triamterene hctz post nasal drip
 

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Nasalcrom nasal


Generic Name: cromolyn sodium (nasal) (KRO mo lin SO dee um)
Brand Names: Nasalcrom

What is Nasalcrom (cromolyn sodium (nasal))?

Cromolyn sodium is an anti-inflammatory medication. It works by preventing the release of substances in the body that cause inflammation.

Cromolyn sodium nasal is used to prevent allergy symptoms such as runny nose, stuffy nose, sneezing, itching, and post-nasal drip.

Cromolyn sodium nasal will not treat allergy symptoms that have already begun. The medication works best if used at least 1 week before you come into contact with things you are allergic to (pollen, dust, pets, etc).

Cromolyn sodium nasal will not treat the symptoms of asthma, sinus infections, or the common cold.

Cromolyn sodium nasal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Nasalcrom (cromolyn sodium (nasal))? You should not use this medication if you are allergic to cromolyn sodium.

Before you use cromolyn sodium nasal, tell your doctor if you have asthma, drug allergies, or polyps in your nose.

Cromolyn sodium nasal will not treat allergy symptoms that have already begun. The medication works best if used at least 1 week before you come into contact with things you are allergic to (pollen, dust, pets, etc).

Stop using this medication and call your doctor if you have severe burning, stinging, or irritation in your nose, nosebleeds, sinus pain, sores in your nose, wheezing, chest tightness, fever, or green/yellow mucus from your nose.

Do not use cromolyn sodium nasal more than 6 times in a 24-hour period. Do not use this medication for longer than 12 weeks unless your doctor has told you to. What should I discuss with my healthcare provider before using Nasalcrom (cromolyn sodium (nasal))? You should not use this medication if you are allergic to cromolyn sodium.

To make sure you can safely use cromolyn sodium nasal, tell your doctor if you have any of these other conditions:

asthma;

drug allergies; or

polyps in your nose.

FDA pregnancy category B. This medication is not expected to 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 cromolyn sodium 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 use Nasalcrom (cromolyn sodium (nasal))?

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

This medicine is usually given as 1 spray into each nostril every 4 to 6 hours during allergy season or within 1 week before you will be exposed to an allergen. Follow your doctor's instructions.

Do not use cromolyn sodium nasal more than 6 times in a 24-hour period. Do not use this medication for longer than 12 weeks unless your doctor has told you to.

To use the nasal spray:

Blow your nose gently before each use.

Keeping your head upright, insert just the tip of the spray bottle into your nostril. Hold your other nostril closed with one finger. Spray the medicine into the nostril while inhaling, then sniff deeply a few times to make sure the medicine gets up into your nasal passages.

Repeat these steps in your other nostril.

After using the nasal spray, rinse the tip with hot water or wipe it with a clean tissue and recap. Avoid getting water into the nasal spray tip.

It may take up to 2 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 2 weeks of treatment.

Store at room temperature away from moisture, heat, and light. Keep the bottle capped when not in use. What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use 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. What should I avoid while using Nasalcrom (cromolyn sodium (nasal))? Avoid getting this medication in your eyes. If this does happen, rinse with water. Nasalcrom (cromolyn sodium (nasal)) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives or itching; difficulty breathing; severe dizziness; swelling of your face, lips, tongue, or throat. Stop using this medication and call your doctor if you have any of these serious side effects:

severe burning, stinging, or irritation in your nose;

nosebleeds, sinus pain, or sores in your nose;

wheezing, tight feeling in your chest; or

fever, green or yellow mucus from the nose.

Less serious side effects may include mild burning or stinging inside your nose after use.

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 Nasalcrom (cromolyn sodium (nasal))?

There may be other drugs that can interact with cromolyn sodium nasal. 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 Nasalcrom resources Nasalcrom Side Effects (in more detail) Nasalcrom Use in Pregnancy & Breastfeeding Nasalcrom Support Group 0 Reviews for Nasalcrom - Add your own review/rating Compare Nasalcrom with other medications Hay Fever Where can I get more information? Your pharmacist can provide more information about cromolyn sodium nasal.

See also: Nasalcrom side effects (in more detail)


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Maxzide


Generic Name: hydrochlorothiazide and triamterene (HYE dro klor oh THY a zide and trye AM ter een)
Brand Names: Dyazide, Maxzide, Maxzide-25

What is Maxzide (hydrochlorothiazide and triamterene)?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Triamterene is a potassium-sparing diuretic that also prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.

The combination of hydrochlorothiazide and triamterene is used to treat fluid retention (edema) and high blood pressure (hypertension).

Hydrochlorothiazide and triamterene may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Maxzide (hydrochlorothiazide and triamterene)? You should not use this medication if you are allergic to hydrochlorothiazide or triamterene, or if you have kidney disease, urination problems, high levels of potassium in your blood, or if you are taking other diuretics similar to triamterene. Do not use potassium supplements unless your doctor has told you to.

Before using this medication, tell your doctor if you have heart or liver disease, glaucoma, diabetes, a breathing disorder, gout, lupus, kidney stones, a pancreas disorder, or an allergy to sulfa drugs or penicillin.

Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and triamterene.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

Do not use potassium supplements, salt substitutes, or low-sodium milk while you are taking hydrochlorothiazide and triamterene, unless your doctor has told you to.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

If you are being treated for high blood pressure, keep using this medication even if you feel fine. High blood pressure often has no symptoms.

What should I discuss with my doctor before taking Maxzide (hydrochlorothiazide and triamterene)? You should not use this medication if you are allergic to hydrochlorothiazide (HCTZ, HydroDiuril, Lotensin HCT, Prinzide, Zestoretic, Ziac, and others) or triamterene (Dyrenium), or if you have: kidney disease or are unable to urinate;

high potassium levels (hyperkalemia);

if you are taking diuretics similar to triamterene, such as amiloride (Midamor, Moduretic), spironolactone (Aldactone, Aldactazide); or

if you are taking potassium supplements (unless your doctor tells you to).

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

diabetes;

heart disease;

cirrhosis or other liver disease;

glaucoma;

a breathing disorder;

gout;

lupus;

a history of kidney stones;

a pancreas disorder; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category C. It is not known whether hydrochlorothiazide and triamterene will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication. Hydrochlorothiazide and triamterene can pass into breast milk and may harm a nursing baby. You should not breast-feed while taking hydrochlorothiazide and triamterene. How should I take Maxzide (hydrochlorothiazide and triamterene)?

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.

Your doctor may occasionally change your dose to make sure you get the best results.

You will need regular medical tests to be sure this medication is not causing harmful effects. Visit your doctor regularly.

This medication can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using hydrochlorothiazide and triamterene.

If you need surgery or a blood transfusion, tell the doctor ahead of time that you are using hydrochlorothiazide and triamterene.

Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life.

Store 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. 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 increased urination, nausea, vomiting, weakness, fever, warmth or flushing in your face, or muscle spasms.

What should I avoid while taking Maxzide (hydrochlorothiazide and triamterene)? Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and triamterene.

Avoid a diet high in salt. Too much salt will cause your body to retain water and can make this medication less effective.

Do not use potassium supplements, salt substitutes, or low-sodium milk while you are taking hydrochlorothiazide and triamterene, unless your doctor has told you to. Hydrochlorothiazide and triamterene may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Maxzide (hydrochlorothiazide and triamterene) 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 hydrochlorothiazide and triamterene and call your doctor at once if you have a serious side effect such as:

eye pain, vision problems;

slow, fast, or uneven heartbeat;

feeling like you might pass out;

swelling or rapid weight gain;

urinating less than usual or not at all;

headache, trouble concentrating, memory problems, weakness, loss of appetite, feeling unsteady, hallucinations, fainting, seizure, shallow breathing or breathing that stops;

low potassium (confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling);

high potassium (irregular heart rate, weak pulse, muscle weakness, tingly feeling);

severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate;

easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin;

patchy skin color, red spots, or a butterfly-shaped skin rash over your cheeks and nose (worsens in sunlight);

fever, sore throat, and headache with a severe blistering, peeling, and red skin rash; or

jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

mild nausea, diarrhea, constipation;

dizziness, headache;

blurred vision;

dry mouth;

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.

What other drugs can affect Maxzide (hydrochlorothiazide and triamterene)? Before using hydrochlorothiazide and triamterene, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by hydrochlorothiazide and triamterene.

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

lithium (Eskalith, LithoBid);

amphotericin B (Amphotec, AmBisome, Abelcet);

methenamine (Hipprex, Mandelamine, Urex);

gout medication such as allopurinol (Zyloprim), colchicine (Colcrys), or probenecid (Benemid);

steroid medication (prednisone and others);

a blood thinner such as warfarin (Coumadin, Jantoven);

insulin or oral diabetes medication;

laxatives;

an ACE inhibitor such as benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), ramipril (Altace), and others; or

indomethacin (Indocin) or other NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and triamterene. 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 Maxzide resources Maxzide Side Effects (in more detail)Maxzide Use in Pregnancy & BreastfeedingDrug ImagesMaxzide Drug InteractionsMaxzide Support Group2 Reviews for Maxzide - Add your own review/rating Maxzide Prescribing Information (FDA) Maxzide Advanced Consumer (Micromedex) - Includes Dosage Information Maxzide MedFacts Consumer Leaflet (Wolters Kluwer) Dyazide Prescribing Information (FDA) Dyazide Consumer Overview Compare Maxzide with other medications EdemaHigh Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and triamterene.

See also: Maxzide side effects (in more detail)


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Nasal steroids


A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes.

Nasal corticosteroids are very effective in controlling allergic inflammation in the nose. Corticosteroids work on multiple cell types and mediators for example, mast cells, macrophages, leukotrienes and so on, to control inflammation. Nasal steroid sprays are usually first line treatment for nasal symptoms of hay fever or allergic rhinitis.

See also

Medical conditions associated with nasal steroids:

Hay FeverNasal PolypsNasal Polyps, PreventionRhinitis Drug List:/tags/nasacort-aq-spray/
/tags/nasarel-spray/
/tags/rhinocort/
/tags/nasonex/
/tags/omnaris/
/tags/nasacort-hfa/
Zetonna
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Dytac 50mg Capsules


1. Name Of The Medicinal Product

Dytac 50mg Capsules

Triamterene 50mg Capsules

2. Qualitative And Quantitative Composition

Each capsule contains 50mg triamterene EP.

3. Pharmaceutical Form

Opaque, maroon-coloured capsules containing as a yellow, granular powder.

4. Clinical Particulars 4.1 Therapeutic Indications

Triamterene is a potassium-conserving diuretic, thought to act by directly inhibiting the exchange of sodium for potassium and hydrogen in the distal renal tubule.

Potassium-conserving diuretic for the control of oedema in cardiac failure, cirrhosis of the liver or the nephrotic syndrome, and in that associated with corticosteroid treatment. When Dytac is used as an adjuvant to potassium-depleting diuretics, such loss may be inhibited and diuresis enhanced.

4.2 Posology And Method Of Administration

Method of Administration

Oral

Dosage

Adults only: When given alone, the usual dosage range is from 3 to a maximum of 5 Dytac capsules a day. The optimal daily dosage is 4 capsules, given in divided doses after breakfast and lunch. After the first week, treatment should preferably be given on alternate days to ensure satisfactory maintenance diuresis without an increase in blood urea levels. When given with another diuretic, lower dosages of both should be used initially.

Elderly: A lower dosage may be sufficient. The normally occurring reduction in glomerular filtration with age should be borne in mind.

4.3 Contraindications

Hyperkalaemia, progressive renal failure, increasing hepatic dysfunction, addison's disease, known hypersensitivity to the drug and anuria. Routine concomitant administration of potassium supplements, or other potassium-conserving drugs, including ACE inhibitors.

4.4 Special Warnings And Precautions For Use

Use with caution in patients with diabetes mellitus, hepatic or renal insufficiency; in those predisposed to gout since Dytac has been shown in rare instances to elevate uric acid levels; with hypotensive agents since an additive effect may result; and in diabetic nephropathy, due to increased risk of hyperkalaemia.

It is advisable to monitor blood urea, serum potassium levels and electrolytes periodically. This is important in the elderly, those with renal impairment and those receiving concomitant treatment with NSAIDs.

Combinations of folate antagonists and triamterene are not advisable in pregnancy or in patients with hepatic cirrhosis because of the increased theoretical risk of folate deficiency developing.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Use with caution with hypotensive agents. When given with another diuretic, lower dosage of both should be given initially. Triamterene reduces excretion of Lithium and may thus precipitate intoxification.

It is advisable to monitor blood urea and serum potassium levels periodically in patients receiving concomitant treatment with NSAIDs. Renal failure, reversible on stopping treatment, has been reported very rarely which may be due to an interaction between triamterene and some NSAIDs.

It has been suggested that the suppression of urinary prostaglandins by NSAIDs could potentiate the nephrotoxic effects of traimterene.

Occasional reports of reduced renal function when triamterene given with indometacin avoid concomitant use.

Triamterene has the following interaction information:

Drugs likely to increase the risk of severe hyperkalaemia when given with triamterene:

• ACE inhibitors angiotensin-II receptor antagonists.

• tacrolimus

• indometacin

• potassium salts.

• trilostane.

• ciclosporin

• aliskiren

• chlorpropamide

• amiloride

• aldosterone antagonists such as eplerenone and spironolactone

Drugs likely to enhance the hypotensive effect when give with triamterene:

• alprostadil

• ACE inhibitors

• drospirenone (monitor serum potassium during first cycle)

• adrenergic neurone blockers

• alcohol

• aldesleukin

• alpha-blockers , also increased risk of first-dose hypotension with post-synaptic alpha-blockers such as prazosin

• general anaesthetics

• angiotensin-II receptor antagonists

• anxiolytics and hypnotics

• with baclofen

• beta-blockers

• calcium-channel blockers

• clonidine

• hydralazine

• levodopa

• MAOIs

• methyldopa

• minoxidil

• diazoxide

• moxisylyte

• moxonidine

• nitrates

• phenothiazines

• sodium nitroprusside

• tizanidine

Effects of diuretics is antagonised by following drugs:

• ketorolac

• indometacin

• oestrogens

• corticosteroids

Hypokalaemia caused by diuretics increases risk of ventricular arrhythmias with following drugs:

• sertindole

• pimozide (avoid concomitant use)

• platinum compounds

• atomoxetine

• amisulpride

Increased risk of postural hypotension when diuretics given with tricyclics.

Increased risk of hyponatraemia when diuretics given with carbamazepine

4.6 Pregnancy And Lactation

There is no clinical evidence to suggest any associated hazards to the foetus, However triamterene has been found to cross the placenta in humans. Nevertheless, drugs should be avoided in pregnancy unless essential, especially during the first trimester. Triamterene may appear in the breast milk, and if the drug is essential, the patient should stop breastfeeding.

4.7 Effects On Ability To Drive And Use Machines

None known.

4.8 Undesirable Effects

Triamterene:

Blood and lymphatic system disorders

Rare or very rare (<1/1000, including case reports)

megaloblastic anaemia, pancytopenia

Metabolism and nutrition disorders

Very common or common (>1/100)

hyperkalaemia (incidence is reduced by Furosemide)

Uncommon (>1/1,000, <1/100)

hyperuricaemia

 

Nervous system disorders

Uncommon (>1/1,000, <1/100)

Headache

Vascular disorders

Uncommon (>1/1,000, <1/100)

hypovolaemia

Gastrointestinal disorders

Very common or common (>1/100)

nausea, vomiting, diarrhoea

Uncommon (>1/1,000, <1/100)

dry mouth

 

Skin and subcutaneous tissue disorders

Uncommon (>1/1,000, <1/100)

Rashes

Rare or very rare (<1/1000, including case reports)

photosensitivity reactions, pseudoporphyria

 

Renal and urinary disorders

Uncommon (>1/1,000, <1/100)

elevation of s-creatinine, transient renal insufficiency

Rare or very rare (<1/1000, including case reports)

Interstitial nephritis, urinary stones

 

General disorders and administration site conditions

Rare or very rare (<1/1000, including case reports)

serum sickness

Weakness, minor decreases in blood pressure, and rash have been reported. Anaphylaxis is a remote possibility.

Metabolic acidosis occasionally occurs. Electrolyte imbalance may also indicate excessive dosage or be secondary to the condition under treatment.

Renal failure, reversible on stopping treatment, has been reported very rarely and has been due to acute interstitial nephritis or an interaction between triamterene and some NSAIDs.

Triamterene has been found in renal stones both alone and in association with other usual calculus components. There is no evidence that stone formation is increased in patients taking triamterene-containing drugs.

Jaundice and abnormalities of serum levels of liver enzymes, have also been reported.

Triamterene may cause a blue fluorescence of the urine under certain light conditions.

Triamterene interferes with bioassay of folic acid.

4.9 Overdose

Symptoms of electrolyte imbalance, especially hyperkalaemia, are likely. Symptoms include nausea, vomiting, weakness, lassitude, muscular weakness, hypotension and cardiac arrhythmias. Treatment consists of gastric lavage with careful monitoring of electrolytes and fluid balance. Cardiac rhythm should be monitored and appropriate measures taken to correct hyperkalaemia as necessary. There is no specific antidote. Renal dialysis may be of some benefit in cases of severe overdosage.

Triamterene is incompletely but fairly rapidly absorbed from the gastro-intestinal tract. It has been estimated to have a plasma half-life of about 2 hours. Triamterene is extensively metabolised and is mainly excreted in the urine in the form of metabolites with some unchanged triamterene; variable mounts are also excreted in the bile.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Triamterene is a potassium-conserving diuretic thought to act by directly inhibiting the exchange of sodium for potassium and hydrogen in the distal renal tubule.

5.2 Pharmacokinetic Properties

Onset of action is 2-4 hours after ingestion. Diuresis generally tapers off 7-9 hours after administration. Triamterene is incompletely but fairly rapidly absorbed from the gastrointestinal tract. It has been estimated to have a plasma half life of about 2 hours. Triamterene is extensively metabolised and is mainly excreted in the urine in the form of metabolites with some unchanged triamterene; variable amounts are also excreted in the bile.

5.3 Preclinical Safety Data

No further information of relevance.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Magnesium stearate

Lactose

Black Iron oxide E172

Erythrosine E127

Titanium Dioxide E171

Gelatin

6.2 Incompatibilities

None known

6.3 Shelf Life

36 months for blister packs

60 months for securitainers/amber glass bottles/polyethylene vials.

6.4 Special Precautions For Storage

Store in a dry place.

6.5 Nature And Contents Of Container

Polypropylene securitainers/amber glass bottles/polyethylene vials contain 30 or 250 capsules Blister packs contain 30 capsules.

6.6 Special Precautions For Disposal And Other Handling

None.

7. Marketing Authorisation Holder

Goldshield Group Limited

NLA Tower

Croydon

Surrey

CR0 0XT

Trading as: Goldshield Pharmaceuticals

8. Marketing Authorisation Number(S)

PL 10972/0017

9. Date Of First Authorisation/Renewal Of The Authorisation

January 1994

10. Date Of Revision Of The Text

28/09/2010


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Osteogenesis Imperfecta Medications


Definition of Osteogenesis Imperfecta: Osteogenesis imperfecta is a condition causing extremely fragile bones. More...

Drugs associated with Osteogenesis Imperfecta

The following drugs and medications are in some way related to, or used in the treatment of Osteogenesis Imperfecta. 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 Osteogenesis Imperfecta

Medical Encyclopedia:

Osteogenesis imperfecta
Drug List: Fortical Miacalcin Miacalcin-Nasal
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Antidiuretic hormones


A drug may be classified by the chemical type of the active ingredient or by the way it is used to treat a particular condition. Each drug can be classified into one or more drug classes.

Antidiuretic hormone, also known as vasopressin is a hormone released by the posterior pituitary. It is important mainly for its actions on the kidneys where it increases the re-absorption of water. Vasopressin is also a powerful vasoconstrictor. Its effects are through two types of receptors, V1 and V2.

Water retention is mediated through V2 receptors, occurs at low plasma concentrations of vasopressin and is due to activation of adenylate cyclase and increased cAMP production in the collecting ducts of the nephrons. It increases the permeability of the membrane to water.

Vasopressin causes contraction of smooth muscle, mainly in the cardiovascular system. Vasocontriction occurs by mediation of V1 receptors and requires higher concentrations if vasopressin.

See also

Medical conditions associated with antidiuretic hormones:

Abdominal Distension Prior to Abdominal X-ray Asystole Diabetes Insipidus Esophageal Varices with Bleeding Gastrointestinal Hemorrhage Hemophilia A Postoperative Gas Pains Primary Nocturnal Enuresis Ventricular Fibrillation Ventricular Tachycardia von Willebrand's Disease Drug List: Stimate-Spray Ddavp Ddavp-Nasal-Spray Ddavp-Rhinal-Tube-Nasal Minirin-Spray Pitressin
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Fortical


Generic Name: calcitonin nasal (kal si TOE nin)
Brand Names: Fortical, Miacalcin Nasal

What is calcitonin nasal?

Calcitonin is a man-made form of a hormone that occurs naturally in the thyroid gland.

Calcitonin nasal is used to treat osteoporosis in women who have been in menopause for at least 5 years.

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

What is the most important information I should know about calcitonin nasal? To make sure you are not allergic to this medication, your doctor may perform an allergy skin test before your first dose of calcitonin nasal.

Before using calcitonin nasal, tell your doctor if you have any nasal or sinus problems such as nasal deformities, a chronic infection, or nasal pain.

Avoid using any other nasal sprays or medicines at the same time you use calcitonin nasal unless your doctor has told you to.

Call your doctor at once if you have any type of severe irritation of your nose, or if you feel light-headed or faint.

Less serious nasal irritation is more likely to occur, such as minor bleeding, redness, itching, tenderness, dryness, crusting, scabs, or nasal congestion.

To be sure this medication is not causing harmful side effects to the inside of your nose, your doctor may want to check your nasal passages often. Visit your doctor regularly.

What should I discuss with my healthcare provider before using calcitonin nasal? Do not use this medication if you are allergic to salmon calcitonin.

To make sure you can safely use calcitonin nasal, tell your doctor if you have any nasal or sinus problems such as nasal deformities, a chronic infection, or nasal pain.

FDA pregnancy category C. It is not known whether calcitonin nasal 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 calcitonin nasal 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 use calcitonin nasal?

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

To make sure you are not allergic to this medication, your doctor may perform an allergy skin test before your first dose of calcitonin nasal.

This medication comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions.

Store unopened calcitonin nasal in the refrigerator but do not allow it to freeze. Once you put the bottle and pump assembly together, you may keep the medicine at room temperature, away from light and heat. Keep the bottle upright while stored. Throw away any unused medicine after 35 days.

Before your first use of the assembled bottle and pump, you must prime the spray. Allow the medicine to reach room temperature before priming.

To prime calcitonin nasal, spray the medicine into the air and away from your face, until a fine mist appears. You will need to prime the pump only before your first use of the newly assembled bottle.

Calcitonin nasal is usually given as one spray per day into only one of your nostrils. Use the other nostril the next day and continue alternating back and forth for each daily dose.

Before each use, gently blow your nose to clear your nostrils.

Hold the nasal spray upright with your first and second fingers on each side of the pump and your thumb on the bottom of the bottle.

Gently insert the sprayer tip into the nostril but not far into your nose. Bend your head forward to aim the spray toward the back of your nose. Pump the spray unit firmly to spray the medicine into your nostril. You do not need to sniff or inhale deeply.

Calcitonin nasal spray delivers a fine mist into the nose. Even if you do not feel the spray while using it, the medication is still being absorbed by your nasal passages.

Avoid blowing your nose for several minutes after using this medication.

Each bottle contains 30 doses of calcitonin nasal. Throw away the medicine after 30 uses, even if there is still medicine left in the bottle.

To be sure this medication is not causing harmful side effects to the inside of your nose, your doctor may want to check your nasal passages often. Visit your doctor regularly.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use 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.

An overdose of calcitonin nasal is not likely to produce life-threatening side effects.

What should I avoid while using calcitonin nasal?

Avoid using any other nasal sprays or nasal medications at the same time you use calcitonin nasal unless your doctor has told you to.

Calcitonin nasal 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. Call your doctor at once if you have any of these serious side effects:

feeling light-headed, fainting; or

severe nasal irritation.

Less serious side effects may include:

bleeding from your nose;

runny or stuffy nose;

dryness, itching, tenderness, or general discomfort of your nose;

crusting, scabs, or sores inside your nose;

redness in or around your nose;

warmth, redness, or tingly feeling under your skin;

headache;

back pain; or

nausea.

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 calcitonin nasal?

There may be other drugs that can interact with calcitonin nasal. 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 Fortical resources Fortical Side Effects (in more detail) Fortical Use in Pregnancy & Breastfeeding Fortical Drug Interactions Fortical Support Group 1 Review for Fortical - Add your own review/rating Compare Fortical with other medications Hypercalcemia Osteogenesis Imperfecta Osteoporosis Paget's Disease Where can I get more information? Your pharmacist can provide more information about calcitonin nasal.

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NTZ Long Acting Nasal


Generic Name: oxymetazoline nasal (ox ee me TAZ oh leen)
Brand Names: Afrin, Afrin Nasal Sinus, Allerest 12 Hour Nasal Spray, Duramist Plus, Duration, Four-Way Nasal Spray, Genasal, Neo-Synephrine 12 Hour, Nostrilla, NRS Nasal, NTZ Long Acting Nasal, Oxyfrin, Oxymeta-12, Sinarest Nasal, Sinex Long-Acting, Twice-A-Day

What is NTZ Long Acting Nasal (oxymetazoline nasal)?

Oxymetazoline is a decongestant. It works by constricting (shrinking) blood vessels (veins and arteries) in your body. The nasal formulation acts directly on the blood vessels in your nasal tissues. Constriction of the blood vessels in your nose and sinuses leads to drainage of these areas and a decrease in congestion.

Oxymetazoline nasal is used to treat congestion associated with allergies, hay fever, sinus irritation, and the common cold.

Oxymetazoline nasal may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about NTZ Long Acting Nasal (oxymetazoline nasal)?

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Do not use more of this medication than is recommended on the package or by your doctor. Who should not use NTZ Long Acting Nasal (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. This could cause a very dangerous drug interaction with serious side effects.

Before taking this medication, tell your doctor if you have

high blood pressure;

any type of heart disease, hardening of the arteries, or irregular heart beats;

thyroid problems;

diabetes;

glaucoma or increased pressure in the eye;

an enlarged prostate or difficulty urinating; or

liver or kidney disease.

You may not be able to use oxymetazoline nasal, or you may require a lower dose or special monitoring during your therapy if you have any of the conditions listed above.

It is not known whether oxymetazoline nasal will harm an unborn baby. Do not use oxymetazoline nasal without first talking to your doctor if you are pregnant. Infants are especially sensitive to the effects of oxymetazoline nasal. Do not use this medication without first talking to your doctor if you are breast-feeding a baby. If you over 60 years of age, you may be more likely to experience side effects from oxymetazoline nasal. You may require a lower dose of this medication. How should I use NTZ Long Acting Nasal (oxymetazoline nasal)?

Use oxymetazoline nasal exactly as directed by your doctor, or follow the instructions that accompany the package. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

To apply the nasal spray, keep your head upright, spray, then sniff hard for a few minutes after administering a dose.

To apply the nasal drops, lie on a bed on your back with your head hanging over the edge. Insert the drops and remain in this position for several minutes. Gently turn your head from side to side.

Do not allow the tip of the container to touch the inside of your nose or any other surface. This spreads the infection.

Also, to prevent the spread of infection, do not share this medication with anyone else.

Discard this medication bottle after use. Do not save it for reuse.

Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. Oxymetazoline nasal should not be used more often than twice a day (every 12 hours).

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Store oxymetazoline nasal at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and use the next one as directed. Do not use a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an oxymetazoline nasal overdose include extreme tiredness, sweating, dizziness, a slow heartbeat, and coma.

What should I avoid while taking NTZ Long Acting Nasal (oxymetazoline nasal)? Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. NTZ Long Acting Nasal (oxymetazoline nasal) side effects

If you experience any of the following serious side effects, stop using oxymetazoline nasal and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

seizures;

unusual behavior or hallucinations; or

an irregular or fast heartbeat.

More commonly, you may experience some sneezing or burning, stinging, dryness, or irritation of the nose. These side effects are usually mild and temporary.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect NTZ Long Acting Nasal (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

Although drug interactions between topical nasal decongestants and drugs taken by mouth are not expected, they can occur. Rarely, oxymetazoline nasal may interact with the following medicines:

furazolidone (Furoxone);

guanethidine (Ismelin);

indomethacin (Indocin);

methyldopa (Aldomet);

bromocriptine (Parlodel);

caffeine in cola, tea, coffee, chocolate and other products;

theophylline (Theo-Dur, Theochron, Theolair, others);

tricyclic antidepressants such as amitriptyline (Elavil, Endep), doxepin (Sinequan), and nortriptyline (Pamelor); other commonly used tricyclic antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), protriptyline (Vivactil), and trimipramine (Surmontil); phenothiazines such as chlorpromazine (Thorazine), thioridazine (Mellaril), and prochlorperazine (Compazine); and other commonly used phenothiazines, including fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), and trifluoperazine (Stelazine).

Drugs other than those listed here may also interact with oxymetazoline nasal. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More NTZ Long Acting Nasal resources NTZ Long Acting Nasal Side Effects (in more detail)NTZ Long Acting Nasal Use in Pregnancy & BreastfeedingNTZ Long Acting Nasal Drug InteractionsNTZ Long Acting Nasal Support Group0 Reviews for NTZ Long Acting Nasal - Add your own review/rating Afrin Advanced Consumer (Micromedex) - Includes Dosage Information Afrin Solution MedFacts Consumer Leaflet (Wolters Kluwer) Compare NTZ Long Acting Nasal with other medications Nasal Congestion Where can I get more information? Your pharmacist has additional information about oxymetazoline nasal written for health professionals that you may read.

See also: NTZ Long Acting Nasal side effects (in more detail)


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Allerest 12 Hour Nasal Spray


Generic Name: oxymetazoline nasal (ox ee me TAZ oh leen)
Brand Names: Afrin, Afrin Nasal Sinus, Allerest 12 Hour Nasal Spray, Duramist Plus, Duration, Four-Way Nasal Spray, Genasal, Neo-Synephrine 12 Hour, Nostrilla, NRS Nasal, NTZ Long Acting Nasal, Oxyfrin, Oxymeta-12, Sinarest Nasal, Sinex Long-Acting, Twice-A-Day

What is Allerest 12 Hour Nasal Spray (oxymetazoline nasal)?

Oxymetazoline is a decongestant. It works by constricting (shrinking) blood vessels (veins and arteries) in your body. The nasal formulation acts directly on the blood vessels in your nasal tissues. Constriction of the blood vessels in your nose and sinuses leads to drainage of these areas and a decrease in congestion.

Oxymetazoline nasal is used to treat congestion associated with allergies, hay fever, sinus irritation, and the common cold.

Oxymetazoline nasal may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Allerest 12 Hour Nasal Spray (oxymetazoline nasal)?

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Do not use more of this medication than is recommended on the package or by your doctor. Who should not use Allerest 12 Hour Nasal Spray (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. This could cause a very dangerous drug interaction with serious side effects.

Before taking this medication, tell your doctor if you have

high blood pressure;

any type of heart disease, hardening of the arteries, or irregular heart beats;

thyroid problems;

diabetes;

glaucoma or increased pressure in the eye;

an enlarged prostate or difficulty urinating; or

liver or kidney disease.

You may not be able to use oxymetazoline nasal, or you may require a lower dose or special monitoring during your therapy if you have any of the conditions listed above.

It is not known whether oxymetazoline nasal will harm an unborn baby. Do not use oxymetazoline nasal without first talking to your doctor if you are pregnant. Infants are especially sensitive to the effects of oxymetazoline nasal. Do not use this medication without first talking to your doctor if you are breast-feeding a baby. If you over 60 years of age, you may be more likely to experience side effects from oxymetazoline nasal. You may require a lower dose of this medication. How should I use Allerest 12 Hour Nasal Spray (oxymetazoline nasal)?

Use oxymetazoline nasal exactly as directed by your doctor, or follow the instructions that accompany the package. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

To apply the nasal spray, keep your head upright, spray, then sniff hard for a few minutes after administering a dose.

To apply the nasal drops, lie on a bed on your back with your head hanging over the edge. Insert the drops and remain in this position for several minutes. Gently turn your head from side to side.

Do not allow the tip of the container to touch the inside of your nose or any other surface. This spreads the infection.

Also, to prevent the spread of infection, do not share this medication with anyone else.

Discard this medication bottle after use. Do not save it for reuse.

Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. Oxymetazoline nasal should not be used more often than twice a day (every 12 hours).

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Store oxymetazoline nasal at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and use the next one as directed. Do not use a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an oxymetazoline nasal overdose include extreme tiredness, sweating, dizziness, a slow heartbeat, and coma.

What should I avoid while taking Allerest 12 Hour Nasal Spray (oxymetazoline nasal)? Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. Allerest 12 Hour Nasal Spray (oxymetazoline nasal) side effects

If you experience any of the following serious side effects, stop using oxymetazoline nasal and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

seizures;

unusual behavior or hallucinations; or

an irregular or fast heartbeat.

More commonly, you may experience some sneezing or burning, stinging, dryness, or irritation of the nose. These side effects are usually mild and temporary.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Allerest 12 Hour Nasal Spray (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

Although drug interactions between topical nasal decongestants and drugs taken by mouth are not expected, they can occur. Rarely, oxymetazoline nasal may interact with the following medicines:

furazolidone (Furoxone);

guanethidine (Ismelin);

indomethacin (Indocin);

methyldopa (Aldomet);

bromocriptine (Parlodel);

caffeine in cola, tea, coffee, chocolate and other products;

theophylline (Theo-Dur, Theochron, Theolair, others);

tricyclic antidepressants such as amitriptyline (Elavil, Endep), doxepin (Sinequan), and nortriptyline (Pamelor); other commonly used tricyclic antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), protriptyline (Vivactil), and trimipramine (Surmontil); phenothiazines such as chlorpromazine (Thorazine), thioridazine (Mellaril), and prochlorperazine (Compazine); and other commonly used phenothiazines, including fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), and trifluoperazine (Stelazine).

Drugs other than those listed here may also interact with oxymetazoline nasal. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Allerest 12 Hour Nasal Spray resources Allerest 12 Hour Nasal Spray Side Effects (in more detail) Allerest 12 Hour Nasal Spray Use in Pregnancy & Breastfeeding Allerest 12 Hour Nasal Spray Drug Interactions 0 Reviews for Allerest2 Hour Nasal - Add your own review/rating Afrin Advanced Consumer (Micromedex) - Includes Dosage Information Afrin Solution MedFacts Consumer Leaflet (Wolters Kluwer) Compare Allerest 12 Hour Nasal Spray with other medications Nasal Congestion Where can I get more information? Your pharmacist has additional information about oxymetazoline nasal written for health professionals that you may read.

See also: Allerest2 Hour Nasal side effects (in more detail)


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Triamterene


Class: Potassium-sparing Diuretics
VA Class: CV704
CAS Number: 396-01-0
Brands: Dyazide, Dyrenium, Maxzide

Hyperkalemia (i.e., serum potassium concentrations ?5.5 mEq/L) may occur with all potassium-sparing agents, including triamterene.b c d More likely to occur in patients with renal impairment and diabetes (even without evidence of renal impairment), and in geriatric or severely ill patients or those receiving prolonged therapy with large doses.a b c d

Uncorrected hyperkalemia may be fatal; monitor serum potassium concentrations at frequent intervals especially during initial therapy, after dosage adjustment, or in patients with concurrent illness that may affect renal function.b c d

Introduction

Potassium-sparing diuretic; pteridine derivative.b

Uses for Triamterene Edema

Management of edema associated with CHF, cirrhosis of the liver, or nephrotic syndrome.b

Management of steroid-induced edema, idiopathic edema, and edema caused by secondary hyperaldosteronism.b

May be used alone but most valuable when used in combination with other diuretics to promote diuresis and/or decrease potassium excretion caused by kaliuretic diuretics.b

May be particularly useful in patients excreting excessive amounts of potassium (especially those who cannot tolerate potassium supplements) and for those in whom potassium loss could be detrimental, such as patients receiving digitalis glycosides or those with myasthenia gravis.a b

Promotes increased diuresis in patients resistant or only partially responsive to thiazides or other diuretics because of secondary hyperaldosteronism.b

May be effective in some patients unresponsive to spironolactone; unlike spironolactone, diuretic effect of triamterene is independent of aldosterone concentrations.a

Used in fixed combination with hydrochlorothiazide for treatment of edema in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked.c d

Used in fixed combination with hydrochlorothiazide for treatment of edema in patients who develop hypokalemia during hydrochlorothiazide monotherapy.c d

Do not use for routine therapy in pregnant women with mild edema who are otherwise healthy.b c d

CHF

In the management of edema associated with CHF, generally used in conjunction with other more effective, rapidly acting diuretics (e.g., thiazides, chlorthalidone, loop diuretics).a Some patients resistant to triamterene monotherapy may respond to such combined therapy.a

Most experts state that all patients with symptomatic CHF who have evidence or a prior history of fluid retention generally should receive diuretic therapy in conjunction with moderate sodium restriction (?3 g of sodium daily), an ACE inhibitor, and usually a ?-adrenergic blocking agent, with or without a cardiac glycoside.112 113

Most experts state that the diuretics of choice for most patients with CHF are loop diuretics (e.g., bumetanide, ethacrynic acid, furosemide, torsemide).a

Do not use diuretics as monotherapy in CHF even if symptoms (e.g., peripheral edema, pulmonary congestion) are well controlled; diuretics alone do not prevent progression of heart failure.

Once fluid retention in CHF has resolved, diuretic therapy should be maintained to prevent its recurrence. Ideally, diuretic therapy should be adjusted according to changes in body weight (as an indicator of fluid retention) rather than maintained at a fixed dosage.

Diuretics should be continued in CHF and comorbid conditions (e.g., hypertension) where ongoing therapy with the drugs is indicated.

Hypertension

Triamterene alone has little if any hypotensive effect; however, it may be used with another diuretic (e.g., hydrochlorothiazide) or a hypotensive agent in the management of mild to moderate hypertension.a However, JNC 7 recommends that thiazides be used as initial therapy for the treatment of uncomplicated hypertension in most patients, either alone or combined with other classes of antihypertensive drugs that have demonstrated benefit (e.g., ACE inhibitors, angiotensin II receptor antagonists, ?-blockers, calcium-channel blockers).119

Used principally in patients with diuretic-induced hypokalemia or to prevent hypokalemia in patients receiving diuretics who are at risk of this adverse effect.a

Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who require a thiazide diuretic and in whom the development of hypokalemia cannot be risked.c d

Used in fixed combination with hydrochlorothiazide for treatment of hypertension in patients who develop hypokalemia during hydrochlorothiazide monotherapy.c d

Used in fixed combination with hydrochlorothiazide for treatment of hypertension as an adjunct to other antihypertensive drugs (e.g., ?-blockers).c d

Triamterene Dosage and Administration General

Monitor serum potassium concentrations following changes in dosage or with concurrent illness or drug therapy.b d (See Hyperkalemia under Cautions and also see Interactions.)

Avoid use of potassium-sparing diuretics, including triamterene, in patients with renal insufficiency, in those with hyperkalemia who have serum potassium concentrations >5 mEq/L while not receiving drug therapy, and in those who develop hyperkalemia during therapy.109 119 b c d

Do not use concurrent potassium supplementation or potassium-containing salt substitutes.b Discontinue potassium supplementation when triamterene is added to other diuretic therapy or when patients are switched to triamterene from other diuretics.b

Do not use fixed-combination triamterene/hydrochlorothiazide tablets or capsules for initial therapy of edema or hypertension, except in patients in whom the clinical consequences of hypokalemia represent an important risk (e.g., patients receiving cardiac glycosides or patients with cardiac arrhythmias).a c d

Do not use as initial monotherapy in severe CHF since bowel edema or intestinal hypoperfusion may delay absorption and subsequent therapeutic effect.a

Careful etiologic diagnosis should precede the use of any diuretic.a

Administration Oral Administration

Capsules: Administer orally twice daily after meals.b

Fixed-combination triamterene/hydrochlorothiazide tablets or capsules: Administer orally once daily.c d

Twice-daily administration of the fixed combination of triamterene and hydrochlorothiazide may increase risk of electrolyte imbalance and renal dysfunction.d

Dosage

Individualize dosage according to patient’s requirements and response.b

If added to an existing antihypertensive regimen, initially reduce dosage of each antihypertensive agent and then individualize dosage according to patient’s requirements and response.b

Abrupt discontinuance may result in rebound kaliuresis; taper dosage gradually.b

Different commercially available fixed-combination triamterene/hydrochlorothiazide preparations may not be therapeutic equivalents.a The oral bioavailabilities of the individual drugs and the amounts and ratios of these drugs in various commercially available fixed-combination preparations may differ.a

Pediatric Patients Usual Dosage† Oral

Initially, 2–4 mg/kg daily or 115 mg/m2 daily, given in a single dose or 2 divided doses after meals.a e

If necessary, increase dosage to 6 mg/kg daily.a Do not exceed 300 mg daily.b e

Hypertension† Oral

Initially, 1–2 mg/kg daily given in 2 divided doses after meals.120 Increase dosage as necessary up to 3–4 mg/kg daily given in 2 divided doses.120 Do not exceed 300 mg daily.120

Adults Edema Monotherapy Oral

Initially, 100 mg twice daily after meals.b After edema is controlled, usual maintenance dosage is 100 mg daily or every other day.a Do not exceed 300 mg daily.b

Combination Therapy Oral

When Dyazide, Maxzide or Maxzide-25 mg, or therapeutically equivalent formulations of these combinations are used, the usual dosage in terms of triamterene is 37.5–75 mg once daily.c d

Patients receiving 25 mg of hydrochlorothiazide who become hypokalemic may be switched to Maxzide-25 mg (37.5 mg triamterene/25 mg hydrochlorothiazide).d

Patients receiving 50 mg of hydrochlorothiazide who become hypokalemic may be switched to Maxzide (75 mg triamterene/50 mg hydrochlorothiazide).d

Hypertension Monotherapy Oral

Usual dosage recommended by JNC 7 as monotherapy: 50–100 mg daily.119 Some patients may benefit from dividing the daily dosage into 2 doses.119

Combination Therapy Oral

Usually combined with a kaliuretic diuretic.a

In conjunction with a kaliuretic diuretic, an initial triamterene dosage of 25 mg once daily has been recommended.109 Titrate dosage upward as needed and tolerated to a suggested maximum triamterene dosage of 100 mg daily.109 119

Initially, administer each drug separately to adjust dosage.a

May use in fixed combination with hydrochlorothiazide if optimum maintenance dosage corresponds to drug ratio in combination preparation.a

Administer each drug separately whenever dosage adjustment is necessary.a

When Dyazide, Maxzide or Maxzide-25 mg, or therapeutically equivalent formulations of these combinations are used, the usual dosage in terms of triamterene is 37.5–75 mg once daily.d

Patients receiving 25 mg of hydrochlorothiazide who become hypokalemic may be switched to Maxzide-25 mg (37.5 mg triamterene/25 mg hydrochlorothiazide).d

Patients receiving 50 mg of hydrochlorothiazide who become hypokalemic may be switched to Maxzide (75 mg triamterene/50 mg hydrochlorothiazide).d

If BP is not adequately controlled by use of 75 mg once daily (of triamterene in the fixed combination of triamterene/hydrochlorothiazide), another antihypertensive agent may be added.d

Prescribing Limits Pediatric Patients Oral

Maximum 300 mg daily.120

Adults Oral

Maximum 300 mg daily.b

The manufacturer states there is no clinical experience to date with dosages of fixed-combination Maxzide or Maxzide-25 mg exceeding 75 mg of triamterene and 50 mg of hydrochlorothiazide daily.d

Special Populations Hepatic Impairment

No specific dosage recommendations for hepatic impairment; caution if using fixed combination with hydrochlorothiazide because of risk of precipitating hepatic coma.c d (See Contraindications under Cautions.)

Renal Impairment

No specific dosage recommendations for renal impairment; do not use in patients with renal impairment and elevated serum potassium; discontinue in patients who develop hyperkalemia while on the drug.b (See Contraindications under Cautions and also see Hyperkalemia under Cautions.)

Cautions for Triamterene Contraindications

Anuria, severe or progressive renal disease or dysfunction (except possibly nephrosis), acute or chronic renal insufficiency, substantial renal impairment.b c d

Preexisting hyperkalemia (?5.5 mEq/L).b d

History of triamterene-induced hyperkalemia.b c d

Concurrent potassium supplementation, including potassium salts or potassium-containing salt substitutes.b (See Interactions.)

Concurrent therapy with potassium-sparing agents (e.g., spironolactone, amiloride hydrochloride, or fixed-combination formulations containing triamterene).b (See Interactions.)

Severe hepatic disease.b

Known hypersensitivity to triamterene or any ingredient in the formulation.b c d

Warnings/Precautions Warnings Hyperkalemia

Hyperkalemia (i.e., serum potassium concentrations ?5.5 mEq/L) may occur with all potassium-sparing agents, including triamterene.b c d (See Boxed Warning.) Serum potassium concentrations persistently >6 mEq/L require careful observation and treatment.b

If hyperkalemia occurs, discontinue triamterene; if using a triamterene/hydrochlorothiazide fixed combination, switch to a thiazide alone.b c d

Evaluate BUN and serum potassium concentrations regularly, especially in patients with suspected or confirmed renal insufficiency.b Monitor serum potassium concentrations closely in geriatric and diabetic patients.b

Warning signs of hyperkalemia include paresthesias, muscular weakness, fatigue, flaccid paralysis of the extremities, bradycardia, and shock.c d

Hyperkalemia has been associated with cardiac irregularities.b Obtain ECG if hyperkalemia present or suspected.b If ECG does not show widening of QRS or arrhythmia in the presence of hyperkalemia, usually sufficient to discontinue triamterene and any potassium supplementation and switch to a thiazide alone.b May administer sodium polystyrene sulfonate to enhance excretion of excess potassium.b

Presence of widened QRS complex or arrhythmia in association with hyperkalemia requires prompt additional therapy.b For tachyarrhythmia, infuse 44 mEq of sodium bicarbonate or 10 mL of 10% calcium gluconate or calcium chloride over several minutes.b For asystole, bradycardia, or AV block, transvenous pacing also is recommended.b The effect of calcium and sodium bicarbonate is transient and repeated administration may be required.b When indicated by the clinical situation, excess potassium may be removed by dialysis or oral or rectal administration of sodium polystyrene sulfonate.b Infusion of glucose and insulin has also been used to treat hyperkalemia.b

Potassium Supplementation

Do not use potassium supplementation (e.g., potassium salts, high potassium diet, salt substitutes) in patients receiving triamterene alone.b Discontinue potassium supplements when triamterene is added to existing diuretic therapy or when patients are switched to triamterene from other diuretics.b

Do not use potassium supplementation with fixed-combination triamterene/hydrochlorothiazide except in severe cases of hypokalemia or if dietary intake of potassium is markedly impaired.a c Such concomitant therapy may be associated with rapid increases in serum potassium concentrations.c Monitor serum potassium concentrations frequently if potassium supplementation is used, especially in patients receiving digitalis or with a history of cardiac arrhythmias.c (See Interactions.)

If serious hypokalemia (serum potassium <3.0 mEq/L demonstrated by repeat serum potassium determinations) occurs in a patient receiving fixed-combination triamterene/hydrochlorothiazide, discontinue fixed combination and initiate potassium supplementation.c

If hyperkalemia occurs in a patient receiving fixed-combination triamterene/hydrochlorothiazide and supplemental potassium therapy, discontinue supplementation and substitute a thiazide diuretic alone for fixed-combination triamterene/hydrochlorothiazide until potassium concentrations return to normal.c

Sensitivity Reactions Hypersensitivity Reactions

Hypersensitivity reactions (e.g., anaphylaxis, rash, photosensitivity) reported; monitor for blood dyscrasias, liver damage or other idiosyncratic reactions.b

General Precautions Use of Fixed Combinations

When triamterene is used in fixed combination with hydrochlorothiazide, consider the cautions, precautions, and contraindications associated with hydrochlorothiazide.d

Use during Pregnancy

Routine use of diuretics, including triamterene, in otherwise healthy women exposes mother and fetus to unnecessary risk and is not generally indicated.b c d Diuretics do not prevent development of toxemia of pregnancy and do not appear to be beneficial in the treatment of toxemia.b c d

Edema may develop during pregnancy due to comorbid pathology or the physiologic and mechanical consequences of pregnancy.b c d Diuretic therapy may be appropiate in the management of edema due to a pathologic cause manifesting during pregnancy.b c d However, dependent edema in pregnancy resulting from restriction of venous return by the gravid uterus may be treated by elevating the lower extremities and using support hose; diuretic therapy to lower intravascular volume is not appropriate in such cases.b c d

Hypervolemia and associated edema, including generalized edema, occurs in the majority of pregnant women and is not harmful to fetus or mother.b c d Increased recumbency will generally provide relief; however, edema may cause extreme discomfort which is not relieved by rest.b c d Rarely, in such cases, a short course of diuretic therapy may be appropriate to provide relief.b c d

Electrolyte Imbalance

Electrolyte imbalance may worsen or develop during diuretic therapy, including triamterene.b Risk of electrolyte imbalance is increased in patients with CHF, renal disease, or cirrhosis.b Full-dose diuretic therapy in patients on restricted salt intake may cause a low-salt syndrome.b

Monitor serum electrolytes regularly.d

Renal Effects

Elevations in BUN and/or Scr may occur, possibly secondary to a reversible reduction of GFR or a depletion of the intravascular fluid volume.d May occur more frequently in patients receiving twice-daily dosing with fixed combination of triamterene and hydrochlorothiazide.d

Monitor BUN and Scr, especially in geriatric patients and those with suspected or confirmed hepatic or renal disease.d If azotemia increases, discontinue fixed-combination triamterene/hydrochlorothiazide preparation.d

Nitrogen Retention

May cause mild nitrogen retention, which is reversible upon drug discontinuance; seldom observed with intermittent (every-other-day) therapy.b

Metabolic Acidosis

May cause a decreasing alkali reserve with the possibility of metabolic acidosis.b

Avoid use of potassium-sparing diuretics in severely ill patients in whom respiratory or metabolic acidosis may occur; acidosis may result in rapid increases in serum potassium concentrations.c d Perform frequent assessments of acid-base balance and serum electrolytes.c d

Megaloblastosis

Triamterene is a weak folic acid antagonist and may contribute to the appearance of megaloblastosis, especially in patients with depleted folic acid stores (e.g., pregnant women, alcoholics).a b Patients with cirrhosis and splenomegaly may have marked hematologic abnormalities; these patients should have periodic blood studies and be observed for exacerbations of underlying liver disease.b

Hyperuricemia

May cause elevations in serum uric acid concentrations, especially in patients predisposed to gouty arthritis.b

Renal Calculi

Has been reported in renal calcluli associated with usual calculus components.b c d Manufacturers state that triamterene may be used with caution in patients with histories of renal calcluli;b c d however, some clinicians recommend that the drug not be used in these patients because of the risk of triamterene nephrolithiasis.a

If a patient passes a urinary calculus during triamterene therapy, the drug should be discontinued and the calculus analyzed for the presence of triamterene and/or its metabolites.a

Rebound Kaliuresis

Because triamterene conserves potassium, it has been suggested that patients who have received intensive therapy or have been given the drug for prolonged periods may develop a rebound kaliuresis if such therapy is discontinued abruptly.b Discontinue drug gradually in such patients.b

Specific Populations Pregnancy

Category C.b c d

Lactation

Distributed into milk in animals and is likely to distribute into human milk.b Discontinue nursing or the drug.b

Pediatric Use

Safety and efficacy in pediatric patients remain to be fully established for triamterene or triamterene in fixed combination with hydrochlorothiazide;b c however, some experts have suggested a triamterene dosage for hypertension based on limited clinical experience.120

Geriatric Use

Reduced clearance and increased risk of hyperkalemia; monitor serum potassium concentrations frequently.b c d (See Hyperkalemia under Cautions.)

Hepatic Impairment

Use with caution in patients with impaired hepatic function.a Do not use in patients with severe hepatic disease.a Diuretic therapy in such patients should be initiated while the patient is hospitalized, because rapid alterations in fluid and electrolyte balance may precipitate hepatic coma.a Monitor serum potassium concentrations closely in patients with hepatic cirrhosis and administer potassium supplementation if required.a (See Contraindications under Cautions.)

Potassium loss has been reported during triamterene therapy in some patients with hepatic cirrhosis and may result in signs and symptoms of hepatic coma or precoma.a

Patients with cirrhosis and splenomegaly may have marked hematologic abnormalities; these patients should have periodic blood studies and be observed for exacerbations of underlying liver disease.b (See Megablastosis under Cautions.)

Renal Impairment

Use with caution; increased risk of hyperkalemia.b Monitor serum potassium concentrations closely.b Do not use in patients with renal impairment and elevated serum potassium; discontinue in patients who develop hyperkalemia while on the drug.b (See Contraindications under Cautions and also see Hyperkalemia under Cautions.)

Common Adverse Effects

Hyperkalemia, azotemia, increased BUN and creatinine, renal calculi, jaundice and/or liver enzyme abnormalities, nausea and vomiting, diarrhea, thrombocytopenia, megaloblastic anemia, weakness, fatigue, dizziness, headache, dry mouth.b

Interactions for Triamterene Specific Drugs, Foods, and Laboratory Tests

Drug, Food, or Test

Interaction

Comments

ACE inhibitor

Increased risk of hyperkalemiab c d

Use caution with concomitant ACE inhibitor therapy; monitor serum potassium concentrations frequentlya b d

Use potassium-sparing diuretics with great caution, if at all, in patients receiving an ACE inhibitor (e.g., enalapril) for CHFa

Discontinue or reduce dosage of potassium-sparing diuretics as necessary in patients receiving an ACE inhibitora

Anesthetic agents

Possible potentiation of anesthetic effectsb

Antidiabetic agents (e.g., insulin, oral agents)

Possible increase in blood glucose concentrationb

Adjust dosage of antidiabetic agent during triamterene therapy and after discontinuanceb

Antihypertensive agents

Possible additive antihypertensive effectsb

Blood products

Increased risk of hyperkalemiab

May promote potassium accumulation; plasma from blood bank may contain up to 30 mEq/L of potassium and whole blood may contain up to 65 mEq/L if stored for >10 daysb

Chlorpropamide

Possible increased risk of severe hyponatremiab c

Diuretics

Possible potentiation of diuretic effectsb

Diuretics, potassium-sparing (e.g. amiloride, spironolactone, other fixed-dose combination formulations containing triamterene)

Increased risk of hyperkalemia; fatalities reportedb

Concomitant use contraindicatedb

Laxatives

Possible decreased potassium-retaining effects of triamterenec

Chronic use or overuse of laxatives may reduce serum potassium concentrations by promoting excessive potassium loss from Gl tractc

Lithium

Reduced renal clearance of lithium and increased risk of lithium toxicityb c

Concomitant use generally contraindicated; if concomitant therapy is necessary, monitor serum lithium concentrations closely and adjust dosageb c

Nondepolarizing neuromuscular blocking agents

Potential increase in neuromuscular blockadeb

NSAIAs (e.g., indomethacin)

Concomitant use with indomethacin may adversely affect renal function (e.g., decreased Clcr, acute anuric renal failure)105 106

Concomitant use with indomethacin not recommendeda

Use caution with other concomitant NSAIAsa c

Preanesthetic agents

Possible potentiation of effects of preanesthetic agentb

Potassium supplements, potassium-containing medications (e.g., parenteral penicillin G potassium) and/or foods containing potassium (e.g., salt substitutes, low-salt milk)

Increased risk of hyperkalemia, especially in patients with renal insufficiencyb

Concomitant use generally contraindicatedb

Tests, fluorometric (e.g., lactic dehydrogenase activity)

Possible interference due to pale blue fluorescence in urinea

Tests, fluorometric assay for quinidine

Interferes with the fluorometric assay of quinidine; the two drugs have similar fluorescence spectrab c

Triamterene Pharmacokinetics Absorption Bioavailability

Triamterene and fixed combinations with hydrochlorothiazide are rapidly absorbed following oral administration;c d peak plasma concentrations achieved within 1–4 hours.a b d Interindividual variation in degree of absorption reported.a

Oral bioavailabilities of triamterene and hydrochlorothiazide from Dyazide capsules are comparable to those of aqueous suspensions of the individual drugs, averaging 85 and 82%, respectively, for the fixed-dose formulation and 100 and 100%, respectively, for the suspensions.111 Dyazide capsules also are bioequivalent to single-entity 25-mg hydrochlorothiazide tablets and 37.5-mg triamterene capsules.110

Oral bioavailabilities of triamterene and hydrochlorothiazide from Maxzide tablets are comparable to those of aqueous suspensions of the individual drugs.d The hydrochlorothiazide component of Maxzide tablets is bioequivalent to single-entity hydrochlorothiazide tablet formulations.d

Onset

Onset of diuresis following oral administration of triamterene usually occurs within 2–4 hours; maximum therapeutic effect may not occur until after several days of therapy.b

Onset of diuresis after oral administration of Dyazide usually occurs within 1 hour and peaks at 2–3 hours.c

Duration

After oral administration of triamterene, diuresis diminishes in approximately 7–9 hours,a b although the total duration of action may be ?24 hours.a

After oral administration of Dyazide, diuresis diminishes in approximately 7–9 hours.c

Food

Administration of Dyazide with a high-fat meal in healthy adults increased the average bioavailabilities of triamterene, 6-p-hydroxytriamterene, and hydrochlorothiazide by about 67, 50, and 17%, respectively; increased the peak concentrations of triamterene and its p-hydroxy metabolite; and delayed absorption of the active drugs by up to 2 hours.110

Administration with food does not affect absorption of triamterene or hydrochlorothiazide from Maxzide tablets.d

Distribution Extent

Distributed into bile.a

Crosses the placenta and distributes into milk in animals.b

Plasma Protein Binding

Approximately 67%.b

Elimination Metabolism

Primarily metabolized to 6-p-hydroxytriamterene and its sulfate conjugate.b 107

Elimination Route

Excreted in urine, primarily as 6-p-hydroxytriamterene.b

Half-life

100–150 minutes.a

Special Populations

Renal clearances of triamterene, hydroxytriamterene sulfate, and hydrochlorothiazide may be reduced in geriatric patients receiving combined triamterene and hydrochlorothiazide therapy, principally as a result of age-related reductions in renal function.107 a

Stability Storage Oral Capsules

Tight, light resistant containers at 15–30°C.a b

Fixed-dose Combination Formulations

Dyazide capsules: Tight, light resistant containers at 20–25°C.c

Maxzide tablets: Tight, light resistant containers at 15–30°C.d

ActionsActions

A pteridine derivative, potassium-sparing diuretic that is structurally related to folic acid.a b

Does not competitively inhibit aldosterone; activity is independent of aldosterone concentrations.b

Does not inhibit carbonic anhydrase.a

Acts directly on the distal renal tubule of the nephron to depress aldosterone-stimulated reabsorption of sodium and excretion of potassium and hydrogen at that site.b

Increases excretion of sodium, calcium, magnesium, and bicarbonate.a

Potassium excretion usually reduced; serum concentrations of potassium and chloride are usually increased.a b

Serum bicarbonate concentrations consistently decreased; urinary pH increased slightly.a

Reductions in glomerular filtration observed during daily, but not intermittent, administration; suggests a reversible effect on renal blood flow.a

Although effective alone, often used in combination with other diuretics that act at different sites in the nephron.a

Little if any hypotensive effect when used alone.a

Advice to Patients

Importance of taking drug after meals to help avoid stomach upset.b

Importance of informing patients that if a single daily dose is prescribed, it may be preferable to take it in the morning to minimize the effect of increased frequency of urination on nighttime sleep.b

Importance of informing patients that if a dose is missed, the patient should take only the prescribed dose at the next dosing interval.b

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.b c d

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

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

Preparations

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

Triamterene

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

50 mg

Dyrenium (with benzyl alcohol and povidone)

WellSpring

100 mg

Dyrenium (with benzyl alcohol and povidone)

WellSpring

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

Triamterene and Hydrochlorothiazide (Co-triamterzide)

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Dyazide (with benzyl alcohol and povidone)

GlaxoSmithKline

Triamterene and Hydrochlorothiazide Capsules

Barr, Mylan, Sandoz, UDL

50 mg Triamterene and Hydrochlorothiazide 25 mg*

Triamterene and Hydrochlorothiazide Capsules

TEVA, Sandoz

Tablets

37.5 mg Triamterene and Hydrochlorothiazide 25 mg*

Maxzide-25 mg (scored)

Mylan

Triamterene and Hydrochlorothiazide Tablets

Barr, Mylan, Pliva, Sandoz, Watson

75 mg Triamterene and Hydrochlorothiazide 50 mg*

Maxzide (scored)

Mylan

Triamterene and Hydrochlorothiazide Tablets

Barr, Mylan, Pliva, Sandoz, Teva, UDL, Watson

Comparative Pricing

This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 03/2011. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.

Dyazide 37.5-25MG Capsules (GLAXO SMITH KLINE): 30/$45.99 or 90/$109.92

Dyrenium 100MG Capsules (WELLSPRING PHARMACEUTICAL CORP): 30/$75.99 or 90/$205.53

Dyrenium 50MG Capsules (WELLSPRING PHARMACEUTICAL CORP): 30/$49.83 or 90/$124.54

Maxzide 75-50MG Tablets (MYLAN): 30/$79.99 or 90/$219.96

Maxzide-25 37.5-25MG Tablets (MYLAN BERTEK): 30/$37.5 or 90/$85.87

Triamterene-HCTZ 37.5-25MG Capsules (SANDOZ): 100/$19.99 or 200/$25.98

Triamterene-HCTZ 37.5-25MG Tablets (SANDOZ): 100/$29.99 or 200/$45.96

Triamterene-HCTZ 50-25MG Capsules (SANDOZ): 100/$155.99 or 300/$439.98

Triamterene-HCTZ 75-50MG Tablets (SANDOZ): 100/$17.99 or 300/$39.96

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 July 2006. 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. Upton RA, Williams RL, Lin ET et al. Absence of a significant pharmacokinetic interaction between hydrochlorothiazide and triamterene when coadministered. J Pharmacokinet Biopharm. 1984; 12:575-86. [IDIS 197834] [PubMed 6533293]

101. Blume CD, Williams RL, Upton RA et al. Bioequivalence study of a new tablet formulation of triamterene and hydrochlorothiazide. Am J Med. 1984; 77(Suppl 5A):59-61. [IDIS 192689] [PubMed 6496560]

102. Blume CD, Williams RL. A new antihypertensive agent: Maxzide (75 mg triamterene/50 mg hydrochlorothiazide). Am J Med. 1984; 77(Suppl 5A):52-8. [IDIS 192688] [PubMed 6388327]

104. Houston MC. Thiazides and thiazide-like diuretics in hypertension. Ann Intern Med. 1985; 103:303. [IDIS 202760] [PubMed 4014913]

105. Favre L, Glasson P, Vallotton MB. Reversible acute renal failure from combined triamterene and indomethacin. Ann Intern Med. 1982; 96:317-20. [IDIS 146179] [PubMed 6949485]

106. Weinberg MS, Quigg RJ, Salant DJ et al. Anuric renal failure precipitated by indomethacin and triamterene. Nephron. 1985; 40:216-8. [PubMed 4000350]

107. Williams RL, Thornhill MD, Upton RA et al. Absorption and disposition of two combination formulations of hydr


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Ipratropium Bromide eent


Class: EENT Drugs, Miscellaneous
VA Class: NT900
Chemical Name: (endo,syn-±-3-(3-Hydroxy-1-oxo-2-pheny lpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo[3.2.1]octane bromide monohydrate
Molecular Formula: C20H30BrNO3•H2O
CAS Number: 66985-17- 9
Brands: Atrovent Nasal Spray

Introduction

Synthetic quaternary ammonium antimuscarinic.1 2

Uses for Ipratropium Bromide Common Cold

Symptomatic relief of rhinorrhea associated with the common cold in adults and children ?5 years of age.1 Does not relieve nasal congestion or sneezing.1

Seasonal Allergic Rhinitis

Symptomatic relief of rhinorrhea associated with seasonal allergic rhinitis in adults and children ?5 years of age.1 Does not relieve nasal congestion, sneezing, or itching eyes.1

Perennial Rhinitis

Symptomatic relief of rhinorrhea associated with allergic and nonallergic perennial rhinitis in adults and children ?6 years of age.2 Does not relieve nasal congestion, sneezing, or postnasal drip.2

Ipratropium Bromide Dosage and Administration Administration Intranasal Administration

Administer in each nostril 2–4 times daily using spray pump supplied by the manufacturer.1 2

Prime pump before first dose with 7 sprays; if used regularly, no further priming required.1 2 If not used for >24 hours, reprime with 2 sprays; if not used for >7 days, reprime with 7 sprays.1 2

Dosage

Intranasal spray pump delivers 0.07 mL of solution per actuation.1 2

Ipratropium bromide 0.03% nasal spray delivers 21 mcg of ipratropium bromide per spray and about 345 sprays per bottle.2

Ipratropium bromide 0.06% nasal spray delivers 42 mcg of ipratropium bromide per spray and about 165 sprays per bottle.1

Pediatric Patients Common Cold Intranasal

Children 5–11 years of age: 84 mcg (2 sprays of the 0.06% solution) in each nostril 3 times daily.1

Children ?12 years of age: 84 mcg (2 sprays of the 0.06% solution) in each nostril 3 or 4 times daily.1

Seasonal Allergic Rhinitis Intranasal

Children ?5 years of age: 84 mcg (2 sprays of the 0.06% solution) in each nostril 4 times daily.1

Perennial Rhinitis Intranasal

Children ?6 years of age: 42 mcg (2 sprays of the 0.03% solution) in each nostril 2 or 3 times daily.2

Adults Common Cold Intranasal

84 mcg (2 sprays of the 0.06% solution) in each nostril 3 or 4 times daily.1

Seasonal Allergic Rhinitis Intranasal

84 mcg (2 sprays of the 0.06% solution) in each nostril 4 times daily.1

Perennial Rhinitis Intranasal

42 mcg (2 sprays of the 0.03% solution) in each nostril 2 or 3 times daily.2

Prescribing Limits Pediatric Patients Common Cold Intranasal

Safety and efficacy beyond 4 days not established.1

Seasonal Allergic Rhinitis Intranasal

Safety and efficacy beyond 3 weeks not established.1

Adults Common Cold Intranasal

Safety and efficacy beyond 4 days not established.1

Seasonal Allergic Rhinitis Intranasal

Safety and efficacy beyond 3 weeks not established.1

Cautions for Ipratropium Bromide Contraindications

Known hypersensitivity to ipratropium or any ingredient in the formulation, or to atropine or its derivatives.1 2

Warnings/Precautions Sensitivity Reactions Hypersensitivity Reactions

Immediate hypersensitivity reactions, including urticaria, angioedema, rash, bronchospasm, and oropharyngeal edema, may occur.1 2

General Precautions Ocular Effects

Caution in patients with angle-closure glaucoma.1 2 Ocular pain or precipitation or worsening of angle-closure glaucoma reported following inadvertent contact of the drug with the eyes.1 2

Genitourinary Effects

Caution in patients with prostatic hypertrophy or bladder neck obstruction.1 2

Specific Populations Pregnancy

Category B.1 2

Lactation

Not known whether ipratropium is distributed into milk following intranasal administration.1 2 Caution advised.1 2

Pediatric Use

Safety established based on studies in children.1 2

Efficacy based on extrapolation from studies in adults with perennial rhinitis and adults and adolescents with common cold or seasonal allergic rhinitis and on the likelihood that the disease course, pathophysiology, and the drug’s effect in children are similar to those in adults.1 2

Safety and efficacy of 0.03% nasal spray not established in children <6 years of age.2

Safety and efficacy of 0.06% nasal spray not established in children <5 years of age.1

Common Adverse Effects

Nasal dryness, epistaxis.1 2

Interactions for Ipratropium Bromide

Limited systemic absorption of intranasal ipratropium minimizes potential for interactions with systemically administered drugs.1 2

Antimuscarinic Agents

Potential for additive pharmacologic effect with other antimuscarinic agents, including orally inhaled ipratropium.1 2

Ipratropium Bromide Pharmacokinetics Absorption Bioavailability

<20% following intranasal administration.1 2

Onset

Common cold: 1 hour.1

Perennial rhinitis: 1 day.2

Distribution Plasma Protein Binding

0–9% (albumin and ?1-acid glycoprotein).1 2

Elimination Metabolism

Metabolized to ester hydrolysis products (tropic acid and tropane).1 2

Elimination Route

Following IV administration, approximately 50% of dose excreted in urine as unchanged drug within 24 hours.1 2 Following intranasal administration at recommended dosages, mean percentage of dose excreted in urine as unchanged drug generally <10%.1 2

Half-life

1.6 hours.1 2

Stability Storage Intranasal Solution

15–30°C; avoid freezing.1 2

ActionsActions

Nonselective competitive antagonist at muscarinic receptors.1 2

When applied locally, inhibits secretions from serous and seromucous glands lining the nasal mucosa.1 2

Ipratropium nasal spray has not produced appreciable changes in pupillary diameter, heart rate, or blood pressure in children or adults.1 2

Ipratropium nasal spray does not alter physiologic nasal functions such as sense of smell, ciliary beat frequency, mucociliary clearance, or air conditioning capacity of nose.1 2

Advice to Patients

Provide careful instruction on priming the pump and administration.1 2

Importance of providing patient a copy of manufacturer’s patient information.1 2

Risk of temporary blurring of vision, precipitation or worsening of angle-closure glaucoma, or ocular pain if ipratropium comes into direct contact with the eye.1 2 Avoid spraying ipratropium nasal spray in or around the eyes.1 2

Importance of notifying clinician if ocular pain, blurred vision, excessive nasal dryness, or episodes of nasal bleeding develop.1 2

Importance of women informing clinicians if they are or plan to become pregnant or plan to breast-feed.1 2

Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs.1 2

Importance of informing patients of other important precautionary information.1 2 (See Cautions.)

Preparations

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

Ipratropium Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Nasal

Solution

21 mcg/metered spray

Atrovent Nasal Spray 0.03% (with benzalkonium chloride)

Boehringer Ingelheim

42 mcg/metered spray

Atrovent Nasal Spray 0.06% (with benzalkonium chloride)

Boehringer Ingelheim

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 August 2005. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.

References

1. Boehringer Ingelheim. Atrovent (ipratropium bromide) Nasal Spray 0.06% prescribing information (dated 2002 Nov 14). In: PDR electronic library (<url>http://www.thomsonhc.com</url>).

2. Boehringer Ingelheim. Atrovent (ipratropium bromide) Nasal Spray 0.03% prescribing information (dated 2002 Nov 14). In: PDR electronic library (<url>http://www.thomsonhc.com</url>).

More Ipratropium Bromide eent resources Ipratropium Bromide eent Use in Pregnancy & Breastfeeding Ipratropium Bromide eent Drug Interactions Ipratropium Bromide eent Support Group 1 Review for Ipratropium Bromide eent - Add your own review/rating Compare Ipratropium Bromide eent with other medications Rhinorrhea
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Neo-Synephrine 12 Hour


Generic Name: oxymetazoline nasal (ox ee me TAZ oh leen)
Brand Names: Afrin, Afrin Nasal Sinus, Allerest 12 Hour Nasal Spray, Duramist Plus, Duration, Four-Way Nasal Spray, Genasal, Neo-Synephrine 12 Hour, Nostrilla, NRS Nasal, NTZ Long Acting Nasal, Oxyfrin, Oxymeta-12, Sinarest Nasal, Sinex Long-Acting, Twice-A-Day

What is Neo-Synephrine 12 Hour (oxymetazoline nasal)?

Oxymetazoline is a decongestant. It works by constricting (shrinking) blood vessels (veins and arteries) in your body. The nasal formulation acts directly on the blood vessels in your nasal tissues. Constriction of the blood vessels in your nose and sinuses leads to drainage of these areas and a decrease in congestion.

Oxymetazoline nasal is used to treat congestion associated with allergies, hay fever, sinus irritation, and the common cold.

Oxymetazoline nasal may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about Neo-Synephrine 12 Hour (oxymetazoline nasal)?

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Do not use more of this medication than is recommended on the package or by your doctor. Who should not use Neo-Synephrine 12 Hour (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days. This could cause a very dangerous drug interaction with serious side effects.

Before taking this medication, tell your doctor if you have

high blood pressure;

any type of heart disease, hardening of the arteries, or irregular heart beats;

thyroid problems;

diabetes;

glaucoma or increased pressure in the eye;

an enlarged prostate or difficulty urinating; or

liver or kidney disease.

You may not be able to use oxymetazoline nasal, or you may require a lower dose or special monitoring during your therapy if you have any of the conditions listed above.

It is not known whether oxymetazoline nasal will harm an unborn baby. Do not use oxymetazoline nasal without first talking to your doctor if you are pregnant. Infants are especially sensitive to the effects of oxymetazoline nasal. Do not use this medication without first talking to your doctor if you are breast-feeding a baby. If you over 60 years of age, you may be more likely to experience side effects from oxymetazoline nasal. You may require a lower dose of this medication. How should I use Neo-Synephrine 12 Hour (oxymetazoline nasal)?

Use oxymetazoline nasal exactly as directed by your doctor, or follow the instructions that accompany the package. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

To apply the nasal spray, keep your head upright, spray, then sniff hard for a few minutes after administering a dose.

To apply the nasal drops, lie on a bed on your back with your head hanging over the edge. Insert the drops and remain in this position for several minutes. Gently turn your head from side to side.

Do not allow the tip of the container to touch the inside of your nose or any other surface. This spreads the infection.

Also, to prevent the spread of infection, do not share this medication with anyone else.

Discard this medication bottle after use. Do not save it for reuse.

Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. Oxymetazoline nasal should not be used more often than twice a day (every 12 hours).

Do not use oxymetazoline nasal for longer than 3 to 5 days. Longer use could cause damage to your nasal tissue and lead to chronic congestion. If your symptoms do not improve, see your doctor.

Store oxymetazoline nasal at room temperature away from moisture and heat.

What happens if I miss a dose?

Use the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and use the next one as directed. Do not use a double dose of this medication.

What happens if I overdose? Seek emergency medical attention.

Symptoms of an oxymetazoline nasal overdose include extreme tiredness, sweating, dizziness, a slow heartbeat, and coma.

What should I avoid while taking Neo-Synephrine 12 Hour (oxymetazoline nasal)? Never use this medication in larger doses or more often than is recommended. Too much oxymetazoline nasal could be very harmful. Neo-Synephrine 12 Hour (oxymetazoline nasal) side effects

If you experience any of the following serious side effects, stop using oxymetazoline nasal and seek emergency medical attention:

an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives);

seizures;

unusual behavior or hallucinations; or

an irregular or fast heartbeat.

More commonly, you may experience some sneezing or burning, stinging, dryness, or irritation of the nose. These side effects are usually mild and temporary.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect Neo-Synephrine 12 Hour (oxymetazoline nasal)? Do not use oxymetazoline nasal if you have taken a monoamine oxidase (MAO) inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), or tranylcypromine (Parnate) in the last 14 days.

Although drug interactions between topical nasal decongestants and drugs taken by mouth are not expected, they can occur. Rarely, oxymetazoline nasal may interact with the following medicines:

furazolidone (Furoxone);

guanethidine (Ismelin);

indomethacin (Indocin);

methyldopa (Aldomet);

bromocriptine (Parlodel);

caffeine in cola, tea, coffee, chocolate and other products;

theophylline (Theo-Dur, Theochron, Theolair, others);

tricyclic antidepressants such as amitriptyline (Elavil, Endep), doxepin (Sinequan), and nortriptyline (Pamelor); other commonly used tricyclic antidepressants, including amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), imipramine (Tofranil), protriptyline (Vivactil), and trimipramine (Surmontil); phenothiazines such as chlorpromazine (Thorazine), thioridazine (Mellaril), and prochlorperazine (Compazine); and other commonly used phenothiazines, including fluphenazine (Prolixin), perphenazine (Trilafon), mesoridazine (Serentil), and trifluoperazine (Stelazine).

Drugs other than those listed here may also interact with oxymetazoline nasal. Talk to your doctor and pharmacist before taking any prescription or over-the-counter medicines.

More Neo-Synephrine 12 Hour resources Neo-Synephrine 12 Hour Side Effects (in more detail) Neo-Synephrine 12 Hour Use in Pregnancy & Breastfeeding Neo-Synephrine 12 Hour Drug Interactions Neo-Synephrine 12 Hour Support Group 0 Reviews for Neo-Synephrine2 Hour - Add your own review/rating Neo-Synephrine 12 Hour Advanced Consumer (Micromedex) - Includes Dosage Information Afrin Solution MedFacts Consumer Leaflet (Wolters Kluwer) Compare Neo-Synephrine 12 Hour with other medications Nasal Congestion Where can I get more information? Your pharmacist has additional information about oxymetazoline nasal written for health professionals that you may read.

See also: Neo-Synephrine2 Hour side effects (in more detail)


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Care Decongestant Nasal Spray


1. Name Of The Medicinal Product

Oxymetazoline 0.05% w/v Nasal Spray

Care Decongestant Nasal Spray

2. Qualitative And Quantitative Composition

The nasal solution contains Oxymetazoline (as hydrochloride) 0.05% w/v.

For excipients, see 6.1

3. Pharmaceutical Form

Nasal spray, solution

4. Clinical Particulars 4.1 Therapeutic Indications

Oxymetazoline Nasal Spray or Care Decongestant Nasal Spray is recommended for the relief of nasal congestion in such conditions as the common cold, catarrh and hayfever.

4.2 Posology And Method Of Administration

Adults and Elderly

While holding upright the spray nozzle should be inserted into each nostril in turn and squeezed firmly twice while breathing in. The application may be repeated up to 2 times a day, or used at bedtime to give relief through the night.

Children

Not recommended for children under 12 years of age.

4.3 Contraindications

Hypersensitivity to any component of the medicinal product.

Patients who are receiving monoamine oxidase inhibitors or within 14 days of stopping such treatment; patients suffering from porphyria, glaucoma, coronary artery disease, hypertension, hyperthyroidism or diabetes.

4.4 Special Warnings And Precautions For Use

If symptoms persist, consult your doctor. Prolonged use may result in rhinitis medicamentosa and should therefore be avoided. Treatment should be limited to a maximum of seven days. Keep all medicines safely away from children.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

If you are taking other medicines, you should see your doctor for advice before taking this medicine.

4.6 Pregnancy And Lactation

The safety to use in pregnancy has not been established and administration of oxymetazoline during pregnancy should be avoided.

4.7 Effects On Ability To Drive And Use Machines

None.

4.8 Undesirable Effects

This medicinal product contains thiomersal (an organomercuric compound) as a preservative and therefore, it is possible that it may cause local skin reactions (e.g. contact dermatitis) and discolouration.

Benzalkonium chloride may cause local skin irritation.

4.9 Overdose

No statement.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Pharmacotherapeutic group (ATC code): S01G A04 Sympathomimetics used as decongestants.

Oxymetazoline is an alpha-adrenoceptor agonist which causes local vasoconstriction when applied to nasal membrane.

5.2 Pharmacokinetic Properties

When applied locally to nasal mucosa, oxymetazoline acts within a few minutes and its effects last for up to 12 hours.

5.3 Preclinical Safety Data

There are no preclinical data of relevance to the prescriber which are additional to that already included in other sections of the SPC

6. Pharmaceutical Particulars 6.1 List Of Excipients

Benzalkonium chloride

Thiomersal

Sodium chloride

Levomenthol

Cineole

Camphor

Methyl salicylate

Poloxamer 188

Sodium citrate (dihydrate) (E331)

Citric acid (anhydrous) (E330)

Purified water

6.2 Incompatibilities

None

6.3 Shelf Life

2 years

6.4 Special Precautions For Storage

None

6.5 Nature And Contents Of Container

White, low density polyethylene/polyethylene copolymer 15ml bottle.

White, high density polyethylene 15ml and 20ml bottle.

6.6 Special Precautions For Disposal And Other Handling

None

7. Marketing Authorisation Holder

Thornton & Ross Ltd

Linthwaite

Huddersfield

West Yorkshire

HD7 5QH

United Kingdom

8. Marketing Authorisation Number(S)

PL 00240/0343

9. Date Of First Authorisation/Renewal Of The Authorisation

24/01/2007

10. Date Of Revision Of The Text

20/12/2010

11 DOSIMETRY (IF APPLICABLE)

Not Applicable

12 INSTRUCTIONS FOR PREPARATION OF RADIOPHARMACEUTICALS (IF APPLICABLE)

Not Applicable


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Astelin Spray


Pronunciation: a-ZEL-as-teen
Generic Name: Azelastine
Brand Name: Astelin
Astelin Spray is used for:

Treating allergy symptoms such as sneezing and itchy, runny nose. It is also used to treat symptoms of nasal passage inflammation such as runny nose, stuffy nose, and postnasal drip. It may also be used for other conditions as determined by your doctor.

Astelin Spray is an antihistamine nasal spray. It works by blocking the action of histamine, which reduces allergy symptoms.

Do NOT use Astelin Spray if: you are allergic to any ingredient in Astelin Spray

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

Before using Astelin Spray:

Some medical conditions may interact with Astelin Spray. 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

Some MEDICINES MAY INTERACT with Astelin Spray. Because little, if any, of Astelin Spray is absorbed into the blood, the risk of it interacting with another medicine is low.

Ask your health care provider if Astelin Spray 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 Astelin Spray:

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

An extra patient leaflet is available with Astelin Spray. Talk to your pharmacist if you have questions about this information. Astelin Spray is for the nose only. Do not get it in your eyes or mouth. If you get Astelin Spray in your eyes, rinse with cool tap water at once. Prime the spray pump before the first use of a new bottle. Remove the blue dust cover over the tip of the bottle and the blue safety clip. To prime the pump, point the spray pump away from you and others. Spray rapidly and firmly several times until a fine mist appears (4 sprays or less). Gently blow your nose to clear your nostrils. Keep your head tilted downward. Place the spray tip ?? to ?? inch into the nostril. Hold the bottle upright, allowing the spray tip to aim toward the back of the nose. Close the other nostril with one finger. Spray rapidly and firmly once and sniff gently at the same time. Repeat in the other nostril as directed. Breathe in gently. Do not tilt your head back after using Astelin Spray. This will help you to avoid the bitter taste that may be caused by Astelin Spray. After using Astelin Spray, wipe the spray tip with a clean tissue or cloth. Keep the dust cover and safety clip on the bottle when it is not in use. If 3 or more days have passed since the last use of this bottle, reprime the pump with 2 sprays or until a fine mist appears. If the nozzle becomes clogged, do NOT clean it by using a pointed object. Remove the spray pump from the bottle. Soak it in warm water, squirting it several times while under water. Dry the spray pump completely. Attach the spray pump to the bottle and reprime. If you miss a dose of Astelin Spray, 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 Astelin Spray.

Important safety information: Astelin Spray may cause drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Astelin Spray 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 Astelin Spray; 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 without checking with your doctor. The medicine has an antihistamine in it. Before you start any new medicine, check the label to see if it has an antihistamine (eg, diphenhydramine) in it too. If it does or if you are not sure, check with your doctor or pharmacist. Astelin Spray 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. Astelin Spray should be used with extreme caution in CHILDREN younger than 5 years old; safety and effectiveness in these 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 Astelin Spray while you are pregnant. It is not known if Astelin Spray is found in breast milk. If you are or will be breast-feeding while you use Astelin Spray, check with your doctor. Discuss any possible risks to your baby. Possible side effects of Astelin Spray:

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:

Bitter taste; drowsiness; fatigue; headache; mild nasal bleeding, burning, discomfort, or stinging; sudden sneezing attack.

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); repeated or persistent nosebleeds; severe nasal irritation.

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: Astelin 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 increased limp muscles; saliva production; seizures; tremors.

Proper storage of Astelin Spray:

Store Astelin Spray at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Protect from freezing. Store with the pump tightly closed. Store away from heat, moisture, and light. Do not use Astelin Spray after the expiration date on the bottle. Keep Astelin Spray out of the reach of children and away from pets.

General information: If you have any questions about Astelin Spray, please talk with your doctor, pharmacist, or other health care provider. Astelin Spray 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 Astelin Spray. 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 Astelin resources Astelin Side Effects (in more detail) Astelin Use in Pregnancy & Breastfeeding Astelin Drug Interactions Astelin Support Group 7 Reviews for Astelin - Add your own review/rating Compare Astelin with other medications Hay Fever
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hydrochlorothiazide and irbesartan


Generic Name: hydrochlorothiazide and irbesartan (HYE droe KLOR oh THYE a zide and ir be SAR tan)
Brand Names: Avalide

What is hydrochlorothiazide and irbesartan?

Hydrochlorothiazide is a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.

Irbesartan is an angiotensin II receptor antagonist. Irbesartan keeps blood vessels from narrowing, which lowers blood pressure and improves blood flow.

The combination of hydrochlorothiazide and irbesartan is used to treat high blood pressure (hypertension).

Hydrochlorothiazide and irbesartan may also be used for purposes not listed in this medication guide.

What is the most important information I should know about hydrochlorothiazide and irbesartan? Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate. Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan. In rare cases, hydrochlorothiazide and irbesartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine. What should I discuss with my healthcare provider before taking hydrochlorothiazide and irbesartan? You should not use this medication if you are allergic to irbesartan or hydrochlorothiazide (Carozide, Diaqua, Ezide HCTZ, HydroDiuril, Microzide, and others), or if you are unable to urinate.

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

kidney disease; liver disease;

congestive heart failure;

glaucoma;

low or high levels of potassium in your blood;

asthma or allergies;

high cholesterol or triglyceride levels;

gout;

lupus;

diabetes; or

an allergy to sulfa drugs or penicillin.

FDA pregnancy category D. Do not use hydrochlorothiazide and irbesartan if you are pregnant. Stop using this medication and tell your doctor right away if you become pregnant. Irbesartan can cause injury or death to the unborn baby if you take the medicine during your second or third trimester. Use effective birth control while taking hydrochlorothiazide and irbesartan. It is not known whether hydrochlorothiazide and irbesartan passes into breast milk or if it could harm a nursing baby. You should not breast-feed while you are using hydrochlorothiazide and irbesartan. How should I take hydrochlorothiazide and irbesartan?

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.

Your doctor may occasionally change your dose to make sure you get the best results.

Your blood pressure will need to be checked often. Visit your doctor regularly.

Call your doctor if you have ongoing vomiting or diarrhea, or if you are sweating more than usual. You can easily become dehydrated while taking this medication, which can lead to severely low blood pressure or a serious electrolyte imbalance.

Hydrochlorothiazide can interfere with the results of a thyroid test. Tell any doctor who treats you that you are using this medication.

It may take up to 4 weeks for this medication to control your blood pressure. Keep using this medicine as directed, even if you feel well. High blood pressure often has no symptoms. You may need to use blood pressure medication for the rest of your life. If you need surgery, tell the surgeon ahead of time that you are using hydrochlorothiazide and irbesartan. You may need to stop using the medicine for a short time. Store at room temperature away from moisture and heat.

See also: Hydrochlorothiazide and irbesartan dosage (in more detail)

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 fast or slow heartbeat, feeling light-headed, or fainting.

What should I avoid while taking hydrochlorothiazide and irbesartan? Drinking alcohol can further lower your blood pressure and may increase certain side effects of hydrochlorothiazide and irbesartan.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Follow your doctor's instructions about the type and amount of liquids you should drink. In some cases, drinking too much liquid can be as unsafe as not drinking enough.

Do not use potassium supplements or salt substitutes while you are taking hydrochlorothiazide and irbesartan, unless your doctor has told you to. Hydrochlorothiazide and irbesartan 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. In rare cases, hydrochlorothiazide and irbesartan can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have muscle pain, tenderness, or weakness especially if you also have fever, nausea or vomiting, and dark colored urine. Call your doctor at once if you have any other serious side effects, such as:

eye pain, vision problems;

feeling like you might pass out;

chest pain, feeling short of breath, even with mild exertion;

fever;

swelling, rapid weight gain;

urinating more or less than usual, or not at all;

jaundice (yellowing of the skin or eyes); or

dry mouth, increased thirst, drowsiness, restless feeling, confusion, increased urination, fast heart rate, feeling light-headed, fainting, or seizure (convulsions).

Less serious side effects may include:

stomach pain, heartburn;

muscle pain;

dizziness, drowsiness;

headache;

runny or stuffy nose, sore throat; or

dry cough.

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.

Hydrochlorothiazide and irbesartan Dosing Information

Usual Adult Dose for Hypertension:

For use in patients not adequately controlled on monotherapy and as initial therapy in patients likely to require multiple drugs to achieve their blood pressure goals:
Initial dose: 1 tablet (12.5 mg-150 mg) orally once a day.
Maintenance dose: Up to 25 mg-300 mg orally once a day.
For use as replacement therapy when substituted for titrated components:
Patients may be given the combination of HCTZ-irbesartan tablets equivalent to the established necessary and safe dose of each drug.

What other drugs will affect hydrochlorothiazide and irbesartan?

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

any other diuretics or blood pressure medications;

steroids (prednisone and others);

lithium (Eskalith, Lithobid);

cholestyramine (Prevalite, Questran) or colestipol (Colestid);

insulin or oral diabetes medications;

a barbiturate such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Luminal, Solfoton);

aspirin or other NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn, Naprelan, Treximet), celecoxib (Celebrex), diclofenac (Arthrotec, Cambia, Cataflam, Voltaren, Flector Patch, Pennsaid, Solareze), indomethacin (Indocin), meloxicam (Mobic), and others;

a muscle relaxer such as baclofen (Lioresal), carisoprodol (Soma), cyclobenzaprine (Flexeril), dantrolene (Dantrium), metaxalone (Skelaxin), or methocarbamol (Robaxin), orphenadrine (Norflex), or tizanidine (Zanaflex); or

a narcotic medication such as hydrocodone (Lortab, Vicodin), meperidine (Demerol), methadone (Methadose), oxycodone (OxyContin), propoxyphene (Darvon, Darvocet), and others.

This list is not complete and other drugs may interact with hydrochlorothiazide and irbesartan. 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 hydrochlorothiazide and irbesartan resources Hydrochlorothiazide and irbesartan Dosage Hydrochlorothiazide and irbesartan Use in Pregnancy & Breastfeeding Hydrochlorothiazide and irbesartan Drug Interactions Hydrochlorothiazide and irbesartan Support Group 4 Reviews for Hydrochlorothiazide and irbesartan - Add your own review/rating Compare hydrochlorothiazide and irbesartan with other medications High Blood Pressure Where can I get more information? Your pharmacist can provide more information about hydrochlorothiazide and irbesartan.
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Lorabid


Generic Name: loracarbef (lor a KAR bef)
Brand Names: Lorabid, Lorabid Pulvules

What is Lorabid (loracarbef)?

Loracarbef is an antibiotic that fights bacteria in your body.

Loracarbef is used to treat many different types of infections caused by bacteria.

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

What is the most important information I should know about Lorabid (loracarbef)? Do not take this medication if you are allergic to loracarbef, or to similar antibiotics, such as Ceftin, Cefzil, Duricef, Fortaz, Keflex, Omnicef, Spectracef, Suprax, and others.

Before taking this medication, tell your doctor if you are allergic to any drugs (especially penicillin).

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Loracarbef will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I discuss with my healthcare provider before taking Lorabid (loracarbef)? Do not take this medication if you are allergic to loracarbef or to any cephalosporin antibiotic, such as:

cefadroxil (Duricef);

cefdinir (Omnicef);

cefditoren (Spectracef);

cefixime (Suprax);

cefprozil (Cefzil);

ceftazidime (Fortaz);

cefuroxime (Ceftin);

cephalexin (Keflex); and others.

Before taking loracarbef, tell your doctor if you have:

kidney disease;

a history of intestinal problems (especially colitis); or

are allergic to any drugs, especially penicillins.

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

FDA pregnancy category B. This medication is not expected to 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 loracarbef 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.

The liquid form of loracarbef may contain sucrose (sugar). Talk to your doctor before using this form of loracarbef if you have diabetes.

How should I take Lorabid (loracarbef)?

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. Take loracarbef on an empty stomach, at least 1 hour before or 2 hours after a meal. Shake the suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked 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. Take loracarbef for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Loracarbef will not treat a viral infection such as the common cold or flu.

Contact your doctor if your infection does not improve or if your symptoms get worse.

Store this medication at room temperature away from moisture and heat.

Throw away any unused liquid medication that is older than 14 days.

What happens if I miss a dose?

Take the medication as soon as you remember the missed dose. If it is almost time for your next dose, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use 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.

Overdose symptoms may include nausea, vomiting, stomach pain, and diarrhea.

What should I avoid while taking Lorabid (loracarbef)? Avoid using antacids within 1 hour before or after taking loracarbef. Antacids can make it harder for your body to absorb loracarbef.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Lorabid (loracarbef) 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. Call your doctor at once if you have any of these serious side effects:

diarrhea that is watery or bloody;

seizure (convulsions);

fever, sore throat, and joint pain with a severe blistering, peeling, and red skin rash;

easy bruising or bleeding, unusual weakness; or

skin rash, bruising, severe tingling, numbness, pain, muscle weakness.

Less serious side effects may include:

mild itching or skin rash;

mild nausea, vomiting, stomach pain, loss of appetite;

warmth, redness, or tingling under your skin;

headache;

dizziness, drowsiness; or

vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Lorabid (loracarbef)?

Before you take loracarbef, tell your doctor if you are also taking:

probenecid (Benemid); or

a diuretic (water pill) such as amiloride (Midamor, Moduretic), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactazide, Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), and others.

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

More Lorabid resources Lorabid Side Effects (in more detail) Lorabid Use in Pregnancy & Breastfeeding Lorabid Drug Interactions Lorabid Support Group 1 Review for Lorabid - Add your own review/rating Lorabid Prescribing Information (FDA) Lorabid Monograph (AHFS DI) Lorabid Advanced Consumer (Micromedex) - Includes Dosage Information Lorabid MedFacts Consumer Leaflet (Wolters Kluwer) Compare Lorabid with other medications Bladder Infection Bronchitis Impetigo Kidney Infections Otitis Media Pneumonia Sinusitis Skin Infection Strep Throat Tonsillitis/Pharyngitis Upper Respiratory Tract Infection Where can I get more information? Your pharmacist can provide more information about loracarbef.

See also: Lorabid side effects (in more detail)


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Lorabid Pulvules


Generic Name: loracarbef (lor a KAR bef)
Brand Names: Lorabid, Lorabid Pulvules

What is Lorabid Pulvules (loracarbef)?

Loracarbef is an antibiotic that fights bacteria in your body.

Loracarbef is used to treat many different types of infections caused by bacteria.

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

What is the most important information I should know about Lorabid Pulvules (loracarbef)? Do not take this medication if you are allergic to loracarbef, or to similar antibiotics, such as Ceftin, Cefzil, Duricef, Fortaz, Keflex, Omnicef, Spectracef, Suprax, and others.

Before taking this medication, tell your doctor if you are allergic to any drugs (especially penicillin).

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Loracarbef will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

What should I discuss with my healthcare provider before taking Lorabid Pulvules (loracarbef)? Do not take this medication if you are allergic to loracarbef or to any cephalosporin antibiotic, such as:

cefadroxil (Duricef);

cefdinir (Omnicef);

cefditoren (Spectracef);

cefixime (Suprax);

cefprozil (Cefzil);

ceftazidime (Fortaz);

cefuroxime (Ceftin);

cephalexin (Keflex); and others.

Before taking loracarbef, tell your doctor if you have:

kidney disease;

a history of intestinal problems (especially colitis); or

are allergic to any drugs, especially penicillins.

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

FDA pregnancy category B. This medication is not expected to 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 loracarbef 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.

The liquid form of loracarbef may contain sucrose (sugar). Talk to your doctor before using this form of loracarbef if you have diabetes.

How should I take Lorabid Pulvules (loracarbef)?

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. Take loracarbef on an empty stomach, at least 1 hour before or 2 hours after a meal. Shake the suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked 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. Take loracarbef for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Loracarbef will not treat a viral infection such as the common cold or flu.

Contact your doctor if your infection does not improve or if your symptoms get worse.

Store this medication at room temperature away from moisture and heat.

Throw away any unused liquid medication that is older than 14 days.

What happens if I miss a dose?

Take the medication as soon as you remember the missed dose. If it is almost time for your next dose, skip the missed dose and use the medicine at your next regularly scheduled time. Do not use 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.

Overdose symptoms may include nausea, vomiting, stomach pain, and diarrhea.

What should I avoid while taking Lorabid Pulvules (loracarbef)? Avoid using antacids within 1 hour before or after taking loracarbef. Antacids can make it harder for your body to absorb loracarbef.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

Lorabid Pulvules (loracarbef) 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. Call your doctor at once if you have any of these serious side effects:

diarrhea that is watery or bloody;

seizure (convulsions);

fever, sore throat, and joint pain with a severe blistering, peeling, and red skin rash;

easy bruising or bleeding, unusual weakness; or

skin rash, bruising, severe tingling, numbness, pain, muscle weakness.

Less serious side effects may include:

mild itching or skin rash;

mild nausea, vomiting, stomach pain, loss of appetite;

warmth, redness, or tingling under your skin;

headache;

dizziness, drowsiness; or

vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect.

What other drugs will affect Lorabid Pulvules (loracarbef)?

Before you take loracarbef, tell your doctor if you are also taking:

probenecid (Benemid); or

a diuretic (water pill) such as amiloride (Midamor, Moduretic), furosemide (Lasix), hydrochlorothiazide (HCTZ, HydroDiuril, Hyzaar, Lopressor, Vasoretic, Zestoretic), metolazone (Mykrox, Zarxolyn), spironolactone (Aldactazide, Aldactone), triamterene (Dyrenium, Maxzide, Dyazide), and others.

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

More Lorabid Pulvules resources Lorabid Pulvules Side Effects (in more detail) Lorabid Pulvules Use in Pregnancy & Breastfeeding Drug Images Lorabid Pulvules Drug Interactions Lorabid Pulvules Support Group 0 Reviews for Lorabid Pulvules - Add your own review/rating Lorabid Pulvules Advanced Consumer (Micromedex) - Includes Dosage Information Lorabid Prescribing Information (FDA) Lorabid Monograph (AHFS DI) Lorabid MedFacts Consumer Leaflet (Wolters Kluwer) Compare Lorabid Pulvules with other medications Bladder Infection Bronchitis Impetigo Kidney Infections Otitis Media Pneumonia Sinusitis Skin Infection Strep Throat Tonsillitis/Pharyngitis Upper Respiratory Tract Infection Where can I get more information? Your pharmacist can provide more information about loracarbef.

See also: Lorabid Pulvules side effects (in more detail)


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Vicks Sinex Decongestant Nasal Spray


1. Name Of The Medicinal Product

Vicks Sinex Decongestant Nasal Spray

2. Qualitative And Quantitative Composition

ACTIVE INGREDIENT

 

 

Percentage quantity

Specification

Oxymetazoline hydrochloride

0.050% w/v

Ph. Eur

3. Pharmaceutical Form

Non-pressurised, aqueous nasal spray solution.

4. Clinical Particulars 4.1 Therapeutic Indications

The symptomatic relief of congestion of the upper respiratory tract due to the common cold, hay fever and sinusitis.

4.2 Posology And Method Of Administration

Adults and children over 12 years:

1-2 sprays per nostril every 6-8 hours unless otherwise advised by your doctor.

Topical application as a nasal spray.

4.3 Contraindications

See your doctor for advice before taking this medicine if you suffer from high blood pressure, any heart complaint, diabetes, thyroid disease, hepatic or renal disorders.

4.4 Special Warnings And Precautions For Use

See your doctor if you feel worse or do not feel better after 7 days. Inform your doctor if you develop new symptoms.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

If you are taking other medicines, you should see your doctor for advice before taking this medicine.

4.6 Pregnancy And Lactation

Before using this medicine, obtain advice from your doctor if you intend to become pregnant, are pregnant or are breast-feeding.

4.7 Effects On Ability To Drive And Use Machines

None known.

4.8 Undesirable Effects

None known.

4.9 Overdose

4.9.1 Symptoms

No information.

4.9.2 Treatment of overdose

No information.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Oxymetazoline hydrochloride:

?-Adrenergic imidazoline derivative, providing localised nasal vasoconstriction.

5.2 Pharmacokinetic Properties

Not applicable. The product provides purely local action.

5.3 Preclinical Safety Data

Not applicable.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Menthol

Eucalyptol

Sodium citrate dihydrate

Tyloxapol

Citric acid anhydrous

Chlorhexidine digluconate

Benzalkonium chloride

Camphor

Disodium edetate

Sodium hydroxide

Purified water

6.2 Incompatibilities

None known.

6.3 Shelf Life

3 years.

6.4 Special Precautions For Storage

None.

6.5 Nature And Contents Of Container

15ml or 20ml polyethylene/polypropylene copolymer bottle with L. D polyethylene dip tube to spray orifice. Green polypropylene screw cap.

6.6 Special Precautions For Disposal And Other Handling

Not applicable.

7. Marketing Authorisation Holder

Procter & Gamble (Health & Beauty Care) Limited

The Heights,

Brooklands,

Weybridge,

Surrey

KT13 0XP

8. Marketing Authorisation Number(S)

PL 0129/5011R

9. Date Of First Authorisation/Renewal Of The Authorisation

12th June 1990

10. Date Of Revision Of The Text

June 2009


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thiopental


Generic Name: thiopental (THYE oh PEN tal)
Brand Names: Pentothal

What is thiopental?

Thiopental is in a group of drugs called barbiturates (bar-BIT-chur-ates). Thiopental slows the activity of your brain and nervous system.

Thiopental is used to help you relax before you receive general anesthesia with an inhaled medication.

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

What is the most important information I should know about thiopental? You should not receive this medication if you are allergic to thiopental or other barbiturates such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Solfoton).

You also should not receive thiopental if you have liver disease, Addison's disease, a severe thyroid disorder (myxedema), severe heart disease, severe low blood pressure, a severe breathing disorder, or a history of porphyria (an enzyme disorder that often causes blue discoloration of the skin).

Avoid drinking alcohol for at least 24 hours after you leave the hospital or surgery center. Thiopental can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure. Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours. What should I discuss with my health care provider before I receive thiopental? You should not receive this medication if you are allergic to thiopental or other barbiturates such as amobarbital (Amytal), butabarbital (Butisol), mephobarbital (Mebaral), secobarbital (Seconal), or phenobarbital (Solfoton), or if you have:

liver disease;

Addison's disease;

severe thyroid disorder (myxedema);

severe heart disease;

severe low blood pressure;

a severe breathing disorder; or

a history of porphyria (an enzyme disorder that often causes blue discoloration of the skin).

Tell your doctor if you have any of the conditions listed above.

FDA pregnancy category C. Thiopental may be harmful to an unborn baby. Tell your doctor if you are pregnant before you receive this medication. Thiopental can pass into breast milk and may harm a nursing baby. Before you receive this medication, tell your doctor if you are breast-feeding a baby. How is thiopental given?

Thiopental is given as an injection through a needle placed into a vein. You will receive this injection in a hospital or surgical setting.

You will be given this medication while you are lying down. You will fall asleep very quickly after thiopental is injected.

Your caregivers will monitor your heart function, blood pressure, and breathing while you are under the effects of thiopental.

What happens if I miss a dose?

Since thiopental is usually given just for anesthesia, you are not likely to be on a dosing schedule.

What happens if I overdose?

An overdose of thiopental is unlikely to occur since the medication is given by a doctor. Your vital signs will be closely watched while you are under anesthesia to make sure the medication is not causing any harmful effects.

What should I avoid after receiving thiopental? Avoid drinking alcohol for at least 24 hours after you leave the hospital or surgery center. Thiopental can cause severe drowsiness or dizziness, which may last for several hours. You will need someone to drive you home after your surgery or procedure. Do not drive yourself or do anything that requires you to be awake and alert for at least 24 hours. Thiopental side effects You will remain under constant supervision during treatment with thiopental. Your caregivers will watch for any serious side effects. Tell your caregivers at once if you feel severe pain while receiving this medication.

Less serious side effects may include:

coughing;

sneezing; or

hiccups.

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.

Thiopental Dosing Information

Usual Adult Dose for Anesthesia:

When used for induction in balanced anesthesia with a skeletal muscle relaxant and an inhalation agent:
The total dose can be estimated and then injected in two to four fractional doses. With this technique, brief periods of apnea may occur which may require assisted or controlled pulmonary ventilation. As an initial dose, 210 to 280 mg (3 to 4 mg/kg) is usually required for rapid induction in the average adult (70 kg).
When used as the sole anesthetic agent:
Moderately slow induction can usually be accomplished in the "average" adult by injection of 50 to 75 mg (2 to 3 mL of a 2.5% solution) at intervals of 20 to 40 seconds, depending on the reaction of the patient. Once anesthesia is established, additional injections of 25 to 50 mg can be given whenever the patient moves. The desired level of anesthesia can be maintained by injection of small repeated doses as needed or by using a continuous intravenous drip in a 0.2% or 0.4% concentration. With continuous drip, the depth of anesthesia is controlled by adjusting the rate of infusion.

Usual Adult Dose for Seizures:

For the control of convulsive states following anesthesia (inhalation or local) or other causes, 75 to 125 mg (3 to 5 mL of a 2.5% solution) should be given as soon as possible after the convulsion begins. Convulsions following the use of a local anesthetic may require 125 to 250 mg given over a ten minute period.

Usual Adult Dose for Coma Induction:

In neurosurgical patients, intermittent bolus injections of 1.5 to 3.5 mg/kg of body weight may be given to reduce intraoperative elevations of intracranial pressure, if adequate ventilation is provided.

Usual Adult Dose for Psychosis:

For narcoanalysis and narcosynthesis in psychiatric disorders, premedication with an anticholinergic agent may precede administration of thiopental. After a test dose, thiopental is injected at a slow rate of 100 mg/min (4 mL/min of a 2.5% solution) with the patient counting backwards from 100. Shortly after counting becomes confused but before actual sleep is produced, the injection is discontinued. Allow the patient to return to a semidrowsy state where conversation is coherent. Alternatively, thiopental may be administered by rapid IV drip using a 0.2% concentration in 5% dextrose and water. At this concentration, the rate of administration should not exceed 50 mL/min.

Usual Pediatric Dose for Anesthesia:

Induction anesthesia:
less than 1 month: 3 to 4 mg/kg intravenously
less than 1 year: 5 to 8 mg/kg intravenously
1 year to 12 years: 5 to 6 mg/kg intravenously
over 12 years: 3 to 5 mg/kg intravenously
Maintenance anesthesia:
1 year and older: 1 mg/kg intravenously as needed

Usual Pediatric Dose for Seizures:

1 year or older: 2 to 3 mg/kg/dose intravenously, repeat as needed.

Usual Pediatric Dose for Head Injury:

1 year or older: 1.5 to 5 mg/kg/dose intravenously; repeat as needed to control intracranial pressure - larger doses (30 mg/kg) to induce coma after hypoxic-ischemic injury do not appear to improve neurologic outcome.

What other drugs will affect thiopental?

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

blood pressure medication; or

a diuretic (water pill).

This list is not complete and there may be other drugs that can interact with thiopental. 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 thiopental resources Thiopental Side Effects (in more detail) Thiopental Dosage Thiopental Use in Pregnancy & Breastfeeding Thiopental Drug Interactions Thiopental Support Group 1 Review for Thiopental - Add your own review/rating Thiopental MedFacts Consumer Leaflet (Wolters Kluwer) Pentothal Prescribing Information (FDA) Pentothal Monograph (AHFS DI) Compare thiopental with other medications Anesthesia Anesthetic Adjunct Coma Induction Head Injury Psychosis Seizures Where can I get more information? Your doctor or pharmacist can provide more information about thiopental.

See also: thiopental side effects (in more detail)


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Otrivine Adult Nasal Spray


1. Name Of The Medicinal Product

Otrivine® Adult Nasal Spray

2. Qualitative And Quantitative Composition

Xylometazoline Hydrochloride 0.1% w/v

For excipients see section 6.1

3. Pharmaceutical Form

Nasal spray, solution

The spray is a clear, colourless solution

4. Clinical Particulars 4.1 Therapeutic Indications

For the treatment of nasal congestion, perennial and allergic rhinitis (including hay fever), sinusitis.

4.2 Posology And Method Of Administration

Adults, children over 12 years and the elderly: One application in each nostril 2 or 3 times daily

Route of administration: Nasal use

4.3 Contraindications

Known hypersensitivity to Otrivine.

Patients with trans-sphenoidal hypophysectomy or surgery exposing the dura mater.

4.4 Special Warnings And Precautions For Use

Patients are advised not to take decongestants for more than seven consecutive days. Otrivine, like other preparations belonging to the same class of active substances, should be used only with caution in patients showing a strong reaction to sympathomimetic agents as evidenced by signs of insomnia, dizziness etc.

• Do not exceed the recommended dosage

• Decongestants should not be used for more than seven consecutive days. If symptoms persist consult your doctor

• If you are pregnant or taking other medicines or are under a doctor's care consult him before using Otrivine

• The adult spray should not be used for infants or children under 12 years

• Each Otrivine pack should be used by one person only to prevent any cross infection

• Some patients who have sensitive nasal passages may feel some local discomfort when applying nasal drops. Other side effects are very rare

• Keep medicines out of reach of children

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

None

4.6 Pregnancy And Lactation

No foetal toxicity or fertility studies have been carried out in animals. In view of its potential systemic vasoconstrictor effect, it is advisable to take the precaution of not using Otrivine during pregnancy.

Label warning: If you are pregnant or taking any other medicines or are under a doctor's care, consult him before using Otrivine.

4.7 Effects On Ability To Drive And Use Machines

None

4.8 Undesirable Effects

The following side effects have occasionally been encountered: A burning sensation in the nose and throat, local irritation, nausea, headache, and dryness of the nasal mucosa.

Systemic cardiovascular effects have occurred, and this should be kept in mind when giving Otrivine to people with cardiovascular disease.

4.9 Overdose

No cases of overdosage in adults have yet been reported. In rare instances of accidental poisoning in children, the clinical picture has been marked chiefly by signs such as acceleration and irregularity of the pulse, elevated blood pressure, drowsiness, respiratory depression or irregularity. There is no specific treatment and appropriate supportive treatment should be initiated.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Otrivine Adult Nasal Spray is a sympathomimetic agent with marked alpha-adrenergic activity, and is intended for use in the nose. It constricts the nasal blood vessels, thereby decongesting the mucosa of the nose and neighbouring regions of the pharynx. This enables patients suffering from colds to breathe more easily through the nose. The effect of Otrivine Adult Nasal Spray begins within a few minutes and lasts for up to 10 hours. Otrivine Adult Nasal Spray is generally well tolerated and does not impair the function of ciliated epithelium.

In a double-blind, saline solution (Otrisal) controlled study in patients with common cold, the

decongestant effect of Otrivine was significantly superior (p<0.0001) to Otrisal saline solution based on rhinomanometry measurement at 1 hour after administration of the study drugs.

5.2 Pharmacokinetic Properties

Systemic absorption may occur following nasal application of xylometazoline hydrochloride solutions. It is not used systemically.

5.3 Preclinical Safety Data

There are no findings in the preclinical testing which are of relevance to the prescriber.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Benzalkonium chloride

Disodium phosphate dodecahydrate (Sodium phosphate)

Disodium edetate

Sodium dihydrogen phophate dihydrate (Sodium acid phosphate)

Sodium chloride

Purified water

6.2 Incompatibilities

None

6.3 Shelf Life

Unopened: 36 months

After the container is opened for the first time: 28 days

6.4 Special Precautions For Storage

Do not store above 25°C.

6.5 Nature And Contents Of Container

Bottle: Low density polyethylene

Cap: High density polyethylene

Spray valve and capillary: Low density polyethylene

Carton: Cardboard

Pack size: 10 ml

6.6 Special Precautions For Disposal And Other Handling

Keep all medicines out of the reach of children

7. Marketing Authorisation Holder

Novartis Consumer Health UK Limited

Wimblehurst Road

Horsham

West Sussex

RH12 5AB

Trading as: Novartis Consumer Health

8. Marketing Authorisation Number(S)

PL 00030/0116

9. Date Of First Authorisation/Renewal Of The Authorisation

Date of first authorisation: 1 October 1997

10. Date Of Revision Of The Text

22 December 2009.

Legal category: GSL


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