Sep
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
Combination Product
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 .,oAits ingredients.
Formoterol skn\)NO 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.
Aug
13
Fenofibrate - Finasteride - Fioricet - Fiorinal - Fiorinal with Codeine
August 13, 2009 | Leave a Comment
Generic Name
Fenofibrate (fen-oe-Flli-brace) IM
Brand Names
Antara TriCor
Lipoten Triglide Lofibra
Type of Drug
Anti-hyperlipidemic (blood-fat reducer).
Prescribed For
High blood cholesterol and/or triglycerides; also prescribed for syndrome X, a condition which increases the risk of type 2 diabetes.
General Information
Fenofibrate works by interfering with the body’s ability to make triglyceride and by increasing its breakdown by enzymes in the body. It also reduces levels of uric acid, total cholesterol, low-density lipoprotein (LDL) cholesterol—the “bad” cholesterol—and other blood lipids. High-density lipoprotein (HDL) cholesterol—the “good” cholesterol—levels are increased. This drug should only be used in people with very high triglyceride levels who are at risk for pancreatitis (inflammation of the pancreas) and have not responded to other treatments, including statin drugs. Generic fenofibrate is not equivalent to the TriCor brand because of a new product formulation and should not be substituted for the brand unless your doctor approves of the switch.
Cautions and Warnings
Do not take fenofibrate if you are allergic or sensitive to any of its ingredients.
People taking fenofibrate and other triglyceride-lowering drugs are mate WOV to die from causes unrelated to triglyceride levels. Fenofibrate reduces the risk of a heart attack or other cardiac event in people with high triglyceride levels and low levels of HDL cholesterol, especially among people with diabetes. The evidence for this benefit is not as strong as it is for the statin drugs.
People taking fenofibrate and gemfibrozil may develop pancreatitis (inflammation of the pancreas).
People with liver or severe kidney disease should avoid fenofibrate. People with less severe kidney disease require reduced
dosage.
People taking fenofibrate are more likely to develop gallstones.
Fenofibrate can destroy muscle cells, leading to kidney failure, especially when combined with a statin cholesterol-lowering drug see “Drug Interactions”).
Possible Side Effects
• Most common: abnormal liver function, abdominal pain, and respiratory disorders.
♦ Common: rash, headache, upset stomach, pain, weakness, tiredness, and flu-like symptoms.
♦ Less common: joint pain, abnormal heart rhythms, reduced sex drive, dizziness, increased appetite, sleeplessness, tingling in the hands or feet, nausea, vomiting, diarrhea, abdominal pain, constipation, stomach noise or gas, frequent urination, vaginal irritation, runny nose, cough, sinus irritation, eye irritation, blurred vision, conjunctivitis (pinkeye). earache, and tiny particles inside the eye (”floaters”).
♦ Rare: allergic reactions including severe rash, itching, liver inflammation or enlargement, gallstones, gallbladder disease, muscle aches, and increased sensitivity to the sun. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Combining fenofibrate and a statin cholesterol-lowering drug (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) can lead to severe muscle pain, muscle cell destruction, and kidney failure. If you have extremely high blood-fat levels, the potential benefits of this combination may outweigh the risks. In people taking this combination, the health of muscles and kidneys must be monitored regularly via blood tests.
• Fenofibrate increases the effects of anticoagulant (blood-thinning) drugs. Your anticoagulant dosage may need an adjustment.
• Combining fenofibrate and cyclosporine can increase the risk of kidney toxicity. This combination should only be used if it is absolutely necessary and the lowest possible dosage is
taken.
• If you are taking cholestyramine or colestipol (both are used
to reduce blood-fat levels) as well as fenofibrate, take the
fenofibrate at least 1 hour before or 4-6 hours after these
drugs.
Food Interactions
All forms of fenofibrate, except TriCor, should be taken with food to get the best effect. TriCor may be taken without regard to food or meals.
Usual Dose
These products may not be substituted for each other because of important dosage differences.
Antara
Adult: 43-130 mg a day with food.
Senior: Begin with 43 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
Lofibra
Adult: 67-200 mg a day with food.
Senior: Begin with 67 mg a day. This beginning dosage also applies to people with kidney disease.
Child: not recommended.
Lipofen
Adult: 50-150 mg a day with food.
Senior: Begin with 50 mg a day. This dosage also applies to people with kidney disease.
Child: not recommended.
TriCor
Adult: 48-145 mg a day.
Senior: Begin with 48 mg a day. This dosage also applies to
people with kidney disease. Child; mk recommended.
Triglide
Adult: 50-160 mg a day.
Senior: Begin with 50 mg a day. This dosage also applies to
people with kidney disease. Child: not recommended.
Overdosage
Little is known about the effects of fenofibrate overdose. Victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
People should take fenofibrate only after a triglyceride- lowering diet and other medications have failed. While taking fenofibrate, follow the diet recommended by your doctor.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule.
Special Populations
Pregnancy/Breast-feeding: Fenofibrate causes fetal injury and death in animal studies. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
This drug should not be taken by nursing mothers because of its potential to affect the nursing infant.
Seniors: Seniors are more likely to experience side effects and should never start with more than the lowest recommended dosage.
Generic Name
Finasteride (fin-ASS-ter-ide) 19
Brand Names
Proscar Propecia
The information in this profile also applies to the following drug:
Generic Ingredient: Dutasteride Avodart
Type of Drug
Alpha-reductase inhibitor and androgen hormone inhibitor.
Prescribed for
Benign prostatic hyperplasia (BPH) and male-pattern baldness. May also play a role in preventing prostrate cancer.
General Information
Finasteride works by interfering with the action of the enzyme alphareductase, which converts testosterone into 5-dihydrotestosterone (DHT). By suppressing DHT levels, finasteride reduces the size of the prostate in most men who take the drug for BPH. You may need to take finasteride for 6-12 months before its effects can be
assessed.
Urine flow improves in about 60% of men taking finasteride for BPH and symptoms improve in about 30%. In one study, men experienced a significant regression in prostate size after 3 months, and the reduction was maintained through the 12-month study period: these men experienced a significant improvement in urine flow that could be maintained up to 36 months.
Studies of finasteride for hair loss on the top and back-middle of the scalp show new hair growth in 65-80% of men taking the drug continuously for 2 years. The drug must be taken for 3 months or more before it begins to have an effect and must be taken continuously to maintain hair growth. Once you stop taking this drug, any new hair you have grown is likely to fall out in the next 12 months. Between 14-17% of men taking the drug continued to lose hair throughout the study period.
Finasteride has been studied as therapy following radical prostatectomy surgery and in the prevention of first-stage prostate cancer, acne in women, and unusual hairiness.
Cautions and Warnings
Do not take finasteride if you are allergic or sensitive to any of its ingredients.
This drug should not be used in women or children. Pregnant women must not handle the tablets and capsules because of the risk to the fetus.
People who do not respond to finasteride may have a condition that causes BPH-like symptoms, such as prostate cancer, bladder or nerve disorders, or physical obstruction of the urinary tubes. Finasteride cannot be used to treat these conditions.
Because it is broken down in the liver, finasteride must be used with caution by people with liver disease.
Finasteride may mask symptoms of prostate cancer by causing a reduction in the level of prostate-specific antigen (PSA), an increasingly acknowledged indicator of prostate cancer.
Possible Side Effects
Side effects are generally mild and often subside with continued use of the drug.
Drug Interactions
• Finasteride may reduce the effectiveness of theophylline and aminophylline, although dosage adjustments usually are not required.
• Finasteride affects the PSA blood test used for prostate cancer screening. Be sure your doctor knows you are taking this drug if you have a PSA test done or are being tested for prostate cancer.
• Dustasteride blood levels may increase when mixed with ritonavir, ketoconazole, cimetidine, and ciprofloxacin, all of which are inhibitors of a liver enzyme called CYP3A4. Blood levels of dutasteride also increase with verapamil and diltiazem.
Food Interactions
You may take finasteride with food if it upsets your stomach.
Usual Dose
Outasteride
Adult: 0.5 mg (1 capsule) once a day. Child: not recommended.
Finasteride
Adult: BPH-5 mg once a day. Male-pattern baldness-1 mg once a day.
Child: not recommended.
Women should not take finasteride. Overdosage
S%’& Ptecls are unlikely. Doses of dutasteride as high as 400 mg a day have been taken with no adverse side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Possible Side Effects (continued)
v Common: impotence, loss of sex semen, breast tenderness an
• and drug sensitivity reaction
• rash.
x drive, decreased amount nd enlargement, testicular ions including lip swelling Special Information
Women who are or might be pregnant should not handle crushed finasteride tablets because small amounts of the drug may be absorbed into the blood, possibly affecting the fetus.
If your sexual partner is or might be pregnant and you start taking finasteride, you must wear a condom during sex to avoid directly exposing her to finasteride in the semen.
Semen volume may decrease while on finasteride. Impotence or reduced sex drive is also a risk.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose. Call your doctor if you miss a dose for 2 or more days.
Special Populations
Pregnancy/Breast-feeding: This drug is not intended for women. Finasteride will harm the fetus if taken during pregnancy. It is not known if finasteride passes into breast milk.
Seniors: Seniors with liver disease should use this drug with caution.
Brand Name
Fioricet
Generic Ingredients
Acetaminophen + Butalbital + Caffeine 91
Other Brand Names
Americet Femcet
Dolgic LQ Margesic
Dolgic Plus Medigesic
Esgic Repan
Esgic-Plus Triad
Type 101 Drug
Barbiturate and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fioricet is one of many combination products containing a barbiturate—butalbital—and an analgesic—acetaminophen. Products of this kind also often contain a sedative or a narcotic. Other analgesic combinations, such as Rorinal, substitute aspirin for
acetaminophen.
Cautions and Warnings
Do not take Fioricet if you are allergic or sensitive to any of its ingredients.
Use this drug with caution if you have kidney or liver disease or a history of porphyria.
Chronic (long-term) use of Fioricet may lead to drug dependence or addiction. It is not recommended for multiple or recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an inability to concentrate. Alcohol increases the CNS depression caused by this drug.
The safety and effectiveness of these medications have not been established in children under age 12.
For additional information see “Cautions and Warnings” in Acetaminophen (page 7).
Possible Side Effects
♦ Most common: lightheadedness, dizziness, sedation, shortness of breath, nausea, vomiting, upset stomach and a feeling of intoxication.
V Less common: weakness, headache, agitation, tremor, uncoordinated muscle movement, disorientation, dry mouth, constipation, facial flushing, changes in heart rate, palpitations, feeling faint, urinary difficulties, rash, and itching.
For additional information see “Possible Side Effects” in Acet-
aminophen (page 7).
Drug Interactions
• Combining Fioricet with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
These medications may reduce the effectiveness of corticosteroids, contraceptives containing estrogen, beta blockers (e.g. propranolol), doxycycline, felodipine, griseofulvin, nifedipine, phenylbutazone, quinine, theophylline, warfarin, and tricyclic antidepressants.
For additional information see “Drug Interactions” in Acetaminophen (page 7).
Food Interactions
Fioricet is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not exceed 6 doses a day.
Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, facial flushing, sweating, and thirst. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fioricet may cause drowsiness. Be careful when driving or performing any task that requires concentration.
You should avoid alcohol while taking this medication.
Do not take Fioricet for longer or in amounts greater than prescribed.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping Fioricet may lead to withdrawal symptoms.
Call your doctor if your headache or pain persists or gets worse, or if you develop side effects that are bothersome or persistent.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one and continue
W<tkh IV61 schedule. Do not take a double dose.
For additional information see “Special Information” in Acetaminophen (page 7).
Special Populations
Pregnancy/Breast-feeding: Fioricet should not be taken during pregnancy. It is associated with birth defects, prolonged labor and delayed delivery, and breathing problems in newborns. Regular use of Fioricet during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fioricet passes into breast milk. Breast-feeding while using Fioricet may cause babies to become tired, short of breath, or have a slow heartbeat. Nursing mothers who must take this drug should use infant formula.
Seniors: Fioricet may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal
Generic Ingredients
Aspirin + Butalbital + Caffeine &9
Other Brand Names
Butalgen Fiorimor
Farbital Fortabs
Fiorigen Lanorinal
Type of Drug
Barbiturate and analgesic (pain reliever) combination. Prescribed For
Symptom relief of tension headache.
General Information
Pain relief products often combine an analgesic with a sedative. The analgesic ingredient in Fiorinal is aspirin; other brand-name products, such as Esgic and Fioricet, contain acetaminophen. The sedative ingredient in pain-relief combinations may be a barbiturate, narcotic, or other sedative. Fiorinal contains the barbiturate butalbital. Fiorinal also contains caffeine, which is ofte” \Ased in analgesic combinations that km,-M beadache because it enhances kkNt %m-relieving effect of aspirin.
Cautions and Warnings
Do not take Fiorinal if you are allergic or sensitive to any of its ingredients.
Do not give Fiorinal to children or teenagers with chickenpox or flu-like symptoms due to the aspirin content and danger of
Reye’s syndrome.
Use Fiorinal with extreme caution if you suffer from peptic ulcer,
problems with blood clotting or other bleeding disorders, or are
about to have surgery.
This drug should be used with caution if you have kidney or
liver disease, diabetes, or a history of porphyria.
Long-term use of this drug may cause drug dependence and addiction. It is not recommended for the treatment of multiple recurrent headaches.
Butalbital is a respiratory depressant and affects the central nervous system (CNS), producing drowsiness, tiredness, and an
inability to concentrate. Alcohol increases the CNS depression caused by butalbital.
The safety and efficacy of Fiorinal use in children under age 12 has not been established.
For additional information see “Cautions and Warnings” in Aspirin (page 110).
Possible Side Effects
✓ Most common: lightheadedness, dizziness, and sedation.
♦ Less common: nausea, vomiting, flatulence, and rash. For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Combining Fiorinal with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, monoamine oxidase inhibitor antidepressants, or other CNS depressants may cause tiredness, drowsiness, and trouble concentrating.
• Fiorinal may enhance the effects of oral anticoagulants (blood thinners), oral antidiabetes drugs, insulin, and mmsteroidal anti-inflammatory drugs ~VASAYDs).
• F10final may decrease the effectiveness of medications taken for gout, including probenicid and sulfinpyrazone.
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal is best taken on an empty stomach but may be taken with
food if it upsets your stomach.
usual Dose
1-2 tablets or capsules every 4 hours or as needed. Do not exceed
6 doses a day. Overdosage
Symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold and clammy skin, lowered heart rate or blood pressure, nausea, vomiting, stomach pain, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose are rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, and bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
Fiorinal may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking Fiorinal.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take Fiorinal for longer or in amounts greater than prescribed.
Call your doctor if your headache pain persists or gets worse, or if you develop any bothersome or persistent side effect.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
PregriancylBreast-feeding. Fiorinal should not be taken during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. Fiorinal increases the risk of birth defects and may cause breathing or bleeding prob-lems in newborns. Regular use of Fiorinal during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal passes into breast milk. Breast-feeding while using Fiorinal may cause tiredness, shortness of breath, or slowed heartbeat in the baby. Nursing mothers who must take Fiorinal should use infant formula.
Seniors: Fiorinal may have a greater depressant effect on seniors. Seniors are also more likely to experience stimulation and disorientation.
Brand Name
Fiorinal with Codeine
Generic Ingredients
Aspirin + Butalbital + Caffeine + Codeine Phosphate 19
Type of Drug
Barbiturate, narcotic, and analgesic (pain reliever) combination.
Prescribed For
Symptom relief of tension headache.
General Information
Fiorinal with Codeine is one of many combination products containing a barbiturate, an analgesic, and a narcotic. In Fiorinal with Codeine, butalbital is the barbiturate, aspirin is the analgesic, and codeine is the narcotic. These products often also contain a sedative, and acetaminophen may be substituted for aspirin.
Cautions and Warnings
Do not take Fiorinal with Codeine if you are allergic or sensitive to any of its ingredients. Even recommended doses of aspirin can cause severe allergic reaction in those with an aspirin allergy.
Do not take this medication if you suffer from peptic ulcer, bleeding disorders, or a history of porphyria.
Use this medication with cautiOi) 11 you have kidney or liver
disease of diabetes.
Fiorinal with Codeine may cause postural low blood pressure (symptoms include dizziness or fainting when rising from a sitting or lying position).
Long-term use of this drug may cause drug dependence or addiction.
It is not recommended for treatment of multiple, recurrent head-
aches.
Fiorinal with Codeine is a respiratory depressant and affects the
central nervous system (CNS), producing sleepiness, tiredness, or inability to concentrate. Alcohol increases the depression caused
by codeine and butalbital.
Do not give Fiorinal with Codeine to children or teenagers with
chickenpox or flu-like symptoms. The aspirin content presents the
danger of Reye’s syndrome.
For additional information see “Cautions and Warnings” in As-
pirin (page 110).
Possible Side Effects
✓ Most common: dizziness, sleepiness, nausea, and vomiting.
♦ Less common: dry mouth, difficulty swallowing, heartburn, rapid heart rate, leg pain and muscle fatigue, urinary problems, rash, fever, earache, stuffy nose, and ringing in the ears. Narcotic analgesics may aggravate convulsions in those who have had them.
For additional information see “Possible Side Effects” in Aspirin (page 110).
Drug Interactions
• Interaction with alcohol, sedatives, barbiturates, sleeping pills, antihistamines, or other drugs that produce sedation may cause tiredness, drowsiness, and trouble concentrating.
• Taking Fiorinal with Codeine with a monoamine oxidase inhibitor antidepressant may cause increased central nervous system effects.
• This medication may reduce the effectiveness of medications for the treatment of gout including probenicid and sulfapyrazone.
• Fiorinal with Codeine may enhance the effects of blood thin- ners, oral antidiabetes drugs, insulin, and anti-inflammatory drugs (NSAIDs).
For additional information see “Drug Interactions” in Aspirin (page 110).
Food Interactions
Fiorinal with Codeine is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
1-2 tablets or capsules every 4 hours or as needed; do not ex-
ceed 6 doses a day.
Overdosage
Usual overdose symptoms include breathing difficulties, nervousness progressing to stupor or coma, pinpointed pupils, cold clammy skin and lowered heart rate or blood pressure, nausea, vomiting, dizziness, ringing in the ears, flushing, sweating, and thirst. Symptoms of mild overdose include rapid and deep breathing, nausea, vomiting, dizziness, ringing or buzzing in the ears, flushing, sweating, thirst, headache, drowsiness, diarrhea, and rapid heartbeat. Severe overdose may cause fever, excitement, confusion, convulsions, liver or kidney failure, coma, or bleeding. Take the victim to a hospital emergency room immediately. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause drowsiness. Be careful when driving or performing any task that requires concentration.
Avoid alcohol while taking this drug.
If you have been taking this medication for more than a few weeks, do not stop taking it without your doctor’s instruction. Suddenly stopping this drug may lead to withdrawal symptoms.
Do not take this drug for longer or in amounts greater than prescribed.
Call your doctor if you experience breathing difficulties, or persistent nausea, vomiting, or constipation.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
For additional information see “Special Information” in Aspirin (page 110).
Special Populations
Pregnancy/Breast-teeding-. Fiorinal with Codeine should not be used during pregnancy. Pregnant women taking it may experience prolonged labor, delayed delivery, and bleeding problems. This drug increases the risk of birth defects and may cause breathing or bleeding problems in newborns. Regular use of Fiorinal with Codeine during the last 3 months of pregnancy may also cause drug dependency in the newborn.
Fiorinal with Codeine passes into breast milk. Breast-feeding while using this drug may cause tiredness, shortness of breath, or a slow heartbeat in the baby. Nursing mothers who must take this drug should use infant formula.
Seniors: This drug may have a greater depressant effect on seniors. Other effects that may be more prominent are stimulation, disorientation, lightheadedness, and dizziness or fainting when rising suddenly from a sitting or lying position.
Aug
13
Ezetimibe - Famciclovir - Famotidine - Felbamate - Felodipine
August 13, 2009 | Leave a Comment
Ezetimibe (eh-HIHI-firri-ibe)
Brand Name Zetia
Combination Product
Generic Ingredients: Ezetimibe + Simvastatin Vytorin
Type of Drug
Cholesterol - lowering agent.
Prescribed For
High cholesterol, high LDL (”bad”) cholesterol, high triglycerides, and low HDL (”good”) cholesterol; also prescribed for two rare genetic disorders called homozygous familial hypercholesterolemia and homozygous sitosterolemia.
General Information
Unlike statin drugs, ezetimibe interferes with the absorption of cholesterol through the intestine and into the bloodstream. Ezetimibe may be helpful for people whose LDL (”bad”) cholesterol remains high despite treatment with a statin drug. Cholesterol-lowering medicines should always be used together with appropriate diet and exercise.
Ezetimibe may be taken alone but is often taken in combination with a statin drug (generally simvastatin). Vytorin is a brand-name combination of these 2 medications. See Stalin Cholesterol-Lowering Agents, page 1052.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
People with liver disease or elevated liver enzyme measurements should not take ezetimibe because its effects on the liver are not known.
Ezetimibe does not slow hardening of the arteries.
There may be a risk of myopathy (skeletal muscle disorder) with ezetimibe; contact your doctor if you experience any unexplained muscle pain, tenderness, or weakness. Ezetimibe + simvastatin has the same effect as simvastatin alone; see Statin Cholesterol-Lowering Agents, page 1052.
Possible Side Effects
Ezetimibe side effects are similar to those reported by people taking a placebo (sugar pill).
V Most common: headache, back pain, joint pain, and abdominal pain.
C,Ibmrnon: muscle ache and respiratory infection.
V Less common: fatigue, chest pain, diarrhea, sore throat, and cough.
For additional information about ezetimibe + simvastatin, see Statin Cholesterol- Lowering Agents, page 1052.
Drug Interactions
• Cholestyramine reduces the amount of ezetimibe absorbed
in the blood. Separate these drugs by 2 hours or more.
• Cyclosporine (to prevent organ transplant rejection) may substantially increase the amount of ezetimibe in the blood. This combination must be monitored closely by your doctor.
• Gemfibrozil (another blood-fat reducer) can increase the amount of ezetimibe in the blood.
• Fenofibrate may increase the effects of ezetimibe. Fibrates
other than fenofibrate should not be used with ezetimibe due to
the risk of gallbladder complications. For additional informa-
tion about ezetimibe + simvastatin, see Statin Cholesterol-
Lowering Agents, page 1052.
Food Interactions
This drug can be taken without regard to food or meals.
Usual Dose
Ezetimibe
Adult and Child (age 10 and over): 10 mg once a day. Child (age 9 and under): not recommended.
Ezetimibe + Simvastatin
Adult: 10 mg ezetimibe plus 10-80 mg simvastatin once a day in the evening. The simavastatin dose depends on individual need.
Overdosage
Little is known about the effects of ezetimibe overdose. Call your local poison control center or a hospital emergency room for information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
If you are taking more than one drug to lower cholesterol or another blood fat, consider the side effects of all of those drugs combined.
,S’D'L’6a) Populations
Pregnancy/Breast-feeding: Little is known about the effects of ezetimibe during pregnancy. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks. Statin drugs should never be taken by a pregnant woman or nursing mother.
It is not known if ezetimibe passes into breast milk. Nursing mothers who must take it should use infant formula.
Seniors: Seniors may use this drug without special precaution.
Generic Name
Famciclovir (fam-SYE-kloe-vere)
Brand Name Famvir
Type of Drug Antiviral.
Prescribed For
Herpes zoster (shingles), genital herpes, herpes labilalis (cold sores), and herpes simplex in HIV-infected people.
General Information
Famciclovir is absorbed into the body and converted to the antiviral penciclovir, the drug that actually works against shingles by interfering with the reproduction of DNA in the herpes virus. Famciclovir does not affect DNA in uninfected body cells. Famciclovir is broken down by the liver and eliminated from the body through the kidneys.
Cautions and Warnings
Do not take famiciclovir if you are allergic or sensitive to any of its ingredients.
Those with reduced kidney function should have their dosage adjusted accordingly.
Severe liver disease reduces the maximum possible concentration of Famciclovir in the blood and increases the time it takes to reach this maximum level; however, dosage adjustment is not normally required.
Possible Side Effer.%
♦ Most common: headache, nausea, and diarrhea.
♦ Less common: fever, fatigue, pain, vomiting, constipation, appetite loss, dizziness, tingling in the hands or feet, sleepiness, sore throat, sinus irritation, itching, gas, dysmemorrhea, and signs of shingles.
Possible Side Effects (continued)
Rare: chills, abdominal pain, back or joint pain, and upset stomach. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Probenecid, cimetidine, and theophylline interfere with the elimination of famciclovir from the body, possibly leading to higher levels of famciclovir in the blood.
• People who took famciclovir and digoxin together experienced increased digoxin In their blood.
Food Interactions None known.
Usual Dose
Shingles
Adult (age 18 and over): 500 mg every 8 hours for 1 week. People with reduced kidney function may require a reduced dose taken as infrequently as once a day.
Genital Herpes
Adult (age 18 and over): 1000 mg twice daily for 1 day; or 250 mg twice a day for up to 1 year for suppression; or 250 mg 3 times a day for 7 days for initial episode. People with reduced kidney function take the same dose but less often, as infrequently as once every 2 days. HIV-infected people should take 500 mg twice a day for 7 days.
Cold Sores
Adult (age 18 and over): 1500 mg as a single dose. Initiate therapy at the earliest sign or symptom of a cold sore (tingling, itching, or burning).
Overdosage
Little is known about the effects of famciclovir ovecdose. Overdose victims should be %Mn to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Famciclovir treatment should be started as soon as shingles is diagnosed. For maximum benefit, be sure to complete the full week of treatment.
Famciclovir is not a cure for genital herpes and it is not known if it will prevent the transmission of the herpes virus to another person. Avoid sexual intercourse when herpes lesions are present even while taking famciclovir for genital herpes.
Begin taking famciclovir at the first sign of a herpes attack (symptoms include pain, tenderness, burning, itching, tingling, ulcers, or scabs). The effectiveness of starting famciclovir 6 hours or more after symptoms or lesions appear has not been established.
Call your doctor if you experience any unusual or intolerable side effects.
If you forget a dose of famciclovir, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot. Do not take a double dose. Call your doctor if you forget more than 2 doses in a row.
Special Populations
Pregnancy/Breast-feeding: Famciclovir should only be taken by a pregnant woman if it is absolutely necessary and the possible benefits outweigh the risks to the fetus.
In animal studies, penciclovir (the active form of famciclovir) passed into breast milk in high concentrations but it is not known if this holds true for humans. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors clear famciclovir from the bloodstream more slowly than younger people and should have their dosage adjusted according to their level of kidney function.
Generic Name
Famotidine (fam-OE-tih-dine) 91
Brand Names
Fluxid Pepcid AC
Pepcid Pepcid Complete
Type of Drug Histamine H2 antagonist.
Prescribed For
Ulcers of the stomach and duodenum (upper intestine). This drug is also used to treat gastroesophageal reflux disease (GERD),
stress ulcer, and other conditions characterized by the production of large amounts of gastric fluids; to prevent stress ulcer and stomach and upper intestinal bleeding; and to stop the production of stomach acid during surgery. Pepcid AC is approved for heartburn.
General Information
Histamine H2 antagonists work by turning off the system that produces stomach acid and other secretions. Famotidine is effective in treating the symptoms of ulcer and preventing complications of the disease, although an ulcer that does not respond to another histamine H2 antagonist will probably not respond to famotidine. Histamine H2 antagonists differ only in their potency. Cimetidine is the least potent; 1000 mg are roughly equal to 300 mg of either nizatidine or ranitidine, or 40 mg of famotidine. All these drugs have roughly equivalent success rates in treating ulcer disease and comparable risk of side effects.
Cautions and Warnings
Do not take famotidine if you are allergic or sensitive to any of its ingredients or to any histamine H2 antagonist.
People with kidney or liver disease should take famotidine with caution because 1/3 of each dose is broken down in the liver and the rest passes out of the body through the kidneys.
Do not self-treat with over-the-counter (OTC) forms of famotidine without the advice and supervision of your doctor.
Possible Side Effects
✓ Most common: headache.
✓ Less common: dizziness, mild diarrhea, and constipation.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• T-_Meat-coated tablets should not be taken with famotidine. The change in stomach acidity that famotidine produces causes the tablets to disintegrate prematurely in the stomach.
• Antacids, anticholinergics, and metoclopramide may slightly reduce the amount of famotidine absorbed into the blood. No special precaution is needed.
Food Interactions
Famotidine may be taken without regard to food or meals.
Usual Dose
Adult 20-40 mg at bedtime, or 20 mg twice a day for 4-8 weeks. Dosage should be reduced in people with severe kidney disease.
Child (age 1-16): 0.23-0.45 mg per lb. of body weight, at bedtime or in 2 divided doses, up to 40 mg a day.
Child (under age 1): Consult your doctor.
Over-the-counter forms of famotidine such as Pepcid AC or Pepcid Complete should only be used for the temporary relief of heartburn, and are not recommended for children under 12 years of age. Do not take more than 2 capsules or chewable tablets in 24 hours.
Overdosage
Little is known about the effects of famotidine overdose, but victims may experience exaggerated side effects. Your local poison control center may advise giving ipecac syrup—available at any pharmacy—to induce vomiting and remove any remaining drug from the stomach. Victims who have definite symptoms should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Take famotidine exactly as directed and follow your doctor’s instructions regarding diet and other treatment in order to get the maximum benefit from the drug. Antacids may be taken together with famotidine if needed.
Do not take the maximum dose continuously for more than 2 weeks without the consent and supervision of your doctor.
Cigarettes worsen stomach ulcers and may reduce famotidine’s effectiveness.
Call your doctor at once if you develop any unusual side eiiecls such as bleeding or bruising,’ iWness, diarrhea, dizziness, or rash. &’A&, tarry stools or vomiting material that resembles coffee grounds may indicate your ulcer is bleeding.
If you forget a dose of famotidine, take it as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations revealed no Pregnancy/Breast-feeding: Although animal studies
damage to the fetus, famotidine should be avoided by women who are or might be pregnant. When this drug is considered crucial by your doctor, its possible benefits must be carefully weighed against
its risks.
Famotidine may pass into breast milk. Nursing mothers who
must take this drug should use infant formula.
Seniors: Seniors may need lower doses due to loss of kidney function and may be more susceptible to side effects.
Generic Name
Felbamate (FEL-bam-ate)
Brand Name Felbatol
Type of Drug Anticonvulsant.
Prescribed For
Partial seizures and Lennox-Gastaut syndrome in children.
General Information
Felbamate is related to the older sedative meprobamate. Exactly how felbamate works is not known, but it raises the seizure threshold and prevents the seizure impulse from spreading in the brain, as do other anticonvulsants. Felbamate should only be used when other seizure drugs have failed because of the risks associated with it. About half of each dose passes out of the body through the kidneys; the other half is broken down and eliminated by the liver.
Cautions and Warnings
Do not take felbamate if you am allergic or sensitive to any of its ‘Irigredlents or to any related drugs such as meprobamate.
Felbamate is associated with an increase in the risk of aplastic anemia, a potentially fatal condition.
Possibly fatal liver failure occurs in people taking felbamate much more often than normal. Regular liver function tests are recommended. People with liver disease should not take felbamate.
Felbamate is not recommended as first-line epilepsy treatment. Felbamate should be used only by those with severe epilepsy for whom the benefits outweigh the risks. Doctors prescribing felbamate should be thoroughly familiar with the drug and must obtain written, informed consent from patients before prescribing.
Felbamate should never be suddenly stopped or seizures may become more frequent. Dosage should be gradually reduced or replaced by another anticonvulsant.
Felbamate may cause increased sensitivity to the sun. Wear protective clothing and use sunscreen while taking this drug. People with kidney disease may require lower doses.
Possible Side Effects
Adult
♦ Most common: sleeplessness, sleepiness, fatigue, headache, dizziness, nervousness, upset stomach, vomiting, constipation, nausea, and appetite loss.
V Common: anxiety, tremors, walking unusually, depression, tingling in the hands or feet, diarrhea, liver inflammation, abdominal pains, respiratory infections, abnormal vision, and taste changes.
✓ Less common: weakness, dry mouth, stupor, abnormal thinking, rash, sinus irritation, sore throat, muscle aches, fever, and chest pain.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Child
✓ Most common: abdominal pain, fever, respiratory infections, sleeplessness, sleepiness, nervousness, vomiting, constipation, and black-and-blue marks.
✓ Common: headache, appetite loss, hiccups, sore throat, coughing, middle ear infections, fatigue, weight loss, temporary loss of urine control, qak”,,NbNW)ng unusually, weak-))855, abnormal thinking, emotional instability, pinpoint pupils, rash, upset stomach, and low white-blood-cell count.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if your child experiences any side effect not listed above.
Drug Interactions
• Combining felbamate and other antiseizure drugs usually requires dosage adjustments due to the risk of drug interaction. Dosage of felbamate should be reduced by 20-33% to reduce the risks of associated side effects.
• Combining felbamate and carbamazepine reduces blood levels of both drugs by roughly half. Dosage adjustments are necessary.
• Combining phenobarbital and felbamate increases the amount of phenobarbital in the blood and decreases felbamate levels. Dosage adjustments are necessary.
• If you combine felbamate and phenytoin, your phenytoin dosage may have to be reduced by as much as 40%. This combination also decreases felbamate blood levels by almost 50%.
• Felbamate increases blood levels of valproic acid and methsuximide.
Food Interactions
Felbamate is best taken on an empty stomach but may be taken with food if it causes upset stomach.
Usual Dose
Adult and Child (age 14 and over): 1200-3600 mg a day, divided into 3-4 doses.
Child (age 2-13): 6.8-20.5 mg per lb. a day, divided into 3-4 doses.
Overdosage
Overdose symptoms may include upset stomach, increased heart rate, and felbamate side effects. Call your local poison control center or a hospital emergency room for more information. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Do not take more felbamate than your doctor has prescribed. Felbamate can cause drowsiness; be careful when, driving perfQ(ft g
Avoid prolonged exposure to the sun while taking felbamate. Call your doctor if you develop any bothersome or persistent side effect.
Maintain good dental hygiene while taking felbamate and use extra care when brushing or flossing because this drug can cause swollen gums. See your dentist regularly.
km ,s %2& nq6re concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, take 1 dose right away and another in 3 or 4 hours, then go back to your regular schedule. Do not take
a double dose.
Special Populations
Pregnancy/Breast-feeding: This drug may cross into fetal circulation. When the drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Felbamate passes into breast milk. Nursing mothers who must take this drug should consider using infant formula.
Seniors: Seniors, especially those with liver, kidney, or heart disease, may be more sensitive to the effects of this drug and should receive lower doses.
Generic Name
Felodipine (feh-LOE-dih-pene) 91
Brand Name Plendil
Combination Product
Generic Ingredients: Enalapril + Felodipine Lexxel
Type of Drug
Calcium channel blocker.
Prescribed For High blood pressure.
General Information
Felodipine is one of many calcium channel blockers available in the U.S. Its once-daily dosage schedule makes it particularly stilted to treating high blood Felodipine blocks the passage of calcium, an essential factor in muscle contraction, into the heart and smooth muscles. Such blockage interferes with the contraction of these muscles, which in turn dilates (widens) the veins and vessels that supply blood to them. This dilating effect reduces blood pressure, the amount of oxygen used by the heart muscle, and the risk of blood vessel spasm. Felodipine is therefore useful in
treating not only high blood pressure but also angina pectoris (brief attacks of chest pain), a condition related to poor oxygen supply
to the heart muscles.
Felodipine only affects the movement of calcium into muscle cells-, it has no effect on calcium in the blood.
Lexxel is a combination of felodipine and enalapril, an angiotensin converting enzyme (ACE) inhibitor.
Cautions and Warnings
Do not take felodipine if you are allergic or sensitive to any of its ingredients.
On rare occasions, felodipine may cause very low blood pressure that may lead to stimulation of the heart and rapid heartbeat and can worsen angina. This reaction may happen when treatment is first started, when dosage is increased, or if the drug is rapidly withdrawn; it may be avoided by reducing dosage gradually.
Studies have shown that people taking calcium channel blockers—usually those taken several times a day, not those taken only once daily—have a greater chance of having a heart attack than do people taking beta blockers or other medications for the same purpose. Discuss this with your doctor to be sure you are receiving the best possible treatment.
Patients taking a beta-blocking drug who begin taking felodipine may develop heart failure or increased angina.
People with severe liver disease may require dosage adjustments.
People taking felodipine who have had a heart attack and have lung congestion may experience worsened heart failure, since this drug can actually reduce the force of each heartbeat.
Possible Side Effects
Side effects produced by calcium channel blockers are generally mild and rarely cause people to stop taking them. Side effects are more common with higher doses and in older patients.
I Most common: swelling in the ankles, feet, or legs; dizziness; lightheadedness; muscle weakness or cramps; facial flushing; and headache.
V Less common: respiratory infections, cough, tingling in the hands or feet, upset stomach, abdominal pains, chest pains,
stomach, , heart palpitations,
Drug Interactions
• Felodipine may increase the amount of beta-blocking drugs in the bloodstream. This can lead to heart failure, very low blood pressure, or an increased incidence of angina. However, in many cases these drugs have been taken together with no problem.
• Felodipine increases the effects of other blood-pressurelowering drugs. Such drug combinations are often used to treat hypertension.
• Cimetidine, ranitidine, and azole antifungals such as ketoconazole and itraconazole increase the amount of felodipine in the blood and may account for a slight increase in the drug’s effect.
• Phenytoin and other hydantoin antiseizure medicines, carbamazepine, and barbiturate sleeping pills and sedatives may decrease the amount of felodipine in the blood, reducing its effect on the body.
• Erythromycin and cyclosporine may increase the side effects of felodipine.
• Felodipine may increase the effects of digoxin, theophylline (prescribed for asthma and other respiratory problems), and oral anticoagulant (blood-thinning) drugs.
• Felodipine may also interact with quinidine (prescribed for abnormal heart rhythm) to produce low blood pressure, very slow heart rate, abnormal heart rhythms, and swelling in the arms or legs.
• Qd(Gii= Channel blockers may cause bleeding when taken alone or combined with aspirin.
Food Interactions
You may take felodipine with food if it upsets your stomach. Avoid taking felodipine with grapefruit juice—it doubles the amount of drug absorbed.
Possible Side Effects (continued) nausea, constipation, diarrhea
throat, runny nose, back pain, rash.
and
♦ Rare: Rare side effects can affect the heart,
blood, and joints. It can affect and
your mood, sex drive,
urinary tract. Contact your do you experience side effect not listed above.
ctor if any Usual Dose
2.5-10 mg a day. No patient should take more than 20 mg a day. Do not stop taking felodipine abruptly. The dosage should be reduced gradually over a period of time.
Overdosage
Felodipine overdose can cause low blood pressure. If you think you have taken an overdose of felodipine, call your doctor or go to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop constipation, nausea, very low blood pressure, breathing difficulties, increased heart pain, dizziness, or lightheadedness, or if other side effects are bothersome or persistent.
Swelling of the hands or feet may develop within 2 or 3 weeks of starting felodipine. The chances of this happening depend on age and dosage. It occurs in less than 10% of people under age 50 taking 5 mg a day and in more than 30% of those over age 60 taking 20 mg a day.
Be sure to continue taking your medication even if you feel well, and follow any instructions for diet restriction or other treatments to help maintain lower blood pressure.
Do not break or crush felodipine tablets.
It is important to maintain good dental hygiene while taking felodipine and to use extra care when using your toothbrush or dental floss because of the chance that the drug will make you more susceptible to certain infections.
If you forget to take a dose of felodipine, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy1filreast-feeding. Animal studies of felodipk”e have shown that it crosses RAW the Zeta) circulation and causes birth iNlfEcls. Women who are or who might become pregnant while taking this drug should not take it without their doctor’s approval. The potential benefit of taking felodipine must be carefully weighed against its risks.
It is not known if felodipine passes into breast milk. Nursing mothers who take felodipine should use infant formula.
Seniors: Seniors, especially those with liver disease, are more sensitive to the effects of this drug.
Aug
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.
Aug
1
Cilostazol
August 1, 2009 | Leave a Comment
Generic Name
Cilostazol (sil-oe-STAY-zol) Lq
Brand Name Pletal
Type of Drug Antiplatelet.
Prescribed For Intermittent claudication.
General Information
In intermittent claudication, leg muscles go into spasm due to reduced blood flow. This occurs when plaque buildup narrows blood vessels leading to the calf or other leg muscles. People with this condition often develop leg pain after walking only a short distance. Cilostazol prevents blood platelets from “clumping together” to begin the process of forming a blood clot, which can further obstruct arteries and worsen intermittent claudication. This drug is broken down in the liver.
Cautions and Warnings
Do not take this drug if you are allergic or sensitive to any of its ingredients.
?P,Ople with congestive heart failure (CHF) should not take cilostazol. Some studies indicate that long-term use of this drug may cause cardiovascular problems.
People with hemostatic disorders or active pathologic bleeding should not take cilostazil.
Drug Interactions
• Avoid mixing cilostazol with ketoconazole, itraconazole, fluconazole, miconazole, fluvoxamine, fluoxetine, nefazodone, or sertraline because this interaction may slow the breakdown of cilostazol, prolonging its effects. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Aspirin can increase the anticoagulant (blood-thinning) effect of cilostazol, but this combination has not caused serious bleeding problems. There is no information on the effect of combining cilostazol and other antiplatelet or anticoagulant drugs. Cilostazol dosage is reduced by 50% when it is combined with any of these drugs.
• Diltiazem increases cilostazol blood levels by about 50%. Cilostazol dosage is reduced by 50% when it is combined with diltiazem.
• Erythromycin and similar antibiotics increase cilostazol blood levels. Take half the regular dose of cilostazol when combining it with any of these drugs.
• Combining cilostazol and omeprazole increases the effects of cilostazol. Cilostazol dosage is reduced by 50% when it is combined with omeprazole.
• Smoking reduces the Olectiveness of cilostazol by causing the liver to break it down faster.
Food Interactions
Take this drug on an empty stomach at least 30 minutes before or 2 hours after meals. Do not drink grapefruit juice at any time while
above. with dosage.
dache, infection, abdominal pain, ab- arrhea.
pitations, rapid heartbeat. dizziness, sea, sore throat, runny nose, back pain, arms or legs.
cough, fainting, and muscle aches. cts can occur in almost any part of the doctor if you experience any side ef- e.
Possible Side Effects
The risk of side effects
♦ Most common: headache
• stool, and diarrhea. • Common: heart palpitations
• stomach, nausea
• swelling in the
♦ Less common: gas,
♦ Rare: Rare side effects body. Contact your fect not listed taking cilostazol because it can interfere with the breakdown of the drug.
Usual Dose
Adult: 100 mg twice a day. 50 mg twice a day when combined with other drugs that may increase the effect of cilostazol. Child: not recommended.
Overdosage
Symptoms of overdose are likely to be the most common side effects. Overdose victims should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Several weeks of cilostazol treatment may be necessary before you notice any improvement in symptoms. Maximum benefit usually occurs after 12 weeks.
If you forget a dose, take it as soon as you remember. If it is almost time for your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Animal studies suggest that cilostazol may harm the fetus, but there is no information on the effect of cilostazol in pregnant women. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
cilostazol may pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors can take this drug without special precaution.
Aug
1
Cholinesterase Inhibitors
August 1, 2009 | Leave a Comment
Type of Drug
Cholinesterase Inhibitors
(KO-lin-ESS-tuh -rase)
Brand Names
Generic Ingredient.- Donepezil
Aricept Aricept ODT
Generic Ingredient: Galantamine
Razadyne Razadyne ER
Generic Ingredient: Rivastigmine
Exelon Exelon Transdermal System
Generic Ingredient: Tacrine Cognex
Prescribed For
Alzheimer’s disease. Also used for vascular dementia, dementia associated with Parkinson’s disease, poststroke aphasia (problems with language), and improvement of memory in multiple sclerosis patients.
General Information
Cholinesterase inhibitors work by increasing the function of certain receptors in the brain that are stimulated by the hosmone acetylcholine. They do t.Ns by interfering with cholinesterase, the 1617yme that breaks down acetylcholine. People with Alzheimer’s disease (a degenerative condition of the central nervous system) develop a shortage of this brain chemical early in the disease. There is no evidence that cholinesterase inhibitors reverse the degenerative effects of Alzheimer’s, but they may slow the rate at which the disease worsens.
Cautions and Warnings
Do not take cholinesterase inhibitors if you are allergic or sensitive to any of their ingredients.
Cholinesterase inhibitors must be discontinued before surgery because they increase the effects of anesthetic drugs.
People with heart disease should use cholinesterase inhibitors with caution because they may slow heart rate and cause fainting. Two studies of people with mild symptoms of Alzheimer’s disease taking galantamine revealed a higher rate of death from heart attack, stroke, or sudden death.
Cholinesterase inhibitors may be expected to cause increased stomach acid production and increased activity of the gastrointestinal tract. Possible complications include ulcers or bleeding. Alcohol and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may worsen this effect.
Using cholinesterase inhibitors may also lead to urinary blockage, increase the risk of generalized seizures, and worsen asthma or other pulmonary diseases. Use with caution if you have these conditions.
People with severe liver dysfunction should not take galantamine or tacrine.
Possible Side Effects
People taking cholinesterase inhibitors generally experience side effects at about the same rate as those taking a placebo (sugar pill).
♦ Most common: headache, general pain, accidents, nausea, diarrhea, sleeplessness, and dizziness.
✓ Common: tiredness, vomiting, appetite loss, and muscle cramps.
♦ Less common: arthritis, depression, abnormal dreams, fainting, black-and-blue marks, and weight loss.
✓ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Cholinesterase inhibitors interfere with anticholinergic drugs (often prescribed for stomach disorders).
• Cholinesterase inhibitors can be expected to increase the ef-
fects of cevimeline, surgical anesthetic drugs, and drugs that
irritate the stomach and intestines, such as aspirin, ibupro-
fen, and other NSAIDs.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be slowed by ketoconazole, itraconazole, quinidine, delavirdine, indinavir, nelfinavir, ritonavir, saquinavir, amiodarone, cimetidine, ciprofloxacin, norfloxacin, clarithromycin, diltiazem, erythromycin, fluconazole, fluvoxamine, celecoxib, chlorpheniramine, clomipramine, cocaine, doxorubicin, fluoxetine, halofantrine, halopendol, levopromazine, methadone, mibefradil, paroxetine, ranitidine, terbinafine, mifepristone, nefazodone, and grapefruit juice.
• The breakdown of cholinesterase inhibitors (except rivastigmine) in the liver can be increased by efavirenz, nevirapine, barbiturates, carbamazepine, corticosteroids, phenytoin, pioglitazone, and rifampin.
Food Interactions
Donepezil can be taken with or without food.
Galantamine and rivastigmine should be taken with morning and evening meals.
The rivastigmine transdermal system patch can be used without regard to meals.
Food reduces the absorption of tacrine into the blood. It is best taken on an empty stomach, but you can take it with food if it upsets your stomach.
Usual Dose
Donepezil
Adult: 5 or 10 mg once a day.
Galantamine
Adult: 8-32 mg a day.
Rivastigmine
Adult: 3-12 mg a day, divided into 2 doses.
RiVUtq1M&A0Y2nsdermaI patch
Adult: Apply one 4.6-mg patch every day to start. Dose may be increased to one 9.5-mg patch every day.
Tacrine
Adult: 40-160 mg a day, divided into 4 doses.
Overdosage
Cholinesterase inhibitor overdose can be very serious. Symptoms include severe nausea, vomiting, salivation, sweating, slow heart rate, low blood pressure, slow breathing rate, convulsions, muscle weakness, and collapse. Take the overdose victim to a hospital emergency room at once. ALWAYS bring the prescription bottle or container.
Special Information
Donepezil should be taken just before bedtime.
Follow the special package directions for rivastigmine solution.
Do not remove the rivastigmine patch from its packaging until just before you are ready to apply it. Apply the patch to clean, dry, and hairless skin on the upper or lower back, upper arm, or chest that is also free of any powder, oil, moisturizer, or lotion that could keep the patch from sticking to your skin properly; skin should also be free of cuts, rashes, and irritations. Avoid places where the patch can be rubbed off by tight clothing. When changing your patch, apply your new patch to a different spot of skin (for example, on the right side of your body one day, then on the left side the next day). Do not use the same spot more than once every 14 days. Wear only one patch at a time and change it every.24 hours. If the patch falls off, apply a new patch for the rest of the day, then replace the patch the next day at the same time as usual.
Tobacco or nicotine use increases the rate at which tacrine and rivastigmine are cleared from the body.
If you forget a dose and take your medication once a day, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with the regular schedule. If you take your medication 2 or more times a day, take your dose as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: One animal study of a cholinesterase inhibitor indicated a small risk of birth defects. When your doctor considers this drug crucial, its potential benefits must be carefully weighed against its risks.
It is not known if cholinesterase inhibitors pass into breast milk. Nursing mothers who must take this drug should use infant formula.
Seniors: Seniors with moderate kidney function loss should not take galantamine. Dosage adjustments are not needed for donepezil, tacrine, or rivastigmine.
Aug
1
Chlorzoxazone
August 1, 2009 | Leave a Comment
Generic Name
Chlorzoxazone (klor-M-uh-zone)
Brand Names
Parafon Forte DSC Strifon Forte DSC
Type of Drug
Skeletal muscle relaxant.
Prescribed For
Pain and spasm of muscular conditions, including strain, sprain, bruising, and lower back problems.
General Information
Chlorzoxazone works primarily on the spinal cord level and on the brain, acting as a mild sedative. This results in fewer spasms, less pain, and greater mobility. Chlorzoxazone provides only temporary relief and is not a substitute for other types of therapy, such as rest, surgery, and physical therapy.
Cautions and Warnings
Do not take chlorzoxazone if you are allergic or sensitive to any of its ingredients, or if you have a condition known as porphyria.
People with poor liver or kidney function should take this drug with caution because serious liver toxicity has rarely occurred in people using chlorzoxazone.
Chlorzoxazone may interact with other drugs that cause nervous system depression (see “Drug Interactions”).
Because it is possible to become dependent on this drug, people with a history of substance abuse should take chlorzoxazone with caution.
Possible Side Effects
♦ Most common: dizziness, drowsiness, lightheadedness, malaise, and aveTStimulation,
♦ Less common: headache, stomach cramps or pain, diar-
rhea, constipation, heartburn, nausea, and vomiting.
• Rare: internal bleeding, liver problems, severe allergic-type skin reactions, and breathing problems. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• The depressive effects of chlorzoxazone may be enhanced by taking it with alcohol, sedatives, sleeping pills, or other nervous system depressants. Avoid these combinations.
Food Interactions
Take this drug with food if it upsets your stomach. The tablets may be crushed and mixed with food.
Usual Dose
Adult: 250-750 mg 3-4 times a day. Child: 125-500 mg 3-4 times a day.
Do not take more medication than is prescribed.
Overdosage
Early signs of chlorzoxazone overdose may include nausea, vomiting, diarrhea, drowsiness, dizziness, lightheadedness, and headache. Victims may also feel sluggish or sickly and lose the ability to move their muscles. Breathing may become slow or irregular, and blood pressure may drop. Contact a doctor immediately or go to a hospital emergency room for treatment. ALWAYS bring the prescription bottle or container.
Special Information
Chlorzoxazone may make you drowsy or reduce your ability to concentrate. Be extremely careful while driving or operating hazardous equipment. Avoid alcoholic beverages.
Chlorzoxazone may turn your urine orange to purple-red; this is not dangerous.
Call your doctor if you develop drowsiness, weakness, an allergic reaction, skin rash or itching, breathing difficulties, black or tarry stools, vomiting of material that resembles coffee grounds, liver problems, or any other severe or bothersome side effect.
4f you miss a dose of chlorzoxazone by more than an hour, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of chlorzoxazone in pregnant women has not been established. Pregnant women should only take chlorzoxazone after carefully weighing its potential benefits against its risks.
It is not known if chlorzoxazone passes into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors, especially those with severe liver disease, are more sensitive to the effects of chlorzoxazone.
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.
Aug
1
Chlorpheniramine Maleate
August 1, 2009 | Leave a Comment
Generic Name
Chlorpheniramine Maleate
(KLOR-ten-ERE-uh-mene MAL-ee-ate) M
Brand Names
Aller-Chlor Efidac 24
Chlor-Trimeton Pediox S
Chlor-Trimeton Allergy 8 Hour Prohist+8 Chlor-Trimeton Allergy 12 Hour QDALL AR
The information in this profile also applies to the following drugs: Generic Ingredient: Cyproheptadine Hydrochloride 0
Generic Ingredient: Dexchlorpheniramine Maleate 19
Type of Drug Antihistamine,
Prescribed For
Stuffy and runny nose, itchy eyes, and scratchy throat caused by seasonal allergy, and other symptoms of allergy such as rash, itching, and hives.
General Information
Antihistamines generally work by blocking the release of histamine (a chemical released by body tissue during an allergic reaction) from body cells at the H, histamine receptor site, drying up secretions of the nose, throat, and eyes.
Cautions and Warnings
Do not use this drug if you are allergic or sensitive to any of its ingredients.
Use chlorpheniramine maleate with care if you have a history of thyroid disease, heart disease, high blood pressure, or diabetes. This drug should be avoided or used with extreme care if you have narrow-angle glaucoma, stomach ulcer or other stomach problems, enlarged prostate, or problems passing urine. It should not be used by people who have deep-breathing problems such as asthma, emphysema, or chronic bronchitis.
Possible Side Effects
V Less common: rash or itching, sensitivity to bright light, increased sweating, chills, lowered blood pressure, headache, rapid heartbeat, sleeplessness, dizziness, disturbed coordination, confusion, restlessness, nervousness, irritability, euphoria (feeling “high”), tingling in the hands or feet, blurred or double vision, ringing in the ears, upset stomach, appetite loss, nausea, vomiting, constipation, diarrhea, urinary difficulties, chest tightness, wheezing, stuffy nose, and dryness of the mouth, nose, or throat. Young children may also develop nervousness, irritability, tension, and anxiety.
Drug Interactions
• chlorpheniramine maleate should not be taken with a mono-amine oxidase inhibitQ(aMkdepiessank, because the combination may cause severe side effects.
• The effects of sedatives, benzodiazepines such as diazepam, and sleeping medications will be increased when any of these drugs is combined with chlorpheniramine maleate. It is extremely important for your doctor to know if you are taking any other medication with chlorpheniramine maleate so that the dosage of that medication can be properly adjusted.
• Anti chol inergenics may cause an increase in side effects of chlorpheniramine maleate.
• Be extremely cautious when drinking alcoholic beverages while taking this drug, which enhances the intoxicating and sedating effects of alcohol.
Food Interactions
You may take this drug with food if it upsets your stomach.
Usual Dose
chlorpheniramine
Adult and Child (age 13 and over): 4 mg every 4-6 hours; do not take more than 24 mg a day.
Child (age 6-12): 2 mg every 4-6 hours; do not take more than 12 mg a day.
Child (age 2-5): 1 mg every 4-6 hours; do not take more than 4 mg a day.
chlorpheniramine, Sustained-Release
Adult and Child (age 13 and over): 8-12 mg at bedtime, or every 8-12 hours during the day; do not take more than 24 mg a day. Child (age 6-12): 8 mg during the day or at bedtime.
Child (under age 6): not recommended.
Cyproheptadine
Adult and Child (age 15 and over): 4-20 mg a day; do not exceed 32 mg a day.
Child (age 7-14): 4 mg 2-3 times a day; do not exceed 16 mg a day.
Child (age 2-6): 2 mg 2-3 times a day; do not exceed 12 mg a day.
Dexchlorpheniramine
Adult and Child (age 12 and over): 2 mg every 4-6 hours. Child (age 6-11): 1 mg every 4-6 hours.
Child (age 2-5): 0.5 mg every 4-6 hours.
Dexchlorpheniramine, Sustained-Release
Adult and Child (age 12 and over): 4-6 mg every 8-10 hours and at bedtime.
Child (age 6-11): 4 mg once a day and at bedtime. Child (under age 6): not recommended.
Tripelennamine
Adult and Child (age 12 and over): 25-50 mg every 4-6 hours; do not take more than 600 mg a day. Adults may take up to 3100-mg, sustained-release tablets a day, although this much is not usually needed.
Child (under age 12): 2 mg per lb. of body weight a day in divided doses; no more than 300 mg a day should be given.
Overdosage
Symptoms of overdose include depression or stimulation, especially in children; dry mouth: fixed or dilated pupils; flushing of the skin; upset stomach; unsteadiness; and convulsions. Overdose victims should be made to vomit as soon as possible with ipecac syrup—available at any pharmacy—to remove excess drug from the stomach. Take the victim to a hospital emergency room immediately if the victim is unconscious.or if you cannot induce vomiting. ALWAYS bring the prescription bottle or container.
Special Information
This drug may cause tiredness or loss of concentration: Be extremely cautious when driving or doing anything that requires close attention.
If you forget a dose of this drug, 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
PregnancylBreast-feeding., Animal studies have shown that some antihistamines may cause birth defects. Do not take any antihistamine without your doctor’s knowledge if you are or might be pregnant—especially during the last 3 months of pregnancy, because newborns may have severe reactions to antihistamines.
Small amounts of some antihistamines pass into breast milk. NV ing mothers who must take chlorpheniramine maleate should use infant formula.
Seniors: Seniors are more sensitive to antihistamine side effects. Dosage reduction may be needed.
Aug
1
Chlordiazepoxide
August 1, 2009 | Leave a Comment
Generic Name
Chlordiazepoxide (klor-dye-az-uh-PDX-ide) 91
Brand Name
Librium
Type of Drug Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation, and withdrawal symptoms of alcoholism; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Chlordiazepoxide is a member of the group of drugs known as benzodiazepines.
Benzodiazepines work by a direct effect on the brain. They can relax you and make you more tranquil or sleepier, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant. Many doctors prefer benzodiazepines to other drugs that can be used to similar effect because they tend to be safer, have fewer side effects, and are usually as effective, if not more so.
Cautions and Warnings
Do not take chlordiazepoxide if you are allergic or sensitive to any of its ingredients or to another benzodiazepine, including clonazepam.
Chlordiazepoxide can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other condkjo(\SiVN\,NhjCb chlordiazepoxide should be used with caution are severe depression, especially with suicidal tendencies, severe lung disease, sleep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease.
Chlordiazepoxide should not be taken by psychotic patients because it is not effective for them and can trigger unusual excitement, stimulation, and rage. It has also produced similar reactions among hyperactive and aggressive pediatric patients.
Chlordiazepoxide is not intended for more than 3-4 months of continuous use. Your condition should be reassessed before continuing chlordiazepoxide beyond that time.
Chlordiazepoxide may be addictive. Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use, but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensitivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state.
Dosage of chlordiazepoxide should be decreased gradually over 4-8 weeks after prolonged use.
Possible Side Effects
Weakness and confusion may occur, especially in seniors and in those who are sickly.
♦ Most common: mild drowsiness during the first few days of therapy.
✓ Less common: depression, lethargy, disorientation, edema, headache, inactivity, slurred speech, stupor, dizziness, tremor, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, inability to fall asleep, and occasional liver - dysfunction. If you experience any of these symptoms, stop taking the medicine and contact your doctor immediately.
♦ Rare: Rare side effects can occur in almost any part of the body. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• Chlordiazepoxide is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, mono-amine oxidase inhibitor and other antidepressants, and antihistamines. Taking chlordiazepoxide with these drugs may result in excessive depression, tiredness, sleepiness, breathing difficulties, or related symptoms.
• Smoking may reduce the effectiveness of chlordiazepoxide by increasing the rate at which it is broken down by the body.
• The effects of chlordiazepoxide may be prolonged when it is
taken with cimetidine, contraceptive drugs, disulfiram, flu-
oxetine, isoniazid, ketoconazole, metoprolol, probenecid,
propoxyphene, propranolol, rifampin, or valproic acid.
• Theophylline may reduce chlordiazepoxide’s sedative effects.
• If you take antacids, separate them by at least 1 hour from your chlordiazepoxide dose to prevent them from interfering with the passage of chlordiazepoxide into the bloodstream.
• Chlordiazepoxide may increase blood levels of digoxin and the chances for digoxin toxicity.
• Levodopa + carbidopa’s effectiveness may be reduced by chlordiazepoxide.
• Phenytoin blood concentrations may be increased when taken with chlordiazepoxide, resulting in possible phenytoin toxicity.
Food Interactions
Chlordiazepoxide is best taken on an empty stomach but may be taken with food if it upsets your stomach.
Usual Dose
Adult: 5-100 mg a day. This range is due to individual response related to age, weight, disease severity, and other characteristics.
Child (age 6 and over): may be given if deemed appropriate by a doctor. Starting dose-5 mg 2-4 times a day. Maintenance dose—up to 30 mg a day for some children, but must be individualized to obtain maximum benefit.
Child (under age 6): not recommended.
Overdosage
Symptoms of overdose are confusion, sleepiness, poor coordination, lack of response to pain such as a pin prick, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be lakes to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Chlordiazepoxide can cause tiredness, drowsiness, inability to concentrate, or similar symptoms. Be careful if you are driving, operating machinery, or performing other activities that require concentration.
If you forget a dose of chlordiazepoxide, take it as soon as you remember. If it is almost time for your next dose, skip the dose you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Chlordiazepoxide may cause birth defects if taken during the first 3 months of pregnancy. Avoid chlordiazepoxide while pregnant.
Chlordiazepoxide may pass into breast milk. Nursing mothers who must take chlordiazepoxide should use infant formula.
Seniors: Seniors, especially those with liver or kidney disease, are more sensitive to the effects of chlordiazepoxide and generally require smaller doses to achieve the same effect.