Denex Dental L Providers, Denex

Welcome to the Providers' section of DenexDental. com. This area offers a number of valuable online resources for Denex Dental Providers.

Developed by dentists, Denex Dental plans are making it easier for patients to take advantage of today's wealth of dental services through the coverage format that's best for them. Participants have the freedom to visit in-network or out-of-network providers-without referrals or pre-authorizations.

As dentists and specialists, you take advantage of an exceptional service team that has simplified claims filing and streamlined reimbursement. Depending on the Denex plan your patients choose, you may not have to submit claims at all. Since you are freed from the hassle of obtaining pre-authorizations before treating your patients, your practice can do what you do best - provide quality dental care.

In short, serving Denex Dental patients is good for both you and your business. If you are interested in becoming a participating provider, please call 1- 800-451-7715 or click here for additional information and application materials.

Talohexal (Citalopram) Report For Patients Like You, Talohexal

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Repligen, Repligen

Inspiring Advances in Bioprocessing

Leader of the pack | Repligen welcomes Atoll

To provide customers with the broadest selection of pre-packed chromatography columns from bench-scale to production-scale, Repligen has acquired Atoll GmBH of Weingarten, Germany. The acquisition combines Repligen's OPUS ® Columns for GMP purification with Atoll's MediaScout ® Columns for process development and screening, solidifying Repligen as a leading supplier in this fast-growing segment. Learn more announcement

Winner - iF Design 2016 Award

Winner - GOOD DESIGN 2015 Award

Notable Mention - CORE77 Design Award

Repligen named a 2015 Technology Fast 500 company by Deloitte; recognized as one of the fastest growing companies in North America

Repligen re-affirms its position as the main strategic supplier of recombinant and native forms of Protein A ligands to GE Healthcare.

Flexure - Definition Of Flexure By The Free Dictionary, Flexure

flexure

The quartz rock must have bee quite pasty when it underwent such remarkable flexure without being shattered into fragments.

Even in the rude circumferential rim or wall of wax round a growing comb, flexures may sometimes be observed, corresponding in position to the planes of the rhombic basal plates of future cells.

The seat flexure design ensures consistent opening and closing torques even if the valve is not operated for extended periods of time.

The DI-1000 achieves exceptional durability and reliability through the use of reasonant flexure elements which eliminate the need for a conventional motor and advanced MID (Mold Interconnect Device) and MCM (Multi-Chip Module) technology.

When introducing FLEXITERM, we broke industry standards by allowing almost three times the amount of board flexure when compared to standard termination systems and further enhanced the capabilities of standard MLCCs.

Compression and flexure tests previously requiring the use of analog measuring transducers can be carried out simply by interchanging the sensor arms, and the system recognizes and adapts to the change of configuration immediately, without requiring any operator intervention, according to the company.

It will result in less axle flexure in the journal area, reducing fretting wear and the potential for components to loosen.

Servohydraulic systems are designed for a wide range of strain rate testing, including tensile, puncture, compression and flexure of materials.

2g Au/t over 9m (COR-169), and (ii) a projected flexure to test for the presence of a widened and enhanced mineralized zone there.

the excellent dynamic performance, coupled with the frictionless flexure suspension, provides exceptional fidelity and precision;

It is said to feature outstanding strength in repeated flexure. abrasion resistance, low residual compression deformation and weathering resistance.

Like most giant greenstone gold deposits including Ahafo, Asumura is located on a flexure of the belt bounding shear zone.

Top Eleven Football Manager Unlimited Token And Cash-2016, Freetop

Top Eleven Football Manager Token and Cash Generator

With unlimited tokens and cash you can develop your own dream team. You can also buy scout player with more stars

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Comprar Barato Online Grifonimod, Grifonimod

Comprar Grifonimod

Aus den unteren und mittleren Anteilen der Grifonimod (nimotop) no prescripcion entsteht der Genitalstrang, aus dem sich spater der Uterus und die oberen zwei Drittel der Vagina bilden. Das untere Drittel der Vagina entsteht aus gastrosef Sinus urogenitalis.

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Donde/Where/Ou

Bendit, planchas de asar.

Mosen Cinto Verdaguer, 3 25100 Almacelles (Lleida) Tel. (34) 973 26 93 96 bendit@bendit. es www. bendit. es

Who Is Dixie L Penn - (859) 234-5353 - Cynthiana - Ky, Resibant

Dixie L Penn

Wednesday: Country dancing with DJ Dixie Lynn, 6:30 to 10 p. m. Shillington Social. 7 to 9 p. m. Good Eatz Green Cafe, 701 Penn Ave. West Reading. Open to all amateurs 14 and older. Duo and solo acts may participate. Two-song or 10-minute.

Ayers/ Michelle Obama’s lack of pride for America /Van Jones /Sean Penn/ Dixie Chicks… AND it’ll get messier. people and who control 70% of the world’s oil supply. l So what should the president do? At least some minor punishment.

No data available

Inibrex, Inibrex

Inibrex

Important Notice: The Drugs. com international database is in BETA release. This means it is still under development and may contain inaccuracies. It is not intended as a substitute for the expertise and judgement of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that the use of any medication in any country is safe, appropriate or effective for you. Consult with your healthcare professional before taking any medication.

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Celecoxib belongs to a group of non-steroidal anti-inflammatory drugs (NSAIDs). This medicine is used to treat osteoarthritis, rheumatoid arthritis, acute pain, painful menstruation and menstrual symptoms. It also helps to reduce numbers of colon and rectum polyps in patients with familial adenomatous polyposis.

Dosage and direction Take Celebrex by mouth with a glass of water, with or without food. Take the drug only as prescribed because dosage and schedule may vary depending on your condition and other factors. Avoid cutting, crushing or chewing this medicine. Do not take the medicine more often than it is prescribed. Do not give up taking it except on the advice of your doctor. It may need time for the medicine to help. Consult your doctor concerning proper dose for you.

Precautions Before taking Celebrex tell your doctor or chemist if you are allergic to it; or if you have other allergies. Inform your doctor or chemist if you have heart, liver or kidney problems. Avoid drinking alcohol and smoking while being treated with this medication. Caution is advised while using Celebrex by pregnant/nursing women or children. Aged people can be more sensitive to side effects of the medicine. During the pregnancy this treatment should be used only when strongly necessary. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Celebrex should not be used by patients having demonstrated a reaction of hypersensitivity to Baclofen.

Possible side effect The most common side effects are skin rash, itching or hives, chest pain, headache, nausea, etc. A very serious allergic reaction rarely occurs. Many people using this medicine do not have serious side effects. Turn to your doctor or pharmacist for more details. In case you notice the effects not listed here, contact your doctor or pharmacist.

Drug interaction Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you used before using this medication. Celebrex can interact with: * medicines for high blood pressure; * other NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen; * aspirin and aspirin-like drugs; * warfarin. Turn to your doctor or pharmacist for more details.

Missed dose If you have missed your dose, take it as soon as you remember. If you see that it is near the time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not take your dose twice.

Overdose If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store your drugs in the bathroom. Keep all drugs away from children and pets.

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information on the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

Celecoxib belongs to a group of non-steroidal anti-inflammatory drugs (NSAIDs). This medicine is used to treat osteoarthritis, rheumatoid arthritis, acute pain, painful menstruation and menstrual symptoms. It also helps to reduce numbers of colon and rectum polyps in patients with familial adenomatous polyposis.

Dosage and direction Take Celebrex by mouth with a glass of water, with or without food. Take the drug only as prescribed because dosage and schedule may vary depending on your condition and other factors. Avoid cutting, crushing or chewing this medicine. Do not take the medicine more often than it is prescribed. Do not give up taking it except on the advice of your doctor. It may need time for the medicine to help. Consult your doctor concerning proper dose for you.

Precautions Before taking Celebrex tell your doctor or chemist if you are allergic to it; or if you have other allergies. Inform your doctor or chemist if you have heart, liver or kidney problems. Avoid drinking alcohol and smoking while being treated with this medication. Caution is advised while using Celebrex by pregnant/nursing women or children. Aged people can be more sensitive to side effects of the medicine. During the pregnancy this treatment should be used only when strongly necessary. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Celebrex should not be used by patients having demonstrated a reaction of hypersensitivity to Baclofen.

Possible side effect The most common side effects are skin rash, itching or hives, chest pain, headache, nausea, etc. A very serious allergic reaction rarely occurs. Many people using this medicine do not have serious side effects. Turn to your doctor or pharmacist for more details. In case you notice the effects not listed here, contact your doctor or pharmacist.

Drug interaction Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you used before using this medication. Celebrex can interact with: * medicines for high blood pressure; * other NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen; * aspirin and aspirin-like drugs; * warfarin. Turn to your doctor or pharmacist for more details.

Missed dose If you have missed your dose, take it as soon as you remember. If you see that it is near the time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not take your dose twice.

Overdose If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store your drugs in the bathroom. Keep all drugs away from children and pets.

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information on the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

Celecoxib belongs to a group of non-steroidal anti-inflammatory drugs (NSAIDs). This medicine is used to treat osteoarthritis, rheumatoid arthritis, acute pain, painful menstruation and menstrual symptoms. It also helps to reduce numbers of colon and rectum polyps in patients with familial adenomatous polyposis.

Dosage and direction Take Celebrex by mouth with a glass of water, with or without food. Take the drug only as prescribed because dosage and schedule may vary depending on your condition and other factors. Avoid cutting, crushing or chewing this medicine. Do not take the medicine more often than it is prescribed. Do not give up taking it except on the advice of your doctor. It may need time for the medicine to help. Consult your doctor concerning proper dose for you.

Precautions Before taking Celebrex tell your doctor or chemist if you are allergic to it; or if you have other allergies. Inform your doctor or chemist if you have heart, liver or kidney problems. Avoid drinking alcohol and smoking while being treated with this medication. Caution is advised while using Celebrex by pregnant/nursing women or children. Aged people can be more sensitive to side effects of the medicine. During the pregnancy this treatment should be used only when strongly necessary. As this medicament can be absorbed by skin, women who are pregnant or may become pregnant should not manipulate this medicine.

Celebrex should not be used by patients having demonstrated a reaction of hypersensitivity to Baclofen.

Possible side effect The most common side effects are skin rash, itching or hives, chest pain, headache, nausea, etc. A very serious allergic reaction rarely occurs. Many people using this medicine do not have serious side effects. Turn to your doctor or pharmacist for more details. In case you notice the effects not listed here, contact your doctor or pharmacist.

Drug interaction Tell your doctor or pharmacist of all prescription and nonprescription/herbal products you used before using this medication. Celebrex can interact with: * medicines for high blood pressure; * other NSAIDs, medicines for pain and inflammation, like ibuprofen or naproxen; * aspirin and aspirin-like drugs; * warfarin. Turn to your doctor or pharmacist for more details.

Missed dose If you have missed your dose, take it as soon as you remember. If you see that it is near the time for the next dose, skip the missed dose and resume your usual dosing schedule. Do not take your dose twice.

Overdose If you think you have used too much of this medicine seek emergency medical attention right away. The symptoms of overdose usually include chest pain, nausea, irregular heartbeat, and feeling light-headed or fainting.

Storage Store your medicines at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store your drugs in the bathroom. Keep all drugs away from children and pets.

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information on the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.

Parisian - Definition Of Parisian By The Free Dictionary, Parasin

Parisian

n. Greek Mythology

The prince of Troy whose abduction of Helen provoked the Trojan War.

Par·is 2

The capital and largest city of France, in the north-central part of the country. Founded as a Gallic fishing village on an island in the Seine River, Paris was captured and fortified by the Romans in 52 bc. Clovis I made it the capital of his kingdom after ad 486, and Hugh Capet established it as the capital of France after 987. Through the succeeding centuries, Paris grew rapidly as a commercial, cultural, and industrial center. The city was occupied by the Germans in World War II from 1940 to 1944.

Pa·ris′ian (pə-rē′zhən, - rĭz′ē-ən) adj. & n.

Parisian

(Placename) of or relating to Paris or its inhabitants

(Placename) a native or inhabitant of Paris

Pa•ri•sian

(pəˈrɪʒ ən, -ˈri ʒən, -ˈrɪz i ən)

1. a native or resident of Paris, France.

2. of or pertaining to Paris, France.

The minute she put her eyes upon Amy, Meg became conscious that her own dress hadn't a Parisian air, that young Mrs.

She said possibly she might, and he negotiated with her for some Parisian studies to reach him in time for the holiday trade in December.

Indeed, I recognised it as being of a Parisian design as yet little known in England; while on the tops of the stockings I laughingly suspected a border designed by a certain eccentric artist, who devotes his strange gifts to decorating with fascinating miniatures the under-world of woman.

It was a novel without a plot and with only one character, being, indeed, simply a psychological study of a certain young Parisian who spent his life trying to realize in the nineteenth century all the passions and modes of thought that belonged to every century except his own, and to sum up, as it were, in himself the various moods through which the world-spirit had ever passed, loving for their mere artificiality those renunciations that men have unwisely called virtue, as much as those natural rebellions that wise men still call sin.

And, besides, there are places where a true Parisian. when he has the rank of the Comte de Chagny, is bound to show himself; and at that time the foyer of the ballet at the Opera was one of those places.

Five men dragged the mare to the fire, and cut her up with the dexterity of a Parisian butcher.

these Parisian saturnalias were the result of them, etc.

Where were the elegant canes of his Parisian epoch?

As for Passepartout, he was a true Parisian of Paris.

Through the closely fastened windows the prisoner could perceive the houses and the pavement, that was all; but, true Parisian as he was, Bonacieux could recognize every street by the milestones, the signs, and the lamps.

Signor Pastrini drew from his fob a magnificent Breguet, bearing the name of its maker, of Parisian manufacture, and a count's coronet.

ignorant of their real enemies, they do not perceive that it is not the Italian who speaks French badly, but those who can say fine things to them in the purest Parisian accent, who are their real foes.

Mupirocin - Fda Prescribing Information, Side Effects And Uses, Mupiderm

Mupirocin

Mupirocin ointment is indicated for the topical treatment of impetigo due to susceptible isolates of Staphylococcus aureus (S. aureus) and Streptococcus pyogenes (S. pyogenes) .

Mupirocin Dosage and Administration

• For Topical Use Only. • Apply a small amount of Mupirocin ointment, with a cotton swab or gauze pad, to the affected area 3 times daily for up to 10 days. • Cover the treated area with gauze dressing if desired. • Re-evaluate patients not showing a clinical response within 3 to 5 days. • Mupirocin ointment is not for intranasal, ophthalmic, or other mucosal use [see Warnings and Precautions (5.2. 5.6 )]. • Do not apply Mupirocin ointment concurrently with any other lotions, creams or ointments [see Clinical Pharmacology (12.3 )].

Dosage Forms and Strengths

Each gram of Mupirocin ointment contains 20 mg Mupirocin USP in a water-miscible ointment base supplied in 22-gram tubes.

Contraindications

Mupirocin ointment is contraindicated in patients with known hypersensitivity to Mupirocin or any of the excipients of Mupirocin ointment.

Warnings and Precautions

Click here to enter Warnings and Precautions

Severe Allergic Reactions

Systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash, have been reported in patients treated with formulations of Mupirocin, including Mupirocin ointment [see Adverse Reactions (6.2 )].

Eye Irritation

Avoid contact with the eyes. In case of accidental contact, rinse well with water.

Local Irritation

In the event of a sensitization or severe local irritation from Mupirocin ointment, usage should be discontinued, and appropriate alternative therapy for the infection instituted.

Clostridium difficile - Associated Diarrhea

Clostridium difficile - associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibacterial drug use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibacterial drug use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C. difficile. and surgical evaluation should be instituted as clinically indicated.

Potential for Microbial Overgrowth

As with other antibacterial products, prolonged use of Mupirocin ointment may result in overgrowth of nonsusceptible microorganisms, including fungi [see Dosage and Administration (2 )].

Risk Associated with Mucosal Use

Mupirocin ointment is not formulated for use on mucosal surfaces. Intranasal use has been associated with isolated reports of stinging and drying. A separate formulation, † Bactroban (Mupirocin calcium) nasal ointment, is available for intranasal use.

Risk of Polyethylene Glycol Absorption

Polyethylene glycol can be absorbed from open wounds and damaged skin and is excreted by the kidneys. In common with other polyethylene glycol-based ointments, Mupirocin ointment should not be used in conditions where absorption of large quantities of polyethylene glycol is possible, especially if there is evidence of moderate or severe renal impairment.

Risk Associated with Use at Intravenous Sites

Mupirocin ointment should not be used with intravenous cannulae or at central intravenous sites because of the potential to promote fungal infections and antimicrobial resistance.

Adverse Reactions

The following adverse reactions are discussed in more detail in other sections of the labeling:

• Severe Allergic Reactions [see Warnings and Precautions (5.1 )] • Eye Irritation [see Warnings and Precautions (5.2 )] • Local Irritation [see Warnings and Precautions (5.3 )] • Clostridium difficile - Associated Diarrhea [see Warnings and Precautions (5.4 )]

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice.

The following local adverse reactions were reported by at least 1% of subjects in connection with the use of Mupirocin ointment in clinical trials: burning, stinging, or pain in 1.5% of subjects; itching in 1% of subjects. Rash, nausea, erythema, dry skin, tenderness, swelling, contact dermatitis, and increased exudate were reported in less than 1% of subjects.

Postmarketing Experience

In addition to adverse reactions reported from clinical trials, the following reactions have been identified during postmarketing use of Mupirocin ointment. Because they are reported voluntarily from a population of unknown size, estimates of frequency cannot be made. These reactions have been chosen for inclusion due to a combination of their seriousness, frequency of reporting, or potential causal relationship to Mupirocin ointment.

Immune System Disorders

Systemic allergic reactions, including anaphylaxis, urticaria, angioedema, and generalized rash [see Warnings and Precautions (5.1 )].

USE IN SPECIFIC POPULATIONS

Click here to enter Use in Specific Populations

Pregnancy

Pregnancy Category B.

There are no adequate and well-controlled studies of Mupirocin ointment in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Developmental toxicity studies have been performed with Mupirocin administered subcutaneously to rats and rabbits at doses up to 160 mg per kg per day in both species. This dose is 22 and 43 times, respectively, the human topical dose (approximately 60 mg Mupirocin per day) based on body surface area. There was no evidence of fetal harm due to Mupirocin.

Nursing Mothers

It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Mupirocin ointment is administered to a nursing woman.

Pediatric Use

The safety and effectiveness of Mupirocin ointment have been established in the age range of 2 months to 16 years. Use of Mupirocin ointment in these age-groups is supported by evidence from adequate and well-controlled trials of Mupirocin ointment in impetigo in pediatric subjects studied as a part of the pivotal clinical trials [see Clinical Studies (14 )].

Mupirocin Description

Mupirocin ointment USP 2% contains the RNA synthetase inhibitor antibacterial, Mupirocin USP. The chemical name is ( E )-(2 S ,3 R ,4 R ,5 S )-5-[(2 S ,3 S ,4 S ,5 S ) - 2,3 - epoxy - 5 - hydroxy - 4 - methylhexyl]tetrahydro - 3,4dihydroxy - β - methyl - 2 H - pyran-2-crotonic acid, ester with 9-hydroxynonanoic acid. The molecular formula of Mupirocin USP is C 26 H 44 O 9. and the molecular weight is 500.6. The chemical structure is:

Each gram of Mupirocin ointment USP 2% contains 20 mg Mupirocin USP in a water-miscible ointment base (polyethylene glycol ointment, N. F.) consisting of polyethylene glycol 400 and polyethylene glycol 3350.

Mupirocin - Clinical Pharmacology

Click here to enter Clinical Pharmacology

Mechanism of Action

Mupirocin is an RNA synthetase inhibitor antibacterial [see Microbiology (12.4 )].

Pharmacokinetics

Application of 14 C-labeled Mupirocin ointment to the lower arm of normal male subjects followed by occlusion for 24 hours showed no measurable systemic absorption (less than 1.1 nanogram Mupirocin per milliliter of whole blood). Measurable radioactivity was present in the stratum corneum of these subjects 72 hours after application.

The effect of the concurrent application of Mupirocin ointment with other drug products has not been studied [see Dosage and Administration (2 )].

In a trial conducted in 7 healthy adult male subjects, the elimination half-life after intravenous administration of Mupirocin was 20 to 40 minutes for Mupirocin and 30 to 80 minutes for monic acid.

Metabolism: Following intravenous or oral administration, Mupirocin is rapidly metabolized. The principal metabolite, monic acid, demonstrates no antibacterial activity.

Excretion: Monic acid is predominantly eliminated by renal excretion.

Renal Impairment: The pharmacokinetics of Mupirocin have not been studied in individuals with renal insufficiency.

Microbiology

Mupirocin is an RNA synthetase inhibitor antibacterial produced by fermentation using the organism Pseudomonas fluorescens.

Mechanism of Action

Mupirocin inhibits bacterial protein synthesis by reversibly and specifically binding to bacterial isoleucyltransfer RNA (tRNA) synthetase.

Mupirocin is bactericidal at concentrations achieved by topical administration. Mupirocin is highly protein bound (greater than 97%) and the effect of wound secretions on the minimum inhibitory concentrations (MICs) of Mupirocin has not been determined.

Mechanism of Resistance

When Mupirocin resistance occurs, it results from the production of a modified isoleucyl-tRNA synthetase, or the acquisition of, by genetic transfer, a plasmid mediating a new isoleucyl-tRNA synthetase. High-level plasmid-mediated resistance (MIC ≥512 mcg/mL) has been reported in increasing numbers of isolates of S. aureus and with higher frequency in coagulase-negative staphylococci. Mupirocin resistance occurs with greater frequency in methicillin-resistant than methicillin-susceptible staphylococci.

Due to its mode of action, Mupirocin does not demonstrate cross resistance with other classes of antimicrobial agents.

Mupirocin has been shown to be active against susceptible isolates of S. aureus and S. pyogenes. both in vitro and in clinical trials [see Indications and Usage (1 )]. The following in vitro data are available, but their clinical significance is unknown. Mupirocin is active against most isolates of Staphylococcus epidermidis.

High-level Mupirocin resistance (≥512 mcg/mL) may be determined using standard disk diffusion or broth microdilution tests. 1,2 Because of the occurrence of Mupirocin resistance in methicillin-resistant S. aureus (MRSA), it is appropriate to test MRSA populations for Mupirocin susceptibility prior to the use of Mupirocin using a standardized method. 3,4,5

Nonclinical Toxicology

Click here to enter Nonclinical Toxicology

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies in animals to evaluate carcinogenic potential of Mupirocin have not been conducted.

Results of the following studies performed with Mupirocin calcium or Mupirocin sodium in vitro and in vivo did not indicate a potential for genotoxicity: rat primary hepatocyte unscheduled DNA synthesis, sediment analysis for DNA strand breaks, Salmonella reversion test (Ames), Escherichia coli mutation assay, metaphase analysis of human lymphocytes, mouse lymphoma assay, and bone marrow micronuclei assay in mice.

Reproduction studies were performed with Mupirocin administered subcutaneously to male and female rats at doses up to 100 mg per kg per day which is 14 times the human topical dose (approximately 60 mg Mupirocin per day) based on body surface area. Neither evidence of impaired fertility nor impaired reproductive performance attributable to Mupirocin was observed.

Clinical Studies

The efficacy of topical Mupirocin ointment in impetigo was tested in 2 trials. In the first, subjects with impetigo were randomized to receive either Mupirocin ointment or vehicle placebo 3 times daily for 8 to 12 days. Clinical efficacy rates at end of therapy in the evaluable populations (adults and pediatric subjects included) were 71% for Mupirocin ointment (n = 49) and 35% for vehicle placebo (n = 51). Pathogen eradication rates in the evaluable populations were 94% for Mupirocin ointment and 62% for vehicle placebo.

In the second trial, subjects with impetigo were randomized to receive either Mupirocin ointment 3 times daily or 30 to 40 mg per kg oral erythromycin ethylsuccinate per day (this was an unblinded trial) for 8 days. There was a follow-up visit 1 week after treatment ended. Clinical efficacy rates at the follow-up visit in the evaluable populations (adults and pediatric subjects included) were 93% for Mupirocin ointment (n = 29) and 78.5% for erythromycin (n = 28). Pathogen eradication rates in the evaluable populations were 100% for both test groups.

There were 91 pediatric subjects aged 2 months to 15 years in the first trial described above. Clinical efficacy rates at end of therapy in the evaluable populations were 78% for Mupirocin ointment (n = 42) and 36% for vehicle placebo (n = 49). In the second trial described above, all subjects were pediatric except 2 adults in the group receiving Mupirocin ointment. The age range of the pediatric subjects was 7 months to 13 years. The clinical efficacy rate for Mupirocin ointment (n = 27) was 96%, and for erythromycin it was unchanged (78.5%).

REFERENCES

1. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Twenty-fifth Informational Supplement. CLSI document M100-S25. Clinical and Laboratory Standards Institute, 950 West Valley Rd. Suite 2500, Wayne, PA 19087, USA, 2015. 2. Patel J, Gorwitz RJ, et al. Mupirocin Resistance. Clinical Infectious Diseases. 2009; 49(6): 935-41. 3. Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically; Approved Standard – Tenth Edition. CLSI document M07-A10. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015. 4. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Diffusion Susceptibility Tests; Approved Standard – Twelfth Edition. CLSI document M02-A12. Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015. 5. Finlay JE, Miller LA, Poupard JA. Interpretive criteria for testing susceptibility of staphylococci to Mupirocin. Antimicrob Agents Chemother 1997;41(5):1137-1139.

How Supplied/Storage and Handling

Mupirocin ointment USP 2% is supplied in 22-gram tubes.

Each gram of Mupirocin ointment USP contains 20 mg Mupirocin USP in a water-miscible ointment base.

NDC 69150-273-02 22-gram tube (1 tube per carton)

Store at 20° to 25°C (68° to 77°F) [see USP Controlled Room Temperature].

Patient Counseling Information

Advise the patient to read the FDA-approved patient labeling (Patient Information ).

Advise the patient to administer Mupirocin ointment as follows:

Use Mupirocin ointment only as directed by the healthcare provider. It is for external use only. Avoid contact of Mupirocin ointment with the eyes. If Mupirocin ointment gets in the eyes, rinse thoroughly with water.

Do not use Mupirocin ointment in the nose.

Wash your hands before and after applying Mupirocin ointment.

Use a gauze pad or cotton swab to apply a small amount of Mupirocin ointment to the affected area. The treated area may be covered by gauze dressing if desired.

Report to the healthcare provider any signs of local adverse reactions. Mupirocin ointment should be stopped and the healthcare provider contacted if irritation, severe itching, or rash occurs.

Report to the healthcare provider or go to the nearest emergency room if severe allergic reactions, such as swelling of the lips, face, or tongue, or wheezing occur [see Warnings and Precautions (5.1 )].

If impetigo has not improved in 3 to 5 days, contact the healthcare provider.

† Bactroban is a registered trademark of the GSK group of companies.

Biomes Pharmaceuticals LLC. Lansing, MI 48906

Questions? 1 (517)507-5222 www. biomesglobal. com

Patient Information

Mupirocin (mue-PIR-oh-sin) Ointment USP

What is Mupirocin ointment?

Mupirocin ointment is a prescription medicine used on the skin (topical use) to treat a skin infection called impetigo that is caused by bacteria called Staphylococcus aureus and Streptococcus pyogenes. It is not known if Mupirocin ointment is safe and effective in children under 2 months of age.

Who should not use Mupirocin ointment?

Do not use Mupirocin ointment if:

• you are allergic to Mupirocin or any of the ingredients in Mupirocin ointment. See the end of this Patient Information leaflet for a complete list of the ingredients in Mupirocin ointment.

What should I tell my healthcare provider before using Mupirocin ointment?

Before using Mupirocin ointment, tell your healthcare provider about all of your medical conditions including if you:

• have kidney problems • are pregnant or plan to become pregnant. It is not known if Mupirocin ointment will harm your unborn baby. • are breastfeeding or plan to breastfeed. It is not known if Mupirocin ointment passes into your breast milk. You and your healthcare provider should decide if you can use Mupirocin ointment while breastfeeding.

Tell your healthcare provider about all of the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Do not mix Mupirocin ointment with other lotions, creams, or ointments.

How should I use Mupirocin ointment?

• Mupirocin ointment is for use on the skin (topical). Do not get Mupirocin ointment in your eyes, nose, mouth, or vagina (mucosal surfaces). • Use Mupirocin ointment exactly as your healthcare provider tells you to use it. • Apply a small amount of Mupirocin ointment, with a cotton swab or gauze pad, to the affected area 3 times each day. • It is important that you take the full course of Mupirocin ointment. Do not stop early because your symptoms may disappear before the infection is fully cleared. • Wash your hands before and after applying Mupirocin ointment. • After applying Mupirocin ointment, you may cover the treated area with a clean gauze pad, unless your healthcare provider has told you to leave it uncovered. • Talk to your healthcare provider if your skin does not improve after 3 to 5 days of treatment with Mupirocin ointment.

What are the possible side effects of Mupirocin ointment?

Mupirocin ointment may cause serious side effects, including:

• severe allergic reactions. Stop using Mupirocin ointment and call your healthcare provider or go to the nearest emergency room right away if you have any of the following signs or symptoms of a severe allergic reaction: o hives o trouble breathing or wheezing o swelling of your face, lips, mouth, or tongue o dizziness, fast heartbeat, or pounding in your chest o a rash over your whole body • eye irritation. Do not get Mupirocin ointment in your eyes. If Mupirocin ointment gets in your eyes, rinse your eyes well with water. • irritation in the area Mupirocin ointment is used. Stop using Mupirocin ointment and call your healthcare provider if you develop an irritation, severe itching, or a rash while using Mupirocin ointment. • a type of diarrhea called clostridium difficile - associated diarrhea (CDAD). CDAD may happen in people who use or have used medicine to treat bacterial infections. The severity of CDAD can range from mild diarrhea to severe diarrhea that may cause death (fatal colitis). Call your healthcare provider or go to the nearest emergency room right away if you have diarrhea while using or after you stop using Mupirocin ointment. • risk of absorption of polyethylene glycol through the skin. Mupirocin ointment contains polyethylene glycol, which in large amounts can cause kidney damage. You should not apply Mupirocin ointment to open skin wounds or damaged skin, especially if you have kidney problems. • increased risk of infection at IV (intravenous) sites. Mupirocin ointment should not be used on skin that is near an IV (intravenous) site

The most common side effects of Mupirocin ointment include:

• burning • stinging or pain • itching

These are not all the possible side effects of Mupirocin ointment. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store Mupirocin ointment?

• Store at 20° to 25°C (68° to 77°F).

Keep Mupirocin ointment and all medicines out of the reach of children.

General information about the safe and effective use of Mupirocin ointment

Medicines are sometimes prescribed for purposes other than those listed in a Patient Information leaflet. Do not use Mupirocin ointment for a condition for which it was not prescribed. Do not give Mupirocin ointment to other people, even if they have the same symptoms that you have. It may harm them. You can ask your pharmacist or healthcare provider for information about Mupirocin ointment that is written for health professionals.

What are the ingredients in Mupirocin ointment?

Active Ingredient: Mupirocin USP

Inactive Ingredients: polyethylene glycol 400 and polyethylene glycol 3350

† Bactroban is a registered trademark of the GSK group of companies.

Biomes Pharmaceuticals LLC. Lansing, MI 48906

Questions? 1 (517)507-5222 www. biomesglobal. com

PACKAGE/LABEL PRINCIPAL DISPLAY PANEL

Sumatriptan (By Mouth) - National Library Of Medicine - Pubmed Health, Sumatript·N

Sumatriptan (By mouth)

Drug classes

Uses

Uses of This Medicine

Sumatriptan is used to treat acute migraine headaches in adults. It is not used to prevent migraine headaches and is not used for cluster headaches. Sumatriptan works in the brain to relieve the pain from migraine headaches. It belongs to the group of medicines called triptans.

Many people find that their headaches go away completely after they take sumatriptan. Other people find that their headaches are much less painful, and that they are able to go back to their normal activities even though their headaches are not completely gone. Sumatriptan often relieves other symptoms that occur together with a migraine headache. such as nausea. vomiting. sensitivity to light, and sensitivity to sound.

Sumatriptan is not an ordinary pain reliever. It will not relieve pain other than from migraine headaches. This medicine is usually used for people whose headaches are not relieved by acetaminophen. aspirin. or other pain relievers.

Sumatriptan has caused serious side effects in some people, especially people who have heart or blood vessel disease. Be sure that you discuss with your doctor the risks of using this medicine as well as the benefits that it can have.

This medicine is available only with your doctor's prescription.

How To Use

Tablet

Your doctor will tell you how much medicine to use. Do not use more than directed.

Swallow the tablet whole with water or other liquids. Do not crush, break, or chew it.

If this medicine does not help your headache at all, do not take more medicine. Call your doctor.

If your headache comes back or you do not get complete relief, wait at least 2 hours before you use another dose. If you feel you need to use the medicine more than 2 times in a day, call your doctor.

Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions.

Use sumatriptan only when you have a migraine. This medicine is not used on a regular schedule.

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

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins. and herbal products.

Do not use this medicine if you have taken another migraine headache medicine in the past 24 hours, such as another triptan or an ergot medicine. These medicines include almotriptan. dihydroergotamine. eletriptan. ergotamine, frovatriptan. methysergide, rizatriptan. or zolmitriptan .

Do not use this medicine if you have taken an MAO inhibitor in the past 14 days.

Tell your doctor if you are using medicine to treat depression .

When Not To Use

This medicine is not right for everyone. Do not use if you had an allergic reaction to sumatriptan. Tell your doctor if you have heart or blood vessel problems, such as a history of heart attack. stroke. or heart rhythm problems.

Warnings

Tell your doctor if you are pregnant, or if you have kidney disease, liver disease, diabetes. high blood pressure. high cholesterol. or a history of seizures. Tell your doctor if you have a family history of heart disease, a history of blood circulation problems (such as peripheral vascular disease), or if you smoke.

Do not breastfeed for at least 12 hours after you take this medicine.

This medicine should be used only for classic or common migraine headaches. It will not work for any other kind of headache or pain.

This medicine may cause the following problems:

Tightness or discomfort in your chest. neck. or jaw

Serotonin syndrome (more likely if used with medicine to treat depression )

Your headaches may become worse if you use this medicine for 10 or more days per month. Keep a journal and write down how often your headaches occur and how often you take this medicine.

This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Call your doctor if your symptoms do not improve or if they get worse.

Keep all medicine out of the reach of children. Never share your medicine with anyone.

Possible side effects

Summary More details

Call your doctor right away if you notice any of these side effects:

Allergic reaction: Itching or hives. swelling in your face or hands. swelling or tingling in your mouth or throat. chest tightness, trouble breathing

Chest pain, especially if it spreads to your arms. jaw, back, or neck. trouble breathing, unusual sweating, faintness

Fast, pounding, or uneven heartbeat, dizziness

Numbness, tingling, cramps. unexplained pain in your hands. arms. legs, or feet, color changes in your fingers or toes

Sudden severe headache (other than the one being treated)

Tightness or discomfort in your chest. neck. or jaw

Vision loss or vision changes that are not part of a usual migraine

If you notice other side effects that you think are caused by this medicine, tell your doctor.

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

Brand names include

There may be other brand names for this medicine.

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

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

Portions Copyright © 2016. Truven Health Analytics, an IBM company. All rights reserved. Use of this content is subject to Truven Health Analytics' full disclaimer, available here.

Artz Name Meaning - Artz Family History At, Artz

Artz Family History

Artz Name Meaning North German and Dutch: patronymic from the personal name A(a)rt, a reduced form of Arnt (see Arndt, Arnold), or sometimes from a reduced form of the personal name Alaert or Adriaan. German and Jewish (Ashkenazic): variant of Arzt ‘physician’.

Source: Dictionary of American Family Names ©2013, Oxford University Press

113,819 Historical Documents with Artz on Ancestry 31,339 Birth, Marriage, and Deaths 14,500 Census and Voter Lists 3,839 Military Records 1,387 Immigration Records 62,754 Member Trees

Ready to discover your family story?

Simply start with yourself and we'll do the searching for you.

Ecoprofen, Ecoprofen

Ecoprofen

Important Notice: The Drugs. com international database is in BETA release. This means it is still under development and may contain inaccuracies. It is not intended as a substitute for the expertise and judgement of your physician, pharmacist or other healthcare professional. It should not be construed to indicate that the use of any medication in any country is safe, appropriate or effective for you. Consult with your healthcare professional before taking any medication.

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Arthritis - Ecoprofen (Brand name: motrin)

Motrin is used for treating rheumatoid arthritis, osteoarthritis, menstrual cramps, or mild to moderate pain. Motrin is an NSAID. NSAIDs treat the symptoms of pain and inflammation. They do not treat the disease that causes those symptoms.

Use Motrin as directed by your doctor.

Take Motrin by mouth with or without food. It may be taken with food if it upsets your stomach. Taking it with food may not lower the risk of stomach or bowel problems (eg, bleeding, ulcers). Talk with your doctor or pharmacist if you have persistent stomach upset.

Take Motrin with a full glass of water (8 oz/240 mL) as directed by your doctor.

If you miss a dose of Motrin and you are taking it regularly, take it as soon as possible. If it is almost time for your next dose, skip the missed dose. 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 the proper use of Motrin .

Store Motrin at room temperature, 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 Motrin out of the reach of children and away from pets.

Active Ingredient: Ibuprofen.

Do NOT use Motrin if:

you are allergic to any ingredient in Motrin

you have had a severe allergic reaction (eg, severe rash, hives, trouble breathing, growths in the nose, dizziness) to aspirin or an NSAID (eg, ibuprofen, celecoxib)

you have recently had or will be having bypass heart surgery

you are in the last 3 months of pregnancy.

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

Some medical conditions may interact with Motrin. 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 product, or dietary supplement

if you have allergies to medicines, foods, or other substances

if you have a history of kidney or liver disease, diabetes, or stomach or bowel problems (eg, bleeding, perforation, ulcers)

if you have a history of swelling or fluid buildup, lupus, asthma, or growths in the nose (nasal polyps), or mouth inflammation

if you have high blood pressure, blood disorders, bleeding or clotting problems, heart problems (eg, heart failure), or blood vessel disease, or if you are at risk for any of these diseases

if you have poor health, dehydration or low fluid volume, or low blood sodium levels, you drink alcohol, or you have a history of alcohol abuse.

Some medicines may interact with Motrin. Tell your health care provider if you are taking any other medicines, especially any of the following:

Anticoagulants (eg, warfarin), aspirin, corticosteroids (eg, prednisone), heparin, or selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) because the risk of stomach bleeding may be increased

Probenecid because it may increase the risk of Motrin 's side effects

Cyclosporine, lithium, methotrexate, or quinolones (eg, ciprofloxacin) because the risk of their side effects may be increased by Motrin

Angiotensin-converting enzyme (ACE) inhibitors (eg, enalapril) or diuretics (eg, furosemide, hydrochlorothiazide) because their effectiveness may be decreased by Motrin.

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

Important safety information:

Motrin may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use Motrin with caution. Do not drive or perform other possible unsafe tasks until you know how you react to it.

Serious stomach ulcers or bleeding can occur with the use of Motrin. Taking it in high doses or for a long time, smoking, or drinking alcohol increases the risk of these side effects. Taking Motrin with food will NOT reduce the risk of these effects. Contact your doctor or emergency room at once if you develop severe stomach or back pain; black, tarry stools; vomit that looks like blood or coffee grounds; or unusual weight gain or swelling.

Do not take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Motrin has ibuprofen in it. Before you start any new medicine, check the label to see if it has ibuprofen in it too. If it does or if you are not sure, check with your doctor or pharmacist.

Do not take aspirin while you are using Motrin unless your doctor tells you to.

Lab tests, including kidney function, complete blood cell counts, and blood pressure, may be done to monitor your progress or to check for side effects. Be sure to keep all doctor and lab appointments.

Use Motrin with caution in the elderly; they may be more sensitive to its effects, including stomach bleeding and kidney problems.

Motrin should be used with extreme caution in children; safety and effectiveness in children have not been confirmed.

Pregnancy and breast-feeding: Motrin may cause harm to the fetus. Do not take it during the last 3 months of pregnancy. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of taking Motrin while you are pregnant. It is not known if Motrin is found in breast milk. Do not breastfeed while taking Motrin .

All medicines can cause side effects, but many people have no, or minor, side effects.

Check with your doctor if any of these most common side effects persist or become bothersome:

Constipation; diarrhea; dizziness; gas; headache; heartburn; nausea; stomach pain or upset.

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

Severe allergic reactions (rash; hives; itching; trouble breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or black, tarry stools; change in the amount of urine produced; chest pain; confusion; dark urine; depression; fainting; fast or irregular heartbeat; fever, chills, or persistent sore throat; mental or mood changes; numbness of an arm or leg; one-sided weakness; red, swollen, blistered, or peeling skin; ringing in the ears; seizures; severe headache or dizziness; severe or persistent stomach pain or nausea; severe vomiting; shortness of breath; stiff neck; sudden or unexplained weight gain; swelling of hands, legs, or feet; unusual bruising or bleeding; unusual joint or muscle pain; unusual tiredness or weakness; vision or speech changes; vomit that looks like coffee grounds; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider.

Parkinson S Disease Symptoms Tremors, Weakness, Trouble Walking, And More, Parkisan

Parkinson's Disease Health Center

What Are the Symptoms of Parkinson's Disease?

Parkinson's disease is a movement disorder that progresses slowly. Some people will first notice a sense of weakness. difficulty walking, and stiff muscles. Others may notice a tremor of the head or hands. Parkinson's is a progressive disorder and the symptoms gradually worsen. The general symptoms of Parkinson's disease include:

Slowness of voluntary movements, especially in the initiation of such movements as walking or rolling over in bed

Decreased facial expression, monotonous speech, and decreased eye blinking

A shuffling gait with poor arm swing and stooped posture

Unsteady balance; difficulty rising from a sitting position

Continuous "pill-rolling" motion of the thumb and forefinger

Abnormal tone or stiffness in the trunk and extremities

Swallowing problems in later stages

Lightheadedness or fainting when standing (orthostatic hypotension )

Recommended Related to Parkinson's

Visit WebMD's Parkinson's Disease Health Center Newly Diagnosed With Parkinson's Disease? Find Help Here Making the Diagnosis: Get Information From the Cleveland Clinic Your Treatment Options: Get Information From the Cleveland Clinic Looking for Clinical Trials? Check This Page Message Board: Neurological Disorders Support Group Suppo.

Call Your Doctor About Parkinson's Disease If:

You suspect Parkinson's disease might be at the root of any of the symptoms listed above. Drugs and other therapies are very effective in the treatment of Parkinson's disease. There are many ways to help a person with Parkinson's disease.

WebMD Medical Reference

Myambutol Oral Uses, Side Effects, Interactions, Pictures, Warnings - Dosing, Miambutol

Myambutol

Uses

Ethambutol is used with other medications to treat tuberculosis (TB). Ethambutol is an antibiotic and works by stopping the growth of bacteria.

This antibiotic treats only bacterial infections. It will not work for viral infections (such as common cold. flu ). Unnecessary use or misuse of any antibiotic can lead to its decreased effectiveness.

OTHER USES: This section contains uses of this drug that are not listed in the approved professional labeling for the drug but that may be prescribed by your health care professional. Use this drug for a condition that is listed in this section only if it has been so prescribed by your health care professional.

This drug may also be used with other medications to help treat a certain serious infection (Mycobacterium avium complex-MAC). It may also be used with other medications to prevent the MAC infection from occurring again in people with advanced HIV disease.

How to use Myambutol

Take this medication by mouth with or without food, usually once daily or as directed by your doctor. This medication may sometimes be taken twice weekly. Take this medication exactly as directed by your doctor.

If you also take antacids that contain aluminum, take this medication at least 4 hours before the antacid.

The dosage is based on your age, weight. medical condition, and response to treatment.

Antibiotics work best when the amount of medicine in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. To help you remember, take it at the same time each day.

Continue to take this medication (and other TB medications) until the full prescribed amount is finished, even if symptoms disappear. Stopping the medication too early or skipping doses may allow the bacteria to continue to grow, which may result in a return of the infection and cause the infection to be more difficult to treat (resistant).

Tell your doctor if your condition persists or worsens.

Side Effects

Headache. loss of appetite, upset stomach. or nausea/vomiting may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: vision changes (such as blurred/decreased vision. color blindness ), symptoms of liver disease (such as persistent nausea/vomiting, unusual tiredness/weakness. severe stomach /abdominal pain. yellowing eyes /skin. dark urine), numbness/tingling of arms/legs, toe/joint pain .

Tell your doctor right away if any of these rare but serious side effects occur: mental/mood disorders (such as confusion, hallucinations ), signs of a new infection (such as fever, persistent sore throat ), easy bleeding/bruising.

A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction. including: rash. itching /swelling (especially of the face/tongue /throat), severe dizziness. trouble breathing .

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www. fda. gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Precautions

Before taking ethambutol, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: eye problems (such as optic neuritis. cataracts. diabetic retinopathy ), liver disease, kidney disease. alcohol use.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Alcohol may increase the risk of liver disease. Avoid alcoholic beverages while using this medication.

During pregnancy. this medication should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast - feeding. If you have HIV disease, do not breast-feed because breast milk can transmit HIV.

Interactions

See also How to Use section.

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring.

To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval.

Keep a list of all the products you use. Share the list with your doctor and pharmacist to reduce your risk for serious medication problems.

Overdose

If overdose is suspected, contact a poison control center or emergency room right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

Notes

Do not share this medication with others.

Laboratory and/or medical tests (such as sputum test, eye/vision exams, kidney/liver function, complete blood count) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

Missed Dose

For the best possible benefit, it is important to take each scheduled dose of this medication as directed. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Storage

Store at room temperature between 68-77 degrees F (20-25 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

Information last revised October 2015. Copyright(c) 2015 First Databank, Inc.

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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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Henri Coanda Lenticular Disc, Getol

Henri Coanda, a Rumanian aeronautical engineer born in 1886, was living in Paris at the turn of the century. By 1910, Coanda had built the world's first designed jet aircraft - the bi-plane "Turbine Aeroplane" which was displayed during an exposition in Paris.

By 1910, Coanda had built the world's first designed jet aircraft - the bi-plane "Turbine Aeroplane" which was displayed during an exposition in Paris.

Coanda, however, missed his critical historic claim to fame while toying with the aircraft's primitive water-cooled 50 hp four-cylinder Clerget motor-driven thermal jet turbine which Coanda called a "Air-Reaction Engine". The motor was connected to a gearbox and then to a compressor which rotated at 4,000 rpm. At the front of the aircraft a huge "Obturator" controlled the amount of air entering the compressor. From the compressor the air then went to the "burning room" combustion chambers located on each side of the fuselage where the engine exhaust was mixed with fuel and ignited, creating very hot expansion of the exhaust which exited through tubes and down the steel-plated sides of the bi-plane producing thrust.

While making slight adjustments while the engine warmed up the thermal jet started the aircraft rolling forward. Not being a pilot, Coanda jumped into the jet aircraft anyway and attempted to fly it. He failed and crashed, being ejected from the aircraft in the process.

Another Turbine Aeroplane was not attempted. However, Coanda noticed that the flames from the engine exhausts went around the protective plates and converged again on the fuselage. This led to Coanda's famous physical phenomenon discovery that when a liquid moves at high speed near a curved surface, it adapts itself to that curvature. This also applies to air, but the flow speed must be much higher for effectiveness. It is a "suction" effect. Thus, the "Coanda Effect" was discovered and Coanda himself quickly experimented with it before filing for three new propulsion patents in 1938.

Patent No. 2,108,652 dated February 15, 1938 concerned airflow acceleration over the periphery of a concave disc.

Coanda Lenticular Disc design, 1944

Despite this remarkable idea, no official interest came of it until the German occupation of Paris in 1940. The SS immediately brought Coanda in and put him to work on designing a large disc to be powered by the latest in German jet engine technology.

Coanda for his part designed a strange lenticular disc with a diameter of 20 meters. It was to utilize twelve Jumo 004B jet engines installed in a radial pattern on its periphery with jet nozzles that forked into three exhaust pipes directed towards the thick external ring. Once lift was achieved, accelerating the engines on one side would cause the other side to go downwards and the craft followed that direction.

While Coanda's design was a masterpiece of jet disc technology, only scale model wind tunnel testing was performed by the end of the war. Such a machine would not be practical due to the large number of jet engines required - vital engines that the Me-262 Schwalbe and Ar 34 Blitz desperately needed.

The large machine would have also consumed large amounts of aviation fuel of which Germany was critically short of by 1944. So, Coanda did further research into smaller-scale aerodynes while the Reich crumbled around him.

Coanda GETOL aircraft prototype?

Postwar, however, Coanda's work was validated by scientists of the Allied research services which declared his propulsion system suitable in 1949. The Cornell Aeronautical Laboratory in the US during 1952 further added to Coanda's credibility when tests performed using his propulsion system came back with positive results.

The AVRO Canada VZ-9V with a control system based on the "Coanda Effect" was built in Malton. Canada in 1958. Although a failure as a GETOL (Ground Effect Take Off and Landing) craft equivalent to a hovering disc Jeep, the "Coanda Effect" worked.

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Sandrena 1, Sandrena

SANDRENA 1.0 MG GEL

Transcript

During the first few months of treatment, breakthrough bleeding, spotting and breast tenderness or enlargement can occur. These are usually temporary and normally disappear after continued treatment. Other side effects Common (affects up to 1 in 10 people): - itching of the skin, rash, pain, increased sweating, swollen feet and lower legs - breasts become tender or painful - increase or decrease in your weight - - headache, dizziness - tummy pains, feeling sick or being sick, flatulence - bleeding or spotting, menstrual disorder - depression, nervousness, lethargy - hot flushes. Uncommon (affects up to 1 in 100 people): - changes to sex drive and mood, anxiety, sleeplessness, apathy, emotional instability, impaired concentration, euphoria, agitation - migraine, delusion, trembling - visual impairment, dry eye - hypertension, superficial phlebitis, purpura - shortness of breath, rhinitis - benign breast or endometrial tumour - increased appetite, high level of cholesterol in the blood - increased heart rate - constipation, digestive disturbance, diarrhoea, rectal disorder - acne, alopecia, dry skin, nail disorder, skin nodule, excessive growth of hair, urticaria (a raised, itchy rash that appears on the skin), painful reddish skin nodules (erythema nodosum) - joint disorders, muscle cramps - increased urinary frequency/urgency, loss of bladder control, urinary tract infection, urine discoloration, haematuria - tender or swollen breast, abnormal growth of the lining of the womb, uterine disorder - tiredness, abnormal laboratory test, weakness, fever, flu syndrome, general feeling of ill health - allergic (hypersensitivity) reaction. Rare (affects up to 1 in 1,000 people): - venous thromboembolism - alterations in liver function and biliary flow - contact lense intolerance - menstrual pain - pre-menstrual like syndrome. Adverse events reported post marketing with frequency not known (cannot be estimated from the available data): - uterine fibroids - hereditary angioedema - cerebral circulatory disorder -. bloating - liver disease causing yellowing of the skin - contact rash, eczema If you have any of these side effects tell your doctor. The doctor may decide to stop your treatment for a while. Dementia HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. The following side effects have been reported with other HRTs: - gall bladder disease - probable dementia over the age of 65 - various skin disorders: - discolouration of the skin especially of the face or neck known as “pregnancy patches” (chloasma) - rash with target-shaped reddening or sores (erythema multiforme) - purpura due to loss of integrity or function of the vessels (vascular purpura)

Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. 5. How to store Sandrena

• KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.

• Do not store above 25°C. • Do not use this medicine after the expiry date shown on the carton or sachet label.

• If your medicine becomes discoloured or shows any other signs of deterioration, consult your pharmacist who will tell you what to do. • Medicines should not be disposed of via waste water or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment. 6. Contents of the pack and other information What Sandrena contains Estradiol is one of the female hormones your body makes. Sandrena sachets contain 1.0 milligrams of estradiol in each sachet. Sandrena gel also contains carbomer 974P, trolamine, propylene glycol, ethanol 96% and purified water. What Sandrena looks like and contents of the pack Sandrena is a smooth, opalescent, alcohol-based gel. The active ingredient in Sandrena is estradiol. This is the new name for oestradiol. The ingredient has not changed. Sandrena is supplied in packs of 28 or 91 sachets Manufacturer and Licence Holder This medicine is manufactured by Orion Corporation, PO BOX 425, FIN-02101, Turku, Finland and is procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE. If you have any questions or are not sure about anything, ask your doctor or pharmacist. They will have additional information about this medicine and will be able to advise you.

PL 15184/1178 - Sandrena 1.0mg Gel

Sandrena is a registered trademark of Orion Corporation. Leaflet revision date: 11/03/14

Blind or partially sighted? Is this leaflet hard to see or read? Phone Lexon (UK) Limited, Tel: 01527 505414 for help.

PATIENT INFORMATION LEAFLET

Sandrena 1.0mg Gel (estradiol) Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. Your medicine is called Sandrena 1.0mg Gel and will be referred to as Sandrena throughout the rest of this leaflet. Please note that the leaflet also contains information about other strengths of the medicine, Sandrena 0.5mg Gel. What is in this leaflet: 1. What Sandrena is and what it is used for 2. What you need to know before you use Sandrena 3. How to use Sandrena 4. Possible side effects 5. How to store Sandrena 6. Contents of the pack and other information 1. What Sandrena is and what it is used for Sandrena is a Hormone Replacement Therapy (HRT). It contains the female hormone oestrogen. Sandrena is used for: Relief of symptoms occurring after menopause During the menopause, the amount of the oestrogen produced by a woman’s body drops. This can cause symptoms such as hot face, neck and chest (“hot flushes”). Sandrena alleviates these symptoms after menopause. You will only be prescribed Sandrena if your symptoms seriously hinder your daily life. You must talk to your doctor if you do not feel better or if you feel worse.

2. What you need to know before you use Sandrena Medical history and regular check-ups The use of HRT carries risks which need to be considered when deciding whether to start taking it, or whether to carry on taking it. The experience in treating women with a premature menopause (due to ovarian failure or surgery) is limited. If you have a premature menopause the risks of using HRT may be different. Please talk to your doctor. Before you start (or restart) HRT, your doctor will ask about your own and your family’s medical history. Your doctor may decide to perform a physical examination. This may include an examination of your breasts and/or an internal examination, if necessary. Once you have started on Sandrena you should see your doctor for regular check-ups (at least once a year). At these check-ups, discuss with your doctor the benefits and risks of continuing with Sandrena. Regularly check your breasts for any changes (see ‘Breast cancer’ below). Go for regular breast screening, as recommended by your doctor. Do not use Sandrena: if any of the following applies to you. If you are not sure about any of the points below, talk to your doctor before using Sandrena. Do not use Sandrena: - if you have or have ever had breast cancer, or if you are suspected of having it - if you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you are suspected of having it

- if you have any unexplained vaginal bleeding - if you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated - if you have or have ever had a blood clot in a vein (thrombosis), such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism) - if you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency) - if you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina - if you have or have ever had a liver disease and your liver function tests have not returned to normal - if you have a rare blood problem called “porphyria” which is passed down in families (inherited) - if you are allergic to estradiol or any of the other ingredients of this medicine Sandrena (listed in section 6). If any of the above conditions appear for the first time while using Sandrena, stop using it at once and consult your doctor immediately. Warnings and precautions Talk to your doctor or pharmacist before using Sandrena. Tell your doctor if you have ever had any of the following problems, before you start the treatment, as these may return or become worse during treatment with Sandrena. If so, you should see your doctor more often for check-ups: - fibroids inside your womb - growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia) - increased risk of developing blood clots (see “Blood clots in a vein (thrombosis)”) - increased risk of getting a oestrogen-sensitive cancer (such as having a mother, sister or grandmother who has had breast cancer) - high blood pressure - a liver disorder, such as a benign liver tumour - diabetes - gallstones - migraine or severe headaches - a disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE) - epilepsy - asthma - a disease affecting the eardrum and hearing (otosclerosis) - a very high level of fat in your blood (triglycerides) - fluid retention due to cardiac or kidney problems - hereditary angioedema. Stop using Sandrena and see a doctor immediately If you notice any of the following when taking HRT: - any of the conditions mentioned in the “Do not use Sandrena” section - yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease - a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness) - migraine-like headaches which happen for the first time - if you become pregnant - if you notice signs of a blood clot, such as: - painful swelling and redness of the legs - sudden chest pain - difficulty in breathing For more information, see ‘Blood clots in a vein (thrombosis)’. Note: Sandrena is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice. HRT and cancer

Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)

Blood clots can be serious, and if one travels to the lungs, it can cause chest pain, breathlessness, fainting or even death.

Taking oestrogen-only HRT will increase the risk of excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the womb lining (endometrial cancer).

You are more likely to get a blood clot in your veins as you get older and if any of the following applies to you. Inform your doctor if any of these situations applies to you: • you are unable to walk for a long time because of major surgery, injury or illness (see also section 3, If you need to have surgery) • you are seriously overweight (BMI > 30 kg/m2) • you have or have had any blood clotting problem that needs long-term treatment with a medicine used to prevent blood clots • if any of your close relatives has ever had a blood clot in the leg, lung or another organ • you have systemic lupus erythematosus (SLE) • you have cancer.

Taking a progestagen in addition to oestrogen for at least 12 days of each 28 day cycle protects you from this extra risk. So your doctor will prescribe a progestagen separately if you still have your womb. If you have had your womb removed (a hysterectomy), discuss with your doctor whether you can safely take this product without a progestagen. In women who still have a womb and who are not taking HRT, on average, 5 in 1,000 will be diagnosed with endometrial cancer between the ages of 50 and 65. For women aged 50 to 65 who still have a womb and who take oestrogen-only HRT, between 10 and 60 women in 1,000 will be diagnosed with endometrial cancer (i. e. between 5 and 55 extra cases), depending on the dose and for how long it is taken. Unexpected bleeding If your doctor has prescribed you progestagen tablets in addition to Sandrena, you will usually have a bleed once a month (so-called withdrawal bleed). But, if you have unexpected bleeding or drops of blood (spotting) besides your monthly bleeding, which: • carries on for more than the first 6 months • starts after you have been taking Sandrena more than 6 months • carries on after you have stopped using Sandrena see your doctor as soon as possible. Breast cancer Evidence suggests that taking combined oestrogen-progestagen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you take HRT. The additional risk becomes clear within a few years. However, it returns to normal within a few years (at most 5) after stopping treatment. For women who have had their womb removed and who are using oestrogen-only HRT for 5 years, little or no increase in breast cancer risk is shown. Compare Women aged 50 to 79 who are not taking HRT, on average, 9 to 17 in 1,000 will be diagnosed with breast cancer over a 5-year period. For women aged 50 to 79 who are taking oestrogenprogestagen HRT over 5 years, there will be 13 to 23 cases in 1,000 users (i. e. an extra 4 to 6 cases). • Regularly check your breasts. See your doctor if you notice any changes such as: - dimpling of the skin - changes in the nipple - any lumps you can see or feel Ovarian cancer Ovarian cancer is rare. A slightly increased risk of ovarian cancer has been reported in women taking HRT for at least 5 to 10 years. Women aged 50 to 69 who are not taking HRT, on average about 2 women in 1,000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be between 2 and 3 cases per 1,000 users (i. e. up to 1 extra case). Effects of HRT on heart and circulation Blood clots in a vein (thrombosis) The risk of blood clots in the veins is about 1.3 to 3 times higher in HRT users than in non-users, especially during the first year of taking it.

For signs of a blood clot, see “Stop using Sandrena and see a doctor immediately”. Compare Looking at women in their 50s who are not taking HRT, on average, over a 5-year period, 4 to 7 in 1,000 would be expected to get a blood clot in a vein. For women in their 50s who have been taking oestrogen-progestagen HRT for over 5 years, there will be 9 to 12 cases in 1,000 users (i. e. an extra 5 cases). For women in their 50s who have had their womb removed and have been taking oestrogen-only HRT for over 5 years, there will be 5 to 8 cases in 1,000 users (i. e. 1 extra case) Heart disease (heart attack) There is no evidence that HRT will prevent a heart attack. Women over the age of 60 years who use oestrogen-progestagen HRT are slightly more likely to develop heart disease than those not taking any HRT. For women who have had their womb removed and are taking oestrogen-only therapy there is no increased risk of developing a heart disease. Stroke The risk of getting a stroke is about 1.5-times higher in HRT users than in non-users. The number of extra cases of stroke due to use of HRT will increase with age. Compare Looking at women in their 50s who are not taking HRT, on average, 8 in 1,000 would be expected to have a stroke over a 5-year period. For women in their 50s who are taking HRT, there will be 11 cases in 1,000 users, over 5 years (i. e. an extra 3 cases).

Laboratory tests If you need a blood test, tell your doctor or the laboratory staff that you are using Sandrena, because this medicine can affect the results of some tests. Pregnancy, breast-feeding and fertility Sandrena is for use in postmenopausal women only. If you become pregnant, stop using Sandrena and contact your doctor. Driving and using machines No studies on the effects of Sandrena on the ability to drive and use machines have been performed. Sandrena contains propylene glycol Sandrena contains propylene glycol, which may cause skin irritation. 3. How to use Sandrena Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. When to start using Sandrena You can start using Sandrena straight away if: - You have never used HRT before - You are changing over from a period-free HRT. Wait for your period to end if: - You are changing over from another type of HRT where you have a period. If you have not had your womb removed, your doctor will normally also prescribe another medicine containing the hormone progestagen. This is normally a tablet taken for 12 to 14 days in each monthly cycle. After each course of progestagen you will usually have a withdrawal bleed, like a period. How much to use Sandrena comes in sachets of 0.5 mg estradiol in 0.5 g of gel, or in sachets of 1 mg estradiol in 1g of gel. Each pack of Sandrena 0.5 mg gel contains only 0.5 g sachets. Each pack of Sandrena 1 mg gel contains only 1 g sachets. Use the amount of Sandrena gel that your doctor has prescribed. Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough. - The recommended dose is between 0.5 mg and 1.5 mg of estradiol a day. - Use the following number of 0.5 g or 1 g sachets depending on the dose, and the pack size prescribed by your doctor: For a 0.5 mg daily dose: Use one 0.5 g sachet.

Other conditions - HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. - Women with a tendency to discoloration of the skin (chloasma) should minimise exposure to the sun or ultraviolet radiation whilst using Sandrena. Other medicines and Sandrena Some medicines may interfere with the effect of Sandrena. This might lead to irregular bleeding. This applies to the following medicines: - Medicines for epilepsy (such as phenobarbital, phenytoin and carbamazepine) - Medicines for tuberculosis (such as rifampicin, rifabutin) - Medicines for HIV infection (such as nevirapine, efavirenz, ritonavir and nelfinavir) - Herbal remedies containing St. John’s wort (Hypericum perforatum). Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines including medicines obtained without a prescription, herbal medicines or other natural products.

For a 1 mg daily dose: There are two options. Use one 1 g sachet or use two 0.5 g sachets. For a 1.5 mg daily dose: There are two options. Use three 0.5 g sachets or use one 0.5 g sachet with one 1 g sachet. If you are also taking progestagen tablets, take them as your doctor has told you. You will normally have a withdrawal bleed after each course of progestagen. How to apply the gel Sandrena should be rubbed gently on dry and clean skin. It should not be swallowed. Where to apply the gel - Do not apply the gel to your breasts, face or on irritated skin. - Apply the gel to your lower body or thighs. - Apply the gel to a different side of your body each day.

Follow these instructions: 1. Apply the gel once a day to the skin on your lower body or thighs. 2. Spread the gel over an area 1–2 times the size of your hand. 3. Allow the gel to dry for a few minutes. 4. Wash your hands after applying the gel. Avoid contact of the gel with your eyes. The gel may irritate your eyes. 5. Do not wash the area where you have applied the gel for at least one hour. If you need to have surgery If you are going to have surgery, tell the surgeon that you are using Sandrena. You may need to stop using Sandrena about 4 to 6 weeks before the operation to reduce the risk of a blood clot (see section 2, Blood clots in a vein). Ask your doctor when you can start using Sandrena again. If you use more Sandrena gel than you should If you use more gel than you should, talk to your doctor or pharmacist. You may feel bloated, anxious or irritable, or your breasts may feel tender. Nausea, vomiting and withdrawal bleeding may also occur in some women. Overdosage is unlikely with transdermal application. Treatment is symptomatic. The gel should be washed. The symptoms disappear when the treatment is stopped or when the dose is reduced. If you swallow Sandrena If you swallow Sandrena there is no need to worry. However, you should talk to your doctor. If you forget to use Sandrena - Apply the missed dose when you remember, unless you are more than 12 hours late. - If you are more than 12 hours late just skip the missed dose. - Missed doses may cause some bleeding between your periods. This is called breakthrough bleeding. If you stop using Sandrena Keep using this medicine as prescribed by your doctor. Keep using Sandrena, even if you seem to be better. If you stop too early or too suddenly your problem may return. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them. Stop using the gel and see your doctor straight away, if you notice any of the following serious side effects: - your blood pressure rises - your skin or the whites of your eyes go yellow (jaundice) - you suddenly have migraine-type headaches (see section 2) - you have signs of a blood clot (see section 2) - you get any of the problems listed in section 2. The following diseases are reported more often in women using HRT compared to women not using HRT: - breast cancer - abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer) - ovarian cancer - blood clots in the veins of the legs or lungs (venous thromboembolism) - heart disease - stroke - probable memory loss if HRT is started over the age of 65. For more information about these side effects, see section 2.

During the first few months of treatment, breakthrough bleeding, spotting and breast tenderness or enlargement can occur. These are usually temporary and normally disappear after continued treatment. Other side effects Common (affects up to 1 in 10 people): - itching of the skin, rash, pain, increased sweating, swollen feet and lower legs - breasts become tender or painful - increase or decrease in your weight - - headache, dizziness - tummy pains, feeling sick or being sick, flatulence - bleeding or spotting, menstrual disorder - depression, nervousness, lethargy - hot flushes. Uncommon (affects up to 1 in 100 people): - changes to sex drive and mood, anxiety, sleeplessness, apathy, emotional instability, impaired concentration, euphoria, agitation - migraine, delusion, trembling - visual impairment, dry eye - hypertension, superficial phlebitis, purpura - shortness of breath, rhinitis - benign breast or endometrial tumour - increased appetite, high level of cholesterol in the blood - increased heart rate - constipation, digestive disturbance, diarrhoea, rectal disorder - acne, alopecia, dry skin, nail disorder, skin nodule, excessive growth of hair, urticaria (a raised, itchy rash that appears on the skin), painful reddish skin nodules (erythema nodosum) - joint disorders, muscle cramps - increased urinary frequency/urgency, loss of bladder control, urinary tract infection, urine discoloration, haematuria - tender or swollen breast, abnormal growth of the lining of the womb, uterine disorder - tiredness, abnormal laboratory test, weakness, fever, flu syndrome, general feeling of ill health - allergic (hypersensitivity) reaction. Rare (affects up to 1 in 1,000 people): - venous thromboembolism - alterations in liver function and biliary flow - contact lense intolerance - menstrual pain - pre-menstrual like syndrome. Adverse events reported post marketing with frequency not known (cannot be estimated from the available data): - uterine fibroids - hereditary angioedema - cerebral circulatory disorder -. bloating - liver disease causing yellowing of the skin - contact rash, eczema If you have any of these side effects tell your doctor. The doctor may decide to stop your treatment for a while. Dementia HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. The following side effects have been reported with other HRTs: - gall bladder disease - probable dementia over the age of 65 - various skin disorders: - discolouration of the skin especially of the face or neck known as “pregnancy patches” (chloasma) - rash with target-shaped reddening or sores (erythema multiforme) - purpura due to loss of integrity or function of the vessels (vascular purpura)

Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. 5. How to store Estradiol

• KEEP OUT OF THE SIGHT AND REACH OF CHILDREN.

• Do not store above 25°C. • Do not use this medicine after the expiry date shown on the carton or sachet label.

• If your medicine becomes discoloured or shows any other signs of deterioration, consult your pharmacist who will tell you what to do. • Medicines should not be disposed of via waste water or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment. 6. Contents of the pack and other information What Estradiol contains Estradiol is one of the female hormones your body makes. Estradiol sachets contain 1.0 milligrams of estradiol in each sachet. Estradiol gel also contains carbomer 974P, trolamine, propylene glycol, ethanol 96% and purified water. What Estradiol looks like and contents of the pack Estradiol is a smooth, opalescent, alcohol-based gel. The active ingredient in Estradiol is estradiol. This is the new name for oestradiol. The ingredient has not changed. Estradiol is supplied in packs of 28 or 91 sachets Manufacturer and Licence Holder This medicine is manufactured by Orion Corporation, PO BOX 425, FIN-02101, Turku, Finland and is procured from within the EU and repackaged by the Product Licence Holder: Lexon (UK) Limited, Unit 18, Oxleasow Road, East Moons Moat, Redditch, Worcestershire, B98 0RE. If you have any questions or are not sure about anything, ask your doctor or pharmacist. They will have additional information about this medicine and will be able to advise you.

PL 15184/1178 - Estradiol 1.0mg Gel

Leaflet revision date: 11/03/14

Blind or partially sighted? Is this leaflet hard to see or read? Phone Lexon (UK) Limited, Tel: 01527 505414 for help.

PATIENT INFORMATION LEAFLET

Estradiol Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. Your medicine is called Estradiol 1.0mg Gel and will be referred to as Estradiol throughout the rest of this leaflet. Please note that the leaflet also contains information about other strengths of the medicine, Estradiol 0.5mg Gel. What is in this leaflet: 1. What Estradiol is and what it is used for 2. What you need to know before you use Estradiol 3. How to use Estradiol 4. Possible side effects 5. How to store Estradiol 6. Contents of the pack and other information 1. What Estradiol is and what it is used for Estradiol is a Hormone Replacement Therapy (HRT). It contains the female hormone oestrogen. Estradiol is used for: Relief of symptoms occurring after menopause During the menopause, the amount of the oestrogen produced by a woman’s body drops. This can cause symptoms such as hot face, neck and chest (“hot flushes”). Estradiol alleviates these symptoms after menopause. You will only be prescribed Estradiol if your symptoms seriously hinder your daily life. You must talk to your doctor if you do not feel better or if you feel worse.

2. What you need to know before you use Estradiol Medical history and regular check-ups The use of HRT carries risks which need to be considered when deciding whether to start taking it, or whether to carry on taking it. The experience in treating women with a premature menopause (due to ovarian failure or surgery) is limited. If you have a premature menopause the risks of using HRT may be different. Please talk to your doctor. Before you start (or restart) HRT, your doctor will ask about your own and your family’s medical history. Your doctor may decide to perform a physical examination. This may include an examination of your breasts and/or an internal examination, if necessary. Once you have started on Estradiol you should see your doctor for regular check-ups (at least once a year). At these check-ups, discuss with your doctor the benefits and risks of continuing with Estradiol. Regularly check your breasts for any changes (see ‘Breast cancer’ below). Go for regular breast screening, as recommended by your doctor. Do not use Estradiol: if any of the following applies to you. If you are not sure about any of the points below, talk to your doctor before using Estradiol. Do not use Estradiol: - if you have or have ever had breast cancer, or if you are suspected of having it - if you have cancer which is sensitive to oestrogens, such as cancer of the womb lining (endometrium), or if you are suspected of having it

- if you have any unexplained vaginal bleeding - if you have excessive thickening of the womb lining (endometrial hyperplasia) that is not being treated - if you have or have ever had a blood clot in a vein (thrombosis), such as in the legs (deep venous thrombosis) or the lungs (pulmonary embolism) - if you have a blood clotting disorder (such as protein C, protein S, or antithrombin deficiency) - if you have or recently have had a disease caused by blood clots in the arteries, such as a heart attack, stroke or angina - if you have or have ever had a liver disease and your liver function tests have not returned to normal - if you have a rare blood problem called “porphyria” which is passed down in families (inherited) - if you are allergic to estradiol or any of the other ingredients of this medicine Estradiol (listed in section 6). If any of the above conditions appear for the first time while using Estradiol, stop using it at once and consult your doctor immediately. Warnings and precautions Talk to your doctor or pharmacist before using Estradiol. Tell your doctor if you have ever had any of the following problems, before you start the treatment, as these may return or become worse during treatment with Estradiol. If so, you should see your doctor more often for check-ups: - fibroids inside your womb - growth of womb lining outside your womb (endometriosis) or a history of excessive growth of the womb lining (endometrial hyperplasia) - increased risk of developing blood clots (see “Blood clots in a vein (thrombosis)”) - increased risk of getting a oestrogen-sensitive cancer (such as having a mother, sister or grandmother who has had breast cancer) - high blood pressure - a liver disorder, such as a benign liver tumour - diabetes - gallstones - migraine or severe headaches - a disease of the immune system that affects many organs of the body (systemic lupus erythematosus, SLE) - epilepsy - asthma - a disease affecting the eardrum and hearing (otosclerosis) - a very high level of fat in your blood (triglycerides) - fluid retention due to cardiac or kidney problems - hereditary angioedema. Stop using Estradiol and see a doctor immediately If you notice any of the following when taking HRT: - any of the conditions mentioned in the “Do not use Estradiol” section - yellowing of your skin or the whites of your eyes (jaundice). These may be signs of a liver disease - a large rise in your blood pressure (symptoms may be headache, tiredness, dizziness) - migraine-like headaches which happen for the first time - if you become pregnant - if you notice signs of a blood clot, such as: - painful swelling and redness of the legs - sudden chest pain - difficulty in breathing For more information, see ‘Blood clots in a vein (thrombosis)’. Note: Estradiol is not a contraceptive. If it is less than 12 months since your last menstrual period or you are under 50 years old, you may still need to use additional contraception to prevent pregnancy. Speak to your doctor for advice. HRT and cancer

Excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the lining of the womb (endometrial cancer)

Blood clots can be serious, and if one travels to the lungs, it can cause chest pain, breathlessness, fainting or even death.

Taking oestrogen-only HRT will increase the risk of excessive thickening of the lining of the womb (endometrial hyperplasia) and cancer of the womb lining (endometrial cancer).

You are more likely to get a blood clot in your veins as you get older and if any of the following applies to you. Inform your doctor if any of these situations applies to you: • you are unable to walk for a long time because of major surgery, injury or illness (see also section 3, If you need to have surgery) • you are seriously overweight (BMI > 30 kg/m2) • you have or have had any blood clotting problem that needs long-term treatment with a medicine used to prevent blood clots • if any of your close relatives has ever had a blood clot in the leg, lung or another organ • you have systemic lupus erythematosus (SLE) • you have cancer.

Taking a progestagen in addition to oestrogen for at least 12 days of each 28 day cycle protects you from this extra risk. So your doctor will prescribe a progestagen separately if you still have your womb. If you have had your womb removed (a hysterectomy), discuss with your doctor whether you can safely take this product without a progestagen. In women who still have a womb and who are not taking HRT, on average, 5 in 1,000 will be diagnosed with endometrial cancer between the ages of 50 and 65. For women aged 50 to 65 who still have a womb and who take oestrogen-only HRT, between 10 and 60 women in 1,000 will be diagnosed with endometrial cancer (i. e. between 5 and 55 extra cases), depending on the dose and for how long it is taken. Unexpected bleeding If your doctor has prescribed you progestagen tablets in addition to Estradiol, you will usually have a bleed once a month (so-called withdrawal bleed). But, if you have unexpected bleeding or drops of blood (spotting) besides your monthly bleeding, which: • carries on for more than the first 6 months • starts after you have been taking Estradiol more than 6 months • carries on after you have stopped using Estradiol see your doctor as soon as possible. Breast cancer Evidence suggests that taking combined oestrogen-progestagen and possibly also oestrogen-only HRT increases the risk of breast cancer. The extra risk depends on how long you take HRT. The additional risk becomes clear within a few years. However, it returns to normal within a few years (at most 5) after stopping treatment. For women who have had their womb removed and who are using oestrogen-only HRT for 5 years, little or no increase in breast cancer risk is shown. Compare Women aged 50 to 79 who are not taking HRT, on average, 9 to 17 in 1,000 will be diagnosed with breast cancer over a 5-year period. For women aged 50 to 79 who are taking oestrogenprogestagen HRT over 5 years, there will be 13 to 23 cases in 1,000 users (i. e. an extra 4 to 6 cases). • Regularly check your breasts. See your doctor if you notice any changes such as: - dimpling of the skin - changes in the nipple - any lumps you can see or feel Ovarian cancer Ovarian cancer is rare. A slightly increased risk of ovarian cancer has been reported in women taking HRT for at least 5 to 10 years. Women aged 50 to 69 who are not taking HRT, on average about 2 women in 1,000 will be diagnosed with ovarian cancer over a 5-year period. For women who have been taking HRT for 5 years, there will be between 2 and 3 cases per 1,000 users (i. e. up to 1 extra case). Effects of HRT on heart and circulation Blood clots in a vein (thrombosis) The risk of blood clots in the veins is about 1.3 to 3 times higher in HRT users than in non-users, especially during the first year of taking it.

For signs of a blood clot, see “Stop using Estradiol and see a doctor immediately”. Compare Looking at women in their 50s who are not taking HRT, on average, over a 5-year period, 4 to 7 in 1,000 would be expected to get a blood clot in a vein. For women in their 50s who have been taking oestrogen-progestagen HRT for over 5 years, there will be 9 to 12 cases in 1,000 users (i. e. an extra 5 cases). For women in their 50s who have had their womb removed and have been taking oestrogen-only HRT for over 5 years, there will be 5 to 8 cases in 1,000 users (i. e. 1 extra case) Heart disease (heart attack) There is no evidence that HRT will prevent a heart attack. Women over the age of 60 years who use oestrogen-progestagen HRT are slightly more likely to develop heart disease than those not taking any HRT. For women who have had their womb removed and are taking oestrogen-only therapy there is no increased risk of developing a heart disease. Stroke The risk of getting a stroke is about 1.5-times higher in HRT users than in non-users. The number of extra cases of stroke due to use of HRT will increase with age. Compare Looking at women in their 50s who are not taking HRT, on average, 8 in 1,000 would be expected to have a stroke over a 5-year period. For women in their 50s who are taking HRT, there will be 11 cases in 1,000 users, over 5 years (i. e. an extra 3 cases).

Laboratory tests If you need a blood test, tell your doctor or the laboratory staff that you are using Estradiol, because this medicine can affect the results of some tests. Pregnancy, breast-feeding and fertility Estradiol is for use in postmenopausal women only. If you become pregnant, stop using Estradiol and contact your doctor. Driving and using machines No studies on the effects of Estradiol on the ability to drive and use machines have been performed. Estradiol contains propylene glycol Estradiol contains propylene glycol, which may cause skin irritation. 3. How to use Estradiol Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure. When to start using Estradiol You can start using Estradiol straight away if: - You have never used HRT before - You are changing over from a period-free HRT. Wait for your period to end if: - You are changing over from another type of HRT where you have a period. If you have not had your womb removed, your doctor will normally also prescribe another medicine containing the hormone progestagen. This is normally a tablet taken for 12 to 14 days in each monthly cycle. After each course of progestagen you will usually have a withdrawal bleed, like a period. How much to use Estradiol comes in sachets of 0.5 mg estradiol in 0.5 g of gel, or in sachets of 1 mg estradiol in 1g of gel. Each pack of Estradiol 0.5 mg gel contains only 0.5 g sachets. Each pack of Estradiol 1 mg gel contains only 1 g sachets. Use the amount of Estradiol gel that your doctor has prescribed. Your doctor will aim to prescribe the lowest dose to treat your symptom for as short as necessary. Speak to your doctor if you think this dose is too strong or not strong enough. - The recommended dose is between 0.5 mg and 1.5 mg of estradiol a day. - Use the following number of 0.5 g or 1 g sachets depending on the dose, and the pack size prescribed by your doctor: For a 0.5 mg daily dose: Use one 0.5 g sachet.

Other conditions - HRT will not prevent memory loss. There is some evidence of a higher risk of memory loss in women who start using HRT after the age of 65. Speak to your doctor for advice. - Women with a tendency to discoloration of the skin (chloasma) should minimise exposure to the sun or ultraviolet radiation whilst using Estradiol. Other medicines and Estradiol Some medicines may interfere with the effect of Estradiol. This might lead to irregular bleeding. This applies to the following medicines: - Medicines for epilepsy (such as phenobarbital, phenytoin and carbamazepine) - Medicines for tuberculosis (such as rifampicin, rifabutin) - Medicines for HIV infection (such as nevirapine, efavirenz, ritonavir and nelfinavir) - Herbal remedies containing St. John’s wort (Hypericum perforatum). Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines including medicines obtained without a prescription, herbal medicines or other natural products.

For a 1 mg daily dose: There are two options. Use one 1 g sachet or use two 0.5 g sachets. For a 1.5 mg daily dose: There are two options. Use three 0.5 g sachets or use one 0.5 g sachet with one 1 g sachet. If you are also taking progestagen tablets, take them as your doctor has told you. You will normally have a withdrawal bleed after each course of progestagen. How to apply the gel Estradiol should be rubbed gently on dry and clean skin. It should not be swallowed. Where to apply the gel - Do not apply the gel to your breasts, face or on irritated skin. - Apply the gel to your lower body or thighs. - Apply the gel to a different side of your body each day.

Follow these instructions: 1. Apply the gel once a day to the skin on your lower body or thighs. 2. Spread the gel over an area 1–2 times the size of your hand. 3. Allow the gel to dry for a few minutes. 4. Wash your hands after applying the gel. Avoid contact of the gel with your eyes. The gel may irritate your eyes. 5. Do not wash the area where you have applied the gel for at least one hour. If you need to have surgery If you are going to have surgery, tell the surgeon that you are using Estradiol. You may need to stop using Estradiol about 4 to 6 weeks before the operation to reduce the risk of a blood clot (see section 2, Blood clots in a vein). Ask your doctor when you can start using Estradiol again. If you use more Estradiol gel than you should If you use more gel than you should, talk to your doctor or pharmacist. You may feel bloated, anxious or irritable, or your breasts may feel tender. Nausea, vomiting and withdrawal bleeding may also occur in some women. Overdosage is unlikely with transdermal application. Treatment is symptomatic. The gel should be washed. The symptoms disappear when the treatment is stopped or when the dose is reduced. If you swallow Estradiol If you swallow Estradiol there is no need to worry. However, you should talk to your doctor. If you forget to use Estradiol - Apply the missed dose when you remember, unless you are more than 12 hours late. - If you are more than 12 hours late just skip the missed dose. - Missed doses may cause some bleeding between your periods. This is called breakthrough bleeding. If you stop using Estradiol Keep using this medicine as prescribed by your doctor. Keep using Estradiol, even if you seem to be better. If you stop too early or too suddenly your problem may return. If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them. Stop using the gel and see your doctor straight away, if you notice any of the following serious side effects: - your blood pressure rises - your skin or the whites of your eyes go yellow (jaundice) - you suddenly have migraine-type headaches (see section 2) - you have signs of a blood clot (see section 2) - you get any of the problems listed in section 2. The following diseases are reported more often in women using HRT compared to women not using HRT: - breast cancer - abnormal growth or cancer of the lining of the womb (endometrial hyperplasia or cancer) - ovarian cancer - blood clots in the veins of the legs or lungs (venous thromboembolism) - heart disease - stroke - probable memory loss if HRT is started over the age of 65. For more information about these side effects, see section 2.

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

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Necrotizing fasciitis . Severe bacterial infection of the fascia, the tissues that line and separate muscles, that causes extensive.

Ivermectin Medlineplus Drug Information, Ivermectine

Ivermectin

Ivermectin is used to treat strongyloidiasis (threadworm; infection with a type of roundworm that enters the body through the skin, moves through the airways and lives in the intestines). Ivermectin is also used to control onchocerciasis (river blindness; infection with a type of roundworm that may cause rash, bumps under the skin, and vision problems including vision loss or blindness). Ivermectin is in a class of medications called anthelmintics. It treats strongyloidosis by killing the worms in the intestines. It treats onchocerciasis by killing the developing worms. Ivermectin does not kill the adult worms that cause onchocerciasis and therefore it will not cure this type of infection.

How should this medicine be used?

Ivermectin comes as a tablet to take by mouth. It is usually taken as a single dose on an empty stomach with water. If you are taking ivermectin to treat onchocerciasis, additional doses 3, 6, or 12 months later may be necessary to control your infection. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ivermectin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you are taking ivermectin to treat strongyloidiasis, you will need to have a stool exam at least three times during the first 3 months after your treatment to see if your infection has cleared. If your infection has not cleared, your doctor will probably prescribe additional doses of ivermectin.

Other uses for this medicine

Ivermectin is also sometimes used to treat certain other roundworm infections, head or pubic lice infestation, and scabies (itchy skin condition caused by infestation with small mites that live under the skin). Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

Before taking ivermectin,

tell your doctor and pharmacist if you are allergic to ivermectin or any other medications.

tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention if you are taking medications for anxiety, mental illness or seizures; muscle relaxants; sedatives; sleeping pills; or tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

tell your doctor if you have or have ever had meningitis, human African trypanosomiasis (African sleeping sickness; an infection that is spread by the bite of the tsetse fly in certain African countries), or conditions that affect your immune system, such as human immunodeficiency virus (HIV).

tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant during your treatment with ivermectin, call your doctor.

ask your doctor about the safe use of alcoholic beverages while you are taking ivermectin.

if you are taking ivermectin for onchocerciasis, you should know that you may experience dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up. if you are taking ivermectin for strongyloidiasis and have had loiasis ( Loa loa infection with a type of worm that causes skin and eye problems) or if you have ever lived in or traveled to areas of West or Central Africa where loiasis is common, you should know that you may have a serious reaction. Call your doctor immediately if you experience blurred vision, head or neck pain, seizures or difficulty walking or standing.

What special dietary instructions should I follow?

Ivermectin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

dizziness

loss of appetite

nausea

vomiting

stomach pain or bloating

diarrhea

constipation

weakness

sleepiness

uncontrollable shaking of a part of the body

chest discomfort

If you are taking ivermectin to treat onchocerciasis, you may also experience the following side effects. Tell your doctor if any of these symptoms are severe or do not go away:

swelling of the eyes, face, arms, hands, feet, ankles, or lower legs

joint pain and swelling

painful and swollen glands of the neck, armpit or groin

rapid heartbeat

eye pain, redness, or tearing

swelling of the eye or eyelids

abnormal sensation in the eyes

Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:

Ivermectin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What should I know about storage and disposal of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

rash

hives

seizure

headache

tingling of hands or feet

weakness

loss of coordination

stomach pain

nausea

vomiting

diarrhea

dizziness

shortness of breath

swelling of the face, arms, hands, feet, ankles, or lower legs

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to ivermectin.

Do not let anyone else take your medication. Your prescription is probably not refillable.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Brand names

Buy Zoximed - Omeprazole - Online Without Prescriptions, Zoximed

Prilosec (Zoximed)

Prilosec is used for treating heartburn or irritation of the esophagus caused by gastroesophageal reflux disease (GERD). It may also be used for short-term treatment of ulcers of the stomach or small intestines. It may also be used with certain antibiotics to treat ulcers of the small intestines and to help prevent them from coming back. It may also be used to treat conditions that cause your body to make too much stomach acid (eg, Zollinger-Ellison syndrome). Prilosec is a proton pump inhibitor (PPI). It works by decreasing the amount of acid produced in the stomach.

Use Prilosec as directed by your doctor.

Take Prilosec by mouth on an empty stomach before eating.

Swallow Prilosec whole. Do not break, crush, chew, or open Prilosec before swallowing.

If you have trouble swallowing the capsule, add 1 tablespoon of applesauce to an empty bowl. Open the capsule and empty the pellets onto the applesauce. Mix the pellets with the applesauce and swallow the mixture at once, followed by a glass of cool water. The applesauce used should not be hot and should be soft enough to be swallowed with out chewing. Do not chew or crush the pellets. Do not store the mixture for further use.

You may take antacids while you are using Prilosec if you are directed to do so by your doctor.

If you also take an imidazole antifungal (eg, ketoconazole), take it at least 2 hours before taking Prilosec.

If you also take sucralfate, take Prilosec at least 30 minutes before taking sucralfate.

Continue to take Prilosec even if you feel well. Do not miss any doses.

If you miss a dose of Prilosec, 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 Prilosec.

Active Ingredient: Omeprazole.

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

Do NOT use Prilosec if:

you are allergic to any ingredient in Prilosec

you are taking an HIV protease inhibitor (eg, atazanavir).

Contact your doctor right away if any of these apply to you.

Some medical conditions may interact with Prilosec. 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 liver problems or stomach or bowel cancer.

Some medicines may interact with Prilosec. Tell your health care provider if you are taking any other medicines, especially any of the following:

Clarithromycin or voriconazole because they may increase the risk of Prilosec's side effects

Anticoagulants (eg, warfarin), benzodiazepines (eg, diazepam), cilostazol, cyclosporine, digoxin, disulfiram, phenytoin, or tacrolimus because the risk of their side effects may be increased by Prilosec

Ampicillins, azole antifungals (eg, ketoconazole), clopidogrel, ginkgo biloba, HIV protease inhibitors (eg, atazanavir), or iron because their effectiveness may be decreased by Prilosec.

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

Important safety information:

Prilosec may cause drowsiness or dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Prilosec with caution. Do not drive or perform other possible unsafe tasks until you know how you react to it.

Contact your doctor if you have any symptoms of a bleeding ulcer, such as black, tarry stools or vomit that looks like coffee grounds, or if you experience throat pain, chest pain, severe stomach pain, or trouble swallowing.

Prilosec may interfere with certain lab tests. Be sure your doctor and lab personnel know you are taking Prilosec.

Prilosec should be used with caution in Asian patients; the risk of side effects may be increased in these patients.

Prilosec should be used with extreme caution in children younger than 2 years old; safety and effectiveness in these children have not been confirmed.

Pregnancy and breast-feeding: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using Prilosec while you are pregnant. Prilosec is found in breast milk. Do not breastfeed while taking Prilosec.

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:

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

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue; unusual hoarseness); chest pain; dark urine; fast or irregular heartbeat; fever, chills, or sore throat; red, swollen, blistered, or peeling skin; swelling of the hands, ankles, or feet; unusual bruising or bleeding; unusual tiredness; vision changes; yellowing of the eyes or skin.

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.

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Anafranil - Fda Prescribing Information, Side Effects And Uses, Enafril

Anafranil

Suicidality and Antidepressant Drugs

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of clomipramine hydrochloride or any other antidepressant in a child, adolescent, or young adult must balance this risk with the clinical need. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction in risk with antidepressants compared to placebo in adults aged 65 and older. Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide. Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. Clomipramine hydrochloride is not approved for use in pediatric patients except for patients with obsessive compulsive disorder (OCD) ( see WARNINGS, Clinical Worsening and Suicide Risk ; PRECAUTIONS, Information for Patients ; and PRECAUTIONS, Pediatric Use ).

Anafranil Description

Anafranil ™ (clomipramine hydrochloride) Capsules USP is an antiobsessional drug that belongs to the class (dibenzazepine) of pharmacologic agents known as tricyclic antidepressants. Anafranil is available as capsules of 25, 50, and 75 mg for oral administration.

Clomipramine hydrochloride USP is 3-chloro-5-[3-(dimethylamino)propyl]-10,11-dihydro - 5H - dibenz[ b, f ] azepine monohydrochloride, and its structural formula is:

Clomipramine hydrochloride USP is a white to off-white crystalline powder. It is freely soluble in water, in methanol, and in methylene chloride, and insoluble in ethyl ether and in hexane.

Inactive Ingredients. D&C Red No. 33 (25 mg capsules only), D&C Yellow No. 10, FD&C Blue No. 1 (50 mg capsules only), FD&C Yellow No. 6, gelatin, magnesium stearate, methylparaben, propylparaben, starch (corn), and titanium dioxide.

Anafranil - Clinical Pharmacology

Pharmacodynamics

Clomipramine (CMI) is presumed to influence obsessive and compulsive behaviors through its effects on serotonergic neuronal transmission. The actual neurochemical mechanism is unknown, but CMI's capacity to inhibit the reuptake of serotonin (5-HT) is thought to be important.

Pharmacokinetics

Absorption/Bioavailability – CMI from Anafranil capsules is as bioavailable as CMI from a solution. The bioavailability of CMI from capsules is not significantly affected by food.

In a dose proportionality study involving multiple CMI doses, steady-state plasma concentrations (C ss ) and area-under-plasma-concentration-time curves (AUC) of CMI and CMI's major active metabolite, desmethylclomipramine (DMI), were not proportional to dose over the ranges evaluated, i. e. between 25 to 100 mg/day and between 25 to 150 mg/day, although C ss and AUC are approximately linearly related to dose between 100 to 150 mg/day. The relationship between dose and CMI/DMI concentrations at higher daily doses has not been systematically assessed, but if there is significant dose dependency at doses above 150 mg/day, there is the potential for dramatically higher C ss and AUC even for patients dosed within the recommended range. This may pose a potential risk to some patients ( see WARNINGS and PRECAUTIONS, Drug Interactions ).

After a single 50 mg oral dose, maximum plasma concentrations of CMI occur within 2 to 6 hours (mean, 4.7 hr) and range from 56 ng/mL to 154 ng/mL (mean, 92 ng/mL). After multiple daily doses of 150 mg of Anafranil, steady-state maximum plasma concentrations range from 94 ng/mL to 339 ng/mL (mean, 218 ng/mL) for CMI and from 134 ng/mL to 532 ng/mL (mean, 274 ng/mL) for DMI. Additional information from a rising dose study of doses up to 250 mg suggests that DMI may exhibit nonlinear pharmacokinetics over the usual dosing range. At a dose of Anafranil 200 mg, subjects who had a single blood sample taken approximately 9 to 22 hours, (median 16 hours), after the dose had plasma concentrations of up to 605 ng/mL for CMI, 781 ng/mL for DMI, and 1386 ng/mL for both.

Distribution – CMI distributes into cerebrospinal fluid (CSF) and brain and into breast milk. DMI also distributes into CSF, with a mean CSF/plasma ratio of 2.6. The protein binding of CMI is approximately 97%, principally to albumin, and is independent of CMI concentration. The interaction between CMI and other highly protein-bound drugs has not been fully evaluated, but may be important ( see PRECAUTIONS, Drug Interactions ).

Metabolism – CMI is extensively biotransformed to DMI and other metabolites and their glucuronide conjugates. DMI is pharmacologically active, but its effects on OCD behaviors are unknown. These metabolites are excreted in urine and feces, following biliary elimination. After a 25 mg radiolabeled dose of CMI in two subjects, 60% and 51%, respectively, of the dose were recovered in the urine and 32% and 24%, respectively, in feces. In the same study, the combined urinary recoveries of CMI and DMI were only about 0.8% to 1.3% of the dose administered. CMI does not induce drug-metabolizing enzymes, as measured by antipyrine half-life.

Elimination – Evidence that the C ss and AUC for CMI and DMI may increase disproportionately with increasing oral doses suggests that the metabolism of CMI and DMI may be capacity limited. This fact must be considered in assessing the estimates of the pharmacokinetic parameters presented below, as these were obtained in individuals exposed to doses of 150 mg. If the pharmacokinetics of CMI and DMI are nonlinear at doses above 150 mg, their elimination half-lives may be considerably lengthened at doses near the upper end of the recommended dosing range (i. e. 200 mg/day to 250 mg/day). Consequently, CMI and DMI may accumulate, and this accumulation may increase the incidence of any dose - or plasma-concentration-dependent adverse reactions, in particular seizures ( see WARNINGS ).

After a 150 mg dose, the half-life of CMI ranges from 19 hours to 37 hours (mean, 32 hr) and that of DMI ranges from 54 hours to 77 hours (mean, 69 hr). Steady-state levels after multiple dosing are typically reached within 7 to 14 days for CMI. Plasma concentrations of the metabolite exceed the parent drug on multiple dosing. After multiple dosing with 150 mg/day, the accumulation factor for CMI is approximately 2.5 and for DMI is 4.6. Importantly, it may take two weeks or longer to achieve this extent of accumulation at constant dosing because of the relatively long elimination half-lives of CMI and DMI ( see DOSAGE AND ADMINISTRATION ). The effects of hepatic and renal impairment on the disposition of Anafranil have not been determined.

Interactions – Co-administration of haloperidol with CMI increases plasma concentrations of CMI. Co-administration of CMI with phenobarbital increases plasma concentrations of phenobarbital ( see PRECAUTIONS, Drug Interactions ). Younger subjects (18 to 40 years of age) tolerated CMI better and had significantly lower steady-state plasma concentrations, compared with subjects over 65 years of age. Children under 15 years of age had significantly lower plasma concentration/dose ratios, compared with adults. Plasma concentrations of CMI were significantly lower in smokers than in nonsmokers.

Indications and Usage for Anafranil

Anafranil ™ (clomipramine hydrochloride) Capsules USP is indicated for the treatment of obsessions and compulsions in patients with Obsessive-Compulsive Disorder (OCD). The obsessions or compulsions must cause marked distress, be time-consuming, or significantly interfere with social or occupational functioning, in order to meet the DSM-III-R (circa 1989) diagnosis of OCD.

Obsessions are recurrent, persistent ideas, thoughts, images, or impulses that are ego-dystonic. Compulsions are repetitive, purposeful, and intentional behaviors performed in response to an obsession or in a stereotyped fashion, and are recognized by the person as excessive or unreasonable.

The effectiveness of Anafranil for the treatment of OCD was demonstrated in multicenter, placebo-controlled, parallel-group studies, including two 10-week studies in adults and one 8-week study in children and adolescents 10 to 17 years of age. Patients in all studies had moderate-to-severe OCD (DSM-III), with mean baseline ratings on the Yale-Brown Obsessive Compulsive Scale (YBOCS) ranging from 26 to 28 and a mean baseline rating of 10 on the NIMH Clinical Global Obsessive Compulsive Scale (NIMH-OC). Patients taking CMI experienced a mean reduction of approximately 10 on the YBOCS, representing an average improvement on this scale of 35% to 42% among adults and 37% among children and adolescents. CMI-treated patients experienced a 3.5 unit decrement on the NIMH-OC. Patients on placebo showed no important clinical response on either scale. The maximum dose was 250 mg/day for most adults and 3 mg/kg/day (up to 200 mg) for all children and adolescents.

The effectiveness of Anafranil for long-term use (i. e. for more than 10 weeks) has not been systematically evaluated in placebo-controlled trials. The physician who elects to use Anafranil for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient ( see DOSAGE AND ADMINISTRATION ).

Contraindications

Anafranil is contraindicated in patients with a history of hypersensitivity to Anafranil or other tricyclic antidepressants.

Monoamine Oxidase Inhibitors (MAOIs)

The use of MAOIs intended to treat psychiatric disorders with Anafranil or within 14 days of stopping treatment with Anafranil is contraindicated because of an increased risk of serotonin syndrome. The use of Anafranil within 14 days of stopping an MAOI intended to treat psychiatric disorders is also contraindicated ( see WARNINGS and DOSAGE AND ADMINISTRATION ).

Starting Anafranil in a patient who is being treated with linezolid or intravenous methylene blue is also contraindicated because of an increased risk of serotonin syndrome ( see WARNINGS and DOSAGE AND ADMINISTRATION ).

Anafranil is contraindicated during the acute recovery period after a myocardial infarction.

Warnings

Clinical Worsening and Suicide Risk

Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18 to 24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.

The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 1 .

Drug-Placebo Difference in Number of Cases of Suicidality per 1000 Patients Treated

No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide.

It is unknown whether the suicidality risk extends to longer-term use, i. e. beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.

All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.

The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.

Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.

Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and nonpsychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to healthcare providers. Such monitoring should include daily observation by families and caregivers. Prescriptions for clomipramine hydrochloride should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.

Screening Patients for Bipolar Disorder – A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression. It should be noted that clomipramine hydrochloride is not approved for use in treating bipolar depression.

The development of a potentially life-threatening serotonin syndrome has been reported with SNRIs and SSRIs, including Anafranil, alone but particularly with concomitant use of other serotonergic drugs (including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, tryptophan, buspirone, and St. John's Wort) and with drugs that impair metabolism of serotonin (in particular, MAOIs, both those intended to treat psychiatric disorders and also others, such as linezolid and intravenous methylene blue).

Serotonin syndrome symptoms may include mental status changes (e. g. agitation, hallucinations, delirium, and coma), autonomic instability (e. g. tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular changes (e. g. tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, and/or gastrointestinal symptoms (e. g. nausea, vomiting, diarrhea). Patients should be monitored for the emergence of serotonin syndrome.

The concomitant use of Anafranil with MAOIs intended to treat psychiatric disorders is contraindicated. Anafranil should also not be started in a patient who is being treated with MAOIs such as linezolid or intravenous methylene blue. All reports with methylene blue that provided information on the route of administration involved intravenous administration in the dose range of 1 mg/kg to 8 mg/kg. No reports involved the administration of methylene blue by other routes (such as oral tablets or local tissue injection) or at lower doses. There may be circumstances when it is necessary to initiate treatment with an MAOI such as linezolid or intravenous methylene blue in a patient taking Anafranil. Anafranil should be discontinued before initiating treatment with the MAOI ( see CONTRAINDICATIONS and DOSAGE AND ADMINISTRATION ).

If concomitant use of Anafranil with other serotonergic drugs, including triptans, tricyclic antidepressants, fentanyl, lithium, tramadol, buspirone, tryptophan, and St. John’s Wort is clinically warranted, patients should be made aware of a potential increased risk for serotonin syndrome, particularly during treatment initiation and dose increases.

Treatment with Anafranil and any concomitant serotonergic agents should be discontinued immediately if the above events occur and supportive symptomatic treatment should be initiated.

The pupillary dilation that occurs following use of many antidepressant drugs including Anafranil may trigger an angle closure attack in a patient with anatomically narrow angles who does not have a patent iridectomy.

Seizures

During premarket evaluation, seizure was identified as the most significant risk of Anafranil use.

The observed cumulative incidence of seizures among patients exposed to Anafranil at doses up to 300 mg/day was 0.64% at 90 days, 1.12% at 180 days, and 1.45% at 365 days. The cumulative rates correct the crude rate of 0.7% (25 of 3519 patients) for the variable duration of exposure in clinical trials.

Although dose appears to be a predictor of seizure, there is a confounding of dose and duration of exposure, making it difficult to assess independently the effect of either factor alone. The ability to predict the occurrence of seizures in subjects exposed to doses of CMI greater than 250 mg is limited, given that the plasma concentration of CMI may be dose-dependent and may vary among subjects given the same dose. Nevertheless, prescribers are advised to limit the daily dose to a maximum of 250 mg in adults and 3 mg/kg (or 200 mg) in children and adolescents ( see DOSAGE AND ADMINISTRATION ).

Caution should be used in administering Anafranil to patients with a history of seizures or other predisposing factors, e. g. brain damage of varying etiology, alcoholism, and concomitant use with other drugs that lower the seizure threshold.

Rare reports of fatalities in association with seizures have been reported by foreign postmarketing surveillance, but not in U. S. clinical trials. In some of these cases, Anafranil had been administered with other epileptogenic agents; in others, the patients involved had possibly predisposing medical conditions. Thus a causal association between Anafranil treatment and these fatalities has not been established.

Physicians should discuss with patients the risk of taking Anafranil while engaging in activities in which sudden loss of consciousness could result in serious injury to the patient or others, e. g. the operation of complex machinery, driving, swimming, climbing.

Precautions

General

Suicide – Since depression is a commonly associated feature of OCD, the risk of suicide must be considered. Prescriptions for Anafranil should be written for the smallest quantity of capsules consistent with good patient management, in order to reduce the risk of overdose.

Cardiovascular Effects – Modest orthostatic decreases in blood pressure and modest tachycardia were each seen in approximately 20% of patients taking Anafranil in clinical trials; but patients were frequently asymptomatic. Among approximately 1400 patients treated with CMI in the premarketing experience who had ECGs, 1.5% developed abnormalities during treatment, compared with 3.1% of patients receiving active control drugs and 0.7% of patients receiving placebo. The most common ECG changes were PVCs, ST-T wave changes, and intraventricular conduction abnormalities. These changes were rarely associated with significant clinical symptoms. Nevertheless, caution is necessary in treating patients with known cardiovascular disease, and gradual dose titration is recommended.

Psychosis, Confusion, and Other Neuropsychiatric Phenomena – Patients treated with Anafranil have been reported to show a variety of neuropsychiatric signs and symptoms including delusions, hallucinations, psychotic episodes, confusion, and paranoia. Because of the uncontrolled nature of many of the studies, it is impossible to provide a precise estimate of the extent of risk imposed by treatment with Anafranil. As with tricyclic antidepressants to which it is closely related, Anafranil may precipitate an acute psychotic episode in patients with unrecognized schizophrenia.

Mania/Hypomania – During premarketing testing of Anafranil in patients with affective disorder, hypomania or mania was precipitated in several patients. Activation of mania or hypomania has also been reported in a small proportion of patients with affective disorder treated with marketed tricyclic antidepressants, which are closely related to Anafranil.

Hepatic Changes – During premarketing testing, Anafranil was occasionally associated with elevations in SGOT and SGPT (pooled incidence of approximately 1% and 3%, respectively) of potential clinical importance (i. e. values greater than 3 times the upper limit of normal). In the vast majority of instances, these enzyme increases were not associated with other clinical findings suggestive of hepatic injury; moreover, none were jaundiced. Rare reports of more severe liver injury, some fatal, have been recorded in foreign postmarketing experience. Caution is indicated in treating patients with known liver disease, and periodic monitoring of hepatic enzyme levels is recommended in such patients.

Hematologic Changes – Although no instances of severe hematologic toxicity were seen in the premarketing experience with Anafranil, there have been postmarketing reports of leukopenia, agranulocytosis, thrombocytopenia, anemia, and pancytopenia in association with Anafranil use. As is the case with tricyclic antidepressants to which Anafranil is closely related, leukocyte and differential blood counts should be obtained in patients who develop fever and sore throat during treatment with Anafranil.

Central Nervous System – More than 30 cases of hyperthermia have been recorded by nondomestic postmarketing surveillance systems. Most cases occurred when Anafranil was used in combination with other drugs. When Anafranil and a neuroleptic were used concomitantly, the cases were sometimes considered to be examples of a neuroleptic malignant syndrome.

Sexual Dysfunction – The rate of sexual dysfunction in male patients with OCD who were treated with Anafranil in the premarketing experience was markedly increased compared with placebo controls (i. e. 42% experienced ejaculatory failure and 20% experienced impotence, compared with 2.0% and 2.6%, respectively, in the placebo group). Approximately 85% of males with sexual dysfunction chose to continue treatment.

Weight Changes – In controlled studies of OCD, weight gain was reported in 18% of patients receiving Anafranil, compared with 1% of patients receiving placebo. In these studies, 28% of patients receiving Anafranil had a weight gain of at least 7% of their initial body weight, compared with 4% of patients receiving placebo. Several patients had weight gains in excess of 25% of their initial body weight. Conversely, 5% of patients receiving Anafranil and 1% receiving placebo had weight losses of at least 7% of their initial body weight.

Electroconvulsive Therapy – As with closely related tricyclic antidepressants, concurrent administration of Anafranil with electroconvulsive therapy may increase the risks; such treatment should be limited to those patients for whom it is essential, since there is limited clinical experience.

Surgery – Prior to elective surgery with general anesthetics, therapy with Anafranil should be discontinued for as long as is clinically feasible, and the anesthetist should be advised.

Use in Concomitant Illness – As with closely related tricyclic antidepressants, Anafranil should be used with caution in the following:

Hyperthyroid patients or patients receiving thyroid medication, because of the possibility of cardiac toxicity;

Patients with increased intraocular pressure, a history of narrow-angle glaucoma, or urinary retention, because of the anticholinergic properties of the drug;

Patients with tumors of the adrenal medulla (e. g. pheochromocytoma, neuroblastoma) in whom the drug may provoke hypertensive crises;

Patients with significantly impaired renal function.

Withdrawal Symptoms – A variety of withdrawal symptoms have been reported in association with abrupt discontinuation of Anafranil, including dizziness, nausea, vomiting, headache, malaise, sleep disturbance, hyperthermia, and irritability. In addition, such patients may experience a worsening of psychiatric status. While the withdrawal effects of Anafranil have not been systematically evaluated in controlled trials, they are well known with closely related tricyclic antidepressants, and it is recommended that the dosage be tapered gradually and the patient monitored carefully during discontinuation ( see DRUG ABUSE AND DEPENDENCE ).

Information for Patients

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with clomipramine hydrochloride and should counsel them in its appropriate use. A patient Medication Guide about “Antidepressant Medicines, Depression and other Serious Mental Illness, and Suicidal Thoughts or Actions” is available for clomipramine hydrochloride. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have. The complete text of the Medication Guide is reprinted at the end of this document.

Patients should be advised of the following issues and asked to alert their prescriber if these occur while taking clomipramine hydrochloride.

Clinical Worsening and Suicide Risk – Patients, their families, and their caregivers should be encouraged to be alert to the emergence of anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, mania, other unusual changes in behavior, worsening of depression, and suicidal ideation, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should be advised to look for the emergence of such symptoms on a day-to-day basis, since changes may be abrupt. Such symptoms should be reported to the patient's prescriber or health professional, especially if they are severe, abrupt in onset, or were not part of the patient's presenting symptoms. Symptoms such as these may be associated with an increased risk for suicidal thinking and behavior and indicate a need for very close monitoring and possibly changes in the medication.

Physicians are advised to discuss the following issues with patients for whom they prescribe Anafranil:

The risk of seizure ( see WARNINGS );

The relatively high incidence of sexual dysfunction among males ( see Sexual Dysfunction );

Since Anafranil may impair the mental and/or physical abilities required for the performance of complex tasks, and since Anafranil is associated with a risk of seizures, patients should be cautioned about the performance of complex and hazardous tasks ( see WARNINGS );

Patients should be cautioned about using alcohol, barbiturates, or other CNS depressants concurrently, since Anafranil may exaggerate their response to these drugs;

Patients should notify their physician if they become pregnant or intend to become pregnant during therapy;

Patients should notify their physician if they are breast-feeding.

Patients should be advised that taking Anafranil can cause mild pupillary dilation, which in susceptible individuals, can lead to an episode of angle-closure glaucoma. Pre-existing glaucoma is almost always open-angle glaucoma because angle-closure glaucoma, when diagnosed, can be treated definitively with iridectomy. Open-angle glaucoma is not a risk factor for angle-closure glaucoma. Patients may wish to be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e. g. iridectomy), if they are susceptible.

Drug Interactions

The risks of using Anafranil in combination with other drugs have not been systematically evaluated. Given the primary CNS effects of Anafranil, caution is advised in using it concomitantly with other CNS-active drugs ( see Information for Patients ). Anafranil should not be used with MAO inhibitors ( see CONTRAINDICATIONS ).

Close supervision and careful adjustment of dosage are required when Anafranil is administered with anticholinergic or sympathomimetic drugs.

Several tricyclic antidepressants have been reported to block the pharmacologic effects of guanethidine, clonidine, or similar agents, and such an effect may be anticipated with CMI because of its structural similarity to other tricyclic antidepressants.

The plasma concentration of CMI has been reported to be increased by the concomitant administration of haloperidol; plasma levels of several closely related tricyclic antidepressants have been reported to be increased by the concomitant administration of methylphenidate or hepatic enzyme inhibitors (e. g. cimetidine, fluoxetine) and decreased by the concomitant administration of hepatic enzyme inducers (e. g. barbiturates, phenytoin), and such an effect may be anticipated with CMI as well. Administration of CMI has been reported to increase the plasma levels of phenobarbital, if given concomitantly ( see CLINICAL PHARMACOLOGY, Interactions ).

Drugs Metabolized by P450 2D6 – The biochemical activity of the drug metabolizing isozyme cytochrome P450 2D6 (debrisoquin hydroxylase) is reduced in a subset of the Caucasian population (about 7% to 10% of Caucasians are so-called “poor metabolizers”); reliable estimates of the prevalence of reduced P450 2D6 isozyme activity among Asian, African and other populations are not yet available. Poor metabolizers have higher than expected plasma concentrations of tricyclic antidepressants (TCAs) when given usual doses. Depending on the fraction of drug metabolized by P450 2D6, the increase in plasma concentration may be small, or quite large (8 fold increase in plasma AUC of the TCA). In addition, certain drugs inhibit the activity of this isozyme and make normal metabolizers resemble poor metabolizers. An individual who is stable on a given dose of TCA may become abruptly toxic when given one of these inhibiting drugs as concomitant therapy. The drugs that inhibit cytochrome P450 2D6 include some that are not metabolized by the enzyme (quinidine; cimetidine) and many that are substrates for P450 2D6 (many other antidepressants, phenothiazines, and the Type 1C antiarrhythmics propafenone and flecainide). While all the selective serotonin reuptake inhibitors (SSRIs), e. g. fluoxetine, sertraline, paroxetine, and fluvoxamine, inhibit P450 2D6, they may vary in the extent of inhibition. Fluvoxamine has also been shown to inhibit P450 1A2, an isoform also involved in TCA metabolism. The extent to which SSRI-TCA interactions may pose clinical problems will depend on the degree of inhibition and the pharmacokinetics of the SSRI involved. Nevertheless, caution is indicated in the co-administration of TCAs with any of the SSRIs and also in switching from one class to the other. Of particular importance, sufficient time must elapse before initiating TCA treatment in a patient being withdrawn from fluoxetine, given the long half-life of the parent and active metabolite (at least 5 weeks may be necessary). Concomitant use of agents in the tricyclic antidepressant class (which includes Anafranil) with drugs that can inhibit cytochrome P450 2D6 may require lower doses than usually prescribed for either the tricyclic antidepressant agent or the other drug. Furthermore, whenever one of these drugs is withdrawn from co-therapy, an increased dose of tricyclic antidepressant agent may be required. It is desirable to monitor TCA plasma levels whenever an agent of the tricyclic antidepressant class including Anafranil is going to be co-administered with another drug known to be an inhibitor of P450 2D6 (and/or P450 1A2).

Because Anafranil is highly bound to serum protein, the administration of Anafranil to patients taking other drugs that are highly bound to protein (e. g. warfarin, digoxin) may cause an increase in plasma concentrations of these drugs, potentially resulting in adverse effects. Conversely, adverse effects may result from displacement of protein-bound Anafranil by other highly bound drugs ( see CLINICAL PHARMACOLOGY, Distribution ).

Monoamine Oxidase Inhibitors (MAOIs)

Serotonergic Drugs

Carcinogenesis, Mutagenesis, Impairment of Fertility

No evidence of carcinogenicity was found in two 2-year bioassays in rats at doses up to 100 mg/kg, which is 24 and 4 times the maximum recommended human daily dose (MRHD) on a mg/kg and mg/m 2 basis, respectively, or in a 2-year bioassay in mice at doses up to 80 mg/kg, which is 20 and 1.5 times the MRHD on a mg/kg and mg/m 2 basis, respectively.

In reproduction studies, no effects on fertility were found in rats given up to 24 mg/kg, which is 6 times, and approximately equal to, the MRHD on a mg/kg and mg/m 2 basis, respectively.

Pregnancy Category C

No teratogenic effects were observed in studies performed in rats and mice at doses up to 100 mg/kg, which is 24 times the maximum recommended human daily dose (MRHD) on a mg/kg basis and 4 times (rats) and 2 times (mice) the MRHD on a mg/m 2 basis. Slight nonspecific embryo/fetotoxic effects were seen in the offspring of treated rats given 50 and 100 mg/kg and of treated mice given 100 mg/kg.

There are no adequate or well-controlled studies in pregnant women. Withdrawal symptoms, including jitteriness, tremor, and seizures, have been reported in neonates whose mothers had taken Anafranil until delivery. Anafranil should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

Nursing Mothers

Anafranil has been found in human milk. Because of the potential for adverse reactions, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother.

Pediatric Use

Safety and effectiveness in the pediatric population other than pediatric patients with OCD have not been established ( see BOX WARNING and WARNINGS, Clinical Worsening and Suicide Risk ). Anyone considering the use of Anafranil in a child or adolescent must balance the potential risks with the clinical need.

In a controlled clinical trial in children and adolescents (10 to 17 years of age), 46 outpatients received Anafranil for up to 8 weeks. In addition, 150 adolescent patients have received Anafranil in open-label protocols for periods of several months to several years. Of the 196 adolescents studied, 50 were 13 years of age or less and 146 were 14 to 17 years of age. The adverse reaction profile in this age group ( see ADVERSE REACTIONS ) is similar to that observed in adults.

The risks, if any, that may be associated with Anafranil's extended use in children and adolescents with OCD have not been systematically assessed. The evidence supporting the conclusion that Anafranil is safe for use in children and adolescents is derived from relatively short term clinical studies and from extrapolation of experience gained with adult patients. In particular, there are no studies that directly evaluate the effects of long term Anafranil use on the growth, development, and maturation of children and adolescents. Although there is no evidence to suggest that Anafranil adversely affects growth, development or maturation, the absence of such findings is not adequate to rule out a potential for such effects in chronic use.

The safety and effectiveness in pediatric patients below the age of 10 have not been established. Therefore, specific recommendations cannot be made for the use of Anafranil in pediatric patients under the age of 10.

Geriatric Use

Clinical studies of Anafranil did not include sufficient numbers of subjects age 65 and over to determine whether they respond differently from younger subjects; 152 patients at least 60 years of age participating in various U. S. clinical trials received Anafranil for periods of several months to several years. No unusual age-related adverse events were identified in this population. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function and of concomitant disease or other drug therapy.

Adverse Reactions

Commonly Observed

The most commonly observed adverse events associated with the use of Anafranil and not seen at an equivalent incidence among placebo-treated patients were gastrointestinal complaints, including dry mouth, constipation, nausea, dyspepsia, and anorexia; nervous system complaints, including somnolence, tremor, dizziness, nervousness, and myoclonus; genitourinary complaints, including changed libido, ejaculatory failure, impotence, and micturition disorder; and other miscellaneous complaints, including fatigue, sweating, increased appetite, weight gain, and visual changes.

Leading to Discontinuation of Treatment

Approximately 20% of 3616 patients who received Anafranil in U. S. premarketing clinical trials discontinued treatment because of an adverse event. Approximately one-half of the patients who discontinued (9% of the total) had multiple complaints, none of which could be classified as primary. Where a primary reason for discontinuation could be identified, most patients discontinued because of nervous system complaints (5.4%), primarily somnolence. The second-most-frequent reason for discontinuation was digestive system complaints (1.3%), primarily vomiting and nausea.

There was no apparent relationship between the adverse events and elevated plasma drug concentrations.

Incidence in Controlled Clinical Trials

The following table enumerates adverse events that occurred at an incidence of 1% or greater among patients with OCD who received Anafranil in adult or pediatric placebo-controlled clinical trials. The frequencies were obtained from pooled data of clinical trials involving either adults receiving Anafranil (N=322) or placebo (N=319) or children treated with Anafranil (N=46) or placebo (N=44). The prescriber should be aware that these figures cannot be used to predict the incidence of side effects in the course of usual medical practice, in which patient characteristics and other factors differ from those that prevailed in the clinical trials. Similarly, the cited frequencies cannot be compared with figures obtained from other clinical investigations involving different treatments, uses, and investigators. The cited figures, however, provide the physician with a basis for estimating the relative contribution of drug and nondrug factors to the incidence of side effects in the populations studied.

Incidence of Treatment-Emergent Adverse Experience in Placebo-Controlled Clinical Trials (Percentage of Patients Reporting Event)

*Events reported by at least 1% of Anafranil patients are included.

Other Events Observed During the Premarketing Evaluation of Anafranil

During clinical testing in the U. S. multiple doses of Anafranil were administered to approximately 3600 subjects. Untoward events associated with this exposure were recorded by clinical investigators using terminology of their own choosing. Consequently, it is not possible to provide a meaningful estimate of the proportion of individuals experiencing adverse events without first grouping similar types of untoward events into a smaller number of standardized event categories.

In the tabulations that follow, a modified World Health Organization dictionary of terminology has been used to classify reported adverse events. The frequencies presented, therefore, represent the proportion of the 3525 individuals exposed to Anafranil who experienced an event of the type cited on at least one occasion while receiving Anafranil. All events are included except those already listed in the previous table, those reported in terms so general as to be uninformative, and those in which an association with the drug was remote. It is important to emphasize that although the events reported occurred during treatment with Anafranil, they were not necessarily caused by it.

Events are further categorized by body system and listed in order of decreasing frequency according to the following definitions: frequent adverse events are those occurring on one or more occasions in at least 1/100 patients; infrequent adverse events are those occurring in 1/100 to 1/1000 patients; rare events are those occurring in less than 1/1000 patients.

Body as a Whole – Infrequent - general edema, increased susceptibility to infection, malaise. Rare - dependent edema, withdrawal syndrome.

Cardiovascular System – Infrequent - abnormal ECG, arrhythmia, bradycardia, cardiac arrest, extrasystoles, pallor. Rare - aneurysm, atrial flutter, bundle branch block, cardiac failure, cerebral hemorrhage, heart block, myocardial infarction, myocardial ischemia, peripheral ischemia, thrombophlebitis, vasospasm, ventricular tachycardia.

Digestive System – Infrequent - abnormal hepatic function, blood in stool, colitis, duodenitis, gastric ulcer, gastritis, gastroesophageal reflux, gingivitis, glossitis, hemorrhoids, hepatitis, increased saliva, irritable bowel syndrome, peptic ulcer, rectal hemorrhage, tongue ulceration, tooth caries. Rare - cheilitis, chronic enteritis, discolored feces, gastric dilatation, gingival bleeding, hiccup, intestinal obstruction, oral/pharyngeal edema, paralytic ileus, salivary gland enlargement.

Endocrine System – Infrequent - hypothyroidism. Rare - goiter, gynecomastia, hyperthyroidism.

Hemic and Lymphatic System – Infrequent - lymphadenopathy. Rare - leukemoid reaction, lymphoma-like disorder, marrow depression.

Metabolic and Nutritional Disorder – Infrequent - dehydration, diabetes mellitus, gout, hypercholesterolemia, hyperglycemia, hyperuricemia, hypokalemia. Rare - fat intolerance, glycosuria.

Musculoskeletal System – Infrequent - arthrosis. Rare - dystonia, exostosis, lupus erythematosus rash, bruising, myopathy, myositis, polyarteritis nodosa, torticollis.

Nervous System – Frequent - abnormal thinking, vertigo. Infrequent - abnormal coordination, abnormal EEG, abnormal gait, apathy, ataxia, coma, convulsions, delirium, delusion, dyskinesia, dysphonia, encephalopathy, euphoria, extrapyramidal disorder, hallucinations, hostility, hyperkinesia, hypnagogic hallucinations, hypokinesia, leg cramps, manic reaction, neuralgia, paranoia, phobic disorder, psychosis, sensory disturbance, somnambulism, stimulation, suicidal ideation, suicide attempt, teeth-grinding. Rare - anticholinergic syndrome, aphasia, apraxia, catalepsy, cholinergic syndrome, choreoathetosis, generalized spasm, hemiparesis, hyperesthesia, hyperreflexia, hypoesthesia, illusion, impaired impulse control, indecisiveness, mutism, neuropathy, nystagmus, oculogyric crisis, oculomotor nerve paralysis, schizophrenic reaction, stupor, suicide.

Respiratory System – Infrequent - bronchitis, hyperventilation, increased sputum, pneumonia. Rare - cyanosis, hemoptysis, hypoventilation, laryngismus.

Skin and Appendages – Infrequent - alopecia, cellulitis, cyst, eczema, erythematous rash, genital pruritus, maculopapular rash, photosensitivity reaction, psoriasis, pustular rash, skin discoloration. Rare - chloasma, folliculitis, hypertrichosis, piloerection, seborrhea, skin hypertrophy, skin ulceration.

Special Senses – Infrequent - abnormal accommodation, deafness, diplopia, earache, eye pain, foreign body sensation, hyperacusis, parosmia, photophobia, scleritis, taste loss. Rare - blepharitis, chromatopsia, conjunctival hemorrhage, exophthalmos, glaucoma, keratitis, labyrinth disorder, night blindness, retinal disorder, strabismus, visual field defect.

Urogenital System – Infrequent - endometriosis, epididymitis, hematuria, nocturia, oliguria, ovarian cyst, perineal pain, polyuria, prostatic disorder, renal calculus, renal pain, urethral disorder, urinary incontinence, uterine hemorrhage, vaginal hemorrhage. Rare - albuminuria, anorgasmy, breast engorgement, breast fibroadenosis, cervical dysplasia, endometrial hyperplasia, premature ejaculation, pyelonephritis, pyuria, renal cyst, uterine inflammation, vulvar disorder.

Postmarketing Experience

The following adverse drug reaction has been reported during post-approval use of Anafranil. Because this reaction is reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate frequency.

Eye Disorders – angle-closure glaucoma.

Drug Abuse and Dependence

Anafranil has not been systematically studied in animals or humans for its potential for abuse, tolerance, or physical dependence. While a variety of withdrawal symptoms have been described in association with Anafranil discontinuation ( see PRECAUTIONS, Withdrawal Symptoms ), there is no evidence for drug-seeking behavior, except for a single report of potential Anafranil abuse by a patient with a history of dependence on codeine, benzodiazepines, and multiple psychoactive drugs. The patient received Anafranil for depression and panic attacks and appeared to become dependent after hospital discharge.

Despite the lack of evidence suggesting an abuse liability for Anafranil in foreign marketing, it is not possible to predict the extent to which Anafranil might be misused or abused once marketed in the U. S. Consequently, physicians should carefully evaluate patients for a history of drug abuse and follow such patients closely.

Overdosage

Deaths may occur from overdosage with this class of drugs. Multiple drug ingestion (including alcohol) is common in deliberate tricyclic overdose. As the management is complex and changing, it is recommended that the physician contact a poison control center for current information on treatment. Signs and symptoms of toxicity develop rapidly after tricyclic overdose. Therefore, hospital monitoring is required as soon as possible.

Human Experience

In U. S. clinical trials, 2 deaths occurred in 12 reported cases of acute overdosage with Anafranil either alone or in combination with other drugs. One death involved a patient suspected of ingesting a dose of 7000 mg. The second death involved a patient suspected of ingesting a dose of 5750 mg. The 10 nonfatal cases involved doses of up to 5000 mg, accompanied by plasma levels of up to 1010 ng/mL. All 10 patients completely recovered. Among reports from other countries of Anafranil overdose, the lowest dose associated with a fatality was 750 mg. Based upon postmarketing reports in the United Kingdom, CMI's lethality in overdose is considered to be similar to that reported for closely related tricyclic compounds marketed as antidepressants.

Manifestations

Signs and symptoms vary in severity depending upon factors such as the amount of drug absorbed, the age of the patient, and the time elapsed since drug ingestion. Critical manifestations of overdose include cardiac dysrhythmias, severe hypotension, convulsions, and CNS depression including coma. Changes in the electrocardiogram, particularly in QRS axis or width, are clinically significant indicators of tricyclic toxicity. Other CNS manifestations may include drowsiness, stupor, ataxia, restlessness, agitation, delirium, severe perspiration, hyperactive reflexes, muscle rigidity, and athetoid and choreiform movements. Cardiac abnormalities may include tachycardia, signs of congestive heart failure, and in very rare cases, cardiac arrest. Respiratory depression, cyanosis, shock, vomiting, hyperpyrexia, mydriasis, and oliguria or anuria may also be present.

Management

Obtain an ECG and immediately initiate cardiac monitoring. Protect the patient's airway, establish an intravenous line, and initiate gastric decontamination. A minimum of 6 hours of observation with cardiac monitoring and observation for signs of CNS or respiratory depression, hypotension, cardiac dysrhythmias and/or conduction blocks, and seizures is necessary.

If signs of toxicity occur at any time during this period, extended monitoring is required. There are case reports of patients succumbing to fatal dysrhythmias late after overdose; these patients had clinical evidence of significant poisoning prior to death and most received inadequate gastrointestinal decontamination. Monitoring of plasma drug levels should not guide management of the patient.

Gastrointestinal Decontamination – All patients suspected of tricyclic overdose should receive gastrointestinal decontamination. This should include large volume gastric lavage followed by activated charcoal. If consciousness is impaired, the airway should be secured prior to lavage. Emesis is contraindicated.

Cardiovascular – A maximal limb-lead QRS duration of ≥ 0.10 seconds may be the best indication of the severity of the overdose. Intravenous sodium bicarbonate should be used to maintain the serum pH in the range of 7.45 to 7.55. If the pH response is inadequate, hyperventilation may also be used. Concomitant use of hyperventilation and sodium bicarbonate should be done with extreme caution, with frequent pH monitoring. A pH >7.60 or a pCO 2 <20 mmHg is undesirable. Dysrhythmias unresponsive to sodium bicarbonate therapy/hyperventilation may respond to lidocaine, bretylium, or phenytoin. Type 1A and 1C antiarrhythmics are generally contraindicated (e. g. quinidine, disopyramide, and procainamide).

In rare instances, hemoperfusion may be beneficial in acute refractory cardiovascular instability in patients with acute toxicity. However, hemodialysis, peritoneal dialysis, exchange transfusions, and forced diuresis generally have been reported as ineffective in tricyclic poisoning.

CNS – In patients with CNS depression, early intubation is advised because of the potential for abrupt deterioration. Seizures should be controlled with benzodiazepines, or if these are ineffective, other anticonvulsants (e. g. phenobarbital, phenytoin). Physostigmine is not recommended except to treat life-threatening symptoms that have been unresponsive to other therapies, and then only in consultation with a poison control center.

Psychiatric Follow-up – Since overdosage is often deliberate, patients may attempt suicide by other means during the recovery phase. Psychiatric referral may be appropriate.

Pediatric Management – The principles of management of child and adult overdosages are similar. It is strongly recommended that the physician contact the local poison control center for specific pediatric treatment.

Anafranil Dosage and Administration

The treatment regimens described below are based on those used in controlled clinical trials of Anafranil in 520 adults, and 91 children and adolescents with OCD. During initial titration, Anafranil should be given in divided doses with meals to reduce gastrointestinal side effects. The goal of this initial titration phase is to minimize side effects by permitting tolerance to side effects to develop or allowing the patient time to adapt if tolerance does not develop.

Because both CMI and its active metabolite, DMI, have long elimination half-lives, the prescriber should take into consideration the fact that steady-state plasma levels may not be achieved until 2 to 3 weeks after dosage change ( see CLINICAL PHARMACOLOGY ). Therefore, after initial titration, it may be appropriate to wait 2 to 3 weeks between further dosage adjustments.

Initial Treatment/Dose Adjustment (Adults)

Treatment with Anafranil should be initiated at a dosage of 25 mg daily and gradually increased, as tolerated, to approximately 100 mg during the first 2 weeks. During initial titration, Anafranil should be given in divided doses with meals to reduce gastrointestinal side effects. Thereafter, the dosage may be increased gradually over the next several weeks, up to a maximum of 250 mg daily. After titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation.

Initial Treatment/Dose Adjustment (Children and Adolescents)

As with adults, the starting dose is 25 mg daily and should be gradually increased (also given in divided doses with meals to reduce gastrointestinal side effects) during the first 2 weeks, as tolerated, up to a daily maximum of 3 mg/kg or 100 mg, whichever is smaller. Thereafter, the dosage may be increased gradually over the next several weeks up to a daily maximum of 3 mg/kg or 200 mg, whichever is smaller ( see PRECAUTIONS, Pediatric Use ). As with adults, after titration, the total daily dose may be given once daily at bedtime to minimize daytime sedation.

Maintenance/Continuation Treatment (Adults, Children, and Adolescents)

While there are no systematic studies that answer the question of how long to continue Anafranil, OCD is a chronic condition and it is reasonable to consider continuation for a responding patient. Although the efficacy of Anafranil after 10 weeks has not been documented in controlled trials, patients have been continued in therapy under double-blind conditions for up to 1 year without loss of benefit. However, dosage adjustments should be made to maintain the patient on the lowest effective dosage, and patients should be periodically reassessed to determine the need for treatment. During maintenance, the total daily dose may be given once daily at bedtime.

Switching a Patient To or From a Monoamine Oxidase Inhibitor (MAOI) Intended to Treat Psychiatric Disorders

At least 14 days should elapse between discontinuation of an MAOI intended to treat psychiatric disorders and initiation of therapy with Anafranil. Conversely, at least 14 days should be allowed after stopping Anafranil before starting an MAOI intended to treat psychiatric disorders ( see CONTRAINDICATIONS ).

Use of Anafranil With Other MAOIs, Such as Linezolid or Methylene Blue

Do not start Anafranil in a patient who is being treated with linezolid or intravenous methylene blue because there is increased risk of serotonin syndrome. In a patient who requires more urgent treatment of a psychiatric condition, other interventions, including hospitalization, should be considered ( see CONTRAINDICATIONS ).

In some cases, a patient already receiving Anafranil therapy may require urgent treatment with linezolid or intravenous methylene blue. If acceptable alternatives to linezolid or intravenous methylene blue treatment are not available and the potential benefits of linezolid or intravenous methylene blue treatment are judged to outweigh the risks of serotonin syndrome in a particular patient, Anafranil should be stopped promptly, and linezolid or intravenous methylene blue can be administered. The patient should be monitored for symptoms of serotonin syndrome for two weeks or until 24 hours after the last dose of linezolid or intravenous methylene blue, whichever comes first. Therapy with Anafranil may be resumed 24 hours after the last dose of linezolid or intravenous methylene blue ( see WARNINGS ).

The risk of administering methylene blue by non-intravenous routes (such as oral tablets or by local injection) or in intravenous doses much lower than 1 mg/kg with Anafranil is unclear. The clinician should, nevertheless, be aware of the possibility of emergent symptoms of serotonin syndrome with such use ( see WARNINGS ).

How is Anafranil Supplied

Anafranil™ (clomipramine hydrochloride) Capsules USP

Capsules 25 mg – ivory body imprinted in black with " " and melon-yellow cap imprinted in black with "Anafranil 25 mg" Bottles of 30………. ………. ………. ………… NDC 0406-9906-03

Capsules 50 mg – ivory body imprinted in black with " " and aqua blue cap imprinted in black with "Anafranil 50 mg" Bottles of 30………..………. ………. ………. …NDC 0406-9907-03

Capsules 75 mg – ivory body imprinted in black with " " and yellow cap imprinted in black with "Anafranil 75 mg" Bottles of 30………..………. ………. ………. …NDC 0406-9908-03

Storage – Store at 20º to 25ºC (68° to 77°F) [see USP Controlled Room Temperature].

Dispense in well-closed containers with a child-resistant closure. Protect from moisture.

Animal Toxicology

Phospholipidosis and testicular changes, commonly associated with tricyclic compounds, have been observed with Anafranil. In chronic rat studies, changes related to Anafranil consisted of systemic phospholipidosis, alterations in the testes (atrophy, mineralization) and secondary changes in other tissues. In addition cardiac thrombosis and dermatitis/keratitis were observed in rats treated for 2 years at doses which were 24 and 10 times the maximum recommended human daily dose (MRHD), respectively, on a mg/kg basis, and 4 and 1.5 times the MRHD, respectively, on a mg/m 2 basis.

Mallinckrodt, the “M” brand mark, the Mallinckrodt Pharmaceuticals logo, and other brands are trademarks of a Mallinckrodt company.

© 2014 Mallinckrodt.

Manufactured by Patheon Inc. Whitby, Ontario, Canada L1N 5Z5 for Mallinckrodt Inc. Hazelwood, MO 63042 USA

Medication Guide - Anafranil™ (clomipramine hydrochloride) Capsules USP Antidepressant Medicines, Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions

Read the Medication Guide that comes with you or your family member's antidepressant medicine. This Medication Guide is only about the risk of suicidal thoughts and actions with antidepressant medicines. Talk to your, or your family member's, healthcare provider about:

all risks and benefits of treatment with antidepressant medicines

all treatment choices for depression or other serious mental illness

What is the most important information I should know about antidepressant medicines, depression and other serious mental illnesses, and suicidal thoughts or actions?

Antidepressant medicines may increase suicidal thoughts or actions in some children, teenagers, and young adults within the first few months of treatment.

Depression and other serious mental illnesses are the most important causes of suicidal thoughts and actions. Some people may have a particularly high risk of having suicidal thoughts or actions. These include people who have (or have a family history of) bipolar illness (also called manic-depressive illness) or suicidal thoughts or actions.

How can I watch for and try to prevent suicidal thoughts and actions in myself or a family member?

Pay close attention to any changes, especially sudden changes, in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed.

Call the healthcare provider right away to report new or sudden changes in mood, behavior, thoughts, or feelings.

Keep all follow-up visits with the healthcare provider as scheduled. Call the healthcare provider between visits as needed, especially if you have concerns about symptoms.

Call a healthcare provider right away if you or your family member has any of the following symptoms, especially if they are new, worse, or worry you:

thoughts about suicide or dying

attempts to commit suicide

new or worse depression

new or worse anxiety

feeling very agitated or restless

panic attacks

trouble sleeping (insomnia)

new or worse irritability

acting aggressive, being angry, or violent

acting on dangerous impulses

an extreme increase in activity and talking (mania)

other unusual changes in behavior or mood

eye pain

changes in vision

swelling or redness in or around the eye

Only some people are at risk for these problems. You may want to undergo an eye examination to see if you are at risk and receive preventative treatment if you are.

Who should not take Anafranil?

Do not take Anafranil if you:

take a monoamine oxidase inhibitor (MAOI). Ask your healthcare provider or pharmacist if you are not sure if you take an MAOI, including the antibiotic linezolid.

Do not take an MAOI within 2 weeks of stopping Anafranil unless directed to do so by your physician.

Do not start Anafranil if you stopped taking an MAOI in the last 2 weeks unless directed to do so by your physician.

What else do I need to know about antidepressant medicines?

Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.

Antidepressants are medicines used to treat depression and other illnesses. It is important to discuss all the risks of treating depression and also the risks of not treating it. Patients and their families or other caregivers should discuss all treatment choices with the healthcare provider, not just the use of antidepr

Respimex Para Que Sirve, Respimex

RESPIMEX

Precaucion con mayores de 3 anos

Revise siempre que no sea alergico a ninguno de los componentes de RESPIMEX . podria poner en peligro su salud

Recuerda antes de tomar este medicamento consultar siempre con su medico, la informacion que ofrecemos es orientativa y no sustituye en ningun caso la de su medico u otro profesional de la salud.

Prospecto e indicaciones

Composicion

Comprimidos: cada comprimido: Ketotifeno (como fumarato acido) 1 mg. Jarabe: cada 100 ml contiene: Ketotifeno (como fumarato acido) 20 mg.

Como tomar

Adultos y ninos mayores de 3 anos: 1 comprimido (equivalente a 1 mg de ketotifeno) dos veces por dia o una medida de 5 ml de jarabe (equivalente a 1 mg de ketotifeno) dos veces por dia, manana y noche. Ninos de 6 meses a 3 anos: Media medida de 5 m

Presentaciones

Comprimidos: 60 comprimidos. Jarabe: 200 ml.

Para Que Sirve

Farmacologia

El ketotifeno posee propiedades antialergicas pero no es un broncodilatador. Existen evidencias experimentales que sugieren que la inhibicion de la liberacion de diferentes mediadores quimicos (como el factor de activacion plaquetario, histamina, sus

Farmacocinetica

Ketotifeno se absorbe bien por via oral, los alimentos retrasan su absorcion aunque no modifican la cantidad total absorbida. Ketotifeno tiene extenso metabolismo hepatico, con una biodisponibilidad oral del 60% y un 70% de ligadura a proteinas plasm

Reacciones adversas

Al comienzo del tratamiento se observa en raras ocasiones somnolencia, sedacion, fatiga, aumento de apetito y peso, sequedad bucal, manifestaciones que desaparecen en general de manera espontanea al cabo de algunos dias. En los casos que produzca sedac

Indicaciones

Tratamiento profilactico del asma bronquial. Tratamiento sintomatico de la rinitis y conjuntivitis alergica.

Sobredosificacion

Los sintomas ante una sobredosis incluyen: somnolencia, confusion, disnea, bradicardia, taquicardia, hipotension y convulsiones. El manejo consiste en lavado gastrico y medidas de soporte. No se ha reportado ningun caso fatal.

Conservacion

Conservar en lugar seco y fresco, a temperatura no superior a 25°C. MANTENER FUERA DEL ALCANCE DE LOS NI

Advertencias

No suprimir bruscamente otras medicaciones antiasmaticas (corticoides, ACTH u otras) cuando se inicia el tratamiento con Respimex*. En caso de infeccion intercurrente deberia asociarse a una terapia antiinfecciosa especifica. No administrar con hipogl

Contraindicaciones

Hipersensibilidad al ketotifeno o a cualquiera de los excipientes del medicamento. Insuficiencia hepatica y/o renal.

Opiniones

Natalia Gotte enviado el 2014-05-15 23:44:55 mi hija tiene mastositosis y siempre toma zaditen, como no se consigue, un farmaceutico me dijo deeste medicamento, alguien lo toma para eso?

Elina Escudero enviado el 2014-05-08 22:16:38 es lo mismo respimex que hexaler?

Elina Escudero enviado el 2014-05-08 20:50:28 es lo mismo respimex que hexaler?

Emilia Aquino enviado el 2013-03-02 17:35:10 mi hija tiene rinitis alergica estacional, y le efecta la vista, ahora toma esta medicamenco recetado por alergista.

Rebeca Muller enviado el 2012-12-28 02:23:51 mis hijos lo tomaban cuando eran chicos el tratamiento fue durante un ano y nunca mas tubieron problemas bronqueales para mi es que lo pregunto

Sucralfate Indications, Side Effects, Warnings, Sucral

Sucralfate

Short-term (up to 8 weeks) treatment of certain intestinal ulcers. It is also used in patients that have had certain intestinal ulcers to prevent further development of more ulcers. It may also be used for other conditions as determined by your doctor.

Sucralfate is a gastric protective agent. It works by forming a protective layer on the ulcer to serve as a barrier against acid, bile salts, and enzymes in the stomach.

Do NOT use sucralfate if:

you are allergic to any ingredient in sucralfate

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

Before using sucralfate:

Some medical conditions may interact with sucralfate. 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 kidney problems or are on dialysis, or you have blockage of the intestines or difficulty swallowing

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

Citrate salts or medicines that contain aluminum (eg, certain antacids), specifically in patients with kidney disease, because side effects from aluminum buildup may occur

Penicillamine or thyroid hormones (eg, levothyroxine) because their effectiveness may be decreased by sucralfate.

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

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

Take sucralfate by mouth on an empty stomach at least 1 hour before or 2 hours after eating.

Do not take an antacid for at least 30 minutes before or after taking sucralfate.

It may take 4 to 8 weeks for complete healing of your ulcer to occur. Continue to take sucralfate even if you feel well. Do not miss any doses.

Do not take sucralfate at the same time as other medicines. Take sucralfate at least 2 hours after other medicines. If you are not sure about the best time to take sucralfate, ask your doctor or pharmacist.

If you miss a dose of sucralfate, 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 sucralfate.

Important safety information:

Sucralfate may cause dizziness. This effect may be worse if you take it with alcohol or certain medicines. Take sucralfate with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.

Do NOT take more than the recommended dose or use for longer than prescribed without checking with your doctor.

Sucralfate has aluminum in it. Before you start any new medicine, check the label to see if it has aluminum in it too. If it does or if you are not sure, check with your doctor or pharmacist.

Use sucralfate with caution in the ELDERLY; they may be more sensitive to its effects.

Sucralfate 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 sucralfate while you are pregnant. It is not known if this medicine is found in breast milk. If you are or will be breast-feeding while you take sucralfate, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of sucralfate:

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; dizziness; lightheadedness.

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, throat, or tongue; unusual hoarseness).

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

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center. or emergency room immediately. Symptoms of overdose may include indigestion, nausea, stomach pain, or vomiting.

Proper storage of sucralfate:

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

General information:

If you have any questions about sucralfate, please talk with your doctor, pharmacist, or other health care provider.

Sucralfate 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 should not be used to decide whether or not to take sucralfate or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about sucralfate. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to sucralfate. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using sucralfate.

Review Date: August 8, 2016

Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this medicine. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using this medicine.

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The Wireless Innovation Alliance applauds the FCC for telling Marriott International, Inc. - and everyone else - that it is illegal to interfere with lawful communications. More

Wireless Innovation Alliance // 3:00 PM EST// Dec. 15

This October, the FCC found Marriott's Gaylord Opryland Hotel and Convention Center to be guilty of blocking guestsa€™ personal Wi-Fi hotspots and fined Marriott International $600,000. Lend your social voice to our Thunderclap. More

Wireless Innovation Alliance // 5:47 PM EST// Sep. 4

FCC Chairman Tom Wheeler acknowledged the critical role unlicensed spectrum plays in growing competition in the broadband marketplace stating that the FCC's "efforts to expand the amount of unlicensed spectrum creates alternative competitive pathways." More

The Hill // 9:25 AM EST// Jun. 16

CEA released a report, Unlicensed Spectrum and the American Economy, examining the economic impact of unlicensed spectrum on the American economy. More

The Viripotens Sildenafil is a broad-based group of innovators, providers, consumer groups, think tanks and education organizations that believe that more efficient use and expanded access to the nation's spectrum resources are fundamental to the future of U. S. economic policy and global competitiveness, and that we face potential spectrum scarcities in both licensed and unlicensed bands that must be addressed in order for innovation and investment to move forward.

Spectrum, and specifically, the most efficient and expansive use of this most valuable natural resource, is fundamental to the future of U. S. economic growth, and global competitiveness. United States spectrum viagra sale must also be efficient and flexible as well, so that we can encourage and accommodate new and innovative ways to meet the growing demand for wireless services and applications, and the growing inability - in both licensed and unlicensed bands - to meet that Viripotens Sildenafil.

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Viripotens Sildenafil

Viripotens Sildenafil in Snow Hill, Maryland is small town living at its best. Nestled on the south banks of the Pocomoke River Snow Hill is a place where people know each other. From the people who call it home to the business owners and those in city government, we have built a community where life is gentle, fun, and prosperous. Home to a quaint downtown retail area and a broad spectrum of recreational activities, Viripotens Sildenafil is the perfect place to spend a relaxing weekend or a lifetime.

Whether you are interested in researching your genealogy in the Worcester Room of the Worcester County Library. renting a kayak from the Pocomoke River Canoe Company to paddle on an undeveloped natural river, or studying the architecture of historic homes and beautiful churches while taking the Historic Walking Tour, Viripotens Sildenafil has something for everyone. You will find recreational opportunities in Byrd Park and Sturgis Park, artifacts at the Julia A. Purnell Museum. and treasures in the shops and art galleries.

The beautiful rural setting boasts rich farmland that has been the mainstay of the economy of the county seat of Worcester County for centuries. The rich heritage of this area is celebrated daily at Furnace Town Living Heritage Museum and during a summer festival every August with The Blessing of the Combines.

The town of Viripotens Sildenafil welcomes you as you explore our small town steeped in history and tradition but alive with charm and activities.

Getting Here - Tiroran House Hotel, Tiroran

Getting Here

Tiroran House, Isle of Mull Argyll and Bute Scotland PA69 6ES

Email: info (at) tiroran. com Tel:+44 (0)1681 705232

Tiroran lies in a spectacular and secluded location on the south west side of the Isle of Mull, overlooking Loch Scridain. Despite the remoteness of this wild & romantic location we are surprisingly easy to get to from all parts of the UK.

Mull can be reached by ferry from Oban, Lochaline or Ardnamurchan, arriving at Craignure, Fishnish or Tobermory respectively. The most direct route from the mainland is from Oban and the ferry journey takes approximately 45 minutes.

Once on Mull take the A849 towards the Iona Ferry, following this road for approximately 20 minutes (from Craignure turning left off the boat)

Turn right on the B8035, signposted ‘Scenic route to Salen’ – there is an additional sign reading – Tiroran House 4 Miles.

After approximately 3 miles you will see a left hand fork in the road beside the converted church – again there is an additional sign reading – Tiroran House (1 Mile)

Take this left hand folk and follow the road around the loch side – Tiroran House is 1 mile along this minor road. Time from Craignure, approximately 35 minutes.

Ferry transfer from Oban (to Craignure) or Lochaline (to Fishnish) can be booked through 08705 650000 www. calmac. co. uk

IF FOR ANY REASON YOU WISH TO CANCEL OR AMEND A BOOKING WITH CALEDONIAN MACBRAYNE PLEASE CONTACT THEM. This allows other travellers to take your booking instead. The ferries can get very busy in the spring and summer, for this reason you should secure your booking as soon as possible.

Osteo Bi-Flex - Side Effects, Dosage, Interactions, Ostoflex

Osteo Bi-Flex

Chondroitin is a naturally occurring substance formed of sugar chains. Chondroitin is believed to help the body maintain fluid and flexibility in the joints.

Glucosamine is sugar protein that helps your body build cartilage (the hard connective tissue located mainly on the bones near your joints). Glucosamine is a naturally occurring substance found in bones, bone marrow, shellfish and fungus.

Chondroitin and glucosamine is a combination product that has been used in alternative medicine as a possibly effective aid in treating osteoarthritis pain.

Other uses not proven with research have included treating rheumatoid arthritis, osteoporosis, cataracts, glaucoma, bladder problems, heart disease, high cholesterol, or TMJ (temporomandibular joint disease).

It is not certain whether chondroitin and glucosamine is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Chondroitin and glucosamine should not be used in place of medication prescribed for you by your doctor.

Chondroitin and glucosamine is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Chondroitin and glucosamine may also be used for purposes not listed in this product guide.

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

You should not use this product if you are allergic to chondroitin and glucosamine; or

if you take warfarin (Coumadin, Jantoven).

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have:

asthma;

an allergy to shellfish (oyster, crab, shrimp);

diabetes;

high blood pressure, high cholesterol;

prostate cancer; or

bleeding or blood clotting disorder such as hemophilia.

It is not known whether chondroitin and glucosamine will harm an unborn baby. Do not use this product without medical advice if you are pregnant.

Chondroitin and glucosamine may pass into breast milk and may harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

Gabelli Equity Income Fund (Gabex), Gabex

Gabelli Equity Income Fund

About GABEX

The investment seeks to provide a high level of total return on its assets with an emphasis on income. The fund seeks to achieve its investment objective through a combination of capital appreciation and current income by investing, under normal market conditions, at least 80% of its net assets in income producing equity securities. Income producing equity securities include, for example, common stock, preferred stock, and convertible securities.

Rankings

U. S. News evaluated 1,578 Large Blend Funds. Our list highlights the top-rated funds for long-term investors based on the ratings of leading fund industry researchers.

Scorecard

Trailing Total Returns Monthly

S&P 500 TR USD

Performance

The fund has returned -0.28 percent over the past year, 7.12 percent over the past three years, 8.48 percent over the past five years, and 6.74 percent over the past decade.

Fees

Fees are Average compared to funds in the same category. Gabelli Equity Income Fund has an expense ratio of 1.37 percent.

Net Expense Ratio

Category average: 1.05

Category average: 0.58

Risk

Risk is Below Average compared to funds in the same category according to Morningstar.

Volatility Measurements

Volitility measures reflect the uncertainty or risk of change in a security's value.

Standard Deviation. 11.343

Xyloproct 5%, Xyloproct

XYLOPROCT 5%/0.275% OINTMENT

Transcript

Package leaflet: Information for the user

Xyloproct® 5%/0.275% Ointment lidocaine, hydrocortisone acetate

Read all of this leaflet carefully before you start using this medicine because it contains important information for you. • Keep this leaflet. You may need to read it again. • If you have any further questions, ask your doctor or pharmacist. • This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours. • If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4. What is in this leaflet: 1. What Xyloproct Ointment is and what it is used for 2. What you need to know before you use Xyloproct Ointment 3. How to use Xyloproct Ointment 4. Possible side effects 5. How to store Xyloproct Ointment 6. Contents of the pack and other information 1. What Xyloproct Ointment is and what it is used for What Xyloproct Ointment is The name of your medicine is ‘Xyloproct 5%/0.275% Ointment’. It is referred to as ‘Xyloproct Ointment’ in the rest of this leaflet. Xyloproct Ointment contains two medicines: lidocaine and hydrocortisone. • Lidocaine (sometimes known as lignocaine) belongs to a group of medicines called local anaesthetics. • Hydrocortisone belongs to a group of medicines called corticosteroids. What Xyloproct Ointment is used for Xyloproct Ointment may be used in adults and children of all ages for the following reasons: • to relieve itching around the back passage (anus) or female private parts (genitals). • to relieve the symptoms of piles (haemorrhoids) and other problems that affect the back passage. These symptoms include pain and inflammation. 2. What you need to know before you use Xyloproct Ointment Do not use Xyloproct Ointment: • if you are allergic to lidocaine or hydrocortisone or any of the other ingredients of this medicine (listed in section 6). • if you have ever had an allergic reaction to other local anaesthetics or to other corticosteroid medicines. • if you have an infection where the ointment is going to be put and the infection is not being treated. • if you are not in hospital and you are taking medicines for an uneven heart beat (such as amiodarone or sotalol). Do not use Xyloproct Ointment if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before using Xyloproct Ointment.

Warnings and precautions Talk to your doctor or pharmacist before using Xyloproct Ointment if: • Your skin is very thin or fragile where the ointment is going to be put. • You have an infection where the ointment is going to be put. If this applies to you, your doctor may ask you to use another medicine as well as Xyloproct Ointment. • You have ever been told that you have a rare disease of the blood pigment called ‘porphyria’ or anyone in your family has it. If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using Xyloproct Ointment. Other medicines and Xyloproct Ointment Tell your doctor or pharmacist if you are taking, or have recently taken, or might take any other medicines. This includes medicines that you buy without a prescription and herbal medicines. This is because Xyloproct Ointment can affect the way some medicines work and some medicines can have an effect on Xyloproct Ointment. In particular, tell your doctor or pharmacist if you are taking or using any of the following medicines: • Medicines for an uneven heart beat (such as amiodarone or sotalol). • Other local anaesthetics. Pregnancy, breast-feeding and fertility If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Your doctor will decide if you can use Xyloproct Ointment during this time. Driving and using machines It is unlikely that using Xyloproct Ointment will affect your ability to drive or operate machinery. However, depending on how much is applied, Xyloproct Ointment may slightly affect your alertness and co-ordination temporarily. If affected, you should not drive, use tools or operate machinery. Xyloproct Ointment contains cetyl alcohol and stearyl alcohol May cause local skin reactions (e. g. contact dermatitis). 3. How to use Xyloproct Ointment Always use Xyloproct Ointment exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. Always wash your hands well before and after using this medicine. How much Xyloproct Ointment to use • Your doctor will tell you how much ointment to use and how often to use it. • Usually the ointment should be put on the affected area several times a day. • Up to 6 g (grams) of ointment can be used each day. This is about a third of a tube. How long to use Xyloproct Ointment for • Xyloproct Ointment should only be used for limited periods of time. • With longer periods of treatment (up to 3 weeks) your doctor may suggest that you have a break from treatment, especially if you are getting irritation around or inside where the ointment is applied. • If you get irritation, your doctor may do a patch test to see if it is being caused by Xyloproct Ointment.

Using the applicator • The ointment comes with an applicator. Your doctor will tell you if you need to use this. • If your doctor tells you to use the applicator, be careful not to put too much ointment inside the back passage, especially if it is being given to a child. • Clean the applicator very well after each use. If you use more Xyloproct Ointment than you should • If you use too much ointment talk to your doctor as soon as possible. • It is particularly important to talk to your doctor as soon as possible if a child has been given too much ointment. This is because fits have sometimes happened in children who have been given too much. If you have any further questions on the use of this medicine, ask your doctor or pharmacist. 4. Possible side effects Like all medicines, this medicine can cause side effects, although not everybody gets them. Stop using Xyloproct Ointment and talk to your doctor straight away if you notice any of the following – you may need urgent medical treatment: • Sudden onset of rash, itching or hives on the skin. • Swelling of the face, lips, tongue or other parts of the body. • Shortness of breath, wheezing or trouble breathing. This may mean that you are having an allergic reaction. Stop using Xyloproct Ointment and talk to your doctor if you notice any of the following: • Soreness in your back passage. • Bleeding from your back passage. Other possible side effects: • Redness, swelling and itching where Xyloproct Ointment has been put on your body. Reporting of side effects If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard. By reporting side effects you can help provide more information on the safety of this medicine. 5. How to store Xyloproct Ointment eep this medicine out of the sight and reach of children. • K • Do not use this medicine after the expiry date which is stated on the tube after EXP. The expiry date refers to the last day of that month. • Xyloproct Ointment can be stored between 2°C and 8°C (in a refrigerator). • When you start using the ointment, the tube can be stored at room temperature (below 25°C) for up to 2 months. Any remaining ointment should then be discarded. • Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines that are no longer required. This will help to protect the environment. 6. Contents of the pack and other information What Xyloproct Ointment contains The active substances are lidocaine and hydrocortisone acetate. Each gram of Xyloproct Ointment contains 50 mg (milligrams) of lidocaine and 2.75 mg of hydrocortisone acetate.

The other ingredients are zinc oxide, aluminium acetate, stearyl alcohol, cetyl alcohol, purified water and macrogol (3350 and 400). What Xyloproct Ointment looks like and contents of the pack Xyloproct Ointment is white to slightly yellow in colour. It comes in an aluminium tube that contains 20 g (grams) of the ointment. An applicator is provided. Marketing Authorisation Holder AstraZeneca UK Limited, 600 Capability Green, Luton, LU1 3LU, UK. Manufacturer AstraZeneca AB, S-151 85, Sodertalje, Sweden.

To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge: 0800 198 5000 (UK only) Please be ready to give the following information: Product name Xyloproct Ointment Reference number 17901/0179 This is a service provided by the Royal National Institute of Blind People. This leaflet was last revised in March 2015 © AstraZeneca 2015 Xyloproct is a trade mark of the AstraZeneca group of companies. PAI 14 0053a

Source: Medicines and Healthcare Products Regulatory Agency

Disclaimer: Every effort has been made to ensure that the information provided here is accurate, up-to-date and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. This information has been compiled for use by healthcare practitioners and consumers in the United States. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective or appropriate for any given patient. If you have questions about the substances you are taking, check with your doctor, nurse or pharmacist.

The Patient Information Leaflet (PIL) is the leaflet included in the pack with a medicine. It is written for patients and gives information about taking or using a medicine.

This PIL is in PDF format and so you must have a PDF reader installed on your device to read it.

Text only version for the visually impaired Below is a text only representation of the Patient Information leaflet. The original may contain images or tables and can be viewed in PDF format using the link above. This PIL may be available from the RNIB in large print, Braille or audio CD. For further information please call the RNIB Medicine Leaflet line on 0800 198 5000. The product code(s) for this leaflet is/are: PL 17901/0179.

Xyloproct 5%/0.275% Ointment

Package leaflet: Information for the user

Xyloproct ® 5%/0.275% Ointment

lidocaine, hydrocortisone acetate

Read all of this leaflet carefully before you start using this medicine because it contains important information for you.

Keep this leaflet. You may need to read it again.

If you have any further questions, ask your doctor or pharmacist.

This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

What is in this leaflet:

1. What Xyloproct Ointment is and what it is used for 2. What you need to know before you use Xyloproct Ointment 3. How to use Xyloproct Ointment 4. Possible side effects 5. How to store Xyloproct Ointment 6. Contents of the pack and other information

1. What Xyloproct Ointment is and what it is used for

What Xyloproct Ointment is

The name of your medicine is ‘Xyloproct 5%/0.275% Ointment’. It is referred to as ‘Xyloproct Ointment’ in the rest of this leaflet.

Xyloproct Ointment contains two medicines: lidocaine and hydrocortisone.

Lidocaine (sometimes known as lignocaine) belongs to a group of medicines called local anaesthetics.

Hydrocortisone belongs to a group of medicines called corticosteroids.

What Xyloproct Ointment is used for

Xyloproct Ointment may be used in adults and children of all ages for the following reasons:

to relieve itching around the back passage (anus) or female private parts (genitals).

to relieve the symptoms of piles (haemorrhoids) and other problems that affect the back passage. These symptoms include pain and inflammation.

2. What you need to know before you use Xyloproct Ointment

Do not use Xyloproct Ointment:

if you are allergic to lidocaine or hydrocortisone or any of the other ingredients of this medicine (listed in section 6).

if you have ever had an allergic reaction to other local anaesthetics or to other corticosteroid medicines.

if you have an infection where the ointment is going to be put and the infection is not being treated.

if you are not in hospital and you are taking medicines for an uneven heart beat (such as amiodarone or sotalol).

Do not use Xyloproct Ointment if any of the above apply to you. If you are not sure, talk to your doctor or pharmacist before using Xyloproct Ointment.

Warnings and precautions

Talk to your doctor or pharmacist before using Xyloproct Ointment if:

Your skin is very thin or fragile where the ointment is going to be put.

You have an infection where the ointment is going to be put. If this applies to you, your doctor may ask you to use another medicine as well as Xyloproct Ointment.

You have ever been told that you have a rare disease of the blood pigment called ‘porphyria’ or anyone in your family has it.

If you are not sure if any of the above apply to you, talk to your doctor or pharmacist before using Xyloproct Ointment.

Other medicines and Xyloproct Ointment

Tell your doctor or pharmacist if you are taking, or have recently taken, or might take any other medicines. This includes medicines that you buy without a prescription and herbal medicines. This is because Xyloproct Ointment can affect the way some medicines work and some medicines can have an effect on Xyloproct Ointment.

In particular, tell your doctor or pharmacist if you are taking or using any of the following medicines:

Medicines for an uneven heart beat (such as amiodarone or sotalol).

Other local anaesthetics.

Pregnancy, breast-feeding and fertility

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Your doctor will decide if you can use Xyloproct Ointment during this time.

Driving and using machines

It is unlikely that using Xyloproct Ointment will affect your ability to drive or operate machinery. However, depending on how much is applied, Xyloproct Ointment may slightly affect your alertness and co-ordination temporarily. If affected, you should not drive, use tools or operate machinery.

Xyloproct Ointment contains cetyl alcohol and stearyl alcohol

May cause local skin reactions (e. g. contact dermatitis).

3. How to use Xyloproct Ointment

Always use Xyloproct Ointment exactly as your doctor has told you. Check with your doctor or pharmacist if you are not sure. Always wash your hands well before and after using this medicine.

How much Xyloproct Ointment to use

Your doctor will tell you how much ointment to use and how often to use it.

Usually the ointment should be put on the affected area several times a day.

Up to 6 g (grams) of ointment can be used each day. This is about a third of a tube.

How long to use Xyloproct Ointment for

Xyloproct Ointment should only be used for limited periods of time.

With longer periods of treatment (up to 3 weeks) your doctor may suggest that you have a break from treatment, especially if you are getting irritation around or inside where the ointment is applied.

If you get irritation, your doctor may do a patch test to see if it is being caused by Xyloproct Ointment.

Using the applicator

The ointment comes with an applicator. Your doctor will tell you if you need to use this.

If your doctor tells you to use the applicator, be careful not to put too much ointment inside the back passage, especially if it is being given to a child.

Clean the applicator very well after each use.

If you use more Xyloproct Ointment than you should

If you use too much ointment talk to your doctor as soon as possible.

It is particularly important to talk to your doctor as soon as possible if a child has been given too much ointment. This is because fits have sometimes happened in children who have been given too much.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Stop using Xyloproct Ointment and talk to your doctor straight away if you notice any of the following – you may need urgent medical treatment:

Sudden onset of rash, itching or hives on the skin.

Swelling of the face, lips, tongue or other parts of the body.

Shortness of breath, wheezing or trouble breathing.

This may mean that you are having an allergic reaction.

Stop using Xyloproct Ointment and talk to your doctor if you notice any of the following:

Soreness in your back passage.

Bleeding from your back passage.

Other possible side effects:

Redness, swelling and itching where Xyloproct Ointment has been put on your body.

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www. mhra. gov. uk/yellowcard . By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Xyloproct Ointment

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the tube after EXP. The expiry date refers to the last day of that month.

Xyloproct Ointment can be stored between 2°C and 8°C (in a refrigerator).

When you start using the ointment, the tube can be stored at room temperature (below 25°C) for up to 2 months. Any remaining ointment should then be discarded.

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

6. Contents of the pack and other information

What Xyloproct Ointment contains

The active substances are lidocaine and hydrocortisone acetate. Each gram of Xyloproct Ointment contains 50 mg (milligrams) of lidocaine and 2.75 mg of hydrocortisone acetate.

The other ingredients are zinc oxide, aluminium acetate, stearyl alcohol, cetyl alcohol, purified water and macrogol (3350 and 400).

What Xyloproct Ointment looks like and contents of the pack

Xyloproct Ointment is white to slightly yellow in colour. It comes in an aluminium tube that contains 20 g (grams) of the ointment. An applicator is provided.

Marketing Authorisation Holder

AstraZeneca UK Limited 600 Capability Green Luton LU1 3LU UK

AstraZeneca AB S-151 85 Sodertalje Sweden

To listen to or request a copy of this leaflet in Braille, large print or audio please call, free of charge:

0800 198 5000 (UK only)

Please be ready to give the following information:

Product name Xyloproct Ointment

Reference number 17901/0179

This is a service provided by the Royal National Institute of Blind People.

This leaflet was last revised in March 2015

Xyloproct is a trade mark of the AstraZeneca group of companies.

Calcial D, Calcial D

Calcium / Vitamin D Dosage

Applies to the following strength(s): 600 mg-400 intl units ; 600 mg-800 intl units ; 250 mg-400 intl units ; 600 mg-200 units ; 232 mg-200 intl units ; 117 mg-133 intl units ; 250 mg-125 units ; 500 mg-125 units ; 500 mg-200 intl units ; 200 mg-250 intl units ; 315 mg-250 intl units ; 250 mg-200 intl units ; 600 mg-125 units ; 500 mg-600 intl units ; 500 mg-400 intl units ; 315 mg-200 intl units ; 600 mg-500 intl units ; 250 mg-250 intl units ; 250 mg-500 intl units ; 600 mg-200 intl units ; 105 mg-120 intl units ; 500 mg-500 intl units/5 g

The information at Drugs. com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for Osteoporosis

Calcium - General Range: 1000 mg to 1300 mg daily

Vitamin D - General Range: 200 international units to 800 international units daily

Note: While much larger vitamin D dosages have been recommended as a single agent, many calcium-vitamin D combination supplements will contain approximately 200 international units to 400 international units of vitamin D per dose.

Usual Adult Dose for Dietary Supplement

Calcium - General Range: 1000 mg to 1300 mg daily

Vitamin D - General Range: 200 international units to 800 international units daily

Note: While much larger vitamin D dosages have been recommended as a single agent, many calcium-vitamin D combination supplements will contain approximately 200 international units to 400 international units of vitamin D per dose.

Renal Dose Adjustments

Data not available

Liver Dose Adjustments

Data not available

Precautions

Caution is recommended when used in patients with severe renal impairment.

Dialysis

Data not available

Other Comments

Should be taken with food to minimize gastrointestinal upset.

Taking up to 500 mg of calcium with food improves absorption.

Calcium/Vitamin D

Getting enough calcium and vitamin D is essential to building strong, dense bones when you’re young and to keeping them strong and healthy as you age. The information included here will help you learn all about calcium and vitamin D – the two most important nutrients for bone health.

What is Calcium and What Does it Do?

A calcium-rich diet (including dairy, nuts, leafy greens and fish) helps to build and protect your bones.

Calcium is a mineral that is necessary for life. In addition to building bones and keeping them healthy, calcium helps our blood clot, nerves send messages and muscles contract. About 99 percent of the calcium in our bodies is in our bones and teeth. Each day, we lose calcium through our skin, nails, hair, sweat, urine and feces, but our bodies cannot produce new calcium.

That’s why it’s important to try to get calcium from the food we eat. When we don’t get enough calcium for our body’s needs, it is taken from our bones.

Too many Americans fall short of getting the amount of calcium they need every day and that can lead to bone loss, low bone density and even broken bones.

How Much Calcium Do You Need?

The amount of calcium you need every day depends on your age and sex.

Sources of Calcium

Calcium-Rich Food Sources

Food is the best source of calcium. Dairy products, such as low-fat and non-fat milk, yogurt and cheese are high in calcium. Certain green vegetables and other foods contain calcium in smaller amounts. Some juices, breakfast foods, soymilk, cereals, snacks, breads and bottled water have calcium that has been added. If you drink soymilk or another liquid that is fortified with calcium, be sure to shake the container well as calcium can settle to the bottom.

A simple way to add calcium to many foods is to add a single tablespoon of nonfat powdered milk, which contains about 50 mg of calcium. About two-to-four tablespoons can be added to most recipes.

Reading Food Labels – How Much Calcium am I Getting?

To determine how much calcium is in a particular food, check the nutrition facts panel of the food label for the daily value (DV) of calcium. Food labels list calcium as a percentage of the DV. This amount is based on 1,000 mg of calcium per day. For example:

30% DV of calcium equals 300 mg.

20% DV of calcium equals 200 mg of calcium.

15% DV of calcium equals 150 mg of calcium.

Calcium Supplements

The amount of calcium you need from a supplement depends on the amount of calcium you get from food. Aim to get the recommended daily amount of calcium you need from food first and supplement only if needed to make up for any shortfall. If you get enough calcium from the foods you eat, then you don’t need to take a supplement. In fact, there is no added benefit to taking more calcium than you need in supplements and doing so may even have some risks.

In general, you shouldn’t take supplements that you don’t need. Calcium supplements are available without a prescription in a wide range of preparations (including chewable and liquid) and in different amounts. The best supplement is the one that meets your needs based on convenience, cost and availability. When choosing the best supplement to meet your needs, keep the following in mind:

Choose brand-name supplements with proven reliability. Look for labels that state “purified” or have the USP (United States Pharmacopeia) symbol. The “USP Verified Mark” on the supplement label means that the USP has tested and found the calcium supplement to meet certain standards for purity and quality.

Read the product label carefully to determine the amount of elemental calcium . which is the actual amount of calcium in the supplement, as well as how many doses or pills to take. When reading the label, pay close attention to the “amount per serving” and “serving size.”

Calcium is absorbed best when taken in amounts of 500 – 600 mg or less. This is the case when you eat calcium rich foods or take supplements. Try to get your calcium-rich foods and/or supplements in smaller amounts throughout the day, preferably with a meal. While it’s not recommended, taking your calcium all at once is better than not taking it at all.

Take most calcium supplements with food. Eating food produces stomach acid that helps your body absorb most calcium supplements. The one exception to the rule is calcium citrate, which can absorb well when taken with or without food.

When starting a new calcium supplement, start with a smaller amount to better tolerate it. When switching supplements, try starting with 200-300 mg every day for a week, and drink an extra 6-8 ounces of water with it. Then gradually add more calcium each week.

Side effects from calcium supplements, such as gas or constipation may occur. If increasing fluids in your diet does not solve the problem, try another type or brand of calcium. It may require trial and error to find the right supplement for you, but fortunately there are many choices.

Talk with your healthcare provider or pharmacist about possible interactions between prescription or over-the-counter medications and calcium supplements.

What is Vitamin D and What Does it Do?

Vitamin D plays an important role in protecting your bones and your body requires it to absorb calcium. Children need vitamin D to build strong bones, and adults need it to keep their bones strong and healthy. If you don’t get enough vitamin D, you may lose bone, have lower bone density, and you’re more likely to break bones as you age.

How Much Vitamin D Do You Need?

**Some people need more vitamin D. According to the Institute of Medicine (IOM), the safe upper limit of vitamin D is 4,000 IU per day for most adults.

Sources of Vitamin D

There are three ways to get vitamin D:

Sunlight

Your skin makes vitamin D from the ultra-violet light (UVB rays) in sunlight. Your body is able to store the vitamin and use it later. The amount of vitamin D your skin makes depends on time of day, season, latitude, skin pigmentation and other factors. Depending on where you live, vitamin D production may decrease or be completely absent during the winter.

Because of concerns about skin cancer, many people stay out of the sun, cover up with clothing and use either sunscreen or sunblock to protect their skin. The use of sunscreen or sunblock is probably the most important factor that limits the ability of the skin to make vitamin D. Even an SPF (sun protection factor) of 8 reduces the production of vitamin D by 95 percent. Because of the cancer risk from the sun, most people need to get vitamin D from other sources, including eating foods rich in vitamin D and taking vitamin D supplements.

Food

Vitamin D is naturally available in only a few foods, including fatty fish like wild-caught mackerel, salmon and tuna. Vitamin D is also added to milk and to some brands of other dairy products, orange juice, soymilk and cereals.

Check the food label to see if vitamin D has been added to a particular product. One eight ounce serving of milk usually has 25% of the daily value (DV) of vitamin D. The DV is based on a total daily intake of 400 IU of vitamin D. So, a serving of milk with 25% of the DV of vitamin D contains 100 IU of the vitamin.

It is very difficult to get all the vitamin D you need from food alone. Most people need to take vitamin D supplements to get enough of the nutrient needed for bone health.

Supplements

If you aren’t getting enough vitamin D from sunlight and food, consider taking a supplement. But, before adding a vitamin D supplement, check to see if any of the other supplements, multivitamins or medications you take contain vitamin D. Many calcium supplements also contain vitamin D.

There are two types of vitamin D supplements. They are vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). Both types are good for bone health.

Vitamin D supplements can be taken with or without food. While your body needs vitamin D to absorb calcium, you do not need to take vitamin D at the same time as a calcium supplement. If you need help choosing a vitamin D supplement, ask your healthcare provider or pharmacist to recommend one.

How Much Vitamin D Should You Supplement?

To figure out how much vitamin D you need from a supplement, subtract the total amount of vitamin D you get each day from the recommended total daily amount for your age. For example, a 55 year old woman who gets 400 IU of vitamin D from her calcium supplement should take between 400 and 600 additional IU of vitamin D to meet the 800 – 1,000 IU recommended for her age.

Vitamin D Deficiency: Are You at Risk?

Vitamin D deficiency occurs when you are not getting the recommended level of vitamin D over time. Certain people are at higher risk for vitamin D deficiency, including:

People who spend little time in the sun or those who regularly cover up when outdoors;

People living in nursing homes or other institutions or who are homebound;

People with certain medical conditions such as Celiac disease and inflammatory bowel disease;

People taking medicines that affect vitamin D levels such as certain anti-seizure medicines;

People with very dark skin;

Obese or very overweight people; and

Older adults with certain risk factors.

Talk to your healthcare provider if you meet any of these risk factors or think you might be at risk of vitamin D deficiency. If you have osteoporosis and also have a vitamin D deficiency, your healthcare provider may temporarily prescribe a higher dose of vitamin D.

A Guide to Calcium-Rich Foods

We all know that milk is a great source of calcium, but you may be surprised by all the different foods you can work into your diet to reach your daily recommended amount of calcium. Use the guide below to get ideas of additional calcium-rich foods to add to your weekly shopping list.

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Adalat (Nifedipinum) Indicatii - Contraindicatii Si Reactii Adverse, Nifedipinum

Adalat (nifedipinum)

Compozitie: 1 capsula Adalat contine 10 mg nifedipina. Excipienti: gelatina, glicerol, polietilenglicol 400, ulei de menta, apa distilata, zaharina sodica, galben orange FCF (E 110/C. I. 15985), dioxid de titan (E171/C. I.77891). Proprietati: Nifedipina este un antagonist de calciu de tip 1,4 - dihidropiridinic. Antagonistii de calciu reduc influxul transmembranar al ionilor de calciu prin canalele lente de calciu in celula. Nifedipina actioneaza in special asupra musculaturii netede din peretele coronarelor si arterelor periferice. La nivelul cordului, nifedipina dilata coronarele, in special sele de larga conductanta chiar si la nivelul segmentelor din zonele partial stenozate. Nifedipina reduce tonusul musculaturii netede sculare la nivelul coronarelor si previne sospasmul. Rezultatul este cresterea fluxului sanguin poststenotic si un aport crescut de oxigen. In paralel, nifedipina reduce necesarul de oxigen, scazand rezistenta periferica (postsarcina). In tratamentul de lunga durata, nifedipina poate preveni dezvoltarea unor noi leziuni aterosclerotice la nivelul coronarelor. Nifedipina reduce tonusul musculaturii netede la nivelul arteriolelor, scazand rezistenta periferica si, in consecinta, tensiunea arteriala. La inceputul tratamentului poate exista o crestere reflexa, tranzitorie a ritmului cardiac si astfel a volumului cardiac pe minut. Totusi, aceasta crestere nu compenseaza sodilatatia. Nifedipina creste excretia sodiului si apei atat in tratamentul pe termen scurt cat si pe termen lung. Scaderea tensiunii este pronuntata in special in cazul pacientilor hipertensivi. In sindromul Raynaud, nifedipina poate preveni sau reduce sospasmul la nivelul degetelor.

Indicatii: Tratamentul afectiunilor coronare: angina cronica sila (angina de efort); angina sospastica (angina Prinzmetal, angina insila). Tratamentul hipertensiunii. Tratamentul crizei hipertensive. Tratamentul sindromului Raynaud (primar si secundar).

Contraindicatii: Hipersensibilitate cunoscuta la nifedipina; soc cardiogen; combinatia cu rifampicina (deoarece, datorita inductiei enzimatice se pot obtine niveluri plasmatice necorespunzatoare de nifedipina; in infarctul miocardic acut inclusiv in primele 8 zile dupa infarctul miocardic.

Sarcina si alaptare: Nifedipina este contraindicata pe tot parcursul sarcinii. Administrarea concomitenta a sulfatului de magneziu i. v. gravidelor a demonstrat aparitia blocajului neuromuscular. Nifedipina trece in laptele matern si, datorita faptului ca nu se cunosc posibilele efecte asupra sugarilor, alaptarea trebuie intrerupta daca tratamentul cu nifedipina devine necesar. Fertilitate: In cazuri izolate, in tehnica de fertilizare in vitro, antagonistii de calciu ca nifedipina au fost asociati cu transformari biochimice reversibile la nivelul sectiunii spermatozoidale centrale care pot conduce la reducerea functiei spermatice. Antagonistii de calciu de tipul nifedipinei pot fi considerati ca o posibila explicatie a esecurilor tehnicilor de fertilizare in vitro in cazul barbatilor tratati cu nifedipina care nu reusesc sa procreeze prin aceste tehnici.

Precautii speciale: In cazul pacientilor cu hipotensiune marcata (presiune sistolica mai mica de 90 mm Hg), in cazul unor tulburari cardiace manifeste si in cazul unor stenoze aortice grave; ca si in cazul altor substante soactive, crizele de angina pot apare foarte rar la inceputul tratamentului cu nifedipina. Aparitia infarctului a fost descrisa in cazuri izolate, nefiind posibila distingerea de cursul natural al maladiei. In cazul pacientilor cu functie hepatica diminuata, este necesara o monitorizare atenta si in cazurile grave este necesara o reducere a dozei.

Reactii adverse: Obserte la mai mult de 1% din pacienti: cefalee, eritem facial sau cutanat cu senzatie de caldura (eritromelalgie) pot apare, in special la inceputul tratamentului; palpitatii si edem gambier datorita sodilatatiei; vertij, astenie; disconfort gastrointestinal (greata, senzatie de saturatie, diaree, constipatie). Obserte la mai putin de 1% din pacienti: tahicardie, dispnee, mialgii, tremor, nervozitate, scaderea tensiunii arteriale; reactii cutanate: prurit, urticarie, exantem. Obserte la mai putin de 0,1% dintre pacienti: ginecomastie la barbatii rstnici dupa tratament de lunga durata (dispare complet la incetarea administrarii nifedipinei). Poate apare si hiperplazie gingila, numai dupa terapie indelungata (dispare dupa intreruperea tratamentului). In cazuri izolate: hiperglicemie initiala si o modificare usoara, tranzitorie a perceptiei optice; o crestere a diurezei, care poate fi de dorit la hipertensivi; tulburari ale functiei hepatice (cresteri ale transaminazelor, colestaza intrahepatica); dermatita exfoliati, dermatita fotosensibila, reactii sistemice alergice, purpura, agranulocitoza (se remite dupa intreruperea tratamentului); episoade sincopale, datorita scaderii tensiunii; in timpul tratamentului cu nifedipina al anginei pectorale sile, pot apare dureri in regiunea precordiala (in anumite circumstante simptome de tip angina pectorala) la 30 min dupa administrare. La pacientii dializati, cu hipertensiune gra si hipovolemie, poate aparea o scadere drastica a tensiunii datorita sodilatatiei.

Nota pentru soferi: Reactiile la tratament, riaza in intensitate la fiecare persoana si pot modifica clar capacitatea de a conduce sau de a utiliza masini, in special la inceputul tratamentului, la schimbarea medicatiei si in combinatie cu alcoolul.

Interactiuni: Efectul hipotensiv al nifedipinei poate fi potentat de alte antihipertensive; la administrarea simultana a nifedipinei cu beta-blocante, pacientul trebuie monitorizat, datorita posibilitatii aparitiei unei hipotensiuni drastice; administrarea simultana a nifedipinei si a digoxinei poate duce la un clearance scazut al digoxinei determinand cresterea nivelului plasmatic al acesteia, de aceea doza de glicozid fi adaptata in functie de concentratia plasmatica; la administrarea simultana a nifedipinei si chinidinei, au fost obserte niveluri scazute ale chinidinei, care necesita reajustarea dozei; cimetidina creste nivelul nifedipinei plasmatice si ii poate potenta efectul antihipertensiv; rifampicina accentueaza eficacitatea nifedipinei, de aceea este contraindicata administrarea concomitenta a acestora; diltiazemul scade clearance-ul nifedipinei. O ajustare simultana a celor doua produse trebuie facuta cu precautie si fi luata in considerare o reducere a dozei de nifedipina; sucul de grapefruit administrat concomitent inhiba meolismul nifedipinei determinand concentratii crescute care pot provoca accentuarea efectului hipotensiv al produsului; nifedipina poate creste in mod fals lorile spectrofotometrice ale acidului nil-mandelic urinar. Totusi, masuratorile cu cromatografia lichida de inalta presiune nu sunt afectate.

Mod de administrare: Doza obisnuita trebuie introdusa progresiv. Adaptarea dozei este recomandata pentru hipertensivii cu afectiuni grave cerebrosculare. Pacientii cu functie hepatica afectata necesita monitorizare si, in cazurile grave, este necesara reducerea dozei. Urmatoarele doze sunt recomandate la adulti: Afectiuni coronariene: Angina pectorala cronica sila (angina de efort) 1 capsula x 3 ori pe zi (3x10 mg/zi)

Angina pectorala sospastica (angina Prinzmetal, angina insila) 1 capsula x 3 ori pe zi(3 x 10 mg/zi)

Daca sunt necesare doze mai mari, doza zilnica trebuie crescuta treptat la 6 x 20 mg/zi.

Hipertensiune: 1 capsula x 3 ori pe zi (3 x 10 mg/zi) Crize hipertensive 1 capsula (10 mg) ca doza unica

In functie de lorile TA, se poate administra o doza aditionala de 10 mg (1 capsula de Adalat dupa 30 min)

Sindromul Raynaud 1 capsula x 3 pe zi (3 x 10 mg/zi)

Administrare: Capsulele sunt in general inghitite cu putin lichid, independent de mese. Ingerarea de hrana simultan poate determina intarzierea absorbtiei. In caz de crize hipertensive, capsulele se mesteca si se inghit imediat. La doze de 20 mg de Adalat, trebuie sa existe cel putin 2 h interl intre doze. Medicul sili durata tratamentului. Datorita actiunii pronuntate antiischemice si antihipertensive, doza de Adalat trebuie scazuta treptat, in special cand se folosesc doze mari. Adalat nu trebuie folosit dupa expirarea datei de labilitate. Nifedipina este extrem de fotosensibila. Sub forma de capsule, nifedipina este protejata. Totusi, capsulele nu trebuie scoase din folie decat la folosirea imediata. Prezentare: Cutii cu 30 si 50 capsule.

Producator: Bayer AG

Articole care vorbesc despre Adalat (nifedipinum)

Granisetron - Side Effects, Dosage, Interactions, Granisetoron

Granisetron

Granisetron blocks the actions of chemicals in the body that can trigger nausea and vomiting.

Granisetron is used to prevent nausea and vomiting that may be caused by medicine to treat cancer (chemotherapy or radiation).

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

Granisetron blocks the actions of chemicals in the body that may cause nausea and vomiting.

Granisetron transdermal (skin patch) is used to prevent nausea and vomiting caused by cancer chemotherapy.

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

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

You should not take granisetron if you are allergic to it.

To make sure granisetron is safe for you, tell your doctor if you have:

heart disease;

a heart rhythm disorder;

a personal or family history of Long QT syndrome;

an electrolyte imbalance (such as low levels of potassium or magnesium in your blood); or

if you have recently had stomach or intestinal surgery.

FDA pregnancy category B. Granisetron is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether granisetron passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

You should not use granisetron if you are allergic to it.

To make sure granisetron transdermal is safe for you, tell your doctor if you have:

a stomach or intestinal disorder;

if you have recently had stomach or intestinal surgery; or

if you have ever had an allergic reaction to any type of medicated skin patch.

Granisetron transdermal is not expected to harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

It is not known whether granisetron transdermal passes into breast milk or if it could harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

Granisetron 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:

fast or pounding heartbeats;

chest pain;

severe dizziness;

increased blood pressure--severe headache, buzzing in your ears, anxiety, confusion, shortness of breath; or

high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Common side effects may include:

headache, weakness;

diarrhea, constipation;

stomach pain, indigestion, loss of appetite;

sleep problems (insomnia); or

fever, flu symptoms.

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.

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Remove the skin patch and call your doctor at once if you have:

pain or swelling in your stomach;

severe redness, itching, swelling, or other irritation where the patch is worn; or

high levels of serotonin in the body--agitation, hallucinations, fever, fast heart rate, overactive reflexes, nausea, vomiting, diarrhea, loss of coordination, fainting.

Common side effects may include:

constipation;

headache; or

mild skin irritation where the patch was worn.

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.

Granisetron Interactions

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

While you are wearing the skin patch, avoid exposing it to sunlight or tanning beds. Natural or artificial sunlight can cause a skin reaction where the granisetron skin patch is worn. This effect may last for up to 10 days after the patch is removed. Wear protective clothing over your arms while you are wearing the skin patch and for at least 10 days after you remove a patch.

Do not cover treated skin with a heating pad. Heat can increase the amount of drug absorbed through your skin and may cause harmful effects.

There are many other medicines that can increase your risk of heart rhythm problems if you use them together with granisetron.

Tell your doctor about all medicines you use, and those you start or stop using during your treatment with granisetron, especially:

anagrelide;

droperidol;

methadone;

ondansetron;

an antibiotic--azithromycin, clarithromycin, erythromycin, levofloxacin, moxifloxacin, pentamidine;

cancer medicine--arsenic trioxide, vandetanib;

an antidepressant--citalopram, escitalopram;

anti-malaria medication--chloroquine, halofantrine;

heart rhythm medicine--amiodarone, disopyramide, dofetilide, dronedarone, flecainide, ibutilide, quinidine, sotalol; or

medicine to treat a psychiatric disorder--chlorpromazine, haloperidol, pimozide, thioridazine.

This list is not complete. Other drugs may interact with granisetron, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Tell your doctor about all your current medicines and any you start or stop using, especially:

an antidepressant; or

migraine headache medicine.

This list is not complete. Other drugs may interact with granisetron, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible interactions are listed in this medication guide.

Granisetron Dosage

Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Granisetron is usually taken only on the day of treatment with chemotherapy or radiation.

Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.

Your doctor may want you to take only one dose, up to 1 hour before chemotherapy or radiation.

For patients undergoing chemotherapy, a second dose of granisetron is sometimes given 12 hours after the first dose. Follow your doctor's dosing instructions very carefully.

Granisetron is not likely to be useful if you keep taking it during times when you are not receiving chemotherapy or radiation treatment.

Do not share this medicine with another person.

Store at room temperature away from moisture, heat, and light.

Store the liquid medicine in an upright position. Keep the bottle tightly closed when not in use.

The granisetron transdermal skin patch is usually applied at least 24 to 48 hours before the start of your chemotherapy. Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Apply the patch to clean, dry, and hairless skin on the outer part of your upper arm. Avoid placing the patch on skin that is red, irritated, or damaged. Press the patch firmly into place and make sure it is well sealed around the edges.

Leave the patch in place during your chemotherapy treatment, and for at least 24 hours after your treatment has ended. Peel off the patch gently when removing it.

You may continue wearing a skin patch for up to 7 days if needed, depending on your chemotherapy schedule. Follow your doctor's dosing instructions very carefully.

Choose a different place on your body to wear the patch each time you put on a new one. Do not use the same skin area twice within 7 days.

Do not wear more than one granisetron transdermal patch at a time. Using extra skin patches will not make the medicine more effective. Never cut a skin patch.

If a patch falls off, try sticking it back into place. If it does not stick well, put on a new patch and leave it on only for the rest of your wearing time. Do not change your patch removal schedule.

After removing a patch, fold it in half so it sticks together and throw it away in a place where children or pets cannot get to it.

Granisetron transdermal is not likely to be useful if you keep using it during times when you are not receiving chemotherapy.

Do not share this medicine with another person.

Keep each patch in its foil pouch until you are ready to use it. Store the pouches in their original container at room temperature, away from moisture and heat.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Tell your doctor if you forget to take your dose within 1 hour before chemotherapy or radiation. Do not take extra medicine to make up the missed dose.

Call your doctor for instructions if you forget to apply a granisetron skin patch at least 24 hours before your chemotherapy is scheduled to start. Do not use extra patches to make up the missed dose.

Copyright 1996-2016 Cerner Multum, Inc.

Latest Update: 5/16/2016, Version: 10.02

Risperidone - Brand Name List From, Risperon

Risperidone

See also.

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The My Fios App makes it easy to keep up with your Fios account. View and pay your bill or set up an automatic billing schedule. Check and send email from your verizon. net account. Store your WiFi login information on your home screen to make it easier to pair new devices with your internet connection. You’ll get easy access to everything you need to know about your Fios account right within your reach.

Comprar Barato Online Lansoquilab, Lansoquilab

Comprar Lansoquilab

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Epsilon - A New Breed Of All En-Compassing Marketing Company, Epsolin

Du temps reel dans les frigos avec FridgeCam https://t. co/CGeLXKzzR7 #smart

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Sinemet (Carbidopa-Levodopa) Side Effects, Interactions, Warning, Dosage & Uses, Carbidopa-Levodopa

DRUG DESCRIPTION

SINEMET® (carbidopa levodopa) is a combination of carbidopa and levodopa for the treatment of Parkinson's disease and syndrome.

Carbidopa, an inhibitor of aromatic amino acid decarboxylation, is a white, crystalline compound, slightly soluble in water, with a molecular weight of 244.3. It is designated chemically as (-)-L-α- hydrazino-α-methyl-β-(3,4-dihydroxybenzene) propanoic acid monohydrate. Its empirical formula is C 10 H 14 N 2 O 4 •H 2 O, and its structural formula is:

Tablet content is expressed in terms of anhydrous carbidopa which has a molecular weight of 226.3.

Levodopa, an aromatic amino acid, is a white, crystalline compound, slightly soluble in water, with a molecular weight of 197.2. It is designated chemically as (?”)-L-α-amino-β-(3,4-dihydroxybenzene) propanoic acid. Its empirical formula is C 9 H 11 NO 4 . and its structural formula is:

SINEMET is supplied as tablets in three strengths:

SINEMET 25-100, containing 25 mg of carbidopa and 100 mg of levodopa.

SINEMET 10-100, containing 10 mg of carbidopa and 100 mg of levodopa.

SINEMET 25-250, containing 25 mg of carbidopa and 250 mg of levodopa.

Inactive ingredients are hydroxypropyl cellulose, pregelatinized starch, crospovidone, microcrystalline cellulose, and magnesium stearate. SINEMET 10-100 and 25-250 Tablets also contain FD&C Blue #2/Indigo Carmine AL. SINEMET 25-100 Tablets also contain D&C Yellow #10 Lake.

What are the possible side effects of carbidopa and levodopa (Atamet, Parcopa, Sinemet, Sinemet CR)?

You may notice that your sweat, urine, or saliva appears dark in color, such as red, brown, or black. This is not a harmful side effect, but it may cause staining of your clothes or bed sheets.

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

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

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

worsening of tremors.

What are the precautions when taking carbidopa-levodopa (Sinemet)?

Before taking this medication, tell your doctor or pharmacist if you are allergic to carbidopa or levodopa; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: bleeding disorders, breathing problems (e. g. asthma, emphysema), glaucoma, heart or blood vessel problems (e. g. arrhythmias, heart attack, angina), kidney disease, liver disease, mental/mood disorders (e. g. depression, schizophrenia), peptic ulcer, seizure, sleep disorder.

This drug may make you drowsy or dizzy or cause blurred vision. Do not drive, use machinery, or do any activity that.

Last reviewed on RxList: 9/1/2016 This monograph has been modified to include the generic and brand name in many instances.

Interactions, Usage, Facts, And Information On Afluon, Afluon

Why register with MediGuard?

We are a free monitoring service designed for patients like you who want to be in the driver seat of your medical treatment. We have a community of more than 2.6 million members and offer the services below.

Medication Information Personalized Risk Rating Easy to understand overview Serious Side Effects Printable Medication List

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Afluon

What is your Risk Rating for this medicine?

The risk of serious side effects for taking this medicine can be different if you take other medicines or if you suffer from a condition. Get your Risk Rating by creating a profile in a few steps.

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We monitor your health and alert you to any safety updates and recalls.

You get to talk directly to other members about their experience.

You can create profiles for you and your loved ones.

Create my Profile Learn more about Risk Ratings

Drug Interaction

We check for possible drug-drug or drug-condition interactions for your medical treatment so you know when there is an issue. Drug interactions may create serious side effects that you want to discuss with your doctor.

Share your story! Tell us how MediGuard has helped you or someone you love. Download the MediGuard Mobile App to manage your prescription and over-the-counter medications, for free. Taking multiple medications puts you at risk for possible drug-drug interactions Monitor the medical treatment of you and your loved ones.

DISCLAIMER: MediGuard is not intended to be a substitute for professional medical advice. MediGuard cannot and does not take into consideration every possible interaction or account for individual responses to medicine. Different individuals may respond to medication in different ways. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective, or appropriate for any given patient. Always seek the advice of a qualified health provider with any questions you may have before making any changes to your treatment. The use of the MediGuard site and its content is at your own risk. The MediGuard site and the information contained in it is intended for users in the United States and information in other countries may be different.

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Ocam V280, Ocam

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