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Myasthenia Gravis Medications


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

Drugs associated with Myasthenia Gravis

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

Learn more about Myasthenia Gravis

Micromedex Care Notes:

Myasthenia Gravis

Medical Encyclopedia:

Myasthenia gravis

Harvard Health Guide:

Symptoms and treatment for Myasthenia Gravis
Drug List: Mestinon Mestinon-Timespan Mytelase Mytelase-Chloride Prostigmin Prostigmin-Bromide Regonol Soliris
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Genitourinary tract agents


Genitourinary tract agents are medicines, which are used to treat conditions of the reproductive organs and excretory system or urinary tract. They include medicines used for bladder spasms, urinary pH modifiers, medicines for erectile dysfunction in men and medicines that suppress uterine contractions to prevent preterm labor.

See also impotence agents miscellaneous genitourinary tract agents tocolytic agents urinary antispasmodics urinary pH modifiers uterotonic agents Drug List:
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Urinary pH modifiers


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

Urinary pH modifiers are agents that increase the pH of urine. They make the urine more alkaline and prevent the formation of kidney stones. Making the urine more alkaline also helps the kidneys to remove toxic substances.

See also

Medical conditions associated with urinary pH modifiers:

Alkalosis Asystole Diabetic Ketoacidosis GERD Hyperkalemia Hyperuricemia Secondary to Chemotherapy Hyponatremia Indigestion Metabolic Acidosis Nephrolithiasis Renal Tubular Acidosis Urinary Alkalinization Drug List: Urocit-K Neut
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Urinary Tract Tumors Medications


Drugs associated with Urinary Tract Tumors

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

Learn more about Urinary Tract Tumors

Micromedex Care Notes:

Bladder Cancer

Medical Encyclopedia:

Bladder cancer Cancer Cancer - renal pelvis or ureter Tumor
Drug List: Theracys Tice-Bcg Tice-Bcg-Vaccine Valstar
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Urinary anti-infectives


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

Urinary anti-infectives are drugs that are used to prevent or treat urinary tract infections. There are several classes of antibacterial agents in this category and they have different mechanisms of action. However, majority of these drugs tend to have high concentration in the urine and therefore are ideal to treat urinary tract infections, or used as prophylaxis for urinary tract infections.

See also

Medical conditions associated with urinary anti-infectives:

Bladder Infection Methemoglobinemia Otitis Media Pneumocystis Pneumonia Prevention of Bladder infection Transurethral Prostatectomy Urinary Tract Infection Drug List: Monurol Hiprex Mandelamine Macrodantin Macrobid Cinobac Furadantin-Suspension Neggram Primsol-Solution Proloprim Trimpex Urex Urolene-Blue-Oral-And-Injection
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antimyasthenic Oral, Parenteral


Class Name: antimyasthenic (Oral route, Parenteral route)

Commonly used brand name(s)

In the U.S.

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

In Canada

Reminyl

Available Dosage Forms:

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

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

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

Before Using This Medicine Allergies

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

Pediatric

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

Geriatric

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

Pregnancy

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

Breast Feeding

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

Interactions with Medicines

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

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

Atropine Metoclopramide

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

Succinylcholine Interactions with Food/Tobacco/Alcohol

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

Other Medical Problems

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

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

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

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

If you are taking this medicine for myasthenia gravis:

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

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

Dosing

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

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

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

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

Storage

Keep out of the reach of children.

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

Do not keep outdated medicine or medicine no longer needed.

Keep the syrup form of pyridostigmine from freezing.

Side Effects of This Medicine

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

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

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

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

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

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

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

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

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

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

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Pyridostigmine Tablets


Pronunciation: peer-id-oh-STIG-meen
Generic Name: Pyridostigmine
Brand Name: Mestinon
Pyridostigmine is used for:

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

Pyridostigmine is a cholinesterase inhibitor. It works by improving nerve impulses in muscles so that the muscles are better able to work.

Do NOT use Pyridostigmine if: you are allergic to any ingredient in Pyridostigmine you are taking quinine or quinidine you have a stomach, intestinal, or urinary blockage

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

Before using Pyridostigmine:

Some medical conditions may interact with Pyridostigmine. 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, heart block, slow heartbeat), a urinary tract infection, asthma, or kidney problems

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

Quinine or quinidine because effectiveness of Pyridostigmine may be decreased Succinylcholine because actions and side effects may be increased by Pyridostigmine

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

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

Pyridostigmine may be taken with or without food. Take with food if it upsets your stomach. If you miss a dose of Pyridostigmine, 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 Pyridostigmine.

Important safety information: Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Pyridostigmine. Use Pyridostigmine with extreme caution in CHILDREN. Safety and effectiveness have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Pyridostigmine, discuss with your doctor the benefits and risks of using Pyridostigmine during pregnancy. Pyridostigmine is excreted in breast milk. If you are or will be breast-feeding while you are using Pyridostigmine, check with your doctor or pharmacist to discuss the risks to your baby. Possible side effects of Pyridostigmine:

All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no COMMON side effects have been reported with this product. 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); diarrhea; fainting; increased production of saliva; increased sweating; muscle weakness; nausea; small pupils; stomach cramps; trouble breathing; vision changes; vomiting; weakness.

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: Pyridostigmine 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 diarrhea; fainting; increased production of saliva; increased sweating; muscle weakness; nausea; small pupils; stomach cramps; trouble breathing; vision changes; vomiting; weakness.

Proper storage of Pyridostigmine:

Store Pyridostigmine between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Pyridostigmine out of the reach of children and away from pets.

General information: If you have any questions about Pyridostigmine, please talk with your doctor, pharmacist, or other health care provider. Pyridostigmine 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 Pyridostigmine. 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 Pyridostigmine resources Pyridostigmine Side Effects (in more detail) Pyridostigmine Dosage Pyridostigmine Use in Pregnancy & Breastfeeding Drug Images Pyridostigmine Drug Interactions Pyridostigmine Support Group 12 Reviews for Pyridostigmine - Add your own review/rating Compare Pyridostigmine with other medications Dysautonomia Myasthenia Gravis Nerve Agent Pretreatment Reversal of Nondepolarizing Muscle Relaxants
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flavoxate


Generic Name: flavoxate (flah VOX ate)
Brand Names: Urispas

What is flavoxate?

Flavoxate reduces muscle spasms of the bladder and urinary tract.

Flavoxate is used to treat bladder symptoms such as frequent or urgent urination, increased night-time urination, bladder pain, and incontinence (urine leakage). These bladder symptoms are often caused by overactive bladder, prostate enlargement, bladder infections, or irritation of the urethra.

Flavoxate will not treat a bacterial or fungal bladder infection. Infections must be treated with an antibiotic.

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

What is the most important information I should know about flavoxate? You should not use this medication if you are allergic to flavoxate, or if you have untreated or uncontrolled narrow-angle glaucoma, a blockage in your digestive tract (stomach or intestines), or if you are unable to urinate.

Before using flavoxate, tell your doctor if you have glaucoma or urinary problems.

Flavoxate can cause drowsiness or blurred vision. Be careful if you drive or do anything that requires you to be alert and able to see clearly. There may be other medicines that can interact with flavoxate. 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.

Stop using this medication and call your doctor if you have serious side effects such as hot and dry skin, confusion, pounding heartbeats, fluttering in your chest, or if you stop urinating.

What should I discuss with my health care provider before taking flavoxate? You should not use this medication if you are allergic to flavoxate, or have certain conditions. Be sure your doctor knows if you have:

a blockage in your stomach or intestines;

a history of stomach ulcer or bleeding; or

if you are unable to urinate.

Before using flavoxate, tell your doctor if you are allergic to any drugs, or if you have:

glaucoma; or

urinary problems.

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

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

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

Take this medicine with water. Store flavoxate at room temperature away from moisture, heat, and light.

See also: Flavoxate 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, wait until then to take the medicine and skip the missed dose. 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.

Symptoms of a flavoxate overdose are not known.

What should I avoid while taking flavoxate? Flavoxate can cause drowsiness or blurred vision. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Flavoxate 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 flavoxate and call your doctor at once if you have any of these serious side effects:

hot, dry skin and extreme thirst;

confusion;

pounding heartbeats, fluttering in your chest; or

urinating less than usual or not at all.

Less serious side effects may include:

dry mouth;

blurred vision;

nausea, vomiting;

drowsiness, nervousness;

spinning sensation;

headache; or

fever.

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.

Flavoxate Dosing Information

Usual Adult Dose for Urinary Incontinence:

100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

Usual Adult Dose for Urinary Frequency:

100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

Usual Adult Dose for Dysuria:

100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

Usual Pediatric Dose for Urinary Incontinence:

Greater than 12 years: 100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

Usual Pediatric Dose for Urinary Frequency:

Greater than 12 years: 100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

Usual Pediatric Dose for Dysuria:

Greater than 12 years: 100 to 200 mg orally 3 to 4 times daily. As symptoms improve dose may be reduced.

What other drugs will affect flavoxate?

Tell your doctor if you are using any other bladder or urinary medications such as darifenacin (Enablex), oxybutynin (Ditropan, Oxytrol), tolterodine (Detrol), or solifenacin (Vesicare).

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

More flavoxate resources Flavoxate Side Effects (in more detail) Flavoxate Dosage Flavoxate Use in Pregnancy & Breastfeeding Drug Images Flavoxate Drug Interactions Flavoxate Support Group 1 Review for Flavoxate - Add your own review/rating flavoxate Advanced Consumer (Micromedex) - Includes Dosage Information Flavoxate Professional Patient Advice (Wolters Kluwer) Flavoxate MedFacts Consumer Leaflet (Wolters Kluwer) Flavoxate Prescribing Information (FDA) Flavoxate Hydrochloride Monograph (AHFS DI) Urispas Prescribing Information (FDA) Compare flavoxate with other medications Dysuria Overactive Bladder Urinary Incontinence Where can I get more information? Your pharmacist can provide more information about flavoxate.

See also: flavoxate side effects (in more detail)


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Mestinon Controlled-Release Tablets


Pronunciation: peer-id-oh-STIG-meen
Generic Name: Pyridostigmine
Brand Name: Mestinon
Mestinon Controlled-Release Tablets are used for:

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

Mestinon Controlled-Release Tablets are a cholinesterase inhibitor. It works by improving nerve impulses in muscles so that the muscles are better able to work.

Do NOT use Mestinon Controlled-Release Tablets if: you are allergic to any ingredient in Mestinon Controlled-Release Tablets you are taking quinine or quinidine you have a stomach, intestinal, or urinary blockage

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

Before using Mestinon Controlled-Release Tablets:

Some medical conditions may interact with Mestinon Controlled-Release Tablets. 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, heart block, slow heartbeat), a urinary tract infection, asthma, or kidney problems

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

Quinine or quinidine because effectiveness of Mestinon Controlled-Release Tablets may be decreased Succinylcholine because actions and side effects may be increased by Mestinon Controlled-Release Tablets

This may not be a complete list of all interactions that may occur. Ask your health care provider if Mestinon Controlled-Release Tablets 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 Mestinon Controlled-Release Tablets:

Use Mestinon Controlled-Release Tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.

Mestinon Controlled-Release Tablets may be taken with or without food. Take with food if it upsets your stomach. Swallow Mestinon Controlled-Release Tablets whole. Do not break, crush, or chew before swallowing. If you miss a dose of Mestinon Controlled-Release Tablets, 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 Mestinon Controlled-Release Tablets.

Important safety information: Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Mestinon Controlled-Release Tablets. Use Mestinon Controlled-Release Tablets with extreme caution in CHILDREN. Safety and effectiveness have not been confirmed. PREGNANCY and BREAST-FEEDING: If you become pregnant while taking Mestinon Controlled-Release Tablets, discuss with your doctor the benefits and risks of using Mestinon Controlled-Release Tablets during pregnancy. Mestinon Controlled-Release Tablets are excreted in breast milk. If you are or will be breast-feeding while you are using Mestinon Controlled-Release Tablets, check with your doctor or pharmacist to discuss the risks to your baby. Possible side effects of Mestinon Controlled-Release Tablets:

All medicines may cause side effects, but many people have no, or minor, side effects. When used in small doses, no COMMON side effects have been reported with this product. 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); diarrhea; fainting; increased production of saliva; increased sweating; muscle weakness; nausea; small pupils; stomach cramps; trouble breathing; vision changes; vomiting; weakness.

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: Mestinon 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 diarrhea; fainting; increased production of saliva; increased sweating; muscle weakness; nausea; small pupils; stomach cramps; trouble breathing; vision changes; vomiting; weakness.

Proper storage of Mestinon Controlled-Release Tablets:

Store Mestinon Controlled-Release Tablets between 68 and 77 degrees F (20 and 25 degrees C). Store away from heat, moisture, and light. Do not store in the bathroom. Keep Mestinon Controlled-Release Tablets out of the reach of children and away from pets.

General information: If you have any questions about Mestinon Controlled-Release Tablets, please talk with your doctor, pharmacist, or other health care provider. Mestinon Controlled-Release Tablets are 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 Mestinon Controlled-Release Tablets. 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 Mestinon resources Mestinon Side Effects (in more detail) Mestinon Use in Pregnancy & Breastfeeding Drug Images Mestinon Drug Interactions Mestinon Support Group 6 Reviews for Mestinon - Add your own review/rating Compare Mestinon with other medications Dysautonomia Myasthenia Gravis Nerve Agent Pretreatment Reversal of Nondepolarizing Muscle Relaxants
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Trospium Extended-Release Capsules


Pronunciation: TROSE-pee-um
Generic Name: Trospium
Brand Name: Sanctura XR
Trospium Extended-Release Capsules are used for:

Treating overactive bladder with symptoms such as urinary incontinence, urgency, and frequency.

Trospium Extended-Release Capsules are an antispasmodic and antimuscarinic agent. It works by reducing muscle tone of the bladder, which decreases urinary spasm and frequency.

Do NOT use Trospium Extended-Release Capsules if: you are allergic to any ingredient in Trospium Extended-Release Capsules you have delayed or slow emptying of the stomach or uncontrolled narrow-angle glaucoma, you are unable to urinate, or you are at risk of developing these conditions you have severe kidney problems you are taking a solid oral potassium product (eg, tablet)

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

Before using Trospium Extended-Release Capsules:

Some medical conditions may interact with Trospium Extended-Release Capsules. 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 use alcohol or have a history of alcohol abuse if you have liver or kidney problems, or glaucoma or increased pressure in the eye if you have stomach or bowel problems (eg, inflammation, constipation, blockage, problems with the muscles in your intestines), myasthenia gravis, bladder blockage, or trouble urinating

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

Solid oral potassium products (eg, tablets) because the risk of stomach or bowel irritation may be increased by Trospium Extended-Release Capsules Anticholinergic medicines (eg, scopolamine), metformin, morphine, procainamide, tenofovir, or vancomycin because they may increase the risk of Trospium Extended-Release Capsules's side effects Phenothiazines (eg, thioridazine) because their effectiveness may be decreased by Trospium Extended-Release Capsules

This may not be a complete list of all interactions that may occur. Ask your health care provider if Trospium Extended-Release Capsules 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 Trospium Extended-Release Capsules:

Use Trospium Extended-Release Capsules as directed by your doctor. Check the label on the medicine for exact dosing instructions.

An extra patient leaflet is available with Trospium Extended-Release Capsules. Talk to your pharmacist if you have questions about this information. Take Trospium Extended-Release Capsules by mouth with water on an empty stomach at least 1 hour before eating, preferably in the morning or as directed by your doctor. If you miss a dose of Trospium Extended-Release Capsules, 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 Trospium Extended-Release Capsules.

Important safety information: Trospium Extended-Release Capsules may cause drowsiness or blurred vision. These effects may be worse if you take it with alcohol or certain medicines. Use Trospium Extended-Release Capsules with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it. Do not drink alcohol within 2 hours before or after you take Trospium Extended-Release Capsules. Check with your doctor before you use medicines that may cause drowsiness (eg, sleep aids, muscle relaxers) while you are using Trospium Extended-Release Capsules; it may add to their effects. Ask your pharmacist if you have questions about which medicines may cause drowsiness. Trospium Extended-Release Capsules may cause dry mouth. To relieve dry mouth, suck on sugarless hard candy or ice chips, chew sugarless gum, drink water, or use a saliva substitute. Do not become overheated in hot weather or while you are being active; heatstroke may occur. Tell your doctor or dentist that you take Trospium Extended-Release Capsules before you receive any medical or dental care, emergency care, or surgery. A severe and sometimes life-threatening side effect called angioedema has been reported with Trospium Extended-Release Capsules. Contact your doctor at once if you develop swelling of the hands, face, lips, eyes, throat, or tongue; difficulty swallowing or breathing; or hoarseness. Use Trospium Extended-Release Capsules with caution in the ELDERLY; they may be more sensitive to its effects, especially dry mouth, constipation, stomach pain or upset, and trouble urinating. Trospium Extended-Release Capsules 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 taking Trospium Extended-Release Capsules while you are pregnant. It is not known if Trospium Extended-Release Capsules are found in breast milk. If you are or will be breast-feeding while you take Trospium Extended-Release Capsules, check with your doctor. Discuss any possible risks to your baby. Possible side effects of Trospium Extended-Release Capsules:

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; dry mouth or eyes; gas; nasal dryness; nausea; upset stomach.

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

Severe allergic reactions (rash; hives; itching; difficulty swallowing or breathing; tightness in the chest; swelling of the mouth, face, lips, throat, or tongue; unusual hoarseness); chest pain; dark urine; difficulty urinating; fainting; fast or irregular heartbeat; hallucinations; mental or mood changes; muscle pain or weakness; red, swollen, peeling, or blistered skin; vision changes.

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: Trospium 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 ( http://www.aapcc.org), or emergency room immediately. Symptoms may include fast or irregular heartbeat.

Proper storage of Trospium Extended-Release Capsules:

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

General information: If you have any questions about Trospium Extended-Release Capsules, please talk with your doctor, pharmacist, or other health care provider. Trospium Extended-Release Capsules are 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 Trospium Extended-Release Capsules. 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 Trospium resources Trospium Side Effects (in more detail) Trospium Dosage Trospium Use in Pregnancy & Breastfeeding Drug Images Trospium Drug Interactions Trospium Support Group 17 Reviews for Trospium - Add your own review/rating Compare Trospium with other medications Interstitial Cystitis Overactive Bladder Urinary Incontinence
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Usept


Pronunciation: bell-a-DON-a/meth-EN-a-meen/METH-i-leen/FEN-ill sa-LI-si-late
Generic Name: Belladonna Alkaloids/Methenamine/Methylene Blue/Phenyl Salicylate
Brand Name: Examples include Urised and Usept
Usept is used for:

Treating painful and irritating symptoms of the urinary tract due to urinary tract infections or diagnostic procedures.

Usept is a urinary antiseptic, analgesic, and anticholinergic combination. It works by helping to kill bacteria in the urine, decreasing pain and inflammation, and reducing muscle spasms in the urinary tract. These actions work together to help relieve discomfort while urinating.

Do NOT use Usept if: you are allergic to any ingredient in Usept you have had a severe allergic reaction (eg, severe rash, hives, difficulty breathing, dizziness) to aspirin, other salicylate medicines, or a nonsteroidal anti-inflammatory drug (NSAID) (eg, ibuprofen, naproxen, celecoxib) you have angle-closure glaucoma, problems with your esophagus, bowel motility problems, a blockage of your bladder or bowel, severe intestinal problems (eg, ulcerative colitis), severe bleeding, flu or chickenpox, myasthenia gravis, severe kidney problems, or you are severely dehydrated you are taking a sulfonamide (eg, sulfamethizole)

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

Before using Usept:

Some medical conditions may interact with Usept. 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 constipation, diarrhea, an infection of the stomach or bowel, a hiatal hernia, or stomach ulcers if you have nervous system problems, glucose-6-phosphate-dehydrogenase (G-6-PD) deficiency, gout, influenza, Kawasaki syndrome, rheumatic disease, open-angle glaucoma, risk factors for angle-closure glaucoma, kidney or liver problems, an enlarged prostate, bladder problems, or you are unable to urinate if you have a history of stroke or brain blood vessel problems (eg, aneurysm), an irregular heartbeat, heart blood vessel problems, congestive heart failure, heart valve problems, or other heart problems if you are on a low-salt diet

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

Anticholinergics (eg, benztropine) because the side effects of Usept may be increased Ketoconazole because the effectiveness of Usept may be decreased Monoamine oxidase (MAO) inhibitors or narcotic pain medicine (eg, codeine) because the risk of serious side effects may be increased Medicine for myasthenia gravis (eg, ambenonium), phenothiazines (eg, chlorpromazine), sulfonamides (eg, sulfamethizole), thiazide diuretics (eg, hydrochlorothiazide), or urinary alkalinizers (eg, sodium bicarbonate) because effectiveness may be decreased by Usept

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

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

Usept may be taken with or without food. Do not take antacids or antidiarrheal medicines (eg, loperamide) within 1 hour before or after taking Usept. Drink plenty of fluids while taking Usept. If you miss a dose of Usept, 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 Usept.

Important safety information: Usept may cause dizziness. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Usept. Using Usept alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks. Do not take Usept more often or in larger amounts than prescribed by your health care provider. Usept may discolor the urine or feces a blue-green color. This is normal and not a cause for concern. Usept contains an aspirin-like medicine, which has been linked to Reye syndrome. Do not give Usept to children or teenagers during or after chickenpox, flu, or other viral infections without checking with your doctor or pharmacist. Use Usept with caution in the ELDERLY because they may be more sensitive to its effects, especially excitement, agitation, drowsiness, and confusion. Usept is not recommended for use in CHILDREN younger than 6 years of age. Safety and effectiveness in this age group have not been confirmed. PREGNANCY and BREAST-FEEDING: It is unknown if Usept can cause harm to the fetus. If you become pregnant while taking Usept, discuss with your doctor the benefits and risks of using Usept during pregnancy. Usept is excreted in breast milk. If you are or will be breast-feeding while you are using Usept, check with your doctor or pharmacist to discuss the risks to your baby. Possible side effects of Usept:

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:

Dry mouth; flushing; nausea; vomiting.

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

Severe allergic reactions (rash; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); blurred vision; difficulty urinating; dizziness; fast or irregular heartbeat.

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: Usept 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 Usept:

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

General information: If you have any questions about Usept, please talk with your doctor, pharmacist, or other health care provider. Usept 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 Usept. 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 Usept resources Usept Side Effects (in more detail) Usept Use in Pregnancy & Breastfeeding Usept Drug Interactions Usept Support Group 0 Reviews for Usept - Add your own review/rating Darcalma Prescribing Information (FDA) Darcalma Concise Consumer Information (Cerner Multum) Darpaz Prescribing Information (FDA) Phosenamine Prescribing Information (FDA) Phosphasal Prescribing Information (FDA) Phosphasal Advanced Consumer (Micromedex) - Includes Dosage Information Prosed EC Advanced Consumer (Micromedex) - Includes Dosage Information Urelle Prescribing Information (FDA) Uribel Prescribing Information (FDA) Ustell Prescribing Information (FDA) Compare Usept with other medications Urinary Tract Infection
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Kwells Kids


1. Name Of The Medicinal Product

Kwells Kids 150 microgram tablets

2. Qualitative And Quantitative Composition

Hyoscine Hydrobromide 150 microgram

For excipients, see section 6.1

3. Pharmaceutical Form

Tablet

Small white circular, flat faced tablets with bevelled edges. One face is bisected by a score line and the other is plain.

4. Clinical Particulars 4.1 Therapeutic Indications

For the prevention of travel sickness.

4.2 Posology And Method Of Administration

Tablets to be sucked, chewed or swallowed

Adults:

Not applicable.

Elderly

Not applicable.

Children

Children over 10: 1-2 tablets every 6 hours if required. Do not take more than 3-6 tablets in 24 hours.

Children 4-10: ?-1 tablet every 6 hours if required. Do not take more than 1?-3 tablets in 24 hours.

Tablets to be taken up to 30 minutes before the start of the journey to prevent travel sickness, or at the onset of nausea.

4.3 Contraindications

Prostatic enlargement, paralytic ileus, pyloric stenosis, glaucoma and myasthenia gravis.

In addition, Kwells should not be given to patients with a known sensitivity to hyoscine hydrobromide or any other component of the product.

4.4 Special Warnings And Precautions For Use

The elderly and patients under medical care (in particular those at risk of acute urinary retention, or with cardiovascular, metabolic, gastrointestinal, liver or renal disease, or suffering from CNS disorders such as seizures) should consult a doctor before taking this product.

In patients with ulcerative colitis its use may lead to ileus or megacolon.

Antimuscarinics should be used with caution in persons with Down's Syndrome.

Caution is advisable in patients with diarrhoea.

Hyperthermia can occur at high ambient temperatures due to decreased sweating, therefore, Kwells should be used with caution in patients with fever.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

The effects of hyoscine may be enhanced by other drugs with anticholinergic properties (including amantadine, some antihistamines, phenothiazine antipsychotics and tricyclic antidepressants), therefore, combining these drugs with hyoscine should be avoided.

There may be an increased risk of side effects when given with MAOIs due to inhibition of drug-metabolising enzymes.

The sedative effect of Kwells may be enhanced with alcohol or CNS depressants.

The reduction in gastric motility caused by Kwells may also affect the absorption of other drugs. There is an antagonism of effect of domperidone and metoclopramide on gastro-intestinal activity.

There could be a reduced effect of sublingual nitrate tablets due to the failure to dissolve properly under the tongue owing to dry mouth.

4.6 Pregnancy And Lactation

The safety of this medicine in pregnancy has not been established. It should only be used during pregnancy, particularly in the first trimester, if the expected benefit to the mother outweighs any potential risk to the developing foetus and on advice of a physician.

Caution is required during lactation as small amounts of this medicine may pass into breast milk.

4.7 Effects On Ability To Drive And Use Machines

May cause drowsiness. If affected do not drive or operate machinery.

4.8 Undesirable Effects

The listed adverse drug reactions are based on spontaneous reports, thus an organization according to CIOMS II categories of frequency is not pertinent.

General: hyperthermia at high temperatures due to decreased sweating.

Eye disorders: blurred vision, mydriasis.

Gastrointestinal disorders: dry mouth.

Immune system disorders: allergic reaction and anaphylactic reaction. Hypersensitivity reactions with respective laboratory and clinical manifestations, including asthma syndrome, mild to moderate reactions affecting skin, respiratory tract, gastrointestinal tract, and cardiovascular system, and symptoms such as rash, urticaria, oedema, pruritus, cardio-respiratory distress, have been reported.

Nervous system disorders: drowsiness, dizziness, sedation and somnolence are commonly reported. Central nervous system stimulation including restlessness, hallucinations and confusion, have been less frequently reported following the administration of hyoscine. There have been rare reports of an increase in seizure frequency in epileptic patients (the same caution for this patient population is included in Section 4.4).

4.9 Overdose

The symptoms of overdosage are tachycardia, arrhythmia, blurring of vision and photophobia, and urinary retention. Drowsiness is usual but paradoxical stimulation with hallucinations may occur.

Treatment: gastric lavage or induced emesis and symptomatic treatment.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Hyoscine hydrobromide is thought to act as an anticholinergic agent by both cutting off stimuli to the vestibular apparatus and also by acting directly on the vomiting centre.

5.2 Pharmacokinetic Properties

Hyoscine hydrobromide is readily absorbed from the gastro-intestinal tract, and in circulation is bound to plasma proteins. It is effective for about 4 hours and is almost entirely metabolised in the body.

5.3 Preclinical Safety Data

Not applicable.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Mannitol

Potato Starch

Gelatin Powder

Aluminium Stearate

Saccharin Sodium

Purified Water (not detectable)

6.2 Incompatibilities

None known.

6.3 Shelf Life

60 months.

6.4 Special Precautions For Storage

Do not store above 25 °C.

6.5 Nature And Contents Of Container

1. Strip packs formed from 0.03mm soft-tempered aluminium coated with polyethylene.

a. Two strips of six tablets in cardboard carton.

b. One strip of twelve tablets in cardboard carton.

2. Blister packs formed from 20um hard-tempered aluminium foil and 250um opaque, white PVC.

a. Two strips of six tablets in cardboard carton.

b. One strip of twelve tablets in cardboard carton

Pack size: 12

6.6 Special Precautions For Disposal And Other Handling

No special precautions necessary.

Administrative Data 7. Marketing Authorisation Holder

Bayer plc

Consumer Care Division,

Bayer House, Strawberry Hill,

Newbury, Berkshire, RG14 1JA,

United Kingdom

8. Marketing Authorisation Number(S)

PL 0010/0330

9. Date Of First Authorisation/Renewal Of The Authorisation

12/10/2005

10. Date Of Revision Of The Text

20/08/2007


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Mytelase Chloride


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

What is Mytelase Chloride (ambenonium)?

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

Ambenonium is used to treat the symptoms of myasthenia gravis.

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

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

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

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

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

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

mecamylamine, (Inversine);

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

blood pressure medications; or

a diuretic (water pill).

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

asthma;

Parkinson's disease; or

a bladder or bowel obstruction.

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

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

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

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

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

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

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

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

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

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

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

severe diarrhea;

muscle twitching; or

cough with sputum (mucus).

Less serious side effects may include:

sweating or urinating more than usual;

drooling, watery eyes;

warmth or tingly feeling;

nausea, vomiting, stomach pain;

blurred vision;

anxiety;

dizziness, spinning feeling; or

muscle cramps.

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

What other drugs will affect Mytelase Chloride (ambenonium)?

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

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

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

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

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

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

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

More Mytelase Chloride resources Mytelase Chloride Use in Pregnancy & Breastfeeding Mytelase Chloride Drug Interactions Mytelase Chloride Support Group 0 Reviews for Mytelase Chloride - Add your own review/rating Ambenonium MedFacts Consumer Leaflet (Wolters Kluwer) Compare Mytelase Chloride with other medications Myasthenia Gravis Where can I get more information? Your pharmacist can provide more information about ambenonium.
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Sanctura XR


Generic Name: trospium (tros PEE um)
Brand Names: Sanctura, Sanctura XR

What is Sanctura XR (trospium)?

Trospium relieves spasms of the bladder.

Trospium is used to treat overactive bladder and symptoms of urinary incontinence, frequency, and urgency.

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

What is the most important information I should know about Sanctura XR (trospium)? You should not take this medicine if you are allergic to trospium, or if you have untreated or uncontrolled narrow-angle glaucoma, a blockage in your digestive system, or if you are unable to urinate. Take trospium on an empty stomach, at least 1 hour before a meal. Avoid drinking alcohol within 2 hours before or after you take trospium. Drinking alcohol can increase certain side effects of trospium.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Trospium can decrease sweating, which makes it easier for you to have heat stroke. Drink plenty of fluids while you are taking this medication.

Before using trospium, tell your doctor if you regularly use other medicines that make you sleepy (such as cold or allergy medicine, sedatives, narcotic pain medicine, sleeping pills, muscle relaxers, and medicine for seizures, depression, or anxiety). They can add to sleepiness caused by trospium. What should I discuss with my healthcare provider before taking Sanctura XR (trospium)? You should not use trospium if you are allergic to it, or if you have:

untreated or uncontrolled narrow-angle glaucoma;

a blockage in your digestive system; or

if you are unable to urinate.

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

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

glaucoma;

liver disease;

kidney disease;

a stomach or intestinal disorder such as ulcerative colitis;

a muscle disorder such as myasthenia gravis; or

an enlarged prostate.

It is not known whether trospium 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 medicine.

How should I take Sanctura XR (trospium)?

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

Take trospium on an empty stomach, at least 1 hour before a meal. Extended-release trospium (Sanctura XR) should be taken once each morning, at least 1 hour before a meal. 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. Store at room temperature away from moisture and heat. What happens if I miss a dose?

Take the missed dose 1 hour before your next meal. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

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

Overdose symptoms may include severe forms of some of the side effects listed in this medication guide.

What should I avoid while taking Sanctura XR (trospium)? This medication may cause blurred vision and may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly. Avoid drinking alcohol within 2 hours before or after you take trospium. Drinking alcohol can increase certain side effects of trospium.

Avoid becoming overheated or dehydrated during exercise and in hot weather. Trospium can decrease sweating, which makes it easier for you to have heat stroke. Drink plenty of fluids while you are taking this medication.

Sanctura XR (trospium) 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. Stop using trospium and call your doctor at once if you have a serious side effect such as:

severe stomach pain or bloating;

severe constipation; or

urinating less than usual or not at all.

Less serious side effects may include:

dry mouth or throat;

headache;

mild constipation;

upset stomach, gas;

drowsiness, or

dry eyes.

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

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

atropine (Atreza, Sal-Tropine, and others);

belladonna (Donnatal, and others);

benztropine (Cogentin);

dicyclomine (Bentyl);

dimenhydrinate (Dramamine);

metformin (Actoplus Met, Avandamet, Glucophage, Glucovance, Janumet, Kombiglyze, Metaglip, PrandiMet);

morphine (Kadian, MS Contin, Oramorph);

procainamide (Procanbid, Pronestyl);

tenofovir (Viread);

vancomycin (Vancocin);

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

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

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

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

This list is not complete and other drugs may interact with trospium. 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 Sanctura XR resources Sanctura XR Side Effects (in more detail) Sanctura XR Use in Pregnancy & Breastfeeding Sanctura XR Drug Interactions Sanctura XR Support Group 5 Reviews for Sanctura XR - Add your own review/rating Sanctura XR Extended-Release Capsules MedFacts Consumer Leaflet (Wolters Kluwer) Sanctura XR Prescribing Information (FDA) Sanctura Prescribing Information (FDA) Sanctura Monograph (AHFS DI) Sanctura Advanced Consumer (Micromedex) - Includes Dosage Information Sanctura MedFacts Consumer Leaflet (Wolters Kluwer) Sanctura Consumer Overview Compare Sanctura XR with other medications Interstitial Cystitis Overactive Bladder Urinary Incontinence Where can I get more information? Your pharmacist can provide more information about trospium.

See also: Sanctura XR side effects (in more detail)


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Nytol One-A-Night (GlaxoSmithKline Consumer Healthcare)


1. Name Of The Medicinal Product

Nytol One-A-Night.

2. Qualitative And Quantitative Composition

Nytol One-A-Night contains 50mg Diphenhydramine Hydrochloride per tablet.

3. Pharmaceutical Form

Tablets to be taken orally.

4. Clinical Particulars 4.1 Therapeutic Indications

An aid to the relief of temporary sleep disturbance.

4.2 Posology And Method Of Administration

Oral administration only.

One tablet to be taken 20 minutes before going to bed, or as directed by a physician.

Do not exceed the stated dose or frequency of dosing.

Do not use in children under 16 years.

4.3 Contraindications

Nytol One-A-Night is contraindicated in patients who are hypersensitive to diphenhydramine or any of the excipients and in those with the following conditions: stenosing peptic ulcer, pyloroduodenal obstruction.

4.4 Special Warnings And Precautions For Use

Nytol One-A-Night should be used with caution in patients with myasthenia gravis, epilepsy or seizure disorders, narrow-angle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis and chronic obstructive pulmonary disease (COPD), moderate to severe hepatic impairment and moderate to severe renal impairment.

Tolerance may develop with continuous use. Seek medical advice if sleeplessness persists, as insomnia may be a symptom of serious underlying medical illness.

May increase the effects of alcohol, therefore alcohol should be avoided.

Avoid use of other antihistamine-containing preparations, including topical antihistamines and cough and cold medicines.

Use with caution in the elderly, who are more likely to experience adverse effects. Avoid use in elderly patients with confusion.

Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.

Keep out of the reach and sight of children.

4.5 Interaction With Other Medicinal Products And Other Forms Of Interaction

Diphenhydramine may potentiate the sedative effects of alcohol and other CNS depressants (e.g. tranquillizers, hypnotics and anxiolytics).

Monoamine oxidase inhibitors(MAOI) prolong and intensify the anticholinergic effects of diphenhydramine. The product should be used with caution with MAOIs or within 2 weeks of stopping an MAOI.

As diphenhydramine has some antimuscarinic activity, the effects of some anticholinergic drugs (e.g. atropine, tricyclic antidepressants) may be potentiated therefore medical advice should be sought before taking diphenhydramine with such medicines.

Diphenhydramine is an inhibitor of the cytochrome p450 isoenzyme CYP2D6. Therefore, there may be a potential for interaction with drugs which are primarily metabolised by CYP2D6, such as metoprolol and venlafaxine.

Diphenhydramine should not be used in patients receiving any of the above drugs unless directed by a doctor.

4.6 Pregnancy And Lactation

Pregnancy

Diphenhydramine crosses the placenta. Because animal reproduction studies are not always predictive of human response and since there is inadequate experience with use of diphenhydramine in pregnant women, the potential risk for humans is unknown. Use of sedating antihistamines during the third trimester may result in reactions in the newborn or premature neonates. This drug is not recommended during pregnancy. Consult a doctor before use.

Lactation

Diphenhydramine has been detected in breast milk, but the effect of this on breastfed infants is unknown. Nytol One-A-Night is not recommended for use during lactation in nursing mothers. Consult a doctor before use.

4.7 Effects On Ability To Drive And Use Machines

Nytol One-A-Night is a hypnotic and will produce drowsiness or sedation soon after the dose has been taken. It may also cause dizziness, blurred vision, cognitive and psychomotor impairment. These can seriously affect the patient's ability to drive and use machines. If affected, do not drive or operate machinery.

4.8 Undesirable Effects

Specific estimation of the frequency of adverse events for OTC products is inherently difficult (particularly numerator data). Adverse reactions which have been observed in clinical trials and which are considered to be common (occurring in > 1/100 to < 1/10) or very common (occurring in > 1/10) are listed below by MedDRA System Organ Class. The frequency of other adverse reactions identified during post-marketing use is unknown, but these reactions are likely to be uncommon (occurring in > 1/1,000 to <1/100) or rare (occurring in < 1/1,000).

General disorders and administration site conditions:

Common: fatigue

Immune system disorders:

Unknown: Hypersensitivity reactions including rash, urticaria, dyspnoea and angioedema

Psychiatric disorders*:

Unknown: confusion, paradoxical excitation (e.g. increased energy, restlessness, nervousness)

* The elderly are more prone to confusion and paradoxical excitation.

Nervous system disorders:

Common: sedation, drowsiness, disturbance in attention, unsteadiness, dizziness,

Unknown: convulsions, headache, paraesthesia, dyskinesias

Eye disorders

Unknown: blurred vision

Cardiac disorders

Unknown: tachycardia, palpitations

Respiratory, thoracic and mediastinal disorders:

Unknown: thickening of bronchial secretions

Gastrointestinal disorders:

Common: dry mouth

Unknown: gastrointestinal disturbance including nausea, vomiting

Musculoskeletal and connective tissue disorders:

Unknown: muscle twitching

Renal and urinary disorders:

Unknown: urinary difficulty, urinary retention

4.9 Overdose

Overdose is likely to result in effects similar to those listed under adverse reactions. Additional symptoms may include mydriasis, fever, flushing, agitation, tremor, dystonic reactions, hallucinations and ECG changes. Large overdose may cause rhabdomyolysis, convulsions, delirium, toxic psychosis, arrhythmias, coma and cardiovascular collapse.

Treatment should be supportive and directed towards specific symptoms. Convulsions and marked CNS stimulation should be treated with parenteral diazepam.

5. Pharmacological Properties 5.1 Pharmacodynamic Properties

Diphenhydramine is an ethanolamine-derivative antihistamine. It is an antihistamine with anticholinergic and marked sedative effects. It acts by inhibiting the effects on H1-receptors.

Diphenhydramine is effective in reducing sleep onset (i.e., time to fall asleep) and increasing the depth and quality of sleep.

5.2 Pharmacokinetic Properties

Diphenhydramine hydrochloride is rapidly absorbed following oral administration. Apparently it undergoes first-pass metabolism in the liver and only about 40-60% of an oral dose reaches systematic circulation as unchanged Diphenhydramine.

It is rapidly distributed throughout the whole body. Peak plasma concentrations are attained within 1-4 hours. The sedative effect also appears to be maximal within 1-3 hours after administration of a single dose.

It is positively correlated with the plasma drug concentration.

Diphenhydramine is approx 80-85% bound to plasma proteins. Diphenhydramine is rapidly and almost completely metabolised. The drug is metabolised principally to Diphenylmetoxyacetic acid and is also dealkylated.

The metabolites are conjugated with glycine and glutamine and excreted in urine. Only about 1% of a single dose is excreted unchanged in urine.

The elimination half-life ranges from 2.4-9.3 hours in healthy adults. The terminal elimination half-life is prolonged in liver cirrhosis.

5.3 Preclinical Safety Data

None stated.

6. Pharmaceutical Particulars 6.1 List Of Excipients

Anhydrous lactose

Stearic acid, powder

Microcrystalline cellulose

Silicon dioxide

Maize starch.

6.2 Incompatibilities

None known.

6.3 Shelf Life

Nytol One-A-Night has a shelf-life of 2 years in HDPE bottles and 3 years in blister packs.

6.4 Special Precautions For Storage

Store in a dry place.

6.5 Nature And Contents Of Container

High density polyethylene bottles with a polypropylene closure and cotton wool wadding, or an aclar/polyethylene/PVC or PVC/PVDC strip with a heat sealable aluminium foil. Bottles of 16 or 20 caplets and strips of 4, 8, 10, 16 or 20 tablets.

6.6 Special Precautions For Disposal And Other Handling

Not appropriate.

7. Marketing Authorisation Holder

Stafford-Miller Limited

980 Great West Road

Brentford

Middlesex

TW8 9GS

Trading as GlaxoSmithKline Consumer Healthcare, Brentford, TW8 9GS, U.K.

8. Marketing Authorisation Number(S)

PL 00036/0069

9. Date Of First Authorisation/Renewal Of The Authorisation

13 February 1995

10. Date Of Revision Of The Text

03 /02/2011


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Urinary Incontinence Medications


Definition of Urinary Incontinence:

Incontinence is the inability to control the passage of urine. This can range from an occasional leakage of urine, to a complete inability to hold any urine.

The three main types of urinary incontinence are:

Stress incontinence -- occurs during certain activities like coughing, sneezing, laughing, or exercise.

Stress incontinence is a bladder storage problem in which the strength of the muscles (urethral sphincter) that help control urination is reduced. The sphincter is not able to prevent urine flow when there is increased pressure from the abdomen.

Stress incontinence may occur as a result of weakened pelvic muscles that support the bladder and urethra or because of a malfunction of the urethral sphincter.

Treatment for stress incontinence may include behavioral changes, medication, pelvic floor muscle training or surgery.

Urge incontinence -- involves a strong, sudden need to urinate followed by instant bladder contraction and involuntary loss of urine. You don't have enough time between when you recognize the need to urinate and when you actually do urinate.

In most cases of urge incontinence, no specific cause can be identified.Although urge incontinence may occur in anyone at any age, it is more common in women and the elderly.

Treatment for urge incontinence may include medication, retraining, and surgery.

Mixed incontinence -- contains components of both stress and urge incontinence.

Drugs associated with Urinary Incontinence

The following drugs and medications are in some way related to, or used in the treatment of Urinary Incontinence. 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 Urinary IncontinenceOveractive Bladder (18 drugs) Learn more about Urinary Incontinence

Medical Encyclopedia:

Urinary incontinence

Harvard Health Guide:

Symptoms and treatment for Urinary Incontinence
Drug List:/tags/a-spaz/
/tags/azo-cranberry/
/tags/colidrops-drops/
/tags/cystospaz/
/tags/detrol-la-extended-release-capsules/
/tags/ditropan-xl-extended-release-tablets/
/tags/elavil/
/tags/gelnique/
/tags/hyomax-dt/
/tags/hyomax-sl/
/tags/hyospaz/
/tags/ib-stat-spray/
/tags/levsin/
/tags/levsinex-extended-release-capsules/
/tags/nulev-orally-disintegrating-tablets/
/tags/sanctura/
/tags/spasdel-drops/
/tags/symax-fastabs-orally-disintegrating-tablets/
/tags/symax-sr-extended-release-tablets/
/tags/urispas/
/tags/vanatrip/

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Valstar


Generic Name: valrubicin (val ROO bi sin)
Brand Names: Valstar

What is Valstar (valrubicin)?

Valrubicin is a cancer (antineoplastic) medication. Valrubicin interferes with the growth of cancer cells and slows their growth and spread in the body.

Valrubicin is used to treat bladder cancer.

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

What is the most important information I should know about Valstar (valrubicin)?

Valrubicin should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Serious side effects have been reported with the use of valrubicin including: allergic reactions (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives); severe heart damage with prolonged use; decreased bone marrow function and blood problems (extreme fatigue; easy bruising or bleeding; black, bloody or tarry stools; fever or chills; or signs of infection); severe nausea, vomiting, diarrhea, and loss of appetite; and others. Talk to your doctor about the possible side effects from treatment with valrubicin.

Who should not use Valstar (valrubicin)? Do not use valrubicin without first talking to your doctor if you have

a urinary tract infection;

a perforated or otherwise damaged bladder;

kidney disease; or

irritable bladder disorder.

The use of valrubicin may be dangerous if you have any of the conditions listed above.

Valrubicin is in the FDA pregnancy category C. Systemic exposure to valrubicin may result in harm to an unborn baby. Do not use valrubicin without first talking to your doctor if you are pregnant. Men and women being treated with valrubicin should discuss with their doctor the appropriate use of birth control during treatment with valrubicin if necessary. Because of the potential for serious side effects in a nursing infant, breast-feeding should be avoided during treatment with valrubicin. The safety and effectiveness of valrubicin in children has not been established. How should I use Valstar (valrubicin)?

Valrubicin should only be administered under the supervision of a qualified healthcare provider experienced in the use of cancer chemotherapeutic agents.

Your doctor will determine the correct amount and frequency of treatment with valrubicin depending upon the type of cancer being treated and other factors. Valrubicin has caused a complete response in only about 1 in 5 patients and delaying surgery could lead to wide-spread bladder cancer, which is lethal. Talk to your doctor if you have any questions or concerns regarding the treatment schedule.

Your doctor will probably want you to have regularly scheduled blood tests and other medical evaluations during treatment with valrubicin to monitor progress and side effects.

Skin accidentally exposed to valrubicin should be rinsed thoroughly with soap and warm water.

Your healthcare provider will store valrubicin as directed by the manufacturer. If you are storing valrubicin at home, follow the directions provided by your healthcare provider.

What happens if I miss a dose?

Contact your doctor if you miss a dose of valrubicin.

What happens if I overdose? If for any reason an overdose of valrubicin is suspected, seek emergency medical attention or contact your healthcare provider immediately.

Symptoms of a valrubicin overdose tend to be similar to side effects caused by the medication, although often more severe.

What should I avoid while using Valstar (valrubicin)?

Valrubicin can lower the activity of your immune system making you susceptible to infections. Avoid contact with people who have colds, the flu, or other contagious illnesses and do not receive vaccines that contain live strains of a virus (e.g., live oral polio vaccine) during treatment with valrubicin. In addition, avoid contact with individuals who have recently been vaccinated with a live vaccine. There is a chance that the virus can be passed on to you.

Skin accidentally exposed to valrubicin should be rinsed thoroughly with soap and warm water.

Valstar (valrubicin) side effects

If you experience an allergic reaction (including difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives) to valrubicin, seek emergency medical attention.

Other, less serious side effects may be more likely to occur. Continue taking valrubicin and talk to your doctor if you experience:

bladder irritation (increased frequency of urination, painful urination, a very strong feeling of needing to urinate, blood in the urine);

urinary incontinence;

urinary tract infection;

red colored urine for 24 hours following a dose; or

nausea.

Talk to your doctor immediately if you have prolonged (longer than 24 hours after a dose) red-colored urine or prolonged bladder irritation.

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 Valstar (valrubicin)? Do not receive "live" vaccines during treatment with valrubicin. Administration of a live vaccine may be dangerous during treatment with valrubicin.

Other drugs may interact with valrubicin. Talk to your doctor and pharmacist before taking any other prescription or over-the-counter medicines, including herbal products, during treatment with valrubicin.

More Valstar resources Valstar Side Effects (in more detail) Valstar Use in Pregnancy & Breastfeeding Valstar Drug Interactions Valstar Support Group 0 Reviews for Valstar - Add your own review/rating Valstar Prescribing Information (FDA) Valstar Advanced Consumer (Micromedex) - Includes Dosage Information Valstar MedFacts Consumer Leaflet (Wolters Kluwer) Valrubicin Professional Patient Advice (Wolters Kluwer) Compare Valstar with other medications Urinary Tract Tumors Where can I get more information? Your healthcare provider may have additional information about valrubicin that you may read.

See also: Valstar side effects (in more detail)


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Neostigmine Methylsulfate


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

Introduction

Reversible anticholinesterase agent.a b c

Uses for Neostigmine Methylsulfate Myasthenia Gravis

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

Not effective in patients resistant to anticholinesterase drugs.a

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

Surgery

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

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

Postoperative Distention and Urinary Retention

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

Aminoglycoside Toxicity

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

Acceleration of Barium Transit through Small Intestine

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

Neostigmine Methylsulfate Dosage and Administration General Diagnosis of Myasthenia Gravis

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

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

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

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

Treatment of Myasthenia Gravis

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

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

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

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

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

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

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

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

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

Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects

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

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

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

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

Parenteral Administration

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

Administration

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

Oral Administration

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

Parenteral Administration

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

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

Surgery: Give by slow IV injection.a

Dosage

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

Pediatric Patients Myasthenia Gravis Diagnosis IM

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

Treatment Oral

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

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

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

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

IM, IV, or Sub-Q

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

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

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

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

Adults Myasthenia Gravis Diagnosis IM

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

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

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

Treatment Oral

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

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

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

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

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

IV, IM, or Sub-Q

Initially, 0.5–2.5 mg as needed.a

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

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

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

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

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

Postoperative Distention and Urinary Retention Prevention IM or Sub-Q

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

Treatment IM or Sub-Q

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

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

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

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

Special Populations

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

Cautions for Neostigmine Methylsulfate Contraindications

Known hypersensitivity to neostigmine.a b c

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

Peritonitis.a b c

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

Warnings/Precautions Warnings Cholinergic Crisis

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

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

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

Concomitant Diseases

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

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

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

Ileorectal Anastomoses

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

Sensitivity Reactions Bromide Sensitivity

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

Specific Populations Pregnancy

Category C.b c

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

Lactation

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

Pediatric Use

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

Common Adverse Effects

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

Interactions for Neostigmine Methylsulfate Specific Drugs

Drug

Interaction

Comments

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

Possible accentuation of neuromuscular blockadea b c

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

Anesthetics, local and general

Interferes with neuromuscular transmissiona b c

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

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

Antiarrhythmic agents

Interferes with neuromuscular transmissiona b c

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

Anticholinergic drugs

Possible reduced intestinal motilityc

Use caution if co-administered with oral neostigminec

Atropine

Antagonizes muscarinic effects of neostigminea

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

Dexpanthenol

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

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

Possible enhanced and/or prolonged neuromuscular blockadea b c

Do not use for reversal of depolarizing neuromuscular blockadea

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

Antagonism of nondepolarizing muscle relaxant effectsa

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

Neostigmine Methylsulfate Pharmacokinetics Absorption Bioavailability

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

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

Onset

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

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

Duration

2.5–4 hours after IM injection.a b

Distribution Extent

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

Plasma Protein Binding

15–25% to serum albumin.a b c

Elimination Metabolism

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

Elimination Route

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

Half-life

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

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

IM: 51–90 minutes.b

Stability Storage Oral Tablets

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

Parenteral Injection

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

Compatibility

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

Drug Compatibility Y-Site Compatibility (Neostigmine Methylsulfate)HID

Compatible

Heparin sodium

Hydrocortisone sodium succinate

Potassium chloride

Vitamin B complex with C

Compatibility in Syringe (Neostigmine Methylsulfate)HID

Compatible

Glycopyrrolate

Heparin sodium

Ondansetron HCl

Pentobarbital sodium

Thiopental sodium

ActionsActions

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

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

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

Advice to Patients

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

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

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

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

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

Preparations

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

Neostigmine Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder

Oral

Tablets

15 mg

Prostigmin (scored)

Valeant

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

Neostigmine Methylsulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Parenteral

Injection

0.5 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

1 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

Disclaimer

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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


Pronunciation: nee-oh-STIG-meen
Generic Name: Neostigmine
Brand Name: Prostigmin
Prostigmin is used for:

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

Prostigmin is a cholinesterase inhibitor. It works by improving the transmission of nerve impulses in muscles so that the muscles are better able to work.

Do NOT use Prostigmin if: you are allergic to any ingredient in Prostigmin you are taking procainamide, a quinine derivative (eg, quinidine), or succinylcholine

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

Before using Prostigmin:

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

if you are pregnant, planning to become pregnant, or are breast-feeding if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement if you have allergies to medicines, foods, or other substances if you have a heart blockage, a slow heartbeat, a blockage of the intestines, or a urinary tract obstruction or infection

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

General anesthetics (eg, cyclopropane), procainamide, or quinine derivatives (eg, quinidine) because they may decrease the effectiveness of Prostigmin Beta-blockers (eg, propanolol) or succinylcholine because side effects may be increased by Prostigmin

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

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

Prostigmin may be taken with or without food. If stomach upset occurs, take with food to reduce stomach irritation. If you miss a dose of Prostigmin, take it as soon as possible. If it is almost time for the 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 Prostigmin.

Important safety information: Prostigmin may cause drowsiness, dizziness, blurred vision, or fainting. Do not drive, operate machinery, or do anything else that could be dangerous until you know how you react to Prostigmin. Using Prostigmin alone, with certain other medicines, or with alcohol may lessen your ability to drive or perform other potentially dangerous tasks. Before you have any medical or dental treatments, emergency care, or surgery, tell the doctor or dentist that you are using Prostigmin. PREGNANCY and BREAST-FEEDING: If you become pregnant, discuss with your doctor the benefits and risks of using Prostigmin during pregnancy. It is unknown if Prostigmin is excreted in breast milk. If you are or will be breast-feeding while you are using Prostigmin, check with your doctor or pharmacist to discuss the risks to your baby. Possible side effects of Prostigmin:

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:

Abdominal cramps; diarrhea; difficulty speaking; dilation of pupils; dizziness; drowsiness; excess saliva; frequent urination; gas; headache; increased sweating; joint pain; muscle twitching; weakness.

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

Severe allergic reactions (rash; itching; hives; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); fainting; increased muscle weakness; interrupted breathing; irregular heartbeat; seizures; vision changes.

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: Prostigmin 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 blurred vision; cold sweating; difficulty swallowing; panic; severe anxiety; stomach cramps; vomiting.

Proper storage of Prostigmin:

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

General information: If you have any questions about Prostigmin, please talk with your doctor, pharmacist, or other health care provider. Prostigmin 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 Prostigmin. 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 Prostigmin resources Prostigmin Side Effects (in more detail) Prostigmin Use in Pregnancy & Breastfeeding Prostigmin Drug Interactions Prostigmin Support Group 0 Reviews for Prostigmin - Add your own review/rating Neostigmine Professional Patient Advice (Wolters Kluwer) neostigmine Injection Advanced Consumer (Micromedex) - Includes Dosage Information neostigmine Concise Consumer Information (Cerner Multum) Neostigmine Bromide Monograph (AHFS DI) neostigmine Advanced Consumer (Micromedex) - Includes Dosage Information Compare Prostigmin with other medications Myasthenia Gravis
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Neostigmine Bromide


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

Introduction

Reversible anticholinesterase agent.a b c

Uses for Neostigmine Bromide Myasthenia Gravis

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

Not effective in patients resistant to anticholinesterase drugs.a

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

Surgery

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

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

Postoperative Distention and Urinary Retention

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

Aminoglycoside Toxicity

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

Acceleration of Barium Transit through Small Intestine

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

Neostigmine Bromide Dosage and Administration General Diagnosis of Myasthenia Gravis

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

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

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

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

Treatment of Myasthenia Gravis

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

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

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

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

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

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

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

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

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

Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects

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

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

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

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

Parenteral Administration

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

Administration

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

Oral Administration

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

Parenteral Administration

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

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

Surgery: Give by slow IV injection.a

Dosage

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

Pediatric Patients Myasthenia Gravis Diagnosis IM

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

Treatment Oral

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

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

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

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

IM, IV, or Sub-Q

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

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

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

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

Adults Myasthenia Gravis Diagnosis IM

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

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

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

Treatment Oral

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

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

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

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

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

IV, IM, or Sub-Q

Initially, 0.5–2.5 mg as needed.a

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

Surgery Reversal of Nondepolarizing Neuromuscular Blocking Agent Effects IV

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

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

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

Postoperative Distention and Urinary Retention Prevention IM or Sub-Q

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

Treatment IM or Sub-Q

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

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

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

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

Special Populations

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

Cautions for Neostigmine Bromide Contraindications

Known hypersensitivity to neostigmine.a b c

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

Peritonitis.a b c

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

Warnings/Precautions Warnings Cholinergic Crisis

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

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

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

Concomitant Diseases

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

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

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

Ileorectal Anastomoses

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

Sensitivity Reactions Bromide Sensitivity

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

Specific Populations Pregnancy

Category C.b c

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

Lactation

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

Pediatric Use

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

Common Adverse Effects

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

Interactions for Neostigmine Bromide Specific Drugs

Drug

Interaction

Comments

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

Possible accentuation of neuromuscular blockadea b c

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

Anesthetics, local and general

Interferes with neuromuscular transmissiona b c

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

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

Antiarrhythmic agents

Interferes with neuromuscular transmissiona b c

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

Anticholinergic drugs

Possible reduced intestinal motilityc

Use caution if co-administered with oral neostigminec

Atropine

Antagonizes muscarinic effects of neostigminea

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

Dexpanthenol

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

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

Possible enhanced and/or prolonged neuromuscular blockadea b c

Do not use for reversal of depolarizing neuromuscular blockadea

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

Antagonism of nondepolarizing muscle relaxant effectsa

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

Neostigmine Bromide Pharmacokinetics Absorption Bioavailability

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

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

Onset

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

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

Duration

2.5–4 hours after IM injection.a b

Distribution Extent

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

Plasma Protein Binding

15–25% to serum albumin.a b c

Elimination Metabolism

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

Elimination Route

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

Half-life

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

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

IM: 51–90 minutes.b

Stability Storage Oral Tablets

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

Parenteral Injection

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

Compatibility

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

Drug Compatibility Y-Site Compatibility (Neostigmine Methylsulfate)HID

Compatible

Heparin sodium

Hydrocortisone sodium succinate

Potassium chloride

Vitamin B complex with C

Compatibility in Syringe (Neostigmine Methylsulfate)HID

Compatible

Glycopyrrolate

Heparin sodium

Ondansetron HCl

Pentobarbital sodium

Thiopental sodium

ActionsActions

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

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

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

Advice to Patients

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

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

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

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

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

Preparations

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

Neostigmine Bromide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder

Oral

Tablets

15 mg

Prostigmin (scored)

Valeant

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

Neostigmine Methylsulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Bulk

Powder*

Parenteral

Injection

0.5 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

1 mg/mL*

Neostigmine Methylsulfate Injection

Abraxis, American Regent, Baxter, Teva

Disclaimer

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

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

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

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

References

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

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

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

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

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

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

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

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

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

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

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