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26

Formoterol - Fosfomycin - Fosinopril - Fosrenol - Ganciclovir

September 26, 2009 | Leave a Comment

Generic Name Formoterol (for-MOH-ter-ol)
Brand Names Foradil Aerolizer Perforomist Foradil Certihaler
Generic Ingredients: Formoterol + Budesonide Symbicort
The information in this profile also applies to the following drug:
Generic Ingredient: Arformoterol Brovana
Type of Drug Bronchodilator.
Prescribed For
Maintenance of asthma, bronchospasm during exercise, and chronic obstructive pulmonary disorder, including chronic bronchitis, and emphysema.
General Information
Formoterol is a long-acting beta-2 agonist, used in the prevention of asthma attacks and bronchial spasms. It is not effective in stopping an asthma attack once it has begun. Patients suffering from severe asthma should always have a short-acting bronchodilator available in case of an acute attack.
Cautions and Warnings
Do not use formoterol if you are allergic or sensitive to any its ingredients.
Formoterol not be used by patients with significantly or rapidly worsening asthma. In some asthma patients, formoterol may increase the chance of death from asthma.
Formoterol is not a replacement for corticosteroid inhalers. Patients should continue to use their corticosteroid inhalers at the same dosage in conjunction with formoterol.
Patients who have been taking inhaled, short-acting beta-2 agonises should stop regular use of these, and use them only to treat acute asthma symptoms.
Formoterol can cause paradoxical bronchospasm, a potentially life-threatening condition. Patients who experience symptoms should discontinue use of formoterol immediately.
Formoterol can cause irregular heartbeat and should be used with caution by patients with a history of heart disease or high blood pressure. Patients with a history of seizures, strokes, or diabetes should also be carefully monitored for a recurrence or worsening of these conditions.
Possible Side Effects
Most common: tremors, dizziness, insomnia, and chest pain.
Common: restlessness, weakness, sore throat, and difficulty breathing.
Less common: lightheadedness, angina, abnormal heart rhythm, heart palpitations, and bronchospasrn.
Rare: severe worsening of asthma, extreme allergic reaction, and angioedema (a potentially life-threatening swelling of the lips and throat). Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Formoterol’s effects may be increased by monoamine oxidase inhibitor (MA01) antidepressants, tricyclic antidepressants, thyroid drugs, other bronchodilators. and some antihistamines.
•    The effect of formoterol may be lessened by beta-blocking drugs, such as propranolol.
•    Formoterol may antagonize the effects of blood-r:~ssurelowering drugs, especially reserpine, methyldupa, and guanethidine.
•    Using formoterol with antihistamt z;, disopyramide; phe- nothja,Z:MtS,’D10cBinamide; quinidine and similar drugs: theo- phylline; and tricyclic antidepressants may increase the risk of heart damage and life-threatening cardiac arrhythmias.
Food Interactions None known.
Usual Dose
Arlormoterol
Adult: Inhale 15 mcg every 12 hours. Child: not recommended.
Formoterol
Adult and Child (age 5 and over)
Foradil Aerolizer: Inhale 12 mcg every 12 hours. Foradil Certihaler: Inhale 10 mcg every 12 hours.
Perforomist: Inhale 20 mcg every 12 hours. Child (under age 5): not recommended.
Formoterol + Budesonide Combination Adult: Inhale 1 puff every 12 hours. Child: riot recommended.
Overdosage
Formoterol overdose may cause nausea, vomiting, tremor, sleepiness, rapid or irregular heartbeat, low blood sugar, blood acidity, and life-threatening cardiac arrhythmias. Patients experiencing severe symptoms should go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
The drug should be inhaled during the second half of your inward breath. This will allow the medication to reach more deeply into your lungs.
Be sure to follow your doctor’s directions for the use of formoterol. Using more than you need can increase the risk of side effects and worsen your symptoms. If your condition worsens after taking formoterol, stop taking it and call your doctor at once.
Call your doctor at once if you develop chest pains, rapid heartbeat, palpitations, muscle tremors, dizziness, headache, or swelling of the throat, or if you still have trouble breathing after using the medication.
If a dose of formoterol is forgotten, take it as soon as you remember. If it is almost time (Ox your next dose, skip the dose you forgot aMmMinue with your regular schedule. Do not take a double dose.
Formoterol capsules must only be used with the inhaler that is provided with this medicine. Do not use other medicines with the formoterol inhaler. Patients should be aware that the gelatin cap-sure may fragment, causing a risk that gelatin particles will be inhaled. This risk is minimized by being careful to pierce the gelatin capsule only once. Capsules should be used immediately after they are taken from the blister pack.
Special Populations
Pregnancy/Breast-feeding: The safety of formoterol in pregnant women has not been studied. The potential benefit of using this medication must be carefully weighed against its risks.
It is not known if formoterol passes into breast milk. Nursing mothers who take this should consider using infant formula.
Seniors: Seniors may be more sensitive to the effects of this drug. Follow your doctor’s directions and report any side effects at once.
Fosamax see Bisphosphonates, page 164
Generic Name
Fosfomycin (fos-foe-MYE-sin)
Brand Name Monurol
Type of Drug Urinary anti-infective.
Prescribed For
Uncomplicated urinary infections.
General Information
Fosfomycin kills a variety of bacteria. It works by preventing bacteria from sticking to the wall of the urinary tract and by interfering with bacterial cell division. In the body, it is converted V) its active form—free (WS bacteria that are resistant to other antibiotics are not resistant to fosfomycin, so this drug may work where others have failed.
Cautions and Warnings
bo not take fosfomycin if you are allergic or sensitive to any of its ingredients. Fosfomycin is meant to be taken once, in a single dose. Taking more than 1 packet of fosfomycin only increases side effects; it does not improve the drug’s effectiveness.
Drug Interactions
• Metoclopramide reduces fosfomycin blood levels. Food Interactions
You may take fosfomycin with or without food. Usual Dose
Adult (age 12 and over): 1 packet mixed with water. Child (under age 12): riot recommended.
Overdosage
Little is known about the effects of fosfomycin overdose. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
Do not take fosfomycin powder in its dry form. Mix the contents of the packet with 3-4 oz. of cool or cold water until it dissolves. Then drink the solution immediately.
Call your doctor if your infection does not improve within 2 or 3 days.
Special Populations
Pregnancy/Breast-feeding: The safety of using fosfomycin during pregnancy is, mV&nown. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
It is not known if fosfomycin passes into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may take fosfomycin without special restriction.
above. vaginal irritation, runny nose, nau-
ts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
¦ Less common: diarrhea
and headache
Rare: Rare side effects body. Contact your fect not listed

Generic Name
Fosinopril (tos-IN-oe-pril) 41
Brand Name Monopril
Combination Product
Generic Ingredients: Fosinopril + Hydrochlorothiazide IM
Monopril HCT Type of Drug
Angiotensin-converting enzyme (ACE) inhibitor.
Prescribed For
High blood pressure and heart failure. Also prescribed for renal failure, kidney hypertension, post-heart attack management, management of people with a high risk of heart disease, diabetes, chronic kidney disease, and preventing a second stroke.
General Information
Fosinopril sodium and other ACE inhibitors work by preventing the conversion of a hormone called angiotensin I to another hormone called angiotensin II, a potent blood-vessel constrictor. Preventing this conversion relaxes blood vessels, thus reducing blood pressure and relieving the symptoms of heart failure. Fosinopril also affects the production of other hormones and enzymes that participate in the regulation of blood vessel dilation. Fosinopril begins working 2-6 hours after you take it.
Cautions and Warnings
Do not take fosinopril if you are allergic or sensitive to any of its ingredients. Severe reactions may involve angioedema, a possibly life-threatening swelling of the face, throat, or intestines (see “Special Information”). These reactions are more likely in hemodialysis patients and those undergoing venom immunization.
Fosinopril occasionally causes very low blood pressure or affects your kidneys. ‘four doctor should check your urine for changes during the first few months of treatment.
ACE inhibitors can affect your white-blood-cell count, possibly increasing your susceptibility to infection. Blood counts should be checked periodically.
Fosinopril may cause serious injury or death to the fetus it taken during pregnancy. Pregnant women should, not take fosinopril.
ACE inhibitors may be less effective in some black patients with high blood pressure, especially when dietary salt intake is high. Nevertheless, they should still be considered useful blood pressure treatments. Swelling beneath the skin to form welts is more common among black patients.
Possible Side Effects
v Most common: chronic cough and dizziness, especially when rising from a sitting or lying position. The cough usually goes away a few days after you stop taking the medicine.
?    Less common: chest pain, low blood pressure, fatigue, diarrhea, headache, vomiting, and nausea.
¦    Rare: Rare side effects can affect your heart, sleeping, stomach and intestines, skin, sex drive, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    The blood-pressure-towering effect of fosinopril is additive with diuretic drugs and beta blockers. Any other drug that causes a rapid drop in blood pressure should be used with caution if you are taking an ACE inhibitor.
•    Fosinopril may increase the effects of lithium: this combination should be used with caution.
•    Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) reduce the blood pressure-lowering effects of fosinopril and other ACE inhibitors. This may cause reductions in kidney function.
•    Fosinopril may increase potassium levels in your blood, especially when taken with dyazide or other potassium-sparing diuretics.
•    Antacids and fosinopril should be taken at least 2 hours apart.
•    Capsaicin may trigger or aggravate the cough associated with fosinopril, kt)eTapy.
•    Indomethacin may reduce the blood-pressure-lowering effects of fosinopril.
•    Phenothiazine sedatives and antivomiting drugs may increase the effects of fosinopril.
•    Severe sensitivity reactions can occur in people taking allopurinol.

Fosinopril may affect blood levels of digoxin. More digoxin in the blood increases the chance of digoxin-related side effects while less digoxin in the blood can compromise its
effectiveness.
Food Interactions
You may take fosinopril with food if it upsets your stomach.
Usual Dose
Adult: 10-80 mg once a day. People with liver disease may require lower dosages.
Overdosage
The principal effect of ACE inhibitor overdose is a rapid drop in blood pressure, as evidenced by dizziness or fainting. Take the overdose victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop swelling of the face or throat, if you have sudden difficulty in breathing, or if you develop a sore throat, mouth sores, abnormal heartbeat, chest pain, persistent rash, or loss of taste perception. Unexplained swelling of the face, lips, hands, and feet can also affect the larynx (throat) and tongue and interfere with breathing. If this happens, the victim should be taken to a hospital emergency room at once.
Some people who start taking an ACE inhibitor after they are already on a diuretic (an agent that increases urination) experience a rapid drop in blood pressure after their first doses or when the dosage is increased. To prevent this from happening, you may be told to stop taking the diuretic 2 or 3 days before starting the ACE inhibitor or to increase your salt intake during that time. The diuretic may then be restarted gradually.
You may get dizzy if you rise to your feet quickly from a sitting or lying position when taking fosinopril.
Avoid strenuous exercise or very hot weather, because heavy sweating or dehydration can cause a rapid decrease in blood pressure.
Avoid over-the-counter diet pills, decongestants, and other stimulants that can raise blood pressure. Also, do not take potassium supplements or salt substitutes containing potassium without consulting your doctor.
If you forget to take a dose of fosinopril, take it as soon as you remember. If it is within 8 hours of your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: ACE inhibitors can cause fetal injury or death. Women who are or might be pregnant should not take ACE inhibitors. Stop taking the drug and contact your doctor if you become pregnant.
Large amounts of fosinopril pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors may be more sensitive to the effects of fosinopril.

Brand Name
Fosrenol
Generic Ingredient Lanthanum Carbonate
Type of Drug Phosphate binder.
Prescribed For
High blood phosphate levels (hyperphosphatemia) in people with end-stage renal disease (ESRD).
General Information
People with ESRD, a form of kidney disease, tend to retain phosphorous. High phosphate levels, in turn, can affect calcium balance in the body and cause deposits of this mineral to build up in the wrong places. Lanthanum helps manage high blood phosphate levels by binding to phosphate in food before it can be absorbed into the blood. This is the same mechanism used by other phosphate-lowering drugs (se,4e%Tner and the antacids aluminum hydroxide -6nd calcium carbonate). Lanthanum, like other phosphate binders, must be taken with meals so that it can bind phosphate ions in the stomach before they can be absorbed into the blood. Very little of this drug is absorbed into the blood and it is not broken down in the body Cautions and Warnings
Do not take fosrenol if you are allergic or sensitive to any of its
ingredients.
People with an active peptic ulcer, ulcerative colitis, Crohn’s
disease, or bowel obstruction should use this medication with
caution.
Researchers found no difference in bone fracture rates or over-
all survival for lanthanum than for other phosphate-binding treatments over 3 years. The study period was too short to assume that it would improve bone fractures or survival beyond 3 years.
Possible Side Effects
Side effects primarily affect the digestive tract and are similar to other phosphate-lowering treatments in type and frequency.
¦    Most common: nausea. vomiting, complications with the dialysis graft, diarrhea, constipation, abdominal pains, and low blood pressure.
¦    Common: bronchitis and runny nose.
?    Less common: high blood calcium levels.
?    Rare: Other side effects may affect any organ or organ system. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Lanthanum strongly binds to phosphate in the stomach and might also bind to other medications in the stomach. However, no interaction was found in tests conducted with warfarin, digoxin, enalapril, furosemide, metoprolol, or phenytoin.
•    Compounds known to interact with antacids should not be taken within 2 hours of taking lanthanum.
Food Interactions
This drug must be taken with or immediately after meals.
usual Dose
Adult: 750-1500 mg with or immediately after each meal. Completely chew each tablet before you swallow it. Do not swallow whole tablets.
Child: not recommended.
Overdosage
There have been no reports of lanthanum overdose, even with single doses up to 1000 mg per pound of body weight. Symptoms of overdose are likely to occur in the digestive tract. Overdose victims may be taken to a hospital emergency room for evaluation. ALWAYS bring the prescription bottle or container.
Special Information
If you forget to take lanthanum with or immediately after a meal, skip the forgotten dose and continue with your regular schedule.
Be sure to follow the low-phosphate diet your doctor prescribes. It is a key element in helping to manage your blood phosphate levels.
Special Populations
PregnancylBreast-feeding., Animal studies with doses several times the maximum human dose revealed some harm to the developing fetus. Pregnancy in a woman with end-stage renal disease, especially those on dialysis, is uncommon because of reduced fertility and carries serious risks for a woman and her baby, including anemia, uncontrolled high blood pressure, and infection. This drug is not recommended for pregnant women.
It is not known if lanthanum passes into breast milk. Nursing mothers who must take it should consider using infant formula.
Seniors: Seniors may use this medication without special restriction.

Generic Name
Ganciclovir (ga.-SYE-kloe-vem) IM
Brand Name
Vitrasert
The information in this profile also applies To The tollowing drug:
GD’K)Phc )ngredient: Valganciclovir Valcyte
Type of Drug
Antiviral.
Prescribed For
Cytornegalovirus (CMV) infections of the eye and CMV infections in other parts of the body, in people with compromised immune
systems.
General Information
Ganciclovir works by preventing reproduction of the virus CMV. Unlike other antiviral drugs, it works only against this virus and herpes simplex virus. The drug is eliminated through the kidneys.
Though most often used for CMV retinitis (eye infection), ganciclovir has also been used for CMV infections of the urine, blood, throat, and semen. It is also used to prevent CMV infection. Ganciclovir is helpful in controlling CMV infection in heart, kidney, and kidney-pancreas transplant patients. Valganciclovir is not indicated for use in liver transplant patients.
Valganciclovir (Valcyte) is broken down by the body into ganciclovir, and all information in this profile applies to both drugs, unless otherwise noted.
Cautions and Warnings
Do not take ganciclovir if you are allergic or sensitive to any of its ingredients.
Ganciclovir causes anemia, reduced white-blood-cell count, and blood-platelet loss. Regular monitoring of blood and platelet counts is recommended while taking this drug.
Ganciclovir is intended only for people who are immunocompromised. It is not intended to treat or prevent CMV infections in newborns.
Detachment of the retina has been noted in people taking ganciclovir, as well as in people with CMV who have not taken the drug. The relationship between ganciclovir and this effect is not well known.
Ganciclovir causes increased sensitivity to the sun; use a sunscreen or wear protective clothes when you go outside.
People with kidney disease should use qw\6,7_l1DAr with caution, and may (eqtst% ieatment at a lower dosage.
Studies of ganciclovir in blacks, Hispanics, and Caucasians showed a trend toward higher blood levels among Caucasians than other groups.
Intravenous ganciclovir has been given to a small number of children under age 12 with mixed results. Side effects were similar to those experienced by adults taking the drug.
Possible Side Effects
¦    Most common: fever, diarrhea, abdominal pain, reduced white-blood-cell counts, anemia, rash, sweating, nausea, vomiting, and appetite loss.
¦    Common: infection; chills; stomach gas; low platelet counts
(symptoms include bleeding or oozing blood); tingling-,
burning; numbness or pain in the hands, arms, legs, or feet-,
itching; pneumonia; weakness; and headache.
Drug Interactions
•    Pentamidine, flucytosine, vincristine, vinblastine, adriamycin, amphotericin B, trimethoprim-sulfamethoxazole, and other cytotoxic drugs may increase the side effects of ganciclovir and should be used together only if absolutely necessary, and only if the potential benefits outweigh the risks.
•    People taking imipenem-cilastatin together with ganciclovir have experienced seizures. Avoid this combination.
•    Mixing ganciclovir with other drugs that can be damaging to the kidneys may increase the rate and extent of kidney damage.
•    Probenecid interferes with ganciclovir release through the kidneys and substantially increases blood levels of ganciclovir.
•    Mixing ganciclovir with the anti-HIV drugs didanosine or zidovudine (AZT) may increase didanosine or AZT levels and reduce ganciclovir levels. Because AZT and ganciclovir both cause anemia and low white-blood-cell counts, many people cannot tolerate this combination.
Food Interactions
High-fat, high-calorie meals can increase the amount of ganciclovir absorbed into the blood. Take this drug with food.
Usual Dose Gar1r.(qtZ,41N
Adult and Child (age 13 and over): 3000 mg a day, divided into 3 or 6 equal doses. People with reduced kidney function will need to have their dosage reduced accordingly, possibly to as little as 500 mg 3 times a week.
Child (under age 13): not recommended.
Valganciclovir
Adult and Child (age 13 and over): 900 mg a day, divided into 2 equal doses of 450 mg each. People with reduced kidney function will need to have their dosage reduced accordingly, possibly to as little as 500 mg 3 times a week.
Child (under age 13): not recommended.
Overdosage
Little is known about the effects of ganciclovir overdose. As much as 6000 mg a day has been taken with only temporary lowering of white-blood-cell count. Call your hospital emergency room for instructions in case of ganciclovir overdose.
Special Information
Ganciclovir does not cure CMV eye infection, and immunocompromised people taking this drug may find their disease worsening. Dosage reductions or discontinuation of the drug may be necessary if white-blood-cell or platelet counts get too low.
Ganciclovir may cause infertility in men and women. Women of child-bearing age should use effective contraception while taking this drug. Men should use a condom while taking the drug and for at least 90 days afterward to avoid passing the drug to their partners.
Good dental hygiene is important while taking ganciclovir to minimize the risk of infection. If you have dental work done while taking this drug, expect the healing process to take longer.
Regular blood tests are necessary to watch for white-bloodcell or platelet-level alterations.
It is very important to take ganciclovir exactly as directed. If you forget a dose, take it as soon as you remember and continue with your regular schedule.
Special Populations
PregnancylBreas>-feeding. Animal studies showed ganciclovir to be toxic to the fetus. There is no reliable information about its effect in pregnant women, but it should be taken only when the possible Oe”6% Outweigh the risks. Women who are likely to become pregnant while taking this drug should use reliable contraception.
It is not known if ganciclovir passes into breast milk, but the possible side effects of this drug on a nursing infant should be kept in mind. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors often have reduced kidney function; dosage adiustments may be needed.

Generic Name
Gemfibrozil oem-Fl-broe-zil)
Brand Name Lopid
Type of Drug
Anti-hyperlipidemic (blood-fat reducer). Prescribed For
High blood triglycerides.
General Information
Gemfibrozil consistently reduces blood triglycerides and reduces the risk of heart disease in people with high levels of triglycerides, low levels of high-density lipoprotein (HDL) cholesterol, the “good” cholesterol, and high levels of low-density lipoprotein (LDL) cholesterol, the “bad” cholesterol. It works by affecting the breakdown of body fats and by reducing the amount of triglyceride manufactured by the liver. It is usually prescribed only for people with very high blood-fat levels who have not responded to dietary changes or other therapies. Gemfibrozil usually has little effect on blood-cholesterol levels, although it may reduce blood cholesterol in some people.
Cautions and Warnings
Do not take gemfibrozil if you are allergic or sensitive to any of its ingredients or have severe liver or kidney disease. Some people taking gemfibrozil have experienced worsening of kidney function.
Gemfibrozil users may have an increased risk of developing gallbladder disease and gallstones.
People taking gemfibrozil and fenofibmte may develop pancreatitis (inflammation 0 the pancreas).
People taking gemfibrozil may develop muscle aches and inflammation. Tell your doctor if you experience muscle tenderness or weakness.
Estrogen drugs may cause massive increases in triglyceride levels. Stopping estrogen therapy in these cases may reduce triglyceride levels to normal.
Gemfibrozil may cause a moderate rise in blood sugar and mild decreases in white-blood-cell counts.
Possible Side Effects
¦    Most common: abdominal and stomach pain, fatigue, heartburn, gas, diarrhea, nausea, and vomiting.
¦    Less common: rash, itching, dizziness, blurred vision, anemia, reduced levels of white blood cells, increased blood sugar, and muscle pain—especially in the arms or legs.
¦    Rare: dry mouth, constipation, appetite loss, upset stom-
ach, sleeplessness, tingling in the hands or feet, ringing or
buzzing in the ears, back pain, painful muscles or joints,
swollen joints, feeling unwell, reduction in blood potassium,
and abnormal liver function. Contact your doctor if you ex-
perience any side effect not listed above.
Drug Interactions
•    Gemfibrozil increases the effects of oral anticoagulant (blood-thinning) drugs. Your anticoagulant dosage must be reduced when starting gemfibrozil.
•    Combining gemfibrozil with a statin cholesterol- lowering drug (atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, or simvastatin) has led to the destruction of skeletal muscles. This effect may begin as early as 3 weeks after you start taking the combination or may not appear for months.
•    Combining gemfibrozil and sulfonylurea antidiabetes drugs or repaglinide may cause unexpectedly low blood sugar levels. The sulfonylurea drug dosage may need adjustment.
•    Gemfibrozil can substantially increase the amount of glitazone antidiabetes drugs in the blood. Glitazone dosages may need to be adjusted.
•    Combining gemfibrozil and cyclosporine may decrease the effectiveness of cyclosporine. This combination should only be used if it is absolutely necessary and the lowest possible dose of gemfibrozil is used.
Food Interactions
Gemfibrozil is best taken on an empty stomach 30 minutes before meals but may be taken with food if it upsets your stomach. It is important that you follow your doctor’s dietary instructions.
Usual Dose
Adult: 1200 mg a day, divided into 2 doses taken 30 minutes
before breakfast and dinner. Child: not recommended.
Overdosage
There have been reported cases of overdosage with gemfibrozil. Symptoms reported with overdosage were abdominal cramps, abnormal liver function tests, diarrhea, joint and muscle pain, nausea, and vomiting. Induce vomiting with ipecac syrup—available at any pharmacy—but call your doctor or local poison control center before doing this. If you go to a hospital emergency room, ALWAYS bring the prescription bottle or container.
Special Information
Your doctor should perform periodic blood counts during the first year of gemfibrozil treatment to check for anemia or other changes in blood components. Liver-function tests are also necessary. Blood-sugar levels should be checked periodically while you are taking gemfibrozil, especially if you are diabetic or have a family history of diabetes.
Gemfibrozil may cause dizziness or blurred vision. Be careful when driving or doing any task that requires concentration.
Gemfibrozil is less effective if you are greatly overweight.
Call your doctor if side effects become severe or intolerable, especially diarrhea, nausea, vomiting, or stomach pain or gas. These may disappear if your doctor reduces the dosage.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose. skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using gemfibrozil during pregnancy is not known. When this drug is considered crucial by your doctor, its potential benefits must be carelO%-y weighed against its risks.
It is R(PM1)Wnif this drug passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors are more likely to develop drug side effects due to normal declines in kidney function.

Tags: abdominal pain, acute asthma, acute attack, asthma attack, asthma attacks, asthma patients, asthma symptoms, beta 2 agonist, bronchial spasms, bronchitis and emphysema, Bronchospasm, Carbonate, chronic bronchitis, chronic obstructive pulmonary disorder, combination product, cyclosporine, diet, digestive tract, dry mouth, emergency, fetus, foradil aerolizer, formoterol, General Information, generic ingredients, half, herpes simplex virus, high blood pressure, histamine, history of heart disease, hiv drug, Infections, inhibitor, irregular heartbeat, kidney disease, Overdose, pregnancy, prescription, prevention of asthma, rash, stomach, sugar, supplement, throat, tingling in the hands, tricyclic

Aug

13

Entecavir - Guaifenesin - Epoetin - Sildenafil Citrate - Ergoloid Mesylates

August 13, 2009 | Leave a Comment

Generic Name
Entecavir (m-M-ah-veer)
Brand Name Baraclude
Information in this monograph also applies to:
Generic Ingredient: Telbivudine Tyzeka
Type of Drug Antiviral.
Prescribed For
Chronic hepatitis B infection in adults.
General Information
Entecavir is a prescription medicine for adults with chronic hepatitis B virus (HBV) infection in which the virus is multiplying and damaging the liver. Entecavir can reduce the amount of virus in the body, make it harder for new liver cells to be infected by the virus, and improve the general condition of the liver. They work by attacking HBV polymerase, an enzyme essential to the reproduction of the hepatitis B virus inside an infected cell. These drugs are eliminated from the bodj,4kalbe kidney. Telbivudine does not wGCK alg4msl HIV infection and can be taken together with HIV drug therapy. These medicines do not cure HBV or stop you from spreading HBV to others, generally through sexual contact or exposure to infected blood. The HBV virus can live outside the body for one week.
Cautions and Warnings
Do not take these medicines if you are allergic or sensitive to any
of their ingredients.
Entecavir should be used with caution in people who have both HIV and HBV because of possible HIV resistance developing after entecavir is taken.
Severe worsening of HBV has occurred in people who stopped taking this medication.
These drugs can lead to further liver damage. In rare cases, they have been associated with liver failure that resulted in death. The safety of this drug in people who have had a liver transplant is not known.
These drugs are eliminated through the kidneys. People with kidney disease may require lower doses.
Telbivudine has also been associated with lactic acidosis, a condition in which excess lactic acid in the body causes the blood to become acidic. Feeling very weak or tired, experiencing unusual Muscle pain, difficulty breathing, stomach pain with nausea and vomiting, feeling cold—especially in your arms and legs, feeling dizzy or lightheaded, and a fast or irregular heartbeat may be signs of lactic acidosis. It is a medical emergency and must be treated in the hospital. This has happened in some people taking these medications.
Possible Side Effects
Entecavir
♦    Most common: headache, fatigue, dizziness, and nausea.
✓    Less common: diarrhea, upset stomach, vomiting, tiredness, and sleeplessness.
✓    Rare: Rare side effects may affect almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Telbivudine
✓    Most common: upper respiratory infection, latigue, not feeling well, missO2 tenderness or weakness, abdominal pain, nasal irritation, and sore throat.
♦    Common: flu or flu-like symptoms, diarrhea or loose stools, and throat pain.
✓    Less common: fever, joint pain, rash, back pain, dizziness, muscle ache, sleeplessness, and upset stomach.
Drug Interactions     low in-
•    These drugs do not affect liver enzymes and have a
teraction potential.
•    Drugs that affect kidney function may affect blood concentrations of entecavir and telbivudine.
•    Other hepatitis B treatments (lamivudine, adefovir, cy-
closporine, and pegylated interferon-alpha 2a) do not affect
either entecavir or telbivudine and are not affected by them. Food Interactions
Take entecavir at least 2 hours after a meal and 2 hours before the next meal. Telbivudine may be taken without regard to food or meals. Usual Dose
Entecavir
Adult and Child (age 16 and over): 0.5-1 mg once daily. People with kidney failure may be treated with as little as 0.05-0.1 mg a day. Child (under age 16): not recommended.
Telbivudine
Adult and Child (age 16 and over): 600 mg once daily. People with moderate to severe kidney failure may be treated with a single 600 mg dose every 2, 3, or 4 days depending on the seriousness of kidney disease.
Child (under age 16): not recommended.
Overdosage
There are no reports of entecavir overdose. People taking single doses up to 40 mg or multiple doses up to 20 mg per day for up to 14 days had no unusual side effects. One person accidentally took an overdose with no consequences. People taking up to 1800 mg a day of telbivudine had no increase in side effects. Overdose victims should be taken to a hospital emergency room for treatment, where dialysis may be necessary to remove the drug from the blood. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor il you develop muscle aches, pains, or weakness; ‘it your skin or the white part of your eyes turns yellow; if your urine becomes dark; if your bowel movements turn light in color; if you don’t feeling like eating food for several days or longer; if you become nauseous; or if you have lower stomach pain. These can be signs of a serious liver problem called hepatotoxicity, which has occurred in some people taking these medications.
Your hepatitis B may get worse or become very serious if you stop taking these medications. Do not stop taking them or change your daily dose without talking to your doctor.
If you forget to take your daily entecavir dose, take it as soon as you remember but do not take a double dose. Call your doctor if you forget to take 2 or more doses in a row.
Entecavir oral solution is a ready-to-use product and should not be mixed with water or any other liquid product. Each bottle of the oral solution comes with a dosing spoon that is calibrated in 1 -mL increments, up to 10 mL. Hold the spoon upright and gradually fill it to the mark next to the prescribed dose. Drink the liquid directly from the dosing spoon. Your pharmacist can help you properly measure your medication dose. Rinse the dosing spoon with water after each daily dose and allow it to air dry.
Special Populations
Pregnancy/Breast-feeding: Animal studies of entecavir revealed slowed development of the skeleton. Animal studies of telbivudine did not reveal any effects on the developing fetus. However, it is not known if either medicine is safe to use during pregnancy or if it helps prevent the hepatitis B virus from passing on to a developing fetus. If your doctor considers entecavir or telbivudine crucial for you, potential benefits must be carefully weighed against their risks. A data bank has been established to collect information from doctors on pregnant women who do take these medicines.
These medicines may pass into breast milk. Nursing mothers who must take these drugs should use infant formula.
Seniors: Dosage reduction may be needed in seniors because of normal declines in kidney function.

Brand Name
Entex PSE
Generic Ingredients
Guaifenesin + Pseudoephedrine Hydrochloride M
Other Brand Names
Anatuss LA    Coldmist Jr.
Aquatab D Dosepack    Coldmist LA
Coldmist    Congess Jr.
Congess SR    Nasabid
Congestac    Nasabid-SR
Deconsal LA    Nasatab LA
D-Feda 11    PanMist
Durasal U    PanMist-Jr.
Duratuss AM/PM    PanMist LA
Dynex    Profen 11
Endal-SR    Pseudovent
Guaimax-D    Sudal 60/500
Guaipax PSE    SudaI120/600
Guaitab    Sudal SR
Guaituss PE    Syn-RX
Guai-Vent PSE    Touro LA
losal El    Tuss-LA
Maxifed    V-Dec-M
Maxifed G    Versacaps
Med-RX    Zephrex
Miraphen PSE    Zephrex LA
The information in this profile also applies to the following drugs:
Generic Ingredients: Guaifenesin + Ephedrine Hydrochloride 19 Broncholate    Bronkaid
Generic Ingredients: Guaifenesin + Phenylephrine Hydrochloride 91
Deconsal Il    PhenaVent
Deconsal Pediatric    PhenaVent D
Endal    PhenaVent LA
Entex LA    PhenaVent PED
Liquibid D    Rescon GG
Liquibid-D 1200    Sinupan
Liquibid-PD    Sinuvent PE
Type of Drug
Decongestant and expectorant combination.
Prescribed For
Cold or allergy and for nasal congestion, runny nose and cough associated with other upper respiratory conditions.
General Information
The decongestant ingredient in Entex PSE, pseudoephedrine, dramatically reduces congestion and stuffiness. The decongestant ingredients ephedrine and phenylephrine act similarly. The expectorant, guaifenesin, is used to help loosen thick mucus that may contribute to chest congestion; the effectiveness of guaifenesin and other expectorants has not been established. There are other drugs on the market using this same general formula—an expectorant plus a decongestant—but they use different decongestant ingredients or a combination of decongestants plus guaifenesin. Nothing cures a cold or allergy, but Entex PSE may provide relief from symptoms.
Cautions and Warnings
Do not take Entex PSE if you are allergic or sensitive to any of its ingredients.
Entex PSE may cause anxiety or nervousness or interfere with sleep.
Do not use Entex PSE if you have ventricular tachycardia (quickened heartrate), or hypertension (high blood pressure).
Entex PSE should be used with extreme caution in those with heart disease, other heart rhythm disorders, thyroid disease, diabetes, glaucoma, stomach ulcer, urinary blockage, or a prostate condition.
Entex PSE should not be used over extended periods of time to treat persistent or chronic cough especially one that may be caused by cigarette smoking, asthma, or emphysema.
Possible Side Effects
Mritl common: anxiety, restlessness, sleeplessness, tension, excitation, dizziness, drowsiness, and headache.
♦ Less common: nausea, vomiting, upset stomach, low blood pressure, heart palpitations, chest pain, rapid or slow heartbeat, abnormal heart rhythms, irritability, euphoria (feeling Possible Side Effects (continued)
“high”), eye irritation and tearing, hysterical reaction, appetite loss, kidney stones, urinary difficulties in men with a prostate condition, weakness, loss of facial color, and breathing difficulties.
Drug Interactions
•    Entex PSE should be avoided if you are taking a monoamine oxidase inhibitor (MAGI) antidepressant for depression or hypertension because the MAGI may cause a very rapid rise in blood pressure or increase side effects such as dry mouth or nose, blurred vision, and abnormal heart rhythms.
•    The decongestant in Entex PSE may interfere with bloodpressure-lowering medication.
Food Interactions
Take Entex PSE with food if it upsets your stomach.
Usual Dose
Adult and Child (age 12 and over): 1 tablet or capsule twice a day or 2 tsp. of liquid 4 times a day.
Child (age 6-11):1/2-1 tablet or 1 capsule twice a day or 1 tsp. of liquid 4 times a day.
Overdosage
Most cases of overdose are not severe. Symptoms include sedation, sleepiness, increased sweating, and increased blood pressure. Hallucinations, convulsions, nervous system depression, and breathing difficulties are more prominent in older adults. Most cases of overdose are not severe. Induce vomiting with ipecac syrup—available at any pharmacy. Call your local poison control center or a hospital emergency room before doing this. If you lseey, treatment. ALWAYS bring the prescription bottle or container.
-SIDt’dial Information
Call your doctor if your side effects are severe or gradually become intolerable.
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: Women who are or might be pregnant should avoid Entex PSE. When your doctor considers this drug crucial, its potential benefits must be carefully weighed
against its risks.
The decongestant in Entex PSE may pass into breast milk. Nursing mothers who must take Entex PSE should consider using in-
fant formula.
Seniors: Seniors are more sensitive to the effects of Entex PSE.

Generic Name
Epoetin (EE-poh-eh-tin)
Brand Names Epogen
Type of Drug
Red-blood-cell growth stimulator.
Prescribed For
Anemia; may also be used for reducing the need for blood or redblood-cell transfusions.
General Information
Epoetin is a natural hormone that stimulates the bone marrow to produce red blood cells. It is used for anemia that does not respond to iron supplements. In most cases of anemia, there are plenty of red blood cells circulating, but they lack iron. People who need epoetin do not have enough red blood cells. Epoetin stimulates the production of new red blood cells to carry needed oxygen.
Cautions and Warnings
Do not use epoetin if you are allergic or sensitive to albumin or products manufactured from animal cells.
People with urtvaRtmliked high blood pressure should not use epoetin.
Some people with chronic kidney failure and severe anemia should not take epoetin. Epoetin is not a replacement for emergency blood transfusion.
Epoetin is not intended for anemia caused by folate or iron deficiency, hemolysis, or gastrointestinal bleeding.
Procrit People using epoetin may require anticoagulant medicine to prevent blood clotting during treatment. Tell your doctor it you have any blood-clotting disorders.
In rare cases, people taking epoetin may have seizures. Avoid driving or any other activities where a sudden seizure could be dangerous. Do not take epoetin if you have a history of seizures or strokes.
Epoetin should be avoided in patients with blood cancers such as lymphoma, because it can act as a growth factor for the tumor.
If your hemoglobin levels become too high, your chance of heart attack, stroke, heart failure, blood clots, and death is increased. It is important to have your blood tested and adjust dosage of epoetin accordingly throughout treatment.
Possible Side Effects
Side effects reported in studies of epoetin were similar to those reported with an inactive placebo (sugar pill).
♦    Most common: high blood pressure, headache, constipation, diarrhea, nausea, joint pain, fever, fatigue, itching, rash, and difficulty breathing.
✓    Common: swelling, vomiting, chest pain, skin reactions at the site of injection, weakness, dizziness, urinary infections, diarrhea, upset stomach, blood clots, anxiety, tingling in the hands or feet, and trunk pain.
✓    Rare: stroke and heart attack. Contact your doctor if you experience any side effect not listed above.
Food and Drug Interactions None known.
Usual Dose
Adult: starting dose-23-69 units per 1b. of body weight 3 times a week by intravenous or subcutaneous injection. Final dose is based on response and need. Surgery patients take 138 units per lb. for 10 days before Surgery or 276 units once a week for 3 weeks before surgery and another dose on the day of surgery. Dialysis patients take epoetin once a week.
Child (under age 12): 23 units per lb. of body weight 3 times a week by intravenous or subcutaneous injection. Final dose is based on response and need.
Child (under 1 month): not recommended.
Overdosage
Little is known about the effects of epoetin overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription container.
Special Information
People taking epoetin should have regular blood tests to assure the drug is working well. Your doctor may want to take blood samples twice a week for several weeks and then test your blood regularly.
Epoetin has been used by athletes to enhance physical performance. This is called blood doping and has resulted in several deaths because the percentage of red blood cells in a blood sample can reach hazardous levels.
Epoetin must be stored in a refrigerator.
Most patients will need to take iron supplements with this drug.
This drug can be given by injection under the skin. For more in-
formation on how to properly administer this drug, see page 1242.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that epoetin may enter fetal circulation. When this drug is considered crucial by your doctor its potential benefits must be carefully weighed against its risks.
It is not known if epoetin passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this product without special precaution.

Type of Drug
Erectile Dysfunction Drugs
Generic Ingredient: Sildenafil Citrate
Viagra    Revatio
Generic Ingredient: Tadalafil Cialis
Generic Ingredient: Vardenafil Levitra
Prescribed For
Erectile dysfunction (ED). sildenafil is also prescribed for pulmonary
hypertension.
General Information
The chemical nitric oxide is released in the penis during sexual stimulation. Nitric oxide causes the release of an enzyme called cyclic guanosine monophosphate (cGMP), which increases blood flow into the penis, producing an erection. cGMP is broken down by the enzyme phosphodiesterase type 5 (PDE5). In men with low levels of cGMP, these medicines help achieve and maintain an erection by inhibiting PDE5, thus causing higher levels of cGMP. ED can be the result of nerve, blood vessel, or psychological problems. These drugs, which are effective in about 70% of men, only help when poor blood flow is the cause of the dysfunction. Women have reported some benefit from sildenafil, although it has been widely studied only in men. Vardenafil and tadalafil are intended only for men. These medicines start working in 30-60 minutes and their effects usually last from 2-4 hours, although some have noted an effect for 24 hours or more. Some drug interactions and kidney or liver diseases extend this time. Tadalafil begins working in 30-60 minutes and can remain in the body for more than 2 days, much longer than the other medicines in this group. Low-dose tadalafil may be taken every day for chronic ED.
Pulmonary hypertension, a rare disease in which high pressure in the blood vessels moves from the heart to the lungs, is sometimes treated with sildenafil.
Cautions and Warnings
Do not take ED drugs if you are allergic or sensitive to any of their ingredients.
These medicines lower blood pressure and should be avoided if you have high (greater than 170/100) or low (less than 90/50) blood pressure. Several people have died from a sudden blood-pressure drop after combining erectile dysfunction medications with other medications that can reduce blood pressure.
These Medicines should never be taken by those taking heart medications called nitrates, as fatal reactions have occurred.
People with heart disease may experience heart problems with sildenafil or vardenafil, including a heart attack. These reactions can occur during or shortly after sexual activity.
Avoid these medicines if you have had a heart attack, stroke, or life-threatening abnormal heart rhythms in the past 6 months, or if you have heart failure, unstable angina pectoris, damage to the penis, or a progressive eye disease called retinitis pigmentosa. Blindness is a rare side effect of sildenafil and may be a problem with all of these medications.
People taking sildenafil or vardenafil have experienced difficulties seeing blue or green colors and may see things with a blue tinge surrounding them. This happens because they affect an enzyme in the eye. The effect clears up after the drug passes out of the body.
People with kidney or liver damage retain these medicines in their bodies longer than people whose kidneys and liver function normally. People with kidney or liver problems should always begin with the lowest possible dosage.
People with priapism (painful erection lasting more than 6 hours) or a condition that predisposes them to priapism—such as leukemia, multiple myeloma, or sickle cell anemia—should be cautious about taking these medicines.
Vardenatil and sildenafil should be avoided by people with stomach or bleeding ulcers because its effect on these conditions is not known.
Possible Side Effects
Sildenafil
✓    Most common: headache and flushing.
♦    Less common: upset stomach, stuffy nose, urinary tract infection, diarrhea, rash, dizziness, seizure, anxiety, prolonged and possibly painful erection, double vision, visual changes, bloodshot eyes, burning eyes, swelling in the eye, and blood vessel diseases in the retina.
✓    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.
Tadalafil
I Most common: headache.
✓    Common: upset stomach. Back pain and muscle aches can develop 12-24 hours after taking tadalafil and go away on their own after 2 days.
Possible Side Effects (continued)
♦    Less common: flushing, nasal congestion, and arm or leg
pain.
♦    Rare-. prolonged or painful erections. Other rare side ef-
fects can occur in almost any part of the body. Contact
your doctor if you experience any side effect not listed
above.
Vardenafil
✓    Most common: headache and flushing.
✓    Less common: upset stomach, sinus infection, flu-like symptoms, dizziness, and nausea.
♦    Rare: prolonged or painful erection. Other rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Do not combine any of these drugs with nitrates (such as nitroglycerin) and other drugs that lower blood pressure. The combination can cause a sudden, rapid drop in blood pressure.
•    Do not take vardenafil if you are taking an alpha blocker (such as alfuzosin, doxazosin, prazosin, tamsulosin, or terazosin). Tadalafil may be taken only with tamsulosin. You may take sildenafil at its lowest possible dose with an alpha blocker, but you must separate the doses by at least 4 hours.
•    Combining cimetidine and sildenafil leads to a substantial (more than 50%) increase in the amount of sildenafil in the blood.
•    Erythromycin, itraconazole, ketoconazole, and protease inhibitors (used to combat HIV) can cause sildenafil blood levels to almost double. Vardenafil levels can increase by 400-1000% when combined with these medicines. It you are taking one of these medicines, do not take more than the %west possible dose of your ED drug. Do not take tadalafil more than once every 3 days if you are also taking one of these medicines.
•    Rifampin can be expected to reduce the effect of ED medicines by reducing the amount of drug in the blood. Other
drugs that may reduce the effects of these drugs are carbamazepine, phenobarbital, and phenytoin.
•    Dihydrocodeine—a widely used prescription pain reliever—may increase the effects of sildenafil, yielding substantially prolonged erections, sometimes lasting for hours.
•    Do not combine sildenafil, tadalafil, and vardenafil. The effects of combining these drugs are not known.
•    Do not take vardenafil if you are taking any medicine to treat an abnormal heartbeat, including amiodarone, procainamide, quinidine, and sotalol.
•    Combining sildenafil with selective serotonin reuptake inhibitors (SSRIs) or tacrolimus may increase the risk of sildenafil side effects.
•    Alcohol adds to the blood-pressure-lowering effects of these medicines.
Food Interactions
Grapefruit juice may increase the amount of these drugs in the blood. Taking sildenafil with a high-fat meal reduces the amount of drug absorbed. Tadalafil and vardenafil may be taken without regard to food or meals.
Usual Dose
Sildenafil
Adult: 50 mg taken about 1 hour before sexual activity. Individual doses can range from 25-100 mg. The maximum dosing frequency is once a day.
Senior: Begin with 25 mg and gradually increase dosage as needed.
Tadalafil
Adult: 10 mg taken about 1 hour before sexual activity. Individual doses can range from 2.5-20 mg. Do not take more than 1 dose of tadalafil a day.
Senior: Begin with 5 mg and gradually increase dosage as needed.
Adult: 10 mg taken about 1 hour before sexual activity. Individual doses can range from 5-20 mg.
Senior: Begin with 5 mg and gradually increase dosage as needed.
Overdosage
sildenafil and tadalafil overdose are likely to produce exaggerated drug side effects. Vardenafil overdose may cause neck pain, muscle aches, or vision changes. Call your local poison control center or hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor and do not engage in sexual activity if the erection produced by ED drugs is painful or lasts 4 or more hours, or if you experience dizziness, nausea, or chest pain after taking an ED drug. In rare cases, men taking ED drugs have reported a sudden decrease or loss of vision and/or hearing. Call your doctor right away if you experience this adverse side effect.
People who use organic nitrates for gardening or other purposes can experience a severe and dangerous blood pressure drop if they take sildenafil or vardenafil. It is not known how long you have to wait to resume nitrate use.
These drugs do not protect against sexually transmitted diseases.
Special Populations
Pregnancy/Breast-feeding: There is no evidence that sildenafil or vardenafil harm the fetus; however, they are not intended for pregnant women or nursing mothers.
Seniors: Men age 65 and over eliminate these drugs more slowly than younger men and should begin with the lowest possible dosage.

Generic Name
Ergoloid Mesylates (ER-goe-loid
MES-il-ates) (GI
Brand Names Caerimal
Hydergine
Type of Drug Psychotherapeutic agent.
Hydrogenated Ergot Alkaloids
Prescribed For
Age-related decline in mental capacity.
General Information
Ergoloid mesylates are used to treat decreased mental capacity of unknown cause in people over age 60. These drugs should not be used for any condition that is treatable with another drug or that may be reversible. People who respond to ergoloid mesylates are likely to have Alzheimer’s disease or some other cause of dementia. Nobody knows exactly how ergoloid mesylates produce their effect, but they improve the supply of blood to the brain in test animals, reduce their heart rate, and improve muscle tone in blood vessels. Some studies show the drugs to be very effective in relieving mild symptoms of mental impairment, while others find it to be only moderately effective. They are most beneficial in people whose symptoms are due to the effects of high blood pressure in the brain.
Cautions and Warnings
Do not take ergoloid mesylates if you are allergic or sensitive to any of their ingredients or you have psychotic symptoms or psychosis.
Ergoloid mesylates should be used with caution in people with liver disease, low blood pressure, or slow heartbeat.
Possible Side Effects
Ergoloid mesylates do not produce serious side effects.
♦ Common: When taken under the tongue, these drugs may
cause irritation, nausea, or upset stomach. Other side ef-
fects are drowsiness, slow heartbeat, and rash.
Drug Interactions None known.
Food Interactions
Do not eat, drink, or smoke while you have an ergoloid mesylates pill under your tongue.
Usual Dose
Starting dose is 1-2 mg 3 times a day. Increase as needed. Do not exceed 12 mg a day.
Overdosage
Symptoms include blurred vision, dizziness, fainting, flushing, headache, appetite loss, nausea, vomiting, stomach cramps, and stuffy nose. Take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
The effects of ergoloid mesylates are gradual and frequently not seen for up to 6 months. A 6-month period of treatment with ergoloid mesylates is recommended before your doctor can fully evaluate your response to the drug. Your doctor should periodically reevaluate your condition to determine if ergoloid mesylates treatment is still needed and that it is working for you.
Dissolve sublingual tablets under the tongue. Do not chew or crush them; they are not effective if swallowed whole.
If you forget a dose, skip it and go back to your regular schedule. Do not take a double dose. Call your doctor if you miss 2 or more consecutive doses.
Special Populations
Pregnancy/Breast-feeding: Ergoloid mesylates may interfere with fetal development. When these drugs are considered crucial by your doctor, their potential benefits must be carefully weighed against their risks.
Ergoloid mesylates pass into breast milk. Nursing mothers who must take these drugs should use infant formula.
Seniors: Seniors are more likely to develop side effects, especially hypothermia (low body temperature).
Generic Name
Erythromycin (eh-rith-roe-MYE-sin) 10
Brand Names
Akre-mycin    Eryderm
Arr/S    Erygel
E-Base    Ery-Tab
E-Glades    Erythra-derm
E-Mycin    PCE Eryc
The information in this profile also applies to all forms of erythromycin:
Generic Ingredient: Erythromycin Estolate LN
Generic Ingredient: Erythromycin Ethylsuccinate E.E.S.    Pediamycin EryPed
Generic Ingredients: Erythromycin Ethylsuccinate + Sulfisoxasole
Eryzole    Pediazole
Generic Ingredient: Erythromycin Stearate Erythrocin Stearate
Type of Drug Macrolide antibiotic.
Prescribed For
Infections of virtually any part of the body: upper and lower respiratory tract infections; sexually transmitted diseases; urinary tract infections; infections of the mouth, gums, or teeth; and infections of the nose, ears, or sinuses. It is prescribed for acne and may be used for mild to moderate skin infections. Erythromycin is effective against diphtheria and dysentery. It is also prescribed for legionnaires’ disease, rheumatic fever, whooping cough, and bacterial endocarditis. It is prescribed to patients with pelvic inflammatory disease as an alternative to penicillin. The eye ointment is used to prevent newborn gonococcal or chlamydial eye infections.
General Information
Erythromycin and other macrolide antibiotics are either bactericidal (bacteria-killing) or bacteriostatic (inhibiting bacterial growth), depending on the organism in question and amount of antibiotic present. Erythromycin is deactivated by stomach acid, so the tablet form is made to bypass the stomach and dissolve in the intestine.
Since the action of this antibiotic depends on its concentration in the invading bacteria, kk is crucial that you follow your doctor’s ISNVKi10ns regarding the spacing of doses as well as the number of days you must take the medication—otherwise, this antibiotic may be much less effective.
Cautions and Warnings
Do not take erythromycin if you are allergic or sensitive to any of its ingredients or to any macrolide antibiotic.
Erythromycin is excreted primarily through the liver. People with liver disease or damage should consult their doctors. Those on long-term therapy with erythromycin should have periodic blood tests. If you restart erythromycin after having experienced liver damage, it is likely that symptoms will recur within 48 hours.
Erythromycin estolate has occasionally produced liver problems (symptoms include fatigue, nausea, vomiting, abdominal cramps, and fever). If you are susceptible to stomach problems, erythromycin may cause mild to moderate stomach upset; discontinuing the drug will reverse this condition.
Colitis (bowel inflammation) has been associated with all antibiotics and can range from mild to life-threatening (see “Possible Side Effects”),
Possible Side Effects
•    Most common: nausea, vomiting, stomach cramps, and diarrhea. Colitis (symptoms include severe abdominal cramps and severe, persistent, and possibly bloody diarrhea) may develop. Side effects of the topical erythromycin include peeling, dryness, itching, and oiliness.
♦    Less common: hairy tongue, itching, irritation of the anal or vaginal region, eye irritation, and skin tenderness. If any of these symptoms appear, call your physician immediately.
♦    Rare: hearing loss—which reverses itself after the drug is stopped and occurs most often in people with liver and kidney problems—and abnormal heart rhythms. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Antacids may slightly affect the release of erythromycin from your body. This effect is not considered important.
•    Do not combine erythromycin with astemizole or terfenadine.
•    Erythromycin may slow the breakdown of carbamazepine (an anticonvulsant prescribed for seizures). Avoid this combination.
•    Mixing erythromycin with rifabutin or rifampin can interfere with the antibiotic’s effect and increase the risk of intestinal side effects.
•    Do not combine erythromycin and pimozide. Two people died after combining pimozide and a macrolide antibiotic.
•    Erythromycin may neutralize penicillin. It may also neutralize the antibiotics lincomycin and clindamycin.
•    Erythromycin interferes with the elimination of theophylline
from the body, possibly leading to theophylline overdose.
•    Mixing erythromycin with a statin cholesterol-lowering drug increases the risk of developing a potentially fatal condition involving severe muscle pain and destruction.
•    Do not mix erythromycin with sparfloxacin, ketoconazole, itraconazole, fluconazole, diltiazem, verapamil, troleandomycin, mibefradil, nefazodone, or clarithromycin. These mixtures can lead to severe, possibly fatal, abnormal heart rhythms. Grepafloxacin (another fluoroquinolone) should only be mixed with erythromycin in hospitalized patients whose hearts can be monitored during treatment.
•    Combining erythromycin and alfentanil (an injectable pain reliever), bromocriptine, buspirone, digoxin, disopyramide, ergotamine, cyclosporine, methylprednisolone (a corticosteroid), tacrolimus, vinblastine, or benzodiazepines (such as alprazolam, diazepam, midazolam, and triazolam) increases the risk of drug side effects.
•    Erythromycin estolate may increase the liver side effects of other drugs that affect the liver.
•    Erythromycin may increase the anticoagulant (blood-thinning) effects of warfarin in people who take it regularly, especially older adults. People taking this combination should be tested regularly.
•    Erythromycin may increase the effects of caffeine.
Food Interactions
Grapefruit juice slows the breakdown of erythromycin, increasing the amount of drug in the blood. For optimum effectiveness, take erythromycin base and erythromycin stearate on an empty stomach with a 6-8 oz. glass of water 1 hour before or 2 hours after meals. Other forms of erythromycin can be taken without regard to food or meals.
\huall Dose
Tablet and Suspension
Adult: 250-400 mg every 6 hours, taken 1 hour before meals, or 500 mg every 12 hours. Maximum dose is 4 g a day.
Child: 15-25 mg per lb. of body weight a day in divided doses depending on age, weight, and severity of infection.
Eye Ointment 1/2 inch 2-6 times a day.
Topical Solution: Apply morning and night.
Doses of erythromycin ethylsuccinate are 60% higher due to differences in chemical composition.
Overdosage
Overdose may cause severe side effects, especially nausea, vomiting, stomach cramps, and diarrhea. Mild hearing loss, ringing or buzzing in the ears, or fainting may also occur. Call your local poison control center or a hospital emergency room for more information. ALWAYS bring the prescription bottle or container.
Special Information
Erythromycin is used instead of penicillin for mild to moderate infections in people who are allergic to penicillin. Erythromycin is not the antibiotic of choice for severe infections.
Erythromycin products should be stored at room temperature, except for oral and topical liquids, which should be kept in the refrigerator.
Call your doctor if you develop nausea; vomiting; diarrhea; stomach cramps; severe abdominal pain; rash, itching, or redness; dark or amber-colored urine; yellowing of the skin or whites of the eyes; or any severe or persistent side effect.
If you forget a dose of oral erythromycin, take it as soon as you remember. If it is almost time for your next dose, space the next 2 doses over 4-6 hours, then continue with your regular schedule. Do not take a double dose.
Remember to complete the full course of therapy prescribed even if you feel well before you finish the medication.
Special Populations
Pregnancy/Breast-feeding: Erythromycin passes into the fetal circulation. Erythromycin estolate has caused mild liver inflammation in about 10% of pregnant women who took it and should not be used if you are or might be pregnant. Other forms of erythromycin have been used sale)y without difficulty.
Erythromycin passes into breast milk. Nursing mothers who must take erythromycin should use infant formula.
Seniors: Seniors with liver disease should use caution. Seniors taking high doses of erythromycin may be at an increased risk of hearing loss.

Tags: Allergy, arms and legs, bacteria, baraclude, blood, chronic hepatitis, dizziness, entecavir, gastrointestinal, GENERIC, Headache, hepatitis b, hepatitis b virus, hiv drug, hiv infection, hiv resistance, hypertension, info, kidney disease, lactic acidosis, liver damage, liver transplant, lower respiratory tract, monoamine, nausea and vomiting, percentage, pregnancy, prescription medicine, priapism, rash, refrigerator, stomach, stomach pain, System, Tadalafil, upset stomach, vardenafil

Aug

1

Chlorpromazine

August 1, 2009 | Leave a Comment

Generic Name
Chlorpromazine (klor-PROE-muh-zene) Al
Brand Names
Sonazine    Thorazine*
The information in this profile also applies to the following drugs: Generic Ingredient: Fluphenazine Hydrochloride RE Generic Ingredient: Thioridazine Hydrochloride 0 Generic Ingredient: Trifluoperazine Hydrochloride
‘Some products in this brand-name group are alcohol- or sugar-free. Consult your pharmacist.
Type of Drug Phenothiazine antipsychotic.
Prescribed For
Psychotic disorders; moderate to severe depression with anxiety; agitation or aggressiveness in disturbed children; intractable pain; and senility. May also be used to relieve nausea, vomiting, hiccups, restlessness, acute intermittant porphyria, and apprehension before surgery or other procedures.
General Information
Chlorpromazine and other phenothiazines act upon a portion of the brain called the hypothalamus. Phenothiazines affect parts of the hypothalamus that control metabolism, body temperature, alertness, muscle tone, hormone balance, and vomiting. Chlorpromazine is available in suppositories and as liquid for those who have trouble swallowing tablets.
Cautions and Warnings
Do not take chlorpromazine if you are AeTgic or sensitive to any oVilsingredients or to any phenothiazine drug. Do not take it if you have very low blood pressure, Parkinson’s disease, or blood, liver, kidney, or heart disease.
Chlorpromazine may depress the cough reflex. People have accidentally choked to death because the cough reflex failed to protect them. Because of its effect in reducing vomiting, chlorpro-mazine may obscure symptoms of disease or toxicity due to over-
dose of another drug.
Use chlorpromazine under your doctor’s strict supervision if you have glaucoma, epilepsy, ulcers, or urinary difficulties.
Avoid exposure to extreme heat, because this drug may upset your body’s temperature-control mechanism. Do not allow the liquid forms of this drug to come in contact with your skin because they are highly irritating.
Chlorpromazine may cause unusually high or low levels of cholesterol.
Possible Side Effects
♦ Most common: drowsiness, especially during the first or second week of therapy. If drowsiness becomes troublesome, contact your doctor.
V Less common: changes in blood components, including anemias, raised or lowered blood pressure, abnormal heart rate, heart attack, sensitivity to light, and faintness or dizziness.
V 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.
Jaundice (symptoms include yellowing of the whites of the eyes or skin) may appear; when it does, it is usually within the first 2-4 weeks of treatment. Normally the jaundice goes away when the drug is discontinued, but there have been cases when it has not.
Phenothiazines may produce extrapyramidal side effects, including spasm of the neck muscles, rolling back of the eyes, convulsions, difficulty swallowing, and symptoms associated with Parkinson’s disease. These side effects seem very serious but usually disappear after the drug has been withdrawn; however, symptoms affecting the face, tongue, or jaw may persist for as long as several years, especially in older adults with a history of brain damage.
Chlorpromazine may cause an unusual increase in psychotic symptoms or may cause paranoid reactions, tiredness, lethargy, restlessness, hyperactivity, confusion at night, bizarre dreams, sleeplessness, depression, decreased sex drive, increased appetite, or euphoria (feeling “high”).
Drug Interactions
•    Be cautious about taking chlorpromazine with over-the-
counter cough, cold, or allergy medications, barbiturates, al-
cohol, sleeping pills, narcotics or other sedatives, or any other
drug that may produce a depressive effect.
•    Aluminum antacids may reduce the effectiveness of phenothiazine drugs.
•    Chlorpromazine may reduce the effectiveness of bromocriptine and appetite suppressants.
•    Anticholinergic drugs may reduce the effectiveness of chlorpromazine and increase the chance of side effects.
•    Phenothiazine drugs may counter the blood-pressurelowering effect of guanethidine.
•    Taking lithium together with a phenothiazine drug may lead to disorientation, loss of consciousness, or uncontrolled muscle movements.
•    Combining propranolol and a phenothiazine drug may lead to unusually low blood pressure.
•    Combining tricyclic antidepressants with a phenothiazine drug can lead to antidepressant side effects.
•    Chlorpromazine may reduce the effectiveness of epinephrine and norepinephrine.
•    Cigarette smoking reduces the amount of chlorpromazine in your blood. Smokers may need larger doses.
Food Interactions
Take liquid chlorpromazine with fruit juice or other liquids. You may also take it with food if it upsets your stomach.
Usual Dose
Adult: 30-1000 mg or more a day, individualized according to your disease and response.
Child (age 6 months and over): 0.25 mg per lb. of body weight every 4-6 hours, up to 200 mg or more a day, depending on disease, age, and response.
Chitty (under 6 months): not recommended.
Overdosage
Overdose symptoms include depression, extreme weakness, tiredness, lowered blood pressure, agitation, restlessness, uncontrolled muscle spasms, convulsions, fever, dry mouth, abnormal heart rhythms, and coma. The victim should be taken to a hospital emergency room immediately. ALWAYS bring the prescription bottle or
container.
Special Information
Call your doctor at once if you develop sore throat, fever, rash, weakness, visual problems, tremors, muscle movements or twitching, yellowing of the skin or whites of the eyes, or darkening of the urine.
Do not stop taking chlorpromazine without your doctor’s knowledge. It may take several weeks before this drug takes effect.
This drug may cause drowsiness. Use caution when driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorpromazine may cause unusual sensitivity to the sun and may turn your urine reddish brown to pink.
If dizziness occurs, avoid rising quickly from a sitting or lying position and avoid climbing stairs. Use caution in hot weather, because this drug may make you more prone to heat stroke.
If you are using sustained-release capsules, do not chew them or break them—swallow them whole. Liquid forms of phenothiazines must be protected from light. Do not take them out of their opaque bottles.
If you take chlorpromazine more than once a day and forget to take a dose, take it right away if you remember within an hour. If you do not remember within an hour, skip the dose you forgot and continue with your regular schedule. If you take 1 dose a day and forget a dose, skip the dose you forgot and continue your regular schedule the next day. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Infants born to women taking this drug have experienced side effects—including jaundice and nervous system effects. Check with your doctor about taking chlorpromazine if you are or might be pregnant.
This drug may pass i”W breast milk. Nursing mothers who must take chlorpromazine should use infant formula .
Seniors: Seniors are more sensitive to the effects of this drug and usually achieve desired results with lower dosages. Some experts feel that seniors should receive ‘/,-1/4 the usual adult dose.

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Jul

16

Allopurinol

July 16, 2009 | Leave a Comment

Generic Name
Allopurinol (al-oe-PURE-in-nol)
Brand Name Zyloprim
Type of Drug
Antigout medication.
Prescribed For
Gout or gouty arthritis; also prescribed to counter the effects of certain therapies for cancer, ulcers, abnormal heart rhythms in heart bypass patients, seizures, and other conditions that may be associated with too much uric acid in the body.
General Information
Unlike other antigout drugs, which affect the elimination of uric acid from the body, allopurinol acts on the system that manufactures uric acid in your body. A high level of uric acid can indicate that you have gout, psoriasis, cancer, or any of a number of other diseases. High levels of uric acid can also be caused by taking certain drugs.
In mouthwash form, allopurinol helps to prevent mouth, stomach, and intestinal ulcers caused by fluorouracil, an antineoplastic drug. Allopurinol may be given before heart bypass surgery to reduce abnormal rhythms and other surgical complications. It can be used to reduce the relapse rates of duodenal ulcers associated with Helicobacter pylori infection and to reduce the vomiting of blood from stomach irritation caused by nonsteroidal anti-inflammatory drugs (NSAIDs). Allopurinol has also been used to control seizures in people for whom standard treatments are not effective.
Cautions and Warnings
Do not take allopurinol if you are allergic or sensitive to any of its ingredients, or if you have ever developed a severe reaction to it. Stop taking the medication immediately and contact your doctor if you develop a rash or any other adverse effects while taking allopurinol. Do not start taking allopurinol again if you stopped it because of a severe reaction.
Allopurinol should be used by children only if they have high uric acid levels due to neoplastic disease or to rare metabolic conditions.
A few cases of liver toxicity have been associated with allopurinol; they improved when the drug was stopped. People taking allopurinol should periodically be tested for liver and kidney function. People with severely compromised kidney function should ake a reduced dose of allopurinol.
Possible Side Effects
✓    Most common: rash associated with severe, allergic, or sensitivity reaction to allopurinol. If you develop an unusual rash or other sign of drug toxicity, stop taking this medication and contact your doctor.
✓    Less common: nausea, vomiting, diarrhea, intermittent stomach pain, gas, upset stomach, headache, insomnia, tingling or numbness in the hands and feet, muscle or joint pain, and drowsiness or lack of ability to concentrate.
✓    Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Large doses of drugs that make your urine more acidic, like megadoses of vitamin C, may increase the risk of kidney stone formation.
•    Alcohol, diazoxide, mecamylamine, or pyrazinamide can increase the amount of uric acid in your blood; an increase in your allopurinol dose may be required.
•    Allopurinol may increase the action of azathioprine, mercaptopurine, or cyclophosphamide and other anticancer drugs, leading to possible toxicity, bleeding, or infection.
•    Allopurinol may prolong the effects of chloropropamide, and can lead to hypoglycemic reactions in patients with kidney disease.
•    Taking allopurinol with probenecid or sulfinpyrazone may cause excessive reduction of uric acid.
•    Allopurinol may interact with some anticoagulant (blood-thinning) medications, reducing the rate at which the anti-coagulant is broken down in the body. Dosage reduction may be necessary.
•    People who are susceptible to ampicillin, amoxicillin, bacampicillin, or hetacillin rash are more likely to develop such a reaction while also taking allopurinol.
•    Combining a thiazide diuretic or an ACE inhibitor (for high blood pressure or heart failure) with allopurinol increases the risk of a drug-sensitivity reaction.
•    Combining vidarabine with allopurinol may increase the risk of neurotoxic effects and anemia, nausea, pain, and itching.
•    Large doses of allopurinol—more than 600 mg a day—may increase the effects of and risk of toxic reactions to theophylline by interfering with its clearance from the body.
Food Interactions
Take each dose with food or a full glass of water. Drink 10-12 glasses of water, juices, soda, or another liquid each day to avoid the formation of crystals in your urine or kidneys.
Usual Dose
Adult and Child (age 11 and over): 100-800 mg a day, depend-, ing on disease and response.
Child (age 6-10): 300 mg a day.
Child (under age 6): 150 mg a day.
The dose should be reviewed periodically by your doctor to be sure that it is producing the desired therapeutic effect.
Overdosage
The expected symptoms of overdose are exaggerated side effects. Allergic skin reactions to allopurinol can be severe and at times fatal. Allopurinol overdose victims should be taken to a hospital. ALWAYS bring the prescription bottle or container.
Special Information
Allopurinol can make you drowsy or make it difficult to concentrate: Take care while driving a car or operating hazardous equipment.
Gout attacks may actually increase during the first few months of taking allopurinol. These attacks should subside.
Call your doctor at once if you develop rash, hives, itching, chills, fever, nausea, muscle aches, unusual tiredness, fever, yellowing of the whites of the eyes or skin, painful urination, blood in the urine, irritation of the eyes, or swelling of the lips or mouth.

Avoid large doses of vitamin C, which can cause the formation of kidney stones during allopurinol treatment. Be sure to drink 1012 8-oz. glasses of water a day while taking this medication.
If you forget to take a dose of allopurinol, take it as soon as possible. If it is almost time for your next regular dose, double this dose. For example, if your regular dose is 100 mg and you miss a dose, take 200 mg at the next usual dose time.
Special Populations
Pregnancy/Breast-feeding: Allopurinol may cause birth defects or interfere with fetal development. Check with your doctor before taking it if you are or might be pregnant.
Allopurinol passes into breast milk. Nursing mothers who must take allopurinol should use infant formula.
Seniors: No special precautions are required. Follow your doctor’s directions and report any side effects at once.

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Jul

16

Adderall

July 16, 2009 | Leave a Comment

Brand Name
Adderall
Generic Ingredients
Dextroamphetamine Sulfate + Dextroamphetamine Saccharate + Amphetamine Aspartate + Amphetamine Sulfate
Other Brand Names Adderall XR
The information in this profile also applies to the following drugs:
Generic Ingredient.* Dextroamphetamine Sulfate RE Dexedrine Dextrostat
Generic Ingredient., Lisdexamfetamine Dimesylate Vyvanse
Type of Drug
Central-nervous-system (CNS) stimulant.
Prescribed For
Attention-deficit hyperactivity disorder (ADHD) and narcolepsy (uncontrollable desire to sleep).
General Information
Amphetamines are stimulants that work on the brain’s feeding center. Adderall, which is a mixture of two forms of amphetamine, may be used as a short-term aid in weight reduction. It should not be taken for longer than a few months for this purpose.
Amphetamines may also be prescribed for childhood ADHD, a condition characterized by distractibility, short attention span, hyperactive behavior, emotional instability, and difficulty controlling impulses. They should be used only after a complete evaluation of the child has been done. Frequency and severity of symptoms and their appropriateness for the age of the child determine whether drug therapy is required. Many experts believe that amphetamines offer only a temporary solution because they do not permanently change behavioral patterns. Psychological, educational, and social measures must also be taken to ensure successful treatment in the long term.

Cautions and Warnings
Do not take Adderall if you are allergic or sensitive to any amphetamine or have heart disease, a heart defect, high blood pressure, hardening of the arteries, liver or kidney disease, tics or Tourette’s syndrome, seizures or abnormal brain wave tests, thyroid disease, glaucoma, or a history of drug abuse.
Amphetamines should be used with extreme caution because they are highly addictive and easily abused.
New or worsening thought patterns, bipolar illness, aggressive or hostile behavior, psychotic behavior, and new manic symptoms can develop during treatment with amphetamines.
Stimulants like amphetamines are not effective and may be dangerous for children whose symptoms are related to environmental factors or primary psychiatric conditions, including psychosis.
Stimulants can cause weight loss and stunted growth in children under age 10. Blurred vision and difficulty focusing can occur.
Possible Side Effects
✓   Common: heart palpitations, restlessness, overstimulation, dizziness, sleeplessness, increased blood pressure, rapid heartbeat, upper abdominal pain, and weight loss.
✓   Less common: euphoria (feeling “high”), hallucinations, muscle spasms and tremors, headache, dry mouth, unpleasant taste in the mouth, diarrhea, constipation, upset stomach, nausea, vomiting, rash, itching, changes in sex drive, and impotence.
✓   Rare: psychotic drug reactions. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•   Combining an amphetamine and a monoamine oxidase inhibitor (MA01) antidepressant may cause a severe increase in blood pressure as well as bleeding inside the skull. Wait at least 2 weeks after stopping an MAGI before taking an amphetamine.
•   Amphetamines may reduce the effectiveness of high blood pressure medicines.
•   Gastrointestinal and urinary acidifying agents such as methenamine reduce the effectiveness of amphetamines.

•   Gastroinstestinal alkalizing agents, such as sodium bicarbonate, and urinary alkalizing agents (acetazolamide, some thiazides) may increase and prolong the effects of amphetamines.
•   Antipsychotic medications such as chlorpromazine, haloperidol, and lithium carbonate inhibit the stimulatory effects of amphetamines and can cause amphetamine poisoning.
•   Amphetamines may enhance the effects of tricyclic antidepressants, norepinephrine, phenobarbital, phenytoin, and meperidine.
•   Amphetamines may decrease the effectiveness of beta blockers.
•   Amphetamines may counteract the sedative effect of antihistamines.
•   Amphetamines can delay the absorption of ethosuximide into the bloodstream.
•   Propoxyphene increases the CNS-stimulating effect of amphetamines. Fatal convulsions have occurred in propoxyphene overdose with amphetamines.
Food Interactions
These drugs may be taken without regard to food or meals.
Usual Dose
Dextroamphetamine and Adderall
ADHD
Child (age 6 and older): 5-40 mg once or twice a day.
Child (age 3-5): 2-5 mg a day. Dose may be increased weekly until maximum response is achieved.
Narcolepsy: 5-60 mg a day.
Weight Control: 5-30 mg a day in divided doses 30-60 minutes before meals; alternately, a single, long-acting dose may be taken in the morning.
Adderall XR
Adults: 20 mg a day.
Child (age 13-17): 10-20 mg every morning. Child (age 6-12): 10-30 mg every morning. Child (under age 6): not recommended.
Lisdexamfetamine
Child (age 6-12): 30 mg every morning. Daily dose may be increased up to 70 mg.
Child (under age 6): not recommended.

Overdosage
Symptoms include tremors, muscle spasms, restlessness, exaggerated reflexes, rapid breathing, dry mouth, constipation, hallucinations, confusion, panic, and overaggressive behavior. These may be followed by depression, exhaustion, abnormal heart rhythms, blood pressure changes, nausea, vomiting, diarrhea, convulsions, and coma. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Amphetamines should be used very cautiously and only when considered absolutely necessary.
When taken for weight control, this drug should be used only when other methods have failed, and will gradually lose its effectiveness as the body starts breaking it down faster. Do NOT increase your dosage when this occurs. The drug must be discontinued.
Amphetamines are addictive and commonly abused. If you feel you have developed a tolerance or dependence to Adderall, contact your doctor. Do not increase your dosage without your doctor’s approval.
Amphetamines may impair your ability to drive or operate heavy machinery. Use with caution. To prevent this drug from interfering with sleep, take it at least 6-8 hours before bedtime.
Do not crush or chew the sustained-release form.
If you forget your once-daily dose, skip it and go -back to your regular schedule the next day. If you take the drug 2-3 times a day and miss a dose, take it as soon as you remember. If it is within 3 hours of your next dose, skip the one you forgot and continue with your regular schedule. Never take a double dose.
Special Populations
Pregnancy/Breast-feeding: Use of amphetamines during the early stages of pregnancy may cause birth defects. Amphetamines also increase the risk of premature delivery and low-birth-weight infants and may cause drug withdrawal symptoms in newborns. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Amphetamines pass into breast milk. Nursing mothers who must take them should use infant formula.
Seniors: Seniors are more sensitive to this drug’s effects.

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Jul

16

Acyclovir

July 16, 2009 | Leave a Comment

Generic Name
Acyclovir
Brand Name Zovirax
Type of Drug Antiviral.
Prescribed For
Initial treatment and maintenance of genital herpes outbreaks; treatment of herpes zoster (shingles); and treatment of varicella (chickenpox).
General Information
Acyclovir is the only oral drug that reduces growth rates of the herpes virus and the related viruses, Epstein-Barr, varicella, and cytomegalovirus (CMV); both oral acyclovir and oral ganciclovir work against CMV Intravenous drugs, including acyclovir injection, may also be used for these viral infections; however, intravenous antiviral drugs are usually reserved for patients with HIV, cancer, or otherwise compromised immune systems.
Acyclovir is selectively absorbed into cells that are infected with the herpes simplex virus, where it is converted into its active form. Acyclovir works by interfering with the reproduction of viral DNA, slowing the growth of existing viruses. It has little effect on recurrent infections. To treat both local and systemic (whole-body) symptoms acyclovir must be given by intravenous injection or taken by mouth. Local symptoms may be treated with the ointment alone. Oral acyclovir may be taken every day to reduce the number and severity of herpes attacks in people who suffer 10 or more attacks a year; it may also be used to treat intermittent attacks as they occur, but treatment must be started as soon as possible to have the greatest effect.
Cautions and Warnings
Do not use acyclovir if you are allergic or sensitive to any of its ingredients. Do not use acyclovir ointment if you have had an allergic reaction to it or to the major component of the ointment base, polyethylene glycol. Do not apply acyclovir ointment inside the vagina because the polyethylene glycol base may cause irritation and swelling of sensitive vaginal tissue. Acyclovir ointment is not intended for use in the eye and should not be used to treat a herpes infection of the eye.
Renal failure has occurred in patients using oral acyclovir, in some cases resulting in death. People with kidney impairment should have dosages adjusted accordingly.
Maintain adequate hydration while taking oral acyclovir. Animal testing indicates that acyclovir may affect fertility in men. These effects may be reversible.
Possible Side Effects
Capsules, Suspension, and Tablets
✓    Most common: feeling unwell, headache, diarrhea, nausea, and vomiting.
✓    Less common: appetite loss, stomach gas, constipation, fatigue, rash, leg pains, sore throat, a bad taste in the mouth, sleeplessness, and fever.
♦    Rare: aching joints, weakness, and tingling in the hands or feet. Contact your doctor if you experience any side effect not listed above.
Ointment
✓    Most common: mild burning, irritation, rash, and itching. These effects are more likely to occur when treating an initial herpes attack than a recurrent attack. Women are 4 times more likely to experience burning than men.
Drug Interactions
•    Do not apply acyclovir together with any other ointment or topical medication.
•    Oral probenecid may decrease elimination of acyclovir from the body, which increases blood levels of oral or injected acyclovir, increasing the risk of side effects.
•    Combining acyclovir and zidovudine (an HIV drug—also known as AZT) may lead to severe drowsiness and lethargy.
Food Interactions
Acyclovir may be taken with food if it upsets your stomach.

Usual Dose
Capsules, Suspension, and Tablets
Adult: genital herpes attack-200 mg every 4 hours, 5 times a day for 10 days. Recurrent infections-400 mg 3 times a day or 200 mg 5 times a day for 5 days. Suppressive therapy for chronic herpes-800 mg a day, every day for up to a year. Herpes zoster800 mg 5 times a day for 7-10 days.
Child (age 2 and over): Acyclovir has been given to children in daily doses as high as 36 mg per lb. of body weight without any unusual side effects.
Child (under age 2): not recommended.
If you have kidney disease, your doctor should adjust your dose according to the degree of functional loss.
Ointment: Apply every 3 hours, 6 times a day for 7 days. Apply enough medication to cover all visible skin lesions. About 1/2 in. of ointment should cover about 4 sq. in. of lesions. Your doctor may prescribe a longer course of treatment to prevent the delayed formation of new lesions over the duration of an attack. Begin using ointment at the first sign of an attack.
Overdosage
Overdose of oral acyclovir may lead to kidney damage due to deposits of acyclovir crystals in the kidneys. Other side effects include agitation, seizures, lethargy, and coma. The risk of experiencing toxic side effects from swallowing acyclovir ointment is quite small. In the case of overdose or accidental ingestion, call your poison control center. ALWAYS bring the prescription bottle or container.
Special Information
Use a finger cot or rubber glove when applying acyclovir ointment to protect against inadvertently spreading the virus. Be sure to apply the medication exactly as directed and to completely cover all lesions. Keep affected areas clean and dry. Loose-fitting clothing will reduce possible irritation of a healing lesion. If you skip several doses, or a day or more of treatment, the drug will not exert its maximum effect.
Acyclovir is not a cure for genital herpes. Herpes may be transmitted even if you do not have symptoms of active disease. To avoid giving the condition to a sexual partner, do not have intercourse while visible herpes lesions are present. A condom offers some protection against transmission of the herpes virus, but spermicidal products and diaphragms do not. Acyclovir alone will not prevent herpes transmission.
Initiate therapy at the first sign of symptoms.
Women with genital herpes have an increased risk of cervical cancer. Speak with your doctor about the need for an annual Pap smear.
Call your doctor if acyclovir does not relieve your symptoms, if side effects become severe or intolerable, or if you become pregnant or want to begin breast-feeding. Check with your dentist if you notice swelling or tenderness of the gums.
Avoid exposure to excessive sunlight or sunlamps because of unusual sensitivity caused by oral acyclovir.
Special Populations
Pregnancy/Breast-feeding: Acyclovir crosses into the circulation of the fetus. Animal studies have shown that large doses—up to 125 times the human dose—cause damage to both mother and fetus. While there is no information to indicate that acyclovir affects a human fetus, do not use it during pregnancy unless it is specifically prescribed by your doctor and the possible benefit outweighs the risk.
Acyclovir passes into breast milk in concentrations up to 4 times the concentration in blood, and it has been found in the urine of a nursing infant. Although no side effects have been found in nursing babies, mothers who must take acyclovir should use infant formula.
Seniors: Shingles attacks in people over age 50 tend to be more severe and respond best to acyclovir treatment if the drug is started within 48-72 hours of the appearance of the first rash. Seniors with reduced kidney function should be given a lower dose of oral acyclovir than younger adults.

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Jul

16

Acetazolamide

July 16, 2009 | Leave a Comment

Generic Name
Acetazolamide (uh-sete-uh-ZOLE-uh-mide) [6j
Type of Drug
Carbonic-anhydrase inhibitor.
Prescribed For
Glaucoma and prevention or treatment of mountain sickness; also prescribed for epilepsy and treatment of drug-induced swelling or swelling due to congestive heart failure.
General Information
By blocking an enzyme in the body called carbonic anhydrase, acetazolamide produces a weak diuretic effect that helps to treat glaucoma by reducing pressure inside the eye. Acetazolamide’s antiseizure properties are also produced by its effect on carbonic anhydrase, though exactly how acetazolamide prevents seizure is not well understood.

Cautions and Warnings
Do not take acetazolamide if you are allergic or sensitive to any of its ingredients or to sulfa drugs.
Do not take acetazolamide if you have low blood sodium or potassium, diabetes, or serious kidney, liver, or Addison’s disease.
Possible Side Effects
Side effects of short-term therapy are usually minimal.
✓    Most common: nausea or vomiting; tingling feeling in the arms, legs, lips, mouth, or anus; appetite and weight loss; a metallic taste; increased frequency in urination; diarrhea; not feeling well; occasional drowsiness; and weakness. You may also experience rash, drug crystals in the urine, painful urination, low back pain, urinary difficulty, and low urine volume.
♦    Rare: Rare side effects can affect the liver, mental state, blood sugar, muscles, and senses. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Avoid over-the-counter drug products that contain stimulants or anticholinergics, which tend to aggravate glaucoma and cardiac disease.
•    Acetazolamide may increase blood concentrations of cyclosporine (used to prevent the rejection of transplanted organs).
•    Acetazolamide may block or delay the absorption of primidone (prescribed for seizure).
•    Avoid aspirin because it may enhance acetazolamide side effects.
•    Combining diflunisal and acetazolamide can result in an excessive lowering of eye pressure.
Food Interactions
Acetazolamide may be taken with food if it upsets your stomach. Because acetazolamide can increase potassium loss, take this drug with potassium-rich foods such as bananas, citrus fruits, melons, and tomatoes.

Usual Dose
Glaucoma
Adult: 250-1000 mg a day.
Child: 4.5-6.75 mg per lb. a day in divided doses.
Diuresis in congestive heart failure or drug-induced swelling Adult: 250-375 mg a day.
Child: 2.25 mg per lb., once daily in the morning.
Epilepsy: 375-1000 mg a day in divided doses.
Mountain Sickness: 500-1000 mg a day. If possible begin medication 24-48 hours before ascent.
Overdosage
Symptoms of overdose include drowsiness, loss of appetite, nausea, vomiting, dizziness, tingling in the hands or feet, weakness, tremors, or ringing or buzzing in the ears. In case of overdose, induce vomiting as soon as possible with ipecac syrup—available at any pharmacy—and take the victim to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Acetazolamide may cause minor drowsiness and confusion, particularly during the first 2 weeks of therapy. Be careful when driving or doing any task that requires concentration.
Call your doctor if you develop sore throat, fever, unusual bleeding or bruises, tingling in the hands or feet, rash, or unusual pains.
Acetazolamide can increase sensitivity to the sun. Avoid prolonged sun exposure and protect your eyes while taking this drug.
Be sure to drink plenty of water or fluids while taking acetazolamide.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: High doses of this drug may cause birth defects or interfere with fetal development. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Small amounts of acetazolamide may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors are more sensitive to this drug’s side effects.

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Jul

2

Acne: Over-the-Counter Treatment: Benzoyl Peroxide

July 2, 2009 | Leave a Comment

Acne: Over-the-Counter Treatment

Benzoyl peroxide is the primary ingredient in most OTC acne treatments. This compound has antimicrobial activity and is usually quite effective for mild acne.

Q. My teenage son has a mild case of acne, but to him it is huge. He washes with strong cleansers and uses a variety of acne medicines. Can you recommend something that will clear up his skin so he doesn’t scrub so much? His face is bright red after all the washing, and I don’t think that is good.

A. You’re right! Acne is not caused by dirt, so vigorous washing won’t help. It may even make things worse.
OTC benzoyl peroxide (Benzac, Clearasil Acne Treatment, Oxy 5, etc.) should do the job. If not, your son should see a dermatologist. Retin-A (tretinoin) and/or antibiotics can work wonders.
Benzoyl peroxide is found in a number of different products, from cleansing bars and liquid cleansers to lotions and even shaving creams. Read the instructions on the label and follow them; the procedure varies a little for the different forms. Benzoyl peroxide can dry the skin and cause irritation. If that happens, use it a little less frequently or look for a product with a lower concentration of the ingredient.
Benzoyl peroxide unplugs pores and discourages thegrowth of skin bacteria. It is not, however, an antibiotic, and skin bacteria don’t seem to develop resistance to it.. Follow the instructions on the product label for application and use.
Side effects: Skin irritation, dryness, redness, scaling, and rash.
Downside: Acne may worsen initially before improving. Use the product for 6 weeks to 2 months to evaluate its effectiveness..
Cost: Varies, depending on - the product; approximately $20 to $30 for a month’s worth of gel .
individuals are allergic to benzoyl peroxide and break out in hives or swelling, so try it out on your forearm first to make sure you will not react badly. If you do, you will have to forgo benzoyl peroxide treatment and look for another way to manage your acne.
A few nonprescription acne products contain active ingredients other than benzoyl peroxide. Resorcinol is generally used in combination with sulfur (Clearasil Adult Care contains them both). Salicylic acid is also found in some OTC acne products. None of these should be used in combination with benzoyl peroxide. All may irritate and dry the skin, and they should not be combined with other products that might irritate the skin. Prescription acne treatment drugs are Cipro and Accutane which are commercial names for generic Ciprofloxacin and Isotretion.

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Jul

1

Drugs for Cancer Treatment

July 1, 2009 | Leave a Comment

The treatment of cancer is difficult because cancer cells are cells that have escaped from the controls that govern normal cell growth and differentiation of function. As a result, uncoordinated growth may develop rapidly, and cancer cells may migrate and invade other tissues. Any anti-cancer drug is therefore likely to damage normal cells, particularly actively growing cells such as those of the bone marrow, and the dose of a cytotoxic agent is often a compromise between that having the desired anti-cancer action and that causing toxicity.
The drugs used in the treatment of cancer can be divided into four main groups, which attack the cells at different points. The alkylating agents interfere with the replication and function of DNA, modify protein synthesis, and have correspondingly wide effects. The antimetabolites interfere with cell metabolism by combining with cell enzymes, or by forming abnormal proteins, or otherwise inhibiting normal development. The cytotoxic antibiotics have an action similar to that of the antimetabolites, but they also have radiomimetic properties, and combined radiotherapy may increase the risks of damage to normal cells. These antibiotics, with the exceptions of dactinomycin and bleomycin, also have undesirable cardiotoxic properties, and dosage requires careful control. Amsacrine is a synthetic cytotoxic agent with some of the properties of the antibiotic group. Some recently introduced drugs include docetaxel, gemcitabine, letrozole, paclitaxel, raltitrexed and topotecan.
The vinca alkaloids are a class apart, as they are plant substances, and act at the metaphase stage of cell division. They are used mainly in acute leukaemias and some lymphomas. Vincristine is almost free from any depressive effects on bone marrow function, vinblastine has some degree of myelosuppressive activity but is less neurotoxic. Vindesine occupies an intermediate position. Etoposide is a synthetic drug with some of the properties of the vinca alkaloids. Other and unclassified cytotoxic agents include the platinum complexes carboplatin and cisplatin, used mainly in ovarian cancer, and the enzyme crisantaspase used in acute lymphoblastic leukaemia. Some cancers are hormone dependent, and the symptoms may be controlled by suitable hormone antagonists. Breast cancer for example may respond to aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Prostatic cancer can be treated with anti-androgens such as fosfesterol, bicalutamidc, cyproterone and flutamide. Certain hormone analogues such as buserelin, goserelin, leuprorelin and triptorelin are also used in cancer of the prostate. A distressing side-effect of high-dose cytotoxic chemotherapy was severe and intractable nausea and vomiting, which could be so intense that patients have been known to refuse further anti-cancer treatment. The problem has since been resolved by the introduction of potent antierneties of the ondansetron type.

Myleran
carmustine   BiCNU
chlorambucil   Leukeran
cyclophosphamide   Endoxana
estramustine   Estracyt
ifosfamide   Mitoxana
lomustine   CCNU
melphalan   Alkeran
mustine   Mustine
thiotepa   Thiotepa
treosulphan   Treosulfan
cladribine   Leustat
gemcitabine mercaptopurine methotrexate
thioguanine   Lanvis
cytarabine   Alexan, Cytosar
fludarabine   Fludara
fluorouracil   Fluoro-Uracil, Efudix
Gemzar Puri-Nethol
Maxtrex

raltitrexed   Tomudex
bleomycin   Bleomycin
dactinomycin   Cosmegen
daunorubicin   DaunoXome
doxorubicin   Doxorubicin
epirubicin   Pharmarubicin
idarubicin   Zavedos
mitomycin   Mitomycin C
mitozantrone   Novantrone
vinblastine   Velbe
vincristine   Oncovin
vindesine   Eldesine
vinorelbine   Navelbine
aldesleukin
amsacrine
bicalutamide
carboplatin
dacarbazine
Proleukin
Amsidine
Casodex
Paraplatin
DTIC
cisplatin   Cisplatin
docetaxel   Taxotere

etoposide
Vepesid
hydroxyurea
Hydrea
iritotecan
Campto
letrozole
Ferrara
octreotide
Sandostatin
paclitaxel
Taxol
pentostatin
Nipent
procarbazine
Natulan
razoxane
Razoxin
topotecan
Hycamptin
tretinoin
Vesanoid
aminoglutethimide
Orimeten
anastrozole
Armidex
buserelin
Suprefact
Cyprostat
Drogenil
flutamide
Lentaron
formestane
goserelin
Zoladex
tamoxifen
Torero
torasemide
Casodex
Emblon, Nottam, Notwadex, Tamofen
bicalutamide
cyproterone

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