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Vulvodynia Medications


Definition of Vulvodynia: Vulvodynia is described as chronic vulvar discomfort with complaints of burning and superficial irritation.

Drugs associated with Vulvodynia

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


Drug List: Aventyl Carbatrol-Sustained-Release-Capsules Effexor-Xr-Extended-Release-Capsules Elavil Epitol Fanatrex Gabarone Lexapro Neurontin Norpramin Pamelor Prozac Prozac-Weekly-Delayed-Release-Capsules Rapiflux Tegretol Tegretol-Xr-Sustained-Release-Tablets Topamax Topamax-Sprinkle Topiragen Vanatrip
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Fibromyalgia Medications


Drugs associated with Fibromyalgia

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

See sub-topics

Topics under Fibromyalgia Epicondylitis, Tennis Elbow (17 drugs) Learn more about Fibromyalgia

Medical Encyclopedia:

Fibromyalgia

Harvard Health Guide:

Symptoms and treatment for Fibromyalgia

Drugs.com Health Center:

Fibromyalgia
Drug List: 5-Htp Amibid-La Amrix-Extended-Release-Capsules Comfort-Pac-With-Cyclobenzaprine Cymbalta Deltasone Desyrel Desyrel-Dividose Effexor Effexor-Xr-Extended-Release-Capsules Elavil Fanatrex Fexmid Flexeril Gabarone Ganidin-Nr Gg-200-Nr Guaifenesin-La Guaifenex-G Guaifenex-La Lexapro Lyrica Meticorten Mobic Mucinex Muco-Fen-1200 Neurontin Nuvigil Organidin-Nr-Immediate-Release-Capsules Pristiq Prozac Prozac-Weekly-Delayed-Release-Capsules Q-Bid-La Rapiflux Revia Savella Skelaxin Sterapred Sterapred-Ds Strattera Topamax Topamax-Sprinkle Topiragen Vanatrip Xyrem
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Flecainide Acetate Tablets 50mg, 100mg (Actavis UK Ltd)


Flecainide Acetate 50mg and 100mg tablets

Read all of this leaflet carefully before you start taking this medicine. Keep this leaflet. You may need to read it again. If you have any further questions, ask your doctor or pharmacist. This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours. Index 1 What Flecainide Acetate tablets are and what they are used for 2 Before you take 3 How to take 4 Possible side effects 5 How to store 6 Further information What Flecainide Acetate tablets are and what they are used for

Flecainide Acetate tablets belong to a group of medicines called anti-arrhythmics. They work by regulating the heart rate.

Flecainide Acetate tablets may be used to treat the following conditions when other drugs are not effective: irregular beats of the upper heart chambers (atria) including Wolff-Parkinson-White Syndrome irregular beats of the lower heart chambers (ventricles). Before you take

Do not take Flecainide Acetate tablets and tell your doctor if you:

are allergic (hypersensitive) to flecainide acetate or any of the other ingredients (see section 6) suffer from conduction problems of the heart, such as a slow or fast heart beat or heart block suffer from heart failure have severely low blood pressure have had a heart attack (myocardial infarction) are in shock due to heart problems (cardiogenic shock) have rapid and irregular heart beat (atrial fibrillation) are taking disopyramide (medicine to treat irregular heart rhythms).

Take special care with Flecainide Acetate tablets and tell your doctor if you:

suffer from low or high levels of potassium in the blood have liver or kidney disease have a pacemaker have any heart disease or an enlarged heart have rapid or irregular heart beats after heart surgery have been told you have disturbances in heart rhythm known as sick sinus syndrome. Taking other medicines

Before taking Flecainide Acetate tablets, tell your doctor if you are taking or have recently taken the following medicines, or are taking any non-prescribed medicines:

verapamil or beta blockers (e.g. propranolol to treat heart diseases) laxatives (to treat constipation) diuretics (‘water tablets’) steroids (e.g. betamethasone, hydrocortisone or prednisolone) sodium channel blockers (e.g. lidocaine to treat irregular heartbeat (arrhythmia) or as a local anaesthetic) phenytoin, phenobarbital or carbamazepine (to treat epilepsy) digoxin (to treat heart conditions) amiodarone, quinidine or disopyramide (to treat irregular heart rhythms) cimetidine (to treat stomach ulcers) fluoxetine or tricyclic antidepressants (e.g. amitriptyline to treat depression) terfenadine or astemizole (to treat allergic reactions) quinine or halfantrine (to treat or prevent malaria) Pregnancy and breast-feeding

Your doctor will only prescribe Flecainide Acetate tablets if it is absolutely necessary. Breast feeding is not recommended whilst taking Flecainide Acetate tablets. Check with your doctor if you are unsure.

Driving and using machines

Flecainide Acetate tablets may cause dizziness or affect your vision. Make sure you are not affected before you drive or operate machinery.

Tests

Your doctor will monitor your progress on a regular basis with ECG (electrocardiogram) and blood tests, and may alter the dose if necessary.

If you see another doctor or go into hospital, let them know what medicines you are taking.

How to take

Always take Flecainide Acetate tablets exactly as your doctor has told you. If you are not sure, check with your doctor or pharmacist. Treament may be started in hospital.

Swallow these tablets whole with water on an empty stomach or one hour before food.

Doses: Adults and adolescents (13-17 years of age) treatment of irregular beats of the upper heart chambers (atria) : starting dose is 50mg twice a day up to a maximum dose of 300mg per day. treatment of irregular heart beats of the lower heart chambers (ventricular) : starting dose is 100mg twice a day up to a maximum dose of 400mg per day. Children under 12 years of age - not recommended Elderly patients or those fitted with pacemakers, with kidney or liver problems or taking amiodarone or cimetidine - a lower dose of flecainide may be given. If you take more Flecainide Acetate tablets than you should

If you have accidentally taken more than the prescribed dose, contact your nearest casualty department or tell your doctor or pharmacist at once.

If you forget to take Flecainide Acetate tablets

If you forget to take a dose take it as soon as you remember, unless it is nearly time to take the next dose. Then go on as before. Never double up on the next dose to make up for the one missed.

If you stop taking the tablets

Talk to your doctor before you stop taking the tablets and follow their advice.

Possible side effects

Like all medicines, Flecainide Acetate tablets can cause side effects, although not everybody gets them.

Stop taking Flecainide Acetate tablets and contact your doctor at once if the following allergic reaction happens: skin rash, swelling of the face, lips, tongue or throat, or difficulty breathing or swallowing.

Tell your doctor if you notice any of the following side effects or notice any other effects not listed:

Very common (occurs in more than 1 in 10 users): dizziness, giddiness, light headedness, headache, double or blurred vision

Common (occurs in less than 1 in 10 users): signs of your heart condition getting worse or development of new heart symptoms, a change in heart beat pattern (especially in patients with existing heart problems)

Uncommon (occurs in less than 1 in 100 users): changes in the numbers and types of your blood cells, difficulty breathing, feeling or being sick

Rare (occurs in less than 1 in 1,000 users): affects on your immune system which may be associated with inflammation, hallucinations, depression, confusion, memory loss, nervousness, anxiety, disturbances of movement, convulsions, ‘pins and needles’ or numbness, problems with co-ordination, raised liver enzyme levels or jaundice (yellow skin and/or whites of the eyes)

Very rare (occurs in less than 1 in 10,000 users): particles in the front of the eye (corneal deposits), lung disease (pneumonitis), sensitivity of the skin to light, flushing or increased sweating, allergic skin reactions (which may be itchy), dry mouth, impairment of taste, joint and muscle pain, impotence.

If you notice any side effects, they get worse, or if you notice any not listed, please tell your doctor or pharmacist.

How to store

Keep out of the reach and sight of children.

Do not store the tablets above 25°C and store in the original packaging.

Do not use Flecainide Acetate tablets after the expiry date stated on the label/carton/bottle. The expiry date refers to the last day of that month.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

Further information What Flecainide Acetate tablets contain The active substance (the ingredient that makes the tablets work) is flecainide acetate. Each tablets contains either 50mg or 100mg of the active ingredient. The other ingredients are croscarmellose sodium, magnesium stearate, maize starch, pregelatinised maize starch, microcrystalline cellulose (E460). What Flecainide Acetate tablets look like and contents of the pack

Flecainide Acetate tablets are white, uncoated tablets.

Pack sizes are 60 tablets

Marketing Authorisation Holder and Manufacturer Actavis Barnstaple EX32 8NS UK

Date of last revision: July 2008.

If you would like a leaflet with larger text, please contact 01271 311257.

Actavis Barnstaple EX32 8NS UK

50134525


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Anxiety Medications


Definition of Anxiety:

The unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, ostensibly resulting from unrecognised intrapsychic conflict.

Physiological concomitants include increased heart rate, altered respiration rate, sweating, trembling, weakness and fatigue, psychological concomitants include feelings of impending danger, powerlessness, apprehension and tension.

Drugs associated with Anxiety

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

See sub-topics

Topics under Anxiety Anxiety and Stress (10 drugs) Generalized Anxiety Disorder (8 drugs) Obsessive Compulsive Disorder (26 drugs in 2 topics) Panic Disorder (26 drugs) Performance Anxiety (1 drug) Post Traumatic Stress Disorder (10 drugs) Social Anxiety Disorder (7 drugs) Learn more about Anxiety

Medical Encyclopedia:

Generalized anxiety disorder Separation anxiety Stress and anxiety Stress versus anxiety

Drugs.com Health Center:

Anxiety Mental Health Disorders
Drug List: 5-Htp Adapin Alprazolam-Intensol-Solution Aminomine Atarax Ativan Buspar Catapres Catapres-Tts-Patches Compazine Compazine-Spansule Compro-Suppositories Corgard Cymbalta Desyrel Desyrel-Dividose Diastat-Gel Diastat-Acudial-Gel Diastat-Pediatric Diazepam-Intensol-Concentrate Dilantin Duo-Vil-2-10 Effexor-Xr-Extended-Release-Capsules Equagesic Equanil Etrafon-2-10 Etrafon-Forte Fanatrex Gabarone Hyzine Klonopin Klonopin-Wafer-Orally-Disintegrating-Tablets Lexapro Librium Limbitrol Limbitrol-Ds Lorazepam-Intensol Mb-Tab Micrainin Miltown Neurontin Niravam-Orally-Disintegrating-Tablets Paxil Paxil-Cr-Controlled-Release-Tablets Paxipam Pexeva Phenytek-Extended-Release-Capsules Phenytoin-Sodium-Prompt Pristiq Remeron Remeron-Soltab-Orally-Disintegrating-Tablets Serax Serzone Sinequan Stelazine Tenormin Tranxene Tranxene-Sd-Sustained-Release-Tablets Tranxene-T-Tab Triavil Trileptal Valium Valrelease Vanspar Vistaril Xanax Xanax_Xr
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Tambocor 50mg Tablets


1. Name Of The Medicinal Product

Tambocor™ 50mg Tablets

2. Qualitative And Quantitative Composition

Each tablet contains flecainide acetate 50mg

3. Pharmaceutical Form

Tablet

4. Clinical Particulars

Tambocor is a potent sodium channel blocking agent for the treatment of the conditions listed below:

The effect on the JT interval is insignificant at therapeutic levels.

4.1 Therapeutic Indications

Tambocor tablets are indicated for:

a) AV nodal reciprocating tachycardia; arrhythmias associated with Wolff-Parkinson-White Syndrome and similar conditions with accessory pathways.

b) Paroxysmal atrial fibrillation in patients with disabling symptoms when treatment need has been established and in the absence of left ventricular dysfunction (see 4.4, Special warnings and special precautions for use). Arrhythmias of recent onset will respond more readily.

c) Symptomatic sustained ventricular tachycardia.

d) Premature ventricular contractions and/or non-sustained ventricular tachycardia which are causing disabling symptoms, where these are resistant to other therapy or when other treatment has not been tolerated.

Tambocor tablets can be used for the maintenance of normal rhythm following conversion by other means.

Tambocor tablets are for oral administration.

4.2 Posology And Method Of Administration

Adults: Supraventricular arrhythmias: The recommended starting dosage is 50mg twice daily and most patients will be controlled at this dose. If required the dose may be increased to a maximum of 300mg daily.

Ventricular arrhythmias: The recommended starting dosage is 100mg twice daily. The maximum daily dose is 400mg and this is normally reserved for patients of large build or where rapid control of the arrhythmia is required.

After 3-5 days it is recommended that the dosage be progressively adjusted to the lowest level which maintains control of the arrhythmia. It may be possible to reduce dosage during long-term treatment.

Children: Tambocor is not recommended in children under 12, as there is insufficient evidence of its use in this age group.

Elderly Patients: The rate of flecainide elimination from plasma may be reduced in elderly people. This should be taken into consideration when making dose adjustments.

Plasma levels: Based on PVC suppression, it appears that plasma levels of 200-1000 ng/ml may be needed to obtain the maximum therapeutic effect. Plasma levels above 700-1000 ng/ml are associated with increased likelihood of adverse experiences.

Dosage in impaired renal function: In patients with significant renal impairment (creatinine clearance of 35ml/min/1.73 sq.m. or less) the maximum initial dosage should be 100mg daily (or 50mg twice daily).

When used in such patients, frequent plasma level monitoring is strongly recommended.

It is recommended that intravenous treatment with Tambocor should be administered in hospitals.

Treatment with oral Tambocor should be under direct hospital or specialist supervision for patients with:

a) AV nodal reciprocating tachycardia; arrhythmias associated with Wolff-Parkinson-White Syndrome and similar conditions with accessory pathways

b) Paroxysmal atrial fibrillation in patients with disabling symptoms.

Treatment for patients with other indications should continue to be initiated in hospital.

4.3 Contraindications

Tambocor is contra-indicated in cardiac failure and in patients with a history of myocardial infarction who have either asymptomatic ventricular ectopics or asymptomatic non-sustained ventricular tachycardia.

It is also contra-indicated in patients with long standing atrial fibrillation in whom there has been no attempt to convert to sinus rhythm, and in patients with haemodynamically significant valvular heart disease.

Unless pacing rescue is available, Tambocor should not be given to patients with sinus node dysfunction, atrial conduction defects, second degree or greater atrio-ventricular block, bundle branch block or distal block.

4.4 Special Warnings And Precautions For Use

Electrolyte disturbances should be corrected before using Tambocor.

Since flecainide elimination from the plasma can be markedly slower in patients with significant hepatic impairment, flecainide should not be used in such patients unless the potential benefits clearly outweigh the risks. Plasma level monitoring is strongly recommended in these circumstances.

Tambocor is known to increase endocardial pacing thresholds - ie to decrease endocardial pacing sensitivity. This effect is reversible and is more marked on the acute pacing threshold than on the chronic. Tambocor should thus be used with caution in all patients with permanent pacemakers or temporary pacing electrodes, and should not be administered to patients with existing poor thresholds or non-programmable pacemakers unless suitable pacing rescue is available.

Generally, a doubling of either pulse width or voltage is sufficient to regain capture, but it may be difficult to obtain ventricular thresholds less than 1 Volt at initial implantation in the presence of Tambocor.

The minor negative inotropic effect of flecainide may assume importance in patients predisposed to cardiac failure. Difficulty has been experienced in defibrillating some patients. Most of the cases reported had pre-existing heart disease with cardiac enlargement, a history of myocardial infarction, arterio-sclerotic heart disease and cardiac failure.

Tambocor should be avoided in patients with structural organic heart disease or abnormal left ventricular function.

Tambocor should be used with caution in patients with acute onset of atrial fibrillation following cardiac surgery.

In a large scale, placebo-controlled clinical trial in post-myocardial infarction patients with asymptomatic ventricular arrhythmia, oral flecainide was associated with a 2.2 fold higher incidence of mortality or non-fatal cardiac arrest as compared with its matching placebo. In that same study, an even higher incidence of mortality was observed in flecainide-treated patients with more than one myocardial infarction. Comparable placebo-controlled clinical trials have not been done to determine if flecainide is associated with higher risk of mortality in other patient groups.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Flecainide is a class I anti-arrhythmic and interactions are possible with other anti-arrhythmic drugs where additive effects may occur or where drugs interfere with the metabolism of flecainide. The following known categories of drugs may intereact with flecainide:

Cardiac glycosides; Flecainide can cause the plasma digoxin level to rise by about 15%, which is unlikely to be of clinical significance for patients with plasma levels in the therapeutic range. It is recommended that the digoxin plasma level in digitalised patients should be measured not less than six hours after any digoxin dose, before or after administration of flecainide.

Class II anti-arrhythmics; the possibility of additive negative inotropic effects of beta-blockers, and other cardiac depressants such as verapamil, with flecainide should be recognised.

Class III anti-arrhythmics; when flecainide is given in the presence of amiodarone, the usual flecainide dosage should be reduced by 50% and the patient monitored closely for adverse effects. Plasma level monitoring is strongly recommended in these circumstances

Class IV anti-arrhythmics; use of flecainide with other sodium channel blockers is not recommended.

Anti-depressants; fluoxetine increases plasma flecainide concentration; increased risk of arrhythmias with tricyclics; manufacturer of reboxetine advises caution.

Anti-epileptics; limited data in patients receiving known enzyme inducers (phenytoin, phenobarbital, carbamazepine) indicate only a 30% increase in the rate of flecainide elimination.

Anti-psychotics: clozapine– increased risk of arrhythmias

Anti-histamines; increased risk of ventricular arrhythmias with mizolastine and terfenadine (avoid concomitant use)

Anti-malarials: quinine increases plasma concentration of flecainide.

Antivirals: plasma concentration increased by ritonavir, lopinavar and indinavir (increased risk of ventricular arrhythmias (avoid concomitant use)

Diuretics: Class effect due to hypokalaemia giving rise to cardiac toxicity.

Ulcer healing drugs: cimetidine inhibits metabolism of flecainide. In healthy subjects receiving cimetidine (1g daily) for one week, plasma flecainide levels increased by about 30% and the half-life increased by about 10%.

Anti-smoking aids: Co-administration of bupropion with drugs that are metabolized by CYP2D6 isoenzyme including flecainide, should be approached with caution and should be initiated at the lower end of the dose range of the concomitant medication. If bupropion is added to the treatment regimen of a patient already receiving flecainide, the need to decrease the dose of the original medication should be considered.

Treatment with Tambocor is compatible with use of oral anti-coagulants.

4.6 Pregnancy And Lactation

There is no evidence as to drug safety in human pregnancy. In New Zealand White rabbits high doses of flecainide caused some foetal abnormalities, but these effects were not seen in Dutch Belted rabbits or rats. The relevance of these findings to humans has not been established. Data have shown that flecainide crosses the placenta to the foetus in patients taking flecainide during pregnancy.

Flecainide is excreted in human milk and appears in concentrations which reflect those in maternal blood. The risk of adverse effects to the nursing infant is very small.

4.7 Effects On Ability To Drive And Use Machines

No effect.

4.8 Undesirable Effects

Body as a Whole: Asthenia, fatigue, fever,oedema.

Cardiovascular: Pro-arrhythmic effects occur but are most likely in patients with structural heart disease and/or significant left ventricular impairment.

In patients with atrial flutter the use of Tambocor has been associated with

1:1 AV conduction following initial atrial slowing with resultant ventricular acceleration. This has been seen most commonly following the use of the injection for acute conversion. This effect is usually short lived and abates quickly following cessation of therapy.

The following adverse effects have also been reported.

AV block-second-degree and third degree, bradycardia, cardiac failure/congestive cardiac failure, chest pain, hypotension, myocardial infarction, palpitation, sinus pause or arrest and tachycardia (AT or VT).

Skin and Appendages: A range of allergic skin reactions have been reported including rashes, alopecia and rare but serious reports of urticaria. There have also been isolated cases of photosensitivity and rash.

Immune System: A small number of cases of increases in anti-nuclear antibodies have been reported, with and without systemic inflammatory involvement.

Haematological: Reductions in red blood cells, white blood cells and platelets have been occasionally reported. These changes are usually mild.

Psychiatric: Rarely, hallucinations, depression, confusion, amnesia, anxiety and insomnia have been reported.

Gastrointestinal: Occasionally nausea and vomiting. The following have also been reported: abdominal pain, anorexia, constipation, diarrhoea, dyspepsia and flatulence (bloating)

Liver and Bilary System: A number of cases of elevated liver enzymes and jaundice have been reported in association with Tambocor treatment. So far this has always been reversible on stopping treatment. Hepatic dysfunction has also been reported.

Neurological: Most commonly giddiness, dizziness and lightheadedness which are usually transient. Rare instances of dyskinesia have been reported, which have improved on withdrawal of flecainide therapy. Rare instances of convulsions, and during long term therapy a few cases of peripheral neuropathy, paraesthesia and ataxia have been reported.There also have been reports of flushing, headache, hypoaesthesia, increased sweating, somnolence, syncope, tinnitus, tremor and vertigo.

Ophthalmological: Visual disturbances, such as double vision and blurring of vision may occur but these are usually transient and disappear upon continuing or reducing the dosage.

Extremely rare cases of corneal deposits have also been reported.

Respiratory: Dyspnoea and rare cases of pneumonitis have been reported.

4.9 Overdose

Overdosage with flecainide is a potentially life threatening medical emergency. No specific antidote is known. There is no known way of rapidly removing flecainide from the system, but forced acid diuresis may theoretically be helpful. Neither dialysis nor haemoperfusion is helpful and injections of anticholinergics are not recommended.

Treatment may include therapy with an inotropic agent, intravenous calcium, giving circulatory assistance (eg balloon pumping), mechanically assisting respiration, or temporarily inserting a transvenous pacemaker if there are severe conduction disturbances or the patient's left ventricular function is otherwise compromised.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Tambocor is a Class 1 anti-arrhythmic (local anaesthetic) agent.

Tambocor slows conduction through the heart, having its greatest effect on His Bundle conduction. It also acts selectively to increase anterograde and particularly retrograde accessory pathway refractoriness. Its actions may be reflected in the ECG by prolongation of the PR interval and widening of the QRS complex. The effect on the JT interval is insignificant.

5.2 Pharmacokinetic Properties

Oral administration of flecainide results in extensive absorption, with bioavailability approaching 90 to 95%. Flecainide does not appear to undergo significant hepatic first-pass metabolism. In patients, 200 to 600 mg flecainide daily produced plasma concentrations within the therapeutic range of 200-1000 µg/L. Protein binding of flecainide is within the range 32 to 58%.

Recovery of unchanged flecainide in urine of healthy subjects was approximately 42% of a 200mg oral dose, whilst the two major metabolites (Meta-O-Dealkylated and Dealkylated Lactam Metabolites) accounted for a further 14% each. The elimination half-life was 12 to 27 hours.

5.3 Preclinical Safety Data

Not applicable

6. Pharmaceutical Particulars 6.1 List Of Excipients

Pregelatinised Starch, USNF

Croscarmellose Sodium, USNF

Microcrystalline Cellulose, Ph Eur

Hydrogenated Vegetable Oil, USNF

Magnesium Stearate, Ph Eur

6.2 Incompatibilities

None known

6.3 Shelf Life

5 years

6.4 Special Precautions For Storage

Do not store above 30°C. Keep container in the outer carton.

6.5 Nature And Contents Of Container

UPVC/PVDC blister packs containing 60 tablets

6.6 Special Precautions For Disposal And Other Handling

Not applicable

7. Marketing Authorisation Holder

Meda Pharmaceuticals Ltd

Skyway House

Parsonage Road

Takeley

Bishop's Stortford

CM22 6PU

United Kingdom

8. Marketing Authorisation Number(S)

PL 15142/0078

9. Date Of First Authorisation/Renewal Of The Authorisation

22 May 1997/ 16 March 2001

10. Date Of Revision Of The Text

13th July 2010


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Flecainide Acetate 100mg Tablets


1. Name Of The Medicinal Product

Flecainide Acetate 100mg Tablets

2. Qualitative And Quantitative Composition

Each tablet contains 100 mg flecainide acetate.

For a full list of excipients, see section 6.1.

3. Pharmaceutical Form

Tablet.

Flecainide tablets are white, circular, biconvex, uncoated tablets one side embossed with a breakline and the identifying letters “C” above the line and “FJ” below, the reverse side embossed with a breakline.

4. Clinical Particulars

Flecainide Acetate is a potent sodium channel blocking agent for the treatment of the conditions listed below.

The effect on the JT interval is insignificant at therapeutic levels.

4.1 Therapeutic Indications

Flecainide Acetate tablets are indicated for:

a) AV nodal reciprocating tachycardia; arrhythmias associated with Wolff-Parkinson-White Syndrome and similar conditions with accessory pathways.

b) Paroxysmal atrial fibrillation in patients with disabling symptoms when treatment need has been established and in the absence of left ventricular dysfunction (see 4.4, Special warnings and special precautions for use). Arrhythmias of recent onset will respond more readily.

c) Symptomatic sustained ventricular tachycardia.

d) Premature ventricular contractions and/or non-sustained ventricular tachycardia which are causing disabling symptoms, where these are resistant to other therapy or when other treatment has not been tolerated.

Flecainide Acetate tablets can be used for the maintenance of normal rhythm following conversion by other means.

Flecainide Acetate tablets are for oral administration.

4.2 Posology And Method Of Administration

Posology

Adults: Supraventricular arrhythmias: The recommended starting dosage is 50 mg twice daily and most patients will be controlled at this dose. If required the dose may be increased to a maximum of 300 mg daily.

Ventricular arrhythmias: The recommended starting dosage is 100 mg twice daily. The maximum daily dose is 400 mg and this is normally reserved for patients of large build or where rapid control of the arrhythmia is required. After 3-5 days it is recommended that the dosage be progressively adjusted to the lowest level which maintains control of the arrhythmia. It may be possible to reduce dosage during long-term treatment.

Elderly patients: The rate of flecainide elimination from plasma may be reduced in elderly people. This should be taken into consideration when making dose adjustments.

Children: Flecainide is not recommended in children under 12 years of age as there is insufficient evidence of its use in this age group.

Plasma levels: Based on PVC suppression, it appears that plasma levels of 200-1000 ng/ml may be needed to obtain the maximum therapeutic effect. Plasma levels above 700-1000 ng/ml are associated with increased likelihood of adverse experiences.

Impaired renal function: In patients with significant renal impairment (creatinine clearance of 35ml/min/1.73sq.m. or less) the maximum initial dosage should be 100 mg daily (or 50 mg twice daily). When used in such patients, frequent plasma level monitoring is strongly recommended.

It is recommended that intravenous treatment with Flecainide Acetate should be initiated in hospital.

Treatment with oral Flecainide should be under direct hospital or specialist supervision for patients with:

a) AV nodal reciprocating tachycardia; arrhythmias associated with Wolff-Parkinson-White Syndrome and similar conditions with accessory pathways.

b) Paroxysmal atrial fibrillation in patients with disabling symptoms.

Treatment for patients with other indications should continue to be initiated in hospital.

4.3 Contraindications

Known hypersensitivity to the active substance (s) or to any of the excipients. Flecainide is contraindicated in cardiac failure and in patients with a history of myocardial infarction who have either asymptomatic ventricular ectopics or asymptomatic non-sustained ventricular tachycardia.

It is also contraindicated in patients with longstanding atrial fibrillation in whom there has been no attempt to convert to sinus rhythm and in patients with haemodynamically significant valvular heart disease.

Unless pacing rescue is available, flecainide should not be given to patients with sinus node dysfunction, atrial condition defects, second degree or greater atrio-ventricular block, bundle branch block or distal block.

4.4 Special Warnings And Precautions For Use

Electrolyte disturbances should be corrected before using flecainide.

Since flecainide elimination from the plasma can be markedly slower in patients with significant hepatic impairment, flecainide should not be used in such patients unless the potential benefits clearly outweigh the risks. Flecainide should be used with caution in patients with impaired renal function and frequent therapeutic drug monitoring should be undertaken. Plasma level monitoring is strongly recommended in these circumstances.

Flecainide is known to increase endocardial pacing thresholds, i.e. to decrease endocardial pacing sensitivity. This effect is reversible and is more marked on the acute pacing threshold than on the chronic. Flecainide should thus be used with caution in all patients with permanent pacemakers or temporary pacing electrodes and should not be administered to patients with existing poor thresholds or non-programmable pacemakers unless suitable pacing rescue is available.

Generally, a doubling of either pulse width or voltage is sufficient to regain capture but it may be difficult to obtain ventricular thresholds less than 1 volt at initial implantation in the presence of flecainide.

The minor negative inotropic effect of flecainide may assume importance in patients predisposed to cardiac failure. Difficulty has been experienced in defibrillating some patients. Usually these patients were reported to have pre-existing heart disease with cardiac enlargement, a history of myocardial infarction, arteriosclerotic heart disease and cardiac failure.

Flecainide should be avoided in patients with structural organic heart disease or abnormal left ventricular function.

Flecainide should be used with caution in patients with acute onset of atrial fibrillation following cardiac surgery.

In a large scale, placebo-controlled clinical trial in post-myocardial infraction patients with asymptomatic ventricular arrhythmia, oral flecainide was associated with a 2.2 fold higher incidence of mortality or non-fatal cardiac arrest as compared with its matching placebo. In that same study, an even higher incidence of mortality was observed in flecainide –treated patients with more than one myocardial infraction. Comparable placebo-controlled clinical trials have not been done to determine if flecainide is associated with higher risk of mortality in other patient groups.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Flecainide is a class I anti-arrhythmic and interactions are possible with other anti-arrhythmic drugs where additive effects may occur or where drugs interfere with the metabolism of flecainide. The following known categories of drugs may interact with flecainide:

Cardiac glycosides: Flecainide can cause the plasma digoxin level to rise by about 15%, which is unlikely to be of clinical significance for patients with plasma levels in the therapeutic range. It is recommended that the digoxin plasma level in digitalised patients should be measured not less than 6 hours after any digoxin dose, before or after administration of flecainide.

Class I anti-arrhythmics: Use of flecainide with other sodium channel blockers (e.g. quinidine ) is not recommended. The clearance of flecainide may be decreased by quinidine in patients who are extensive metabolises, since quinidine inhibits the enzyme responsible for the metabolism of flecainide.

Class II anti-arrythmics: The possibility of additive negative inotropic effects of beta-blockers and other cardiac depressants with flecainide should be recognised.

Class III anti-arrythmics: When flecainide is given in the presence of amiodarone the usual dosage of flecainide should be reduced by 50% and the patient monitored closely for adverse effects. Plasma level monitoring is strongly recommended in these circumstances.

Class IV anti-arrythmics: Calcium-channel Blockers: increases myocardial depression and asystole with verapamil.

Other Anti-arrythmics: Concomitant administration of flecainide with other anti-arrhythmics drugs may increase myocardial depression.

Antidepressants: fluoxetine increases plasma-flecainide concentration and there is an increased risk of arrhythmias with tricyclics.

Anti-epileptics: Limited data in patients receiving known enzyme inducers (phenytoin, phenobarbital, carbamazepine) indicate only a 30% increase in the rate of flecainide elimination.

Anti-psychotics: clozapine – increased risk of arrhythmias

Antihistamines: There is an increased risk of ventricular arrhythmias with mizolastine and terfenadine(avoid concomitant use);

Antimalarials: quinine increases plasma concentration of flecainide, and there is an increased risk of arrhythmias with halofantrine;

Antivirals: plasma concentration increased by ritonavir, lopinavar and indinavir (increased risk of ventricular arrhythmias (avoid concomitant use).

Diuretics: cardiac toxicity increased if hypokalaemia occurs.

Ulcer healing drugs: Cimetidine inhibits metabolism of flecainide. In healthy subjects receiving cimetidine (1g daily) for one week, it was observed that plasma flecainide levels increased by 30% and the half-life increased by 10%.

Anti-smoking aids: Co-administration of bupropion with drugs that are metabolized by CYP2D6 isoenzyme including flecainide, should be approached with caution and should be initiated at the lower end of the dose range of the concomitant medication. If bupropion is added to the treatment regimen of a patient already receiving flecainide, the need to decrease the dose of the original medication should be considered.

Treatment with flecainide is compatible with use of oral anticoagulants.

4.6 Pregnancy And Lactation

There is no evidence as to drug safety in human pregnancy.

In New Zealand White rabbits high doses of flecainide caused some foetal abnormalities, but these effects were not seen in Dutch Belted rabbits or rats. The relevance of these findings to humans has not been established. Data have shown that flecainide crosses the placenta to the foetus in patients taking flecainide during pregnancy.

Flecainide is excreted in human milk and appears in concentrations which reflect those in maternal blood.

The risk of adverse effects to the nursing infant is very small.

4.7 Effects On Ability To Drive And Use Machines

Flecainide Acetate .can cause dizziness, visual disturbances and other neurological effects which may affect the ability to drive or use machines. Patients should be warned not to drive or operate machinery if they feel that they have been affected.

4.8 Undesirable Effects

Body as a Whole: Asthenia, fatigue, fever, oedema.

Cardiac disorders: Pro-arrhythmic effects occur but are most likely in patients with structural heart disease and/or significant left ventricular impairment.

In patients with atrial flutter the use of flecainide has been associated with 1:1 AV conduction following initial atrial slowing with resultant ventricular acceleration.

AV block-second-degree and third degree, bradycardia, cardiac failure/congestive cardiac failure, chest pain, hypotension, myocardial infarction, palpitation and sinus pause or arrest and tachycardia (AT or VT).

Skin and subcutaneous tissue disorders: There have been isolated cases of photosensitivity. Allergic skin reactions, including rare reports of serious urticaria. Alopecia.

Gastrointestinal disorders: Occasionally nausea and vomiting. The following have also been reported: abdominal pain, anorexia, constipation, diarrhoea, dyspepsia and flatulence (bloating)

Hepato-biliary disorders: A number of cases of elevated liver enzymes and jaundice have been reported in association with flecainide treatment. So far this has always been reversible on stopping treatment. Hepatic dysfunction has also been reported.

Nervous systems Disorders: Most commonly giddiness, dizziness, and light-headedness which are usually transient. Rare instances of dyskinesia, which has improved on withdrawal of flecainide therapy, have been reported. Rare instances of convulsions and, during long-term therapy, a few cases of peripheral neuropathy, paraesthesia and ataxia have been reported. There also have been reports of flushing, headache, hypoaesthesia, increased sweating, somnolence, syncope, tinnitus, tremor and vertigo.

Eye disorders: Visual disturbances, such as double vision and blurring of vision may occur but these are usually transient and disappear upon continuing or reducing the dosage. Extremely rare cases of corneal deposits have also been reported.

Immune system disorders: A small number of cases of increases in anti-nuclear antibodies, with and without systemic inflammatory involvement, have been reported.

Blood and the Lymphatic systems disorders: Reductions in red and white blood cells and platelets have occasionally been reported. These changes are usually mild.

Psychiatricdisorders: Rarely, hallucinations, depression, confusion and amnesia have been reported.

Respiratory disorders: Dyspnoea and extremely rare cases of pneumonitis have been reported.

4.9 Overdose

No specific antidote is known.

There is no known way of rapidly removing flecainide from the body but forced acid diuresis may theoretically be helpful. Neither dialysis nor haemoperfusion are helpful and injections of anticholinergics are not recommended. Treatment may include therapy with an inotropic agent, intravenous calcium, giving circulatory assistance (e.g., balloon pumping) mechanically assisting respiration or temporarily inserting a transvenous pacemaker if there are severe conduction disturbances or the patient's left ventricular function is otherwise compromised.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

ATC code: C01B C04

Flecainide acetate is a Class IC antiarrhythmic agent used for the treatment of serious symptomatic ventricular and supraventricular arrhythmias. It should not be used to control asymptomatic ventricular arrhythmias in patients who have previously suffered myocardial infarction. The most common adverse effects affect the central nervous system.

Electrophysiologically, flecainide is a local anaesthetic-type (Class IC) of antiarrhythmic compound. It is an amide type of local anaesthetic, being structurally related to procainamide and encainide in so far as these agents are also benzamide derivatives. The potency of flecainide as an antiarrhythmic agent is associated with the presence and the positions of the trifluoroethody groups on the benzamide ring, which augment the drugs lipophilicity and with the presence of the non-substituted piperidylmethyl group in the amide chain. Flecainide is some 10 times more potent than procainamide and 2-3 times more potent than encainide.

The characterisation of flecainide as a Class IC compound is based on a triad of features: marked depression of the fast sodium channel in the heart; slow onset and offset kinetics of inhibition of the sodium channel (reflecting slow attachment to and dissociation from sodium channels); and the differential effect of the drug on the action potential duration in ventricular muscle versus Purkinje fibres, having no effect in the former and markedly shortening it in the latter. This composite of properties leads to a marked depression in conduction velocity in fibres dependant on the fast-channel fibres for depolarisation but with a modest increase in the effective refractory period when tested in isolated cardiac tissues. At very high concentrations flecainide exerts a weak depressant effect on the slow channel in the myocardium. This is accompanied by a negative inotropic effect.

Flecainide has no significant interaction with the autonomic nervous system. The drug does not appear to have a measurable effect on coronary, pulmonary or other regional circulations.

In vitro metabolic studies have confirmed that P450 2D6 is involved in the metabolism of flecainide.

5.2 Pharmacokinetic Properties

Flecainide is almost completely absorbed after oral administration and does not undergo extensive first-pass metabolism. The bioavailability from flecainide acetate tablets has been reported to be about 90%. Flecainide is extensively metabolised (subject to genetic polymorphism), the 2 major metabolites being m-O-dealkylated flecainide and m-O-dealkylated lactam of flecainide, both of which may have some activity. It is eliminated mainly in the urine, approximately 30% as unchanged drug and the remainder as metabolites. About 5% is excreted in the faeces. Excretion of flecainide is decreased in renal failure, heart failure, and in alkaline urine. Haemodialysis removes only about 1% of unchanged flecainide.

The therapeutic plasma concentration range is generally accepted as 200 to 1000ng per ml. The elimination half-life of flecainide is about 20 hours and it is about 40% bound to plasma proteins. Flecainide passes the placenta and is excreted in breast milk.

5.3 Preclinical Safety Data

There are no pre-clinical 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

Also contains:

Microcrystalline cellulose

Maize starch,

Pregelatinised maize starch

Croscarmellose sodium and

Magnesium stearate.

6.2 Incompatibilities

Not applicable.

6.3 Shelf Life

Three years.

6.4 Special Precautions For Storage

Do not store above 25?C.

Keep container in the outer carton.

6.5 Nature And Contents Of Container

The blister packs are manufactured from 250µm white rigid PVC/PVDC coated with 60g/m2 PVDC and 20µm hard temper aluminium foil with 5-7g/m2 PVC/PVDC compatible heat seal lacquer.

Pack sizes:

Blister packs: 28, 30, 56, 60, 84, 90, 112, 120, 168, 180.

Not all pack sizes may be marketed.

6.6 Special Precautions For Disposal And Other Handling

Not applicable.

7. Marketing Authorisation Holder

Zentiva

One Onslow Street

Guildford

Surrey

GU1 4YS

United Kingdom

8. Marketing Authorisation Number(S)

PL 17780/0024

9. Date Of First Authorisation/Renewal Of The Authorisation

30/03/2009

10. Date Of Revision Of The Text

22/02/2011

LEGAL CATEGORY

POM


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Selfemra


Generic Name: fluoxetine (floo OX e teen)
Brand Names: PROzac, PROzac Weekly, Rapiflux, Sarafem, Selfemra

What is Selfemra (fluoxetine)?

Fluoxetine is a selective serotonin reuptake inhibitors (SSRI) antidepressant. Fluoxetine affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

Fluoxetine is used to treat major depressive disorder, bulimia nervosa (an eating disorder) obsessive-compulsive disorder, panic disorder, and premenstrual dysphoric disorder (PMDD).

Fluoxetine is sometimes used together with another medication called olanzapine (Zyprexa) to treat depression caused by bipolar disorder (manic depression). This combination is also used to treat depression after at least 2 other medications have been tried without successful treatment of symptoms.

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

What is the most important information I should know about Selfemra (fluoxetine)? Do not take fluoxetine together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). A dangerous drug interaction could occur, leading to serious side effects.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Tell your doctor right away if you become pregnant while taking this medication. Fluoxetine may cause heart defects or serious lung problems in a newborn if you take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant. Do not start or stop taking fluoxetine during pregnancy without your doctor's advice. What should I discuss with my healthcare provider before taking Selfemra (fluoxetine)? Do not take fluoxetine together with pimozide (Orap), thioridazine (Mellaril), or a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate). A dangerous drug interaction could occur, leading to serious side effects. You must wait at least 14 days after stopping an MAO inhibitor before you can take fluoxetine. You must wait 5 weeks after stopping fluoxetine before you can take thioridazine (Mellaril) or an MAOI. Tell your doctor about all other antidepressants you take, especially Celexa, Cymbalta, Desyrel, Effexor, Lexapro, Luvox, Oleptro, Paxil, Pexeva, Symbyax, Viibryd, or Zoloft.

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

cirrhosis of the liver; kidney disease;

diabetes;

glaucoma;

seizures or epilepsy;

bipolar disorder (manic depression); or

a history of drug abuse or suicidal thoughts.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. Tell your doctor right away if you become pregnant while taking this medication. Fluoxetine may cause heart defects or serious lung problems in a newborn if you take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant. Do not start or stop taking fluoxetine during pregnancy without your doctor's advice. Fluoxetine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give fluoxetine to anyone younger than 18 years old without a doctor's advice. How should I take Selfemra (fluoxetine)?

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.

Do not crush, chew, break, or open an extended-release capsule. Swallow it whole. Breaking or opening the pill may cause too much of the drug to be released at one time.

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

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment. Do not stop using fluoxetine suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using fluoxetine.

To treat premenstrual dysphoric disorder, the usual dose of fluoxetine is once daily while you are having your period, or 14 days before you expect your period to start. Follow your doctor's instructions.

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

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

If you miss a dose of Prozac Weekly, take the missed dose as soon as you remember and take the next dose 7 days later. However, if it is almost time for the next regularly scheduled weekly dose, skip the missed dose and take the next one as directed. 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 may cause nausea, vomiting, fever, sleepiness, rapid or uneven heartbeat, confusion, fainting, seizures, or coma.

What should I avoid while taking Selfemra (fluoxetine)?

Avoid taking tryptophan while you are taking fluoxetine.

Drinking alcohol can increase certain side effects of fluoxetine. This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Selfemra (fluoxetine) side effects Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have a serious side effect such as:

severe blistering, peeling, and red skin rash;

very stiff (rigid) muscles, high fever, sweating, fast or uneven heartbeats, tremors, overactive reflexes;

nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or

headache, trouble concentrating, memory problems, weakness, confusion, hallucinations, fainting, seizure, shallow breathing or breathing that stops.

Less serious side effects may include:

cold symptoms such as stuffy nose, sneezing, sore throat;

drowsiness, dizziness, feeling nervous;

mild nausea, upset stomach, constipation;

increased appetite, weight changes;

sleep problems (insomnia);

decreased sex drive, impotence, or difficulty having an orgasm; or

dry mouth.

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 Selfemra (fluoxetine)? Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by fluoxetine. Tell your doctor if you regularly use any of these medicines. Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes 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. Using an NSAID with fluoxetine may cause you to bruise or bleed easily.

Tell your doctor about all other medications you are using, especially:

any other antidepressants such as amitriptyline (Elavil, Vanatrip, Limbitrol), escitalopram (Lexapro), imipramine (Tofranil), sertraline (Zoloft), and others;

alprazolam (Xanax);

clopidogrel (Plavix);

clozapine (Clozaril, Fazaclo);

flecainide (Tambocor);

haloperidol (Haldol);

vinblastine (Velban);

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

migraine headache medicine such as almotriptan (Axert), frovatriptan (Frova), sumatriptan (Imitrex, Treximet), naratriptan (Amerge), rizatriptan (Maxalt), or zolmitriptan (Zomig); or

seizure medication such as phenytoin (Dilantin) or carbamazepine (Carbatrol, Equetro, Tegretol).

This list is not complete and other drugs may interact with fluoxetine. 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 Selfemra resources Selfemra Side Effects (in more detail) Selfemra Use in Pregnancy & Breastfeeding Drug Images Selfemra Drug Interactions Selfemra Support Group 0 Reviews for Selfemra - Add your own review/rating Selfemra Prescribing Information (FDA) Selfemra Advanced Consumer (Micromedex) - Includes Dosage Information Fluoxetine MedFacts Consumer Leaflet (Wolters Kluwer) Fluoxetine Prescribing Information (FDA) Fluoxetine Hydrochloride Monograph (AHFS DI) Prozac Consumer Overview Prozac Weekly Delayed-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer) Prozac Weekly Prescribing Information (FDA) Sarafem MedFacts Consumer Leaflet (Wolters Kluwer) Sarafem Prescribing Information (FDA) Compare Selfemra with other medications Premenstrual Dysphoric Disorder Where can I get more information? Your pharmacist can provide more information about fluoxetine.

See also: Selfemra side effects (in more detail)


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Norpramin


Generic Name: desipramine (des IP ra meen)
Brand Names: Norpramin

What is Norpramin (desipramine)?

Desipramine is a tricyclic antidepressant. Desipramine affects chemicals in the brain that may become unbalanced.

Desipramine is used to treat symptoms of depression.

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

What is the most important information I should know about Norpramin (desipramine)? Do not use this medication if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. What should I discuss with my healthcare provider before taking Norpramin (desipramine)? Do not use this medication if you are allergic to desipramine, or if you have recently had a heart attack. Do not use desipramine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take desipramine before the MAO inhibitor has cleared from your body.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take desipramine:

heart disease, or a history of heart attack, stroke, or seizures;

a family history of sudden death related to a heart rhythm disorder;

bipolar disorder (manic-depression);

schizophrenia or other mental illness;

liver disease;

overactive thyroid;

diabetes (desipramine may raise or lower blood sugar);

glaucoma; or

problems with urination.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Desipramine may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether desipramine 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.

Older adults may be more likely to have side effects from this medication.

Do not give desipramine to anyone under 18 years old without the advice of a doctor. How should I take Norpramin (desipramine)?

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. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking desipramine. You may need to stop using the medicine for a short time.

Do not stop using desipramine without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment. Store desipramine at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. An overdose of desipramine can be fatal. Symptoms may include uneven heartbeats, extreme drowsiness, vomiting, blurred vision, confusion, hallucinations, muscle stiffness, feeling hot or cold, seizure (convulsions), or coma. What should I avoid while taking Norpramin (desipramine)? Avoid drinking alcohol. It can cause dangerous side effects when taken together with desipramine.

Grapefruit and grapefruit juice may interact with desipramine. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.

Desipramine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Desipramine can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun. Norpramin (desipramine) 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 new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

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

fast, pounding, or uneven heart rate;

seizure (convulsions);

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

sudden numbness or weakness, especially on one side of the body;

sudden headache, problems with vision, speech, or balance;

easy bruising or bleeding, unusual weakness;

tremors, restless muscle movements in your eyes, tongue, jaw, or neck;

very stiff (rigid) muscles, high fever, sweating, confusion, tremors, feeling like you might pass out;

urinating less than usual or not at all;

extreme thirst with headache, nausea, vomiting, and weakness;

skin rash, severe tingling or numbness, pain and muscle weakness; or

nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

vomiting, constipation;

dry mouth, unpleasant taste;

weakness, lack of coordination;

feeling anxious, restless, dizzy, or drowsy;

sleep problems (insomnia), nightmares;

blurred vision, trouble concentrating, headache, ringing in your ears;

breast swelling (in men or women); or

decreased sex drive, impotence, or difficulty having an orgasm.

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 Norpramin (desipramine)? Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by desipramine. Tell your doctor if you regularly use any of these medicines, or any other antidepressants.

Before taking desipramine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

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

cimetidine (Tagamet); or

heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

This list is not complete and there are many other medicines that can interact with desipramine. 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 using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

More Norpramin resources Norpramin Side Effects (in more detail)Norpramin Use in Pregnancy & BreastfeedingDrug ImagesNorpramin Drug InteractionsNorpramin Support Group0 Reviews for Norpramin - Add your own review/rating Norpramin Prescribing Information (FDA) Norpramin MedFacts Consumer Leaflet (Wolters Kluwer) Norpramin Monograph (AHFS DI) Norpramin Advanced Consumer (Micromedex) - Includes Dosage Information Desipramine Prescribing Information (FDA) Compare Norpramin with other medications ADHDDepressionDysautonomiaVulvodynia Where can I get more information? Your pharmacist can provide more information about desipramine.

See also: Norpramin side effects (in more detail)


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Pamelor


Generic Name: nortriptyline (nor TRIP ti leen)
Brand Names: Pamelor

What is Pamelor (nortriptyline)?

Nortriptyline is in a group of drugs called tricyclic antidepressants. Nortriptyline affects chemicals in the brain that may become unbalanced.

Nortriptyline is used to treat symptoms of depression.

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

What is the most important information I should know about Pamelor (nortriptyline)? Do not use nortriptyline if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. What should I discuss with my healthcare provider before taking Pamelor (nortriptyline)? Do not use this medication if you are allergic to nortriptyline, or if you have recently had a heart attack. Do not use nortriptyline if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take nortriptyline before the MAO inhibitor has cleared from your body.

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

heart disease;

a history of heart attack, stroke, or seizures;

bipolar disorder (manic-depression);

schizophrenia or other mental illness;

diabetes (nortriptyline may raise or lower blood sugar);

overactive thyroid;

glaucoma; or

problems with urination.

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

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. It is not known whether nortriptyline 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.

Older adults may be more likely to have side effects from this medication.

Do not give this medication to anyone under 18 years old without the advice of a doctor. How should I take Pamelor (nortriptyline)?

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. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking nortriptyline. You may need to stop using the medicine for a short time.

Do not stop using nortriptyline without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take a few weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve during treatment with nortriptyline. Store nortriptyline at room temperature away from moisture and heat.

See also: Pamelor dosage (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. An overdose of nortriptyline can be fatal.

Overdose symptoms may include extreme drowsiness, confusion, agitation, hallucinations, blurred vision, vomiting, muscle stiffness, feeling hot or cold, fainting, seizure (convulsions), or coma.

What should I avoid while taking Pamelor (nortriptyline)? Avoid drinking alcohol. It can cause dangerous side effects when taken together with nortriptyline.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). They can add to sleepiness caused by nortriptyline.

Grapefruit and grapefruit juice may interact with nortriptyline. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.

Nortriptyline can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Nortriptyline can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun. Pamelor (nortriptyline) 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 new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

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

fast, pounding, or uneven heart rate;

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

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

confusion, hallucinations, or seizure (convulsions);

easy bruising or bleeding, unusual weakness;

restless muscle movements in your eyes, tongue, jaw, or neck;

tremors;

extreme thirst with headache, nausea, vomiting, and weakness;

feeling light-headed or fainting; or

urinating less than usual or not at all.

Less serious side effects may include:

nausea, vomiting, stomach pain, loss of appetite;

constipation or diarrhea;

weight changes;

dry mouth, unpleasant taste;

weakness, lack of coordination;

numbness or tingly feeling;

blurred vision, headache, ringing in your ears;

mild skin rash;

breast swelling (in men or women); or

increased sweating.

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

What other drugs will affect Pamelor (nortriptyline)?

Before taking nortriptyline, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Before taking nortriptyline, tell your doctor if you are currently using any of the following drugs:

cimetidine (Tagamet);

guanethidine (Ismelin);

reserpine; or

heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

This list is not complete and there are many other medicines that can interact with nortriptyline. 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 using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

More Pamelor resources Pamelor Side Effects (in more detail) Pamelor Dosage Pamelor Use in Pregnancy & Breastfeeding Drug Images Pamelor Drug Interactions Pamelor Support Group 17 Reviews for Pamelor - Add your own review/rating Pamelor Prescribing Information (FDA) Pamelor MedFacts Consumer Leaflet (Wolters Kluwer) Pamelor Monograph (AHFS DI) Pamelor Advanced Consumer (Micromedex) - Includes Dosage Information Nortriptyline Prescribing Information (FDA) Compare Pamelor with other medications Burning Mouth Syndrome Cyclic Vomiting Syndrome Depression Diabetic Nerve Damage Dysautonomia Migraine Prevention Neuralgia Neurosis Pain Panic Disorder Persisting Pain, Shingles Primary Nocturnal Enuresis Reflex Sympathetic Dystrophy Syndrome Smoking Cessation Tinnitus Vulvodynia Where can I get more information? Your pharmacist can provide more information about nortriptyline.

See also: Pamelor side effects (in more detail)


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Adapin


Generic Name: doxepin (Sinequan) (DOX e pin)
Brand Names: Sinequan

What is doxepin (Sinequan)?

Doxepin is in a group of drugs called tricyclic antidepressants. Doxepin affects chemicals in the brain that may become unbalanced.

Doxepin (Sinequan or other generic name) is used to treat symptoms of depression and/or anxiety associated with alcoholism, psychiatric conditions, or manic-depressive conditions.

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

What is the most important information I should know about doxepin (Sinequan)? You should not use doxepin if you are allergic to it, or if you have glaucoma or problems with urination. Do not use doxepin if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take doxepin before the MAO inhibitor has cleared from your body.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. What should I discuss with my healthcare provider before taking doxepin (Sinequan)? You should not use doxepin if you are allergic to it, or if you have glaucoma or problems with urination. Do not use doxepin if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take doxepin before the MAO inhibitor has cleared from your body.

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

sleep apnea (breathing stops during sleep); or

bipolar disorder (manic-depression).

diabetes (doxepin may raise or lower blood sugar).

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. It is not known whether doxepin 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 doxepin 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. Do not give doxepin to anyone younger than 18 years old without the advice of a doctor. How should I take doxepin (Sinequan)?

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.

Measure doxepin oral concentrate (liquid) with the special dose-measuring dropper provided. Do not use a regular table spoon. If you do not have a dose-measuring dropper, ask your pharmacist for one.

Empty the measured dose from the medicine dropper into a small glass (4 ounces) of water, milk, orange juice, grapefruit juice, tomato juice, prune juice, or pineapple juice. Do not use grape juice or a carbonated soft drink to mix doxepin oral concentrate. Stir the mixture and drink all of it right away. Do not save it for later use.

It may take 2 to 3 weeks before your depression symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve. Do not stop using doxepin suddenly after long-term use, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using doxepin. 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. An overdose of doxepin can be fatal.

Overdose symptoms may include uneven heartbeats, extreme drowsiness, agitation, vomiting, dilated pupils, blurred vision, confusion, hallucinations, feeling hot or cold, muscle stiffness, feeling light-headed, fainting, seizure (convulsions), or coma.

What should I avoid while taking doxepin (Sinequan)? Do not drink alcohol. Doxepin can increase the effects of alcohol, which could be dangerous. Doxepin may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Doxepin (Sinequan) 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.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

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

fast heart rate;

confusion, hallucinations, unusual thoughts, seizure (convulsions);

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

feeling like you might pass out;

restless muscle movements in your eyes, tongue, jaw, or neck;

tremors or uncontrollable shaking;

urinating less than usual or not at all; or

extreme thirst with headache, nausea, vomiting, and weakness.

Less serious side effects may include:

feeling dizzy, drowsy, or tired;

nausea, vomiting, diarrhea, constipation, loss of appetite;

dry mouth, increased sweating;

weight gain;

lack of coordination;

numbness or tingly feeling;

blurred vision, headache, ringing in your ears;

mild skin rash or itching;

decreased sex drive; or

breast swelling (in men).

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 doxepin (Sinequan)? Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by doxepin. Tell your doctor if you regularly use any of these medicines, or any other antidepressant.

Before taking doxepin, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

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

cimetidine (Tagamet);

tolazamide (Tolinase);

heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Quin-G); or

phenothiazines such as chlorpromazine (Thorazine), fluphenazine (Permitil, Prolixin), perphenazine (Trilafon), prochlorperazine (Compazine, Compro), promethazine (Pentazine, Phenergan, Anergan, Antinaus), thioridazine (Mellaril), or trifluoperazine (Stelazine), and others.

There are many other drugs that can interact with doxepin. 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. Keep a list of all your medicines and show it to any healthcare provider who treats you. More Adapin resources Adapin Side Effects (in more detail) Adapin Use in Pregnancy & Breastfeeding Adapin Drug Interactions Adapin Support Group 1 Review for Adapin - Add your own review/rating Doxepin Prescribing Information (FDA) doxepin Advanced Consumer (Micromedex) - Includes Dosage Information Doxepin MedFacts Consumer Leaflet (Wolters Kluwer) Doxepin Hydrochloride Monograph (AHFS DI) Silenor Consumer Overview Sinequan Prescribing Information (FDA) Sinequan Monograph (AHFS DI) Sinequan MedFacts Consumer Leaflet (Wolters Kluwer) Compare Adapin with other medications Anxiety Depression Insomnia Reflex Sympathetic Dystrophy Syndrome Urticaria Where can I get more information? Your pharmacist can provide more information about doxepin (Sinequan).

See also: Adapin side effects (in more detail)


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Tofranil


Generic Name: imipramine (im IP ra meen)
Brand Names: Tofranil, Tofranil-PM

What is Tofranil (imipramine)?

Imipramine is in a group of drugs called tricyclic antidepressants. Imipramine affects chemicals in the brain that may become unbalanced.

Imipramine is used to treat symptoms of depression.

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

What is the most important information I should know about Tofranil (imipramine)? Do not use imipramine if you have recently had a heart attack, or if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Call your doctor at once if you have any new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. What should I discuss with my healthcare provider before taking Tofranil (imipramine)? Do not use this medication if you are allergic to imipramine, or if you have recently had a heart attack. Do not use imipramine if you have used an MAO inhibitor such as isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) within the past 14 days. Serious, life-threatening side effects can occur if you take imipramine before the MAO inhibitor has cleared from your body.

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

heart disease;

a history of heart attack, stroke, or seizures;

bipolar disorder (manic-depression);

kidney or liver disease;

overactive thyroid;

diabetes (imipramine may raise or lower blood sugar);

adrenal gland tumor (pheochromocytoma);

glaucoma; or

problems with urination.

If you have any of these conditions, you may not be able to use imipramine, or you may need a dosage adjustment or special tests during treatment.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening symptoms of depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Imipramine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby. Do not give this medication to anyone younger than 18 years old without the advice of a doctor. How should I take Tofranil (imipramine)?

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. Your doctor may occasionally change your dose to make sure you get the best results from this medication. Follow the directions on your prescription label.

If you need to have any type of surgery, tell the surgeon ahead of time that you are taking imipramine. You may need to stop using the medicine for a short time.

Do not stop using imipramine without first talking to your doctor. You may need to use less and less before you stop the medication completely. Stopping this medication suddenly could cause you to have unpleasant side effects. It may take up to 3 weeks of using this medicine before your symptoms improve. For best results, keep using the medication as directed. Talk with your doctor if your symptoms do not improve after 3 weeks of treatment. Store imipramine at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose? Seek emergency medical attention if you think you have used too much of this medicine. An overdose of imipramine can be fatal.

Symptoms of an imipramine overdose may include uneven heartbeats, extreme drowsiness, agitation, vomiting, blurred vision, sweating, muscle stiffness, swelling, shortness of breath, blue lips or fingernails, feeling light-headed, fainting, seizure (convulsions), or coma.

What should I avoid while taking Tofranil (imipramine)? Avoid drinking alcohol. It can cause dangerous side effects when taken together with imipramine.

Avoid using other medicines that make you sleepy (such as cold medicine, pain medication, muscle relaxers, medicine for seizures, or other antidepressants). They can add to sleepiness caused by imipramine.

Grapefruit and grapefruit juice may interact with imipramine. Discuss the use of grapefruit products with your doctor before increasing or decreasing the amount of grapefruit products in your diet.

Imipramine can cause side effects that may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be awake and alert. Avoid exposure to sunlight or artificial UV rays (sunlamps or tanning beds). Imipramine can make your skin more sensitive to sunlight and sunburn may result. Use a sunscreen (minimum SPF 15) and wear protective clothing if you must be out in the sun. Tofranil (imipramine) 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 new or worsening symptoms such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

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

fast, pounding, or uneven heart rate;

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

sudden numbness or weakness, especially on one side of the body;

sudden headache, confusion, problems with vision, speech, or balance;

feeling short of breath, even with mild exertion;

swelling, rapid weight gain;

confusion, hallucinations, or seizure (convulsions);

easy bruising or bleeding, unusual weakness;

restless muscle movements in your eyes, tongue, jaw, or neck;

urinating more or less than usual;

extreme thirst with headache, nausea, vomiting, and weakness;

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

Less serious side effects may be more likely to occur, such as:

nausea, vomiting, stomach pain, loss of appetite;

constipation or diarrhea;

dry mouth, unpleasant taste;

weight changes;

weakness, lack of coordination;

feeling dizzy, drowsy, or tired;

nightmares;

blurred vision, headache, ringing in your ears;

breast swelling (in men or women); or

decreased sex drive, impotence, or difficulty having an orgasm.

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 Tofranil (imipramine)?

Before taking imipramine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Before taking imipramine, tell your doctor if you are currently using any of the following drugs:

cimetidine (Tagamet);

clonidine (Catapres);

guanethidine (Ismelin);

methylphenidate (Concerta, Ritalin, Daytrana); or

heart rhythm medications such as flecainide (Tambocor), propafenone (Rhythmol), or quinidine (Cardioquin, Quinidex, Quinaglute).

If you are using any of these drugs, you may not be able to use imipramine, or you may need dosage adjustments or special tests during treatment.

There are many other medicines that can interact with imipramine. 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 using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

More Tofranil resources Tofranil Side Effects (in more detail)Tofranil Use in Pregnancy & BreastfeedingDrug ImagesTofranil Drug InteractionsTofranil Support Group9 Reviews for Tofranil - Add your own review/rating Tofranil MedFacts Consumer Leaflet (Wolters Kluwer) Tofranil Advanced Consumer (Micromedex) - Includes Dosage Information Tofranil Prescribing Information (FDA) Imipramine Professional Patient Advice (Wolters Kluwer) Imipramine Prescribing Information (FDA) Imipramine Hydrochloride Monograph (AHFS DI) Tofranil-PM Prescribing Information (FDA) Tofranil-PM MedFacts Consumer Leaflet (Wolters Kluwer) Compare Tofranil with other medications ADHDDepressionInterstitial CystitisNight TerrorsPainPanic DisorderPrimary Nocturnal Enuresis Where can I get more information? Your pharmacist has information about imipramine written for health professionals that you may read.

See also: Tofranil side effects (in more detail)


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Limbitrol DS


Generic Name: amitriptyline and chlordiazepoxide (a mi TRIP ti leen and klor dye az e POX ide)
Brand Names: Limbitrol, Limbitrol DS

What is Limbitrol DS (amitriptyline and chlordiazepoxide)?

Amitriptyline is a tricyclic (try-SYE-klik) antidepressants. Amitriptyline affects chemicals in the brain that may become unbalanced.

Chlordiazepoxide is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). Chlordiazepoxide affects chemicals in the brain that may become unbalanced and cause anxiety.

The combination of amitriptyline and chlordiazepoxide is used to treat depression and anxiety.

Amitriptyline and chlordiazepoxide may also be used for purposes not listed in this medication guide.

What is the most important information I should know about Limbitrol DS (amitriptyline and chlordiazepoxide)? You should not use this medication if you have recently had a heart attack, or if you are allergic to amitriptyline (Elavil), chlordiazepoxide (Librium), or to Valium, Xanax, or any other benzodiazepine. Do not use this medication if you have taken an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days. Amitriptyline and chlordiazepoxide can harm an unborn baby or cause birth defects. Do not use amitriptyline and chlordiazepoxide if you are pregnant.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Do not drink alcohol while taking this medication. What should I discuss with my healthcare provider before taking Limbitrol DS (amitriptyline and chlordiazepoxide)? You should not use this medication if you have recently had a heart attack, or if you are allergic to amitriptyline (Elavil), chlordiazepoxide (Librium), or to any benzodiazepine such as alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), or oxazepam (Serax). Do not use this medication if you have taken an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam), or tranylcypromine (Parnate) in the last 14 days.

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

epilepsy or seizure disorder;

a thyroid disorder;

kidney or liver disease;

heart disease;

bipolar disorder (manic-depression);

a history of suicidal thoughts or behavior;

history of drug or alcohol addiction;

narrow-angle glaucoma; or

problems with urination.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

This medication can harm an unborn baby or cause birth defects. Do not use amitriptyline and chlordiazepoxide if you are pregnant. Tell your doctor right away if you become pregnant during treatment. Use effective birth control while you are using this medication. It is not known whether this medication passes into breast milk or if it could harm a nursing baby. You should not breast-feed while taking amitriptyline and chlordiazepoxide.

The sedative effects of this medication may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are taking amitriptyline and chlordiazepoxide.

How should I take Limbitrol DS (amitriptyline and chlordiazepoxide)?

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.

It may take up to 4 weeks before your symptoms improve. Keep using the medication as directed and tell your doctor if your symptoms do not improve after 4 weeks of treatment. If you need surgery, tell the surgeon ahead of time that you are using amitriptyline and chlordiazepoxide. You may need to stop using the medicine for a short time.

If you use this medication long-term, your blood will need to be tested on a regular basis. Do not miss any scheduled appointments.

Do not stop using amitriptyline and chlordiazepoxide suddenly, or you could have unpleasant withdrawal symptoms. Ask your doctor how to avoid withdrawal symptoms when you stop using the medicine. Amitriptyline and chlordiazepoxide may be habit-forming and should be used only by the person it was prescribed for. Never share this medication with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it. Store at room temperature away from moisture and heat. Keep track of the amount of medicine used from each new bottle. Benzodiazepines are drugs of abuse and you should be aware if anyone is using your medicine improperly or without a prescription. 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. An overdose of amitriptyline and chlordiazepoxide can be fatal, especially if taken with alcohol.

Overdose symptoms may include irregular heartbeats, extreme drowsiness, overactive reflexes, stiff muscles, dilated pupils, vomiting, feeling hot or cold, feeling like you might pass out, or seizure (convulsions).

What should I avoid while taking Limbitrol DS (amitriptyline and chlordiazepoxide)? Do not drink alcohol. Amitriptyline and chlordiazepoxide can increase the effects of alcohol, which could be dangerous. This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Limbitrol DS (amitriptyline and chlordiazepoxide) side effects Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. Call your doctor at once if you have a serious side effect such as:

confusion, hallucinations, unusual thoughts or behavior;

feeling light-headed, fainting;

seizure (convulsions);

weak or shallow breathing;

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

sudden numbness or weakness (especially on one side of the body), headache, confusion, problems with vision, speech, or balance.

Less serious side effects may include:

dry mouth, stuffy nose, blurred vision;

dizziness, drowsiness;

feeling restless or tired;

constipation, bloating, loss of appetite;

strange dreams or nightmares; or

decreased sex drive, impotence, or difficulty having an orgasm.

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 Limbitrol DS (amitriptyline and chlordiazepoxide)?

Before taking this medicine, tell your doctor if you have used an "SSRI" antidepressant in the past 5 weeks, such as citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), or sertraline (Zoloft).

Cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures or anxiety can add to sleepiness caused by amitriptyline and chlordiazepoxide. Tell your doctor if you regularly use any of these medicines, or any other antidepressant.

Many drugs can interact with amitriptyline and chlordiazepoxide. Below is just a partial list. Tell your doctor if you are using:

celecoxib (Celebrex);

cimetidine (Tagamet);

darifenacin (Enablex);

ropinirole (Requip);

terbinafine (Lamisil);

ADHD medications (Adderall, Ritalin, Strattera);

anti-malaria medication such as chloroquine (Arelan), hydroxychloroquine (Plaquenil, Quinaprox), or quinine (Qualaquin);

cancer medications such as gefitinib (Iressa), imatinib (Gleevec), or nilotinib (Tasigna);

a heart rhythm medication such as amiodarone (Cordarone, Pacerone), flecainide (Tambocor), propafenone (Rythmol), or quinidine (Quin-G);

HIV medication such as delavirdine (Rescriptor) or ritonavir (Norvir);

medicine to treat or prevent nausea and vomiting, such as metoclopramide (Reglan) or promethazine (Pentazine, Phenergan);

medicine to treat psychiatric disorders, such as aripiprazole (Abilify), chlorpromazine (Thorazine), fluphenazine (Permitil), haloperidol (Haldol), perphenazine (Trilafon), or thioridazine (Mellaril);

a narcotic such as methadone (Methadose, Dolophine) or propoxyphene (Darvon, Darvocet).

This list is not complete and there are many other drugs that can interact with amitriptyline and chlordiazepoxide. 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. Keep a list of all your medicines and show it to any healthcare provider who treats you. More Limbitrol DS resources Limbitrol DS Side Effects (in more detail) Limbitrol DS Use in Pregnancy & Breastfeeding Drug Images Limbitrol DS Drug Interactions Limbitrol DS Support Group 3 Reviews for Limbitrol DS - Add your own review/rating Limbitrol DS MedFacts Consumer Leaflet (Wolters Kluwer) Limbitrol DS Advanced Consumer (Micromedex) - Includes Dosage Information Limbitrol Prescribing Information (FDA) Compare Limbitrol DS with other medications Anxiety Depression Where can I get more information? Your pharmacist can provide more information about amitriptyline and chlordiazepoxide.

See also: Limbitrol DS side effects (in more detail)


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Maxalt


Generic Name: rizatriptan (RYE za TRIP tan)
Brand Names: Maxalt, Maxalt-MLT

What is rizatriptan?

Rizatriptan is a headache medicine that narrows the blood vessels around the brain. Rizatriptan also reduces substances in the body that can trigger headache pain, nausea, sensitivity to light and sound, and other migraine symptoms.

Rizatriptan is used to treat migraine headaches. Rizatriptan will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Rizatriptan should not be used to treat a common tension headache, a headache that causes loss of movement on one side of your body, or any headache that seems to be different from your usual migraine headaches. Use this medication only if your condition has been confirmed by a doctor as migraine headaches.

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

What is the most important information I should know about rizatriptan? You should not take this medication if you are allergic to rizatriptan, if you have any history of heart disease, or if you have coronary heart disease, angina, blood circulation problems, lack of blood supply to the heart, uncontrolled high blood pressure, ischemic bowel disease, a history of a heart attack or stroke, or if your headache seems to be different from your usual migraine headaches. Do not take rizatriptan within 24 hours before or after using another migraine headache medicine, including almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex, Treximet), zolmitriptan (Zomig), or ergot medicine such as ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine). Do not use rizatriptan if you have taken a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the past 14 days.

Before taking rizatriptan, tell your doctor if you have liver or kidney disease, high blood pressure, a heart rhythm disorder, or coronary heart disease (or risk factors such as diabetes, menopause, smoking, being overweight, having high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

Also tell your doctor if you are also taking an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil, Pexeva), sertraline (Zoloft), trazodone (Desyrel, Oleptro), venlafaxine (Effexor), or vilazodone (Viibryd).

Rizatriptan will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

After taking a rizatriptan tablet, you must wait two (2) hours before taking a second tablet. Do not take more than 30 mg of rizatriptan in 24 hours.

What should I discuss with my healthcare provider before using rizatriptan? You should not take this medication if you are allergic to rizatriptan, or if you have:

coronary heart disease, angina (chest pain), blood circulation problems, lack of blood supply to the heart;

a history of heart disease, heart attack, or stroke, including "mini-stroke";

severe or uncontrolled high blood pressure;

ischemic bowel disease; or

a headache that seems different from your usual migraine headaches.

Do not take rizatriptan if you have taken a monoamine oxidase inhibitor (MAOI) such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the past 14 days.

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

liver disease; kidney disease (especially if you are on dialysis);

high blood pressure, a heart rhythm disorder; or

coronary heart disease (or risk factors such as diabetes, menopause, smoking, being overweight, having high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

Rizatriptan disintegrating tablets may contain phenylalanine. Talk to your doctor before using this form of rizatriptan if you have phenylketonuria (PKU).

FDA pregnancy category C. It is not known whether rizatriptan 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 rizatriptan 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. Do not give a rizatriptan regular tablet to anyone under 18 years old. Only rizatriptan orally disintegrating tablets (Maxalt-MLT) are for use in children who are at least 6 years old. How should I use rizatriptan?

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. Overuse of migraine headache medicine can actually make your headaches worse.

Take rizatriptan as soon as you notice headache symptoms, or after an attack has already begun.

Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to see if you have any serious side effects.

Take one rizatriptan tablet whole with a full glass of water.

To take rizatriptan orally disintegrating tablets (Maxalt-MLT):

Keep the tablet in its blister pack until you are ready to take the medicine. Open the package and peel back the foil from the tablet blister. Do not push a tablet through the foil or you may damage the tablet.

Using dry hands, remove the tablet and place it in your mouth. It will begin to dissolve right away.

Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing.

Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

After taking a tablet: If your headache does not completely go away, or goes away and comes back, take a second tablet two (2) hours after the first. Do not take more than 30 mg of rizatriptan in 24 hours. If your symptoms have not improved, contact your doctor before taking any more tablets.

Contact your doctor if you have more than four headaches in one month (30 days).

If you use rizatriptan long-term, your doctor may want to check your heart function using an electrocardiograph or ECG (sometimes called an EKG), a machine that measures electrical activity of the heart. This will help your doctor determine if it is still safe for you to use this medication. Visit your doctor regularly.

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

Since rizatriptan is used as needed, it does not have a daily dosing schedule. Call your doctor promptly if your symptoms do not improve after using rizatriptan.

After taking a rizatriptan tablet, you must wait two (2) hours before taking a second tablet. Do not take more than 30 mg of rizatriptan in 24 hours.

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

Overdose could cause high blood pressure (severe headache, blurred vision, buzzing in your ears, anxiety, confusion, chest pain, shortness of breath, uneven heartbeats, or seizure).

What should I avoid while using rizatriptan? Do not take rizatriptan within 24 hours before or after using another migraine headache medicine, including:

almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), sumatriptan (Imitrex, Treximet), or zolmitriptan (Zomig); or

ergot medicine such as ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine).

Rizatriptan may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Rizatriptan 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 rizatriptan and call your doctor at once if you have a serious side effect such as:

feeling of pain or tightness in your jaw, neck, or throat;

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

sudden numbness or weakness, especially on one side of the body;

sudden severe headache, confusion, problems with vision, speech, or balance;

sudden and severe stomach pain and bloody diarrhea;

numbness or tingling and a pale or blue-colored appearance in your fingers or toes; or

(if you are also taking an antidepressant) -- agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Less serious side effects may include:

mild headache (not a migraine);

dry mouth, mild nausea;

pressure or heavy feeling in any part of your body;

dizziness, drowsiness, tired feeling; or

warmth, redness, or mild tingling under your skin.

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 rizatriptan?

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

propranolol (Inderal, InnoPran); or

an antidepressant such as citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Rapiflux, Sarafem, Selfemra, Symbyax), fluvoxamine (Luvox), paroxetine (Paxil, Pexeva), sertraline (Zoloft), trazodone (Desyrel, Oleptro), venlafaxine (Effexor), or vilazodone (Viibryd).

This list is not complete and other drugs may interact with rizatriptan. 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 Maxalt resources Maxalt Side Effects (in more detail)Maxalt Use in Pregnancy & BreastfeedingDrug ImagesMaxalt Drug InteractionsMaxalt Support Group46 Reviews for Maxalt - Add your own review/rating Maxalt Monograph (AHFS DI) Maxalt Advanced Consumer (Micromedex) - Includes Dosage Information Maxalt Consumer Overview Maxalt MedFacts Consumer Leaflet (Wolters Kluwer) Maxalt Prescribing Information (FDA) Maxalt-MLT Orally Disintegrating Tablets MedFacts Consumer Leaflet (Wolters Kluwer) Compare Maxalt with other medications Migraine Where can I get more information? Your pharmacist can provide more information about rizatriptan.

See also: Maxalt side effects (in more detail)


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Tambocor


Pronunciation: fle-KAY-nide
Generic Name: Flecainide
Brand Name: Tambocor

Tambocor sometimes produces new irregular heartbeats (arrhythmias), which can be life-threatening.


Tambocor is used for:

Treating and preventing various types of irregular heartbeat that lead to life-threatening heart rhythm disturbances.

Tambocor is an antiarrhythmic. It works by stabilizing the heart rhythm when the heart is beating too fast or in an irregular rhythm.

Do NOT use Tambocor if: you are allergic to any ingredient in Tambocor you have severe heart problems (eg, certain types of heart blocks or shock) or a history of severe heart problems you are taking an HIV protease inhibitor (eg, ritonavir)

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

Before using Tambocor:

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

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have heart problems (eg, congestive heart failure, heart attack, sick sinus syndrome) or a history of heart problems if you have severe kidney or liver problems if you have abnormal potassium blood levels

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

Calcium channel blockers (eg, nifedipine, verapamil), cimetidine, HIV protease inhibitors (eg, ritonavir), or serotonin norepinephrine reuptake inhibitors (eg, duloxetine) because they may increase the risk of Tambocor's side effects, including heart problems, blood problems, or seizures, may be increased Antiarrhythmics (eg, amiodarone, quinidine, disopyramide), arsenic, beta-blockers (eg, propranolol, sotalol), droperidol, pimozide, serotonin receptor antagonists (eg, dolasetron), or ziprasidone because the risk of side effects, such as irregular heartbeat or other heart problems, may be increased Digoxin because the risk of its side effects may be increased by Tambocor

This may not be a complete list of all interactions that may occur. Ask your health care provider if Tambocor 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 Tambocor:

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

Take Tambocor by mouth with or without food. The initial dose of Tambocor will be given by a qualified health care provider in a medical setting. If you miss a dose of Tambocor, take 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 take 2 doses at once.

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

Important safety information: Tambocor may cause dizziness, blurred vision, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Tambocor with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Tell your doctor or dentist that you take Tambocor before you receive any medical or dental care, emergency care, or surgery. Do not suddenly stop taking Tambocor without checking with your doctor. LAB TESTS may be performed to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments. Tambocor should not be used in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Tambocor while you are pregnant. Tambocor is found in breast milk. If you are or will be breast-feeding while you are using Tambocor, check with your doctor. Discuss the risks to your baby. Possible side effects of Tambocor:

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

Blurred vision; constipation; difficulty focusing; dizziness; faintness; headache; nausea; seeing spots; stomach discomfort; tiredness; unsteadiness; weakness.

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); chest pain; difficulty breathing; fainting; fast heartbeat; heart attack; life-threatening irregular heartbeat; lightheadedness; pounding in the chest; seizures; tremor; yellowing of the skin or eyes.

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: Tambocor 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 fainting; nausea; seizures; slow heartbeat; vomiting.

Proper storage of Tambocor:

Store Tambocor at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Tambocor out of the reach of children and away from pets.

General information: If you have any questions about Tambocor, please talk with your doctor, pharmacist, or other health care provider. Tambocor 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 Tambocor. 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 Tambocor resources Tambocor Side Effects (in more detail) Tambocor Use in Pregnancy & Breastfeeding Drug Images Tambocor Drug Interactions Tambocor Support Group 7 Reviews for Tambocor - Add your own review/rating Tambocor Prescribing Information (FDA) Tambocor Advanced Consumer (Micromedex) - Includes Dosage Information Tambocor Concise Consumer Information (Cerner Multum) Tambocor Monograph (AHFS DI) Flecainide Prescribing Information (FDA) Compare Tambocor with other medications Atrial Fibrillation Atrial Flutter Paroxysmal Supraventricular Tachycardia Supraventricular Tachycardia Ventricular Tachycardia Wolff-Parkinson-White Syndrome
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sumatriptan oral/nasal


Generic Name: sumatriptan (oral/nasal) (soo ma TRIP tan)
Brand Names: Imitrex, Imitrex Nasal

What is sumatriptan?

Sumatriptan is a headache medicine that narrows blood vessels around the brain. Sumatriptan also reduces substances in the body that can trigger headache pain, nausea, sensitivity to light and sound, and other migraine symptoms.

Sumatriptan is used to treat migraine headaches. Sumatriptan will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

Sumatriptan should not be used to treat a common tension headache, a headache that causes loss of movement on one side of your body, or any headache that seems to be different from your usual migraine headaches. Use this medication only if your condition has been confirmed by a doctor as migraine headaches.

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

What is the most important information I should know about sumatriptan? You should not use this medication if you are allergic to sumatriptan, if you have any history of heart disease, or if you have coronary heart disease, angina, blood circulation problems, lack of blood supply to the heart, uncontrolled high blood pressure, severe liver disease, ischemic bowel disease, a history of a heart attack or stroke, or if your headache seems to be different from your usual migraine headaches. Do not use sumatriptan within 24 hours before or after using another migraine headache medicine, including sumatriptan injection, almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), rizatriptan (Maxalt), naratriptan (Amerge), zolmitriptan (Zomig), or ergot medicine such as dihydroergotamine (D.H.E. 45, Migranal), ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine). Do not use sumatriptan if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days.

Before using sumatriptan, tell your doctor if you have liver or kidney disease, seizures, high blood pressure, a heart rhythm disorder, or coronary heart disease (or risk factors such as diabetes, menopause, smoking, being overweight, having high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

Also tell your doctor if you are taking an antidepressant such as citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor).

Sumatriptan will only treat a headache that has already begun. It will not prevent headaches or reduce the number of attacks.

After taking a sumatriptan tablet, you must wait two (2) hours before taking a second tablet. Do not take more than 200 mg of sumatriptan tablets in 24 hours.

After using sumatriptan nasal spray, you must wait two (2) hours before using a second spray. Do not use more than 40 mg of sumatriptan nasal spray in 24 hours.

What should I discuss with my healthcare provider before using sumatriptan? You should not use this medication if you are allergic to sumatriptan, or if you have:

coronary heart disease, angina (chest pain), blood circulation problems, lack of blood supply to the heart;

a history of heart disease, heart attack, or stroke, including "mini-stroke";

severe or uncontrolled high blood pressure;

severe liver disease;

ischemic bowel disease; or

a headache that seems different from your usual migraine headaches.

Do not use sumatriptan if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days.

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

liver disease; kidney disease;

epilepsy or other seizure disorder;

high blood pressure, a heart rhythm disorder; or

coronary heart disease (or risk factors such as diabetes, menopause, smoking, being overweight, having high cholesterol, having a family history of coronary artery disease, being older than 40 and a man, or being a woman who has had a hysterectomy).

FDA pregnancy category C. It is not known whether sumatriptan will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication.

Your name may need to be listed on a sumatriptan pregnancy registry when you start using this medication.

Sumatriptan can pass into breast milk and may harm a nursing baby. Do not breast-feed within 12 hours after using sumatriptan. If you use a breast pump during this time, throw out any milk you collect. Do not feed it to your baby. This medicine should not be given to anyone under 18 or over 65 years of age. How should I use sumatriptan?

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. Overuse of migraine headache medicine can actually make your headaches worse.

Use sumatriptan as soon as you notice headache symptoms, or after an attack has already begun.

Your doctor may want to give your first dose of this medicine in a hospital or clinic setting to see if you have any serious side effects.

Take one sumatriptan tablet whole with a full glass of water. Do not split the tablet.

After taking a tablet: If your headache does not completely go away, or goes away and comes back, take a second tablet two (2) hours after the first. Do not take more than 200 mg of sumatriptan oral tablets in 24 hours. If your symptoms have not improved, contact your doctor before taking any more tablets.

Sumatriptan nasal spray comes with patient instructions for safe and effective use. Follow these directions carefully. Ask your doctor or pharmacist if you have any questions. Blow your nose to clear your nasal passages before using the nasal spray. Try not to sneeze or blow your nose just after using the spray.

After using the nasal spray: If your headache does not completely go away after using the spray, call your doctor before using a second spray of sumatriptan. If your headache goes away and then comes back, you may use a second spray if it has been at least two hours since you used the first spray. Do not use more than 40 mg of sumatriptan nasal spray in 24 hours. If your symptoms do not improve, contact your doctor before using any more sprays.

Contact your doctor if you have more than four headaches in one month (30 days).

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

Since sumatriptan is used as needed, it does not have a daily dosing schedule. Call your doctor promptly if your symptoms do not improve after using sumatriptan.

After taking a sumatriptan tablet, you must wait two (2) hours before taking a second tablet. Do not take more than 200 mg of sumatriptan tablets in 24 hours.

After using sumatriptan nasal spray, you must wait two (2) hours before using a second spray. Do not use more than 40 mg of sumatriptan nasal spray in 24 hours.

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

Overdose symptoms may include tremors or shaking, skin redness, breathing problems, blue-colored lips or fingernails, vision problems, watery eyes or mouth, weakness, lack of coordination, or seizure (convulsions).

What should I avoid while using sumatriptan? Do not use sumatriptan within 24 hours before or after using another migraine headache medicine, including:

sumatriptan injection, almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt, Maxalt-MLT), or zolmitriptan (Zomig); or

ergot medicine such as dihydroergotamine (D.H.E. 45, Migranal), ergotamine (Ergomar, Cafergot, Migergot), dihydroergotamine (D.H.E. 45, Migranal), or methylergonovine (Methergine).

Sumatriptan may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Sumatriptan 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 sumatriptan and call your doctor if you have a serious side effect such as:

feeling of pain or tightness in your jaw, neck, or throat;

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

sudden numbness or weakness, especially on one side of the body;

sudden severe headache, confusion, problems with vision, speech, or balance;

sudden and severe stomach pain and bloody diarrhea;

seizure (convulsions);

numbness or tingling and a pale or blue-colored appearance in your fingers or toes; or

(if you are also taking an antidepressant) -- agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Less serious side effects may include:

mild headache (not a migraine);

pressure or heavy feeling in any part of your body;

feeling hot or cold;

dizziness, spinning sensation;

drowsiness;

nausea, vomiting, drooling;

unusual taste in your mouth after using the nasal spray;

burning, numbness, pain or other irritation in your nose or throat after using the nasal spray; or

warmth, redness, or mild tingling under your skin.

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.

Sumatriptan Dosing Information

Usual Adult Dose for Cluster Headache:

Initial dosage when symptoms of headache appear:
Subcutaneously: 4 to 6 mg; may repeat if needed at least 1 hour after initial dose; maximum: 12 mg/day.
ORAL: Initial single dose: 25 mg given with fluids as soon as possible after the onset of a migraine; range: 25 to 100 mg/dose; maximum single dose: 100 mg; may repeat after 2 hours; maximum: 200 mg/day taken. The maximum single oral dose recommended is 100 mg. Do not split tablets.
NASAL SPRAY: Initial single dose: 5 mg, 10 mg, or 20 mg administered in one nostril, given as soon as possible after the onset of migraine; 10 mg dose may be administered as 5 mg in each nostril; may repeat after 2 hours; maximum: 40 mg/day.

Usual Adult Dose for Migraine:

Initial dosage when symptoms of headache appear:
Subcutaneously: 4 to 6 mg; may repeat if needed at least 1 hour after initial dose; maximum: 12 mg/day.
ORAL: Initial single dose: 25 mg given with fluids as soon as possible after the onset of a migraine; range: 25 to 100 mg/dose; maximum single dose: 100 mg; may repeat after 2 hours; maximum: 200 mg/day taken. The maximum single oral dose recommended is 100 mg. Do not split tablets.
NASAL SPRAY: Initial single dose: 5 mg, 10 mg, or 20 mg administered in one nostril, given as soon as possible after the onset of migraine; 10 mg dose may be administered as 5 mg in each nostril; may repeat after 2 hours; maximum: 40 mg/day.

Usual Pediatric Dose for Migraine:

Use in children and adolescents less than 18 years of age not recommended by manufacturer. Results of clinical studies are mixed with regards to efficacy, particularly with oral and injectable sumatriptan.
Intranasal:
Children 5 to 12 years: 5 mg, 10 mg, or 20 mg administered in one nostril as a single dose. A double-blind, placebo controlled study of 129 patients (8 to 17 years) used a weight-based dosing regimen: 20 to 39 kg: 10 mg; 40 kg or more: 20 mg. A small retrospective review of 10 children (5 to 12 years; mean: 9.9 years), used intranasal doses of 5 mg (n=2) or 20 mg (n=8).
Adolescents 12 years or older: 5 mg, 10 mg, or 20 mg administered in one nostril as a single dose.
Subcutaneously: Children and Adolescents 6 to 18 years: 3 to 6 mg single dose. An open labeled prospective trial of 17 children 6 to 16 years with juvenile migraine used subcutaneous doses of 6 mg in 15 children (30 to 70 kg), and 3 mg/dose in two children (22 kg and 30 kg). Another open-label prospective trial in 50 consecutive children (ages 6 to 18 years) with severe migraine used subcutaneous doses of 0.06 mg/kg/dose. Relief was reported as good/excellent in 84% of the patients; 16% reported fair to poor relief; additional studies are needed.

What other drugs will affect sumatriptan?

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

an antidepressant such as citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), or venlafaxine (Effexor).

This list is not complete and other drugs may interact with sumatriptan. 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 sumatriptan resources Sumatriptan Side Effects (in more detail)Sumatriptan DosageSumatriptan Use in Pregnancy & BreastfeedingDrug ImagesSumatriptan Drug InteractionsSumatriptan Support Group104 Reviews for Sumatriptan - Add your own review/rating Compare sumatriptan with other medications Cluster HeadachesCyclic Vomiting SyndromeMigraineNew Daily Persistent Headache Where can I get more information? Your pharmacist can provide more information about sumatriptan.

See also: sumatriptan side effects (in more detail)


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sertraline


Generic Name: sertraline (SER tra leen)
Brand Names: Zoloft

What is sertraline?

Sertraline is an antidepressant in a group of drugs called selective serotonin reuptake inhibitors (SSRIs). Sertraline affects chemicals in the brain that may become unbalanced and cause depression, panic, anxiety, or obsessive-compulsive symptoms.

Sertraline is used to treat depression, obsessive-compulsive disorder, panic disorder, anxiety disorders, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder (PMDD).

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

What is the most important information I should know about sertraline? Do not take sertraline if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects.

You may have thoughts about suicide when you first start taking an antidepressant, especially if you are younger than 24 years old. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

Video: Treatment for Depression

Treatments for depression are getting better everyday and there are things you can start doing right away.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking sertraline, do not stop taking the medication without first talking to your doctor. What should I discuss with my healthcare provider before taking sertraline? Do not use sertraline if you have used an MAO inhibitor such as furazolidone (Furoxone), isocarboxazid (Marplan), phenelzine (Nardil), rasagiline (Azilect), selegiline (Eldepryl, Emsam, Zelapar), or tranylcypromine (Parnate) in the last 14 days. A dangerous drug interaction could occur, leading to serious side effects. You must wait at least 14 days after stopping an MAO inhibitor before you can take sertraline. After you stop taking sertraline, you must wait at least 14 days before you start taking an MAOI.

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

liver or kidney disease;

seizures or epilepsy;

a bleeding or blood clotting disorder;

bipolar disorder (manic depression); or

a history of drug abuse or suicidal thoughts.

You may have thoughts about suicide while taking an antidepressant, especially if you are younger than 24 years old. Tell your doctor if you have worsening depression or suicidal thoughts during the first several weeks of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits for at least the first 12 weeks of treatment.

FDA pregnancy category C. SSRI antidepressants may cause serious or life-threatening lung problems in newborn babies whose mothers take the medication during pregnancy. However, you may have a relapse of depression if you stop taking your antidepressant during pregnancy. If you are planning a pregnancy, or if you become pregnant while taking sertraline, do not stop taking the medication without first talking to your doctor. It is not known whether sertraline 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. Do not give sertraline to anyone younger than 18 years old without the advice of a doctor. Sertraline is FDA-approved for children with obsessive-compulsive disorder (OCD). It is not approved for treating depression in children. How should I take sertraline?

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.

Sertraline may be taken with or without food. Try to take the medicine at the same time each day. Follow the directions on your prescription label.

The liquid form of sertraline must be diluted before you take it. To be sure you get the correct dose, measure the liquid with the medicine dropper provided. Mix the dose with 4 ounces (one-half cup) of water, ginger ale, lemon/lime soda, lemonade, or orange juice. Do not use any other liquids to dilute the medicine. Stir this mixture and drink all of it right away. To make sure you get the entire dose, add a little more water to the same glass, swirl gently and drink right away.

This medication can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking sertraline. It may take up to 4 weeks before your symptoms improve. Do not stop using sertraline without first talking to your doctor. You may have unpleasant side effects if you stop taking this medication suddenly. Store at room temperature away from moisture and heat.

See also: Sertraline 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 extreme drowsiness, vomiting, rapid heart rate, agitation, or tremor. What should I avoid while taking sertraline? Drinking alcohol can increase certain side effects of sertraline.

Do not take the liquid form of sertraline if you are taking disulfiram (Antabuse). Liquid sertraline may contain alcohol and you could have a severe reaction to the disulfiram.

This medication may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Sertraline side effects Get emergency medical help if you have any of these signs of an allergic reaction: skin rash or hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have a serious side effect such as:

very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, feeling like you might pass out;

agitation, hallucinations, fever, overactive reflexes, tremors;

nausea, vomiting, diarrhea, loss of appetite, feeling unsteady, loss of coordination; or

headache, trouble concentrating, memory problems, weakness, fainting, seizure, shallow breathing or breathing that stops.

Less serious side effects may include:

drowsiness, dizziness, tired feeling;

mild nausea, stomach pain, upset stomach, constipation;

dry mouth;

changes in appetite or weight;

sleep problems (insomnia); or

decreased sex drive, impotence, or difficulty having an orgasm.

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.

Sertraline Dosing Information

Usual Adult Dose for Depression:

Initial dose: 50 mg orally once a day.
Increase dose by 50 mg increments no more often than weekly.
Maintenance Dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Obsessive Compulsive Disorder:

Initial dose: 50 mg orally once a day.
Increase dose by 50 mg increments no more often than weekly.
Maintenance Dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Panic Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Post Traumatic Stress Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Social Anxiety Disorder:

Initial dose: 25 mg orally once a day, after one week, the dose may be increased to 50 mg once a day. Increase dose by 50 mg increments no more often than weekly.
Maintenance dose: Can increase once a week, to a maximum of 200 mg once a day.

Usual Adult Dose for Premenstrual Dysphoric Disorder:

Initial dose: 50 mg orally once a day, either throughout the menstrual cycle or limited to the luteal phase of the menstrual cycle (depending on the clinical judgement of the physician).
Patients not responding to a 50 mg per day dose may benefit from dose increases (at 50 mg increments/menstrual cycle) up to 150 mg per day when dosing daily throughout the menstrual cycle, or 100 mg per day when dosing during the luteal phase of the menstrual cycle. If a 100 mg per day dose is established with luteal phase dosing, a 50 mg per day titration step for three days should be utilized at the beginning of each luteal phase dosing period.
The effectiveness of sertraline for longer than three months has not been systematically evaluated in controlled trials.

What other drugs will affect sertraline?

Ask your doctor before taking a nonsteroidal anti-inflammatory drug (NSAID) for pain, arthritis, fever, or swelling. This includes 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. Using an NSAID with sertraline may cause you to bruise or bleed easily.

Before using sertraline, 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 or anxiety). They can add to sleepiness caused by sertraline.

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

cimetidine (Tagamet);

digitoxin (Crystodigin);

fentanyl (Abstral, Actiq, Fentora, Duragesic, Ionsys, Lazanda, Onsolis);

linezolid (Zyvox);

lithium (Lithobid, Eskalith);

St. John's wort;

tramadol (Ultram, Ultram ER, Ultracet);

5-hydroxytryptophan (5-HTP);

valproate (Depacon, Depakene);

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

cough and cold medicines;

any other antidepressant such as amitriptyline (Elavil), bupropion (Wellbutrin), citalopram (Celexa), desvenlafaxine (Pristiq), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), milnacipran (Savella), nortriptyline (Pamelor), paroxetine (Paxil), or venlafaxine (Effexor);

heart rhythm medication such as flecainide (Tambocor), propafenone (Rhythmol), and others; or

migraine headache medicine such as almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex, Treximet) or zolmitriptan (Zomig).

This list is not complete and other drugs may interact with sertraline. 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 sertraline resources Sertraline Side Effects (in more detail) Sertraline Dosage Sertraline Use in Pregnancy & Breastfeeding Drug Images Sertraline Drug Interactions Sertraline Support Group 397 Reviews for Sertraline - Add your own review/rating sertraline Advanced Consumer (Micromedex) - Includes Dosage Information Sertraline Prescribing Information (FDA) Sertraline MedFacts Consumer Leaflet (Wolters Kluwer) Sertraline Hydrochloride Monograph (AHFS DI) Zoloft Prescribing Information (FDA) Zoloft Consumer Overview Compare sertraline with other medications Anxiety and Stress Bipolar Disorder Body Dysmorphic Disorder Depression Dysautonomia Dysthymia Generalized Anxiety Disorder Obsessive Compulsive Disorder Panic Disorder Post Traumatic Stress Disorder Postpartum Depression Premenstrual Dysphoric Disorder Social Anxiety Disorder Trichotillomania Vulvodynia Where can I get more information? Your pharmacist can provide more information about sertraline.

See also: sertraline side effects (in more detail)


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Lexiva


Pronunciation: FOS-am-PREN-a-vir
Generic Name: Fosamprenavir
Brand Name: Lexiva
Lexiva is used for:

Treating HIV infection in some patients when used in combination with certain other medicines.

Lexiva is an HIV protease inhibitor. It works by slowing the growth of HIV, the virus that causes AIDS.

Do NOT use Lexiva if: you are allergic to any ingredient in Lexiva or to amprenavir you are taking alfuzosin, amprenavir, astemizole, cisapride, conivaptan, delavirdine, erythromycin, an ergot medicine (eg, ergotamine), pimozide, rifampin, salmeterol, St. John's wort, or terfenadine you are taking a hormonal contraceptive (eg, birth control pills), certain benzodiazepines (eg, midazolam, triazolam), or certain HMG-CoA reductase inhibitors (eg, lovastatin, simvastatin) you are taking sildenafil for pulmonary arterial hypertension (PAH) you are taking flecainide or propafenone along with ritonavir

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

Before using Lexiva:

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

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have had a severe allergic reaction (eg, a severe rash, hives, itching, breathing difficulties, dizziness) to a sulfonamide medicine such as acetazolamide, celecoxib, certain diuretics (eg, hydrochlorothiazide), glyburide, probenecid, sulfamethoxazole, valdecoxib, or zonisamide if you have liver problems, hepatitis, or a history of abnormal liver function tests if you have a history of heart problems, high blood pressure, kidney problems, diabetes, bleeding problems (eg, hemophilia), high blood cholesterol or lipid levels, or a skin rash if you smoke

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

Astemizole, cisapride, ergot medicines (eg, ergotamine), erythromycin, pimozide, salmeterol, or terfenadine because serious side effects, such as seizures, blood vessel problems, or heart problems (eg, irregular heartbeat), may occur Flecainide or propafenone along with ritonavir because serious heart problems (eg, irregular heartbeat) may occur Alfuzosin because the risk of severe low blood pressure may be increased Certain benzodiazepines (eg, midazolam, triazolam) because serious side effects, such as increased or prolonged sedation or breathing problems, may occur Hormonal contraceptives (eg, birth control pills), especially if taken along with ritonavir, because their effectiveness may be decreased and liver problems may occur Amprenavir because it may increase the risk of Lexiva's side effects Rifampin or St. John's wort because they may decrease Lexiva's effectiveness Conivaptan, certain HMG-CoA reductase inhibitors (eg, lovastatin, simvastatin), ranolazine, or sildenafil (when used for PAH) because the risk of their side effects may be increased by Lexiva Delavirdine because its effectiveness may be decreased by Lexiva Many prescription and nonprescription medicines (eg, used for cancer, infections, asthma, immune suppression, inflammation, aches and pains, gout, high blood pressure, high cholesterol, heart problems, irregular heartbeat, angina, blood clotting problems, mood or mental problems, sinus problems, stomach problems or indigestion, erectile dysfunction, , PAH, seizures, sleeping problems, urinary problems, HIV infection), multivitamin products, and herbal or dietary supplements (eg, herbal teas, coenzyme Q10, garlic, ginseng, ginkgo) may interact with Lexiva, increasing the risk of side effects

This may not be a complete list of all interactions that may occur. Ask your health care provider if Lexiva 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 Lexiva:

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

An extra patient leaflet is available with Lexiva. Talk to your pharmacist if you have questions about this information. Take Lexiva by mouth with or without food. If you take an aluminum- or magnesium-containing antacid, ask your doctor or pharmacist how to take it with Lexiva. Do not change your dose or stop taking Lexiva without talking with your doctor first. Continue to take Lexiva even if you feel well. Do not miss any doses. Taking Lexiva at the same time(s) each day will help you remember to take it. It is important to not miss any doses of Lexiva. If you miss a dose of Lexiva, take it as soon as you remember. If you miss a dose of Lexiva by more than 4 hours, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

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

Important safety information: Do not take more than the recommended dose without checking with your doctor. Lexiva is not a cure for HIV infection. Patients may still get illnesses and infections associated with HIV. Remain under the care of your doctor. Lexiva does not stop the spread of HIV to others through blood or sexual contact. Use barrier forms of birth control (eg, condoms) if you have HIV infection. Do not share needles, injection supplies, or items like toothbrushes or razors. When your medicine supply is low, get more from your doctor or pharmacist as soon as you can. Do not stop taking Lexiva, even for a short period of time. If you do, the virus may grow resistant to the medicine and become harder to treat. Lexiva may improve immune system function. This may reveal hidden infections in some patients. Tell your doctor right away if you notice signs or symptoms of an infection (eg, fever, sore throat, weakness, cough, shortness of breath) after you start Lexiva. Severe and sometimes life-threatening skin reactions have occurred in patients taking Lexiva. Contact your doctor right away if you develop any type of skin reaction (eg, red, swollen, blistered, or peeling skin). Changes in body fat (eg, an increased amount of fat in the upper back, neck, breast, and trunk, and loss of fat from the legs, arms, and face) may occur in some patients taking Lexiva. The cause and long-term effects of these changes are unknown. Discuss any concerns with your doctor. Diabetes patients - Lexiva may affect your blood sugar. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Lexiva may raise your blood sugar. High blood sugar may make you feel confused, drowsy, or thirsty. It can also make you flush, breathe faster, or have a fruit-like breath odor. If these symptoms occur, tell your doctor right away. Hormonal birth control (eg, birth control pills) may not work as well while you are using Lexiva. To prevent pregnancy, use an extra form of birth control (eg, condoms). Lab tests, including liver function, cholesterol or triglyceride levels, white blood cell count, and blood sugar levels, may be performed while you use Lexiva. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Caution is advised when using Lexiva in CHILDREN; they may be more sensitive to its effects, especially vomiting. Lexiva should be used with extreme caution in CHILDREN younger than 2 years old; safety and effectiveness in these children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you are planning to become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Lexiva while you are pregnant. It is not known if Lexiva is found in breast milk. Mothers infected with HIV should not breast-feed. There is a risk of passing the HIV infection or Lexiva to the baby. Possible side effects of Lexiva:

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:

Diarrhea; headache; nausea; tiredness; vomiting.

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; unusual hoarseness); loss of appetite; signs of infection (eg, fever, chills, sore throat); swollen, reddened, or blistered skin; symptoms of a heart attack (eg, chest pain; fainting; numbness of an arm or leg; sudden, severe headache or vomiting); symptoms of kidney stones (eg, lower back or side pain, blood in the urine, painful urination); unusual increase in thirst or urination; unusual tiredness or weakness; weight loss; yellowing of the skin or eyes.

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: Lexiva 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.

Proper storage of Lexiva:

Store Lexiva at 77 degrees F (25 degrees C). Brief storage at temperatures between 59 and 86 degrees F (15 and 30 degrees C) is permitted. Store away from heat, moisture, and light. Do not store in the bathroom. Keep the container tightly closed. Do not use it after the expiration date. Keep Lexiva out of the reach of children and away from pets.

General information: If you have any questions about Lexiva, please talk with your doctor, pharmacist, or other health care provider. Lexiva 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 Lexiva. 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 Lexiva resources Lexiva Side Effects (in more detail) Lexiva Use in Pregnancy & Breastfeeding Drug Images Lexiva Drug Interactions Lexiva Support Group 0 Reviews for Lexiva - Add your own review/rating Lexiva Prescribing Information (FDA) Lexiva Monograph (AHFS DI) Lexiva Advanced Consumer (Micromedex) - Includes Dosage Information Lexiva Consumer Overview Compare Lexiva with other medications HIV Infection Nonoccupational Exposure
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Lopressor Tablets


Pronunciation: MET-oh-PROE-lol TAR-trate
Generic Name: Metoprolol Tartrate
Brand Name: Lopressor

Do not suddenly stop taking Lopressor. Sharp chest pain, irregular heartbeat, and sometimes heart attack may occur if you suddenly stop Lopressor. The risk may be greater if you have certain types of heart disease. Your doctor should slowly lower your dose over several weeks if you need to stop taking it. This should be done even if you only take Lopressor for high blood pressure. Heart disease is common and you may not know you have it. Limit physical activity while you are lowering your dose. If new or worsened chest pain or other heart problems occur, contact your doctor right away. You may need to start taking Lopressor again.

Tell your doctor or dentist that you take Lopressor before you receive any medical or dental care, emergency care, or surgery.

Tell your doctor if you have a history of diabetes or if you take medicine to lower your blood sugar (eg, glyburide, insulin). Lopressor may hide signs of low blood sugar, such as fast heartbeat. Be sure to watch for other signs of low blood sugar (eg, anxiety, chills, dizziness, drowsiness, fainting, headache, tremor, unusual sweating, vision changes, weakness). Tell your doctor right away if these effects occur.

Lopressor should not usually be used by patients who have a history of certain lung or breathing problems (eg, asthma) or who have a certain type of adrenal gland tumor (pheochromocytoma). It may worsen these conditions. Tell your doctor if you have a history of breathing problems or adrenal gland tumors. If you have these conditions and must take Lopressor, your doctor may need to adjust your dose or prescribe additional medicine to reduce the risk of side effects. Check with your doctor for more information.

Tell your doctor if you have a history of overactive thyroid. Lopressor may hide symptoms of overactive thyroid (eg, fast heartbeat). Do not suddenly stop taking Lopressor; suddenly stopping Lopressor could worsen your condition. Your doctor should slowly lower your dose over several weeks if you need to stop taking it. Check with your doctor for more information.


Lopressor is used for:

Treating high blood pressure. It may be used alone or with other medicines. It is also used for the long-term treatment of chest pain (angina) and for reducing the risk of death because of heart problems in certain patients who have had a heart attack. It may also be used for other conditions as determined by your doctor.

Lopressor is a beta-adrenergic blocking agent (beta-blocker). It works by reducing the amount of work the heart has to do (reduces chest pain) and the amount of blood the heart pumps out (lowers high blood pressure). It is also used to stabilize the heart rhythm in conditions in which the heart is beating too fast or in an irregular rhythm.

Do NOT use Lopressor if: you are allergic to any ingredient in Lopressor or to another beta-blocker (eg, propranolol) you have a very slow heart rate (eg, bradycardia), certain types of irregular heartbeat (eg, atrioventricular [AV] block, sick sinus syndrome), moderate to severe heart failure, very low systolic blood pressure (less than 100 mm Hg), or severe blood circulation problems you are taking mibefradil

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

Before using Lopressor:

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

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have an adrenal gland tumor (pheochromocytoma), an overactive thyroid, or are scheduled to have surgery if you have low blood pressure or a history of heart attack, slow or irregular heartbeat, heart failure, or other heart problems; chest pain or angina; blood circulation problems; or liver problems if you have diabetes mellitus, chronic obstructive pulmonary disease (COPD), bronchitis, breathing problems, or a history of asthma

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

Amiodarone, bupropion, cimetidine, digoxin, diltiazem, diphenhydramine, disopyramide, flecainide, certain HIV protease inhibitors (eg, ritonavir), hormonal contraceptives (eg, birth control pills), hydralazine, hydroxychloroquine, ketanserin, mefloquine, mibefradil, monoamine oxidase inhibitors (MAOIs) (eg, phenelzine), phenothiazines (eg, thioridazine), propafenone, propylthiouracil, quinazolines (eg, alfuzosin), quinidine, reserpine, certain selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine, paroxetine), terbinafine, or verapamil because serious side effects, such as very slow heart rate, very low blood pressure, fainting, severe dizziness, or lightheadedness when standing, may occur Clonidine because stopping it or Lopressor suddenly can lead to a rapid increase in blood pressure Barbiturates (eg, phenobarbital), indomethacin, or phenylpropanolamine because they may decrease Lopressor's effectiveness Bupivacaine, disopyramide, flecainide, hydralazine, ketanserin, or lidocaine because the risk of their side effects may be increased by Lopressor

This may not be a complete list of all interactions that may occur. Ask your health care provider if Lopressor 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 Lopressor:

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

Take Lopressor by mouth with food or immediately following a meal at the same time each day. If you miss a dose of Lopressor, take 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 take 2 doses at once.

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

Important safety information: Lopressor may cause drowsiness, dizziness, or lightheadedness. These effects may be worse if you take it with alcohol or certain medicines. Use Lopressor with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Lopressor may cause dizziness, lightheadedness, or fainting; alcohol, hot weather, exercise, or fever may increase these effects. To prevent them, sit up or stand slowly, especially in the morning. Sit or lie down at the first sign of any of these effects. Patients who take medicine for high blood pressure often feel tired or run down for a few weeks after starting treatment. Be sure to take your medicine even if you may not feel "normal." Tell your doctor if you develop any new symptoms. Do not suddenly stop taking Lopressor without first consulting your doctor. If your doctor decides you should no longer use Lopressor, you will need to stop Lopressor gradually according to your doctor's instructions. If your doctor has instructed you to check your blood pressure and heart rate regularly, be sure to do so. Do not take any medicines used to treat colds or congestion without first talking with your doctor or pharmacist. Diabetes patients - Lopressor may hide signs of low blood sugar, such as rapid heartbeat. Be sure to watch for other signs or low blood sugar. Low blood sugar may make you anxious, sweaty, weak, dizzy, drowsy, or faint. It may also make your vision change; give you a headache, chills, or tremors; or make you more hungry. Check blood sugar levels closely. Ask your doctor before you change the dose of your diabetes medicine. Tell your doctor or dentist that you take Lopressor before you receive any medical or dental care, emergency care, or surgery. If you have a history of any severe allergic reaction, talk with your doctor. You may be at risk of an even more severe allergic reaction if you come into contact with the substance that caused your allergy. Some medicines used to treat severe allergies may also not work as well while you are using Lopressor. Lab tests, including liver function, kidney function, blood pressure, and complete blood cell counts, may be performed while you use Lopressor. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments. Lopressor should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Lopressor while you are pregnant. Lopressor is found in breast milk. If you are or will be breast-feeding while you use Lopressor, check with your doctor. Discuss any possible risks to your baby. Possible side effects of Lopressor:

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:

Constipation; diarrhea; dizziness; dry mouth or eyes; gas; headache; heartburn; lightheadedness; mild drowsiness; muscle aches; nausea; stomach pain; trouble sleeping; unusual tiredness or weakness; vomiting.

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, unusual hoarseness); blue or unusually cold hands or feet; chest pain; chills, fever, or sore throat; fainting; hallucinations; mood or mental changes (eg, confusion, depression, foggy thinking, short-term memory loss); pounding in the chest; severe dizziness or lightheadedness; shortness of breath; slow or irregular heartbeat; swelling of the arms, hands, and feet; unusual bruising or bleeding; vision changes; wheezing; yellowing of the skin or eyes.

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: Lopressor 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 difficult or slowed breathing; fainting; severe dizziness; very slow heart rate; weakness.

Proper storage of Lopressor:

Store Lopressor at room temperature, between 59 and 86 degrees F (15 and 30 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Lopressor out of the reach of children and away from pets.

General information: If you have any questions about Lopressor, please talk with your doctor, pharmacist, or other health care provider. Lopressor 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 Lopressor. 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 Lopressor resources Lopressor Side Effects (in more detail)Lopressor DosageLopressor Use in Pregnancy & BreastfeedingDrug ImagesLopressor Drug InteractionsLopressor Support Group8 Reviews for Lopressor - Add your own review/rating Compare Lopressor with other medications AnginaAngina Pectoris ProphylaxisAtrial FibrillationBenign Essential TremorHeart AttackHigh Blood PressureLeft Ventricular DysfunctionMitral Valve ProlapsePremature Ventricular DepolarizationsSupraventricular Tachycardia
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methylene blue Oral, Intravenous


METH-i-leen BLOO

Available Dosage Forms:

Solution

Therapeutic Class: Diagnostic Agent, Kidney Function

Uses For methylene blue

Methylene blue injection is used to treat a condition called methemoglobinemia. This condition occurs when the blood cannot deliver oxygen where it is needed in the body. Methylene blue injection is also used as a dye to stain certain parts of the body before or during surgery.

methylene blue is to be given only by or under the direct supervision of a doctor.

Before Using methylene blue

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

Allergies

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

Pediatric

No information is available on the relationship of age to the effects of methylene blue injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of methylene blue injection in geriatric patients.

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

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

Interactions with Medicines

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

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

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

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

Buspirone Nefazodone Trazodone Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

The presence of other medical problems may affect the use of methylene blue. Make sure you tell your doctor if you have any other medical problems, especially:

Glucose-6-phosphate dehydrogenase (G6PD) deficiency (a hereditary metabolic disorder affecting red blood cells)—May cause hemolytic anemia or make methemoglobinemia worse. Kidney disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body. Proper Use of methylene blue

A nurse or other trained health professional will give you methylene blue in a hospital. methylene blue is given through a needle placed in one of your veins.

methylene blue must be given very slowly, so the needle will remain in place for several minutes.

Precautions While Using methylene blue

Your doctor will check your progress closely while you are receiving methylene blue. This will allow your doctor to see if the medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using methylene blue while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using methylene blue, tell your doctor right away.

Make sure your doctor knows about all the other medicines you are using. methylene blue may cause a serious condition called serotonin syndrome when taken with other medicines to treat depression (such as amitriptyline, bupropion, citalopram, desipramine, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline, venlafaxine, Aventyl®, Celexa®, Cymbalta®, Effexor®, Elavil®, Lexapro™, Luvox®, Norpramin®, Pamelor®, Paxil®, Prozac®, Tofranil®, Wellbutrin®, or Zoloft®), medicine to treat migraine headaches (such as eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), ergot medicine (such as ergotamine, Cafergot®, Ergomar®, or Wigraine®), or certain antibiotics (linezolid, Zyvox®). Check with your doctor first before taking any other medicines. The symptoms of serotonin syndrome include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering or shaking, diarrhea, trouble with coordination, or fever.

Before you have any medical tests, tell the doctor in charge that you are using methylene blue. The results of some tests may be affected by methylene blue.

methylene blue Side Effects

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

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

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose Anxiety back pain bluish fingernails, lips, or skin chest pain chills confusion difficulty with breathing dizziness headache leg pain nausea and vomiting severe sweating stomach pain trembling unusual tiredness or weakness

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

More common Greenish blue to blue discoloration of the urine and stools Less common Diarrhea nausea and vomiting painful urination or increased need to urinate

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

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

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

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

More methylene blue Oral, Intravenous resources Methylene blue Oral, Intravenous Drug Interactions Methylene blue Oral, Intravenous Support Group 0 Reviews for Methylene blue Oral, Intravenous - Add your own review/rating Compare methylene blue Oral, Intravenous with other medications Methemoglobinemia
read more / Download


Urolene Blue


Generic Name: methylene blue (Intravenous route)

METH-i-leen BLOO

Available Dosage Forms:

Solution

Therapeutic Class: Diagnostic Agent, Kidney Function

Uses For Urolene Blue

Methylene blue injection is used to treat a condition called methemoglobinemia. This condition occurs when the blood cannot deliver oxygen where it is needed in the body. Methylene blue injection is also used as a dye to stain certain parts of the body before or during surgery.

This medicine is to be given only by or under the direct supervision of a doctor.

Before Using Urolene Blue

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

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

Pediatric

No information is available on the relationship of age to the effects of methylene blue injection in the pediatric population. Safety and efficacy have not been established.

Geriatric

No information is available on the relationship of age to the effects of methylene blue injection in geriatric patients.

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

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

Interactions with Medicines

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

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

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

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

Buspirone Nefazodone Trazodone Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

Glucose-6-phosphate dehydrogenase (G6PD) deficiency (a hereditary metabolic disorder affecting red blood cells)—May cause hemolytic anemia or make methemoglobinemia worse. Kidney disease, severe—Use with caution. The effects may be increased because of slower removal of the medicine from the body. Proper Use of Urolene Blue

A nurse or other trained health professional will give you this medicine in a hospital. This medicine is given through a needle placed in one of your veins.

This medicine must be given very slowly, so the needle will remain in place for several minutes.

Precautions While Using Urolene Blue

Your doctor will check your progress closely while you are receiving this medicine. This will allow your doctor to see if the medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using this medicine, tell your doctor right away.

Make sure your doctor knows about all the other medicines you are using. This medicine may cause a serious condition called serotonin syndrome when taken with other medicines to treat depression (such as amitriptyline, bupropion, citalopram, desipramine, duloxetine, escitalopram, fluoxetine, fluvoxamine, imipramine, nortriptyline, paroxetine, sertraline, venlafaxine, Aventyl®, Celexa®, Cymbalta®, Effexor®, Elavil®, Lexapro™, Luvox®, Norpramin®, Pamelor®, Paxil®, Prozac®, Tofranil®, Wellbutrin®, or Zoloft®), medicine to treat migraine headaches (such as eletriptan, sumatriptan, zolmitriptan, Imitrex®, Relpax®, or Zomig®), ergot medicine (such as ergotamine, Cafergot®, Ergomar®, or Wigraine®), or certain antibiotics (linezolid, Zyvox®). Check with your doctor first before taking any other medicines. The symptoms of serotonin syndrome include mental changes (confusion, hyperactivity, memory problems), muscle twitching, excessive sweating, shivering or shaking, diarrhea, trouble with coordination, or fever.

Before you have any medical tests, tell the doctor in charge that you are using this medicine. The results of some tests may be affected by this medicine.

Urolene Blue Side Effects

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

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

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose Anxiety back pain bluish fingernails, lips, or skin chest pain chills confusion difficulty with breathing dizziness headache leg pain nausea and vomiting severe sweating stomach pain trembling unusual tiredness or weakness

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

More common Greenish blue to blue discoloration of the urine and stools Less common Diarrhea nausea and vomiting painful urination or increased need to urinate

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

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

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

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

More Urolene Blue resources Urolene Blue Drug Interactions Urolene Blue Support Group 0 Reviews for Urolene Blue - Add your own review/rating Urolene Blue oral and injection Concise Consumer Information (Cerner Multum) Methylene Blue Monograph (AHFS DI) Compare Urolene Blue with other medications Methemoglobinemia
read more / Download


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