drowsiness: Be extremely cautious when driving, operating hazardous machinery, or doing anything that requires concentration.
Dimenhydrinate may cause dry mouth, nose, or throat. Sugarless candy, gum, or ice chips can usually relieve these symptoms. Constant dry mouth may increase the likelihood of developing tooth decay or gum disease. Pay special attention to oral hygiene while you are taking dimenhydrinate, and contact your doctor if dry mouth lasts more than 2 weeks.
If you forget to take a dose of dimenhydrinate, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that meclizine may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant —especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of dimenhydrinate may pass into breast milk. Dimenhydrinate may also slow milk production. Nursing mothers who must take dimenhydrinate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and should take the lowest effective dose.
Generic Name
Diphenhydramine Hydrochloride
(dye-fen-HYE-druh-mene hye-droe-KLOR-ide) 91
Brand Names
40 Winks
AllerM,ly,
AllerMax Maximum Strength Altaryl Children’s Allergy Banophen
Banophen Allergy
Benadryl Allergy
Benadryl Children’s Allergy* Benadryl Children’s Dye Free Benadryl Dye Free Allergy
Liquid Gels
Children’s Pediacare Nighttime Cough’
Compoz Gel Caps
Compoz Nighttime Sleep Aid Diphen AF
Diphenhist
Dormin
Dytuss
Genahist
Midol PM
Miles Nervine
Nytol Quick Caps
Nytol Quick Gels Maximum Strength
Scot-Tussin Allergy*
Siladryl
Simply Sleep
Sleep-Eze 3
Sleepinol Maximum Strength Sleepwell 2-Nice
Snoozefast
Sominex Original Formula Sylphen Cough
TheraFlu Thin Strips Multi Symptom
Triaminic Thin Strips Cough and Runny Nose
Tusstat
Unisom
‘Some products in this brand-name group are alcohol- or sugar-free.
Type of Drug Antihistamine.
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy and for other symptoms of allergy such as itching, rash, and hives; also prescribed for motion sickness, insomnia, and Parkinson’s disease.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction), drying the nose, throat, and eye secretions. Diphenhydramine is the most common active ingredient found in nonprescription sleep aids.
Cautions and Warnings
This drug should not be used if you are allergic or sensitive to any of its ingredients. It should be avoided or used wilt extreme care if you have narrow-angle glaucoma, stomach ulcer, intestinal abslmcfion, other stomach problems, difficulty urinating, or enlarged prostate. It should not be used by people who have sleep apnea or deep-breathing problems such as asthma. Use with care if you have a history of thyroid disease, heart disease, emphysema, chronic bronchitis, or high blood pressure.
Drug Interactions
• This drug should not be taken with a monoamine oxidase inhibitor antidepressant.
• The effects of sedatives, sleeping medications, and other central-nervous-system (CNS) depressants will be intensified when combined with diphenhydramine hydrochloride; it is extremely important that doses of these drugs are properly adjusted.
• This drug increases the intoxicating and sedating effects of alcohol.
Food Interactions
Take this drug with food if it upsets your stomach.
Usual Dose
Allergy
Adult: 25-50 mg 3-4 times a day.
Child (over 20 tbs.): 12.5-25 mg 3-4 times a day.
Nighttime Sedation
Adult and Child (age 12 and over): 25-50 mg at bedtime.
couqh. SIN%
Adult and Child (age 12 and over): 25 mg every 4 hours; do not take more than 150 mg in 24 hours.
Child (age 6-12): 12.5 mg every 4 hours; do not take more than 75 mg in 24 hours.
mouth, and weakness.
g, rash, sensitivity to bright light, per-
s, lowering of blood pressure, head-
t, sleeplessness, dizziness, disturbed sion, restlessness, nervousness, irri- eling “high”), tingling and weakness of lurred or double vision, ringing in the , appetite loss, nausea, vomiting, con- urinary difficulties, thickening of lung s of the chest, wheezing, nasal stuffi-
h, nose, or throat.
Possible Side Effects
✓ Common: drowsiness
✓ Less common: itching
• fever, chills
• rapid heartbeat
confusion
euphoria (feelin
hands or feet, blurre
• upset stomach
• diarrhea, secretions, tightnes
• and dry
Child (age 2-6): 6.25 mg every 4 hours; do not take more than
25 mg in 24 hours.
Child (under age 2): not recommended.
Thin Strips
TheraFlu
Adult and Child (age 12 and over): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Triaminic
Child (age 6-12): 1 strip every 4 hours; do not take more than 6 strips in 24 hours.
Overdosage
Symptoms of overdose include depression or stimulation—especially in children; dry mouth; fixed or dilated pupils; flushing; and upset stomach. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy. Take the overdose victim to a hospital emergency room immediately if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be extremely cautious when driving or operating hazardous equipment.
If you are taking this medication for motion sickness, take the first dose at least 30 minutes prior to exposure.
If you forget to take a dose of diphenhydramine hydrochloride, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 miDMIns of pregnancy—because newborns may have severe reactions to antihistamines.
SMM) amounts of antihistamine pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects and may require lower dosages.
Generic Name
Disopyramide (die-soe-PIE-rah-mide) 92
Brand Names Norpace
Type of Drug Antiarrhythmic.
Prescribed For Abnormal heart rhythms.
General Information
Disopyramide phosphate slows the rate at which nerve impulses are carried through heart muscle, reducing the response of heart muscle to those impulses. It acts on the heart similarly to the more widely used antiarrhythmic medications procainamide hydrochloride and quinidine sulfate. Disopyramide is often prescribed for people who do not respond to other antiarrhythmic drugs.
Cautions and Warnings
Do not take disopyramide if you are allergic or sensitive to any of its ingredients or if you have heart block, unless you have a cardiac pacemaker.
This drug can worsen heart failure or trigger severely low blood pressure. It should be used in combination with another antiarrhythmic agent or beta blocker with caution.
In rare instances, disopyramide has caused a reduction in blood-sugar levels. Therefore, the drug should be used with caution by diabetics, older adults—who are more susceptible to this effect—and people with poor kidney or liver function. Ask your doctor if you should have your blood-sugar levels checked while taking this drug.
Because of its anticholinergic effects, men with a severe prostate condition and people who have glaucoma, myasthenia gravis, or severe difficulty uritx;aA:jng should use disopyramide with caution.
People with liver or kidney disease must take a reduced dose of disopyramide.
Potassium levels affect the action of disopyramide. People with blood potassium levels that are out of the normal range must correct this imbalance before starting disopyramide.
Norpace CR
Possible Side Effects
♦ Most common: dry mouth, urinary difficulty, and constipation.
♦ Common: blurred vision; dry eyes, nose, and throat; frequent urination; nausea; stomach pain or bloating; gas; dizziness; fatigue; headache; and nervousness.
♦ Less common: itching, rashes, muscle weakness, generalized aches and pains, not feeling well, low blood-potassium levels, increases in blood-cholesterol and triglyceride levels, heart failure, and low blood pressure.
♦ 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
• Phenytoin and rifarnpin may increase the rate at which the body removes disopyramide from the blood. Your disopyramide dose may need alteration if this combination is used. Other drugs known to increase drug breakdown by the liver, such as barbiturates and primidone, may also have this effect.
• Other antiarrhythmic drugs, such as procainamide and quinidine, may increase the effect of disopyramide, making dosage reduction necessary. At the same time, disopyramide may reduce the effectiveness of quinidine.
• When disopyramide is combined with a beta-blocking drug, increased disopyramide effects, additive effects, or depression of heart function may result.
• Azole antifungals, clarithromycin, diclofenac, doxycycline, erythromycin, imatinib, isoniazid, nefazodone, nicardipine, propofol, protease inhibitors, telithromycin, and verapamil may increase the amount of disopyramide in your blood, causing abnormal heart rhythms or other cardiac effects.
• Disopyramide may reduce the effectiveness of oral anticoagulant (blood-thinning) drugs. Your doctor should check your anticoagulant dosage to be sure you are getting the right amount.
• Hydantoins may cause a decrease in the effectiveness of disopyramide.• Disopyramide may increase the amount of digoxin in your blood, though the amount of the increase is not likely to af-
fect your heart.
• St. John’s wort may decrease disopyramide levels.
Food Interactions
Disopyramide should be taken on an empty stomach at least 1
hour before or 2 hours after meals. Usual Dose
Adult: 400-800 mg a day (divided into 2 or 4 doses for the immediate-release form). In severe cases, 400 mg every 6 hours may be required. This level of dosage should be monitored in the hospital. The sustained-release preparation is taken every 12 hours. People with reduced kidney function should receive a lower dosage, depending on the degree of kidney function present. People with liver failure should take 400 mg a day.
Child (age 13-18): 2.5-7 mg a day per lb. of body weight. Child (age 5-12): 4.5-7 mg a day per lb. of body weight. Child (age 1-4): 4.5-9 mg a day per lb. of body weight.
Child (under age 1): 4.5-13.5 mg a day per lb. of body weight.
Overdosage
Overdose symptoms are breathing difficulties, abnormal heart rhythms, and unconsciousness. In severe cases, overdosage can lead to death. Overdose victims should be made to vomit with ipecac syrup—available at any pharmacy—to remove any remaining drug from the stomach. Call your doctor or poison control center before doing this. If you must go to a hospital emergency room, ALWAYS bring the prescription bottle or container. Prompt and vigorous treatment can mean the difference between life and death in severe overdosage.
Special Information
Disopyramide may cause symptoms of low blood sugar: anxiety, chills, cold sweats, drowsiness, excessive hunger, nausea, nervousness, rapid pulse, shakiness, uaus~M% weakness, tiredness, or cool, pale skim If kNSN)appens to you, eat some chocolate, candy, U rilher high-sugar food, and call your doctor at once.
Disopyramide can cause dry mouth, urinary difficulty, constipation, or blurred vision. Call your doctor if these symptoms become severe or intolerable, but do not stop taking the medication without your doctor’s approval.
If disopyramide is required for a child and capsules are not appropriate, your pharmacist can make a liquid product. Do not do this at home: This medication requires special preparation. The liquid should be refrigerated and protected from light and should be thrown away after 30 days.
Do not crush, chew, or open sustained-release capsules.
If you forget to take a dose of disopyramide, take it as soon as possible. However, if it is within 4 hours of your next dose, skip the dose you forgot and go back to your regular schedule. Do not take a double dose.
Special Populations
PregnancylBreast-feeding: Do not take this drug if you are pregnant or planning to become pregnant while using it, because it will pass into the fetus and may affect its development. When disopyramide is considered crucial by your doctor, its potential benefits must carefully be weighed against its risks.
Disopyramide passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of this drug.
Generic Name
Dofetilide (DOH-fet-a-lyed)
Brand Name Tikosyn
Type of Drug Antiarrhythmic.
Prescribed For
Specific abnormal heart rhythms.
General Information
Dofetilide is used to establish and maintain normal sinus rhythm in the heart. Dofetilide is available only to hospitals and doctors who receive specific training and education on how to use this drug because of the risks associated with using it.
Cautions and Warnings
Do not take dofetilide if you are allergic or sensitive to any of its ingredients.
Dofetilide is reserved for people whose abnormal heart rhythms have not responded to other drugs. People taking dofetilide must be in a hospital or other facility for at least 3 days where appropriate blood tests can be performed to monitor kidney and heart function.
This drug is cleared through the kidneys. Poor kidney function increases the amount of dofetilide in the body. Liver disease has no effect on dofetilide blood levels.
Dofetilide, like other antiarrhythmic drugs, can cause severe and sometimes fatal abnormal rhythms of its own.
Do not take dofetilide without first talking to your doctor if you have a low blood level of potassium or magnesium.
Women may be at a greater risk for some arrhythmias caused by dofetilide.
Possible Side Effects
Serious heart arrhythmias can develop in up to 31b% of patients taking up to 1000 mcg a day of dofetilide. People taking daily doses above 1000 mcg a day are at up to 5 times greater risk for arrhythmias.
• Most common: headache, chest pain, and respiratory infection.
♦ Common: difficulty breathing, nausea, and dizziness.
♦ Less common: flu; sleeplessness; accidental injury; back pain; diarrhea; abdominal pain; angina; anxiety: joint pain; weakness; atrial and ventricular arrhythmia; high blood pressure; pain; heart palpitations; swollen legs, ankles, or arms; sweating; and urinary infections.
♦ Rare: some arrhythmias, heart attack, hives, slow heartbeat, stroke, facial or other paralysis, tingling in the hands or feet, cough, liver damage, migraine, fainting, and sudden death. Contact your doctor if you experience any side effect not listed above.
‘D?Ug Interactions
Dofetilide should not be given with drugs that are known to interact with it. Dofetilide must be stopped at least 2 days before any potentially interacting drug is taken.
• Do not mix dofetilide with any product containing verapamil, a calcium channel blocker, or trimethoprim, used for urinary infections. These combinations can substantially raise the amount of dofetilide in the blood.
• Some drugs may increase the amount of dofetilide in the blood by inhibiting enzymes that break it down in the liver. They include delavirdine, indinavir, btonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, clarithromycin, cannabis, diltiazem, erythromycin, fluconazole, fluvoxamine, itraconazole, ketoconazole, mifepristone, nefazodone, norfloxacin, mibefradil, selective serotonin reuptake inhibitors (SSRIS), troleandomycin, and zatirlukast.
• Some drugs may reduce the amount of dofetilide in the blood by stimulating enzymes that break it down in the liver, including efavirenz, nevirapine, carbamazepine, corticosteroids, modafanil, phenobarbital and other barbiturates, phenytoin, pioglitazone, and rifampin. Amiloride, metformin, megestrol, and triamterene can interfere with the elimination of dofetilide via the kidney, raising blood levels of the drug.
• Other drugs that can increase the effects of dofetilide are Other antiarrhythmic drugs, bepridil, phenothiazines, and tricyclic antidepressants.
• Mixing dofetilide with digoxin may lead to a ventricular arrhythmia called torsade de pointes. Thiazides, furosemide, and other potassium-depleting diuretics can also increase the risk of this arrhythmia.
Food Interactions
Grapefruit juice may increase dofetilide blood levels.
Usual Dose
Adult: 125-500 mcg twice a day.
Child (under 18 years): not recommended.
Overdosage
Dofetilide overdose is likely to cause significant heart rhythm problems. Overdose victims must be treated symptomatically by their cardiologist.
Special Information
Read all information supplied to you before you begin taking this medication and read it again if anything in your treatment program changes.
Tell your doctor about any changes in your prescription or nonprescription drug use or in your use of vitamins, minerals, and other dietary supplement products.
Be sure that any other doctor or hospital that treats you and might prescribe another drug knows you are taking dofetilide.
Call your doctor at once if you develop any signs of altered electrolyte balance including excessive or prolonged diarrhea, sweating, vomiting, appetite changes, or excessive thirst.
If you forget to take 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: Dofetilide causes birth defects in animal studies. Pregnant women should take this drug only after discussing with their doctors its potential benefits and risks.
It is unknown whether dofetilide passes into breast milk. Nursing mothers who take it should consider using infant formula.
Seniors: Older adults may take this drug without special restriction.
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.