atropine diphenoxylate and myasthenia
 

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ED Pills

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Intard


Intard may be available in the countries listed below.

Ingredient matches for Intard Atropine

Atropine sulfate (a derivative of Atropine) is reported as an ingredient of Intard in the following countries:

Bahrain Oman Diphenoxylate

Diphenoxylate hydrochloride (a derivative of Diphenoxylate) is reported as an ingredient of Intard in the following countries:

Bahrain Oman

International Drug Name Search


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Atropine/Diphenoxylate Solution


Pronunciation: AT-row-peen/dye-fen-OX-i-late
Generic Name: Atropine/Diphenoxylate
Brand Name: Lomotil
Atropine/Diphenoxylate Solution is used for:

Treating diarrhea. It may also be used for other conditions as determined by your doctor.

Atropine/Diphenoxylate Solution is an antidiarrheal and anticholinergic combination. It works by decreasing the motion of muscles in the intestines and prolonging the time it takes to move the contents through the body.

Do NOT use Atropine/Diphenoxylate Solution if: you are allergic to any ingredient in Atropine/Diphenoxylate Solution you have diarrhea caused by certain conditions (eg, pseudomembranous colitis, enterotoxin-producing bacteria, food poisoning) you have jaundice (yellowing of the eyes or skin) you have a blockage of the stomach or bowel, angle-closure glaucoma, myasthenia gravis, urinary blockage, excess acid in the stomach or throat, esophagus problems (eg, difficulty swallowing, inflammation), bowel muscle weakness, or heart problems with severe bleeding you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atropine/Diphenoxylate Solution:

Some medical conditions may interact with Atropine/Diphenoxylate Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a history of jaundice (yellowing of the eyes or skin) or megacolon if you have abnormal blood levels of electrolytes (eg, potassium, sodium), ulcerative colitis, liver or kidney problems, Down syndrome, numbness due to nerve damage, prostate problems (enlarged prostate), a blockage of the bladder, trouble urinating, heart problems (eg, congestive heart failure, irregular heartbeat), hiatal hernia, asthma, open-angle glaucoma, or risk factors for glaucoma if you are dehydrated

Some MEDICINES MAY INTERACT with Atropine/Diphenoxylate Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) they may increase the risk of Atropine/Diphenoxylate Solution's side effects Barbiturates (eg, phenobarbital) or sodium oxybate (GHB) because the risk of their side effects may be increased by Atropine/Diphenoxylate Solution Monoamine oxidase inhibitors (MAOIs) (eg, phenelzine) because the risk of serious side effects, including severe high blood pressure, may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atropine/Diphenoxylate Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atropine/Diphenoxylate Solution:

Use Atropine/Diphenoxylate Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Atropine/Diphenoxylate Solution by mouth with or without food. Use the dropper than comes with Atropine/Diphenoxylate Solution to measure your dose. Ask your pharmacist for help if you are unsure of how to measure your dose. If you miss a dose of Atropine/Diphenoxylate Solution and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Atropine/Diphenoxylate Solution.

Important safety information: Atropine/Diphenoxylate Solution may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Atropine/Diphenoxylate Solution with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Atropine/Diphenoxylate Solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. This could increase the risk of serious side effects. If your symptoms do not get better within 10 days (2 days for children) or if they get worse, check with your doctor. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting. Atropine/Diphenoxylate Solution may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Tell your doctor or dentist that you take Atropine/Diphenoxylate Solution before you receive any medical or dental care, emergency care, or surgery. Use Atropine/Diphenoxylate Solution with caution in the ELDERLY; they may be more sensitive to its effects, especially excitement, agitation, or drowsiness. Atropine/Diphenoxylate Solution should not be used in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed. Caution is advised when using Atropine/Diphenoxylate Solution in CHILDREN 2 years of age and older; they may be more sensitive to its effects. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Atropine/Diphenoxylate Solution while you are pregnant. Atropine/Diphenoxylate Solution is found in breast milk. If you are or will be breast-feeding while you use Atropine/Diphenoxylate Solution, check with your doctor. Discuss any possible risks to your baby.

When used for longer than a few weeks or at high doses, some people develop a need to continue taking Atropine/Diphenoxylate Solution. This is known as DEPENDENCE or addiction. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Possible side effects of Atropine/Diphenoxylate Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased sweating; difficulty sleeping; dizziness; drowsiness; dry mouth, nose, or skin; headache; loss of appetite; loss of taste; nausea; nervousness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abdominal bloating or swelling; agitation; changes in heartbeat; confusion; continued or severe diarrhea; delirium; difficulty focusing your eyes; difficulty urinating; exaggerated sense of well-being; excitement; fast/irregular heartbeat; fever; hallucinations; numbness of the hands or feet; severely enlarged pupils; severe or prolonged restlessness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Atropine/Diphenoxylate side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include coma; difficulty breathing; dilated or constricted pupils; disorientation; fever; flushing; hallucinations; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; unusual eye movements; urinary retention; vomiting.

Proper storage of Atropine/Diphenoxylate Solution:

Store Atropine/Diphenoxylate Solution at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atropine/Diphenoxylate Solution out of the reach of children and away from pets.

General information: If you have any questions about Atropine/Diphenoxylate Solution, please talk with your doctor, pharmacist, or other health care provider. Atropine/Diphenoxylate Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atropine/Diphenoxylate Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Atropine/Diphenoxylate resources Atropine/Diphenoxylate Side Effects (in more detail) Atropine/Diphenoxylate Use in Pregnancy & Breastfeeding Drug Images Atropine/Diphenoxylate Drug Interactions Atropine/Diphenoxylate Support Group 23 Reviews for Atropine/Diphenoxylate - Add your own review/rating Compare Atropine/Diphenoxylate with other medications Diarrhea
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Myasthenia Gravis Medications


Definition of Myasthenia Gravis: Myasthenia gravis is a neuromuscular disorder characterized by variable weakness of voluntary muscles, which often improves with rest and worsens with activity. The condition is caused by an abnormal immune response.

Drugs associated with Myasthenia Gravis

The following drugs and medications are in some way related to, or used in the treatment of Myasthenia Gravis. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

Learn more about Myasthenia Gravis

Micromedex Care Notes:

Myasthenia Gravis

Medical Encyclopedia:

Myasthenia gravis

Harvard Health Guide:

Symptoms and treatment for Myasthenia Gravis
Drug List: Mestinon Mestinon-Timespan Mytelase Mytelase-Chloride Prostigmin Prostigmin-Bromide Regonol Soliris
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Atropine Sulphate Injection 600mcg in 1ml


Atropine Sulphate Injection

Important information about your medicine Your doctor or nurse will give you the injection. If this injection causes you any problems talk to your doctor, nurse or pharmacist. Please tell your doctor or pharmacist, if you have any other medical conditions or have an allergy to any of the ingredients of this medicine. Please tell your doctor or pharmacist, if you are taking any other medicines. Read all of this leaflet carefully before you start using this medicine. In some circumstances this may not be possible and this leaflet will be kept in a safe place should you wish to read it. Keep this leaflet. You may need to read it again. If you have any further questions, please ask your doctor or your pharmacist. This medicine has been prescribed for you personally and you should not pass it on to others. It may harm them, even if their symptoms are the same as yours. Where to find information in this leaflet 1. What Atropine Sulphate Injection is and what it is used for 2. Before you are given Atropine Sulphate Injection 3. How to use Atropine Sulphate Injection 4. Possible side effects 5. Storing Atropine Sulphate Injection 6. Further information What Atropine Sulphate Injection is and what it is used for

Atropine Sulphate Injection belongs to a group of medicines known as anticholinergics.

It is used: before general anaesthesia to reduce saliva secretions. to restore normal heartbeat during a cardiac arrest. as an antidote to some insecticides and in mushroom poisoning. in combination with other drugs to reverse the effect of muscle relaxants used during surgery. Before you are given Atropine Sulphate Injection You should NOT be given Atropine Sulphate Injection if you: are sensitive or allergic to Atropine Sulphate Injection or any of the other ingredients in this injection. suffer from closed-angle glaucoma (a condition that affects your eyes). are a man with an enlarged prostate. suffer from myasthenia gravis (weakness of breathing muscles). suffer from pyloric stenosis (a narrowing of the opening that takes food away from your stomach). suffer from paralytic lleus (your intestine stops functioning properly). suffer from ulcerative colitis - a disease of the colon and rectum. Please tell your doctor or nurse before being given the injection if you have: urinary difficulties heart failure had a heart attack had a heart transplant chronic pulmonary obstructive disease (a condition where the airflow to your lungs is restricted and you may cough and feel breathless) an overactive thyroid high blood pressure fever diarrhoea reflux oesophagitis (heartburn) Using other medicines:

Please tell your doctor or nurse if you are taking or have recently taken any other medicines, including medicines obtained without a prescription. This is especially important with the following medicines as they may interact with your Atropine Sulphate Injection:

medicines to treat psychosis or depression. amantadine (a medicine for Parkinson's Disease) antihistamines (medicines used to treat hayfever and allergies medicines to regulate your heart (disopyramide and mexiletine) ketoconazole (a medicine to treat fungal infections). Medicines that you take by allowing them to dissolve slowly in your mouth - atropine may cause your mouth to become dry, making it more difficult for these medicines to dissolve. Pregnancy or breast feeding:

Please tell your doctor or nurse before being given this injection if you are pregnant or breast feeding. The doctor will then decide if the injection is suitable for you.

Driving and using machines:

You should not drive or use machinery if you are affected by the administration of Atropine Sulphate Injection.

How to use Atropine Sulphate Injection

Your nurse or doctor will give you the injection

Your doctor will decide the correct dosage for you and how and when the injection will be given.

Since the injection will be given to you by a doctor or nurse, it is unlikely that you will be given too much. If you think you have been given too much, you feel your heart beating very fast, you are breathing quickly, have a high temperature, feel restless, confused, have hallucinations, or lose co-ordination you must tell the person giving you the injection.

Possible side effects

Like all medicines, Atropine Sulphate Injection can cause side effects, although not everybody gets them.

drowsiness blurred vision dry mouth with difficulty swallowing thirst dilation of the pupils flushing dryness of the skin slow heart beat followed by fast heart beat palpitations (you are aware of your heart beating) difficulty in passing urine or constipation vomiting rashes confusion

If you think this injection is causing you any problems, or you are at all worried, talk to your doctor, nurse or pharmacist.

Storing Atropine Sulphate Injection

Your injection will be stored at less than 25°C and protected from light. The nurse or doctor will check that the injection is not past its expiry date before giving you the injection.

Further information What Atropine Sulphate Injection contains:

This injection contains the active ingredient atropine sulphate. Each 1 ml of solution contains 600 micrograms in a sterile solution for injection.

This injection contains the following Inactive Ingredients: sulphuric acid and water for injections.

What Atropine Sulphate Injection looks like and contents of the pack:

Atropine Sulphate Injection is a supplied in 1 ml clear glass ampoules. 10 ampoules are supplied in each carton.

The marketing authorisation number of this medicine is: PL 01502/0016R

Marketing Authorisation Holder: hameln pharmaceuticals ltd Gloucester United Kingdom Manufacturer hameln pharmaceuticals gmbh Langes Feld 13 31789 Hameln Germany

For any information about this medicine, please contact the Marketing Authorisation Holder

This leaflet was last approved 2008-08-18

44171/42/08


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Atropine Ointment


Pronunciation: AT-row-peen
Generic Name: Atropine
Brand Name: Generic only. No brands available.
Atropine Ointment is used for:

Widening (dilating) the pupils for an eye exam or to treat certain inflammatory conditions of the eye. It may also be used for other conditions as determined by your doctor.

Atropine Ointment is an anticholinergic agent. It works by blocking the chemical acetylcholine, which relaxes the ciliary muscle of the eye and causes the pupil to dilate.

Do NOT use Atropine Ointment if: you are allergic to any ingredient in Atropine Ointment you have glaucoma or are at risk for glaucoma you have ever had a severe reaction to atropine

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atropine Ointment:

Some medical conditions may interact with Atropine Ointment. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have numbness due to nerve damage, a blockage of the bladder, prostate problems, or difficulty urinating

Some MEDICINES MAY INTERACT with Atropine Ointment. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Atropine Ointment's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atropine Ointment may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atropine Ointment:

Use Atropine Ointment as directed by your doctor. Check the label on the medicine for exact dosing instructions.

To use Atropine Ointment in the eye, first, wash your hands. Using your index finger, pull the lower eyelid away from your eye to form a pouch. Squeeze a thin strip of ointment into the pouch. After using Atropine Ointment, gently close your eyes for 1 to 2 minutes. Wash your hands to remove any medicine that may be on them. Wipe the applicator tip with a clean, dry tissue. To prevent germs from contaminating your medicine, do not touch the applicator tip to any surface, including the eye. Keep the container tightly closed. If you miss a dose of Atropine Ointment, use it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not use 2 doses at once.

Ask your health care provider any questions you may have about how to use Atropine Ointment.

Important safety information: Atropine Ointment may cause harm if it is swallowed. If you may have taken it by mouth, contact your poison control center or emergency room right away. Atropine Ointment may cause blurred vision. Use Atropine Ointment with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Atropine Ointment may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Lab tests, including eye exams, may be performed while you use Atropine Ointment. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Atropine Ointment should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Atropine Ointment while you are pregnant. It is not known if Atropine Ointment is found in breast milk. If you are or will be breast-feeding while you use Atropine Ointment, check with your doctor. Discuss any possible risks to your baby. Possible side effects of Atropine Ointment:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; eye itching, burning, or stinging; irritation at the application site.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); difficulty urinating; dry mouth; eye pain; fever; flushing or dryness of the skin; irregular or rapid heartbeat; unsteadiness on your feet.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of Atropine Ointment:

Store Atropine Ointment at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atropine Ointment out of the reach of children and away from pets.

General information: If you have any questions about Atropine Ointment, please talk with your doctor, pharmacist, or other health care provider. Atropine Ointment is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atropine Ointment. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Atropine resources Atropine Dosage Atropine Use in Pregnancy & Breastfeeding Atropine Drug Interactions Atropine Support Group 0 Reviews for Atropine - Add your own review/rating Compare Atropine with other medications Pupillary Dilation Refraction, Assessment Uveitis
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Atropine


Pronunciation: AT-row-peen
Generic Name: Atropine
Brand Name: Generic only. No brand available.
Atropine is used for:

Decreasing the production of saliva and secretions of the airway prior to surgery. It is also used to treat spasms in the stomach, intestines, and other organs. It may also be used to counteract the effects of certain other medicines or for other conditions as determined by your doctor.

Atropine is an anticholinergic. It works by blocking the effects of a chemical in the body (acetylcholine) in the nervous system, stomach, intestines, certain glands (eg, salivary gland), urinary tract, and other tissues.

Do NOT use Atropine if: you are allergic to any ingredient in Atropine you have adhesions between the iris and lens of the eyes, asthma, blocking of the stomach or bowel, ulcerative colitis, bleeding, angle-closure glaucoma, myasthenia gravis, difficulty urinating due to a blockage, excess acid in the stomach or throat, esophagus problems (difficulty swallowing), or bowel muscle weakness

Contact your doctor or health care provider right away if any of these apply to you.

Before using Atropine:

Some medical conditions may interact with Atropine. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a history of megacolon or a predisposition to angle-closure glaucoma if you have numbness due to nerve damage, prostate problems (enlarged prostate), blockage of the bladder, trouble urinating, heart problems (congestive heart failure), hiatal hernia, or open-angle glaucoma

Some MEDICINES MAY INTERACT with Atropine. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Atropine's side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Atropine may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Atropine:

Use Atropine as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Atropine is usually given as an injection at your doctor's office, hospital, or clinic. If you will be using Atropine at home, a health care provider will teach you how to use it. Be sure you understand how to use Atropine. Follow the procedures you are taught when you use a dose. Contact your health care provider if you have any questions. Do not use Atropine if it contains particles, is cloudy or discolored, or if the vial is cracked or damaged. Keep this product, as well as syringes and needles, out of the reach of children and pets. Do not reuse needles, syringes, or other materials. Ask your health care provider how to dispose of these materials after use. Follow all local rules for disposal. If you miss a dose of Atropine, contact your doctor right away.

Ask your health care provider any questions you may have about how to use Atropine.

Important safety information: If your symptoms do not get better within a few days or if they get worse, check with your doctor. Atropine may cause drowsiness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Atropine with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Atropine; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting. Atropine may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Tell your doctor or dentist that you take Atropine before you receive any medical or dental care, emergency care, or surgery. Use Atropine with caution in the ELDERLY; they may be more sensitive to its effects. Atropine should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Atropine while you are pregnant. It is not known if Atropine is found in breast milk. If you are or will be breast-feeding while you use Atropine, check with your doctor. Discuss any possible risks to your baby. Possible side effects of Atropine:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased salivation; decreased sweating; difficulty sleeping; difficulty swallowing; dilation of the pupils; dizziness; drowsiness; excitement; fever; headache; hot, flushed, dry skin; loss of taste; mild to severe dryness of the nose and mouth; nausea; nervousness; thirst.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); changes in heartbeat; confusion; delirium; diarrhea; difficulty focusing your eyes; difficulty urinating; fast/irregular heartbeat; hallucinations; rash; restlessness with weakness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include anxiety; coma; difficulty breathing; dilated pupils; disorientation; hallucinations; high blood pressure; high body temperature; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; urinary retention; vomiting.

Proper storage of Atropine:

Store Atropine at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Atropine out of the reach of children and away from pets.

General information: If you have any questions about Atropine, please talk with your doctor, pharmacist, or other health care provider. Atropine is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Atropine. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Atropine resources Atropine Use in Pregnancy & Breastfeeding Atropine Drug Interactions Atropine Support Group 1 Review for Atropine - Add your own review/rating Atropine Professional Patient Advice (Wolters Kluwer) Atropine Advanced Consumer (Micromedex) - Includes Dosage Information Atropine Monograph (AHFS DI) Atropine Prescribing Information (FDA) atropine Concise Consumer Information (Cerner Multum) AtroPen Prescribing Information (FDA) Compare Atropine with other medications Anticholinesterase Poisoning AV Heart Block Bradyarrhythmia Organophosphate Poisoning
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Atropine Sulphate Injection BP 600mcg / ml


1. Name Of The Medicinal Product

Atropine Sulphate Injection BP 600mcg/ml.

2. Qualitative And Quantitative Composition

Atropine Sulphate BP 0.06% w/v.

3. Pharmaceutical Form

Sterile solution for injection.

4. Clinical Particulars 4.1 Therapeutic Indications

1. Drying secretions prior to anaesthesia.

2. Reversal of excessive bradycardia.

3. Indicated with neostigmine for reversal of neuromuscular block.

4.2 Posology And Method Of Administration

Adults

Bradycardia

Management of bradycardia of acute myocardial infarction: Initial dose 300 – 600mcg intravenously, the dose may be increased by incremental doses of 100mcg up to 1mg if necessary.

Caution is required as atropine may aggravate ischaemia or infarction.

Treatment of bradycardia or asystole due to overdosage with parasympathetic agents:

1-2mg subcutaneously, intramuscularly or intravenously.

Drying secretions

300 – 600mcg subcutaneously or intramuscularly 30 – 60 minutes prior to induction of anaesthesia. Alternatively, 300 – 600mcg may be given intravenously immediately prior to induction of anaesthesia.

Reversal of competitive neuromuscular block

0.6 – 1.2mg by slow intravenous injection for control of muscarinic side effects of neostigmine in reversal of competitive neuromuscular block. Atropine should not be given routinely with neostigmine as it may mask signs of overdose.

Children aged 1 year and over

Caution should be exercised in children and reduced doses are necessary.

Drying secretions: 20mcg/kg intramuscularly 30 – 60 minutes prior to induction of anaesthesia. This dose should be reduced on hot days or in fever.

Other indications are not recommended for children.

Elderly

Caution should be exercised in the elderly and reduced doses may be required.

Routes of administration: Intravenous, intramuscular or subcutaneous injection.

4.3 Contraindications

Known hypersensitivity to atropine, prostatic enlargement, paralytic ileus, pyloric stenosis, closed angle glaucoma or patients with narrow angle between iris and cornea. Atropine should not be given to patients, particularly children, when ambient temperatures are high due to the risk of provoked hyperpyrexia.

4.4 Special Warnings And Precautions For Use

Atropine should be used with caution in children and the elderly, patients with ulcerative colitis as ileus and megacolon may result and those with diarrhoea. Caution is required in patients having a fever, conditions characterised by tachycardia such as thyrotoxicosis, cardiac insufficiency or failure and in cardiac surgery or acute myocardial infarction. Atropine should be given with care to patients with hypertension. Extreme caution is necessary in patients with myasthenia gravis or autonomic neuropathy.

Caution is required when atropine is administered systemically to patients with chronic obstructive pulmonary disease, as a reduction in bronchial secretions may lead to the formation of bronchial plugs.

Antimuscarinics may delay gastric emptying, decrease gastric motility and relax the oesophageal sphincter. They should be used with caution in patients whose conditions may be aggravated by these effects e.g. reflux oesophagitis.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Effects of atropine may be enhanced by concomitant administration of drugs having antimuscarnic properties. The reduction in gastric motility caused by atropine may affect absorption of other drugs.

4.6 Pregnancy And Lactation

Safety in human pregnancy has not been established although atropine does cross the placenta. Atropine may have antimuscarinic effects in infants. Therefore it is not advisable to administer atropine during pregnancy or breast feeding unless considered essential.

4.7 Effects On Ability To Drive And Use Machines

None as used on sedentary patients.

4.8 Undesirable Effects

Common side effects include dryness of the mouth with difficulty in swallowing and talking, thirst, mydriasis with cycloplegia and photophobia, flushing and dryness of skin, transient bradycardia followed by tachycardia, palpitations and arrhythmias, urinary retention, constipation.

Other reported side effects include anaphylaxis, urticaria and rash occasionally progressing to exfoliation.

Occasionally vomiting and dizziness. Retrosternal pain may occur due to gastric reflux. Rare occurrences include confusional states and fever.

Atropine may cause raised intra-ocular pressure and mental confusion especially in the elderly.

4.9 Overdose

Symptoms: Flushing and dryness of the skin (rash may appear on the face and upper trunk), tachycardia, rapid respiration, hyperpyrexia, CNS stimulation (restlessness, confusion, excitement, paranoid and psychotic reactions, hallucinations and delirium and occasionally seizures and convulsions). Severe overdose may be indicated by CNS depression, coma, circulatory and respiratory failure and death.

Treatment: Supportive therapy as necessary. Neostigmine or carbachol antagonise peripheral adverse effects. In children the body surface should be kept moist.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Atropine is an antimuscarinic alkaloid with both central and peripheral actions. It first stimulates and then depresses the central nervous system and has antispasmodic actions on smooth muscle and reduces secretions, especially salivary and bronchial secretions.

5.2 Pharmacokinetic Properties

Rapidly cleared from blood and distributed throughout the body.

Completely metabolised in the liver and excreted in the urine as unchanged drug and metabolites.

Atropine crosses the placenta and traces are found in breast milk. Atropine crosses the blood brain barrier.

5.3 Preclinical Safety Data

None stated.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Sulphuric Acid BP

Water for Injections HSE

6.2 Incompatibilities

Atropine is incompatible with alkaloids, tannic acid and mercury salts.

6.3 Shelf Life

36 months.

6.4 Special Precautions For Storage

Store below 25°C.

6.5 Nature And Contents Of Container

1ml neutral glass ampoules in packs of 5, 10 or 100.

6.6 Special Precautions For Disposal And Other Handling

None stated.

7. Marketing Authorisation Holder

Antigen International Limited

Roscrea

Co. Tipperary

Ireland

8. Marketing Authorisation Number(S)

PL 02848/0211

9. Date Of First Authorisation/Renewal Of The Authorisation

3 April 2000

10. Date Of Revision Of The Text

February 2000


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Mytelase Chloride


Generic Name: ambenonium (am ben OH nee um)
Brand Names: Mytelase Chloride

What is Mytelase Chloride (ambenonium)?

Ambenonium affects chemicals in the body that are involved in the communication between nerve impulses and muscle movement.

Ambenonium is used to treat the symptoms of myasthenia gravis.

Ambenonium may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Mytelase Chloride (ambenonium)? You should not use this medication if you are allergic to ambenonium, or if you are using certain medications.

Be sure your doctor knows if you use: mecamylamine, (Inversine), atropine (Atreza, Donnatal, Sal-Tropine, Lomotil, Lomocot, and others), blood pressure medications, or a diuretic (water pill).

Before using ambenonium, tell your doctor if you have asthma, Parkinson's disease, or a bladder or bowel obstruction.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

What should I discuss with my health care provider before taking Mytelase Chloride (ambenonium)? You should not use this medication if you are allergic to ambenonium, or if you are using certain medications. Be sure your doctor knows if you use:

mecamylamine, (Inversine);

atropine (Atreza, Donnatal, Sal-Tropine, Lomotil, Lomocot, and others);

blood pressure medications; or

a diuretic (water pill).

To make sure you can safely take ambenonium, tell your doctor if you have any of these other conditions:

asthma;

Parkinson's disease; or

a bladder or bowel obstruction.

It is not known whether ambenonium will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether ambenonium passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using ambenonium. How should I take Mytelase Chloride (ambenonium)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Ambenonium is usually taken every 3 to 4 hours during the day. Follow your doctor's instructions.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

Store at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe diarrhea, muscle twitching, anxiety, sweating, and cough or breathing problems.

What should I avoid while taking Mytelase Chloride (ambenonium)?

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Mytelase Chloride (ambenonium) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if you have a serious side effect such as:

severe diarrhea;

muscle twitching; or

cough with sputum (mucus).

Less serious side effects may include:

sweating or urinating more than usual;

drooling, watery eyes;

warmth or tingly feeling;

nausea, vomiting, stomach pain;

blurred vision;

anxiety;

dizziness, spinning feeling; or

muscle cramps.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Mytelase Chloride (ambenonium)?

Tell your doctor about all other medicines you use, especially:

atropine (Atreza, Sal-Tropine), belladonna (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm Scop);

bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

bladder or urinary medicines such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

irritable bowel medicines such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine); or

ulcer medications such as glycopyrrolate (Robinul) or mepenzolate (Cantil).

This list is not complete and other drugs may interact with ambenonium. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Mytelase Chloride resources Mytelase Chloride Use in Pregnancy & Breastfeeding Mytelase Chloride Drug Interactions Mytelase Chloride Support Group 0 Reviews for Mytelase Chloride - Add your own review/rating Ambenonium MedFacts Consumer Leaflet (Wolters Kluwer) Compare Mytelase Chloride with other medications Myasthenia Gravis Where can I get more information? Your pharmacist can provide more information about ambenonium.
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atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid


AT-roe-peen SUL-fate, hye-oh-SYE-a-meen SUL-fate, meth-EN-a-meen, METH-i-leen BLOO, FEN-il sal-I-si-late, ben-ZOE-ik AS-id

Commonly used brand name(s)

In the U.S.

Prosed EC Trac Tabs Urised

Available Dosage Forms:

Tablet Tablet, Enteric Coated

Therapeutic Class: Urinary Antispasmodic

Pharmacologic Class: Atropine

Chemical Class: Salicylate, Non-Aspirin

Uses For atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid

Atropine , hyoscyamine , methenamine , methylene blue, phenyl salicylate , and benzoic acid combination medicine is an anticholinergic, anti-infective, and analgesic. It is given by mouth to help relieve the discomfort caused by urinary tract infections; however, it will not cure the infection itself. This combination medicine may also be used for other conditions as determined by your doctor.

atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid is available only with your doctor's prescription.

Before Using atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Unusual excitement, nervousness, restlessness or irritability, and unusual warmth, dryness, and flushing of skin are more likely to occur in children, who are usually more sensitive to the effects of atropine and hyoscyamine (contained in this combination medicine). Also, when atropine and hyoscyamine are given to children during hot weather, a rapid increase in body temperature may occur. In infants and children, especially those with spastic paralysis or brain damage, atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid may be more likely to cause severe side effects.

Geriatric

Confusion or memory loss, constipation, difficult urination, excitement, agitation, drowsiness, or dryness of mouth may be more likely to occur in elderly patients, who are usually more sensitive than younger adults to the effects of atropine and hyoscyamine. Also, this combination medicine may cause eye pain in patients who have untreated glaucoma.

Pregnancy Pregnancy Category Explanation All Trimesters X Studies in animals or pregnant women have demonstrated positive evidence of fetal abnormalities. This drug should not be used in women who are or may become pregnant because the risk clearly outweighs any possible benefit. Breast Feeding Benzoic Acid

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Methylene BlueBenzyl BenzoateMethenamineAtropineHyoscyamine

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Ambenonium Amitriptyline Amoxapine Bupropion Citalopram Clomipramine Desipramine Desvenlafaxine Doxepin Duloxetine Escitalopram Fluoxetine Fluvoxamine Imipramine Isocarboxazid Linezolid Maprotiline Mirtazapine Nortriptyline Paroxetine Phenelzine Potassium Protriptyline Selegiline Sertraline Tranylcypromine Trimipramine Venlafaxine Vilazodone

Using atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Buspirone Nefazodone Trazodone

Using atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Arbutamine Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Problems

The presence of other medical problems may affect the use of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid. Make sure you tell your doctor if you have any other medical problems, especially:

Bleeding problems (severe)—This combination medicine may increase heart rate, which would make bleeding problems worse Brain damage (in children)—May increase the central nervous system (CNS) effects of this combination medicine Colitis (severe) or Dryness of mouth (severe or continuing) or Enlarged prostate or Fever or Glaucoma or Heart disease or Hernia (hiatal) or High blood pressure or Intestinal blockage or other intestinal or stomach problems or Lung disease or Myasthenia gravis or Toxemia of pregnancy or Urinary tract blockage or difficult urination—This combination medicine may make these conditions worse Dehydration or Kidney disease or Liver disease—Higher levels of medicine may result and increase the risk of side effects Overactive thyroid—May increase the heart rate Proper Use of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid

While you are taking this combination medicine, it is important for your urine to be acidic. To do this, your doctor may recommend that you eat more protein and such foods as cranberries (especially cranberry juice with vitamin C added), plums, or prunes. You should avoid foods that make the urine more alkaline, such as most fruits (especially citrus fruits and juices), milk, and other dairy products.

Take atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid only as directed. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

Each dose should be taken with a full glass (8 ounces) of water or other liquid (except citrus juices and milk). Drink plenty of water or other liquids every day, unless otherwise directed by your doctor. Drinking enough liquids will help your kidneys work better and lessen your discomfort.

To help clear up your infection completely, keep taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid for the full time of treatment even if you begin to feel better after a few days. Do not miss any doses.

In order for atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid to work well, your urine must be acid (pH 5.5 or below). To make sure that your urine is acid:

Before you start taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid, check your urine with phenaphthazine paper or another test to see if it is acid. If you have any questions about this, check with your health care professional. You may need to change your diet; however, check with your doctor first if you are on a special diet (for example, for diabetes). To help make your urine more acid you should avoid most fruits (especially citrus fruits and juices), milk and other dairy products, and other foods which make the urine more alkaline. Eating more protein and foods such as cranberries (especially cranberry juice with vitamin C added), plums, or prunes may also help. If your urine is still not acid enough, check with your doctor. Dosing

The dose of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For oral dosage form (tablets): For relief of urinary tract symptoms: Adults and children 12 years of age and older—1 to 2 tablets four times a day. Children 6 to 12 years of age—Dose must be determined by the doctor. Children up to 6 years of age—Use is not recommended. Missed Dose

If you miss a dose of atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid

If your symptoms do not improve within a few days or if they become worse, check with your doctor.

These medicines may make you sweat less, causing your body temperature to increase. Use extra care not to become overheated during exercise or hot weather while you are taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid, since overheating may result in heat stroke. Also, hot baths or saunas may make you dizzy or faint while you are taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid.

atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid may cause some people to have blurred vision. Make sure you know how you react to atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid before you drive, use machines, or do anything else that could be dangerous if you are not able to see well. If your vision continues to be blurred, check with your doctor.

atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid may cause dryness of the mouth. For temporary relief, use sugarless candy or gum, melt bits of ice in your mouth, or use a saliva substitute. However, if your mouth continues to feel dry for more than 2 weeks, check with your dentist. Continuing dryness of the mouth may increase the chance of dental disease, including tooth decay, gum disease, and fungus infections.

Do not take atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid within 2 or 3 hours of taking antacids or medicine for diarrhea. Taking antacids or antidiarrhea medicines and atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid too close together may prevent atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid from working properly.

atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

Less common or rare Blurred vision eye pain skin rash or hives Symptoms of overdose Blood in urine and/or stools diarrhea dizziness drowsiness (severe) fast heartbeat flushing or redness of face headache (severe or continuing) lower back pain pain or burning while urinating ringing or buzzing in the ears shortness of breath or troubled breathing sweating unusual tiredness or weakness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common Difficult urination (more common with large doses taken over a prolonged period of time) dryness of mouth, nose, or throat nausea or vomiting stomach upset or pain (more common with large doses taken over a prolonged period of time)

atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid may cause your urine and/or stools to turn blue or blue-green. This is to be expected while you are taking atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid.

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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More atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid resources Atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid Use in Pregnancy & Breastfeeding Atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid Drug Interactions Atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid Support Group 16 Reviews for Atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid - Add your own review/rating Compare atropine, hyoscyamine, methenamine, methylene blue, phenyl salicylate, and benzoic acid with other medications Urinary Tract Infection
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atropine and pralidoxime


Generic Name: atropine and pralidoxime (AT roe peen and PRAL i DOX eem)
Brand Names: DuoDote

What is atropine and pralidoxime?

Atropine blocks the action of chemical called acetylcholine (ah see til KO leen), which may exist in high levels in the body after a poisoning. Atropine also stimulates the heart and reduces the secretions of the nose, mouth, and lungs to improve breathing.

Pralidoxime reverses muscle weakness or paralysis caused by a poison or nerve agent.

The combination of atropine and pralidoxime is used as an antidote to treat poisoning by a pesticide (insect spray) or a chemical that interferes with the central nervous system, such as nerve gas.

This medication is not effective as an antidote for all types of pesticide poisonings. You may need medications or additional treatments.

Atropine and pralidoxime may also be used for purposes not listed in this medication guide.

What is the most important information I should know about atropine and pralidoxime? If possible, before you receive atropine and pralidoxime, tell your doctor if you have heart disease, coronary artery disease, a heart rhythm disorder, high blood pressure, narrow-angle glaucoma, kidney disease, enlarged prostate, urination problems, a breathing disorder such as asthma or COPD, if you are allergic to any medication, or if you have recently had a heart attack. Also tell your doctor if you are pregnant or breast-feeding. In an emergency situation it may not be possible before you are treated to tell your caregivers about your health conditions or if you are pregnant or breast-feeding. Make sure any doctor caring for you afterward knows that you have received this medication. What should I discuss with my health care provider before receiving atropine and pralidoxime? If possible, before you receive atropine and pralidoxime, tell your doctor if you have:

an allergy to any medication;

heart disease, coronary artery disease;

high blood pressure;

kidney disease;

asthma, COPD (chronic obstructive pulmonary disorder), bronchitis, emphysema, or other breathing problem;

a heart rhythm disorder;

narrow-angle glaucoma;

an enlarged prostate or urination problems; or

if you have recently had a heart attack.

FDA pregnancy category C. It is not known whether atropine and pralidoxime will harm an unborn baby. Tell your doctor if you are pregnant. Atropine and pralidoxime can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby. In an emergency situation, it may not be possible before you are treated with atropine and pralidoxime to tell your caregivers if you are pregnant or breast-feeding. Make sure any doctor caring for your pregnancy or your baby knows you have received this medication. How is atropine and pralidoxime given?

Atropine and pralidoxime is injected into a muscle in your upper thigh. A healthcare provider will give you this injection.

Atropine and pralidoxime is usually given as soon as possible after the onset of poisoning symptoms. If you still have symptoms after 10 to 15 minutes, you will receive 2 more injections.

Your breathing, blood pressure, oxygen levels, kidney function, and other vital signs will be watched closely while you are receiving this medication.

After treatment with atropine and pralidoxime, you may be watched for up to 72 hours to make sure the medicine has been effective and you no longer have any effects of the poison.

What happens if I miss a dose?

Since atropine and pralidoxime is given by a healthcare professional in an emergency setting, you are not likely to miss a dose.

What happens if I overdose?

Since this medication is given by a healthcare professional in a medical setting, an overdose is unlikely to occur.

Overdose may occur if you receive atropine and pralidoxime but you have not actually been exposed to the specific poisons this medication is designed to treat. Symptoms may include vision problems, feeling unsteady, loss of balance or coordination, trouble concentrating, fast heart rate, confusion, hallucinations (seeing or hearing things), decreased sweating, hot and dry skin, fainting, weak or shallow breathing, or breathing that stops. What should I avoid after receiving atropine and pralidoxime?

Avoid becoming overheated or dehydrated during exercise and in hot weather. Atropine can decrease sweating and you may be more prone to heat stroke for a short time after receiving this medication.

Follow your doctor's instructions about any restrictions on food, beverages, or activity.

Atropine and pralidoxime side effects

Some of the side effects of atropine and pralidoxime may be similar to the symptoms of poisoning. Your caregivers will watch you closely to determine whether your body is responding well to the medication, or if you are having any serious side effects.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Tell your caregivers at once if you have a serious side effect such as:

pounding heartbeats or fluttering in your chest;

painful or difficult urination;

trouble swallowing;

feeling like you might pass out;

confusion;

loss of movement in any part of your body;

slow heart rate, weak pulse, fainting, slow breathing (breathing may stop); or

chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling.

Less serious side effects may include:

dry mouth, dry nose, dry skin;

dry eyes, blurred vision;

increased sensitivity of your eyes to light;

headache;

dizziness, drowsiness;

muscle weakness;

constipation, stomach pain, bloating, nausea, vomiting;

loss of interest in sex, impotence; or

mild skin rash.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Atropine and pralidoxime Dosing Information

Usual Adult Dose for Organophosphate Poisoning:

TREATMENT OF MILD SYMPTOMS
Mild symptoms include blurred vision, miosis, excessive, unexplained runny nose, increased salivation such as sudden drooling, chest tightness or difficulty breathing, tremors throughout the body or muscular twitching, nausea and/or vomiting, unexplained wheezing, coughing or increased airway secretions, acute onset of stomach cramps, and tachycardia or bradycardia.
First dose: In the situation of known or suspected organophosphorous poisoning, administer one (1) atropine-pralidoxime 2.1 mm/0.7 mL-600 mg/ 2 mL injection (DuoDote auto-injector) into the midlateral thigh if the patient experiences two or more MILD symptoms of nerve gas or insecticide exposure. Emergency medical services personnel with mild symptoms may self-administer a single dose of atropine-pralidoxime (DuoDote).
Wait 10 to 15 minutes for atropine-pralidoxime (DuoDote) to take effect. If, after 10 to 15 minutes, the patient does not develop any SEVERE symptoms (strange or confused behavior, severe difficulty breathing or copious secretions from lungs/airway, severe muscular twitching and general weakness, involuntary urination and defecation, convulsions or unconsciousness), no additional atropine-pralidoxime (DuoDote) injections are recommended, but definitive medical care should ordinarily be sought immediately. For emergency medical services personnel who have self-administered atropine-pralidoxime (DuoDote), an individual decision will need to be made to determine their capacity to continue to provide emergency care.
Additional doses: If, at any time after the first dose, the patient develops any of the SEVERE symptoms listed above, administer two (2) additional atropine-pralidoxime (DuoDote) injections in rapid succession, and immediately seek definitive medical care.
TREATMENT OF SEVERE SYMPTOMS
Severe symptoms include strange or confused behavior, severe difficulty breathing or copious secretions from lungs/airway, severe muscular twitching and general weakness, involuntary urination and defecation, convulsions or unconsciousness.
Immediately administer three (3) atropine-pralidoxime (DuoDote) injections into the patient's midlateral thigh in rapid succession, and immediately seek definitive medical care.

Usual Adult Dose for Nerve Agent Poisoning:

TREATMENT OF MILD SYMPTOMS
Mild symptoms include blurred vision, miosis, excessive, unexplained runny nose, increased salivation such as sudden drooling, chest tightness or difficulty breathing, tremors throughout the body or muscular twitching, nausea and/or vomiting, unexplained wheezing, coughing or increased airway secretions, acute onset of stomach cramps, and tachycardia or bradycardia.
First dose: In the situation of known or suspected organophosphorous poisoning, administer one (1) atropine-pralidoxime 2.1 mm/0.7 mL-600 mg/ 2 mL injection (DuoDote auto-injector) into the midlateral thigh if the patient experiences two or more MILD symptoms of nerve gas or insecticide exposure. Emergency medical services personnel with mild symptoms may self-administer a single dose of atropine-pralidoxime (DuoDote).
Wait 10 to 15 minutes for atropine-pralidoxime (DuoDote) to take effect. If, after 10 to 15 minutes, the patient does not develop any SEVERE symptoms (strange or confused behavior, severe difficulty breathing or copious secretions from lungs/airway, severe muscular twitching and general weakness, involuntary urination and defecation, convulsions or unconsciousness), no additional atropine-pralidoxime (DuoDote) injections are recommended, but definitive medical care should ordinarily be sought immediately. For emergency medical services personnel who have self-administered atropine-pralidoxime (DuoDote), an individual decision will need to be made to determine their capacity to continue to provide emergency care.
Additional doses: If, at any time after the first dose, the patient develops any of the SEVERE symptoms listed above, administer two (2) additional atropine-pralidoxime (DuoDote) injections in rapid succession, and immediately seek definitive medical care.
TREATMENT OF SEVERE SYMPTOMS
Severe symptoms include strange or confused behavior, severe difficulty breathing or copious secretions from lungs/airway, severe muscular twitching and general weakness, involuntary urination and defecation, convulsions or unconsciousness.
Immediately administer three (3) atropine-pralidoxime (DuoDote) injections into the patient's midlateral thigh in rapid succession, and immediately seek definitive medical care.

What other drugs will affect atropine and pralidoxime?

If possible, before you receive this medication, tell your doctor about all other medicines you use, especially:

aminophylline (Phyllocontin, Truphylline);

morphine (Avinza, Kadian, MS Contin, Oramorph);

reserpine;

theophylline (Elixophyllin, Theo-24, Uniphyl);

a barbiturate such as butabarbital (Butisol), secobarbital (Seconal), pentobarbital (Nembutal), or phenobarbital (Solfoton); or

a tranquilizer such as chlorpromazine (Thorazine), fluphenazine (Permitil), perphenazine (Trilafon), prochlorperazine (Compazine), thioridazine (Mellaril), or trifluperazine (Stelazine).

This list is not complete and other drugs may interact with atropine and pralidoxime. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More atropine and pralidoxime resources Atropine and pralidoxime Use in Pregnancy & BreastfeedingAtropine and pralidoxime Drug InteractionsAtropine and pralidoxime Support Group0 Reviews for Atropine and pralidoxime - Add your own review/rating Compare atropine and pralidoxime with other medications Nerve Agent PoisoningOrganophosphate Poisoning Where can I get more information? Your doctor or pharmacist can provide more information about atropine and pralidoxime.
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PB Hyos Elixir


phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide
Dosage Form: oral elixir
PB Hyos Elixir DESCRIPTION:

Each 5 mL (teaspoonful) of elixir contains:
Phenobarbital, USP ............................................. 16.2 mg
(WARNING: may be habit forming)
Hyoscyamine Sulfate, USP .............................. 0.1037 mg
Atropine Sulfate, USP ..................................... 0.0194 mg
Scopolamine Hydrobromide, USP ................... 0.0065 mg
Alcohol not more than 23.8%

INACTIVE INGREDIENTS:

Artificial Grape Flavor, Ethyl Alcohol, FDC Blue #1, FDC Red #40, Glycerin, Purified Water USP, Sodium Saccharin, Sorbitol Solution 70%, and Sucrose.

CLINICAL PHARMACOLOGY:

This drug combination provides peripheral anticholinergic/antispasmodic action and mild sedation.

INDICATIONS AND USAGE:

FDA has classified the following indications as “possibly” effective: For use as adjunctive therapy in the treatment of irritable bowel syndrome (irritable colon, spastic colon, mucous colitis) and acute enterocolitis. May also be useful as adjunctive therapy in the treatment of duodenal ulcer. IT HAS NOT BEEN SHOWN CONCLUSIVELY WHETHER ANTICHOLINERGIC/ ANTISPASMODIC DRUGS AID IN THE HEALING OF A DUODENAL ULCER, DECREASE THE RATE OF RECURRENCES OR PREVENT COMPLICATIONS.

CONTRAINDICATIONS:

PB Hyos Elixir is contraindicated in patients with known hypersensitivity to any of the ingredients. Phenobarbital is contraindicated in patients with acute intermittent porphyria and in those patients in which phenobarbital produces restlessness and/or excitement.
It is also contraindicated in patients with glaucoma, obstructive uropathy; paralytic ileus; myasthenia gravis; intestinal atony; unstable cardiovascular status in acute hemorrhage; hiatal hernia associated with reflux esophagitis; obstructive disease of the gastrointestinal tract; or severe ulcerative colitis.

WARNINGS:

Heat prostration can occur with belladonna alkaloids in high temperatures.
Diarrhea may be an early symptom of incomplete intestinal obstruction, especially in patients with ileostomy or colostomy. In this instance, treatment with this drug could be harmful.
PB Hyos Elixir may produce drowsiness and blurred vision. The patient should be warned about engaging in hazardous work or activities requiring mental alertness, such as operating a motor vehicle or other machinery.
Phenobarbital may decrease the effect of anticoagulants, and larger doses of the anticoagulant may be needed for optimal effect. When phenobarbital is discontinued, the dose of the anticoagulant may have to be decreased. Phenobarbital may be habit forming and should not be administered to patients who are susceptible to addiction or to those with a history of physical and/or psychological drug dependence.
Barbiturates should be used with caution in patients with hepatic dysfunction.

PRECAUTIONS:

GENERAL: Use with caution in patients with: autonomic neuropathy, hepatic or renal disease, hyperthyroidism, coronary heart disease, congestive heart failure, cardiac arrhythmias, tachycardia, and hypertension.
Belladonna alkaloids may produce a delay in gastric emptying (antral stasis) which would complicate the management of gastric ulcer. Do not rely on the use of the drug in the presence of complication of biliary tract disease. Theoretically, with overdosage, a curare-like action may occur.
CARCINOGENESIS, MUTAGENESIS, IMPAIRMENT OF FERTILITY: Long-term studies in animals have not been performed to evaluate carcinogenic potential.
PREGNANCY CATEGORY C: Animal reproduction studies have not been conducted with PB Hyos Elixir. It is not known whether PB Hyos Elixir can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. PB Hyos Elixir should be given to a pregnant woman only if clearly needed.
NURSING MOTHERS: It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when PB Hyos Elixir is administered to a nursing woman.

ADVERSE REACTIONS:

Adverse reactions associated with anticholinergics and/or anticonvulsants are: dry mouth; tachycardia; urinary hesitancy and retention; palpitation; blurred vision; prolonged pupil dilation; cycloplegia; increased ocular tension; loss of taste sense; headache; nervousness; drowsiness; weakness; dizziness; insomnia; nausea; vomiting; severe allergic reaction or drug idiosyncrasies, including anaphylaxis, hives and/or other dermal manifestations; decreased sweating; impotence; suppression of lactation; constipation; bloated feeling and musculoskeletal pain. Elderly patients may react with symptoms of excitement, agitation and drowsiness to even small doses of the drug. Phenobarbital may produce excitement in some patients, rather than a sedative effect. In patients habituated to barbiturates, abrupt withdrawal may produce delirium or convulsions.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

OVERDOSAGE:

The signs and symptoms of overdose are headache, nausea, vomiting, blurred vision, dilated pupils, hot and dry skin, dizziness, dryness of the mouth, difficulty in swallowing, and CNS stimulation. Call your doctor or local Poison Control Center if overdosage is suspected.

DOSAGE AND ADMINISTRATION:

The dosage of PB Hyos Elixir should be adjusted to the needs of the individual patient to assure symptomatic control with a minimum of adverse effects.
Adults: One or two teaspoonfuls of elixir three or four times a day according to conditions and severity of symptoms.
Pediatric patients: For children age 2 and under, consult a physician for dosage and administration. Children ages 2 and over may be dosed every 4 to 6 hours.

HOW SUPPLIED:

PB Hyos Elixir is a purple colored, grape flavored liquid. 1 Pint (16 fl oz.) bottles NDC 49769-395-16.
Tamper evident by foil seal under cap. Do not use if foil seal is broken or missing.
WARNINGS: KEEP THIS AND ALL DRUGS OUT OF THE REACH OF CHILDREN. IN CASE OF ACCIDENTAL OVERDOSE, SEEK PROFESSIONAL ASSISTANCE OR CONTACT A POISON CONTROL CENTER IMMEDIATELY.
Manufactured for:
Kylemore Pharmaceuticals
Port St. Joe, FL 32456
Rev. 02/10 395-10

PACKAGING:

Below represents the current labeling being used:


PB HYOS 
phenobarbital, hyoscyamine sulfate, atropine sulfate, scopolamine hydrobromide  elixir Product Information Product Type HUMAN PRESCRIPTION DRUG NDC Product Code (Source) 49769-395 Route of Administration ORAL DEA Schedule      Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength PHENOBARBITAL (PHENOBARBITAL) PHENOBARBITAL 16.2 mg  in 5 mL HYOSCYAMINE SULFATE (HYOSCYAMINE) HYOSCYAMINE SULFATE 0.1037 mg  in 5 mL ATROPINE SULFATE (ATROPINE) ATROPINE SULFATE 0.0194 mg  in 5 mL SCOPOLAMINE HYDROBROMIDE (SCOPOLAMINE) SCOPOLAMINE HYDROBROMIDE 0.0065 mg  in 5 mL Inactive Ingredients Ingredient Name Strength ALCOHOL   FD&C BLUE NO. 1   FD&C RED NO. 40   GLYCERIN   WATER   SACCHARIN SODIUM   SORBITOL   SUCROSE   Product Characteristics Color purple Score      Shape Size Flavor GRAPE Imprint Code Contains          Packaging # NDC Package Description Multilevel Packaging 1 49769-395-16 473 mL In 1 BOTTLE None
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date unapproved drug other 03/01/2010 10/31/2012
Labeler - Kylemore Pharmaceuticals, LLC (831892471) Revised: 03/2011Kylemore Pharmaceuticals, LLC
More PB Hyos Elixir resources PB Hyos Elixir Side Effects (in more detail) PB Hyos Elixir Dosage PB Hyos Elixir Use in Pregnancy & Breastfeeding PB Hyos Elixir Drug Interactions PB Hyos Elixir Support Group 0 Reviews for PB Hyos - Add your own review/rating Compare PB Hyos Elixir with other medications Duodenal Ulcer Enterocolitis Irritable Bowel Syndrome
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Neostigmine Methylsulfate


Class: Parasympathomimetic (Cholinergic) Agents
Note: This monograph also contains information on Neostigmine Bromide
VA Class: AU300
CAS Number: 59-99-4
Brands: Prostigmin

Introduction

Reversible anticholinesterase agent.a b c

Uses for Neostigmine Methylsulfate Myasthenia Gravis

Symptomatic management of myasthenia gravis to improve muscle strength.a b c

Not effective in patients resistant to anticholinesterase drugs.a

Differential diagnosis of myasthenia gravis.a However, edrophonium is preferred except in lengthy procedures involving tests of limb strength.a

Surgery

Postoperative reversal of the effects of nondepolarizing neuromuscular blocking agents (e.g., tubocurarine, metocurine, gallamine [all no longer commercially available in the US], pancuronium).a b

Not effective and should not be used for reversal of depolarizing neuromuscular agents (e.g., succinylcholine, decamethonium).a

Postoperative Distention and Urinary Retention

Prevention and treatment of postoperative distention and urinary retention after excluding mechanical obstruction;a b bethanechol chloride usually preferred.a

Aminoglycoside Toxicity

Has been used to antagonize the neuromuscular blocking effects of aminoglycoside antibiotics† (e.g., kanamycin) with variable results; some clinicians found neostigmine ineffective.a (See Specific Drugs under Interactions.)

Acceleration of Barium Transit through Small Intestine

Has been used to accelerate barium transport through the small bowel†; other agents may be more effective.a

Neostigmine Methylsulfate Dosage and Administration General Diagnosis of Myasthenia Gravis

Discontinue all anticholinesterase drugs for at least 8 hours before administering neostigmine methylsulfate.a

Administer atropine sulfate IM 30 minutes before or IV concurrently with IM neostigmine methylsulfate to prevent adverse muscarinic effects.a

Determine placebo response by measuring muscle strength in cranial musculature before and after atropine sulfate administration.a

Other myopathies may show slight improvement in muscle strength; however, only myasthenia gravis responds with marked improvement.a

Treatment of Myasthenia Gravis

Dosage, route, and frequency of administration depend on the requirements and clinical response of the patient.a Carefully individualize dosage according to individual requirements and response and minimize adverse effects by precise dosage adjustment.a

Use parenteral form if oral therapy is impracticalb or in acute myasthenic crisis if difficulty in breathing and swallowing is present.c Transfer to the oral formulation as soon as tolerated.c

Dosage requirements may vary from day to day, according to remissions and exacerbations of the disease and the physical and emotional stress suffered by the patient.a

Treat mild exacerbations by increasing dosage under medical supervision as long as increase produces symptomatic improvement.a

Complete restoration of muscle strength is rare; do not attempt to relieve all symptoms by increasing dosage above maximum response level.a

Once stabilized on neostigmine, may teach patients how to recognize adverse muscarinic effects and self-modify dosage or take atropine, if necessary.a

Individual muscle groups respond differently to the same dose; may produce weakness in one while increasing strength in another.a Measure vital capacity whenever increasing dosage to ensure good respiratory function.a Have adequate facilities for CPR, cardiac monitoring, endotracheal intubation, and respiratory assistance available during dosage adjustment.a

Patients may become refractory after prolonged treatment; decreasing dosage or withdrawing drug for several days under medical supervision may restore responsiveness.a

If the patient is placed on a ventilator or corticosteroid therapy is begun, reduce dosage or eliminate neostigmine, if possible.a

Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects

Always have atropine and medications to treat shock readily available in case of hypersensitivity reaction.b

Give IV atropine sulfate or glycopyrrolate immediately prior to or concurrently with neostigmine (in separate syringes) when reversing the actions of nondepolarizing neuromuscular blocking agents to minimize neostigmine's adverse muscarinic effects.103 a b If bradycardic, give IV antimuscarinics before neostigmine to increase pulse rate to about 80 bpm.a b

Optimum time for neostigmine administration is during hyperventilation when blood CO2 concentration is low.b

Patient must be well ventilated; maintain patent airway until complete recovery of normal respiration is assured.a b Observe closely for recurrent respiratory depression.a

Parenteral Administration

Prior or simultaneous administration of atropine may be advisable when administering large parenteral doses of neostigmine methylsulfate.a b

Administration

Administer neostigmine bromide orally; administer neostigmine methylsulfate IV, IM, or sub-Q.a b c

Oral Administration

Administer orally, adjusting frequency and timing of administration according to individual response.a

Parenteral Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer neostigmine methylsulfate IV, IM, or sub-Q.a b

Surgery: Give by slow IV injection.a

Dosage

Available as neostigmine bromide and neostigmine methylsulfate; dosage expressed in terms of the salts.a b c

Pediatric Patients Myasthenia Gravis Diagnosis IM

Children: 0.025–0.04 mg/kg.103 a Give 0.011 mg/kg atropine sulfate sub-Q or IM 30 minutes before neostigmine or IV immediately before the IM neostigmine test dose.103 a (See Pediatric Use under Cautions.)

Treatment Oral

2 mg/kg daily divided into doses administered every 3–4 hours as needed.103 (See Pediatric Use under Cautions.)

Adjust dosage so the patient takes larger doses at times of greatest fatigue (e.g., 30 minutes before meals if difficulty eating).a c

Oral dosage changes may take several days to show results.a When a further increase in dosage produces no corresponding increase in muscle strength, reduce dosage to the previous level.a

Oral dosage requirements are approximately 30 times parenteral dosage requirements.a Generally 15 mg oral neostigmine bromide is equivalent to 0.5 mg parenteral neostigmine methylsulfate.c

IM, IV, or Sub-Q

0.01–0.04 mg/kg every 2–4 hours.103 104 In neonates, myasthenia gravis tends to be self-limiting; gradually reduce daily dosage until drug can be withdrawn.a (See Pediatric Use under Cautions.)

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

Infants: 0.025–0.1 mg/kg (with atropine sulfate or glycopyrrolate).103 (See Pediatric Use under Cautions.)

Children: 0.025–0.08 mg/kg (with atropine sulfate or glycopyrrolate).103

Adults Myasthenia Gravis Diagnosis IM

0.022 mg/kg.103 a Give 0.011 mg/kg atropine sulfate IM 30 minutes before the test or IV atropine sulfate immediately before the IM neostigmine test dose.a

If cholinergic reaction occurs, discontinue test and give 0.4–0.6 mg or more IV atropine sulfate.a

If test is inconclusive, retest another day using 0.031 mg/kg neostigmine methylsulfate IM preceded by 0.016 mg/kg IM atropine sulfate.a

Treatment Oral

Initially, 15 mg 3 times daily.a Increase gradually at intervals ?24 hours.a

Usual maintenance dosage: 15–375 mg daily (average 150 mg daily);a c some patients may require 30–40 mg every 2–4 hours.a

Adjust dosage so the patient takes larger doses at times of greatest fatigue (e.g., 30 minutes before meals if difficulty eating).a c

Oral dosage changes may take several days to show results.a When a further increase in dosage produces no corresponding increase in muscle strength, reduce dosage to the previous level.a

Oral dosage requirements are approximately 30 times parenteral dosage requirements.a Generally 15 mg oral neostigmine bromide is equivalent to 0.5 mg parenteral neostigmine methylsulfate.c

IV, IM, or Sub-Q

Initially, 0.5–2.5 mg as needed.a

Give 0.6–1.2 mg IV atropine sulfate concurrently with (but in a separate syringe) large parenteral neostigmine doses to counteract adverse muscarinic effects; observe patient closely for cholinergic reactions.a b

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

0.5–2.5 mg.a Give concurrently with (but in a separate syringe) or immediately after 0.6–1.2 mg IV atropine sulfatea b or 0.2–0.6 mg glycopyrrolate.a Repeat as required; total neostigmine methylsulfate dose usually ?5 mg.b

For cardiac or severely ill patients, titrate dosage with a peripheral nerve stimulator.a b

Full recovery usually occurs within 3–5 minutes but may be delayed in patients with extreme debilitation, hypokalemia, or carcinomatosis, or with concurrent use of certain broad spectrum antibiotics (e.g., aminoglycosides) or anesthetic agents (e.g., ether).a

Postoperative Distention and Urinary Retention Prevention IM or Sub-Q

0.25 mg as soon as possible after surgery; repeat every 4–6 hours for 2–3 days.a b

Treatment IM or Sub-Q

0.5 mg; exclude mechanical obstruction before giving neostigmine.a b

If no response within 1 hour of first dose in patients with urinary retention, catheterize patient; repeat 0.5-mg doses every 3 hours for at least 5 doses after bladder is emptied.a b

Prescribing Limits Adults Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

Usually do not exceed total dose of 5 mg.a b

Special Populations

No special population dosage recommendations at this time.a b c

Cautions for Neostigmine Methylsulfate Contraindications

Known hypersensitivity to neostigmine.a b c

Mechanical obstruction of the intestinal or urinary tract.a b c

Peritonitis.a b c

Neostigmine bromide should not be used in patients with known hypersensitivity to bromides.a c

Warnings/Precautions Warnings Cholinergic Crisis

Overdosage may result in cholinergic crisis (e.g., excessive salivation and sweating, miosis, nausea, vomiting, diarrhea, bradycardia or tachycardia, hypotension, confusion, seizures, coma, severe muscle weakness, paralysis); may result in death.a b c If overdosage occurs, withdraw all anticholinesterase drugs, maintain adequate respiration, and give IV atropine.a b c

Myasthenic crisis due to increased disease severity also causes extreme muscle weakness; symptomatic differentiation from cholinergic crisis may be difficult.a b c Time to onset of symptoms approximately 1 hour after dose suggests neostigmine overdosage; onset 3 hours after dose suggests underdosage or resistance.a May require use of edrophonium chloride for the differential diagnosis.a b c

If severe cholinergic reaction occurs, discontinue immediately and institute appropriate therapy as indicated (e.g., atropine sulfate).a b c

Concomitant Diseases

Use with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, or peptic ulcer.b c

Avoid large oral doses in patients with megacolon or decreased GI motility because of risk of accumulation and toxicity when GI motility is restored.a Also avoid large oral doses in conditions that might cause increased absorption from the intestinal tract.c

Do not use in patients with peritonitis or doubtful bowel viability.a

Ileorectal Anastomoses

Neostigmine-induced peristalsis may disrupt recently completed ileorectal anastomoses if given postoperatively.a Halothane anesthesia may decrease risk; however, manufacturer states neostigmine should not be administered in the presence of high concentrations of halothane or cyclopropane.a b

Sensitivity Reactions Bromide Sensitivity

Use caution in patients with known bromide sensitivity; acneiform rash may develop.a Usually disappears when neostigmine bromide is discontinued.a

Specific Populations Pregnancy

Category C.b c

Risk of uterine irritability and induction of premature labor if anticholinesterase agents are given IV near term.b c

Lactation

Not known whether neostigmine is distributed into milk.b c Discontinue nursing or the drug.b c

Pediatric Use

Manufacturers state that safety and efficacy have not been established in pediatric patients, but the drug has been used in this population (e.g., neonatal myasthenia gravis).103 104 b c

Common Adverse Effects

Salivation, muscle fasciculation, intestinal cramps, diarrhea.a b c

Interactions for Neostigmine Methylsulfate Specific Drugs

Drug

Interaction

Comments

Aminoglycosides (e.g., kanamycin, neomycin, streptomycin )

Possible accentuation of neuromuscular blockadea b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Anesthetics, local and general

Interferes with neuromuscular transmissiona b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Do not administer neostigmine in presence of high halothane or cyclopropane concentrationsa b

Antiarrhythmic agents

Interferes with neuromuscular transmissiona b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Anticholinergic drugs

Possible reduced intestinal motilityc

Use caution if co-administered with oral neostigminec

Atropine

Antagonizes muscarinic effects of neostigminea

Interaction used to therapeutic advantage to counteract muscarinic symptoms of neostigmine toxicity; however, atropine also may mask manifestations of neostigmine overdose and prevent early detection of cholinergic crisisa b c

Dexpanthenol

Converted to pantothenic acid in vivo; possible additive effects due to increased acetylcholine productiona

Neuromuscular blocking agents, depolarizing (e.g., decamethonium [no longer commercially available in the US], succinylcholine)

Possible enhanced and/or prolonged neuromuscular blockadea b c

Do not use for reversal of depolarizing neuromuscular blockadea

Neuromuscular blocking agents, nondepolarizing (e.g., gallamine, metocurine, tubocurarine [all no longer commercially available in the US], pancuronium)

Antagonism of nondepolarizing muscle relaxant effectsa

Interaction used to therapeutic advantage to reverse muscle relaxation induced by neuromuscular blocking agents after surgerya

Neostigmine Methylsulfate Pharmacokinetics Absorption Bioavailability

Poorly absorbed (1–2%) from GI tract following oral administration.a c

Peak plasma concentrations occur 1–2 hours after oral ingestion with considerable interindividual variations or about 30 minutes after IM injection.a b c

Onset

Effects on peristaltic activity begin 2–4 hours after oral administration or 10–30 minutes after parenteral injection.a b

Maximal effects within 20–30 minutes after parenteral administration.a

Duration

2.5–4 hours after IM injection.a b

Distribution Extent

Not expected to cross the placenta in therapeutic doses; may cross the placenta with large oral doses.a Not known whether distributed into human milk.a

Plasma Protein Binding

15–25% to serum albumin.a b c

Elimination Metabolism

Metabolized via hydrolysis by cholinesterases and by microsomal enzymes in the liver.a b c

Elimination Route

Excreted in urine as unchanged drug (50%) and metabolites (30%).a b

Half-life

Oral: 42–60 minutes (mean: 52 minutes).c

IV: 47–60 minutes (mean: 53 minutes).b

IM: 51–90 minutes.b

Stability Storage Oral Tablets

Tight containers at <40°C; preferably 15–30°C.a

Parenteral Injection

15–30°C.b Protect from light; store in carton until use.b Do not freeze.a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Drug Compatibility Y-Site Compatibility (Neostigmine Methylsulfate)HID

Compatible

Heparin sodium

Hydrocortisone sodium succinate

Potassium chloride

Vitamin B complex with C

Compatibility in Syringe (Neostigmine Methylsulfate)HID

Compatible

Glycopyrrolate

Heparin sodium

Ondansetron HCl

Pentobarbital sodium

Thiopental sodium

ActionsActions

Reversibly inhibits acetylcholinesterase and prolongs and exaggerates the effects of acetylcholine.a b c Has direct cholinomimetic effect on skeletal muscle.a b c

Produces generalized cholinergic responses including miosis, bradycardia, increased tonus of intestinal musculature, constriction of bronchi and ureters, and stimulation of secretion by salivary and sweat glands.a

At sufficiently high dosage, directly blocks action at autonomic ganglia, causes CNS stimulation followed by CNS depression and, ultimately, depolarization blockade.a c

Advice to Patients

Patients with myasthenia gravis: Importance of carefully following prescribed dosage instructions.a Importance of keeping a daily record of condition to assist clinician in determining optimal therapeutic regimen.c

Importance of informing clinician of any allergy to bromide or anticholinesterase drugs.a c

Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.a b c

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a b c

Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Neostigmine Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder

Oral

Tablets

15 mg

Prostigmin (scored)

Valeant

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Neostigmine Methylsulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Parenteral

Injection

0.5 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

1 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions February 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Miller LS, Staas WE Jr, Herbison GJ. Abdominal problems in patients with spinal cord lesions. Arch Phys Med Rehabil. 1975; 56:405-8. [PubMed 1164181]

101. Glick ME, Meshkinpour H, Haldeman S et al. Colonic dysfunction in patients with thoracic spinal cord injury. Gastroenterology. 1984; 86:287-94. [PubMed 6690355]

102. Miller LS. Neostigmine for severe constipation with spinal cord lesions. Ann Intern Med. 1984; 101:279.

103. Gunn VL, Nechyba C, eds. The Harriet Lane handbook: a manual for pediatric house officers. 16th ed. Philadelphia, PA: Mosby; 2002:772

104. Behrman RE, Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2004:2470

a. AHFS drug information 2007. McEvoy GK, ed. Neostigmine bromide, neostigmine methylsulfate. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1245-7.

b. American Regent Laboratories, Inc. Neostigmine methylsulfate injection, USP prescribing information. Shirley, NY; 2002 Sept.

c. ICN Pharmaceuticals, Inc. Prostigmin (neostigmine bromide) tablets prescribing information. Costa Mesa, CA; 1998 Nov.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1203-4.

More Neostigmine Methylsulfate resources Neostigmine Methylsulfate Side Effects (in more detail) Neostigmine Methylsulfate Use in Pregnancy & Breastfeeding Neostigmine Methylsulfate Drug Interactions Neostigmine Methylsulfate Support Group 0 Reviews for Neostigmine Methylsulfate - Add your own review/rating Compare Neostigmine Methylsulfate with other medications Myasthenia Gravis
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antimyasthenic Oral, Parenteral


Class Name: antimyasthenic (Oral route, Parenteral route)

Commonly used brand name(s)

In the U.S.

Aricept Cognex Exelon Mestinon Mestinon Timespan Mytelase Chloride Prostigmin Bromide Razadyne Razadyne ER Razadyne IR

In Canada

Reminyl

Available Dosage Forms:

Tablet Syrup Tablet, Extended Release Capsule, Extended Release Solution Tablet, Disintegrating Capsule Uses For This Medicine

Antimyasthenics are given by mouth or by injection to treat myasthenia gravis. Neostigmine may also be given by injection as a test for myasthenia gravis. Sometimes neostigmine is given by injection to prevent or treat certain urinary tract or intestinal disorders. In addition, neostigmine or pyridostigmine may be given by injection as an antidote to certain types of muscle relaxants used in surgery.

These medicines are available only with your doctor's prescription.

Before Using This Medicine Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to medicines in this group or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Although there is no specific information comparing use of antimyasthenics in children with use in other age groups, these medicines are not expected to cause different side effects or problems in children than they do in adults.

Geriatric

Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. Although there is not much information comparing use of antimyasthenics in the elderly with use in other age groups, these medicines are not expected to cause different side effects or problems in older people than they do in younger adults.

Pregnancy

Antimyasthenics have not been reported to cause birth defects; however, muscle weakness has occurred temporarily in some newborn babies whose mothers took antimyasthenics during pregnancy.

Breast Feeding

Antimyasthenics have not been reported to cause problems in nursing babies.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking any of these medicines, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using medicines in this class with any of the following medicines is not recommended. Your doctor may decide not to treat you with a medication in this class or change some of the other medicines you take.

Atropine Metoclopramide

Using medicines in this class with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Succinylcholine Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of medicines in this class. Make sure you tell your doctor if you have any other medical problems, especially:

Intestinal blockage or Urinary tract blockage or Urinary tract infection—These medicines may make the condition worse. Proper Use of This Medicine

Your doctor may want you to take this medicine with food or milk to help lessen the chance of side effects. If you have any questions about how you should be taking this medicine, check with your doctor.

Take this medicine only as directed. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance of side effects.

If you are taking this medicine for myasthenia gravis:

When you first begin taking this medicine, your doctor may want you to keep a daily record of: the time you take each dose. how long you feel better after taking each dose. how long you feel worse. any side effects that occur.

This is to help your doctor decide whether the dose of this medicine should be increased or decreased and how often the medicine should be taken in order for it to be most effective in your condition.

Dosing

The dose medicines in this class will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of these medicines. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

For ambenonium For oral dosage form (tablets): For myasthenia gravis: Adults and teenagers—At first, the dose is 5 milligrams (mg) three or four times per day. Then, if needed, the dose will be adjusted by your doctor. Children—The dose is based on body weight or size and must be determined by your doctor. The total daily dose is usually 300 micrograms (mcg) per kilogram (kg) (136 mcg per pound) of body weight or 10 mg per square meter of body surface area. This dose may be divided into three or four smaller doses. If needed, the total daily dose will be increased to 1.5 mg per kg (0.68 mg per pound) of body weight or 50 mg per square meter of body surface area. This dose may be divided into three or four smaller doses. For neostigmine For oral dosage form (tablets): For myasthenia gravis: Adults and teenagers—At first, the dose is 15 milligrams (mg) every three or four hours. Then, the dose is 150 mg taken over a twenty-four-hour period. Children—The dose is based on body weight or size and must be determined by your doctor. The total daily dose is usually 2 mg per kilogram (kg) (0.91 mg per pound) of body weight or 60 mg per square meter of body surface area. This dose may be divided into six to eight smaller doses. For injection dosage form: For myasthenia gravis: Adults and teenagers—The usual dose is 500 micrograms (mcg) injected into a muscle or under the skin. Children—The dose is based on body weight and must be determined by your doctor. It is usually 10 to 40 mcg per kg (4.5 to 18.2 mcg per pound) of body weight, injected into a muscle or under the skin, every two or three hours. For urinary tract or intestinal disorders: Adults and teenagers—The usual dose is 250 to 500 mcg, injected into a muscle or under the skin, as needed. Children—Use and dose must be determined by your doctor. For pyridostigmine For oral dosage forms (syrup and tablets): For myasthenia gravis: Adults and teenagers—At first, the dose is 30 to 60 milligrams (mg) every three or four hours. Then, the dose is 60 mg to 1.5 grams (usually 600 mg) per day. Children—The dose is based on body weight or size and must be determined by your doctor. The total daily dose is usually 7 mg per kilogram (kg) (3.2 mg per pound) of body weight or 200 mg per square meter of body surface area. This dose may be divided into five or six smaller doses. For long-acting oral dosage form (extended-release tablets): For myasthenia gravis: Adults and teenagers—The usual dose is 180 to 540 mg one or two times per day. Children—Dose must be determined by your doctor. For injection dosage form: For myasthenia gravis: Adults and teenagers—The usual dose is 2 mg, injected into a muscle or vein, every two or three hours. Children—The dose is based on body weight and must be determined by your doctor. It is usually 50 to 150 micrograms (mcg) per kg (22.7 to 68.1 mcg per pound) of body weight, injected into a muscle every four to six hours. Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Keep out of the reach of children.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Do not keep outdated medicine or medicine no longer needed.

Keep the syrup form of pyridostigmine from freezing.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Symptoms of overdose Blurred vision clumsiness or unsteadiness confusion convulsions (seizures) diarrhea (severe) increase in bronchial secretions or watering of mouth (excessive) increasing muscle weakness (especially in the arms, neck, shoulders, and tongue) muscle cramps or twitching nausea or vomiting (severe) shortness of breath, troubled breathing, wheezing, or tightness in chest slow heartbeat slurred speech stomach cramps or pain (severe) unusual irritability, nervousness, restlessness, or fear unusual tiredness or weakness

Check with your doctor as soon as possible if any of the following side effects occur:

Rare Redness, swelling, or pain at place of injection (for pyridostigmine injection only) skin rash (does not apply to ambenonium)

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common Diarrhea increased sweating increased watering of mouth nausea or vomiting stomach cramps or pain Less common Frequent urge to urinate increase in bronchial secretions unusually small pupils unusual watering of eyes

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

The information contained in the Thomson Healthcare (Micromedex) products as delivered by Drugs.com is intended as an educational aid only. It is not intended as medical advice for individual conditions or treatment. It is not a substitute for a medical exam, nor does it replace the need for services provided by medical professionals. Talk to your doctor, nurse or pharmacist before taking any prescription or over the counter drugs (including any herbal medicines or supplements) or following any treatment or regimen. Only your doctor, nurse, or pharmacist can provide you with advice on what is safe and effective for you.

The use of the Thomson Healthcare products is at your sole risk. These products are provided "AS IS" and "as available" for use, without warranties of any kind, either express or implied. Thomson Healthcare and Drugs.com make no representation or warranty as to the accuracy, reliability, timeliness, usefulness or completeness of any of the information contained in the products. Additionally, THOMSON HEALTHCARE MAKES NO REPRESENTATION OR WARRANTIES AS TO THE OPINIONS OR OTHER SERVICE OR DATA YOU MAY ACCESS, DOWNLOAD OR USE AS A RESULT OF USE OF THE THOMSON HEALTHCARE PRODUCTS. ALL IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE OR USE ARE HEREBY EXCLUDED. Thomson Healthcare does not assume any responsibility or risk for your use of the Thomson Healthcare products.


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Neostigmine Bromide


Class: Parasympathomimetic (Cholinergic) Agents
Note: This monograph also contains information on Neostigmine Methylsulfate
VA Class: AU300
CAS Number: 59-99-4
Brands: Prostigmin

Introduction

Reversible anticholinesterase agent.a b c

Uses for Neostigmine Bromide Myasthenia Gravis

Symptomatic management of myasthenia gravis to improve muscle strength.a b c

Not effective in patients resistant to anticholinesterase drugs.a

Differential diagnosis of myasthenia gravis.a However, edrophonium is preferred except in lengthy procedures involving tests of limb strength.a

Surgery

Postoperative reversal of the effects of nondepolarizing neuromuscular blocking agents (e.g., tubocurarine, metocurine, gallamine [all no longer commercially available in the US], pancuronium).a b

Not effective and should not be used for reversal of depolarizing neuromuscular agents (e.g., succinylcholine, decamethonium).a

Postoperative Distention and Urinary Retention

Prevention and treatment of postoperative distention and urinary retention after excluding mechanical obstruction;a b bethanechol chloride usually preferred.a

Aminoglycoside Toxicity

Has been used to antagonize the neuromuscular blocking effects of aminoglycoside antibiotics† (e.g., kanamycin) with variable results; some clinicians found neostigmine ineffective.a (See Specific Drugs under Interactions.)

Acceleration of Barium Transit through Small Intestine

Has been used to accelerate barium transport through the small bowel†; other agents may be more effective.a

Neostigmine Bromide Dosage and Administration General Diagnosis of Myasthenia Gravis

Discontinue all anticholinesterase drugs for at least 8 hours before administering neostigmine methylsulfate.a

Administer atropine sulfate IM 30 minutes before or IV concurrently with IM neostigmine methylsulfate to prevent adverse muscarinic effects.a

Determine placebo response by measuring muscle strength in cranial musculature before and after atropine sulfate administration.a

Other myopathies may show slight improvement in muscle strength; however, only myasthenia gravis responds with marked improvement.a

Treatment of Myasthenia Gravis

Dosage, route, and frequency of administration depend on the requirements and clinical response of the patient.a Carefully individualize dosage according to individual requirements and response and minimize adverse effects by precise dosage adjustment.a

Use parenteral form if oral therapy is impracticalb or in acute myasthenic crisis if difficulty in breathing and swallowing is present.c Transfer to the oral formulation as soon as tolerated.c

Dosage requirements may vary from day to day, according to remissions and exacerbations of the disease and the physical and emotional stress suffered by the patient.a

Treat mild exacerbations by increasing dosage under medical supervision as long as increase produces symptomatic improvement.a

Complete restoration of muscle strength is rare; do not attempt to relieve all symptoms by increasing dosage above maximum response level.a

Once stabilized on neostigmine, may teach patients how to recognize adverse muscarinic effects and self-modify dosage or take atropine, if necessary.a

Individual muscle groups respond differently to the same dose; may produce weakness in one while increasing strength in another.a Measure vital capacity whenever increasing dosage to ensure good respiratory function.a Have adequate facilities for CPR, cardiac monitoring, endotracheal intubation, and respiratory assistance available during dosage adjustment.a

Patients may become refractory after prolonged treatment; decreasing dosage or withdrawing drug for several days under medical supervision may restore responsiveness.a

If the patient is placed on a ventilator or corticosteroid therapy is begun, reduce dosage or eliminate neostigmine, if possible.a

Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects

Always have atropine and medications to treat shock readily available in case of hypersensitivity reaction.b

Give IV atropine sulfate or glycopyrrolate immediately prior to or concurrently with neostigmine (in separate syringes) when reversing the actions of nondepolarizing neuromuscular blocking agents to minimize neostigmine's adverse muscarinic effects.103 a b If bradycardic, give IV antimuscarinics before neostigmine to increase pulse rate to about 80 bpm.a b

Optimum time for neostigmine administration is during hyperventilation when blood CO2 concentration is low.b

Patient must be well ventilated; maintain patent airway until complete recovery of normal respiration is assured.a b Observe closely for recurrent respiratory depression.a

Parenteral Administration

Prior or simultaneous administration of atropine may be advisable when administering large parenteral doses of neostigmine methylsulfate.a b

Administration

Administer neostigmine bromide orally; administer neostigmine methylsulfate IV, IM, or sub-Q.a b c

Oral Administration

Administer orally, adjusting frequency and timing of administration according to individual response.a

Parenteral Administration

For solution and drug compatibility information, see Compatibility under Stability.

Administer neostigmine methylsulfate IV, IM, or sub-Q.a b

Surgery: Give by slow IV injection.a

Dosage

Available as neostigmine bromide and neostigmine methylsulfate; dosage expressed in terms of the salts.a b c

Pediatric Patients Myasthenia Gravis Diagnosis IM

Children: 0.025–0.04 mg/kg.103 a Give 0.011 mg/kg atropine sulfate sub-Q or IM 30 minutes before neostigmine or IV immediately before the IM neostigmine test dose.103 a (See Pediatric Use under Cautions.)

Treatment Oral

2 mg/kg daily divided into doses administered every 3–4 hours as needed.103 (See Pediatric Use under Cautions.)

Adjust dosage so the patient takes larger doses at times of greatest fatigue (e.g., 30 minutes before meals if difficulty eating).a c

Oral dosage changes may take several days to show results.a When a further increase in dosage produces no corresponding increase in muscle strength, reduce dosage to the previous level.a

Oral dosage requirements are approximately 30 times parenteral dosage requirements.a Generally 15 mg oral neostigmine bromide is equivalent to 0.5 mg parenteral neostigmine methylsulfate.c

IM, IV, or Sub-Q

0.01–0.04 mg/kg every 2–4 hours.103 104 In neonates, myasthenia gravis tends to be self-limiting; gradually reduce daily dosage until drug can be withdrawn.a (See Pediatric Use under Cautions.)

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

Infants: 0.025–0.1 mg/kg (with atropine sulfate or glycopyrrolate).103 (See Pediatric Use under Cautions.)

Children: 0.025–0.08 mg/kg (with atropine sulfate or glycopyrrolate).103

Adults Myasthenia Gravis Diagnosis IM

0.022 mg/kg.103 a Give 0.011 mg/kg atropine sulfate IM 30 minutes before the test or IV atropine sulfate immediately before the IM neostigmine test dose.a

If cholinergic reaction occurs, discontinue test and give 0.4–0.6 mg or more IV atropine sulfate.a

If test is inconclusive, retest another day using 0.031 mg/kg neostigmine methylsulfate IM preceded by 0.016 mg/kg IM atropine sulfate.a

Treatment Oral

Initially, 15 mg 3 times daily.a Increase gradually at intervals ?24 hours.a

Usual maintenance dosage: 15–375 mg daily (average 150 mg daily);a c some patients may require 30–40 mg every 2–4 hours.a

Adjust dosage so the patient takes larger doses at times of greatest fatigue (e.g., 30 minutes before meals if difficulty eating).a c

Oral dosage changes may take several days to show results.a When a further increase in dosage produces no corresponding increase in muscle strength, reduce dosage to the previous level.a

Oral dosage requirements are approximately 30 times parenteral dosage requirements.a Generally 15 mg oral neostigmine bromide is equivalent to 0.5 mg parenteral neostigmine methylsulfate.c

IV, IM, or Sub-Q

Initially, 0.5–2.5 mg as needed.a

Give 0.6–1.2 mg IV atropine sulfate concurrently with (but in a separate syringe) large parenteral neostigmine doses to counteract adverse muscarinic effects; observe patient closely for cholinergic reactions.a b

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

0.5–2.5 mg.a Give concurrently with (but in a separate syringe) or immediately after 0.6–1.2 mg IV atropine sulfatea b or 0.2–0.6 mg glycopyrrolate.a Repeat as required; total neostigmine methylsulfate dose usually ?5 mg.b

For cardiac or severely ill patients, titrate dosage with a peripheral nerve stimulator.a b

Full recovery usually occurs within 3–5 minutes but may be delayed in patients with extreme debilitation, hypokalemia, or carcinomatosis, or with concurrent use of certain broad spectrum antibiotics (e.g., aminoglycosides) or anesthetic agents (e.g., ether).a

Postoperative Distention and Urinary Retention Prevention IM or Sub-Q

0.25 mg as soon as possible after surgery; repeat every 4–6 hours for 2–3 days.a b

Treatment IM or Sub-Q

0.5 mg; exclude mechanical obstruction before giving neostigmine.a b

If no response within 1 hour of first dose in patients with urinary retention, catheterize patient; repeat 0.5-mg doses every 3 hours for at least 5 doses after bladder is emptied.a b

Prescribing Limits Adults Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

Usually do not exceed total dose of 5 mg.a b

Special Populations

No special population dosage recommendations at this time.a b c

Cautions for Neostigmine Bromide Contraindications

Known hypersensitivity to neostigmine.a b c

Mechanical obstruction of the intestinal or urinary tract.a b c

Peritonitis.a b c

Neostigmine bromide should not be used in patients with known hypersensitivity to bromides.a c

Warnings/Precautions Warnings Cholinergic Crisis

Overdosage may result in cholinergic crisis (e.g., excessive salivation and sweating, miosis, nausea, vomiting, diarrhea, bradycardia or tachycardia, hypotension, confusion, seizures, coma, severe muscle weakness, paralysis); may result in death.a b c If overdosage occurs, withdraw all anticholinesterase drugs, maintain adequate respiration, and give IV atropine.a b c

Myasthenic crisis due to increased disease severity also causes extreme muscle weakness; symptomatic differentiation from cholinergic crisis may be difficult.a b c Time to onset of symptoms approximately 1 hour after dose suggests neostigmine overdosage; onset 3 hours after dose suggests underdosage or resistance.a May require use of edrophonium chloride for the differential diagnosis.a b c

If severe cholinergic reaction occurs, discontinue immediately and institute appropriate therapy as indicated (e.g., atropine sulfate).a b c

Concomitant Diseases

Use with caution in patients with epilepsy, bronchial asthma, bradycardia, recent coronary occlusion, vagotonia, hyperthyroidism, cardiac arrhythmias, or peptic ulcer.b c

Avoid large oral doses in patients with megacolon or decreased GI motility because of risk of accumulation and toxicity when GI motility is restored.a Also avoid large oral doses in conditions that might cause increased absorption from the intestinal tract.c

Do not use in patients with peritonitis or doubtful bowel viability.a

Ileorectal Anastomoses

Neostigmine-induced peristalsis may disrupt recently completed ileorectal anastomoses if given postoperatively.a Halothane anesthesia may decrease risk; however, manufacturer states neostigmine should not be administered in the presence of high concentrations of halothane or cyclopropane.a b

Sensitivity Reactions Bromide Sensitivity

Use caution in patients with known bromide sensitivity; acneiform rash may develop.a Usually disappears when neostigmine bromide is discontinued.a

Specific Populations Pregnancy

Category C.b c

Risk of uterine irritability and induction of premature labor if anticholinesterase agents are given IV near term.b c

Lactation

Not known whether neostigmine is distributed into milk.b c Discontinue nursing or the drug.b c

Pediatric Use

Manufacturers state that safety and efficacy have not been established in pediatric patients, but the drug has been used in this population (e.g., neonatal myasthenia gravis).103 104 b c

Common Adverse Effects

Salivation, muscle fasciculation, intestinal cramps, diarrhea.a b c

Interactions for Neostigmine Bromide Specific Drugs

Drug

Interaction

Comments

Aminoglycosides (e.g., kanamycin, neomycin, streptomycin )

Possible accentuation of neuromuscular blockadea b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Anesthetics, local and general

Interferes with neuromuscular transmissiona b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Do not administer neostigmine in presence of high halothane or cyclopropane concentrationsa b

Antiarrhythmic agents

Interferes with neuromuscular transmissiona b c

Use cautiously, if at all;a neostigmine dosage adjustment may be neededa b c

Anticholinergic drugs

Possible reduced intestinal motilityc

Use caution if co-administered with oral neostigminec

Atropine

Antagonizes muscarinic effects of neostigminea

Interaction used to therapeutic advantage to counteract muscarinic symptoms of neostigmine toxicity; however, atropine also may mask manifestations of neostigmine overdose and prevent early detection of cholinergic crisisa b c

Dexpanthenol

Converted to pantothenic acid in vivo; possible additive effects due to increased acetylcholine productiona

Neuromuscular blocking agents, depolarizing (e.g., decamethonium [no longer commercially available in the US], succinylcholine)

Possible enhanced and/or prolonged neuromuscular blockadea b c

Do not use for reversal of depolarizing neuromuscular blockadea

Neuromuscular blocking agents, nondepolarizing (e.g., gallamine, metocurine, tubocurarine [all no longer commercially available in the US], pancuronium)

Antagonism of nondepolarizing muscle relaxant effectsa

Interaction used to therapeutic advantage to reverse muscle relaxation induced by neuromuscular blocking agents after surgerya

Neostigmine Bromide Pharmacokinetics Absorption Bioavailability

Poorly absorbed (1–2%) from GI tract following oral administration.a c

Peak plasma concentrations occur 1–2 hours after oral ingestion with considerable interindividual variations or about 30 minutes after IM injection.a b c

Onset

Effects on peristaltic activity begin 2–4 hours after oral administration or 10–30 minutes after parenteral injection.a b

Maximal effects within 20–30 minutes after parenteral administration.a

Duration

2.5–4 hours after IM injection.a b

Distribution Extent

Not expected to cross the placenta in therapeutic doses; may cross the placenta with large oral doses.a Not known whether distributed into human milk.a

Plasma Protein Binding

15–25% to serum albumin.a b c

Elimination Metabolism

Metabolized via hydrolysis by cholinesterases and by microsomal enzymes in the liver.a b c

Elimination Route

Excreted in urine as unchanged drug (50%) and metabolites (30%).a b

Half-life

Oral: 42–60 minutes (mean: 52 minutes).c

IV: 47–60 minutes (mean: 53 minutes).b

IM: 51–90 minutes.b

Stability Storage Oral Tablets

Tight containers at <40°C; preferably 15–30°C.a

Parenteral Injection

15–30°C.b Protect from light; store in carton until use.b Do not freeze.a

Compatibility

For information on systemic interactions resulting from concomitant use, see Interactions.

Drug Compatibility Y-Site Compatibility (Neostigmine Methylsulfate)HID

Compatible

Heparin sodium

Hydrocortisone sodium succinate

Potassium chloride

Vitamin B complex with C

Compatibility in Syringe (Neostigmine Methylsulfate)HID

Compatible

Glycopyrrolate

Heparin sodium

Ondansetron HCl

Pentobarbital sodium

Thiopental sodium

ActionsActions

Reversibly inhibits acetylcholinesterase and prolongs and exaggerates the effects of acetylcholine.a b c Has direct cholinomimetic effect on skeletal muscle.a b c

Produces generalized cholinergic responses including miosis, bradycardia, increased tonus of intestinal musculature, constriction of bronchi and ureters, and stimulation of secretion by salivary and sweat glands.a

At sufficiently high dosage, directly blocks action at autonomic ganglia, causes CNS stimulation followed by CNS depression and, ultimately, depolarization blockade.a c

Advice to Patients

Patients with myasthenia gravis: Importance of carefully following prescribed dosage instructions.a Importance of keeping a daily record of condition to assist clinician in determining optimal therapeutic regimen.c

Importance of informing clinician of any allergy to bromide or anticholinesterase drugs.a c

Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs and dietary or herbal supplements, as well as any concomitant illnesses.a b c

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.a b c

Importance of informing patients of other important precautionary information. (See Cautions.)

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Neostigmine Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder

Oral

Tablets

15 mg

Prostigmin (scored)

Valeant

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Neostigmine Methylsulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Parenteral

Injection

0.5 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

1 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

Disclaimer

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS Drug Information. © Copyright, 1959-2011, Selected Revisions February 2008. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

† Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Miller LS, Staas WE Jr, Herbison GJ. Abdominal problems in patients with spinal cord lesions. Arch Phys Med Rehabil. 1975; 56:405-8. [PubMed 1164181]

101. Glick ME, Meshkinpour H, Haldeman S et al. Colonic dysfunction in patients with thoracic spinal cord injury. Gastroenterology. 1984; 86:287-94. [PubMed 6690355]

102. Miller LS. Neostigmine for severe constipation with spinal cord lesions. Ann Intern Med. 1984; 101:279.

103. Gunn VL, Nechyba C, eds. The Harriet Lane handbook: a manual for pediatric house officers. 16th ed. Philadelphia, PA: Mosby; 2002:772

104. Behrman RE, Kliegman RM, Jenson HB, eds. Nelson textbook of pediatrics. 17th ed. Philadelphia: Saunders; 2004:2470

a. AHFS drug information 2007. McEvoy GK, ed. Neostigmine bromide, neostigmine methylsulfate. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1245-7.

b. American Regent Laboratories, Inc. Neostigmine methylsulfate injection, USP prescribing information. Shirley, NY; 2002 Sept.

c. ICN Pharmaceuticals, Inc. Prostigmin (neostigmine bromide) tablets prescribing information. Costa Mesa, CA; 1998 Nov.

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:1203-4.

More Neostigmine Bromide resources Neostigmine Bromide Side Effects (in more detail) Neostigmine Bromide Use in Pregnancy & Breastfeeding Neostigmine Bromide Drug Interactions Neostigmine Bromide Support Group 0 Reviews for Neostigmine Bromide - Add your own review/rating Neostigmine Professional Patient Advice (Wolters Kluwer) neostigmine Concise Consumer Information (Cerner Multum) neostigmine Injection Advanced Consumer (Micromedex) - Includes Dosage Information Neostigmine MedFacts Consumer Leaflet (Wolters Kluwer) neostigmine Advanced Consumer (Micromedex) - Includes Dosage Information Compare Neostigmine Bromide with other medications Myasthenia Gravis
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Lomotil Solution


Pronunciation: AT-row-peen/dye-fen-OX-i-late
Generic Name: Atropine/Diphenoxylate
Brand Name: Lomotil
Lomotil Solution is used for:

Treating diarrhea. It may also be used for other conditions as determined by your doctor.

Lomotil Solution is an antidiarrheal and anticholinergic combination. It works by decreasing the motion of muscles in the intestines and prolonging the time it takes to move the contents through the body.

Do NOT use Lomotil Solution if: you are allergic to any ingredient in Lomotil Solution you have diarrhea caused by certain conditions (eg, pseudomembranous colitis, enterotoxin-producing bacteria, food poisoning) you have jaundice (yellowing of the eyes or skin) you have a blockage of the stomach or bowel, angle-closure glaucoma, myasthenia gravis, urinary blockage, excess acid in the stomach or throat, esophagus problems (eg, difficulty swallowing, inflammation), bowel muscle weakness, or heart problems with severe bleeding you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Lomotil Solution:

Some medical conditions may interact with Lomotil Solution. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a history of jaundice (yellowing of the eyes or skin) or megacolon if you have abnormal blood levels of electrolytes (eg, potassium, sodium), ulcerative colitis, liver or kidney problems, Down syndrome, numbness due to nerve damage, prostate problems (enlarged prostate), a blockage of the bladder, trouble urinating, heart problems (eg, congestive heart failure, irregular heartbeat), hiatal hernia, asthma, open-angle glaucoma, or risk factors for glaucoma if you are dehydrated

Some MEDICINES MAY INTERACT with Lomotil Solution. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) they may increase the risk of Lomotil Solution's side effects Barbiturates (eg, phenobarbital) or sodium oxybate (GHB) because the risk of their side effects may be increased by Lomotil Solution Monoamine oxidase inhibitors (MAOIs) (eg, phenelzine) because the risk of serious side effects, including severe high blood pressure, may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Lomotil Solution may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Lomotil Solution:

Use Lomotil Solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Lomotil Solution by mouth with or without food. Use the dropper than comes with Lomotil Solution to measure your dose. Ask your pharmacist for help if you are unsure of how to measure your dose. If you miss a dose of Lomotil Solution and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Lomotil Solution.

Important safety information: Lomotil Solution may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Lomotil Solution with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Lomotil Solution; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. This could increase the risk of serious side effects. If your symptoms do not get better within 10 days (2 days for children) or if they get worse, check with your doctor. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting. Lomotil Solution may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Tell your doctor or dentist that you take Lomotil Solution before you receive any medical or dental care, emergency care, or surgery. Use Lomotil Solution with caution in the ELDERLY; they may be more sensitive to its effects, especially excitement, agitation, or drowsiness. Lomotil Solution should not be used in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed. Caution is advised when using Lomotil Solution in CHILDREN 2 years of age and older; they may be more sensitive to its effects. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Lomotil Solution while you are pregnant. Lomotil Solution is found in breast milk. If you are or will be breast-feeding while you use Lomotil Solution, check with your doctor. Discuss any possible risks to your baby.

When used for longer than a few weeks or at high doses, some people develop a need to continue taking Lomotil Solution. This is known as DEPENDENCE or addiction. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Possible side effects of Lomotil Solution:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased sweating; difficulty sleeping; dizziness; drowsiness; dry mouth, nose, or skin; headache; loss of appetite; loss of taste; nausea; nervousness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abdominal bloating or swelling; agitation; changes in heartbeat; confusion; continued or severe diarrhea; delirium; difficulty focusing your eyes; difficulty urinating; exaggerated sense of well-being; excitement; fast/irregular heartbeat; fever; hallucinations; numbness of the hands or feet; severely enlarged pupils; severe or prolonged restlessness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Lomotil side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include coma; difficulty breathing; dilated or constricted pupils; disorientation; fever; flushing; hallucinations; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; unusual eye movements; urinary retention; vomiting.

Proper storage of Lomotil Solution:

Store Lomotil Solution at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Lomotil Solution out of the reach of children and away from pets.

General information: If you have any questions about Lomotil Solution, please talk with your doctor, pharmacist, or other health care provider. Lomotil Solution is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Lomotil Solution. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Lomotil resources Lomotil Side Effects (in more detail) Lomotil Use in Pregnancy & Breastfeeding Drug Images Lomotil Drug Interactions Lomotil Support Group 16 Reviews for Lomotil - Add your own review/rating Compare Lomotil with other medications Diarrhea
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Lomotil


Pronunciation: AT-row-peen/dye-fen-OX-i-late
Generic Name: Atropine/Diphenoxylate
Brand Name: Examples include Lomotil and Lonox
Lomotil is used for:

Treating diarrhea. It may also be used for other conditions as determined by your doctor.

Lomotil is an antidiarrheal and anticholinergic combination. It works by decreasing the motion of muscles in the intestines and prolonging the time it takes to move the contents through the body.

Do NOT use Lomotil if: you are allergic to any ingredient in Lomotil you have diarrhea caused by certain conditions (eg, pseudomembranous colitis, enterotoxin-producing bacteria, food poisoning) you have jaundice (yellowing of the eyes or skin) you have a blockage of the stomach or bowel, angle-closure glaucoma, myasthenia gravis, urinary blockage, excess acid in the stomach or throat, esophagus problems (eg, difficulty swallowing, inflammation), bowel muscle weakness, or heart problems with severe bleeding you are taking sodium oxybate (GHB)

Contact your doctor or health care provider right away if any of these apply to you.

Before using Lomotil:

Some medical conditions may interact with Lomotil. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a history of jaundice (yellowing of the eyes or skin) or megacolon if you have abnormal blood levels of electrolytes (eg, potassium, sodium), ulcerative colitis, liver or kidney problems, Down syndrome, numbness due to nerve damage, prostate problems (enlarged prostate), a blockage of the bladder, trouble urinating, heart problems (eg, congestive heart failure, irregular heartbeat), hiatal hernia, asthma, open-angle glaucoma, or risk factors for glaucoma if you are dehydrated

Some MEDICINES MAY INTERACT with Lomotil. Tell your health care provider if you are taking any other medicines, especially any of the following:

Antihistamines (eg, diphenhydramine), medicine for Parkinson disease (eg, benztropine), or tricyclic antidepressants (eg, amitriptyline) because they may increase the risk of Lomotil's side effects Barbiturates (eg, phenobarbital) or sodium oxybate (GHB) because the risk of their side effects may be increased by Lomotil Monoamine oxidase inhibitors (MAOIs) (eg, phenelzine) because the risk of serious side effects, including severe high blood pressure, may be increased

This may not be a complete list of all interactions that may occur. Ask your health care provider if Lomotil may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use Lomotil:

Use Lomotil as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Take Lomotil by mouth with or without food. If you miss a dose of Lomotil and you are taking it regularly, take it as soon as possible. If several hours have passed or if it is nearing time for the next dose, do not double the dose to catch up, unless advised by your health care provider. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Lomotil.

Important safety information: Lomotil may cause drowsiness, dizziness, or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Lomotil with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol or use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Lomotil; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor. This could increase the risk of serious side effects. If your symptoms do not get better within 10 days (2 days for children) or if they get worse, check with your doctor. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Report any symptoms of fluid or electrolyte loss to your doctor: dry mouth; thirst; weakness; lethargy; drowsiness; restlessness; muscle pain or cramps; muscle weakness; low blood pressure; infrequent urination; rapid heartbeat; stomach disorders such as nausea and vomiting. Lomotil may make your eyes more sensitive to sunlight. It may help to wear sunglasses. Tell your doctor or dentist that you take Lomotil before you receive any medical or dental care, emergency care, or surgery. Use Lomotil with caution in the ELDERLY; they may be more sensitive to its effects, especially excitement, agitation, or drowsiness. Lomotil should not be used in CHILDREN younger than 13 years old; safety and effectiveness in these children have not been confirmed. Caution is advised when using Lomotil in CHILDREN 13 years of age and older; they may be more sensitive to its effects. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Lomotil while you are pregnant. Lomotil is found in breast milk. If you are or will be breast-feeding while you use Lomotil, check with your doctor. Discuss any possible risks to your baby.

When used for longer than a few weeks or at high doses, some people develop a need to continue taking Lomotil. This is known as DEPENDENCE or addiction. Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Possible side effects of Lomotil:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Blurred vision; constipation; decreased sweating; difficulty sleeping; dizziness; drowsiness; dry mouth, nose, or skin; headache; loss of appetite; loss of taste; nausea; nervousness.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abdominal bloating or swelling; agitation; changes in heartbeat; confusion; continued or severe diarrhea; delirium; difficulty focusing your eyes; difficulty urinating; exaggerated sense of well-being; excitement; fast/irregular heartbeat; fever; hallucinations; numbness of the hands or feet; severely enlarged pupils; severe or prolonged restlessness; speech disturbance; unusual weakness; vomiting.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

See also: Lomotil side effects (in more detail)

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately. Symptoms may include coma; difficulty breathing; dilated or constricted pupils; disorientation; fever; flushing; hallucinations; hyperactivity; muscle weakness; restlessness; seizures; severe dizziness; unusual eye movements; urinary retention; vomiting.

Proper storage of Lomotil:

Store Lomotil at room temperature, between 68 and 77 degrees F (20 and 25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep Lomotil out of the reach of children and away from pets.

General information: If you have any questions about Lomotil, please talk with your doctor, pharmacist, or other health care provider. Lomotil is to be used only by the patient for whom it is prescribed. Do not share it with other people. If your symptoms do not improve or if they become worse, check with your doctor. Check with your pharmacist about how to dispose of unused medicine.

This information is a summary only. It does not contain all information about Lomotil. If you have questions about the medicine you are taking or would like more information, check with your doctor, pharmacist, or other health care provider.

Issue Date: February 1, 2012 Database Edition 12.1.1.002 Copyright © 2012 Wolters Kluwer Health, Inc. More Lomotil resources Lomotil Side Effects (in more detail) Lomotil Dosage Lomotil Use in Pregnancy & Breastfeeding Drug Images Lomotil Drug Interactions Lomotil Support Group 16 Reviews for Lomotil - Add your own review/rating Lomotil Advanced Consumer (Micromedex) - Includes Dosage Information Lomotil Concise Consumer Information (Cerner Multum) Lomotil Prescribing Information (FDA) Compare Lomotil with other medications Diarrhea
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Centrine



Dosage Form: FOR ANIMAL USE ONLY
Centrine®
AMINOPENTAMIDE
HYDROGEN SULFATE
Veterinary Injection and Tablets
Centrine Description

Centrine (aminopentamide hydrogen sulfate) is a potent antispasmodic agent. As a cholinergic blocking agent for smooth muscle, its action is similar to atropine.

ACTION

Centrine effectively reduces the tone and amplitude of colonic contractions to a greater degree and for a more extended period than does atropine.

Centrine effects a reduction in gastric secretion, a decrease in gastric acidity and a marked decrease in gastric motility.

The mydriatic and salivary effects of Centrine are less than those produced by atropine at similar dosage, permitting the control of vomiting and diarrhea with less distress to the animal due to dryness of the mouth and blurred vision.

INDICATIONS

Centrine is indicated in the treatment of acute abdominal visceral spasm, pylorospasm or hypertrophic gastritis and associated nausea, vomiting and/or diarrhea.

Contraindications

Centrine should not be used in animals with glaucoma because of the occurrence of mydriasis.

Warning

FOR USE IN DOGS AND CATS ONLY.

Precautions

Dryness of the mouth is the most commonly reported side effect. Blurring of vision may occur and dryness of the eyes may occur if larger (greater than therapeutic) doses are used. Centrine should be used cautiously, if at all, in pyloric obstruction because of its action in delaying gastric emptying. These effects frequently decrease with continued administration of the drug. Disturbances in urination are relatively infrequent. They vary from slightly hesitancy in initiating urination to complete inability to urinate; the latter is an indication for discontinuing the drug. After a day or two, it may be resumed at a lower dosage level.

DOSAGE

Centrine (aminopentamide hydrogen sulfate) may be administered by subcutaneous or intramuscular injection or by oral tablets according to the following schedule. If the desired effect is not obtained, the dosage may be gradually increased up to a maximum of 5 times the doses listed. When the condition has been brought under control by parenteral medication, treatment can be continued, if desired, with 0.2 mg scored tablets according to the dosage schedule.

Weight of Animal Amount to be Administered Every 8 to 12 hours Dosage Injectable Volume Oral Tablets 10 lbs or less 0.1 mg 0.2 mL 1/2 Tab 11 lbs to 20 lbs 0.2 mg 0.4 mL 1 Tab 21 lbs to 50 lbs 0.3 mg 0.6 mL 1 1/2 Tabs 51 lbs to 100 lbs 0.4 mg 0.8 mL 2 Tabs Over 100 lbs 0.5 mg 1.0 mL 2 1/2 Tabs CAUTION

Federal law restricts this drug to use by or on the order of a licensed veterinarian.

How is Centrine Supplied

0.5 mg/mL Centrine (aminopentamide hydrogen sulfate) VETERINARY INJECTION, 10 mL vials.

0.2 mg Centrine (aminopentamide hydrogen sulfate) VETERINARY TABLETS, bottles of 100.

NDC 0856-2401-10 – 0.5 mg/mL – 10 mL vials.
NDC 0856-2400-60 – 0.2 mg – bottles of 100.

Store at controlled room temperature 15° to 30°C (59° to 86°F).

Fort Dodge Animal Health
Fort Dodge, Iowa 50501 USA

92686
Rev. September 1996
4260F

NADA 43-079, Approved by FDA
NADA 43-078, Approved by FDA

PRINCIPAL DISPLAY PANEL - 10 mL Vial Label

NDC 0856-2401-10

Centrine®
AMINOPENTAMIDE
HYDROGEN SULFATE
Veterinary Injection

FORT DODGE®

contains 0.5 mg/mL
aminopentamide hydrogen sulfate

10 mL

CAUTION: Federal law restricts this
drug to use by or on the order of a
licensed veterinarian.

NADA 43-079, Approved by FDA


Centrine 
aminopentamide sulfate  injection, solution Product Information Product Type PRESCRIPTION ANIMAL DRUG NDC Product Code (Source) 0856-2401 Route of Administration SUBCUTANEOUS, INTRAMUSCULAR DEA Schedule      Active Ingredient/Active Moiety Ingredient Name Basis of Strength Strength aminopentamide sulfate (aminopentamide) aminopentamide sulfate 0.5 mg  in 1 mL Inactive Ingredients Ingredient Name Strength No Inactive Ingredients Found Product Characteristics Color      Score      Shape Size Flavor Imprint Code Contains          Packaging # NDC Package Description Multilevel Packaging 1 0856-2401-10 10 mL In 1 BOTTLE None
Marketing Information Marketing Category Application Number or Monograph Citation Marketing Start Date Marketing End Date NADA NADA043079 09/05/1970
Labeler - FDAH, Division of Wyeth (149957656) Revised: 07/2010FDAH, Division of Wyeth

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Mestinon Timespan


Generic Name: pyridostigmine (py rid o STIG meen)
Brand Names: Mestinon, Mestinon Timespan

What is Mestinon Timespan (pyridostigmine)?

Pyridostigmine affects chemicals in the body that are involved in the communication between nerve impulses and muscle movement.

Pyridostigmine is used to treat the symptoms of myasthenia gravis. It is also used in military personnel who have been exposed to nerve gas.

Pyridostigmine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Mestinon Timespan (pyridostigmine)? You should not use pyridostigmine if you are allergic to it, or if you have a bladder or bowel obstruction.

Before taking pyridostigmine, tell your doctor if you have asthma, kidney disease, an ulcer or other serious stomach disorder, high blood pressure, heart disease, overactive thyroid, or a history of seizures.

The amount and timing of this medicine is extremely important to the success of your treatment. Carefully follow your doctor's instructions about how much medicine to take and when to take it.

This medication may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

If you need surgery, tell the surgeon ahead of time that you are using pyridostigmine. You may need to stop using the medicine for a short time. What should I discuss with my health care provider before taking Mestinon Timespan (pyridostigmine)? You should not use pyridostigmine if you are allergic to it, or if you have a bladder or bowel obstruction.

To make sure you can safely take pyridostigmine, tell your doctor if you have any of these other conditions:

asthma;

kidney disease;

an ulcer or other serious stomach disorder;

high blood pressure, heart disease;

overactive thyroid; or

a history of seizures.

It is not known whether pyridostigmine will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. It is not known whether pyridostigmine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take Mestinon Timespan (pyridostigmine)?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medicine with food or milk if it upsets your stomach. Do not crush, chew, or break an extended-release tablet. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

Measure liquid medicine with a special dose measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose measuring device, ask your pharmacist for one.

The amount and timing of this medicine is extremely important to the success of your treatment. Carefully follow your doctor's instructions about how much medicine to take and when to take it.

Your doctor may occasionally change your dose to make sure you get the best results. You may be asked to keep a daily record of when you took each dose and how long the effects lasted. This will help your doctor determine if your dose needs to be adjusted.

If you need surgery, tell the surgeon ahead of time that you are using pyridostigmine. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat.

Keep the tablets in their original container, along with the canister of moisture-absorbing preservative that comes with this medicine.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include nausea, vomiting, diarrhea, stomach cramps, sweating, blurred vision, drooling, and weak or shallow breathing.

Worsening muscle weakness, or no change in your myasthenia gravis symptoms, may also be signs of overdose.

What should I avoid while taking Mestinon Timespan (pyridostigmine)? This medication may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Drinking alcohol can increase certain side effects of pyridostigmine. Mestinon Timespan (pyridostigmine) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using pyridostigmine and call your doctor at once if you have any of these serious side effects:

extreme muscle weakness, muscle twicthing;

slurred speech, vision problems;

severe vomiting or diarrhea;

cough with mucus;

confusion, anxiety, panic attacks;

seizure (convulsions); or

worsening or no improvement in your symptoms of myasthenia gravis.

Less serious side effects may include:

cold sweat, pale skin;

urinating more than usual;

watery eyes;

mild nausea, vomiting, or upset stomach;

warmth or tingly feeling; or

mild rash or itching.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Mestinon Timespan (pyridostigmine)?

Tell your doctor about all other medicines you use, especially:

atropine (Atreza, Sal-Tropine);

belladonna (Donnatal, and others);

benztropine (Cogentin);

clidinium (Quarzan);

clozapine (Clozaril, FazaClo);

dimenhydrinate (Dramamine);

methscopolamine (Pamine), scopolamine (Transderm Scop);

glycopyrrolate (Robinul);

mepenzolate (Cantil);

bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare);

bronchodilators such as ipratropium (Atrovent) or tiotropium (Spiriva);

cold medicine, allergy medicine, or sleeping pills that contain an antihistamine such as diphenhydramine (Tylenol PM) or doxylamine (Unisom);

heart rhythm medication such as quinidine (Quin-G), procainamide (Procan, Pronestyl), disopyramide (Norpace), flecaininde (Tambocor), mexiletine (Mexitil), propafenone, (Rythmol), and others;

irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Hyomax), or propantheline (Pro Banthine);

medicine to treat Alzheimer's dementia, such as donepezil (Aricept), rivastigmine (Exelon), or tacrine (Cognex); or

a steroid such as betamethasone (Celestone) or dexamethasone (Cortastat, Dexasone, Solurex, DexPak).

This list is not complete and other drugs may interact with pyridostigmine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

More Mestinon Timespan resources Mestinon Timespan Side Effects (in more detail)Mestinon Timespan Use in Pregnancy & BreastfeedingDrug ImagesMestinon Timespan Drug InteractionsMestinon Timespan Support Group1 Review for Mestinon Timespan - Add your own review/rating Pyridostigmine Prescribing Information (FDA) Mestinon MedFacts Consumer Leaflet (Wolters Kluwer) Mestinon Prescribing Information (FDA) Pyridostigmine Bromide Monograph (AHFS DI) Regonol Prescribing Information (FDA) Compare Mestinon Timespan with other medications DysautonomiaMyasthenia GravisNerve Agent PretreatmentReversal of Nondepolarizing Muscle Relaxants Where can I get more information? Your pharmacist can provide more information about pyridostigmine.

See also: Mestinon Timespan side effects (in more detail)


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Norflex


Generic Name: orphenadrine (or FEN a drin)
Brand Names: Norflex

What is Norflex (orphenadrine)?

Orphenadrine is a muscle relaxant. It works by blocking nerve impulses (or pain sensations) that are sent to your brain.

Orphenadrine is used together with rest and physical therapy to treat skeletal muscle conditions such as pain or injury.

Orphenadrine may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about Norflex (orphenadrine)? Do not take this medication if you are allergic to orphenadrine, or if you have problems with urination, an enlarged prostate, glaucoma, a blockage in your stomach or intestines, trouble swallowing, or myasthenia gravis. Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time. Orphenadrine may be habit-forming and should be used only by the person it was prescribed for. Orphenadrine should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Orphenadrine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which can increase some of the side effects of orphenadrine. What should I discuss with my healthcare provider before taking Norflex (orphenadrine)? Do not take this medication if you are allergic to orphenadrine, or if you have:

problems with urination;

enlarged prostate;

glaucoma;

a blockage in your stomach or intestines;

trouble swallowing; or

myasthenia gravis.

Before taking orphenadrine, tell your doctor if you are allergic to any drugs, or if you have:

heart disease;

a heart rhythm disorder; or

coronary artery disease.

If you have any of these conditions, you may need a dose adjustment or special tests to safely take orphenadrine.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether orphenadrine passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. How should I take Norflex (orphenadrine)?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take this medicine with a full glass of water. Do not crush, chew, or break the extended-release tablet. Swallow the pill whole. Breaking or crushing the pill may cause too much of the drug to be released at one time.

Orphenadrine is only part of a complete program of treatment that may also include rest, physical therapy, or other pain relief measures. Follow your doctor's instructions.

Orphenadrine may be habit-forming and should be used only by the person it was prescribed for. Orphenadrine should never be given to another person, especially someone who has a history of drug abuse or addiction. Keep the medication in a secure place where others cannot get to it. Store orphenadrine at room temperature away from moisture, heat, and light. What happens if I miss a dose? Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose. What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. An overdose of orphenadrine can be fatal.

Overdose symptoms may include blurred vision, fast heart rate, confusion, weak or shallow breathing, cold or clammy skin, feeling like you might pass out, or seizure (convulsions).

What should I avoid while taking Norflex (orphenadrine)? Orphenadrine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid drinking alcohol, which can increase some of the side effects of orphenadrine. Cold or allergy medicine, narcotic pain medicine, sleeping pills, and medicine for seizures, depression or anxiety can add to sleepiness caused by orphenadrine. Tell your doctor if you regularly use any of these medicines, or any other muscle relaxer. Norflex (orphenadrine) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using orphenadrine and call your doctor at once if you have any of these serious side effects:

fast, pounding, or uneven heartbeats;

confusion, anxiety, agitation, tremors, hallucinations;

seizure (convulsions); or

urinating less than usual or not at all.

Less serious side effects may include:

dry mouth or throat;

blurred vision, dilated pupils;

headache;

drowsiness, dizziness;

nausea, vomiting, constipation; or

weakness.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Norflex (orphenadrine)?

Before taking orphenadrine, tell your doctor if you are taking any of the following medicines:

atropine (Donnatal, and others), benztropine (Cogentin), dimenhydrinate (Dramamine), methscopolamine (Pamine), or scopolamine (Transderm-Scop);

bronchodilators such as ipratroprium (Atrovent) or tiotropium (Spiriva);

glycopyrrolate (Robinul);

mepenzolate (Cantil);

bladder or urinary medications such as darifenacin (Enablex), flavoxate (Urispas), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare); or

irritable bowel medications such as dicyclomine (Bentyl), hyoscyamine (Anaspaz, Cystospaz, Levsin, and others), or propantheline (Pro-Banthine).

This list is not complete and there may be other drugs that can interact with orphenadrine. Tell your doctor about all your prescription and over-the-counter medications, vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start a new medication without telling your doctor.

More Norflex resources Norflex Side Effects (in more detail) Norflex Use in Pregnancy & Breastfeeding Drug Images Norflex Drug Interactions Norflex Support Group 5 Reviews for Norflex - Add your own review/rating Norflex Prescribing Information (FDA) Norflex Monograph (AHFS DI) Norflex Advanced Consumer (Micromedex) - Includes Dosage Information Norflex MedFacts Consumer Leaflet (Wolters Kluwer) Antiflex Advanced Consumer (Micromedex) - Includes Dosage Information Compare Norflex with other medications Migraine Muscle Spasm Where can I get more information? Your pharmacist can provide more information about orphenadrine.

See also: Norflex side effects (in more detail)


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Uveitis Medications


Definition of Uveitis: Uveitis is an inflammation of the the uvea, the layer between the sclera and the retina, which includes the iris, ciliary body, and the choroid.

Drugs associated with Uveitis

The following drugs and medications are in some way related to, or used in the treatment of Uveitis. This service should be used as a supplement to, and NOT a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners.

See sub-topics

Topics under Uveitis Cyclitis (8 drugs) Panuveitis (0 drugs) Uveitis, Anterior (27 drugs in 4 topics) Uveitis, Posterior (17 drugs in 2 topics) Learn more about Uveitis

Medical Encyclopedia:

Uveitis

Harvard Health Guide:

Symptoms and treatment for Uveitis
Drug List: Ak-Cide Ak-Dex-Ophthalmic Ak-Neo-Dex Ak-Pentolate Ak-Trol Aristocort Aristocort-Forte Atropin-Care-Drops Atropisol Azasan Azulfidine Azulfidine-En-Tabs-Delayed-Release-Tablets Blephamide-Suspension Blephamide-S-O-P-Ointment Cetapred Clinacort-Injection Clinalog-Injection Cortisporin-Ophthalmic Cortisporin-Ophthalmic-Suspension-Drops-Suspension Cortomycin-Eye-Ointment Cortomycin-Suspension Cortone-Acetate Cyclogyl Cylate Decadron-Ocumeter Dexacidin Dexacine Dexasol-Drops Dexasporin Enbrel Fml-S-Suspension Fml-S-Liquifilm Homatropaire-Drops Imuran Isopto-Atropine-Drops Isopto-Cetapred Isopto-Homatropine-Drops Ken-Jec-40-Injection Kenalog-40-Suspension Maxidex-Suspension Maxitrol-Drops Methadex Metimyd Neo-Decadron Neo-Decadron-Ocumeter Neo-Dex Neo-Dexair Neo-Poly-Bac Neo-Poly-Dex Neotricin-Hc Npd-Ophthalmic-Ointment Ocu-Cort Ocu-Dex-Ophthalmic Ocu-Lone-C Ocu-Pentolate Ocu-Trol Ocu-Tropine Ozurdex Poly-Pred-Drops Poly-Dex-Drops Pred-G Pred-G-S-O-P Remicade Retisert Sulfazine Tac-3-Injection Tobradex Tobradex-St-Drops Trexall Triam-Forte Triamcot-Injection Triamonide-40-Injection Triesence Triple-Antibiotic-Hc-Ophthalmic-Ointment Trivaris U-Tri-Lone-Injection Vasocidin-Drops Vexol Zylet
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